Low back pain is the bane of many peoples’ existence…
And that can be especially true for runners.
When you’re looking forward to a long weekend run after a hard week of work, the last thing you want to deal with is low back pain that forces you to walk or stop running altogether. Running is supposed to be your stress relief, but that aggravating back pain only adds to the stress of your week.
It’s frustrating to see how many runners still deal with this issue, as well as how many people end up sustaining longer term injury as a result of pushing through it.
But, there is one silver lining to its commonality: with so many runners coping with low back pain, movement and running specialists have nailed down some of the most common causes. (And with more knowledge behind the “why,” the better you can work towards actually alleviating or preventing the issue in the long-term.)
Common Cause #1: Pelvic Drop
Also referred to as “hip drop,” this issue occurs during the stance phase of your gait, when the hip opposite to your stance leg drops lower than the other. As you can see in the image here, this results in an unlevel pelvis:
Most commonly, pelvic drop develops as a result of insufficient glute activation, strength, or control. The glutes do more than just act as the powerhouse for your running — they also provide a bulk of the stability for your hips and trunk through dynamic motion.
Why Pelvic Drop Causes Low Back Pain
When one side of your hip drops lower than the other, you can already observe visual compensations in the body.
For this runner below, you can see that there’s a slight side-bend leaning towards the stance leg. As a result, the left side of their lower back gets compressed, leading to increased loading in the spine along the facet joints. Over time, this will cause the joints and surrounding tissues to experience inflammation or hypertrophy, both of which will amount to pain in the low back.
Many runners also experience some degree of pain in the spine opposite to their stance leg. This indicates that the paraspinals and quadratus lumborum (muscles in your low back that connect to the pelvis) are straining themselves to try and lift the hip back to its normal level.
Unsurprisingly, when these muscles are overworked, they fatigue at a much faster rate, increasing the likelihood of pain and potential muscle strain.
On top of these two major pain points, people most commonly experience some degree of sciatica (or, general nerve compression) within the stance leg. The nerve roots in the low back become aggravated from the increased pressure or pinching, which then causes pain to travel through the hip joint and down the leg.
Long story short: pelvic drop seems minor at first, but it can wreak havoc on the tissues and nerves of your lower back anatomy.
Steps to Correct Pelvic Drop
The “logical” solution would be to simply keep your pelvis level while running… but running biomechanics are far more nuanced than logic alone.
To see real results, you have to tackle the root cause of the issue; go straight for the glutes.
Your first step to correcting pelvic drop is to assess how well your glutes are activating. More often than not, people have weakened glutes that don’t turn on properly during activity. So, before you dive headfirst into building muscular strength, you’ll want to start out with progressive activation drills (likely involving resisted isometric exercises) to make sure both your gluteus medius and gluteus maximus are firing to the best of their ability.
Once you’ve nailed down the activation, that’s when you can ease into strength work! You’ll want to focus on improving your dynamic strength via single-leg drills, as these will best emulate the workload your glutes have to take on while running. Some of the most common running-specific drills we suggest are Romanian deadlifts and Bulgarian split squats, as both of these exercises demand ample glute strength for stability and shock absorption.
From there, you can transition into more complex exercises that recruit unilateral trunk control (or, simply put, other workouts that train one side of the body at a time). We often have our runners practice dynamic side planks and stability ball work to improve core engagement, pelvic alignment, and gluteal muscle recruitment.
It’s best to work with a trained running specialist or physical therapist who can provide real-time running biofeedback as you work through a training plan. This will not only help you identify when you present pelvic drop, but also how much progress you make as you commit to more running-specific training.
Common Cause #2: An Upright Trunk
Runners are often told to “run tall” or “keep your chest up.”
It’s a common cue that many coaches (or other runners) might suggest while you’re running. Plenty of people experience upper body fatigue and gradual changes in posture the further they are into a run, so this cue is meant to remind you not to hunch your shoulders or round your upper back.
Unfortunately, while the cue is well-intended, it often results in the common error of running too upright (or, in some cases, running with a slight backwards lean in the trunk):
This is often one of the trickier errors to catch with the naked eye, as it’s such a subtle aspect of your running form. Plus, it isn’t necessarily caused by any biomechanical deficiencies — more often than not, it’s the aforementioned cues that lead people to believe that they have to run with an upright posture.
Why an Upright Trunk Causes Low Back Pain
While pelvic drop is caused by deficiencies in your gluteal muscles, running with an upright trunk almost has the opposite effect: it puts your glutes at a disadvantage.
Ideally, when you run, you should implement a slight forward trunk lean (and we mean slight; it’s only about 8-10 degrees!). This primes your body to sit in a slight hip hinge, which allows for optimal glute activation and recruitment as you run.
But if you run with a fully upright trunk, or even just an insufficient degree of forward lean, you’re taking away the access to your glutes… and that’s where the compensation kicks in.
When the glutes aren’t being properly utilized to stabilize the body or absorb impact forces, your lumbar paraspinal muscles are forced to take over instead. These muscles aren’t built to handle the repetitive loading of your runs, so they end up taking in those exorbitant amounts of force and distributing them onto your passive anatomical structures.
