LOWER BACK PAIN: Causes and Solutions

LOWER BACK PAIN: Causes and Solutions

Lower Back Pain

If you’re suffering from lower back pain then you’ll be happy to know that there are proven ways of relieving it. Often it’s possible to cure it completely.

Lower back pain is one of the most common pain complaints in the modern world. As many as 80% of Australians will suffer from lower back pain at some point in their lives. Poor posture, a sedentary lifestyle and incorrect heavy lifting causes most lower back conditions. Issues with the lower back can also cause sciatica and other leg pains.

I encourage you to make an appointment if you experience any of the following:

  • lower back pain
  • sciatica – pain down the back of the leg
  • back muscle spasm
  • back strain
  • stiff back
  • lower back ache

Lower Back Pain Causes

The causes of lower back pain are either injury, lifestyle or posture. The specifics of these can be complex. Therefore it’s important to identify the root cause/s before moving on to treatment. Below I go into some detail about the likely causes of your back pain.

Posture

Your static posture indicates how balanced your various muscle groups are. When we look at posture in a person with lower back pain, we are looking at the position of the pelvis, lower back and legs. This gives valuable information about any muscular imbalances. If the pelvis is not in a ‘neutral’ and ‘balanced’ position it will lead to poor posture. Poor posture leads to poor movement, and often back injury and back pain.

In a posture assessment we are looking for:

  • anterior pelvic tilt
  • posterior pelvic tilt
  • asymmetry left and right

In the image below you can see how the position of the hips effects the entire body.

By Anonymous (Posture & Foundation Garments) [Public domain], via Wikimedia Commons

Sitting

Sitting for prolonged periods of time aggravates many cases of lower back pain. Is the feeling of having to ‘stretch out’ the lower back when you stand up from the desk or get out of the car familiar to you? It is unclear why static posture is so aggravating to lower back pain. The effects of posture and movement are an evolving scientific discovery. Suffice it to say that the human body feels and works best when regular movement:

  • circulates the blood
  • lubricates joints
  • contracts and stretches muscles
  • causes variations in the position of the fascia

Tight Hip Flexors

The role of your hip flexors is to bring your knees in the direction of your chest (flex your hips). Consider that most people sit for a large portion of the day. It’s therefore no surprise that their hip flexors become short. Short and tight hip flexors have a considerable effect on posture and biomechanics. When your hip flexors are short, your will most likely develop an ‘anterior pelvic tilt’. Furthermore, your glutes will become weak as a result of ‘reciprocal inhibition’. Reciprocal inhibition is the notion that tight muscles on one side of the body creates weak muscles on the other side.

Having an anterior pelvic tilt means that the muscles in your lower back must work harder. This is because they are taking on the job of the glutes. Furthermore, they are also opposing your tight hip flexors. The below image gives a visual perspective of this explanation.

“Anterior tilt/lordosis and the muscles that become lengthened and weak” flickr photo by sportEX journals https://flickr.com/photos/sportex/8271843421 shared under a Creative Commons (BY-ND) license

Weak Glutes

There is a strong correlation between weak glutes and lower back pain. This is because the glutes are the main power centre for the back. If they’re not performing well, the muscles of the lower back tend to do all the work. This is most evident during heavy lifting that requires bending forward. It is also evident during activities such as walking, running, playing sport etc. During these activities weak glutes will lead to your lower back muscles working harder than they need to. This leads to stiffness, and eventually pain.

Tight Hamstrings

Another major contributor to lower back pain is tight hamstrings. If you bend forward and have difficulty touching your toes, then your hamstrings are probably tight. Surprisingly, the answer to tight hamstrings is not always stretching. In many cases the hamstrings are already ‘overstretched’ as a result of poor posture. The body reinforces overstretched muscles with hardened tissue. This is due to the sustained stretch that they endure, and the body’s need to compensate. This hardened tissue is what creates the feeling of tightness within the hamstrings.

Bulging Disc (Herniated Disc)

A bulging disc, or herniated disc, is where a portion of your intervertebral disc protrudes out from between the vertebrae. Bending forward to lift a heavy object is usually what causes this injury. Bulging discs are also a natural phenomenon that occurs with ageing. Symptoms of a herniated disk include sciatica, and pain when:

  • sitting
  • bending forward
  • coughing

The gold standard for diagnosing a bulging disc is MRI scan. Yet it is important to understand that images often have little to no correlation to a patient’s pain. In fact, research shows that imaging of any injury can increase the experience of pain! This is due to the psychological effects of such a perceivably concrete diagnosis. The reality is that in most cases of disc herniation there are no symptoms. Your therapist should only use imaging for lower back injuries sparingly. Usually a good therapist will only use it in cases where they need extra clarity. It is for the above reasons that modern practitioners frown upon routinely scanning the spine and other areas of the body.

In the below video I explain the recovery process following a disc injury.

