Did you know that your spine started forming on the seventeenth day of your embryonic adventure in your mum’s body and continued to form until you were 25?

Just imagine, you are floating in the uterus. Chances are nobody knows about your existence yet. The first somite (segment) of your spine has just formed. It will keep going, one somite after another and it will eventually give form to the whole spine, arms, legs, hips and all the rest of you. 

I remember seeing the front of the spine on day five of my dissection class. Having spent the previous four days removing all of the tissues that lay over it, what I saw in front of me was beyond words. It seemed like a structure that could’t be more perfect, even though the specimen before me was about 90 years old. I was amazed. The perfectly shaped segments, not ‘fitted’ together, but actually grown out of a common beginning. Never separate, seamlessly intermeshed. Extremely strong yet flexible. I finally understood the meaning of the spinal ‘column’. Each part the continuation and reflection of its neighbour. Magnificent. 

So why does our spine suffer so often?

It would all be okay if we stayed on all fours. You see, we inherited our structure from quadrupeds but then, somewhere in our evolution, some of our ancestors decided to stand up on our hind legs (allegedly to see further afield) and that was not what our structures were designed for. From a purely mechanical point of view, our structures are inherently unstable. Moreover, animals moving about on four legs elongate their spine with every single step they take, exercising and lubricating all the bits. With only two legs doing the stretching, the spine is much more difficult to lengthen. When our spine is supple and soft, then it’s great. If, however, we don’t move much our spines start stiffening, gradually becoming more rigid and more vulnerable. 

How to get acute back pain in two easy steps

Seeing patients in my clinic gives me a chance to listen to their stories. Listening to how people injure themselves, one can develop a pretty good recipe of how to do one’s back in. 

It only takes two movements combined together. What you need to do is bend forward and, whilst you are in this position, rotate your torso. Please don’t try it at home. In my less enlightened years before I learned anatomy, I managed to do it myself. Whilst vacuuming the floor, I saw a fluff of dust in a very ‘tricky to get’ corner. Determined to get it, I bent forward to get into a good position and then whilst I almost had it, I rotated my torso to get the perfect angle. I felt a very weird sensation in my back and that was it. I couldn’t straighten my body again. Frustratingly, that fluff of dust was still there! I walked funny, slightly bent in the middle for three days before it started feeling like my back might forgive me. 

Why does it happen?

The lumbar spine is not designed to rotate. It can side-bend really well, but rotation is just not its thing. The snag is, you can force it into rotation by bending forward. When you are bent forward the vertebrae open up and separate from each other at the back of your spine, creating more space between them. If you rotate from here, you are forcing your lumbar spine to rotate more than it should. 

Now here is the really interesting bit: if that happens, your body gets alarmed. As far as it is concerned, this feels like you are going to bring your spine completely out of alignment. Because your muscles are designed to always protect your bones, they will respond by tensing up dramatically to protect your spine — a process called ‘splinting’. Have you ever had a splint? It’s designed to not let you move. This is why people who ‘throw out their backs can’t straighten up again afterwards. The muscles hold their contraction in order to ‘grip’ your vertebrae and surrounding structures so that you are not able to rotate more and subsequently hurt yourself. Your body stops you mid-movement so that you are protected from … erm… yourself.

It’s not just vacuuming, of course. You might bend forward and then rotate to reach something on the floor. You might bend to lift something heavy and then put it away on your side. You might sneeze whilst bending forward. You get the idea. In all such cases, if you exceed what your myofascial body knows (better than you) to be safe, you will be forced to stop.

Thankfully, if it’s just a case of muscles tensing up to protect a perfectly healthy structure, then after a few days you should be able to move with more ease. After all, a healthy spine can lift just short of 500 kilograms without any damage. If your vertebrae are already compressed and struggling because of your sedentary lifestyle, then the situation is quite different. If say, your discs are not in a great condition (because you’re old, or chronically dehydrated, or spend too much time hunched over or slouching), or you have preexisting spinal postural imbalances, then your thoughtless-albeit-diligent imprudence might cause a cascade of trouble, all the way up to rupturing the nucleus of the vertebral disc and impinging the spinal nerve.

Most people hurt their backs on Friday afternoon

Why would that be? Let me illustrate the scenario for you. You have just finished a week of work. You are tired, and you are … in a hurry to relax. You just have to reach for the one thing on the floor, or move one heavy box… You are rushing, you don’t pay attention, you stretch too far and… boom! Lower back pain ensues. 

