It’s time for more Meet Your Muscle!
I’d like to introduce the Iliopsoas muscle, a key hip flexor (bringing your knee towards your chest) and a common source of lower back pain. First note that the Iliopsoas is actually made up of the Iliacus and the Psoas Major and Minor. In the lower back, they are separate muscles but once they cross the pelvis into the thigh they merge as one and are usually just referred to as the Iliopsoas, or inner hip muscle.
One of the most important features of the Iliopsoas is that it originates from either side of the spine in the back on the sides of the lumbar vertebrae and reaches across the body to attach in the front at the top of the inner thigh. Specifically, the psoas muscle is starting at the lateral surface of T12 and L1-5 vertebrae, merging with the iliacus in the concave surface of the pelvis and ending at the lesser trochanter of the femur. These landmarks aren’t as important to know as the fact that this muscle reaches from the spine in the back to the leg in the front and that abdominal work or hip flexion can lead to pain the lower back region even if you feel that you haven’t been working your lower back. For example, I tried the P90X Ab Ripper X program for the first time a few years back and was confused when the next day I couldn’t stand up from pain in my back above my sacrum (tailbone area). Critics have suggested that this P90X workout works hip flexors more than abdominals, but it certainly showed me that they definitely can work together even when you don’t realize it.
In Western culture, we spend a lot of time seated, be it in the car, at our desks or on the couch, keeping our hips in a flexed position (versus the extended position of standing). This and the fact that like most posture muscles, the iliopsoas is predominantly slow twitch fibres, makes the muscle susceptible to pathological shortening and contracture. Bodyworkers often candidly refer to this muscle as the Ilio-So’-Ass, and for good reason :) (NB - There are two types of muscles - slow and fast twitch - slow twitch fibers contract for long periods of time but with little force while fast twitch fibers contract quickly and powerfully but fatigue very rapidly - long periods of contracture lead to chronic shortening.)
So what do you do with your tight Iliopsoas muscle pulling on your lower back and upper thigh? How do you correct the contracture that is tilting your pelvis, compromising your posture and causing you pain? Good news! This is a very treatable condition with Massage Therapy. Put as much of a priority on recovery as you do exercise and book yourself an appointment with a competent therapist.
All of Massage Therapy is complimented by a consistent stretching routine, but if you cannot get a massage right now, be sure to add the “fencer’s stretch” to your recovery routine. Refer to the picture for the proper form, but what you want to do is rest on one knee and one foot, each bent at 90 degrees. Keeping your body upright, track your front knee forward until you feel a stretch in the opposite side of the hips. Breathe deeply and hold the stretch for at least 90 seconds per side, letting each exhale take tension away. Coax the muscle into it’s original length with the stretch’s duration, which is always more important than intensity when it comes to stretching.
This pose in yoga is often used to open the ‘front gate’ of the hips, a key step in developing freedom of motion in the joints this muscle crosses (i.e. the lumbosacral joint and the hip joint). Many people will place their opposite elbow on the leading knee to create a torso rotation, but it is well enough to stretch out the Iliopsoas by gently moving your knee forward and simply breathing deeply into the stretch. It is called the ‘fencer’s stretch’ because it resembles the lunging stance a fencer makes when he strikes.
If you want to address other muscles that attach to the lower spine, look up the Quadratus Lumborum, another usual suspect in low back pain and easily treated/stretched back to it’s healthy length.
I hope you have enjoyed getting to know the Iliopsoas and creating a greater understanding and awareness of what is going on inside your body. Please feel free to make any requests of areas of the body you’d like to meet!
It’s Meet Your Muscle Monday!
I’d like to introduce the Pectoralis Minor. This muscle starts from the coracoid process and splits into three attachments to connect to the 3rd, 4th, and 5th ribs. The coracoid process is a thumb-like part of the shoulder blade on your back that reaches under your collarbone and provides an attachment for muscles on your front.
Most of us know the popular Pectoralis Major, oft admired in mirrors in gyms and bathrooms around the world. The large, fan-like Pec Major is the main ‘pusher’ of the chest, responsible for bringing your arm from outstretched beside you to outstretched in front of you (horizontally adducting the humerus). It’s little brother beneath it, the Pec Minor, is always recruited to help in these jobs, as well as the jobs of the shoulder muscles, but being attached to the shoulder blade and not the upper arm gives it it’s own special function, and it’s own special problems. It’s main jobs are to stabilize the ‘floating’ bone of the shoulder blade, attached to nothing but the muscles it provides a base for. When we flex, thus shorten the pec minor, it pulls and rotates the shoulder blade down. Imagine your shoulder blades as wings and the action of the pec minor as spreading those wings by pulling their corners in.
