Understanding and treating pelvic incidence-lumbar lordosis mismatch – Muscle spasms and low back pain
Many patients we see have terrible back pain and muscle spasms because of the struggles their musculoskeletal frame goes through trying to keep their body balanced and their head in its correct position. That is, the head up right and in vertical alignment with their pelvis.
If you are reading this article, this type of back pain and spasm probably does not need to be described to you or what type of pain medications you can take to help you. You have already gone down this route. If you are like the people we talk to, you probably would like to have a better understanding of what is going in you back so you can be more proactive in your treatment choices.
In your visits to your doctors you may have heard terms such as “sagittal misalignment,” or “sagittal malalignment.” You may have been told you have “adult spinal deformity.” What you clearly have is pain and limitation in movement, and probably a suggestion to have a multi-level spinal fusion surgery.
Muscle spasms and low back pain
In this illustration we see the muscles that help balance the pelvis and keep our body in proper alignment. Is is typically these muscles that spasms and cause pain when there is spinal instability in the lumbar spine caused by lumbar ligament damage, weakness and laxity.
- The erector spinae is comprised of three muscles, the Iliocostalis, the longissimus, and the spinalis. This muscle complex attaches the base of the skull to the pelvis. As the name implies, the Erector spinae keeps the spine erect.
- The abdominals are the four main muscle groups sometimes referred to as part of the “core muscles.”
- The transversus abdominis stabilizes the trunk and are often the key to helping back pain patients in physical therapy.
- The rectus abdominis or “six pack,” muscles. These muscles connect the rib cage to the pelvis.
- The external oblique muscles and internal oblique muscles –the muscles of the abdominal core that provides twisting motion
Bulging discs, herniated discs and a situation mimicking a stenosis
In this illustration below we see many things happening. All these things lead to pain and loss of function. What we are going to be looking at is the Anterior (front side) and Posterior (back side) tilting of the pelvis and its effects on the kinematics (movement) of the lumbar spine.
- In the A and B illustrations (A) Anterior pelvic tilt with lumbar extension and (B) intervertebral lumbar extension, we see the the frontward or anterior pelvic tilt impacts into the lumbar spine and increases the lumbar lordosis or loss of the natural spinal curvature. This actions tends to shift the nucleus pulposus anteriorly and reduces the diameter of the intervertebral foramina. In other words and more simply, creates a bulging or herniated disc in the front and disruption of the spinal curve in the back. Pain at front and back.
The mimic of a stenosis type situation on certain movements.
- In the C and D illustration components of this illustration we have posterior pelvis tilt which flexes the lumbar spine and decreases the lordosis. (Unnatural alignment of the spine again creating a loss of lordosis situation). When this happens, this tends to shift the nucleus pulposus posteriorly, stretching the posterior ligament complex including the capsular ligaments, the spinal ligaments, and the interspinous ligaments. All this contributing to and reduces the diameter of the intervertebral foramina (a stenosis type of pinching on the nerves). In other words and more simply, creates a bulging or herniated disc in the back and disruption of the spinal curve in the front. Pain at front and back.