Lower Back Pain
When a client comes in and tells you they have lower back pain the first thing we, as bodyworkers, must determine is whether the pain is truly in the lower back or across the posterior sacrum. Knowing where the pain actually is will help to determine what might be causing it. True lower back pain can be caused by a variety of things including:
• A shortened or hypertonic quadratus lumborum, or QL, muscle
• Immobilization of the floating ribs
• Imbalances in the iliopsoas muscle
• Compression in the lumbar vertebrae
• Tension in the abdominal muscles
We are going to explore the interrelatedness of these conditions by beginning with QL. Why does QL become tight? QL is generally reacting to any of the other possible causes for lower back pain. For example, if the floating ribs are immobile, QL, which inserts on the 12th rib, is unable to move naturally and has to work much harder than it should to twist, bend, walk, stabilize, etc. the middle of the body. Eventually the muscle is tired and inflammed, and this leads to hypertonicity.
The floating ribs can become immobile because the diaphragm is tightened or not moving properly. This can be brought on by not breathing correctly. How many of you breath fully using the diaphragm? How many of your clients do? Floating ribs can also be immobile due to tension in iliocostalis. This tension could be from misalignments in the rest of the ribcage, compression of the cervical vertebrae, or a twist in the hips.
A twist in the hips can be linked back to many different things including, tension in the abdominal muscles and imbalances in iliopsoas. One of the origins for psoas major is the transverse processes of the lumbar vertebrae, while iliacus originates from the iliac fossa of the hip bone. Iliopsoas, the combination of both muscles, inserts on the lesser trochanter of the femur. If, for example, the right iliopsoas is tighter than the left it will pull up on the femur and down on the lumbar vertebrae.
This not only creates a shortening of the abdominal space on one side, it also compresses the lumbar vertebrae on the right side, tightens the abdominal muscle wall on the right side, and pulls the femur into mild lateral rotation. As the right femur moves even mildly toward lateral rotation, the hip will generally follow and twist lateral. In response to this the left side will generally move toward medial rotation.
This twist alone tends to create some misalignments of the sacroiliac or SI joints. But adding to the problem is the fact that the fibers of iliacus at its origin spread all the way across the iliac fossa and onto the base of the sacrum. This means that the fibers of iliacus cross the anterior aspect of the SI joint. If iliopsoas is tightened on the right side, iliacus will pull the hip bone and sacrum together on the right side. This creates tension in the ligaments and joint capsule of the right SI joint.
All of this leads to further tension in that side of the abdominal muscles, further misalignment and immobilization of the floating ribs, further compression of the lumbar vertebrae, and more hypertonicity of QL.
We focused on iliopsoas, but the twist in the hips could come from numerous things – repetitive activities, shortened abdominal muscles from sitting too much, or a knee problem on only one side. The compression of the lumbar vertebrae can also be brought on by sitting too much, degenerating discs, or tension in other muscles such as latissimus dorsi. And the immobilization of the floating ribs could be in direct relation to the position of the first rib, an immobile diaphragm, or shortened abdominal muscles. So, why does QL become tight? And what should we do to relieve the tension?
Odds are good that no matter which of these things is causing the tension, we will achieve relief from the pain in QL and the lower back by working in depth on the hips, lower back, and abdomen. Next time we’ll look at the possible causes for sacral pain.