Lower Back Pain & Running
Most of us can run through minor injuries with the help of a warm up routine and painkillers, but lower back pain is one of those horrible things that can be unmanageable.
We get lower back pain while running because of inflammation around the nerves and muscles, but that often isn’t the root cause. It could be core weakness leading to instability or your desk job posture putting stress on the lower spine.
The good news is that lower back pain usually improves itself with rest and physiotherapy, although musculoskeletal injuries can extend the recovery time to months instead of weeks.
There are also ways to alleviate lower back pain while running, such as warming up with stretches, strengthening your core, and working on your running form. These could be just what you need to hit the pavement pain-free.
Causes of Lower Back Pain While Running
Weak core muscles, including the abdominals and lower back
Core weakness leads to poor running form through poor balance and pelvic stability, increasing the risk of muscle strain and lower back pain.
Running too much or increasing mileage too quickly
Beginners and pro runners alike can suffer from overtraining through a lack of rest, impacting not just the lower back but the legs too.
Sitting at a desk all day
Those with desk jobs that head out running are at a high risk of lower back pain from poor posture – a lumbar support pillow can be a good investment.
Not adequately warming up before running
A lack of stretching before running can mean that all the tightness in your lower back, pelvis, and hamstrings builds up while running.
Radiating pain
Problems with the pelvis, hips, legs, and middle and upper back can sometimes spread through to the lumbar region.
Previous injuries and strains
Injuries and strains to the lower back and pelvis can present themselves while running and sometimes out of the blue.
Irritation or misalignment of the sacroiliac joint
This joint connects the lower spine to the pelvis and can cause instability when running. Most problems come from repetitive or acute trauma.
Pinched nerves and inflammation, including sciatica
Impinged or irritated nerves and excessive inflammation can make running impossible as your lower back causes acute pain that worsens.
Inefficient running mechanics, such as excessive heel striking or overstriding
Bad form or technique can cause symptoms in your your lower back and put you out of action for weeks. Look at what the professionals do for pointers, or have a gait / running assessment from a physiotherapist.
Diagnosis
Some people try and run through lower back pain, but it can be dangerous to do so without a proper diagnosis and is not advisable.
A physiotherapist can help diagnose the cause of your lower back pain, although sometimes it’s a case of drawing familiarities.
Medical history
Do you have a history of lower back pain? Previous injuries and symptoms like sciatica or impact injuries can recur and give you pain.
Physical exams
Testing your range of motion, flexibility, and strength can identify any weaknesses, imbalances, or mobility issues contributing to your pain. A qualified physiotherapist is the best professional for the job.
Running observation
Gait analysis can identify any biomechanical issues in your running form / technique that could contribute to lower back pain, such as poor stride length and landing on your heels.
Imaging tests
X-rays, MRI, or CT scans can accurately visualise the structures of your spine to identify any abnormalities—these are useful when there isn’t an obvious problem.
Treatments
Minor lower back pain goes away on its own after one to two weeks with or without a running hiatus, but running with lower back pain can worsen the problem and put you out of action for weeks or months.
Physiotherapy
Techniques such as spinal manipulation, mobilisation, and soft tissue massage from a qualified physiotherapist can help alleviate lower back pain and improve joint mobility.
Lower back pain that persists for several weeks or months despite rest and self-care measures will require a physiothrapist to treat the underlying issues and promote healing.
Likewise, suppose your lower back pain interferes with your daily activities or running routine. In that case, a physiotherapist can help manage your symptoms and develop a treatment plan that returns some normality to your life.
Ice and heat
Lower back pain that puts you out of action can benefit from ice and heat treatment to reduce inflammation and make your day bearable.
Rest and activity modification
Low-impact activities like walking, cycling, or swimming can replace running over the few weeks you need to improve. You don’t have to stop moving, but you need to reduce the strain on your lower back until the pain is manageable.
There is a risk of aggravating your lower back pain to the point that it becomes unbearable and delays your improvement and rehabilitation. Pushing through the pain can lead to further damage and prolonged recovery time.
In many cases, the wisest decision is to miss a week’s running, allowing your body to heal correctly and for the pain to settle. This short break can often prevent the injury from worsening and requiring several weeks to heal instead of one or two.
Stretch a few times every day
Stretch in the morning, at lunchtime, and in the evening to get the blood flowing. Mobility stretches like prone lumbar extensions and pelvic tilts can help. Check out this NHS advice for instructions on how to do them.
Orthotics / Running shoes
Custom orthotics or proper running shoes that cater for your gait pattern can address any form of issues contributing to your lower back pain. A few excellent brands include Hoka and On Running, but an assessment with a physiotherapist is recommended to advise you appropriately before buying running shoes.
Painkillers
Ibuprofen capsules can help manage pain and inflammation, and ibuprofen gels can reduce pain at the source.
Gradual return to running
The last thing you want is to aggravate your lower back and go back to square one, so it’s best to ease back into running with less distance and pace for the first few weeks and give your body longer recovery periods.
What Physiotherapy Looks Like
Seeing a physiotherapist for lower back pain first involves a discussion of your lower back pain, including your medical history and running habits, and a physical examination to identify some underlying issues or contributing factors.
It is sometimes necessary for us to analyse the running form of athletes to provide guidance on technique. This is called a biomechanical running assessment.
We will then discuss some manual therapies, mobilisations, and exercises that we can do to start your recovery and some you can do at home to alleviate pain.
Examples include:
- Sports massage: Applying pressure to reach deeper layers of muscle to release tension and muscle tightness, and improve blood flow.
- Myofascial release: Gentle, sustained pressure on connective tissue to reduce pain and restore motion.
- Trigger point therapy: Identifying and applying pressure to specific points of tension to alleviate pain.
- Spinal mobilisation: Gentle, passive movements are applied to the spine to improve joint mobility and reduce pain.
- Spinal manipulation: High-velocity, low-amplitude thrusts applied to specific spinal segments to improve joint function and alleviate pain.
- Core strength and stability exercises: Strengthening the surrounding muscles – deep abdominal muscles and back muscles improves spinal stability and reduces pain.
- Gluteal and hip strengthening: Targeting weak gluteal and hip muscles to improve running form and reduce stress on the lower back.
- Flexibility exercises: Stretching tight muscles, particularly in the hips and hamstrings, improves mobility and reduces strain on the lower back.
- Ultrasound therapy: These high-frequency sound waves promote tissue healing and reduce inflammation.
Conclusion
You might be able to grimace through lower back pain while running, but previous injuries, weak core muscles, and bad technique will keep it coming back, and often it won’t stop until you break the cycle and overcome your issues.
A simple recipe of adequate rest, physiotherapy, core strengthening exercises, and form modification can reduce lower back pain within a few weeks and get you hitting your best times. If you can overcome the psychological barrier of easing off and focusing on recovery, you’ll be well on your way to normal physical activity and pain-free running.