Posts tagged ‘pain’
Looking for persons to be involved as clinical massage case studies or to receive occasional sessions (Exeter, UK only!)
I have just come back from Brighton after spending a couple of days up there at The Jing Institute of Advanced Massage Training attending the introductory module that marked the commencement of the 2nd part of a BTEC Level 6 professional diploma programme in sports and clinical massage ( http://www.jingmassage.com/Level6BTEC.asp ). This is a post graduate qualification for already qualified massage therapist (i.e. those who have qualified to at least ITEC Level 3 standard). The 1st part of the diploma which I completed at the end of last year consisted mainly of practical and hands-on technique modules for common musculoskeletal pain pathologies such as lower back lower, shoulder, neck, headaches (as just a few examples) which spanned a 12 month period, whilst this 2nd part of the programme will span 18 months and look further into orthopaedic assessment tests, injury and rehab exercises. During the next 18 months I am required to give 200 hours worth of treatments, which equates to about 3 sessions (on 3 different people) every week between now and October 2012 (each treatment would therefore be a 1 hour session for each person each time). If you are interested, I would love to hear from you, you could come in just for a one off taster, the occasional session as and when your schedule permits or a series of sessions, whatever suits you so long as you give enough notice for me to schedule in advance. First come, first served!
In addition to the 200 hours of on-going sessions as described above which will only require an initial in-take consultation and then a signature from each recipient for each session received thereafter, I am also required to produce 6 case studies. Each case study requires me to see the same person over a series of 4 consecutive sessions and so being case studies I’d also be required to conduct an initial consultation as well as a brief de-brief after each session which will go towards the write-up submission for each case study. The case studies are required to be spread throughout the 18 month duration, so rather than than have all the case studies done all at once right now, I would be looking for just a single person to be a case study to be fitted within roughly 2 – 3 month blocks at a time. As each case study will be treated 4 times on an on-going weekly basis, it is important to note that if you would like to be a case study that you can commitment to a series of 4 weekly treatment (i.e. for 1 whole month) during a particular time period that can be agreed between us. Bearing in mind that I will be spreading these 6 case studies out between now and October 2012, if at any time between now and then you yourself or anyone you know that would suitable as a case study please do get in contact.
For both the case studies as well as occasional session recipients the main requirement in common to both is that you have some kind of muscle related or musculoskeletal pain condition that you would be wiling to receive clinical massage sessions for and provide honest feedback on.
I am very happy to answer any questions that you may have or give more detailed information about what’s involved before you commit yourself either by return email, phone or Skype.
Please pass on the information contained herein to anyone you think would be interested, provided that they live within commuting distance of Exeter (UK) of course.
Many thanks and best wishes,
Email: info@isca-therapies.co.uk
Important muscles involved in hand, wrist & arm pain – Part 1
There are many intricate muscles and soft tissue structures in the hand, wrist and arm which can cause various types of pain, numbness sensations, weakness, pins and needles or electric shock type of sensations when they become constricted, tight or dehydrated through physical over use or misuse, bad posture, accidents, old injuries (such as high velocity neck impact or whiplash) and deep scar tissue, and/or combined with unremitting emotional stress.
2 muscles which I’d like to draw the reader’s particular special attention to in this article are the scalenes and pectroalis minor muscles. These are 2 very important and relevant muscles which massage therapists who have been through advanced trainings in say for example clinical massage techniques will know how to treat efficiently and very specifically. Both of these muscles are very much neglected in most general relaxation massage work. The scalenes muscles are located in the base of the lower neck and attach to the first and second ribs, whilst the pectoralis minor muscles covers the 2nd, 3rd and 4th rib in the region of the front upper chest. Both muscles although located respectively in the neck and upper shoulder region are often highly relevant in hand, wrist and arm pain pathologies, one of the main reasons behind this is that the brachial nerve plexus and its subsequent other sub branching nerves serving the arm passes directly underneath both of these muscles so any tightness in either of these muscles is going to have a direct physical effect on creating nerve related aggravation in these regions.
[Trigger Point Pain Referral Pattern for Scalenes Muscle Group]
[Trigger Point Pain Referral Pattern for Pectoralis Minor Muscle]
Signs of nerve related impingement or over simulation can include pins and needles, intermittent shooting pains over a certain region (such as down the arm), electric shock type sensations, or areas of numbness. Nerve impingement caused by the scalenes or pectoralis minor muscles can also cause the muscles and proprioception to misfire so causing symptoms of weakness or spasm in the arm, hand or wrist. Symptoms of carpel tunnel or other repetitive strain injury type side effects can also be triggered or caused by soft tissue tension in these apparently unrelated areas further up and away from the hand, wrist and lower arm (but which you now know after having read this article and viewing the related videos are very much related).
