“Lift with your knees!” you have heard this before right? It’s not a bad word of advice when helping your buddy move furniture or picking up that heavy bag of dog food. Why do we say this? To protect our back from pain right? It is widely accepted that if you pick up something heavy the “wrong” way your body will suffer the consequences later. It’s a pretty straight forward equation: Bad body mechanics + heavy items = low back pain. It’s not only lifting, other common explanations for low back pain are, “I sat in a 5 hour meeting and didn’t get up to move around” or “I think I just slept wrong”. While yes, these could very well be factors contributing to back pain, it’s important to know that there are other explanations as well that aren’t as straight forward and obvious.
There are two main concepts that are critical to understand to help set the stage for why this is true. First, is to understand that the low back is a part of a system, it does not act alone and when other parts of that system are dysfunctional it can cause pain in other places apart of that system. Secondly, pain is tricky! Pain is an alert system for our body to say something is wrong but the body part ringing that bell may not be the culprit. Pain location does not always follow the straight forward equation.
Pain location ≠ Pain Causation
With that in mind, we are going to lay out for you three causes for low back pain that you would never expect.
A Bad Day
For years we have thought that pain is strictly mechanical. You step on a nail, it turns on pain receptors and you experience pain. Then as things heal, the pain calms down and it eventually goes away. But what that model failed to explain is why people have persistent pain. Research that has been done over the past few decades aimed at uncovering other causes of pain that do not fit this train of thought. What we have found is that our emotional selves and physical selves are very closely linked. Factors like stress can have a strong effect on how we feel and experience sensations, especially pain. So what we find is that during a particularly stressful time, like a bad day, symptoms like low back pain can come up or worsen. This is because stress has an effect on our body’s nervous system and it makes it very hypersensitive to any type of stimulus. So our back becomes less resilient to daily tasks because your alarm system is more readily available to go off than it was before. Dr. Louw has done a lot of research on this topic and does a fantastic job giving you a brief overview of this concept. Check out his explanation here.
When thinking of a bad day or a stressful season contributing to pain, maybe we could think about other things like sleep, meditation, or things that bring us joy to help combat pain.
The lumbar spine and the pelvic floor are very closely related not only because of their close proximity but also because they work together in your abdominal pressure management system. Your pressure management includes the pelvic floor, the diaphragm and the Transverse abdominis (which has attachments to your lumbar spine). All 3 structures need to work in-sync with one another to create a healthy amount of pressure in your abdomen. When your pressure management is not used correctly we find issues like, hemorrhoids , urinary incontinence and fecal incontinence due to unbalance pressure being put on your pelvic floor. As a result, it is very common that people with these types of issues also experience low back pain. While seemingly unrelated, improving the efficiency and health of your pelvic floor and pressure system can make a large impact on low back pain. For more in-depth information pressure management and what happens when it goes awry check out our blog here.
Learning more about your pelvic floor, symptoms of pelvic floor dysfunction and specifically how to treat it could be your missing link to chronic back pain.
Hips that DO lie
When evaluating a client with low back pain, apart from assessing their spine the next important thing to look at is the hips. There are many reasons for this. First and foremost, we want to rule out the hip as the cause of pain. As discussed before, pain is tricky and we cannot always take it for face value. We have to look at the surrounding areas and evaluate their role in the matter. The low back is a common referral sight of pain for the hips so looking over that detail could mean you are missing the root cause all together. The hip and low back relationship is a great example of pain location ≠ pain causation.
While your slipped disc or tight psoas can contribute to pain, don’t forget about these other factors.
Identifying the best stress relief techniques that work for you could help quiet that back pain during a bad day or a stressful season could do far more for you than foam rolling your back for hours on end when your back is flared up.
Reaching out to a pelvic floor therapist to discuss your urine leakage you thought was normal or pain with intercourse you have been shy to talk about could be a key factor in helping you make strides forward with your back pain no one has been able to help you with.
Performing a few hip stretches each evening before bed, or better yet, finding a practitioner to help you screen your hips and surrounding joints could be the missing puzzle piece in decreasing your back pain flare ups.
Pain location doesn’t mean pain causation.