Low Back Pain

Low Back Pain: Beyond the Spine 

Low back pain is one of the most common causes of physical limitation in adults and older adults, but also at very young ages, and can affect everything from basic activities, such as walking or bending over, to athletic or occupational performance. It is located in the lower back, between the rib cage and the pelvis, and can appear suddenly or develop progressively over time. 

Although many people associate it solely with "poor posture" or heavy lifting, the reality is much more complex. Low back pain is typically influenced by multiple factors: muscular overload, biomechanical alterations, lack of mobility, muscle weakness, accumulated physical stress (in both athletes and non-athletes), and even the way the nervous system processes pain.

Most Common Symptoms of Low Back Pain Pain in the lower back.

Symptoms can vary depending on the cause, but the most common signs include: 

• Pain localized in the lower back 

• Stiffness or a feeling of being locked up when getting up or moving 

• Discomfort when sitting or standing for prolonged periods 

• Pain that can radiate to the glutes, legs, or feet 

• Muscle tension or a feeling of overload 

• Limited ability to bend, twist, or carry weight 

• Recurrent episodes of "lumbago" or muscle spasms 

In some cases, the pain does not always reflect serious structural damage, but rather a combination of nervous system sensitivity, mechanical tension, and inefficient movement patterns. 

Why Does It Occur?

The lumbar region functions as a force transmission hub between the trunk and the lower extremities. When there is an alteration in this coordination, certain structures receive more load than they can tolerate. 

Common factors include: 

• Sedentary lifestyle or muscle weakness

• Repetitive overload (athletic or non-athletic) 

• Compensatory movements 

• Lack of lumbopelvic control 

• Restricted hip mobility 

• Prolonged physical or emotional stress 

A Key Fact That Is Often Overlooked: The Role of the Glutes 

One of the least considered aspects of low back pain is the function of the gluteal muscles, especially the gluteus maximus and medius, within lumbopelvic biomechanics. 

The glutes are not only involved in movements like walking, running, or standing up; they also help stabilize the pelvis and correctly distribute loads (whether standing, sitting, or lying down) between the hip, pelvis, and lumbar spine. 

When these muscles do not work efficiently—whether due to weakness, neuromuscular inhibition, or poor activation—the lumbar region may overcompensate, increasing tension, mechanical overload, and the risk of recurrent pain.

Interesting Fact: 

Much of persistent lumbar discomfort does not originate exclusively in the lower back, but rather in poor load management between the glutes, hip, and trunk. In other words: sometimes the problem is not only where it hurts. 

The Hip-Trunk Connection: A More Comprehensive Biomechanical View 

The hip acts as a bridge between the legs and the spine. If it loses mobility or stability, the lumbar region typically takes on extra work to compensate. This explains why, in many patients, treating only the painful area does not always resolve the problem if the behavior of the glute-hip-pelvis complex is not also analyzed. 

Therefore, a complete functional assessment can be essential to identify: 

• Gluteal activation deficits 

• Hip mobility restrictions 

• Lumbar compensations 

• Postural and movement alterations 

Therapeutic Approach 

From a modern physical therapy perspective based on biomechanics and neuroscience, the treatment of low back pain should not focus solely on relieving symptoms, but on understanding which structures are being overloaded and why. 

The combination of:  

• Manual therapy 

• Myofascial release

• Invasive techniques such as: 

◦ Percutaneous Electrolysis Therapy (EPTE) 

◦ Neuromodulation 

• Therapeutic exercise 

• Movement re-education  

can help reduce pain, improve function, and decrease recurrences.