Low-Back-Pain by Dr. Kevin Purcell, D.C.

For some, low back discomfort is a chronic, long lasting issue; perhaps part of your daily life. At times it is completely debilitating. At other times it is like a headache and lowers the quality of life. I am going to write a series of three articles that address some of the reasons for low back pain, proper diagnosis of the issue(s) and some treatment options.

Low back pain can be difficult to treat because most health care providers have a difficult time properly differentially diagnosing, specifically, where the pain is coming from. Or, they get one cause and leave out another. The key to successful treatment is to name specific cause(s) for the pain and manage them.

We want to treat the root causes in addition to getting symptomatic relief. Typically, low back pain is a combination of things going wrong.

There are several issues you and your team will want to address when considering the source of low back pain. Here is a list of three (three articles) of the key issues:
(1) soft tissue health,
(2) degenerative joint disease (osteoarthritis) ,
(3) lumbar nerve root impingement, which if often tied to disc dessication, thinning or herniation.

As we age and discomfort becomes chronic, all three may be in play at the same time.

I will start with the least complicated of the three issues as it usually accompanies the other two:Soft Tissue.

When it comes to soft tissue health,
–tight hamstrings (back of thigh),
–the piriformis (both found in the buttocks)
–and quadratus lumborum (low back muscle)
can decrease normal range of motion– and this decreased ROM is often part of the discomfort/pain puzzle.

But the most common soft tissue culprit of chronic low back pain is shortened or fibrotic psoas muscles.

The anatomy is a little more complicated than what follows, but in an effort to communicate more easily, I will leave out some of medical terms for now.

The psoas originates along boney parts of each of the five lumbar vertebrae.
From both the left and right side of the vertabrae, it runs downward and inserts on the lesser trochanter of the femur. That is the upper inside of your thigh bone. The psoas’ job is as a hip flexor. Think of raising your knee when standing or riding a bike as you unweight or bring the pedal upward.

Trouble with the psoas can mean trouble with the lower spine and nerves of the lumbar plexus what are called L1 – L4 on the spine.

The psoas can become chronically shortened from sitting long hours at your computer.

Because the psoas attaches to the vertebrae of the lumbar spine, when it is tight it can pull on those lumbar joints (facets) and this can cause discomfort or ache when sitting or riding.

A telltale sign of this is feeling pain when rising from long hours at your computer– and being unable to straighten up– and this is painful. More severe and even debilitating pain can occur when the patient has disc disease or osteoarthritis at the same time along with the muscular dysfunction.

Because a tight psoas muscles also restricts hip extension (leg back), it decreases range of motion when we run or walk and may alter your running or walking gait.

Lastly, the genitofemarol nerve from the lumbar plexus pierces the psoas. With a shortened or tight psoas, this nerve can become entrapped –and results in pain radiating into the sex organs, typically a testicle or labia on one side only.

In summary, a tight psoas can create havoc for patients, both functionally and through painful symptoms: discomfort on a bike, trouble standing straight from sitting, altered gait, chronic low back pain and groin pain.

I suggest ongoing preventative care to keep the psoas supple and functioning properly. Keep in mind, all care is meant to keep us in motion.

For those who are handicapped by this, or recovering and undergoing rehabilitation, care is focused on
–maintaining or re-establishing motion.
–Then we add or maintain strength.
— Consistency rules. Anything that disrupts consistency (injury, deep fatigue, illness) disrupts your health.

If you find yourself with acute or chronic problems in this area, find a good doctor or therapist who is experienced with manually releasing the psoas (or other muscle mentioned above). I use Active Release Technique (ART) but there are others ways to get this done. Become of a student of your condition and become your best advocate.

Feel free to ask questions and I will do my best to assist. I plan to follow up next with articles concerning degenerative joint disease and disc disease.

