Archive for June, 2010

Important Muscles Involved in Lower Back Pain – Part 3 : Rectus Abdominus

The Rectus Abdominus muscle is the most superficial (i.e. closest to the surface of the body) of the layer of muscles making up the abdominal wall.  This muscle is also informally known as the “six-pack” or “abs” muscle as its appearance is known as such on a person with a well defined and toned set of Rectus Abdominus muscles.

So what has a muscle on the front side of the body got to do with back pain? Well, first off, this muscle provides stability and movement to the lower half of the front part of the body, but also it works in opposition yet at the same time complements the muscles at the back of the body, in particular the muscles which attach either side of and make movement of the spinal column possible such as the Erector Spinae and Transversospinales group of muscles.  A weak or over contracted Rectus Abdominus muscle causes us to slouch forward, thus putting extra strain and over activating the muscles of the lower back and gluteal region to compensate.

If we now also have a look at the trigger point pain referral diagram above, you should be able to discern that trigger points in the Rectus Abdominus muscle can causes referred pain to be felt in the lower back as well as in some cases the mid back region towards the bottom of the rib cage (see illustration A at the top of that diagram).

So as always, following on from the precedent set up in part 1 and part 2 of this series, we a video now for you giving a basic overview of the anatomy relating to this muscle just to give an appreciation of where it is located, its size and shape, and what it does in terms of body movement actions that it helps us to accomplish:

The Rectus Abdominus and underlying deeper muscles of the abdominal cavity form the front and sides of what can be considered a corset like structure of musculature, whilst the muscles of the lower back and lower spine region form the enclosing back side of this corset of muscles.  The muscles of the pelvic floor (i.e. deep internal pelvis area) are also part of the integrity of the bottom side of this corset like structure, whilst the top of this corset is formed of the (respiratory) diaphragm which is a sheet of muscle lining the bottom section of the rib cages and is a major muscle involved in breathing.  An imbalance in strength or weakness anywhere within this corset structure therefore can causes problems elsewhere as all parts are interdependent upon one another structurally.  It is therefore important to address all these areas in any exercise routine designed to holistically address lower back pain.  The video which follows below is a very useful 10 minute yoga routine designed to holistically exercise the muscles and structure of the core:

Regular execution of an exercise routine such as the one demonstrated above are useful not only in terms of balancing tension in the physical structure through stretching and toning, but it also promotes and trains our ability to become more and more aware of sensations going on within our bodies (that we were not aware of before), in turn and over time we then learn how to use these cues to provide finer degrees of movement control and discernment over what messages our bodies are trying to give to us.

Release of tension and the increase of awareness within our core, particularly the abdominal region can help with challenges that we may be experiencing with the internal organs located therein.  For example IBS (Irritable Bowel Syndrome) or constipation to name just but 2 can be helped as physical compression and physical stress is taken off of the digestive organs from the surrounding muscles as their tension is released.  Abdominal related disturbances such as IBS and constipation very usually have an emotional cause at their core, so being able to provide even just a few moment of respite in order to stimulate a body-wide or body-region specific relaxation can help dissipate the emotional charge associated bit by bit over time.  We recommend receiving body therapy related work to effect a guided significant muscular release from a practitioner such as ISCA Therapies if you wish to fast track your recovery in addition to doing home exercise routines.

Join me for part 4 where we’ll start looking into muscular imbalances in the hip and pelvis region and how these can contribute to lower back pain. Muscular imbalances in the hip and pelvis body area is a meaty topic in itself so will be spread across a number of forthcoming articles.

If you have found these series of articles useful and interesting so far, please do let me know.  Also if you have any other comments or questions, please do let me have them, there is bound to be someone else out there with the same question but who hasn’t written in for whatever reason.  We will use your comments to formulate articles and Q&A summaries for future articles on this blog.  Take care and speak soon!


17 June, 2010 at 23:30 11 comments

Important Muscles Involved in Lower Back Pain – Part 2 : Psoas

The Psoas muscle is one of the most commonly involved yet under treated muscle in lower back pain conditions, save to say it is probably the number 1 missing link in a lot of cases where the muscle has never been directly addressed and appropriately rehabilitated in many cases of unresolved lower back pain.  Due to the relatively deep location of the main fibres of the psoas muscle, it is seldom treated directly unless the practitioner concerned has had training in the appropriate techniques.  The muscle itself covers a very large area of the lower back and pelvic areas, significantly it attaches to the front facing side of each of the lowest set of 5 vertebrae bones of the spine, continues on to lines in the inside of the pelvis (where it is sometimes becomes known as the “iliacus” muscle) and finally attaches to the top inner part of the femur (aka tigh bone).  Due to its attachment to the front of the lower spine, tension in the psoas muscle can pull the spine forward causing an excessive forward curvature in this region (known as an excessive “lordosis”) which in turn causes the opposing muscles attached to the back facing side of the spine to become over stretched and over tensioned (muscles including the quadratus lumborum and other spinal muscles which we discussed in part 1 of this article series).

