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Standing Back Pain: Working through the Dura Mater Erik Dalton, PhD Low back pain from prolonged standing usually results from various forms of sacroiliac dysfunctions. The most common reason for the sacrum becoming stuck "crooked" between the two iliac bones is a "left unilateral flexed sacrum." In these clients, prolonged standing forces the left sacral base to move anteriorly/ inferiorly and become stuck in this position. Aberrant sacroiliac problems often prevent the left facet joints at L5 and S1 from closing during prolonged standing. This leads to generalized hip and back pain. 95 percent of all unilateral flexed sacrums occur on the left. Unlike painful sciatic like sacroiliac dysfunctions, such as backward sacral torsions, the longer the client stands the unilateral flexed sacrum can ache deeply on both sides of the low back. This is primarily due to sinuvertebral nerve innervation of the dura and joint capsule at L5-S1. To assess this dysfunction, therapists palpate both sacral bases, checking for differences in depth. If the sacrum is deep on the left, it is rotated to the right. By sliding the thumbs down to the inferior lateral angles of the sacrum, the therapist can determine which side is most inferior. If the left inferior lateral angle is more inferior than the right and the left sacral base is deep, the sacrum is probably dragging on the left end of the dural membrane, causing the aching back. The myoskeletal contract/ relax technique for a left unilateral flexed sacrum is successful in correcting this prevalent chronic back and hip pain complaint. Addressing the left unilateral flexed sacrum. • With the client lying on her right side (knees and hips flexed), grasp the client's left wrist with your right hand. • Use the left palm to contact the inferior left sacral border just above the coccyx. • Establish a slow, sustained counter between the two hands and gently pull on the client's left arm while your left palm braces at the sacrum. • The client is asked to inhale and hold to a count of five while gently pulling her left arm against the therapist's isometric resistance. • As the client exhales, the therapist takes up the slack by lightly pulling on the client's arm while maintaining constant pressure on the inferior sacral angle. • Anterior/superior palm pressure to the inferior lateral angle of the sacrum causes the left sacral base to move posteriorly into its proper position. The stuck facets at L5-S1 are encouraged to close as the pull from the therapist's right hand leftrotates the client's trunk. Repeat this three to five times and re-check for sacral base symmetry. Therapists should remember that most sacroiliac dysfunctions are associated with muscle imbalances in the psoas, piriformis, biceps femoris and weak gluteals. Because fibers of the biceps femoris muscle often originate at the sacrum instead of the ischial tuberosity, hypercontraction of these lateral hamstrings produces a constant drag on the sacrum, dura and the entire pelvic girdle. The first step in relieving sacroiliac dysfunction is to balance all muscle groups attaching to the pelvis from below and above. Obviously, some of these muscles need lengthening while others require restoration of tone. After myofascial balance is established in the muscles attaching to the pelvis, assessment and correction of any bony restrictions distorting the dural membrane can be addressed. Learn more about the Dura Mater and Pain Management at www.erikdalton.com NEW- Dalton’s Collection of Works: A compilation of Dalton's finest articles for only $27.95! The Freedom From Pain Institute offers therapist continuing education through national seminars, state of the art videos and manuals, and certified home study programs. 800-709-5054 [email protected]