A Physiotherapist’s Experience: Back pain and Half-marathons

Jan 13

I was able to run my second half-marathon after my chronic lower back injury. I suffered a pretty severe back injury that resulted in tingling, numbness and weakness in my left leg. I tried my best to figure it out on my own but didn’t have any luck. I began consulting other physiotherapists, doctors and chiropractors who provided different options that did not improve my pain. I was eventually able to find a variety of options that all contributed to my healing and the ability to run again! I now bring my experience as a patient to my community using skills and knowledge I gained from experiencing unrelenting back and leg pain for years. If you’re interested in learning more about my journey to recovery, click here to read.

The anxiety of lower back pain

Lower back injuries can be stressful as it can severely limit your ability to function. Pain is a challenging symptom to come to grips with because of how subjective it is. This means that you are the only person feeling what you are feeling and it may be different from what others are experiencing. Trying to describe something others can’t see can be very frustrating.

What is the silver lining?

Pain is our body’s way of protecting us. An example is touching a hot stove – we reflexively move our hands away to avoid further injury to our fingers. With back pain, your body is telling you that something may need to change whether it is a repeated activity or how you are moving. The danger is when we choose to ignore pain and push forward. There are some situations where this is helpful and other times more harmful.

How do I know if pain is helpful or harmful?

There are several factors to consider whether the pain you are feeling is helping you or harming you.

Pain that may be helpful

If the pain lasts for a short period and dissipates, this may be your body getting used to a new movement or position. If you feel looser and more able to complete certain tasks this is also a good sign. It is also good to differentiate between soreness after a workout versus pain.

How high is the intensity? Is the pain a 2 out of 10? Anything higher than 5 may be pushing it. Does the pain intensity decrease as you complete the movement more? That would indicate that the movement may be helpful.

Symptoms of pain, tingling, burning and numbness are associated with nerve injury. If tingling is transient and does not last this is a good sign. If your symptoms improve as time elapses, this would also be positive. If pain, tingling and burning are initially in your arm and leg and start to travel towards your neck, this is an improvement (also known as centralization). Decrease in the size of the area of pain, burning, numbness or tingling indicates an improvement in your condition.

Not so helpful Pain

If your pain lingers after an activity or movement and stays worse the next day, this is a sign from your body that something may be irritated and it would be best to rest. This could be described as a sharp pain with certain movements, a dull ache, tingling or numbness. Constancy would also indicate that there is inflammation or a recent irritation.

If the pain intensity is higher than 6, you may be causing reinjury. Does your pain increase as your repeat the activity? This could also indicate irritation of a certain tissue, joint or nerve.

If the symptoms of pain, tingling, burning and numbness travel down your arm or leg – this indicates stress to the nerve (also known as peripheralization) and worsening of your condition. If the surface area of pain, numbness, tingling and burning increases in size, this indicates a worsening of symptoms as well. It is best to stop what you are doing and find positions of comfort to reduce this phenomenon.

Remember that all of this is subjective, each person experiences pain differently and some people have a different pain scale based on what they’ve experienced in their lifetime. It is sometimes helpful to get a second opinion from a professional who can listen to your story and determine pain patterns.

With my back injury, I had to pay attention to these signs to understand what activities were safe versus harmful. After receiving treatment using a variety of approaches, I was able to run again.

Respecting your body

In my 6-year journey of back pain, I learned to respect what my body was telling me. It started with running around the block twice for me before my leg started to become irritated with tingling. I would let my body rest and the next day I recovered with no lingering symptoms. I waited an additional day before returning to activity again. I continued to do this until I was able to run further with little to no symptoms in my leg.

Every session was slightly different. There would be times where my tingling would increase for a short period of time at the start and improve as I ran further. Other times, I tried to increase my pace and my body would tell me a simple NO with increased tingling in my foot. I did experience back pain, but it was a low grade of 3 out of 10. I would receive treatment from my physiotherapist or complete stretches and exercises to find relief so I could continue to participate in running.

Eventually I began running 5km, 10km and even 15km over the next year. If I respected what my body was telling me, the nerve in my back healed over time and allowed me to progress more gradually.

Patience

I’m not going to lie; this was a frustrating part of my life. Prior to my injury, I would be working out 4 times a week lifting heavy weight, playing sports regularly and feeling confident in my body. I didn’t have to think about what I was doing and how I was doing it. But suddenly all of that was taken away from me. When I was invited to play squash, I had to say no because I was in so much pain. I couldn’t exercise so my mood and confidence plummeted. It was a tough time for me mentally, emotionally and physically.

What I later realized upon reflecting on my journey, was that poor habits eventually caught up to me. That included improper lifting form, a lack of training and knowledge of muscular imbalances, avoiding mobility warm-ups and not respecting my body’s pain signals. These are now nuggets of wisdom I pass down to all my clients with lower back and leg pain.

This sounds like me, where should I start?

Seek help. I know that I prolonged my injury and potentially made it worse trying to noodle my way through trying to find a solution on my own. It is really hard to assess yourself - take it from a physiotherapist trying to solve their own pain. A set of second eyes on your injury can provide insight on your daily life patterns and how you are moving. We often get in our own echo chambers and choose to interpret information that will confirm our own biases. Having an outside perspective will help you see something you are blind to. I know this because I sought help later on and it revealed a lot more than what I was understanding myself.

Do I need surgery?

This isn’t my question to answer, but from what I know, surgeons will recommend that you start with physiotherapy first for at least 6-8 weeks. The risks of surgery are infections or complications with the procedure. To make the decision to go under the knife, you want to be absolutely certain that you tried your best to manage it conservatively with movement and exercise. If considerable time and effort have been put into rehab with no lasting change, you can be more certain that you are making a better-informed choice. There are also some less invasive options such as injections with physiotherapy that are offered before surgery as well (for the nerds out there, here is the link to the journal article.)

Your physiotherapist is trained to find signs that would point to surgery if the need was immediate. That’s why it’s important to seek help and have a trained professional take a thorough history so you do not waste time if your condition is surgical. If you are concerned about surgery or need a second opinion, you can book with one of our clinicians who can complete a thorough history and answer some of your questions.

Perfection, pain linked to emotions and the antidote which is joy

Perfection is the enemy of joy. I now know this because I wanted my leg and back to be perfect after years of rehabilitation. But when I focused on the frustration of me not achieving full pain relief and how my body was not normal, my leg symptoms would get worse. I would go through flare ups not knowing why this was occurring even though my physiotherapist found nothing wrong with my mechanics. As I talked with friends, family and my healthcare team, I realized that an increase of emotions such as stress and anxiety, would increase my pain. It was described as my fight or flight response being on high alert when I started to ruminate on how crappy I felt or that my body was not the same as before. I soon found that in order to find victory over my pain, I had to think differently about my discomfort. Instead of it being an obstacle to perfection of my body, it became a part of me and my story. The antidote to this perfection was finding joy in running by being present.

There is hope

I hope this blog has helped you gain some perspective with your lower back pain. Or perhaps you have a friend who needs some encouragement. One of my goals as a physiotherapist in the London, Ontario community is to spread hope by providing insight and potential answers to your lower back pain. If you would like to book with our team to get help, click here to learn more about our physiotherapists or boo k now.

Half Marathon Report

Race: TCS Toronto Half-Marathon
Time: 1:55:28
Pace: 5:28 min/km
Personal Note: I shaved off 5 minutes and 16 seconds from last year! I’m so grateful; the Toronto Waterfront Marathon had a lot of good energy. I’m thankful that I am able to run and hoping to do it again next year!