Holiday Stress and Low Back Pain
November 5, 2007 – 3:03 pmWelcome to my first Blog entry.
With the Holidays in full-swing, do you see an increase of stressed clients in pain? I seem to have more clients complaining of low back pain during the Holidays. Sacral torsions from prolonged standing with weight-bearing on one leg (Mall Back) is common. Do you think the sacroiliac ligaments are getting strained or possibly piriformis syndrome from increased walking, stooping and bending? Thoughts?
29 Responses to “Holiday Stress and Low Back Pain”
One of the most helpful lessons I have learned in the past few years is to assess properly and to listen. I do see a lot of this SI joint pain, the way that I know this is by what the client says. Where is the pain? Is it constant, unilateral, when did it start, and what makes it better or worse. Client information given up at intake and while they are on the table is as valuable a tool as any.
Our responsibility, as practitioners, to know what to do with the information is another part of this equation. Learning the symptoms of specific conditions takes a lot of time, research, and continued study well after initial massage school. I have found it very helpful to get into the World Wide Web to do much of that research. Your e-newsletter keeps me motivated and clued into assessment and treatment. You have a chapter in the Advanced book about history taking that I found useful, thanks.
All that to say, yes, I do think people are having much stress through that SI joint, and I am grateful to be learning the proper techniques to help alleviate that discomfort.
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By geo on Nov 6, 2007
Thanks for that thoughtful response geo. Do you find that hyper- or hypo-mobile SI Joints cause the most pain. Sometimes it seems that trauma-related hypermobile joints from such things as falling on one hip while rollerblading, snowboarding, etc. are more painful on the loose side…in the beginning… but after a few weeks or months, the chronic condition switches to the hypomobile joint. I have always assumed the switch in painful sides results from strained long dorsal sacroiliac ligaments which are fighting a battle trying to keep the pelvis stable. I just can’t figure out why the mechanoreceptors and chemoreceptors on the injured (loose side) calm down and quit sending painful noxious messages to the brain….Any thoughts?
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MyoSkelAlign22 reply on January 8, 2008:
I wonder if the shift in pain from the loose to the tight side doesn’t have to do with the body over time reorganizing itself above the injury site, as in how it carries the weight of the head and chest, i.e. neck and low back musculature shifting their functional patterns to avoid the SI pain on the one side, changing the way the SI is loaded from above - and all this only to find, as you point out, that the pain doesn’t go away it merely disappears temporarily to show up in another area in a different form. Suppose the same argument could be made from below, as ankles, knees, or other parts of the body’s base of support could similarly shift as the body works to escape the SI discomfort. I always took this explanation to be what was meant by the line, “if your pain goes away thats your problem”. That fixing the pain locally, whether we do it, or whether a shift our client makes on their own does it, just tends to chase the discomfort around. Thats all somewhat of a dodge of your question, Erik, because it doesn’t answer what exactly quiets the injured side, quiets the mechano and chemoreceptors except to say that the body works pretty hard to do whatever it can to quiet down the injured side, only, alas, to chase the pain elsewhere. Oh, and lastly, may I ask what of the nociceptors
surely they feel left out of the discussion.
By Erik Dalton on Nov 7, 2007
I don’t know exactly what the chemical situation is, but I would think it has something to do with the bodies gating mechanism. If we remained acutely aware of a harmful situation for longer than it takes the body to adapt, then we would all have sensory deprivation tanks installed in our homes and nothing would ever get done. Joking aside, I find, most often, a discomfort at the side of hypomobility. I find “tender points” with in the overstretched tissue upon palpation, but chief complaints by clients seem to manifest in the close packed side of SI joint dysfunctions. Likely nerve irritation due to the close quarters, or maybe it is the constant strain in the area with out movement. I recall that the joints enjoy oscillation. I wonder if there is a muscle/fascia component to the discomfort, in their attempt to create movement where movement should be?
In stating “I have always assumed the switch in painful sides results from strained long dorsal sacroiliac ligaments which are fighting a battle trying to keep the pelvis stable.” are you speaking of the hypomobile side gluing down to create stability or visa versa? Would you speak about sacrifice of mobility for stability? That may help me……….Thanks, I’ll try to keep up!
