One of the most common injuries that we see in our clinic are back injuries, in particular - low back pain. This can come in many shapes or forms but most commonly people find this aggravated after lifting or bending down or after sitting down for a long time such as in an office or driving a car. What’s the cause? How do we fix this? We’ll attempt to shed some light into this issue in our 3-part series.

We always go back to our principle of regional interdependence that we have discussed time and time again. This principle refers to the concept that seemingly unrelated impairments in a remote anatomical region (body part) may contribute to, or be associated with, the patient’s primary complaint......

By extrapolation, that simply means that although there is pain in the back, chances are, that the CAUSE of the problem is actually coming from somewhere else in the body.

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Looking at the diagram below, the lower back/lumbar spine region (in red), is expected to be an area of stability.

Now, an area of "stability" is not the same as area of "stiffness", just like how an area of "mobility" is not the same as an area of "loose-ness". Therefore, we want the lower back region to have some movement, but predominantly have stability.

However, therapists try to increase the movement of the lower back or stretch it. When an initial pain or injury occurs, the lower back can stiffen up. Even for a stable part of the body, we still need some degree of movement in that part and lack of sufficient movement can cause pain, hence the various techniques of spinal mobilisations/manipulations and stretches to regain that movement.

This brings us back to the regional interdependence concept; instead of looking at the lower back which requires stability more than mobility, what parts should be more “mobile” and moving? In this context in particular, we suggest looking at the thorax (mid-back/chest) and the hips.

The thorax and the hips are expected to be mobile, and in many cases nowadays especially people with lower back problems, the thorax and the hips don’t move very well, or are stiff. How would this cause a problem? Well, if your hips and thorax aren’t moving so well, and you still need to move – what moves? Your lower back.

Your lower back, which is meant to be stable, is sandwiched by stiff hips and thorax, which are meant to be mobile. As a result, your lower back has to compensate and do the work. This is what causes a lot of problems for a lot of people.

Now, this does not mean every back injury can be fixed or treating the thorax or hips, but a lot of the times it is a huge contributor, and it does mean yours might. Too easily we tone down our stiffness as “Oh, I’m just tight here and there, but I have a bad back.”

Have a look at your hips and other parts of the body, maybe they’re the reason you have a “bad back”. We see this “tightness” issue almost all the time, it’s so very common, everyone has it, right? It is true that it is common, but it does not make it normal. Let’s not take the common as the new normal – be better.

Why then do some people just keep hurting their back even after the pain disappears and the movement returns? Do they just have a “bad back”? There are even recommended exercises to strengthen your back or your core and you still get a “bad back”. Why is this so?

The answer to this question comes to the initial question of how people get back pain in the first place. Any injury is a multifactorial risk complex; this may include your work, the way you lift items, the way you sit, your seat, the sports you do, how you do your sports and the list continues. Among the many things you cannot change easily, there are things you can: how you do things.

Think back on your sports and activities. If you’re a football player, how are you kicking the ball with stiff hips and very little rotation in your trunk? By using your lower back – you’re kicking with your back.

If you’re lifting and you can’t bend down or up because of your stiff hips or mid back, how are you lifting? Using your lower back – you’re lifting an X kg weight with your back.

You’re a runner and your hips can’t move very well – you’re kicking the ground with the power produced by your lower back.

You’re an office worker who gets sore after sitting for a while and going to stand up and walk – if your hips cannot straighten up, and you need to stand, your back curves so that you can stand with your hips "not quite straight" – your lower back again.

In Part 2 of this series, we look at the myths surrounding back pain, and in Part 3, we look at some management strategies and mobility work that could help with back pain.

As always, this blog does not substitute medical advice. If you are suffering from back pain, please seek advice from a health professional.

Thanks for reading, and if this resonates with you, please feel free to share this around!

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