Lower Back --- 'Every-Morning' Pain

and Deep Muscle (Psoas, etc.) Stretches


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This 'Lower-Back---Every-Morning-Pain' page

! Note ! A few more links and images may be added ---
especially if I find better stretches or other pain relievers.

Strange ---- Lower Back Pain --- every morning, on waking up :

I had been experiencing low back pain of various types for years (esp. from 2005 to 2012) --- mostly in the lower right back. Then, for the past year or so (2011-2012), it got especially bad on waking in the morning. It felt like I had been on a torture rack all night. I had a hard time getting out of bed. Even rolling out of bed and onto the floor was painful.


It's a common condition :

Then I did a web search on keywords like low back pain morning and found that Google presented many similar search-word combinations:

These proffered word combinations suggested that many, many others have this problem. However, it was disappointing to find that, among the thousands of 'hits' (web pages), there was lots of complaining and yearning for a solution, but hardly any evidence of anyone who found anything that definitely worked for them.

Of course, there were the usual internet dwellers offering un-tried conjectures for solutions --- from the somewhat plausible to the 'are-you-kidding-me?' variety. Examples: Have you tried magnesium? You should take boatloads of vitamin C. Prayer is the answer. etc. etc. (I'm sure most of the afflicted victims have done plenty of praying.)

And there were the usual posts of people going from doctor to doctor, chiropractor to chiropractor, physical therapist to physcial therapist --- with no solution found. Only lots of money down the drain, and in some cases more harm was done.

    Furthermore, there were the usual reports of medical doctors who were convinced the victim's pains were psychologically caused --- or stress is the cause. Sheesh! If the human mind or stress can cause that much pain, then the Defense Department should be looking into those causes as weapons of mass debilitation.

    It would be sweet justice if those kinds of doctors (there are all too many of them) are destined to sit in hell --- eternally suffering from painful conditions like those their patients described to them. And the devil repeatedly tells those doctors, for all eternity, "It's all in your mind" --- alternated with "It's just stress".

    A further-furthermore: Watch out if a doctor tells you that you have a 'syndrome'. That is just a name for a condition for which they do not know a cause or a cure. But you can be sure they will charge you a boatload for giving your pain a name, even though that name won't help you one bit.

    Come on, U.S. doctors. If you don't know a cause or solution, just say so --- and don't charge a bundle for that observation. And ... Keep your wild-assed, unsubstantiated, useless, hurtful conjectures to yourself.


A possible solution :   (psoas --- and other muscle --- stretches)

Anyway, after wading through lots of unhelpful pages like those described above, I found a 'Lower-back-pain-only-in-morning' thread of postings on a 'medhelp.org' forum.

A 'medhelp.org' search on the terms low back pain morning indicates that there are over 16,000 postings on this subject, at medhelp.org.

I found that at least a hundred-plus people, who posted to medhelp.org, were suffering from the 'lower-back-pain-worst-in-the-morning' problem. Like so many others there, my pain goes away (almost completely) after I get up --- when I am standing and walking around for a little while.

    However, to be more complete in the description of my symptoms, I point out that I frequently experience some less extreme pain in the lower (right) back when I get up from sitting --- from a chair in front of the TV, or getting out of the driver's seat of my car.

FINALLY --- in the medhelp.org 'Lower-back-pain-only-in-morning' forum thread (link above), I found a post by 'CindiK' who mentioned that she found 'psoas' muscle stretching (suggested by 'Hawnsun') was giving some long-sought relief.

I found some pictures of the 'psoas' on the web that showed that it is a 'deep muscle' --- actually impossible to touch via massage, because the muscle exists under other back muscles and within the pelvic structure --- attached at the L1 through L5 vertebrae and stretching down to the upper thigh bones, on the right and left of the lower spine.

           

    (It's no wonder that people report that manipulations by their chiropractors did not provide relief. One cannot adequately get to the psoas muscles from the surface of the body.

    And it is no wonder that U.S. medical doctors can provide no cure via their usual two weapons --- drugs and surgery. Pain killers are not a cure. Painkillers cannot manipulate these muscles. And, if it is a muscle problem, not a bone or cartilage problem, what kind of surgery would provide relief?)

On the web, I found diagrams for a psoas stretch where you kneel on one knee with the foot of the other leg far in front --- like the diagram at the top of this page. That diagram pretty much describes the stretch, wordlessly.

Here is another diagram of the stretch, using a few words --- along with a photo.

