Back Clinic Chiropractic. This is a form of alternative treatment that focuses on the diagnosis and treatment of various musculoskeletal injuries and conditions, especially those associated with the spine. Dr. Alex Jimenez discusses how spinal adjustments and manual manipulations regularly can greatly help both improve and eliminate many symptoms that could be causing discomfort to the individual. Chiropractors believe among the main reasons for pain and disease are the vertebrae’s misalignment in the spinal column (this is known as a chiropractic subluxation).
Through the usage of manual detection (or palpation), carefully applied pressure, massage, and manual manipulation of the vertebrae and joints (called adjustments), chiropractors can alleviate pressure and irritation on the nerves, restore joint mobility, and help return the body’s homeostasis. From subluxations, or spinal misalignments, to sciatica, a set of symptoms along the sciatic nerve caused by nerve impingement, chiropractic care can gradually restore the individual’s natural state of being. Dr. Jimenez compiles a group of concepts on chiropractic to best educate individuals on the variety of injuries and conditions affecting the human body.
For individuals experiencing pelvis pain symptoms and associated problems, can integrating pelvic floor physical therapy exercises help with treatment and prevention?
Pelvic Floor Physical Therapy
The pelvic floor muscles are located at the base of the pelvis and protect the pelvic organs like the vagina, cervix, uterus, bladder, urethra, and rectum. (U.S. Food and Drug Administration. 2019)
When the muscles fail to function correctly, individuals can experience symptoms like:
Painful intercourse
Prolapse – when an organ or tissue drops or shifts out of place.
Urinary incontinence
Constipation problems
These conditions are common in pregnant individuals or older women.
These symptoms can be treated with pelvic floor physical therapy to alleviate discomfort. Pelvic floor physical therapy can help women and individuals with vaginas:
Alleviate issues like painful sex, urinary leakage, and prolapse.
In physical therapy, individuals work on breathing, relaxation, and lengthening and strengthening techniques to train their muscles to function optimally.
Causes of Pelvic Floor Issues
Pelvic floor dysfunction tends to happen with age, during pregnancy, or in combination with events like the postpartum period and menopause, which can lower hormone levels.
Individuals who are pregnant are especially prone to pelvic floor issues but might not know they have a problem.
The pregnancy weight of a uterus can pressure and strain the muscles.
If left untreated, these symptoms can worsen over time.
Pelvic Floor Physical Therapy
An individual will meet with a specialist to discuss symptoms and undergo a physical examination that includes:
Pelvic floor exam.
Evaluation of posture, mobility, and core strength.
Once the initial exams and evaluation are complete, the practitioner will go over pelvic floor exercises and provide a treatment plan.
Recommended exercises vary based on symptoms but focus on relaxing, stretching, and/or strengthening muscles.
Muscle Relaxation
To relax the muscles, a therapist may recommend breathing exercises.
For pregnant individuals, this means timing breaths with contractions.
For individuals experiencing constipation, breathing exercises can help the body relax and reduce strain.
Stretching Muscles
Stretching can help relieve muscle tightness and stiffness.
A therapist may help stretch the pelvic floor through various therapy modalities.
This type of physical therapy can help loosen tight muscles or help gently reset dislocated organs back into place.
Strengthening Muscles
After the pelvic floor is loose and relaxed, the focus typically switches to strengthening the muscles.
Strength work may target abdominal muscles or the pelvic floor muscles themselves.
With time, commitment, and targeted treatment, individuals can use pelvic floor physical therapy to loosen tissues, strengthen muscles, and restore function.
Sartori, D. V. B., Kawano, P. R., Yamamoto, H. A., Guerra, R., Pajolli, P. R., & Amaro, J. L. (2021). Pelvic floor muscle strength is correlated with sexual function. Investigative and clinical urology, 62(1), 79–84. doi.org/10.4111/icu.20190248
Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. doi.org/10.1016/j.gtc.2008.06.003
Soave, I., Scarani, S., Mallozzi, M., Nobili, F., Marci, R., & Caserta, D. (2019). Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Archives of gynecology and obstetrics, 299(3), 609–623. doi.org/10.1007/s00404-018-5036-6
For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?
Posture Awareness
Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.
Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791
Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184
Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400
For women experiencing lower back and pelvic pain, could understanding symptoms help in the diagnostic process, treatment options, and prevention?
