"When I run, the pain goes down my leg"

"I get a pain in my back when I try to serve"

"I can’t bend down for the low ones"

t one time or another approximately 80% of us will have experienced back pain resulting in varying degrees of incapacity. Back pain ranks with headache and upper respiratory infection as a leading cause of lost time and decreased efficiency in the work place. It is the most common reason for diminished performance capacity and down time among recreational athletes. People with back pain find it difficult or impossible to participate in fitness activities. They can’t swing a golf club. Or serve a tennis ball. Or go for the low outside one. Or reach for the high outside one. Or run. They become anxious, depressed, frustrated and angry. They lose their cool; sometimes they lose their mates, sometimes their jobs. The cost is tremendous, the effects all pervasive.

Back pain has many different causes, which is one reason for the profusion of treatments. Your capacity to cope with low back pain depends to a great extent on your ability to understand what is going on in your specific caseIn the following, I hope to give you sufficient information to enable you to participate more intelligently in the management of your back pain. It is not intended for use in self-diagnosis or treatment or to substitute for competent medical care.


The spine or vertebral column may be thought of as a segmented rod of limited flexibility. Between each two segments (vertebra) is a cushion (disc) made of interlacing fibrocartilage surrounding a gelatinous substance. The discs connect the vertebral segments in the front; small spinal joints link them in back. The spinal nerves run through the center. These nerves, which supply the muscles and other tissues of the back and legs, emerge between the vertebrae, passing downward, behind and to the side of the discs. 

b ligaments in the front and back connect the vertebral column and, although they serve as reinforcement for the discs, the posterior ligament is thinnest and weakest where it needs to be best - in the lumbar region. This weakness contributes to the frequency of disc protrusion and herniation in this area.

Movement of the spinal column is through contraction of several muscle groups in both the back and front of the spine. In general, those in the back move the trunk to the rear (extension) and those in front, including the abdominals, bend it forward (flexion). Both groups, contracting unilaterally result in lateral flexion of the spine toward the side of contraction. In the lower back, the greatest range of motion is into extension. Torsional (twisting) or lateral movements are more restricted. 


All pain is caused by irritation of nerve-endings called pain receptors. In relation to the lower back, they are located in the joint capsules, ligaments, in certain bony parts, in the lining of the muscles (fascia) and in the lining of the blood vessels within the muscles. These receptors may be stimulated by mechanical factors such as twisting, stretching, crushing or tearing thus setting off the sequence of events resulting in the perception of pain. Lack of oxygen or the accumulation of toxic substances such as lactic acid may also activate the system.

Most first incidents of low back pain, originate from stimulation of pain receptors in the joint capsules or in the muscles. This is usually the result of twisting or torsional movements exceeding the normal ranges of motion (as in reaching up and back to return a high hard one in tennis), or of over-stretching tight muscle and fascia (as in bending forward from the waist to pick off a low one). 


The body is vulnerable primarily through a combination of ligamentous weakness and muscle imbalances, which I have dubbed the "psoas dysfunction/insufficiency syndrome." The psoas major is a large muscle on either side of the spine running from the front of the vertebral column downward and forward to cross the front of the hip joint. Its tendon then runs backward to attach to a small bony protuberance at the top of the inside of the thigh bone. It is the muscle responsible for the initiation of flexing the thigh at the hip joint as in walking, for arching (swaying) the lower back, and, in part, for pulling the torso forward on the pelvis. This is perhaps the most important postural muscle in the body. Under ideal alignment conditions, (i.e. ear over shoulder over hip over knee over front of ankle) with the erect body at rest, only the psoas and the calf muscles show significant electrical activity. 

The poor posture that facilitates injury to the low back, is, in many cases, due to laxity of the spinal and pelvic ligaments, tightness and weakness of the psoas major, along with weakness of the abdominal muscles. This combination encourages the hyperlordotic or "sway-backed" alignment: the source of most early cases of low back pain.