Precision Work For Low Back Pain
- eastwestgeneralema
- May 21
- 3 min read
By Jimmy Chang
Low back pain is usually the “scapegoat” rather than the real anatomical “criminal”. That’s because the lumbar is part of a kinetic chain—a biomechanical system that coordinates movement and transfers force. Dysfunctions in nearby muscles in the chain above and below will cause it to tighten up.
The most common example is when we sit for long periods of time. Our hip flexor muscles become locked in a short-tight position which forces the top of your pelvis to tilt forward. To keep you upright, your lumbar spine has to curve in. Which then means your lumbar muscles (quadratus lumborum and erector spinae) work overtime to keep your midsection stabilized.
What’s actually happening?
When you sleep, your body automatically puts down more tortilla (fascia fuzz) onto your burritos. With healthy normal movement, you continuously break down these extra fuzz-fibers, allowing your muscles to glide.
Without healthy movement, these fuzz fibers harden and get stuck. Over time, layers and layers can build into a mound that fuses with surrounding muscle burritos into one big clump of tortillas stuck together. Hence, a trigger point, more commonly known as “muscle knot.”
This is what actually happens. All of your muscle fibers are basically saran-wrapped by collagen tissue called fascia. You are held together by bundles upon bundles of fascia-muscle burritos.
So back to the lower back. When lower back pain is caused by muscular imbalance, there are often clumps of mashed burritos up and down the chain.
Most Common Target Areas For Low Back Pain
Deep-six gluteal muscles, most notably the piriformis muscle: These are six rotator and stabilizer muscles that run diagonally across both sides of your glutes.
Because modern humans do a lot of sitting, these muscles are often the most sedentary and dehydrated. The D6 causes lower back pain because if they can’t do their job and rotate, the lower back muscles have to work harder to stabilize during walking and other daily activities.
Hip flexors, such as psoas and tensor fasciae latae: Sitting down is a hip flexion. Staying seated for long periods of time, day after day, locks your flexors short. Short hip flexors cause a forward pelvic tilt, making your low back work harder to brace you when you walk.
Lower rib muscles: Above the chain, we have the diaphragm, which attaches to the ribs. Slouching and shallow breathing means it doesn’t get the movement it needs. When you breathe, the diaphragm also stabilizes the spine by dropping down and essentially filling your belly with pressure –like an internal weightlifting belt. When the diaphragm is so stuck it can no longer do that, it again forces the low back to work harder.
How can massage help?
There are many massage modalities that deal with low back pain. I prefer precise focus work. After relaxing the client’s body, I like to “camp out” in problematic areas —using my elbow to “persuade” adhesed muscles to “unstick.” Key word: “persuade.” Go in too hard, too fast and the muscles clench, pushing the therapist out. Leave too soon and damaged fascia fibers remain stuck. We’ll let you in on a little secret: muscle fibers don’t literally “get stuck” or “turn into knots.” That’s just colloquial phrasing for massage therapists.
There are many solutions to these problems, one of which is precise focus work. With the glute and hip flexor muscles, I like to sink in with an elbow for an extended period of time, following the lines of tension. Once the right depth is achieved, I use oscillating, micro-movements to persuade the mounds of unneeded collagen fibers to unstick. “Go collagen go, you’re free! You’re free!”
With the ribs, I use gentle mobilization to move the ribs up and down. With many clients, including myself, the lower ribs are so rigid that even gentle movement can feel intense.
Of course, there are many more target areas to focus on to support lower back pain. Precise focus work across kinetic chains can be applied to resolve issues all over the body, not just the lower back.
If you’re curious about how precise focus work can help you, book a session at East West Integrative Medicine to work with our massage therapists!
Sources:
PIRIFORMIS 101 | PIRIFORMIS TRIGGER POINTS & SELF PIRIFORMIS RELEASE
Kalstein Chiropractic
Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective
Jay P Shah, Nikki Thaker, Juliana Heimur, Jacqueline V Aredo, Siddhartha Sikdar, Lynn H Gerber
Diaphragm excursion and thickness in patients with chronic low back pain with and without lumbar instability
Gil Heldey: Fascia and Stretching: The Fuzz Speech
Various causes of hip pain, and how to fix it (image)
How do I breath correctly for singing? What is support? (image)
Restore ease of movement with this easy trick (image)
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