Self-Treatment for Lower Back Pain
By Justine Calderwood, PT, MSPT
When it comes to low back pain, many people falsely believe that it stems solely from tight back muscles and/or tight hamstrings. I have seen many people suffering from low back pain come into the clinic, and after checking their motion, find that they can bend forward and place their hands on the floor and their hamstring flexibility is normal. These are people that have tried back stretches (such as hugging their knees to their chest, and/or stretching their hamstrings) without relief from their pain.
What is often over-looked is the role that the hips play in contributing to low back pain. Tightness and soft-tissue restrictions in the front of the hips and lower abdomen can cause pain in the low back, and pain can even start to migrate up the back or down into the legs. How does this happen? Tightness in the hips or lower abdomen causes a strong pull from the front of the pelvis, creating an excessive curve of the low back, which in turn pinches the lumbar joints, nerves and discs together. Abdominal scars, such as those from C-sections, appendectomies, hernia repair, etc, no matter how small the incision, can also contribute to restrictions from the front of the body, in turn affecting the lumbar spine.
Without boring you with too many details, it is good to note that the psoas muscle starts at each lumbar vertebrae, attaches onto the lumbar discs, and then travels through the pelvis to attach onto the inner thigh bone. It joins up with the iliacus muscle to form the iliopsoas, commonly referred to as the “hip flexors”. Take a look at this illustration, which shows these muscles from a front-view. The psoas is the only muscle in the body that connects the upper half to the lower half, and it plays an important role in pelvic alignment and its effect on the spine.
If you suspect that your low back pain is stemming from the involvement of your psoas and/or hip flexors, you can try some myofascial self-releases to see if it would help your pain. To check the psoas muscle, feel around in the lower abdomen area (about 1-2” just to the outside of your belly button, moving downward about 3-4” in a vertical line) to discover if you have any tender or firm areas, which usually are indicative of restriction(s). Use a small, inflatable ball (4-6” in diameter), and place it in the area where you find any tenderness or firmness, and then lie face-down onto the ball. Allow the ball to gently press into the area you wish to treat, allowing it to soften and release for a minimum of 5 minutes. Then move the ball to another area and repeat this process in several problematic areas every day.
To check for tenderness or tightness in the hip flexors, sit in a chair and feel around the front of your hip, right where it creases (hint: if you place your hand in the crease and then lift your leg, like you’re marching, the hip flexor will pop right up into your hand). Check the soft tissue from this area diagonally to your belly button for any pain or firmness to touch. If you find a problematic area, you can use a small inflatable ball to release this area as well. Simply lie face-down and place the ball in the area where you find tenderness or firmness. Allow the ball to gently press into the area you wish to treat, allowing it to soften and release for a minimum of 5 minutes. Then move the ball to another area and repeat. You can safely do this type of release every day.
I recommend checking both sides of your body for psoas or hip flexor tenderness, because sometimes the most restricted side is NOT the side that you’re having pain on. Listen to your body, trust what you find, and self-treat accordingly. This type of treatment is gentle so don’t worry too much about “doing it right”; your body will only release if it needs to and when it is ready to.
You can use the inflatable ball for self-releases while lying in bed or on the floor, if you’re able to safely get on and off the floor. The softer surface of the bed won’t press the ball into your body as firmly as if you lie on the floor, so choose what works best for you. Also, experiment by lying on different surfaces, using different size/texture/firmness of treatment balls (inflatable ball, tennis or pinky ball, plastic ball or a knobby ball), and different positions (lying face down, partially side-lying with a pillow for support, or even leaning over a padded chair or countertop). It all depends on your comfort level, how well you move around, and what your body prefers….so learn to listen to your body’s clues. Keep in mind, however, that if something just doesn’t “feel right” or you’re having more pain by trying these techniques, it’s OK to listen to your body and STOP at any point.
At The Healing Spot Physical Therapy, LLC we specialize in hands-on therapy targeted at restoring balance to the body. We find and release soft-tissue restrictions and show you what you can do at home to help yourself, which complements our one-on-one treatment approach. We serve the communities of Woodland Park, Divide, Florissant, Lake George, Green Mountain Falls, Cascade, and Manitou Springs, Colorado. If you are interested in specialist physical therapy care for low back pain or other conditions, we’d love to help you move easier and feel better.
Disclaimer: Please use your own best judgement when trying self-treatment techniques such as the ones shown above. If you experience sharp, shooting pain or if you feel like it would be best to have a healthcare professional, such as your physician or physical therapist, evaluate you, then please give them a call. If your injury is recent you may want to first get examined by your healthcare provider. If you have osteoporosis or a history of compression fracture, then please avoid using the ball directly on your spine. If you are pregnant please do NOT attempt the psoas release shown above. If you have any questions or concerns about whether these exercises are right for you please check with your healthcare provider or call our clinic at 719.270.1123.