Running With Low Back Pain: Should You Keep Going or Stop?

running action shot

Dr Brea Kunstler (Physiotherapist and Run Coach)

You wake up one day and “ouch!” Suddenly you feel pain in your lower back that you haven’t had before. Or perhaps you’ve woken up with stiffness and a feeling of dread that your back is about to “go out”. Or maybe you’re out and about, at work, or just doing your normal activities, when this horrible pain in your back makes you feel like you’ve aged 10 years in a few seconds.

Running with low back pain raises an obvious question. So what do you do, as a runner, if you start to experience back pain? Do you stop running and wait several days or weeks for it to resolve? Do you keep running and hope for the best? Or do you do something in the middle?

Before we talk about running and low back pain, let’s first look at the difference between serious low back pain that needs immediate treatment and back pain that will likely just resolve on its own.

Understanding Low Back Pain: Why It Happens

Low back pain can come in many different forms, and it can happen to anyone, regardless of their activity levels. That said, it’s more common in those who do less physical activity (Alzahrani et al., 2019).

Safety First: When to See a Physio

Low back pain can be caused by many different factors. For example, poor back strength during lifting can trigger it. Damage to different structures can also cause it, such as in acute pain. Sometimes, though, there’s no damage at all, or the damage has already healed. In this case, fear of movement and maladaptive practices linked to ongoing or chronic pain can actually prolong the disability.

Person performing a forward lunge exercise barefoot to improve running strength, balance, and lower body mobility during physiotherapy.

When Should You See a Physio?

Because low back pain is so complex, it’s worth seeking the advice of a qualified physiotherapist or medical professional if your pain persists for more than a few days. You should also seek advice if you notice any of the following signs and symptoms, known as “red flags” (Verhagen et al., 2016):

  • Numbness around your groin or “saddle area”
  • Sudden trouble peeing or controlling your bladder
  • You’ve had cancer before
  • You’re losing weight without trying
  • Your back pain doesn’t ease with rest, or it wakes you up at night
  • You recently had a significant fall or accident
  • You’re older, typically over 50–65
  • You take long-term steroid medications
  • You have a fever
  • You use steroids or medications that weaken your immune system
  • You inject drugs

If you’re navigating back pain and aren’t sure where to start, our musculoskeletal physiotherapy team can assess your symptoms and guide your next steps.

I Don’t Have Any Red Flags. Can I Run With Low Back Pain?

The short answer is yes.

Typically, if you can run comfortably without making the pain worse, either during or after your run, then it’s fine to keep doing what you’re doing. In fact, maintaining your regular activities is often recommended for people with low back pain. One of the worst things you can do for back pain recovery is to stop all activity and rest completely (MyBackPain, n.d.).

Clinicians use clinical guidelines as a “rule book” to help them understand what treatments to prescribe, and for which conditions. A 2024 systematic review, which compiled all the studies on this topic, found that clinical guidelines on low back pain commonly recommend exercise as a treatment. However, they rarely recommend specific exercises (Comachio et al., 2024). This means you have the flexibility to choose the exercise that works best for you, including the exercise you might already be doing. Walking and running can be more effective than doing nothing at all for low back pain. That said, some people might actually find more relief in lower-impact activities, such as strength training, swimming and cycling (Pocovi et al., 2022).

If you want tailored guidance on how running fits into your recovery, our run and exercise coaching program with Dr Brea Kunstler can help you build a plan around your body and your goals.

It's our Naram Melbourne physiotherapy clinic

Low back pain can be a painful and upsetting condition. It can stop people from doing the activities they love, and it can encourage them to rest more than they should to get better. It’s important to keep moving when you have low back pain, and to avoid complete rest, if you want to get better.

Make sure you reach out to one of our physiotherapists if your pain lasts more than a few days, or if you aren’t sure how to keep moving safely and enjoyably during your recovery. Be sure to check out MyBackPain’s treatment guide too, for a reliable summary of the evidence on different treatments.

If you’re a runner managing an ongoing niggle, our blog on whether running helps or hinders your bone health is also worth a read, along with our guide on Pilates and running for injury prevention.

References:

Alzahrani, H., Mackey, M., Stamatakis, E., Zadro, J. R., & Shirley, D. (2019). The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies. Scientific Reports, 9(1), 8244.

Comachio, J., Ferreira, M. L., Mork, P. J., Holtermann, A., Ho, E. K. Y., Wang, D. X. M., … & Ferreira, P. H. (2024). Clinical guidelines are silent on the recommendation of physical activity and exercise therapy for low back pain: A systematic review. Journal of Science and Medicine in Sport, 27(4), 257-265.

MyBackPain. (n.d.). MyBackPain. https://mybackpain.org.au/

MyBackPain. (n.d.). Low Back Pain Treatments. https://mybackpain.org.au/treatments/low-back-pain-treatments.

Pocovi, N. C., De Campos, T. F., Christine Lin, C. W., Merom, D., Tiedemann, A., & Hancock, M. J. (2022). Walking, cycling, and swimming for nonspecific low back pain: a systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 52(2), 85-99.

Verhagen, A. P., Downie, A., Popal, N., Maher, C., & Koes, B. W. (2016). Red flags presented in current low back pain guidelines: a review. European Spine Journal, 25(9), 2788-2802.

Need some help achieving your running goals? Book a telehealth appointment with Performance Medicine’s exercise and run coach, Dr Brea Kunstler, to see how she can help you achieve your goals. She can provide a referral to a trusted shoe provider who will give you 10% off the RRP of your new shoes.

Dr Brea Kunstler