Running provides excellent aerobic conditioning for the body, but for some people the repetitive stress and impact that comes from running—especially long-distance running—can lead to back pain or aggravate existing back problems. If this is the case, is it necessary to give up running? Not always.

Sprains and strains to lower back ligaments, muscles, and tendons are common running injuries. These soft tissue injuries can occur suddenly or can be the result of prolonged stress sustained over weeks, months, or years running workouts. These types of injuries can usually be treated and the individual can return to running.

As a general rule, the risk of a back injury can be minimized by integrating minor changes to warm-up and training regimens, running shoes, running surfaces, and average daily distances. Improved conditioning of the abdominal, lower back, and other muscles involved in running is also essential to preventing back injuries.

Warm Up Thoroughly

Lower back sprains and strains are more likely to occur if an adequate warm up is not done prior to running. A thorough warm up should include the both the core muscles (abs and lower back) and leg muscles.

Examples of running warm-up exercises include:

  • Gradually building speed. Start with a slow 1 to 2 minute walk and then slowly working into a jog and then, ultimately, the full speed of the run.
  • Engaging in aerobic exercise. Aerobic exercises, such as burpees, push-ups, jumping jacks, or skipping rope may help warm the body up before a run.
  • Yoga. Engaging in even a few minutes of yoga prior to a run can help to stretch the back muscles out while also raising blood flow and preparing the body for exercise.

The goals of warm-up exercise is to facilitate blood flow and allow the muscles time to acclimate to the motion of running.

Cool Down

Just as it is valuable to warm up before running, cooling down after a workout is also important. Engaging in a cool-down routine can help the body transition to less-intensive physical activity. Common cool down activities include:

  • Reversing the start of a workout by slowing the pace of a run gradually until walking for 2 to 3 minutes
  • Riding slowly on a stationary bike
  • Engaging in dynamic stretching, such as yoga

Cooling down the various muscle groups activated by running can help to flush out the toxic metabolic breakdown products (i.e. lactic acid) and prevent soreness and injury. After cooling down, it is also important to gently stretch the lower back.

See Common Running Injuries: Back Pain


Invest in Well-Fitted Running Footwear

Experts recommend buying footwear suited to individual biomechanics. With this in mind:

  • Visit with a running specialist or doctor to determine any level of under- or over-pronation, stride length, and arch height.
  • Plan to replace running shoes every 250 miles or when they show significant wear.
  • Do not place shoes in the dryer, as this can change the shape of the shoe’s internal structure.
  • Running socks are also important. Choose socks that are not so tight that the toes bunch up or so loose that they slide down the heel while running.

It is best to allow low-mileage days to break in a new pair of shoes. Some people find a pair of shoes they particularly like and purchase several pairs that they can alternate over time, or have a backup pair when the original pair finally wears out.

When planning for a long run, consider using Vaseline or another skin barrier to protect the skin around the toe web spaces, toenails, and heels. This tactic is also valuable to protect the skin from water exposure if running on wet terrain or in the rain.

Improve Running Form

Running form can minimize impact on the back and other muscle groups involved in running. Advice on running form includes:

  • Keeping the chest aimed outward, with shoulders back and relaxed.
  • Pumping arms only forward and backward, never across the bod.y
  • Developing a comfortable striking motion from mid-foot to toes.
  • Taking shorter, faster strides rather than larger, bounding strides.

Running with improper form can dramatically increase the stress to the back and can contribute to joint injuries (hip, knee and ankle) developing over time. Some runners use a heel strike that can dramatically increase the stress on the bones, discs, muscles and ligaments of the spine. A visit to a running coach, who will take a video and provide an analysis and coaching, can go a long way in improving one's running form.

See Common Running Injuries: Back Pain


Commit to a Smart Running Program

Studies have shown that overtraining can be detrimental to overall conditioning as well as cause overuse injuries, such as stress fractures.1Lehmann et al. Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med 12 (1991); Oct;(5): 444-52. Abstract accessed February 4, 2015 In order to minimize the risk of overtraining:

  • Run only 3 to 4 times per week.
  • Do not increase both the distance and speed simultaneously; increase either the distance or the speed, and increase only gradually.
  • Incorporate cross training and stamina training into workout schedules.
  • Include at least one rest day per week in workout schedules.
  • Do not increase daily running totals by more than 2 miles per week.

If back pain occurs or persists despite these measures, take a break and seek medical attention from a doctor trained in sports medicine and/or back conditions. Much like being committed to improving running by adhering to a regular schedule, when injured one needs to be committed to appropriate rest and not try to sneak back into the running schedule.

To best achieve running goals, take the time to fully recover and then start over with conditioning and stamina exercises.

  • 1 Lehmann et al. Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med 12 (1991); Oct;(5): 444-52. Abstract accessed February 4, 2015

Dr. Isador Lieberman is an orthopedic surgeon at the Texas Back Institute. He has been performing spine surgery for more than 25 years. He has served as Professor of Surgery at the Cleveland Clinic Lerner College of Medicine and as Medical Director of the Scoliosis & Spine Tumor Program at Texas Health Resource Hospital.