Last week I had a new client come in for low back pain. During the intake she told me that she had been having chiropractic adjustments and ultrasound on her lower back for several weeks and it did not seem to be helping at all.
I was watching her as I was listening to her. Her right shoulder was slightly anterior and medial, but it was the lack of movement in the right side of her ribcage that eventually caught my attention. I started her in a supine position and found that her right external oblique was shortened and tight. This had led to tension in her diaphragm. I followed the trail superior on the ribcage and found that serratus anterior on her right was also shortened and tight.
The upper digitations of the origin of external oblique interdigitates with the lower digitations of the origin of serratus anterior. This means that the position and mobility of ribs 5 through 8, the ribs on which both muscles attach, can affect the tone of both muscles. Furthermore, the lower digitations of the origin of external oblique interdigitates with the fibers of one of the origins for latissimus dorsi, meaning the position and mobility of ribs 9 through 12, the ribs on which both muscles attach, can affect the tone of both of these muscles.
Conversely, shortening or tension in serratus anterior (possibly caused by upper rib dysfunction, forward head syndrome, or a shoulder in medial rotation), external oblique (possibly caused by sitting too much, overworking the abdominal muscles, or a twisted hip), and/or latissimus dorsi (possibly caused by a shoulder in medial rotation, a twisted hip, or compression in the lower thoracic, lumbar and/or sacral vertebrae) can cause immobility and positional shifts in the ribs.
Additionally, the fascia of external oblique and serratus anterior is interconnected. The same is true for the fascia of external oblique and latissimus dorsi. Fascial connections are another way in which these muscles can effect one another and the bones on which they attach. So, how does all of this relate to lower back pain? For that, we need to further look into the muscle attachments.
Latissimus dorsi, which we now know is intimately connected to external oblique through shared bony attachment and fascia, has as one of its origins the spinous processes of T7 through S5. Shortening of or tension in this muscle can create compression in lumbar and/or sacral vertebrae, which can be a contributing factor in lower back pain.
Latissimus dorsi also originates from the posterior iliac crest of the hip bone. If the right external oblique is shortened and pulling on its insertion at the anterior and lateral iliac crest, it is possible that the right hip could be pulled superior and anterior. The superior position of the hip would shorten latissimus dorsi while the anterior position would move the fibers into elongation, leaving latissimus dorsi tight from fighting for stability. Both the twist in the hip bone and the tension in the muscle could contribute to lower back pain.
This short anatomical discourse leaves out quadratus lumborum and its attachments to the hip bones and twelfth rib; the thoracolumbar fascia and its attachments to the lower ribcage, lumbar spine, and sacrum; and the relationship between these two structures and what we have already discussed. For this particular client I worked her abdomen, her ribcage (anterior, lateral, and posterior), and finally her lower back for 7 minutes. When she came out of the treatment room she had no pain.
I would love to teach you fast, painless, easy ways to work these structures. Full Circle’s first course of the year is SMRT: Shoulder, Axilla, Ribcage, & Upper Back in fantastic San Diego, CA. Please join us by registering at https://efullcircle.com/spontaneous-muscle-release-technique-shoulder-axilla-ribcage-upper-back/