Ask the Doctors

Dr. Robert Ashley

Dear Doctor: I am 55, and I love to run. I don't overdo it, usually only seven to 10 miles per week. But now that I have arthritis in my back, doctors have told me to quit running. Yes, running hurts most days, but I feel as if I can conquer the world after a good run. I tried to run/walk, but it's just not me. Do I have to give it up altogether?

Dear Reader: I understand your love of running and the feeling that comes from being outside, focusing on the movement of your legs and forgetting the stresses of your day. So do millions of others in the United States. In 2014, 19 million people in this country participated in a competitive run; that's up from 5 million in 1990.

But there is a downside to running, especially on the back. In short, the discs between the spine's vertebral bones become strained and compressed. A 2011 study of 25 long-distance runners (ages 23 to 69) in the United Kingdom measured disc strain by having the runners undergo an MRI before and after a one-hour run. After the run, the authors found significant compression of every lumbar disc evaluated. They also found that 23 out of 25 runners had some degree of lumbar disc degeneration, with most people's degeneration occurring at the L5-S1 segment in the lower back. The findings are relevant because decreased disc height has been linked to low back pain.

True, the disc height should recover afterward, especially if you only run for an hour, but if you run regularly, the strain on the discs increases. In fact, decreased disc height and disc degeneration are seen more frequently in elite runners than in the general population.

One cause for low back pain among runners could be weakness in the deep core muscles that stabilize the spine. Weakness in this area puts more stress on the spine and increases the load on the superficial muscles of the abdomen and back; a 2018 study published in the Journal of Biomechanics supported this connection.

Other studies have found a decrease in back pain among people who increase their core strength. So there's hope -- but it will take work. Physical therapy is the place to start. A physical therapist can recommend exercises to help stabilize the spine, as well as exercises to strengthen the core muscles. A 2015 review of four studies found that core-strengthening exercises led to a significant decrease in back pain and an increased ability to exercise. But you have to make a daily commitment to doing the recommended exercises.

Even if you've already tried physical therapy, you should try it again. Strengthening your lower back muscles and your abdominal muscles will put less strain on your lower back, allowing you to run with a better posture.

Lastly, don't forget the importance of footwear. A recent 2018 study showed that more minimalist footwear was linked to decreased strain upon the back. Such footwear has a thinner (and thus more natural) sole and affects the biomechanics with running in a way that puts less strain upon the back. Some people can develop Achilles tendonitis or knee problems with such shoes, but they might be beneficial to you.

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.