This means that the path of your running impact forces are being directed towards the spine, rather than through the hip and glute muscles. Not only does this limit the amount of power your glutes can put towards stronger running, but it also means your lumbar spine and tissues are taking the brunt of the impacts in excessive amounts — which is exactly where that symptomatic low back pain comes from.
Running with an upright trunk can be especially detrimental to those who deal with stenosis, which is when your lumbar vertebrae are compressed close enough together to aggravate or pinch the nerves within your spine.
In this case, your upright posture can worsen stenosis, as extension-based postures in the spine can increase the load on your vertebrae and spinal nerves. The nerve roots that travel through the back and sides of your vertebrae end up getting compressed further with upright, backwards, or lateral bend in posture. (When you pair that initial aggravation with the high loading forces associated with running, you’re just adding insult to injury.)
Steps to Correct an Upright Trunk
Achieving a slight forward trunk lean isn’t particularly difficult; but, hitting that highly specific range of ideal trunk lean can be a little trickier. (How are you supposed to know what 8-10 degrees of forward lean even looks like, right?)
That’s why, when it comes to actually implementing trunk lean, we tend not to focus on the numbers in the moment. Instead, we utilize one of two cues that help runners get a physical feel of what enough trunk lean does for their running.
One cue is to act like you’re Superman, ripping open your work shirt to jump into action and save the world. The other is to pretend that you’re running into a strong wind, keeping your chest puffed out and leaning forward just enough so you don’t get knocked over.
In most cases, these cues are enough to help runners adapt their form on the fly and familiarize themselves with a slight forward lean. But, of course, there’s always benefit to honing your biomechanical foundation, as well…
Changing your trunk lean can be a simple adjustment in real time, but some runners have difficulty maintaining that positioning. To ensure that your body is up for the challenge, it’s essential that you implement exercises that develop gluteal control as well as muscular endurance in the low back.
(While there’s a wide range of exercises to choose from, here are a few running-specific drills we prompt our runners to do: bird dogs, Superman on a bosu ball, and squatting lat pull-downs.)
Common Cause #3: Over-Stride
You’ve likely heard about this one in some capacity or another; just about every resource will tell you all about the dangers of over-striding.
In its most basic definition, over-stride refers to the point at which your leading foot reaches too far out in front of you while running. (Though, there are actually a handful of specific parameters that can help define when your stride becomes an over-stride.)
Over-stride can be brought on by a myriad of reasons, but one of the most common causes is low running cadence. A low cadence often causes runners to elongate their strides to try and cover more ground per step. Unfortunately, most runners adapt by reaching farther forward, rather than extending their stride back.
(Interestingly enough, over-stride frequently presents itself alongside several of these other errors, as well. In particular, trunk lean and limited hip extension have the largest potential influence on over-stride, which you can read more about in the link above.)
Why Over-Stride Causes Low Back Pain
There’s a reason why over-stride is so commonly antagonized in the running community: it can lead to a whole host of biomechanical deficiencies, many of which can contribute to low back pain over time.
Over-stride positions your body in a way that limits sufficient joint flexion at your hips, knees, and ankles. This alone already increases your braking forces, as your legs are straighter upon landing each step. On top of that, when your joints aren’t bent enough upon impact, this limits proper muscle contraction in your glutes, quads, and calves — all of which are vital components for active shock absorption.
If these high impact forces don’t travel through your muscular system, they impose themselves on your passive structures instead, like your bones, joints, and ligaments.
The redundant impacts of your running will continuously add load and pressure against your bony anatomy. And even if these tissues weren’t built to transfer energy, the amount of force that your body sustains while running is powerful enough to travel up the bony structures of your leg and towards your low back.
Some runners may experience low back pain that’s caused by more than just that general loading on the bony anatomy. For instance, people who have sciatic nerve tension may feel more aggravation in the low back when they over-stride, as the leg that reaches forward sustains more forces, increasing tension on the affected nerve.
Additionally, many runners who over-stride also present other form errors (like an upright trunk). Which, you can imagine why it would be such an issue — an upright trunk takes away from efficient glute recruitment, directing forces towards the spine. Combine that with even higher braking forces and loading from over-stride, and you’ve got double the recipe for disaster.
Steps to Correct Over-Stride
There are several techniques that can assist you in your journey to eliminate over-stride.
Your primary goal is to limit how far your leading leg reaches out in front of you, making sure that it makes contact with the ground right beneath your center of gravity. Not only will this decrease the amount of force impacting your spine and legs, but you’ll also establish more effective joint flexion and muscle contraction by association.
In order to reign in that stride, though, there are several training aspects and cues that you should implement to create a smooth progression.
To start, it’s highly beneficial to practice isolated exercises that work on mobility at the hip and knee joints. Independently focusing on your joint flexion allows for improved muscle contraction and controlled range of motion as is necessary while running. You can achieve this kind of practice in tandem with running-specific muscle activation or strengthening exercises (like squats, hip hinge drills, or Bulgarian split squats).
