Return to running after lower back pain

Lower back pain is the most common injury worldwide, so returning to running after lower back pain would have to be the most common challenge faced by runners.

Regardless of how gently you return to running, it’s common for your back pain to get angry after a slightly faster running session, or after your first long run.

It creates a cycle of frustration, but there’s a solution!

A carefully planned training program can get you flying again, while avoiding the triggers for further lower back pain episodes.

We explain the triggers, the changes you can make and how to structure your program to return to running after lower back pain.

runners in park

Understanding lower back pain

For the most common condition in the world (experienced by 1 in 8 people worldwide on any given day), we know surprisingly little about lower back pain.

We can diagnose specific causes of lower back pain in cases of nerve compromise and bony fractures. But in the vast majority of cases, we can’t actually find the structure at fault.

Getting an MRI might show a number of “injuries”, but we now know that most of these “injuries” are completely normal for any lumbar spine.

This chart below shows the percentage of adverse findings on MRI for people WITHOUT lower back pain.

Return to running after lower back pain

If a person without back pain can have a disc bulge, it means that finding a disc bulge on a scan is unlikely to be the cause of lower back pain.

So for back pain clients, we classify them into specific causes that we can identify (nerve, bone, etc) and non-specific causes (which may involve muscle, joint, and other soft tissues). The most common type of lower back pain is the latter category – non-specific lower back pain.

We’ll plan our training program below for a common lower back pain episode.

If you’re experiencing altered sensation (such as tingling or numbness), any feeling of weakness or clumsiness, or you’re generally feeling unwell, it is important that you visit your Doctor or Physiotherapist within a day or two to get a firm diagnosis as your back pain may involve nerve compromise or other complicating factors.

The program below would not be appropriate for you in this circumstance.

Effect of lower back pain on running technique

Think of the pain as a deterrent for the brain to allow certain actions. If it hurts, the brain will try to figure out a way of avoiding it.

For most lower back pain episodes, arching backwards will cause pain and tilting or rotating to your end of range will cause pain.

During the running action, these movements will occur with faster running, downhill running and fatigued running.

The way the brain naturally avoids these triggers is to round the back (leaning forward while dropping the chest), limit how far the leg is allowed to move behind you or to switch on all the spinal muscles to brace the spine and fight against all movements.

Each of these changes is associated with a negative outcome as the compromise limits another aspect of your technique.

Rounding your back takes the hips away from their optimal angle and begins to overuse hamstrings to drive, instead of glutes and calves.

Restricting how far the leg moves behind you causes similar changes but also overworks hip flexors to pull the leg forward. Unfortunately the main hip flexors attach to your spine, so overworking them puts more pressure on your back.

And lastly, excessive muscle bracing to restrict all movements. It ruins your efficiency (you run like a wooden doll) and leads to early spinal muscle fatigue, causing more lower back pain and a greater risk of muscle spasm.

How to modify your running technique while recovering from lower back pain

Here are some tips from our Physio team on tweaking your running technique for returning to running after lower back pain:

  1. Keep your cadence on the higher side to limit your stride length – that isn’t necessarily 180 steps per minute (as you’ll often hear quoted) as it depends on your pace
  2. Avoid excessive forward trunk lean – although it feels tempting to take the pressure off the back, it actually adds more muscle load to the lower back
  3. Think about running quietly/softly – the loudness of your impact directly correlates to the spike in force through your body, so less noise = less force spike
  4. Take regular short walk breaks – muscle fatigue leads to longer strides and more lumbar spine loading so take a short 30-60sec walk break at set intervals to avoid a “tired” running technique

Program changes for running after lower back pain

Here are the aspects of a typical running program and how they relate to running after lower back pain episodes:

Frequency of sessions

Let’s start with the best one – you need to run MORE OFTEN!

Yup, you read that right. More frequent running sessions (eg. 6 sessions/week vs 3 sessions/week) reduces the time between runs and offsets some of the stiffness that occurs with lower back pain.

You still need to manage loading so you can’t take 3 x 10k each week and make it 6 x 10k each week.

As an example, if you go from running 3 x 10k each week and swap that for 6 x 5k each week, you can preserve your weekly distance while avoiding the “rustiness” that occurs with prolonged rest periods.

Speed sessions

Unfortunately there’s no way of hitting top speed without putting pressure on your lower back.

So your best compromise is to lengthen your speed intervals. If you can’t hit top speed, make your 200m intervals into 800m intervals so they require a less-than-max pace.

Alternatively you can ditch your speed work until the back has fully recovered and return to faster running after lower back pain has completely resolved.

Long runs

Long runs are slower so they naturally have less muscle pressure on the lumbar spine, but there is more fatigue and this often leads to longer strides and more lateral movement.

So the safest option for running after lower back pain is to make your long run fairly flat (ie. avoid hills) and add short walk breaks at set intervals.

And while this may not sound like the sexiest option (runners having to walk, WTF!!!), it’s better than only covering half the distance or flaring the injury up again. It’s also a viable option to complete longer races before you’re back to 100% (popularised by Olympian Jeff Galloway).

Vertical/hill sessions

Downhill running after lower back pain can be problematic as you tend to lean slightly backwards as you descend steeper or faster hills, putting more compressive forces through the lower back.

A safer option would be stairs – you still get your vertical but the stairs limit the issue of overstride, taking away the compression risk.

For stair running, power up the stairs at max effort but back off a little for descending stairs.

Sample running program (with explanations)

This program would be an early (building) phase program that I’d use for one of my mid-pack 10k runners. It would vary each week but this gives an overview of the rationale behind the design.

DaySessionReason
MondayRecovery run or walkAn easy 5k shuffle or 3k easy walk will reduce the likelihood of any stiffness after your Sunday long run
TuesdayStair session
30 minutes
Adding in stairs for power and heart rate recovery, but avoiding hills due to the excessive pressure o the lumbar spine.
For this session, focus on slow building of pace over 10 steps, hold that pace for 40-50 steps, then easy run down, rest and repeat.
WednesdayEasy runCruising pace held over a comfortable distance (around 5-6k for this example)
ThursdayLong intervalsFor this session, we’d opt for an interval of 1k to 1 mile (5-8min) with a slow building of pace at the start of the interval. Around 3-5 reps would cover it (total distance ~ 5km)
FridayRecovery runSame as Monday
SaturdayCross-training or recovery swimA non-running activity to get the body moving with gentle multi-axial movements (moving with a combo of bend, twist and sideways tilt) – swimming or deep water walking works well; rower, cycling, ski erg or Elliptical cross-trainer would be OK but not ideal as they have limited mobility benefits for the lower back
SundayLong run:walk
90 minutes
The run:walk design (8 minute run : 2 minute walk) allows for fatigue to build endurance but reduces its negative effect on running technique.