Lower Back Pain

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Lower back pain is a very common complaint, but can have a number of different causes. There are a number of non-muscular causes of lower back pain; here we will focus on the muscular aspects. When lower back pain develops, it can be an indication of built-up muscle tension or muscle strain. Although the pain may be felt primarily or wholly in the back, usually it has developed in response to tension or weakness elsewhere in the body.

Causes of Lower Back Pain 

The most common muscles that stiffen up and/or cause pain in the lower back are the lumbar erectospinae muscles (LES) and the quadratus lumborum (QL). The erectospinae muscles are postural muscles that run the length of the spine – ‘lumbar’ refers to the part of the body from the bottom of the rib cage to the top of the pelvis. The QL is also a postural muscle involved in bending the trunk and acts as an accessory muscle for breathing.

Because the lower back is so centrally located and has so little skeletal support (compared to other areas of the body), the muscles in the lower back regularly have to counteract tension or weakness elsewhere. Tight muscles above, below, or opposite create resistance, meaning the lower back has to work harder (contract more). Similarly, if there is a weakness in other muscle groups, for example, the core abdominal muscles, the lower back works harder to compensate for that weakness. All this can lead to chronically tight muscles, spasm, or muscle strain.

How Sport and Remedial Massage Therapy Can Help

In a session for lower back pain, it is important to identify the underlying cause of the pain as well as using techniques to ease the primary point of perceived pain in the lower back. The case history will be used to determine the most likely areas of tension, whether it be in the gluteal muscles/external rotators, the hamstrings, the psoas, or the upper back. The area of the primary complaint will be assessed to determine whether that muscle is tight and should be released, or if it is overworked and just needs a break. The treatment will be designed to alleviate the immediate pain along with the underlying cause of the tension. Stretches or exercises will be recommended that can help you prevent the problem from returning.

Most of the time, non-specific lower back pain can be greatly improved, if not resolved, with sport and remedial massage therapy. Depending on your particular situation, additional work may be recommended, whether it be Pilates to help strengthen core muscles, or a visit to another type of practitioner for manipulation and further exercises and assessment.

You should consult with your medical practitioner for lower back pain if:

– if your back pain follows a trauma, such as a car accident or fall off a ladder
– if you have symptoms that may indicate cauda equina: lower extremity muscle weakness, numbness in the groin, rectum pain, bowel disturbance, paralysis of one or both legs – if you develop these symptoms you should contact your GP immediately or go to A&E (https://www.nhs.uk/conditions/slipped-disc/pages/symptoms.aspx)
– if you have been or are currently being treated for cancer
– if you also have osteoporosis or osteopenia
– if you are taking steroids
– if you have a weakened immune system
– if you also have blood in the urine or burning during urination, along with one-sided back pain
– if the pain is severe and does not improve after a day or two of typical remedies (i.e. rest and over-the-counter painkillers)
– if you also have neurological symptoms in the legs and/or arms, such as weakness, tingling, or numbness

When in doubt, contact your medical practitioner for advice.

For more information on lower back pain, here are some links that may be of interest to you:

General information on back pain from the National Institute of Health: https://www.niams.nih.gov/Health_Info/Back_Pain/back_pain_ff.asp

Symptoms of a slipped disc: https://www.nhs.uk/conditions/slipped-disc/pages/symptoms.aspx

NICE guidelines on treatment of non-specific lower back pain: https://www.nice.org.uk/nicemedia/live/11887/44346/44346.pdf

Summary of examination of research on massage therapy and lower back pain: https://www.ncbi.nlm.nih.gov/pubmed/19561560

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. All reasonable care has been taken in compiling the information but no warranty is made as to its accuracy. For diagnosis and treatment of medical conditions it is always advisable to consult a doctor or other health care professional to ensure the specific details of your case are taken into account.

Copyright © Katherine Creighton Crook 2011

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