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By geo on Nov 8, 2007
In 9 out of 10 cases I find that the painful side,the hypermoblile or overstretched side is not the problematic side. Once the hypomobile or overcontracted side is released then the joint can move more freely. I have also always believed that pain that changes from one side to another is a positive result of deep tissue work. Pain that changes has the ability to move out of the body which is a good thing and my intension as a body worker.
As far as “holiday pain” goes, I have found more shoulder and neck pain this year so far, but you never know! The holiday season has just begun!
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By Risa Koonin on Nov 8, 2007
Hello Again Geo:
Are we the only therapists out there interested in SI Joints? I find pelvic dysfunction extremely interesting and confusing. The more dialog we can arouse, the better our understanding.
When discussing hyper- and hypomobility and pain I always flash back to studies that find the age of greatest human back and hip pain (25 to 45)occurs at the same time we have the greatest amount of movement at the SI Joints. Researchers speculate this is partly due to increased activity (and possible injuries)during those years but can’t completely explain the relationship.
Of course, women experience more SI Joint pain than men…partly because they have a wider and more shallow pelvis which limits the joint surface space at the L-shaped (auricular)SI joint. Fewer grooves means less stability so it makes sense they would experience more Upslips and torsions. Women also tend to be more hypermobile–particularly after the relaxin hormone has been secreted following the birthing process.
I’d like to continue our discussion of nerve pain eminating from the sacral nerve plexus and how it relates to joint hyper and hypomobility when I return from a workshop in San Antonio, Texas this week. Have to leave now to catch my airport express ride but will continue this discussion on Monday. Maybe we can include some thoughts on the relationship of SI joint pain and coccyx and piriformis pain…double and tripple-crush syndromes…talk soon>>>ERIK
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By Erik Dalton on Nov 8, 2007
I see a lot of SI joint pain in my practice–it almost feels like resolving this problem has become a specialty! I agree with earlier posts that the hypomobile side is the painful side and that lumbar tissue superior to the joint splints in an attempt to assist in hypomobility. Pain patterns in gluteus minimus and gluteus medius differ on both sides in a predictable way. Oftentimes, there are knots along the sacrum and, especially, around the coccyx.
Improper lifting or getting under a sink and working a wrench while the body is in a twisted position, for example, are scenarios that put people into this mess. And, on a practical basis, it’s fine to say “Don’t do that anymore,” to a client once you’ve corrected the situation, but how do we stabilize the pelvis once the correction has been made?
I look forward to the discussion about the contribution of the sacral nerves to this syndrome. This is an area where I don’t have much knowledge. I am looking for the relationship these nerves have to the viscera and the contribution that organ irritation has to this syndrome.
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By Linda Gutowski on Nov 12, 2007
And, on a practical basis, it’s fine to say “Don’t do that anymore,”
The only problem with this is the fact that people need to go back to work, need to drive and need to tend to their children. We can’t always change those external factors. But we can get the joint, ligament, and muscle to act in a functional way. We can suggest they pay attention to movement patterns, and re-educate themselves.
Seems as if the gluteal nerve pain will correct when the inferior gluteal nerve is given the proper pathway in which to travel, due to the normalization of the SI joint. This is what I see often.
Good talks! I like this blog. I look forward to many more treatment oriented conversation, thanks Erik and group.
I see a bunch of left hip pain in runners. Is that due to right anterior hip rotation, and a left side shift in weight bearing. It seems to me this stretches the IT band and all associated tissues, causing extra pull on the fibers there as they would have further to reach to get to the ground.??
Please help…….
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By geo on Nov 14, 2007
If your clients run on a road, they may be compensating for the slight bevel built into the road that encourages drainage.
