Ever wonder why you’ve got an aching across both sides of your lower back?
Chances are that you’ve had treatment for it in the past, got relief for about 2-3 days and then the symptoms return. It can be expensive as well a frustrating for anyone returning to a manual therapist over and over again. Usually the therapist looks at your back, continues to give the muscles a rub and then hopefully get the Lumbar spinal joints moving – Which is fine! But, only if you want a short term release.
As an osteopath, we look at the whole. So when I hear a diagnosis of “tight muscles due to lack of movement” or something really boring and un-imaginative like that, you’ll usually catch me with my eyes firmly rolled into the back of my head.
The WHAT, is easy to figure out. The muscles get tight, due to a lack of range of motion (RoM) or bad posture….. Fine. But WHY?
It’s the WHY that matters: WHY are those muscle groups tight? WHY are they potionally hypoxic and/or fibrotic? WHY do the Lumbar spinal joints have a reduced RoM? WHY is the diagnosis relevant to this person? and WHY is it so common?
Finding the what and treating it is simple, its figuring out the ‘why’ that makes the treatment last.
The predisposing and maintaining factors, these things will vary from patient to patient, lifestyle, activity levels, work habits, driving patterns. they all add up.
The illopsoas muscle group, or hip flexors, are actually in front of the spine, attaching from the anterior surfaces of vertebral bodies T12 – L5, and running down to the groin.
Naturally, based on nothing more than looking at its location, its clear that it will have an impact on the Lumbar spine (LSp). Attachment from T12 to L5 will cause compression of the LSp when that muscle gets tight. For us to understand this a process called muscle shortening needs to be explained…
Have you ever been on the phone for a long period of time, and then you come off the phone, your bicep feels tight, sore and when you straighten your arm it feels as if it’s going to snap? That is adaptive muscle shortening. It’s an energy saving mechanism. When muscles are only ever held in a shortened position, either in resting or actively, they shorten. This happens in the iliopsoas muscle group.
How? How many hours have you spent sat down today? As a culture we spend all our time sat down, we get in our car to go to work, we then sit at a desk answering emails for 8 hours, we then get in our car to get back home, where we sit on the couch watching Netflix. Some of us occasionally go for a run or go to the gym. But even the more active people still spend way too long sat down, and even when they are active they aren’t engaging the iliopsoas muscle group properly (IT band pain in runners – but let’s save that for another day). It’s something we will struggle to escape in modern society.
But fear not, ways to overcome this will be given in due course… less drama, more calmer!
So, we’ve learnt how adaptive muscle shortening occurs, the important of looking a bit more holistically as opposed to a reductionist approach. But how does tight hip flexors equate to a band of tension, aching in the lower back?
Tight hip flexors make the hips flex, we flex forward …… with me? If the hips remain flexed, as we stand up, the brain does anything it can to make sure that the eyes are on the horizon and level, meaning that we need to generate extension (leaning back) from somewhere to compensate for that hip flexion. The easiest thing to do is to extend the LSp. We already have a slight extension through the LSp as part of our natural curvatures, called a lordosis, what his does is make it deeper, which means more compression through the Lip.
Which means, apart from make you look like a duck, is approximates the joints of the LSp together. Commonly resulting in a decreased RoM… And we come full circle!
Tight hip flexors = compressed spine = decrease range of motion = tight back muscles = aching across your lower back.
Bish, Bash, Bosh
Now, this is obviously quite a simplified story. Very rarely are things this simple: Anatomy, physiology and pathology often complicate this far more than I’d like. But this is a pretty good start to help you understand what might be causing your non-specific lower back pain, and more importantly, to get you to start questioning why it’s happening in the first place. Don’t be satisfied with a practitioner telling you the obvious.