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Low Back Pain: What’s The Cause?

As physical therapists, low back pain is the most common complaint we treat year after year. In fact, low back pain is the most common cause for missing work, the second most common reason for a doctor’s visit, and it is estimated that the annual cost of low back pain on American’s is near one BILLION dollars (1)! A back injury can be quite frightening and leaves many patients in a panic to determine the cause. However, for most cases, there is not a clear cut “injury” (i.e disc injury, spinal stenosis, muscle strain), which can pinpoint the cause of the pain. The term for this diagnosis is non-specific back pain(2).

Non-specific low back pain can be frustrating as finding something to blame will make the pain feel justified. You may try to go to the doctor to find out what’s wrong, but they might not be able to pinpoint anything specific causing your ailment. Luckily, no distinct diagnosis does not mean there is no known treatment! Physical therapy, exercise, and activity modifications have proven to be the most effective treatment for non-specific low back pain.

Inactivity Crisis

Inactivity is one of the major causes of back pain. With the increase of sedentary jobs and declining participation in regular physical activity, we have seen a sharp increase in the prevalence of low back pain. Lack of activity places increased stress on the low back in a variety of ways (3).

First, a sedentary lifestyle leads to weight gain, meaning more for your spine to carry throughout its daily tasks. Prolonged sitting has also been shown to decrease the strength in the muscles surrounding the spine, specifically the spinal stabilizers, glute muscles, and abdominals. As these muscles weaken, your back ends up working harder than it should due to lack of muscle support, potentially leading to discomfort. Increased time sitting will also cause hip tightness, again, making placing stress on the low back.

Activity Modifications and Exercise Treatment

First and foremost, beginning a simple walking program should be part of your routine. Simply walking thirty minutes, five times a week, will prevent weight gain, improve cardiovascular health, and improve mood and cognition (4). One study found that walking at a moderate intensity twice weekly was effective at reducing chronic low back pain and improving function in patients with chronic low back pain (5). You can also break up your exercise throughout the day. If thirty minutes seems daunting at first, try three ten minute walks throughout the day.

After this, it is important to work on increasing core strength to offset any instability that may be present in the low back. By strengthening the muscles are the spine, you are providing a better support system to your back, making it more resistant to pain or injury. One of my favorite exercises to strengthen the core is the “anti-rotation press.” This exercise is proven to safely and effectively increase core strength (see below).

In order to do this exercise, you need a theraband or a cable machine. Hold the band or cable with hand-over-hand grip. Keep your toes/knees/hips facing forward as you press the cable straight away from chest. Resist the rotational force and maintain tension through your core as you do so. Start by holding this for ten seconds, repeat six times, up to three times per week.

Increased sitting has a tendency to put our hip flexors and hamstrings in a shortened position for extended periods of time resulting in a decrease in hip motion. Our back is the ultimate compensator. Lack motion in the hips causes the body to compensate by moving too much through the spine. A simple way to increase hip motion is a stretch that can be accomplished with nothing more than a doorway. Pictured below, this stretch will improve motion at your spine to take the pressure of the lower back while walking and exercising.

In order to complete this exercise, stand at a doorway with your feet shoulder width apart facing forward. Place your right or left foot forward on the chair/stool and place your hands on the doorway so elbows are slightly above shoulders. Then you want to contract your core muscles and your glute muscles and drive your hips forward to feel a stretch on the front of the right thigh if the right foot is on the ground. Hold for three to five seconds, repeat ten times each foot daily.

If you are interested in learning how you can control the health of your spine through exercise and activity modifications, click below to schedule your free discovery visit with a physical therapist.


1. Crow, William Thomas, and David R Willis. “Estimating Cost of Care for Patients With Acute Low Back Pain: A Retrospective Review of Patient Records.” Journal of the American Osteopathic Association, vol. 109, no. 4, Apr. 2009.
2. BALAGUE, F., MANNION, A. F., PELLISE, F., & CEDRASCHI, C. (2012). Non-specific low back pain. Lancet, 379(9814), 482-491.
3. Van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2011). A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal, 20(1), 19-39.
4. “Global Recommendations on Physical Activity for Health.” Global Recommendations on Physical Activity for Health, World Health Organization, 2010, pp. 58–59
5. Shnayderman, Ilana, and Michal Katz-Leurer. “An Aerobic Walking Programme versus Muscle Strengthening Programme for Chronic Low Back Pain: A Randomized Controlled Trial.” Clinical Rehabiliation 27.3 (2013): n. pag. Web.