Facet Joint Pain

Facet joint pain feels sharp, and can make it difficult to turn in one direction. Either a lack of movement, or too much movement within the joint causes symptoms. A facet joint injury is usually caused by awkward or twisting movements. It can be unpredictable in its occurrence rate. Often this injury comes on with no obvious correlation to lifestyle or activity.

Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [CC BY 3.0], via Wikimedia Commons

Stress

Stress has become accepted as a cause of many health issues, including lower back pain. The effects of stress can create a ‘fight or flight’ response that can be hard to switch off, even after the stressful situation has passed. The accumulation of tension due to stress can cause persistent chronic muscular tension.

Lower Back Pain Treatment

Treatment options for lower back pain vary a lot depending on the cause/s of your pain. Naturally, the methods used to treat a bulging disc, a lower back strain or spasm will be quite different. Even when there is a clearly diagnosed injury, treatment needs to be tailored to the patient. Your therapist will take into account your particular strengths and weaknesses. In this way the treatment will target the factors that allowed this injury to occur in the first place.

Posture

Addressing posture as part of an overall treatment can give great results. This is not so much because of the improved static posture. It is more due to an improvement in your movement. A good posture allows you to move in ways that are healing to the body, instead of damaging.

In many cases addressing posture involves strengthening weak muscles such as the core and glutes. It also involves lengthening tight muscles such as the hip flexors.

Myotherapy

Myotherapy is a very effective treatment for lower back pain. It makes use of most of the methods and techniques listed below. Therefore I will go into more detail under those headings.

Massage

Massage for lower back pain can be very effective. Generally your therapist will target the tight muscles in your back to begin with. They will also target key postural muscles such as the hip flexors. This is a go-to for many people suffering from lower back pain. Forms of massage include:

  • remedial massage
  • deep tissue massage
  • myofascial release
  • trigger point therapy

Dry Needling

‘Dry needling’ is also known as ‘myofascial dry needling’. It is a powerful modality that can often give instant pain relief. Your therapist can use this to target tight muscles in the back. They can also treat relevant postural muscles using needles. Dry needling for lower back pain benefits include:
  • pain relief
  • relaxation of tight muscles
  • stress relief by activating the ‘rest and relax’ response

Mobilisation

Mobilisation works by introducing movement to stiff joints. Mobilising the lower back can give good relief. This works very well for a stiff back. Mobilisation is also an effective tool in acute lower back injuries. This is because in these cases the patient requires gentle treatment.

Manipulation

‘Manipulation’ is also known as ‘adjustment‘. It is another effective method of increasing the mobility of joints. This is where the therapist applies a sudden movement to a joint. It then produces an audible ‘popping’ sound. Manipulation to the lower back is usually safe and effective when treating back pain. There are risks that go with manipulating the the lower back in some circumstances. An example of this is where the patient experiences sciatic pain. In these cases your therapist may choose a more gentle mobilisation approach. Generally speaking, these methods are as effective.
 
Another thing to consider when manipulating the lower back is what is causing the pain. Is it a lack of movement? Or is it because of a laxity in the joints causing instability? In cases where instability is causing pain, manipulation may create further problems.

Muscle Energy Technique (MET)

MET is a technique that involves the patient doing gentle muscle contractions. The therapist applies a small amount of resistance to these contractions. It works with a concept called reciprocal inhibition. This means that muscles on one side of a joint will relax to accomodate contraction and movement of the muscles on the other side of the joint. MET is painless and effective. Your therapist can use it to release tension in the lower back, and restore movement to the joints. It is also effective for restoring posture by activating some muscle groups and lengthening others.

Exercises

Movement is medicine! Exercise is paramount to recovering from lower back pain. Most natural movements such as walking and moving about in general will help. As well as this, corrective exercises can have an even stronger impact on your recovery.

In most cases of back injury, the body compensates by switching off certain muscle groups that stabilise the spine. Specifically, small muscles (called multifidus) cease to work properly. It is only through corrective exercise that these muscles will pick up the reigns again and start firing. Without re-activating your multifidus muscles, other muscles will continue to over-work. This causes ongoing tightness and pain. This compensation can also contribute to further injury over time.

Corrective exercise is even more important for those suffering from chronic lower back pain. In the below video I demonstrate a few fundamental exercises as a starting point.

Stretches

Stretches are a fantastic way to get relief from lower back pain. However, there are some stretches that you must be careful with. This is particularly important if you have had a recent back injury. For example, we do not recommend bending forward after a lumbar disc herniation.  In most cases stretches should target the muscles that cause improper posture. For example, stretching the hips flexors will relieve strain in the lower back.

Conclusion

Lower back pain has varying causes, and treatment depends on what your specific needs are. Your number one call to action is to embrace movement and exercise. Your therapist can apply a variety of techniques to help you get relief. They should also be advising you of self-care methods. Simply put, move more, live well! I’m here to help if you get into trouble.

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