The body’s pelvic region has many functions crucial for functionality with the host. The various muscles surrounding the pelvis help provide stability to the body’s core, allow circulation to the heart in the cardiovascular system, support the reproductive and abdominal organs, and much more the body requires. The pelvic joints’ various muscles also allow hip mobility and function for the lower body extremities. When traumatic injuries or abnormal activities start to affect the pelvic floor muscles, the various issues can affect the functionality of the pelvic region and cause problems in bladder control for both the male and female bodies. Many of these issues correlate with trigger points surrounding or on the pelvic floor muscles that can affect how the vital organs operate in the body. Today’s article examines the pelvic floor muscles, how trigger points correlate with pelvic pain, and managing pelvic pain is associated with trigger points. We refer patients to certified providers who incorporate multiple techniques in the lower body extremities, like pelvic pain treatments related to trigger points, to aid individuals dealing with pain symptoms along the pelvic floor muscles near and surrounding the pelvis. We encourage and appreciate patients by referring them to our associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer
What Are The Pelvic Floor Muscles?
Have you been experiencing bladder issues that constantly make you go to the bathroom? Have you been dealing with severe cramps that mimic sciatica pain? Or does it hurt when you are sitting down? Many of these issues correlate with muscle pain associated with trigger point pain along the pelvic floor muscles. The pelvic floor muscles are a unique anatomical body location with a balance of different pressures (visceral, muscular, or liquid) that play a fundamental role in the body’s lower extremities. The pelvic floor muscles have four divided compartments but have different parts and functions to allow optimal bodily function. The four pelvic floor compartments include:
Anterior or urinary (bladder)
Medium or genital (uterus in women, prostate in men)
Posterior or anterior (anus, anal cavity, and rectum)
Peritoneal (endopelvic fascia and perineal membrane)
Some of the functions that the pelvic floor muscles allow the body to perform properly include proper contraction for sexual function, allowing respiration in the abdominal organs, maintaining bodily fluid actions like going to the restroom, and maintaining good posture by working together with the thoracolumbar and lumbosacral columns of the spine. Studies reveal that the spine’s autonomic nerves, which include the sympathetic and parasympathetic, help supply the posterior and anterior compartments in the pelvic floor. When traumatic factors affect the pelvic floor muscles, it can lead to correlating issues regarding trigger points in the pelvic muscles.
How Do Trigger Points Correlate With Pelvic Pain?
The pelvic floor has four different components to allow the muscles to function properly when traumatic factors start to invoke pain-like symptoms that can affect pelvic functionality in both the male and female body, thus developing trigger point pain associated with pelvic pain. For the female body, trigger points along the bulbospongiosus muscle (part of the pelvic floor muscles) may cause aching pain in the perineal region. In contrast, in the male body, trigger points along the retroscrotal area may cause discomfort while sitting erect. According to the book, “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., stated that many individuals that are dealing with trigger point pain along their pelvic floor muscles would often complain about feeling localized aching pain in their anal region and may experience painful bowel movements when going to the bathroom.
Studies reveal that myofascial trigger points develop “muscle contraction knots” of the pelvic floor muscles, may be identified in many patients suffering from pelvic pain syndrome (urological, colorectal, and gynecological), and are associated with trigger points. Trigger points are tricky when diagnosing where the pain is located since myofascial pain syndrome mimics other chronic conditions of the surrounding muscles, causing referred pain. Additional studies reveal that the location and severity of pelvic floor myofascial pain was significantly correlated with various pelvic pain symptoms that can affect both males and females with different conditions. When doctors recognize that their patients are dealing with trigger points associated with pelvic pain after an examination, they devise a treatment plan and work with other specialists to manage trigger points and reduce pain in the pelvic region.
Top 3 Pelvic Floor Exercises- Video
Have you been dealing with urinary issues that make it tricky to go to the bathroom? Do you have trouble finding a comfortable position when you are sitting down? Or do you feel pain radiating down your buttock and leg? Pelvic pain is a common issue that can affect both men and women that can cause various pain symptoms that correlate with trigger points along the pelvic floor muscles. When trigger points affect the pelvic floor muscles, it can lead to referred pain that connects with pelvic pain in the body’s lower extremities. Many factors can affect the pelvis, like issues affecting the digestive, reproductive, or urinary systems, a trauma in the surrounding pelvic muscles that causes them to be weak or corresponding issues on the hips and lower back. Trigger points associated with pelvic pain may be tricky. Still, they can be treatable with different therapies that can reduce the pain and help strengthen those weak muscles in the pelvic region. The video above demonstrates three other pelvic floor exercises that can help support the pelvic muscles and reduce the trigger points from reoccurring in the pelvic area of the lower body.
