A pain in the low back is a likely experience for everybody. By pain I mean discomfort, stiffness, ache or pain. Sometimes one has a good idea of why and can grasp a meaning behind their pain experience. On the other hand we may be at a complete loss and have no idea what is going on. By virtue of having a body we are motion ready. Starting off in life moving around is incredibly important but the importance wanes. The body deconditions and we get older.
Pain is a sensory emotional experience and is a word derived from penalty. There are many ideas about pain and where it comes from, in this blog I will only explore Muscles and Joints.
The lower back or the lumbar spine and pelvis have many components that can signal pain to the brain. If we take the areas of the hips, buttocks and lower back they will account for 40% of MSK pain presentation in primary Care (1). When differentiating pain experiences Lee takes into account a range of information, mostly beyond the scope of this blog. Here we can consider the joints of the spine as painful (2). In the lumbar spine there are (usually) 5 on either side called facet joints.
Componentry basics: A joint passes forces generated in the body around corners or across anatomical planes. Muscles are linear, joints are angular often covering more than one direction at once like the facet joints of the spine do. Classically on leaning back or laying on the floor painful facet joints might be noticed.
Muscles of the lower back typically are the Quadratus Lumborum and Psoas that can be painful. Also the erector spinae are very important in posture and can be a source of insidious pain onset. As muscles spasm and foreshorten from injury deconditioning or poor posture the shape of the spine can change (as well as the waist) Creating pressure differences on the intervertebral discs and facet joints.
Muscles and discs are viscoelastic and thus can be like a mattress. Through our repeated bad habits over the years we can insidiously develop a back pain experience because we are continually loading the same parts of the body. Like loading the same parts of a mattress over the years. However, the human body unlike a mattress has a capacity for regeneration when the load is shifted or shared.
Finally here I will mention the pelvis, which I call the wing nut of the body. The part that most people would say is out of alignment but from a whole body perspective the pelvis serves to share the error. A wonky pelvis is unlikely to be a pelvis problem in my opinion. The Sacroiliac Joints are usually blamed (3).
You may be feeling pain from your facet joints, Sacroiliac joints, Disc joints or QL and Psoas muscles. But if we consider a compensatory back then we start to see dysfunctional layers that accumulate. Meaning your pain experience is in the low back but caused by an earlier dysfunction elsewhere in the body. The key is don’t leave it too long to ask Lee for help.
- Masters S and Lind R (2010) Musculoskeletal Pain – Presentations to General Practice. Aus Fam Phys 39 (6) 425
- Hourigan CL and Bassett JM (1989) Facet Syndrome: Clinical Signs, Symptoms, Diagnosis and Treatment JMPT 12 (4) 293
- Bernard TN and Cassidy JD (1991)The Sacroiliac Joint Syndrome: Pathophysiology, Diagnosis and Management. in Frymoyer J W (Ed) The Adult Spine. Raven Press. NY, 1991.