Heel pain and the lower back


As runners, terms like plantar fasciitis, Achilles tendonitis, "runner's knee" and "pulled hamstring" become part of our group discussions. Sometimes the back is overlooked as a source of leg pain. I recently saw a fellow runner on a follow up visit for heel pain. On this visit his symptoms were slightly different. He stated that he felt a deep ache in his calf and a fuzzy sensation in his heel. His symptoms were aggravated by sitting for more than two hours and actually felt better when he ran.


My impression was that this slightly different presentation might be due to a lumbar spine issue. While evaluating his back I found that I could replicate some of his heel symptoms by applying pressure to his lower back. We then discussed some principles of back care including limiting the amount of time he was sitting, using a lumbar support in his work chair and performing a couple of simple back flexibility exercises. He was already involved in an appropriate trunk strengthening program. After 10 days he reported that he felt better than he had in a long time and was back to running without pain.


What is the best way to deal with back pain? Generally, the place to start is an evaluation of the things you do on a daily basis and assess if any of these may be contributing to your back pain. A few examples could be: sitting for long periods of time (greater than 1 hour), lifting mechanics (keep the back relatively straight and bend at the knees), and sitting or standing posture. Often simple modifications to your daily activities can be immensely helpful for the back.


Massage is a treatment that is often sought and recent research has provided evidence of long-term improvements. There are a variety of massage techniques, research is not sufficient at this time to say which is most effective. In my experience, a deep tissue massage seems to provide the most substantial results.


Manipulation, or adjustment as a chiropractor may say, is also a frequent choice of treatment. A greater volume of research is now supporting this treatment option, both in the acute and chronic situation. This is quite a paradigm shift for the medical community. Recently I was conversing with our local orthopedic spine surgeon and was surprised to hear his acceptance of manipulation as a legitimate treatment for acute low back pain.


What a "pop" does is often misunderstood or misrepresented. For years the thought was that your spine, or a segment of it, was "out of place" or "out of alignment". The current research does not support this claim, or model. What is known is that after a "pop" there is a reflex muscle relaxation that occurs in the region of the "pop". This reflex relaxation provides some pain relief and also allows the spine to move more freely and naturally. As a practitioner, this technique is rewarding because it is quick, simple, and for some can provide substantial relief.


Exercise! We love exercise. But which is most helpful. For runners, that are generally more fit than the average person, abdominal strengthening and stretches targeting areas of tightness will probably be most effective. Three years ago, a group of physical therapists in Australia, found that strengthening of the deep abdominal muscles (as well as the lower back muscles) provided long term improvement for patients with lower back pain. These abdominal exercises were not the typical crunch we are familiar with. The emphasis is on tightening the stomach muscles that draw the stomach inward while breathing outward. This takes a little practice to get used to but once mastered can be incorporated into a variety of abdominal exercises you may already be performing.


This is a brief overview of treatment approaches for lower back issues. If you feel your symptoms may be related to your lower back be sure to seek a consultation with a highly recommended health care provider familiar with the needs of runners.




Bryan Whitesides MPT, OCS

Physical Therapist


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