Low Back Pain (LBP) is the most expensive, benign condition in industrialized countries. Experts have estimated that approximately 80% of Americans will experience LBP during their lifetimes. Nearly 65 million Americans report a recent episode of back pain. Some 16 million adults — 8 percent of all adults — experience persistent or chronic back pain, and as a result are limited in certain everyday activities. In fact, about 31 million Americans experience low back pain at any given time. Based on these stats it’s not surprising that in our clinic, and many other PT clinics, lower back pain is one of the most common ailments we treat. Many people are treated for back pain with lots of different tools including massage, chiropractic care, medicine, exercise, yoga, even surgery or injections, and of course physical therapy.

Of course we look at lower back pain a little differently than most traditional therapists. As with everything we treat here at Pinnacle PT, we aren’t just looking at the structure of the lower back (arthritis or disc bulges etc.) as the only reasons for pain, which is good because most LBP doesn’t have an identifiable structural cause. Instead, we look at the function, and position of the lower back (lumbar spine) and anything that could be influencing its position or function.
The lower back is basically the connection from the pelvis to the ribcage. It includes the 5 lumbar spinal segments and the muscles (back and abdominal) that move those segments. If it is over compressed, twisted, or suboptimally positioned it may hurt. (Image 1) Therefore, we need to address and assess anything that impacts the ribcage (For example: arms and breathing), or pelvis (ie: legs). Basically everything you do can impact your lower back.
The most common thing we see that impacts the lower back is a pelvis that is tilted forward on one side or both as it’s “normal” resting posture. Sometimes we refer to this as the “open scissors” back (see Image 3) This alignment increases the compressive and/or rotational force through the lumbar spine and muscles. This position is influenced by the way we stand, walk, and breathe. So to help you lower back pain we need to address the reasons why your back is in the position it is in otherwise it’ll be really hard to make it feel better. If traditional PT, chiropractic or orthopedic solutions have not fully helped you lower back pain, lets us know as the root cause may not have been addressed yet.
Our exercises at Pinnacle Physical Therapy attempt to inhibit or turn “off” the back muscles by turning “on” the outer abdominals, glutes, hamstrings and diaphragm. We place these muscles in a better biomechanical position to oppose the back muscles by having our patients perform a pelvic tilt (“tuck your bottom”) and reach forward with the front ribs moving down and in with exhalation. This will assist to decompression the back. Image 3 assists with understanding this concept as you will see the front side “closing” and the back side “lengthening” or decompressing.
Once the body is more “balanced” and learns for all of the muscles stated above to work together the goal with be to land in the “middle” and be like image 3. This image demonstrates how the pelvis and ribs are in a mid-range position secondary to the back, abdominals, diaphragm, hamstrings and glutes working together to balance the body.
Check out the “Decompression for your Lower Back” video below provides a great demonstration of a commonly used technique we implement to achieve the concepts describe above.