Massage therapy for Low back pain
Low Back pain is probably the number one reason people seek out treatment from a registered massage therapist. The pain can vary from mildly annoying to intensely debilitating. There are many causes of low back. So many that it is to difficult to cover them all in a single article. This is why this post will focus primarily on hip flexors, as a cause of low back pain.
The problem might not be where the pain is
In order to understand how the hip flexors can cause low back pain, it is first necessary to have a brief understanding of their anatomy and function.
There are 4 primary hip flexors:
- the psoas major
- the psoas minor
- the iliacus
- rectus femoris
The psoas major, minor and iliacus all blend into the same tendon, and for this reason they are commonly grouped together and called the iliopsoas. All of these muscles are primarily responsible for flexing the hip up, or bending forward at the waist ( hence the name, hip flexors). Like all the muscles of the body, the hip flexors have a primary action but are also responsible for secondary movements, and other functions. ( Again, discussing all their functions would take way to long, so this article will keep it simple.)
How hip flexors can cause low back pain.
Hip flexors can cause lowback pain in 2 ways:
- they can pull on pain sensitive structures of the low back
- they can alter low back and pelvis posture, causing compression of pain sensitive structures of the low back,
1. Pulling on pain sensitive structures of the low back
As depicted in the diagram, the iliopsoas attaches to the anterior surface of the vertebrae of the low back,and the discs that are found in between them. When these muscles get tight and/or shorten it can pull on the vetebrae, and the discs, causing pain in the low back. This pain causes the muscles of low back to reflexively tighten, causing more discomfort. The pain is felt in the low back, even if the actual cause is in the front.
2. Altered posture causing low back pain
Tightening and shortening of the hip flexors can also cause a distortion in the low back and pelvis posture. When standing, tight hip flexors will pull the pelvis anteriorly. This is called, an anterior pelvic tilt. This position of the pelvis causes the natural curve of the low back ( lordotic curve) to increase. When the lordotic curve is increased it jams together the small joints found in between each vertebrae ( facet joints). This can cause grinding of the joints, causing pain, and eventually degeneration and arthritis. This posture can also cause narrowing of the small hole that allows the nerves of the legs to exit the spine. This can cause compression of the nerves, leading to low back ,and even leg pain. The muscles of the low back are also affected, because they are placed is a squished up position. This causes them to chronically shorten, and tighten. In this short and tight state, they can develop painful trigger points, and limit natural spine movement. Again, leading to low back pain.
Why do hip flexors get tight in the first place?
Tight hip flexors are a common issue in our society because the majority of us spend most of our day sitting. We sit at work, we sit at home, we sit everywhere we go. In the sitting position, the hip flexors are placed in a shortened position. Over time the muscles adapt to this position, and become short and tight. Then when you try and stand up, the hip flexors cannot lengthen and stretch, so they pull the spine anteriorly.
Another reason hip flexors are so prone to getting tight is because they are primarily postural muscles. There are 2 types of muscles found in the body:
1 Postural muscles:
- help with movement but also help us with upright posture
- become short and tight when under stress ( mechanical, chemical, emotional stress)
2 phasic muscles.:
- Primarily responsible for movement, do not assist us with posture
- Become atrophied, weak and lengthened when under stress
Since the hip flexors and the deep muscles of the low back are primarily postural, they are naturally predisposed to shortening and tightening. This causes a sort of tug of war between the back muscles and the hip flexors, creating back pain and lack of mobility.
How massage therapy can help
Since massage therapy’s primary focus is to release tight shortened muscles, it is extremely effective in treating low back pain, caused by tight hip flexors.
The massage therapy treatment should focus on the low back musculature, deep hip flexors, as well as muscles of the legs, mostly the quads. To access the hip flexors the registered massage therapist must slowly work through the abdominal muscles in the area between the belly button and the pelvic bone. The iliopsoas is pretty deep, so the RMT must work quite deeply in the anterior pelvic area. It can be somewhat uncomfortable, so it is important that you let your RMT know if the treatment becomes to painful.
After the deep hip flexors are treated, released and lengthened, the muscles of the lowback will release much easier and actually stay loose.
Exercises are usually necessary to make sure the issue doesn't return, and to fix postural dystortions that are related to tight hip flexors.
Stretching and strengthening exercises are vital in preventing the issues related to tight hip flexors from returning.
The muscles that need to be stretched are the iliospoas, quadriceps, and Quadratus Lumborum muscles.
The muscles that need to be strengthened are the glutes, hamstrings and core muscles.
A registered massage therapist can easily show you how to stretch and strengthen all the necessary structures.
Once the muscles imbalances have all been addressed with massage therapy, and exercises, the pressure on the pain sensitive structures will decrease. Which in turn, will decrease your low back pain, and prevent it from returning.
If you have any questions about low back pain, and how your hip flexors may be at fault, do not hesitate to contact us at MyoCare Registered Massage Therapy. All our experienced RMT’s a trained to assess and treat low back pain, and tight hip flexors.