Living with lower back pain is not fun and when it interferes with running, it is on a whole different level. 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. This 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. Now 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!
What Causes Lower Back Pain When Running
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. 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). This happens to go hand-in-hand with an excess mid-back curve and forward neck posture.
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) they hold the lower back in extension. This can be 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.
There is also the possibility of a hip flexor muscle called Psoas (pictured below) contributing to lower back pain. While the Psoas is a hip flexor, because of its attachment to the lumbar spine, it directly impacts the lower back when overworked and weak.
Psoas Muscle
Important Muscles in Running with Lower Back Pain
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!! Isolated stretching hardly does you any good!! It is functional movement and dynamic exercises that are going to effectively address the tight muscles!
Wearing a Brace for Lower Back Pain When Running
Your true core is your entire torso! Imagine we drew a rectangle connecting your shoulders and hips to each other, including the sides, front, and back. Connect your neck to this ‘rectangle’ and now you see the stabilizers of your body!
Let’s divide your body into the ‘movers’ and the ‘stabilizers’. Your arms and legs do the movement for you while the stabilizers stabilize your body. The problem with all dysfunctions in movement comes from the use of the ‘movers’ in stabilization and the use of the ‘stabilizers’ in movement. This always results in injury and dysfunction.
A 7-month-old baby working on strengthening the core to stand up is the best example of how to build core strength. See what I mean in the video below.
If you don’t have the core strength to stabilize your lower back when running, then you should not be running. First you have to develop 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.
Don’t Make This Mistake
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.
-Dr.Shakib