Unraveling the Truth About Running and Spinal Health
Activities like running, lifting weights, and swimming not only improve the health of our heart but also strengthen our bones and muscles, providing substantial health benefits. However, it's not uncommon for some runners to experience pain early in their routine or even after years of activity, leading many to question whether the benefits outweigh the discomfort. The answer is a resounding yes. In this blog, we will dispel some common myths surrounding physical activity and pain. Specifically, we'll explore why some individuals experience pain when they begin running or later in their running career, and how to effectively manage and prevent this from happening.
A False Belief: Running = Back Pain
Despite popular belief, running is not the villain in the story of spinal health. Many assume that the repetitive impact of running harms the spine, but recent research suggests quite the opposite. In fact, running can be a protagonist, offering a host of benefits for spinal health when done correctly. The pervasive myth that running inevitably leads to back pain needs a closer look, and that’s precisely what we’re here to do. Let’s dive into debunking this common misconception using the latest research to guide us.
How Running Benefits the Spine
One common myth around running and lower back pain revolves around the spinal disc. Spinal disc are the cushioning material between each of our vertebrae and they allow us to move, run, and do many of our everyday activities in a smooth and coordinated manner. However, these disc and their health are commonly pointed to as the culprit in the development of spinal pain, specifically lower back pain.
One of the common misconceptions around these spinal disc is that over time running “wears out the disc” and this “wearing out of the disc” leads to lower back pain. Luckily for us our disc aren’t tires and they don’t wear out in a similar way. What does happen to our disc when we run?
They get stronger, at least according to researchers that looked at the MRI findings of a group of runners with a running history of over 10 years and averaging more than 50km/week. The researchers compared the MRI findings of the runners to a group of non-physically active individuals.
Here’s what they found.
The intervertebral disc (IVD)-to-vertebral body height ratio measures the proportion of the disc height relative to the adjacent vertebral bodies. This metric assesses the disc's height as a percentage of the combined height of the vertebral bodies directly above and below the disc.
Importance in Spinal Health:
Structural Integrity: A greater IVD-to-vertebral body height ratio indicates a thicker disc, which is beneficial for spinal health. Thicker discs are better at absorbing shocks and reducing stress on the spine during movement.
Indicative of Disc Health: This ratio is a critical measure in evaluating the health of the spine. Healthy, hydrated discs tend to maintain their height, while degenerated discs lose height due to dehydration and wear.
Functional Implications: Maintaining a higher disc height helps preserve the natural curvature and biomechanics of the spine, which is essential for reducing the risk of spinal stiffness, pain, and functional limitations. It ensures proper distribution of mechanical loads across the spine, decreasing the likelihood of injury and degenerative changes.
Runners had 20% thicker intervertebral disc
Runners had Lower Pfirrmann grades (a way to measure the amount of degeneration on MRI)
Runners had greater IVD-to-Vertebral Body Height Ratio
If running leads to wearing out the disc then we would expect to see the opposite of the above findings; higher Pfirrmann scores, which the opposite was found in the study, lower IVD-to-Vertebral Body Height Ratio, and thinner disc compared to the control. Running in this group of individuals actually increased the health of our disc. It is thought that this occurs through increased nutrients being delivered to the spinal disc due to the motion of the spine when running.
Similar findings have been found in larger studies as well. For instance in recent research review, Impact of Running Exercise on Intervertebral Disc: A Systematic Review, researchers found that long-term running exerts a mild positive effect on the spinal disc.
Why The Lower Back Pain?
If studies show that runners can develop healthier spinal disc, why the lower back pain? Well, studies also consistently show that regular runners tend to have stronger core muscles and better back muscle endurance than non-runners. This significantly benefits our spinal health and translates to better movement stability and control when doing other activites. Running increases blood circulation, which in turn helps deliver essential nutrients to spinal tissues, promoting disc health and flexibility. These physiological benefits contribute to a more resilient spine, capable of withstanding daily stress more effectively. Enhanced core strength ensures better distribution of forces during running, mitigating the impact on the lower back and reducing the risk of microtraumas that can accumulate over time to cause pain.
Running stimulates the strengthening of the muscles surrounding the spine, acting as natural support and shock absorbers. The activity promotes the flow of fluids within spinal discs, ensuring they remain hydrated and nourished. Regular dynamic loading and unloading of the spine during running encourage its structural integrity.
So why is it that the misconception of running leading to lower back pain persist?