Managing Pelvic Pain Associated With Trigger Points
Various treatments can manage pain associated with trigger points through multiple therapies that can reduce pain-like symptoms along the pelvic floor muscles. Many therapies, like trigger point therapy and muscle training, can help reduce the pain along the pelvic floor muscles and bring back bowel function to the pelvic region. Studies reveal that doctors provide a range of protocols designed to strengthen the pelvic floor muscles and the different muscle groups around the pelvic area while improving function. However, treatment alone can only go so far, as people must take corrective actions to ensure that the trigger points do not return in the future. Movements like corrective posture exercises focusing on the lower back, hips, and pelvis and eating a fiber-rich diet can reduce pelvic pain. This allows the individual to get their lower half mobility back.
Conclusion
The pelvic floor muscle has four divided components that will enable optimal bodily function that has different jobs in the male and female bodies. The pelvic floor muscles have many crucial functions that provide the host stability in the body’s core, allow circulation to the cardiovascular system, and, most importantly, support the reproductive and abdominal organs. When issues affect the pelvic floor muscles, it can lead to pelvic pain associated with trigger points that can disrupt many from going to the bathroom or disrupting sexual functionality. All is not lost, as various therapies can reduce the pain and strengthen the pelvic muscles in the lower body. This allows lower body mobility back to the host and prevents unnecessary issues from reoccurring.
References
Bordoni, Bruno, et al. “Anatomy, Abdomen and Pelvis, Pelvic Floor.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 18 July 2022, www.ncbi.nlm.nih.gov/books/NBK482200/.
Marques, Andrea, et al. “The Status of Pelvic Floor Muscle Training for Women.” Canadian Urological Association Journal = Journal De L’Association Des Urologues Du Canada, Canadian Medical Association, Dec. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2997838/.
Meister, Melanie R, et al. “Pelvic Floor Myofascial Pain Severity and Pelvic Floor Disorder Symptom Bother: Is There a Correlation?” American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, Sept. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6732028/.
Moldwin, Robert M, and Jennifer Yonaitis Fariello. “Myofascial Trigger Points of the Pelvic Floor: Associations with Urological Pain Syndromes and Treatment Strategies Including Injection Therapy.” Current Urology Reports, U.S. National Library of Medicine, Oct. 2013, pubmed.ncbi.nlm.nih.gov/23943509/.
Raizada, Varuna, and Ravinder K Mittal. “Pelvic Floor Anatomy and Applied Physiology.” Gastroenterology Clinics of North America, U.S. National Library of Medicine, Sept. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2617789/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
The body’s musculoskeletal system consists of bones, cartilage, ligaments, tendons, and connective tissues. These parts get pushed to the extreme with everyday wear and tear, job, school, house chores, and tasks. All the flexing and contracting cause tightness, strain, and soreness that can contribute to negative muscle behavior that holds the muscles in an unhealthy position and in a semi-flexed or tightened state. An example is an unhealthy posture that becomes the norm for an individual. A percussive massage can release tightness, maintain flexibility, relieve discomfort, alleviate stress, and improve circulation.
Percussive Massage Therapy
A percussive/percussion massage is a form of physical therapy that utilizes vibration through repeated pressure bursts to massage muscles. Percussive therapy offers more control over targeted muscle groups than foam rollers and other static massagers. The treatment involves using an electric massage device to relieve muscle tension. Different massage heads for various therapeutic purposes move rapidly and forcefully, applying pressure directly to the soft tissues while the vibrations help release and loosen the areas.
How The Massage Works
Fascia, which wraps around the muscles and joints, can become tight and inflamed, causing soreness and pain.
Research shows that tight fascia can limit mobility and proper range of motion.
When a muscle group is stiff and limits the range of motion of a specific part of the body, the rest of the muscles and body will overcompensate. This increases the risk of serious injury.
Percussive therapy loosens the tissues and increases blood circulation.
Once the stiffness and soreness are relieved, continued percussive therapy can prevent tightness from reforming, improve the range of motion, and speed up muscle recovery.
Massage guns can penetrate up to an inch into the soft tissue, stimulating the muscles and helping release tension.