   

I did that stretch once (moving my pelvis toward the ground) and found significant resistance. (Right leg back stretched my right psoas.) That stretch seemed to reduce some tightness in my lower back. I tried the stretch a few minutes later and the resistance was much less. I did a few more of that kneeling stretch (holding on to a chair or bed to steady myself) that evening.

The next morning my stiffness and pain on getting up was much less. And by doing the stretch a couple of more times, after rising, the tightness and pain were almost immediately resolved (for that morning).

My wife goes to 'hot yoga' sessions. I should start going. The 'warrior pose' (shown below) --- with or without the back knee on the ground --- looks like a good psoas stretch. (However, I am concerned that some stretches, like seated stretches, may do my over-tight muscles more harm than good. So I will continue, carefully, at home for a while --- where I do not feel pressured to keep up with the contortionists.)

   

After doing the stretch for just a few days, I found (like CindiK and Hawnsun) that this may be an 80 to 90% solution rather than a 100% solution. I think that I may need to also stretch the 'quadratus lumborum' muscle (pictures below), which wraps the lower back just above the iliacus muscles and the pelvic structure.

In addition, I may need to stretch my hamstrings, which are so tight I cannot touch my shins (much less my toes) without bending my knees.

For those who gain more from a movie than still images, here is a movie describing the 'psoas' and 'quadratus lumborum' muscles. This movie emphasizes how deep these muscles are.


A good site on multiple low-back and mid-back stretches :

In looking for 'psoas stretches' on the internet, I ran across a great site (floota.com) that documents stretches for several back muscles (psoas, quadratus lumborum, rhomboid). The author of that web site was a searcher-for-back-pain-solutions, like so many others. He found solutions for himself and documented them on the floota.com website.

Apparently, he found that the kneeling stretch (a la warrior) was not enough for him --- he added a loop around the foot, as seen on the pictures below. As you can see, he uses the edge of a bed on which to plant his rear knee.

   


On 'quadratus lumborum' stretching:

Since I did not find total relief from the every-morning low back pain (within the first week of trying kneeling psoas stretches), I have to consider the possibility that there may be another muscle (or two or ...) involved in the problem.

In fact, the author of 'floota.com' points out that he found benefits from stretching the 'quadratus lumborum', which is located over the upper part of the psoas muscles, where it/they attach to the L1 through L4 vertebrae. (But the 'quadratus lumborum' does not appear to attach to the L5 vertebra.) See the following diagrams.

   

To stretch the 'quadratus lumborum' muscle, 'floota' devised this stretch (on the edge of a bed again) in which he puts pillows under his 'quadratus lumborum' area and rotates one leg behind him, off the bed.

   

I have found that pillows flatten out too much for me to feel much benefit. I have a foam roller (the commercial kind, 6 inches in diameter) and tried that in place of pillows, but found that it was too big. However, I had some 4 inch foam rollers (cut from the long tubular foam floats that they sell for kids to use in a swimming pool), and that seems to work well for me --- on deep carpeting or on a bed.

I will continue the kneeling psoas stretch and the quadtratus lumborum stretch on the 4-inch foam roller --- and hamstring stretches --- and report back here --- eventually --- hopefully to report good results.


Scoliosis issues (laterally curved spine) and my physical therapy experience :

To be more complete in a description of my particular case, I should point out that I was referred to a sports medicine doctor (for low back pain) back in 2007. He took x-rays and showed me that I had scoliosis in my back.

It looked really bad to me, but he said it was not real bad. The degree of curvature in my spine looked almost as bowed as in the figure below.

    (I guess you have to be bent into a pretzel to be considered bad --- like when doctors say 350 mg/deciLiter trigycerides is nothing compared to what they've seen in some patients --- even though 350 is over twice the recommended 150 max --- and some doctors recommend 100 as the max. I guarantee you, anyone with 350 and above triglycerides for a period of years is going to have serious cartilage and vision problems. 350 is nothing to pooh-pooh about. And I doubt that so-called 'mild' scoliosis, like that pictured above, is something to pooh-pooh.)

Given all the years that I have had lower back problems (on and off --- late-teens, 30's, 40's, 50's, 60's) --- especially lower RIGHT back problems, it seems likely that my scoliosis might be currently aggravated by (if not originally caused by) an ultra-tight RIGHT psoas muscle --- leading to a condition like that pictured in the following diagram.


The Spanish says "When the psoas muscle is too short on
one of the sides, it mal-adjusts the spinal vertebrae."