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By Linda Gutowski on Nov 15, 2007
Yeah, I thought about this, however most of the folks are training on trails. Very uneven footing, bilaterally. They do some track workouts and road work, but they keep it mixed……
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By geo on Nov 15, 2007
Hi Risa, Linda and Geo:
Spent lots of time between clients yesterday entering an SI blog entry and when I submitted it, Internet Explorer had timed me out. The tech guy at Massage Mag is trying to retrieve it but if it’s gone, will re-enter tonight after work. Guess I shoulda written it in Word and copied and pasted…oh well.
Appreciate hearing all your comments on this fascinating subject.
Linda: A popular practice for stabilizing a hypermobile SI joint that has pretty-much been abandoned is the SI Joint belt. During my training with Phillip Greenman at Michigan State College of Osteopathic Medicine, he handed out flyers that described the belts that wrap around the pelvis to secure the joints during the acute injury stage.
At the time (early 90’s) much of the research was saying that ligaments must be mildly stressed following injury to encourage fibroblast activity, scarring and tightening. Therefore, clients/patients were told it was OK to “run through the injury”. Most of the new research on low back pain today says to continue activity and avoid bed rest, etc.
However, at the First Fascial Congress at Harvard Medical School a few weeks ago an intriguing ligament presentation was made (soon to be published in Spine Journal) that showed that stressing ligaments following an injury caused a dramatic failure rate, i.e., the more the ligament was used, the weaker it became.
So, this study is saying to completely rest any ligamentous injury for the first 48 to 72 hours and then slowly begin activity. No Motrin or Advil is recommended because they believe that the inflammatory waste products (histamines, prostaglandins, kinnins, seratonin, lactic acid, etc.) stimulate fibroblast activity.
Therefore, I sometimes recommend purchasing a rubber low back belt from Wallgreens and securing it around their pelvis so that the apex of the SI joint at S2 is nice and snug. This will help during the acute stages. Try it…it works.
Will delve into the pain issue tonight>>>thanks>>>ERIK
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By Erik Dalton on Nov 15, 2007
Hello Linda:
One of my teaching assistants just e-mailed me this message posted on your very nice “Fingertips” website (http://massage.largeheartedboy.com/). Thanks for taking the time to share your thoughts on my blog. I know you must stay very busy keeping up with your own manual therapy adventure. Stay in-touch….Gobble Gobble
Erik Dalton’s New Blog
Erik Dalton has launched a blog called Tech Talk. You can go to the website and comment on his posts and start a possible dialog with Dalton himself.
Some background on Dalton from his website: Erik Dalton, Ph.D., shares a broad therapeutic background in Rolfing® and osteopathy through innovative pain-management workshops, books and videos. Developer of the Myoskeletal Alignment Techniques® and founder of the Freedom From Pain Institute®, Dalton is dedicated to research and treatment of chronic pain conditions.
Dalton is also author of Advanced Myoskeletal Techniques, which has nothing but five star reviews at Amazon.com. After reading people’s comments, now I want to go out and buy his book! I’ve not attended any of Dalton’s classes yet, but I stumbled across his work while researching help for a client with severe scoliosis.
It’s interesting that I have found two new massage blogs from respected professionals in our field. I found them from an e-newsletter I receive from Massage Magazine. This must be a side project of the magazine and I think it’s wonderful that these innovators in the massage industry are now so accessible.
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By Erik Dalton on Nov 20, 2007
I just received an e-mail from a participant in this year’s Costa Rica workshop where Tom Myers was my special guest (Aaron Mattes will co-teach in 2008).
He was asking me why I place more emphysis on pain due to mechanical and chemical irritation to sensory receptors than pinched nerves. This was my response to him.
Although spinal nerves travel through small intervertebral foraminal openings, rarely does a bone-on-nerve dysfunction occur. Significant facet hypertrophy, disc collapse or intraneural edema must accompany the vertebral misalignment before the client experiences pain. While commonly associated with the spine, pinched nerve compressive lesions are actually rare. Researchers suggest that only 10 to 15% of SI joint and spine related problems are caused by direct pressure of bone on nerve tissue. Clients with this type of nerve occlusion usually report numbness, burning or a “pins and needles” feeling.
