Spine injuries in runners: A functional approach.

Interest and participation in running has increased over the past several decades. There has also been a substantial increase in the incidence and prevalence of injuries associated with running. The etiology of running injuries is multifactorial. Of all the musculoskeletal injuries associated with running, lumbar spine injuries are among the least common - yet can be the most debilitating. The impact load generated during heelstrike travels up the lower extremity kinetic chain and converges on the lumbar spine. This impact load is minimized through a series of normal biomechanical actions of the joints and the soft tissues that support them. Dysfunction at any link in the lower extremity kinetic chain can set off a cascading series of mechanical adaptations throughout the spinal axis. Similarly, spinal pain and dysfunction can create peripheral joint adaptations. These mechanical adaptations may become painful or may create a painful dysfunction at a more distant site. There are a variety of structures in the lumbar spine that can cause pain. Mechanical, vascular, biochemical, and neurochemical factors may also be involved in the production of low back pain and radiculopathy. Running stresses the normal biomechanics of the lumbar spine. Changes in normal tissue function including strength, strength balance, flexibility, and proprioception may be caused by these stresses or be the cause of them. New adaptive functional running patterns occur. A thorough rehabilitation plan that addresses all aspects of the injury requires an accurate and complete diagnosis that is made as soon as possible. The rehabilitation program is divided into acute and subacute phases. Education, physical modalities, medication, manual therapy, traction and therapeutic exercise are used to help meet the goals of the acute phase of rehabilitation. The goals of the subacute phase are met by optimizing strength, endurance, and coordination of the neuromuscular system as it affects the lumbar spine and preventing any further injury or recurrences. Running specific rehabilitation may start early in the subacute phase and then progress as the runner's spine stabilization skills improve.