Got Back Pain?!
- Dan
- Jan 30, 2019
- 4 min read
Nearly every American will, at some point in their life experience back pain of some kind. It is almost inevitable. For the specialty of medicine that I am going into back pain makes up a majority of my patient population. These patients have pain by a plethora of causes. Some of the extrinsic causes (i.e. associated with lifestyle) can include trauma, disc herniation, recurring injury, etc. Even though these causes can really only be prevented, there are ways to make your body less susceptible to these mechanisms of injury.
When a body is subject to a force of any kind, that force can only be dissipated through the surrounding tissues. This force can disrupt joints, tendons, ligaments, and muscles. If the force is directed through an area with nice, strong, and healthy muscles then there will be less of an effect on the joints, tendons, ligaments, etc. However, if the surrounding area does not have this support then the joints, tendons, and ligaments are more prone to injury. In the back, for example, this can lead to a disruption of the posterior longitudinal ligament and resultant disc herniation. This herniated disc can cause pain in and of itself, or by compressing a nerve exiting between the surrounding vertebrae.
In contrast, there are also intrinsic causes of back pain. These can include imbalances in muscles or other soft tissues, muscular compensation for an existing injury, and various musculoskeletal imbalances like pelvic tilt or leg length discrepancies-- in addition to hundreds of other possible causes. Some of these mechanisms can be acute or chronic, and some can even correct themselves over time.
From personal experience I had a spasm in my quadratus lumborum, AKA the “QL.” The QL is a muscle that originates from the posterior iliac crest and inserts on the 12th rib; it is innervated by the branches coming from T12-L4. This is the muscle that aids in side-bending (lateral flexion of the spine), movement of the 12th rib during exhalation, and hip hiking (elevates the ilium with ipsilateral contraction). This muscle was in spasm for several months—not finding much relief from most of the stretches/remedies that I tried. It wasn’t until I learned about fascia that I was able to fully alleviate my pain. Fascia is the very thin, paper thin, connective tissue that overlies most of our soft tissues and muscles. Fascia is commonly overlooked and forgot about by medical students and doctors because we just tear through it in anatomy class. But fascia serves a very important role in many different aspects of our anatomy and physiology. Fascia is like an envelope that covers your insides from head to toe. Microscopically it’s composed of collagen and elastin, and it has blood vessels and nerves that terminate within it. It’s a rich and important tissue, but more importantly it’s over looked. My point here is that if one muscle is spastic it can cause strain on its share of the body’s fascia which can affect another body part in the body through this fascial chain.
In my case, my tensor fascia latae (AKA the TFL) was tight. The important feature about this muscle, as described in its name, is that it is where a majority of body’s fascia comes together. The chronicity of this problem was so severe that my gluteus maximus became tight as these two muscles are close in proximity. Following the anatomy more superiorly we get to the quadratus lumborum, whose fascia draws into the gluteus maximus. Long story short, it was a tight muscle in my leg that caused my spastic quadratus lumborum. It was through the proper fascial stretching of the correct muscles that I was finally able to alleviate the pain caused by my spastic quadratus lumborum.
The take home message from this anecdote is to pay attention to all of your muscles. Yes pain can be an indicator of something more serious going on in your body. Yes pain is uncomfortable so it is easy to take pain medications and muscle relaxants. But it is important to understand the anatomy of your body. Make sure you work out your weak muscles, balance your strong muscles, roll out your fascia with a ball or foam roller, and use static stretching at least 3 times weekly.
It was this experience and treatment plan that lead me to Osteopathic Medicine.
Citations:
Bae, H.-I., Kim, D.-Y., & Sung, Y.-H. (2017). Effects of a static stretch using a load on low back pain patients with shortened tensor fascia lata. Journal of Exercise Rehabilitation, 13(2), 227–231. https://doi.org/10.12965/jer.1734910.455
Fascia - an overview | ScienceDirect Topics. (n.d.). Retrieved January 30, 2019, from https://www.sciencedirect.com/topics/medicine-and-dentistry/fascia
McHugh, M. P., & Cosgrave, C. H. (2010). To stretch or not to stretch: the role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports, 20(2), 169–181. https://doi.org/10.1111/j.1600-0838.2009.01058.x
Tensor Fascia Lata Muscle - an overview | ScienceDirect Topics. (n.d.). Retrieved January 30, 2019, from https://www.sciencedirect.com/topics/medicine-and-dentistry/tensor-fascia-lata-muscle
The QL and Lower Back Pain. (2018, February 23). Retrieved January 30, 2019, from https://www.protouchpt.com/ql-lower-back-pain/
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