Running & Low Back Pain

Low back pain is one of the most common sources of musculoskeletal pain, with an estimated 65-80% of the total population likely to experience it at some point throughout their lifetime. [7]

Of the various ways to treat low back pain, exercise is usually used first-line; among other modes of treatment. [8]

When thinking of what exercises you might use to ward off low back pain, running might not be the first one to come to mind.

However, there is a growing body of research to suggest that it might be rightfully placed toward the top of this list.

So, the aim of this article is to discuss this research and break down what the relationship actually is between running and low back pain.

We’ll talk about:

• What the risk of low back pain from running is

• The effect of running on low back pain

• Possible mechanisms through which running might influence low back pain

Table of contents

The plan for this article is as follows:

• Prevalence of low back pain (LBP) in runners vs non-runners

• Effects of running on people with chronic LBP

• Possible mechanisms

  • Increased intervertebral disc height

  • Psychological effects

  • Increased physical activity

• Bullet-point take-homes

Prevalence of LBP in runners vs non-runners

As we mentioned before, low back pain is highly prevalent.

The chance that the average person will experience back pain at some point in their life is significantly greater than the chance that they will never experience it.

However, these statistics are in regard to the total population, not individual categories of the population such as runners vs non-runners.

A 2020 systematic review set out to identify what the prevalence of low back pain is in runners specifically.

The numbers they found looked dramatically different- with prevalence of low back pain being somewhere between 0.7-20.2%. [6]

While there isn’t as much data available to draw from compared to the total population, it’s certainly a more appealing number than the 65-80% that’s commonly reported more broadly.

I want to be clear, though: this does NOT mean that if you run you can avoid low back pain entirely.

There are various reasons why low back pain may come up.

This just means that people who run tend to experience low back pain less often and to a lesser severity than those who don’t run; on average.

What does this mean? Why does this matter?

Well, it suggests that there may be a protective effect of running from low back pain.

From these numbers alone, it can be said that if you are a runner then you are less likely to experience back pain.

Why this may be the case will be discussed shortly.

Effects of running on people with chronic LBP

Just before, we looked at the likelihood of back pain arising in runners vs non-runners.

Now, let’s flip the script.

If you had current back pain and you began a running program, what would happen?

Well, a randomized controlled trial from this year (2025) [1] looked at this question exactly.

The researchers took 40 adults with chronic low back pain and had them begin a run/walk interval program.

Each subject underwent three 30-minute run/walk workouts per week. The workouts were scaled to the person’s ability and progressed over the course of 12 weeks.

At the end of the 12 weeks, although the pain was not eliminated entirely, all of the subjects reported decreases in their pain and disability.

Furthermore, none of the subjects experienced increases in their symptoms, indicating that running was safe for them despite their pre-existing back pain.

Possible mechanisms

To summarize the previous two sections: running seems to be safe and beneficial for preventing and reducing severity of back pain.

But, why would this be? Why would running be helpful for low back pain?

As far as I can tell, there’s three reasons that are most likely:

• Increased intervertebral disc height

• Psychological influences

• Physical activity increases

Increased intervertebral disc height

To me, one of the most interesting aspects of running is the effect that it seems to have on your intervertebral discs.

So, let’s talk about what this means and what’s actually happening.

Your spine is made up of alternating segments of vertebrae (bone) and intervertebral discs.

One function of these discs is to act as a shock absorber. Without them, your spine would be one long stretch of bone and fractures would become more likely.

These discs are made up of a network of connective tissue as well as compounds called proteoglycans. These proteoglycans act like a sponge, absorbing water and hydrating the disc.

This has two effects worth mentioning for the purposes of this article.

First, it helps to increase the shock-absorbing capacity of the disc.

Second, it increases the height of the disc.

With age, though, the proteoglycan concentration in our discs decreases, leading to a decrease in intervertebral disc height. [10]

The risk of some forms of lower back pain, such as stenosis or disc related pain, may increase as a result. [11,12]

Running as a form of exercise is unique insofar that it imposes a high volume of impact on your body.

Among other forms of adaptation, one of the ways you get better at running is by becoming better able to handle this high volume of impact.

Since the discs are responsible for shock absorption throughout your spine, it makes sense that there may be a connection here.

Cross-sectional studies suggest that people with a history of running tend to experience significantly less age-related changes to their intervertebral discs than those without a history of running. [4,5]

Furthermore, those with a longer history of running as well as those who ran greater distances per week tended to be even better off than those with a lesser running history. [4]

In my view, this provides a plausible explanation for why prevalence of low back pain in runners is so much less than in the general population.

