Running Doc: Give your running shoes a regular checkup

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Dear Running Doc:

I have had low-back, achy pain without radiation into my legs for about two years. When I stretch, I seem to get better. I have had MRIs, CT scans, and EMGs and have seen five doctors, and everyone says they can’t find a cause. When I read articles on the internet, I find runners get back pain from leg-length discrepancies but my doctors say I have none! I run on a soft path, so you can’t blame this on a curved road or hard surface! Any ideas?

Richard S., Queens, NY

Thanks, Richard. It’s good medicine to rule out all serious possibilities, but finding out what it’s not is only half the battle. So you can imagine how an athlete I saw recently, just like you, must have felt after he’d laid out more than $5,000 in doctors’ fees (and about four times that amount for tests) before I ever saw him, and I had to break the news that his problem was something simple he’d been doing to himself all along.

It could be extremely easy to miss. When Dave walked into my office, he looked like the classic runner with low-back pain: in his late 40s, working out regularly but stretching irregularly, and vaguely aware that hamstrings grow tighter with age and can make older athletes vulnerable to a stiff and achy lower back. So Dave worked religiously to stretch and strengthen those. But it had done no good.

So he’d made up his mind to face “the truth.” However, the MRI his first physician ordered had turned up nothing. Neither had a CAT scan. Nor had X-rays, flexion-extension X-rays, and a CT myelogram to check for disk trouble.

Every one of the doctors he’d seen since then had given him the most plausible diagnosis: probably a pulled or strained muscle that needed stretching and strengthening. After $10,000 in electronic imaging, he was back where he started.

Here we go again, I thought. This guy never bothered to tell his doctors that he runs 40 miles a week. No wonder they had him tested for everything else in the book. If this isn’t a classic leg length discrepancy case, I don’t know an orthotic from an Ace bandage. After all, it doesn’t take much to throw your gait off and make the longer leg work harder, which is usually the side where the pain is more pronounced. A difference as meager as a quarter inch will do it. The remedy is simple: a small lift in the other shoe. Usually about half the size of the spread is enough, so a quarter inch difference would generally be successfully treated with an eighth-inch lift.

But not this time. Though leg length differences can be measured extremely finely with a standing pelvic X-ray, a well managed tape measure can usually tell us all we need to know. And the astonishing news this tape measure was telling me was that Dave was actually one of the symmetrical ones. His legs were the same length. Precisely. Despite all the incriminating evidence to the contrary, including the cello-string tight back muscles on the side of what should have been his longer leg. So what could be causing this guy’s back trouble, anyway?

The answer was right at the end of his legs. Turns out that Dave had more than a fondness for his running shoes. He had a relationship with them, wearing them the way some of us wear a favorite sweater – for years and years. Oh, he knew about the 500 mile cutoff after which most shoes are too beaten up to do you much good any more. But these were his “lucky trainers.” What would he do without them?

Stop his back pain, that’s what. After what he conservatively guessed was 1,200 miles of punishment, Dave’s shoes were understandably badly broken down. But it was how they had broken down that mattered: unevenly. Thanks to who knows-what – a manufacturing peculiarity, a quirk in Dave’s gait, maybe even the angle of the roads he’d run on — one shoe was about a quarter inch lower than the other. Shorter legs or shorter shoes, turns out his body didn’t discriminate. Very probably, most wouldn’t.

So I had to advise Dave to spend just a little more, about $100 or so, for some new footwear. “Lose the old shoes and you’ll lose the pain,” I promised. And he did.

My suggestion to you, Richard: Go back to your sports doctor and don’t give up or allow a non-answer. Be a persistent, educated consumer. And always bring your running shoes to the exam. A good sports doc will always ask to look at them!

Enjoy the ride.

* * *

Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

Want your question answered in this column? Write to running doc at running doc@nydailynews.com or write your questions or comments in the comments section below.

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Running Doc: Give your running shoes a regular checkup

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