2 Reasons Neuromuscular Therapists Target the Abdominal Muscles for Low Back Pain
Low Back Pain is one of the Most Common Reasons Consumers Seek Massage Therapy
According to the CDC, low back pain is causing more disability in the world than any other condition. In fact, 25% of adults reported low back pain, (LBP) in the three months prior to their investigation. While LBP has several symptoms and characteristics, it can be broadly classified as:
- Acute – lasting less than 4 weeks
- Subacute – lasts between 4 – 12 weeks
- Chronic – lasts more than 12 weeks
The vast majority of acute patients do not seek medical intervention and the low back pain will typically resolve naturally. However, despite any veracity to their usage, opioids are prescribed to treat acute low back pain when the patient seeks medical evaluation. In 2017, 13.7% of the acute LBP medical visits were prescribed opioids as intervention.
LBP is also one of the most common reasons consumers seek out Massage Therapy. According to the American Massage Therapy Association Industry Fact Sheet, 43% of respondents received Massage Therapy in the past year for pain relief or pain management.
“Low back pain is most likely the result of both pathoanatomical and biochemical influences, and it clearly involves a complex pathophysiological process with symptoms and signs emanating from biochemical changes in the tissues.”1
According to the 3rd Edition of “Travell, Simons & Simons’ Myofascial Pain and Dysfunction,” trigger points (TrPs) in the abdominal muscles, “may cause as much distress as pain stemming from visceral dysfunction.” When observing visceral dysfunction, typically the renal pathologies create a dull, ipsilateral ache in the upper abdomen, sides of the body, or back; while abdominal muscle trigger points are often described as “burning,” “fullness,” “bloating,” “swelling,” or “gas.”
The main trigger point referral that will be addressed through Neuromuscular Therapy belongs to the Rectus Abdominis. The upper portion can refer pain bilaterally to the mid-back region. Typically, the patient will indicate pain going across their back in a horizontal pattern. Studies have shown resolving the trigger points in the upper region of rectus abdominis have relieved back pain.
It is important to consider that backaches at this level are more likely associated with latissimus dorsi. Trigger points found in the lower portion may refer bilateral pain to the sacrum and low back region. This referral, similar to the upper fibers, will run horizontally across the sacroiliac region.
Abdominal Wall Mechanism
This structure contributes to the mobility and stability of the lumbar spine and pelvis. The Abdominal Wall Mechanism is comprised of the external oblique, internal oblique, transverse abdominis, and rectus abdominis muscles along with the abdominal fascia and rectus sheath.
The external oblique blends with the abdominal aponeurosis which attaches to the linea alba and the lower portion of the external oblique which attaches to the anterior superior iliac spine blends into the inguinal ligament. Superiorly, the external oblique will interdigitate and fuse with the serratus anterior. Additionally, the pectoralis major and its fascial components will also blend with the abdominal fascia. These connections provide a link to the shoulder girdle muscles and the abdominal musculature.
The internal oblique, which lies deep to the external oblique, attaches to the lateral portion of the inguinal ligament, iliac crest while the upper portion connects to the last four ribs, abdominal aponeurosis, and linea alba. The lower attachments will contribute to the mechanism of dysfunction related to low back pain.
The transverse abdominis lies deep to the internal oblique. This muscle is also attached to the lateral third of the inguinal ligament and iliac crest anteriorly. It shares its attachments with the internal oblique muscle. The fibers however, run horizontally as it approaches its attachment to the abdominal aponeurosis and the linea alba.
The final muscle of this mechanism is the rectus abdominis. The bellies of rectus abdominis lie on either side of the linea alba. It is surrounded by the rectus sheath which has contributions from the other three oblique muscles. Its inferior attachment at the pubic ramus is of particular interest when considering its role in low back pain.
The abdominal mechanism functions to:
- Provide anterior and anterolateral support to the spine
- Increase tension to the thoracolumbar and abdominal fascia
- Check anterior shear via control of pelvis in sagittal plane
- Control the rate and amplitude of torsion to lumbar spine
- Control relationship of abdominal wall to thorax
- Increase compression at sacroiliac joints and pubic symphysis
This dynamic stabilization and importance of attenuating trunk and ground forces is a key component in the abdominal function. Taking into consideration the attachments of the musculature to the innominate bone and the pubic ramus; dysfunction and contracture of these muscles will bring the pelvis into a posterior tilt. This would cause an over-lengthening of the posterior musculature such as the erector spinae group, quadratus lumborum, and gluteus maximus. The muscular imbalance must be addressed by lengthening the fibers of the abdominal group by removal of contracture dysfunctions and contracture of the posterior muscles.
This posture can be easily perpetuated long periods of sitting either at a work station or while watching TV. Of course, it goes beyond flexion of the spine and contraction of the abdominal muscles. This position also has a direct influence on the glenohumeral joint and the coxal joint which bring in to consideration an even greater number of muscles.
1Porterfield, J. A., & DeRosa, C. (1991). Mechanical low back pain: Perspectives in functional anatomy. Philadelphia: Saunders.
DISCLAIMER | This article contains techniques taught in National Holistic Institute’s Advanced Neuromuscular Therapy Program and is for informational purposes only. Readers are advised to not attempt the techniques described without proper training. Doing so may result in serious physical injury. Please contact National Holistic Institute if you are interested in registering for classes.
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