Low back pain is one of the leading causes of people missing work. It is also one of the most common reasons people go to see their doctor. Oftentimes, this leads to unnecessary imaging (x-rays, MRIs, CT scans) or even surgery that doesn’t always fix the problem. So, why does your back hurt? Let’s dive into some reasons why people have back pain and how physical therapy can stop low back pain in its tracks!
When it comes to assessing a patient who comes to see me for low back pain, I will screen not only the lumbar spine (low back), but I will also look at the thoracic spine (middle back where your ribs attach), and the hip joints. This is because low back pain is often coming from somewhere else. Here are some common issues I find when assessing a patient for back pain: decreased hip mobility, inability to activate abdominal muscles effectively, poor sitting or standing postures, and/or poor body mechanics with daily activities like squatting or bending. Now that you know a few reasons why back pain could happen, let’s dive into a few different types of pain you might have.
We can break down low back pain into two distinct categories: 1. Localized back pain and 2. Back pain that radiates (radicular back pain).
Localized Back Pain
Let’s take a look at low back pain that is more localized. This type of pain is typically easier to treat because the pain is isolated to one area of your back. People describe this type of pain as sharp, a deep ache, or even as a tight/restricted feeling in the low back. I have personally experienced this type of low back pain… I bent over to pick up a piece of paper (of all things!), and suddenly I couldn’t stand up because my back “gave out.” I have had several patients tell me stories like this. If we look at what really is going on here, we would find that this can happen when one of the small joints in our back (called facet joints) rotates or moves and then gets stuck while the rest of the spine moves back into a neutral position. Sometimes this resolves all on its own, but can happen again if we aren’t able to create stability in our spine. However, not all localized back pain happens because of these facet joints. We have a lot of small stabilizing muscles surrounding our spine which can be strained or pulled with repetitive or sudden movements, which could leave you feeling stuck or tight. Many times, this kind of low back pain can be treated with a combination of manual therapy techniques, core strengthening exercises, and mobility exercises. Now, let’s take a look at low back pain that might radiate down the leg.
Radicular Back Pain
When there is radiating pain, it could mean that one (or more) of the nerves that exit your spine are getting irritated by something, such as increased muscle tension, a joint that isn’t moving correctly, or even a herniated disc 
(more commonly known as a bulging disc). It can be very scary to have burning, tingling, or numbness that moves into your leg, especially when it comes out of nowhere. This kind of back pain can happen because of improper lifting techniques, poor body mechanics over time, or a limitation at another joint, such as the hip.
The first thing that we want to do is figure out what movements or positions decrease your pain and what movements increase your pain. When a certain movement decreases pain, it is called centralization. This means that the nerve pain (numbness, tingling, burning) is leaving the leg but remaining in the glute (your butt) or low back. As the nerve pain centralizes, there could be increased pain in the back or the glute, but it is a GOOD thing. I imagine you think this sounds crazy, but it’s good because it means the pain is staying in one spot rather than traveling. On the flipside, when a certain movement increases pain or numbness/tingling, it is called peripheralization. This means that the symptoms travel further down the leg. Sometimes this can make you feel better because the pain might not feel as severe, but the area that is affected is larger. Figuring out what movements reduce pain, such as bending forward (lumbar flexion) or leaning backwards (lumbar extension), is an important step. This will help structure a home exercise plan that includes gentle strengthening and mobility exercises that will help alleviate tension or irritation to the nerve.
Regardless of what has caused your back pain, physical therapy can help address any limitations that you might have. With either radicular pain or localized pain, we will first restore normal pain-free movement. Once pain is managed, we will work on gaining strength in the muscle groups that need strengthening, typically the core and glutes. When these muscle groups are weak, our low back has to pick up the slack, creating instability. As our core and glute strength increases, we are able to improve stability. Gaining strength isn’t the only piece we want to focus on. Remember when I said that low back pain can be caused by tight hips? Well, we want to get those joints moving! By implementing mobility exercises to the joints that are restricted, it can help restore normal body mechanics with functional movements. While gaining strength and mobility is key, we want to make sure that you can integrate these aspects into your life, especially with activities that are important to you.
Whether you want to be able to get on the floor to play with grandkids or run in a local race, the therapists here at Complete Physical Therapy can give you the tools you need to kick low back pain to the curb!