Low Back and Pelvic Pain In Women
In women, lower back and hip pain that radiates to the front pelvis area can have a variety of causes. The pain can feel dull, sharp, or burning. The main causes of lower back and pelvic pain in women fall into two categories. (William S. Richardson, et al., 2009)
Musculoskeletal and nervous system
Related causes of pain affect how your muscles, nerves, ligaments, joints, and bones move.
Examples include sciatica, arthritis, and injury.
Other organ system-based
Causes may stem from the following:
Acute/chronic conditions or infections
Kidneys – stones, infection, and other ailments or conditions.
Reproductive system – such as the ovaries.
Gastrointestinal system – inguinal hernias or appendix.
Musculoskeletal and Nervous System Causes
Musculoskeletal and nervous system-related causes can be from injuries like a fall or practicing unhealthy posture.
Overuse Injuries and Trauma
Frequent use and repetitive movements can lead to overuse injuries to the muscles, ligaments, and joints. :
Exercises, sports, and physical activities that require repetitive twisting and bending.
Lifting, carrying, and placing objects that require movements that are repeated regularly.
Trauma from vehicle collisions, accidents, falls, or sports accidents can inflict acute and chronic bodily injuries, like strained muscles or broken bones.
Depending on the type of trauma, healing and recovery time and treatment vary.
Both types of injuries can lead to numbness, tingling, pain, stiffness, popping sensations, and/or weakness in the legs.
Mobility Problems
Over time, a decreased range of motion and mobility in muscles and joints can cause discomfort and pain. Causes include:
Long periods of time spent in the same position.
Sitting for extended periods.
The pain often feels dull, achy, and stiff.
It can also lead to muscle spasms characterized by quick episodes of sharp and intense pain.
Posture
Posture while sitting, standing, and walking affects the body’s range of motion.
It can affect the nerves and blood circulation to the back and pelvic region.
Prolonged unhealthy postures can contribute to lower back pain and muscle strain.
Posture-related symptoms can feel achy and stiff and lead to quick episodes of severe or intense pain, depending on the position.
Sciatica and Nerve Compression
A bulging or herniating vertebral disc most commonly causes sciatica and pinched or compressed nerves.
The sensations can be sharp, burning, electrical, and/or radiating pain along the nerve pathway.
Arthritis
Arthritis inflammation causes swelling, stiffness, pain, and the breakdown of cartilage that cushions the joints.
Hip arthritis causes groin pain that can radiate to the back and becomes more intense when standing or walking.
Thoracic and lumbar spine arthritis, or degenerative disc disease, are other common causes of back pain.
Sacroiliac Joint Dysfunction
The sacroiliac joints connect the lower spine and pelvis.
When these joints move too much or too little, it can cause sacroiliac joint pain, leading to a burning sensation in the lower back and pelvic area. (Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa. 2017)
Renal and Urinary Causes
Kidney Stones
Kidney stones are the build-up of minerals and salts, which form into hard stones in the kidneys.
When the kidney stone begins to move to the bladder, pain symptoms will present.
It can trigger severe back and side pain that radiates to the pelvic region.
Other symptoms include – a change in urine color, pain when urinating, nausea, and vomiting.
Kidney Infection and Urinary Tract Infections
Urinary tract and kidney infections are also causes of lower back and pelvic pain in women.
They cause fever, continued urge to urinate, and painful urination.
Gynecological Causes
Pelvic Inflammatory Disease
Infections, known as pelvic inflammatory disease, occur when sexually transmitted bacteria spread through the vagina, womb, fallopian tubes, or ovaries. Symptoms include:
Pain during intercourse.
Bleeding between periods.
Vaginal discharge.
Pain in the lower abdomen or groin.
Fever.
Ovarian Cysts
The cyst can be a solid or fluid-filled sac on the surface or within an ovary.
Small ovarian cysts are unlikely to cause pain.
Large cysts or those that rupture can cause mild to severe pain.
The pain can occur during menstruation or intercourse and present acutely in the back, pelvis, or lower abdomen.
During Pregnancy
Back pain and discomfort in the pelvis area are common.
As the body adjusts, the bones and round ligaments in the pelvis move and stretch, which can cause discomfort.
Symptoms are usually normal but should be discussed with a healthcare provider during check-ups.