Aside from being an accessory muscle in breathing (because of it’s attachment at the ribs), the pec minor is responsible for relatively small jobs in movement and stabilization. Despite its small role and stature, this little muscle can cause big problems. It’s unique position attaching ribs in the front to the scapula in the back means that it covers the passage of the brachial plexus (an important bundle of nerves leaving the neck and supplying the arm with sensation and movement) as well as the major axillary (armpit) artery and vein. What this means is that when it becomes chronically shortened or tight from posture or overuse, it compresses these nerves, arteries and veins and creates pain and loss of movement/sensation in seemingly unrelated structures.
Trigger points (tight bundles of muscle fibers) developed in the pec minor will often create pain, tingling or numbness starting in the shoulder and radiating all the way down the side of the arm into the pinky, ring and middle finger. Massage therapy clients describing these symptoms rarely suspect nerve compression and are always somewhat surprised that treating the feelings in their hand and arm starts with deep tissue work up in their chest.
Why is this relevant to the athlete? The chest is a trophy muscle that often gets overworked without proper recovery. This is because we can readily see it and monitor its growth and development. It’s exercises are usually the first we learn and develop comfort with when pursuing a fitness lifestyle. When this muscle is over trained and chronically in a shortened position, one can create an unbalanced physique with the forward-rounded shoulders so often seen in gyms around the bench press area. Appearance aside, the compression of the axillary artery and vein pinches off the supply of nourishment of oxygenated blood to the muscles of the arms and hands. The compression of the nerves of the brachial plexus reduces the transmission of sensory and motor signals too. This means the arms and hands are less able to recognize what’s happening to them and where they are in space as well as being less able to respond quickly and accurately to what the brain is telling them to do. Having responsive and well nourished arms and hands should be of interest to any athlete trying control and take their body to higher levels of performance.
To return a tight Pectoralis Minor to it’s healthy length and open up the space for these important vessels and structures to pass through, I always recommend deep tissue massage. The pec minor is highly responsive to this treatment. At home, you can stretch the pec minor with the very popular ‘doorway stretch’, that is, standing in a doorway with your elbows out in a T position (like you were flexing your biceps) and leaning into the stretch with the edges of the door pushing your elbows back. This is a good stretch for the Pec Major too, so try moving slightly into a Y position to target the pec minor directly. Hold the stretch for at least 90 seconds. Inhale and feel the musculature tighten up. Then exhale and let the breath take all tension with it. Let each exhale gently ease you deeper into the stretch. The key to stretching is consistency and duration. Don’t rush it. Do more than 90 seconds if you wish, but never less. Try to do it every day until you feel the range of motion has increased.
I hope you have enjoyed getting to know the Pectoralis Minor and creating a greater understanding and awareness of what is going on inside your body. Next muscle, next Monday!
It’s Meet Your Muscle Monday (I swear I wrote this yesterday but was too busy living to post)
I’d like to introduce every massage therapist’s friend and foe, the Levator Scapulae. Friend because it will always bring us business with clients coming in gripping the painful spot where their upper back meets their neck, and foe because the habits that create it’s painful problems are so persistent that lasting relief can be hard to acheive. The levator scapula’s main job is to lift up the shoulder blade and help in bending your neck sideways. When it comes to the first job, it’s a bit of a workaholic and tends to get trigger points that can create headaches and neck pain from it’s long hours.
First, you need to picture your spine. It’s like a stack of children’s building blocks (vertebrae) with squashed marshmallows (intervertebral discs) between them. The many muscles of the neck not only serve to move the upper portion of this stack, but also act as ‘guy wires’ stabilizing the tower holding up your big head. No offense, but it’s a ten pound sphere balancing on the end of a hockey stick. Or as Mike Myers said in “So I Married An Axe Murderer”, “Look at the thing, it’s like an orange on a toothpick.” Needless to say, the toothpick needs some help.
Enter the hardworking and highly-prone-to-problems Levator Scapulae. Most neck muscles move from the vertebrae to stable attachments like the collarbone, ribs or back down to other vertebrae. The Levator, however, starts from either side of the top four vertebrae below the skull and attaches to it’s insertion at the top of the middle corner of the triangular shoulder blade. Midway through the path, the four attachments form one muscle, flip around and fix to the scapula (imagine it like a calligraphy stroke). The scapula (shoulder blade) is a highly movable, ‘floating’ bone held in place only by the muscles it provides a base for. This mobility makes the levator muscle the most vulnerable neck muscle to getting much too contracted or much too stretched, making for maligned vertebrae, compressed discs and the burny aching pain so many seek relief from.
How does it get overstretched or too contracted? Here are a few common problems:
Pillow Problems - we spend 1/3 of our 24 hours with our neck in a fixed, unconscious position. Pillowing that keeps the head outside of the neutral position for that time will cement the neck into problematic positions. If you’re a back sleeper, give your head a cushion for it’s placement but make sure your eyes are pointing up, not out. If you’re a side sleeper, the pillow should fill the exact amount of space that your shoulder and arm create between it and the bed. Remember: neutral position.
