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!

Pain Relief for racers at Bayfield Race Week!

My colleague, BeckySue, and I are providing massage for the racers during Bayfield Race Week 2012 in Bayfield, WI. As a pain relief specialist I want to know how I can best help them. To answer my own questions, I thought about what kinds of pain people who sail might have. I thought more and I tried to mimic some of the repetitive actions used in sailing to get more ideas. I researched pain associated with sailing. I even interviewed someone from the Wayzata Yacht Club.

What I found out was that most people have pain between their shoulder and their neck. Many have forearm pain in an area that we massage therapists call the "wad of three," (For more information about forearm pain, please read my blog post entitled Tour De Cycling Anatomy). Still others have low back pain and knee pain.
There is a famous quote by Ida Rolf, a founder of the structural integration types of bodywork. It goes: "Where you think it is, it ain't." I want to relieve pain by correcting postural malalignment, breaking up adhesions, restoring muscles to a more normal resting length and freeing nerves that may be entraped by soft-tissue.

When Bayfield Race Week racers come to me for their massage, I will provide a brief but solid assessment: Is one shoulder higher or lower? More anterior? Do they stand with a forward bend?When they stand, do I see the back of the hands? These types of observations give me clues about the kind of pain they may be experiencing.  For example, if I see a high shoulder on the right, I can lengthen the muscles that elevate the shoulder. On the low side, I can restore the shoulder depressors to a more normal resting length. Similarily if I see a lot of the back of their hands, I know that the "medial rotators of the humerus" will need some TLC. If they bend forward when standing, I can lengthen the muscles that flex the hips, thereby taking some strain off the muscles that are stuck check reining the spinal flexion.

So... you might be wondering what does all of this mean to the Bayfield Race Week racers, in English?  It means that I use Precision Neuromuscular Therapy techniques to address structural shifts, restore muscles to a more normal resting length, relieve trigger points that can refer pain, and free nerve entrapments. People LOVE the way they feel when they are closer to neutral balance alignment and the work feels GREATwhile it is being performed!

Thanks for reading and have a remarkable, pain-free Bayfield Race Week!

Gina McCafferty, LMT
Pain Relief Specialist