Pain in the lower back and groin can be a sign of miscarriage or labor – including preterm labor.
Sexually Transmitted Infection
Sexually transmitted infections, like chlamydia or gonorrhea, can cause lower back and groin pain.
Other symptoms can include – painful urination, vaginal discharge, intercourse pain, and bleeding between periods.
Yeast Infection
A yeast infection – overgrowth of the fungus candidiasis.
A common vaginal infection with symptoms including – itching, swelling, irritation, and pelvic pain.
Other Causes
Appendicitis
When the appendix becomes blocked, infected, and inflamed.
In most cases, a major symptom is pain that starts near or around the belly button.
In other cases, it can start in the lower back and radiate to the right side of the pelvic area. (Johns Hopkins Medicine. 2023)
Associated pain can worsen over time or when coughing, moving, or taking deep breaths.
It involves soft tissue and part of the intestine, pushing through weak groin muscles.
Pain presents in the abdomen, lower back, or pelvis, especially when bending or lifting objects.
Pancreatitis
Inflammation in the pancreas.
Infection, bile stones, or alcohol can cause it.
One symptom is abdominal pain that radiates to the back.
The pain becomes worse during and after eating.
Other symptoms include nausea, vomiting, and fever.
Enlarged Lymph Nodes
Lymph nodes lie in the internal and external regions of the iliac artery in the pelvis.
These can become enlarged by infection, injury, and, in rare cases, cancer.
Symptoms include pain, swelling, redness, skin irritation, and fever.
Enlarged Spleen
The spleen is located behind the left side of the rib cage.
It filters the blood and supports new blood cell creation.
Infections and diseases can cause the spleen to become enlarged.
An enlarged spleen – a condition known as splenomegaly – causes pain in the upper left part of the belly and sometimes the left shoulder and upper back.
However, some individuals with an enlarged spleen experience abdominal symptoms – not being able to eat without discomfort. (Mount Sinai. 2023)
Diagnosis
Depending on the cause of your pain, a healthcare provider may be able to diagnose it with a physical exam and by asking questions about your condition.
Other tests may be needed to find the cause, particularly blood work and imaging (X-ray or magnetic resonance imaging).
Treatment
Treatment of symptoms depends on the cause.
Once a diagnosis is made, an effective treatment plan will be developed and contain a combination of therapies:
Lifestyle Adjustments
For injuries caused by muscle strains, joint sprains, overuse, and smaller traumas, pain can be resolved with:
Rest
Ice therapy
Over-the-counter pain relievers – acetaminophen or ibuprofen.
Braces or compression wraps can help support the body and alleviate symptoms during healing and recovery.
Exercises to improve posture
Paying attention to form when lifting objects
Stretching can help ease the pain.
Medication
Medications can be used in a variety of ways to help in the treatment of lower back and pelvic pain. If an infection is the cause, medications will be prescribed to remove the infection and resolve the symptoms, which can include:
Antibiotics
Antifungals
Antivirals
Medications may also be prescribed to help manage pain symptoms and may include:
Medication to relieve nerve pain
Muscle relaxants
Steroids
Physical Therapy
A physical therapist can help to correct problems with:
Posture
Decreased mobility
Walking gait
Strengthening
A physical therapist will provide exercises to help increase and maintain strength, range of motion, and flexibility.
Pelvic Floor Therapy
This is physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvis.
It helps with pain, weakness, and dysfunction in the pelvic area.
A treatment plan will be developed to help with strength and range of motion in the pelvic muscles.
Chiropractic Care
Chiropractors offer spinal and hip adjustments to realign the joints of the spine.
Some more severe conditions could require surgery.
Ovarian cysts, hernias, and other infections sometimes require surgery to remove infected or unhealthy tissue – ruptured ovarian cysts or appendicitis.
Recommended surgeries can include:
A hernia repair.
Hip replacement.
Gallbladder removal to prevent recurring pancreatitis.
Prevention
Not all conditions and diseases cause lower back and pelvic pain. Symptoms can be prevented and reduced by adopting lifestyle changes. Prevention recommendations can include:
Staying hydrated.
Using proper bending and lifting techniques.
Eating healthy foods.
Regularly engaging in some form of physical activity – walking, swimming, yoga, cycling, or strength training.
Maintaining a healthy weight.
