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How To Handle That Persisting Low Back Pain

If you’ve experienced low back pain, you should know two things: 1. We’re sorry! This is one of the worst afflictions. 2. Relief is possible—but you have to be patient, because the pain may come from a variety of sources.

As with many symptoms runners experience, lower back pain is rarely the result of just one issue. “Most runners have a unique mix of factors that produce mechanical stress on their bodies—deficits in strength, mobility or coordination of core, hip or leg muscles; postural deficits and gait mechanics,” says Alison Gillespie, a physical therapist in Seattle who specializes in treating runners.

Self-diagnosing pain can be tricky, so see a doctor or physical therapist. But if you’re up for some detective work, start here.

Adjust your alignment.

When your pelvis is in a neutral position, the load on your spine is evenly distributed, and you’re less likely to experience low back pain. But if your pelvis tilts forward (anterior) or backward (posterior), your spine and the muscles that work to keep it stable are put in a mechanically disadvantaged position.

For instance, a runner with tight hip flexors and quadriceps may find herself in an anterior pelvic tilt, which can increase compression on the vertebrae, according to Gillespie. “Add the impact loading from  many miles of running and bingo—back pain,” she says.

Another common scenario is the runner who tends to grip her glutes, which can lead to a tucked tailbone—or posterior pelvic tilt, says Micaela Zettel, a physical therapist who treats athletes in Ontario, Canada.

So how do you find neutral? Zettel recommends shifting your weight forward or backward until it is distributed evenly over your feet. Your ribs should be stacked over your hips. To check, test your breathing. When you inhale, the area around your lower ribs should expand—not your chest or belly. Finally, if you notice yourself gripping your glutes, allow your bum to relax and gently untuck.

When running, Zettel says to lean slightly forward so that your foot strikes the ground underneath you (not out in front). Aim for a cadence of 170–180 steps per minute.

Strengthen your core and glutes.

“When physical therapists talk about core muscles, what they’re interested in is the tiny slow-twitch postural muscles that help stabilize the spine,” says Gillespie. “If these muscles are not firing in a coordinated way, your power-producing muscles—such as the hip flexors, glutes, rectus abdominus and erector spinae muscles—will pull on the spine and destabilize it.”

Train your deep core muscles to work together with exercises that incorporate your pelvic floor muscles as well. Bird dogs, planks and bridges are good ones.

Having weak or inactive glutes also puts you at increased risk for low back pain. Because many women tend to be quad-dominant, Gillespie recommends starting with exercises that isolate and activate the glutes like clamshells, band walks and donkey kicks—then gradually integrating functional movements, such as squats and lunges.

Upgrade Your Seat

We’ve been told that sitting is bad for our bodies. But did you know it’s not just the duration, but also how we sit that impacts our health? Zettel offers the following steps to keep low backs happy.

  • Sit on the bony part of your butt to achieve a neutral pelvis. You may need to untuck your tailbone and lift the fleshy parts to find it.
  • Line up your sternum with your pubic bone. You may need to either drop your ribs or lift your chest.
  • If needed, use a back support to help keep your ribs stacked over your pelvis. On a long drive, you can roll up a towel to put along the small of your back and maybe another to place vertically between your shoulder blades.
  • Get up and take breaks whenever possible.