Category Archives: Treatment Notes

Tilt is Not Game Over – Solve Back Pain

Back pain and specifically low back pain is a problem most of us will experience. But we don’t have to live with that In fact, over 80% will deal with one episode of low back pain and over 60% of us will have 2 episodes of serious low back pain.

How does low back pain start and what’s the cause?

Low back pain can be caused by a wide variety of issues, sometimes it’s a major traumatic experience such as a fall or a car accident, other times it can be a internal (visceral) issue, but most of the time low back pain is caused by repetitive stress. Basically, most people do something on a regular basis such as sitting all day or bending over at work that leads to poor bio mechanics or in other words poor posture.

Incorrect bio mechanics of the low back leads to compensation by the body, creating muscle imbalance, fascia adhesions, muscle spasm, nerve irritation, fibrotic tissue, inflammation, changes in the position of the spinal column and then ultimately pain.

One the most common causes of poor bio mechanics of the low back is due to the anterior pelvic tilt. An anterior pelvic tilt occurs when the pelvis (3 different bones) moves forward in relatio

Figure 1

n to where it normally should be, which is neutral. Common symptoms of an anterior pelvic tilt include low back pain, groin pain, tight hips, inner knee pain, and stiffness in the morning or after activity, tightness in the muscles in the low back and groin region. The image Figure 1 shows the difference between a neutral and anterior pelvis.

As a result of anterior pelvic tilt, you will generally have tight hip flexors (illopsoas) and tight low back muscles (lumbar paraspinals). These tight muscles create added stress on the low back joints and spine, causing pain, inflammation, spasm and tenderness.

So if you have anterior pelvic tilt, how do you correct the problem? Well it depends on many factors. However, for many, a weak core and glutes (butt) can be a common issue. Strengthening the abdominal region along with the gluteal region can help balance out the pelvis in many cases. In other cases, muscle weakness is not the issue, but rather muscle inhibition, meaning muscles are strong in the right areas, they are just not working in the way they are designed to or firing correctly. Sometimes an anterior pelvic tilt is due to structural imbalance, an example of this is the hips are not moving correctly (no range of motion) causing the pelvis to compensate. Often a pattern in this is due to compensation from prolonged sitting. This often shortens the psoas muscles and creates imbalance in the quadriceps and firing pattern issues in other muscle groups.

If you are dealing with low back pain talk to us, we are specialists who not only treat low back pain, but locate the source of the imbalance and work with you to return that balance. Properly getting assessed is the first step towards resolving your pain. We can help treat not only low back pain, but low back pain due to an anterior pelvic tilt.

Where’s Waldo?

For those who know me or who have booked time with me for one ache or another, you have heard me refer to my first session as “Where’s Waldo”. For those unfamiliar with the kids book series (whereswaldo.com) where you look for Waldo in a sea of similar, but unrelated images. Waldo has a red and white striped shirt and hat. That should be easy… right? Well this is one analogy that I use to help clients understand anatomy, fascia, and the work I do to help them feel better, and manage pain and discomfort. Not everyone is a “body geek” and is as curious about how it all works like I am, and as such I have found many ways to describe this so that most can understand. Quite a few teachers have contributed to my analogy bank, such and friend and teacher Walt Fritz who’s similar approach and use of analogies have greatly influenced what I do.

So why Waldo? Quite simply looking for the cause of discomfort or pain can often be like looking for Waldo in the pages of a book. On some pages you can search for some time, and other times you turn the page say “There he is!”

To me, myofascial release has always about finding connection; connection with the tissue in distress. For years I believed that when I found tightness in the body I was finding fascial restriction, as that was what I was taught. But with a greater knowledge of science and anatomy, I am reasonably sure that what I am effecting is much more than just the fascia. I now know how the nervous system drives much of what I do with my hands.

Whether it is the nervous system/fascial system/muscular system/skeletal system creating the pain, it matters little if we have no way to connect with the pain and dysfunction. This is where engaging hands-on, evaluating the response, and together determining the relevancy of the contact in relation the pain is paramount. The feedback loop we engage in as client/therapist directs our work. All the while remaining open to the possibility that “Waldo” may not be in the obvious spot.

