If you suffer from lower back pain, know that it is very common in the United States, especially in urban areas like NYC where many people work 9-5 sedentary hours. Most of the time, this pain is persistent and builds up after years of imbalances and weakness. Luckily, professional physical therapists can help with this treatment. Through sports massages and deep tissue massages at Upper West Side, physical therapy can alleviate muscle pain and muscle injury.

There are many reasons why back pain is so common and pervasive in cities and towns all across the United States, from New York City to suburbs and rural communities. You've probably heard of or experienced many of the most common ones, such as a weak core, inactive and weak glute muscles, too much sitting, remote work, sports injuries, age, lack of hamstring flexibility, etc.

But there are also four other specific biomechanical factors that often go under the radar for healthcare and rehab providers as well as patients when it comes to preventing and treating low back injuries of all kinds..

When someone comes to me with low back issues, I always examine and assess for these four factors and in the vast majority of cases, one or more of these issues plays a role, whether it is the cause, outcome or some combination. This is not always the case, which is why it is vital for any sports injury and rehabilitation therapist, from physical therapists to chiropractors to doctors and personal trainers, to do a full and thorough intake and assessment to better understand each person's unique challenges.

In short, it is so important with any injury to consider the joints and muscles above and below the injury. It's usually not enough to "zoom in" on the low back, or any injury for that matter, itself in order to achieve significant and sustainable results. A broader, zoomed out analysis is vital.

So when someone comes in with knee pain, for example, I always evaluate what is going on at the the foot, ankle, hips and pelvis so I can see the entire picture.

When doing an assessment, I don't assume that any of these factors are present. To the contrary, the assessment is what gives me the information to determine which ones are, if any.

1. Thoracic Spine

The Thoracic spine spans the mid and upper back and in so many people who suffer from low back pain, the T-spine lacks proper extension and rotational mobility. When this happens, the neck and low back become susceptible to overuses and increased wear and tear in order to compensate.

To be more specific, it is important to understand that the lumbar spine is built for stability more than mobility whereas the thoracic spine is built for mobility over stability. So let's say the thoracic spine loses its mobility due to inactivity, poor posture, injury or weakness. As a result, thoracic extension may become limited.

But the body still has to be able to extend in order to perform routine, professional and recreational activities. In order to do so, often times the lumbar spine is where the body then gets its extension from.

Regaining mobility in the T-spine through specific stretches, strength exercises and manual therapy can have a dramatic impact on the rehabilitation of low back injuries.

2. Hip Internal Rotation

When the hip joint does not internally rotate sufficiently, the low back can often be negatively impacted. This is due to the body's need to compensate for this lack of mobility by becoming more mobile in other joints, including the knee and lumbar spine. When one part of the body does not function correctly, other parts of the body are often the victims.

In these situations it is all about increasing mobility with very specific exercises that target the joint itself, not the muscles. Active Release treatments can definitely help, but doing consistent mobility exercises is the key.

3. Ankle Mobility

As with hip mobility limitations, a lack of Dorsiflexion in the ankle, due to calf tightness and/or ankle joint immobility, is directly correlated with low back pain. When I have clients perform a squat assessment with their feet slightly elevated, in many cases their low back discomfort significantly lessons as compared to squatting without their heels elevated. This is due to the fact that by elevating the heels, the ankle and calves are taken out of the equation,

In a lot of these situations people are unaware that their calves and ankles were a problem at all. But when I treat their calf muscles with ART and have them regularly stretch their caves AND perform an ankle mobility exercises daily, their low back problems begin to diminish, especially in combination with other treatments and exercises.

4. Tight / Short Hip Flexors

When the hip flexors, particularly the Illiacus and Psoas, are shortened, they can tip the pelvis forward and pull the lumbar spine into hyperextension and compression as well as contribute to the weakening of the Glute muscles.

Increased compression and hyperextension of the lumbar spine can cause an overactivity in the lumbar erector muscles leading to muscle spasms and strains. It also increases wear and tear on the facet joints and intervertebral discs. This can contribute to joint arthritis and inflammation.

Stretching and treating the hip flexor muscles is often an integral part of low back treatments with my clients.

In summary...

One take home message is that the pain is not often where the problem is. Another is that it's important to think outside the box when considering the causes and thus treatment for any injury, especially ones that occur in the low back.

Frequently Asked Questions

What are some overlooked causes of low back pain?

Some overlooked causes of low back pain include poor posture, weak core and glute muscles, limited hip mobility, prolonged sitting, stress, and muscular imbalances that affect movement and spinal stability.

Can tight hips contribute to lower back pain?

Yes. Tight hip flexors and limited hip mobility can place extra stress on the lumbar spine, alter movement patterns, and contribute to chronic low back discomfort and stiffness.

How does poor posture affect the lower back?

Poor posture can increase pressure on the spinal discs, muscles, and joints of the lower back. Prolonged slouching or forward posture may contribute to pain, tightness, and reduced mobility over time.

Can stress contribute to back pain?

Yes. Stress can increase muscle tension, reduce recovery, affect sleep quality, and contribute to chronic pain patterns, including lower back pain and stiffness.

Why are weak glutes linked to low back pain?

Weak glute muscles may force the lower back muscles to compensate during walking, lifting, and exercise. This compensation can increase strain on the lumbar spine and surrounding tissues.

What role does core strength play in back pain prevention?

Core muscles help stabilize the spine and support proper posture and movement mechanics. Weak core muscles may increase spinal stress and reduce overall stability during daily activities.

Can prolonged sitting worsen lower back pain?

Yes. Sitting for long periods can tighten the hips, weaken postural muscles, reduce circulation, and increase stress on the lower back, especially with poor posture.

What treatments can help relieve low back pain?

Low back pain treatment may include corrective exercise, mobility work, massage therapy, Active Release Techniques (ART), posture correction, stretching, and strength training depending on the cause of symptoms.

How can mobility exercises help back pain recovery?

Mobility exercises can improve flexibility, restore joint movement, reduce stiffness, and improve movement patterns that may contribute to lower back pain.

When should someone seek professional help for low back pain?

Professional evaluation is recommended if pain is severe, persistent, worsening, associated with numbness or weakness, or interfering with daily activities, exercise, or sleep.

Check out our Blog for several articles on low back health and many other topics.