More frequently, nerve roots become agitated from prolonged exposure to chemical or mechanical irritation. This condition develops slowly as the nerve’s dural sheath is rubbed, scraped or over-stretched. However, when such neurocompression does exist, referrals should be made to appropriate medical professionals for an orthopedic work-up. Nerve-stretching techniques developed by David Butler are sometimes helpful in releasing slightly-restricted neural structures.
Contraindications for Butler’s nerve mobilization techniques include irritable conditions, inflammation, spinal cord signs, malignancy, severe nerve root compression, peripheral neuropathy, and complex regional pain syndromes.
As with all manual therapy procedures, the goal remains the same: “To restore maximal pain-free movement within postural balance”.
What makes the bone-on-nerve or foot-on-the-hose “pinched nerve theory” so popular is that therapists viewing anatomy texts or cadavers can easily visualize how spinal nerves could become entrapped as they make their way through the bony little holes between vertebrae.
For most of mankind, it is far easier to believe something that we can see versus something invisible to the naked eye. Despite this human tendency, somatic therapists must understand that spinal joints and muscles have massive nociceptive and mechanoreceptive innervation that is profoundly affected by sustained compressional loading due to tension, trauma and poor posture. While not clearly apparent, sensory receptors are the primary reason for client visits.
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By Erik Dalton on Nov 20, 2007
Hello Erik and fellow readers. I’m sure most of you are aware of the First International Fascia Research Congress that just took place in Boston. Wish I could have been there, I understand it was quite the place to be for the weekend, a lot of research was presented by the tops in the world on the subject. I know Mr. Dalton was there with his thinking cap on.
I see they have posted the oral and poster presentation abstracts at their site:
http://fascia2007.com/abstracts.php
Some very interesting reads….enjoy!!
Happy holidays all, stay healthy, keep the stress at bay.
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By geo on Nov 28, 2007
Hello again Geo:
Glad you brought up the First International Fascial Congress held at Harvard a few weeks ago.
There were a number of interesting presentations from the world’s leading researchers and clinicians. One of my favorite was from a guy from Montreal named Serge Gracovetsky. A delightful guy and a fellow musician, Gracovetsky has irritated biomedical researchers for years with his ideas on lifting.
Much controversy exists in the biomedical and rehabilitation community as to the preferred strategy for lifting. This may actually come as some surprise to many of you who believe that lifting with a flat or arched back (lordotic posture) is unequivocally the safer and more efficient way to lift objects from the ground.
Serge is a proponent of what is called the rounded back (kyphotic posture) lifting theory. At a Rolf Institute annual meeting presentation in the early 80’s, Serge argued that the back muscles are not strong enough to properly support the spine and that when lifting naturally (without being coached how to lift) people will round their backs relying on the posterior ligaments and lateral thoracolumbar fascia to support their spines. He insists that lifting with an arched back is dangerous, since contraction of the erector spinae muscles increases the compressive load on the spine.
In fact, a fundamental problem in spinal biomechanics is explaining why vertebrae and discs are not crushed during the lifting of even relatively small loads. This problem has been wrestled with by spinal experts for years.
Gracovetsky attempts to solve the problem by proposing a model of the spine where lifting occurs without great involvement of the back muscles. They argue that lifting with a rounded back (kyphotic lifting posture) is safer since this results in less contraction of the erector spinae (lower back) muscles.
He believes that to lift properly, we must rely on passive bracing of the posterior ligamentous system and the thoracolumbar fascia of the spine for support. They claim that this lifting posture/strategy is to be preferred, since it results in less spinal compression and less tendency for shear forces in the spine.
Gracovetsky argues that the lower back muscles are not located posterior enough to the spine to be able to exert very much extensor torque and that since the erectors are located very close and lateral to the spine, they were never intended to generate much power.
Am currently writing an in-depth article on the subject with my perspective. Anyone else have an opinion on Serge’s theories???
Off to Costa Rica to buy property and build a house>>>talk when I return on the 12th of December>>Merry Merry …ERIK
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MyoSkelAlign22 reply on January 8, 2008:
Is the fundamental problem you mention explainable by the spine or something around the spine working as a tensegrity structure? I’m asking, I don’t know, but I sure like Snelson’s art.