Make sure you dedicate ample time to these drills before diving into actual form correction, as it won’t be an easy change at first.
Learning to apply those mechanics as you run is trickier than you might expect. But, that’s why we have a couple of tricks up our sleeves to help runners adapt their strides with different approaches.
One cue we often use is known as the “shopping cart drill,” which is a visualization cue we use for real-time running retraining. We simply prompt people to imagine that they’re pushing a shopping cart in front of them as they run, and that they want to avoid hitting their shins against it. Oftentimes, that cue is effective enough to keep runners from striding too far out.
However, the shopping cart drill isn’t the final solution to eliminating over-stride. We usually use this drill as a way to familiarize the body with the feeling of proper foot landing while the runner is still progressing through their training.
For long-term relief, runners see the best results by increasing their cadence (or, how many steps you take per minute). The higher your cadence, the faster your steps turnover, meaning you have less time to reach your leg out in front of you. (You’re effectively forcing your feet to land beneath you by taking more rapid steps!)
Common Cause #4: Limited Hip Extension
Alright, we’ve mentioned how important joint flexion is for preventing low back pain — and, sufficient extension can play a role in pain prevention, as well.
More specifically, we’re talking hip extension, or how far you can bring your leg out behind you as you run. (During your running gait, it begins with terminal stance and continues through the pre-swing phase.)
With a normal range of hip extension, your hamstrings, glutes, and calves are able to activate and contract as necessary, allowing for efficient running form and gait stride.
But, as you can infer, having limited hip extension will yield the opposite results: inactive muscles and improper contraction, leading to inefficient running and displaced loading forces.
The tricky thing with limited hip extension is that there are so many potential causes. Many runners simply have tight hips or hip flexors, but others may have more specific restrictions at the hip joint related to mobility or changes in the joint itself. Finally, they may just have decreased strength in their leg muscles that doesn’t allow them to effectively contract the muscles needed to extend the leg.
Why Limited Hip Extension Causes Low Back Pain
Your hip flexor muscle (more officially known as the “iliopsoas” or “psoas” muscle) runs from the inside of your thigh up to the side of your spine.
Because there is a direct connection between the thigh and spine, any tightness that occurs in the psoas muscle will end up pulling at the lumbar vertebrae. This line of pull increases the amount of extension in your lumbar spine (i.e., excessive curving in the low back), limiting the degree to which your leg can extend behind you.
As you can imagine in this case, extending your leg can create a lot of discomfort in the low back. Simply trying to stretch your leg further behind you will place increased pressure on your lumbar spine, compressing the vertebrae and creating that aggravating pain.
Additionally, limited hip extension can lead to muscular compensations similar to those associated with pelvic drop.
Many runners who have insufficient hip extension present an anterior pelvic tilt as they run. Not only does this further increase the curvature of your lumbar spine, but it also means that you’re positioned in a way that (once again) does not prime the glutes for activation. Consequently, many of the muscles in your back and abdomen have to take over for the sake of retaining stability. (Namely, the paraspinal muscles, your quadratus lumborum, and your obliques are the first three to step in.)
Steps to Improve Hip Extension
Fortunately, the fix for limited hip extension is quite straightforward: to start, all you truly need is a consistent stretching program for your hips.
Tight hips are so common these days because they’re brought on by sedentary lifestyle habits — sitting at a desk for work, commuting back and forth, sitting while watching TV. These positions keep our hip flexors contracted for long periods of time, which is what builds that tightness in the first place.
And while many of these scenarios feel like necessary or routine parts of our lives, these regular habits actively work against the range of motion and dynamism needed for successful running.
But! That doesn’t make it impossible to combat. Implementing consistent stretching will do just the trick to keep your hips from staying taut and limiting your runs.
Most traditional stretching programs will suggest holding each stretch for 30 seconds. However, our team has found firsthand that increasing your static stretches to 1-2 minutes can yield much better results.
This is because our muscles need a bit of extra time before giving into their own pliability. (If they immediately gave into a stretch, we wouldn’t be able to retain the same kind of strength or stability as we do.) By holding the stretch for a minute or two, we allow the tissue to truly relax into the stretch.
With that tip in mind, find the right stretching program for you. If you perform your stretches consistently for about 6-8 weeks, you’ll likely notice a major improvement in your back pain with running. (And by that point, you’ll just be in the habit of regularly stretching to prevent those same symptoms down the line!)
Get Back to Pain-Free Running
Countless medical professionals have told runners that the sport is bad for their back — but we know now how untrue that is.
Running itself is not the issue; it’s a matter of assessing and adapting your biomechanics to avoid common pain and injury. And, it’s also a matter of ensuring that we build our bodies up with the proper, progressive training to handle the rigors of running in the first place.
If you’re dealing with low back pain from running, don’t just focus on the symptoms! Dial into the true root cause of your pain and work with a specialist to set the next actionable steps to recovery.
By doing the foundational work for your training and honing your running form, you can fully eliminate your pain with running and finally get back to enjoying the sport you love.