Tightness in the scalenes muscles can cause tingling all the way down to the thumb and first fingers of the hand, whilst pectoralis minor tension cause refer tingling all the way down to the ring finger and little finger. Constriction of the blood supply serving the arm from a tight pectoralis minor muscle can also cause feelings of coldness or lack of circulation to the fingers.
Habitual shallow breathing, particularly whereby the type of breathing only involves the use of the upper chest (rather than full deep belly breaths) is another potential cause of chronic tightness in the scalenes muscles. Stress management through gradual build up practice of proper relaxing deep breathing is the perfect antidote. Notice when you’re stressed or shallow breathing, be gentle and kind to yourself, congratulate yourself for noticing and just start by receiving 3 deep breaths in and out and build up that number over time, the idea is that over time it builds up to more of an unconscious habit rather than a conscious effort.
As with all these topic, there’s always so much that could be written or linked to, this is just what I could cobble together off the top of my head and without turning this into a fully blown dissertation as well as given the fact that I would like to go to bed in a moment (!!), but if you want to know more or have any suggestions I would be glad to receive your feedback as always and compile a part 2 or further subsequent parts as a follow on to this particular article as the demand unfolds.
Be well! 🙂
Email: info@isca-therapies.co.uk
Visit the ISCA Therapies website: www.isca-therapies.co.uk
Self Treatment of Muscular Pain with Heat or Cold
There are many effective natural self treatments for common ailments which can be readily be found in most households without the need for popping into a local pharmacy. In fact, there are many of these natural types of remedies which were in common use and remain as effective (if not more so but without side effects or overdosing issues) as any modern commercially available alternative, it’s just that most of us have grown up with the modern equivalent not knowing that there was nothing wrong with the natural alternative from yesteryear – just asking your grandparents should be proof enough of this!
One such natural remedy is the use of moist heat or cold for muscular and soft tissue aches and pains. There is clear distinction of when heat should be used and when cold should be used, sometimes a alternating or contrast bathing procedure maybe followed, but the important thing to remember is that heat should not be used on any swollen area or an acute injury – an acute injury is one that has occurred within the past 48 hours.
So starting off with the use of heat for chronic muscular pain. The best type and source of heat for soft tissue related pain is usually moist heat and this can be easily sourced from a hot damp flannel held in the area of pain in order to sooth it. The heat also encourages increased blood flow into the area which brings in with it new nutrients to replace the pain causing toxic stagnated blood that can build up and get trapped in over tense muscles and soft tissues. The temperature of the damp flannel should be hot enough to produce a deeply penetrating and soothing effect, but obviously without causing scolding. Ways of achieving this can be as simple as pouring boiling hot water over a flannel in bowl and leaving it to soak for a little bit, or placing a cold damp flannel inside a polythene bag and popping it into the microwave for just a few seconds. Apply the hot damp flannel in the required places and hold it there still or dab and move it around occasionally as you feel it necessary occasionally for between 5 to 10 minutes. Do this 3 times a day; morning, noon and night over a week period and see how you go. If you find that by doing this that the pain decreases over time carry on beyond the week and as often as necessary, but if things don’t get any better at all it would be wise to seek medical attention before the week is up.
Many people are familiar with the use of cold ice packs (or more usually supermarket packs of frozen vegetables such as peas) as first aid in the case of acute injuries of muscles, tendons or ligaments. So, in the first 48 hours it can be very beneficial to the healing process to apply a source of icy coldness to an injured area in order to alleviate pain. Ice is also very beneficial for any type of swelling (whether acute or chronic) as the cold encourages the blood vessels to contract and thus squeeze out excess fluid that might be causing swelling. When using ice cubes as the source of cold during a treatment, keep them moving and circulating around the affected area for between 5 to 7 minutes or until the area turns a rosey pink colour, then leave to rest. Carry on with this method of ice application as necessary throughout your day in order to reduce pain and swelling. If an affected area is quite large, the use of water frozen into a paper cup may be more effective, just peel back the sides in order to expose the ice and hold the cup from the base, this keeps the fingers that are holding the cup from getting damp and numb but also enables a longer lasting application of ice to a larger surface area. Consider having these paper cups of frozen ice ready in your freezer as a standby!
