Low Back Pain After Sprinting

Hi, could it be around the sacroiliac (SI) joint? A tilted pelvis would probably cause pain around this joint,as could a marked difference in leg length. Worth checking for. Beware that if the pelvis is tilted in main cause pressure on the hamstrings and lead to pulls.

Thanks for the reply. I tested and couldn't discern any leg length difference. This client is very, very tight in her calfs and hamstrings and (not surprisingly) weak in her hip flexors. She reports that she feels she "uses her low back for power" when sprinting. If it's the SI joint could it be from excessive lateral movement of her hips when she runs?

Could be but it could also be because of bad posture due to poor core stability. have you tested that?

Well, it's kind of odd. She does a significant amount of abdominal work so her midsection is rock solid and slow situps are no problem. She can hold a prone bridge, but not for long and has moderate difficulty contracting her abdominals when doing so. Again, when doing this (i.e., plank position) she reports extreme tension and stress in her low back. Does this means it's primarily a TVA problem?

TVA one of few muscles of the inner unit that help stiffen the axial skeleton. Internal Obliques, Diaphragm, Deep Multifidus and pelvic Floor Muscles are the others.

Outer unit uses the stiffness of the axial skeleton to create movement. If one unit not functioning properly, then will effect the other. TVA may not be the only muscle which is the problem. Static stability which the plank measures seems to be pretty weak if cannot hold for a long time. There is a problem if the lower back starting to take the strain. Sit ups are only a trunk flexion muscle with little stability properties when compared to the other inner and outer unit muscles so will not really help stability.

There tends to be a lot of flexion work on the anterior of the body but no posterior exercises to strengthen back and hamstrings.

The thoracolumbar fascia (outer unit back muscle) is a major sheath that helps transmit force and disperse force. This area tends to be the a neglected area in stregnthening as it is so important in the acceleration/deceleration of movements and change of movement by the body. If this is not trained, lower back pain can also occur. Look on the web for exercises like alternating supermans, rotational exercises.

Tight calves and hamstrings can create a posterior tilt on the pelvis. Hip flexors tend to be lax and not effective in hip flexion. All can lead to back pain. Start developing stretching in the hamstrings and calves, strengthen hip flexors and start working on more dynamic stability work - olympic lifts will develop this.

Few suggestions but sure there will be others from other users.

Hope this helps.

alex

Hi I agree pretty much with Alex on this one, although on word of caution. If she does have an SI joint problem then the hamstrings may be tight as a protective mechanism to stabilise the joint because of lack of form closure, thus i would not reccommend stretching them (thats if it is an SI problem).

Have you actually tested the length of the hip flexors through a thomas test for eg?

Also just because someone's mid section is rock solid - it doesn't men that their inner unit (as Alex mentioned) is working correctly. She may have a dominant outer unit. Again - the prone bridge does not necessarily mean she was contracting her inner unit muscles too. Slow sit ups are not really the best way for her to develop true inner unit function also.

A tight quadratus lumborum on one side may give the appearance of a leg discrepency too. Also this may explain the pain on one side.

Are you able to measure her lumbar curve and pelvic tilt? as this may give you more of a clue as to what is happening? Aswell as the surrounding muscle balance.

Hop the problem resolves!

James

To all,

I am stumped by this case and would greatly appreciate any help one might be able to provide. I am treating a 40 yr. old male, who is 6 months post microdiscectomy of L5-S1 on the right (they only took out a small piece of lamina, but cut through the thoracolumbar fascia and ligamentous attachments to L5). He was doing well post surgery when unfortunately he reinjured himself doing a 3 minute plank. He did have good core strength prior and was able to do a 2 minute plank without significant difficulty. He is now 6 months post injury and he complains of right lower back pain, 2 inches lateral to the incision site on the right. He has significant limitations and most forms of exercise flare up his low back pain. On exam, he seems to have significant weakness on the right lower extremities, yet there is no evidence of CNS compromise (reflexes normal and asymmetric and no muscle wasting). I gather it is a functional weakness related to pain.

My initial thoughts are that possibly he injured his QL with the 3 minute plank but I was wondering if anyone else has any thoughts on what could be injured from this exercise in a patient that already has a compromised right lower back ligaments due to surgery.

Many thanks in advance,
Alvin