Myofascial Elements of Low Back Pain

Myofascial Elements of Low Back Pain Blog  Low back pain

Both toothaches and backaches are rumored to be miserable enough to drive a person mad. Back pain treatments take billions from the health care industry annually. For those who suffer from pain in the lower back, there is hope for relief. Research shows that some individual therapies may not be sufficient alone. However, experts are leaning toward the conclusion that a multi-disciplinary approach is optimal. These are some important topics to consider.

Etiologies Of Chronic Low Back Pain

Although there are many etiologies of low back pain and diversities within those origins, these are some common culprits of back pain:

  • Facet arthropathy
  • Herniated disc
  • Spondylosis
  • Stenosis

Also, trigger points are common sources, and trigger injections may control muscle spasms. The spasmodic movements are caused by chronic postures, which lead to stretch trauma in the weaker muscle groups. Therapies targeting these specific groups alone may actually be harmful by overworking the muscles.
Micro-traumas have a combined effect that leads to spinal dysfunction. The trunk muscles and their isometric support lend stability to the spinal column. In diagnosing pain sources in the lower back, physicians usually evaluate spinal alignment, movements and stress. Too much relative flexibility in certain areas is more often a culprit than too little flexibility. Muscle and trunk problems are the first priority to address, and other spinal stresses are the next priority. When using this approach, it may be possible to completely eliminate the pain.

Spinal Mechanics

Increased or decreased curvature of the lumbar region can result in pain. Obesity, muscle hypertrophy and other issues may make diagnosis more difficult. Lordosis or outward curvature may be caused by the following:

  • Anterior pelvic tilt
  • Weak abdominal muscles
  • Shortened hip flexors

Posterior pelvic tilt may reduce lordosis. Since hip flexor shortening contributes greatly to incorrect posture that leads to pain, physicians should perform a strength test.

Lumbar Flexion

This flexion is a common daily activity while bending or standing. When bending, lumbar flexion should comprise 50 percent of the motion, and hip flexion should take over about halfway through the motion. When it does not, this leads to pain and possible muscle tearing. Extension tests that show a degree range above 30 indicate incorrect lumbar flexion and possible hip extension issues.

Lumbar Extension

With an anterior curve increase, this motion varies greatly in range. In most cases, damage is due to excessive extension on a few specific spinal segments. Hip flexors and abdominal muscles prohibit lumbar extension to a point. If there is hyper-extension of this region, structural damage to discs and prolapse can occur. As discs become degenerative, an important ligament is no longer pulled tight and allows further damage. When left untreated, this condition leads to stenosis.

Rotational Motion

Lower spine rotation should be about 13 degrees when the applicable segments contribute correctly. Also, rotational restriction is completed by the thoracic spine. If symmetry is lacking between the lengths and strengths of the abdominal muscles, mobility is limited. As a result, there is a difference in muscle mass. The outcome is a postural change that leads to pain. Strengthening the weakened muscles is an important corrective component.

Lateral Flexion

Most mobility in this area is in the lower thoracic spine. Lateral flexion rotates in the direction of the curve convexity. Since segmental and lateral movements work together, impairment of one will affect the other. Limited side bending capabilities and pain are the results.

Since there are so many muscle groups and regions affecting low back pain, it is important to work with a physician or physical therapist who addresses all of them together. Treating the pain with back strengthening alone will not suffice. There must also be abdominal strengthening and opposing hip flexor lengthening.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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