The Cause of Lower Back Pain... Five Primary Problems
A Holistic View Points Toward Skeletal Muscles
It is often stated in conventional literature that the cause of
lower back pain cannot be precisely identified. This perspective
derives from a mechanistic, non-integrated view of the body
which has been our legacy since the scientific revolution. When
the body is viewed as a collection of isolated parts rather than
an elegant, integrated whole, the causes of lower back pain
become a bewildering thing.
However, a holistic view of the body can begin to sort out the
confusion. By evaluating the relationship between the body's
overall structure in gravity and it's function in movement, the
causes of lower back pain begin to reveal themselves.
A holistic perspective guides us to one of the most overlooked
sources, not only of lower back pain, but chronic pain in
general. That source is skeletal muscle.
As Drs. Janet Travell and David Simons made explicitly clear in
their exhaustive 2-volume work, Myofascial Pain and
Dysfunction: The Trigger Point Manual, a vast proportion of
chronic pain in the body is not due to problems with damaged
nerves, disrupted bursae, and degenerative joints, but
dysfunction in the soft tissue, especially skeletal muscles.
The cause of lower back pain can be broken down into five
primary problems which interconnect with one another. The
following breakdown is adapted from the St. John Neuromuscular
Therapy training, a method of postural analysis and clinical
massage therapy focused on musculoskeletal alignment and
treating compensatory muscular patterns.
Five Primary Problems
1) Ischemia (pronounced: Iz skeem ee ah)
The first
cause of lower back pain is ischemia. "Ischemia" means lack of
blood. Without adequate blood to provide nutrients and oxygen,
soft tissues such as muscles, tendons, ligaments, and fascia
build up lactic and other toxins and become painful. Ischemia
occurs when muscles are chronically contracted over a period of
time. The most prevalent cause of lower back pain, by far, is
muscular strain and spasm due to ischemia.
2) Trigger Points
The second cause of lower back pain
is trigger points. A trigger point is an area of the soft tissue
which, after chronic contraction and reduced blood flow, becomes
an area of high neurological activity. For example, fibers in an
ischemic muscle (a muscle with low blood) can become an active
trigger point in response to biochemical changes in the tissue.
Active trigger points cause referred sensation to other parts of
the body. That sensation can be pain, tingling, numbness,
thermal sensations (hot or cold), weakness, a general achy
quality, or the feeling that "it just doesn't feel right." For
example, you might have a trigger point in a muscle of your
lower back which refers sensation down into your buttocks, or
even down the leg. This is NOT same thing as the referred pain
caused by nerve compression and nerve entrapment which will be
covered next.
3) Nerve Compression and Nerve Entrapment
The third
cause of lower back pain is nerve compression and entrapment.
Nerve compression is the pressure put on a nerve by a bone or an
intervertebral disc. Nerve compression occurs when the spine
becomes misaligned for some reason (faulty movement patterns,
injury, chronic muscular tightness) and one of the discs between
the vertebrae get squeezed on one side so that it bulges out the
other side. If the bulging puts pressure on a spinal nerve, then
you've got pain! Nerve entrapment is when a nerve is caught or
pinched by the soft tissues. For example, the sciatic nerve (the
largest nerve in the body) runs down through the buttocks and
can become entrapped by the piriformis muscle when that muscle
is very tight. This can result in pain down the back of the leg.
4) Structural Imbalance, aka Postural Distortion
The
fourth cause of lower back pain is structural imbalance or
postural imbalance. In a sense, this issue is the most
significant of all. The reason for that lofty status is due to
the fact that structural imbalance is often the root problem
responsible for ischemia, trigger points, and nerve compression
or entrapment.
If the body is distorted off its center line of gravity,
compensating muscular patterns can result. To illustrate the
point, put your elbow on the table in front of you with your
forearm pointed straight up to the ceiling. Now imagine you've
got a bowling ball resting in your palm. If your forearm is
completely straight up and down, the weight of the bowling ball
will be supported by the bones of your forearm. Theoretically,
you could hold that bowling ball there indefinitely.
But if you shifted off that center line, even a tiny bit, then
the muscles of your arm would have to engage in order to hold up
the bowling ball. Even the strongest human in the world wouldn't
be able to hold that ball there for long. This is precisely what
can happen with your body. If your alignment is off such that
your head is not centered over your shoulders over your hips
over you feet, then the core muscles of your body must
perpetually engage in order to hold your body up!
5) Dysfunctional Biomechanics
The fifth cause of
lower back pain is dysfunctional biomechanics. This is often a
secondary result of structural imbalance and is evidenced by
faulty movement patterns. For example, if you've got nagging
lower back pain you might hold your body in a restricted way,
walk differently, or reach for things with limited range of
movement. It's logical to do that, and not recommended to fight
against your body's self-imposed limitations. It's trying to
protect you from pain. Until the structural imbalance is
addressed, and the pain is relieved, there's wisdom in those
limits. However, repetitive movements can become patterned into
your nervous system such that, even after structural and
muscular problems have been eliminated, you still move in a
limited, protective way. This can revive structural and muscular
imbalances. That's why even a minimum regime of daily stretches
can be vital to full recovery.