Lower Back Pain – Common Causes and How to Treat It

Lower back pain (LBP) is a common disorder that the majority of people and athletes have experienced at one point in their lives. For some people it stops them being able to do their jobs and/or stops them from training and staying fit. Which in turn can lead to chronic pain later on in life and/or weight gain. I have also treated and trained a large number of people who have or have had LBP. Two common causes for lower back pain (LBP) are being sat down at a desk for hours every day as well as from incorrect technique during heavy exercise. This in turn leads people to think that LBP is the norm and it’s part of everyday life, but it’s not.

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There are fewer cases of reported LBP in less developed countries as their posture and biomechanics haven’t been ruined from sitting. However, as less developed countries become more urbanised and commercialised the incident of LBP is on the rise.  People are spending more time in office jobs stuck in their chairs and less in manual labour jobs outside. This doesn’t mean I’m telling everyone you can never sit at your desk again. That would be simply unrealistic as most people earn their living that way, in this article I will explain some of the reasons as to why LBP happens. I will also show you a number of simple exercises that you can incorporate in your everyday life to help treat and prvent LBP.

Joint-by-Joint Approach – Mobility v Stability
One of the main causes that I’ve observed with my clients getting LBP (more specifically in their lumbar spine) is not because their lumbar spine is weak, it’s because their lumbar spine is compensating for a lack of mobility and/or stability in another part of the body.

To help understand how joint pain occurs and how the body moves, the Joint-by-Joint approach was developed by Gray Cook and Michael Boyle. Cook and Boyle describe how the human body works as a stack of joints, with each
joint needing more stability or mobility than the one above or below it. To read more about the Joint-by-Joint approach click on this link http://graycookmovement.com. Below I’ve gone over the basics of this approach and how it applies to LBP.

Here are main joints in the body, working from top to bottom showing if mobility or stability is more important for pain free and correct movement.

Stabilitymobility

  • Gleno-humeral (shoulder) – Mobility
  • Scapula (shoulder blade) – Stability
  • Thoracic Spine (Upper Back) – Mobility
  • Lumbar Spine (lower Back) – Stability
  • Hip – Mobility
  • Knee – Stability
  • Ankle – Mobility
  • Foot- Stability

Injuries and joint pain are closely linked to correct joint function. Dysfunction at one joint will lead to a pain or an injury at the joint above and below. An example is lack of ankle mobility leads to knee pain. This is very common with Athletes who strap their ankles to make them more stable from fear of twisting (e.g. Basketball players). This does however restrict the movement at the ankle which becomes less mobile and more stable. This forces the joint above the knee to compensate for lack of movement at the ankle and it becomes too mobile and less stable, the knee joint tries to rotate and can lead to a serious knee injury (common injury from this is MCL/ACL damage).

Hip Mobility

By using the Joint-by-Joint Approach above we can see that LBP can be caused by a lack of mobility at the hips. This lack of hip mobility causes the hips to be very stiff. This leads to an increase of mobility and increased movement at the Lumbar spine, which is not good. The Lumbar spine is designed to mainly be stable but when it becomes too mobile we tend to get LBP. (Imagine your lower back is a thin piece of wood, if you then keep bending back and forth for a long time it’s going to snap – back pain!) The main causes for the hips being very stiff and immobile is due to long periods of sitting everyday and/or by regularly exercising heavily without stretching. The hip is designed to be a very mobile joint, which enables your lower body to move in multiple plans while transferring large amounts of force. When the hips lose this mobility and range of motion, the lower back compensates to this lack of movement. Therefore having mobile hips is very important for having a healthy lower back and for performance in the gym and out on the sports field.

Here are a few stretches will help improve your hip mobility when done on a daily basis.

Hip Flexor Stretch

Version 2

Place right foot on a swiss ball behind you; come onto 1 knee with your left foot flat on the floor out in front. Move your hips back so there is a small gap between your bottom and back foot, and squeeze your Glute on your back leg (squeeze your buttocks as hard as you can) and if done correctly you will feel an aggressive stretch in your back quad and the front of your hips. The aim of this stretch is to release your hip flexors (Rectus Femoris, Psoas and Iliacus). Perform this stretch for 30 seconds on each leg and repeat twice.

