Back Pain While Running: The 4 Most Common Causes and Fixes
Lower back pain affects millions of people annually and can be debilitating for runners.
It can be frustrating wanting to run long on Saturday after a hard week of work only to be met with lower back pain that forces you to walk or even stop all together. Running is supposed to be the weekend release, and now you are spending time working on trying to “release” your lower back stiffness.
Having suffered with lower back pain myself, since working on my dad’s farm as a teenager (lots of bending to weed and pick produce!), I have firsthand knowledge of the pestering annoyance of an aching lower back. At times, my back pain has kept me from running and cycling. Now, after being a guinea pig over the past 20 years, I have found solutions that work and keep me active and strong. I look forward to sharing those with you while providing education on the cause of your back pain.
This is designed specifically for runners, although the tips can help most people decrease lower back pain and improve strength in the process.
The 4 Main Causes of Lower Back Pain with Distance Running
#1 Pelvic drop
Penalties: Facet compression, paraspinal strain, nerve compression
Running is a single leg sport. What I mean by this is that at no point in time during running are two feet on the ground. This means you need solid control of your hips, pelvis, and core to keep level and biomechanically sound.
When you land on 1 leg, most of your body weight (center of mass) is medial or inside your stance leg. The never yielding force of gravity will pull on your body, and unless you have good gluteus strength and control, gravity will win. The result is the hip opposite the stance leg will sink towards the group (pelvic drop) causing increased workload to the stance hip muscles, hip joint, and knee.
Pelvic drop looks something like this…
High Pelvic Drop Normal Pelvic Drop
What does this mean for your lower back?
In this example, you can see the left side of the lower back is being compressed as the runner side bends towards the stance leg. This creates increased joint loading at the spine along the facet joints. Over time, and since distance running is a higher repetitive sport, those joints and the surrounding tissues will become inflamed and hypertrophy causing pain.
Additionally, the opposite side of the spine (in this case the right), will be asked to work even harder to try and lift the right hip and muscle fatigue will set in. This occurs at the paraspinals and quadratus lumborum tissues causing muscle strain.
When a pelvic drop is present, increased compression occurs at the nerve roots on the stance leg side which is a common cause of sciatica in runners.
As you can see pelvic drop can wreak havoc on the lower back bony anatomy, muscles, and nerves.
Why does pelvic drop occur?
Basically, your gluteus medius and maximus muscles aren’t neutrally active enough, strong enough, or have enough dynamic awareness to stabilize the hip and trunk. This isn’t just about getting stronger by doing squats and deadlifts. Controlling shock single leg shock absorption is a coordinated skill that takes practice. Yes, runners need to practice running!
- Improve “neural activation” of the gluteus medius and maximus through progressive resisted isometrics
- Improve dynamic strength by performing single leg training drills such as the Romanian dead lift, and Bulgarian split squat
- Work on unilateral trunk control with dynamic side planks and stability ball work
- Find a trained running specialist or physical therapist to utilize real-time running biofeedback that will help you learn proper running form
#2 Running with an Upright or Extended Trunk
Penalties: Facet Compression, Disk compression, Muscle Spasm, Sciatica
Has someone ever told you to “get your chest up” or “run tall”?
These are very common cues given during track workouts or by well-meaning running friends and, for the most part, they can apply to many who “hunch” while running due to fatigue or poor form.
More often is the case however, that most runners are too upright or even leaning backwards!
Here is an example…
8-10 Degree Trunk Lean Upright Trunk Lean
Many running research studies now report, and tout the biomechanical and performance benefits, of utilizing a forward trunk lean. The ideal range is between 8-10 degrees of trunk lean.
This does not mean “flex” your spine like you would to tie your shoes. It’s more like Superman or Supergirl extending their thorax as they rip off their work shirt to save the world. You can also imagine having to run into a strong wind with chest puffed
out and leaning forward so you don’t fall over.
Why does a forward trunk lean alleviate back pain?
A forward trunk lean of 8-10 degrees facilitates a slight “hip hinge” allowing greater access to the gluteal muscles. By increasing the mechanical access to the glutes you remove workload from the lumbar paraspinal muscles. Additionally, as you accept impact through your “active” muscular system, you remove load and strain through you “passive” system (facet and disc). When the trunk is upright, the line of force acting upon the body is through the spine, while using a forward trunk lean, moves the line of force through the hips. The result is less mechanical work and strain on the lumbar spine and lumbar tissues.