It is also sometimes effective to contrast bath an area, starting off with 5-7 minutes of cold work as described in the paragraph above, followed immediately by 5-7 minutes of moist heat as previously described, then going back to cold for 5-7 minutes once again and then ending with heat again for 5-7 minutes. This causes a pumping and flushing action to be set-up as the blood vessels are encouraged to contract and squeeze out blood and toxins during the cold phase, whilst the heat phase encourages fresh blood to flow back in and fresh nutrients to be made available to cells and tissues as the blood vessels are encouraged to open back up. Contrast bathing is ideal for sub-acute pain, this is where the 48 hour or so duration of acute injury has passed by but where some swelling might still exist. Sometimes, certain injuries lapse into sub-acute from being chronic, once again, contrast bathing as described here is ideal for encouraging beneficial flushing actions of the blood circulation to the troubled area and ultimately this will have a beneficial effect and act as a naturally effective method of pain management.
The appropriate use of heat and cold (as well as contrast bathing) as partially described here are just a small part of a repertoire of highly effective soft tissue pain management and pain resolution techniques that are used as an integrated part of a typical clinical massage session. Specially sourced volcanic basalt stones are used instead or as an alternative to the hot damp flannels and ice cubes; these stones which once heated or cooled retain a stable temperature for between 20 to 30 minutes which allow these sources of heat or cold to be used for longer and more effectively without needing to re-heat or re-cool allowing for more deeply penetrating effects.
For more information on clinical massage and further self care articles, subscribe to this blog (top left hand side of this page). If you live in or near Exeter (UK), contact Henry at ISCA Therapies (www.isca-therapies.co.uk) on info@isca-therapies.co.uk for your no obligation consultation or to book your clinical massage appointment series which will effectively put you back in charge of your own pain.
If you have any questions or comments relating to this article, I would warmly welcome your feedback below or via email. Be well!
Muscles of the TMJ – Jaw Pain & Headaches
The TMJ or temporomandibular joint is the formal anatomical name given to the jaw joint, where the mandible bone (which forms the lower jaw) meets the skull (at the temporal bone). There are a number of muscles which attach to and surround this joint and which are involved in mastication (i.e. chewing) as well as other facial movements involving the jaw. Excessive chronic tension in the muscles connected with and surrounding the TMJ can cause not only local pain perception in the area of the jaw itself, but can also set-up pain referral patterns (through trigger points) causing regular experiences of headaches, migraines, involuntary teeth grinding (bruxism), gum or tooth related pain and even tiniuts (ringing in the ears). Muscular tension or shortening in the muscle fibres resulting in restricted range of movement of the jaw joint can also cause pain and even a limited opening movement of the mouth itself (e.g. trismus). Differences in the tensioning of the muscles on opposite sides of the face / jaw can cause uneven bite or malocclusion scenarios.
Physical trauma such as those caused by whiplash or other sudden violent impact to the skull or neck area can set-up chronic “holding” tension which then becomes “locked” into the muscles of the skull, jaw or neck as the body freezes itself up in that split second reaction of self defensive protection. This tensioned holding scenario in muscles and related soft tissues (in any area of the body) is seen so commonly after many traumatic or sudden impact related situations (including high exertion force tooth extractions as well as many other invasive dental procedures). What is not always commonly understood is that an effective and permanent unlocking of this tension will still not be permitted by the body itself long (week, months or years) after the perceived danger event has passed until it is satisfactorily notified that the threat has passed, and so in clinical massage therapy it is the goal to gradually introduce this notification of safety to the body to begin the process of gently unlocking itself; the muscles and soft tissues affected will be engaged in this process through safe, gentle, specific and highly focused manipulation and release work.
Apart from the physical conditions described above, unrelenting stress and emotional upset experienced by a person is another way in which muscles of the TMJ can become dysfunctional or become locked into a chronic pain pattern. In fact, the emotional element is perhaps the most common underlying cause of TMJ dysfunction and pain, simply because there is an actual physical neurological connection between the sensory (as well as the motor) nerves within the TMJ itself which in turn interfaces with the brain and spinal chord via a branch of the Trigeminal nerve. The feedback loop within this neurological pathway means that emotional stress can cause the muscles of the TMJ to clench or tighten up (quite a lot of people will unconsciously clench or even grind their teeth as a response to coping with or being faced with stress); likewise tightening up or clenching of the muscles in this area causes an increased perceptual registering of emotional stress to be generated in (the primitive reptilian part of) the brain and nervous system. So, as you can see that one feeds back into the other causing a potentially vicious cycle, until something comes along which can interrupt this cycle! Physical exercises which help to stretch and relax the soft tissues of the TMJ are a vital consideration as well as whole body and mind relaxation practices or activities in order to lower emotional stress and decrease sympathetic nervous system tone (and therefore increase the parasympathetic nervous system response).