By Erik Dalton on Nov 28, 2007
He believes that to lift properly, we must rely on passive bracing of the posterior ligamentous system and the thoracolumbar fascia of the spine for support. They claim that this lifting posture/strategy is to be preferred, since it results in less spinal compression and less tendency for shear forces in the spine.
Gracovetsky argues that the lower back muscles are not located posterior enough to the spine to be able to exert very much extensor torque and that since the erectors are located very
Erik- Can you simplify this for us…….
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By geo on Nov 30, 2007
By observing dock-workers and others in the industrial lifting population, Gracovetsky initially theorized that people instinctively rounded their backs into a kyphotic or reversed lumbar lordotic posture to conserve energy by shifting some of the weight to the posterior spinal ligaments.
As a result, he received quite a lot of criticism by other scientists with the release of his Spinal Engine book in 1988. This was partly due to his focus on ligaments as a primary support system for bracing the intervertebral discs during forward bending.
Granted, ligaments are well-designed to restrain excess motion and reduce stress at joints, but when loaded for prolonged periods, they can deform or creep which often leads to spinal instability and back pain. Researchers also pointed out that one of the Serge’s primary support ligaments (supraspinous) was commonly absent below L-4 in dissection studies and therefore, unable to stabilize the most vulnerable of all spinal segments…L-4/5 and L5/S1.
Personally, I think the missing link generally overlooked by Serge’s critics is the role the thoracolumbar fascia plays in the lifting process. With longer lever arms, this tough fascial support system has the ability to provide the erector spinae muscles the leverage they need to produce a beautiful antigravity springing system to lift the trunk off the pelvic girdle. Regrettably, in many of the clients we see in clinic, their bodies are “stuck” in (either) an intrinsic or extrinsic state of collapse from prolonged sitting, injuries, poor posture, etc.
So, for Serge’s kyphotic lifting posture to function optimally, I believe proper muscle activation (firing order) is of critical importance. Here is a proposed (lifting) firing order pattern I believe would help buttress Serge’s argument.
The first three muscles to fire to brace the trunk and stabilize the spine in preparation for trunk extension would be transversus abdominis, external obliques, and the multifidi. Then, the biceps femoris, gluteus maximus and contralateral erector spinae muscles must fire in a “crossing” pattern through the long dorsal sacroiliac ligaments to help lift the load.
This intimate connection between muscles, thoracolumbar fascia and spinal/pelvic ligaments are the key to kyphotic trunk lifting…particularly if you believe that contractile receptors exist in lateral thoracolumbar fascia.
Fortunately, several studies are underway including some work by my good friend and fellow Rolfer, Robert Schleip, to help determine the extent of fascial contractibility. We know that ligaments contain proprioceptive and nociceptive receptors that work to protect and stabilize the spine but the jury is still out on the role of fascial innervation. Personally, I can’t imagine this vast and complex fascial support system not being monitored by the brain…but time will tell.
In closing, I’d like to offer this question and answer to dwell on: What are the contractile fibers in fascia called?
Answer… MUSCLES >>>>>Happy Holidays
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MyoSkelAlign22 reply on January 8, 2008:
Is that muscle firing pattern Australian?
By Erik Dalton on Dec 17, 2007
New Year’s (Therapy) Resolutions. When walking or running try activating the ipsilateral gluteus maximus muscle on heel strike. Squeeze it hard with each step!
This simple muscle activation tip will do wonders for restoring foot, lower limb and pelvic balance.
Try it first for a week (works best at first barefooted or with non-suported shoes). What do you feel happening in the rest of your body as a result of this simple muscle activation cue? What are your knees doing? Do you feel a change in positioning of your pelvis in the sagittal plane as you walk? Erik
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By Erik Dalton on Dec 19, 2007
Very Interesting!!
