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.

Physical Activities Does Not Wear Out Our Spine

I've written more than five other posts on our back / spines recently, well here's another article to align with our Instagram and Facebook posts this week. You can watch the three videos here.

We've all been sitting a whole lot more, myself included during the circuit breaker. Here's what research is suggesting, that it is actually physical inactivity and not physical labor that is associated with degenerative (or wear and tear) changes in the thoracic and lumbar spine.

The researchers studied 385 subjects on the relationship between short and long term physical inactivity and degenerative changes of the thoracic and lumbar spine over a period of 14 years. They grouped the subjects into those who did no physical activity, or did so irregularly for 1 hour a week, regularly for 1 hour a week, or regularly for more than 2 hours a week.

In addition, physical labor, walking and cycling were investigated additionally.

Correlations between physical inactivity and thoracic and lumbar disc degeneration were analyzed after accounting for sex, age, Body Mass Index, hypertension, diabetes and back pain.

Subjects with disc degeneration in the thoracic and lumbar spine were more common in those with no physical activity, irregular activity < 1 hour compared than those with regularly activity > 1 hour or more a week.

You'll be happy to know that there was no obvious significant association statistically for subjects who did physical labor, walking or cycling with disc degeneration.

The researchers concluded that physical inactivity over the 14 years they studied demonstrated a strong correlation with disc degeneration of the thoracic and lumbar spine.

Just like we wrote previously that running more miles does not wear out your knees, being active, doing physical labor will not wear out your spine too.

Keep moving.


Reference

Maurer E, Klinger C et al (2020). Long-term Effect Of Physical Inactivity On Thoracic And Lumbar Disc Degeneration- An MRI-based Analysis of 385 Individuals From The General Population. Spine DOI: 10.1016/j.spinee.2020.04.016


My boys wanted the same picture as me, so here's my older boy.

And here's my younger boy below.