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Back Pain

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Dealing with Back Pain





Back pain can be a debilitating problem which can impact your quality of life. Having worked in rehabilitation for many years, I have witnessed firsthand the frustration experienced by many workers who have lost their lively hood because they are unable to bend, twist or carry loads.


This article will identify three muscle groups that contribute to chronic back pain and what you can do to ensure these muscles work effectively.


The first point you need to be aware of is that back pain rarely just happens. In most cases back pain happens over a period of time when the muscles in the back, legs, shoulders and stomach are constantly over stretched or are weak and have been strained. The actual strain, tear or bulging disc in the back may happen suddenly but the strain and over stretching has been occurring for a period of time which eventually leads to injury.


The physiological make up of the back and surrounding musculature is complex with many muscles involved in orchestrating day to day movements and actions. For example let’s say you wanted to reach forward to pick up something of the table. Did you know there are 10 muscles that work in your body to allow this process to happen and only 3 of these muscles are located in the back region? The three back muscles involved are the Latissimus Dorsi, Infraspinatus and Teres major. The other muscles are in the arms and shoulder region. This demonstrates that back pain can be complex, and may not always be caused by a back muscle just because the pain is felt in that particular area.


When you study the back it is important you understand the insertion and origin points of different muscles. This will provide insight into how those muscles relate to other muscles and how they interact during movement.


Below I have identified the 3 key muscles that have a direct impact on chronic back pain.


Psoas Major





 The Psoas Major muscle connects from the vertebrae (T12-L1-5) to the thigh bone (femur) and is responsible for flexion and lateral rotation of the thigh. If the thigh is fixed and not moving it also helps with trunk flexion (Platzer, 2004).


 The Psoas Major is a major contributor to back pain for the following reasons:


  • If the Psoas muscle is tight because it has not been stretched and thus is in a contracted state, your Psoas will want to bring your lower back forward, moving you into an anterior tilt.

  • The pressure exerted by the Psoas Major, whilst in a contracted state, can compress the joints and discs of the lumbar vertebrae. This pressure causes degeneration and will make you more susceptible to injury. A shortened Psoas on one side will pull the spine or pelvis to that side, leading to many painful problems, including scoliosis (Platzer, 2004).




Quadratus Lumborum (QL)






  The Quadratum Lumborum starts at the iliac crest of the ilium and from there it runs and attaches itself to the 12th rib and the transverse processes of the 1st to 4th lumbar vertebrae. The QL is a muscle of the posterior abdominal wall lying deep inside the abdomen and dorsal to the iliopsoas. It is located close to many structures such as the kidneys, the colon and the diaphragm, as well as nerves, abdominal muscles and the spine (Koestler and Myers, 2002).


 The QL is a major contributor to back pain for the following reasons:


  • Overuse and strain of the QL occurs when one sits at a desk using a reclined seat for an extended period of time, which releases the intrinsic back muscles and weakens them in the long term. The weak back muscles must now be compensated by the QL leading to painful tension and stiffening of the muscle (Koestler and Myers, 2002).

  • A muscular imbalance of the pelvis or spine can force the QL to stabilize them. An example of this occurs when there are unequal leg lengths.

  • If the gluteal muscle is weakened or overused (particularly the gluteus medius), the QL will be excessively recruited in order to stabilize the pelvis (Koestler and Myers, 2002) which can lead to over strain.

  • Lastly, one side of our body could be weaker than the other. On that side of the body that is weak, having problems with the QL will most likely lead to chronic pain and tensions in the mid and upper back and in time it will affect further down the kinetic chain (i.e. hip, knee, shoulder, neck and head).


 Erector Spinae





 The Erector Spinae group is made up of three muscles, the spinalis most medially, the longissimus in the centre and iliocostalis laterally. The origin points for the Erector Spinae muscle are:


Posterior crest of the ilium

Lower posterior surface of the sacrum

Lower 7 ribs

Spinous processes of T9-L5Transverse processes of T1-12


 The insertion points for the Erector Spinae muscle are:


Angles of the ribs

Transverse processes of all vertebrae

Base of the skull



The most important function of the Erector Spinae muscles is to work with the abdominals to help stabilize the torso. Together the erectors and abdominals form what some athletes call the core or powerhouse of the body (Benson, Smith and Bybee, 2003). These muscles are essential for good posture while standing or sitting. The Erector Spinae is also involved with 50% of flexion which can lead to a breakdown of muscle strength when overused or strained (Filler, 2004).


