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Added September 13, 2015 Last Updated April 3, 2017
Back pain relief core strengthening with mobilization movements may help many people who are looking for simple and free methods to reduce or eliminate their low back pain. The latest research has concluded that movement is the best therapy for chronic low back pain and when acute pain is experienced, it is best to continue to move and limit or eliminate bed rest. These simple movements are best performed during periods of no pain or low level discomfort.
This article is intended for both the massage therapist looking for home care techniques to teach to their clients and the individual looking for ways to maintain a pain free lifestyle. Our body's are intended to be in motion. The modern working world has established a sedentary way of earning a living. We need to be much more creative to add needed motion back into our lives.
Understanding how to develop and maintain good body mechanics on a daily basis is central to preventing and recovery from back related pain syndromes. These movements are so easy to perform that anyone can participate. Structural mechanical alignment within the joints and body segments can be facilitated with body mobilizations. The more often they are utilized throughout the day or week the greater the benefit will be. There is no way to overestimate the value of movement and core body strength. Remaining active is the number one priority when it comes to low back pain.
The muscles that support core movements of the hips and lower back are the abdominal muscles, iliopsoas, quadratus lumborum, pelvic floor, erector spinae and multifidi. It seems that the internet is loaded with gadgets, mechanism’s and machines that support abdominal crunches. Crunches are a great way to develop and strengthen the rectus abdominus for a well-defined six pack, but when it comes to reducing or eliminating low back pain it can have the opposite end result.
The rectus abdominus can develop muscular trigger points that refer pain across the low back and across the mid back just below the shoulder blades. Other rectus abdominus trigger points can refer pain to the lower body quadrant on the same side just above the pelvis running along the ilium and bilaterally just below the belly button. The key to minimizing developed trigger points in this muscle is two-fold. Step one DIY trigger point treatments or professional massage and step two simple movement mobilizations that strengthen the transversus abdominis.
The amazon link to the left provides a visual guide to trigger points. If you click on the link it will open and you can roll over the image on amazon to see the abdominal trigger points more clearly. The 1st trigger point is in the upper portion the muscle fibers as the muscle attaches to the rib cage and is a mustard yellow. The referral zone is posterior across the upper back below the shoulder blade as seen in the image to the left of the anterior torso.
The 2nd trigger point is in the lower muscle fibers as it attaches anterior at the pubic bone and is orange. The referral zone spans out around the abdominal cavity posteriorly from the lumbar spine, across the sacrum and ilium as seen in the image to the left of the anterior torso.
To treat the rectus abdominis trigger points yourself use a small medicine ball or medium rubber ball while lying on your stomach place the ball in the region of either trigger point between you and the table, floor or a firm bed. The pressure exerted by your own body weight will help release the fibers in this area. You can also roll over the ball to increase force and add cross fiber friction.
The strength of the transversus abdominis (TA) has a lot to do with the ability to maintain a neutral spinal postural position throughout the day and while in a sitting position. TA can be seen in the image above and is often underappreciated for its’ role as a pelvic stabilizer. The following video presented by Tim Keeley from Physio Fitness Australia YouTube channel shows how to easily add specific, focused movement to a daily routine that engages & strengthens the transversus abdominis and pelvic floor musculature.
The role of the multifidus musculature is to stabilize the low back. They are intended to fire first, for example, when we go to lift a bag of groceries out of the car. They are deep muscles that attach along the spine and when they contract first they stiffen the spine protecting the delicate features of the spine and allowing larger low back muscles to function. This is followed by the contracture of the larger back musculature and movers of the shoulder girdle in the act of lifting the bag of groceries out of the car. When the multifidi do not fire properly or not at all, it leaves the low back vulnerable to injury.
The multifidus is a group of muscles found deep and attach along the spinal column from the base of the tail bone and sacrum to the base of the scull. These muscles control the fine movements between each individual vertebrae. Part of the muscle attachment for the multifidi is to the membrane of the vertebral joint capsule. When the multifidi muscles contract as a group they actual pulls the capsule away from the vertebrae preventing them from being pinched during compression of the spinal joints.
This function of the multifidi may explain how small movements can often result in extreme pain. Another structurally significant component of the multifidus group is that they are innervated by a signal nerve. In addition, when we do lift an object too heavy or perform some other action that leads to pain the multifidi are often shut off by a reflexive response that is initiated by the joint the muscle is in control of. The reason for this shutdown is to protect the joint structure from a possible bone crushing injury.
The erector spinae group of muscles can be seen in the image to the right of the thoracic & lumbar spine while the multifidus lie deep to the erector spinae and can be seen on the left side . The multifidus group may develop trigger points that mimic intervertebral disc injury or may continue to refer pain experienced by recovering patients as disc pain after the acute ruptured disc has healed. The referral pain pattern is along the spinous process and transverse process of the vertebrae that they act on. DIY trigger point therapy and joint mobilization can be an effective treatment protocol. (Scroll down to the middle of the page to find the discussion on trigger point therapy for low back pain.)
