Sports Physiotherapy for Runners

Most Common Spinal Conditions in Running

Lumbar Facet Joint Pain Facet joint irritation is the most common spinal condition in runners and is almost always traceable to a failure of hip extension on one or both sides. When the hip can't extend freely through the push-off phase, the lumbar spine tilts anteriorly and extends to compensate, compressing the facet joints on the affected side with every stride. The pattern is predictable: pain that starts as a mild ache in the early kilometres and progressively intensifies as the run continues, often accompanied by a stiffness that is worst immediately after stopping and gradually eases with walking. Runners frequently attribute this to tight hip flexors and spend months stretching them without addressing the facet joint or the movement pattern driving the problem.

Lumbar Disc Irritation Disc-related pain in runners tends to present differently to facet pain, it is more provoked by the sustained post-run recovery positions than by the dynamic impact of the stride itself. Runners with disc involvement often find that sitting in the car after a long run, sustained desk work later in the day, or waking up the morning after a hard session is more provocative than the run itself. The disc is stressed during running by the compressive and shear forces of footstrike, particularly when a stiff thoracic spine forces the lower lumbar segments to twist while simultaneously absorbing the impact forces of footstrike. When thoracic stiffness prevents the upper body counter-rotation from absorbing its share of the rotational demand, the disc at the lower lumbar segments absorbs the deficit.

Sacroiliac Joint Dysfunction The sacroiliac joint manages the transfer of ground reaction force from the stance leg into the trunk with every footstrike. In runners with asymmetrical hip mechanics, a longer stride on one side, reduced glute activation on one side, or a habitual lateral trunk lean, the two sides of the pelvis experience different rotational forces with every stride. Over time, this asymmetry creates a progressive rotational imbalance at the sacroiliac joint that presents as a deep, unilateral posterior pelvic pain. Runners with SI joint dysfunction describe a pain that is localised to one side of the pelvis or lower back, is worst in the first few kilometres before warming up, and often has a catching or locking quality on the affected side during the stance phase of running.

Thoracic Spine Stiffness Thoracic rotation is the counterbalancing mechanism that allows the pelvis to rotate freely during running without the lumbar spine being dragged into rotation with it. When thoracic rotation is restricted, which is almost universal in runners who spend most of their waking hours sitting at a desk, the pelvis and lumbar spine rotate as a single unit rather than as two independently mobile segments. This transfers the full rotational demand of running into the lumbar joints and discs rather than distributing it across the full spine. A runner with thoracic stiffness will almost always have a reduced arm swing on the restricted side and a compensatory lateral trunk lean, and their lumbar spine will be doing the work of two spinal regions with every stride.

Nerve Root Irritation and Referred Pain Runners frequently present with leg symptoms, pain, tingling, or heaviness in the buttock, posterior thigh, or calf, that they attribute to hamstring tightness, piriformis syndrome, or ITB problems. In many of these cases, the source is the lumbar spine rather than the structure where symptoms are felt. Lumbar facet joints can refer pain into the buttock and posterior thigh in patterns that are indistinguishable from hamstring pain without clinical assessment. Lumbar disc irritation can produce nerve root symptoms that travel into the calf and foot. Runners who have been stretching and foam rolling the same structure for months without improvement should consider whether the lumbar spine is the actual source of what they're feeling.

How Athletic Spine Approaches Running Injuries

Runners are among the most self-aware patients at Athletic Spine, they've usually already identified the pattern of their pain, tried multiple interventions, and arrived with a clear account of what works temporarily and what doesn't. What they haven't usually had is an assessment that looks at the full movement system rather than the symptomatic structure in isolation.

Assessment at Athletic Spine for a runner starts with the running stride itself. That means evaluating hip extension range and how it changes between sides, assessing thoracic rotation and how the counter-rotation pattern responds to increasing pace, identifying whether the pelvis is staying level or dropping and rotating asymmetrically during the stance phase, and understanding where in the run the movement pattern begins to degrade.

From there, rehabilitation is built around the specific mechanical failure that's driving symptoms. For most runners, that involves two parallel streams: restoring the mobility in the joints that are supposed to be contributing to the stride, hip extension, thoracic rotation, and retraining the neuromuscular control patterns that protect the lumbar spine during the specific phase of the stride where the breakdown is occurring.

Runners are kept running throughout rehabilitation wherever possible. Complete rest removes the movement stimulus the spine needs to adapt and delays return to sport without addressing the mechanical cause. The approach at Athletic Spine adjusts the environment, modifying the running surface, gradient, and target pace, while maintaining as much running as the presentation allows, and progressively reintroduces the full demands of the runner's training as the movement system improves.

Runners who come through Athletic Spine leave understanding exactly what their spine is doing during their stride, what their early warning signs look like as pace and distance increase, and how to prepare and adapt their training when symptoms begin to emerge, without needing passive treatment to manage a problem that never fully resolves on its own.