Living with lower back pain is bad and when it interferes with running, it is on a whole different level regardless of if you are new to running or are a veteran. Before we get into it more in detail, please understand that lower back pain can be a symptom of what is referred to as Pelvic Floor Dysfunction which should ALWAYS be looked into when lower back pain is assessed. If you think your lower back pain running is related to your running form you’re not wrong, but it also has to do with your breathing, and THAT may be news to you. In this blog, we will discuss:
- What causes lower pain when running?
- Why lower back pain might get worse running uphill.
- How you can relieve your lower back pain and
- Why a back brace should almost always be avoided!
Let’s start with the likely cause of your back pain.
What Causes Lower Back Pain When Running
Running form is a great indicator of future issues if any, and to an astute practitioner treating athletes and runners, this is a daily routine. Let’s explore some basic anatomy here before investigating the role of posture in lower back pain and running.
We are all born with a natural curve to our spine. The lumbar (lower back) spine and cervical (neck) spine curve are in the same direction, and the thoracic (mid-back) spine curve is in the opposite direction creating this S shape pattern when looking at the profile.
Unfortunately, many people have developed too much curve in the lower back spine (hyperlordosis) also referred to as the anterior hip, which goes hand in hand with the excess mid-back curve and forward neck. This all happens as a result of the center of gravity shifting which then leads to a modification of these curves.
The lower back muscles work directly with the lower abdominals in maintaining a neutral position of the lower back and pelvis. When these lower back muscles are hypertonic (overactive) and in a shortened state, they hold the lower back in an extended position, seen in the image to the right. 
This not only means tight and weak lower back muscles, but also weak lower abdominals and tight hip flexors. If this has become your natural posture due to too much sitting behind the computer or a result of previous injuries, running in this condition is like adding hundreds of miles to a car that is not aligned. Where the added mileage to a car with a good alignment is not a concern, with the alignment being off, it’s one thing to commute 15min to work daily, but your wanting to run is like taking this car that’s out of alignment cross country.
There is also the possibility of a hip flexor muscle called Psoas (pictured below) contributing to your lower back pain. While Psoas is a hip flexor because of its attachment to the lumbar spine, it directly impacts the lower back when overworked and weak.
A weak psoas muscle issue does not stay isolated to the psoas and that goes for all muscles; the synergists (muscles that work together with the same action in mind) and antagonists (muscles that do the opposite action) are always impacted so with a simple decline in one area, there are a series of changes that take place.
Psoas Muscle
What makes a runners’ lower back pain more persistent is the fact that runners put more miles on a body that needs the fixing right away. The more miles that are put in, the more urgent the type, and timing of the attention to the problem is needed.
When it comes to the muscles and joints involved in running and when lower back pain is present, we need to ALWAYS pay attention to the following muscle groups:
- Psoas and Iliacus
- Paraspinals
- Adductors
- Obturator Internus and Externus
- Piriformis
- IT Band
- All Gluteus Muscles (maximus, medius and minimus)
- Hamstrings
- Quads
- Multifidi
- Quadratus Lumborum
- Pelvic floor
and joints:
- Lower back
- Lower mid-back
- Sacroiliac joints
- Hips
- Knees
- Ankles
One of the biggest mistakes people make is stretching!! Yes, isolated stretching hardly does you any good!! It is dynamic stretching that is going to be the effective way of addressing the tight muscles in everyone, especially the runners.
What is Dynamic Stretching?
Static versus dynamic stretching may not be something you are familiar with. Static stretching is when you sit down, for instance, with your legs stretched, trying to reach your ankles with your hands to stretch the hamstring.
What is important to pay attention to is the fact that in the process of reaching your ankles, you stretch your hamstring BUT you also hunched your back to reach the ankles; you reached the ankle not with your arms only but with your arms and shoulder blades stretched out; you did not hip hinge forward but bent forward at the waist!! You reached your ankles dysfunctionally vs functionally and THAT is the reason why static stretching does not work.
To do this correctly, all of those ‘ingredients’ need to be in place and the right way of doing it is what a baby does, which is the CORRECT way of the ‘happy baby pose’. I said correct because there is a mechanical way to duplicate what that pose looks like but the actual correct way involves biological breathing which is more than likely not taking place.
Read this blog to understand the difference between functional vs dysfunctional movement which is why some rehabilitation programs work and most don’t!
Lower Back Pain Radiating to the Abdomen
Unfortunately, this is not that uncommon and that is not because of the running but because of the lower back challenge. There is a difference between pain radiation and referred pain which I strongly recommend you read about but for now, do know that in the absence of disc issues and pain associated with your internal organs, the likely cause is trigger points in the Multifidi and a specific muscle of your pelvic floor.
