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Lower back pain- the common culprits

Lower back pain is the most widely experienced musculoskeletal pain in the UK. 70% of people suffer from lower back pain at some point in their lives (Al Mazroa and Mohammad A. 2010), and around 100 million work days are lost to lower back pain each year in the UK, more than any other form of disability. In the US, the estimated annual cost of lower back pain on the economy is 100-200 billion every year! (Croft P et al. 1993), (Katz JN, 2006)

Often, lower back pain is completely preventable too. Unfortunately, the modern day lives that we lead don’t help to keep lower back pain at bay. Many of us spend hours every day behind a desk, me included! Humans are designed to be upright, active, running, jumping. All of this activates all of the postural muscles around the spine, and keeps balance in the muscular systems- sitting at a desk does not. So what tends to happen is that imbalances form, muscles in the posterior chain (back of the lumbar spine) get tight and overactive, and our core stability muscles get weak.

I was treating a young gentleman the other day who couldn’t understand why he had severe lower back pain when he felt he had been working very hard on his core stability- when I checked the exercises he had been doing for his ‘core’, it was very heavy on the forward flexion movements: sit-ups, crunches, leg lifts, twisting motions. What he had been working on here was a muscle called the rectus-abdominis, (your six pack abdominals). These muscles are responsible for forward bending movements, but don’t offer your lower back much protection or support at all. The set of muscles needed for lower back pain are your trans-abdominals (trans-abs for short). These hug your spine from the inside and protect it from the stresses and strains of daily life- it is these trans-abs that are the core we refer to as physiotherapists. Exercises like the plank, side plank, single leg balance and supine table top all help to target these muscles.

So when the trans-abdominals get weak, the body has to start relying on other muscles that can help offer some support to the lower back. Muscles called your quadratus lumborum and erector-spinae (found in the aforementioned posterior chain) tend to get overworked and tight and this reduces the flexibility and movement in the spine. This is often what causes the lower back symptoms. Releasing these with sports massage and deep tissue techniques will help target the symptoms, but without addressing weaknesses as well, the muscles will simply continue to tighten back up. Strengthening programmes are the key to long term relief from lower back pain. Working with a Pilates-based strengthening programme can help eliminate weakness, but perfect technique is essential otherwise you can simply revert back to using the muscles in the posterior chain. Pilates is only effective when being done properly!

Croft P et al. The prevalence and characteristics of chronic widespread pain in the general population. Journal of Rheumatology, 1993, 20:710-3.

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2. Erratum in: Lancet, 2013, 381(9867):628. Al Mazroa, Mohammad A.

Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006, 88(suppl 2):21-24.

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