That said, in that same data set where researchers had people with back pain begin run-programs, they also measured changes in intervertebral disc height. [3]

Although the data are not yet published, one of the authors noted on a recent podcast that there did not seem to be any significant changes in disc height.

This suggests that 12 weeks may not be long enough to elicit the changes that occur at the intervertebral disc specifically.

Or, it could be the case that running limits the age-related decline that naturally occurs. In other words, there may still be an age-related decline that occurs, it just happens more slowly and leaves you with greater disc height in your later years than if you hadn’t been running.

So, to understand why these people with low back pain saw relief from running, we must look to other reasons; such as those pertaining to psychology.

Psychological influences

Another analysis that was performed on the low back pain patients who underwent a running program looked at the subjects’ fears and beliefs regarding running, exercise, and the resilience of their backs & bodies. [2]

Broadly speaking, the subjects went from viewing running as dangerous for their back to viewing running as safe as well as viewing themselves as more resilient than they thought previously. 

This alone could have been a very powerful factor influencing the reduction in back pain that the subjects experienced.

The relationship between our beliefs about pain & injury and the actual pain we experience is much more profound than most people give credit for.

Pain is meant to serve as a proxy for damage.

Sometimes pain is a good measurement of damage endured by the body. If you were to roll your ankle right now and sprain a ligament, the nerves around that area and in your spinal cord would sensitize and send a feeling of pain to your brain. [14,15]

The purpose of doing so would be to protect this area and discourage you from doing further damage.

Other times, though, pain fails to serve as a good measurement of damage.

In other words, pain may be present in the absence of any tissue damage. [16]

Why this would happen isn’t very well understood.

One thought is that there could have been previous damage that healed, but the sensitized nerves sending the pain signals fail to desensitize. In this case, the signal of pain would remain in the absence of any damage.

This is thought to be a big contributor to states of chronic pain.

Another factor, though, is what we believe and think about pain, injury, and how resilient our bodies are. [13]

In other words, if you believe that deadlifts are dangerous for your back, then you are more likely to experience low back pain after deadlifting.

If you have low back pain and believe that an activity, such as running, will make it worse, then you may be more likely to experience a worsening of symptoms after running.

In a sense, your body will be looking for the pain, and if it looks hard enough it may very well find it; or create it.

This is thought of as a nocebo effect; the opposite of a placebo effect.

For instance, if you take a pill you think will have benefits and then you experience those benefits, that is a placebo effect.

If you take a pill you think will cause harm and then you experience that harm, that is a nocebo effect.

If these beliefs are challenged and changed, though, then your likelihood of experiencing pain decreases.

This doesn’t necessarily mean that you can just think your way out of these beliefs.

I often describe this to people in the following way: we can convince your conscious mind that an activity is safe, but your subconscious mind may not be on board.

To convince that aspect of you, it would take a graded exposure approach where you undergo the activity that is seen as dangerous and slowly build it up over time.

In the 12 week running study in low back patients mentioned before, the subjects performed run/walk intervals where the majority of time was spent walking in the beginning.

It was very low-level, low-effort, and well tolerated by all subjects.

Over time, this slowly progressed to spend more time running and less time walking.

Basically, this provides evidence to your "subconscious mind” that the activity is safe and there is no need to worry.

These same themes can be said for your lower back and other joints more generally.

If you understand that they are truly resilient, they are not fragile, and they can adapt and improve, then you will be less likely to experience pain.

Graded exposure as described previously is one way to achieve this understanding.

Physical activity increases

Sedentary behavior is considered a significant factor for a wide array of chronic diseases, and increased physical activity is one of the most potent means of reducing chronic disease risk.

My aim here isn’t to convince you that exercise is healthier than sitting on the couch.

My aim is to say that this same relationship exists for low back pain as well.

Individuals who are sedentary are more likely to experience low back pain than those who are active. [18]

Similarly, evidence suggests that increased physical activity is associated with decreases in low back pain risk; although risk doesn’t seem to decrease in perfect proportion with physical activity increases. [9,17]

With that said, the subjects in the study at hand [1,2,3] may have experienced decreases in their low back pain just by way of increasing physical activity.

Now, none of these effects are likely serving as the single and sole reason why running seems to be beneficial for low back pain.

They are likely additive in nature.

Nevertheless, these three are the most probable causes for this association.

Take-home messages

We’ve covered a lot so far.

