What to Know about Running with Back Pain

When we think of common injuries faced by runners, it’s the feet and legs that tend to be pain points—shin splints, ankle sprains, stress fractures. But many runners, both new and experienced, endure discomfort and even pain elsewhere in the body, most notably in the lower back.

“Low-back pain is one of the leading causes of disability in the world,” says Ashleigh McAdam, PT, DPT, OCS, GCS, a physical therapist at HSS Paramus. “It’s something we see in physical therapy all the time. Typically with runners, most of the injuries are in the lower leg, but there is some prevalence of low back pain in runners as well.”

The potential causes for running-induced back pain include:

• a disc problem, such as a herniated disc, which can often lead to nerve irritation, such as sciatica;
• spinal stenosis;
• a muscular issue or strain;
• joint overload or irritation.

Even the aging process—with its normal physiological changes, such as increased muscle stiffness—can cause a longtime runner to experience new back pain, says McAdam, who is also a geriatric specialist.

Below are tips on how to prevent and ease running-induced back pain. If you’re not sure which exercises would work for you, a physical therapist can help identify your specific therapeutic exercise needs, says Andrew Paul Creighton, DO, assistant attending physiatrist at HSS.

“Sometimes the issue may be that the runner needs more mobility in their hips to take stress out of the back,” he says. “Or it may be that the runner needs more core stability and endurance and exercise should be targeted to this impairment.”

How to prevent back pain when running

Core strengthening: For many runners, back pain can be exacerbated by muscle weakness or core instability, McAdam says. A lack of core strength can cause a runner’s pelvis to tilt out of neutral position, causing deviation in the spine or hips that could contribute to a flare up of pain, she says. “Staying in neutral position gives you a good foundation to propel yourself forward,” McAdam says, “which is what running is.”

The intrinsic core muscles—the deepest layer of core muscles attached directly to the spine—are key here, McAdam says. Runners can have a big impact on these inner abdominal obliques by practicing subtle, targeted exercises, such as pelvic tilts, bridges and planks.

Cross training: All runners should cross train because physical activity should be well rounded and address the other systems of the body. Runners who include strength training and stretching as part of their overall workout regimen can improve their running performance. 

General physical activity guidelines recommend most adults get at least two nonconsecutive days of strength training each week. (The off days give muscles time to recover.) Along with the core strength exercises listed above, McAdam says, runners can use free weights, resistance bands or even their own body weight to strengthen their upper and lower extremities. Compound movements, such as squats and step ups, are good options.

To add stretching and flexibility work to their training plan, runners can try a dynamic warm-up before each run, McAdams says. These moving stretches can include high-knees jogging, gentle mini-squats and butt kicks. Then, after a run, cap off the workout with static stretches held for 30 to 60 seconds. These include reaching forward for a hamstring stretch and holding a foot behind you for a quad stretch.

All of this cross training doesn’t only help with strength and flexibility, McAdam says. It also aids in stability and balance, which are especially important in a single-limb sport like running. “It’s important that runners have good stability,” she says, “so if they encounter a pebble, they’re not going to roll their ankle, but adapt and keep their form.”

Tips to ease running-induced back pain

Try the treadmill or the track. When McAdam is helping a patient rehabilitate and return to running, she makes sure they run intervals on the treadmill before heading outdoors. If you’ve been running outside when you experience back pain, try moving your workout indoors—at least temporarily. A treadmill allows for more consistent pacing, and it has more give than rugged outdoor terrain. If the pain eases or evaporates after some time on the treadmill, McAdams says, that could mean the discomfort was related to terrain factors, such as negotiating hills, pavement or uneven ground on a running trail.

Once you’ve mastered the treadmill, try moving your run to an outdoor track. McAdam’s tip: Jog the straights and walk the turns until you’re pain-free. Then progress back to your usual running route.

Focus on footwear. Good-quality, well-fitting footwear is an important tool in preventing back pain while running, Dr. Creighton says. “Many running stores have the ability to watch you run and tailor a shoe to the runner,” he says.

That means shoe specialists can help you find the perfect footwear based on alignment at the foot and ankle, how the foot and ankle move during a run, the width of the foot and other specifications. “Taking advantage of this assessment and getting fitted for the proper sneaker can make a huge difference for both the high-level and recreational runner,” he adds.

See a specialist. If modifications to the run don’t help, or if the pain doesn’t subside within 48 hours (or gets worse), it’s probably time to consult a physical therapist for more individualized assistance, Dr. Creighton says. “It can be helpful to look at how the runner is running and see if there is a way to decrease the load coming up from the legs to the back,” he says. “This can be done by videotaping the runner running and analyzing the gait. It can be helpful to work with a physical therapist for this and sometimes have a formalized running analysis.”