Lower Back Pain After Running: How to Treat it, According to Physical Therapists

If you’re a runner, you may have had an injury or two in your day. Maybe you were told to take extra care of your knees and hips, but running can cause or contribute to lower back pain, as well. “Eighty percent of the population will get back pain at some point in their lives, and runners don’t get a free pass either,” says Steven Goostree, PT, DPT, a physical therapist at Hinge Health. A 2020 review published in the journal BMC Musculoskeletal Disorders found that up to 20% of runners report that they experience lower back pain. 

You don’t have to be a part of these statistics, though. While back pain can be frustrating as a runner, there are always steps you can take to prevent and manage it without breaking your stride. Here’s a look at what causes lower back pain after running, how to fix it, and ways to prevent it.

Why Does My Back Hurt After Running? 4 Causes

There are many different contributors to back pain in general, and just as many causes of lower back pain after running. Most causes of back pain from running can be managed with simple interventions such as stretching, strengthening, and gentle movement. They include:

Muscle strain. This can happen especially if you’ve ramped up mileage very quickly, are training intensely, or have changed terrain, such as switching from a flat track surface to multiple hills. “Overexerted muscles can get grumpy,” says Dr. Goostree. While your body can handle a lot without experiencing harm, you might feel it if you do too much too quickly without preparing your body. 

Muscle imbalances. Certain muscles in your back, core, hips, and legs may be weak, while others are tight. “Runners often have core weakness, which can contribute to lower back pain,” explains Dr. Goostree. Some people arch their back when they run, a condition known as hyperlordosis. This is usually due to tight, tense muscles in the front of the body and weak muscles in the back, which can irritate back muscles, joints, and discs, notes Dr. Goostree.

Facet joint irritation. Facet joints are found along the spine. They allow you to turn and bend at the back (flexibility) while preventing excessive motion (stability). “These joints can get irritated if they’re overworked, which can affect spinal discs that act as shock absorbers when you run,” says Dr. Goostree.

Sacroiliac (SI) joint pain. The SI joints (there are two of them) connect your lower spine to your pelvis. Running further or at a higher intensity than your body is prepared for can put pressure on these joints, contributing to pain and inflammation.

How To Reduce Back Pain After Running

It can be frustrating to experience back pain after a run, but it doesn’t mean that you have to give it up and it certainly doesn’t mean you’re stuck with pain. There are always steps you can take to prevent and minizine pain related to running. Here are the top four tips from Hinge Health physical therapists: 

• Warm up. Marathon runners who don’t warm up before running are 2.6 times more likely to experience low back pain than those who do, according to a 2021 study published in Pain Research Management. “I recommend a dynamic warm up, where you perform a series of short, quick stretches versus longer ones that you hold for a sustained period, “ says Dr. Goostree. 

• Avoid overtraining. Increase running distance, duration, and intensity gradually, and build in days for cross-training.

• Adjust your running form if needed. If you have pain from running, you may need to change your technique. Try to look straight ahead when running and not downward (as long as the terrain makes it safe to do so). Keep your shoulders relaxed. Your arms should swing backward and forward, not across the midline of your body. Try to lift your leg straight at your hip, and land as softly as possible. If needed, you can work with a physical therapist who can do a gait analysis to pinpoint any issues. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. 

• Stay hydrated. The discs in your back, which are made up of about 75% water, need to stay hydrated in order to work their best, notes Dr. Goostree. To prevent dehydration, the American Council on Exercise advises drinking about 20 ounces of water two hours before a run, and seven to 10 ounces of fluid every 10-20 minutes during a workout. 

What You Can Do to Speed Up Healing

Most cases of back pain from running resolve on their own within a few days to a few weeks. But there are things you can do to speed up the process, including: 

• Stay active. If you’re in a lot of pain, it’s okay to listen to your body and take a break from running, says Dr. Goostree. But don’t lounge around in bed all day. Remain as active as you can, and focus on low impact activities such as walking, cycling, and strength training. Studies show people with back pain recover faster when they are active.

• Heat. Heat (like a heating pad) temporarily relieves pain by relaxing tight muscles. Use heat periodically throughout the day for 20 minutes at a time. 

