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Lower Back and Extremity problems

By Dr. Ricard Izzo

The biomechanics of running requires that the lower back move in order for proper coordinated lower extremity motion. The anatomy of the lower back consists of muscles, tendons, ligaments, discs, and joint surfaces. For the purposes of this article we will concentrate on joints and muscles.

Soft tissue can shorten, tighten, and/or weaken, hypertrophy, or be over stretched and strained. Muscles that have shortened can do less work. This is due to the fact that work is defined as force times distance. Thus if the resting length of the muscle is shortened, the potential distance it can go is reduced. In running, the work is the distance per stride or the quantity of mileage. An example of this is the runner who works full time at a white collar job, sitting all day long. Over time his (or her) hip flexors will shorten, causing tightening of the thigh and lower back, with resultant altered stride biomechanics. Since hip flexors originate in the lower back, when they tighten they can also cause lower back pain.

During normal running gait, gluteal muscles contract in order to stabilize the pelvis. With shortened, tightened gluts there is a change in gait, with more stress placed on joint surfaces and the surrounding soft tissue (which is recruited so that "normal" gait is maintained). In other words your body compensates for the problem. But not for long! Subsequently, abnormal compensation causes the body to react by further compensation, and running efficiency deteriorates. Added stress causes imbalance to the system with the end result being muscle breakdown in the form of strains, ligamentous sprains, and increased wear on joint surfaces.

During running, the lower back must rotate, flex, and extend so that maximum force can be exerted through the center of gravity. For normal motion to occur, extremity musculature must pull against a fixed object (the core). The core is defined as the area located from mid chest to mid thigh. This is where power in almost every sport develops. Proper alignment of the core, specifically the lower back is necessary for the muscles to pull efficiently with maximum work being done per contraction (in this case each stride). Normal joint mechanics of the lower back and pelvis are vital in coordinated motion between the body and the lower extremities. With joint position being off, motion cannot occur normally due to the fact that more energy is necessary to do work (force times distance). The quality as well as the quantity of motion is decreased. What this means in real terms, is that in a 5k or in a situation where you need smooth, fluid, efficient motion, your body is working harder than it should with resulting decreased performance. There is a loss of energy to abnormal motion. This also comes into play for the marathon. Loss of energy to inefficient motion takes its toll after 100,000 steps in a race. This can have direct, and indirect effects. Since the hamstrings attach onto the pelvis, a decrease in pelvic motion (specifically the sacroiliac joint) can cause shortening, or lengthening of the muscles with a strain being the result. This also can cause the leg on that side to pull up and a functional leg length deficiency occurring. Pelvic misalignment causing sacroiliac dysfunction can also cause toe in or toe out resulting in knee and foot problems. Another important function of the lower back joints is to guide motion while the discs and ligaments absorb and dissipate the force generated with each step. Joint motion should allow for full range of motion so that rotation, flexion, and extension of the spine is in concert with the extremity movement, in this case the pushing off of your foot with each stride. Even when the symptoms of joint and muscle dysfunction are not evident the problem may still exist and should be addressed and fixed before symptoms arise and degenerative changes occur.

Chiropractic sports doctors check for these imbalances of the spine, soft tissue and extremities, and treat them with hands on care, including physiotherapy, spinal adjustments, rehabilitative exercises, and stretching.

A good approach in preventing injuries is to; get regular checkups for musculoskeletal imbalances before symptoms occur, follow a regular strengthening and flexibility program, and .oh yea run. 

Dr. Richard A. Izzo
(914) 251-1223
r.izzo@worldnet.att.net