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Lower Back Pain After Running: Causes, Treatment & Physio Advice

Written by Feroz Mansoor, MSK Physiotherapist
Stride Lab London
Clinically reviewed: August 2026

Lower back pain can be particularly frustrating for runners and it can be particularly confusing. Some people find running aggravates their symptoms, while others feel better once they start moving.

This article looks at what the science tells us about lower back pain and running, including spinal loading, discs, strength, biomechanics and when a running-focused physio assessment may be useful.

Why Does My Lower Back Hurt After Running?

Lower back pain after running can have several contributors, including a recent increase in running volume or intensity, muscular fatigue, reduced tolerance to repeated spinal loading, or sensitivity from the lumbar joints, discs or surrounding tissues. In some runners, pain is influenced more by prolonged sitting or spinal movement than by running itself. The important first step is identifying how the symptoms behave and what changed in training before they started.

Is running bad for your lower back — or can running actually be beneficial?

The scientific evidence increasingly suggests that running should not automatically be regarded as harmful to the lumbar spine. In fact, lower back pain appears to be relatively uncommon compared with many other running-related injuries, and appropriately dosed running may be compatible with — and potentially beneficial for — spinal health.

For runners with persistent symptoms, assessment by a running-focused physio can be useful because lower back pain is rarely explained by one factor alone. Training load, spinal movement, strength, running tolerance, sleep, previous episodes of pain and general health may all influence symptoms.

A good physio assessment should therefore look beyond simply identifying a painful structure.

How common is lower back pain in runners?

Lower back pain is extremely common in the general population, but running does not appear to place runners at uniquely high risk. A systematic review examining the prevalence and incidence of lower back pain among runners found that lower back pain occurred less frequently in runners than many other running-related injuries. This is an important starting point. Running involves repeated loading of the spine, but loading is not the same as damage. Bone, muscle, tendon and other biological tissues generally respond to appropriately dosed mechanical loading by adapting. The spine is no different. Problems are more likely to occur when the load being imposed exceeds the body’s current capacity to tolerate and recover from that load.

For a runner, the relevant question may therefore be less:

“Is running damaging my back?”

and more:

“Is the amount and type of running I am currently doing greater than my back is prepared for?”

Does running damage the discs in your back?

One of the most persistent fears surrounding running and lower back pain concerns the intervertebral discs. The discs sit between the vertebrae and help distribute load through the spine. Because running involves repeated ground-contact forces, it is easy to assume that thousands of running strides must gradually “wear out” these structures. Research does not support such a simple explanation.

A frequently cited MRI study published in Scientific Reports investigated long-term runners and found that people who regularly ran demonstrated signs of better intervertebral disc composition and disc hypertrophy compared with inactive individuals. This does not prove that running prevents disc problems or that everybody with disc-related pain should immediately start running. It does, however, challenge the idea that repeated running inevitably causes spinal discs to deteriorate. For a physio working with runners, this distinction is important because fear of spinal damage can sometimes become more limiting than the physical findings themselves.

Why does running sometimes trigger back pain?

Running may not inherently damage the spine, but it still represents a significant physical stimulus. During each stride, forces generated through ground contact must be transmitted through the feet, legs, pelvis and trunk. The muscles surrounding the hips, pelvis and lumbar spine repeatedly control these forces. If running duration, intensity or frequency suddenly increases, these tissues are exposed to a greater workload. Consider a runner who has comfortably completed three 5 km runs each week for several months. They start marathon training and within a few weeks their long run increases from 8 km to 18 km. The body is now being asked to tolerate considerably more repeated loading. The runner may have the cardiovascular fitness to complete the distance, but that does not necessarily mean every tissue has developed the same capacity. This is why cardiovascular fitness and musculoskeletal capacity should not be considered identical. You can feel aerobically comfortable while a particular structure gradually becomes more sensitive to load

Does running technique cause lower back pain?

Biomechanics are often blamed when a runner develops pain.

Common explanations include:

  • excessive anterior pelvic tilt
  • excessive lumbar extension
  • excessive trunk rotation
  • reduced hip extension
  • weak glutes
  • overstriding
  • excessive vertical movement.

These factors may be relevant in some individuals, but research does not support the idea that there is one “correct” running pattern that prevents injury. A systematic review examining whether running biomechanics are associated with running-related injuries found that the overall relationship between individual biomechanical variables and injury was limited. This has important implications for both runners and physios.

Seeing pelvic movement or trunk rotation on a treadmill video does not automatically mean you have identified the cause of somebody’s back pain.

A running physio should instead ask whether a particular characteristic:

  1. reproduces or influences symptoms,
  2. fits with the clinical history,
  3. is supported by physical examination, and
  4. produces a meaningful change when modified.

Running analysis is therefore most useful when it forms part of a broader clinical assessment rather than being used to identify arbitrary “faults”.