Tips on stretching and strengthening exercises for the Psoas Major, QL and Erector Spinae



The Psoas Major can tighten and shorten causing back pain if it is not stretched or strengthened. Below I have identified some easy ways to maintain correct elasticity in the Psoas Major:


 Sitting for extended periods of time can cause the Psoas Major to rest in a shortened position. Therefore the best sitting position for the Psoas Major is a position that is always changing. When you do have to sit in your chair, try not to lean forward as this shortens your Psoas muscle (Koestler and Myers, 2002). The best sitting position is when you use the whole chair with your bottom and lower back against the back of the chair. It is also important that you don’t hook your feet under the chair as this creates hip flexion and forces the Psoas Major to contract which shortens the muscle. The best position for your legs is when you position your feet flat on the floor with your shin and thigh bones at 90 degrees. Lastly try and mix sitting with standing whilst you are at work. Place your phone on a shelf so you have to stand up to answer it (Filler, 2004).


 When sleeping at night, it is important you don’t lie on your stomach. When you are lying on your stomach your back is hyper-extended which exacerbates a tight Psoas. The best sleeping position is on your side or on your back.


If you have a tight Psoas Major, it is important you incorporate some stretches into your daily routine.  



Another effective way to loosen the Psoas Major is use a ball slightly larger & softer than a tennis ball. This massage technique releases your Psoas through an active range of motion (Filler, 2004).

  • Lay on the ball, about 1-2 inches outside your belly button.

  • You’ll feel your Psoas respond as you lower yourself. It may cause you some discomfort.

  • Arch your back; come up onto your elbows. This will result in a more forceful stretch and release on your Psoas (Filler, 2004).


 Strength exercises for a weak Psoas Major are as follows:

  • Hanging Leg Lifts

  • Leg Throws

 The QL is another muscle group that must be stretched on a regular basis to reduce soft tissue adhesion, overuse and strain. One technique that can be used to breakdown soft tissue adhesion that may occur with the QL is Self-myofascial release (SMR). “Self-myofascial release uses a foam roller to breakdown soft tissue adhesions and scar tissue in fascia. Fascia is a three dimensional fibrous matrix that interconnects throughout all cells of the body” (Koestler and Myer, 2002, p124). Fascia surrounds muscles, bones and joints which gives our body structural integrity and strength. Abnormal fascia can be the leading cause of chronic pain and reduced flexibility (Koestler and Myers, 2002).

 Below I have provided an example to demonstrate how you can use a foam roller on the QL:





The QL stretch involves:


  • Keeping the top arm on your ear as best as possible

  • Keeping bottom hand reaching for inside of the foot

  • Keeping top hand reaching for the outside of the foot

  • At full stretch try to look up at the ceiling/sky through your arm. This will put you in a slight arch




Strength exercises you can perform for QL are:


  • Side Plank
  • Side Bridge


Lastly the Erector Spinae is directly responsible for posture control and stabilisation. With an inactive lifestyle the Erector Spinae muscles can become weak which can cause over compensation by other muscle groups in the kinetic chain to stabilise and support the spine leading to back pain and strain on those muscles (Benson, Smith and Bybee, 2003). Here are 3 exercises that you can do to increase the strength of Erector Spinae muscles:


  • Standing Superman
  • Prone Superman
  • Dead lifts


There are also a number of stretches you can perform at night before bedtime to keep the Erector Spinae muscles subtle and loose. These are shown below:





The Psoas Major, QL and Erector Spinae are fundamentally responsible for most back complaints. If you can keep the right balance between the elasticity and strength of these muscle groups you are on your way to achieving a pain free life without the debilitating pain experienced by over use, strain or weakness in these muscle groups.




Benson, M. and Smith, D. R. and Bybee, R. F. (March 2003). The Muscle Activation of the Erector Spinae during Hyperextension with and without the Pelvis Restrained. (Bio-mechanics). Research Quarterly for Exercise and Sport , Vol. 74, No. 1


Filler, A.G. (2004). Do you Really Need Back Surgery? A Surgeon's Guide to Neck and Back Pain and How to Choose Your Treatment.Oxford University Press: New York.


Koestler, A.J. and Myers, A. (2002) Understanding Chronic Pain. University Press of Mississippi: Jackson USA


Platzer, W. (2004). Color Atlas of Human Anatomy, Vol 1: Locomotor system (5th ed.).


QL stretch image:



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