Lower Back Strain
A Case Study
I began this note thinking about a friend’s back strain, and wondering how I could help him. I’m not local so I can’t work on him directly. In the past I have been able to give him specific cues allowing him to resolve issues independently. This ‘study’ provides some of the thought surrounding our dialogue.
[Note: The healing modality of Structural Integration (aka ‘Rolfing’) offers hope for the healing of injury through the medium of connective tissue integrity. This article addresses injury through this lens. I do not claim accreditation before the medical profession, and suggest that any concerns which are medical in nature be first brought before that community.]
Case Details
My friend is a strong, healthy, left-hand dominant, man in his mid 40’s with a long history of involvement with guitar and baseball. He has practiced Ashtanga Vinyasa over the past 5 years, with periodic breaks to accommodate acute pain in his mid to low back. He also experiences inhibiting pain in his left shoulder close to the border of the deltoid and triceps muscles.
Following an injury to his spine when he was younger, he was helped back to his feet with a chiropractor’s suggestion he stay away from torquing his mid to low back. Recent incidences of back pain have arisen when practicing ‘pavrita parsvokonasana’ (revolved side angle pose), revolving to the right.
Previously, Structural Integration (aka ‘Rolfing’) resolved the acute pain and introduced stability, allowing him the freedom to play guitar and to practice asanas without pain. However, during a more recent practice his pain was reignited while pressed further into the twist. Memory of the initial incident (and suggestion) have returned to him, and he is now moderating on the right.
Observation Concepts
Concept: “Look for transitions in mobility”
When trying to better understand a structural imbalance, observe where there is a shift in mobility. Structural imbalance below the surface is reflected at the surface as a constraint in movement.
Concept: “If you can’t locate it, have your client move”
If it is difficult to locate where the loss of mobility is centered, request movement until interruptions in fluid movement can be located.
For example, observe a person’s spine while they walk about a room. Notice where there is movement along the spine, where there is absence of movement, and points of transition between the two. Where movement transitions into ‘quiet’ can often reveal structural ‘disquiet’ below the surface.
Concept: “‘Mirror’ to increase perception, and proprioception”
To understand mobility restrictions more deeply, it can be useful to ‘mirror’ a person’s structural patterning. Mirroring provides insight into another person’s experience that they may not be able to communicate with words. It enables us to feel ‘internally’ what we find difficult to perceive ‘externally’. This is a powerful tool for developing empathy.
Observation
When revolving to the left , my friend begins his twist from the base of his spine close to the hips. While movement in this direction is limited, it continues by smooth gradation through what we can observe of his low, mid, and upper back.
When revolving to the right we can see a shift in mobility limitation at the base of his rib cage (T11 L1). In the posterior image he indicates that the locus of his pain is just lateral to the base of his rib cage (T11, T12). It is also possible to see a concentration of tension to the left of the spine, perhaps to stabilize the area of injury.
‘Mirroring’ Exercise:
Stand with your feet wide and parallel with your hips balanced, and revolve to the left. Attempt to begin the movement from the base of the spine with even and gradual movement along the spine’s entire length. Remain here for 5 to 10 breaths, then ask yourself how you feel?
Rest for a moment.
Now revolve to the right, again maintaining balanced hips. Movement along the spine is even and gradual until the base of the rib cage, where significant rotation is introduced including medial movement of the scapula.
Remain here for 5 to 10 breaths, then ask yourself how you feel? Be interested in everything: breath restriction, muscular, emotional disturbance, etc.
Analysis
A fall while skateboarding led to the torquing of the rib cage in relation to the spine. The structural strain might have been most acute where the formidable cage of the ribs gave way to the unprotected column of lumbar vertebrae. We could expect a loss of integrity at this junction.
Asana practices, requiring organized and balanced tissue in support of fluid and even movement, have unearthed a disequilibrium in transitional movement from lumbar to thoracic spine.
[Note: Ida P. Rolf, PhD., the founder of Structural Integration (aka ‘Rolfing’), identified this span of the spine as the ‘lumbar dorsal hinge (LDH)’. Healthy movement at this ‘hinge’ requires health in the involved tissues structures (e.g. diaphragm, iliopsoas) and their linkages. Poor integration here often impacts function distally.]
Subsequent to injury, his body began the effort of healing the injury and stabilizing the spine. His body introduced a fascial (specialized connective tissue) thickening in support of pre-existing layering, anchoring this to nearby surfaces with an intent toward stability.
In addition to decreased mobility (due to new fascial material) along this segment of his spine, we might expect interference in related mechanisms such as respiratory function (i.e. diaphragmatic efficiency) and functional linkages into the lower body (e.g. iliopsoas).
Recommendation
As the cause of the imbalance is likely an adhesion or the disorganization of structural elements, it will be valuable to work along two related lines: 1) internal proprioception, and 2) decompression.
Proprioception & Breathing
Increased proprioception can often help us to release tensional patterns involved in physical misalignment. Breathing, directed inward into areas of tension, can be one of the most productive tools in this investigation.
By heightening our internal awareness we may be better able to understand what needs to occur in terms of tensional release and rebalancing in our own body. For example, my friend might discover that the unconscious tension to the left of his spine (see ‘Analysis’) is directly resulting in a lack of integrity to the right of his spine.
And while direct intervention by a practitioner of Structural Integration might set the stage (through the release of adhesions and movement re-education), freedom from long-term tensional patterning is often in the hands of the individual.
Decompression
My second recommendation is to reduce strain through decompression. Pain is related to nerve compression. Decompression of the affected area can allow for a shift in component relationships, and the lessening of pain.
Concept: ‘Its easier to correct an imbalance if we have a bit of room to maneuver’
Introducing length and space (i.e. decompression) may reduce his level of pain. As he is working independently, this will require him to deepen his understanding of weakness, thickening, and adhesion at the site of impact. In effect, he will have to increase his proprioception.
One way to improve proprioception is through breath. And breath can be used to introduce length and space through expansion. This can be seen as a journey of healing through self-awareness, utilizing breath as the mechanism and the lens.
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Thank you for reading this case. If you’re interested in reading more, or have a case you’d like to offer for discussion, I’d be happy to hear from you directly:
smitchellgold@gmail.com
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