As well as the perception of stress levels in our daily lives, history of invasive dental work and the related impact of other physical or emotional trauma, the type of food which makes up our diet can also have an effect. The more prolonged and harder we have to chew our food, the higher the chances of the TMJ muscles becoming chronically tense. Of course, as with any other set of muscles in the body, there are many effective preventative self care exercises and things that one can do in order to look after our TMJs and ease pain, preferable before it becomes chronic.
This video shows examples of just some of the self care exercises you can do in order to reduce tension in the muscles of the TMJ:
Chronic TMJ dysfunction and pain can respond very favourably to specific and effective physical therapy approaches such as clinical massage which mixes and combines elements from trigger point therapy, neuromusclar massage, myofascial release, stretching, acupressure massage, craniosacral therapy, as well as sometimes work with hydrotherapy to bring in soothing sources of moist heat and cold as appropriate all into the same session to suit the needs of the individual client. Here is a very informative article from a massage therapy trade journal written by a dental nurse who subsequently devised a unique clinical massage protocol for alleviating TMJ (as well as other jaw, teeth and headache) related pain conditions after training in clinical massage techniques herself and pooling this together with her dental nurse training:
TMJ & Clinical Massage Article (Today’s Therapist Magazine Dec/Jan 2009) – PDF File
Here is a very highly recommended website with lots of visual charts depicting the pain referral patterns that can be experienced and get set-up due to trigger point activity in muscles of the head and neck – have a look to see if the charts below match up with any pain patterns you might be experiencing:
www.triggerpoints.net/head-and-neck-pain.htm
A list of some the important muscles involved in jaw pain and movement restriction issues:
Masetter
Lateral Pterygoid
Medial Pterygoid
Temporalis
Digastric (plus others in the “suprahyoid” group)
These muscles are commonly indicated for frequently reoccurring headaches with pain radiating patterns which can be mapped out predictably by the person experiencing them:
Suboccipitals
Upper Trapezius
Sternocleidomastoid
Another informative site with TMJ related information and along with a helpful beginner’s musculoskeletal tutorial summarizing which muscles are involved in performing what physical movements of the jaw have a look at http://abbottcenter.com/bostonpaintherapy/2009/10/01/jaw-pain-and-tmj-final-details/
If you are interested in wading even more into some technical depth, this particular article is somewhat heavy on technical anatomical description and details, but well worth reading if you have the relevant background and want to investigate how and why clinical massage (and myofascial release work in particular) can help address TMJ related chronic pain issues:
TMJ & MFR Article (Today’s Therapist Magazine – Jul/Aug 2008) – PDF File
This entire article was prompted by some recent sessions I’d performed with a client to help them out with TMJ related pain including subconscious teeth grinding at night, regular headaches around the perimeter of the ears and down the side of the neck, malaligned bite and a very limited ability to open the mouth – so limited that opening the mouth to take a bit from a sandwich was virtually impossible such was the pain as well as just the physical restriction in range of movement of the jaw before we got to work. Conventional MRI scans had not been able to shed any light on what was going for this client, yet we managed to produce a significant shift in jaw movement with decrease in pain from session 1 as well as reduction in teeth grinding at night, all to a degree which had not been experienced with conventional other treatments elsewhere. Improvements continued in session 2 and session 3 will be next week (at the time of writing this article). Will aim to update with progress on this blog as we progress. The protocols and techniques I use aim to produce effective and permanent shifts on a 4 to 6 session basis when performed on a weekly session basis – provided that the client also diligently follows the additional selfcare advice at home as well as attending the weekly regular sessions.
It has been reported by one particular source that 90% of musculoskeletal issues have an element of TMJ involvement to it, yet TMJ dysfunction isn’t necessarily the root cause (no pun intended). “As a above, so below” provides us with a useful perspective from which we could spring board off of in order to begin looking at the picture of the body in an alternative and more holistic relationship, so according the Lovett Brothers Principle each vertebrae bone in the spine has is intimately related to a matching counterpart at the opposite end, thus the bones of the jaw, skull and neck have counterparts which they are affected by (and visa-versa) in the lumbar (lower back) and sacral areas of the pelvis.
TMD or TMJD (temporomandibular joint dysfunction) as it is sometimes referred to as is certainly a very big topic, I hope I’ve managed to cover as many of the salient issues as possible here, but there is still so much more that I could say that hasn’t been raised in this particular article, so I would very much welcome your feedback, comments, questions and suggestions for amendments, additions and further articles on this topic.
