Lower Back Pain Causes

Why Does My Back Hurt?

If you are experiencing lower back pain, the causes can be difficult to determine. It is the number two reason that people see a health care provider, yet science has a lot to learn about all the factors that contribute to it. In spite of this, the effects of low back pain are quite clear. The decreased ability to move and function can have profound effects on your life.

While it may be difficult to determine the exact reasons your back hurts, I like to break down what we do know into two categories - structural and functional.

Structural factors refer to anatomical anomalies, like the shape of your bones or damaged soft tissue. Functional factors refer to anything that is not structural in nature, such as muscle tension or compensation patterns.

Structural Factors

Ever heard the saying that "form follows function"? It's a principle used in the fields of architecture and design, where the function of the structure or object being designed is determined first. The structural components are then put together with that purpose in mind.

In biology, the opposite applies. Form exists first, so function is dictated by form. For example, it would be extremely difficult for us to walk on two legs if our limbs were shaped like those of a dog or cat. It can cause problems when our structure deviates too far from the norm.

Most official diagnoses for the source of low back pain are structural in nature. They can often be identified by standard tests and imaging studies, such as x-ray or MRI.

Some examples of structural causes of lower back pain include:

  • scoliosis
  • herniated disc
  • degenerative disc
  • spinal stenosis
  • osteoporosis

Minor injuries, like a torn muscle can be considered structural in nature. Adhesions, or restrictions in the connective tissue can also contribute to back pain. These things will not show up on an x-ray or MRI. Instead, a proper assessment depends on the clinician's skill in palpation and orthopedic assessment.

Fortunately, most back pain is not structural in nature.

Functional Factors

Functional issues may be a response to structural problems. One example is the muscle spasm that can accompany a disc herniation. Tension and spasm tend to increase in response to pain, which can aggravate your symptoms. This is known as the pain-spasm-pain cycle. 

More commonly, functional issues represent compensation for something else happening in the body, which could be structural or functional in nature. A structurally short leg can cause the pelvis to tilt to one side. This shortens some muscles and lengthens others, creating a functional scoliosis. An injury to the foot or ankle will make you limp for a while. That limp is a compensation pattern which can overwork the muscles in the lower back.

One final source of functional factors is habit. Many sources of pain can be identified by looking at the way you use your body on a daily basis.

Functional causes of lower back pain tend to involve some combination of the following:

  • muscle tension/spasm
  • muscle fatigue
  • imbalance in the musculature

In my experience, pain often originates in an area remote to the site that hurts the most. I have been reminded time and again through my years of practice that pain is a symptom, not a cause. In addition to the low back muscles themselves, the muscles of the legs, hips, and abdomen can all contribute to a tension pattern that causes lower back pain. 

What you feel in your low back may have origins deep in your abdomen, or even down in your feet. It may be related to your foot wear, especially if you wear high heels. It may be related to the way you sit or stand at work. Even the way you sleep can be a factor.

Is it any wonder that low back pain is so poorly understood?

Treatment for Lower Back Pain

In addition to standard medical treatment, complementary treatments have proven to be effective in helping to decrease low back pain. Massage therapy, stretching, yoga, and strengthening are effective in decreasing the symptoms of low back pain when used in conjunction with standard medical care.

 Click here to learn about my approach to treating low back pain by combining massage and stretching.

Lower Back Pain Stretches

Speaking of stretching, there's no reason that you can't ease your pain by incorporating stretching into your daily routine. Sherman et al recommend specifically targeting the muscles of the legs, hips, and back.

Click here to learn stretches you can do to reduce your low back pain.

Exercises for Lower Back Pain

In addition to stretching the shortened muscles, a balanced treatment of the region requires that we address the other side of the coin. We also need to strengthen any muscles that are weakened or overstretched.

Click here for information on exercises for lower back pain.

About the Author

My name is Lovelace Linares. I have been practicing massage in Atlanta since 2001. I taught all aspects of massage for nine years, five of which I directed the massage program at the Atlanta School of Massage.

I'm a bit unconventional in my thinking. I believe that self discovery is the purpose of life. Through it, we can all achieve our greatest potentiontial, both individually and as a society.

To that end, i believe that true relaxation comes from two things: (1) Alleviating pain that you are aware of and (2) addressing tension you are not aware of. Self-awareness is the key.

My practice is located inside Urban Body Studios on the scenic Atlanta Beltline. Orthopedics, Deep tissue, Swedish massage, neuromuscular therapy, Thai massage, and stretching are some of the techniques that I use in my practice.

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Daniel C. Cherkin, Karen J. Sherman, Janet Kahn, Robert Wellman, Andrea J. Cook, Eric Johnson, Janet Erro, Kristin Delaney, Richard A. Deyo; A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain A Randomized, Controlled Trial. Annals of Internal Medicine. 2011 Jul;155(1):1-9. Available at: http://annals.org/article.aspx?articleid=747008. Accessed October 29, 2013.

Linda J. Vorvick, MD, C. Benjamin Ma, MD, David Zieve, MD, MHA. Low back pain - acute. A.D.A.M. Medical Encyclopedia. June 29, 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004668/. Accessed on October 29, 2013.

"Low Back Pain Fact Sheet," NINDS. Publication date July 2003. NIH Publication No. 03-5161. Available at: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed on October 29, 2013.

Sherman KJ, Cherkin DC, Wellman RD, et al. A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. Arch Intern Med.2011;171(22):2019-2026. doi:10.1001/archinternmed.2011.524. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1106098. Accessed on October 29, 2013.