Low Back Pain in Runners: A Systematic Review and Meta-Analysis of Prevalence, Incidence and the Share of Running-Related Injuries

Background: Running is widely practised, but the effect of habitual running on the lumbar spine remains contested. No quantitative synthesis of low back pain in runners existed, and published estimates ranged from below 1% to above 40%. Objective: To estimate pooled prevalence and incidence of low back pain among runners, the low-back share of running-related injuries, heterogeneity, and small-study effects. Methods: PubMed/MEDLINE, Europe PMC and Crossref were searched for primary studies reporting a low-back count against a defined denominator; reporting followed PRISMA 2020. Twenty-five studies from sixteen countries were included. Three denominator-specific outcomes were pooled separately using random-intercept logistic regression, and small-study effects were assessed with Peters regression. Results: The low back accounted for 4.88% of running-related injuries (95% CI 3.29 to 7.17; k = 7). Pooled prevalence was 10.11% (95% CI 4.48 to 21.24; k = 10; 10,817 runners) and incidence was 2.44% (95% CI 1.17 to 5.04; k = 11; 9,682 runners). Log sample size explained 48.6% and 57.6% of between-study variance; estimates in cohorts of at least 500 runners were 4.07% and 1.32%. Apparent higher prevalence in elite and ultra-distance cohorts did not persist after adjustment for study size. Conclusion: About one running injury in twenty is located at the low back, and approximately one runner in twenty-five reports low back pain in large cohorts. Small-study effects inflate published estimates; low back pain in a runner should not be attributed to running by default.