I work with several quadraplegics (complete injuries to the spine in the c3-c4 region, no ability to control muscles below nipple level), and impartial quads (injuries to the spine in the c3-c4 region, partial control of muscles below the spine, some sensation in the muscles and tissue below nipple level, and ability to stand and sort of walk a little, using movement from the hips to motor the legs).
The clients are athletes and being upright in the chair is a must, ie: trying to activate the erector spinea even though they are unable to consciously control any muscle below nipple level. Unfortunately, they have no conscience control of biceps femoris, gluteus maximus or any of the abdominal muscules. I have found however, that working these muscles does reduce the faccidity, and hopefully allows unconscience control by the mind. (?) All admit their brain recognizes pain below the nipple level even though they do not feel consciencly. The brain will provide signals to the area and result in contraction or movement should pain occur.
I’ve seen improvement in the erector spinea muscles by working the deep muscles of the spine as well as the erector spinae muscles and moving them closer to the spine. Using techniques of upper cross syndrome, there is a decrease in the amount of kyphosis in the upper thoracic area. Release of the deep muscles of the spine in the lumbar region and working the QL decreases scoliotic curvature from being in a chair. Strengthening of the lats and opening of the chest and pectoral region improves posture in the chair. Therefore, I’ve THEORIZED these muscles are unconsciencly controlled by the brain.
The idea of contractile receptors in the lateral thoracolumbar fascia seems to present a possibility with this population.
Looking for thoughts, ideas and opinions on this subject. Have not been able to find a lot of research on the subject (even on the internet).
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By Willie Hafer-Allen on Dec 19, 2007
Q. The idea of contractile receptors in the lateral thoracolumbar fascia seems to present a possibility with this population.
Looking for thoughts, ideas and opinions on this subject. Have not been able to find a lot of research on the subject (even on the internet).
A. Hello Willy:
I believe you’re on the right track with your thoughts on unconscious “brain-monitoring” of paralized limbs. Sensory information from receptors (particularly pain-sensing nociceptors) fast-track their way to the thalymus which is a kinda’ sorting and switching station in the brain. The thalamus then decides which part of the brain to relay the information for intrepretation. It may send to areas of sensing, feeling or thinking.
Although the perception of touch or pain may not be consciously felt in your client’s paralized legs, neural activity may still be monitored by the limbic system. Recall that the limbic system is the cortical level regulating muscle tone and it does it on an unconscious level.
Below are some interesting links to Robert Schleip’s research on fascial contractibility. Also included is a U-Tube Interview with Robert at the Harvard Fascial Congress. Google any of these research studies to review his ongoing research.
Robert Schleip PhD
Institute of Applied Physiology,
Ulm University, Germany
Related Publications:
Schleip R. Klingler W. Lehmann-Horn F. Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Medical Hypotheses. 65(2):273-7, 2005.
Schleip R. Naylor IL. Ursu D. Melzer W. Zorn A. Wilke HJ. Lehmann-Horn F. Klingler W. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Medical Hypotheses. 66(1):66-71, 2006.
Schleip R. Fascial plasticity — a new neurobiological explanation: part 2. Journal of Bodywork and Movement Therapies. 7(2): 104-16, 2003.
Schleip R. Fascial plasticity — a new neurobiological explanation: part 1. Journal of Bodywork and Movement Therapies. 7(1): 11-9, 2003.
http://www.fasciaresearch.de/2005PosterFreiburg.pdf
http://www.youtube.com/watch?v=y01_bpLMpqU
Let me know if any of this research helps in you wonderful efforts working with quadraplegics…Best to you >>>ERIK
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By Erik Dalton on Dec 21, 2007
Howdy MyoSkelAlign22:
Like the name you’ve chosen for my blog. Did you create it just for this forum or are you a “Certified Myoskeletal Therapist?”
Looking forward to responding to your nice suggestions on SI Joint pain. Regrettably, I just returned from the health club and have been trying to finish a new article I’m writing titled, “Don’t Get Married”.
The gist of this article focuses on problems with getting too involved with certain biomechanical concepts and later discovering they are invalid. Research today is moving so fast that it’s not a good idea to become too ‘married’ to any one concept.
