“I can’t run because of my back”
Sound familiar? If I had a pound for every time I heard somebody say this I’d be writing this blog from my private yacht in the Caribbean, and not in rainy Manchester. It is a common concern for people with low back pain.
Is Running an acceptable and effective treatment for Adults with Chronic Low Back Pain?
I write this on the back of reading the recent ASTEROID study from Neason et al. (2024), which answers this common question among patients. Chronic (or persistent) low back pain is a widespread issue that affects millions of people globally. It remains one of the most common conditions we see in physiotherapy clinics. While various forms of aerobic exercise are known to help reduce pain and disability, running has often been considered a high-impact activity and often avoided by individuals suffering from LBP due to fear of further harming or damaging their back. However, recent research suggests that running may not only be safe but potentially highly effective for those dealing with chronic back issues. This study provides valuable insights into this debate, exploring whether running is a viable form of exercise for adults with chronic non-specific low back pain.
They say you can’t out run a bad diet, but can you out run a bad back?
Exercise, particularly aerobic exercise, is a well-established treatment for chronic LBP. Research consistently shows that exercise reduces pain, improves function, and lowers the risk of disability associated with back pain. Whether it’s walking, cycling, swimming, or other lower-impact exercises, staying active is a critical component in the management of back pain.
However, despite the proven benefits of physical activity, there is an ongoing stigma that running, due to its higher impact on joints and tissues, may exacerbate LBP rather than alleviate it. Many patients and even healthcare providers lean toward lower-impact exercises like walking or swimming, often shying away from running. Are these concerns justified or is it a myth?
It is interesting to note that recreational runners tend to have lower rates of chronic LBP and healthier spinal tissue compared to non-runners. This supports the idea that running, when done correctly, may help maintain or improve spinal health.
What the ASTEROID Study Reveals
The recent ASTEROID study investigated the safety and efficacy of running in individuals with chronic LBP. The study focused on 40 participants aged 18-45 years, all of whom suffered from chronic, non-specific LBP.
The participants were divided into two groups: a running group and a control group. Over the course of 12 weeks, the running group engaged in a walk-run program consisting of 30-minute sessions – similar to the famous NHS couch-to-5k program. These sessions were designed to gradually increase running time and intensity in a controlled manner.
The results, drum roll please....
Lower pain and disability: Participants in the running group experienced a significant reduction in both pain and disability scores compared to those in the control group (non-runners)
Adverse Events: Only one adverse event relating to LBP was reported, and notably, that participant still returned to running within the 12-week study. This suggests that running can be safe for those with low back pain. Considering there was a total of 105 running hours across all participants in the study, one adverse event can be considered very low (under 1% of training time)
Running Vs cycling, swimming and walking: Although the study did not directly compare running to other forms of aerobic exercise, such as cycling or swimming, it’s known that longer or more frequent aerobic activities generally produce clinically meaningful changes in pain intensity and disability. Therefore, greater benefits may have been seen with increased training in this study, i.e. 12-week is considered moderate for long term health changes to be seen.
Breaking the Stigma Around Running and Back Pain
A surprising finding in the ASTEROID study was that fewer than half of the participants had engaged in running for fitness prior to their back injury. This highlights how common the avoidance of running is due to fear of exacerbating back pain. The ASTEROID study helps to debunk this stigma by showing that, with a gradual and structured approach, running can be a safe and effective form of exercise for adults with chronic LBP.
If you enjoy running or are interested in taking it up, this research shows that there’s little reason to avoid it—especially when integrated into a controlled, progressive exercise program. In fact, it can be a great way to manage and reduce your pain.
So, if you’ve been avoiding running due to concerns about your back, the question remains: what’s stopping you?
In Sale, we are blessed with several running clubs including Sale Harriers, Sale Dragons and the Mile Shy Club. The latter is aimed at runners new to the sport and would be a great place to start your journey into running and out of pain.
As always, it’s essential to consult with a healthcare professional for an formal assessment of your back pain. Physiotherapy can rule out more serious or sinister features of back pain before providing guidance on a return to running or other activity.
Stay active.
Marcus.
Chartered Physiotherapist and Owner
OnTrack Physiotherapy.
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