Modified Pigeon Pose

Version 2

Start in a press up position. Bring the right knee forward and place next to the right hand on the floor, and your left foot as close to your left hand as you can. Let your body relax and hips lower to the floor and either rest on your hands or elbows and arms for a more advanced stretch. Let the back leg (left) relax with your left foot laces down. The aim off this stretch is too release your hip extensors (piriformis, Gluteal Group). Perform this stretch for 30 seconds on each leg and repeat twice.

Hip Adductor Stretch

Version 2Version 2
 
Start on all fours. Place your left leg out to the side and keep your left knee locked out. Maintain a neutral spine throughout the stretch. Support your weight through your hands and rock your hips back towards your heel and forward towards of the floor. You should feel the muscles on the inside of the left leg stretch. Perform this stretch for 30 seconds on each leg and repeat twice.

Anterior and Lateral Core stability

The other common cause of LBP is from having weak muscles in your anterior and lateral core. You might have often heard people say your need to strengthen your ‘core’ muscles. But what does core actually mean? This core basically means muscles that connect your lower ribs to your pelvis and Lumbar spine, which run down the side and front of your torso. Not just your ‘abs’. The main muscles that make up the ‘anterior and lateral core’ are External obliques, internal obliques, Rectus abdominis, and Transverse abdominis. There are spinal extensor muscles that stabilise the spine but in the majority of people these are not the muscles that lack strength. Is it when these core muscles become inactive and weak and along with poor hip mobility that people tend to experience lower back pain. These muscles stabilise the lumbar spine and during exercise and movement enable a smooth and powerful transfer of force through spine to the external regions of the human body. Having a stable lumbar spine and strong muscles in anterior and lateral core is like building a house with strong foundations. If you don’t build the strong foundations the house will fall apart. If you don’t stabilise and strength the lumbar spine and muscles around it, the human body and lower back will suffer from pain and most likely you will get an injury.

Once you have stretched out your hips, next you need to stabilise the lumbar spine. Here are a few exercises you can do to strengthen your ‘core’.

 

Deadbugs –Anterior Core Stability 

Lie flat on your back, feet and arms in the air with knees at right angles. Brace your stomach muscles, pull your ribs down and flatten your lower back against the floor with your stomach muscles. Imagine someone is about to punch you in the stomach, and you have to tense your stomach muscles. Maintain the tension  in your stomach and straighten 1 leg out at a time while maintaining a flat lower back. Do 10 reps on each leg, rest and then repeat 3 times. If your lower back starts to arch, rest and then do the same number of rests with out arching your back. If done correctly you will feel this down the front of your stomach.

Side Plank – Lateral Core

Version 2

Lying on your side with your foot and forearm in contact with the floor. Maintain a neutral spine. Brace your core with the same technique as Deadbugs, ribs downs and squeeze your glutes and quads. Imagine someone is about to kick you in the stomach. Hold for 30-40 seconds each side. Repeat 3 times. If you struggle to hold the side plank for 30 secs from your feet, drop your bottom knee down to the floor so your forearm and knee are in contact with the floor 

Perform the hip stretches and core exercises everyday twice a day. Even if you don’t have LBP and spend the majority of your day sat down still incorporate these exercises into your workouts.  If you lift weights and exercise regularly these exercise should be part of your programme already. It will only take 10minutes so you can easily fit it into your day. You can do them as part of your warm up before your gym session. If your warm up consists of 5minutes on a cross trainer, then replace the cross trainer with these exercises. Doing 5minutes of cardio before any sessions is not a warm up especially if you have LBP. You need to mobilise and stabilise the joints so they are ready to transfer force efficiently and correctly. If you’re doing a strength session you can also perform these exercises in your rest periods. For example if you have tight hips and are doing heavy squats, you can do one of the hip stretches in your rest period instead of checking twitter on your phone.

There will be more complicated and serious cases of LBP where these exercises won’t be able to help. In these situations seek help from a fully qualified Osteopath or Physiotherapist.

The Gluteal muscle (buttocks) also play an important role in preventing LBP. In my next article I will go over how the glutes improve sports performance and injury prevention. The stronger your glutes the faster you can run, heavier you can squat and less likely you are get lower back pain and knee injuries.

