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The Injurance Blog Pt4 - Back Pain & Endurance Performance

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

Back pain is perhaps he most common of all ailments that we see with endurance athletes. This week Sam and Dr Lindsay give us the low down on the things you can do to ease back pain.

The Podiatrist's View

From a podiatry perspective there is no definitive research into the area of back pain and foot orthoses. However this is my specialism, having researched this area extensively.

It is my opinion that there is indeed a place for orthotics in the management of back pain even if it is only in a very specific group of patients that suffer from the condition. For my PhD research I recruited subjects that had all tried and exhausted other forms of treatment, except foot orthoses.

I corrected any underlying biomechanical / alignment issues with an orthotic insert, these issues included leg length discrepancies, foot biomechanics and most significantly poor proprioception (balance). All of the subjects responded amazingly well to the orthoics and their back pain was reduced.

In simple terms if the foundations of a house are unstable then there will be issues higher up. Therefore if you have poor proprioception when you test your balance then by improving this it can help just like Pilates or core strengthing would do this around the spine and pelvis. I certainly wouldn’t say that foot orthoses can help every patient with back pain but if you’ve already tried many other modalities and not seen any long term improvement or you have recurrent episodes then your next step is a podiatry assessment to see if your foot biomechanics might be contributing.

The Physio's View

Whilst the current literature suggests runners have a low risk of developing low back pain, increased risk factors are those that are running in poor footwear, are heavier and have desk jobs. It is thought that typical causes of LBP in runners is hip tightness causing reduced flexibility in surrounding muscles. Many experts believe that in the case of tight hamstrings the pelvis can become rotated too far forward or backward and create undue strain to the lower back. We have blogged about this previously, GO HERE to read.

Running is thought to put high levels of repetitive stress on the back and for those with pre-existing LBP it is important to take extra measures to reduce a flare up of symptoms.

1) Warm up properly including a dynamic stretching regime to the hip muscles and hamstrings.
2) Cool down with static stretches. Foam rolling the legs after exercise can help prevent further muscle tightness.
3) Include core stabilising exercises to your exercise regime to strengthen up the back muscles and lumbopelvic stabilisers, in particular the gluteal muscles.
5) Cross training is useful so as to avoid overuse or stress injuries occurring.
6) Wearing correct footwear and checking your biomechanics can be key (as per advice above).
7) Make sure your workstation is set up correctly in order to maintain a healthy posture through the day and avoid any posture dysfunction contributing to LBP.

NB: If running causes back pain, don't presume it's the running which is the cause. Your daily acivities and posture may likely be the cause and running is simply the trigger of LBP so widen your thoughts with regards to treatment and prevention.

It is more common for LBP to occur on the bike and when transitioning from bike to running in triathlon events. If cycling is the cause of LBP then areas to look at initially bike fitting. The most common bike fitting issues which lead to lower back pain are:

1. Saddle too high causing the hips to drop as your foot stretches to reach the pedals. This causes a side to side rocking of the pelvis.
2. Reach is too far from the saddle to handlebars, leading to the rider stretching to reach the handlebars.
3. Handlebars are too low, leading to the rider having to flex the back to get into a lower position.
4. Spending lots of time in the aero position can cause tightness in the hip flexors which can in turn lead to lordosis / pelvic rotation as per linked article above.

To combat, you should:
1. Improve mobility and flexibility of back and hips
2. Improve core strength and stability
3. Build up endurance and mileage gradually to cope with cycling posture.
4. In short terms, try a slightly higher cadence and lower gears to avoid extra strain on muscles with using higher gears.

We'd love to hear from you if you have suffered from hot foot during a running or triathlon event. Comment below this post on THE ENDURANCE STORE Facebook page and let us know your experiences and questions!

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