Back pain injuries are one of the most common issues in the world when it comes to musculoskeletal disorders. In fact, 50–80% of adults experience at some point in their life (1). In my practice runners often would come to me complaining of back pain. But, can running cause low back pain, or is it another factor?
We typically think of runners knee and IT Band syndrome as “running Injuries” but can back injuries be added to that list? In my practice a lot of runners thought of back pain as a nuisance but what if we shift our thoughts to it being a running injury and treat it as such?
While I have seen few runners that have actually had back pain caused by running, they do still suffer from low back pain. Typically it is caused by dysfunctions outside of running that then translate into running causing the low back pain. The repetitive nature of running can amplify the effects of existing soft tissue imbalances and movement dysfunctions that lead to back pain.
What Causes Low Back Pain in Running?
Poor Dynamic Control of the Lumbo-pelvic region
Running gait is repetitive by nature. You do the same motion over and over again. As our legs repetitively swing forward and backward through the gait cycle a huge amount of movement comes from the hips.
In order to have that movement at the hips, we not only need a lot of mobility but also stability at the pelvis and hips to provide a good base of support for the motion.
Often, I see runners that lack either range of motion at the hip or the dynamic stability of the region (usually both), compensate by over-extending through their low backs (arching or hyperlordosis). This causes the pelvis to rotate anteriorly and put excess strain on the low back.
This hyperlordosis not only puts extra strain on the low back but also inhibits your glutes. Meaning they don’t work as well to give you the power we need for running. I have a whole article on increasing Hip Extension to improve your running.
Muscle Imbalances During Running Can Cause Low Back Pain
As I said above the Hips and pelvis help create a base of support for the body, especially in runners. For us as runners to move properly and efficiently we must maintain the appropriate balance of stability and mobility in the region.
Problems arise when there is an imbalance in the muscle groups here either by soft tissue tightness, weakness, or inhibition of muscle groups. The body is great at compensating as can be noted from above with the increased lordosis due to decreased mobility.
For example, a compensatory strategy of the body for weak glutes is to overuse the lower back muscles and possibly even the hamstrings and calves. See where I’m going with this? Overuse of the back muscles can cause pain in the low back during running (and day to day life).
Limited Thorax Mobility
Oh how I love the thorax region. This area is your thoracic spine chest and ribs all combined. I don’t like to limit this region to the thoracic spine only due to all the other factors that contribute to it, mainly the ribs.
Limited mobility in this area has an adverse effect in a lot of areas. The neck, shoulders, and low back/hips can all suffer from decreased mobility in the thorax. I definitely find this to be a problem for most office type workers that sit at a desk all day but most people struggle with thorax mobility.
The thorax region should be able to rotate and extend adequately. Without these two motions, the lumbar spine will have to overcompensate (again) by going into hyperlordosis.
How to Identify If You Have Runner’s Low Back Pain
The following symptoms are things to be on the lookout for:
1. Pain in the lower back while running that starts about 10-15 minutes into the run.
2. Pain that refers (moves) to the buttocks but doesn’t go down to the knee or cause any numbness or tingling.
3. Pain and tenderness when pushed on over the dimples in your back
4. Worsening pain with leaning back or bending sideways.
5. Back stiffness not exclusively while running
6. Pain starts insidiously (no apparent reason or trauma)
Factors That Can Cause Low Back Pain in Running
1. Significant increase in load or intensity of running (can you see a pattern here in running injuries?)
2. Worn out running shoes
3. Slacking on your core strengthening
4. Recent injury to the knees, hips, or feet in the past 12 months
5. Running more hills than normal
6. Asymmetry in muscles of the lower body causing imbalances and different torques on the low back. (focus on single leg exercises first and foremost!! Check out my Run Strong Program to do this!)
7. Poor warm-up for running
Ways to Help Running Low Back Pain
Working on running form is one of the first steps. However, this can be multifactorial. For good running form, you need to improved hip/pelvis mobility and stability. You will also need to work on thorax mobility which I’ve given you a couple of exercises to work on DAILY above.
Check out my post on Hip Extension for Improved Running as well for more tips on mobility!
Stay tuned on the blog for updates to this page and more ways to improve hip/pelvis mobility and stability. I could do a whole month-long series on these topics!!
Remember that this is just general advice and to always seek evaluation by a Health professional if you are having significant pain by either a physical therapist or other medical professional!
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- Fatoye, F., Gebrye, T. & Odeyemi, I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int 39, 619–626 (2019). https://doi.org/10.1007/s00296-019-04273-0
Dr. Abby Siler, PT, DPT is a Physical Therapist with 10 years of experience in a variety of settings. She has spent the majority of her time treating athletes in orthopedic clinics and worker’s compensation cases. She is a runner herself for the past 15 years and a lifelong athlete. Dr. Abby loves to teach runners how to stay injury free and out of her clinic.