Lower back pain is common and often chronic but the good news is that you can usually do something about it and it needn't cause disruption to your running routine
Lower back pain can be frustrating and debilitating whether before, during or post run. It is actually fairly common but be reassured that, more often than not, episodes of back pain are self-limiting and certainly won’t mean the end of your running or race day ambitions.
There are different structures within the back that can be the source of your pain:
- The facet joints that connect the vertebrae can become irritated and inflamed. This is more common in runners with large curves in their lower back (lordosis).
- The discs can be affected by age or injury, potentially leading to sciatica symptoms.
- The lumbar spine muscles can be prone to general muscle tightness, particularly with fatigue or smaller areas known as trigger points which can also refer pain.
- The sacroiliac joints connect the base of the spine to the pelvis. Leg length differences, muscle imbalances or weight bearing can result in pain here.
It’s important not to become too focused on the source of the pain however, as the reality is that most low back pain in runners is non-specifi c and attributable to multiple factors. It’s always worth seeing a therapist for an assessment, particularly if you’re having sciatica, muscle weakness, changes in sensation or bladder and bowel function.
What are the causes?
- Muscle weakness or imbalance – The repetitive ground reaction forces, which can be multiple times a runner’s body weight, can put stress on the lumbar spine. We need sufficient muscular support to attenuate these forces. There is a misconception that our ‘core’ only refers to our six pack, but it is actually the integration of a team of muscles (deeper abdominals, pelvic floor, lower back muscles, diaphragm and gluteals) that support our spine, enabling us to run efficiently. Frequently, our superficial abdominals, quadriceps and hip flexors try and overwork for us, which can affect the pull on your pelvis and strain on your spine.
- Technique and posture – Running with your pelvis either too tucked (posterior tilt) or too arched (anterior tilt) can affect the stresses to your lower back. A posterior-tilted pelvis will tighten your hamstrings and limit your hip extension causing your glutes to be less recruited, whereas an anterior-tilted pelvis will lead to hip-flexor tightness, lengthened abdominals and lumbar spine-loading. Many runners hold themselves upright or rigid through their torso, bracing with abdominals, but actually your spine and trunk need to move. Constantly contracting muscles will mean they fatigue, giving you less support.
- Mobility – Stiffness in your hips and spine can also predispose you to pain, meaning your muscles and joints don’t go through their full range and this can result in weakness and inflammation.
- Changes in training load/surfaces – Suddenly increasing your training load can predispose you to any injury, particularly if you don’t have sufficient muscle support or suddenly change to harder surfaces such as road running. Or you may find that hill running can be more aggravating for your back pain. If you extend from the lower back in an upright posture, the lumbar muscles and joints are more loaded. It’s important to use your hip extensors (gluteals) to propel you up the hill. Think about leaning forward, with ribs over pelvis, driving through the arms and trunk to put your core muscles in a more favourable position to support your spine. The good news is that these are all things that we can do something about, whether it be technique modification, or strength and mobility work. Here are five exercises that will help strengthen and mobilise your lower back.
5 exercises to strengthen and mobilise the lower back:
- Deep core activation
Runners need to recruit the deeper abdominal layer to provide muscular support around the lower back. Lying on your back is a good starting point for this, then progress to more weight-bearing positions, adding resistance. Aim for your pelvis to be in a neutral position, not too tucked or arched. Take a breath in and as you exhale think about drawing both sides of your pelvis together, imagine tightening a zip from pubic bone to belly button or tightening a notch on a belt. You shouldn’t feel your superficial abdominals working here. When you have mastered this, you can progress to rotating, lifting or straightening a leg or arm, and other positions such as hands and knees.
- Single leg squat with rotation
Stand up, take one leg out behind you and squat down on the front leg. As you lower, rotate your trunk towards the front leg, making sure your knee remains in line, but not over your toes. As you come up, bring the leg through and rotate away from the front leg. If you feel unstable, you can do the same exercises but with a small amount of weight through the back leg. This position mimics the demands of running and encourages your glutes to work.
- Single leg bridge
On your back, recruit your deep abdominals lightly, then push up into a single leg bridge, keeping your pelvis level. You can start with double leg if you find it difficult to maintain a level pelvis. Don’t over arch as you will feel it in your lower back. You can make this more hamstring specific by having your foot up on a bench/chair.
- Side plank with rotation
Engage your deeper abdominals, then push up into a side plank keeping your ribs and pelvis in line. You can make this easier by having the bottom leg bent. Inhale and rotate your trunk, inhale and return to the starting position.
- Chicago rolls
On your side, take one leg over the other, then open up through the top arm gently rotating your spine. Gradually increase the range as you feel comfortable.
Don’t forget to include a dynamic warm up to mobilise the muscles that attach around the lower back and pelvis, such as leg swings forward and back and side to side. Classes such as yoga and Pilates can also be beneficial in assisting your mobility and strengthening your core.