The low down on lower back pain (Part 1)

‘I really must get my back looked at…’ How often have you heard somebody say that — or indeed said it yourself?

Lower back pain is so common that it’s almost an oddity to meet someone who’s never experienced it. And many of us just accept it as a fact of life — especially as we get older.

But as there really is no need to put up with it, let’s start with some detective work…

Do any of these symptoms sound familiar?

  • You struggle to turn over in bed pain-free
  • Walking or standing is painful after a while
  • Lying on the affected side, or putting weight on it, hurts
  • You’ve had to resort to moving on all fours at times
  • Even coughing and sneezing is painful.

If the answer is ‘yes’ to one of more of those, and your GP has ruled out disc problems, pinched nerves or arthritis, the problem could be referred muscle spasm pain caused by trigger points.

Dr Janet Travell and Dr David Simons say in their book Myofascial Pain and Dysfunction: The Trigger Point Manuals that ‘trigger points are the primary cause of pain at least 75% of the time and are a factor in nearly every painful condition’.

You will certainly never find the real cause of back pain if you just look for it in the lower back. Instead, the source may well be trigger points in the buttocks — and trigger points in the lower back can in turn cause pain in the buttocks and hips. The pain can also be traced to trigger points in the abdominal and psoas (lumbar region) muscles, and — to further confuse diagnosis — back pain is a composite: it arrives from trigger points both above and below the point where you actually experience discomfort. And what’s more, the longer you leave it untreated, the more muscles get in on the act — you can end up with quite a lengthy list!

There’s never a quick fix for lower back pain, but if you’ve ruled out other causes and all the evidence points towards muscle spasm, then seek treatment from a therapist who works with myofascial release and trigger points. They will put you on the road to recovery with specialist clinic-based therapy and treatment you can do at home.

There are so many potential trigger points that for now we’re just going to look at those found in the gluteal and piriformis muscles in the buttocks as they’re both common culprits and relatively easy to self-treat.

The gluteal maximus trigger points produce pain in the lower back, the sacroiliac joint, the tail bone, and the buttocks themselves. Your hips may also feel stiff.

Glut med trpsGluteal medius refers pain to the lower lumber region — just below the belt line — as well as the crest of ilium, the sacrum, and the back of the upper thigh.

Gluteal minimus refers down and along the outside of the thigh to the knee and ankle, and can be mistaken for sciatica. The trigger point originating in the piriformis can cause nerve entrapment or tension and can twist the sacroiliac joint, further exacerbating discomfort.

Among the symptoms linked to these trigger points are…

  • Having difficult getting out of chairs
  • Being unable to touch your toes
  • Needing to constantly change position when seated
  • Difficulty finding a comfortable sleeping position
  • Increased pain when standing or walking
  • Standing and walking with your pelvis thrust forward.

You can deactivate the gluteal and piriformis trigger points yourself, with the following treatment:

  • Place a source of heat — a wheat bag is best, or a hot water bottle — around the buttock area and make sure the side and the sacrum are covered for some of the time. This is important because warming the muscles helps with the deactivation process.
  • Take a tennis ball and place it between one part of the buttock that’s the source of the pain and a wall. For the purposes of this exercise, the buttock is divided into an upper and lower section.
  • LBP self treat trp tennis ballStart along the edge of the iliac crest (the hip bone), and move in different directions — across, up and down. Then relocate the ball to the lower section of the buttock, and repeat. You’ll almost certainly find more than one trigger point, and they may well be very tender! Go over each area two or three times.
  • Always work within a pain threshold of 0-10, with 10 being unbearable. Never go beyond 7 to ensure your muscles don’t go into spasm — let your body do the healing!
  • Have a look at this video to see how the tennis ball should be used to treat buttock trigger points and those found elsewhere on the body.

Once your trigger points have been deactivated, try these preventative stretches to help keep you that way…

Lying cross-over knee pull down

Glute stretch

Lie on your back and cross one leg over the other. Bring your foot up to your opposite knee and with your opposite arm pull your raised knee towards the ground.

Keep your shoulders on the ground and concentrate on pulling your raised knee to the ground, not up towards your chest.  Hold the stretch for 20 seconds and maintain controlled breathing. Take a deep breath in when you start and breathe out as you start the pull on the opposite knee.

Gluteal Stretch – Lying Leg Resting Buttocks

Glut med and max pirif stretchLie on your back and slightly bend one leg. Raise the other foot up onto your bent leg and rest it on your thigh (the bent knee should be at a right angle). Then reach forward, holding onto the back of your knee (photo shown is slightly different) and pull towards you. Hold the stretch for 20 seconds. Again breathe in to begin and out when you pull leg towards you.


In Part 2 of this exploration of common lower back pain trigger points and their treatment, we’ll focus on the quadratus lumborum — also known as The Joker!