If lower back pain is just a symptom, then what is the true underlying cause?

If the patient has an anteriorly tilted pelvis, due to compensatory reasons they will naturally have an excessive lumbar lordotic curve.  

Why….? Because one’s posture is governed by their eyeline. If the pelvis is tilted forward, one's centre of gravity will be forward of their midline. If their entire upper body was to be forward then that person would walk around with their entire body on the same angle as their pelvic tilt. Aside from making them look ridiculous, if would not be a posture conducive to balance nor function.

The patient compensates in order to have both their centre of gravity (middle of the pelvis) and their eyes in a plumb line.

Biomechanically this compensation occurs by creating an excessive lordotic lumbar curve, a kyphosed thoracic spine, leading into lordotic cervical spine.  

So, what does an excessive lordotic lumbar curve have to do with back pain?

EVERYTHING.

An excessive lumbar curve effects the following lower back structures in the following ways:

1. Muscles - shortened due to the origin and insertion being pushed closer together
2. Facet Joints - jammed together to the point of touching.
3. Intervertebral discs - compromised due to the pressure created by the vertebral bodies being pushed closer posteriorly and further apart anteriorly
4. Connective tissue - solidifies as a result of constant load and or to create a protective brace for weakness to the compromised lower back region.
5. SacroIliac Joint (SIJ) - Jammed and compromised due to the pelvis being anteriorly tilted and the lordotic lumbar spine

The above five structures are the most common source of back pain. We have identified that an excessive lordotic curve comprises all or many of these structures causing dysfunction and pain.

We have also identified that an anterior pelvic tilt creates the excessive lordotic curve that affects the lower back pain structures creating pain.

So if we now identify what causes the anterior pelvic tilt, then we will identify the true underlying cause of back pain.

THE HIPS

•  Weakened major glute, hamstring and adductor muscles
•  Cause the deeper external rotators of the hip to be under constant load
•  Causing them to remain shortened and contracted
•  Which holds the hip joints in a constant internally rotated position,
•  Which holds the pelvis in a constant anteriorly tilted position  

THE TRUE UNDERLYING CAUSE OF BACK PAIN IS WEAKENED MUSCLES THAT ARE INTEGRAL TO MAINTAINING CORRECT POSTURE.

Treatment that only focuses on the back, whilst ignoring the weakened postural muscles is treating the symptoms not the true cause of your back pain