Spring is here and along with it the start of running season. When a runner comes into my office presenting with back pain, it is my job as a chiropractor to determine the underlying cause of the pain and then develop a plan of action to get him or her fully healed and back out on the trail as soon as possible.

Back pain may be a simple problem arising from a minor muscle strain that heals quickly with adjustments, exercises and home care or it may signal a more serious condition requiring urgent medical attention. The physical examination is designed to rule in or out the most serious potential problems first.

More Worrisome Symptoms and Causes

The impact of running can cause a non-symptomatic bulging disc to herniate causing pressure on the spinal cord or nerve roots. In long distance runners stress fractures can occur. A recent trauma, such as a slip-and-fall or car accident may also result in a fracture or disc herniation that becomes more noticeable with running.

The most important telltale signs of a serious back or nerve injury include radiating pain, weakness, numbness or tingling down the front, back or side of one or both legs. If the patient describes or the exam reveals one or more of these symptoms an x-ray and/or MRI will be necessary to evaluate the spine, vertebrae and nerve roots. If imaging shows one of these conditions is present the patient is advised to discontinue running until their back is stabilized. This may require surgery or a lengthy period of rest and physical therapy.

Less Worrisome Symptoms and Causes

Once the history and initial neurological evaluation rule out a serious injury or medical condition then a muscle strain, biomechanical imbalance or structural fault are more likely. At this point it is safe to proceed with a combination of physical exam and/or x-rays to localize the precise muscles and joint structures involved. These conditions can generally be treated with a combination of chiropractic care, physical therapy, ice, stretching, anti-inflammatories, massage and other conservative measures.

A list of potential muscle strains causing low back pain may include paraspinal muscles, gluteal muscles, hamstrings, or hip flexors. Gait analysis can reveal altered biomechanical patterns from the feet on up, the forces from which can manifest as low back pain.

A common structural fault, known as antero- or retrolisthesis, occurs from forward or backward slippage of a vertebrae. Another type of structural fault involves congenital fusion or non-fusion of a spinal joint. This often happens in the region of the fifth lumbar vertebrae and the sacrum and is called sacralization or lumbarization. In some individuals, one side may be fused while the same joint on the opposite remains unfused, causing instability and pain. Such biomechanical faults are revealed on x-ray.

The Bottom Line

Back pain can be confusing and misleading and signs and symptoms can overlap. If you experience back pain while running, do not try to diagnose the cause of your back pain to determine if it is minor or serious. The best advice for dealing with running-related back pain is to stop, walk and make an appointment to see a qualified healthcare practitioner.