Monday, June 24, 2013

Lower back pain.


Myofascial Pain Syndrome of the Low Back

By Dr. Greg Fors
Back Pain Occurrence:
Self-Care myofascial release products can reduce pain and enhance the strength and flexibility of your low back.
You are not alone; approximately 80% of the population suffers with back pain some time in their life. At any give time nearly one-third of us are experiencing some form of back pain! This sometimes disabling condition is second only to the common cold for problems that drive individuals to a doctor. It strikes the young as well as the elderly, with an increase in occurrence of back pain during the third to sixth decades of a person's life. Back pain tends to happen more than once to individuals, with reoccurring episodes increasing in severity. Back pain is also very expensive, costing our healthcare system more than $20 billion dollars a year. Chronic low back pain is the most expensive benign condition in industrial countries and the most common cause of disability in persons younger than 45 years. So learn all you can and do something now before you become a statistic of chronic back pain.
Your Back:
  • Is composed of boney vertebra stacked upon each other
  • These vertebra are held together by tough fibrous bands called ligaments, which can also become injured
  • There are shock absorbing discs between each vertebra
  • These moveable vertebra and discs form the spinal column
  • The back muscles attach to the spinal column and pelvis acting like dynamic guy-wires holding you upright
  • The spinal column also serves to protect the delicate spinal cord and exiting spinal nerves.
Your Back is Working Overtime
Humans sit and stand upright against gravity all day long. This causes a tremendous burden to be placed on your spine and back muscles; in fact your back muscles, unlike other muscles, are always at work. Your back muscles work hard to maintain your posture, whether you are quietly sitting or just standing in line. They also work overtime to stabilize your body so you can do work with your arms and legs.
It's easy to see that without proper maintenance, your back muscles can get overworked and become painful. You don't let your car go long without any maintenance; if you do it soon stops working, right? The same with your back. If you don't stretch and strengthen your back muscles, and you overwork them, they can soon develop painful muscle knots, known as myofascial trigger points.
Back muscles with myofascial trigger points become shortened, weakened, and painful, affecting the function of your spine. When the spine does not function properly the joints and discs of the spine wear out prematurely. It's like the front end of you car, if the linkages (muscles) are out of alignment (too loose or too tight) your tires (joints and discs) will wear out prematurely.
The muscles of your back are composed of many layers, generally divided into three major layers: superficial, intermediate, and deep. These muscles, along with your abdominal muscles, form the core stability of you back.

Causes of Back Pain:
Back pain is caused by a wide variety of physical, physiological and environmental factors. Very occasionally back pain can be caused by rare and dangerous pathological processes (e.g. tumors, infections). Because of this anyone with back pain must have their condition properly diagnosed by a competent doctor. Once these pathological diseases have been ruled out, mechanical causes of back pain are left and should be properly treated so the condition does not become recurrent and/or disabling.
The major underlying factor in mechanical back pain is muscle imbalance which can eventually lead to many other problems, such as spinal joint degeneration (arthritis), disc herniation and disc degeneration. These conditions can lead to pressure on delicate nerves that exit from the spinal cord causing an extremely painful condition.
The major cause of these muscle imbalances in the core muscles of your back are myofascial trigger points (muscle knots). These myofascial trigger points are hyperirritable spots in over stressed muscles that cause local pain, stiffness, and referred pain to other regions, such as in your buttock, hip or down your leg. Myofascial trigger points cause muscles to shorten and weaken; because of this, trigger points interrupt the normal motion and function of your vertebra and they fire pain signals into your spinal cord, causing your back to become hypersensitive and irritated by almost any activity. These myofascial trigger points can be released by utilizing trigger point therapy massage.
Relieve Myofascial Pain Syndromes of the Low Back:
It is now possible to apply trigger point therapy to pain-causing myofascial trigger points and adhesions at home by utilizing the FENIX Rehab System. You can learn how to do this by clicking here. There you will be shown how to apply the FENIX Rehab System step-by-step. To find your treatment points go to "How to Find a Trigger Point" and click on to get step-by-step instructions.
The "Joker of Low Back Pain" Muscle-Quadratus Lumborum:
One of the most frequent causes of chronic myofascial pain syndrome of the low back is the quadratus lumborum muscle. The quadratus lumborum runs from the top of your pelvis to your bottom rib on each side of your low back and works hard to stabilize your spine. The quadratus lumborum refers pain down over the sacroiliac joint area, (the area under the big dimples on each side of the bottom of your low back) and to your buttock. Severe pain can be referred to the hip joint and disturb sleep. You will find this major low back trigger point at the outer end of line C in the picture of the model. It is found at your waist slightly below your bottom rib, about a hands width lateral to your spine. (See pictures provided). See the location of the muscle indicated on the model.
Aching Back
Oh, my aching back!

