Low Back Pain.: A look at Structural Shifts in the Pelvis

So many patients in my center in Washburn, WI seek massage for relief from low back pain. Pain that isn't getting better with the standard treatments. Many are surprised to find out that where it hurts may not be why it hurts. I wrote this post for those of you who have back pain that isn't getting better, or have back pain that keeps coming back. This is for people who want results! .And maybe for peopl;e who want to know why this kind of massage is pain relief that works on the source of pain, not just the symptoms.This is part I and it deals with a structural shift called anterior inclination (or rotation) of the pelvis. There are other distortions that we will look at such as unilateral flexion, torsion, and pelvic shear, but they are posts for another day.

Lets take a look at one of the most common structural shifts that causes back pain: anterior inclination of the pelvis. This shifting, commonly an anterior rotation or flexion of the pelvis, can wreak havok on the muscles of the back that are trying to checkrein the flexing of the spine.   

As you can see in this illustration, when the hip flexors tighten (I call this tight short, or adaptively shortened), pulling the anterior superior iliac spine or ASIS (the ledge or bump that you can see on the front of your hip bones) downward it can cause a postural distortion that influences pain, disc degeneration, and wear and tear on the soft-tissue in the low back.

What do the muscles in your core have to do with back pain? Looking at the psoas major muscle below, observe its attachment to each vertebrae on the front of the lumbar spine, see it merge with the iliacus, and attach again on the femur, the largest and strongest bone in the body. If you think of  muscle as a rope that connects Point A to Point B, then tie a knot in the rope, it will make the rope shorter. Now you understand what we mean by a shortened muscle. If the shortened muscle is the psoas, which connects your deep abdomen (core?) to your thigh bone, it can create a postural distortion that causes a lot of back pain. 

In addition to the psoas, the rectus femoris and sartorius muscles may also be strong contributors to your postural distortion. These muscles attach on the hip bone and below the knee, making them hip flexor as well. 

Below, the pictures show what happens to the front of your body as well as the back when the hip flexors get too tight, or "adaptively shortened" as I like to say. Anterior inclination of the pelvis from shortened hip flexors can cause an increased lordotic curve, or lumbar curve, thereby tightening the back muscles. 

Anterior inclination of the pelvis from shortened hip flexors can cause an increased lordotic curve, or lumbar curve, thereby tightening the back muscles.

You can see in the picture of increased lumbar curve that there isn't a lot of space for the muscles, nerves and fascia to all communicate and move freely.

In these pictures, the hip flexors and their assistants are tight short. Trigger points in these muscles can refer pain to these areas of the low back as well. 

What are trigger points? They are areas of constricted tissue that can refer pain to the same location or further away from the source.
These charts show common trigger point referal patterns in the psoas and low back.

 The red areas show where the trigger points refer the pain. Trigger points in the psoas or quadratus lumborum may be one reason that when the back pain is treated directly it never seems to go away.

If you are seeking results-oriented massage for back pain and make sure your massage therapist performs a solid postural assessment and can perform results-oriented work to:
1.restore the right muscles to a more normal resting length,

2.release the trigger points, and

3.get your body back into neutral balance alignment.

Thanks for reading and good luck on your journey back to a pain-free lifestyle!