So your lower back hurts. You're wondering why massaging, icing, heating, and tending to the area is not helping the pain at all. The answer may be simpler than you think - the source of the pain is NOT where the hurt is. Understanding referred pain is the step toward gaining a wholistic view of why your low back hurts and how to fix it.
Referred Back Pain Patterns
Referred back pain is the concept that your pain is caused by one area, 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" .
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
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 low 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 low back. For more about Psoas trigger points specifically check out this blog post: Psoas Function and Trigger Points.
Psoas Referred Pain Pattern Chart : 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 actually be caused by 5 different muscles, and typically it's caused by multiple muscle 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
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!
 Davies, Clair, and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 3rd ed., New Harbinger Publications, Inc., 2013.
 Donnelly, Joseph M. Travell, Simons & Simons Myofascial Pain and Dysfunction: the Trigger Point Manual. 3rd ed., Wolters Kluwer Health, 2019.