It is important to understand the shift in anatomy that occurs as a person ages. In their early teens, the os coxae are 3 separate bones, there is no iliolumbar ligament and the multifidi are thick and strong. By their 60s, both os coxae have fused onto the sacrum and the iliolumbar ligament has come and gone. Start by understanding the anatomy.
The quadratus lumborum is complicated. It has 3 bellies that shift in size, composition, and stability as the person ages.
The sacrum and ilium fuse through the sacroiliac joint in the late 30s to late 50s. The thick multifidi of the low back atrophy quickly during this phase and low back problems are more common.
The quadratus us a relatively small muscle that is surrounded by pillars of thick muscle with the psoas in the front and the multifidi in the back. IT’s stability is largely dependant on the balance of the pelvis. It’s trigger points can be activated and deactivated by changes in the facet joints of the lumbar vertebrae.
The first step is pelvic balancing. Pelvic balancing also provides longer-lasting results than solely using direct treatment of the ligament.
Each therapist has their own method of pelvic balancing. I prefer craniostructural work with SOT blocking but also use METs, strain-counterstrain, and some NMT techniques.
Decompression of the sacrum often releases the lower lumbar vertebrae for easier mobilization. Pay attention to which side is more posterior or has tighter multifidi. Releaing it at this point will make sacroiliac work easier for you and more comfortable for the client.
This protocol will release the tender tissues on the sacrum that restrict sacral mobility and release of the quadratus lumborum, including the sacral multifidi.
When addressing this trigger point, feel for the trigger point stiffness around L3. There will be stiffness in the lamina groove and an irritable locus along the transverse process of L3. They should be released when working with the lamina groove and mobilizing vertebrae..
This protocol is key for releasing the quadratus lumborum. Be gentle but thorough in releasing the multifidi so that the lumbar vertebrae are mobilized.
Gentle static pressure to release the lumbar vertebrae makes the release of the QL easier and less painful. Look for the irritable locus on the side of the displaced vertebra and hold it for 30-90 seconds to mobilize the vertebra and release the trigger point.
When dealing with this trigger point, this treatment around the iliolumbar ligament is where the trigger point is located. It is important to get the 4th and 5th lumbar mobilized.
This protocol will release the root of the quadratus lumborum and the transverse processes of the 4th and 5th lumbar vertabrae.
Self-Care can be very important when this problem is a result of habitually torquing the pelvis through poor seating practices, strong muscular imbalances or a hyper-mobile pelvis.
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This patient had recovered from a frozen shoulder but developed shoulder pain at the end of his golf swing. More traditional neuromuscular techniques weren’t working. The chiropractic wasn’t working. Integrative Craniosacral was the right solution for lasting relief.
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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