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Low Back Pain

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Low Back Pain is a common condition that affects many of our patients. To understand what causes low back pain, it’s important to understand the spine. The spine is made up of vertebrae, which are stack like blocks and form your spine. These are your low back joints. 

The joints are surrounded by ligaments that stabilize and secure these blocks in place. On top of those ligaments are muscles, that layer on top of your back in various different layers. 

All of these layers of or surrounding the spine could be contributing or causing low back pain. 

What causes low back pain?

Sharp low back pain could be coming from the joint either moving too much or too little. This causes irritation in the joints, which can irritate the ligaments and cause the low back muscles to spasm. Back pain can be a combination of all three of these things. It’s important to treat all three elements – usually treating only one piece does not bring relief. 

Low Back Pain Affects the Surrounding Muscles

The muscles of the back don’t work alone – they are connected to lots of other muscles that connect deep in to the spine, such as the diaphragm. All of these muscle connections can be contributing to the spasming in the back. 

It’s important to address not just the muscles of the back, but all muscles that connect to the spine, which can include the rib cage, hip, pelvis and even the head and neck. All of these muscles need to be balanced to take the stress off of the ligaments and the joint.

Chronic low back pain can cause the irritated muscles of the low back to develop trigger points. Trigger Points in the muscles can cause local and referred pain throughout the body. 

Quadratus Lumborum (QL) Trigger Points + Referred Pain

Trigger Points in the muscles are often the cause of localized and referred pain throughout the body. Trigger Points in the Quadratus Lumborum (QL) muscles of the low back are often the source of low back pain, but they can also cause pain in the sacral and buttock region.

A trigger point is a hyperirritable taut band of skeletal muscle tissue, also known as a “knot” in the muscle. They are often painful to touch. They can also cause radicular pain or pain in another location than the actual trigger point location.

The quadratus lumborum is often a site of low back pain. It runs from the bottom of the last rib (12th rib) to the top of the pelvis (iliac crest). Along the way, it attaches on the side to the lumbar vertebrae (L1-L4). It functions to:

When a trigger point occurs in this muscle, you may experience pain in the sacral and buttock region, even though the actual cause of the pain is much higher in the muscle. This is called referred pain. The actual trigger points themselves may also be painful.

Low Back Pain Treatment

It’s important to examine the whole body alignment. From there, the joints, ligaments and muscles all need to be addressed. Trigger points respond well to different myfascial release techniques, including trigger point release, where you put deep pressure into the trigger point, hold it for a minimum of one minute and then let go which will help blood and cells rush to the area to help heal the knotted up tissue. Deep trigger points usually require more of a skilled hand (see your physical therapist).

Once the joints, muscles and fascia are healthy and moving properly, then adding exercises to stretch and strengthen the appropriate muscles. It’s important to fix the alignment first, to make sure everything is moving properly. 

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