Common Muscle Injuries

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Unraveling the Mystery of Low Back Pain #6:

Common Muscle Injuries

Unraveling the Mystery of Low Back Pain #6:

Common Muscle Injuries

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

[email protected]@benbenjamin.com

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Side-lying position system

Matteschair

Webinar GoalWebinar Goal

• Gluteus muscles

• Iliopsoas

• Hamstrings

• Quadriceps

• Gluteus muscles

• Iliopsoas

• Hamstrings

• Quadriceps

Explore the assessment, treatment, and balancing of the pivotal muscles in and around the low back:

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PretestPretest1. The psoas muscle is directly attached to the intervertebral discs.

True or False?

2. The psoas muscle is the antagonist to the gluteus maximus. True or False?

3. Chronic muscle tension in all or one of the quadriceps muscles tend to make the pelvis tip anteriorly. a. Allb. One

4. How does stretching affect the neural signal of the muscle being stretched?a. Increases itb. Decreases itc. No effect (signal stays the same)

5. Chronic low back pain felt in the muscles of the low back is generally a good indication that they are the cause of the pain. True or False?

1. The psoas muscle is directly attached to the intervertebral discs. True or False?





AnatomyAnatomy

The Role of Muscles in Low Back Pain

The Role of Muscles in Low Back Pain

• Injured frequently but heal quickly

• Injuries may recur due to poor alignment, improper exercise, or weak core muscles

• Muscles connecting trunk to pelvis and lower body are particularly vulnerable

• Injured frequently but heal quickly

• Injuries may recur due to poor alignment, improper exercise, or weak core muscles

• Muscles connecting trunk to pelvis and lower body are particularly vulnerable

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Gluteus Muscles: MaximusGluteus Muscles: Maximus

• Largest, most superficial of gluteus muscles

• Origin: ilium, sacrum, coccyx, sacrotuberous ligament

• Insertion: IT band, gluteal tuberosity

• Fascial connections: lumbodorsal fascia, gluteal aponeurosis

• Largest, most superficial of gluteus muscles

• Origin: ilium, sacrum, coccyx, sacrotuberous ligament

• Insertion: IT band, gluteal tuberosity

• Fascial connections: lumbodorsal fascia, gluteal aponeurosis

Gluteus maximusGluteus maximus

Gluteus Muscles: MaximusGluteus Muscles: Maximus

• Powerful hip extensor

• Helps keep the trunk erect

• Helps externally rotate the femur

• Supports the extended knee

• Primary antagonist: iliopsoas

• Powerful hip extensor

• Helps keep the trunk erect

• Helps externally rotate the femur

• Supports the extended knee

• Primary antagonist: iliopsoas


Gluteus Muscles: Medius & MinimusGluteus Muscles: Medius & Minimus

• Origin: ilium

• Insertion: greater trochanter

• Origin: ilium

• Insertion: greater trochanterGluteus maximusGluteus maximus

Gluteus mediusGluteus medius

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• Origin: ilium

• Insertion: greater trochanter

• Origin: ilium

• Insertion: greater trochanterGluteus maximusGluteus maximus


Gluteus minimusGluteus minimus


• Abduct the thigh

• Internally or externally rotate the thigh

• Support the body in walking (prevent pelvis from dropping to other side)

• Abduct the thigh

• Internally or externally rotate the thigh

• Support the body in walking (prevent pelvis from dropping to other side)





• Medius: frequently injured with sacroiliac joint or surrounding ligaments

• Minimus: not frequently injured

• Medius: frequently injured with sacroiliac joint or surrounding ligaments

• Minimus: not frequently injured




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Iliopsoas Muscle(s)Iliopsoas Muscle(s)

• Iliacus origin: iliac fossa

• Psoas origin: lumbar vertebrae & discs

• Both insert at the lesser trochanter

• Iliacus origin: iliac fossa

• Psoas origin: lumbar vertebrae & discs

• Both insert at the lesser trochanter

PsoasPsoas

IliacusIliacus

Iliopsoas Muscle(s)Iliopsoas Muscle(s)