A forward trunk lean will particularly benefit those dealing with stenosis. Stenosis is typically made worse with extension based postures due to higher loading of the vertebra and spinal nerves. The nerve roots that exit in the posterior-lateral part of the spine are compressed most with lumbar extension (leaning back) and side bending. Once you add 2.5-5x body weight compression forces associated with running, the insult to the spinal nerves is increased.
To be able to run with a forward trunk lean for distance, proper lumbar muscle endurance and gluteal control is necessary. Core neutral lumbar endurance drills such as Superman on the ball, bird dogs, and squatting lat pulldowns are a good place to start.
Penalties: Disc Compression, Facet Compression, Knee and Hip Joint Loading
What exactly is over-striding? Is there an actual definition of what makes an over-stride?
I am sure you have read an article or two at some point telling you to avoid over-striding. Most sources will agree to avoid an over-stride but fail to define the parameters of normal striding.
Even in the research world, there is not a clear agreement on how to measure or define an over-stride.
So here is the best definition I have found so far.
Over-Stride= When the distance between initial heel contact and midline of the hip equals 15-20 degrees (with the hip joint center being vertex)
These pictures will help:
Over Stride Optimal Stride Length
Ideally, to decrease the forces on your spine and legs, you should aim to make initial contact with the ground near the vertical midline of your hips and trunk. This will create a bend at the hip and knee allowing access to the quadriceps and gluteal muscles. The result will be increased muscular work and less joint loading.
A forward trunk lean will help to bring your stride back to normal levels. Also, practicing improving the bend of your hip and knee (sitting back slightly) will aid in controlling over-stride. Again, practice this a bunch as it won’t feel easy at first.
#4 Limited Hip Extension
Penalties: Iliopsoas Strain (hip flexor), Oblique Strain, Quadratus Lumborum Strain
Hip extension refers to the distance your thigh travels behind the line of your trunk. In running gait this means the angle of hip range of motion in terminal stance (last point of contact with the ground).
A normal range of motion will allow firing of the hamstrings, gluteus muscles, and calf. Adequate hip extension will allow for the proper ratio of muscle activation while improving efficiency of your gait stride.
Limited hip extension could be due to iliopsoas (hip flexor) tightness, hip joint restriction, or decreased posterior chain strength.
The cost of deficient hip extension is increased workload on the lumbar paraspinal and quadratus lumborum muscles, anterior pelvic tilt, and abdominal/oblique strain. The hip flexor runs from your front inside thigh to the side of your spine. Due to this line of pull, any tightness in the iliopsoas will increase lumbar extension by pulling forward on the lumbar vertebra. This is particularly important for those with extension intolerance or stenosis.
Begin a consistent hip flexor stretching program. Traditional stretching programs recommend stretching for a hold of 30 seconds; however, I have found greater results by increasing this to 1-2 minutes. This gives the muscle tissue time to stretch and for the natural “protecting” mechanism of the muscle to give way allowing greater flexibility.
The reason the hip flexor gets so tight is from our sedentary lifestyle with computer work, commuting, and sitting in front of the TV at night. This keep the hip flexor tight and contracted compared to the ranges of motion needed for running.
A solid stretching program (check out this blog article for the best stretch) https://www.compedgept.com/blog/balance-your-hips-with-running-stretching-the-hip-flexors, performed over 6-8 weeks will make a huge difference in decreasing your back pain with running.
You Can Run Long Without Back Pain
Over the past 10 years I have had the pleasure of treating 100’s of runners who complain or have been limited by back pain. Almost all had been told by the doctor that running is “bad for your back.” This just simply is not true. Running by itself is not bad for you; however, running with the biomechanical errors noted in this blog will affect your back.
Humans are built to run, especially longer distances. The issue is that we have not put in the proper training to build our bodies to tolerate the higher force and symmetry demands of running. By doing the “foundation work” and practicing running form you can eliminate your pain with running and enjoy the sport you love.
If you are looking for assistance in learning more about your own back pain, I highly suggest you look for a running gait lab, like ours at Competitive EDGE, to perform a gait analysis to pinpoint your exact issue. There are centers like this around the country and they are invaluable in keeping you running long and strong.
Kevin Vandi, DPT, OCS, CSCS
Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.