Why do I get lower back pain from running?

Lower back pain (LBP) represents the most common musculoskeletal condition in both the general population and in sports, however the prevalence and incidence of LBP among runners is low compared to the general population (Maselli et. al., 2020).

This lower incidence and prevalence of LBP among runners may mean that running is ‘protective’ against LBP. Let me explain further…

Why does my lower back hurt when I run?

The science is not clear on any specific risk factors for LBP. That’s to say, LBP may not simply be caused by ‘tight hip flexors’, ‘tight hamstrings’, or a ‘weak core’, for example.

Rather, it appears that LBP can and does ‘just happen’ to most of us across our lifespan. This is irrespective of fitness or physical attributes/deficits, etc.

Clinically, one observation among runners that I see quite consistently is that runners experiencing lower back pain on gait analysis may overstride (i.e. heel out in front of body). There may be a correlation between this pattern of running and an athlete’s LBP.

The mechanism possibly being some load attenuation from the heel strike occurring at the lower back.

Is it okay to run with lower back pain?

It’s perfectly fine to run with some LBP. The caveat being that if the LBP is acute and disabling – think having difficulty to put shoes and socks on – then trying to run ‘through the pain’ while not facilitating any tissue damage, may trigger pain and escalate symptoms.

Outside of such acute and disabling LBP episodes, running with pain that is ‘tolerable’ to the individual can be performed.

We know that beyond the acute and early period of symptom onset, ongoing pain experienced in the lower back does not equate to biological tissue damage. Rather any increase in pain is more reflective of sensitisation of tissues.

Uphill running and the associated neck flexion position (chin on chest) may confer a greater neural load on the spine, which may trigger symptoms, so be wary with uphill running.

The literature (Wernli et al, 2020) says that those experiencing LBP should, as best as possible, ‘get on with life’ rather than become fearful and avoiding certain activities/movement patterns.

How do I stop my lower back from hurting when I run?

Unfortunately there are no ‘quick and certain’ fixes for stopping LBP. Some people like to stretch the anterior hip and thigh muscles (quadriceps/hip flexors), while others find some relief from gluteal stretching.

I will encourage a runner with LBP to be patient with the pain settling over time, while reassuring them that getting out and running is not only a safe thing to do, but a favourable thing to do.

For the overstriding runner experiencing LBP, I suggest some gait retraining as a means to possibly reducing load at the lower back and possibly symptoms.

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