Lower back pain is one of the most common types of chronic pain around.

One reason for this is because the lower back is the transition point between the upper and lower body, which makes it very susceptible to strain and injury. 

Why? Because any time an activity is performed with the arms or the legs, the lower back comes into play. It supports the torso so the muscles that attach from the torso to the arm or leg can move the limb. The lower back is also involved in any weight-bearing activity. Even when you are sitting, if your back is not supported, the lower back is being challenged.

Another important thing to understand about the lower back region is that the pelvis, which makes up the bottom portion of this region, is constantly changing position. Most other joints are pretty much stable in their position; one bone simply moves on the other bone at the joint. In the lower back region, the rib cage and pelvis are constantly changing in relationship to each other. This creates the possibility of severe changes in muscle length occurring that strain the muscles of the lower back.

The final reason that this area is one of the most commonly complained about is actually a misunderstanding of what this area is. The lower back and the gluteal region are in close proximity to each other, and, often, the medical establishment treats them as one area. However, they are distinctly different. 

The delineating line between the lower back and the gluteal region is the pelvic rim. Most people perceive this as their hips. Put your hands on your hips with your thumbs in the back. Now imagine a line running across the back of your body from thumb to thumb. This is the separating line between the lower back and the gluteal region. If your pain is below this line, it is in the gluteal region. If your pain is above the line, it is in the lower back.

PAIN ON BOTH SIDES OF THE BACK

Possibility 1: Muscle Imbalance Between Quads and Hip Flexors Versus Glutes and Hamstrings
By far the most common reason for pain across the lower back is a muscle imbalance that develops between the quads and hip flexors (the muscles on the front of the body) versus the glutes and hamstrings (the muscles on the back of the body).

Possibility 2: Forward Center of Mass
If your ear and shoulder are in front of the hip joint, your pain may be coming from something referred to as forward center of mass. This postural variation makes you look as if you are bent forward from the hip joint.

Possibility 3: Strained Quads Causing Shortened Hamstrings
This is actually somewhat rare, accounting for only about 10 percent of cases. There is typically a reason why the quads haven’t been working normally and have weakened to the point where the hamstrings could overtake them in strength.

SINGLE-SIDED BACK PAIN

Possibility 1: Strained Gluteus Medius (Glute Med) Causing Lower Muscle To Overwork
If you have pain on just one side of your lower back, the most likely cause is a strained hip muscle called the gluteus medius (glute med). This strain can be either on the same side as the pain or on the opposite side. The gluteus medius plays a pivotal role in supporting you, especially when standing on one leg, as in the case of walking. 

Possibility 2: Strained Hamstring Causing Quad To Shorten
Another possible cause of lower back pain only on one side is a strained hamstring causing the quad to shorten. The quad is attached to the front of the pelvis, while the hamstring is attached to the back. If the hamstring strains, the pain imbalance between the quads and hamstrings increases, causing the quads to shorten more, pulling the pelvis down in the front and causing an increased arching at the lower back. This in turn causes the lower back muscles to shorten, strain, and emit pain at one side of the lower back.

Possibility 3: Strained Quad Causing Shortened Hamstring
Just as a strain of the hamstrings can have an effect on the position of the pelvis and the length of the lower back muscles, so can a strained quad. If the quad strains, this will decrease the force that helps oppose the force created by the hamstring. This causes the hamstring to shorten. Since the lower back muscles (QLs) attach from the bottom of the rib cage to the top of the pelvis, the increased space between the [bottom of the back rib cage and the top of the pelvis] will cause the lower back muscles to be overstretched. Thus they strain and emit pain at the lower back.

Possibility 4: Deficit Of Single-Sided Hip, Knee, Or Ankle Musculature
There is one other option of a cause for pain in one side of the back: an injury of the hip, knee, or ankle. If none of the scenarios I have identified above seem to fit your situation, I want you to think about whether you had an injury, be it a strain, a sprain, or even a prior surgery, to your hip, knee, or ankle. If the strength of the musculature at these locations did not return to full capacity, then a deficit of strength remains. 

Clinical tests to pinpoint the cause of your pain and tailored strength training exercises to relieve it, can be found on my website, or in my book, The Pain Cure Rx (as seen on Public Television). Although I refer to it as strength training, I don’t want you to be alarmed. The phrase simply implies that the technique incorporates some form of resistance to make your muscles stronger. When you make the muscles stronger, you restore their power to do the functional activities you are trying to perform and begin to resolve your pain naturally.