Everyday Tips for Low Back Pain...

What you wear matters:

▪ Wear comfortable, low-heeled shoes.

▪ Do not carry a wallet in your back pocket. This simple fix can save you a whole lot of trouble in your low back.

Move, and move often:
▪ Exercise regularly. A sedentary lifestyle contributes to low back pain. Seek out low impact exercise such as swimming, walking, water aerobics, yoga, and pilates.

▪ Try to maintain a healthy lifestyle and weight. Excess weight aggravates low back problems.

▪ This old adage holds true: if you have to lift things, lift from your legs, not your back. A trick to help you do this is to tuck your tailbone under (meaning do not let your butt stick out) - you will feel your abdominal muscles kick in and this will give you added support while you lift. Try to hold the object close to your body and avoid twisting.

▪ If you have to stand for long periods of time (at work or while doing the dishes for example), rest 1 foot on a low stool to relieve pressure in the low back. Change feet whenever you start to feel tension in the low back, or every 5 to 10 minutes or so. Try to maintain good posture when standing - keeping the belly gently pulled in and the shoulders slightly back will help.

Sleep and Back Pain:
▪ Invest in a mattress with good support. A sagging mattress stresses muscles in the low back and can set you up for trigger points

▪ If you sleep on your side, place a pillow between the knees. This relieves pressure on the low back and the buttocks.

▪ Avoid sleeping on your stomach if you have low back pain. If you absolutely must, try placing a thin pillow under the hips to relieve low back pressure.

▪ If you sleep on your back, try placing a pillow under your knees. This restores the spine's natural curve and relieves tension.                                      

Sitting Comfortably:
▪ Sit in a chair with good lumbar support. Get up to stretch and walk around as much as possible for as long as possible (this could mean adopting simple changes like going to the bathroom furthest from your desk, parking further away, and taking a brisk ten minute walk during your lunch break). A small pillow or rolled up towel under the low back may provide extra support while seated (while driving for example). Resting the feet on a low stool can also help.

▪ Avoid crossing legs while seated. If you must, switch legs often.

Self Treatment:

▪ Self treatment  is tricky for the low back, but it can be very helpful. Try a tennis ball under one side of the low back or buttocks at a time while lying on the floor or another firm surface. For the buttocks (gluteal muscles), a tennis ball against a wall while standing also works very well. Gently move over the ball to apply pressure to your active trigger points. Special tools are also sold to aid in self massage - ask your myofascial pain therapist which tools they recommend. 

▪Heat can be very therapeutic. If you don't like to use a heating pad, try a hot wattle bottle or a rice sock (fill an old sock with rice and heat it in the microwave for a minute, it can be reused many times). Try to use heat for at least 10 minutes at a time.

▪ Correct any considerable leg length discrepancy if one exists by wearing a lift in one shoe. Your Myofascial Trigger Point Therapist can help you determine if you have a leg length discrepancy.

▪ Sit down to put on pants and shoes. Extreme bending (and worse, trying to catch a fall) can seriously irritate the muscles of the low back and buttocks.



Muscles Involved in Low Back Pain and Stretches That Can Help:

 Stretching is an integral part of successful therapy. However, not every muscle listed is necessarily involved in your low back pain, and muscles other than those listed may be contributing to your pain. The most important thing to remember that these tips and stretches are just meant as a guideline; certain stretches may be contraindicated in your case. Please talk to your Myofascial Trigger Point Therapist about which stretches would be the most helpful, and which, if any, you should avoid.  Listening to your body is paramount - if something does not feel right to you, just stop.