Benefits
Improved mobility
Percussive massage distributes the thickened fascia fluid to relieve pressure and tightness.
Repeated pressure at high speed thins the fluids, making the fascia more workable so the muscles can move easily and efficiently.
Reduced Soreness
Lactic acid builds up in the muscles after working, physical activity, and exercise.
This build-up causes soreness and pain.
The percussion forces muscle fibers to release the lactic acid, reducing the soreness.
Decreased DOMS/Delayed Onset Muscle Soreness
It’s common to experience pain and soreness 24 to 72 hours after unfamiliar physical activity, such as a new job, exercise routine, or rehabilitation after injury or surgery.
This is known as delayed onset muscle soreness or DOMS, which results from tiny muscle fiber tears.
Percussive therapy increases skin temperature, blood flow, and hormonal responses to reduce inflammation and pain.
Increases Relaxation
After work, school, physical activities, and working out, a percussive massage session can help the body wind down and relax.
A percussive massage will help the muscles release and relax when the body is exhausted or overwhelmed.
How To Use A Percussive Massager
Before starting a new medical treatment, including percussion therapy, talk to your doctor, physical therapist, or chiropractor.
Ensure you know the difference between normal muscle soreness and pain from an injury.
Don’t use a massager on an injured muscle or body part, as the aggressive motion could aggravate the injury.
Avoid using the device on bones or joints.
Never use a massage gun directly on the neck; perform the massage on the shoulders and upper back.
Start with the lowest intensity level.
The low and medium settings should provide plenty of power for most users.
As you become more comfortable with the device, you’ll understand how your body reacts then you can try out the higher settings.
A percussive massager should be used in short bursts on small, targeted areas.
It is recommended to perform treatments for only a few minutes.
Seeing the muscles turning reddish during the massage signals that blood is flowing and it’s time to move on to another area.
If the massage gun makes the skin sore or sensitive, make tiny circles instead of holding the massager in one spot.
Combined with chiropractic and professional massage, percussive therapy can help individuals maintain a relaxed musculoskeletal system.
Best Massage Guns
References
Cafarelli, E et al. “Vibratory massage and short-term recovery from muscular fatigue.” International journal of sports medicine vol. 11,6 (1990): 474-8. doi:10.1055/s-2007-1024840
Cerciello, Simone, et al. “Clinical applications of vibration therapy in orthopedic practice.” Muscles, ligaments and tendons journal vol. 6,1 147-56. 19 May. 2016, doi:10.11138/mltj/2016.6.1.147
Cheatham, Scott W et al. “Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals.” International journal of sports physical therapy vol. 16,3 766-777. 2 Jun. 2021, doi:10.26603/001c.23530
García-Sillero, Manuel et al. “Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training.” International journal of environmental research and public health vol. 18,15 7726. 21 Jul. 2021, doi:10.3390/ijerph18157726
Jack Martin, “A critical evaluation of percussion muscle gun therapy as a rehabilitation tool focusing on lower limb mobility.” A literature review. Department of Health and Wellbeing. The University of Winchester. osf.io/preprints/sportrxiv/j9ya8/
Imtiyaz, Shagufta et al. “To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS).” Journal of clinical and diagnostic research: JCDR vol. 8,1 (2014): 133-6. doi:10.7860/JCDR/2014/7294.3971
Konrad, Andreas et al. “The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles’ Range of Motion and Performance.” Journal of sports science & medicine vol. 19,4 690-694. 19 Nov. 2020
All sports differ in the relative importance of various physical skills contributing to the game and individual performance. Baseball is a precision sport with fast, explosive movements and full-body activity. The ability to repeatedly perform near maximum level with little rest is necessary for baseball players. Baseball training involves a multidimensional approach that focuses on speed, agility, and strength in a way that is relative to the motions and requirements of the sport.
Baseball Training
Trainers have to assess the unique needs of the sport and determine the time needed to improve each quality within the athlete. They should focus on the following:
Baseball training workouts are targeted at increasing running speed, bat speed, pitching, and throwing velocity that breaks down the muscle groups for improving performance while decreasing the risk of injury. Training consists of combined conditioning that includes:
Throwing a baseball at high velocity is a full-body movement that requires total body development.
Strong leg, hip, and core muscles are necessary to transfer power from the ground, up through the lower body, to the torso, and then the arm and hand to generate a fast, whipping ball release.