Here are some bullet-point thoughts to take home:

• If you are currently experiencing low back pain or have dealt with chronic low back pain, running is likely to improve your symptoms & function so long as appropriate amounts & progressions are used.

• Similarly, running is unlikely to worsen low back pain symptoms and seems to be safe in such conditions.

• Running may have a protective effect on your back by either limiting the natural age-related decline that occurs or by the discs themselves adapting and increasing over time.

• The answer to which is truly happening seems to be unanswered in the research thus far.

• Your spine & body overall is much more resilient and adaptable than you may give it credit for. If you understand this, pain frequency & severity is likely to be lower.

• Similarly, if you view your body as “fragile” (which is NOT reality), pain frequency and severity may be higher.

• Performing regular activity and adapting to that activity is a good way to prove to your "subconscious mind” of this reality.

References

1. Neason C, Samanna CL, Tagliaferri SD, et al. Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial. Br J Sports Med. 2025;59(2):99-108. Published 2025 Jan 2. doi:10.1136/bjsports-2024-108245

2. Neason C, Samanna CL, Tagliaferri SD, et al. Fears and beliefs about running in adults with chronic low back pain: a mixed methods study from the ASTEROID randomised controlled trial. Sports Med Open. 2025;11(1):66. Published 2025 Jun 8. doi:10.1186/s40798-025-00861-6

3. Tagliaferri SD, Belavy DL, Bowe SJ, et al. Assessing safety and treatment efficacy of running on intervertebral discs (ASTEROID) in adults with chronic low back pain: protocol for a randomised controlled trial. BMJ Open Sport Exerc Med. 2023;9(1):e001524. Published 2023 Jan 17. doi:10.1136/bmjsem-2022-001524

4. Belavý, D., Quittner, M., Ridgers, N. et al. Running exercise strengthens the intervertebral disc. Sci Rep 7, 45975 (2017). https://doi.org/10.1038/srep45975

5. Mitchell UH, Bowden JA, Larson RE, Belavy DL, Owen PJ. Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study. PLoS One. 2020;15(2):e0229457. Published 2020 Feb 21. doi:10.1371/journal.pone.0229457

6. Maselli F, Storari L, Barbari V, et al. Prevalence and incidence of low back pain among runners: a systematic review. BMC Musculoskelet Disord. 2020;21(1):343. Published 2020 Jun 3. doi:10.1186/s12891-020-03357-4

7. Urits, I., Burshtein, A., Sharma, M. et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep 23, 23 (2019). https://doi.org/10.1007/s11916-019-0757-1

8. Shipton, E.A. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther 7, 127–137 (2018). https://doi.org/10.1007/s40122-018-0105-x

9. Alzahrani H, Mackey M, Stamatakis E, Zadro JR, Shirley D. The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies. Sci Rep. 2019;9(1):8244. Published 2019 Jun 3. doi:10.1038/s41598-019-44664-8

10. Machino M, Nakashima H, Ito K, et al. Age-related degenerative changes and sex-specific differences in osseous anatomy and intervertebral disc height of the thoracolumbar spine. J Clin Neurosci. 2021;90:317-324. doi:10.1016/j.jocn.2021.06.020

11. Mohd Isa IL, Teoh SL, Mohd Nor NH, Mokhtar SA. Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. International Journal of Molecular Sciences. 2023; 24(1):208. https://doi.org/10.3390/ijms24010208

12. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. doi:10.3174/ajnr.A4498

13. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J. 2011;11(9):895-903. doi:10.1016/j.spinee.2011.08.006

14. Hoegh M. Pain Science in Practice (Part 3): Peripheral Sensitization. J Orthop Sports Phys Ther. 2022;52(6):303-306. doi:10.2519/jospt.2022.11202

15. Hoegh M. Pain Science in Practice (Part 4): Central Sensitization I. J Orthop Sports Phys Ther. 2023;53(1):1-4. doi:10.2519/jospt.2023.11569

16. Hoegh M. Pain Science in Practice (Part 5): Central Sensitization II. J Orthop Sports Phys Ther. 2023;53(2):55-58. doi:10.2519/jospt.2023.11571

17. Alzahrani, H., Mackey, M., Stamatakis, E. et al. The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies. Sci Rep 9, 8244 (2019). https://doi.org/10.1038/s41598-019-44664-8

18. Baradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R. Association between sedentary behavior and low back pain; A systematic review and meta-analysis. Health Promot Perspect. 2021;11(4):393-410. Published 2021 Dec 19. doi:10.34172/hpp.2021.50