Dealing with Low Back Pain as a Runner
When you think of running injuries you typically consider things like knee pain or Achilles tendinitis keeping runners from being able to train or race. Despite the lack of research available on the topic, low back pain in runners is a very real thing and can be extremely frustrating to deal with. Runners that experience low back pain probably blame their 9-5 desk job but don’t stop to think about how they’re running may actually be the problem…
Thankfully I have only experienced low back pain with running once. I would be able to get through about 3 miles without any issues before there would be a nagging pain on the right side of my low back. It would hang around for the rest of the run and improve by the next day, only to keep repeating the same cycle for about 2 months. I convinced myself the pain was “tolerable” because I was still able to train but I wish I would’ve just taken the time to look deeper into my running form to see that my own mechanics were to blame. Once I knew the problem, the pain quickly got better.
Common running form impairments could be behind your low back pain.
Running is made up of you taking thousands of steps over and over again. When you think about that, our running form becomes very important. Weakness. Muscular imbalances. Limited mobility. All of these affect how efficiently our body moves with each stride and anything that impairs our running form can wreak havoc on our body, particularly your low back. Here are a few common running impairments that I am going to discuss further in this blog:
Pelvic Drop
Restricted Hip Mobility
Lumbar Hypertension
Muscular Imbalances
Hip stabilizer weakness that causes your pelvis to drop with each step might be the culprit.
We (as physical therapists) talk a lot about hip weakness being the cause of knee pain or even foot pain in runners. It would only be fitting to also add low back pain to the list. Here’s why: your pelvis forms a joint with your lumbar spine, or low back, so it’s no surprise that any abnormal movement at the pelvis would affect your low back. When you are standing on one leg, your lateral hip muscles should be able to engage to stabilize your pelvis to keep it level. When these muscles lack enough strength, the opposite side of your pelvis drops which does two things:
You have to shift your weight towards the stance leg to compensate for the pelvis drop which compresses the facet joints on that side of your low back
The lumbar muscles on the opposite side are having to work overtime to try and level out your pelvis which put them at risk for an overuse muscle strain
What to do: strengthening your lateral hip muscles (particularly the gluteus medius) is key! Exercises that emphasize single leg stability and strength effectively target this muscle group.
Tight muscles around your hip joint interrupt the normal motion of the swing phase in running.
Your hip requires a specific range of motion into both flexion and extension when running. A common issue I see in runners is limited hip extension. When a runner has trouble with extending their leg behind them during the push off phase in running, their body will find a way to mimic the motion. The easiest option: overextend the low back (which we talk more about in a second). Tightness in the front hip flexor muscles can restrict hip mobility and add extra stress to the low back.
Your hips also are required to slightly rotate with each stride and tightness in the external and internal hip rotator muscles might be holding you back from getting the most out of each stride.
What to do: start with strengthening the hip flexors and hip rotator muscles since tightness is commonly a consequence of weakness. Adding in some gentle hip opening stretches as a complement to training is also very helpful.
When your low back overextends in running, it’s trying to compensate for some other issue.
Now I previously hinted about how limited hip mobility might cause a person to want to overextend their lumbar spine as they push off their back leg. The repetition of this movement increases the compressive forces on the lumbar spine which can quickly lead to aggravation for runners. Runners that tend to run with an excessively upright posture also fall victim to this same thing as they overextend their low back with each stride.
Another common factor that I see with runners with low back pain is a muscular imbalance between the lumbar extensors and deep abdominal muscles. The weaker core muscles rely more heavily on the smaller lumbar muscles for trunk stability which can lead to irritation and low back pain in runners.
Working with a running physical therapist to analyze your form and fix impairments is extremely helpful.
If you’re a runner that’s been dealing with low back pain for a while, it’s time to do something about it. Contact your local physical therapist to see about having someone take a look at your running form and suggest corrective exercises to make sure low back pain doesn’t ruin your training. It can be extremely difficult to feel lost when trying to self-diagnosis your low back pain! Working with a running physical therapist that understands how to balance your rehab and training is important.
