Why Your Lower Back Hurts (and how to fix it)

More than 80% of the population will feel lower back pain at some point (I sometimes wonder how that statistic isn't 100%).

So it's important to understand how and why it shows up, so we know how to treat it.

The Physical

We may trigger lower back pain through:

- a muscle strain or pull

- a sudden increase in training intensity (load or volume)

- not moving enough or staying in the same posture for too long

This is the most obvious and easiest to comprehend because we can see a link between physical action and lower back pain.

If you don't move your back enough, it will hurt when you do. And if you do too much beyond your back's capacity, it will also hurt.

Sitting around and barely moving our spines is a good way to create weakness and dysfunction in the area. If you don't use it, you lose it.

The sweet spot is somewhere in the middle, where you're moving your spine on a daily basis with some level of challenge. Listening to our body and the signals of pain helps us moderate intensity.

My general advice is to leave 2-4 reps in the tank for most strength exercises. This gives you a challenge, but it's far enough away from failure to keep you away from your capacity limits.

The Psychological

Back pain can also be triggered by:

- fear of movement

- negative thoughts/beliefs about pain

- anxiety and stress

- frustration and anger

- depression

Outside of anything physical happening to your lower back, all of these factors can create the feeling of lower back pain. Not all hurt equals harm, and our mind is a powerful factor in these instances.

For example, if I hurt myself weeks ago trying to pick up a heavy box, and I go to do it again, it'll naturally cause some anxiety. I may play the scenario in my head again, be hesitant in my movement, and I may feel my lower back tighten up in anticipation. Even though I haven't done anything physical yet, it's causing sensations in my back.

Our mind can be a pro and a con because our perceptions of pain can affect our outcomes. Just believing we'll get better tends to make it so (which is easier said than done, but it's important to understand).

People in pain get stuck in a negative feedback loop. They're in pain, so they don't move. Because they don't move, they lose physical capabilities and confidence in what they can do. This leads to less movement, more pain, and the cycle continues.

Your body isn't fragile. Challenging yourself is the best way to build confidence in your ability to handle different stresses.

Lifestyle & General Health

Other general factors that can cause lower back pain include:

- poor sleep

- smoking

- excessive alcohol consumption

- poor diet

- cardiovascular disease and co-morbidities

For example, diabetes is a significant condition that affects our body's ability to process sugar. While it doesn't affect the lower back directly, diabetes has been linked with higher levels of back pain. The changes to the body that come with diabetes (and many co-morbidities like it) can increase pain sensitivity.

You could argue that the life habits that lead to something like diabetes also lead to lower back pain. So while one may not cause the other, they share a common ancestry.

If you don't take care of general health principles like nutrition, sleep, and stress management, your pain outcomes will be worse.

I had a client once who was dealing with knee pain from an old injury we resolved months ago. Upon further investigation, she was going through a stressful time at work, sleeping 4 hours per night and eating out (if she even remembered to). This had gone on for the last two weeks.

Without doing any stretches or strengthening work for her knee, we focused on managing her stress, getting quality sleep, and finding quick, but healthier food options. Within a few days, her pain was completely gone.

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As you can see, pain is a multi-factorial phenomenon; it's incredibly difficult to nail down one specific cause of your lower back pain. Roughly 90% of cases are "non-specific" based on the evidence.

Did you lift a box wrong, or did you get a lousy night's sleep, skip breakfast, and try to power through a workout, leading to a back strain?

Do you have a weak spine, or do you have poor habits when it comes to things like smoking and drinking alcohol?

It's important to understand that lower back pain is not solely related to what's physically and structurally happening in your spine.

Understanding that is the first step towards treatment and a positive outcome, free of back pain.

To your good health,

Coach Stephen

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References:

📚Beyer et al. (2015) Am J Sports Med

📚NICE guidelines (2020 update)

📚Qaseem et al. (2018) Ann Intern Med

📚Stochkendahl et al. (2018) Eur Spine J.

📚Wong et al. (2017) Eur J Pain

Thanks for reading.

P.S.

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