Why Does My Back Hurt? 2 Areas to Check First.

"Why does my back hurt?" is one of the most frequent questions in my physical therapy clinic. 

I work with a wide range of people who experience back pain and it is always different.

• Different ages - from high schoolers to grandparents
• Different mechanism of injury - picking up a piece of paper off the floor, maxing deadlifts, sneezing
• Different presentations - in the middle of the back, on the side, everywhere, or everything.

But the one thing that pops up more frequently than I can count is the back being blamed for back pain. But back pain isn't always caused by the back. So, instead of asking "Why does my back hurt?", let's rephrase that question into "What is causing my back to hurt?".

I'm going to explain this in a bit more detail, tell you specifically where to look, then show two movements to determine if this applies to your specific case. 

Maybe the cause of your back pain isn't your back.

The back is often the victim, not the perpetrator. 

"Wait... WHAT? But I remember when I hurt my back 14 years ago. The MRI showed a disc bulge. I know the exact movement that caused the pain!"

Don't write me off yet - let me explain. Then, I'll tell you how to check it yourself.

We often ask the back to do too much - to move more than it should or work harder than it wants.

When it does too much, it becomes irritated and painful.

Here are 2 specific and very common examples:

1. When you're lifting overhead and the Thoracic region of the spine is stiff, the low back will move too much and arch. Too much movement in the low back --> Pain
2. When you're deadlifting and the hips don't drive forward through the hip hinge motion, the back will help out to lift the weight. Working too hard --> Pain 

In both of these cases, the low back is doing way too much because something else won't do enough. The back is the victim in both these scenarios.

So maybe that injury years ago was the initial cause of pain. But since that time, maybe the pain is persisting because the back is now overworking. Maybe the disc bulge is painful because there's too much strain on the low back. Maybe bending and picking up a piece of paper (or sneezing) was just the final incident before the back just finally gave up. 

If you have recurring back pain, it is likely that the back is just the unlucky area that is painful.

The Answer

The answer then is not to focus all of your effort on the back. Yes, alleviate the pain - you cannot ignore that first step! But if you focus solely on the back pain, it will always come back. You need to find and then fix the underlying cause. You need to determine why the back was overworking and change that underlying cause.

The answer: Make sure all the regions of the body are moving well. 

If your back hurts, check these 2 areas. They might be the cause of your back pain.

The cause of pain is rarely the location of pain, so back pain is rarely caused by the back.

Yes, it could be a muscle strain, facet joint pain, pinched nerve, or sacroiliac joint pain; but what caused that injury? The answer to that question is the direction you should take for lasting back pain relief.

So "Why does my back hurt?". We need to do a Physiotherapy Evaluation to be certain. But...

...most of the time it is the section above or below the painful area. In the case of low back pain, that means it may be the Thoracic Spine or the hips.

When these are off, the back will complain and will give you pain.

Thoracic Spine mobility and back pain

When the Thoracic region of the spine is stiff, the low back has to move more to compensate. Overhead lifting without sufficient thoracic mobility = low back arching.

The best way to test the Thoracic Spine is to assess rotation. It is very easy to cheat with this movement, so make sure you rotate - don't shift sideways! Refer to the video to make sure you're doing it right and for an easy corrective exercise that is laser-focused on this movement.

Hip control and back pain

Squatting, deadlifting, lunges, or just standing from a chair all have one thing in common - the hip straightens and the back is supposed to remain still (for the most part). We typically refer to this movement as a "hip hinge". The hip muscles should do the moving, and the low back muscles should stabilize the spine. Trouble happens when the hips don't want to work. So the back tries to work harder.

But the back isn't designed to lift a 400-pound deadlift; it's designed to stabilize the spine as the legs lift 400 pounds.

When the hip doesn't extend, the back muscles overactivate and arch. Too much activation under load = low back pain.

Use the quadruped hip extension assessment in the video to see if you're hips can move well. Like the previous assessment, it is very easy to cheat. Make sure to keep the back still - no twisting, dropping, or tilting. Check out the video for a detailed explanation of this assessment as well as a way to improve your hip muscle extension.

To review: Don't always blame your back for your low back pain.

Take it in 3 steps:

1. Alleviate the low back pain
2. Fix the underlying cause
3. Plan for the future