Quadratus Lumborum muscle TP
Quadratus Lumborum muscle TP

Identiying Quadratus Lumborum TP
Identifying the quadratus lumborum muscle trigger points

Trigger Point Therapy

The accompanying picture demonstrates the position for trigger point therapy for the quadratus lumborum muscle. Use a digit just long enough to apply adequate pressure to create a referral sensation. A slight angle to the digit is sometimes helpful angled inward toward the spine. Trigger points in the quadratus lumborum many times cause the gluteus medius (see in up-coming explanation) to form myofascial trigger points. These two muscles together are often times the cause of chronic low back pain that fails to respond to treatment. Always stretch the quadratus muscle after trigger point therapy, go slow and easy, only do as much as you can without pain (see picture), hold for about 60 seconds.
Treat Quadratus Lumborum TP
Stretch Quadratus Lumborum TP
Treating & stretching lateral low-back muscles quadratus lumborum

The "Deep Lumbago Muscles":
Moving in toward your spine along line C, before you come to line B you will find the iliocostalis and longissimus spinal muscles known as the "lumbago muscle." The myofascial trigger points of these muscles refer pain down, all along the entire low back (lumbar spine) to the mid-buttock. The FENIX Rehab System has been designed to specifically treat these pain-causing spinal muscles on each side of the vertebra. The ililcostalis and longissmus spinal muscles are farther out from the spine are deactivated with the paired angled outward digits (see picture). For location and deactivation of these trigger points see pictures of the model in the guidebook or located here.
Always stretch the muscles around your back after applying trigger point therapy. Go easy. Only do as much as you can without pain, (see picture) maintain for about 60 seconds.
Identify Iliocostalis and Longissimus
Iliocostalis and Longissimus Myofascial Trigger Points
Deactivate Iliocostalis Longissimus
Technique to deactivate trigger points of the Iliocostalis lumborum and longissimus muscles on each side of the spine

Moving in further on line C you come to line B which parallels the boney ridge at the middle of your back. Line B lies about 2 finger widths away from or these boney bumps of the spine (lateral to the spinous processes). Deep in these paraspinal tissues lie the deep multifidi and rotatore muscles connecting the lumbar vertebra together. These muscles cause severe deep aching pain right around the level of the myofascial trigger point.
These deep muscles around the spine generally develop active pain-causing myofascial trigger points from sudden over work of the lower back. This happens when lifting objects too far from the body or with the back twisted, or when bent over for long periods of time. These deep myofascial trigger points easily become chronic and disabling. These deep myofascial trigger points, when positioned at the bottom of your low back (on each side right above the large dimples), can also refer pain to the posterior and outside aspect of your leg, mimicing sciatica.

Multifidi Myofascial Trigger-Pain Pattern in Red

X marks Multifidi and Rotatore Myofascial Trigger Points
FENIX therapeutic digit placement for deactivation of deep Multifidi and rotatore myofascial trigger points on each side of the spine

Therapeutic technique to deactivate myofascial trigger points in multifidi and rotatore muscles on each side of the spine. Therapeutic digits angled inward go on each side of the boney bumps of your spine (never place digit on boney bump only on muscle)
Mid-back and low-back muscles (keep knees slightly bent)

The Fenix Rehab System has been designed to specifically treat these pain-causing spinal muscles on each side of the vertebra. The multifidi and rotatore muscles deep and close into the spine can be treated with the paired angled-in therapeutic digits (see picture). For location and deactivation of these trigger points see pictures of the model in the guidebook or located here. Always stretch the muscles around your back after applying trigger point therapy. Go easy. Only do as much as you can without pain, (see picture) maintain for about 60 seconds.
For relief of myofascial pain syndromes of your low back pain, self-care trigger point products are vital.

The "Lumbago Muscle"- Gluteus Medius:
Another major "lumbago muscle" is in the upper buttock called the gluteus medius muscle. Many times this muscle with the previously described quadratus lumborum above cause severe chronic back pain that will not respond until the myofascial trigger points in both these muscles are deactivated. This important muscle can be found along line A in the picture of the model. To locate line A find the large boney bump next to the dimple in your low back (models left hand) and the boney bump at the front of your bony pelvis. Now draw an imaginary line connecting these two bumps, about 1 1/2" below the top of your pelvic rim (iliac crest).
You will find these muscles three major trigger points by moving outward or lateral along line A, along the line of your jean pocket. These gluteus medius myofascial trigger points lie 1/2 to 3/4 the distance outward or laterally along the length of line A. The halfway mark would be approximately at the letter A on the model. These trigger points, if you have them, will be extremely tender to pressure and will refer pain strongly into the low back especially over the sacrum or "tail bone" area. See pictures of the model for location and deactivation position for these myofascial trigger points.