Anterior Head Carriage - holding our head in front of our body makes the 10lbs of weight that much more of a burden on the neck muscles and forces them to contract against the stretch. Not only do they tire and become overstretched, but they develop headache causing trigger points from the overworking. I tell my clients to imagine a helium balloon attached to the top of their head, lifting off of the ground (their shoulders). Keep your chin in, walk with your chest in front of your face and let your shoulders drop back and down.
Elevated Arms - everywhere we go we have our arms on armrests, floating up to use keyboards (I just had to check myself!), resting on tables or desks, holding steering wheels, etc. Adjust your position so your shoulders can hang back and down, be it in the car or in the office, so your levator isn’t sitting all day in a shortened position it will later have a hard time coming out of. Back when phones were bigger, holding them between the shoulder and the ear was a problem leading to pain but not so much anymore. Either way, avoid that too and use a headset or bluetooth.
Stress ‘Turtling’ - Proponents of the mind/body connection (including yours truly) suggest that the levator will elevate our shoulders to help us draw our head into our body, subconsciously protecting ourselves from the stressors in our environment. Check your shoulders when you’re experiencing negative emotions and remind yourself repeatedly to let them ‘melt’ or ‘sink’ back to their neutral position. This may take some practice. It did for me!
As always, I recommend massage as the best way to work out the chronic problems caused by our levator scapulae, but it is the habits we have in using it that will recreate them everytime. Trigger points at it’s origin and insertion will cause pain around the entire shoulder complex as well as headaches far away in the front of your head for some. Be more mindful of this muscle and give it a break! It will thank you with pain relief and relaxation.
Hope you’ve enjoyed getting to know the infamous Levator Scapulae and creating a greater understanding and awareness of what’s going on inside your body. Next muscle, next Monday!
It’s Meet Your Muscle Monday!
Introducing Piriformis! This one starts on the rear surface of the triangular bone at the base of your spine called the sacrum and reaches across your pelvis and attaches to the top of the femur. When it contracts, it makes the leg ‘laterally rotate’ (what you would do to show someone the inside of your leg)
This muscle is important to know because it is a common culprit for pain referring to the buttocks and down the rear thigh from a condition commonly known as ‘Sciatica’. The body’s largest, strongest and longest nerve, the sciatic nerve runs behind the piriformis in 87% of the population (sometimes right through it, sometimes both), providing sensory and motor innervation for the hamstrings, lower leg and the foot. Sciatica is a general term describing several conditions affecting the nerve, but it helps to know that sometimes it’s just a contracted Piriformis pushing on or squeezing the nerve and causing pain that can be relieved through therapy, heat and stretching. This will not only relieve the pain, but make your legs more responsive in both movement and sensation.
A contracted Piriformis is often the result of trigger points (bundles of taut muscle fibers) that commonly occur at the origin beside the sacrum or beside it’s insertion at the top of the femur. These will create a deep ‘butt ache’ at the site of the trigger point and a diffuse deep ache down the back of the thigh to above the knee. One can get trigger point therapy from a massage therapist and/or heat and stretch these trigger points themselves.
To stretch this muscle, try one of the two positions in the above picture. I prefer the ‘leg in front’ version. Some of you may recognize this from yoga, a practice that pays a lot of attention to ‘opening the gate’ of the hips.
Guidelines for stretching:
Duration is more important than intensity. A muscle needs to be coaxed out of it’s contracted position. Going into the stretch too deeply too early will just create a guarding response. Make it a rule to hold each position for a minimum of 90 seconds, breathing deeply and allowing each exhale to take you deeper into the stretch. You may feel the muscle jump or twitch. This is a good sign of the trigger point releasing. Let your body weight deepen the stretch and let your breath do the work.
Once your piriformis has returned to it’s regular length, be mindful of your habitual postures. Sitting cross legged a lot can keep your leg in a ‘laterally rotated’ position and lock the muscle into a contracture. Even your ankles being rotated outwards while sleeping on your back can shorten the muscle. Be aware of your foot position while walking. Toes pointed outwards while using your leg and gluteal muscles will condition them to work in a shortened position. Also, check your foot while driving. Try to keep your toes pointed up rather than out to keep your muscle operating at it’s natural healthy length. For the guys, if you have a thick wallet in your back pocket, sitting on it regularly will tighten this muscle and cause pain as well.
Hope you’ve enjoyed getting to know the “Pesky Piriformis” and creating a greater understanding and awareness of what’s going on inside your body. Next muscle, next Monday!
"Maintain your focus and elevate."