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 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!