Pregnancy and Sciatica
References
Richardson, W. S., Jones, D. G., Winters, J. C., & McQueen, M. A. (2009). The treatment of inguinal pain. Ochsner journal, 9(1), 11–13.
Kurosawa, D., Murakami, E., & Aizawa, T. (2017). Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clinical neurology and neurosurgery, 161, 104–109. doi.org/10.1016/j.clineuro.2017.08.018
Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The spine journal : official journal of the North American Spine Society, 6(2), 131–137. doi.org/10.1016/j.spinee.2005.08.001
Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)
Rehabilitation Exercise Program
A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)
Post-Surgery
The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:
Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries
A guide on what to expect in physical therapy.
Postural Retraining
After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.
Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.
Prone Press Up
One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.
To perform the exercise:
Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.
Sciatic Nerve Gliding
Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.
After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.
To perform the exercise:
Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.
Supine Lumbar Flexion
After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.
To perform the exercise:
Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.
Hip and Core Strengthening
Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.
Return-to-Work and Physical Activities
Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:
Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.
Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.
Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. doi.org/10.2519/jospt.2012.3854
Individuals experiencing headaches on top of the head could be caused by different factors. Can recognizing what triggers pain or pressure help prevent this type of headache, and healthcare providers develop effective treatment plans?
Headache On Top of The Head
Various factors could cause a headache on top of the head; common causes include:
Stress
Sleep problems
Eye strain
Caffeine withdrawal
Dental problems
Hormonal changes
Alcohol consumption
Causes
Many causes have to do with underlying issues happening in other parts of the body.
Stress
Stress is a common cause of headaches, including one on top of the head.
Researchers don’t know exactly how stress causes headaches, but they think it causes tightening of the muscles in the back of the head or neck, which
pulls the tissues down, resulting in pain or pressure in the scalp and/or forehead area.
These are also called tension headaches.
Headaches caused by stress generally feel like dull pressure rather than throbbing pain.
Sleep Problems
Not getting enough sleep can induce a headache on top of the head.
When the mind and body do not get proper sleep, it can interfere with body functions like temperature, hunger, and sleep-wake cycles, which can lead to headaches.
It is common to feel more stressed when sleep-deprived, which can cause or compound a headache and other symptoms.
Eye Strain
You may develop a headache on the top of your head after you’ve been reading, watching, or otherwise focusing on something for a while.
Over time, your eye muscles tire and have to work harder, causing them to contract.
These spasms can lead to headaches. Squinting can make the muscle contractions even worse.
Caffeine Withdrawl
Individuals may feel pain on the top of their heads if they skip their regular coffee.
Regular caffeine consumption can lead to dependency and withdrawal symptoms, which include headaches when intake is reduced or stopped.
This type of headache can be moderate to severe and can feel worse with activity.
Teeth issues like cracks, cavities, or impaction can irritate the trigeminal nerve, setting off head pain.
Teeth grinding can also lead to headaches.
Hormonal Changes
Individuals who have a low level of thyroid hormone may experience headaches.
This could be from having too little thyroid or a symptom of the condition.
Like stress-induced headaches, this type is generally dull and not throbbing.
Some women may feel pain on the top of their heads before menstruation triggered by estrogen levels dropping.
Alcohol
Some individuals develop a headache on the top of their head or elsewhere within a few hours after drinking alcohol.
This is known as a cocktail headache.
Alcohol-induced headaches usually resolve within 72 hours.
The mechanism behind this headache is not fully researched, but it’s been thought that the widening of blood vessels in the brain/vasodilation when consuming alcohol may trigger head pain.
This type of headache is different than a hangover headache that comes from overconsumption and is based on dehydration and the toxic effects of alcohol. (J G Wiese, M. G. Shlipak, W. S. Browner. 2000)
Rare Causes
Top-of-the-head pain can also result from more serious and rare causes:
Brain Tumor
Headaches are one of the most common symptoms of brain tumors.
A headache on the top of the head depends on the location and size of the tumor. (MedlinePlus. 2021)
Brain Aneurysm
This is a weak or thin area in a brain artery that bulges and fills with blood, which can cause a life-threatening rupture.
A medical professional will be able to help identify the type of headache being experienced, offer treatment options, and advise on how to manage triggers.
