L is for Lumbar

It’s no secret that back pain is common among the general population – more so in recent times, where we find ourselves leading increasingly sedentary lives – or at the least, spending a lot more time in a sitting position, rather than up and about, out in the wild trying to catch our dinner or foraging for food!

The lumbar region of your spine (lower back) is made up of five vertebrae and bears the majority of the body’s weight, it also happens to be the second most flexible region of your spine after the cervical region, your neck. There’s clearly a stability vs mobility issue at play in this region but we’ll save that for another post!

We see a fair number of clients presenting with lower back pain. After taking a comprehensive history we will quite often (to the surprise of the client) ask them to lay on the table face up…yes, so that they are laying on their back. “Now what good is that?” I hear you say, how will you treat their back if they are lying on it? Well, this is what we wish to explain.

There are several muscles which attach to your lumbar vertebrae and have influence on your posture, movement, and level of comfort – or indeed, discomfort. (Which could be thought of as the amount of  pain experienced).  Three key muscles we find which can be over tight, contain trigger points or be dysfunctional are the Quadratus Lumborum, Psoas Major and Iliacus:

Quadratus Lumborum (viewed from back)

Quadratus Lumborum – attaches on the top ridge of your pelvis (iliac crest), the lowest rib, and the upper four lumbar vertebrae.

Psoas Major highlighted at left; Iliacus on right (with QL shown above iliac crest) (viewed from front)

Psoas Major – attaches to the lumbar vertebrae and the lesser trochanter of the femur (inside, top of your leg).

Iliacus – attaches on the inside of your pelvis (iliac fossa) and also the lesser trochanter of the femur (in fact it’s tendon blends with that of Psoas Major).

When in a sitting position, the Psoas Major and Iliacus (known commonly as Iliopsoas) are held in a shortened position. The connective tissue (fascia) around the muscles responds to stimuli slower than muscle fibres in contracting and relaxing. If it’s held in certain positions for long periods of time then it adapts its length to be shorter. The fascia will then remain shortened for a longer period of time. If this is difficult to imagine, think of muscles as being elastic, snapping back to length easily, whereas fascia is plastic and stays in a formed shape for longer.  So, when you stand, those fibres which have become accustomed to a shorter than optimal position, stay short, and are put under greater tension than they should. Because the psoas muscle attaches from the leg to the lumbar vertebrae you can experience the short/tight pulling as back pain.

By assessing these muscles first we can determine whether or not they are contributing to your lower back pain. Does that make sense?

The other muscle we mentioned above was quadratus lumborum. Because these muscles (one on each side) attach on your spine and pelvis they tend to be the postural muscles which take the brunt of the work when other back muscles are either weak or dysfunctional. So although they are relatively small muscles in your back they do play a large role in back pain.

There’s obviously a whole load of other muscles and soft tissues which could be contributing to back pain, but don’t be surprised if we start working on your hip flexors initially!

A final piece of advice – to start to counteract the possible tightness in your hip flexors you should be stretching them…just like this (showing stretch of left side):

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