Fears and beliefs about running in adults with chronic low back pain: a mixed methods study from the ASTEROID randomised controlled trial.

Many people with chronic low back pain are told, or come to believe, that running will hurt their back. This study looked at those beliefs within a trial comparing a 12 week digitally delivered run walk interval program against a waitlist, in 40 adults with long standing low back pain. Before starting, a quarter of participants thought running was unsafe.

Among the 19 who did the running program and were interviewed afterward, beliefs about safety generally shifted, and interviews identified themes around fear of pain or injury, the influence of past experiences and healthcare advice, and how direct positive experience helped change minds. Because this part of the study is qualitative, based on interviews with a small group who completed the intervention, it describes experiences and shifting beliefs rather than proving that running itself is safe or effective for back pain, and the findings may not reflect everyone with chronic low back pain.

If you have ongoing low back pain, you may have heard that running could make things worse. This study looked at what people with chronic low back pain actually believe about running, and whether those beliefs change after trying a structured run walk program.

Before the program started, a quarter of the 40 participants said they thought running was unsafe. After 19 people completed a 12 week program involving walking and running intervals, interviews suggested that many of their fears softened, and some described how actually trying running, alongside advice from healthcare providers and their own past experiences, shaped how safe they felt it was. This was a small study based on interviews, so it tells us about how beliefs can shift in this group, not whether running is proven safe or helpful for everyone with back pain.

It offers insight into fears and experiences rather than firm answers about outcomes.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This paper speaks to a common clinical conversation: whether running is appropriate advice for patients with chronic low back pain, and why many patients hold the belief that it is not. Using semi-structured interviews with 19 participants who completed a 12 week digitally delivered run walk interval program within a 40 person randomised trial, the qualitative analysis identified four themes, including fear that running will cause pain or injury, beliefs shaped by prior advice from healthcare professionals and personal experience, fears being challenged and replaced during the program, and positive lived experience as a driver of belief change.

Separately, questionnaire data showed greater improvements in belief in running's safety across several surfaces and sprinting in the intervention group compared with waitlist controls, though these are self-reported belief scores, not pain or injury outcomes, and the abstract does not report whether adverse events occurred. The qualitative findings inform understanding of barriers and facilitators to recommending running, particularly the role clinicians may play in shaping negative beliefs, but they describe experiences within a self-selected, small group who completed the intervention, not an intervention-effect estimate. The study does not establish that running training is broadly safe or effective for chronic low back pain, and the waitlist comparator received no running intervention, so expectation or attention effects for the belief measures cannot be ruled out.