Lower back

Lower back pain

The most common problem through the door — stiffness, a deep ache, or a back that has locked up and will not move.

What it typically feels like

  • A deep, dull ache across the lower back
  • Stiffness that is worst first thing, then eases
  • Sudden spasm on bending or lifting
  • Pain that spreads into the buttock or hip

Most lower back pain is not a disc, a slipped anything, or damage that shows on a scan. It is muscle and joint pain — tissue that has been loaded in a way it was not ready for, or held in one position for too long, and has protested.

What usually causes it

Rarely one dramatic moment. Far more often a build-up:

  • Sitting for long stretches, which shortens the hip flexors and switches the glutes off, leaving the lower back to do their job as well as its own.
  • Lifting with a pattern the body cannot hold under load — often not the weight itself, but the fifteenth rep of it when form has gone.
  • A sudden change in training — new sport, more mileage, back after a layoff.
  • Weak or unco-ordinated glutes and trunk, so the load lands on the spine rather than being shared.

The spasm on bending is usually the last straw, not the cause. Something has been building for weeks.

What treatment involves

Assessment first, because “lower back pain” is a description, not a diagnosis. The pain is often in the back while the cause sits in the hips, the glutes, or how you move.

Hands-on work settles the muscle spasm and restores movement. Then the part that stops it returning: identifying what loaded it badly and changing that, with specific strengthening for whatever is not pulling its weight.

How long it takes

Acute spasm usually eases significantly within a session or two. Changing the pattern underneath takes longer — typically several weeks with exercises between sessions. Anyone promising a permanent fix in one session is guessing.

What is actually in the lower back

Five large vertebrae carrying the weight of everything above them, with the pelvis beneath and a thick column of muscle either side. It is the most common problem through the clinic door.

Erector spinae
The long muscle columns running either side of the spine. They extend the back and hold you upright, and they are what goes into spasm when a back "locks up".
Quadratus lumborum
Deep, between the lowest rib and the pelvis. Frequently the real source of a one-sided lower back ache that will not settle, and often missed because it sits underneath everything else.
Glutes
Not the back, but they belong in any account of it. When the glutes do not do their share of the work, the lower back does it instead, every time.
Sciatic nerve
The thickest nerve in the body, running from the lower back through the buttock and down the leg. Irritation anywhere along it can send symptoms the whole way down.
Lumbar discs and facet joints
The shock absorber and the guide rails. Both can refer pain into the buttock and thigh without anything being wrong with the buttock or thigh.

Why it goes wrong

Most lower back pain is not damage, and scans in people with no pain at all routinely show changes that sound frightening on a report. Far more often it is a combination of stiffness, muscles doing the wrong share of the work, and a body that has been in one position too long. Pain travelling below the knee, or any change to bladder, bowel or saddle sensation, is a different matter and needs medical assessment.

3D anatomy See the structures involved on the interactive model

The honest next step

This page describes what is common, not what you have. The only way to know is to have it assessed — and your first session includes a full assessment, so you leave knowing what is actually going on.

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