What causes low back pain?
Low back pain can have numerous causes – disc herniation, dehydration, kidney issues, sciatic nerve impingement, cancer and more. But now that I’ve terrified you with the possibilities, let me share something. Every single case of low back pain that I have encountered has been almost entirely due to muscle tension. Every time someone tells me that they suffer from chronic, dull pain in their low back (with occasional sharp spasms), I ask them three questions:
1) Is it at it’s worst after long periods of either laying in bed or sitting in a chair?
2) Does it feel better after you’ve moved around a little?
3) Does lying on a hard floor relieve the pain?
Answering yes to these three questions virtually guarantees that the pain is being caused by strain in the low back muscles.
Wait, what was that about dehydration?
Before I go further into the link between the muscles and low back pain, we should talk about proper hydration for a second and how it can affect this region. First, we are meant to be mostly water. That means that we need to stay properly hydrated in order for all the parts to function properly. Our organs, tissues, even cells, require a certain fluid balance in order to function properly. When this balance starts tilting towards less fluid, everything becomes less efficient. This means that our blood becomes thicker, as there is more solid matter compared to the liquid that carries.
Like a stream that’s full of storm debris, this causes the blood to bunch in narrows and flow unevenly. For organs like the kidneys, which require a steady flow to properly filter the blood, dehydration can cause swelling. When that occurs, they press on nearby muscles, which then causes the muscle to become stretched which weakens it. That then increases the strain on the unaffected nearby muscles, which have to make up for the loss of the other muscles. So for those muscles unaffected by the swelling, they end up being more sore and less able to recover during times when they would normally be able to shift the load.
Hopefully I didn’t lose anyone there. It gets more straightforward after this.
One last thing about dehydration – there is a net of connective tissue which binds everything in our body and generally keeps it in place. When we become dehydrated, this tissue drys out and stiffens. This tightening of the connective tissue limits mobility, organ function, and blood flow, which can worsen any pre-existing conditions and lead to general discomfort. So remember to drink water throughout the day.
So what specifically causes muscle problems for the low back?
The most obvious answer is back strain, but honestly, our back is one of the most developed muscles in our body, so why is it so easily strained? The answer is that it isn’t easily strained. The problem that most people have with their backs has been in development for a long time, and treating the back alone is usually not enough to keep the problem from coming back. Explaining how this comes about and explaining some of the easy ways to deal with it was one of my major reasons for writing this entry.
Is posture a factor?
Poor posture is often given as a cause for low back pain but that to is kind of a misleading answer. Our posture is often based on a number of factors, including previous injuries, recovery from said injuries, repeated tasks, amount of time being sedentary, lifestyle, weight distribution, and training.
Let’s face facts – people under the age of fifty in first world nations were raised in a way that is still pretty new in human history. We didn’t have nearly the amount of access to climbing trees, swimming holes, farm work, empty fields, chores, and manual labor that previous generations did. What we did have were comfy chairs, calorie-rich foods, organized sporting leagues, and video distractions that are still increasing in number. This basically means we didn’t have the same access to unfettered movement along with necessity to do said movements, out of either boredom or obligation. The result of this is that children were less likely to develop equal muscular development throughout their entire bodies and instead would develop certain muscles groups almost exclusively to others.
How that appears in teens and adults is that whatever they spent a lot of time doing as children will be reflected in their muscle development. Spend a lot of time playing soccer? Then expect to see strong legs and torso muscles with less development in the upper body. Swimming? You’ll probably be in pretty good health, but you may not be great at running. Playing video games or hunched over a computer? Everything will be drawn forward, leading to a hunched appearance. Are you starting to see the pattern?
Usually these things become so set, that by the time posture lessons are introduced, it’s too late. It is much harder to fight a body’s natural configuration as time passes. The muscles which have already started to establish patterns of movement greatly increase in strength during late childhood through the teens, which means if that 13-year-old is slouching because it’s his natural posture, forcing him or her to sit up straight will not be pleasant for that student. However, if positive changes have been established, poor posture will improve naturally. This takes longer, but watching for improvements in unforced posture is an excellent visual guide for seeing how things are progressing.
What is it specifically about tight muscles?
As I said earlier, treating just the back won’t provide long term relief for chronic back pain. Every muscle exists in a state of balance with another muscles applying pressure the exact opposite direction. This constant pressure is exerted any time we are exerting force to hold ourselves in any position (the only exception to this is when we are completely limp, but even then, some muscles are in use for activities such as breathing.) Whenever we move, we change the balance between the muscles, so that one is exerting more force and one is exerting less. This allows our joints to move in one direction or another. For complicated movements, several muscles may be involved.
Our torso is an example of an area where multiple movements can be accomplished simultaneously. If you ever get a chance to observe a skilled belly-dancer, you will be amazed at the variety of movements that can be made at the same time by someone with proper skill and muscle control. Most of us, unfortunately, do not fall into this category. For the majority of the population, the only movements that are regularly made are bending forward, arching back, and maybe a little rotation. This limited amount of movement means that only the muscles responsible for those movements receive constant stimulation, strengthening, and strain, while the others become weaker and less flexible.
What this means for the back is that when strain is placed on it, there are fewer muscles that can take the load. As such, if one or several muscles are near the point of failure, they can go into spasm, which can lead to pain. Muscles that are in spasm are basically muscles that cannot completely relax, so they are caught in mid-contraction, which means they are both weaker and under more strain, which is why they are so uncomfortable. Worsening this situation is the fact that the muscles that pull our torso forward are also generally tight, which reduces the ability of the muscles in the back to completely contract or relax.
