So your lower back is killing you. You're wondering why massaging, icing, heating, and tending to the area are not helping the pain at all. The answer may be more simple than you think - the source of the pain is NOT where the hurt is. Understanding referred pain is the step toward gaining a holistic view of why your low back hurts and how to fix it.
Referred Back Pain Patterns
Referred back pain (a.k.a. "back referred pain") is the concept that your pain is caused by one area of the body, but the pain manifests in another. As beautifully stated by Amber and Clair Davies in their Trigger Point Therapy Workbook: "It’s a mistake to assume the problem is at the place that hurts" [1].
Back pain is no exception to referred pain, and it is commonly overlooked in tending to the problem. Next time your X hurts, ask your medical professional if the problem could be stemming from Y or Z muscles.
Referred Back Pain Example - Psoas Muscle
Psoas Muscle
Referred back pain patterns become more clear when looking at a muscle's function in the body, not just where it is located. The Psoas muscle (that big, mean hip flexor that refers pain to the low back) for example, is located in the front of the body but refers pain to the lower back and upper thigh. Psoas referred back pain makes more sense, however, when you see the muscle is actually attached to the lower spine and upper thigh (femur). When Psoas is tight, it pulls on the lower back vertebrae and tilts the pelvis forward - which causes the referred pain felt in the lower back.
Referred back pain caused by Psoas needs to be addressed in the front of the body, even if it is felt in the lower back. For more about Psoas trigger points specifically check out this blog post: Psoas Trigger Points.
Psoas Referred Pain Trigger Point Chart [2]: This is an example referred pain pattern caused by the Psoas muscle on one side of the body. Generally, both Psoas muscles are tight, and the red portion is symmetric on each side.
Low Back Pain-Referring Muscles
Referred low back pain can be caused by up to 5 different muscles, and typically it's caused by multiple muscles at once. As discussed in my article 5 Muscles Contributing to Your Low Back Pain, these 5 muscles include:
1 Low back muscle: Quadratus Lumborum (QL)
2 Glute/buttock muscles: Gluteus Medius & Piriformis
2 Hip flexor muscles: Psoas & Iliacus
Any of these 5 muscles can be solely or partially contributing to your back referred pain at any time. I personally dealt with lower back pain for years and learning to master these 5 muscles was what finally brought me relief.
Back Referred Pain Relief
When navigating your referred back pain and low back tightness, it is helpful to have a tool that can reach and release all 5 crucial areas. This is why I love QL Claw - a massage therapy tool designed to release all 5 specific back-pain-inducing muscles. QL Claw is the most versatile deep tissue massage tool around, with uses well beyond the big 5 muscles. Check QL Claw out at the link below!
Referred Back Pain Relief Tool: QL CLAW
QL Claw Releasing Back Referred Pain Muscles
Read next: QL and Psoas Muscles
Sources:
[1] Davies, Clair, and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 3rd ed., New Harbinger Publications, Inc., 2013.
[2] Donnelly, Joseph M. Travell, Simons & Simons Myofascial Pain and Dysfunction: the Trigger Point Manual. 3rd ed., Wolters Kluwer Health, 2019.