Low back pain (LBP) can be so severe and debilitating that it can completely derail your training.

It’s hard to run if your back, buttocks or leg hurts. You either won’t try to do it or you try to suffer through it only to be rewarded with worsening symptoms later on. However, initial activity and exercise are critical when treating LBP.

When to Return to Running after Experiencing Low Back Pain

One critical indicator that you are ready to return to running is whether or not you can walk with a normal gait. In particular, can you walk normally with a longer stride length during your normal gait cycle? The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone as it means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from jogging or running.

If you are unable to walk normally, then I don’t recommend that you begin running yet. First, focus on returning to normal activities (including walking). The emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises.

photo credit: Practical Cures; FlickrCC

Everyone’s recovery will be different. It should be entirely symptom dependent as to whether or not you completely stop running. There are times when the pain can be so severe that running is not an option. Other times, the pain is minor, so gentle jogging can still be performed. Listen to your body on what it can handle. The pain will tell you if you need to stop.

If the pain worsens, then taper back or stop running for a period of time as you rehabilitate. Avoid any form of bicycling. Instead, exercising in the pool (swimming or aqua jogging) can be highly effective in maintaining cardiovascular fitness and VO2 max. Utilizing an elliptical trainer may also be an option.

Rule for Returning to Running:

Follow the rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. You must stop that activity.  If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

• Don’t resume your running or jogging program until you can walk normally at a quick pace.
• If you have stopped running for a period of time, be sure to slowly taper back into your running as your back begins to feel better. Don’t quickly resume your prior training volume. Instead, taper back up.
• Prior to running, perform a very thorough warm up (complete with press-ups, superman exercises, and bridging). Then transition into a running specific warm up at a very slow pace.
• Continue with the strengthening program at least until you resume your full volume of training.
• Although you will need to progress and train on uneven ground and hills, initially start with level terrain only.
• Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
• Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval training or hill repeats, until you have worked back up to your previous running distances and paces without pain. This may take 4-6 weeks or more and is very dependent on the severity of the case.
  I often advise a run/walk routine as you progress back into running. It can be as frequent as one minute of jogging followed by one minute of walking. Taper up the time you’re jogging during each new session.

Prior to returning to your full and normal training activities, insure the following:

• Complete lumbar mobility has returned.
• If you experienced leg pain, your involved leg is as flexible as the other.
• Your hip mobility on both sides is equal.
• Your involved leg is as strong as the other leg, particularly hip abduction (glutes medius) and the hip external rotators. Test this by jumping up and down on one leg. Do you feel strong? Is there pain associated with this? If the strength isn’t there or the pain remains, you are not ready to taper up to full training activities.
• You can jog, run, sprint, and jump without pain.

With proper treatment, low back pain (LBP) should resolve in as quickly as two weeks. Severe episodes can take 4-6 weeks or longer. Continue with your rehabilitation until you are performing all exercises and running normally.

I highly recommend continuing with a lower extremity stretching protocol and lumbar and pelvis stabilization exercises as a method of prevention for future episodes of low back pain. There are countless “core” exercises and back stretches that you can perform, but which ones are best to help you to recover faster and experience less pain? Research is clear that performing proper core exercises and particularly, lumbar stabilization exercises are the most effective treatment modality for LBP.

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If you are currently suffering from LBP and/or have experienced it in the past or you desire to prevent the most common complaint in today’s society, then you need to check out Treating Low Back Pain (LBP) during Exercise and Athletics.

I have designed this complete guide and system to help runners just like you (and me) prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

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Disclaimer:  This article is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.