Individuals dealing with chronic knee discomfort, hip tightness, and lower back pain could be experiencing dormant gluteal-butt syndrome. Can recognizing the symptoms and signs and incorporating lower body and core fitness help prevent and treat the condition?
Dormant Gluteal Butt Syndrome
Knee, hip, and lower back problems could be traced back to weakened buttocks. Some scientists call the condition “dormant butt syndrome” (Ohio State University, .2023). However, researchers are learning about the important role the gluteal muscles provide in maintaining the lower body strong and healthy. (Hal David Martin, Manoj Reddy, Juan Gómez-Hoyos. 2015)
What Is It?
The syndrome is defined as weak buttock muscles and tight hip flexors. Experts from the Ohio State Wexner Medical Center have worked with individuals dealing with knee, hip, or back injuries and believe many of these issues are linked to weakened gluteal muscles. (Ohio State University.2023) The glutes are the muscles of the hips and buttocks. Weakened muscles fail to absorb the shock they’re supposed to during activities, which results in overloading the surrounding muscles and joints and increases the risk of injury. (Ohio State University, .2023)
Dormant gluteal-butt syndrome can result from a sedentary lifestyle and prolonged inactivity, like sitting for long periods.
The condition also occurs in runners and other physically active individuals who forget about these muscles with targeted exercises.
Exercises
Exercises to target the gluteals and prevent dormant gluteal-butt syndrome include activities/exercises that work the hips and core.
When walking properly, the gluteals should execute hip extension naturally.
Unhealthy postures, excessive sitting, and continued dysfunctional biomechanics mean walking without achieving optimal hip extension. (Hadi Daneshmandi. 2017)
When this happens, the gluteal muscles never get to fully function work, ending up with a series of aches and pains.
Pilates exercises can be adjusted to address order, repetition, and variation to strengthen the gluteals. (Laís Campos de Oliveira, 2015)
Hamstring Curls
Lie face down on an exercise mat.
Use your hands to create a cushion for the forehead.
Bend both knees so the feet point up towards the ceiling.
Let the knees be slightly apart, but keep the heels together.
Squeeze the heels together and tighten the gluteal muscles.
Hold for 3 seconds, then release the buttocks.
Repeat 10 times and then rest.
Hamstring curls can also be done using a weight machine.
Place the hands just behind the backside with the fingers pointing forward if possible.
Raise the body up.
Keep your head up and look straight ahead.
Raise one leg as high as possible.
Hold for as long as possible.
Lower and raise the other leg.
Repeat for a total of 3 reps.
Lining Up With A Wall Posture Helper
Standing posture is important to proper buttock function. Lining the body up with a wall can help train the body to maintain proper posture.
Find a wall and stand against it from the heels to the back of the head.
Work the backs of the legs and spine as firmly as possible into the wall.
Work to get the back of the skull into the wall as well.
Add some abdominal work by working the waistline inward and upward.
Hold for up to one minute.
The alignment is how you want to hold your body.
As you move off the wall, learn to maintain that posture throughout the day and night.
Repeat the wall exercise several times for reinforcement.
If aching of the hip, back, or knee is part of daily struggles, working out the gluteal muscles may be the solution. Contact the Injury Medical Chiropractic and Functional Medicine Clinic for a full consultation.
Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. doi.org/10.1093/jhps/hnv029
Daneshmandi, H., Choobineh, A., Ghaem, H., & Karimi, M. (2017). Adverse Effects of Prolonged Sitting Behavior on the General Health of Office Workers. Journal of lifestyle medicine, 7(2), 69–75. doi.org/10.15280/jlm.2017.7.2.69
Campos de Oliveira, L., Gonçalves de Oliveira, R., & Pires-Oliveira, D. A. (2015). Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial. Journal of physical therapy science, 27(3), 871–876. doi.org/10.1589/jpts.27.871
“Various problems with the sacrum make up or contribute to a significant portion of lower back problems. Can understanding the anatomy and function help prevent and treat back injuries?”
The Sacrum
The sacrum is a bone shaped like an upside-down triangle located at the base of the spine that helps support the upper body when sitting or standing and provides pelvic girdle flexibility during childbirth. It comprises five vertebrae that fuse during adulthood and connect to the pelvis. This bone takes and endures all of the body’s pressure and stress from everyday activities and movements.
Formation
Humans are born with four to six sacral vertebrae. However, fusion does not take place in all sacral vertebrae simultaneously:
Fusion starts with the S1 and S2.
