484: 6 Back Pain Myths Runners Believe (And What to Do Instead)

6 Back Pain Myths Runners Believe (And What to Do Instead)

Most runners with a sore back fall into one of two groups, and both are stuck.

The first group has decided it's just aging.

It's never going to get better. I'll run until I can't.

They don't believe there's a fix, so they push through.

The second group has decided to play it safe.

Rest until it's better.

They're afraid of making it worse, so they stop adding distance and only do what they can.

Different choices, same problem.

One group doesn't believe their back can change. The other is afraid to load it. Both are making decisions from a myth, and neither has a plan.

In this article, I'll walk through six of the most common back pain myths I hear from runners, what the research says about each, and what to do instead. This is about non-specific low back pain, the most common kind, not pain from a known cause like a fracture.

A quick safety note: Some back pain needs medical attention first. Get evaluated promptly with significant trauma; numbness, tingling, or weakness; pain that doesn't change with position or movement and wakes you at night; or unexplained weight loss or fever. Loss of bowel or bladder control is an emergency.

Myth 1: "Rest until it's better"

Why it makes sense. There is some benefit to taking it easy after an acute bout of back pain. Lying down often brings real relief, and a day or two of letting the pain calm down is reasonable.

Why it's a myth. Staying in rest works against you. Extended bed rest or inactivity leads to muscle atrophy, so you're getting weaker. That's why your back hurt in the first place: the tissue was overloaded and couldn't handle the load you placed on it. Resting for weeks weakens that tissue further, which puts you at greater risk the next time.

The research points the same direction. A Cochrane review (Dahm et al., 2010) found moderate-quality evidence that people with acute low back pain may get small benefits in pain relief and function from advice to stay active compared with advice to rest in bed. That research looked at bed rest advice for acute pain, not at stopping running specifically, and the benefits were small. But the direction favors staying active.

What to do instead. Adjust the load rather than stopping everything. Use this loading rule: pain stays at or below 4 out of 10, it doesn't increase during the training session, and it isn't worse the next morning.

To get back into activity after a day or two of rest, cut what you were doing before by about half. If your usual weekday run is five miles, start with two to three the first week and see how your body responds. Do the same with your strength training.

Think of a rusty hinge. It doesn't loosen up by sitting still.

Your body was made to move. It just needs the right progression.

Myth 2: "I'll only do what I can"

Why it makes sense. If I'm careful, don't add distance, and don't push, I'm protecting my back. And protecting it for a few days is reasonable.

What it looks like. Mileage frozen for months. No hills, no speed, no strength progressions. Avoiding bending and lifting, and calling it being careful.

Why it's a myth. The trap is when protecting becomes the plan for months. A systematic review in the Spine Journal found that fear-avoidance beliefs were linked to poorer outcomes in subacute low back pain lasting 4 weeks to 3 months. They were mostly not predictive in very acute or chronic pain, and an earlier review found little evidence linking early fear to poor outcomes, so the evidence is mixed. It's a pattern worth watching for, not a certainty.

Here's the logic I use with runners. Tissues adapt to the load you give them. A load frozen in place keeps your capacity frozen in place too.

What to do instead. Build back in steps instead of staying put. As I describe in my running injury series, I reduce load by about 50%, see how the area responds, then progress as long as pain stays within the loading rule.

Pain works like a smoke alarm that goes off every time you make toast. It's trying to protect you, but it isn't measuring a fire.

Myth 3: "The scan shows what's wrong"

Why it makes sense. People love having an answer. Your back hurts, the scan shows a disc herniation, so the pain must be coming from the disc.

Why it's a myth. A systematic review of 33 studies covering 3,110 people without back pain (Brinjikji et al., 2015) found disc bulges in 30% of 20-year-olds and 84% of 80-year-olds. Disc protrusions went from 29% to 43%, and annular fissures from 19% to 29%. The authors concluded that many of these findings are likely part of normal aging and unassociated with pain.

There's a nuance worth keeping. A second meta-analysis by the same group, in adults 50 and younger, found that some findings (disc degeneration, bulge, protrusion, extrusion, and Modic 1 changes) were more common in people with back pain. So findings can matter, but they aren't a verdict on their own. A scary-sounding report can describe a back that hurts or one that doesn't. Don't let a report label you as fragile.

Having gray hair doesn't mean you're old, and being older doesn't mean you have gray hair. I have a friend who started going gray in his twenties. He was more than half gray by 30, and he's completely white now in his early forties. The two are connected, but one doesn't cause the other. Scan findings and pain work the same way.

Think of the rings in a tree trunk: they tell you the tree's age. Spines are similar. Scan an 80-year-old and you'll likely find a disc bulge, simply because they're 80.

What to do instead. Look at the whole picture: your pain story, your load story, and how you move. If you've had imaging, ask what the findings mean in the context of your symptoms rather than treating the report as the answer.

Myth 4: "A stronger core fixes it"

Why it makes sense. Your core supports your spine, so a strong core should take pressure off your spine and help your back feel better. That's partially true.

Why it's a myth. It's incomplete. Core work isn't wrong, and it isn't magic. A Cochrane review of motor control exercise for chronic non-specific low back pain (Saragiotto et al., 2016) found it more effective than minimal intervention, but little or no different from other forms of exercise at 3 to 12 months. The authors said the choice of exercise should depend on preference, therapist training, cost, and safety. A smaller review found a short-term edge for core stability exercise over conventional exercise, so the evidence is mixed.

Takeaway: Core exercises aren't magic. Exercise in general helps, and the best exercise is the one you'll do consistently.

