Lower back pain can be caused by a number of different issues. Typically muscle strains or ligament sprains will be the instigator during an episode of acute lower back pain. With longer lasting issues it is most likely a disc injury such as an annular tear or a herniation that is painful, with facet joints and the Sacroiliac joint being other common sources of pain.

The reason lower back keeps coming back, however, is much simpler than identifying the specific structure that is damaged or irritated. The reason is because you are doing something that is causing pain or irritation. 

For many people the issue is either prolonged inactivity like sitting, or repetitive motions like bending or lifting. These can cause pain acutely when done in excess, and they also perpetuate pain if continued, which is often unavoidable to some extent if it is work related.

Muscle imbalances

‘Muscle imbalances’ is a phrase you might have heard from a friend or potentially from a healthcare professional as an explanation for your lower back pain. This is very unlikely to be the case. 

First, symmetry is not normal, and not even necessarily beneficial. You likely have a dominant hand, which makes you better at fine motor tasks. Your joints likely have slight differences in shape or size on each side of your body. The left and right hemispheres of your brain are very different, both anatomically and even more so functionally. So forcing yourself to look or perform as if symmetrical may do more harm than good.

Second, asymmetry is more likely a result of pain or dysfunction than a cause. Did you sprain your ankle because you started limping afterwards, or did you start limping because you sprained your ankle? Hopefully you recognize that one of those is actually impossible.

The one very solid case for trying to reduce asymmetry, is after surgery when trying to restore function. But in that case you are mostly using symmetry as a proxy for limb strength prior to injury, if you didn’t measure it.

What you should focus on is modifying, or maybe taking a break from the movements or activities that caused the pain or injury, then gradually reintroducing them as things improve. Add in a full body, progressive strength and conditioning program once you are feeling ready, and you will be able to prevent many recurrences. 

Note: if you have any of these symptoms, you need to go get evaluated immediately. These are signs of serious injury that needs rapid intervention:

• Progressive loss of strength in your hips and/or legs
• Numbness/tingling in the genital/anal region
• Loss of bowel or Bladder control
• Redness/swelling over spine