4 thoughts on “Lower Back Pain – Common Causes and How to Treat It”

  1. I have been a LBP chronic patient for too long! I was very active in my teens and 20’s, and by this I mean I moved furniture up and down stairs ( couches & more) all by myself so I think that’s the start of at least 1 out of 2 herniated discs! I was an avid gym member and went up to 4 to 5 times a week for 2 to 3 hours at a time and I had never felt better emotionally or physically but I was 36 & still had LBP. I WAS very built but in the sleek, cut way. Not bulging muscles!
    I had 2 kids. I was 19 for the first and 30 for our last. I have ALWAYS taken pride into how I looked physically because it makes me feel almost euphoric! I don’t use SSRI’s due to high sensitivity so working out is my ONLY outlet!
    Over the course of 5 years I trained myself and conditioned my body to be able to jog! It was easier than walking which really stumped my dr.! I would go twice a day!
    After one of my surgeries on my shoulder I went for a jog after it healed and I twisted my ankle and injured my knee!
    I looked into this and they wanted to operate but I instead tried another approach because I was going to hike the Appalachian Trail. I got VERY DEEP massages that took away the pain in my knee!
    It was just tight IT bands! I was amazed!
    I have had both shoulders operated on and now I’ve lost ALL the upper strength I admired in myself when I’d do pull-ups at the gym. I can barely do a push-up!
    I’m in rough shape now because after my dad passed in 2008 and then my brother killing himself in 2011 I have been in a massive rut and even tho I typically eat pretty healthy, I have gained 45 pounds and I’m only 5’2!
    I DO try to go for walks but I have nerve damage in my right foot. I step and it’s as if I have flames shooting thru the ends of my toes! Keep in mind that none of this stops me 100% of the time but it dies at least 80 %!
    I’m TOO YOUNG to feel so lost, angry, confused, scared, ashamed and close to giving up!
    I may be 52 but I look like I’m 35 or so I’m told A LOT! Gotta love that! My free spirit and quest for the healthy life I could be living keeps me looking young!
    I have BROUGHT several types of surgeries to many Drs over the course of 15 to 20 years & they have said, “NO” to all!
    I have 2 herniated discs, arthritis and 5 of the lower discs don’t have fluid!
    I stretch, do yoga, keep limber use ice and heat when needed, use about 4 or more back salves and or patches from OTC to try to ease it along with the pain meds I’m prescribe and I’m still at a level 6 in my shoulders, 6 on my knees and 8.5 in my back. It’s not even just the lower part! It’s about a foot from the sacrum to the middle of my back and from the left ( sometimes in my stomach) all the way across to the right side!
    This is EVERYDAY, i am ready to have the nerve sensor in my brain cut out!
    Like I said, I’m too young and the first 52 years of my life have flown by and knowing pretty close to the age I’ll die isn’t going to go any slower! Maybe 25 to 30 years is what I have left and the last 20 of my. 52 have been a constant struggle!
    I could live with a level 4 or 5 with no pain meds ( the pain scale isn’t really effective) but where I’m at now and at a 7 or 8 daily isn’t living! I have grandkids that I’m missing out on! My daughter was crying saying she wishes I’d come back!
    I’m sure there’s more but I’m tired. I’m hoping that someone may see this and help! ??????

    1. Hi Denise,
      Thanks for you’re message. Sorry for the delayed response as I’ve been away over the weekend.
      I’m sorry to hear about your injuries and pain you experienced over the years and now.
      I’m sure I’ll be able to help you as I’ve trained people back to full fitness from lower back pain and other injuries. Where about’s do you live? I’m based in London, UK. If you live in London as well, I’m sure I can come visit you for a consultation, or you can visit me in the gym at work in central London near Hyde Park/Oxford Street.
      If you don’t live in London or the UK, I can offer some advice and expertise online, and try and recommend someone you can visit who lives near you.
      I Look forward to hearing from you
      Tom Mans

  2. An fascinating discussion is value comment. I feel that you must write extra on this matter, it may not be a taboo topic but generally individuals are not enough to speak on such topics. To the next. Cheers

    1. Thanks Clash of clans. It’s also a very complex topic. Many people myself included in the past try and single out one cause of lower back pain, but the reality it is a number of causes, from a lack of movement, too much movement, load, stress levels, sleep, strength.. The list goes on.

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