What to do instead. Think in this order: mobility, then stability, then strength. Stability here means control of movement, not just a stronger trunk.

Don't get me wrong, I love planks and side planks for runners. But they're step one. You have to learn to control the movement, not just hold still.

If you want to learn more details about the exact progression I use to treat pain, join me in my free masterclass: https://www.realliferunners.com/backpain 

Myth 5: "Running is bad for your back"

Why it makes sense. Running places a force of roughly 2.5 to 3 times your body weight on your body with each step. It's easy to assume that much pounding must wear out your discs.

Why it's a myth. The research doesn't support that assumption. In a small cross-sectional study of 17 men aged 44 to 62, long-term runners (more than 10 years, averaging over 50 km a week) showed less age-related decline in their lumbar discs than inactive controls.

Separately, a 12-week randomized trial called ASTEROID put 40 adults aged 18 to 45 with chronic low back pain on a progressive run-walk program, 3 days a week for 30 minutes. Its abstract concluded that running may improve disc health, though the effect appears to be level-specific.

Let's be clear about the limits. The runner study shows an association, not proof. The trial was small, and the participants were younger and not regular runners. So the honest takeaway is that the data don't support "running destroys your back." They don't prove that running fixes it either.

Researchers have proposed two competing ideas for discs: repeated loading may strengthen disc tissue, while overload may damage it faster than it repairs. Think of a muscle that gets stronger with load but can be overworked.

What does matter. The dose and the progression. As I discussed in my progressive overload episode, build load gradually rather than in sudden jumps.

Who this isn't for. Runners with red flags or a specific diagnosis.

Myth 6: "It's never getting better, it's just aging"

Why it makes sense. Back pain is common as we get older, and it can feel like the price of getting older. If there's no fix, the logical move is to run until you can't.

Why it's a myth. There are four pieces to this.

Scans and age. As we saw in Myth 3, spine changes on imaging are common with age and often unrelated to pain.

The course of back pain. A meta-analysis of 33 cohorts and 11,166 people (Menezes Costa et al., 2012) tracked pain scores out of 100. In people with acute pain, scores fell from 52 at baseline to 23 at 6 weeks and 6 at one year. In people with persistent pain, they went from 51 to 33 at 6 weeks and 23 at one year. Most of the improvement came in the first six weeks, and people with persistent pain still had low to moderate pain at one year on average.

Exercise. A large Cochrane review (Hayden et al., 2021; 249 trials, 24,486 participants) found moderate-certainty evidence that exercise probably reduces chronic low back pain compared with no treatment, usual care, or placebo. A systematic review done to inform a World Health Organization guideline found that structured exercise programs probably reduce pain and functional limitations in adults and older people with chronic low back pain.

Age. One review reports chronic low back pain in about 20 to 25% of people over 65, which means most older adults don't have it. Older adults tend to have poorer outcomes on average, but researchers planning a Cochrane review noted no evidence that the effects of exercise depend on age.

Let's keep it honest: better doesn't mean cured. An older review reported that most people with acute back pain had at least one recurrence within a year. The goal is a plan to reduce pain and manage flare-ups.

What to do instead. Normal doesn't mean untreatable, and pushing through isn't a plan. A plan is.

Calling it aging is like calling a squeaky door "just old." It still responds to oil.

What to do instead

Here's the short version of all six myths and what I suggest instead:

• Rest until it's better becomes stay gently active.

• Only do what I can becomes build back in steps.

• The scan shows the problem becomes scans find age.

• A stronger core fixes it becomes consistent exercise helps.

• Running is bad for you becomes dose and progression matter.

• It's never getting better becomes most people improve, and a plan helps.

Notice what both groups were missing: a plan. Pushing through isn't a plan, and protecting isn't a plan.

A plan starts with an evaluation, then an assessment of what's likely going on, then treatment in a consistent order: mobility, then stability, then strength, guided by a loading rule you can trust.

Join me for the free class

Think of this article as part one. Part two is my free class on low back pain on Thursday, October 29th. If you can't make it live, register anyway and I'll send you the replay. You can register at realliferunners.com/backpain.

In the class, I'll walk you through the step-by-step process and framework I use to help runners with back pain.

Common doesn't mean untreatable, and careful doesn't mean stuck.

This article is educational and isn't a substitute for individualized care. If you're unsure, get evaluated. Listen to the episode above.

References

• Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010.

• The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2013.

• Pincus T, Vogel S, Burton AK, Santos R, Field AP. Fear avoidance and prognosis in back pain: a systematic review and synthesis of current evidence. Arthritis Rheum. 2006;54:3999-4010.

• Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4).

• Brinjikji W, Diehn FE, Jarvik JG, et al. Meta-analysis of lumbar spine degeneration on MR imaging in adults 50 and younger with and without low back pain. AJNR Am J Neuroradiol. 2015;36.

• Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016.

• Review of core stability exercise versus conventional exercise in the management of chronic low back pain.

• Intervertebral disc health in middle-aged long-term runners compared with non-active controls (cross-sectional study).

• ASTEROID running trial abstract (ISSLS 2025).

• Menezes Costa LC, Maher CG, et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-24.

• Acute low back pain: systematic review of its prognosis (2003).

• Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;Issue 9.

• Systematic review to inform a WHO clinical practice guideline: benefits and harms of structured exercise programs for chronic primary low back pain in adults.

• Physical activity for the treatment of chronic low back pain in elderly patients: a systematic review.

• Jesus-Moraleida FR, Silva JP, Pereira DS, et al. Exercise therapy for older adults with low-back pain (Cochrane protocol). 2016.