Henry Tang (Clinical Massage Therapist) – Spaces of Possibilities Wellness Centre (Crows Nest, Sydney, Australia)
Visit the Space of Possibilities Web Page at: www.facebook.com/SOPcentre
Please leave comments below or email me at: SOPcentre@gmail.com
Healing Back Pain the Emotional Way
Guest blog article by Louise Woods – EFT, NLP & Holistic Practitioner…
Back pain is traditionally treated in a number of ways – all of them involving physical manipulation of some kind. Massage, Soft Tissue Therapy, Chiropractic, Osteopathy etc all involve a practitioner physically touching, massaging and applying pressure to your back. There can however, be a different way to address your back problems. It might surprise you that your emotions could be causing your physical pain. Just think about all the commonly used statements we often say, such as:
• He’s a pain in the neck
• I’ve got the weight of the world on my shoulders
• She put my back up
• Get off my back
• Get a backbone
• Bend over backwards
One way to address our negative emotions and stress is by using EFT or Emotional Freedom Techniques. EFT is like a psychological version of acupuncture. We tune in to how we feel and use our fingertips to “tap” on specific comfort points on our body. This releases the negative emotions and stress we have been carrying and calms us down. Once we release our negative emotions our physical body is often healed too.
EFT can be learnt easily and applied to many different issues. It can be used on your own or with the guidance of a practitioner. This is often very helpful when we don’t know what our underlying issue is. The practitioner can help you gain an insight and understanding to your issue that you can’t achieve on your own. This allows you to see the proverbial wood through the trees.
The following representations are ones that are commonly used. Your issue may be completely different to these ones but they may just speak to you! Our back is our support so it could be that you feel life is not supporting you right now or that someone is not there for you. Lower back problems are often associated with money worries. The middle back often represents guilt issues. The upper back can represent a lack of emotional support, feeling unloved or holding back love.
Our shoulders represent our ability to experience joy in life. Our attitude can make life a burden – i.e. we can get weighed down by our problems. Our neck is associated with flexibility so it could be that you are feeling inflexible about a certain situation or person. You might not be able to see all sides of an issue or are being stubborn.
To help you work out what emotion is underlying your pain the following questions are helpful:
• If there were an emotion in your back what would it be?
• If your shoulders could talk, what would they say?
• If your neck found a voice what would it say?
These questions can quickly bring up the emotion or stress we are holding in our body. Try it – you might be surprised by the answer! Our body often holds the answers. We just need to be quiet enough to listen to what it is trying to tell us. So give your body the gift of listening and see what response you get. It could be the pressure of your job weighing on your shoulders. It could be the lack of love that you are holding in your neck or your money worries that are irritating your lower back. Once you know what the underlying emotion or stress is you can use EFT to help you release it. With that your back pain could be a thing of the past. Of course there could be physical causes too e.g. an injury, bad posture, strained muscle etc. In this case it is always worth seeing an experienced practitioner who will work magic on your muscles!
To learn more about EFT and how to benefit from listening to your body, please visit my blog: www.devoneft.com.
Louise Woods
EFT & Holistic Practitioner
07866 013 637
Resolving back pain through spinal manipulation
(1).jpg "Deep Muscles of the Spine")
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!
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!
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.
Freeing up the shoulder and opening up the rib cage!
Treated a client today who came in barely able to internally rotate her right shoulder girdle and had given up doing even light exercise due to stiffness all the way down the back as well pain next to the shoulder blade which onsets when reaching her arm up.
We worked on the major shoulder girdle muscles, in particular worked on Teres Minor which was very tense and tender at both attachment points (i.e. outside edge of shoulder blade half way down and top of the arm – to use non technical anatomical descriptions) . Also did fascial release work on serratus anterior muscle on the side of the rib cage. Client was feeling slight burning or crackling sensations as the taught and dehydrated connective tissue (fascia) began to yield and begin to give us back some flexibility to allow movement to happen more freely. We ended up with greatly improved range of movement afterwards.
Wondered and asked client if she suffered with asthma as the intercostal muscles in-between the outside surface of the ribs seemed very restricted from what I was able to palpate (feel) during the time that we were working on serratus anterior, she confirmed that she did have asthma. I explained that there is a set of techniques I can perform on her during a series of future sessions in order to free up the currently restricted muscles and soft tissues of the rib cage which will help ease the asthma and help free up the breathing making it become less shallow.
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