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495 Views 3 Replies Latest reply: Apr 8, 2013 6:27 PM by JamesJohnsonLMT RSS
Kessa78 Rookie 2 posts since
Apr 7, 2013
Currently Being Moderated

Apr 8, 2013 12:21 AM

Sore lower back

Hi everyone, I have been having pain in my lower back and have been trying to think of what may have caused it. A couple of years ago i was getting really bad shin splints from running so went to a podiatrist and had orthotics fitted. The podiatrist said that my feet over pronate so this has probably caused the shin splints. My orthotics have been giving me blisters on the sole of my feet from running so I decided to take them out a couple of months ago. i thought maybe my shin splints were caused by being new to running. My feet then stopped blistering and everything has been fine except this constant lower back pain. I am thinking that taking the orthotics out may have been a bad idea. What are your thoughts?

  • gilbertholdings Amateur 27 posts since
    Mar 6, 2013
    Currently Being Moderated
    1. Apr 8, 2013 3:35 AM (in response to Kessa78)
    Sore lower back

    seems pretty clear.  with orthotics, no back pain, without, back pain.  you could check with a doctor but it's hard to imagine a doctor coming to a different conclusing based on your info.  maybe though they could help with why you were getting blisters with the orthotics and fix that problem.





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  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    2. Apr 8, 2013 9:22 AM (in response to Kessa78)
    Sore lower back

    Shin pain from walking and running has lot more to do with taking too long of a step or stride than the amount of foot pronation.  Taking too long a step or stride leads to a higher rate of "impact loading" into the body. Taking too long a stride can be a factor in back pain.  If your back pain is related to running, than conciously strive to shorten your step or stride length. Do a browser search for cadence training for running. 

    Damien Howell PT, DPT, OCS - www.damienhowellpt.com

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Apr 8, 2013 6:27 PM (in response to Kessa78)
    Re: Sore lower back

    It would help to separate short-term effects from long-term ones, but that leads to persuasive arguments on both sides of this issue.

     

    The #1 reason why people visit doctors voluntarily, is to relieve pain and discomfort. If the doctor does not wave a magic wand and make their pain go away ASAP, the doctor's practice will fail. For this reason, physicians are forced to come up with short-term solutions, not only to short-term problems, but to long-term problems as well.

     

    This aspect of medicine has led to overuse of narcotics and other dangerous drugs as a way to address pain. In your case, you have a podiatrist who actually tried to solve your back pain with a longer-term solution, and I applaud the intent. What you need to realize is that it takes a while for any body to adjust to an orthotic, and if the orthotic does its job, it will need to be adjusted later to account for the gradual changes that occur in your body as a result of its use. In this way, orthotics should be fine-tuned over a period of years the way an optometrist may change a prescription for lenses to correct your ever-changing visual needs.

     

    The problem with orthotics is that by nature, they tend to restrict motion. No doubt, the good Dr. was aiming to restrict excess pronation as a way to limit the load put on your core structure by this overuse syndrome. Here's where we get into a gray area. You were new to running, and you experienced pain, not only in your shins, but in your back. Your body had adjusted over time to an activity level that you changed by becoming more active. Even if you were not an over-pronator (but especially if you were), the process of adapting your body to running would probably hurt some. Yes, shin splints are encountered by many beginning runners, and I went through that period myself.

     

    Here's where the story gets interesting, because I think you will find my personal experience to be quite relevant. In most useful experiments, a better conclusion is reached when there is a "control," which allows an experimental factor to be applied in different ways to different subjects, or to some subjects and not others, to better prove the effect is not a fluke. Without this control, a conclusion can be easily confused with coincidence.

     

    My problem with shin splints was in only one leg. Not only was that leg measured by a neuromuscular specialist and determined to be slightly shorter (for either anatomical or biomechanical reasons) than the other, but the arch was measured by a running shoe specialist to be lower than the other. In other words, it was slightly pronated. The important fact I found out later by my own measurements, after I had received considerable training on the subject, is that the length of the 1st metatarsal bone in the pronated foot was also shorter than the same bone in the other foot.

