Running and Back/Foot Pain
Running is a sport that continues to gain an increasing following. With that, an increase in the running population that some deem not ready to run also increases. Some view running as a fitness activity and should not be performed unless certain mobility/stability goals are met. Injuries often prevent an individual from moving to the fitness level and running. Many PT's, myself included, have instructed patients to hold off on running, while their back or foot pain is present due to concerns over worsening injury. But what do you do if you have a patient who tells you running decreases their pain?
This may seem surprising to some, but I have had several patients, myself included, where running actually decreased pain. There are a couple potential reasons for this. In regards to back pain, a component of running or walking for that matter involves spinal rotation. The repetitive rotation of the spine may act as a mobilizing force to the spine. This mobilization may work similarly to repeated motions in lowering the threat level of the nervous system, especially at any "restricted" levels. In regards to foot pain, a couple theories are present. The running may act by forcing activation of intrinsic muscles, providing additional support to the foot. Remember what we learned about higher levels of contraction - they lead to overflow activation of additional muscles. An alternative theory is that the pain may have a neural component and the mobilization of the lumbar spine when running (as discussed before) leads to a decrease in neural tension and pain. I have found personally that my occasional "plantar fascia" pain only comes on if I haven't ran in a couple weeks. I have a significant lumbar component to mine as well if you recall my sciatic nerve pain. When my tibial nerve is tensioned, my plantar fascia pain is recreated during a SLR. The symptoms improve with repeated sideglides, but are completely eliminated with regular running.
There is no rule as to which patients will benefit from this. Likely many patients' symptoms will be aggravated with running initially, but don't be surprised if you have a patient report that running improves their symptoms. What I recommend is treat the impairments. Look for mobility deficits throughout and work to make them symmetrical. That can serve as a base for treatment and then build stability and strength on top of that.
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