So where does this lead you as a client? Well essentially it means that together we will work in a way that will possibly be very unfamiliar. Notice I said together. You are an active participant in finding the source, and together we’ll work to address it for relief.

How do we do this?  By engaging the tissue in distress. Tissue in distress is the term I use to describe how the body reacts to injury, trauma, or surgery. I believe it is primarily a function of the nervous system, rather than blaming the fascia being the primary culprit. As distress or injury affects the nerves, it seems that a characteristic density or tightness envelops the area, creating pain or other dysfunction. This is the felt-sense that I seek out when evaluating and treating and this is the tissue in distress or “red and white” while searching for Waldo. Once we locate tissue in distress, we narrow the focus on it, snagging it, so that both you and I are in connection with it. Then, I ask for feedback from you the client, to determine if this tissue is part of the pain/problem. If you affirm the sensation, I stay in contact with the snagged tissue in distress until we note a change in tone of the area. As the tissue softens, so to speak, the normal effect is a lessening of the pain or dysfunction. We continue to seek out the tissue in distress until the area feels clear and loose. Simplistically, we are engaging the nerves and its surrounding tissue in distress and creating a sensory feedback to the brain, which in turn signals the affected area to change its tone, reducing tightness/pain. While not an explanation to satisfy a neuroscientist, it meets my needs while treating.

So if you are interested in “Finding Waldo” give my call, or drop an email, and we’ll book a session.

What Is Myofascial Release?

Myofascial Release, or MFR, is simply one of the most effective methods for relieving pain, restoring posture, and returning one to function. Myofascial Release is a hands-on technique that provides sustained pressure into myofascial restrictions (tightness, scar tissue, injured areas) to eliminate pain and restore motion. The theory of Myofascial Release (“myo” meaning muscle and “fascia” meaning connective tissue) requires an understanding of the fascial system (or connective tissue). The fascia is a specialized system of the body that has an appearance similar to a spider’s web or a sweater.
Fascia is very densely woven, covering and inter-penetrating every muscle, bone, nerve, artery and vein as well as all of our internal organs including the heart, lungs, brain and spinal cord. The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one structure that exists from head to foot without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.
Fascia also plays an important role in the support of our bodies, since it surrounds and has attachments to all structures. These structures would not be able to provide the stability without the constant pull of the fascial system. In fact, our bones can be thought of as tent poles, which cannot support the structure without the constant support of the guide wires (or fascia) to keep an adequate amount of tension to allow the tent (or body) to remain upright with proper equilibrium.
In the normal healthy state, the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When we experience physical trauma, scarring, or inflammation, however, the fascia loses its pliability. It becomes tight, restricted and a source of tension to the rest of the body. Trauma, such as a fall, whiplash, surgery or just habitual poor posture over time and repetitive stress injuries has a cumulative effect. The changes they cause in the fascial system influence comfort and the functioning of our body. The fascia can exert excessive pressure producing pain or restriction of motion. They affect our flexibility and stability, and are a determining factor in our ability to withstand stress and strain.
While Myofascial Release may share some commonalities with traditional massage, it is a modality that reaches deeper and creates lasting change. It shares a common goal with standard physical therapy practice, however works from a different perspective. In a traditional physical therapy setting, pain is often viewed as a result of weakness. Strengthening an already tight system often only makes the problem worse. Myofascial Release relieves the tightness and pressure from your body, allowing strength and function to return in a natural manner and returning you to your desired state.

The Wonderful World of Fascia

If you understand fascia, then you understand that a lot of what we thought we knew about the musculoskeletal system was wrong. Muscles are not isolated entities with clearly defined borders and individualized functions. Our musculoskeletal system is just that: a system of systems, linked together by a highway of connective tissue we call fascia.

Sweater   SBL

Fascia penetrates and surrounds every muscle and organ in our body. It links together muscles, and groups of muscles, from the top of our skulls (epicranial fascia) to the bottom of our feet (plantar fascia).

