From the desk of Nicole A. Trincia, LNCMT…
Over one quarter of people in the U.S. suffer from lower back pain (National Health Interview Survey, 2002 http://http://www.ncbi.nlm.nih.gov/pubmed/17077742). Even those who are diligent with exercise and stretching may have difficulty relieving this often annoying and sometimes debilitating syndrome. I myself, even as a physically active massage therapist who stretches daily, have experienced lower back pain that would not seem to go away. There are a myriad of different causes of lower back pain, including repetitive stress, improper body mechanics, and spinal imbalances or degeneration. In getting to the root cause of your lower back pain, it is important to consider not just the “immediate” muscles of lower back (i.e. the quadratus lumborum) but the supporting muscles: in particular the elusive iliopsoas.
The iliopsoas consists of the psoas major muscle which connects to the iliacus muscle (originating at the 12th thoracic vertebra through the 5th lumbar vertebra and inserting at the lesser trochanter of the femur). It actually runs somewhat diagonally from the middle of your back to the inside of your upper hip bone. It is the strongest hip flexor, and hence most apt to become hypertonic from common hip flexing activities (or inactivity!), such as sitting for long periods of time at a computer or driving in a car. It is difficult to palpate and also challenging to stretch.
Doing some sort of forward bend may seem like the best lower back stretch, but is sometimes not enough. Depending on your specific physical circumstance, this stretch may not be appropriate for you, or could even aggravate your spine. I experienced a bulging disc at L5-S1, where forward bending actually, unknowingly at first, exacerbated my lower back pain! What I have found to work is kneeling next to a bed (for support with my arms,) with one leg bent at a ninety degree angle and the other leg extended behind me, with a strong pelvic tilt. This pelvic tilt is essential to engaging and releasing the iliopsoas, unlike other lunges (also commonly referred to as a “runner’s stretch”) that you may have tried in the past. The other key: breathe! Breathe deeply and slowly on your inhale and relax and exhale slowly as you lean into this stretch. Also, make sure not to extend your bent knee past the top of your foot. If you need to, move the foot of your bent knee out a little bit- but make sure your pelvis is tucked!
For those even more adventurous (and not pregnant or with acute abdominal issues), my ultimate iliopsoas stretch (thank you Ana Forrest!) requires a rolled up yoga mat (folded in thirds lengthwise, then rolled lengthwise and duck taped). Lie face down on a clean floor or a regular yoga mat with the rolled up mat under your abdomen. The rolled up mat should fit nicely below your rib cage, but above your pelvis. With your face turned to one side at a time, again breathe deeply and slowly, allowing your abdominal muscles to soften with each exhale. This will probably feel uncomfortable or awkward at first if you have never done this before, or you have a lot of tension in your core (physically and or emotionally!) Eventually, as you allow yourself to relax, you will begin to access and release the iliopsoas muscle and your elusive back pain!
Try these daily stretches along with regular massage (twice a week if necessary for persistent back pain, or at least once a month). Suggest to your massage therapist to work on your hip adductor muscles. As your iliopsoas runs through the middle of your body, and is thus difficult to access, the hip adductors are close “relatives” that are more accessible and often involved in the tension pattern of the iliopsoas and lower back.
Licensed Massage Therapist
Nicole Trincia is a Massachusetts Licensed and Nationally Certified Massage Therapist who has been practicing in the Greater Boston area for over eleven years. She graduated from Healing Touch Institute in 2000, with certification in Holistic Massage Therapy. Her training includes Swedish, Esalen, Neuromuscular, Myofascial, Sports and Pregnancy Massage as well as Polarity, Aromatherapy, and yoga. As a member of the Associated Bodywork and Massage Professionals (ABMP), Nicole has expanded her massage into an integrative style, customized to the unique needs of her clients. She incorporates Cranio Sacral, Thai Massage, Hot Stone, assisted stretching, and Feldenkrais techniques. In 2010, she successfully completed the First Degree of the Usui System of Reiki Healing.