The lumbar area’s main function is to support your upper body and transmit it’s weight evenly to your hip bone and lower limbs. This area consists of five vertebrae containing five pairs of facet joints– these joints are responsible for your daily movements of bending backward, forward and side-ward. In between each vertebral bone is your annulus fibrosus and nucleus pulposus collectively know as your vertebral disc. This special disc functions as a cushion in between your vertebrae to prevent bone to bone contact.

The main supporting structures of your lower back are your muscles! These structures contract to help prevent excessive motion that may damage your vertebral joints and discs. The back muscles mostly associated with back pain are your Erector Spinae muscle whose function is to extend your spine or bending backward with some rotatory function and your Quadratus Lumborum whose purpose is to laterally flex(side bending) your spine. Affectations of the QL is the most common source of back pain. This hardworking muscle comes in pairs connecting the spine to the pelvis and when contracting all together produces an extension motion of your lower back. The two QL activate more when the erector spinae of your lower back is weak or relaxed especially on prolonged sitting and computer use.

In between your vertebral bones and disc arises your spinal nerves. These delicate structures’ purpose is to transmit movement signals from your CNS to your lower limbs as well as transmit sensation from specific parts of your limbs back to your CNS. When ANY structure in your spine impinges on these nerves they create a unique type of discomfort involving symptoms such as Electric like pain, muscle weakness and altered sensation down to your lower legs. This symptom is called Peripheralization and can be caused by impingement, inflammation or trauma.

Ischemia is defined as a loss of blood supply to any part of the body. The Erector Spinae and Quadratus lumborum are the most common muscles that may undergo ischemia. How does this happen? First is due to faulty posture– slouch sitting all day without regular breaks can lead to some compression to the blood vessels of your lower back. Second is due to recent trauma. Injuries to your low back muscles may alter the normal blood flow to your muscles  Both of these causes can lead to discomfort and weakness of your low back muscles

When we say mechanical the first thing that comes to mind is movement– anything that involves impaired movement or position of your low back structures fall under the mechanical category– which the most common cause of low back pain in PT clinics. Cases such as lumbar strain, facet joint impingement, sacroiliac dysfunction and muscle tightness all examples of this type. Visit a PT to determine whether your pain is Ischemic or mechanical of origin

Your vertebral discs fall into a different category due to the different classifications of damage to your disks. Syndromes such as disc bulge and slipped disc fall under this category and may produce peripheralization if a nerve root impinges. The culprits of these are also impaired posture and recent trauma. Disc injuries are more likely to occur when the supporting muscles of your low back are weak and posture is already impaired

Swelling can occur on your vertebral joints, disc or muscles. When this inflammation grows and impinges your spinal nerves, peripheralization may occur. It is important to consult your physician for anti-inflammatory medications coupled together with Physical therapy.

Systemic in origin is one of the red flags of Physical therapy and further evaluation from your physician is needed. This type is caused by other problems outside your lumbar muscles and bones. The pain you feel on your low back is termed referred pain meaning pain coming from different origins in your body that is felt in a specific region on your body. Most common sources of referred pain to your low back are your kidneys, digestive tract and pelvic organs. Referral to a physician is a must!