As the individual gets older, the overall shape of the sacrum begins to solidify, and the vertebrae fuse into a single structure.
The process usually starts in the mid-teens and finishes in the early to mid-twenties.
It is believed to start earlier in females than males.
The sacrum in a female is wider and shorter and has a more curved top or the pelvic inlet.
The male sacrum is longer, narrower, and flatter.
Structure
The sacrum is an irregular bone that makes up the back/posterior third of the pelvic girdle. There is a ridge across the front/anterior portion of the S1 vertebra known as the sacral promontory. Small holes/foramen on both sides of the sacrum are left over after the vertebrae fuse together. Depending on the number of vertebrae, there can be three to five foramen on each side, though there are usually four. (E. Nastoulis, et al., 2019)
Each anterior foramen is typically wider than the posterior or dorsal/backside foramen.
Each sacral foramina/plural of foramen provides a channel for the sacral nerves and blood vessels.
Small ridges develop between each of the fused vertebrae, known as transverse ridges or lines.
The top of the sacrum is called the base and is connected to the largest and lowest of the lumbar vertebrae – L5.
The bottom is connected to the tailbone/coccyx, known as the apex.
The sacral canal is hollow, runs from the base to the apex, and serves as a channel at the end of the spinal cord.
The sides of the sacrum connect to the right and left hip/iliac bones. The attachment point is the auricular surface.
Right behind the auricular surface is the sacral tuberosity, which serves as an attachment area for the ligaments that hold the pelvic girdle together.
Location
The sacrum is at the level of the lower back, just above the intergluteal cleft or where the buttocks split. The cleft starts at around the level of the tailbone or coccyx. The sacrum is curved forward and ends at the coccyx, with the curvature being more pronounced in females than males. It connects to the L5 lumbar vertebra by way of the lumbosacral joint. The disc between these two vertebrae is a common source of low back pain.
On either side of the lumbosacral joint are wing-like structures known as the sacral ala, which connect to the iliac bones and form the top of the sacroiliac joint.
These wings provide stability and strength for walking and standing.
Anatomical Variations
The most common anatomical variation applies to the number of vertebrae. The most common is five, but anomalies have been documented, including individuals with four or six sacral vertebrae. (E. Nastoulis, et al., 2019)
Other variations involve the sacrum’s surface and curvature, where the curvature differs widely between individuals.
In some cases, the first and second vertebrae do not fuse and remain separately articulated.
Failure of the canal to completely close during formation is a condition known as spina bifida.
Function
Studies on the sacrum are ongoing, but some proven functions include:
It serves as an anchor point for the spinal column to attach to the pelvis.
It provides stability for the body’s core.
It acts as a platform for the spinal column to rest on when sitting.
It facilitates childbirth, providing pelvic girdle flexibility.
It supports upper body weight when sitting or standing.
It provides extra stability for walking, balance, and mobility.
Conditions
The sacrum can be a main source or focal point for lower back pain. It is estimated that 28% of men and 31.6% of women aged 18 years or older have experienced low back pain in the past three months. (Centers for Disease Control and Prevention. 2020) Conditions that can cause sacrum pain symptoms include.
Sacroiliitis
This is a common condition of sacroiliac/SI joint inflammation.
A doctor only makes the diagnosis when all other possible causes of pain have been ruled out, known as a diagnosis of exclusion.
About half of all chordomas form in the sacrum, but the tumors can also develop elsewhere in the vertebral column or at the base of the skull. (National Library of Medicine. 2015)
Spina Bifida
Individuals can be born with conditions that affect the sacrum.
Spina bifida is a congenital condition that can arise from the malformation of the sacral canal.
Unlocking the Secrets of Inflammation
References
Gruss, L. T., & Schmitt, D. (2015). The evolution of the human pelvis: changing adaptations to bipedalism, obstetrics and thermoregulation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 370(1663), 20140063. doi.org/10.1098/rstb.2014.0063
Nastoulis, E., Karakasi, M. V., Pavlidis, P., Thomaidis, V., & Fiska, A. (2019). Anatomy and clinical significance of sacral variations: a systematic review. Folia morphologica, 78(4), 651–667. doi.org/10.5603/FM.a2019.0040
Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 36(8), 370–375.
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