This will improve generating power in the throwing muscles.
The objective is to build power utilizing a heavy and then a light load to build arm speed, and using proper form will improve throwing velocity safely.
Proper trunk rotation during arm cocking and strength and flexibility training should involve trunk rotational exercises to develop the obliques so that maximum arm speed can be generated.
Players have to deal with consistent failure and remain confident.
Hitting Mistakes
References
Ellenbecker, Todd S, and Ryoki Aoki. “Step-by-Step Guide to Understanding the Kinetic Chain Concept in the Overhead Athlete.” Current reviews in musculoskeletal medicine vol. 13,2 (2020): 155-163. doi:10.1007/s12178-020-09615-1
Fleisig, Glenn S et al. “Biomechanical Analysis of Weighted-Ball Exercises for Baseball Pitchers.” Sports health vol. 9,3 (2017): 210-215. doi:10.1177/1941738116679816
Rhea, Matthew R, and Derek Bunker. “Baseball-specific conditioning.” International journal of sports physiology and performance vol. 4,3 (2009): 402-7. doi:10.1123/ijspp.4.3.402
Seroyer, Shane T et al. “The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention.” Sports health vol. 2,2 (2010): 135-46. doi:10.1177/1941738110362656
The posterior section of the lower half of the body consists of the hips, low back, pelvis, legs, and feet, which provide stability to the body while supporting the upper body’s weight. The various muscles surround the lower extremities and make different motions for mobility and functionality by contracting and retracting when the legs and hips are in motion. The various muscles that provide stability to the hips and the legs are the iliopsoas muscles. When normal age or incidents affect the lower body extremities, it can correlate to the development of trigger point pain. Today’s article examines the iliopsoas muscles, how referred trigger pain affects the thighs and low back, and treating trigger point pain on the thighs and low back. We refer patients to certified providers who incorporate multiple techniques in the low back and thigh pain therapies related to trigger points to aid individuals dealing with pain symptoms along the iliopsoas muscle in the lower back, thigh, and near the pelvis. We encourage and appreciate patients by referring them to our associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer
What Is The Iliopsoas Muscle?
Have you been dealing with muscle cramps in your thighs? What about feeling muscle stiffness in your lower back when you are stretching? Or do you feel your thigh muscles become heavy after a workout? Many of these issues correlate with the iliopsoas muscle becoming overused and developing trigger points, thus affecting the thighs and lower back. In the lower body extremities, the muscles that help provide stability to the hips are the iliopsoas muscles. The iliopsoas muscles consist of three muscles: iliacus, psoas major, and psoas minor, which can work individually or as a unit. When working individually, the iliacus muscle provides stability to the pelvis, the psoas major muscle helps stabilize the lumbar spine when a person is sitting, and the psoas minor helps with flexion of the trunk and stretch the iliac fascia. As a unit, however, these muscles work together to become the primary flexors of the thighs and allow hip flexion.
Studies reveal that the iliopsoas is a deep muscle group that anatomically connects the spine to the body’s lower limbs. The iliopsoas muscles have an important function in the body’s lower limbs as primary hip flexors for daily activities, especially for those in sports. However, many impairments and pathologies affect the iliopsoas, which causes significant limitations and challenges since the symptoms mask the pain, causing individuals to think they are dealing with low back and hip pain.
Referred Trigger Pain On The Thighs & Low Back
Since the iliopsoas muscles provide hip and thigh flexion to the lower body, many impairments and pathologies can affect this muscle group, causing issues in the hips, thighs, and even the lower back. These impairments can cause the iliopsoas muscles to be overused and overstretched, thus potentially developing trigger points along the iliopsoas muscles, causing referred pain on the thighs and low back. Studies reveal that when the iliopsoas muscle becomes overused or traumatic issues affect it, it can lead to problems in hip flexion and impairment in the lower extremities. In “Myofascial Pain and Disorders: The Trigger Point Manual,” written by Dr. Janet G. Travell, M.D., when trigger points begin to affect the iliopsoas muscles, it is known as the “Hidden Prankster” as normal factors like poor posture can overload the back causing trigger points to form not only on the iliopsoas muscles but the hamstrings, gluteal, thoracolumbar paraspinal, and posterior cervical muscles. Trigger points can mimic other chronic conditions that cause referred pain in different body areas. Trigger point pain in the iliopsoas muscle can lead to back pain, groin pain, snapping hips, and standing up difficult for the individual if it is not treated immediately.