     

    It has long been documented that the relative length of one's 1st metatarsal bone has a direct relationship to the skeletal stability of the foot, and that it tends to affect biomechanics in such a way as to encourage pronation as a way to achieve more stability. However, it is not so cut-and-dried as that. The motion of pronation recruits biomechanical action from the leg muscles all the way through the pelvic core into the back, eventually causing pain syndromes in many people who simply walk or stand, let alone athletes who run. So, in your case, you may have gotten away with excess pronation for many years before you took up our favorite sport, but running was the straw that broke the camels back, so to speak.

     

    Now, back to my story, because remember, I had the problem in just one leg, which means that going forward, I had a "control" for running. After studying the effects of metatarsal length on foot and leg biomechanics, and some solutions that had been developed to compensate for this rather common anatomical characteristic, I modified the shoe of the suspect foot to compensate for the differences between both sides. I tried several solutions that were suggested to me as I limped through training and a few races. Basically, I was creating my own custom orthotics, not blindly, but based on what had been suggested to me, and on what I had learned.

     

    I tried the common suggestions first, ones used by others, but things did not improve. They even got worse in some cases. Motion control shoes, OTC orthotics, an arch support, a heel lift, in different combinations, are some of the things I tried. Meanwhile there was ice, stretching, compression gear, braces, the usual stuff.

     

    I got my cues from superior runners, who had been through surgery and applied the usual fixes, with varying degrees of success. In one case, a standout runner with many overall wins to his credit, with a similar problem foot, had repeated bouts of pain from a neuroma. I suggested he try the fixes I had learned about, but to no avail. He continued to have problems despite the common interventions, and despite many good performances at shorter distances, was never able to survive a pain-free marathon. He was forced to abandon that distance, which he had the potential to excel at, because of the problem with his foot. When you advise runners with superior skills, the information tends to flow one way, from them to you. It is hard for a superior runner to accept equipment strategy from an ordinary runner like myself. Eventually, he cut back on running in favor of full-body strength training, having had a major title to his credit in the past. His talent wasn't wasted, only re-purposed. He helped me a lot as he watched me run.

     

    Finally, I put what I had learned to work, in stages, on my own shoes. In neutral shoes, raising the footbed slightly by gluing a thin full-length sole onto the bottom of one shoe, was a fix for leg length patterned after a shoe that had been prescribed for another runner friend who swore by the effects. That helped some, but there was still the metatarsal issue to solve.

     

    I added a small round pad made of tough gel material underneath the ball of the foot (formed by that metatarsal), to compensate for the timing in the order with which the metatarsals strike the ground with each stride. I'm not going to say the effect was magical, because it took a while to adapt, but an important benefit of the change, is that I was able to increase my mileage substantially without pain. Eventually, I was able to master the marathon in my own way, running them without the foot pain and qualifying for Boston twice out of three attempts. Both legs functioned the same way, and soreness stopped favoring one leg. I eventually replaced the glued-on soles with a thin neutral gel pad as an insert, and mass-produced it for my many shoes. Problem solved. Not looking back, except to occasionally help solve similar problems for folks like yourself.

     

    Now, one lesson to learn from all this is that it takes time to adjust to the sport, for sure (please heed Damien's advice on stride length). Another important lesson is that targeted changes to your footwear can help. Still another is that common solutions are often too common and non-specific, to address a specific problem. A lesson I hope was not lost, is that failure to make targeted changes can hurt even an elite runner. The most important lesson is that these changes can be made, whether by a professional or by yourself, successfully, if they are properly targeted.

     

    I think your DPM has attempted to craft a solution for your foot. It may have been a bit ahead of your adaptations, or way too far ahead. Perhaps it is too much of an ideal and your biomechanics cannot catch up, so you get the blisters and foot pain. There are Podiatrists out there who prescribe orthotics in stages, taking metatarsal length into account (which not all DPMs do), and banking on the body's ability to gradually wean itself off excess pronation. Anyone in sports-med can learn from that approach.

     

    Now for a flip side to short-term vs, long-term. Adaptations can go both ways. One of the all-time greats in running, Haile Gebreselassie, is an over-pronator. A few years back, he held the world record in the marathon. Go figure. I think what he has going on, is a very small stature, low weight, and a lifetime of running, starting with 10k to school and back, that allowed his body to gradually grow into adapting to what would be for the rest of us, serious anatomical or biomechanical flaws. You can try duplicating that lifetime of achievement if you wish, but adult onset runners usually need a lot more help than that.

     

    Good luck, and I hope you can learn from others' experience.

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