Back, ankle, running, mechanics!

Jan 11th, 2014

Karis asked The Guru for the following Physiotherapy Advice:

Hi Guru,

Late last year I put my back out bending over (had general lower back pain which localised to the right, restricted movement on bending forwards, pain worse on sitting, better with walking, no tingling or weakness). I had a course of physio which seemed to put it right and was told it was a facet joint issue.

A few months ago due to lateral foot pain, I started wearing orthotics which seemed to cause a resurgence in low grade back pain which eased with rest (since stopped wearing them). Around the same time I was told I was okay to resume running despite a bad ankle sprain and embarked on a back to running programme. This seemed to compound the problem and now I have more persistent right sided lower back pain. This time though there is tingling in the lateral calf and upper buttock area and I sometimes get a sort of burning/pinprick type sensation in the posterior thigh area (all on the right side). Once again pain is worse on sitting (although better if I sit straight!) and if I walk too fast or run for a train etc, or stand for a long period.

Do you think this is more of a disc issue now? What should I be doing to make it better (I don’t fancy becoming reliant on painkillers!)? Am I okay to do low impact exercise such as cross trainer/recumbent bike? How connected is the pain to the ankle sprain and/or poor biomechanical compensation?

Any help would be much appreciated.

Jan 11th, 2014

The Guru Responded:

Hi Karis
It sounds as if the true, underlying cause of what’s wrong with you
has yet to be indentified. You’ve got a load of different symptoms
which may have a very similar cause….You don’t want to chase the
symptoms, you need to deal with the cause.
I wouldn’t worry if you did or didn’t have a facet problem, and yes
you do sound more discy today BUT i don’t think they need to be
treated any differently as the cause will be the same.
Orthotics are good for some people, with some things, some of the
time. They need to be correctly used rather than just bunged into a
pair of shoes, and on the face of it, it sounds as if either your feet
do not need orthotic control or you’ve still got a pelvic/central
issue which is giving you functional issues with your mechanics/feet
and so doesn’t need orthotics. Cause and effect.
Fast walking, running also may imply that you’ve got some restriction
around the front of your hips (big stride = trouble) which may be due
to poor glut control and/or an unstable low lumbar spine….
This is where you need to start. Don’t live on pain killers, get the
root cause sorted [physio in sport]…

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