A “Chicken And Egg” Question Answered: Spinal Injury or Poor Posture?


As a Physical Therapist that specializes in treating spinal pain, I often get asked questions about back pain and how to treat it. But the most common question that has come up the last few weeks is this…

How common is back pain today in our modern society?”

And my answer is often shocking to them!

The PTs that wear the white lab coats (researchers) give us the following statistics for back pain in America:

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  • 80% of all Americans will have 1 episode of debilitating back pain at some point in their life…
  • 60% of these will have a re-occurrence within one year…
  • 45% of these will have a re-occurrence within four years…
  • 10-15% of these will become permanently disabled, costing huge expenditures on the medical system


These are pretty astounding, and what’s even wilder is that people with back pain will go through those first stages or percentages before they look for solutions.

The studies also stated that the primary indicator that was present with all of the permanently disabled population was a non functioning or non contracting lumbar multifidus muscle. This is the deepest spinal muscle posteriorly and attaches from one lumbar vertebra to the one above it. There are many of them on either side of the spine and they go up the entire spine. Deep to the long spinal muscles, these lumbar multifidii basically stop working at the first spinal injury. One’s ability to reconnect with these muscles and strengthen them are the key to staying out of the 60%, 45% and 10-15% listed above.


However, the lumbar multifidus typically does not work for other reasons as well. And if you look on the front side of the spine then you will find the psoas and iliacus, the primary hip flexors. These muscles are hot buzz words in the industry these days and are often short and tight, causing the spine to get stuck in an arch, or sway back position.


So what came first, the chicken or the egg? The injury and the multifidus stopped working or chronic hip flexor tightness that does not allow the proper mechanics for the multifidus to contract properly?

In my opinion, it does not matter as long as we release the hip flexors and strengthen the multifidus, back pain has a great chance of improving and staying away for good. Other things need to be addressed, but this is a great starting point based on my 18 years of experience treating back pain.

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