I’m really excited about this particular two-part project. It deals with the concept of core stability….fact or fiction?
New research is debunking this whole transversus abdominis mantra that trainers and manual therapist have been married to since the Richardson/Hodges research on core muscle timing was released in the late 90’s.
These new concepts I’m getting ‘engaged’ to will fit in perfectly with our SI joint discussion. Hope to get back to you on Friday (my 64th Birthday)with some biomechanical ‘fodder’.
Thanks for your thoughtful blog entry…talk soon…ERIK
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By Erik Dalton on Jan 9, 2008
SI joint stuff MyoSkelAlign22:
Acute SI joint injury from a fall often creates local hypermobility in one hip. The body/brain deals with pelvic instability in a variety of ways depending primarily on the degree of strain. Body weight, activity level and genetics are factors that influence the healing time-frame. In the short term, damage may be limited to the long dorsal sacroiliac ligament but in time the joint’s articular cartilage(s) may become a factor.
Mechanoreceptors stimulated by alterations in normal SI joint movement begin flooding the spinal cord’s neuronal pool with noxious messages that manifest as subthreshold stimuli and the neurons are said to be facilitated. If the injury involves actual tissue damage, accompanying waste products such as kinins, bradykinins, potassium ions, serotonin, and lactic acid trigger sensitive chemoreceptors causing subthreshold stimuli to escalate to action potentials that travel up the cord warning the brain of the possibility of tissue damage.
If the incident is severe, nociceptors can fast-track information to the brain for interpretation. The thalamus analyses the input and relays the information to one of three cortical areas responsible for thinking, sensing and feeling. Due to the high volume of input from mechanoreceptors, chemoreceptors and nociceptors during an acute episode, the signals often gets jumbled (cross-talk) and the brain becomes confused as to the exact location and severity of the injury. To cover its bases, the thalamus layers the area with protective muscle guarding (splinting) to prevent further insult to vulnerable sacral plexus nerves and joint structures. This often signals the beginning ornery pain/spasm/pain cycles responsible for creating pelvic obliquity and loss of lumbopelvic rhythm. Unleveling of the sacral base leads to compensations that travel up the spine and down through the legs. In time, distorted body alignment sinks its tentacles deep into joints of the feet, knees, hips, ribs and spine creating satellite pain sites.
Regrettably, the brain has the ability to memorize these aberrant postural patterns and relearn them as normal. Neuroscientists call this condition spinal learning, reflex entrainment or neuroplasticity. It’s important that the therapist correct these strain patterns before they have a have a chance to burn a groove in the central nervous system and become chronic. A serial-type therapy where the client is seen a couple of times a week is often helpful in breaking or preventing formation of these patterns.
I really like spring tests that assess joint play followed by gait analysis and anatomical landmark evaluations. My personal belief is that the therapeutic goal should always focus on testing and restoring function first, i.e., range of motion, flexibility, joint play, motor control and firing order patterns. Let face it…there is no perfect posture. Bodies typically vary from side-to-side and, although, anatomical landmark and visual observations are useful for structural integration work, in a pain management setting, restoring function should precede postural alignment
As you say Mr. MyoSkel, the strain patterns can travel up (ascending syndrome) or down (descending syndrome) creating pain-generating compensation as they compress joints and strain related soft tissues. So unless the postural imbalances are properly assessed and corrected in their early stages, it’s often difficult to locate the “key” lesion. This commonly leads us on a useless journey of ‘chasing the pain’.
The problem with SI joint strain and accompanying sacral base unleveling is the influence it has on the reciprocal motion at L5-S1. As the sacrum sidebends right and rotates left during the normal walking cycle, the lower lumbar spine must do the opposite. Any fixation can cause facets to jam and discs to loose their ability to create a rotary torque.
