May 2015 16

When back ache isn't back ache

By: Dave Wheeler

Kirsty is a full-time fitness instructor with a busy work schedule teaching several adult and childrens classes a day.

During the week, whilst taking a class, her back went. Over the next 2 days it got progressively worse to the point where sitting & standing became difficult and even using the clutch in her car was hard.

When Kirsty arrived for treatment, she had trouble even taking off her shoes.


A little bit of anatomy

I examined her lower back muscles - called quadratus lumborum (QL) - the small square muscles that lie either side of the spine, but they were fine. There was no sign of them being any more tight than usual. Her erector spinae muscles - the long muscles that run all the way down from the neck to the coccyx either side of the spine - but again, they were fine.

It's useful at this point to know a little about the anatomy of the muscles of the back. The QL muscle attaches to the bottom of the lower rib and runs down towards the top of the pelvis, where it attaches. Another large muscle attaches to the top of the pelvis, too - the glutes (the muscles of the buttocks).


The body is an amazingly adaptive system

I've blogged before about the 3 sets of muscles that make up the glutes. It turns out that Kirsty had a severe glute strain - if you like, a real pain in the bum.

In order to allow her to carry on with her punishing schedule, the other muscles nearby had taken over the duties of the glutes. This is typical of the way that the body is able to compensate for injury.

The ability of the body to compensate for injury by calling in other muscles which usually do something else, in order to help out.

There is, though, a downside: when nearby muscles take over the job of another one, they're doing things that they're not really designed to, so they tend to tire out fairly quickly.

This is what had happened to Kirsty. To keep her going, the QL which is close to the glutes, tried to help out by taking over some of the glutes work. But because the QL isn't designed for it, they got worn out quickly.

What Kirsty experienced as back pain was actually a pain in the arse. Literally.

This is why she found it painful to move her leg to use the clutch.


Treating Kirsty

Apart from massage of the QL in the lower back to ease the symptoms, I also treated the injured glute. 

Kirsty was also advised to ice the injured area with frozen peas, to bring down any remaining inflammation.


As ever, if you think I can help, give me a call.