Helpful, little-known facts about back pain

Many people deal with back pain by taking medication. Some others swear by heat or ice packs. But very few people are able to solve the underlying problem. Back pain is one of those things that seems to keep returning, which means that people have to manage it for years or sometimes even decades. Let’s talk about one of the causes of chronic back problems and what we can do about it.

Back pain is often the result of a lack of muscular control in the back, hips, abdomen, side-body, and pelvis. An imbalance in muscle strength and muscle lengths causes one or more muscles to be irritated, to seize up, to tear, or in a worst-case scenario, for a disc to slip or rupture because the hips and spine are torqued and movements are unsupported.

The quads and hamstrings are in a direct relationship with one another because they attach to opposite sides of the hip (front and back, respectively). The quads are like a set of ropes that pull and release the front of the leg and hip, and the hamstrings pull and release the back of the leg and hip. If one of these sets of muscles is chronically tight and shortened, then the other muscle set has no choice but to slacken and elongate. This is a proprioceptive response called reciprocal inhibition. The body is programmed to elicit this inhibition in order to protect the joint that lies between the two muscles. The joint being protected in the hamstring and quad relationship is the hip. When this muscle relationship is not managed, then the hip will tilt forward as it is pulled by the hypertonic quad, leaving the spine with an uneven base. 

This tension pattern usually gets people’s attention because they feel tightness in their hamstrings because they are being pulled taught by the tight quads and responding with resistance to that pull in order to protect the joint. They may also feel low back pain because the twisted pelvis forces the vertebrae of the low back to twist as well. They will then try to treat the problem, either by stretching the hamstrings (which just makes them hold on tighter to try to shorten again), getting a back massage, or taking pain meds. Much of the time, the original cause of this tension, tight quads, goes undetected and the problem continues.

In my work over the years, I’ve found that this issue requires a 3-part solution:

1. Performing self-myofascial release (foam rolling), stretching, and/or receiving massage to release the hypertonic muscle set and all that it’s sticking to.

2. Shortening and strengthening the hyper-lengthened muscle set through conscious engagement exercises.

3. Checking both legs and hips to make sure both sides are at least close to even in strength.

STEP ONE: 
If there were a kingpin to release in low back pain, it would be the quads. The quads are the large set of muscles on the front of the leg, connecting the knee and the hip. This is where I start with clients who have back pain; by doing deep massage work on the quad tendon and quad/IT overlap, and prescribing stretches and foam rolling for the quad. While it is important to apply flush massage techniques to the low back and hips in order to help clear away inflammation, true relief in the low back will come from releasing the quads.

STEP TWO:
Once the quads are released, the hamstrings in the back of the leg can be strengthened and shortened back to their optimum length. If you start with this step before releasing the quads, it may be more difficult to turn on the hamstrings. Strengthening and shortening the hamstrings will help release the hips and the low back. 

STEP THREE
Check the quad and hamstring on both legs. You will want both hamstrings to have a similar amount of strength to one another, and the quads to have similar flexibility. Indescrepencies in strength and flexibility between the left and right sides will cause torque in the hips and back, which is where low back issues stem from.

Below, find a detailed description of how to foam roll the quad tendon effectively. More pointers for releasing the quad can be found on my Instagram account @raisethebarwellness, or by setting up a one-on-one video or in-person session with me.

If you have a foam roller, use my pics here to find your quad tendon. Foam roll up and down 10 or more times for about two inches right below the hip bone. Then, rock side to side about ten times on that tendon, with the leg relaxed. You should foam roll both legs. If you have back pain, you’ll probably find that one quad tendon is tighter than the other. In the first pic at the top of this article, I’m using a foam roller to release the front of my hip, or for those of you who know anatomy, the top of my quadriceps group where muscle turns to tendon.

You may find that the tendon is either really tender or kind of numb. Numbness means that this spot has been chronically tight for a long time. Tenderness means it is a newer tension. Newer tension is not usually the original problem, but an effect of other areas that were tight, first. If it’s an old, numb tension, you can be almost certain that it’s one of the original causes of some other pains you might have.

The moral of the story? When we feel pain, it’s a sign that something is wrong. It’s our job to discern what’s happening and what to do. Often, we’re not given the correct tools to solve the issue for the long term. We may be looking for a simple or obvious solution, but in my experience, multi-faceted solutions are most helpful in the long term.

When it comes to back pain, the back is usually the last domino to fall in a more complex tension pattern. There may be many pieces to deal with before you’re able to get full pain relief. If you’re working with a massage therapist, ask them to work on your quad tendon, to help with your back pain. If you have tight hamstrings, try stretching the quads to help the hamstrings relax, instead of stretching the hamstrings. Tension in the hamstrings releases because they no longer have to remain under tension in order to provide the overpowerful quads with an equal but opposite tug of war partner. By strengthening the hamstrings and releasing the quads, we are not only providing treatment for the hips and knees, we’re also providing treatment for the spine.