I have had chronic lower back pain along with gluteal and hamstring achiness in both legs. This did not come about by any accident or injury. It all started after I completed additional schooling that entailed sitting for 3 hours in a car round trip for travel and 6 hours in the classroom for 5 weeks (2004). It could have been building up prior to that. After several chiropractor visits and several visits to 3 different osteopathic docs, and an MD, nothing worked. Xrays showed inconclusive according to the docs. It has now been 4 years since the initial onset beginning with the notice of achy hamstrings. I had given up hope. However, 2 weeks ago I had visited a massage therapist and right off the bat she told my my QL muscles were like rock. They were terribly painful upon touch (7/10) which I had no idea until then. I only saw her 2x so far and with her help and my own self-massaging the muscles seem to be somewhat less painful, maybe a 5/10 but still very tight and hard. I've been using a racquetball, cross-fibering with thumb and knuckles with oil, and occasionally I use a heating pad. I believe we're beginning to break up the muscle mass, (it's beginning to feel more fibrous in areas) and she is also massaging to lengthen the muscle back to it's healthy muscle memory. I feel less stiff afterwards but as the day goes on my back seems to be back where is was. My question is how can I help restore the muscle memory of the QL muscles on my own? Would just performing long deep thumb strokes be adequate or would you suggest something else, or in addition to? I know that just breaking down the muscle mass is not enough. And also, could the tightening of these QL muscles have anything to do with the achiness of the gluts and hamstrings? If so, any suggestions? My massage therapist has not yet addressed these muscles as the QL were so significantly tight, felt like bone. I see her again tomorrow. Hope this is enough info. to make any judgements. Your insight
would be greatfully appreciated! Margo

Hi Margo,

I agree that the QL is involved but it is actually the end result of a contracted iliopsoas muscle. Have you read any of the other threads on this forum? If you look at threads that have to do with low back pain, hamstring/knee/hip/ITB pain, you'll get a much better understanding of what has happened to you from all those hours of sitting.

Sitting causes the iliopsoas to shorten due to muscle memory. The iliopsoas will rotate your pelvis forward and down, shorten your quadriceps (putting even more of a strain on the pelvis tilt), OVERSTRETCH your hamstrings (please do not stretch them until you release all of the pelvis muscles, you could tear them).

You can easily treat all of your muscles, and the best part about self-treatment is you can do it every day. As a massage therapist myself, I'm glad you finally went to a MT, and she sounds like she is good so you may want to share my treatment protocol with her. You'll need a copy of my book Treat Yourself to Pain-Free Living so you know how to do the self-treatments. You can look for the protocol on this forum, or when you have the book come back and I'll be happy to give it to you.

Wishing you well,
Julie

Julie, (have a cup of coffee... this may take a while)
It's been about 3 weeks now since I've been doing the low back pain protocol I pulled from another thread. And yes, I've read many, many threads relating to this topic so I understand anatomically what's happening. I do have your 'Pain Free' book. Here's where I am currently...
1. No change in the hamstring/gluteal pain. Still feel achiness and a feeling of pressure or compression when I sit longer than 30 minutes. Still can't stretch the hams because the pain feels like they have been overstretched or traumatized, so I don't stretch them. (In the past I've been told to stretch, stretch, stretch...and did.) This is all on the left side. The right seems better than it has been, so I'm not concerned with this side but I keep treating it just the same. ( As I write this I have to switch sitting positions from one cheek to the other.)
2. Pain is also still at the ham/gluteal connection site. I guess one would call this the ischial area.
3. Slight hip achiness. Have been more diligent with the TFL treatment lately so it may be a little better... hard to say at this point.
4. QL soreness when massaged and stretched. Can't ever seem to stretch pain free. Does not hurt when standing, unless I put pressure on them. I'm not sure how the psoas plays into this as I can't feel if the psoas is contracted or has knots in them. (I've read this psoas/lower back pain connection on p. 117.) My pain is upon bending and twisting throughout daily life activities. And I am very careful when doing such movements. When standing for a long time it's a relief for my low back when I squat all the way down keeping my feet flat on the floor, but you don't want to stay there for too long. I was told by one doc that my back is a bit lordodic.
5. Erector spinae and QL muscles feel sore when I lie on the floor . They feel as if swollen, or perhaps I've working them too hard. This feeling seems less after I complete the lower back protocol. Is this because their tension had been released so they feel less swollen but then tighten back up the next day? Thus making them feel swollen and sore again?

