Low Back Pain Series, Part 1
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.
COMPLETE, NOT PARTIAL DIAGNOSES, IS IMPORTANT
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.
TREAT ROOT CAUSE and GAIN RELIEF FROM SYMPTOMS
We want to treat the root causes in addition to getting symptomatic relief. Typically, low back pain is a combination of things going wrong.
THREE CAUSES OF LOWER BACK PAIN
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.
SOFT TISSUE HEALTH AND ISSUES
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.
A PSOAS PRIMER
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.