Addressing the Root of Low Back Pain

Dr. Anne Zauderer

Approximately 60-80% of the population will experience an episode of low back pain during their lifetime. Of that group, 60-86% will have more than one episode of low back pain1,2. In addition to this, the cost associated with low back pain in the United States could exceed $100 billion per year; two-thirds of this cost is a result of lost wages and reduced productivity3. What is concerning about these statistics is not only the cost but also the recurrence of this condition. Pain medication blocks the signals of pain, but it does not address the root cause of why the pain is there.

So what is the root cause of low back pain? There are many theories, which may touch on the root cause, but don’t address it exactly. In my experience, most of the people who have insidious, recurring low back pain also have a weakness in their core stabilizing muscles.  These muscles are not the abdominal muscles that give you a “six pack.” Typically, when we think of muscles we think of movement. However, these muscles do not move the body, they stabilize the body. This is a critically important task because if the pelvis and spine are not stabilized before movement, you leave the body more prone to injury. The three main muscles that stabilize the low back and pelvis prior to movement are: transverse abdominis, multifidi, and pelvic floor muscles.

A number of MRI studies have shown that people with chronic low back pain have fat infiltration of their multifidi muscles, which is a sign of atrophy or weakening of these muscles. These small muscles are deep in the spine and provide stabilization of vertebrae and curvatures. A study by Kjaer and colleagues4 observed the degree of fat infiltration of the lumbar multifidi muscles, and categorized it as none, slight and severe. The degree of atrophy of these muscles was strongly associated with low back pain in adults.

Apart from a major injury, what else can weaken these core, stabilizing muscles? For most people, it is a lack of movement. When we sit for long periods during the day, we “turn off” or inhibit these muscles. It goes back to the old adage, “if you don’t use it, you’re going to lose it!” These stabilization muscles get turned off because we are not using them when we sit for long periods (more than 30 minutes) and lounge in our chairs. However, when we go to stand up without the stabilization of these muscles, we leave ourselves more prone to injury. Over time, this creates more wear and tear on the vertebrae and discs, creates more inflammation, and eventually low back pain. This is why, for most people, an episode of low back pain starts with either a trivial injury or no injury at all. The low back has been weakening for years and so it doesn’t take much to trigger an injury or pain.

If these muscles are the key to preventing the recurrence of low back pain, then we should exercise them, correct? Activation of these muscles is vitally important to resolving the pain. However, because these muscles don’t move the body, they are sometimes difficult to find and strengthen without some guidance. A great resource to help with this is a program by Dr. Eric Goodman called Foundation Training5. He has a series of videos that can help walk you through how to active your core muscles.

If you want a more hands-on approach to learning, you can join me, Dr. Anne Zauderer, and certified yoga therapist, Susan Levine, for a morning workshop on Saturday, March 24 from 10:00am – 12:00pm. We will demonstrate how to isolate and strengthen all three of the stabilization muscle groups. Please see the side bar for more information.


  1. Aure O, Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: A randomized, controlled trial with 1-year follow-up. Spine 2003;28:525-532.
  2. Suni J, Rinne M, Natri A, Pasanen M, Parkkari J, Alaranta H. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability. Spine 2006;31:E611-E620.
  3. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 2006;88(suppl 2): 21-24.
  4. Kjaer P, Bendix T, Sorensen J, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Medicine 2007;5:2.

Addressing the Root of Low Back Pain

Saturday, March 24th

10:00am – 12:00pm

Cost: $20 (class size is limited to 15 participants)

Dr. Anne Zauderer and Susan Levine

Join us for a workshop on how to isolate and strengthen the core stabilization muscles of the low back and pelvis. These muscles play a vitally important role in many functions in the body, and a weakness in them can contribute to a number of conditions, including:

  • Low back pain
  • Pelvic pain
  • Urinary incontinence
  • Balance issues
  • Distention of the abdominal muscles (“mummy tummy”)
  • Post-pregnancy physical complications
  • Loss of function or stiff movement

In this class we will teach you functional exercises to strengthen your stabilization muscles. Because of this, participants must be able to get up and down off the floor. Please bring a yoga mat, if you have one.