By JoAnn Rahl, BCSI –
What do you call a painful spot in your muscle that refers pain to a satellite location? In the bodywork profession it would be known as a Myofascial Trigger Point. Myo means muscle and fascia refers to the connective tissue matrix. A trigger point is the source point location of the referred pain. Most people would know this as a knot or adhesion in their muscle. Another question to ask, why are knots and adhesions created by the body in the first place, do they serve a function?
One of the most common pain complaints is the low back. The muscles pictured below are the psoas and iliacus; they are also referred to as the iliopsoas. They span a large territory beginning at the twelfth thoracic vertebrae, continuing along all five of the lumbar vertebrae, and then crossing the pelvis ending up at the top medial part of the femur or leg bone. Their main functions are hip flexion, enabling you to lift the femur for walking and as a spinal stabilizer. The X’s in the picture represent the Myofascial Trigger Points (MTP’s). The red solid and speckled areas represent the local or satellite referred pain patterns, these are the areas you will feel the pain. What you will notice from the diagrams is the iliopsoas refers pain not only to the front of the body but to the back of the body as well in the area of the lumbar spine.
So following our line of inquiry, why would someone’s iliopsoas choose to create a trigger point in this location? One common cause is prolonged sitting or slouching which will shorten the muscles into a holding pattern. This type of trigger point can often be alleviated by muscular therapy and stretching that can be taught to and done by the client. Please note the primary focus of the therapy and stretches must be localized WHERE THE TRIGGER POINTS ARE not solely at the site of the pain pattern. MTP’s can also occur as a result of bodily trauma from a fall or sports injury. If as a result of an injury a disc begins to bulge or exhibits symptoms of herniation the nearby myofascial structures in this case the iliopsoas can create an adhesion which may act as a temporary stabilizer, bracing the vertebrae and discs to help prevent further damage giving you some extra time to find a good doctor. This is a beneficial and functional MTP.
There is however another type of functional MTP which is not beneficial. This we can call the “compensatory MTP pattern”. One of the most prominent and primary core stabilizers is called the Transversus Abdominis (TA). When this abdominal muscle is working properly it acts as a girdle of sorts translating stability from the bottom of the pelvic floor muscles, up the front of the abdomen and then circling around to the back of the lumbar spine. It is your primary line of defense against low back pain. When this muscle is dysfunctional and weak the surrounding myofascial structures such as the iliopsoas and other low back muscles may try to protect your spine by creating adhesions to temporarily compensate as a functional substitute for a lack of true core strength.
To check the relative tone of your (TA) lie down on a flat surface and place your fingertips on and around your belly button and slide them downward about an inch towards your pubic bone. Begin to move your hands laterally to the inside lip of the top of your hip bones, this is called the Anterior Superior Iliac Spine (ASIS). In a recumbent relaxed state your core musculature should also be relaxed, a core that cannot relax can be as troublesome and unhealthy as one that cannot contract and hold that contraction on command during activity. If you consciously relax your belly your fingers should meet a supple and yielding surface. Now draw your knees up so they are bent leaving your feet anchored on the flat surface. Take a deep breath, exhale press your fingers firmly into your abdominals and draw your belly button back and down into your spine. If your TA is activating properly you should feel your fingers meet resistance from the core musculature which is now girdling your spine.
Kinesthetic literacy, to be able to sense and read the language of the body is a necessary skill for structural health. When we become consciously aware of what our body experiences within any given movement we can be proactive instead of reactive. The next time you receive a pain message you can ask: is the location of the pain symptom also the location of the cause of that discomfort or is this pain message referred from somewhere else in the body? Is the discomfort caused by a structure that is too tight or too weak or both? Pain is a message from the body asking for us to pay attention and differentiate symptoms from causes. The healing journey begins when we start to dialogue with the wisdom within us and ask the next question.
About the Author
Jo Ann Rahl graduated from Ramapo College with a BA and has been a practioner in the field of complementary medicine since obtaining her massage license in 1998. Her career path has followed a progression from traditional Swedish Massage, Neuromuscular Therapy, and Myofascial Release to what she has experienced as the cutting edge of bodywork, Structural Integration. In 2005 she became certified in Kinesis Myofascial Integration, and thru the International Association of Structural Integrators, a Board Certified Structural Integrator.
“The two critical aspects that differentiate Structural Integration from any other modality I have received or practiced are the focus on the fascial system, and the necessity of client participation within the bodywork session. Through movement education, and the development of motor sensory awareness, we can learn to release old dysfunctional patterns and re-member functional possibilities of movement and being.”