Chiropractic, Muscles & Poor Posture
Kieran Finnegan: Chiropractor, Myotherpaist (SLM) & Sports Massage Therapist
I’m in a unique position as a chiropractor & with an estimated 10,000 hours treating the muscles & fascia as a myotherapist, (trained & mentored by Steve Lockhart) my experience is similar to what the research shows (see below); that the muscles & fascia are a significant cause of back pain. This is why I don’t limit myself to just one or the other & don’t do the usual short chiropractic treatment using adjustments as the primary intervention, as its not effective in treating the muscles, fascia & posture.
Most people I treat with pain have had there problems on & off for many months and it could potentially be a build of many more months if not years prior to that, the idea you can resolve chronic myofascial (muscle & fascia) pain that has accumulated over years, in a 15 minute treatment without actually treating the muscles & fascia is not practical & in my personal opinion I believe this approach has more to do with treating as many people an hour thus increasing profits, rather than a patient focused approach & trying to resolve the underlying causes.
Muscle pain & dysfunction usually stem from trigger points ‘knots’, which are non articular in origin (1,2) meaning not originating from the spine or joint. There are biochemical changes within the muscles/fascia due to chronic overuse (3,4,5) again not originating from the spine or joints. Myofascial (muscles & fascia) pain is a significant health problem affecting as much as 85% of the general population (6). The muscles & fascia of the low back are more accepted as sources of low back pain(7). In the US it is estimated that the muscles/fascia alone of the low back account for 240 billion health expenditures every year. (8) Interestingly things such as spinal degeneration, arthritis, disc buldges are believed not to to be overly related to back pain & more of a coincidental finding. (9,10)
How Posture & Muscles Cause Pain.
A tell tale sign that your muscles/posture may be a contributing factor, is if your pain is felt more so when weight-bearing as its the responsibility of your muscles & fascia to hold your body upright against gravity. If pain is exacerbated by standing, sitting, exercising or holding certain positions, the shortened muscles will begin to pull and other muscles will have to compensate causing pain & tension. For example, having tightness in the front of the legs, hips & pelvis will pull the lower back/spine forward causing the lower spine to compensate. Most postural problems affecting the low back stem from imbalances of the muscles & fascia of the legs and pelvis, although there are many so called ‘musculoskeletal experts’ claiming to address things such as a tilted/rotated pelvis, short leg etc (more details in next article) however, very few of them address the underlying causes, namely the muscles & fascia.
Other signs that muscles are either a direct or in-direct contributing factor is if heat provides relief, such as a heat pack or a hot shower, when a muscle becomes chronically tight it will restrict blood flow to the area causing the muscles to fatigue quicker and waste products to build up & stimulate pain receptors in the muscles(11), when you put heat on the area this causes the blood vessels to dilate which brings fresh blood to the area and removes the waste products(12). Similarly if stress aggravates your problem the muscles are often involved, when someone is in a stressful situation a part of there nervous system is stimulated also contracts the muscles, if your muscles are already tight and blood is been restricted the threshold at which pain is caused is lowered so any added stress whether it be physical or mental more readily exacerbates the problem.
In the next article I will show you was you can diagnose your own postural issues which will help guide you in seeking the right treatment & if you are getting treatment based of your posture you can objectively see if it is been addressed.
1.) Barbero M1, Cescon C, Tettamanti A, Leggero V, Macmillan F, Coutts F, Gatti R. Myofascial trigger points and innervation zone locations in upper trapezius muscles.BMC Musculoskelet Disord. 2013 Jun 8;14:179. doi: 10.1186/1471-2474-14-179.
2.) Shah JP1, Gilliams EA2.Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008 Oct;12(4):371-384. doi: 10.1016/j.jbmt.2008.06.006. Epub 2008 Aug 13.
3.) Branchini M, Lopopolo F, Andreoli E, Loreti I, Marchand AM, Stecco A. Fascial Manipulation® for chronic aspecific low back pain: a single blinded randomized controlled trial Published online 2016 Jan 8. doi: 10.12688/f1000research.6890.2
4.) Stecco C, MD1 and Day J, A, PT2 The Fascial Manipulation Technique and Its Biomechanical Model: A Guide to the Human Fascial System
6.) Jafri MS1. Mechanisms of Myofascial Pain. Int Sch Res Notices. 2014;2014. pii: 523924.
7.) Borg-Stein J1, Wilkins A. Soft tissue determinants of low back pain. Curr Pain Headache Rep. 2006 Oct;10(5):339-44.
8.) Yelin E1. Cost of musculoskeletal diseases: impact of work disability and functional decline. J Rheumatol Suppl. 2003 Dec;68:8-11.
9.) Chou R., Fu R., Carrino J., Deyo R., Imaging strategies for low-back pain: systematic review and meta-analysis. The Lancet, Vol 373, No. 9662 p463–472, 7 February 2009
10.) Webster S, Cifuentes M., Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occup Environ Med. 2010 Sep;52(9)
11.) Carel Bron1,2 and Jan D. Dommerholt3,4,5 Etiology of Myofascial Trigger Points. Curr Pain Headache Rep. 2012 Oct; 16(5): 439–444.