Lower Right vs Left Back Pain

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Lower Back Pain

Published: 28 November 2015

Are you suffering from lower right back pain OR lower left back pain?

Is it important to distinguish between the two sides? Of the lower back pain patients I see, many of them find that the pain is either confined to the right or left side (as opposed to both sides or the middle) - of those patients, about 25% have the pain restricted to the left side and about 75% to the right side.

Put simply, the cause of one-sided back pain is mostly due to our bodies favouring one side more than the other in our day to day activities, and our bodies become out of balance. Over a long period of time, this can lead to a breakdown - either on the stronger side (favoured side), or on the weaker side (non-favoured) for different reasons.

Specifically, with lower left or right sided back pain, the cause is either due to overuse (where it is the stronger side - or to weakness (where the weaker side cannot support the strength of the stronger side). As a result, breakdown in the joints, muscles, ligaments, discs and nerves may occur.

In my experience, breakdown generally occurs on the stronger side due to over-activity, fatigue and tightness and on the weaker side due to overstretching and weakness. The following explains the two groups of reasons further. In these examples I’ll use the example of lower right side back pain (but the explanations apply equally to left sided back pain - just switch them around).

When I see clients with lower right back pain, their overuse is typically caused by one of the following:

• Overuse and tightness. If you favour movement predominantly on the right side of your body for hours every day, then a pattern evolves is that your right side can become overactive and tight.

• Posture - where you naturally favour the right side due to your natural postural alignment. In other words you stand or sit leaning to the right. Over time this can place excess strain on the right side of your lower back potentially resulting in damage to joints, ligaments, muscles, discs and nerves - thereby causing overuse, strain and tightness and eventually resulting in pain. The main reasons for natural poor posture are flat feet, scoliosis and leg length differences.

• Manual Work - Overuse and tightness of the right side of your lower back may also result from manual work performed repetitively over time. This may be heavy labour such as brick laying, cleaning, painting etc. (especially where poor lifting technique is used), or result from a poor ergonomic setup at your desk which favours your right side for mouse and keyboard use.

  This will potentially result in overuse and tightness causing eventual breakdown and pain. The reasons for overuse are usually due to lack of awareness of a good sitting posture and poor working equipment and stations. Ergonomics and computer posture are very important at work as you spend up to nine hours a day at this repetitive activity.

• Underuse and weakness. In my clinic I see a lot of this cause of lower right back pain. If you underuse the right side of your body, weakness to the muscles over your right side may result. Over time this will result in excess pressure over the right lower back causing pain from muscles, ligaments, discs, joints and nerves. This is a result of excess pressure and compression on these structures, which will eventually scream for help!!

Treating one sided lower back pain

Ultimately, a long term resolution always requires identifying your causes of your lower back pain. If the cause is on the stronger side and is occurring as a result of fatigue and tightness, then treatment should address both of these aspects, and then address the weaker side through back strengthening exercises which will help balance your back and reduce the risk of further injury.

If the cause is on the weaker side due to overstretching and weakness, treatment must address the weakness through strengthening and awareness of using both sides equally.

The cause needs to be addressed from the outset. If the cause has resulted in a joint, disc, muscle, nerve or ligament being injured, correction of the injured structure may require a Physiotherapist to correct its alignment at an early stage.

Low back pain exercises for your hurting side will depend on the cause and the structure that is injured. Once a correct diagnosis is found rehabilitation is usually very successful.

Diagnosis is the key!