Blog 11: The Overuse Injuries Playbook
Part 11: Lower Back Pain: Why Your Back Hurts and How to Fix It for Good
Welcome back to The Overuse Injury Playbook. I'm Dr. Keirstyn, a chiropractor and endurance coach. In this series, we are breaking down the most common injuries that sideline athletes. In Part 1, we covered plantar fasciitis, in Part 2, we tackled Achilles tendinopathy, in Part 3, we broke down shin splints, in Part 4, we looked at runner's knee, in Part 5, we covered IT band syndrome, in Part 6, we looked at meniscus injuries, and in Part 7, we covered stress fractures, and in Part 8, we looked at high hamstring tendinopathy in Part 8, we looked at high hamstring tendinopathy, and in Part 9, we covered groin and adductor strains and in Part 10, we looked at hip flexor strains. Today, we are diving into the deep, nagging ache that makes every mile feel harder than it should: lower back pain.
It starts as a dull ache in your lower back during a long run. At first, you only notice it in the last few miles, when fatigue sets in and your form starts to break down. But as the weeks go on, the ache shows up earlier. Soon, it hurts to bend over and tie your shoes, and you feel stiff every time you get out of the car after a long drive. You might even notice that your back tightens up within the first mile of every run, and it takes forever to loosen up.
This is lower back pain, and it is one of the most common complaints I see in endurance athletes. The frustrating part is that it often gets better with rest, only to come back the moment you ramp up your training again. That cycle repeats because the pain resolves, but the underlying drivers do not.
What Lower Back Pain Actually Is
Your lower back, or lumbar spine, is built for stability and load bearing. It is designed to handle compressive forces and transfer power from your legs to your upper body. What it is not designed for is excessive movement, especially repetitive rotation and flexion under load.
Lower back pain in endurance athletes is rarely caused by a single traumatic event. It is usually an overuse injury caused by repetitive stress across the lumbar discs and facet joints that gradually exceeds the tissue's adaptive capacity. The pain can show up as a dull ache, a sharp pinch, or a deep stiffness that makes it hard to move freely.
The most consistent pattern I see is this: the pain gets better, the athlete returns to training, and within weeks or months it is back. What is happening is that 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.
Why Your Lower Back Is Overworking
Lower back pain is rarely just about the lower back itself. It is usually a sign of weakness and instability elsewhere in the chain.
Weak Glutes: If your glutes are not driving hip extension properly, your lower back has to work overtime to stabilize your pelvis with every stride. This creates excessive load on the lumbar spine that it was never designed to handle alone.
Restricted Hip Mobility: If your hips are tight and cannot move through their full range of motion, your lower back compensates by moving more than it should. This repetitive end range movement under load is a recipe for disc and facet irritation.
Stiff Thoracic Spine: If your mid back is stiff and cannot rotate properly, your lower back compensates by rotating more than it should. The lumbar spine is not designed for significant rotation, and forcing it into that role leads to pain.
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.
Load Spikes: 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.
How to Actually Fix Lower Back Pain
To heal lower back pain, we must reduce the irritation and build the strength and stability your spine needs to handle the load.
Manage the Load: Avoid activities that cause sharp pain or a lingering ache. If running hurts, reduce your volume and intensity. Keep your runs flat and at an easy pace. If running is too painful, swap it for swimming or flat road cycling to maintain your aerobic fitness without aggravating your back.
Build Glute Strength: Your glutes are the primary protective mechanism for your lumbar spine. Use the Glute Bridge and Single Leg Deadlift to build hip extension strength and take the load off your lower back. Strong glutes mean your lower back does not have to work as hard to stabilize your pelvis.
Improve Hip Mobility: Tight hip flexors and restricted hip extension force your lower back to compensate. Incorporate the Figure 4 Stretch and Pigeon stretch to release tension in your hips and restore proper movement.
Build Core Stability: Your core is designed to brace and stabilize your spine, not to crunch and flex it. Use the Modified Plank and Modified Dead Bug to build anti movement core strength that protects your lower back under load.
Improve Thoracic Mobility: A stiff mid back forces your lower back to rotate more than it should. Daily thoracic rotation work reduces the compensatory lumbar rotation demand that drives facet and disc irritation.
Manual Therapy: In the clinic, I use soft tissue therapy and joint mobilizations to restore proper movement to your hips, thoracic spine, and lower back, ensuring your pelvis is moving efficiently. I also assess your gait to identify any compensations that are contributing to the pain.
What to Watch For
If your lower back pain is accompanied by numbness, tingling, or weakness in your legs, it is a sign that the issue may involve nerve compression. These are red flags that require immediate attention.
Also, if you have been stretching your lower back aggressively and the pain is getting worse, stop. Overstretching an irritated spine can delay healing and create more instability.
Final Word
Lower back pain is the most common musculoskeletal complaint in the world. In athletes, it is also one of the most preventable. The path to a back that holds up through decades of sport is not complicated, it is consistent. Mobile hips, a thoracic spine that rotates well, glutes that fire, a core that braces rather than crunches, and movement patterns that load the hip rather than the lumbar spine.
Up next in Part 12, we will look at shoulder pain, the nagging ache that makes every swim stroke feel harder than it should.
Struggling with lower back pain that keeps coming back? Book an assessment with me, Dr. Keirstyn, at Endurance Therapeutics. Let's find the root cause and build a plan to get you back to training pain free.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161