Massage & Bodywork

September/October 2013

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Hypertonic Weak & Inhibited 2 and dysfunction of the lower-crossed syndrome. Treatment strategies are most effective when massage and stretching are used to reduce muscle tightness prior to core strengthening and muscular reeducation. The lower-crossed syndrome. When the lumbar Mediclip image (copyright lordosis is increased Lippincott Williams & Wilkins, in the lower-crossed 1998). All rights reserved. syndrome, it also throws the center of weight distribution through the lumbar spine in a posterior direction. The lumbar spine is designed so that the large and substantial bodies of the lumbar vertebrae carry the primary weight load from the upper body. However, when this weight load moves in a posterior direction with an exaggerated lumbar lordosis, the posterior vertebral arch structures carry a greater amount of that weight (Image 3). When greater amounts of weight are borne by the posterior vertebral arch structures, there is increased compression on the lumbar facet joints, which can lead to joint irritation and early arthritis in the spinal joints. In addition, degenerative changes in the lumbar vertebrae may result. Increased weight load on the posterior vertebral arch can cause small stress fractures, leading to a condition called spondylolysis. In more severe cases, the anterior vertebral body may actually separate from the posterior arch structures and slip forward, which occurs in a condition called spondylolisthesis. Treatment Strategies Treatment strategies for the lower-crossed syndrome focus on the lumbar extensors and iliopsoas muscles. Various techniques, such as deep stripping methods, myofascial approaches, and trigger point treatment, are aimed primarily at the erector spinae, multifidus, and quadratus lumborum muscles, as these are the main ones that perpetuate the problem. Want more treatment options? Visit the Online Education Center at www.abmp.com to see Whitney Lowe's webinars, where he explores specific treatment approaches for common pathologies. It is crucial for the practitioner to have a solid understanding of where these muscles lie, as they are not always easy to palpate due to their depth. These key lumbar extensor muscles are most effectively treated with a small contact surface (thumb, finger, knuckle, pressure tool, or other small-diameter surface) and a treatment method that is highly specific to the involved tissues. These targeted treatment methods make very good massage treatment more effective than many of the other general or superficial approaches that are routinely used. Deep stripping methods performed with the thumb or fingers produce excellent results, but can cause overload and fatigue of the thumb and finger muscles if used too extensively or improperly. It is important to use good hand and thumb alignment and proper body mechanics to deliver these strokes effectively. Keep in mind that the lumbar extensor muscles blend into the broad lumbodorsal fascia that extends across the top of the sacrum and connects with the posterior sacroiliac ligament complex. While the lumbodorsal fascia is not primarily muscular contractile fiber, it is still a very important part of the myofascial complex throughout this region, and so it should be treated. The iliopsoas is also a key focus of treatment when its tightness contributes to the exaggerated Posterior arch structures carry greater lumbar lordosis load during lordosis. Mediclip image dysfunction. 3 (copyright Lippincott Williams & Wilkins, 1998). All rights reserved. www.abmp.com. See what benefits await you. 105

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