If you suffer from a bad lower back, then many things could be the cause. While we might think that the best solution would be to rub the point where it hurts and to rest it, this could in fact have nothing to do with the cause of the pain in the first place.
It's important to think of the body as being entirely interconnected. While you might feel pain in your back then, this does not necessarily mean that you have a bad back. Rather, you could have a problem with your musculature in other parts of your body and it may be that which is causing you difficulties with back pain. This is called 'referred pain'.
Perhaps one of the most common culprits for lower back pain not located in the lower back, is a pelvic tilt. Pelvic tilts are usually the result of imbalances in your leg musculature and can cause a number of problems, including lower back pain. On top of this, a pelvic tilt can affect height, knee pain and stomach flatness.
What Is a Pelvic Tilt?
Your pelvis is the bone that connects the base of the spine to the rear legs. The word is derived from the Latin for 'basin' and if you look at a picture of a skeleton, it’s the large, flat plate that goes just above the legs where the groin is.
The pelvis is attached to a number of muscles in the back and legs, including the hip flexors and the hip extensors. Hip flexors are those muscles on the front of the legs that are responsible for moving the leg upwards and they include the psoas muscle and iliac muscle as well as the Sartorius. The quadriceps are also hip flexors. The hip extensors meanwhile include the gluteus maximus (the buttocks) and the hamstrings.
What's important to recognize, is that these muscles place strain on our pelvis even when we aren't using it – constantly tugging it slightly. Ideally, there should be an equilibrium between the force coming from both sides, such that the pelvis and the back are able to remain perfectly straight. Unfortunately though, it is increasingly common for us to experience imbalances in these muscles that cause a pelvic tilt.
Types of Pelvic Tilt
There are multiple different kinds of pelvic tilt, which include:
Anterior Tilt: Here the front of the pelvis points slightly downwards and the back rises upwards. This results in an exaggerated curve in the bottom spine, protruding buttocks, a decrease in height and a slight paunch. This is also the most common form of pelvic tilt, caused by prolonged sitting which causes the hip flexors to shorten (due to the leg being constantly up) and the extensors to lengthen. This is a very common cause of back pain today due to the large amount of sitting we do in the office.
Posterior Tilt: A posterior tilt is caused by the opposite set of conditions, whereby the leg extensors shorten and the flexors get stretched.
Lateral Tilt: It's also possible – though less common – for the pelvis to tilt sideways. Often this is associated with scoliosis, or with uneven leg lengths. This can cause pain in the knee as one side hits the ground sooner than the other.
How to Correct an Anterior Pelvic Tilt
For the purpose of this post, we're going to focus mainly on the anterior pelvic tilt as this is the most common complaint. There are several ways to do this but the most common strategy is to use various stretches. Try holding each of the three positions below for around 20 seconds and repeat several times at the end of the day to start noticing improvements.
Bridge: The bridge involves lying flat on your back with your legs bent and feet placed flat on the floor. From there, you will then be using your hands to push your hips upwards towards the sky. You can do this by going into a full bridge (arching your whole back with hands behind your head), or just raising the hips while keeping your shoulders on the floor.
Quad Stretch: A simple way to stretch your quads is to stand on one leg and to pull the other foot behind you to touch against your buttocks. You should then feel the stretch across your quadriceps.
Deep Squat: Get into a squat position, then lower yourself so that your buttocks are lower than your knees. Now use your elbows to gradually push your knees outwards and feel the stretch.
Another strategy, is to use exercise. These should focus primarily on the transverse abdominis, which is a 'band' of muscle surrounding the mid-section and located deep below the surface where it can't be seen. This muscle is often referred to as 'nature's weight belt', and its job is essentially to support the lower spine and hold the gut it. When you tense this muscle – by trying to pull your belly button in towards your spine – this will pull in the stomach while at the same time straightening your pelvis. You might find that this movement gives you immediate relief from back pain and forces you into an upright posture.
You can train the transverse abdominis, simply by repeating this motion a few times and holding it for 20 seconds or so each time. You can even practice this in the morning while lying in bed.
Another strategy is to try tying a piece of string very lightly around your stomach at the level of your belly button. Every time you relax your stomach and allow it to protrude outwards, it will then push against the string, reminding you to pull your stomach in and correct your posture. Do this until you form the positive habit and keep your stomach flat naturally (though be careful, as technically we are supposed to breathe from our stomachs… so the string is not a permanent solution by any means!).
Many lifestyle factors contribute to the shortening of our leg flexors and lengthening of our extensors, but the biggest culprit is simply the amount of time we spend sitting, which in turn is mostly a result of our 9-5 jobs.
The solution then, is to stop sitting so regularly and to spend more time in varied postures. One answer to this is the 'standing desk', which is gradually becoming more and more popular. While you might not be able to concentrate fully in a standing position, you can at least use a standing desk in order to check e-mail first thing in the morning and this can in turn reduce the amount of time you're spending in a seated position (it's also said to encourage more blood-flow and thus keep us more alert and awake).
Alternatively, you can look into chairs that promote better posture. Some 'kneeling chairs' work by forcing you into a kneeling position which in turn straightens out your spine and stretches your hip flexors.
Unfortunately though, many of us won't have the freedom in the way we work to start introducing new chairs to the office. Making big changes like these is beyond the means of many of us, so more useful are changes we can make immediately.
One solution then, is to try 'straddling' your chair rather than sitting on it normally. The cause of your back pain is that your legs are spending too much time in a 'bunched up' position, so what you're really aiming to do is to stretch out the upper portion. By straddling your legs down either side of the chair, you can angle them slightly more downwards and thereby increase the stretch slightly. Again, you might notice that this provides you with instant relief while sitting – and if so then you're probably on the right track.