Introduction: Understanding Low Back Pain
If you’ve ever struggled with low back pain, you’re not alone. It’s one of the most common reasons people seek medical help, miss work, or avoid doing the things they love. Almost every human has experienced low back pain at some point in their life, and almost everyone else will in the future. While symptoms can range from intensely painful to mildly irritating, there is a common misconception that the pain necessarily originates from the lower back itself. In reality, low back pain most often stems from imbalances or dysfunctions in other parts of the body that affect spinal alignment and posture. The spine, after all, is part of a larger interconnected system.
This article takes a holistic approach to understanding low back pain. By recognizing that the body’s weaknesses or instabilities elsewhere — such as in the hips, thoracic spine, shoulders, and even ankles — can significantly affect the lower back, we can better address the root causes. If a weakness or imbalance becomes severe enough, it can result in pronounced pain and discomfort in the lower back. We’ll explore five often-overlooked factors that could be contributing to your discomfort, and we’ll discuss ways to address them so you can feel better, move more freely, and start living without nagging pain.
1. Overactive Psoas: A Common Cause of Low Back Pain
What is the Psoas Muscle?
Let’s start with the psoas — a deep, powerful muscle that connects your lumbar spine (the lower back) to your upper thigh bone (femur). The psoas plays a vital role in movements like walking, running, and squatting, and it’s key to stabilizing the pelvis and supporting the spine. When the psoas is functioning well, it works smoothly with other muscles to keep your pelvis aligned and help with fluid movement.
How the Psoas Muscle Becomes Overactive
But here’s where things can go awry: In today’s world of long hours spent sitting at desks, driving cars, and lounging on the couch, the psoas can become shortened and tight. Over time, this leads to an overactive muscle that pulls your pelvis into an anterior tilt. Additionally, repetitive movements like squatting or lunging, along with poor engagement of your glutes and core, can create a situation where the psoas takes over and works harder than it should.
Stress is another major contributor. The psoas is often referred to as the “muscle of stress” because it plays a role in the body’s fight-or-flight response. When we’re stressed, anxious, or fearful, the psoas contracts and holds on for dear life. This constant contraction can lead to muscle imbalances that affect posture and spinal alignment, resulting in low back pain.
How an Overactive Psoas Leads to Low Back Pain
When the psoas becomes overactive, one of the most common outcomes is anterior pelvic tilt — this is when your pelvis tilts forward too much, creating an exaggerated curve in your lower back (known as lumbar lordosis). This excessive curvature can put unnecessary pressure on your spinal discs and vertebrae, leading to discomfort, stiffness, and pain in your lower back.
Not only does the overactive psoas put pressure on your lower back, but it also creates tension in other muscles that try to compensate. Muscles like the quadratus lumborum and the spinal erectors often get pulled into overwork, leading to muscle fatigue and more strain on the spine.
How to Assess an Overactive Psoas
So, how do you know if your psoas is the culprit behind your low back pain? First, check your posture in the mirror. Do you notice that your hips seem to be in front of the arch of your foot, or that your lower back has a pronounced arch? Another sign is if you feel a pinching sensation in your hip flexors, especially when you squat or lunge. These are all red flags that your psoas might be doing more work than it should.
What to Do About It
The good news is that you can take steps to release the tension in your psoas. Start with psoas trigger point release — this involves applying pressure to specific spots in the muscle, often using techniques like acupressure or deep tissue massage. Since the psoas is so connected to the body’s stress response, it responds better to relaxation techniques rather than aggressive stretching.
Next, work on strengthening the glutes and core. These muscles work in opposition to the psoas and counteract the forward tilt, offering better support for the spine and reducing strain on your lower back.
I personally recommend the Optimized Athletics psoas release tool. There are far more expensive ones on the market, but I find this one to be both accessible and effective.
2. Weak Hip Internal Rotation: A Source of Undetected Imbalances
What is Hip Internal Rotation?
Hip internal rotation is the ability of your thigh bone (femur) to rotate inward toward the midline of your body. It’s a movement that’s crucial for everyday activities like walking, squatting, and twisting. The hip joint has to be able to rotate in all directions to maintain proper alignment and stability, which ultimately supports the entire kinetic chain from the ground up.
How Weak Hip Internal Rotation Contributes to Low Back Pain
If your hip lacks adequate internal rotation, your body will try to compensate by relying more on the lumbar spine to create rotation during activities like squatting, lunging, or even walking. For instance, during a squat, when the hip reaches around 90 degrees of flexion, it naturally begins to rotate inward to preserve joint stability. If your hip can’t do that, the lumbar spine will take on the job of rotating, which can cause strain on the discs and muscles in the lower back. The result? More low back pain and discomfort.