Trigger Point Therapy: Iliopsoas Muscle- Video
Since the iliopsoas muscles provide hip and thigh flexion to the lower body, many impairments and pathologies can affect this muscle group, causing issues in the hips, thighs, and even the lower back. These impairments can cause the iliopsoas muscles to be overused and overstretched, thus potentially developing trigger points along the iliopsoas muscles, causing referred pain in the thighs and low back. Studies reveal that when the iliopsoas muscle becomes overused or traumatic issues affect it, it can lead to problems in hip flexion and impairment in the lower extremities. In “Myofascial Pain and Disorders: The Trigger Point Manual,” written by Dr. Janet G. Travell, M.D., when trigger points begin to affect the iliopsoas muscles, it is known as the “Hidden Prankster” as normal factors like poor posture can overload the back causing trigger points to form not only on the iliopsoas muscles but the hamstrings, gluteal, thoracolumbar paraspinal, and posterior cervical muscles. Trigger points can mimic other chronic conditions that cause referred pain in different body areas. Trigger point pain in the iliopsoas muscle can lead to back pain, groin pain, snapping hips, and standing up difficult for the individual if it is not treated immediately.
Treating Trigger Point Pain On The Thighs & Low Back
When trigger point pain begins to cause issues in the thighs and low back, the iliopsoas muscles will suffer from muscle spasms, stiffness, and difficulty standing. This is due to nerve entrapment from aggravated iliopsoas muscles caused by trigger points. However, various treatments can manage trigger point pain in the thighs, and low back through multiple techniques that pain specialists utilize can help relieve the pain symptoms from the iliopsoas muscle and manage trigger point pain. Studies reveal that combination treatments like soft tissue manipulation and trigger point therapy can help release the tiny nodules from the affected muscle and reduce the symptoms from re-occurring in the body. Other treatments, like correcting one’s posture, strength exercising, and even stretching, can help lengthen the iliopsoas muscles, stretch and strengthen the surrounding muscles, and prevent pain-like symptoms from affecting the thigh and low back muscles again. These various treatments can even improve hip mobility in the lower body extremities.
Conclusion
In the lower body extremities, an iliopsoas is a group of deep muscles that provide stability to the lumbar spine and allow hip and thigh flexion. These groups of deep muscles can work individually or together to enable the individual to sit, stand and move around through physical activities; however, when the iliopsoas muscles become overused or suffer from a traumatic event, they can develop trigger points that can cause mobility issues on the thighs, hips, and lower back. Even though trigger points are difficult to diagnose, they are treatable through various treatments. Various treatments, like soft tissue massages, trigger point therapy, strength exercising, or stretching the iliopsoas muscles, can release trigger points from the affected body part and help bring back mobility function to the hips, thighs, and low back.
References
Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Iliopsoas Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 2 Apr. 2022, www.ncbi.nlm.nih.gov/books/NBK531508/.
Dydyk, Alexander M, and Amit Sapra. “Psoas Syndrome.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 June 2022, www.ncbi.nlm.nih.gov/books/NBK551701/.
Kameda, Masahiro, and Hideyuki Tanimae. “Effectiveness of Active Soft Tissue Release and Trigger Point Block for the Diagnosis and Treatment of Low Back and Leg Pain of Predominantly Gluteus Medius Origin: A Report of 115 Cases.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Feb. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6382483/.
Lifshitz, Liran, et al. “Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment.” Current Sports Medicine Reports, U.S. National Library of Medicine, June 2020, pubmed.ncbi.nlm.nih.gov/32516195/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
The function of the SI joints is to allow torsional or twisting movements when moving the legs that act as levers. Without the sacroiliac joints and the pubic symphysis at the front of the pelvis, which allow these precision movements, the pelvis would be at higher risk of a fracture. The sacroiliac joints transmit body weight and all the physical forces down through the sacrum to the hips and legs. Individuals, especially athletes with pain in the lower back, hip, groin, or leg, could be experiencing SIJ/sacroiliac joint dysfunction. A physician or surgeon could recommend sacroiliac joint surgery for severe SI joint dysfunction and pain that has not resolved with conservative treatment.
