Treatment for Lower Back Pain Using Neuromuscular Therapy
Part 2
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Continued from Part 1...

Neuromuscular Therapy: My Preferred Method of Treatment for Lower Back Pain

Neuromuscular therapy is one of my most relied upon methods of treatment. Especially in cases where muscles are in significant spasm, this approach is second to none.

This technique is both a method of postural evaluation and a therapeutic massage technique designed to create homeostasis, or balance, between the nervous system and the muscular system.

Homeostasis is achieved with 2-pronged approach…

  1. Reducing (or even eliminating) muscular compensation by correcting postural imbalances
  2. Calming down muscles in spasm and eliminating myofascial trigger points with a very specific massage technique (described in Part 2)

Neuroumuscular Therapy Postural Evaluation

When I see a client who's suffering from lower back pain, I first evaluate for pelvic torsion. If a torsion in the pelvis exists, it will create what's called a functional leg-length discrepancy.

This does not mean that an individual's legs are actually a different length, but rather that the pelvic torsion has altered the position of the hip joints extending one leg down and pulling the other up.

This is a critical point because functional leg-length discrepancy is correctable with manual therapy techniques, whereas a structural leg-length discrepancy - in which bone length of the leg is actually different - will require a shoe lift on the side of the short leg.

(Too often I find that individuals are prescribed shoe lifts in cases where they have a functional leg-length difference, not a structural difference. The problem with this is that it reinforces the muscular compensation patterns responsible for pain.)

A leg-length discrepancy creates diagonal lines of muscular compensation as the body attempts to hold itself upright in gravity.

If pelvic torsion exists, it must be corrected as a fundamental part of the treatment for lower back pain. If a torsion is not corrected, the muscular compensations and trigger points in the back, pelvis, and legs responsible for pain will persist.

Neuromuscular Therapy Evaluation for Myofascial Trigger Points

I will then evaluate for the presence of myofascial trigger points by palpating both the muscles reported by my client to be painful, as well as muscles common to lower back pain problems.

In brief, myofascial trigger points are areas in muscles that, once activated by ischemia (low blood flow) caused by compensating effort, will create radiating and/or referred sensations to other parts of the body.

Potential sensations might include pain, tingling, numbness, thermal sensations (hot or cold), or an achey feeling. Sensations may mimic where a client experiences pain or may produce sensations in other regions.

Whichever the case, radiating or referred sensations produced by palpation confirms the presence of trigger points and these will always need to be treated.

A common pattern, then, leading to lower back pain is as follows...

  1. Torsion in the pelvis which leads to…
  2. Muscular compensation in muscles of the back, pelvis, and legs which leads to…
  3. Some (or many) of the compensating muscles becoming ischemic (low blood flow) from overuse… which leads to…
  4. The activation of myofascial trigger points in those muscles which leads to…
  5. The presence of pain both locally in the compensating muscles and potentially in the referral zones of myofascial trigger points

Treatment for Lower Back Pain Using Neuromuscular Therapy

Since postural imbalances are caused by soft tissues (muscles, fascia, tendons, ligments) that have adapted to a contracted, shortened state, correcting the imbalance is accomplished by lengthening these tissues.

A variety of modalities can be used for lengthening short soft tissues including Neuromuscular Therapy, Deep Tissue Massage, Myofascial Release and Active Isolated Stretching.

However when it comes to releasing myofascial trigger points, I rely exclusively on the Neuromuscular method.

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Stephen O'Dwyer, cnmt

Neuromuscular Therapist & Pain Relief Researcher

Stephen O'Dwyer, CNMT


Lower Back Pain Answers

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