Download Standing Back Pain: Working through the Dura Mater Erik Dalton

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
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