• Over-the-counter (OTC) pain relievers. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for back pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. Just remember: This is a short-term solution to help you get back to your normal activities. If you find that you depend on pain relievers after every run, talk to your doctor.

• Physical therapy. A physical therapist can develop an exercise program to help strengthen and stretch all the muscles that support your back. Exercise with a mind-body focus, like Tai Chi and yoga, may also be helpful because it can help relieve some of the stress and anxiety that can be associated with back pain, especially when it interferes with your ability to do one of your favorite activities. 

When to See a Doctor

Most cases of lower back pain when running can be handled at home. But you should see a doctor if pain lasts for more than four to six weeks or if you experience any of the following:

• Your pain is getting worse, not better, with the treatments mentioned above 

• The pain radiates down your leg, or you experience leg weakness or tingling

• You have bladder or bowel incontinence

• Your pain affects your balance or makes it hard to walk 

Prevention 

Back pain after running is, well, a pain, but there are things you can do to help prevent it so you can continue, whether you’re a casual runner or training for a marathon. 

• Strength train. This one’s important. “Strengthening all the muscles in and around your back helps prevent muscle imbalances,” says Dr. Goostree. A 2018 study published in the Journal of Biomechanics found that runners with weak deep core muscles are more likely to develop back pain. Exercises such as planks on an unstable surface can help.

• Run on the right terrain. “I prefer folks to run outside, rather than on the treadmill, since it can alter running mechanics which can contribute to back strain,” explains Dr. Goostree. “Slightly softer surfaces, like grass or turf, instead of concrete, are good options, too.” If running outside isn’t an option, just be mindful of your running stride and listen to your body if you develop new pains. 

• Shorten your stride. “It’s not uncommon for runners to overstride, which puts more pressure on joints,” says Dr. Goostree. Shorter strides allow your feet to land under your body (instead of in front), which helps absorb the impact of that force better.

Strengthening and stretching the muscles in and around your back is crucial to managing and preventing running-related back pain. The given exercises are recommended by Hinge Health physical therapists as a starting point.

Start by working these into your routine once or twice a week and build up to doing them daily if they’re helpful. If you have any concerns or questions about whether this routine is right for you, check with your healthcare provider first.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Check Your Sneakers 

Running shoes tend to lose their cushioning and support after three to six months, or about 350-500 miles of running. Check the bottoms of your shoes frequently. Once the tread begins to wear down, it’s time to replace them, advises Dr. Goostree. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References: 

1. Maselli, F., Storari, L., Barbari, V., Colombi, A., Turolla, A., Gianola, S., Rossettini, G., & Testa, M. (2020). Prevalence and incidence of low back pain among runners: a systematic review. BMC Musculoskeletal Disorders, 21(1). doi:10.1186/s12891-020-03357-4

2. Wu, B., Chen, C.-C., Wang, J., & Wang, X.-Q. (2021). Incidence and Risk Factors of Low Back Pain in Marathon Runners. Pain Research and Management(2021), 1–7. doi:10.1155/2021/6660304

3. What is Correct Running Form? (2017, October 12). ACE Physical Therapy and Sports Medicine Institute. https://www.ace-pt.org/ace-physical-therapy-and-sports-medicine-institute-what-is-correct-running-form/

4. Weber, S. (2021, February 23). A Runner’s Guide to Lower Back Pain. University Hospitals. https://www.uhhospitals.org/blog/articles/2021/02/a-runners-guide-to-lower-back-pain 

5. Healthy Hydration. (2009, January 29). American Council on Exercise. https://www.acefitness.org/resources/everyone/blog/6675/healthy-hydration/

6. Raabe, M. E., & Chaudhari, A. M. W. (2018). Biomechanical consequences of running with deep core muscle weakness. Journal of Biomechanics, 23(67), 98–105. doi:10.1016/j.jbiomech.2017.11.037

7. Chou, R. 2021, September 20). Low Back Pain in Adults (Beyond the Basics). UptoDate. https://www.uptodate.com/contents/low-back-pain-in-adults-beyond-the-basics

8. Sports & Back Pain: When to See A Doctor. (2020, December 21). Cleveland Clinic. https://health.clevelandclinic.org/do-you-have-sports-related-back-pain-know-when-to-call-a-doctor/#:~:text=The%20pain%20radiates%20to%20your,for%20more%20than%20two%20months.