Is a weak core responsible for running-related back pain?

“Your core is weak” remains one of the most common explanations given to people with lower back pain. It is also an oversimplification. The trunk muscles certainly play an important role during running. They help control the relationship between the rib cage and pelvis while forces move between the upper and lower body. But lower back pain does not simply occur because the abdominal muscles are weak.

Some runners with excellent trunk strength develop back pain. Others with relatively poor trunk strength remain completely pain-free. Strength should therefore be considered as one component of physical capacity, rather than a binary concept of having either a strong or weak core. A systematic review investigating treatments for lower back pain in athletes found that exercise-based approaches generally reduced pain and improved function, although no single exercise programme was clearly superior. For a physio, this means rehabilitation can be tailored to the runner rather than automatically prescribing the same core programme to everybody.

Should runners train their legs as well as their backs?

Yes.

The lower back does not operate independently from the rest of the body. Running requires force to be produced and controlled through the calves, quadriceps, hamstrings, gluteal muscles and trunk. Reduced capacity anywhere within this system may influence how load is distributed. A randomised trial involving recreational runners with chronic lower back pain compared lower-limb strengthening with lumbar extensor and stabilisation exercises. The findings support a broader rehabilitation approach rather than concentrating exclusively on the painful lumbar area.

A running physio may therefore include exercises such as:

  • squats
  • split squats
  • deadlift variations
  • step-ups
  • calf raises
  • hip-extension exercises
  • loaded carries
  • trunk endurance exercises.

The important question is not whether an exercise is traditionally labelled a “back exercise”. It is whether it helps develop the physical capacity required for running.

Should you stop running if your back hurts?

Not necessarily. One of the most interesting developments in this area is research directly investigating running as rehabilitation for people with chronic lower back pain. The ASTEROID randomised controlled trial investigated a progressive running and education programme in adults with chronic non-specific lower back pain. The study found that running could be an effective exercise option for adults with chronic non-specific lower back pain. This is significant because runners with back pain have historically sometimes been advised to avoid impact exercise. Modern evidence makes blanket restrictions increasingly difficult to justify.

A physio assessing a runner should instead consider:

How much running can this person currently tolerate?

Suppose pain consistently develops after 60 minutes. Stopping all running for six weeks may not be required. A more appropriate strategy may be to temporarily reduce runs to 30–40 minutes, maintain cardiovascular conditioning and progressively build the runner’s tolerance back towards longer distances.

When should you see a physio for lower back pain?

A physio assessment can be useful when:

  • pain repeatedly occurs during running
  • symptoms are getting progressively worse
  • your normal running distance is reducing
  • pain persists despite modifying training
  • symptoms repeatedly return when mileage increases
  • sitting or spinal movement significantly influences symptoms
  • you are unsure how to return to running
  • you need a structured strength and conditioning programme.

A running-specific physio assessment may include:

  • detailed training-history review
  • lumbar movement assessment
  • neurological screening where indicated
  • hip and lower-limb strength testing
  • functional loading tests
  • running assessment
  • discussion of recovery and training progression.

The aim should not simply be to identify which spinal structure hurts.

The more useful objective is to understand why the runner’s current load is exceeding their present capacity and how that can be changed.

How much pain during running is acceptable?

There is no universal pain number appropriate for every diagnosis.

A mild, stable discomfort during running that settles soon afterwards is very different from progressive pain associated with weakness or neurological symptoms.

Useful questions include:

  • Does the pain increase throughout the run?
  • Does it alter your running technique?
  • Does it settle shortly after finishing?
  • Is it worse the following morning?
  • Is each successive run becoming more painful?
  • Are symptoms starting earlier?
  • Is pain spreading into the leg?
  • Is walking becoming painful?

A physio will often consider the response during the following 24 hours as well as what happens during the run itself.

If a runner completes a session with mild discomfort but returns to baseline by the next day, the training dose may have been tolerable.

If symptoms remain substantially aggravated for several days, the session may have exceeded current capacity.

What about disc-related back pain?

Some runners experience symptoms that appear mechanically influenced by spinal position.

Pain may be aggravated by:

  • prolonged sitting
  • repeated bending
  • getting up after sitting
  • sustained flexed positions.

Others find that specific spinal movements reduce their symptoms.

These patterns may provide useful information during a physio assessment, although symptoms alone cannot reliably identify one anatomical structure.

Importantly, the word disc should not automatically be interpreted as meaning that the spine is damaged or fragile.

Disc degeneration and disc bulges are common imaging findings, including in people without pain.

Clinical behaviour matters at least as much as scan terminology.

Do runners with back pain need an MRI?

Usually not initially.

MRI scans frequently demonstrate changes such as:

  • disc degeneration
  • disc bulges
  • facet-joint changes
  • reduced disc height.