(It's sad that in searching for an image like this,
I could find only pictures of 'normal' psoas-spine configurations
on U.S. web sites, including medical and chiropractic clinic sites.
I finally found this image on a European site. This is probably an
indication of how hard it will be to find a solution to this type
of problem from U.S. doctors, chiropractors, and physical therapists.)

Anyway, that sports medicine doctor (in 2007) recommended physical therapy --- so I went to a physical therapy clinic next door to his office for about 12 sessions, about one per week. The lead physical therapist had me doing a 'hip flexor' stretch -- the one done on your back with one knee at a time to the chest (image below).

I see on the internet that this stretch is often recommended as a stretch for the psoas and iliacus and quadratus lumborum. But it never did anything for my psoas --- or, I should say, nothing significantly helpful for my lower back pain.

In fact, after doing the kneeling type of stretch and this on-your-back stretch, you will see why the kneeling type stretches the psoas better ---- namely, you need to get one leg behind you and almost PERPENDICULAR to your spine. THAT stretches the psoas --- like the following two images show.

   

In fact, the image on the right indicates that one can get an even 'deeper' stretch of the 'psoas' by pulling on the rear foot with your hand. This is similar to the stretch suggested at floota.com (above) by using a loop around the rear foot. (If you have knee problems, this may be out of the question.)

I point out the difference in these two stretches for others having the 'low-back-pain-every-morning' problem. That is, if you are doing the stretch LYING ON YOUR BACK with one knee at a time to the chest, it will probably not stretch your psoas adequately. You will probably get more benefit from the KNEELING stretch --- with your back erect (if possible) and one foot-and-knee forward and the other knee on the ground behind you. Move your pelvis GENTLY toward the ground to feel the stretch.

And when you feel you no longer get significant stretch/resistance that way, you may wish to try the psoas stretch at floota.com where he shows the use of a loop over the back foot. With the back knee on the bed (and the body on the edge of a bed), the loop is used to pull the back foot toward your head. Of course, this (again) should be done GENTLY.

In yoga, you see similar stretches --- like the two below.

   

My psoas would snap like a piece of worn dental floss if I tried these. (By the way, I doubt if forming the fingers of one hand in the form of a circle is going to do much for the psoas --- so that is surely optional for our purposes here. However, it might take your mind off of the 'hurts-so-good' pain of the stretch.)


Another stretch that the physical therapy clinic eventually prescribed for me was a piriformis stretch. But you can see, in the following diagrams of the piriformis muscle, that the piriformis muscle has nowhere near the extensive effect on the lower spine as the psoas. It's main effect on the lower spine MIGHT be to affect the angle of the platform on which the L5 vertebra sits.

   

I hope to report back with closer to 100% resolution of the back-pain-in-the-morning problem --- after trying the quadratus lumborum stretch (done with a 4-inch foam roller under the waist, on the edge of a bed), and after trying the psoas stretches --- maybe including the loop-over-the-foot stretch.

Some hamstring (and piriformis) stretches might be beneficial as well.

Perhaps these stretches will reduce the acuteness of my scoliosis.


X-rays and pelvic tilt :

One more thing I should mention: I 'rescued' my back x-rays, that were taken in 2007, from the doctor's office, since I knew they would just throw them away eventually and never look at them again.

I have suspected for several years now that my scoliosis (and my lifetime of incidents of lower right back cramps) may be due to one leg being slightly shorter than the other. And, in fact, for a couple of years now, I have been wearing a heel lift in my left street shoe or tennis shoe --- since, when looking in a mirror, it seemed that the left-heel lift straightened a slight tilt that I could see in my upper body.

Sure enough, when I looked at the bottom of the front view x-ray, I noticed that the 2 lowest points of my pelvis did not determine a horizontal line. One point was about a quarter inch lower than the other.


I am referring to the 2 low points of the pelvis, seen on the right in this image.

This may not seem like much, but a quarter inch drop over a distance of about a foot corresponds to the floor of a 12 foot wide room dropping about 3 inches from one side of the room to another. Any marble or pencil dropped on that floor is going to definitely roll to the low side of that room.

And a tilt like that of the surface on which the L5 vertebra lies, over a period of decades, is bound to have an effect on the spine.


This image shows the 'platform' for the L5 vertebra.


    X-ray images of my back are to be placed above.

    Although the sports medicine doctor showed me my scoliosis x-rays as digital images on a computer, his office said they only had x-ray film to give me. If I can devise a way to take a digital camera picture of those x-rays (say, against a lighted white background), I will post those pictures here. The reason? The reason being to help document this condition and eventually provide an 'information platform' from which others can find relief from their painful lower-back conditions. And, I hope those others would extend the documentation for the benefit of still others.


