Tips From a Licensed Massage Therapist

What You Can Do

Pregnant women, office workers, and those with sedentary lifestyles are most susceptible to lower back pain. The cause however usually isn't the back itself, it's the legs. If  leg lengths are different the pelvis will be tilted. It is rare for someone to have an anatomically longer leg. The usual cause of leg length differences is a muscle imbalance in the thighs and or hips.

QuadricepsCredit: example, if the right quadricep muscle group is short and tight it will begin to pull on the right side of the pelvis. It is uncommon though to see the upper body leaning in the same direction. The brain is constantly at work to keep the eyes level with the horizon; in this example lower back muscles shorten on the left side to pull the torso back to center . 

Since the pelvis is the foundation the back sits upon, any imbalance in the legs will contribute to back pain. A few sources of leg imbalances can be created by a fallen arch on one foot, a weak ankle, a tight knee,  or muscle or bone injury.  Many people think of their pelvis as stationary, but it is three bones held together by cartilage. Flexibility in the pelvis is important for the transfer of motion between the upper and lower body. It is also extremely important  during childbirth. Discrepancies in the pelvis can result from sitting on a wallet everyday or misalignment of the pubic bones at the pubic symphysis.

Luckily there is more than one option to put your feet back under you. As a massage therapist I'd say most people have some form of leg and or hip asymmetry. If you know someone with a good eye there are a few ways to check at home. On a firm surface, lay on your back and have your friend place their thumbs just under the inner ankle bones. To be certain their thumbs are in the same place, have them slide their thumbs toward your head until the bones stop their movement. Have them look to see if one ankle is slightly lower than the other.

Now find the ASIS (Anterior Superior Iliac Spine).  In laymens terms put your hands on top of your hip bones. Walking your fingers forward feel for a bony projection right as the front edge makes a downward turn. There is a groove just under the ASIS for your friend to place their thumbs and see if one side is lower than the other. 

If the right ankle was lower and the right ASIS is lower that usually means the right side of pelvis is rotated forward creating the longer leg. However, if the right ankle is lower and the right ASIS is higher then there is a pretty good chance the right leg is anatomically longer. If one leg is structurally longer than the other it is often recommended to wear a lift in the shoe of the shorter leg. In either case a medical professional can confirm or deny your findings.

Since the muscles hold the skeleton in place I also recommend looking for a massage therapist who specializes in myoskeletal alignment, rolfing or structural integration. Both the American Massage Therapy Association and Associated Bodywork and Massage Professionals have searchable directories to find a therapist in your area. 

Stretching, yoga, and strength training can also bring the body back into balance. There are a few goals to keep in mind when stretching. It shouldn't hurt. Slowly bring the muscle into a stretch just until a gentle tension is felt. As the tension begins to dissipate while stretching, slowly move to the next gentle tension barrier. I recommend holding each stretch for 2 minutes to engage the connective tissue as well. When the connective tissue is stretched the muscle will receive better circulation and nourishment. These are the 2 things tight muscles typically lack. 

Pay attention to the amount of flexibility on either side of the body. Ideally both sides should stretch the same distance. Some people think that if an area of the body hurts then it must need to be stretched. Quite frequently however, the sore side is already the loose side. In the instance where muscles are already loose yoga and/or strength training can help rebuild muscle tone. Strengthening the abdominal muscles is almost always indicated when lower back pain is present. The abs are the front of the lower back. If they are weak and/or carrying extra weight they will begin to pull the spine of the lower back forward.

It sounds like common sense to say everything in the body is connected, but I've met several people who have never thought of their body in that way. Since gravity is constantly at work and our legs and hips form the foundation for the upper body, when they are not aligned properly back pain eventually sets in.