Sacroiliac Joint Surgery
There are two sacroiliac joints. They connect the large iliac bones that make up the sides of the pelvis and the sacrum or triangle-shaped vertebrae between the iliac bones at the base of the spine. Pain in this area can come from sacroiliitis or inflammation of an SI joint, and referred pain may present. A doctor will consider causes such as:
There is a pathology of sacroiliac joint dysfunction in athletes. Sports that require repetitive and/or asymmetric loading that includes:
Kicking
Swinging
Throwing
Single-leg stance
Any athlete can develop sacroiliac joint dysfunction, but the highest prevalence activities include:
Soccer
Football
Basketball
Gymnastics
Golfing
Powerlifting
Cross-country skiing
Step aerobics
Stair stepper machines
Elliptical machines
Fusion Surgery
Surgery is not for patients with less than six months of confirmed localized pain or impairment with other causes ruled out. Surgery is the last option for SI joint pain unless it is an emergency. Doctors and surgeons will recommend non-invasive treatment methods before recommending surgery. Surgery recommendations come when the pain has become intolerable, and the individual can no longer move or operate.
Sacroiliac joint fusion is a minimally invasive procedure involving a small incision less than two inches long.
Under image guidance, titanium implants are inserted across the sacroiliac joint to provide stability.
Holes in the hardware allow for adding bone or for the bone to grow naturally across or onto the area to maintain stability.
This surgery can be either outpatient or overnight, depending on surgeon preference and the type of support available.
Surgery Recovery Time
For most individuals, recovery time is around three weeks on crutches.
Pain management depends on whether screws or bolts are involved; bolts tend to be more uncomfortable.
Post-op pain dissipates in a few days or a couple of weeks.
Fusion itself takes six or more months to complete.
Conservative Treatment Options
Conservative treatment modalities to reduce the inflammation can include:
Chiropractic
Physical therapy
Nonsurgical spinal decompression
Medications
Injections
Rest
Staying off your feet for a few days can help decrease pressure on the SI joint.
Using an ice or heating pad on the lower back and/or buttocks.
Massaging the surrounding muscles may help if the apparent cause is an injury.
A doctor could suggest using a cane, walker, or crutches under medical supervision.
Medications
Medications include anti-inflammatories such as ibuprofen, naproxen, or prescription alternatives.
Acetaminophen helps with pain but not inflammation.
Corticosteroids
Steroids are the most powerful anti-inflammatory.
A common nonsurgical treatment is cortisol steroids, injected under X-ray guidance.
Injections go directly to the source.
Oral steroids spread throughout the body but can cause undesirable side effects.
Chiropractic and Physical Therapy
Depending on the severity of the condition, chiropractic and physical therapy may be able to strengthen the muscles around the area and realign the joint.
A chiropractor will level the pelvis through sacroiliac joint manipulation and mobilization.
It works by applying compression around the hip and across the joint.
Back, Hip, and Radiating Pain
References
Brolinson, P Gunnar, et al. “Sacroiliac joint dysfunction in athletes.” Current sports medicine reports vol. 2,1 (2003): 47-56. doi:10.1249/00149619-200302000-00009
Heil, Jessica. “Load-Induced Changes of Inter-Limb Asymmetries in Dynamic Postural Control in Healthy Subjects.” Frontiers in human neuroscience vol. 16 824730. 11 Mar. 2022, doi:10.3389/fnhum.2022.824730
International Journal of Spine Surgery. (2020*) “International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac joint Pain): Coverage Indications, Limitations, and Medical Necessity.” doi.org/10.14444/7156
Peebles, Rebecca DO1; Jonas, Christopher E. DO, FAAFP2. Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management. Current Sports Medicine Reports: 9/10 2017 – Volume 16 – Issue 5 – p 336-342
doi: 10.1249/JSR.0000000000000410
The lower back works with the body’s lower extremities by stabilizing the hips and helping support the upper body’s weight. The lower back also has many functions when it comes to mobility. The lower back allows the person to bend, twist, and rotate the torso without any pain inflicted on the body. When normal factors or traumatic issues start to cause low back pain in the individual, the pain-like symptoms can correlate to the development of trigger points in the lower back muscles. Today’s article examines the quadratus lumborum, how myofascial trigger pain affects the low back, and how to manage myofascial trigger pain through various treatments. We refer patients to certified providers who incorporate multiple techniques in low back pain therapies related to trigger points to aid individuals dealing with pain symptoms along the quadratus lumborum in the lower back. We encourage and appreciate patients by referring them to our associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer
What Is The Quadratus Lumborum?