Many of these findings also occur in pain-free people.

The NICE guideline for low back pain and sciatica advises against routinely requesting imaging in non-specialist settings unless imaging is likely to change management.

For most runners with uncomplicated mechanical lower back pain, a detailed physio and medical history plus physical examination may therefore be more useful initially than immediately arranging an MRI.

When is lower back pain more concerning?

Most running-related lower back pain is musculoskeletal and does not represent serious disease.

However, seek urgent medical assessment for symptoms including:

  • progressive leg weakness
  • significant or worsening numbness
  • changes in bladder or bowel control
  • numbness around the saddle or genital region
  • severe pain associated with systemic illness
  • unexplained weight loss
  • significant trauma
  • suspicion of fracture, infection or malignancy.

These are not situations where a runner should simply modify mileage and monitor symptoms.

What type of exercise is best?

There is no single best exercise for lower back pain.

A large Cochrane review investigating exercise therapy for chronic lower back pain concluded that exercise probably reduces pain compared with no treatment or usual care.

Useful approaches may include:

  • resistance training
  • walking
  • running
  • Pilates-style exercise
  • trunk endurance training
  • aerobic conditioning
  • general strength training.

A physio should therefore choose exercises according to the runner’s presentation rather than simply following one branded rehabilitation method.

For runners, there is also an important principle:

Eventually rehabilitation must prepare you to run.

Exercises performed on a treatment table may be useful early in rehabilitation, but they do not reproduce the repeated loading demands of a 10 km race, half marathon or marathon.

How should a physio progress return to running?

A typical return-to-running progression might involve:

Stage 1 – Restore comfortable daily movement

Walking, sitting and routine activities become manageable.

Stage 2 – Introduce short easy running

Run for a duration clearly below the previous symptom threshold.

Stage 3 – Increase duration

Gradually build continuous running while monitoring symptoms during the following 24 hours.

Stage 4 – Restore normal frequency

Progress towards the runner’s usual number of sessions per week.

Stage 5 – Reintroduce intensity

Add threshold running, intervals and hills progressively rather than simultaneously.

Stage 6 – Restore long-run capacity

The long run often creates the greatest cumulative loading exposure and may therefore be rebuilt more gradually.

A physio can help decide which variable should progress first.

Increasing mileage, speed and hills simultaneously may make it difficult to establish which element is driving symptoms.

Movement rather than fear

Modern lower-back-pain management has moved away from the idea that the spine must be protected from normal movement.

The World Health Organization guideline for chronic primary lower back pain recommends approaches including education and structured exercise rather than relying solely on passive treatment.

This is especially relevant to runners.

Fear of damaging the spine can lead some people to stop running long after the original painful episode has settled.

Reduced activity can then produce deconditioning, making returning to running more difficult.

A running physio should therefore aim not simply to reduce pain but to help the runner regain confidence and progressively restore capacity.

The key message for runners

Running should not automatically be considered harmful to the lower back.

Research suggests that lower back pain is not unusually common among runners, and long-term running has even been associated with potentially favourable adaptations within the intervertebral discs.

Emerging research also suggests that appropriately progressed running itself can form part of rehabilitation for some people with chronic non-specific lower back pain.

However, pain should not simply be ignored.

Consider:

What changed in your training?

How far can you run before symptoms develop?

How quickly do symptoms settle?

What happens the next morning?

Do symptoms spread into the leg?

Do you have adequate strength and conditioning for your current training load?

For many runners, successful management involves temporarily modifying running volume, maintaining physical activity, progressively strengthening the trunk and lower limbs and then rebuilding running exposure. A running-focused physio can help identify which factors are most relevant rather than simply blaming posture, a weak core or a scan finding. The objective is not to create a perfectly straight spine or eliminate every movement seen during running analysis. It is much simpler: build a runner whose back has sufficient capacity to tolerate the running they want to do.

Running Assessment in London

At Stride Lab London, our running assessments combine clinical reasoning with objective running data.

Depending on your needs, an assessment may include:

  • injury and training-history review
  • strength and functional assessment
  • treadmill running
  • video running analysis
  • sensor-based running data
  • cadence and stride characteristics
  • assessment of relevant asymmetries
  • real-time testing of running modifications
  • rehabilitation or performance recommendations.

Whether you are dealing with a recurring running injury, returning after rehabilitation or simply want to better understand your running mechanics, the aim is to provide useful information you can actually apply to your training.

Learn more about the Stride Lab London Running Assessment

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Contact Stride Lab London to arrange your assessment.

 

This article is intended for general educational purposes and does not replace individual medical or physiotherapy assessment. Seek urgent medical assessment for significant or progressive neurological symptoms, changes in bladder or bowel function, saddle numbness, significant trauma or other concerning symptoms.