Low back pain is very common but difficult to accurately diagnose. It can be caused by problems in the spine or pelvis, involving the muscles, joints and/or nerves. Common sources of low back pain are:
- Injured Spinal Bones and Discs. Physicians can identify many problems with the spinal bones and discs through assessment and diagnostic tests. Fractured or damaged spinal bones are usually diagnosed on x-rays or other scans and physicians follow treatment protocols. Herniated or ruptured discs may result in medical treatment, physical therapy or a surgical referral. Massage and bodywork can provide some relief for patients with injured spinal bones or discs, but medical consultations are recommended.
- Low Back Muscles may become tight from trauma, overuse or inactivity. Muscle spasms contribute to low back pain and usually respond well to massage, Myofascial Release and other bodywork. Pain medication and muscle relaxers may provide temporary relief, but do not usually correct the problem.
- Pelvic Joints. Pelvic rotation and muscle tension create shearing forces in the pelvic joints, particularly at lumbar sacral (L5–S1) and the sacroiliac (SI) joints. Pelvic stabilization, Myofascial Release, mobilization techniques and postural correction can realign the pelvis and release tension in tight fascia, muscles and ligaments that distort pelvic joints.
- Pelvic Muscles. Tight gluteal, piriformis and other hip muscles may be the cause of low back pain, but are often missed by healthcare workers. Muscle tension can distort the normal position of bones in the pelvis and lower back, causing pain and numbness in the low back, hips or legs. Bodywork from a well-trained therapist can often effectively relieve low back pain and restore function without the use of medication.
“Piriformis Syndrome” versus Sciatica. True sciatica is rare. Piriformis syndrome is different from true sciatica. Sciatica is usually defined as a radiculopathy, or compression of a nerve root as it exits the spine. However, just like sciatica, piriformis syndrome can cause pain, numbness and tingling along the sciatic nerve, which runs down the back of the leg and into the foot.
Low back pain should always prompt an assessment of the buttocks muscles. When the pain is localized in the low back, treatment of buttocks muscles is not always considered. Tight piriformis muscles may be the cause of low back pain and not be recognized by physicians and bodyworkers. These muscles rotate the leg externally and are connected between the anterior sacrum and greater trochanter. Tight piriformis muscles can not only pinch the sciatic nerve (that goes up to the lumbar spine), but can also create shearing forces in the lumbar sacral area. Medical treatment often includes anti-inflammatory and pain medications, but the majority of sciatic-like pain problems are in the soft tissue and may be resolved by an experienced therapist without medication.
Piriformis syndrome is more common with women, runners and very active people. Extended sitting and weak gluteal muscles can also cause this problem. Females are affected more than males (6:1) because of the shape of the pelvis, monthly hormones and pregnancy. Medical evaluation is necessary for persistent symptoms that do not respond to stretching and bodywork.
Self-Care Stretches. Stretches can effectively relieve tension and pain when the proper muscles are engaged and the stretches are sustained for at least 3 to 5 minutes. Chronic issues may require regular stretching and therapy as part of your routine. Even though muscle tightness is not the
culprit for all low back pain, regular stretches can improve function and decrease pain for most. Effective stretching involves finding the tight muscles while in the stretch and holding that position until you feel decreased pain or tightness. Although shorter stretches (less than one minute) feel good, tight fibers within the muscles and fascia require at least 3 to 5 minutes to release stored tension. While in the stretch, wait until you feel the pain soften. You can then change the angle of your stretch to grab a new area of tightness and maintain this hold for full release. When stretches are done effectively, restricted tissue is opened layer by layer. Daily stretching and regular therapy should restore comfort and function for these low back and buttock issues, as well as enhance other health and healing. An experienced therapist can release muscles and tissue at a deeper level, along with providing suggestions and encouragement for self-care.
