Low Back Pain 101: What causes low back pain?

What causes low back pain? There are so many possible answers to this question, but in this article we’re going to narrow it down to the most common ones we see here at Revitalize Physical Therapy. When a patient comes in telling us that they’ve tried so many things to get relief for their back and NOTHING works..well our minds tend to  jump straight to blaming the pelvic floor. Keep reading to learn about how the pelvic floor can be what causes low back pain!

Anatomy

With low back pain, people assume that the root of the pain is somewhere in the spine or the SI joints. However, there are a lot of structures such as pelvic floor muscles, ligaments, and fascia that are in very close proximity in the low back and pelvis. All of these structures function to support and stabilize the spine and pelvis, but can be problematic if there is any dysfunction such as weakness or tightness.  

The key muscles that work together in this area are the pelvic floor muscles, the back muscles, diaphragm, hip muscles, and the core.  If you haven’t done exercises that incorporate all of these muscles, there’s a good chance that they aren’t coordinating well together.  People often isolate muscle groups and only strengthen that one muscle group such as the core or glute muscles. However, these muscles can’t work as strongly if you don’t recruit the others listed above.  That’s why it’s important to do exercises that incorporate these multiple muscles in order to gain more strength and stability through the back.

Without proper stability and support at the spine and pelvis, the body begins to adapt to abnormal motions and movement patterns as their new ‘normal’. The longer these go on without being corrected or applying proper support to the back, pain begins to develop and worsen. 

Causes for Low Back Pain

1. Pelvic Floor. One of the major culprits for low back pain (but often overlooked) is the pelvic floor!  Since the pelvic floor attaches to all aspects of the pelvis, the coccyx, and the sacrum, it has a major impact on the spine and the stability of our low back.  Here are a couple of ways the pelvic floor can cause low back pain:
   • If the pelvic floor muscles are tight or painful, it can refer pain to the back or abdomen with trigger points - just like any other muscle in your body. Think of your upper trap muscles above your shoulders. Many people experience tightness in these muscles, which can lead to neck pain or even headaches. Have you experienced that before? The pelvic floor muscles work similarly: Trigger points in the pelvic floor may cause you to feel pain in your back.
   • Overactivity in the pelvic floor muscles can also “pull” on the bony structures such as the coccyx and sacrum.  This will put them in a less than ideal position and can lead to low back pain due to the alignment issues. However, if you are only trying to fix the alignment of the bones without addressing the tight pelvic floor, it will keep getting pulled back into that poor position.
   • For some people, they can have low back pain if the pelvic floor muscles are weak or uncoordinated.  Since the pelvic floor provides a lot of stability for the pelvis and spine, if they aren’t working properly, then the spine has to do extra work and this can lead to pain.2.
2. Joint Mobility.  Besides the pelvic floor, we see a lot of patients who deal with back pain as a result of poor joint mobility. People who sit all day with poor posture tend to get stiffness throughout their spine that can lead to pain and limited range of motion. Gently adding movement throughout your day, like exercising and stretching, is the best way to prevent that stiffness from setting in.
3. Sacroiliac (SI) joint. The SI joint can very easily shift out of ideal position if there is muscle tightness or weakness present among the pelvic stabilizers. This poor positioning of the SI joint can be one sided or happen on both, but can cause pain along the top of the buttocks. 
4. Core Weakness. With all 4 layers of our abdominal muscles wrapping around and attaching onto the spine and pelvis, they provide a lot of support for the spine. If these muscles are weak or uncoordinated, they won’t be able to provide the trunk support we need for activity and everyday movements.  Then, this added stress gets added to the spine and can lead to low back pain.
5. Fascia. Fascia is the layer of connective tissue in between the skin and muscle that connects through the abdomen, low back, and pelvis. If tightness develops in any of those areas, it causes increased tension across the rest of the fascia. This can cause the sensation of tightness or limitations in movements and can also cause limitations in joint movements. 
6. Diastasis Rectus Abdominis (DRA). This is a condition we see in pregnant and postpartum women who are experiencing low back pain. This occurs when the two muscle bellies of your abdominals are separated and therefore unable to functionally stabilize your spine and pelvis during movements. The lack of tension across the core muscles puts extra pressure on the spine and back muscles. 

What to do when nothing seems to help

If you’ve repeatedly tried stretching, core exercises, yoga, chiropractic or traditional Physical Therapy with no relief for your back pain- it might be time to book your consultation with a pelvic floor physical therapist. Those other things might not be working for you because they aren’t addressing the root of your pain (ie: the pelvic floor). The pelvic floor is too often brushed aside when looking for the root of low back pain, but you deserve a physical therapist who has been specially trained to assess all of the possibilities INCLUDING the pelvic floor. 

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