Lower back pain in runners – causes and prevention

Jo Perkins is one of our experts in the Run Mummy Run Community Run Club in association with ASICS. Jo is a sports medicine physiotherapist with a special interest in women’s health and female exercise. She provides essential content around common running problems and injuries, and how to overcome them for the RMR CRC. These blogs are exclusive to RMR CRC members for a few months before being made public, so if you do want to get expert advice on your running, as well as a training sessions, expert Q&As, access to exclusive kit and much more, join the club today! Here, Jo talks about all the common causes of back pain in runners and some practical tips to help minimise it.

Lower back pain can be really frustrating and potentially debilitating, whether it be before, during or post run. It is actually fairly common, but be reassured that more often than not episodes of back pain are self-limiting and it certainly doesn’t mean the end of your running or race-day ambitions. This is a review of the potential causes of back pain and ways to help prevent it.

Sources of pain

There are different structures within the back that can be the source of your pain:

  • The facet joints that connect the vertebrae can become irritated and inflamed. This is more common in runners with large curves in their lower back (lordosis).
  • The discs can be affected by age or injury, potentially leading to sciatica symptoms.
  • The lumbar spine muscles can be prone to general muscle tightness, particularly with fatigue, or smaller areas knows as trigger points which can also refer pain, particularly if they are weaker or over recruited.
  • The sacroiliac joints connect the base of the spine to the pelvis. Leg length differences, muscle imbalances or weight bearing can potentially result in pain here.

It is important to not get too focused on the source of the pain however, as the reality is that most lower back pain in runners is non specific and attributable to factors that can be modified such as strength, mobility and technique. It is always worth seeing a physiotherapist for an assessment, particularly if you are having sciatica, muscle weakness, unexplained weight loss, changes in sensation, or bladder and bowel function.

Causes of lower back pain in runners

Muscle weakness or imbalance – The repetitive ground reaction forces, which can be up to to two times a runners body weight, can put stress on the lumbar spine. We therefore need sufficient muscular support to attenuate these forces. There is a misconception that our ‘core’ only refers to our six-pack muscles, but it is actually the integration of a team of muscles (deeper abdominals, pelvic floor, lower back muscles, diaphragm and gluteals) that support our spine, allowing you to run both pain free and efficiently. Frequently our superficial abdominals, quadriceps and hip flexors try and overwork for us, which can affect the pull on your pelvis and strain on your spine.

Technique and posture – Running with your pelvis either too tucked (posterior tilt) or too arched (anterior tilt) can affect the stresses to your lower back. A posterior tilted pelvis will tighten your hamstrings and limit your hip extension causing your glutes to be less recruited, whereas an anterior tilted pelvis will lead to hip flexor tightness, lengthened abdominals and lumbar spine loading. Many runners hold themselves upright or rigid through their torso, bracing with abdominals, but actually your spine and trunk needs to move. Constantly contracting muscles will mean they fatigue and tire, giving you less support.

Mobility – Stiffness in your hips and spine can also predispose you to pain, meaning muscles and joints don’t go through their full range and can result in weakness and inflammation.

Changes in training load/surfaces – Suddenly increasing your training load can predispose you to any injury, particularly if you don’t have sufficient muscle support or suddenly change to harder surfaces such as road running. You may find that hill running can be more aggravating for your back pain. If you extend from the lower back in an upright posture, the lumbar muscles and joints are more loaded. It is important to use your hip extensors (gluteals) to propel you up the hill. Think about leaning forward, with ribs over pelvis, driving through the arms and trunk to put your core muscles in a more favourable position to support your spine.

Footwear – Your running shoes have an important role to play in shock absorption. Choose a supportive shoe and change them regularly, particularly if you are racking up the miles.The good news is that these are all things that we can 

Exercises to prevent lower back pain in runners

1. Deep core activation

It is important to recruit your deeper abdominal layer to give you muscular support around your lower back. Lying on your back is a good starting point to do this, then progress to more weight bearing positions, adding resistance. Aim for your pelvis being in a neutral position, not too tucked or arched. Take a breath in and as you exhale think about drawing both sides of your pelvis together, imagine tightening a zip from pubic bone to belly button or tightening a notch on a belt. You shouldn’t feel your superficial abdominals working here. When you have mastered this, you can progress to rotating, lifting or straightening a leg or arm, and other positions such as hands and knees.

2. Single leg squat with rotation


In standing, take one leg out behind you and squat down on the front leg. As you lower, rotate your trunk towards the front leg, making sure you knee remains in line, but not over your toes. As you come up bring the leg through and rotate away from the front leg. If you feel unstable you can do the same exercises but with a small amount fo weight through the back leg. This position mimics the demands of running and encourages your glutes to work.

3. Single leg bridge


On your back, recruit your deep abdominals lightly, then push up into a single leg bridge, keeping your pelvis level. You can start with double leg if you find it difficult to maintain a level pelvis. Don’t over arch as you will feel it in your lower back. You can make this more hamstring specific by having your foot up on a bench/chair.

4. Side plank with rotation

Recruit your deeper abdominal, then push up into a side plank keeping your ribs and pelvis in line. You can make this easier by having the bottom leg bent. Inhale and rotate your trunk, inhale and return to the starting position.

5. Chicago rolls


On your side, take one leg over the other, then open up through the top arm gently rotating your spine. Gradually increase the range as you feel comfortable.

6. Other glute and lumbar mobility exercises


It is also important to include a dynamic warm up to mobilise the muscles that attach around the lower back and pelvis, such as leg swings forward and back and side to side. Classes such as yoga and Pilates can also be beneficial to assist in your mobility and strengthening. 

About  Jo

Jo Perkins (BSc MSc Sport Med) is sports medicine physiotherapist with a special interest in women’s health and female exercise. She graduated from Cardiff Uni, then went on to complete an MSC in Sport and Exercise in Medicine. She has worked in professional Rugby Union since 2008, but developed a passion for women’s health following the birth of her daughter, Sienna. She has her own physiotherapy company and has extensively trained in supporting women through pregnancy, post partum and the menopause, as well as through menstrual cycles. She went on to have her son Rory in 2018, and has since been involved in research for women’s exercise.

*Featured image by Darwin Laganzon from Pixabay

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