Runners Get Less Back Pain, Not More
The SparkNotes
Across nineteen studies, back pain prevalence in runners ran from under 1% to about 20%.
In the general population the equivalent figures are far higher — a lifetime prevalence averaging around 47%.
The reviewers went as far as suggesting running may be protective for the lumbar spine.
They also said the underlying studies are few and methodologically weak, which is the part most people quoting this will leave out.
The risk factors that did show up are mostly things you can change.
The Whole Story
Ask most people what running does to your back and you will get some version of the same answer. All that impact. All that pounding. It must add up.
A systematic review of nineteen studies looked for the evidence that it does, and found close to the opposite.
The numbers
Across those studies, the prevalence of low back pain among runners ranged from 0.7 to about 20%, and incidence from 0.3 to 22%.
Set that against the general population. Lifetime prevalence of low back pain in the general adult population has been reported anywhere from 11 to 84%, averaging around 47. Point prevalence — how many people have it right now — averages around 18%.
And set it against other sports. Across athletes generally, lifetime prevalence has been reported from 1 to 94%, with rowing and cross-country skiing at the top of the range.
Runners sit at the low end of both comparisons.
The reviewers' own conclusion, stated cautiously: given the low levels of incidence and prevalence, running could be interpreted as a protective factor against the onset of low back pain.
Before you send this to someone
The same paper says the available studies are scarce and methodologically weak, and calls for better research. That is in their own key points, not buried.
Which means this is not proof that running protects your back. It is a consistent absence of the harm everyone assumes, across nineteen studies of varying quality.
That is still worth knowing. It is just not the same sentence.
And there is an obvious alternative explanation the review cannot rule out: people whose backs hurt tend to stop running. If your sample is people who currently run, you have partly selected for people whose backs are fine.
What did show up as a risk
The review pulled together the risk factors reported across the studies. Most are unremarkable, and that is the point — they are ordinary training and physical variables rather than anything about running itself.
Running for more than six years.
A body mass index above 24.
Greater height.
Not doing any other aerobic activity during the week.
Restricted hip flexion range of motion.
A leg length difference.
Poor hamstring and back flexibility.
Notice how many of those are modifiable, and notice what is missing. Not mileage. Not pace. Not surface. Not footwear.
The one worth sitting with is doing no other aerobic activity in the week — because that is a training-variety problem, and it is fixable by Thursday.
A change of language the authors argue for
One of their key points is a naming argument, and it is more useful than it sounds.
They suggest low back pain in runners is better described as a running-related DISORDER than a running-related INJURY.
Injury implies damage, a moment, a thing that happened. Most of this is not that. It is a sensitive back in a person who runs, which is a different problem with a different answer — and the answer is rarely to stop.
What happens when someone stops
It makes everything harder to come back from. The longer the break, the more fear-avoidant, deconditioned and weaker somebody gets.
There is a case to be made that a long stretch of rest — with no red flags and nothing more serious going on — leaves you at greater risk of developing pain somewhere else, purely from the deconditioning and the deloading.
And the longer you are off, the slower the ramp back has to be, because you are trying to avoid a sharp jump in acute load against a chronic exposure that has quietly dropped away underneath you.
Rest can be a good short-term answer for a day or two. Past that, working to a symptom threshold with guided movement is usually the better one.
What to do with it if you run
Do not treat back pain as evidence that running was the mistake. The population data does not support that.
Look at the modifiable list first: hip flexion range, hamstring flexibility, and whether running is the only aerobic thing you do.
If you have been running more than six years, you are in the higher-risk group — which is an argument for adding variety and strength work, not for stopping.
And if it does not settle, get it assessed rather than resting it. Backs respond to graded loading, and stopping is one of the least effective things you can do.
Follow along as Resurgo comes together.
Read next: Ten Things About Back Pain That Should Change How You Train · Why Avoiding the Painful Movement Stops Working