Blog 1: Lower Back Pain in Athletes
Part 1: Understanding Lower Back Pain in Athletes: The Types, The Causes and Why It Keeps Coming Back
Welcome to Lower Back Pain in Athletes. In this five-part series on one of the most common, most mismanaged, and most misunderstood injuries I, Dr. Keirstyn owner and chiropractor of Endurance Therapeutics, see in my practice. This series is for runners, triathletes, hockey players, golfers, cyclists, and every athlete in between who has dealt with lower back pain that just will not seem to fully go away.
First I am Dr. Keirstyn the owner and chiropractor at Endurance Therapeutics! We are starting with the clinical picture; what is actually happening in the lower back, why athletes are particularly susceptible, and why the way most people approach this injury is exactly why it keeps coming back.
Lower Back Pain Is Not One Thing
This is the part that most athletes miss entirely. Lower back pain is a symptom, not a diagnosis. And the treatment that works for one type of lower back pain can make another type significantly worse. Understanding which structure is involved is the foundation of actually fixing it.
The four main drivers I see in athletic lower back pain:
Muscle and Soft Tissue:
Strains, spasm, and trigger points in the erector spinae, quadratus lumborum, and multifidus. This is typically sharp at onset, improves with movement, and is directly related to a specific load or movement demand. Common in athletes who have dramatically spiked their training volume or returned to sport after time off.
Disc Related Pain:
The intervertebral discs sit between the vertebrae and act as shock absorbers. When they are compressed asymmetrically or repeatedly loaded in flexion under force, they can bulge or herniate, sometimes pressing on nearby nerve roots. Disc pain tends to be worse with sitting and forward flexion, and may refer pain into the glute, hamstring, or down the leg.
Facet Joint Irritation:
The facet joints are the small paired joints at the back of each vertebral level. They guide movement and share load with the disc. Facet pain is typically worse with extension and rotation, often felt as a deep, localized ache in the lower back that is worse first thing in the morning and after sustained postures. Very common in golfers and hockey players.
Sacroiliac Joint Dysfunction:
The SI joint connects the sacrum to the pelvis and is a significant load transfer point between the spine and lower limbs. SI joint pain is typically felt just below the belt line on one side, is often aggravated by single-leg loading, and is commonly seen in runners and triathletes. Frequently mistaken for disc pain.
In practice, these presentations often overlap. Many athletes with disc irritation also have facet involvement. Many with SI joint issues also have gluteal muscle dysfunction contributing to the picture. Treating one without addressing the others is why so many athletes cycle through periods of improvement and flare.
Why Athletes Are Particularly Susceptible
There is a common assumption that athletic people have stronger, more resilient backs than sedentary people. In some ways this is true, the muscles surrounding the spine in well-trained athletes are generally more developed. But athletic training also creates specific vulnerability patterns that are just as real:
Repetitive asymmetrical loading — sports like golf, hockey, and tennis involve repeated rotation in one direction. Over thousands of repetitions, this creates asymmetrical loading across the lumbar discs and facet joints that gradually exceeds the tissue's adaptive capacity.
Sustained flexion postures — cyclists and triathletes spend hours in a hip-flexed, lumbar-loaded position on the bike. The discs and posterior spinal structures are under sustained compressive and tensile forces that accumulate across a training season.
Compensation patterns — when the glutes are inhibited, the hip flexors are tight, or the thoracic spine is restricted, the lumbar spine compensates. It moves more than it should, in directions it is not designed for, under loads it was never meant to handle alone. The lumbar spine is built for stability and load-bearing — not for the rotation and repeated end-range movement that compensation forces it into.
Load spikes — as we covered in our Load Management series, sudden increases in training volume or intensity without adequate preparation are among the most reliable injury triggers available. The lower back is often the first structure to express that overload.
Why It Keeps Coming Back
The most consistent pattern I see with lower back pain in athletes is this: it gets better, the athlete returns to training, and within weeks or months it is back. The cycle repeats. What is happening is that the pain resolves but the underlying drivers do not.
Rest reduces the inflammatory response and makes the pain tolerable. But the gluteal inhibition that was overloading the lumbar spine is still there. The hip mobility restriction that was forcing the lower back to compensate for movement the hip could not produce is still there. The thoracic stiffness that prevented proper rotation through the mid-back is still there. The athlete goes back to training with the same movement patterns, the same loading demands, and the same underlying deficits, and the same structure fails again.
This is why the rest of this series matters. Parts 2 through 4 address the actual drivers. Part 5 brings it together into a plan that protects the back for the long term.
Up Next: The Real Drivers
In Part 2 of Lower Back Pain in Athletes we go deep on the three physical factors that are behind the majority of athletic lower back pain; weak and inhibited glutes, restricted hip mobility, and a stiff thoracic spine. Understanding how each of these drives lumbar load is the key to breaking the cycle. See you there.
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Lower back pain that keeps coming back is not bad luck, it is a sign that the underlying drivers have not been addressed. I work with athletes across every sport to find what is actually driving the problem and fix it properly. Reach out to book an assessment at Endurance Therapeutics.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161