Basic Stretch for Buttocks Muscles. Lie on your back with both feet flat on the floor and your knees bent. Pull your right knee up to your chest, grasp the knee with your left hand and pull it towards your left shoulder. Hold the stretch until the pain softens. Start with short stretches and increase the length of the hold, as tolerated. (Sustained relief of muscle tension requires at least 3 to 5 minutes.) When the pain or tension softens, adjust the angle of the stretch to a new area of tightness or pain. Repeat for each side. A variation of this stretch is resting the ankle over the opposite knee for support and control of the stretch. This stretch can also be done in the “down dog” (on hands and knees) or sitting positions.
First Aid for Acute Pain. For sudden onset of low back pain or an acute flare-up, rest your lower back and apply ice. Try lying flat on your back with your knees bent to rest the lumbar area. More relief may be found while lying flat on your back with your hips bent 90 degrees and your legs resting on the seat of a chair that is pulled against your upper legs. Flexing the hips rotates the pelvis and flattens the lower back, decompressing the lower spine. Ice reduces inflammation within 72 hours of an acute injury. Using ice any time can be a simple and effective pain reliever.
Recovery Exercises for Low Back Pain. Recovery from low back pain may be gradual, but you can improve healing and function by adding simple exercises with continued stretches. Start with low back extension exercises while lying flat on your back on the floor with your knees up (hips are flexed about 45 degrees.) Press the low back flat against the floor and hold it. Ensure that you are flattening your low back by sliding your hand between the low back and the floor. Press the low back flat against the floor and hold for 10 seconds and then relax. Try doing three sets per day of 10 presses each set and work up from there. Most persons will notice results within a few days, but adding this routine to other daily exercises and stretches will improve the health of your back and abdominal core. This exercise extends the low back
(decompressing the low back), activates and relaxes low back muscles, rotates the pelvis upward and activates core abdominal muscles.
Low back pain often causes the muscles next to your spine to go into spasm and you may notice guarding as your body prevents full movement even after the pain has dissipated. Resting your back with your knees elevated and gradually increasing activity will help these muscles relax. Heat is very effective to promote circulation and healing, but not within 72 hours of an injury. Stretches, light exercise, massage and Myofascial Release will restore tight or injured tissues to greater function with decreased pain.
Strengthening your core is important for back health. Consult a trainer for the best exercises for you and your situation. Balanced muscles in the abdomen and back with proper hip position will bring health and better function in your daily activities.
Balanced Pelvis. The word pelvis in Latin means basin, describing its shape, and symbolizes the centrality and foundation for structure and function. The female pelvis is wider, shorter and more spacious than the male pelvis to accommodate fetal development and birthing. This shape makes it more vulnerable to rotation and imbalance, especially with the presence of the relaxin hormone during each menstrual cycle and throughout each pregnancy. The entire pelvic structure and surrounding tissues are stressed during pregnancy and delivery. As a result, many women develop an imbalanced pelvis, which causes asymmetrical movement with excessive tension on lower body muscles, ligaments and joints. Forward tilt of the female pelvis and a rotational twist of the pelvic ring are common pelvic imbalances and can lead to pain and dysfunction throughout the body. This may involve pain in the hips, legs or lower back. It can also contribute to neck, jaw and headache pain. Pelvic imbalance can be gradually corrected through stretches, exercises and conscious postural adjustments. A trained therapist can provide specific treatment to balance your pelvis and recommend self-care. Having a balanced pelvis will contribute to healthier function and decreased pain.
Back to Basics. Low back pain and other annoying health problems usually affect the entire body and are a reminder to focus on fundamental health and wellness. Start with finding enough time for sleep and rest. Managing your stress will avoid many acute and chronic health problems. Healthy diet and hydration are essential for your body to fight diseases and maintain good health. Your exercise routine should include stretching, strengthening and increased heart rate (aerobic) at least three times per week. A well-trained therapist can assist you with holistic bodywork and guidance for daily self-care.
Steve Metzger, RN-CMT, is an advanced Myofascial Release Therapist with Revive Therapy in Sacramento, California, specializing in holistic women’s health and sports bodywork.