The Real Causes of Low Back Pain -A Physio Explains

 In Back and Neck Pain

The Real Causes of Low Back Pain -A Physio Explains

Low back pain is an enormous burden on society with up to 80% of society being affected by low back pain in their lifetime (1).

Having suffered debilitating lower back pain (lumbar disc injury) whilst at university I now find it very easy to empathise with low back pain sufferers. There is nothing quite like suffering low back pain to develop an innate understanding of the myriad of emotions that accompany the physical pain of a sore lower back or low back injury. My own personal experience of working through a nasty and debilitating low back injury over the course of three years continues to have been a ‘valuable’ experience as a physiotherapist in that it has made me more astute in the management of my client’s physical and emotional pains relating to their low back injury.

Lower Back Damage

Damage to the low back can be loosely defined as an acquired defect or disruption of a given low back structure (1).

The damage to the given structure of the low back (eg the dics, ligament, nerve root, muscle) hampers the given structure’s ability to tolerate the loads that daily living subjects the lower back to. See below for an illustration of low back structures that can be damaged (image does not display low back muscles).

low back anatomy physio

Meanwhile an injury to the low back involves damage to a living tissue (structure) either by high forces as the result of movement, or by a chemical influence.

It is important to note that an episode of lower back pain does not mean u now have a 'bad back' #myth #physio Click To Tweet

The reality of developing lower back pain

The fear, the anxieties, the confusion, and unfortunately the well-meaning stories from friends and family members about their bad back experiences, can all contribute to what is often an overwhelming negative experience, and for many low back pain sufferers a potential ‘dark patch’ in their life’s journey.

Fortunately all low back pain sufferers do not need to endure negative experiences. . Research has shown that successful and permanent treatment for back pain must be based on educating back pain sufferers.

According to Trish Wisbey Roth and Nick Sinfield authors of The Back Pain Personal Health Plan -Bounce Back Edition it’s important to teach back pain sufferers to:

Recognise and change ingrained perceptions and beliefs about their pain and the resulting emotional stress this produces. This holistic approach which treats lower back pain as a physical, mental, an emotional issue, offers a more effective and lasting treatment option.

Part of this education process is ensuring that the low back pain sufferer has a reasonable understanding of the causes of their lower back pain.

Lower Back Pain Causative Factors

When treating low back pain sufferers inside a physiotherapy consultation I spend significant time detailing out a client’s causative factors, in terms of the development of their low back pain. While every back pain sufferers factors are unique, there are many patterns that exist from back pain sufferer to back pain sufferer.

My physio experiences mirror that of the research in that the back pain clients who have a good understanding of their low back pain causes tend to go onto a faster and more complete outcome. In working through their rehabilitation the knowledge of their contributing back pain factors tends to also aid in minimising the psychological impact as outlined above.

Factors such as the below can effect the development of low back pain:

-body weight
-tight hip structures
-your feet
-previous injury history
-a stiff thoracic spine

In the below video I  outline the concept of ‘contributory factors’ (or causative factors) in the development of low back pain.

Rehabiltating Low Back Pain

A sound rehabilitation program will be tailored to address each of the contributory lower back pain factors. I have found that when the top two or three contributing factors are addressed initially the client experiences positive momentum in the easing of their low back pain.

I am often heard saying to my back pain clients that if they wish to ‘take out insurance’, or in other words decrease the likelihood of the back pain recurring, than all causative or contributory factors need to be both identified and addressed through out the rehabilitation program.

If you have any questions or would like to leave a comment please do so in the comments below.

Brad Beer (APAM)

Brad Beer physiotherapist runner author

Physiotherapist, Author ‘You CAN Run Pain Free!‘, Founder POGO Physio


(1) The Biomechanics of Back Pain. M Adams, N Bogduk, K Burton, P Dolan (2002) pg 131-132.

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