Low Back Pain in Runners: Causes and Treatment
Low back pain affects nearly 80% of the United States’ population at some point in their lifetime. As a Physical Therapist, it is the most common diagnosis I treat ranging from young adults to the geriatric age, and sedentary to the most active patients.
Chronic issues in the lower back, which are the ones present for more than six months, can be due to traumatic events or general wear and tear to the structures of the spine. Although it is said that running or any continuous, long-term form of exercise causes wear and tear on joints, low back pain is shown to be one of the less frequent complaints among runners. Research shows that the loading on the joints that occurs in distance running is beneficial to the intervertebral discs of the spine, compared to other activities such as weight lifting and impact sports such as soccer.
What does this really mean? Well, the discs are the shock absorbers of the spine. They help keep each vertebrae separated during any physical activity. They are made up of a good amount of fluid that fluctuates in volume throughout the day, depending on how much you load your spine. For those who have lost a significant amount of fluid, they are at the highest risk to develop back pain due to the pressure among the vertebrae. The muscles that run along our spine keep those discs in place and help them retain the most fluid possible. This is why muscle strengthening in this area is very important, especially if you want to continue running long distances.
Of course, this is not the case for sprinting and high impact running. This is why speed sessions should only be short in length and not consume more than 10% of a given runner’s weekly mileage, in order to maintain a low risk of back issues.
Most of the runners I have treated for any back-related pain have either had the pain long before they began a running program or after being evaluated, they demonstrate significant weakness in their core muscles. Both cases respond well to a strengthening and flexibility program along with some tweaks to their current running program.
If you are experiencing mild to moderate lower back pain or you want to prevent back pain, a good starting point is testing out your core strength. Below is the most common test I use for athletes who have been in their training program for more than six months.
- Hold plank position (on elbows) for 30 seconds
- Lift each arm for 15 seconds
- Lift each leg for 15 seconds
- Lift one arm and opposite leg for 15 seconds
- Lift opposite arm/leg for 15 seconds
- Return to plank position and hold for 30 seconds
This is pretty challenging, as the entire routine is three minutes long! But, if you are able to complete this circuit, then you are considered to have GOOD core strength. For my patients who are less advanced and not distance runners or athletes of high impact sports, I will shorten the plank test by 5-15 seconds for each hold.
Once you have a starting point of where your core strength is at, then the next step is to begin incorporating specific exercises that target every core muscle, at least three times per week. Most people think the core muscles are just the abdominals, but your core is actually your entire trunk—from the chest and upper back muscles, down to the lower back and hips. Below are a few good exercises that involve zero equipment that I prescribe to my patients.
- Glute Bridges
- Standard Planks + variations
- Side Planks
- Russian Twists
- Bird Dog
- Fire Hydrant
Now that strengthening is squared away, next up is taking care of flexibility issues. So many of my patients who run admit they skip stretching after training. This can most definitely lead to not only lower back issues, but hip and knee problems as well. The most commonly tight muscles that lead to lower back dysfunction are the hamstrings, followed by the piriformis muscle, which is a deeper muscle underneath the glutes.
The hamstrings connect up in the pelvic bone and help control proper posture of the lower back. Basically when the hamstrings are tight they can cause a bigger curve in the spine, and holding that posture alone will lead to lower back discomfort. These tight muscles will constantly pull the lower back into a deeper curve while performing activities, such as running. The simplest stretch I prescribe is a wall stretch. Lie on your back as close to a wall as possible with hips at a 90-degree angle and legs perpendicular to the floor. Hold this for five sets of 60 seconds every day, and I guarantee it will loosen up your hamstrings in no time!
Stretching the piriformis muscle is just as easy—lie on your back and put your right ankle over your left bent knee and pull the left knee towards your chest and repeat on the opposite leg for five sets of 30 seconds.
A proper training program consists of more than just running. Strengthening and flexibility exercises, a balance between high and low mileage and speed work, adequate rest and proper nutrition are all equally important to prevent low back pain or any other conditions that will eventually keep you from reaching your goals. As with any injury, if you are experiencing low back pain that does not relieve with core strengthening or rest, get checked out by a specialist or Physical Therapist.
- Influence of Low Back Pain Status on Pelvis-Trunk Coordination During Walking and Running, Online Publication, Jul 15, 2011 ,
- Running exercise strengthens the intervertebral disc, Online Publication, Apr 19, 2017 ,