A 45 year old male presented to the clinic with right side lower back pain. The patient was an avid runner, averaging around 50km per week. The onset of back pain usually came halfway into a run or post run, was debilitating and usually resulted in the patient lying flat on the floor for hours. He had started to develop other aches throughout the body such as the right knee and movement restrictions in his neck. He had seen many practitioners in relation to this issue which involved manipulating the spine, massage of the lower back and was told that he had dysfunctional gluteal muscles, which he began addressing with a gluteal strengthening program
In our first treatment, the client presented with acute lower back pain, restricting any kind of forward bending. He had difficulty getting himself dressed that morning and disappointingly revealed that he was starting to “rethink the whole running thing”.
While the goal of the initial treatment was to reduce the patient’s pain presentation, there was still a strong focus on thorough assessment of how the rest of the body moved.
He tested positive for an overactive right piriformis muscle. The infamous piriformis attaches from the greater trochanter of the femur to the anterior sacrum and, during gait/running, is responsible for externally rotating the hip as well as stabilising the femur in the acetabulum along with the other gluteal muscles. It was identified that the piriformis was facilitated due to an inhibition of the Gluteus Maximus in the movement of hip extension (a vital movement in running). This further resulted in an overactive right quadratus lumborum (QL), and an inhibited right psoas muscle which are both well known causes of lower back pain.
The treatment involved reducing tone in both the right QL and piriformis followed by activating internal hip rotation and Gluteus Maximus-initiated hip extension.
The client felt immediate relief and was given exercises to continue activating and strengthening the inhibited muscle groups.
The client returned the next week with the same lower back pain. He informed that he had been feeling great initially post treatment and had gone back to running his usual 40-50kms per week. However, after 3 days the same lower back pain began to resurface towards the end of his run. He admitted that he had done the prescribed exercises the first few days, but decided that because he was feeling so good, they may not be required anymore because he was fixed.
On assessment it was found that both the piriformis and QL muscle were once again overactive.
The importance of corrective exercises cannot be underestimated when dealing with dysfunctional posture and movement patterns that result in pain syndromes. The way we hold ourselves and move through space is the result of our neuromuscular programming. This programming is composed of many factors that include: posture, activities, lifestyle, emotional states and trauma. The myotherapist plays an integral part in identifying and treating dysfunctions and compensation patterns by reducing tone from overactive muscle groups and activating inhibited groups. This is an important point – the myotherapist treats patterns not muscles, with the intent of placing the patient in the optimal position to re-program their own neuromuscular patterning. This is where the “magic” lies, because by doing corrective exercises at least once per day, we are essentially giving new input into our nervous system and revalidating it through repetition. In this way, over time, we are able to alter the patterning of our neuromuscular system to best serve our health, lifestyle and activities in the most efficient, functional and pain-free way.
This was explained to the patient, who became extremely diligent in performing his corrective exercises. The patient came back fortnightly for more functional exercise progressions and some minor fine-tuning manual therapy. He continues to run pain free.
Vlad Mizikov – Elite Myotherapist
