Working with the Multifidus Muscle
Dealing with back pain for any length of time will certainly involve the multifidus muscle. While its not likely to have a specific multifidus injury, the muscle itself is HIGHLY prone to dysfunction and trigger point development.
Welcome back!
How To Get A Quadratus Lumborum Stretch
Stretching in the case of quadratus lumborum injury or long term tension is fairly simple and straightforward. In the video below, I’ll show you how.
How To Sleep With A Disc Bulge
Should You Use Inversion Therapy For Back Pain?
Aerobics For Back Pain?
What to Do with Anterior Pelvic Tilt AND Disc Herniation!
Treatment for Sacroiliac Joint Pain
What is the Sacroiliac Joint?
The joint is comprised of the area in which the sacrum and iliac bones meet.
Stabilization of the SI Joint: Two Types
Form Closure
Form closure is the stability that happens when the tight fitting joint surfaces of the SI joint are close together. This is very much dependent on the size and shape of each person’s structure.
Force Closure
Force closure is the support offered to the SI joint by the ligaments and muscular systems.
Most research is is clear that no muscles directly move the SI joints, but its important to understand how their dysfunction can promote sacroiliac joint dysfunction.
Addressing Sacroiliac Joint Pain
Sacroiliac joint treatment options beyond medical interventions are quite simple, in fact. They need to be separated into 2 different scenarios:
What to do when the sacroiliac joint is OUT:
As mentioned previously, there are not any muscles in particular that move the SI joints. However, there are some movements that are useful in assisting the mobilization of the sacroiliac joints.
Unfortunately, sometimes its not possible to get the joints back into balance on your own. Many times with patients, I have to help them by anchoring certain parts of their pelvis or sacrum while they perform movements in order to re-balance the area. Therefore, its recommended to see a trained professional to help with this.
The good news is, on more than a number of occasions, someone walks into my office with sacroiliac joint pain of a 9 on a 10 scale, and within 5 minutes, I can get them down to a 2 or a 3. This just demonstrates how much potential to cause pain these joints have, AND how quickly it can be resolved by doing the right steps to resolve it.
What to do when the sacroiliac joint is IN:
Once significant pain is resolved, and sacroiliac joint inflammation is reduced, corrective exercises and stretches must be implemented in order to effectively restore balance to the muscular “slings” that support the area.
Sacroiliac joint exercises need to focus on two areas. Some of the key muscles that need to be addressed are found in two different “layers” of muscles.
The Inner Unit:
The inner unit muscles are a deep set of muscles that help stabilize your entire core and are frequently shut off, or possess inappropriate activation patterns during periods of pain. They include:
-The muscles of the pelvic floor
-The transverse abdominus
-The multifidus
-The diaphragm
These muscles must be isolated to ensure proper activation and sequencing, then integrated with the next group of muscles, called the Outer Unit.
The Outer Unit:
The outer unit is further segmented into 4 systems, but in essence, involves the following muscles:
-The gluteals (all of them)
-The spinal erectors
-The abdominal wall
-The groin muscles
-The hip flexor and quadricep muscles
The real trick to resolving any problem with back pain seems to always come back to the correction of the deep muscular stabilizer systems of the body, then re-integrating them with the larger, more powerful muscles.
If you don’t follow this sequence, your results will be limited to symptom relief for the short term. I have seen this time and again in my practice with patients who have progressed their programs too quickly just to “get stronger”.
When I end up seeing them after the many therapists they have seen prior to me, I have to take them back to the beginning anyway. In this situation, unfortunately, they have been taught to OVER activate the larger muscles, and I have to re-train them to focus on the micro-movements that need to be done.
Lesson here: Whats worth doing is worth doing RIGHT the first time!
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Inflammation and Back Pain
Pelvic Tilt Measurement
A common email question I receive is about measuring pelvic tilt. The best way to measure pelvic tilt is with a specialized set of calipers that were developed by neuromuscular therapist Paul Chek. These can be quite pricey, and are only usually found in the offices of skilled therapists.
The other way to measure pelvic tilt, which is quick, cost-free, and easily done is home is by looking at your belt line in the mirror. Usually, the front of your belt line rests either slightly above, or slightly below the Anterior Superior Iliac Spine, which is the small bony protuberance just above your thigh. The backside of your belt line usually rests again just above or below the Posterior Superior Iliac Spine, which are found about 2 inches to the side of the spine.
When you look in the mirror at your side view, you will look at the angle of the belt line. For men, the line should be parallel to the ground, with neither the front or the backside higher than the other, with normal measuring 0-5 degrees. For women, the angle should be slighter lower on the front side than the backside within approximately 7-10 degrees being normal.
It is important to note, that these are the “textbook” normal values for pelvic tilt. It should not be the ONLY evaluation for normal function and balance of the core muscles. You should also evaluate the range of motion and strength of all the associated muscles in order to really test total function of this area. You do NOT have to be perfect, but close enough to be out of pain!
Sam Visnic–
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"Having someone like Sam to refer my patients to who is as comprehensive, brilliant and caring as he is makes my job so much easier!! I feel assured that my patients are in good hands and are going to get the results they so desperately want. I highly recommend Sam to anyone who is looking to resolve their back pain easily and effectively!”
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HealthSource Chiropractic and Progressive Rehab