Will Marathon Running Hurt Your Back?

A patient who came in earlier this week asked if I still did any running. He had signed up for the Singapore marathon early next month and was worried that he may hurt his back taking part. He wanted my views since he had heard about my compression fracture (pictured below) as he had the occasional back ache.

Spot my compression fracture at L1?

I shared with him what I did and showed him the evidence that running definitely did help my low back pain. Of course I am not running as fast nor as long as when I used to race. I hardly run more than 7 km at a go now. Mainly due to a lack of time rather than an inability to.

I also shared with him other evidence of how researchers studied a group of runners who had never attempted a marathon before. 

28 runners (14 males, 14 females) with an average age of 30 signed up for their first marathon and were recruited by researchers. They went for a high resolution MRI screening 16 weeks before (time period 1) the race and another 2 weeks after the race (time period 2). 

The scans were subsequently assessed by senior musculoskeletal radiologists. At time period 1, 61 percent (17 out of the 28) of the runners had disc degeneration at mainly L4-L5 and L5-S1 levels. However, none of them had any back pain nor other symptoms.

Subsequently, the subjects underwent a 16 week training program. 21 out of the 28 runners completed both the 500 miles (800km) training and the race. The other 7 did not complete the training nor started the race. None of them dropped out due to spine related issues.

During time period 2, the researchers found no progression (or worsening) in those who had the disc degeneration in the second MRI. In fact, there was a regression in 2 out of 8 patients with bone marrow oedema in their sacroiliac joints (SIJ). Meaning their scans improved!

The only 'blemish' was one participant who had a small increase in the size of a subcondral cyst. However, this participant remained pain free.

Still thinking about doing that first marathon? Well, you know that running will not wear out your knees nor worsen your back. In fact your joints and connective tissues love movement. Movement lubricates your joints and hydates your connective tissues. So go run that marathon!

Reference

Horga LM, Henckel J, Fotiadou A et al (2021). What Happens To The Lower Lumbar Spine After Marathon Running: A 3.0T MRI Study Of 21 First-time Marathoners. Skeletal Radiol. 51: 971-980. DOI: 10.1007/s00256-021-03906-5.

My L1 is 'collapsed' compared to above and below

X-ray of my back 2 weeks after my first accident above.