Should I run with lower back pain? Physio advice on when to worry and when to push on

Ever been stuck in bed and wondering if you should run with lower back pain?

It’s a tricky question that poses more questions:

Is it even possible to run with lower back pain if it’s severe?

Are you doing more damage?

If you run with lower back pain, will it help it to free up?

What causes lower back pain with running?

We see lower back pain more often in male runners and runners over 40 years old.

It affects new runners as much as experienced runners.

It’s often linked to an increase in training load, such as running further or faster, or adding a strength program.

It’s worth noting that it’s not linked to the magic “10% rule” of building training volume – read more about why that rule is rubbish!

The #1 cause of lower back pain in running

The most common cause of lower back pain in runners is reduced hip range of motion, particularly hip extension (leg moving behind you.)

As the runner strides out to run faster or on a downhill, the leg moving behind the body runs out of hip range.

This causes the pelvis to forcefully rotate forwards, jamming the back and overloading the lumbar spine joints.

The other main cause of lower back pain in running

Another common cause of lower back pain in runners is muscle overwork.

If muscles around the spine need to work harder to maintain trunk position, due to a braced or upright running posture, the muscles fatigue and cause pressure across the lower back.

This muscle overactivity can continue after a run as the muscles become painfully tight.

How can you tell which is causing your pain?

As a general rule, one sided lower back pain is more likely due to a stiff hip joint.

Generalized lower back pain, affecting both sides equally, is more likely due to muscle overwork.

Can you run with lower back pain if it’s severe?

If you’re trying to run with lower back pain but the pain stops you from getting into your normal running stride, you shouldn’t be running.

If you can’t move properly, trying to run with lower back pain will worsen muscle fatigue and increase protective bracing around the back, known as lower back muscle spasm.

Long story short, trying to push on will make your back more painful and take longer to recover.

Swap the run for a comfortable walk for a few days until you feel like it’s freeing up.

Are you doing more damage if you run with lower back pain?

In 99.99% of cases, you won’t cause more structural damage to a back injury if you try to run with lower back pain.

Almost all lower back pain cases don’t have a structural cause as we’d see with a knee or ankle injury. There’s no damage to ligaments or joints that we can detect on imaging.

However there are some injuries, like a Pars Defect (stress fracture in the spine) that can worsen if you run with lower back pain.

Remember that this category of injuries is extremely rare!

If in doubt, see our checklist at the bottom of this post about when to seek medical attention.

If you run with lower back pain, will it help it to free up?

Most cases of lower back pain have a mix of muscle spasm and joint irritation.

Once the muscle spasm passes – it’s the nasty grabby pain you get on movement – then trying to run with lower back pain is worthwhile.

As you run with lower back pain, it’ll feel more comfortable and looser.

Don’t get too cocky and try to run faster! Just enjoy the freedom and let the back continue to loosen up.

How can you avoid or fix lower back pain with running?

Avoiding or fixing lower back pain with running can be done by correcting the biomechanical deficit or reducing the load on the back.

Correcting the biomechanical deficit

Managing hip mobility issues can be achieved with exercises like a walking lunge or a sumo squat stretch, in addition to regular running.

The exercises safely push the hip towards the end of its range while regular running can improve the quality of tissue in and around the hip joint.

Reducing the load on the lower back

To reduce load on the lower back, you can modify your sessions to Fartlek sessions (mix of fast and slow running) and even swap your long run for a run:walk (eg. 10 minutes running to 1 minute walking).

Both types of sessions reduce the consistent muscle loading around the back by changing your running posture and pace.

This gives the muscles a chance to recover and avoids cumulative muscle fatigue.

If you’re training on hills or hill repeats, swap it for a stair session.

Stairs limit your stride length, which avoids overextending the hip, and reduces the backwards tilt of the trunk on descending, which reduces the compression on lower back joints.

When should you seek medical help for lower back pain with running?

If you’re not sure about whether medical help is required, remember that mild transient lower back pain is common.

If you have any of these features, it’s best to seek a medical opinion:

> pain referring down your leg/s

> any weakness, pins & needles or numbness in the legs

> the pain is worsening week on week

> constant pain that doesn’t settle within 24 hours after a run

> night pain that keeps you awake