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Copyright 2013 The Moderate Voice
  • ShannonLeee

    oh man, lower back pain is a major influence in my life. I threw my back out at the young age of 17. I was weight training and had the safety devices set to low. I failed to lift the weight and went crashing down….my life was never the same. 20 some odd years later. I have become very good at managing the pain and I effectively live a normal athletic life, but not without a lot of personal training and self awareness. Lower back problem is a massive problem and effects so many people.

    thanks for writing about this KP.

  • DR. CLARISSA PINKOLA ESTÉS, Managing Editor of TMV, and Columnist

    incredibly clearly written. Thank you Dr. P!! Just this alone should be common knowledge for everyone from the time they’re little. Owner’s manual: EVERYONE has a body to watch over like best friend.

    And ShannonLee, I’m sorry that happened to you, and glad you are taking good care of yourself and remain active and aware. That’s good.

  • Thank you. Very informative.

  • KP

    You are welcome, it is my please to share whatever I know with all of you.

    ShannonLeee, my LB issues also began when I was in my teens and in athletics. It is the reason I became a DC and focus on sports med and disability evaluation.

    Like other traits we inherit from our parents (hair color, features, longevity genes, etc) low back weakness if often passed along to children. At times I have studied a dad’s x-rays alongside his son’s and see the same structural anomaly.

    Some of us are prone to heart disease, dementia, or cancer; and some to various kinds of arthritis. Others seem almost immune to these issues. Those prone to osteoarthritis (wear and tear in the spine) can learn to manage it’s progression and the pain.

    The other causes of wear and tear are repetitive or acute trauma. I have treated some of the NFL’s San Diego Chargers. Beautiful bodies and very fit men. But when we look inside at the cervical spine of a 30 year old man who uses his head as a battering ram it is often riddled with degenerative changes and spurring. A past history of repetitive trauma in the weight room, on the football field or acute trauma from a couple of car accidents is a predictor for the cascade or sequelae of degenerative joint disease (DJD) ten years later.

  • JSpencer

    Chronic pain of any kind is no joke and can seriously reduce ones quality of life. I suffered from lower back pain for several years beginning around the age of 50. I was able to control the pain with physical therapy and back exercises for a few years, but eventually that stopped helping. In the end I had a microdiscectomy (which was an outpatient procedure believe it or not). This was 8 years ago. I’ve been pain free for 8 years and lead a very active life with relatively few physical restrictions. I’m not quite as limber as I was when I pole vaulted and wrestled back in the day but I feel pretty damned good. For me the microdiscectomy was a life safer.

  • sheknows

    Thank you Kevin for a much needed series. Probably every woman in the world has lower back issues at one time or another. I used to have more when I worked on the computer almost 6 hrs a day at my last job. Sitting made me miserable. Used to apply a heated rice sack to my lower back all the time.( Jasmine rice is lovely). Noticed though that I have not had ANY lower back issues since I retired. It was almost an immediate remedy to my problem within a month.
    I work out 3x a week now but do not have any good exercises for my lower back. I use suspension weights for upper body and back but don’t know how to strengthen the lower. I have a few health issues but have “thrown” my lower back out before. Don’t really want to risk that. Any suggestions?

  • KP

    I work out 3x a week now but do not have any good exercises for my lower back. I use suspension weights for upper body and back but don’t know how to strengthen the lower. I have a few health issues but have “thrown” my lower back out before. Don’t really want to risk that. Any suggestions?

    sheknows, I have dozens of exercises that would be beneficial. Best to start simply, limit yourself to 5 to 10 reps so you don’t get too sore and focus on perfect form. It will be longer than a comment here so I will attempt to post some images of a few with some thoughts as an article. “Functional Strength of the Core”. Not sure I can get images up but will try.

  • sheknows

    Thank you so much for taking the time Kevin. I love this, we can have a completely holistic website for mind, spirit ( have had a few religious articles but could use more) and now body. 🙂

  • DR. CLARISSA PINKOLA ESTÉS, Managing Editor of TMV, and Columnist

    i’ll help you KP, if you cant get the images up. Just let me know. You just do multiple images the way you do a single image, placing it first with your blinking cursor in the part of the text you want the image to go. Let me know. Happy to help.

    archangel/ dr.e