In my clinic, we deal with all contributing factors to these issues and in this case, apply modalities such as Active Release Technique or ART and Pelvic Floor Therapy to address the cause of the abdominal pain coming from lower back pain.
Wearing a Brace for Lower Back Pain When Running
If you have lower back pain while you’re running, Do NOT go buy a back brace. While you know your lower back muscles are a part of your core what people consider their core is only part of the true core and if you think having a six-pack means a strong core, you are mistaken!
Your true core is your torso, from your top to the bottom with the shoulder and hip sockets on the top and the bottom of this imaginary rectangle. Connect your neck to this ‘rectangle’ and now you see the stabilizers of your body!!
If we were to divide your body into the ‘movers’ and the ‘stabilizers’, your arms and legs do the movement for you while the stabilizers stabilize your body (excluding the arms and legs). The stabilizers are designed to not fatigue easily but they are also not designed with the type of muscles that act fast. The ‘movers’ are the opposite.; the source of energy for each group is different as well. The problem with all dysfunctions in movement comes from the use of the ‘movers’ in stabilization and the use of the ‘stabilizers’ in movement. For instance, when you go to throw a ball, it should be the arms that do the throwing and the moment you involve a twist in your upper body to add to your ‘power’ to throw, and you involve your shoulder blade with the arm extension, you go from the perfect design of your body to the modified design of the body. THAT means injury and dysfunction.
A 7-month-old baby working on strengthening the core to stand up is the best coach to teach us how to build that core. Here, you see how the whole torso has to stabilize itself and its 4 corners (top 2 shoulder sockets and bottom 2 hip sockets) when crawling which involves the movement of the arms and legs. This table-top (torso) does not collapse every time the arm or leg is off the ground- its integrity in stabilization does not depend on the arm and the leg muscles but the muscles of the ‘table top’.
So if you don’t have the core strength to stabilize your lower back when running, then you should not be running until you have developed that stability. A brace is not going to fix the issue but limit your mobility, resulting in more issues down the road. How you build the core strength and stabilization necessary to run without pain will be discussed in the sections below.
Lower Back Pain from Running Uphill
Do you notice that the back pain is worse when running uphill? Is it because you are out of breath or is it your form that is failing? Or is it both?
When you run out of breath, you are struggling and with the struggle and challenge comes the failure of posture. More than likely, at this point, you are twisting your torso with every arm swing forward and backward, you are bending forward because your lower back muscles are tired, your hip flexors are tired so they don’t lift the legs but instead flex your torso (hip flexors do both hip flexion and torso flexion) to say the least.
Let’s explore the breathing apparatus which btw is the reason why babies have a wider abdomen; they are not fat, their breathing apparatus is perfect which is so important. Each breath is the opportunity to emphasize strength in the core and when done incorrectly, only adds more to the problems of movement.
Functional movement, proper posture, and good running form all have this one thing in common, and that is proper breathing. Breathing is the first sign of life in a newborn and proper breathing is the first step to correcting any musculoskeletal issue.
How to Relieve Lower Back Pain When Running
We are all born breathing the correct way, but our breathing mechanics have become modified to accommodate our lifestyle of sitting too much and being glued to our digital devices. The result is postural decline and dysfunctional movement.
Proper breathing mechanics is not all we are hardwired with; every baby on the planet is born with the blueprint of movement which gets detailed the first 2-4 years of life.
What it takes to breathe properly is also what it takes to stabilize your torso. This is step one to the rehabilitation of any musculoskeletal issue. This is the strong foundation you need in order to build on.
Now, bringing things back to the lower back, with the proper breathing comes the ability to create and maintain a neutral spine. This is accomplished with the lower abdominal and lower back muscles working together. Do the exercise below to work on a neutral spine and stabilizing the torso.
This is the very basic level of what it takes to run without the lower back pain, but you don’t stop there. The location of pain is not always the root cause of the pain, and since the whole body is connected, the different parts work together to perform movement and the issue is never isolated to just one muscle or joint.
If only the lower back is addressed in the treatment of lower back pain, then the relief, if any, will be short-lived because what is feeding the issue is still present and sooner or later the pain returns.
As mentioned before, lower back pain left unaddressed can also contribute to other issues such as pelvic floor dysfunction which is most often equated to incontinence; this is explored best in my blog: Pelvic Floor Dysfunction and Runners. My Youtube Channel is full of functional exercises for all with playlists for lower back , and playlist for runners specifically..
If you’re a runner and you have lower back pain, don’t try to push through it. If you’ve tried stretching, maybe even physical therapy and nothing seems to help, contact me for an evaluation and discussion of your exercises and running plan.