4 Running Postures that Cause Back Pain

If you suffer from back pain when you run, your path to recovery can be simple. The fixes to stop back pain tend to be very basic movements that target fundamentals. I typically prescribe 2-3 exercises and, combined with my manual therapy, I get people pain-free in 1 week. But the more important question is, “why did you get back pain to begin with?” You’ve probably been a runner for a while now and have logged some miles in the past months, to only suddenly have unexplained pain in your back. A lot can be explained by the impact forces that occur when you run. I’d highly recommend reading my other BLOG post “3 Lies Told to Runners.” There are a lot of misconceptions and lies told to runners that biomechanically don’t make sense and you can find truths in my BLOG. 

Where you have pain can tell a lot about how you are running and why you have pain. Neck pain is not as common but can usually be an indication of a forward head posture when you run. Middle back pain is usually due to limited mobility combined with excessive arm sway, resulting in a rigid back posture. Low back pain is usually an indication of weak core muscles resulting in a forward hip posture. As you can see, your running posture can have dramatic effects on running back pain and performance.  Reach out to me to schedule a free consultation either in-person or online to stop your pain fast.

There are specific measurements I take of my runners like shank angles, shank angle at touchdown, max shank angles, reversal of swing, etc. but those are all biomechanical geek talk.  I don’t mind sharing my thoughts and measurements but that’s for a different discussion.  We’ll keep it basic here for you to be able to analyze how you run and adjust your posture.

Middle Back

You probably haven’t thought much about how you move your arms when you run, right? Typically, as runners, we focus on the legs and feet to improve performance, but did you know that all your speed, tempo, Fartlek, hill runs don’t mean anything if your posture is off in your middle back? You read that correctly. The movement of your middle back is crucial to your running performance because the most vital organ, your lungs, are right underneath and how you are breathing can dramatically impact your run. Most pain that originates from the middle back during a run is typically a sign of a hypomobile or rigid middle back.

Low Back & Hip Rotation

Often I find runners try to increase their pace by increasing their stride length (measured as the distance the foot travels). This often results in a heavy, heel strike pattern which increases the ground reaction forces on the body. For more information on that, check out my other blog about impact forces. When it comes to posture, increasing your stride length often results in a lot of rotation in the low back and pelvis. The best way you can measure this yourself is to try and feel for your ASIS, the bony parts located in the front of your hips. Try running and feel for those bony points. Typically, you will have some rotation so it’s okay if you’re rotating a little bit but if you notice your hands are moving a lot, then more than likely you’re rotating a lot at your lower back. Over time this can lead to back pain and, if not treated, injury.

Hip Flexion

When you run you want only a slight amount of hip flexion to allow a slight forward lean in your torso. The best way to notice this is by where your nose is relative to the horizon. Are you looking straight ahead or slightly up? Then your hips are in a good position. If you notice you are looking down, then you might be flexing at your hips more than you should. This can also be caused by an increased stride length and a straight knee when you heel strike. So, if that sounds like your running style, that could explain some of the back pain

Leg Posture

The leg is the part of the body most runners pay attention to and try to change. Usually, it all starts with knee pain and you want to stop it fast to be able to keep running.  Well, I hate to be the bearer of bad news but if you have knee pain when you run, the problem is 90% NOT your knee. You might be thinking, “well why does my knee hurt then” and the answer is simple. Your hip and ankle are very dynamic joints that work and move in so many complex ways with a variety of body tissues assisting resulting in problems arising quickly. Your knee on the other hand basically works in a flexion/extension movement (not saying other movements don’t happen but let's keep it simple) and unfortunately, due to that limited movement, the knee takes the brunt of the force of problems in other joints.

When you are running you want to land on the middle portion of your foot, as in a mid-foot strike pattern. You also want to have a slight bend in your knee and have your kneecap (patella) facing the direction you are traveling when your foot touches the ground. Analyzing this on your own can be a little difficult and to do it properly you’ll need a full camera set up to capture you running. A simpler way to analyze this is to evaluate your cadence (how many steps you take for every 1 minute you run). To do this, warm up to your typical pace, put your phone timer to 15 seconds, then count how many times your right foot strikes the ground in those 15 seconds. Take that number and multiply it by 2 (for each foot), then multiply that number by 4 (15 seconds x 4 = 1 minute). You want your cadence to be above 160 to be at a midfoot strike pattern. If it is below 160 then you are heel striking and placing excess forces on your body, likely leading to back pain.

Typically runners don’t usually get formal training on how to run. Many of us just throw on some shoes and go outdoors for a jog. Typically that is okay and if you progress slowly your body adapts to running in a natural way. But if you’re having middle back pain, low back pain, knee or foot pain at any point in your run, then you need to work on your posture and technique. Hopefully, this information will help get you started and possibly fix any issues you may have. If you are not able to fix your problem areas and the pain has not stopped or has gotten worse, reach out to a professional who can analyze your movement for you. I offer free, no obligation consultations to everyone.  I’m going to follow up this BLOG with a review of good stretches and exercises you can do to help avoid pain while you run. Your body is the most precious piece of equipment in your athletic career, so take good care of it.

~ Dr. Estrada, DPT, OCS

You Deserve the Best, Expect the Best

Dr. Estrada is an Endurance Specialist at EPRSG and has over 15+ years of experience. He has completed over 10+ half marathons, marathons, and triathlons. His experience ranges from swimming, running, cycling, mountain biking, and many other sports. He has coached many athletes ranging in ages from high school to senior athletes in their 90s.

Schedule your free consultation today to see how Dr. Estrada can improve your performance!