Aug 2014 30

Lower back pain

By: Dave Wheeler

4 out of 5 of us suffer from lower back pain at some point in our lives.

In 95% of cases, this lower back pain isn't serious - it's just painful!

In around 5% of cases, pain in the lower back is due to trouble in the spine itself: often prolapsed ("slipped") discs. But for most of us, it's all to do with the muscles in the back or buttocks.

The causes of lower back pain

Back ache can be caused by different things. Here are just some examples:

  • sitting at a desk all day
  • driving a lot
  • bending down to pick up something 
  • a change in your exercise programme

One client of mine bent down to pick up a weed from her garden expecting to have to pull hard to get it out of the ground - only to find that the weed came out really easily. As a result her back "locked up", it went into spasm

Then again, another client recently came to me with lower back pain simply caused by a weekend of moving furniture - her back was relatively weak, and 2 days of bending and stretching just overused the muscles which became sore.

Treating lower back pain

In the first instance, try a hot water bottle behind your back when you're sitting or lying down.

If the problem is muscle that's in spasm or that's become overused, then the heat should help to loosen things up.

If heat doesn't sort it out then you can seek help from a manual therapist: a  remedial massage therapist, physiotherapist or osteopath.

The important thing is to make sure that your therapist takes account of both lifestyle and your posture when treating you - the treatment you need will depend on whether your lower back muscles are generally too tight or too weak. This depends on your posture

The treatment that you need will be specific to your circumstances, your lifestyle and your posture. Your remedial massage therapist may use a combination of some of these treatments:

  1. massage both along the muscle's fibres
  2. massage across the fibres (this is often more effective if you're lying on your side)
  3. trigger point therapy - this involves identiying one or more typical points around the edge of the muscle which refer pain around the hip and down the buttocks and applying direct pressure
  4. assisted stretching - a method called muscle energy technique is really useful in cases where the lower back muscles are really tight
  5. positional release - this is way of releasing muscles that have "locked up"

A good therapist will treat your symptoms to give you immediate relief from your back pain but will also help you make adjustments to try to stop it recurring. So you should also expect to be given advice on very specific stretches or strengthening exercises that take account of your personal situation.

The muscle of the lower back - quadratus lumborum

Although there are several muscles in the lower back, the one that is most often the cause of lower back pain is quadratus lumborum (or QL):

  • quadratus is latin for "square"
  • lumborum is latin for "lumbar

So quadratus lumborum is the square muscle of the lumbar region of the spine.

The muscle fibres run in parallel down from the lowest rib to the top of the pelvis, attaching to the lower 5 transverse processes (these are the bits that stick out like bolts from either side of the spine as it goes up the body).

As the diagram shows, there are other muscles between the last rib and the pelvis, but the QL is the most troublesome.

(And just to be accurate, the quadratus lumborum, although known as the muscle of the lower back, is strictly speaking actually the back of the abdominal wall rather than a muscle of the back! But more of that in a later blog.)

As ever, if can help, give me a call.