Resolving back pain through spinal manipulation

When most people think of spinal adjustments, they will most likely associate this with having the vertebrae bones in the spine being “clicked” or “cracked” into alignment by a chiropractor, osteopath or physiotherapist.  There are also different “grades” of adjustment or manipulation ranging on a scale from 1 thru 5, with 5 being the most radical in terms of movement range adjustment and thus requiring the most amount of applied manual force directed at the joint.  Generally, a grade 3, 4 or 5 adjustment will be carried out by a licensed chiropractor, osteopath or physiotherapist and involve moves that are known in the trade as High Velocity Low Amplitude (HVLA) adjustment techniques – also sometimes called High Velocity Thrust techniques depending on the profession you speak to.

What most people don’t realize is that a completely spontaneous physical adjustment of the spine (or any other bone to bone joint for that matter) can occur and often does during a remedial or clinical massage session, or indeed in any situation where the soft tissue interconnecting with the joint in question is being manipulated in a precision and focused manner.  Indeed, you wouldn’t necessarily go to your massage therapist asking them specifically to manipulate or adjust your spine for you in the same way that a chiropractor or osteopath might do for example as it’s usually beyond their scope of training and practice.   However, equally beneficial indirect and spontaneous bone joint adjustments can and do occur during clinical massage and soft tissue work such as fascia release, and as well as being a lot gentler than high velocity thrust adjustments, these spontaneous adjustments themselves occur because a number of other bio-mechanical conditions (as well as mental states) have aligned themselves within that person that has allowed that change to take place – that person and their being was “ready” to allow that particular change.  Sometimes but rarely direct manipulation is required as a last resort, but even among prominent and highly experienced osteopaths and chiropractors, there are those who have ditched this part of their training and instead have exclusively taken to the softly softly approach with consistent success and hardly ever go back to performing direct physical manipulation of bones.

If you have not yet read our articles on the Psoas and Quadratus Lumborum muscles, please feel free to click the aforementioned links to convince yourself that these 2 very major muscles which attach to the spine can have a significant effect on lower back pain symptoms as well as being able to bear significant load on the spine itself and thus causing potential alignment deviation.  Precision massage therapy offered by therapists trained in clinical massage can of course help release and balance tension in these deep muscles of the lower back.

The intrinsic muscles of the spine which we have not devoted specific articles to are the erector spinae and transversospinales muscle groups, below is a diagram showing the complexity of these 2 muscle groups and their relationship with regards to their attachment points on the spinal column plus the other msucles which we have already discussed previously:

Trigger point pain pattern charts and diagrams are included below to complete this discussion on the soft tissue approach to spinal adjustment and alignment:

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.