Why do I have low back pain? This is one of the most common questions I get in my Neuromuscular Therapy practice near Boston. After all, this is the most common insurance claim, pointed out by Dr. David Eisenberg in his surprising study that showed that about 60% of our population goes to alternative therapists without telling their doctors! He asked insurance companies what their three most common complaints were. They answered: low back pain, low back pain and low back pain. So he followed up with a study that compared the benefits of accupuncture, chiropractic and massage therapy treatments on low back pain. Massage Therapy came out on top.
Neuromuscular Therapy is a specialty treatment somewhere between Physical Therapy and Massage Therapy with a focus on Trigger Points in soft tissue locations that refer pain away from their hyperactive nodules. Trigger Points are one of the most common causes of low back pain. They occur in muscles of the back, but also can come from muscles in the pelvis, hips and abdomen. There are two volumes of medical information on Myofascial Pain and Dysfunction: The Trigger Point Manual by Drs. Travel and Simons. (See the Amazon store in the sidebar.) The second volume on the lower body was published in 1991 and marked a turning point in the medical understanding of low back pain. Because it is only 18 years old, this information is considered new to medicine and is still not well known nor taught extensively in Schools of Medicine or Physical Therapy. Research is limited and those of us who treat Trigger Points are going on the information in these two precious volumes, our own experience and the mentoring and further writings of such pioneers in the field as Dr. Leon Chaitow, Judith Walker Delaney (my teacher) and her original partner in developing the American Neuromuscular Therapy protocols, Paul St. John.
Trigger Points are my focus as a Neuromuscular Therapist, but there are other causes of low back pain. Usually when a patient comes to me they have already been through the medical route and have had medical causes for low back pain ruled out or treated. Some of these are disc herniation, congenital spinal deformities, spinal diseases, facet joint hypertrophy, sacroiliac joint dysfunction, scoliosis and pelvic diseases.
What muscular causes of low back pain do I look for?
1) Unaccustomed overuse
2) Accumulated tension
3) Life and the affects of aging for those over age 45
4) Structural asymmetry like a leg length discrepancy
5) Old injuries or surgeries
6) Repetitive stress
7) Posture and positional stress
8) Emotional stress like withheld anger
The muscles most commonly causing low back pain are following:
1) Quadratus lumborum
2) Multifidi (sometimes rotatores)
3) Longissimus thoracis and iliocostalis lumborum
4) Gluteus medius and maximus (sometimes gluteus minimus)
Other muscles that contribute are the rectus abdominus and soleus.
The ligaments that cause low back pain are mostly the iliolumbar and sacroiliac, and with them, the lumbosacral fascia.
The entries that follow will treat each of these points.