Trigger Points – Back is out but it hurts in the front

Client Description

People complain of a stiff and/or painful back but it is most painful near the fold of the hip in the front. They move stiffly and tend to have other back problems. The low back has flattened and become stiff. It may or may not have pain that feels like they are fragile and may move in a way that makes their back “go out.”

Many of the cases that I’ve seen have already been to a doctor for an ultra-sound or cat scan without notable problems in the radiology report.

The cases that I’ve seen fall into one extreme or the other. They are either young and very athletic or older and notably overweight. Both of these postures create an imbalance between the deep abdominals and the superficial abdominals. One study showed this as being most common in teenage female soccer players with very tight abdominals. I have also seen this in overweight people with a tight, bloated abdomen.

If they can associate an activity that started the problem, it is something that pulls the pelvis forward on one side. Clients have reported that this started after activities like kicking a ball, sex and slipping on ice.


Self Care

Self-care should be recommended and followed up by your bodywork professional. This can be an extreme imbalance that leads to herniated discs.
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Therapy Notes

This is a condition known as “Psoas Paradox” or “Psoas Minor Syndrome.” In both descriptions, the upper sections of psoas major/minor have tightened to lock the low back in a compressed reverse curve.  Psoas frequently not present  but when the psoas minor is involved, the taut tendon can be palpated through the abdominal wall.

Care must be taken during treatment as attempts to stretch or work directly on the psoas, while the client is supine, can be problematic. Staring with techniques to restore the lumbar curve while prone can be helpful. Effective and safe treatment of this requires a good working knowledge of the dynamics of deep abdominal and low back work.

Some medical professionals resolve this with minor surgery that clips the psoas minor tendon.
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Tony Preston has a practice in Atlanta, Georgia where he sees clients.

He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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The Body

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