The most significant factor of recent research is that these individually shut off multifidi do not automatically regain their function after the initial injury has healed. The good news from recent studies is that these low, reacting or none firing muscles can be turned back on with mild movement therapy. Learning to engage the multifidus from the cervical spine through the lumbar spine may be one of the most important lessons toward a pain free lifestyle. The following video presented by Tim Keeley shows how to engage and strengthen the multifidus muscles.
The next muscles that need to be discussed are the erector spinae group and the quadratus lumborum or QL for short. The QL and erector spinae can be seen in the image above and can become very tight or short in individuals experiencing low back pain. The quadratus lumborum can develop trigger points that refer pain down into the sacroiliac joint, across the ilium, down into the attachment for the hamstrings and to the outside of the hip toward the greater trochanter.
The QL is deep to the erector spinae muscle group which function as extensors of the spinal column. These muscles can also develop trigger points that play a role in chronic and sub-acute back pain. The erector spinae tend to refer pain along the spine and as they reach the lumbar region down into the sacroiliac joint through the sacrum and into the tail bone. DIY trigger point treatment has been found effective for both the QL and erector spinae musculature, followed up with strengthening and lengthening mobilization.
The quadratus lumborum has been nicknamed the "hip hiker" as it rises or hikes the hip to allow for walking. It also allows for lateral trunk flexion to either side. Weakness or inhibition in this muscle can greatly effect an individual's gait. Lengthening mobilization for the QL and postural reset which is found at the end of the article can help reduce low back pain by balancing the QL and erector spinae back extensors.
Now two more muscles that act together must be addressed iliacus and psoas major. Because they function together in hip or trunk flexion they are often referred to as iliopsoas. Iliopsoas is either over treated or overlooked when it comes to low back pain. Iliacus has trigger points that can refer pain along the lumbar spine and into the lumbosacral region. Dr. Janet Travell nick named iliacus and psoas major the “hidden prankster”.
The psoas major lies deep within the abdominal cavity from front to back it lies deep to the digestive organs. Psoas attaches to the transverse processes and vertebral body's from T12 through L5. The muscle fibers move laterally as the join the iliacus at the pelvis. The iliopsoas crosses the pubic bone to attach to the lesser trochanter of the femur.
The iliacus muscle contains the primary trigger point in the belly of the muscle up near the iliac crest. This point is deep to the abdominal wall and will refer pain to the sacroiliac joint and up long the lumbar spine toward the 12th rib. If both iliacus muscles contain a trigger point the pain may feel like it radiate across the back horizontally.
The psoas major muscle can have two significant trigger points one along the inner thigh where its tendon attaches to the lesser trochanter of the femur. The second trigger point is deep within the abdominal cavity as the psoas major muscle attaches to the transverse processes and body's of the lumbar vertebrae. The following mobilization exercises can be helpful in releasing this deeper trigger point.
The aim of this article is to provide back pain relief core strengthening with simple
movement mobilizations that will provide a solid foundation for individuals
recovering from chronic or sub-acute low back pain. The previous mobilization performed by Tim Keeley
would not be classified as simple, yet provides a solution for strengthening
iliopsoas. Continuing to work on good body mechanics along with structural alignment is part of a pain free lifestyle. To continue our discussion of
simple movements that strengthen the hips and low back Tim Keeley provides us
with a unique look at a spinal reset exercise.
Get massage smart thanks Tim Keeley of Physio Fitness Australia for their educational YouTube videos. Get massage smart does not validate their accuracy and recommends that any individual consult their personal physician before engaging in any physical mobilization routine.
The next video by Adarsh Williams provides a look at active isolated stretching for the psoas muscle. The Mattes Technique is performed by extending the hip; there by lengthening the psoas by reciprocal inhibition. The full extension of the movement should not be held longer than 2 seconds. It is helpful to breathe out with the extension and in with the return movement.
The following sequence of strengthening mobilizations is designed to work the abdominals, quadratus femoris & iliopsoas and gluteus maximus. Adarsh goes on to demonstrate A.I.S to lengthen the sacrospinalis muscles of the low back, pirifomis, upper hamstrings, & gluteus maximus. The first mobilization is good for individuals who tend to under utilize their gluteus maximus. This is sometimes referred to as gluteal amnesia. The Maximus works hard while rising from a seated position, climbing stairs and running. So it is easy to see in a sedentary lifestyle, it may become weak.
When the gluteus maximus is not firing properly injury can occur. The inhibition of the muscle is often referred to as gluteal amnesia as mentioned above or sometimes more commonly as lazy glutes. This term can apply to gluteus medius and minimus as well, remember they are medial hip rotators. Physiotherapist Tim Keely will show us three activation techniques that when done safely will help to reduce and eliminate inhibition of the gluteus maximus, reducing the likelihood of overload and injury of the hamstring and TFL. As a result hip, knee and ankle stability can be improved and some situation of low back pain eliminated.
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