Low Back Pain Causes – A “Big Picture” Perspective

18 September 2013

Lower back pain (LBP) is one of the most common ailments treated by remedial massage therapists.

The success or otherwise of treatment depends on the causes or contributing factors, the competency of the practitioner and, often, whether the client is willing to follow advice (eg exercise or stretching).

If you mention LBP and any physical therapist just wants to focus the entire treatment on that area, you’d be well advised to leave and never come back.

The reason is that with LBP (as with many other ailments), there can be a myriad of causes and/or contributing factors, many of which the sufferer probably isn’t aware of.

By just focusing the entire treatment just on the lower back area, there is a good chance the therapist may aggravate the problem by increasing any existing inflammation.

Here’s just a few things any practitioner should consider:

•          Is the pain just due to, say, poor posture from working at a computer, studying or maybe driving a taxi or truck all day? Or perhaps even the vibrating and spinal compaction effects of riding a motor cycle or flying a helicopter while wearing a helmet?

•          What type of pain – more on one side than the other, sharp, burning, tingly, achy, numbness, etc.

•          Foot, ankle, hip, knee, spine, shoulder, jaw or other postural alignment issues.

•          Recent or old fractures, torn soft tissue, whiplash, etc.

•          Vertebral disc or other spinal damage or deterioration of some type.

•          Overall medical/disease/surgical history and use of pharmaceuticals.

•          Various sprains, strains and other overuse or repetitive injuries.

•          Deterioration or tears in joint/capsular cartilage or lubrication (eg clicking or grinding in hip joint).

•          Stress factors.

•          Exercise or sporting activity.

•          Age, height and weight factors.

The list just goes on and on.

LBP may be the result of any one or any combination of those factors.

Any health practitioner of any type who doesn’t take ALL those potential factors into account simply is not doing his or her job.

When they are all taken into account and the appropriate treatment given (and/or advice, if followed), a competent remedial massage or other physical therapist should be able to make at least a noticeable difference in a client’s pain levels in just one session.

If that doesn’t happen, there’s a good chance that treatment is beyond the scope of those therapists. Medical intervention may be required, at least initially by ordering investigative x-rays, scans, MRIs or ultra-sounds or possibly just by prescribing medication for immediate pain relief without which a remedial massage may not be possible.

This would normally be the case where there is some sort of probable vertebral/spinal damage or deterioration. But there also could be medical issues like kidney stones, infection, cancer or other disease.

In cases of sudden onset acute lower back pain, eg. bending down to pick up a paperclip and not being able to stand up straight again, it may be best to see a doctor first to get some strong pain relief. Without it, lying on a massage table in one position, eg. on your back, for an extended time may be too painful and not allow your therapist to give you an effective treatment.

Here’s some examples of where pain is increased or decreased with various activities and the likely or usual pathological implications (causes) of those pain behaviours.

•          Increased pain with sitting, coughing, back (spinal) flexion; or decreased when standing, walking or back extension is usually associated with intervertebral discs.

•          Increased pain with standing or walking – spinal canal stenosis (narrowing of the spinal canal). The pain may also be from vascular claudication (insufficient blood flow).

•          Increased when sleeping – non-musculoskeletal cause. If pain increases when rising from sleep, it is usually due to acute inflammation or ankylosing spondylitis (a type of spinal arthritis).

•          Increased when in prolonged positions – connective tissue inflexibility or McKenzie Postural Syndrome (prolonged poor posture overload, usually in under 30s).

•          Increased when sneezing – dural or spinal chord involvement. The Dura Mater is the outer membrane around the brain and spinal chord through which all nerves must pass.

•          Increased with spinal extension or decreased with spinal flexion may involve facet joint arthrosis/osteoporosis (degeneration of joints in the vertebral discs). Types of facet joint sprains may also be involved with decreased pain with spinal extension or increased pain with flexion.

•          Sciatic pain down the leg may be due to spinal deterioration or entrapment, but it may simply be a case of the sciatic nerve being impinged in tight buttocks muscles.

In some of the above cases (eg if vertebrae are chipped or cracked and compromising nerves), and depending on the severity of the condition, surgery may be the only option to relieve back pain – but only as a last resort.

In most cases, remedial massage by a competent and experienced professional can usually offer at least limited relief by helping to correct alignment issues that put more pressure on damaged discs and vertebrae that are more likely to trap nerves.

So if you suffer low back pain, before putting yourself through a battery of medical tests and expenses, try a thorough remedial massage to see if that helps.

David Hall ©


Mount Louisa-based Townsville massage therapist specialising in Remedial Massage for all types of muscle and/or joint aches and pains, headaches and migraines and preparation for and recovery from sporting, exercise and fitness activities including Defence fitness tests. I guarantee the best value for money remedial massage in Townsville. CALL NOW on (07) 4774 6973 or 0438 774 819 to book an appointment.