Now on a positive note, finally!! I have noticed more ROM as I stand and swivel my hips around. When I walk my 2 miles and really use by hips there are times when there is no lower back side pains. I can also hang on a pull-up bar with a very relaxed back with less pain in the lumbar. Before your book I couldn't let myself relax while hanging as I felt I would definitely pull something and that would probably be a 2 week recovery period, as it has happened before when I pulled a back muscle just scrubbing out the bathtub, and it was only a SLIGHT twinge!

At this point I should mention that I am a classically trained flutist. And back in the 1980's while in grad school I realized my back would ache if I stood too straight and tall. (I was told I needed to do this by my flute instructor.) I was probably over arching the lower back. I discovered it helped if I slightly rotated my pelvis backwards, just to decrease the degree of arch in the lower back. Never thought about this again for years. I just try to play in a more relaxed, natural position.

If all these achy muscle issues stems from the psoas (and quads), how can I treat the psoas in addition to what you explain in you book? I seem to be missing something as I had hoped to have some relief by now. Since the psoas goes from the femur to the lumbar vertebrae can one self-treat the psoas in the upper portion or is just stretching what it takes? I've been doing the psoas stretches in your book.

If you were to ask me what is my most pressing issue of all this I would have to say it is the hamstring/gluteal achiness and pain, and should I do strengthening exercises in addition to treatment at this point?

I have 2 other issues I like mention since they've been going on for over a year also. And maybe it's all related.
1. Muscles knots, pain/stiffness in the left upper back ( rhomboids, levator, and far left side of the scapula hurts upon touch, I assume it's the infraspinatus and maybe the teres major/minor as well. ( I currently work at an osteopathic med school in the fitness center so I get some advice from med students on anatomy.) I've been using a ball against the wall on these areas and also lying on the ball. Can't seem to release these knots. I've been following your book. I have decreased them a little after treatment but they keep coming back. Is it just a matter of time, doing them daily for a period of time? Sometimes I stay on these areas for longer than 60 seconds.
2. I get numbness/tingling in my right thumb. This occurs in two ways: 1) when I sleep on my back. To relieve this I have to get out of bed. I tend to think it has to do with compression. I was told by a retired doc/friend it is a brachial plexus matter, but what to do with this info.? He has worked the right pectoral minor a couple times but the sensation still occurs. Haven't detected any sore spots in the Brachialis, (chart #2), nor the scalenes. Could I just not be pressing hard enough? I realize you don't want to be too aggressive on the neck. Don't seem to feel any radiating pain upon pressing these areas either. I've come across a stretch on the web where I stand with my arms reaching out to the opposite walls and hold this for 1 -2 minutes. I do this before I jump into bed. Sometimes I feel it works, other times not too sure. I haven't been very consistent with this to give definite answer. I just have to remember to do it before bed. The second way this sensation occurs is when I play my flute. After a couple of minutes my right thumb tingles, and sometimes the 1st and 2nd digits. I have to stop playing for a minute or 2 before continuing. I use to have this problem with only the 3rd, 4th, and 5th digits but that has subsided for reasons I can't explain. Would specific upper body training of some sorts help? I had been using rubber tubing for several months to work the rotator cuff muscles. This never relieve the numbness/tingling. Boy this was long!! If you can shuffle through all this with any more guidance, your help and knowledge is truly appreciated.
Margo

Hi Margo,

Whew! From the sounds of it your quadratus lumborum is contracted, and that usually means that the erector spinae and gluteus maximus muscles are also in spasm. Since you've been to all the doctors and had all the tests, we can be pretty sure that muscles are the problem, it's just a matter of working out the source of the pain.

I wish you were here in Texas (or North Carolina since I'm teaching two workshops there) or in New York (I'm working in Piermont on April 29th). It's a real challenge to figure this out via the forum. Do you know a good massage therapist in your area, someone who is trained at trigger point therapy?

I'm glad to see you aren't stretching your hamstrings, I think it's best to leave them alone until we can find the cause of your pain. You could do some of the treatments with the ball, but be gentle and don't stretch. Since your erector spinae and QL feel sore and swollen, I think you're right that it's because they are tight, and since you get some relief when you do the full protocol, that's probably the reason.

