by Dr. Richard Beauchamp, M.D., FRCSC
Soft tissue injuries are the most frequent causes of back pain. Many muscle units extending from the pelvis all the way up to the neck support the spine. These are the spinae erectae and the quadratus lumborum muscles. Injuries to these muscles can lead to dysfunction and the development of back pain. Injuries are most frequently a result of weak pelvic and abdominal muscles superimposed on a poor running technique. Initial treatment for a runner with a recent injury means resting the back for about a week to let the soft tissues heal (NO RUNNING). Application of ice is a good anti-inflammatory agent without the side effects of oral medication. Ice should be applied with a towel covering for 20 minutes three times a day. Pain that lasts more than two to three weeks could also be treated with oral anti-inflammatories. During all of these treatments, maintaining an activity level is important (active rest). Cycling, walking and general muscle strengthening exercises are to be encouraged.
Semi-Solid Tissue Causes of Back Pain—Discs, Cartilage, Ligaments Spinal discs (slipped discs) between the vertebrae are prone to degenerate with age. Cartilage and ligament degeneration is known to occur beginning by the third decade. This results in the collapse of the spinal discs with impingement on the nerves in the spine, which can then give referred pain down the leg. If the referred pain goes no further than the thigh, then the cause is often disc degeneration only. If the pain goes further down the leg, to the calf or foot, then compression of the nerve (pinched nerve) is often the cause (sciatica). If this occurs, advice from a doctor is essential. If the neurological involvement is severe, further investigation and treatment are required. Spinal disc degeneration is seen most frequently in weightlifters and soccer players as reported in the Journal of Orthopaedics and Sports Physical Therapy. There were no signs of accelerated degenerative disc disease found in runners. Without sciatica, most cases of nerve impingement respond to short periods of rest with a concentrated physiotherapy program to strengthen the abdominal and pelvic muscles.
Solid Tissue Causes of Back Pain—Bone The main integrity of the spine is afforded by the bony architecture. The discs and the ligaments hold the vertebral bodies both together as well as apart. The bony vertebral bodies contribute to the vertical height of the spine. Conditions such as osteoporosis and trauma result in the loss of bony depth through bone collapse; this can be associated with the development of spinal deformity (scoliosis-sideways curvature or kyphosis-hunchback) over time with the development of back pain. Stress fractures of the lowermost portion of the spine (sacrum) have been described. The best approach for the management of bony deformity and pain is prevention. Runners, especially women, Plain X-Ray of lumbar spine (side view) Model of the spine showing the pelvis, vertebrae (bones), discs, and nerves should be pro-active with calcium nutrition, exercise and strengthening programs. Beware of the female athlete triad: amenorrhea, osteoporosis and anorexia! With degenerative disc disease, there is loss of support from the discs causing the bony vertebrae to approximate each other. This results in the development of arthritis of both the disc spaces and the many small joints between the vertebrae (facets). Basic management of arthritis (weight control, muscle strengthening, anti-inflammatories) may be an effective method to treat arthritis and bone and joint disease of the spine.