Have you been experiencing low back pain? Do you feel relief when you stretch your lower back, only to have the pain return later? Do you feel tenderness or soreness on the sides? Many of these complaints are correlated with low back pain associated with trigger points along the quadratus lumborum. The quadratus lumborum is a flat, quadrangular-shaped muscle in the iliac crest and deep back. This muscle plays an important part in the thoracolumbar fascia that covers the posterior body area while involving the lower and upper parts of the limbs. According to “Myofascial Pain and Dysfunction: The Trigger Point Manual,” written by Dr. Janet G. Travell, M.D., mentioned that the quadratus lumborum functions to control the side bending to the opposite side by lengthening contraction. Other studies reveal that various actions on the lumbar spine have been attributed to the quadratus lumborum. When the quadratus lumborum goes through these different actions, it can cause the muscles to become overused, or when injuries occur in the lower back, it can lead to various issues that can develop into overlapping conditions in the lower back.
Myofascial Trigger Pain Affecting The Low Back
When it comes to the lower back, many individuals worldwide experience some pain in their backs, and low back pain is common. Various factors cause low back pain from lifting heavy objects, over-exerting the sides with rapid turning, or even normal wear and tear of the body, which can cause lower back pain. When low back pain affects the quadratus lumborum, it can develop trigger points or myofascial trigger pain. Studies reveal that low back pain from the quadratus lumborum can present myofascial pain, causing the individual to have an acute pain episode in their lower back. Myofascial trigger pain is developed when the affected muscle has been overused and causes tiny knots to form along the muscle fibers. When myofascial trigger pain is in the quadratus lumborum, it becomes activated acutely through awkward movements or sudden trauma in the lower back, affecting the mobility of the lower back and the hips. Additional studies reveal that the prevalence of myofascial trigger pain in the quadratus lumborum, when being diagnosed, can display significantly less hip abduction strength. Low back pain associated with myofascial trigger pain can correlate with other chronic issues affecting the body’s lower extremities.
Trigger Point Release: Quadratus Lumborum- Video
Are you experiencing mobility issues in your hips? Do you feel symptoms of tenderness or stiffness in your lower back? Does it hurt when you are bending down to pick up an item? Most of these symptoms correlate with low back pain, potentially involving trigger points along the quadratus lumborum. Trigger points are formed when the muscle has been overused or been through a traumatic event like an auto accident, and since low back pain is common worldwide, it can mask other chronic conditions that overlap the pain. The video explains where the quadratus lumborum is located in the back, where the trigger points are marked, and how to manage the trigger points through manual manipulation while reducing pain away from the lower body. When myofascial trigger pain begins to wreak havoc on the affected muscles in the lower back. Various treatments applied to the lower back can help alleviate the symptoms caused by trigger points associated with the lower back along the quadratus lumborum.
Managing Myofascial Trigger Pain Through Various Treatments
Since low back pain is common worldwide and can potentially lead to the development of trigger points along the various lower back muscles, especially the quadratus lumborum, many individuals would utilize medication specifically for low back pain to reduce the pain symptoms; however, it only masks the pain caused by myofascial trigger pain. Studies reveal manual trigger-point therapy techniques that healthcare providers use to assess patients who are in pain from myofascial trigger pain. Many will go to a pain specialist to manage trigger points when the pain becomes too much for the individual. Another method that many people should utilize as part of their daily practice is doing gentle side stretching on the quadratus lumborum to loosen up the stiff muscles and reduce the chances of trigger points forming in the affected muscle in the future.
Conclusion
The quadratus lumborum is a flat, quadrangular-shaped muscle in the iliac crest and deep back. This muscle helps with posterior mobility of the lower extremities and, when overused, can develop myofascial trigger pain associated with the low back. This can lead to various common back pain issues that affect how a person moves and become unstable when in motion. Fortunately, low back pain associated with myofascial trigger pain is treatable through various treatments that can reduce the pain and manage trigger points located in the low back. When people incorporate treatments to alleviate pain in their lower back, they will begin to experience relief and have their sense of purpose back in their lives.
References
Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Abdomen and Pelvis, Quadratus Lumborum.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 18 July 2022, www.ncbi.nlm.nih.gov/books/NBK535407/.
de Franca, G G, and L J Levine. “The Quadratus Lumborum and Low Back Pain.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, Feb. 11AD, pubmed.ncbi.nlm.nih.gov/1826922/.
