When your lower back hurts again and again ...

When your lower back hurts again and again ...

(This article was published on 20.03.2024 at Orthinform - Patient information: https://orthinform.de/patienteninformationen/wenn-das-kreuz-immer-wieder-schmerzt)

The current state of affairs.

According to the current state of science, almost two thirds of the general German population is affected by low back pain within a year; around one fifth report chronic back pain, i.e. back pain that lasts three months or longer and occurs almost daily, during the same period. This pain can severely restrict everyday activities and significantly impair your quality of life. 

If the lower back hurts, the cause is obviously sought. With the best intentions of helping the patient, costly X-rays and MRIs of the spine are carried out, where ‘serious’ abnormalities can be found, which are then quickly recognised as the cause of the pain. And this while many people have damaged discs and osteoarthritis but no pain at all. Patients think they have a serious back problem and stop being active and doing sport. Things that are good for them right now. 

Obviously, what you see in pictures does not always correspond to reality. The doctor gets the best impression of the possible cause of the low back pain by examining the motor function of the pelvis and hips. If this examination does not lead to a clear result, an imaging examination remains the most obvious next step in order to make a sound diagnosis.

The hip as a possible cause of low back pain.

All in all, this is reason enough to look at the causes of back pain from a motor perspective. 
Where the spine stabilizes, the hip joints are geared towards mobility. This central robustness of the spine and the mobility of the external hip joints are normally perfectly harmonized. They lead to healthy everyday motor skills and impressive motor skills in the field of sport, which in both cases are characterized by harmony and aesthetics. 

Reduced hip mobility leads directly to a disruption of this motor balance. The stability of the lumbar spine decreases because it has to compensate for the reduced movements in the hip joint, e.g. by tilting the sacrum forwards and increasing the hollow back. 

It is not so much the ‘damaged’ intervertebral discs and facet joints that cause low back pain, but rather the sacral joints with the lumbar spine (lumbosacral joint) and the ilium, which is also a joint part of the hip joint (sacroiliac joint). The relatively large sacroiliac joint in particular has only a small range of motion, a maximum of around 3 degrees, and stands in stark contrast to the hip with its large and varied range of motion. 
The sacroiliac joint connects the spine to the leg and, as the largest axial joint in the body, is an important and biomechanically diverse ‘real’ joint with joint space, joint surfaces, joint capsule, joint cartilage, an extensive ligamentous apparatus and a high density of nociceptors for pain perception, despite its low mobility. These characteristics give the sacroiliac joint an enormous load-bearing capacity in addition to an important sensory function for pain perception. This is necessary to cope with the high loads involved in all forms of walking, running, and jumping and thus prevent damage to the spine.
The most typical complaint of the strained sacroiliac joint, which most patients report and which they can also localize well, is pain along the side of the sacrum at the level of the joint between the sacrum and ilium. This pain can radiate via the various connective tissues into the iliac crest and the gluteal muscles on the one hand and into the back muscles immediately adjacent to the spine on the other. The functionally weakened lumbosacral joint leads to localized pain in the center of the lower back. 

Exercise video

In this video you will learn how you can counteract your low back pain in a relatively simple but effective way: To do so, click on the above link that leads to the original publication.

© Paul Geraedts