PURPOSE:
Evaluation of mechanical lumbar pain
Evaluation also beneficial for:
Knee Pain
Ankle Pain
ANATOMY:
Superficial Posterior Fascial Line (1)
-Plantar fascia
-Gastrocnemius (medial head)
-Hamstrings (semimembranosus/semitendinosus)
-Sacrotuberous ligament
-Erector spinae
-Cranial aponeurosis
PHYSIOLOGY:
Ankle Function
-Triceps surae length
-Talocrural mobility
-Anterior tibialis strength
Knee Function
-Hamstring/popliteus length
-Tibio-femoral mobility
-Rectus femoris strength
Hip Function
-Hamstring/gluteal length
-Acetabulo-femoral mobility
-Rectus femoris strength
Spinal Function
-Erector spinae length
-Facet / sacroiliac mobility
-Rectus abdominis strength
PRIMAY RESTRICTION
Ankle mobility – gastrocnemius length (2, 3)
RATIONALE
The gastrocnemius shortens due to activities of daily living. Basic ambulation requires the muscle to lift our bodyweight thousands of times each day. Further complicating the dysfunction, the vast majority of shoes are heeled where the heel is 1″ taller than the toe. High heels further increase the dysfunction by increasing the tone.
Decreased soft tissue lengths of the gastrocnemius has several effects on the movement. Locally, the gastrocnemius limits ankle dorsiflexion and may actually pull the ankle into plantar flexion (posterior collapse of tibia) to allow the hip hinge to occur. As the tibia falls posteriorly, the distal femur glides anteriorly and the proximal femur moves posteriorly limiting hip flexion. This alters the pelvic mobility creating compensatory hyper flexion typically at L5/S1 but may also be present at L3/4 or L4/5.
Globally, the tightness in the gastrocnemius tensions the entire posterior fascial line making it dysfunctional. This increases the tension in the hamstrings which can create low back pain by tensioning the sacrotuberous ligament. This can also tension the erector spinae that can lead to disc or facet pathologies.
REFERENCES:
1. Myers T. Anatomy Trains: Myofascial Meridians for Movement and Manual Therapists.
2. Kase K. KINESIO – TAPING Course Manual: K1 & K2.
3. Sahrmann S. Diagnosis and Treatment of Movement Impairments
In this case, pressure is usually felt mostly in the lumbar area (lower back) and
over time, this will result in excruciating pain. And yet this is more of an exception than a rule in the western world or countries influenced by the western world.
This is an important distinction because it is the
underlying diagnosis (vs.
Age – Muscles and bones age which can result
in less support for the back muscle’s. They can not only be affected at the spinal level of origin, but also peripherally, at their destination, back to
the spine. Although not backed by scientific evidence,
there have been cases where physical treatments have resulted in faster recovery from lower back pain.