Doctor-Approved Strategies for Managing Lower Back Pain in Endurance Athletes

Lower back pain (LBP) is one of the most common physical complaints among endurance athletes. Whether you’re training for your first half-marathon or logging decades of long-course triathlons, the lower spine can be a weak link if not supported by intentional strength, mobility, and recovery practices.

Fortunately, most back pain in endurance athletes is preventable—and treatable—without stopping training. The key lies in addressing the root causes and applying strategies that strengthen and stabilize the body over time.

This guide outlines evidence-backed strategies to help runners, cyclists, and other endurance athletes manage and prevent lower back pain, both in-season and off-season.

1. Start With the Core

The term “core” refers to the muscles of the trunk that support the spine, pelvis, and hips. Weak or underactive core muscles allow for excessive motion at the lumbar spine, which can lead to irritation and chronic pain. Research supports the role of core strengthening exercises in reducing LBP in athletic populations¹.

What to do:

●     Perform exercises like dead bugs, bird-dogs, planks, and side planks 2–3 times per week.

●     Progress to dynamic drills like kettlebell carries, cable chops, or medicine ball throws once you’ve built a base of endurance and control.

These movements enhance the stability endurance your spine needs during long training sessions.

2. Improve Hip Mobility

Restricted movement in the hips—especially in the flexors and rotators—forces the lumbar spine to overcompensate. Over time, this leads to excessive lumbar extension or rotation, both common pain triggers in endurance athletes.

In one study, athletes with decreased hip range of motion were significantly more likely to experience back discomfort².

What to do:

●     Incorporate dynamic warm-ups with lunges, leg swings, and deep squat holds.

●     Stretch hip flexors, hamstrings, and glutes regularly—especially after long runs or rides.

Improved hip mobility allows the spine to remain neutral and share load across the entire kinetic chain.

3. Don’t Skip Recovery—Especially Sleep

One of the most overlooked contributors to back pain is inadequate recovery. Endurance training places repetitive stress on tissues. Without proper sleep, the body struggles to repair microtrauma in muscles, tendons, and joints.

Research shows that athletes who sleep fewer than 7 hours per night are at higher risk for both new and recurring injuries³.

What to do:

●     Prioritize 7–9 hours of consistent, high-quality sleep.

●     Reduce blue light exposure in the evenings and create a wind-down routine.

●     Consider naps or rest days after high-intensity sessions.

Think of sleep as your body’s best anti-inflammatory.

4. Monitor Training Volume and Spikes

It’s not just what you do—it’s how quickly you increase it. Sudden spikes in training load, including mileage, intensity, or frequency, can overwhelm the body’s ability to adapt, increasing the risk of lower back pain. Even in well-conditioned athletes, this rapid progression can compromise neuromuscular control.

One study on ACL injury recovery proposed a framework for how neuromuscular fatigue and altered central motor control may impact joint stability, particularly when the nervous system is under stress. While the study focused on knee rehabilitation, the principle also applies to the spine: fatigue impairs motor control, making the lumbar region more vulnerable to strain during prolonged activity or under cumulative load stress.⁴

What to do:

●     Increase total weekly training load gradually—ideally by no more than 10% per week.

●     Schedule rest days and incorporate deload weeks every 4–6 weeks to allow for neuromuscular recovery.

●     Track subjective fatigue indicators such as prolonged soreness, irritability, sleep disruption, or declining motivation. These can signal the need to adjust your plan.

By managing fatigue and pacing progression, endurance athletes can support motor control and reduce the chances of lower back discomfort over time.

5. Learn to Breathe and Brace

The diaphragm plays a key role in stabilizing the spine. Athletes who rely on shallow chest breathing often underutilize the deep abdominal stabilizers that protect the lumbar region.

A foundational study demonstrated that diaphragmatic activation increases intra-abdominal pressure, which stiffens the spine and reduces injury risk⁵.

What to do:

●     Practice diaphragmatic (belly) breathing while lying down.

●     Progress to loaded exercises like front-loaded carries or squats while maintaining 360° pressure.

●     Integrate breath control into endurance sessions—especially under fatigue.

Better breathing equals better spinal support.

6. Warm Up and Cool Down With Intention

Rushing into a run or jumping off the bike without proper transitions puts the lower back at risk. Cold, stiff muscles and joints lack the extensibility and resilience needed for endurance movement.

What to do:

●     Use dynamic warm-ups (e.g., lunges, leg swings, inchworms) to prep tissues and joints.

●     Post-training, perform slow walking, gentle hip stretches, and deep breathing to shift into recovery mode.

Even five minutes before and after a session can dramatically affect how your back feels the next day.

7. Build Posterior Chain Strength

Cyclists and runners often develop quad-dominant patterns. Without balanced strength in the glutes, hamstrings, and back extensors, the lumbar spine bears more of the work—especially during hill efforts or acceleration.

What to do:

●     Include Romanian deadlifts, glute bridges, single-leg hip thrusts, and banded walks in your gym sessions.

●     Focus on form and tempo, not just weight. The goal is controlled engagement, not fatigue.

Strength here is your long-term insurance policy against recurring back issues.

8. Pay Attention to Equipment and Form

Poor mechanics are often the missing link. A slightly misaligned bike saddle, improper running shoes, or a stride issue can compound over time, stressing the lower back.

What to do:

●     Get a professional gait analysis or bike fit every 1–2 years.

●     Record your form (video works well) and look for asymmetries or excessive motion.

●     Fix small issues before they become chronic problems.

Subtle changes in posture or technique can create major relief over time.

9. A Realistic Example

Consider a 40-something endurance athlete balancing training with family and work. He reported nagging lower back discomfort after long runs, especially during the last 20 minutes. With a few changes—a focused hip mobility routine, weekly strength training, and consistent diaphragmatic breathing—he noticed a steady improvement. While occasional tightness still occurred, it no longer sidelined him from training.

This kind of progress is realistic—and sustainable—for most endurance athletes.

Final Thoughts

You don’t need to stop training to address lower back pain. In fact, the best solutions aren’t about doing less—but doing smarter. With a focus on stability, mobility, breathing, and recovery, endurance athletes can reduce pain, enhance performance, and keep doing what they love for years to come.

When in doubt, listen to your body—and don’t be afraid to seek professional help when symptoms persist. Consistent, thoughtful action always outperforms short-term fixes.

About the Author

Dr. Antti Rintanen is a medical doctor with a background in sports and performance health. He is the founder of The Internet Doctor, where he shares evidence-based strategies to help active individuals train smarter, recover better, and avoid injury.

References

1. Stuber KJ, Bruno P, Sajko S, Hayden JA. Core stability exercises for low back pain in athletes: a systematic review of the literature. Clin J Sport Med. 2014;24(6):448–456. https://pubmed.ncbi.nlm.nih.gov/

2. Kendall KD, Patel C, Wiley JP, Pohl MB, Emery CA, Ferber R. Steps toward the validation of the Trendelenburg test: the effect of experimentally reduced hip abductor muscle function on frontal plane mechanics. Clin J Sport Med. 2013;23(1):45–51. https://pubmed.ncbi.nlm.nih.gov/

3. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129–133. https://pubmed.ncbi.nlm.nih.gov/

4. Grooms DR, Appelbaum G, Onate JA. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. J Orthop Sports Phys Ther. 2015;45(5):381–393. https://pubmed.ncbi.nlm.nih.gov/

5. Hodges PW, Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000;522(Pt 1):165–175. https://pubmed.ncbi.nlm.nih.gov/