While running offers many benefits, it can lead to lower back pain when not practiced correctly. Common culprits include overtraining, inadequate recovery time, and poor running form, all of which can lead to lower back pain. Additionally, insufficient core strength can leave the spine unsupported during the high-impact activity of running. The correlation between intense training schedules and the occurrence of lower back pain is well-documented, showing that runners who engage in frequent, high-intensity sessions without adequate rest are more likely to experience spinal stress and subsequent pain. The more run down the body gets - no pun intended - the more likely the body is going to be unable to recover and the more likely we are going to develop pain. That’s why recovery is key when it comes not only to running, but all strenuous activities.
If you look at the picture below our chance for injury increases the less trained we are. For this reason it’s crucial for individuals who are getting into running to follow a plan that steadily and smartly increases their training in a managed way and not too quickly as the body can only adapt so quickly. On the other side of the coin many runners that are in their later years or running high mileage each week do not allow themselves enough time to fully recover before their next run, increasing their risk of developing pain.
Evidence from multiple studies shows that runners with lower back pain often train more frequently, take fewer rest days, and have longer total running years. This suggests that excessive training without adequate recovery might contribute to the development of lower back pain. To avoid this, runners should consider adopting training schedules that allow for sufficient recovery and include exercises that strengthen the core, legs, and back.
Training Modifications to Prevent Back Pain
To avoid the pitfalls of overtraining, it's crucial to follow a balanced running schedule that incorporates rest days and varies in intensity. Including low-impact activities like swimming or cycling can help maintain cardiovascular fitness while giving the muscles utilized during running a break. Incorporating strength training activities can help to make the bones, muscles, and joints stronger reducing the risk of future injury. This approach ensures that your muscles, ligaments, and tendons have time to recover between runs, which is essential for preventing injuries and promoting long-term spinal health. Runners should also consider alternating hard training days with easier days or complete rest to allow for adequate muscle recovery, which helps prevent overuse injuries, including back pain.
For beginners, a plan might include running two to three days a week interspersed with yoga, pilates sessions, or strength traininig to enhance core strength and flexibility. More advanced runners could incorporate interval training twice a week, with longer runs reserved for when the body feels recovered. Each plan should be tailored to individual fitness levels and back health status to optimize benefits and minimize risks.
Run To Better Health
It's clear that running, when approached correctly, offers substantial benefits for spinal health rather than detriments. The evidence from research strongly counters the myth that running leads to back pain and instead highlights how it can strengthen the spine, enhance disc health, and positively contribute to overall well-being. Runners not only enjoy greater intervertebral disc health but also exhibit lower signs of degeneration, as demonstrated by significant findings such as a 20% thicker intervertebral disc, lower Pfirrmann grades, and a greater IVD-to-vertebral body height ratio.
Understanding the role of proper training and recovery is crucial in harnessing these benefits while mitigating the risk of developing pain. It's essential for runners, both new and seasoned, to adopt balanced training regimens that include adequate rest, varied intensities, and complementary strength training. By doing so, runners can maintain their spinal health, improve endurance, and enjoy the many benefits of running without unnecessary pain.
I hope you enjoyed this blog and as always feel free to reach out to me at drcoffman@optimizecolumbus.com with any questions.
References
Shu D, Dai S, Wang J, Meng F, Zhang C, Zhao Z. Impact of Running Exercise on Intervertebral Disc: A Systematic Review. Sports Health. 2024;0(0). doi:10.1177/19417381231221125
Shuo, Luan., Qing, Wan., Hai-Jie, Luo., Xiao, Li., Songjian, Ke., Caina, Lin., Yuanyuan, Wu., Shaoling, Wu., Chao, Ma. (2015). Running exercise alleviates pain and promotes cell proliferation in a rat model of intervertebral disc degeneration.. International Journal of Molecular Sciences, 16(1):2130-2144. doi: 10.3390/IJMS16012130
Daniel, L., Belavý., Matthew, J., Quittner., Nicola, D., Ridgers., Yuan, Ling., David, Connell., Timo, Rantalainen. (2017). Running exercise strengthens the intervertebral disc. Scientific Reports, 7(1):45975-45975. doi: 10.1038/SREP45975
Mitchell UH, Bowden JA, Larson RE, Belavy DL, Owen PJ. Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study. PLoS One. 2020 Feb 21;15(2):e0229457. doi: 10.1371/journal.pone.0229457. PMID: 32084224; PMCID: PMC7034897.