Did you get Sombra when you were at my shopping cart? Sombra is really good at going way deep into the muscles and helping them to release tension. I use it here when I'm working on someone with chronic muscle tension. Also, arnica gel is great for after treating yourself because it heals bruised muscles and lessens swelling and pain. My athlete clients LOVE it. One other thing that works well is soaking in a hot tub of water with two cups of Epsom salts, it helps to draw toxins out of your body. In fact, if you have access to a real hot tub with jets, that is another way to get the muscles to relax.

Look at a professional drawing of the iliopsoas and see exactly where it inserts into your thigh bone. There is one spot at the very top of your leg where you can reach this muscle and treat it very effectively. It's tricky but with determination you'll find it. When you do, hold the pressure on it for 60 seconds and then continue holding the pressure while you try to lean back (stretching the muscle).

As for your thumb and hand, the numbness and pain can be coming all the way from your neck (scalenes), pectoralis minor (impinging on the brachial plexus and therefore the three nerves to your wrist and hand), the biceps, flexors, extensors, and a muscle of your thumb called the opponens pollicis. If you go to http://www.carpaltunneltreatment.org you can read all about it. Since you play the flute, the odds are your sternocleidomastoid (SCM for short) is involved in this situation, and also the way you sleep can be a part of the problem if your head is turned while you're sleeping.

I think if you just continue searching, treating, and having the patience that you obviously have, you'll find the answer.

Wishing you well,
Julie

Julie,
It's been almost 1 year since I tried your method. I did the protocol religiously for 2 months. But sadly I quit because I didn't feel any better. This past month I saw a massage therapist. She confirmed your findings that I had tight quads and psoas among other tightness in the pelvis and a twisted vertebra in the upper thoracic which may very well be the reason my body is slightly twisting to the right and my left arm is a little forward. She has given me treatment and stretches for the quads, lower back, and QL to do on my own. I've gotten some relief in the QL, but only enough to take the edge off, and I have to work at it every day to get to the same place I was the day before...not progressing any further. I wonder if the reason I didn't have any success with your method is that either I didn't do each protocol long enough, or thorough enough. However, it took about an hour and a half to get through it all. But now, I think spending more time with the quads and psoas may be what I need to be doing most. What are your thoughts? I just can't get through the entire protocol any more. I need to start again from scratch. Can I get relief working on the quads and psoas as they seem to be the beginning of most of my issues? I need to start again from scratch.
Margo

Hi Margo,

I'm glad you've gone to a massage therapist, it helps when someone can actually feel the tension in the muscles. Since she confirmed that it is your illiacus & psoas, together called the iliopsoas, that is causing the problem. It is definitely easier to treat the illiacus and the iliopsoas (where they merge together).

As you mentioned, it sounds like you would benefit by doing the treatments for the quadriceps and the quadratus lumborum, and then just stretching the iliopsoas. If your therapist would treat the illiacus, right along the inside curve of the pelvis, you'll see how much relief you get. I've found that releasing the illiacus and quadriceps will automatically ease the tension on the psoas, and since the psoas is underneath your intestines, and is right next to the femoral artery, it's best to leave it alone anyway and just stretch it. Some therapists try to go directly through the intestines, with the idea that the intestines will move out of the way, but if you have any scar tissue in your abdominal region, or if you've ever had children, this isn't going to happen. It could be dangerous, so why try.

For now, don't worry about doing all of the other muscles, just do the treatments for the QL, quads, and iliopsoas stretch, then you can add the others at another time as things start to relax. The odds are you weren't doing the self-treatments deep enough, so you were only addressing the upper fibers of the muscles.

Did you show your therapist the Protocol? It would be great if she would do trigger point therapy on each of the muscles listed, in the order given. She sounds like she really knows what she's doing, so that's excellent.

For the upper thoracic area, I suggest you do the erector spinae treatments. There are so many muscles involved in the twist that it will be best if you take the direction of your therapist, she'll know which muscles are tight and then you can look up the self-treatments in my book.

Keep in touch. It sounds like you're on the right track and I believe that between your self-treatments and your therapists work, you'll start to get relief.

Wishing you well,
Julie