Causes of Lower Back Pain
March 14th, 2010
As a massage therapist, back pain – especially mild to moderate lower back pain – is my bread and butter. There are so many potential causes, and so few medical sources of relief. And most everyone will experience lower back pain at some point in their lives, and it’s usually not about a slipped disc or a severely torn muscle.
Sometimes, it’s not even really about your lower back! Many of the muscles that attach to your hip bones or legs can pull the lumbar vertebrae out of alignment.
Have a look at what I’m talking about.
When these muscles don’t have normal flexibility, or when they have sore spots or sticking points, they can tilt the “bowl” of the pelvis forward and downward, increasing the curve in your lower back (sometimes called “swayback”).
Have a look at psoas major, in particular – see how it directly attaches to the bones in the spine? When that muscle is tight, it pulls directly on your vertebrae.
When those bones are out of whack, they can pinch nerves that come out of your spinal cord, and can lead to bulging or slipped discs. Additionally, the primary muscle in your lower back (quadratus lumborum, not shown here) has to work overtime to keep your body upright, since you don’t have the benefit of stacking the vertebrae in the way they were meant to be stacked.
Most of us spend a lot of time sitting and walking, which activates these hip flexor muscles. If you have an exercise ball at home, try draping yourself over it face up to get a good stretch. Or try the “heel to glutes” stretch if you’re able. Ask me for a demo of how to do this properly, without injuring yourself.
And if you come in for your next session with lower back pain, don’t be surprised if I don’t spend the entire session on your back. Sometimes, the cause isn’t where you think it is!
Fixing Heel Pain
December 22nd, 2009
Many of us know this story too well: Each morning, those first few steps out of bed produce intense, sharp pain in your heels. As the day progresses, your heel pain subsides to a dull ache, but prolonged walking brings it back again, and the next morning those sharp pains have returned.
If this sounds familiar, the odds are good you have a condition called plantar fasciitis. It affects some ridiculously huge percentage of the population in this country, and seems to especially target women in their thirties and older. (Men get it too, of course.)
The plantar fascia is connective tissue that wraps the bottom of your foot, like a piece of thick plastic wrap. Muscles in your calf (gastrocnemius, soleus, and others) extend around the bottom of the heel — think Achilles tendon — connecting to this “plastic wrap” on the bottom of your foot. When your calf muscles are tight, they can cause strain on the plantar fascia.
When this strain is prolonged, irritation and inflammation can occur. If the problem isn’t addressed, your body can lay down new bony tissue, creating heel spurs (ouch).
So, how do we treat plantar fasciitis? If you see a physical therapist or doctor, they might recommend a night brace for your ankle, or they might recommend icing. Those are great to help you manage the pain and prevent it from recurring.
When you come see me, I will work on your feet, but I’ll also address your tight, overworked calf muscles. I might also spend some time stretching your hip flexors, since tight hip flexors can lead to overworked calf muscles. These efforts will reduce pressure on the plantar fascia, allowing the irritation and inflammation to calm down.
In between your appointments, ice your feet, wear a brace at night, and stretch those calf muscles with a stretch rope or towel! Try an “active assisted” stretch – ask me for a demo when you come in for your next appointment.
“My Arm Goes Numb” – Is it Thoracic Outlet Syndrome?
October 10th, 2009
I attended massage school at the Downeast School of Massage in Waldoboro, Maine. This meant an hour and a half commute each way, 3-6 days per week, for close to a year.
The commute goes up Route 1, with lots of speed changes and traffic lights. My car is a stickshift, so most of the commute I held my left arm out in front, with my hand on the wheel, while my right arm worked the gearshift. Posture is a type of repetitive action just like any other, and the muscles on the front left side grew tight and overused.
Eventually, my left arm would go numb at night if I lay on my side, and I lost grip strength in my left hand. This is not good for a budding massage therapist!
Coincidentally (or perhaps not so coincidentally), about the time this started to bother me, we discussed a condition in Pathology class called thoracic outlet syndrome. Immediately, I knew this was my issue. I treated myself with some focused stretching & self-massage, and quickly regained function.
Thoracic outlet syndrome is named for the thoracic outlet, which is the space between your collarbone and your first rib. This is a narrow passageway, but it is crowded with blood vessels, nerves, and muscles. If muscles in this area are tight, they can make the thoracic outlet even smaller, constricting nerves or blood vessels.
The primary muscles involved in this condition are anterior deltoid, subclavius, and (most especially) pectoralis minor.
Pectoralis minor is a deep muscle that runs diagonally across your chest from your shoulder to the middle of your ribcage. It’s the red structure with three main “branches” in this image:
As you can see, pec minor directly covers the thoracic outlet, and when it is tight, can draw the shoulder down, compressing nerves (in yellow) and arteries and veins (red & blue).
There are many ways to treat this condition, including surgery. However, massage therapy and stretching are gentle, non-invasive way to start treating this issue before it gets any worse.
Next time you see me, ask for tips on stretching and self-massage for this area. In the meantime, check out this video of a guy performing a very simple stretch for pec minor:
http://www.youtube.com/watch?v=aEtuF9m_xOY
This bodybuilder doesn’t have the best form in the world, but at least he’s stretching! And something about the video just cracks me up. There are better stretches available – ask me about the “active assisted doorway stretch” next time you come in for your appointment.
Piriformis: Pain in the You-Know-Where
September 2nd, 2009
I spend several hours a week working at my friend’s farm in North Yarmouth. It’s a pleasure to be out there – and every week I get to come home with a bounty of fresh, organic local vegetables.
Lately, the harvest has been full of bush beans and cherry tomatoes. While these veggies are delicious, they also require extended periods of bending over while twisting and reaching. This is murder on the low back!
To relieve the pain, I went to see a massage therapist friend. I told her I thought there was something out of whack with my sacroiliac joint. She poked around briefly and then mumbled “Nope. Piriformis.”
So what is this muscle? Piriformis originates from your sacrum (base of your spine) and attaches to the top of your thigh bone. It rotates your leg outward. When you lift your leg straight out in front of you, piriformis also brings the leg away from the center of the body, to the side. (Imagine a martial artist doing a roundhouse kick.)
When piriformis has a trigger point, you may feel pain down the back of your leg or into your sacroiliac joint (center of your low back). When piriformis becomes enlarged from repetitive use or strain, it can entrap the sciatic nerve, causing pain and numbness all the way down the leg!
This mimics the condition known as sciatica. It’s called “piriformis syndrome,” and it’s common in runners, golfers, and other athletes, as well as computer workers. It’s also common in people who carry wallets in their back pockets and sit on them all day.
Treating trigger points in the piriformis is just like treating any other muscle. My job involves bringing oxygen to the area, along with simple stretches to increase range of motion. Sometimes treatment may be slightly painful in the moment, but as long as it’s therapeutic pain (“hurts so good”), it may actually be beneficial. As always, remember to communicate with me about pain levels during treatment!
In between appointments, it’s a good idea to stretch your piriformis. I found a really nice video online explaining a good piriformis stretch. I’ve shown this stretch to many of you – it’s always good to see it again. Click here to have a look.
Keep in mind: proper form for this seated stretch is crucial! If you have difficulty maintaining proper form, you can also try this while laying on your back, which stabilizes your spine.