Many people suffer with back pain. Whether we sit too long or stand too long, everything seems to head straight to the low back. However, many times even though pain is felt in the low back, it may not necessarily be the muscles int he low back that are causing the pain. The low back is an area where a lot of muscles attach, originate, and run through - muscles that control both the upper and lower body. Low back pain is often influenced by tight or overworked muscles in the surrounding areas, particularly the glutes, core, and lower back itself.
The Glutes:
The gluteal muscles—gluteus maximus, gluteus medius, and gluteus minimus—play a vital role in stabilizing the pelvis and supporting the lower back. When these muscles become tight or weak, they can contribute to poor posture and increased strain on the lumbar spine. Massage therapists may target these muscles using techniques like deep tissue massage, myofascial release, and trigger point therapy to release tension and restore mobility.
Another muscle in this area that can cause a lot of problems in this area is the piriformis muscle. This muscle starts attached the inside of the sacrum (the big flat bone at the base of your spine), runs under all the gluteal muscles, and attaches to the top of the greater trochanter (the big bone at the top of your upper leg where it sits in the hip socket). So since this muscle has such a range, it gets aggravated easily and can cause pain that radiates into both the low back and hips. Gentle stretching, along with massage techniques like kneading or friction therapy, can help release the piriformis and reduce associated symptoms. Fortunately this muscle is easy to stretch on your own with the popularly-recommended "Figure 4 Stretch".
The Abs:
I once had a teacher in massage school say; "The #1 cause of low back pain is tight glutes. The #2 cause of low back pain is weak abs." This can be quite true. The core muscles, including the transverse abdominis, rectus abdominis, and obliques, (the muscles that make up your six-pack) are integral to maintaining spinal stability. When these muscles are either overworked or underworked, they can cause imbalances that lead to low back pain. Core exercises and stretching for upper and lower abdominal muscles can help decrease the "overloaded" feeling that can make the low back hurt.
A little-known muscle in the abdominal area that can cause low back pain is the Psoas (pronounced So-azz). This small but mighty muscle runs from the vertebrae in the low back just under where the lowest ribs attach to the spine, along the back wall of the abdominal muscles, to the lesser trochanter (the smaller bone on the top of the upper leg, next to the one that sits in the hip socket). It is mostly responsible for joining up with the iliacus muscle that allows you to flex your hip, but it is also responsible for helping to stabilize the low back and allow it to bend. This muscle can cause low back pain when it gets tight because of where it is attached and how it moves. While massage therapists can work on this muscle, it is a little invasive and can be uncomfortable, so many therapists will work on other things around this muscle to get a similar effect. You can stretch this muscle on your own by kneeling on one knee, and stretching your arms straight up, then leaning backwards gently, stretching the front of the hip.
The Back:
Even though most low back pain can come from places other than the back, the back is not completely in the clear. Muscles in the back such as the Quadratus Lumborum (the big core muscles that wrap around your sides) can also get tight or overworked and can cause pain in the low back. Additionally, any muscles that attach into the pelvis, and even into the legs such as the fip flexors and hamstrings can cause the back to hurt.
Massage therapy is a great way to manage low back pain because it can target many different muscle groups, and therapists receive extensive training in anatomy so they can identify not only which muscle groups are affected, but also what other areas may be causing the issues. It can seem frustrating for someone in pain who comes in because the low back hurts, but the therapist starts to work on the hips and glutes. Sometimes the source of the problem is not the location of the pain. This is especially true in a complex area like the low back. So yes, a sore low back in a pain - and now you can see why it really can also be considered a pain in the butt.
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