It is made up of tightly packed collagen and elastin fibers, woven together like the fibers of a sweater, that are reside in a gel-like bath called ground substance. Ground substance has the unique ability to go from gel to liquid-form in response to pressure, heat, or stretch.
Fascia also contains specialized cells called fibroblasts, which give it the ability to produce more fascia. This usually occurs along lines of mechanical stress as a sort of reinforcement mechanism. You see this happen a lot, especially in the upper/middle back of office workers.
As a corollary to being able to reproduce itself, fascial tissue also contains smooth muscle cells and proprioceptors embedded within its cellular matrix. These give it the means to not only sense stretch and positional change, but the ability to contract or relax in response to it as well (another thing that we thought only muscle could do). Fascia contains up to nine times as many mechanoreceptors than regular muscle tissue.
The two main types of proprioceptors in fascia are Ruffini and Pacini endings. Ruffini endings decrease muscle tone and inhibit sympathetic nervous system activity in response to stretch or direct pressure. Conversely, Picini endings tense your muscles in response to pressure or vibration, providing joint stability throughout the body.

Houston, We Have a Problem

Unfortunately, the qualities that make fascia so dynamic also make it susceptible to deformation. Fascial tissue that is repeatedly exposed to excessive strain can become dense, knotted or otherwise stuck together. These areas of increased tension and are called adhesions. These adhesions can cause your muscles to lose independent movement, dragging their neighbors along with them for every movement.

Adhesions often develop around the site of previous injury and in areas of high mechanical stress like the upper back, neck, rotator cuff, glutes, and calves. They often cause decreased blood flow, are painful to the touch, and alter normal posture. FasciaBackFortunately, there are a number of excellent myofascial release techniques to choose from to keep these adhesions at bay. Myofascial release is a manual therapy technique in which gentle, sustained pressure is used on the soft tissues while traction is applied to the fascia. This technique results in softening and lengthening of the fascia and breaking down of scar tissue and adhesions between skin, muscles and bones.

How adductors and quadriceps affect back pain

The basis of pelvic balance relies on the ability of all the muscles which attach at the hip and groin to relax and extend after workout or exercise. But as we all know, without stretching post-workout, the muscles remain shortened and develop adhesions or contractures.

adductors

 

Adhesions result when a certain group of muscle fibres stay stuck together after contracting, not releasing and then acting as a group rather than as individual muscle bundles.
A contracture is a knot or trigger point which develops along the muscle belly, usually, because of repeated muscle contracting and not relaxing at that location in the muscle belly.
The result is a developing knot or trigger point in the muscle with the presence of excessive proteins binding the muscle filaments together and trapping lactic acid and other proteins in a knot.  Medically it appears the required enzymes necessary for the releasing of these muscles appears to be absent or in short supply at the knot.

adductor_magnusgracilispectineus

Myofascial Release Therapy  and Trigger Point Therapy will release both adhesions and contractures. When the muscle doesn’t want to release, the use of these techniques will at the muscle knot locations, and attachment points assist the muscles to release.

How does tight quadriceps and adductors affect ilio-psoas?

By adding external pelvic tension against the hip bone. The attachments of the quadriceps and adductors along the pubic bone and especially upper iliac ( hip bone) pull the iliac into an outflare exerting outward pulling strain on the iliac, straining the iliac, and iliopsoas, as a consequence.

The ilio-psoas is two muscles which are hip flexors and torso flexor. The psoas is combined with the quadratus lumborum at the back of the lumbar acting as your core flexor-extensor combination. Any imbalance will often result in low back pain.
What I have discovered in performing multiple treatments on the ilio-psoas is that there is always accompanied tightness in the adductors and quadriceps on the same side as a tight ilio-psoas.

I have found that releasing the adductors and quadriceps first will result in a lessening of the tension on the iliacus, and ilio-psoas as a consequence.

If you have low back or hip tightness or pain I welcome you to try this therapy approach and be amazed at how quickly the discomfort reduces after treating the adductors and quadriceps.