I’m often amused by the common use of the term “low back pain”. People generally assume it refers to at least one condition or disorder, however in my expertise this is often rarely the case. Understanding the various ways in which low back pain will come about is essential to effectively addressing it. In Clinical Trigger point therapy, we tend to acknowledge many subcategories of the low back pain complaint:
Pain within the lumbar Paraspinal region: Muscle tension within the lumbar paraspinal muscle groups is quite common and is sometimes caused by postural distortion. Trigger points in the lumbar paraspinal muscles can refer pain either in the thoraco-lumbar junction and flank regions or into the gluteal region, reckoning on that specific muscle is concerned. Pain in the lumbar paraspinal region is quite frequently solely created by trigger point activity in the Ilio-Psoas muscle group.
Pain across the Belt-line: I would estimate that 70% of the patients that come to me for low back pain complaints present with pain in the “belt-line” region. Often the pain presents unilaterally, but in more established complaints it can be present bilaterally. The unilateral pain distribution typically involves referred pain from trigger points in the ipsilateral (on the same side). Whereas a bilateral pain distribution can also include a contribution from trigger point activity in the Rectus Abdominis muscle.
Pain in and around the Sacro-Iliac Joint: Pain in the S.I. Joint region is quite common, and can be produced by trigger point activity in several muscles and by articular dysfunction in the joint itself. The S.I. joint is rather unique in that there are no muscle groups that directly act on it (or move it), but muscle tension in the adjacent muscles will often cause the joint to become displaced or dysfunctional. Trigger point activity in the Quadratus Lumborum, Gluteus Medius, and Piriformis muscles can refer pain and tenderness to the S.I. Joint. More often than not, addressing the trigger points in these muscles will alleviate S.I. joint pain, but chronic complaints may require the use of joint manipulation techniques as well.
Pain in the Gluteal or Buttock Region: I typically see gluteal pain presentations that are secondary conditions to belt-line and sciatic pain complaints. Tenderness and pain in this region is often the result of satellite trigger point activity developing in the Gluteus Maximus muscle. Trigger points in the Gluteus Medius, Gluteus Minimus, and Bicep Femoris muscles can refer pain to the buttock region as well.
Pain down the back or side of the leg: Pain that travels down the back or side of the leg can have several sources. First and foremost, a disc herniation in the lumbar spine can entrap the nerve roots as they exit the spine and cause radiating pain, numbness, tingling, and motor disturbances in the leg. I don’t see this condition often but when I do it is fairly obvious, as the patient will suffer from severe, unrelenting pain and present with an extreme antalgic posture. Surgery is the only viable option for these patients, and is usually very successful in my experience. The most frequent cause of sciatica symptoms, in my clinical experience, is trigger point activity in the Gluteus Minimus and Piriformis muscles. Trigger point activity in Gluteus Minimus muscle is nearly always secondary to Quadratus Lumborum trigger point activity, so I typically see patients with unaddressed cases of belt-line pain complaints develop sciatica complaints over time. Trigger point activity in the Piriformis muscle can cause the muscle to entrap the Sciatic nerve as it exits the pelvic region. This condition is called Piriformis Syndrome and is well established in the medical literature, though it occurs infrequently.