Also affecting the situation are the muscles which connect to the pelvis. Because our back and abdominal muscles connect to our pelvis, if that bone is then being pulled out of position by the muscles of the upper legs, our back and abdominal muscles have to work that much harder to pull the pelvis back up. This connection basically means that in terms of muscle balance and tension, our upper legs are mirrors for our lower torso. Tight hamstrings will exert downward pressure of the muscles of the low back, while tight quads will increase the curve in the lower back. Combined, these two factors will distort the shape of the low back region, increasing pressure and weakening the surrounding structures. Over time, this leads to not only muscle pain, but the increased pressure on the spine increases the chance of a disc herniation or rupture.
Is there anything else that can be a factor in this?
There is one last major factor – abdominal extension. Basically this is a fancy way of saying the more your lower abdomen, or belly, protrudes much past your hips, it starts placing a forward and downward pressure on your pelvis. As I mentioned, this increases both the curve and pressure placed on the lower back, which then increases back pain. This can even occur in pregnancy, where the strain exists for a limited period of time. If the back is already compromised, then the additional weight can cause a situation of strain that exists long afterward.
So what can I do to prevent or reverse low back pain?
Drink lot of water.
Funny. What else?
Ok, you want the long answer. There are several things that can help alleviate or reverse chronic low back pain that is due to chronic muscle strain. First, work with someone who knows muscles. My education in acupuncture and massage (ahem) have trained me extensively in both how to treat and train muscles, but there are several naturopaths, physical therapists, chiropractors, osteopaths, and personal trainers out there (make sure they are licensed in your state) who can help with exercises and treatments to release the muscles and connective tissue involved. Most can also teach you home exercises and stretches that will speed the reversal of the situation and speed your recovery. I am going to close with a few exercises and activities that you can do at home if you have muscle-related low back pain.
Before that, what about pilates and yoga?
I’m a big believer in both of these approaches, but classes can get expensive and going the dvd route can be risky if you don’t have previous class experience. If you want to try these and are short on funds, a lot of community centers and community colleges offer basic classes.
For ALL exercises listed below, remember to breathe! Holding your breath just increases pressure on the low back and if you can’t breathe, your muscles will tense up.
As a prelude to this stretch and the next one, first we need to locate the sit bones. When you are standing upright, put your fingers against the fold at the bottom of your buttocks and the top of the back of your leg. Now press slightly inward and upward. The bones that you feel are sometimes referred to as your “sit bones”. For this stretch and the next one, you’ll want your sit bones to be right on the edge of the chair you are sitting on. And yes, it needs to be a chair, preferably one that is high enough so that your knee is even with your hip. You can try it on a bed, but the softer surfaces makes the stretch less effective.
Now, with your sit bones on the edge of the chair, leave one knee bent while you extend the other leg so that it is straight, with your heel on the floor and your toes pointed to the ceiling. Now lean forward from the hips (do not bend at the waist – it shouldn’t feel like you are bowing.) Keep leaning forward until you feel a mild stretch. This is one you can do multiple times a day and you should hold each stretch for about thirty seconds and then switch legs.
Again, sit on the edge of the chair. Now bend one leg to ninety-degrees so that the ankle is under the knee. Then take the other leg and cross it over so that the ankle is on top of the thigh of the first leg. Then, as before, lean forward from the hips. This time you should feel the stretch deep in your glutes. Again, this can be done throughout the day and you want to go about 30 seconds each time and remember to switch legs.
Supine Gluteal Stretch
Lay on your back with your feet pointed towards a wall. You want to be close close enough to the wall so that you can place one foot flat against the wall while your upper leg is parallel to the floor. Your knee and hip should each be bent to ninety degrees. As we did in the piriformis stretch, take your other leg and cross it over it so that the ankle is resting on the thigh of the first leg. At this point, you may already feel a mild stretch in the glutes. Play with the depth of the position until you feel a mild stretch. This one may be done less often, but try to hold the stretch on each side for a minute before switching.
This a basic yoga pose that can really help stretch both the legs and the back. Stand up straight with your shoulders back and your feet about hips distance apart and flat on the floor. Bend forward from the hips with a straight back until you start to feel a stretch in your hamstrings. If you can’t go very far, support your weight by placing your hands on your legs. As you become more flexible, move you hands farther down your legs until you can place your palms on the floor in front of your toes. Hold this stretch for about 2 or 3 easy breaths before slowly rolling up, straightening your back one vertebrae at a time.
Sit at the edge of a chair or exercise ball with your hips and knees each bent to 90 degrees and your feet directly beneath your knees. Next engage your kegel muscles (the muscles you use to stop the stream of urine) and alternate lifting first one foot and then the other like you are marching in place. You only need to lift each foot about an inch off the ground, as the muscles involved do not have a large range of motion. Try to do this exercise 50 to 100 times at least once a day.
Lay on your back on the floor with your legs extended and your toes pointed towards the ceiling. Now lift your legs about an inch off the floor with your heels together and your toes pointed slightly outwards. Your butt should not be clenched during this movement, as we are trying to engage the muscles in the abdomen and upper thigh. Also, make sure you are not pressing your low back into the floor. You should be able to slide your hand between your back and the floor as you do this, but if you can’t feel your back when you do this, you have too much curve in your spine. Try to hold your feet off the floor for as long as can, but if you start getting short of breath or shaking, take a break.
Mini-Boat to Full Boat Pose
This is similar to the previous exercise, but this time we are also bringing our shoulders off the ground. Engage the legs as before but this time also have your arms extended with your fingers pointed towards the ceiling. Most of your weight should be balanced on your sacrum (the triangular bone at the base of your spine) as you lift your legs and shoulder off the ground. Again, if you get too tired, take a break. Eventually, you’ll be able to progress to boat pose, where both the upper and lower body are completely off the ground.
So, thanks for sticking to the end. Hopefully this information will give you a better idea of how to understand and deal with chronic muscle-related low back pain.