Lower back pain causes can be broken down into three major categories:
Often more than one cause is contributing to pain.
For example, one might be have a musculoskeletal cause such as postural distortion creating chronically sore back muscles which are then worsened by an aggravating factor such as being overweight which stresses the muscles further.
If you have had an MRI, X-ray, or other test that has come back negative, and if your physician has found nothing wrong with you, then chances are very good that a Musculoskeletal Cause is the problem.
If that’s the case, I strongly urge you to thoroughly explore the Musculoskeletal Causes section.
For a more in-depth look at the larger reasons that the musculoskeletal causes of lower back are not more widely discussed in the medical literature see my article, The Cause of Lower Back Pain: A Neuromuscular Perspective.
Lower back pain causes of a musculoskeletal origin are much more common than those of a pathological cause.
Ischemia - A restriction in the blood supply to muscles (or other soft tissues such tendons, ligaments, fascia), causing a deficiency in oxygen and glucose both of which are essential for cellular metabolism (to keep tissue alive). Ischemia results from chronic muscular contraction due to lack of stretching, inactivity, muscle imbalances, and repetitive overuse. This restriction of blood underlies all musculoskeletal lower back pain causes.
Iliopsoas Syndrome - When the iliopsoas muscle, composed of the iliacus and psoas muscles, becomes dysfunctional (i.e. chronically tight, short, & ischemic) the result can be localized pain and trigger point referrals.
Sacroiliac Joint Dysfunction - Often confused with Sciatica, Sacroiliac Joint Dysfunction causes pain due to either hypomobility or hypermobility of one or both sacroiliac joints.
Piriformis Syndrome - Piriformis Syndrome causes pain as a consequence of entrapment of the sciatic nerve by an extremely hypertonic piriformis muscle. Pain is often felt in the buttocks and sometimes down the back of the leg.
Nerve Compression and Nerve Entrapment - Nerve compression causes back pain as a consequence of pressure on a nerve from a bone spur or bulging intervertebral disc. Nerve entrapment causes back pain as a consequence of a nerve being entrapped by soft tissues such as muscles or fascia.
Trigger Points - Myofascial Trigger Points in ischemic muscles can refer pain to other parts of the body. Referred sensation could be pain, tingling, numbness, thermal sensations (hot/cold), or a generalized achey feeling.
Sensory-Motor Amnesia - This is a phenomenon whereby we lose sensory-motor control of our muscles allowing them to remain chronically contracted. Chronic muscular contraction is one of the chief causes of low back pain.
Postural Distortion - If the body is not balanced and upright in gravity then muscular imbalance can develop causing postural distortion. This can lead to muscular strain, ischemia, and trigger points. It can also lead to one-sided lower back pain.
Tight Leg Muscles - When the long muscles of the legs such as the hamstrings, adductors, and quadriceps are tight and short this can put strain on the lower back, especially when walking.
Dysfunctional Biomechanics - Any number of influences can result in dysfunctional body biomechanics and cause back pain including pelvic torsion, inflexible muscles, or faulty habitual movement patterns. An example of this is described here.
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Lower back pain causes of a pathological origin are much less common than those of a musculoskeletal origin.
True Sciatica - When the sciatic nerve, the largest nerve in the body, becomes compressed by a bulging intervertebral disc, it can result in pain down the buttocks, the back of the leg, and sometimes foot. True Sciatica must be distinguished from other causes which can produce sciatic symptoms such as trigger points and sacroiliac joint dysfunction.
Herniated Disc - When an intervertebral disc, which forms the cushion in between each of our vertebrae, becomes compressed, it can bulge to the point of bursting. This is a disc herniation.
Spinal Stenosis - When the spaces within the spine narrow, it is called Spinal Stenosis. This narrowing can be caused by a variety of different things including bone spurs, arthritis, calcium deposits, and spinal tumors.
Ankylosing Spondylitis - An inflammatory disease resulting in the fusion of vertebrae.
Spondylolisthesis - A condition in which a vertebrae becomes displaced, either forward or backward, in relation to the vertebrae below it.
Scoliosis - A curvature of the spine, either an S-curve or a C-Curve. There are two general types: structural and functional. Structural scoliosis is a congenital condition in which the spine itself possesses a curve. Functional scoliosis, on the other hand, is caused by postural distortion which forces the spine into a compensatory curve.
Osteoarthritis - A common joint disorder that often begins to appear in middle age and affects a large percentage of the population by the age of seventy.
Rheumatoid Arthritis - A degenerative autoimmune disease that results in joint inflammation. While it can be a cause of back pain, it most commonly affects fingers, wrists, feet, ankles, and knees.
Endometriosis - A disorder suffered by women in which cells from the lining of the uterus grow in other areas of the body such as the bladder, bowel, rectum, and ovaries.
Viscerogenic - Viscerogenic Back Pain arises from the visceral organs such as the kidneys, pancreas, or pelvic viscera. Viscerogenic pain is not relieved or aggravated by spinal movement or rest. It can potentially be confused with referred pain from Iliopsoas Syndrome.
Fibromyalgia - Also called Fibromyositis and Fibrositis, this is a condition in which there is generalized pain and tenderness throughout the body. While most of the literature on the subject states that there is no known cause, one possible explanation might be found in Pfluger's Law of Generalization*.
*The Law of Generalization is a neurological law that explains how multiple injuries, traumas, and/or muscular strains can build up over time. The Law of Generalization states that:
"When the irritation becomes very intense it is propagated in the medulla oblongata (lower half of the brain stem), which becomes the focus from which stimuli radiate to all parts of the (spinal) cord, causing a general contraction of all muscles of the body.” (My emphasis)
It is very common for the primary causes of low back pain to be accompanied by aggravating factors.
Being Overweight - Extra weight on the body forces the back muscles to overwork and therefore can result in back pain. Also, being overweight is often means that an individual is not exercising regularly. This can result in weak core muscles which must be strong in order to support a healthy back.
Sedentary Lifestyle - Chronic muscular contraction occurs most easily when the body’s muscles are not exercised and stretched out regularly, resulting in both weakness and inflexibility. One of the chief reasons muscles regain an anchor hold of tightness again and again is because their antagonist muscles are weak or perhaps not firing at all. This is why overall strengthening throughout the body is essential to resolve lower back pain.
Stress - There is a strong connection between stress and back pain. Stress can cause chronic muscular contraction, postural distortion, and general fatigue. Often muscular contraction can persist in the body, even when sleeping, and even after stressful circumstances have passed.
Static Stretching - Especially with very tight muscles, static stretching can promote more back strain than relief. This is major problem for individuals either trying out yoga for the first time or just pursuing static stretches too vigorously. They push themselves too hard and end up straining themselves.
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