Hip

Hip or Lower Back Pain?

maybe even hamstring or piriformis pain…

By Cassidy Phillips – Founder of Trigger Point Performance Therapy

Groin Trigger Point Chart

Hip (Upper hamstrings, piriformis) Trigger Point Chart

Lower back Trigger Point Chart

From one time or another, I think we have all felt some form of hip or back pain. If you haven’t you’re lucky. When I was going through the worst of my problems I went to see a back specialist, and he said that there was no hope. He said I had a chronic pelvic tilt and a degenerating disk in the L4-5 region.

As you can imagine when I was given this news, I wasn’t real happy. I wasn’t willing to listen to the doctor say that I had a 60 year-old back and that I should reduce my active lifestyle to nothing. I didn’t want to believe it. I forced myself to figure out what was going on with my body and realized that I had to look closely at my biomechanics, muscular structure, and the way that I functioned everyday in life in order to remedy this situation

doctor

I slowly realised that all the pain I felt was tied together and radiated to different areas of my body. Every doctor said I needed to treat my back, so I did. I only treated my back but found relief just for a day or so. I never saw results that lasted a long period of time.

So, I thrust myself into this role of figuring out what was really going on. I wanted to understand my biomechanics and used my own body for my research. I had to address the way I sat and stood. I had to address so many of my biomechanical dysfunctions when I was not training.

seated

That is the key. Everyone thinks that it occurs while you are training/exercising, but in actuality it’s in your everyday life that your biomechanics get thrown off. Ultimately, this compromises your muscular structure and can potentially affect the rest of your life.

Muscles are designed to create and maintain structural integrity in the body.

structural

We have to rely on the structural integrity of the muscles to keep us pain free and allow biomechanics to be proper throughout life. Strength, tone, flexibility and hydration are all vital in keeping the muscles healthy.

If you think about it, in order to have structural integrity you must have a solid foundation. I see that foundation as a full functioning foot with great range of motion; a foot that can support the weight of the upper body no matter what happens. The biomechanical chain reaction beginning with the foot can take dysfunction from the lower leg all the way up to the lower back.

foot

The body’s foundation (the foot) is compromised when the soleus muscle in the back of the leg under the calf gets tight and forces you to lose dorsiflection or range of motion in the foot. This happens because the muscles in the lower leg connect in the bottom of the foot, thereby controlling the foot (like a puppet).

footpuppet

When you lose dorsiflection in the foot, the counter muscle on the front of the shin, the anterior tibialis, becomes tight and overworked which forces the knee to go forward. The body’s natural reaction is to adjust for the shift in weight. This creates an unstable platform for the knee and puts added stress on the knee joint. All joints have muscles and tendons that support the functionality of the joint. When the knee joint is compromised, the muscles in the inner, mid, and outer thigh are forced to work harder to maintain the structural integrity of the leg.

pevic-tilt

When the knees go forward, the butt shifts back. This is when the muscles in the thigh area, the quadriceps, now take a lot of the impact and become overworked. The quads are the biggest muscle group and take the absorbtion of each step when you run or walk. As the quads become tight they pull up on the patella. Because they originate in the pelvic region, the quads will also pull down on the pelvis, forcing an even more dramatic pelvic tilt.

quads-front

As the pelvis tilts, you may try to lift the upper body to counterbalance the weight. When you try to straighten your upper body and not lean forward, you end up arching your back, therefore, compressing the L4-5 area. The more compression there is on the L4-5 area, the more you compromise the neurological feed to the lower extremities.

Furthermore, when the quads lose their strength and flexibility and become tight and overworked they pull on the pelvis. The opposing muscles/tendons, the IT bands and hamstrings, then lengthen beyond their capacity subsequently creating their own unique aches and pains. Instead of just stretching and massaging the IT bands and hamstrings, you must take the pelvic tilt out of the equation. This will produce better long term results.

hamstring

Also during this biomechanical chain of events, a muscle called the psoas is engaged. The psoas connects in the groin and at T12 in the middle of the back. It unites the front to the back.

psoas_drawing

When the psoas is strong and flexible, it facilitates good posture and prevents compression on the lower back. On the contrary, when the psoas is challenged it can contribute to the upper body leaning in-front of the pelvis which worsens the compression on the L4-5 area. It also has the capability of compressing the diaphragm consequently compromising your ability to breathe.

h201

Next, the piriformis is a muscle set deep within the glut region. A tight piriformis is a by-product of the pelvic tilt, but more importantly the piriformis can be challenged by the way that you sit.

piriformis

When you sit, the knees will splay out to the side. As the knees rotate outward, the piriformis will bind up and go into spasm.

chair_slouch

As soon as you stand up and walk, the knees come out straight in front of the body, and the piriformis muscle elongates therefore causing pain in the general glut area.

The sciatic nerve runs directly through the piriformis muscle. When the piriformis goes into spasm or tightens it can impinge the siatic nerve.

piriformis

If the piriformis and glut region is not managed regularly with massage, a build up of scar tissue and adhesions surrounding the sciatic nerve can compromise the neurological feed to the lower extremities.

Overall, the body’s posture and ability to function properly is influenced by the biomechanics and muscular structure. Here you can see the results of bad biomechanics and poor weight distribution.

biomechanics_stick_figures_

Addressing the lower back independently, you can massage and strengthen the acute area in the back, but fundamentally, you must tackle the biomechanical chain to eliminate the root cause of this problem. Basically, you have to redefine the way your foot hits the ground and then eliminate the pelvic tilt.

back

In conclusion, it is important to remember that every bone has a muscle that surrounds it and every joint has a muscle and a tendon that supports it. If you do not strengthen and create elasticity (with massage) in the muscle, general aches and pains will result. By generating elasticity within the muscle, you are building a sound platform for structural integrity and positive biomechanics.

Exercises: Examples of massages for the areas discussed above

TP Footballer & Baller Block Soleus Exercise

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TP Double Ball Calf Exercise

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TP Single Ball Calf Exercise

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TP Quadballer 0 Degree Quad Exercise

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TP Quadballer 45 Degree Quad Exercise

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TP Quadballer 90 Degree Quad Exercise

90quads_front90quads_feet


TP Ball Piriformis Exercise

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piriformis_standing


Video Exercises: Video examples of massages for the areas discussed above

TP Footballer & Baller Block

foot_block_vid



TP Double Ball Video

double_ball_vid


TP Quadballer Video

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