Xs mark Gluteus Medius Myofascial Trigger Points

Posterior thigh and lateral low-back muscles (gluteals and hamstring)

Identifying the Gluteus medius myofascial trigger points at the top lateral buttock
Using FENIX Gluteus medius myofascial trigger points
Lateral hip muscle buttock muscles gluteals/TFL piriformis

The Pseudo-Sciatica Muscle - Gluteus Minimus:
Moving out laterally 3/4 the distance along line A you will find the gluteus minimus muscle. This muscle will generally have a cluster of myofascial trigger points, so gently search around. They all tend to be extremely tender and send severe pain down the back and/or lateral aspect of you leg. This is why the gluteus minimus is known as the "pseudo-sciatica" muscle. See pictures of the model for myofascial trigger point location and deactivation position. The Fenix Rehab System can and should be shared with your doctor or therapist. They can help you pin-point the trigger points needing treatment.The Fenix Rehab System is an ideal home-care active therapy program to assist you and your healthcare provider in keeping you as pain-free and drug free as possible. Don't forget to stretch the gluteus minimus after performing trigger point therapy, see picture of the model and follow the instructions. Do the stretch slow and easy without causing yourself any pain for about 60 seconds.

X's mark Gluteus Minimus Myofascial Trigger Points

Gluteus Minimus Myofascial Trigger Point 
You can effectively deactivate all your pain-causing trigger points conveniently at the home with quality trigger point therapy products offered by FENIX.  To learn the details of this effective technique click on the following link.
Spinal traction and decompression

Strengthen the Core Muscles of the Low Back

Once you have begun to remove the chronic myofascial trigger points from your low back, with a FENIX Rehab System, you will want to fully strengthen the core muscles that support your lumbar spine. The rehab of these core muscle is best targeted utilizing an inexpensive exercise ball. Through FRE, Inc. you can purchase an exercise ball; either the one from DynaFLex which comes with an excellent video and sells for $32.95 or the Valeo Body Ball without a video selling for $19.99.
You wan to focus on strengthening the muscles on each side your lumbar spine called the Erector Spinae muscles. Also further out are the lateral stabilizers of the low back called the Quadratus Lumborum. You also need to strengthen the muscles that stabilize your pelvis, the Gluteus Maximums and Gluteus Medius. By following the pictures below you can see how to stretch and strengthen these core muscles, either by laying face down and raising one leg at a time or laying on your side and raising your leg, it's that simple.
After strengthening the posterior and lateral muscles of your lumbar spine, it's important to strengthen the front stabilizer the abdominal muscles. You do this with the exercise ball by doing a reverse abdominal crunch. Start at a sitting position on the ball and then lower your upper body slowly down.
Tractioning out the low back Strengthening Core low back Stretching for lateral back
Tractioning out the low back, hold as long as comfortable 2-5 minutes Strengthening Core low back muscles Gluteus Maximums, Erector Spinea focus lifting leg with your buttocks Stretching for lateral back stabilizers the Quadratus lumborum and Gluteus Medius, Tensa Fascia Latae
Strengthening pelvis & low back Strengthens the abdominal muscles
Strengthening the lateral stabilizers of pelvis and low back - Gluteus Medius, Quadratus Lumborum Reverse Abdominal Crunch Strengthens the abdominal muscles

Do not cause yourself any pain with exercises and check with your doctor before doing any home care program. Perform these exercises in three light sets of 8 to 12 repetitions. But only do as many as you are comfortable with, without causing yourself pain.


  1. Thanks for such a nice article. I really like the information shared in this blog. Lower back pain can cause more than pain, it can cause multiple overall long term health issues. Lumbago is a form of arthritis, if not treated at onset, it will contribute to other heath issues from chronic fatigue to upper respiratory disease.
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  2. When assessing upper back pain one has to look at the host of upper back pain causes. Is it too much computer work? Is it too much assembly line work? Like staring down at parts all day. All of these activites reinforce poor posture which can stress the upper back and lead to excruciating pain. upper left back pain

  3. Thank you for sharing. Did you know that 80% of the population will experience back and/or neck pain?
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  6. Stretching exercises are the best treatment for back pain problems. These exercises not only treat the pain but also effect other body parts in an indirect way to keep your body fit. back muscle pain in Canada