I just took a great course a couple of weeks ago that focused on the position of the pelvis and it’s involvement in low back pain. The course provided a great way to assess the position of the pelvic bones (hip bones) and the sacrum (bone between the pelvic bones just below the lowest back vertebrae. It is important that the pelvic bones and sacrum be level as that is the position that the low back spine will continue upwards. So imagine that the hip flexor that attaches to the front of the right pelvic bone is tight and pulls the front of the right pelvis down and tilts the whole pelvis so it is facing more forward and to the right, that is how the spine will start going up. That means that your torso will be also more forward and leaned to the right. The body will immediately recognize this and tighten your left low back to pull your torso so it is back upright. This will cause pain in the left low back as it is chronically tightening.
The course I took covered over some really simple effective comfortable methods to reduce tightness of certain muscles that are pulling the pelvis out of alignment therefore reducing the need of back muscles to tighten to pull the body back into alignment. Being able to identify the causes of pelvic misalignment allows me to give exercises that will hold the correction so that the client is able to keep up the changes over longer time for long term effects.
Identifying what postures or biomechanics can be contributing to the issue in the beginning are also reviewed to help hold the changes for longer term. It goes to back up that the pain you feel is often in a different area from where the cause is. Working in the area of discomfort is necessary to provide relief but would only be helpful for a short term and must be followed up with exercises at home and awareness of posture and biomechanics that, as describe above, can be contributing.
Here is a picture of the pelvis from the front and slightly above. The Sacral Promontory is where the L5 (lowest back vertebrae) sits and starts the spine upwards.