Lower Back Pain From Running: The What, Why, and How to Fix It
A guest post from Physical Therapist, Mike Swinger.
Let’s talk about an issue that doesn’t get a lot of press: low back pain in runners. Sure, core strength has been addressed ad nauseam over the last few decades, as well as the acknowledgment that it’s important for running and low back health.
But very little has been discussed about the who, what, and why when it comes to low back issues for runners.
So...who is ready for a deep dive with me?
Lower Back Pain From Running: Where is it really?
First, it’s helpful to understand where pain is coming from. In your low back, there are several structures that can become ‘cranky.’ And yes, “cranky” is a medically recognized term! Muscles including the Psoas, Iliacus, Paraspinals, Quadratus Lumborum, Glutes, and Piriformis all have the potential to be tight and/or overworked.
The key to keeping your muscles happy is maintaining proper balance, flexibility, and strength. I realize that’s rather vague, but we’ll add more depth as we go along. Stay with me!
What are facets? And what do they have to do with lower back pain in runners?
Secondly, the joint surfaces of your low back, called Facets, can become irritated and inflamed. When you look at the stack of vertebral segments, the largest parts of the bones are separated by rubbery discs. These discs provide cushion and separation between the bone surfaces.
So unless you’ve got a severe case of disc degeneration or injury, the only places where the vertebrae contact each other is at the Facets. When the facets become irritated, the small ligaments, joint capsules, and surfaces of the bone (ie Periosteum) will become inflamed.
This inflammation gives a more sharp or deep/achy sensation when you move a certain way. It can also give a pinching sensation. If things are inflamed enough, it can also compress the nerves and create any myriad of numbness, tingling, burning, or aching extending down your leg.
This inflammatory effect is also true of the Sacroiliac (SI) joints, the joints between your tailbone and pelvis.
Lower Back Pain From Inflamed Ligaments
Inflammation of the ligaments of your low back can be a big source of pain. This is especially true of female runners, and even more so, female runners who have had babies.
There are several major ligaments that keep your lower vertebrae, sacrum, and pelvis stable. By stable, I mean the correct amount of controlled movement at the correct time. If the ligaments have been stretched out by injury or repetitive improper movement patterns, then the area can become unstable.
This instability causes the ligaments to be overstretched or overstressed and leads to inflammation. This inflammation and instability can also be a big factor in why certain muscles have difficulty engaging when they’re supposed to. Look up pictures of the Iliolumbar, Sacroiliac, and Sacrotuberous Ligaments if you’re suspicious if this applies to you.
Lastly, there are certainly other more extreme instances of painful structures that we’ll not go into detail about here. Specifically, things like disc bulges, disc herniations, spinal stenosis, spondylosis, and spondylolisthesis are all very real and common factors with low back pain in the general population. I see these conditions daily in my practice as a PT, but these are less common in runners.
What is Pain?
One other quick note on the concept of pain. It’s important to understand that all the structures I just mentioned can become inflamed, irritated, tight, cranky, etc...but appreciate that what happens next is simply nerve impulses to your central nervous system.
From there, your brain has to figure out what those signals mean in the context of the other thousands of signals it is currently sorting out. Pain comes from how your brain perceives the signals coming from those structures. Previous injuries and chronic issues can definitely influence this! This helps us understand why some people seem to have a higher pain tolerance than others. We could go off on a myriad of tangents here, but at least a glance at pain from a philosophical perspective is helpful.
Lower Back Pain in Runners: Why Correct Rotation Matters
Quick biomechanics lesson: Every joint in your body moves in three planes of motion. Certain joints specialize in certain directions.
Your low back likes to move forward and backward (sagittal plane of motion). They do okay moving sideways (aka side-bending or frontal plane of motion).
Your lumbar joints (aka those found in the spine of your lower back), don’t like to rotate very much (transverse plane of motion). The structure of the joints simply doesn’t allow for a lot of rotation. If too much rotation is happening, the joints start bonking into each other and that’s not a good thing. This is when the Facets, joint capsules, and ligaments come under duress and become inflamed.
“But, Mike, I thought running was only a forward activity, there shouldn’t be rotation taking place, this isn’t golf or tennis, what gives?!”
True, grossly speaking, running is a mostly forward/linear activity. However, when you look at the reciprocal patterns between your arms and legs, you see a lot of rotation that needs to take place to allow your left leg to drive forward at the same time that your right arm swings forward.
Ideally, the movement of rotation should come from your hips and thoracic spine (mid-upper back), with minimal rotation coming from the low back.