Grover, Casey, et al. “Atraumatic Back Pain Due to Quadratus Lumborum Spasm Treated by Physical Therapy with Manual Trigger Point Therapy in the Emergency Department.” Clinical Practice and Cases in Emergency Medicine, University of California Irvine, Department of Emergency Medicine Publishing Western Journal of Emergency Medicine, 29 May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6682240/.
Phillips, S, et al. “Anatomy and Biomechanics of Quadratus Lumborum.” Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine, U.S. National Library of Medicine, Feb. 2008, pubmed.ncbi.nlm.nih.gov/18441751/.
Roach, Sean, et al. “Prevalence of Myofascial Trigger Points in the Hip in Patellofemoral Pain.” Archives of Physical Medicine and Rehabilitation, U.S. National Library of Medicine, Mar. 2013, pubmed.ncbi.nlm.nih.gov/23127304/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Workout recovery is as important as working out. Pushing muscle past its normal levels creates tiny tears in the muscle tissue. It is the repairing process that generates muscle growth. Muscles that aren’t allowed to recover will not grow or gain muscle mass, and muscle strength could be reduced, making working out a struggle and hindering health goal progress. The body needs time to repair the muscles to reduce the risk of injury. Allowing enough time for recovery reduces overuse-related muscle breakdown and injuries. Muscle recovery supplements can expedite the healing process.
Muscle Recovery Supplements
Reasons for taking supplements include their ability to heal damaged muscles faster, aid in injury recovery, reduce muscle soreness, reduce muscle fatigue, and provide the muscle cells with energy during recovery.
Some studies have found that taking a creatine supplement may aid muscle recovery and greater muscle strength during recovery.
Citrulline Malate
Citrulline is a non-essential amino acid found in watermelon that converts into nitric oxide.
Nitric oxide helps open blood vessels and improve blood circulation.
This allows oxygen and nutrients to reach the muscle faster, speeding the recovery process.
Citrulline also improves the bioavailability of L-arginine, another amino acid that aids protein synthesis.
Magnesium
Magnesium assists with muscle recovery by helping the muscles relax.
When the body doesn’t have enough magnesium, there is a greater chance of muscle cramps.
Magnesium helps support healthy muscle contraction.
Tart Cherry Juice Extract
This extract works by reducing inflammation in the muscle.
Inflammation is normal, but too much can increase muscle soreness and the risk of injury.
One study found that cherry juice helps minimize post-exercise muscle pain.
Supplement Plan
After selecting a supplement plan that is the most beneficial for the individual, the next step is to devise a schedule for taking them.
When using a muscle recovery supplement can either be a pre-workout supplement or a post-workout supplement.
The recommended time to take a specific supplement is based on the type.
Individuals should talk with their doctor and a nutritionist before starting any new supplement regimen.
This helps ensure the supplements are safe and minimize negative side effects given health and medical conditions.
Nutrition In Recovery
References
Cooke, M.B., Rybalka, E., Williams, A.D. et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr 6, 13 (2009). doi.org/10.1186/1550-2783-6-13
DiNicolantonio, James J et al. “Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis.” Open heart vol. 5,1 e000668. 13 Jan. 2018, doi:10.1136/openhrt-2017-000668
Gough, Lewis A et al. “A critical review of citrulline malate supplementation and exercise performance.” European journal of applied physiology vol. 121,12 (2021): 3283-3295. doi:10.1007/s00421-021-04774-6
Kuehl, Kerry S et al. “Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial.” Journal of the International Society of Sports Nutrition vol. 7 17. 7 May. 2010, doi:10.1186/1550-2783-7-17
Vitale, Kenneth C et al. “Tart Cherry Juice in Athletes: A Literature Review and Commentary.” Current sports medicine reports vol. 16,4 (2017): 230-239. doi:10.1249/JSR.0000000000000385
Weinert, Dan J. “Nutrition and muscle protein synthesis: a descriptive review.” The Journal of the Canadian Chiropractic Association vol. 53,3 (2009): 186-93.
Wolfe, Robert R. “Branched-chain amino acids and muscle protein synthesis in humans: myth or reality?.” Journal of the International Society of Sports Nutrition vol. 14 30. 22 Aug. 2017, doi:10.1186/s12970-017-0184-9
Zhang, Shihai, et al. “Novel metabolic and physiological functions of branched-chain amino acids: a review.” Journal of animal science and biotechnology vol. 8 10. 23 Jan. 2017, doi:10.1186/s40104-016-0139-z
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