Massage & Bodywork

September/October 2013

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technique @work | the science of movement | Energy work | Myofascial techniques Stand Up Against Low-Back Pain By Whitney Lowe In the last column ("Take a Stand Against Plantar Fasciitis," July/ August 2013, page 102), we looked at one of the detrimental effects of Muscle tightness standing occupations. In addition to plantar fasciitis, numerous other biomechanical challenges may develop from standing occupations. In this installment, we explore the impact on 1 the low back and pelvis and the role of massage therapy in addressing these disorders. Low-Back and pelvic Challenges Standing occupations create chronic soft-tissue problems resulting from improper posture, often with additional challenges caused by the movement and position required for the work. In addition to chronic muscular demands, there are detrimental effects on bones and joints from the compressive loads sustained during long periods of standing. The junction between the low back and pelvis is a key biomechanical junction because this is where the upper-body weight is transmitted to the pelvis and eventually distributed down the lower limbs. Biomechanical imbalances in this region lead to numerous problems, such as chronic low-back pain, disc pathology, facet-joint dysfunction, myofascial trigger points, sacroiliac-joint dysfunction, 104 massage & bodywork september/october 2013 and more. Let's take a look at how these problems develop. The spine has a natural lordotic curve in the lumbar region, primarily for shock absorption. However, standing for long periods can often exaggerate that lordotic curvature. Consider the female salesclerk who stands all day in high-heeled shoes. Not only must she overcome the challenges of standing on a hard floor, which exaggerates the impact of the ground reaction force on the body, but her highheeled shoes increase the anterior pelvic tilt and lumbar lordosis. Lower-Crossed Syndrome The challenging posture of the anterior pelvic tilt and exaggerated lumbar lordosis is perpetuated by muscle tightness (Image 1). There is a pattern referred to as the lowercrossed syndrome that demonstrates this biomechanical challenge. The lower-crossed syndrome is characterized by tightness in the lumbar extensor muscles (primarily erector spinae, multifidus, and quadratus lumborum) and iliopsoas. Hypertonicity in the iliopsoas muscle pulls the lumbar vertebrae forward, while tightness in the lumbar extensor muscles exaggerates the lordosis. At the same time, there is a functional inhibition of the abdominal and gluteal muscles. Connecting those paired patterns of hypertonicity and functional inhibition produces a crossed pattern in the lumbopelvic region (Image 2). A common suggestion to address this postural dysfunction is to encourage strengthening of the abdominal muscles to offset the anterior pelvic tilt. However, if the tightness in lumbar musculature is not addressed first, strengthening will only have minimal effectiveness. Massage and stretching are excellent tools for addressing the hypertonicity Muscle tightness is perpetuated from anterior pelvic tilt. Mediclip image (copyright Lippincott Williams & Wilkins, 1998). All rights reserved.

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