Lower back pain when looking down is caused by muscular concerns in most patients. However, other explanations for lumbar pain upon neck flexion are plausible in less common scenarios. We are often asked by readers what causes this very specific type of pain and felt it was time to dedicate an article to explaining why movement of the neck can affect the opposite end of the vertebral column, causing discomfort in the lower lumbar zone.
Counter-intuitively, when this type of pain occurs, the neck is usually functioning fine and experiences no pain at all, even though it acts as the trigger for the lumbar pain to occur. Instead, the origin of pain typically resides in the greater lower back anatomy and can usually be traced to muscular injury or imbalances residing therein. However, there are exceptions to this rule which will also be covered in this focused dialog.
This treatise examines the expression of lumbar back pain only when the neck is flexed forward, chin to chest. We will provide a detailed analysis of why this type of dorsalgia occurs and how it can be eliminated.
This is a simple symptomatic expression wherein the patient feels a sharp, pulling pain in their lower back when the neck is flexed. Neck flexion describes looking downward so that the chin moves towards the chest. Typically, flexion is easily achieved and no stiffness exists in the neck. Pain is also usually absent in the neck region, although some patients might also experience some discomfort in the middle or upper back during flexion, as well as, or instead of, lower back pain.
The lumbar pain is often described as stabbing. It can exist directly over the spine or on one or both sides of the vertebral column. Patients often describe the feeling as if something was going to rip in their lower back due to being stretched too far. The pain is usually centered in the lower lumbar area, but can extend downwards into the upper buttocks in some patients or upwards in the thoracolumbar frontier in others.
Many patients find that the pain is worse when they are in certain positions. Some find that perfectly straight legs exacerbates the problem, especially when seated or reclining, while others feel that sitting is the worst posture for them to endure. Some degree of lower back pain may exist at all times, but typically, the primary discomfort only comes on when the neck is flexed forward and might be made worse when the remainder of the anatomy is positioned in specific ways. We have witnessed virtually every combination of flexion and posture creating pain, but the combinations detailed above represent the “average” patient profiles.
The most common sources of lower back pain from looking downwards are soft tissue problems that have caused the muscles of the region to change in strength and length. We have seen contrasting causations providing similar symptoms in many different patients and each type of muscular concern can be created by a wide range of possible contributors. This fact can make accurate diagnosis especially difficult.
Injury to the back muscles can cause them to shorten and tighten. Since the entire back musculature moves together when the neck is flexed, this tightness can cause guarding (usually expressed as extreme resistance to movement) and eventually pain. Luckily, lumbar strain will usually resolve without any particular treatment, as long as it is not a chronic version of RSI.
Muscular imbalances can strengthen, shorten and tighten lumbar paraspinal muscles or elongate them and weaken them, depending on many factors. The thing to remember about muscle imbalances is that muscles work as opposing sets (antagonistic pairing) for either mobility or support. When one set is much tighter or stronger then its matched set, it will pull the weaker set out of alignment, making these soft tissues even weaker and more stressed due to constant tension. Therefore, if an imbalance is the source of pain, it would be logical, since the typical symptomatic expression involves tightness, guarding and sharp pulling pain.
Muscular imbalances can exist in the upper body, pulling the back muscles upwards due to overly tight and strong chest or frontal shoulder muscle sets. Imbalances can also occur in the lower body, with the lumbar muscles being pulled downwards due to tight hip flexors or tight hamstrings, especially in combination with weak frontal and oblique abdominal muscles.
Spinal structural causes are less common, but some stenosis and disc problems can be exacerbated when performing neck flexion. Similarly, select scoliosis patients have described identical lumbar pain when rotating the neck to one side while looking downwards. Finally, the existence of Chiari Malformation and/or tethered spinal cord syndrome can produce this symptomatic pattern that often escalates to become debilitating in some patients. Fortunately, this is the most uncommon of all causations.
Experience has shown that most injury-related muscular lower back pain will organically sort itself out in a matter of days or weeks. In the time spent healing injury, it is wise to mobilize the body gently and not maintain a sedentary existence. However, it is unwise to overdo it or place continuing stress on the painful region of the back. Chronically painful back muscles often point towards a muscular imbalance that should be evaluated and addressed in order to fully resolve.
If you suspect a muscular imbalance as the root cause of pain, then it is best to seek diagnosis from a trained physical therapist or sports medicine practitioner. These care providers are experts in figuring out the specifics of pain syndromes like this one and will surely provide the best hope for positive results.
Structural spinal issues should be managed by a neurologist and/or orthopedist for best outcomes. Some patients might just have to learn to live with pain when looking down for spinal concerns that are significant and difficult to eliminate.
Bad posture can create chronic tension in the back muscles and a forward head posture is one of the worst factors that may contribute to this type of pain. Posture exercises, PT and Alexander Technique are all helpful for fixing anatomical positioning issues.
We would be remiss to not talk about the common mindbody link to this pain syndrome. Often the cause will certainly be muscular, but there has been no injury and no definitive imbalances exist. In other cases, injury has occurred, but has since healed and any imbalances that exist are incidental and not causative for pain. Remember, the body is amazingly flexible in its ability to function almost flawlessly, even when demonstrating atypical structural characteristics. In these instances, the true cause of muscular tension and pain might be regional oxygen deprivation most often linked to a mindbody syndrome. Ischemia will cause muscles to become tight and weak, much in the same manner as a structural imbalance. Higher levels of ischemia will create spasm and dramatic pain that can also affect the connective tissues, such as ligaments and tendons. For patients who can not find relief, or those who suspect psychogenic causation, we highly recommend using knowledge therapy as an alternative type of medicine to cure the condition and prevent substitute symptoms from occurring due to placebo response from ineffectual structurally-targeting treatment.