How to work towards chronic back pain

Have a seat. Keep sitting for at least 8 hours a day. Don’t get up too often and wait for your colleagues to bring you a cup of tea from time to time. Then, drive home and sit down for dinner. When it’s time to relax, sit down on a sofa and watch some telly. Remember, don’t move too much. Repeat at least 5 times a week. The front of your thighs will shorten in a matter of few weeks. 

What happens next? Well, if you are lucky… nothing. For a while.

Our bodies are remarkably resilient when properly maintained, but a lot of us don’t ever think about our bodies until they hurt. Our bodies are incredibly efficient. Any activity that is done continuously teaches the cells that maintain our connective tissue where they need to reinforce things, and they do this at the expense of the parts that we don’t use. In the case of our couch potato scenario, the quadriceps shorten and pull the pelvis forward, thus increasing the curve in the lumbar spine. Interestingly, the tight quads will never hurt. After all, they’re diligently doing what they’re told. What might become very vocal, though, is the lumbar spine, which doesn’t like to be arched like that. 


One might think to give it some care. A hot pack, some heat cream or even a back massage will ease the discomfort, right? Unfortunately, none of this will help long-term, because the real culprit is way over on the other side of the body, pulling away, tightening and shortening as you continue to watch cat videos on the internet. Surely and predictably, the pain will be back the next day or two. In this scenario, the lower back is the victim of the tight muscles in your legs. Now, if you really want to make a difference, a deep, passive and then active fascial release of the legs might be needed. 

Hip flexors 

The tight quads can be a real problem but, as I mentioned earlier, they won’t hurt at all. As it usually happens in the body, if the tension persists, it will travel to other structures. The usual victims of the long-term quad tension are our deep hip flexors. 

Ladies and gentlemen, meet my two favourite muscles, Psoas Major and Iliacus.  

The psoas is very interesting. It’s the only muscle that directly links upper and lower body, and also the only muscle with its own nerve plexus. It extends from the lumbar spine, travelling via the abdomen and pelvis to attach to the top of the inside of the leg. The bigwigs of the bodywork world thoroughly and sometimes viciously disagree on what it does and how to fix it. However if you were to want to even contact it, you need to go in through the abdomen, not the back, because there’s at least six layers of tissue (the exact number varies, depending how you count) to get through to the psoas from the back. 

Iliacus forms the inner lining of pelvis, and shares an attachment tendon with the psoas. Here, too, back massage just won’t cut it. To ease the tension in the Iliacus, the therapist needs to gently negotiate their way into the pelvis from the front, and invite it to relax. 

Quadratus lumborum

A significant proportion of lower back pain is caused by tension and imbalance between the pelvis and the lower ribs. There is usually a very well known suspect in such cases: the quadratus lumborum (QL) muscle. Have you ever sneezed or coughed and felt a sharp pain in your back, or have felt a stabbing sensation in your hips or pelvis, deep in the tissues? Next time you do, say hello to your own, individual and unique QL imbalance. 

This pain pattern is usually very confusing, because the location of the muscle doesn’t hurt — the connected structures do. Of course, if you know your anatomy, you can identify the QL and test it directly, and then you will be sure if it needs treatment. However, and interestingly (I sense a pattern here), it is almost impossible to reach this muscle from the back. So again, the back massage will do nothing for it. To really connect with the QL, the therapist needs to access it from the side, assist it with breathing (since  part of its job is to pull on some of the structures that move during breathing) and then use movement to really help it elongate and balance with the other side.

Emotional component 

We might go through periods of back pain in our life when we don’t feel supported. The most common trigger for back pain in men is, believe it or not, pregnancy. A lot of men suffer from back pain when their partner is in the third trimester of pregnancy. It makes sense if you think that most men whose partners are pregnant are fully in the supportive role at this stage. There is a lot of stress in a preparation for the arrival of the baby, and there is not much room for men to be supported at this stage.

We might also experience lower back pain when transitioning into new phases or life (like moving to a new city, starting a new job, or losing a source of income), as well as during periods of anxiety and heightened stress. 

What to do if you suffer from back pain?

First, remain calm. If you’re in one of those heightened states I mentioned, try to slow down and relax. Believe it or not, a lot of lower back pain just requires patience, rest, and gentle activity to improve. That being said, the fascial release and craniosacral therapies that we practice at Healing Space would be a great start. Once you feel better and the muscles and fascia are balanced, then I would recommend a nice and restorative back massage to provide your body with some much needed TLC.