From studying the work of Serge Gracovetsky, I’m convinced that proper lumbar lordosis is necessary to drive the body’s spinal engine during gait. At left heel strike the right shoulder moves forward creating a pull on the latissimus dorsi through the thoracolumbar and lumbodorsal fascia…and SI joint ligaments. This force is countered by contraction of the contralateral biceps femoris and gluteus maximus. At left heel strike, the torso is left-rotated and the pelvis is right rotated. This causes a rotary torque in the lumbar spine’s annular disc fibers and facet joints. As this storage of kinetic energy is released, a ‘pulse’ of mechanical energy efficiently propels the body forward. However, to properly ‘wind-up’ the system and drive the spinal engine, the lumbar spine and pelvis must be functional.
There are dozens of therapeutic approaches for balancing the myofascial system and we all have our own thing that works for us. I personally like Vladimir Janda’s upper and lower crossed work for restoring proper spinal curves, springing techniques for identifying functional aberrations, and retraining exercises to establish proper firing order patterns and core stability.
Regrettably, myofascial work alone doesn’t always free motion restricted joints. As prolonged asymmetrical compressive forces cram facets closed on one side, synovial fluid dries and articular cartilage degrades. Gently Myoskeletal techniques engage the deep transversospinalis muscles in the osteoligamentous canal as the client places an activating force through the area. We call these client-activated movements enhancers. Sometimes these maneuvers are successful in releasing the deep spine-related tissues responsible for joint blockage and sometimes they don’t work at all. That’s why I like to keep a good referral base of chiropractors and manipulative osteopaths that can put a high-velocity low amplitude force through the stubborn joint fixation so I can continue restoring function to the rest of the structures that drive the spinal engine.
Thanks for your input MyoSkel. Will get to your other questions tomorrow…ERIK
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By Erik Dalton on Jan 12, 2008
Hi Erik,
How can I get your E-newsletter? I have a couple of questions to ask you too if you do not mind.
Thanks!!
Jon Borges
Intuitive Touch By Jon
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By jon Borges on Jan 24, 2008
Jon: Sign up for my Monthly Technique E-newsletter by visiting:
http://erikdalton.com/asccustompages/newsletter.asp
Thanks for joining our little group of Myoskeletal bloggers. I’ll try to answer any questions you have and if I’m not sure, other visitors may be able have some suggestions.
Hope to hear from you and enjoy the e-newsletters. You can read all my published articles and past e-newsletters by visiting: http://erikdalton.com/articles.htm
Talk soon….ERIK
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By Erik Dalton on Jan 24, 2008
Great Post!
I’d like to share a knowledge that Serola Sacroiliac Belt is one of the most effective method for back pain relief. I know a lot of people who wear this belt and the results have been astonishing. Feel free to visit their website at http://www.serola.net
Thank you.
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By Guest with Severe Back Pain on Apr 2, 2008
Hi Erik,
I just found your website this morning while surfing for fascia info. I’am a college student age 41, in therapeutic massage therapy and love it! The question I have for you has been left unanswered for me for the past 10-12 yrs. I constantly have lower lumbar pain (it hurts to exercise, so I’m always gaining weight) and when I do try to walk for exercise, within 10 minutes, I get an itching sensation from my coxal area all the way down to my feet. I must stop, I start crying because the itching and tingling on the interior of these areas is so bad, I literally claw myself to get relief! It usually takes at least 20 minutes of my clawing and sitting still before it passes. The other morning when getting ready to step out of the shower,I had the same sensation from my knees to my feet! This is the first time this has ever happened.
I will be graduating in December of this year and I so much want to get in shape and lose weight, but it hurts; can you please give me some advice on what in the world I can do about this? Thank You. I have enjoyed reading the questions and answers on your website. Please respond soon if you can. Have A Great Day!!
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By Marilyn Ebelhar on Apr 10, 2008
Hello Marilyn:
I’d get an lumbar spine MRI to rule out sciatic nerve occulusion. If you’re experiencing bilateral itching below the knees, I would suspect L5-S1. If the itching occurs only on one side a time, it’s probably a fixable problem.
Bilateral itching that turns to lower limb pain or even worse…numbness, requires an orthopedic work-up.
Let me know what you find out…ERIK
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By Erik Dalton on Apr 11, 2008