Why Flexibility Matters to Prevent Lower Back Pain in Runners
Since rotation should come from the hips and thoracic spine, one of the main underlying factors of low back pain is a lack of flexibility of the hips. If your hips don’t rotate or extend well, this will directly drive excessive movement into your low back.
Hip flexors, glutes, piriformis, and hip adductors are all factors here. Do not neglect warming up these movements prior to running, as well as taking the time to address flexibility deficits via stretching and myofascial work.
Try these exercises to factor in these muscles:
Thoracic spine and rib cage motion are also critical. A few quality minutes with your foam roller and other upper body stretches can go a long way here. Stretches for your pecs and lats will be very helpful as well.
Try these exercises to factor in these muscles:
Strength Building to Prevent Lower Back Pain in Runners
Once your movement is clean and dialed in, then it’s time to build the strength! The second biggest mistake people make when it comes to core and hip strengthening, is that they tend to focus on one specific muscle or area. The biggest mistake is not doing anything at all!
Rather than try to come up with a specific exercise for each core and hip muscle (since there are dozens of them), it is best to focus on strength and stability of a few key movements as they pertain to running.
It’s helpful to ask the question, “What does your core do while running?” Concisely put, your core overcomes the vertical forces of gravity while simultaneously moving all your parts forward. We could come up with a whole list of things that your core does, but let’s keep it boiled down to that for now. We need to be strong in all planes of motion, combined with the vertical component of gravity.
Think about the positions you are in while running, then add gravity x2-3!
It’s beneficial to fire up a few key muscles (abs, glutes, etc) initially, but we need to progress our strengthening to more global movements to truly get the gains we need.
As a hypothetical progression, first focus on being able to balance on one leg. If you can’t balance on one leg, then all the bridges, planks, and crunches aren’t going to carry over very well. From there, add in various upper body movements combined with a vertical load.
Again, hypothetical progression:
Balance on one leg, standing tall
While balancing, hinge your upper body forward/backward
Still balancing, rotate your hips left and right keeping your head and shoulders still
Split squats holding 10-20# overhead
Split squats holding 10-20# rotated to the left, then right
Split squats holding 10-20# with arms extended out front
If you need more after that, progress to jumping lunges while holding weights in the listed positions. For my money, this is the ultimate core exercise progression for runners!
Lower Back Pain Prevention: Running Form Matters
Once you have worked on your strength, the last step is to make sure that it translates to your running form. Proper movement and strength are critical, but if our neuromuscular patterns and habits aren’t also dialed in, then all our efforts won’t fully payout.
There are many excellent and helpful form drills out there, but the ones I’ll mention today are my personal favorites. Again, every time our foot hits the ground, we need to be able to absorb the ground reaction force without extraneous movement.
Unwanted movement in our low back is ultimately where pain comes from!
A series of form drills that I call the ‘Zombie drills’ are my go-to for keeping your core strong and spine stable while running. These are very simple to do and can be done as part of your warm-up, as well as sprinkled in throughout your run.
How to do Zombie Drills:
The drills consist of running at an easy pace with your hands held high overhead, then straight out in front, and out to the side. Try each of those positions for 10 seconds, paying careful attention to what your core and hips are doing.
Essentially these drills cause the lever arm of your upper body to change, which forces your core muscles to dial in more quickly. Sorry for the physics moment there!
When your muscles can quickly stabilize your joints, your low back will be much happier!
I hope this has been helpful and insightful as you continue your running journey. Please holler with any questions or comments regarding low back issues or other running injury concerns!
Feel free to reach out via social media on Facebook @mikerunphys or Instagram @runphys, or my blog at runphys.com. Also, I’d love to see pics or videos of you performing the core exercises or form drills I mentioned in this article. Have fun with them and be sure to tag me so I can cheer you on!
Run Fast Friends!
Mike Swinger, Physical Therapist
Mike Swinger is a Physical Therapist based in the beautiful Leelanau County, Michigan. He specializes in working with runners and triathletes, both in the clinic as well as out on the roads and trails. To optimize your running, he helps you to answer the questions, “Where do I need more Flexibility? What muscles need to Fire Up? How can I improve my Form?” Find more about him on Facebook, Instagram, or his website.
A Note from Brent:
I got hooked on Mike when I won a copy of his book Runner’s Fix. Have you ever had a running-related injury, niggle, or discomfort that’s been bothering you for at least a few days? It’s bad enough that you take notice, but not quite to the point of needing to see a PT? This book would be perfect for you.
The book is organized by body part, so you can easily flip to the relevant chapter. These short chapters explain why you may be experiencing this pain, and what to do about it. Quick and easy exercises and stretches (with pictures!) that are explained in a conversational, easy to digest way.
I seriously can’t recommend it enough. Check it out for yourself 😊