Low Back Pain: Ignite Your Core

When we think of having a strong core, we generally strive for obtaining that summer ready 6 pack, however; the core muscles I’m referring to are the pelvic floor and Transversus Abdominus. Don’t get me wrong, as much as the 6 pack or the most outer layer of abdominals ( rectus abdominus) is aesthetically pleasing, they don’t’ support our foundational structure, the spine and pelvis. The Transversus Abdominus and pelvic floor muscles make up the deepest layer of musculature, supporting the spine and pelvis and when strengthened and engaged properly, can off load strain on the low back and significantly reduce low back pain.

Think of the T.A as a corset on ladies and a cummerbund on men, cinching muscle to bone, wrapping around our entire midsection front to back. Most of us don’t know how to engage this layer of muscle properly, if at all. When I explain to patients how to engage this layer, I use the analogy of trying to stop the flow of urine, engaging belly to spine, as opposed to pushing out your 6 pack. This can be tricky at first as it is the opposite from what we typically think flexing our muscles means. There is a series of exercises I prescribe to patients who experience chronic low back pain, women who have given birth or anyone who has had abdominal surgeries. (Laparoscopy, appendectomy, hysterectomy etc.)

The relationship between the low back, transversus abdmoninus and pelvic floor muscles.

Try to find your core by lying on your back and sucking your belly towards your spine and see if you can repeat this a few times, noticing any differences, working up to 20 repetitions.

Inhale through your nose, then as you exhale hug your belly towards your spine. You can feel the TA contract under your fingertips.

The ultimate goal is to restore your core and reduce or prevent low back pain and don’t worry, your 6 pack will get better looking along the way too maybe even dare I say, the 8 pack? I keep telling myself, it’s in there somewhere!

Fascia Forward by Jil

So, I decided to make an actual name for my blog instead of "My Blog". Here it is! Fascia Forward by Jil. I also just learned, being new to this whole blog thing, what blogging actually meant. It's an outlet for anything and everything, medical or non-medical, it's all happening in Fascia Forward by Jil. I will stick to mostly informative medical massage information pertaining to anatomy and pathophysiology of the musculoskeletal system and its associated conditions, but I will also be throwing in the random most common "massage phrases of the week" and what those actually mean as well as some valuable massage therapy tips. Like this one,

Ladies this ones for you,

It honestly doesn't phase massage therapists that you forgot to shave your legs; we also treat men. Now you can rest easy. You're welcome.

Let's talk about low back pain: How, Why and Prevention

So What causes low back pain?

One of the most common ailments I see is low back pain. So what causes this? Often it can be from a lifting and twisting injury, where there is too much strain placed on the deepest layer of low back muscles called multifidi. These muscles provide stability between the pelvis and lumbar (low back) and the deep core muscles. Our center of gravity is located in between the low back and the pelvis at the second sacral vertebrae. When our center is unstable, mechanical force is translated elsewhere and muscle imbalances form, creating more instability and results in compensatory pain IE: low back strain. Sitting and sedentary lifestyles have been branded as the "new smoking". The most compression and force on the low back and its associated structures (intervertebral discs, vertebrae, nerves, musculature) is when in the seated position. How often do you sit while at work? Do you spend a lot of time in your car? Are you active before or after your work day? It is important to get up and move around every hour to relieve disc pressure and circulate blood flow to your tissues. Stretching is another great way to traction the spine from the pelvis, create space around discs by elongating musculature and increasing blood flow.

Sciatica Vs. Piriformis Syndrome

~ Sciatica is caused by an L4/L5/S1 disc herniation or bulge compressing the root of the Sciatic nerve. This can cause shooting pain down the legs and into the foot, numbness, tingling and weakness especially in the foot resulting in Foot Drop or the inability to lift the toes while walking. This is irreversible damage but symptoms and pain can be managed with massage therapy and therapeutic yoga where surgical intervention may not be necessary.

~ Piriformis syndrome is the compression of the sciatic nerve under the Piriformis muscle in the buttocks, when it becomes too tight and adhered. Shooting pain down the legs is common, however; there is no weakness or numbness. A tight Piriformis muscle is usually caused by prolonged sitting or repetitive external rotation like in skate skiing, hockey or ice skating. Does not cause long term damage or effects. Can be managed and treated with Massage therapy and stretching.

Here are a few key stretches to relieve low back pain and sciatica symptoms.

Bring your feet together and knees wide, arms stretched out above your head, drawing your tailbone down towards your heels. Forehead rests on the floor. Hold for at least 1 minute.

Lying on your back, bring one knee in towards your armpit, flex both of your feet to keep your spine long. Hold for at least 30 seconds then switch sides.

Seated on the floor, plant the sole of your right foot on the outside of your left extended leg. Place your your right fingertips behind you to keep your spine long, avoiding rounding in your back. Reach up with your left arm to place your elbow on the outside of your right knee and press into each other to twist from your abdomen. Hold stretch for at least 30 seconds and repeat on the other side.

Lying on your back, bend both knees to plant the sole of your left foot on the floor. Place the outside of your right foot on your left thigh and reach your arms through the figure 4 to hang onto your left hamstring. Pull your left thigh closer towards your body to accentuate the stretch in your right outer hip. Hold stretch for at least 30 seconds and repeat on the other side.

Lying on your back, hug your right knee in towards your chest, then cross your leg over your left side body. Keep both shoulder blades on the floor and if you need to stack pillows under your right knee to allow for this to happen with support then go ahead and do so. Hold each side for at least 30 seconds.

Watch this video on how to self massage using a foam roller to tight muscles and alleviate pain associated with the low back and sciatica. The foam roller is a great tool to use in between massage therapy appointments to maintain soft tissue health. I am also a big advocate for using tennis or lacrosse balls in order to get to deeper musculature, especially in the gluteals. Foam rollers apply a broader pressure, where as tennis balls apply a point specific pressure, allowing for a more intense self massage experience. In sensitive areas like the Iliotibial Band (IT band), I like to use the foam roller, and in thicker areas like the gluteals, I prefer to use tennis balls. Explore them both and see which area and pressure tool suits you best. For best results, foam roll daily for 5 - 10 minutes along with the stretches above and massage therapy treatments for maintenance.