Hidden muscular causes of neck and back pain

Abstract prepared for Chiropractic & Osteopathic College of Australasia Conference, November 1999

The three ‘big ones’ are considered here: piriformis, quadratus lumborum, and levator scapulae.

Tight or inflexible iliopsoas can alter the biomechanics of the lumbar, thoracic and cervical spine. When in the vertical load-bearing position, tight iliopsoas prevents the pelvis from sitting in what might be considered a ‘neutral’ position; excessive lumbar lordosis can be the result. In concert with an anteriorly-tilted pelvis, the thoracic curve (kyphosis) increases; similarly the cervical lordosis increases in an attempt to maintain the weight of the head over the body’s centre of gravity. Kapandji (1974) suggests that the ideal position of the pelvis is one that produces a shape in the spine that which requires the least muscular effort to support. Standard stretching exercises for the hip flexors are often ineffective, extending the lumbar spine and aggravating the problem in many instances. Appropriate bracing techniques will be demonstrated.

Piriformis syndrome is generally taken to describe the condition when a large or tight piriformis entraps the common peroneal or tibial portions of the sciatic nerve between piriformis and the greater sciatic foramen (Freiberg described a surgical operation to relieve this phenomenon as long ago as 1934), or when part of the sciatic nerve pierces piriformis. All the standard indicators of disc-induced sciatica can be mimicked by this condition. It is generally accepted that in 10-20% of the population (Travell and Simons, 1983), the common peroneal portion of the sciatic nerve pierces piriformis , but recent research from Japan suggests that this range is conservative. In a study of 450 pelvis halves, Chiba et al., 1994, identified eight additional variations on how portions of the sciatic nerve may pierce piriformis and suggested this may occur in up to 37% of the population. Three effective stretches for this muscle will be demonstrated.

Quadratus lumborum is a common site of the pain of low back pain. The causes of pain in this muscle are varied and will be discussed. Quadratus lumborum is commonly associated with actual leg length differences (and may be in the induced cases, too) so effective stretching exercises can be a helpful adjunct to other therapies.

Levator scapulae is a common source of neck pain and dysfunction. Tightness in this muscle is frequently associated with scalenus tension. The anatomy of levator scapulae suggests that no single exercise can stretch all its fibres; a combination of lateral flexion and flexion combined with lateral flexion is required. The scalenus group (anterior and medial) have been suggested as the cause of Thoracic Outlet Compression Syndrome by many authors, but stretching these muscles presents the practitioner with special difficulties. Unless levator scapulae is sufficiently relaxed, putting the neck into the sort of rotated and extended positions that will stretch scalenus, the neck may spasm. Stretches for both these muscles will be shown.

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