Having compressed discs in your neck and back is no fun. And if you are a runner, they can be downright debilitating. Compressed discs can cause numerous problems, but with the right exercises and postural corrections, there are solutions to resolve pain and discomfort so you can stay on the trails this spring.
Before we delve into how to manage compressed discs, let’s first talk about what disc compression really is. In essence, a compressed disc is a disc that has lost height, which can come from a lot of different places. Causes can be traumatic, but for most of us, it is a normal process in our back that occurs as we age. If you think about a disc, it is fluid filled (not like a balloon, but more like silly putty), and is made from very tough rings of collagen. A lot of people think that discs are fragile, but they are actually very strong and robust. Believe me, I have cut into them before and dulled many a scalpel in the dissection process.
The fluid contained in the tissue of the disc gives it height and strength. With more fluid, there is higher hydrostatic pressure, which stiffens the surrounding tissue as it expands, giving the disc more strength. Through movement, gravity and living your life, the hydrostatic pressure in a disc goes up and down over the course of the day. There is actually some truth in the adage that you are taller in the morning and shorter at the end of the day because of this fluid shift. Over years of this happening, plus other normal degenerative changes that occur as we get older, our discs become less adept at returning to their normal volume and they start to compress.
We’ve established what a compressed disc is, but what causes your back to hurt? A lot of the time, it’s not the disc itself. When the disc is shorter, all the surrounding structures come closer together, openings get smaller and the chances of having symptoms related to those changes increase. The joints of the back are called the facet joints. When the disc is compressed, the surfaces of the facet joints are in closer proximity to each other, and with certain movements or postures, those surfaces can lock out forcefully, giving you a zinger. The holes that your nerve roots come out of are called foramen. With a compressed disc, those holes are smaller, and with certain movements or postures, the foramen can close down and pinch the nerve root.
So now what? With compressed discs and tighter tolerances for the other structures in your back, how can you run with less pain? In order to address that, you’ve got to fix posture and strengthen certain muscles to stabilize the spine. This will give you the best chance of running without pain or reduced symptoms. Let’s look at posture first.
When we talk about proper posture (with running, or anything for that matter), it’s important to know which postures increase pressure and pain across the structures of the back and neck. Generally speaking, when you go into extension with your back, or your neck, the facet joints lock and the foramen close down. As I discussed earlier, that can cause pain. Extension in the low back looks like increased lordosis (think aggressive curve, or sway back in the lumbar region). Extension in the neck looks like your head in front of your shoulders while looking up (think of looking down at a cell phone but having to tilt your head up because you wear bifocals). Neck extension can also be just plain old chin up posture.
Aggressive extension in the low back and neck can lead to issues down the road. So, what is good posture supposed to look like? In the low back, we want to gently tuck the pelvis so that the top of the pelvis is level. This will flatten the curve in the lumbar spine, opening the facet joints and foramen. Shoulders should be in line with the hip joints, not thrown back with chest up or leaning too far forward. The neck should be fairly straight with the chin slightly tucked at a 90-degree angle. I jokingly tell patients, “If someone were going to punch you in the gut, what posture would you assume?” That’s good posture.
In the position described above, you are in what we call “neutral spine.” In this posture, you are stacked in a strong position on your discs (compressed or not), and you have offloaded the facet joints and foramen (because you are not in extension), giving yourself the best chance of success and less pain. Now, we need to strengthen the muscles that keep you there. The two to focus on are the transverse abdominus (core) and longus colli (deep neck flexors). There are many exercises that we use to strengthen those two muscle groups. As always, it’s important to see your PT to make sure that you actually know how to turn on those muscles properly. Assuming you can, things like planks, chin tucks and proper sit-ups can all help to build strength and support proper posture when running.
Lastly, having a strong core and deep neck flexors also addresses one very important factor when it comes to trail running. It helps to reduce compressive forces across your discs. When your foot hits the ground, compressive forces are exerted across your body, including your discs. As the weight of your body comes down, structures compress to absorb the load. If your discs are already shortened, then they have less capacity to absorb forces, and you will feel symptoms in the surrounding structures (facets, foramen, nerves) as they close from the compression. By externally proving support with your muscles, you can absorb some of the compressive forces, putting less stress on the discs and back in general. So, not only will pain levels be lower, but having good posture and a strong core will also improve your running efficiency. It’s a win-win.
These are the ins and outs of disc compression and a few ideas as to what we can do about resolving pain and discomfort. Hopefully, through better posture and a stronger core and deep neck flexors, you can keep putting in the miles. See you on the trails!
Medical disclaimer. What I write here in no way substitutes for an in-person, thorough evaluation by a licensed Physical Therapist. As with many body issues, there can be multiple factors involved with your aches and pains, and, in some cases, more serious underlying conditions that can be manifesting as physical symptoms. It is always best to have a PT that you can see when you have concerns, so that you can make sure your personal situation is being addressed appropriately and safely. This column should, in no way, serve as a substitute for seeing a licensed medical practitioner.