Trigger Points – Fragile Low Back with SI Joint Pain

This is one of several posts about a stiff, fragile low back. A stiff low back is usually a combination of a binding intervertebral joint with more than one muscles involved. If you have a stiff low back, you should compare these posts.

Client Description

These people complain of sharp pain in the low back that feels like it will  “go out,” as well as pain in the sacroiliac joint. This pattern is a combination of trigger points in two different muscles that become activate together. Sometimes, the stiff low back bothers them more, and the SI joint is achy.  At times, the low back problem is sharp and debilitating. In other cases, the low back is stiff, and the SI joint is more bothersome. This person will tend to squat or reach to the side to pick up something off of a coffee table or chair instead of bending forward at the waist.

It usually bothers people more intensely in the morning and can make going to the bathroom at night a real problem. In severe cases, these people have trouble getting out of bed in the morning and may crawl to the bathroom. It often bothers them after they have been seated or for a while such as long car trips or a conference.

This condition commonly a occurs just after performing a task that involves teetering forward at the waist including, but not limited to; cutting grass, washing dishes, raking leaves, vacuuming or scrubbing a floor. It can also come from bending forward and reaching out awkwardly as when someone stacks dishes in the back of a low cabinet, especially when they twist while reaching out.

Self Care

Supine Twist by Yoga Poses8

The supine twist helps problems like this by mobilizing the binding vertebra.  Twist slowly from side to side while holding your abdomen in. The tender vertebra will often click with a feeling of relief. Many clients find that doing this before getting out of bed offers relief when their low back problematic.

Bridge Pose by YogaOutlet

Bridging also helps, if it can be done without intense pain. I find them to be more effective when they are done in the Active Isolated Stretching method. Lift gently to the point of tension and only hold for about 2 seconds. If done properly, the range of motion increases each time. Raise 10-15 times or until the back arches slightly above the straight position like the person in this picture. I usually suggest that the person grips the back of their shoes, if possible. Some people have overly tight quads and cannot do that.

Icing helps to reduce pain and inflammation. Heat feels good when it is applied but makes the condition worse when inflammation occurs a few hours later. Vapocoolants like Icy-Hot offer temporary relief.

Avoid the offending exercises mentioned above until this your back has strengthened and stabilized.

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Therapy Notes


This is a combination of two muscles that are affected by a binding lumbar vertebra; multifidus and quadratus lumborum. The sharp pains around the affected vertebrae, L3, are attributed to the multifidi. Other vertebrae may be binding and need treatment.

The QL creates the fragile low back with referral into the SI joint. The trigger point is in the deep, iliolumbar section of the QL at the L3 vertebra.

The lumbar vertebra has to be freed. It can be done in many ways; osseous adjustment, static pressure on the vertebra, METs, craniosacral work, etc.  This is more likely to stabilize and have lasting relief when the pelvis, spine, and cranium are treated for distortions and restrictions as well.

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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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