17: Low Back Pain in Runners: When Hormones, Sleep, and Core Stability Collide

Is your low back pain coming from running or is it something else entirely?In this episode of Interdisciplinary Case Miles, Dr. Sara Raiser, sports medicine physician and running medicine speicalist, Dr. Kate Mihevc Edwards, orthopedic physical therapist and running PT, and sports dietitian Kelsey Pontius walk through a runner case involving low back pain during the perimenopause transition.The case involves a 41-year-old female physician and half-marathon runner who initially seeks help for nutrition during perimenopause. During the consultation, she casually mentions intermittent low back pain, poor sleep, and high work stress, factors that can all influence recovery and musculoskeletal health.The conversation expands into a deeper discussion of how hormonal changes, sleep quality, fueling habits, biomechanics, and pelvic floor health can all play a role in back pain for runners. We explain how shifting hormones like estrogen, progesterone, and testosterone influence collagen health, tendon recovery, muscle repair, sleep quality, and energy levels. For active women, these changes can show up as slower recovery, stubborn body changes, and nagging aches that weren’t there before.In this episode, we discuss:Why low back pain in runners is often multifactorialThe impact of perimenopause and hormonal changes on recovery and connective tissueHow sleep and fueling patterns influence injury risk and healingWhy runners with back pain should evaluate core stability, breathing, and pelvic floor functionHow hip mobility and running mechanics can affect the lower backWhen back pain requires medical evaluation—and when runners can safely stay activeStrategies to keep running while managing back discomfortIf you're a runner dealing with low back pain, sleep disruption, hormonal changes, or training stress, this episode explores how all of these factors intersect and what you can do to stay healthy and keep running.If you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives. This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners.00:00 — Podcast IntroductionMeet the hosts and overview of Interdisciplinary Case Miles.01:05 — Case Introduction: Perimenopausal Runner. A 41-year-old half-marathoner experiencing body changes, sleep issues, and intermittent low back pain.02:30 — Nutrition & Hormonal Changes in PerimenopauseHow hormonal shifts affect recovery, metabolism, and nutrition needs.05:10 — Addressing Body Changes & Sleep FirstBody neutrality, sleep quality, and fueling regularly during busy workdays.08:00 — Medical Evaluation of Low Back PainDr. Reiser explains axial back pain, possible causes, and clinical screening.11:00 — Physical Therapy AssessmentCore activation, breathing patterns, pelvic floor health, and movement mechanics.14:00 — Running Mechanics & Back PainHip mobility, posture, and how running form can influence back stress.17:00 — Training Modifications & Staying ActiveWhen runners should modify activity instead of stopping completely.20:00 — Managing Persistent “Niggling” PainUnderstanding chronic discomfort and avoiding unnecessary interventions.22:00 — Pre-Run & Post-Run StrategiesSimple mobility and activation exercises that may reduce pain.23:30 — Key Takeaways from Each ExpertBack pain management, nutrition mindset during body changes, and pelvic floor considerations.24:45 — Episode Wrap-UpClosing thoughts and invitation to follow and share the podcast. Become a supporter of this podcast: https://www.spreaker.com/podcast/the-running-injury-podcast-formerly-interdisciplinary-case-miles--6623567/support.If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case.Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at [email protected].