• Flex the hip

• Flex the trunk; help us stay erect

• Critical in moving and stabilizing the low back and pelvis

• Flex the hip

• Flex the trunk; help us stay erect

• Critical in moving and stabilizing the low back and pelvis

PsoasPsoas

IliacusIliacus

Iliopsoas InjuriesIliopsoas Injuries

• Compromise low back functioning

• May occur at the attachment or in the muscle belly

• May place stress on discs and ligaments

• Compromise low back functioning

• May occur at the attachment or in the muscle belly

• May place stress on discs and ligaments

PsoasPsoas

IliacusIliacus

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Quadriceps & HamstringsQuadriceps & Hamstrings

• Must be in balance for low back health

• Rectus femoris crosses both knee and hip joints

• Short or tense rectus femoris stresses the low back

• Must be in balance for low back health

• Rectus femoris crosses both knee and hip joints

• Short or tense rectus femoris stresses the low back

Crosses thehip jointand knee joint




AssessmentAssessment

Gluteus Medius Assessment Gluteus Medius Assessment

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Gluteus Maximus Assessment Gluteus Maximus Assessment

Iliopsoas AssessmentIliopsoas Assessment

Iliopsoas Assessment (leg length)Iliopsoas Assessment (leg length)

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TheoryTheory

Direct and Indirect Causes of PainDirect and Indirect Causes of Pain

• Direct: what is causing pain at the moment (ligament sprain, nerve root compression, muscle tear, etc.)

• Indirect: what made the back get hurt in the first place (weak abdominal muscles, hyperlordosis, short psoas, pelvis misalignment, etc.)

• Direct: what is causing pain at the moment (ligament sprain, nerve root compression, muscle tear, etc.)

• Indirect: what made the back get hurt in the first place (weak abdominal muscles, hyperlordosis, short psoas, pelvis misalignment, etc.)

Guest InstructorGuest Instructor

• Vincent Cambrea• Vincent Cambrea

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Concepts in Muscle InnervationConcepts in Muscle Innervation

• Agonist: prime mover

• Antagonist: opposes prime mover

• Synergist: helper muscle

• Agonist: prime mover

• Antagonist: opposes prime mover

• Synergist: helper muscle

Neural DriveNeural Drive

• The number and amplitude of innervation to a muscle

• Increases as muscles shorten and decreases as muscles lengthen

• Shared between agonist and antagonist muscles

• The number and amplitude of innervation to a muscle

• Increases as muscles shorten and decreases as muscles lengthen

• Shared between agonist and antagonist muscles

Reciprocal InhibitionReciprocal Inhibition

• A shortened muscle inhibits its functional antagonist by decreasing its neural drive

• A shortened muscle inhibits its functional antagonist by decreasing its neural drive

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Synergistic DominanceSynergistic Dominance

• A synergist (helper) muscle becomes the prime mover due to weakness or inhibition of the agonist

• Increases demand on the synergist muscles

• Decreases neuromuscular efficiency

• May lead to premature breakdown

• A synergist (helper) muscle becomes the prime mover due to weakness or inhibition of the agonist

• Increases demand on the synergist muscles

• Decreases neuromuscular efficiency

• May lead to premature breakdown

Implications for Low Back PainImplications for Low Back Pain

• Psoas: agonist

• Gluteus maximus: antagonist

• Hamstrings: synergist

• Psoas: agonist

• Gluteus maximus: antagonist

• Hamstrings: synergist

When spinal mechanics are altered and/or the psoas is in a chronically shortened position, the gluteus maximus will become neurologically inhibited — thereby placing increased demand on the hamstrings. This includes the attachment of biceps femoris on the sacrotuberous ligament.

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TreatmentTreatment

TreatmentTreatment

Watch the video at the end of the WebinarWatch the video at the end of the Webinar

Psoas Technique Iliacus Release

Gluteus Medius Release

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Massage Therapy Massage Therapy

Exercise TherapyExercise Therapy

• Active Isolated Stretching & Strengthening (AIS)• Active Isolated Stretching & Strengthening (AIS)

Psoas

Iliacus

Gluteus maximus

Exercise TherapyExercise Therapy• IMAP: Trains low back strength

in an aligned neutral position• IMAP: Trains low back strength

in an aligned neutral position

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QuestionsQuestions

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

Post-testPost-test1. The psoas muscle is directly attached to the intervertebral discs.

True or False?





1. The psoas muscle is directly attached to the intervertebral discs. True or False?





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Common Muscle Injuries