Let's Talk About Backs Baby

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Basic Low Back Self Treatment

**Always perform self-treatment techniques within a comfortable range of movement. If you have no comfortable range of movement consult your PT or qualified Manual Therapist for appropriate evaluation and treatment**

According to the National Institutes of Health, low back pain (LBP) is the top reason for calling off from work as well as the most common form of workplace injury. Most people have had at least one episode of intense LBP. If you're one of those people, then you know how rare it is to score a same-day treatment appointment! Even though the body is an extremely complex integrated system, looking into the anatomy and the relationships between all the structures can help open some understanding as to why you feel the way you do when pain arises. 

While you are waiting for that appointment date to arrive, there are things you can do to help yourself. Knowledge can be comforting especially when you're in pain! So, here we go with some LB basics.

Your low back/lumbar spine is known as the "adapting spine" because it adapts to the forces of gravity in order to keep you upright and moving. Many structures impact the function of your low back and need to "play well together" in order for it to function at it's best, the following are especially influential:

1. Your respiratory diaphragm
This large muscle significantly influences movement and comfort throughout the body, especially in the low back because of its attachments to the:
- Lower six ribs
- Sternum (the lowest portion aka your xiphoid process)
- And, wait for it!...the top 3 lumbar vertebrae AND their discs
Pain always affects breathing mechanics. The pain breath is shallow, shorter and frequently held. Remember, the diaphragm is a muscle and when held in contraction, (via the pain breath) it tightens, shortens and impacts mobility in the lumbar spine by way of those attachments.
2. Your small intestine:
It has a ligament type fascia attachment called the root of the mesentery which attaches to the back wall of the trunk and crosses diagonally over the lumbar spine. Tensions on the root of the mesentery for example due to (but not limited to) inflammation in the digestive system or scar tissue from abdominal surgeries, can influence the position and movement of the lumbar spine, especially L2 & L3. When the position and movement of joints are impaired then the door to pain is opened.

3. Your colon (aka large intestines):
It also attaches to the inside back wall of the abdomen on both the right and left sides. In part, those attachments run parallel to the lumbar spine and for a wide variety of reasons, can contribute to both LBP and pelvic pain. Releasing tensions along the entire tract and curvatures of the large intestines can be very effective in easing LBP.

4. The muscles and facias of your pelvis including but not limited to:
The Psoas (connects your femur to the inside surface of your hip bone/iliac) and the piriformis (connects your sacrum to your femur). It's important to note that muscles and fascia are separate tissues and can be worked separately to help relieve LBP.  What is fascia? Great question glad you asked! Think chicken breast...the meat is the muscle while that thin whitish tissue laying over and connecting to the chicken breast is the fascia. 

5. Your psoas muscles a closer look:
The psoas muscles are especially important in low back function because they attach to both the vertebrae AND discs of the 12th thoracic and first 4 lumbar vertebrae. 

6. The position and mobility of your sacrum (the S part of your SI joint):
The piriformis muscle attaches to the sacrum and uppermost portion of the femur. When the piriformis is too tight it blocks normal movement of the sacrum. The sacrum works closely in cooperation with the 5th lumbar vertebra. When the sacrum isn't moving well, the lumbar spine has to adapt, that adaptation is sometimes dysfunctional and contributes to LBP. 

It's said that bones don't move joints muscles do. I don't entirely agree with that. The body has a wide range of structures and tissues that function as a coordinated integrated unit. The reality is that many structures have the potential to alter the position and movement of your joints. Everything really is connected and for optimal results, the body needs to be treated as an integrated unit during the course of rehabilitation, especially when dealing with LBP. 

YES, the song is right, the foot bones connected to the leg bone, leg bone to thigh bone, thigh bone to hip bone, etc. ultimately what happens in the ankle, for example, has the potential to contribute to TMJ and headaches (in part because of the fascia system mentioned so briefly above). But that information is for another day! 

Additional resources for your exploration and to build your self-care skills:

Foundation Training: https://www.youtube.com/user/DoAFounder
Ecoscue Method: https://www.youtube.com/user/EgoscueAustin/videos
Ask Doctor Jo: https://www.youtube.com/watch?v=750nkDg9XPI
Dr. Mike Hsu: https://www.youtube.com/watch?v=SiPOBea-OL8
7 Simple exercises to help prevent LBP: https://www.youtube.com/watch?v=20zybMbnVoU

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