Back pain in runners: navigating ups and downs

No wonder distance running is such a popular sport. Not only can it be done anytime, anywhere, the cost of equipment is minimal and the fitness rewards are high. Despite these big pluses however, there is a significant downside for athletes who choose to run, which is that the risk of picking up a lower-limb injury is comparatively high. For example, in a 6-month study of 87 recreational runners, at least one lower limb injury was suffered by 79% of the runners during the observation period⁽¹⁾. In another study of 583 habitual recreational runners, researchers found that over the 12-month observation period, 252 men (52%) and 48 women (49%) reported at least one lower-limb injury that was severe enough to affect running habits, resulting in a visit to a health professional, or requiring the use of medication⁽²⁾. Among the wider running population as a whole, research suggests that the risk of sustaining a lower-limb injury can be anything from one injury per 147 hours of training to as high as one injury per 17 hours of training⁽³⁾.

Back pain in runners

As we’ve alluded to above, most running injuries involve the lower limbs, affecting for example, the knees, hips, ankles, hamstrings etc. But it might surprise you to learn that the impact forces generated during running and the need to maintain posture and stability can also affect the trunk – specifically the health of the lower back⁽⁴⁾. And while running-related back injuries receive limited attention compared to lower limb injuries, the incidence of back pain in runners is surprisingly high with studies suggesting up to 20.2% of runners may be affected at any one time⁽⁵⁾.

In the research that has been carried out on lower back pain and running, there seems to be a link with high levels of lumbar lordosis (the natural curvature of the spine in the lower back region – see figure 1)⁽⁶⁾. That’s significant because lumbar spine posture changes with different gradients during running. And that matters because excessive lumbar lordosis is known to shown to result in greater spinal loading and shear forces in the forward/backwards direction compared to normal lordosis⁽⁷⁾. There has also been some evidence suggesting that compared to running on the flat, lumbar lordosis is increased during downhill running and decreased during uphill running⁽⁸⁾.

Figure 1: Normal lumbar lordosis vs. excessive lumbar lordosis