You’ve been running for years now and you’ve figured out how to work around the little aches and pains you’ve experienced in the past.
But those aches and pains were in your feet, ankles, and knees.
This time you’re starting to feel a very uncomfortable pain in the back of your hip, sometimes feeling like it’s the back of your pelvis.
The pain is triggered most with running, but it’s even starting to creep into your daily activities now too. You stretch and stretch and…stretch.
Sadly, no change. The pain is steadily getting worse and disrupting your running more than any other pain has before.
For me, specializing in the spine, this is similar to many stories I hear from runners that come in to see me. Let me share what I’ve learned from working with these running friends of mine.
How back pain can present in active runners
Back pain can present in interesting and surprising ways to anyone who hasn’t experienced it before.
Sometimes runners will come in with straightforward pain when they run. It’s a broad band of pain that runs across the lower back.
Other times the pain will present as a pinpoint pain, the size of a thumb or fist print, the rests at the bottom of the lumbar spine and just to one side. This spot is usually around where the sacroiliac joint (SIJ) lies.
Another common complaint is aching pain that runs down the posterior buttock on one side while running.
And even others can have an aching pain or numbness that runs all the way down the back of the leg to the knee or foot or into the big toe.
Are these all manifestations of back pain? Yes. These pains nearly always indicate pathology at the spine.
We even have runners who come in reporting chronic hamstring pain on one side. We’re talking several months and even years of pain in the hamstring.
They’ve tried all kinds of different treatments. But after intensive testing, we find that it’s actually pain referring from their lumbar spine. No wonder they weren’t getting better.
Why does running trigger my back pain?
This, like many other questions, will vary depending on each individual. But let me offer a few common contributing factors I observe among most runners with lumbar pathologies.
First, it’s important to understand that lumbar pain can most often be traced back to the intervertebral disc. These discs are most stressed, or triggered, by compression and shear stresses.
Experienced runners have strong legs, but there are a few common weaknesses around the lumbar spine, however.
One weakness is the ability to properly accept axial load, or compression, through the spine.
This is partly due to decreased tissue strength in the spine due to a lack of stimulus, and partly due to poor muscle activation. Let me explain.
Providing steadily increasing stimuli of anything will push the body to adapt and strengthen against the stimulus. For the most part, runners generally avoid heavy strength training.
Heavy strength training, especially performing movements like squats or deadlifts and even farmer’s carries, provides a great stimulus of axial load through the spine.
The vertebrae of the spine obey Woolfe’s law and adapt their structure to become increasingly better at absorbing axial load.
Maybe you trip slightly and step down hard to catch yourself, or run downhill, or push your pace faster than normal. These are just a few of the factors that can increase the axial load your spine must accept.
When your spine has to accept more load than it’s adapted to handle, tissue damage and pain can be the result.
Running athletes tend to be more susceptible to tissue damage resulting from excessive axial load due to a lack of heavy stimulus through the lumbar spine.
Factor in shear stress on top of compression stress, and now we’ll understand how running can trigger back pain.
Shear stress occurs across the disc when the vertebrae don’t move in parallel together.
Your lumbar spine will flex and extend and even rotate in small ranges while you run. These movements must be controlled and coordinated throughout the entire spine so as to limit the shear stress across the discs.
The movements of the vertebrae are best stabilized by the coordination of many muscles in our back and abdominal region, which we’ll just call our core.
These muscles act to stabilize our spine to reduce shear stress on the discs.
Generally, my runner patients demonstrate good core strength, but poor core coordination and endurance.
In other words, they don’t activate their core well while running, and they can’t maintain that core activation during the entirety of their run.
This leaves them more susceptible to lumbar injury the further they run because they’re more susceptible to those axial and shear stresses.
Decreasing risk of lumbar injury while running
If you know anything about us here at Zona, you’ll know the first thing I will say to STOP doing immediately: stretching.
If you have any of those pain presentations I discussed above, stretching may feel good for a moment, but it’s just going to slow down your recovery in the end.
The most flexible runners are generally the ones having the most problems with low back pain. I’m serious.
Second, lay down for 10 minutes after you run. This relieves the axial compression on your lumbar spine as you get out of gravity by laying down.
This is the best recovery you can do after running to treat your low back pathology.
Third, you need to practice activating your core properly to stabilize your spine. Then begin incorporating this strategy while you run.
This is hard to explain through type. We work very hard to perfect this technique with our patients in person, so I can’t do it justice here.
But the end goal is to be able to brace your core, using only about 20% effort in your core contraction, to stabilize your spine.
So you should be able to completely stiffen and stabilize your lumbar spine by bracing your core using a minimal effort contraction.
Fourth, you need to increase the endurance of that core contraction so you can maintain your lumbar stability throughout the entire run. We find that performing side planks and bird dogs are a wonderful way to do this.
I would recommend doing your side planks and bird dogs right before you run. This way you activate your core before running and work on improving your core endurance all in one.
One last helpful tidbit. Be careful not to take large steps at the beginning of your run.
Over and over again I see runners take really large steps the first 2–3 strides until they get into their normal rhythm. This increases the stress to the lumbar spine before your core is even ready to fire and protect.
Keep those first few steps intentionally short until you get into your stride rhythm. An easy change to avoid a potential pain trigger.
In summary, yes running is stressful to the lumbar spine. That doesn’t mean you should be scared of running by any means.
But you do need to improve your ability to reduce and control those stresses to your lumbar spine. Stretching isn’t the answer.
Do this by practicing bracing your core to stabilize your spine using a light core contraction.
Then improve your core endurance with basic exercises that challenge your ability to hold your spine stable and steady.
I see a lot of runners with back pain, and these patients are averaging about 3 total visits before they’re back to running pain-free.
If you need help getting out of pain and back to breaking your PRs, set up a free phone consultation.
No pain, more gains!