Low Back Pain and Running: Understanding Why It Happens and Why It Sticks Around

Low back pain is one of the most common complaints among runners. Maybe not as common as knee pain or Achilles tendonitis, but it's there. Some experience a sharp, sudden onset of pain after a single training session. Others deal with a dull, nagging ache that lingers for weeks or even months, flaring up during long runs or speed sessions. It's complex and may be a bit different for everybody. While many runners assume low back pain comes from a single structural problem—like a disc issue, a “weak core,” or poor posture—the truth is much more complex.

In this post, we’ll break down how low back pain develops in runners, why acute pain sometimes becomes chronic, and why addressing multiple factors (not just biomechanics) is the key to long-term relief.

How Low Back Pain Happens in Runners

Running is often thought of as a “lower body” sport, but your spine is central to the movement. The low back (lumbar spine) and pelvis act as a shock absorber and stabilizer with every stride. When you run, ground reaction forces travel from your feet up through the legs, hips, and into the spine. If that system is imbalanced, your back can take on more stress than it should.

Common biomechanical contributors include:

• Hip stiffness or weakness – Limited hip extension can cause compensatory movement in the lumbar spine.

• Poor trunk control – Weak or delayed activation of the deep core muscles may leave the spine less supported.

• Stride mechanics – Overstriding or excessive pelvic tilt could increase strain on the low back.

• Training errors – Sudden increases in mileage, speed, or hill work can overload tissues faster than they can adapt.

These issues can lead to irritation of muscles, ligaments, discs, or joints around the lumbar spine. But here’s where the story gets more complicated: not every runner with “imperfect” mechanics or a structural change in their spine experiences pain. Some runners with disc degeneration on MRI scans run pain-free, while others with no visible structural changes suffer with chronic discomfort.

The Complexity of Low Back Pain

Research over the past two decades has shifted how we understand pain. Low back pain is no longer seen as just a “structural problem” but as a biopsychosocial condition—meaning biology, psychology, and social context all play a role.

This explains why two runners can have the same training error or the same MRI finding, yet one recovers quickly and the other develops chronic pain.

Factors that influence low back pain include:

• Physical load: Training intensity, volume, recovery, and biomechanics.

• Physiological factors: Sleep, nutrition, systemic inflammation, and overall fitness.

• Psychological factors: Stress, anxiety, fear of movement, and catastrophizing (“my back is ruined”).

• Social context: Work demands, family stress, lack of social support, or even cultural beliefs about back pain.

In short, pain is not just about tissue damage. It’s the brain’s interpretation of threat, influenced by many overlapping factors. And before you go running for that x-ray or MRI, know this: "arthritis" can happen at any any in the spine, as early in your 20s. These changes are a natural part of aging, and can be present in individuals as old as 90, even though they have no pain. Why is that? Shouldn't pain get worse as we get older since arthritis worsens as we get older?

Not necessarily. Most back pain occurs in the middle age ranges, from 40-60. When we have high stress, we may not exercise as much as we used to, and all the social and psychological and physiological factors are the main drivers for why pain sticks around, even though the biological issues are healed.

Why Acute Pain Becomes Chronic

Most episodes of acute low back pain improve within a few weeks. But for some runners, pain becomes persistent or recurrent.

Here’s why acute pain can stick around:

1. Sensitization of the nervous system
   When pain signals fire repeatedly, the nervous system can become more sensitive. Over time, even normal movements (like jogging or bending forward) can trigger pain because the system is “on high alert.”

2. Fear-avoidance cycle
   Runners often respond to pain by avoiding movement. While rest feels safe, too much inactivity can cause deconditioning, stiffness, and greater sensitivity to load when running is reintroduced. This cycle can reinforce pain.

3. Stress and recovery mismatch
   Chronic stress—whether from training load, work, or life—reduces the body’s ability to heal. Studies show poor sleep and high stress are strong predictors of persistent back pain.

4. Misinterpretation of pain
   Many runners are told their back is “weak,” “damaged,” or “unstable,” which can create fear and hypervigilance. In reality, the spine is a strong and adaptable structure. Fear-driven movement avoidance often does more harm than good.

Breaking the Cycle

The good news is that low back pain, even when chronic, is highly treatable. Instead of chasing one single “fix,” runners benefit most from a comprehensive approach:

1. Restore movement and load tolerance

• Graded exposure to running, strength training, and mobility work helps build resilience. Build slow, keep pain at 3-4/10 or below, and progress each week.

• Core and hip strengthening can support spinal mechanics, but the goal isn’t “perfect form”—it’s tolerance and adaptability.

2. Address lifestyle factors

• Prioritize sleep, protein intake, and hydration to support tissue recovery.

• Manage stress through mindfulness, journaling, or mental skills training.

3. Challenge unhelpful beliefs

• Remember: pain does not equal damage. MRIs often show “abnormalities” in pain-free athletes.

• The spine is robust—it’s designed to handle load, even in long-distance running. It's strong and stable and is meant to bend, twist, and extend.

4. Use variety to build resilience

• Cross-training (cycling, rowing, swimming) can help maintain fitness while reducing repetitive strain.

• Varying terrain and pace keeps your body adapting and your spine challenged in different ways.

The Takeaway

Low back pain in runners is rarely the result of one single “flaw.” Yes, biomechanics and training load matter—but so do sleep, stress, mindset, and overall health. Acute pain becomes chronic when the nervous system gets stuck in a heightened state, often fueled by fear, stress, and avoidance.

The path forward is not found in total rest or chasing the “perfect” posture. It’s about building resilience—physically and mentally—so your spine can handle the demands of running.

Time and again, the research is clear: runners who return to movement, challenge unhelpful beliefs, and address the whole picture—not just the painful area—recover better and stay pain-free longer.

So if low back pain has been holding you back from running, know this: your back is strong, your body is adaptable, and with the right approach, you can get back to training, racing, and enjoying the sport you love. If you're struggling with back pain and want to get back to racing, click here to schedule your free call with me.