By Sarah Court, PT, DPT, e-RYT
Traditionally, the thinking around how to approach low back and pelvic girdle pain has had a singular approach: find the ‘tight’ muscle and stretch it, and then find the ‘weak’ muscle and make it stronger.
While it’s true that muscular tone imbalances can and do create the kind of postural disequilibrium that leads to pain, in particular chronic pain syndromes, our approach needs to consider a broader perspective: how the brain is controlling the relative tone of our tissues, and how our muscles work together in what are called myofascial chains, or long links of muscles that are linked through fascial relationships.
Let’s look first at the myofascial relationships in the body. There are two different types of muscles in the body: global movers and local stabilizers. The global mover muscles are typically more on the surface of the body, and are made for creating movement – say, reaching for a glass, or doing a squat, or running up stairs. They are linked via their fascial relationships from head to toe, and work in conjunction with each other to create our movements. These muscles are made of fibers that can only sustain an output for a brief period of time – for the duration of the movement itself. Think of these like the sprinter muscles of your body: made to do a task that has a relatively short duration and a specific beginning and end.
What this can mean is if there is a weakness somewhere in the chain of linked muscles, it can lead to compensatory movement patterns and pain in a seemingly unrelated part of the body. For example, shoulder pain could be coming from a weak link in the hip, or a painful knee can be caused by a weak posterior line link on the opposite side of the body.
Local stabilizers, on the other hand, are deeper inside the body, and their job is to keep the torso stable while movement is taking place. Their fibers are made specifically for endurance, meaning their job is to be on at a lower level of engagement all the time that you are upright or moving around. These are your ‘marathon’ muscles: playing a supporting role throughout the day as you sit, stand, walk or run to provide stability to the trunk.
These local stabilizers have been identified as the diaphragm, the transversus abdominus, the multifidi, and the pelvic floor, and together they create a stable core for your body to move on top of.
When this muscle system isn’t working properly, it will often recruit some of the musculature of the global system as compensation, and since these ‘sprinter’ muscles burn out easily – muscles that aren’t even made to stabilize – it can lead to things like low back and pelvic pain.
So what might cause a disruption in this stabilizing system? In a word: trauma.
When an area of the body undergoes a painful experience, be it surgery, childbirth, a car accident, that experience is registered by the brain in a number of ways, and this creates a cascade of sensory and motor disruption.
One of these effects is called cortical smudging.1 Your brain has two maps of your body that lie quite literally from ear to ear across the top of your head.
There’s a version for sensation, and a version for movement, and they are side by side on the top of your brain where the sensory and motor cortices meet. When pain is experienced in a certain part of the body, it affects these two maps by ‘smudging’ that area of the map. For the sensory map, if pain is chronic and ongoing, this smudge makes it difficult for the brain to figure out the exact location of the pain (which is why it can feel like it moves around, or it’s in a general area, but hard to pinpoint).
For the motor map, the smudging makes it very difficult for the brain to send movement messages to that part of the body. So in the instance of pelvic floor trauma, when the neuromuscular communication to the local stabilizers has been disrupted, the brain creates a compensatory movement pattern using different muscles, such as the paraspinals of the low back, which in turn become overworked, exhausted, and ultimately painful.
Simply stretching or massaging the low back won’t sufficiently address the problem. We have to reset the brain’s communication with these areas of the body, via a technique called neuromuscular activation, which is one of the techniques we use at Postureworks.
With neuromuscular activation, we stimulate the correct muscles to come on at the right time. For the local stabilizers of the core, which includes the pelvic floor, we use suspension and high frequency vibration to re-activate these stabilizers without pain or compensation. Retraining the neuromuscular system takes frequent repetition, as we are quite literally re-mapping the brain’s connection to this part of the body for proper activation. With repetition, correcting these imbalances via resetting the neuromuscular control will train the brain to stop using the wrong muscles for the job and thus get rid of painful dysfunctional patterns.
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Sarah Court, PT, DPT, e-RYT graduated with a Doctor in Physical Therapy from Mount St. Mary’s University. She has experience in orthopedic and neurologic settings, rehabilitating patients post-surgery or injury, and managing chronic neuromuscular conditions. Since 2005, Sarah has been an international yoga teacher and yoga teacher trainer, and developed her own continuing education program for movement professionals. She gives clients the tools to move intelligently, and integrates Neurac/Redcord, yoga, and other movement and breathing techniques into her treatments. Sarah has a BA in Art and Architecture from Princeton University.
- Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the Motor Cortex is Related to the Severity of Low Back Pain. Spine 2017 Aug 1;42(15):1172-1178.