I am a 41-year-old man. I've been running for more than 30 years. An MRI recently confirmed that the tightness and burning in my left glute and hamstring, and my lower back stiffness, are bulges and tears with the L4/5 and L5-S1 discs. I just had a steroidal injection, which reduced my pain by 50 to 60 percent. My question is this: Do you believe that long-distance running has caused my disc issues? I tend to think that my disc problems are the result of age and the bad posture, poor lifting, and the occasional incident (like a wave-rider mishap 10 years ago), but some health professionals are discouraging my running, as though it is definitely the culprit. What do you think? Thanks–Chris Chris, It sure is easy to blame things on running, but there is little data to support the contention that running causes disc disease or hastens its progression beyond an individual’s genetic predisposition. Sports that I consider high risk for disk injury include rowing, football, wrestling, hockey, gymnastics, tennis, and golf; all share some or many of the common mechanisms of herniation-flexion, rotation, and compression of the spine. In straight-ahead running on the roads or the track, the compressive loads are probably minimal compared to the forces that occur in the lumbar spine of a football interior lineman (or woman). So to answer your question, I would say that it is slightly possible that your running caused your disc problems and quite possible that running can make your pain worse at times. I tend to side with your assessment that genetics, bad posture, poor core strength, improper lifting, and the incidental incidents like the “wave rider” crash did more to damage the discs. Herniated discs usually take 6-12 months to “heal” and during that time it is important to stay fit with walking or any activity that does not flair your pain. You should look at your core strength and do simple strengthening activities like forward, side, and back bridges to help support your spine. Fredericson and Moore have a nice article on core stabilization here . I would also recommend that you find a provider who works with athletes and is skilled in manual therapy to assess your pelvis and low back. If the pelvis is rotated, you can get pain in the buttocks, groin, and hamstring that is similar to radicular disc pain. With time and strengthening, you should be able to get back to running, but it will be a long term project. I hope this helps. Cheers, Bill Have a question for the Sports Doc? E-mail him at sportsdoc@rodale.com . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.
Post-Marathon Foot Pain
I ran my first marathon yesterday. I felt good, considering the mileage. I went to bed and woke up the next morning with a slightly swollen left foot (left side of the foot just above where the arch meets the heel). It is red and hurts to walk. Occasionally, the area pops when I walk. Is this just an injury from the repetition of running, or should I be concerned? I'd like to start running this weekend.–Nicole Congratulations on finishing your first marathon. I hope you will have the chance to complete many more. I am assuming from your description that the pain is on the lateral side of the foot at about the level of the base of the fifth metatarsal. You can find this spot by following long bone of the foot (metatarsal) from its head at the toe end to its base in the mid foot. If the pain is located where your finger drops off the bone, you have most likely stressed the tendon that inserts on the base–the peroneal tendon. If the pain is just above that location, you may have “subluxed” or “locked” your cuboid bone (one of the metatarsals). The peroneal muscle helps stabilize the ankle while running and walking. It contracts when you toe off and, if you are a mid-foot or toe striker, when you land with each stride. Consider the number of steps in a marathon run and you can appreciate the strain on the muscle and tendon from the race. This should resolve with rest and it would be best to not resume running until the area has healed. The cuboid is one of the metatarsals and functions to support the integrity of the arch structure and helps with force dissipation through the foot. The cuboid syndrome disrupts (minimally) the normal motion and dynamic structure of the calcaneocuboid portion of the midtarsal joint. This change in the cuboid position and motion irritates the surrounding joint capsule, the ligaments, and the peroneus longus tendon causing pain and loss of function. This diagnosis of easily missed and the syndrome is not consistently taught to physicians and other health care providers. The treatment is a simple manual therapy reduction that can be done in the office by physicians, chiropractors, and physical therapists who are trained in the technique. Of course there is also a chance you have a stress fracture or soft tissue injury, so if you are not healing, you should seek medical attention. I hope this helps. Cheers, Bill Have a question for the Sports Doc? E-mail him at sportsdoc@rodale.com . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.