Hidden Causes of Lower Back Pain

Sitting at a desk coupled with a long commute leads many Americans to suffer from chronic low back discomfort. Often people pursue massage therapy in hopes of pain relief. But is getting a massage really that helpful for more than a few days? Recent research finds that receiving massage once a week for ten weeks has a significant reduction in low back pain, lasting for up to six months.

However, the clinicians claimed the difference between relaxation and structural massage was negligible. In both practicing and receiving a range of relaxation and deep structural massage for twenty years, I have a somewhat different view. My definitive answer: yes, if performed with deeper pressure, a focus on hip flexor release, and post-massage self-care instruction for the client. When looking for a massage therapist to help move your body into a state of less pain, keep in mind that the most effective session will include these three elements.
Tight hip flexors are almost always the true culprits of chronic low back pain. These muscles include tensor fascia lata (TFL), psoas, iliacus and sartorius—along with the quadriceps. Your massage therapist must have the skill and experience in releasing these muscle groups in order to help release your low back tension from its sore and inflexible position. Simply massaging the quadratus lumborum and paraspinal muscles is not enough for lasting relief. In fact, only working on the posterior back can worsen your pelvic tilt, increasing low back discomfort and dysfunctional movement.
What does this look like observing yourself in the mirror? When one psoas/quad/TFL is tighter, you will experience a kind of “caving inward” on that side. Visually, it will be a lateral collapse, like a slight side bend that often includes a rolled-in shoulder on the same side. You wll appear to lean in a lopsided way, with one shoulder lower and one hip higher on one side, and little space between your lowest rib and iliac crest.
Psoas syndrome is a frequently missed diagnosis; with a hypertonic psoas, you will have difficulty in achieving a fully erect posture. Some osteopathic physicians also find that spasm of psoas is responsible for more disabling effects than any other pathological diagnosis of back muscles.
Without addressing these hypertonic core postural and hip flexor muscles, the constant pressure can cause disc degeneration. They will be compressed, leading to thinner, less flexible discs. Bulging, herniation and tearing can occur, especially with twisting motions.
In addition to receiving a massage from a skilled therapist and addressing your low back pain in a thorough way, you must commit to lifestyle changes wherever possible. Here are some  other factors to consider for more lasting relief.
  1. Hydration: What is your daily water intake? My personal benchmarks are: 3 glasses before lunch, 2-3 in the afternoon, and one in the evening before eight pm. Having at least one “clear” urine a day gives your kidneys and liver plenty of assistance removing noxious, pain-producing cell waste. This keeps muscles optimally hydrated, hence they are less likely to suffer minor tears and restricted movement. Make sure you have an insulated thermos-type container in your car (no one likes hot-car water) and at your workstation at all times. Be careful with consuming alcohol and caffeinated  drinks as they are diuretics, both dehydrating you and preventing deep and restorative sleep cycles.
  2. Frequent breaks from prolonged sitting: Insist on an ergonomic workstation, and take a hydration/bathroom break at least every hour. Consider working from home whenever possible to limit time sitting in your vehicle.
  3. Poor mattress/pillow: Mattresses should be supportive but not rigid on your shoulder and hip pressure points. My favorite is a combination of three to four inch latex topper and spring mattresses foundation. Note: stomach sleeping subjects your spine and especially your neck and low back to constant strain; it is not recommended.
  4. Over-toned/tight quads: foam-rolling is essential for the strongest and biggest muscle group—the quadriceps. Additionally, stretches should be held for 45 seconds. Make sure your gluteal muscles are being strengthened as counter-postural support for pelvic stability.
  5. Heavy purse/computer bag/backpack: Consider a clutch purse, a rolling bag/ backpack to reduce shoulder and back strain.
  6. Unsupportive shoes: flip-flops, clogs, and high heels create dysfunctional gait and subsequent low back strain. Take a break from them as your low back is mending.
Remember that your health is your greatest asset.

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