At last month’s “Ask the Doc” event I received a lot of questions about lower back pain in runners. Common complaints I heard were tightness in the hips, pain in the back, buttocks or calf, burning into the leg or a sense of weakness.
Research says that lower back pain comprises merely seven to 11% of all running injuries. However, clinically I see that lower back pain is a common issue among runners. Some runners can injure their backs because of the repetitive nature of running, while others struggle to continue running following a back injury. Either way, back pain is a big deal for runners!
What does a lower back injury look like?
My clients are always surprised when I tell them that lower back pain may not always show up in the back.
Symptoms such as tightness, pulling, pain and cramping anywhere from your feet all the way up to your back can be a symptom of something happening in the lower back or spine.
Unfortunately, many runners seek help for pain in their legs, hips and feet without improvement because the root cause of their pain is in their back and is never addressed.
What can cause lower back injuries in runners?
Improper running form
Leaning too far forward from the hips or landing with your foot too far in front of you with your knee straight can cause increased tension through the nervous system and soft tissue around the spine. This increased tension can pull on the back and cause increased tightness in both the back and lower extremities.
Postural changes and strength deficits
Standing too erect, increasing forward pelvic tilt, knee valgus or hip drop and over pronating can contribute to core weakness, glute inhibition and muscle tightness around the hips. This can ultimately lead to mechanical issues in the back. The core and hips serve to support the back; if the back doesn’t have a good support team, it can easily end up injured.
Tightness can lead to more inefficient movement patterns. For example, decreased hip extension is frequently associated with lower back pain. Many runners aren’t able to extend their hip because of increased tightness in the front of their hips and are forced to gain the motion they need for running through increased movement in the back.
What should I do if lower back pain is affecting my running?
Strength train. Think of strength training as building up your defenses against injury. The more strength you have, the more easily your body can handle repetitive forces over a long period of time. Weak or untrained muscles will fatigue faster and be more likely to contribute to dysfunctional movement patterns. Weakness is also a precursor to tightness in muscles. So if you are always told you are tight or inflexible, it is likely you are also weak.
I advocate getting your gait analyzed by a physical therapist if you believe your running form is contributing to your pain OR if you have had pain for a long time. Sometimes, one small change in your gait can make a world of difference in your pain.
Be proactive. If you are hurting, don’t ignore it. Pain is a warning sign that something is wrong. The biggest misconception runners have is that physical therapists, doctors or chiropractors will make them stop running – oftentimes that is not the case. Remember, the sooner you take care of the issue the sooner you will be running without pain.
Regardless of why your back hurts, don't let it continue to impact your running.