How to Assess Hip Internal Rotation
To check if you have limited hip internal rotation, lie on your back and try to rotate one leg inward, keeping your buttocks flat on the floor. If one side has significantly less range of motion, this could indicate a restriction that might be contributing to your low back pain.
What to Do About It
A simple exercise that can help restore hip internal rotation is the banded hip internal rotation drill. This involves using a resistance band to gently encourage the femur to rotate inward. Incorporating this drill into your routine can help improve your hip mobility and reduce unnecessary stress on your lower back.
3. Limited Thoracic Rotation: How Your Upper Back Affects Your Lower Back
Role of the Thoracic Spine
The thoracic spine (upper and mid-back) plays a key role in trunk rotation. Every time you twist, reach, or bend, the thoracic spine is working. But when this part of your spine becomes stiff or restricted, it forces your lumbar spine to pick up the slack, which can lead to low back pain.
How Limited Thoracic Rotation Contributes to Low Back Pain
When thoracic rotation is limited, the body often compensates by over-rotating the lumbar spine to make up for the lack of movement in the upper back. This over-rotation places additional strain on the lumbar vertebrae and discs, increasing shear forces that can lead to discomfort and pain. In fact, what you might perceive as tightness in your lower back could actually be the result of excessive motion happening in the lumbar spine due to a stiff thoracic spine.
How to Assess Thoracic Rotation
Try a simple test by lying on your back and doing a spinal twist. Swing one leg over your body and see if your knee can touch the floor while keeping your shoulder grounded. If you can’t achieve this comfortably on both sides, or if there’s a significant restriction on one side, it’s a sign that limited thoracic rotation could be contributing to your low back pain.
What to Do About It
Incorporating thoracic mobility drills can help restore motion to the upper back and reduce the compensatory strain on your lumbar spine. Wall-based thoracic rotations and seated twists are great exercises to start with.
4. Limited Overhead Shoulder Extension: The Ripple Effect on Your Spine
How Shoulder Instability Affects Posture
Limited shoulder mobility, especially in overhead extension, can throw off your posture and lead to compensations in your lower back. When you can’t fully extend your arms overhead, it can cause your upper back (thoracic spine) to round, leading to thoracic kyphosis — a hunched upper back. This misalignment often causes your lower back to over-arch (lumbar lordosis), contributing to pain and strain in the lower spine.
How Shoulder Restrictions Lead to Low Back Pain
When your shoulders can’t fully extend overhead, your body often compensates by arching the lower back more than it should. This compensation can increase the stress on the lumbar spine, which leads to low back pain.
How to Assess Overhead Shoulder Extension
To assess your shoulder extension, stand facing a wall with your hand slightly above eye level. Hinge forward and try to extend your arm behind your ear. If you feel restricted or notice a big difference in range of motion between the two sides, it could be a sign that shoulder mobility issues are contributing to your low back pain.
What to Do About It
Lat pullovers are a great exercise to improve overhead shoulder mobility. When done carefully and with a pause at the end range of motion, they can help to override faulty nervous system limitations by creating conscious stability.
5. Ankle Instability: The Foundation of Your Movement
Importance of Ankle Stability
The ankles may be small, but they play a critical role in maintaining proper alignment throughout the body. Ankle instability can have a profound effect on your posture and overall movement, often leading to low back pain.
How Ankle Instability Leads to Low Back Pain
When the ankles are unstable — whether through overpronation (rolling inward [This is much more common}) or oversupination (rolling outward [Though less common, can occur as a pain avoidance pattern after a foot break, plantarfasciitis, ect]) — it can throw off the alignment of your knees, hips, and lower back. For example, overpronation causes your knee to collapse inward, which creates an uneven hip height and places uneven stress on the spine.
How to Assess Ankle Instability
You can assess your ankle stability by performing a single-leg balance test. Stand on one leg and see how long you can maintain balance. If you’re wobbling or find it difficult to stay stable, it could indicate ankle instability. Also, look at your walking mechanics to see if you notice signs of overpronation or oversupination. The simplest way is probably just to look at your feet and see if they do this:
What to Do About It
Strengthening the muscles around the ankle can help improve stability. Exercises like single-leg kicks or single-leg kettlebell switches are effective at building ankle strength and reducing compensatory movement up the chain that can lead to low back pain.
Conclusion: A Whole-Body Approach to Low Back Pain
After over a decade of helping people with chronic pain, one thing I’ve learned is that low back pain is rarely an isolated issue. It’s almost always a symptom of dysfunction somewhere else in the body. By addressing weaknesses or imbalances in the hips, thoracic spine, shoulders, and ankles, you can restore balance, improve alignment, and take pressure off your lower back.
If you’re still unsure where to start or how to move forward, I’d be happy to help! Consider scheduling an assessment with me to dive deeper into your posture and movement patterns. Together, we can create a plan to help you get back on track — pain-free!
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