The Cause of Lower Back Pain
A Neuromuscular Perspective

Confusion about the Cause of Lower Back Pain

Regarding the cause of lower back pain, a quote from conventional literature offers a discouraging point of view:

“Even with today's technology, the exact cause of low back pain can be found in very few cases.” (My emphasis)

I have been treating lower back pain for thirty years and I can tell you that this statement is simply untrue.

It reflects the widespread confusion about the cause of lower back pain in the conventional medical world.

The reason for this confusion lies in the non-holistic approach medicine has adopted during the last hundred years. The body is no longer viewed as a whole but rather as an assembly of individual parts.

This non-holistic view, combined with the rise of technological advancements, has led to extreme specialization in medicine. While current technologies have provided countless benefits to medicine, they have done little to ease the pain of millions of lower back pain sufferers.

When the body is not seen as a whole, simple things can be easily missed. Like a severe muscular compensation in the lower back caused by a torque in the pelvis. This is just one example of a problem that whole body evaluation might identify and an X-ray would miss.


Confusion about the causes of back pain can be summarized in this way:

1. The majority of back pain is caused, not by disc herniation or other pathology, but by musculoskeletal dysfunction, such as muscular compensation and imbalance.

2. A majority of physicians receive only minimal training in the musculoskeletal system which results in little useful guidance other than prescribing painkillers or suggesting physical therapy.

Many of my clients run into two problems with physical therapy:

• Physical therapy exercises are often far too generic. Because back pain is most frequently caused by very individual muscular compensations, generic PT exercises are often not only ineffective but can potentially aggravate the problem.

• Physical therapy exercises often suggest strengthening the muscles that are in pain. This makes no sense. Doing strengthening exercises with muscles that are in spasm tends to trigger a defensive reaction in the body and delay pain relief.

Proper Order of Rehabilitation 

To relieve back pain of a musculoskeletal origin the correct order of rehabilitation must followed, otherwise pain relief is not only delayed but the problem can be aggravated.

1. Relieve muscular spasm
2. Restore flexibility
3. Restore proper biomechanics
4. Build strength
5. Build endurance

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Stephen O'Dwyer, cnmt

Neuromuscular Therapist & Pain Relief Researcher

Stephen O'Dwyer, CNMT


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