MUSCLES OF THE TORSO (UPPER/LOWER BACK) AND THEIR ACTIONS:
FLEXORS: rectus Abdominis, psoas (depending on position)
EXTENSORS: spinalis, longissimus, iliocostalis, multifidus
SIDE BENDERS (LATERAL FLEXION): quadratus lumborum, obliques
ROTATORS: internal external obliques
TRANSVERSE ABDOMINIS: stabilization, breathing, compression

COMMENTS: lower back; the two most common muscles involved are the multifidus and the quadratus lumborum. The next most common muscle is the gluteus medius, and the piriformis. Working these muscles will usually help most lower back pain. Muscle dysfunction often start as a result of emotional upset e.g. tension, stress, fear anxiety, this causes local areas of vasoconstriction and sustained muscle contraction that leads to muscle fatigue, which in tern leads to altered patterns of movement and altered joint mechanics. The body then begins to develop abnormal function and movement patterns, of the lumber muscles. This creates stress on the facet joints and discs. The result of these changes is that movement becomes restrictive and painful. This sets up a pattern of pain, and further dysfunction to both muscles and joints, eventually leading to postural adaptations.

INJURY: muscle strains, as a result of the above, occurs when the Para spinal muscles become tight. This sustained contraction decreases blood supply to the muscles, which leads to an accumulation of waste products, and eventual muscle fatigue. If this involves the multifidus muscles (which are essential in stabilizing the back), then bending forward with rotation e.g. gardening or reaching for an object can easily cause a muscle strain or damage to the joint. This can also cause a ligament sprain, facets syndrome, and sacroiliac joint dysfunction. Piriformis Syndrome, which is caused by a hypertonic piriformis muscle making it short and tight. Usually caused by Sacroiliac joint dysfunction or by overuse resulting from pelvic obliquity that leads to weakness of the gluteus medius of the ipsilateral side. The piriformis then over works trying to substitute as an abductor if the piriformis muscle is short and tight the muscle is often in a sustained contraction which irritates the sciatic nerve which, lies under the muscle or sometimes travels through it.

IMBALANCE: Lower Crossed Syndrome: Muscles that tend to be tight and short and easily facilitated: Iliopsoas, the lumbar region of the erector spinae, piriformis, rectus femoris, tensor fascia lata, quadratus lumbourum, adductors, and hamstrings.

Muscles that tend to be inhibited and weak: gluteus maximus. Medius, and minimus, abdominals.

ASSESSMENT: Visual postural assessment. Functional exercise assessment, computerised Biofeedback, isolation and integration assessment, gravity pattern testing, palpation, case history.

MASSAGE: Soft Tissue Release, Muscle Energy Techniques, Myofascial Release, Trigger Point Therapy, Deep Tissue Massage

CORRECTIVE EXERCISE/STRETCHING: Working to address any imbalances by strengthen weak muscles, and relaxing tight muscles. Specific stretching exercises combined with Soft Tissue Release to target over short tight muscles, which restrict the range of movement at various joints.