The two biggest things your health professional fails to consider when it comes to your lower back pain.

When patients come in to see us for lower back pain, and they have been elsewhere, inevitably they will tell us one of a number of things:

  • I’ve had this low back pain for years and it’s not getting any better
  • I am doing an exercise program but I’ve reached a plateau – and if I stop doing the exercises it goes back to square one
  • I’ve had all the scans and there isn’t anything major – but the pain just isn’t improving
  • I’ve done all of my “core” stability exercises and it isn’t helping.

…sometimes a combination, and sometimes more than that!

I guess where the advantage lies when treating patients in this condition is that they have normally seen pretty competent health professionals – which means by the time they get to us – we know what you have tried.  It means that we really don’t need to go over old ground, most of the time.

Usually, there are two main things that other health professionals don’t adequately consider when it comes to lower back pain – and I can summarise it in a very simple phrase:

“Tight at the front, weak at the back”

Fail No. 1 – Tight at the front

Most health professionals, when looking at back pain, fail to consider the key muscle which is the driver for most back pain.  It is a muscle that is actually deeper than your core abdominal muscles – it is called the Psoas.

Psoas attaches into the front of 5 vertebrae of your spine, crosses underneath your bowels and then attaches into the front of your hip.  It is the only muscle that crosses the centre of gravity, and is incredibly important acting as a mover and stabiliser of your back and pelvis.

If your psoas muscles are tight, it can cause:

  • Pain referral into your lower back
  • Back stiffness in the morning when you wake up
  • Other muscles up into your shoulders and down your hips and legs to compensate, causing pain in those areas as well.

It is extremely important not only to get this muscle assessed properly, but also to have it treated gently and properly, as there are many important vessels and organs that run around and through it.

Fail No. 2 – Weak at the back

It is a fact that when people have lower back pain, the deepest layer muscles in your lower back shrink.  These are called the multifidus muscles.

The reasons for this shrinking are a little complex (and I can address this in a later blog) – but the important thing is that those deep back muscles need to be strengthened in order for them to grow back to a size your body needs to support your weight, and offset the tightness of psoas.

If your deep back muscles are weak, it can cause:

  • Too much fatigue in your back – which means a “tight” feeling towards the end of the day and after things like housework or sport
  • Strength exercises for your glutes and “core” are ineffective, because you need the multifidus muscle working first before you can activate anything else
  • Ongoing low back pain because the muscles are forever in a protective mode, which doesn’t allow the movement you need to get things going again.

What is needed to correct these problems?

Simply two things:

  • A full assessment of the psoas muscles to see if they are contributing to your posture or pain picture
  • An accurate strength test for your multifidus muscles to specify exactly how strong your back is, and an exercise program to counter any deficits.

We have put together some more resources (here and here) on our website to explain this more… and treating backs in this very simple, logical way has helped people from elite athletes to people who are out of work and had failed back surgery.

By Chris Fawcett - Director HPM Centre

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