The muscles covered will be
1. Quadratus lumborum
2. Paraspinal muscles
3. Gluteal muscles
4. Piriformis

Quadratus Lumborum:
Quadratus Lumborum Muscle and Trigger Point Referral Pattern
Quadratus Lumborum Gebauer Image
The Quadratus Lumborum is a common source of pain in both the low back and the buttocks. The "QL" is primarily used for maintaining upright posture and bending sideways. The QL is aggravated by prolonged periods of sitting and by a rotated pelvis - sitting with legs crossed to one side for example.
Quick swooping movements that involve twisting the torso, such as sweeping floor, vacuuming and shoveling snow aggravate MTrPs (myofascial trigger points)in the QL.
 Quadratus lumborum trigger points are often found together with trigger points in the gluteal muscles.
Pain is likely to be felt along the crest of the ilium (along the top of the pelvis), in the low back and sacro-iliac joints, in the buttocks and in the groin.
Pain is generally deep, dull, and aching, but may be sharp during movement.
Coughing and sneezing can be extremely painful.
Stretch for quadratus lumborum (c)
QL stretch



Paraspinal Muscles:

Paraspinal Muscles Trigger Point Referral Pattern
Paraspinals- Gebauer




Superficial group: Erector Spinae (Longissimus and  Iliocostalis)
Deep Group: Semispinalis, Multifidus, Rotatores
 

These muscles all fall under the group 'Paraspinal muscles'. They consist of a superficial group of muscles that run longitudinally (parallel) along the whole length of the spine, and a group of deeper muscles that are much shorter and run diagonally to connect the vertebrae. These muscles primarily extend the spine and contribute to rotation of the spine to some extent (particularly for stabilization). 

Trigger points may occur in these muscles at any point along the spine. The pain produced by these trigger points is often felt locally, however, some trigger points in these muscles send pain to the SI region or down into the buttocks (see picture). Pain from these muscles groups may also be felt in the abdomen. The pain is often unilateral (one-sided), and is felt as a deep ache in the spine. The pain can be quite intense, and often feels as if it is coming from the bones rather than the muscles. Trigger points in the deep, short, spinal muscles can even pull vertebrae out of place. The pain from MTrPs in these muscles often restricts spinal motion and a person's activity, making it especially difficult to rise from a chair or climb stairs facing front.

Sitting twisted to one side can aggravate the deep spinal muscles. As can quick, awkward movements, particularly those that involve bending and twisting.  These muscles are also very sensitive to repetitive strain.
Additional Tip for Problems with the Paraspinals:
Avoid walking or jogging on slanted ground or slanted beach.
Stretch for Low Back
Cat Back Stretch








Arch back and lift head
Cat Back Stretch 2

Round back and tuck chin toward chest
Cat Back Stretch 3


Gluteal Muscles:


Gluteus Maximus, gluteus medius, gluteus, minimus

The gluteals are very important muscles - essentially they allow you to walk and move your legs in, out, and back. Surprisingly, the gluteal muscles are also a very common source of low back pain - the main offender among them is the gluteus medius. Pain is usually felt as low back pain, but is also felt over the sacrum as well as over the buttock. The gluteus maximus can also refer pain to the low back.

People with MTrPs in the gluteals will usually complain of pain while walking, lying on the back of the affected side, and when sitting in a chair.

Sleeping on the side without support between the legs is particularly aggravating to the gluteals, as is sitting too long in one position. The stop and start pace of tennis can also set up MTrPs in the gluteals.

Piriformis



The piriformis refers pain to the sacroiliac joint region, the buttock, and over the posterior hip joint. 

Driving a car for long periods with the foot on the accelerator can aggravate the piriformis.  In this position the foot is usually rotated outward, contracting the piriformis.

















Gluteals and Piriformis Stretch:




                                         

 

Ilio-psoas:

The Ilio-psoas consists of two muscles: The psoas (pronounced so-az), and the iliacus. The Ilio-psoas flexes the thigh at the hip and helps maintain upright posture. The iliacus primarily refers pain to the lower abdomen, front of the hip and upper thigh. The psoas refers pain to the lower back and is an often overlooked, major contributor to low back pain.

Pain is distinctive with psoas trigger points - they create a vertical pattern of pain from the bottom rib down to the SI joint. Pain is usually more intense when standing and less when seated.

Difficulty may be noticed when trying to get up from a seated position, especially one that is deep seated like a very soft couch.

Sitting with knees above the chest and sleeping in the fetal position shorten the iliopsoas and may activate MTrPs.

Special tip for Iliopsoas problems:

Raise your chair into a slightly higher than normal position, so that the knees are lower than hips. This can help relieve tension in the psoas.

Iliopsoas Stretches (easy to hard):



                                    
                  

                                                    
                      













 
 
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