What I am getting at, in this section, is that people with the back-pain-in-the-morning problem should probably have a determination made whether they have some scoliosis (the kind many doctors consider 'mild') --- and, if so, see if they can get a determination made whether they have one leg shorter than the other (even if it is only a quarter inch or so difference). Heel lifts might be a partial solution for their back problems.

I have not been able to find any place on the internet (even at chiropractic clinic and orthopedic clinic web sites) where they describe a foolproof way of determining whether one leg is shorter than the other. The x-ray examination that I describe above, to determine if your pelvis is tilted, is better than anything that I have found so far.


Disk degeneration :   (another issue to be considered?)


In my x-rays, it appears I have almost no disk between L5 and S1,
quite similar to the situation in this x-ray of someone else.
L5-S1 disk degeneration may also be related to my lower back pains.

   
Normal L5-S1 spacing (left) and degenerated
L5-S1 spacing (before and after a surgical insert).


In this image, the L5 vertebra is shifted forward, above its S1 platform.
A shifted L5 might be an issue for some people with 'every-morning' lower back pain.


Some 'extreme' yoga positions :   (that will REALLY stretch the psoas)

If you can do the following yoga poses, then you probably don't have much tightness in your psoas muscles.


Below is a yoga position (the 'Triangle pose'), that shows the psoas on one side circled. But it is probably the psoas on the other side that is getting the most stretch.


It is probably the case that the kneeling 'lunge' stretch is a more effective
stretch for the psoas --- but 'the triangle' could augment the lunge stretch.

Some web searches on low back muscles (and back pain) :

Some links to Google searches that can provide more info on low back muscles --- and stretches and exercises for pain in those muscles :

  • back pain psoas (over 200,000 hits, 2012 Apr) (Add keywords to zero in on particulars --- for example, add 'stretch' or 'yoga'.)

  • back pain quadratus lumborum (over 100,000 hits, 2012 Apr) (Add keywords to zero in on particulars --- for example, add 'stretch' or 'morning'.)


Some links to forums (or collections of postings) on this issue :


Summary and conclusion :

These searches and forums reveal many sad stories of people in pain looking for relief. Hopefully this web page of mine will help those who stumble upon it.

It's no wonder that hardly any people report 'every-morning' lower back pain relief from a chiropractor, since most chiropractors do 'manipulations' of the area along the spine. But the 'psoas' muscles --- and even the 'quadratus lumborum' muscles --- are buried beneath other muscles --- and the psoas muscle is even 'hidden' inside the pelvic bone structure. Chiropractors cannot adequately reach the psoas muscles.

Hence stretching (and yoga) seems to be the best way to reach those muscles.

And it is certainly no wonder that hardly any people report relief from a U.S. medical doctor, because the U.S. doctor's typical mode of operation, in the 'every-morning' low back pain cases, is to prescribe pain killers. And when those don't work (as they almost certainly won't --- because when the drugs wear off, the psoas and other deep muscles will in most cases still be ultra-tight), the typical doctor will refer the patient to an orthopedic surgeon --- and many (if not most) of those MD's do not ever suggest that the patient try stretching the psoas and other deep muscles (this according to hundreds of web postings which document no help at all --- and, typically, grief --- from such doctors).

Since some of the accounts in these links reported good results with psoas stretches, that seems to be the best avenue for relief from 'every-morning' lower back pain --- that I have found, so far.

If I find better solutions, I hope to post them here.


By the way, while you're at your doctor to have x-rays for a scoliosis check, have your triglycerides checked. (I am referring to comments on triglycerides made above.)

Then, if you have high triglycerides, remove the refined sugar and most of the refined flour (and other starches, which are just long chains of sugars) from your diet. That is the way you reduce high triglycerides.

That is, clean out your refrigerator and pantry. Get rid of the cokes (and other sugar-water, like popsicles), donuts, sweet rolls, pies, cakes, cookies, candies, syrupy goo, etc.

Instead, to satisfy your sweet tooth, use strawberries, blueberries, oranges, tangerines, apples, watermelon, cantaloupe, grapes, raisins, apricots, plums, etc. etc.

If being over-weight is exacerbating your low back pain, then this treatment for high triglycerides is going to help you.

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Page was first posted 2012 Apr 28. Changed 2012 Apr 29.