As can be seen from the above diagram set depicting the trigger point pain referral patterns for the psoas, the first illustration shows the pain pattern for the back of the body which is essentially quite straightforward as it is just a localised pattern (relative to the absolutely position of the psoas muscle itself) running parallel along either side of the lower part of the spine.   The second illustration however might be a surprise as it shows pain referral which can get set-up and experienced on the front of side of the body which in this case is a region around the inner groin and inner thigh area, so anyone experiencing pain in these areas it’s possible to attribute this to trigger points in your psoas muscle.  Proper and thorough treatment of the trigger points in the psoas muscle requires that the practitioner goes in gradually and eases in deeply moving the intestines aside in order to make contact with the psoas (and iliacus), the direction of aim is toward the spine in order to work directly on the psoas (but not ultimately to make contact with the spine).  This procedure need not be excruciatingly painful for you the client so long as your practitioner maintains a “listening sense of touch” at all times, as well as working slowly and gradually in rather than forcing their way in with battling haste and impatience.

The following video gives a nice interactive over view of the anatomy for the psoas muscle and gives a few pointers on what issues may arise as a result of the psoas muscle being overly locked in tension or on the flip side in weakness (which is generally rare):

So, here is our first video showing you a classic de facto standard stretch for the psoas muscle, note that a varation of this stretch can also be done whilst lying totally flat on the floor i.e. the leg that would have been hanging off the edge of the bench in the video example would instead be stretched out straight flat against the floor instead:

Now, here are 2 alternatives…  The first variation is a stretch that can be performed standing (instead of lying down):

The second variation is a bit more complicated to grasp, but fine once you’ve understood what you’ve got to do!  This video was for me personally a very interesting stumble upon as it’s is based upon the paradigm of myofascial stretching.  I myself perform myofoscial release work for releasing individual muscles, but have never really looked into studying myofascial stretching before and has thus whetted my appetite, so any comments welcome about this from either total new comers or those experienced in myofascial stretching already.  I tried the exercise in the video below for the first time earlier on just before writing this article and it is certainly effective yet gentle and holistic (i.e. you can feel other parts of your body gradually and subtly freeing up as well during the stretch process) all at the same time:

Remember, if you have on-going lower back pain and have never had your psoas muscle properly treated for trigger points and properly (myofascially) released by a suitably qualified massage or physical therapist, chances are that this is exactly what the missing link is.

Take care for now and see you for the part 3!

15 June, 2010 at 00:21 9 comments

Important Muscles Involved in Lower Back Pain – Part 1 : Quadratus Lumborum

This Quadratus Lumborum muscle is perhaps one of the most relevant yet not always adequately treated muscle by healthcare practitioners who work directly hands-on with the body’s physical structures in relation to attempting to resolve lower back pain conditions.  I will bring to your attention other relevant and important muscles involved in lower back pain and movement restriction issues in this series of forthcoming blog articles.  These articles will feature informative videos that I have come across on YouTube giving an introductory overview of the relevant anatomy background followed by useful self help stretching exercises to facilitate release of tension in the muscle being reviewed.

In the above image, drawing C illustrates the anatomical positioning of the Quadratus Lumborum muscle, note that this muscle is actually semi deep and beneath another group of muscles called the Erector Spinae group which sit directly on top.  Drawings A and B illustrate the pain referral pattern that can get set-up when there are trigger points in this muscle, as is usual with the phenomenon of trigger points the actual apparent location of the pain or soreness experienced as defined by the shaded areas in the above diagram is referred i.e. it’s possible that no pain maybe directly felt in the muscle itself even though micro tension knots in the muscles itself are causing pain to be referred and felt in the buttocks.

Here’s an interactive anatomy lesson and an example of some exercises you can do to help stretch and free up this muscle, although to do them requires additional equipment (a swiss ball) and would not be recommended to an absolute beginner:

The self help exercises which follow in each article must feel comfortable to do at all times, there is no useful benefit to be gained and the chance of injury to occur by pushing yourself into any discomfort or further pain.  Also, remember to breath in deeply and breath out just as you’re about to go into the stretch, many people commonly (and unconsciously) hold their breath as they are about to perform stretches find that they can go a lot further as well as with less resulting pain after changing over to breathing properly as suggested.

So to finish off with, here are some simple exercises which do not require additional equipment and can be done by most, if not all when adapted to within your tolerance level.

The exercises should ideally be performed daily as part of a rehabilitation program and in conjunction with regular visits to a suitably qualified massage or physical therapist who can perform the supporting release or soft tissue manipulation work on the muscles involved.

See you in part 2!  Take care now.

14 June, 2010 at 00:19 9 comments

Henry Tang – Therapeutic & Advanced Clinical Massage Practitioner (Crows Nest, Sydney, Australia)

Click image above to visit Spaces of Possibilities Wellness Centre, Crows Nest, Sydney, Australia.

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