Hi! This is Dr. Andrea Furlan here. Today I'm going to talk to you about exercises
for myofascial pain syndrome of the lumbar spine. The lumbar spine is the
area in the lumbar sacral area and there are so many muscles there, and when a
person has myofascial trigger points in the area
it really hurts. I know because I had myself, and I did those exercises. I still
do them, so I'll teach you what I teach my patients when they have myofascial
pain syndrome. I explained in another video what is myofascial pain syndrome
and that's basically muscle pain. It is pain that is originated in the muscles.
So today just pay attention and stay here. I'll tell you what are those exercises
that I do for myself, and I recommend my patients to do when they have myofascial
pain that is coming from the lumbar muscles. Do you remember the four types
of exercise that I recommend when people have myofascial pain syndrome? So think
about it: if it's muscle pain what are the types of exercise: S S A R
stretching strengthening aerobics and relaxation exercises. So we use the same
principles here. We'll start with the stretching exercises. We'll start with
the quadratus lumborum muscle. This is a very large muscle that we have. It's a
muscle that attaches from the lowest ribs to the pelvic bone. What it does
is when we are walking for example, we have to elevate our pelvis to be
able to clear the floor, so this muscle contracts when we are walking. Also when
we are sitting for prolonged period of time, this muscle also has to be
contracting, both of them in the right and left side, to stabilize our spine.
When we are sitting and if you work or you stay sitting there the majority of
the day, like if you have a desk work, then this muscle might be tight and it
might be a cause of the low back pain if you have myofascial pain.
So I'll show you what happens when the quadratus lumborum is tight because
of trigger points. So standing on this position
if the quadratus lumborum is not tight we would be able to go down. This is
called lateral bending, up to the head of the fibula. Fibula is this small bone
that we have in the leg, and there's a head of the fibula here, it's about two
centimeters below the knee line so we would be able to touch the head of the
fibula, which is about two or three centimeters below the knee. So you see
here I don't have tightness of this quadratus lumborum muscle on this side.
Let's see on the other side, so if you go on this side I start feeling some
puling of this muscle on this side here, but still I can go on. And try not to
cheat by going forward. You go on your side, so doing this on the side I can
touch the head of the fibula. So this is exactly the exercise that I teach people
to stretch the quadratus lumborum. So you would go to this side, and remember
take a deep breath and then go: one, two, three, four, five, six, seven, eight, nine, ten.
Stay there, take another deep breath: 1 2 3 4 ,5 6 7 8 9 10. 1 2 3 4 5 6 7 8 9 10. If this
is too easy, you can add some of your arm movements to stretch a little bit more,
and then come back slowly and do the same thing for the other side: 1 2 3 4 5
6 7 8 9 10. one two three four five six seven eight
nine ten. One two three four five six seven eight nine ten. And I feel the
pulling of the muscle here. That's a good feeling. So the other muscle that we
have to stretch is called pyiriformis. Pyriformis is a tiny muscle in the
buttock area, but it can hurt a lot, especially if you have trigger points in
the muscle that is squeezing the sciatic nerve then you can have a pain that is
not only in the buttock area in the lower lumbar area, but also go down,
travel down the back of the leg, so this muscle, to stretch this muscle I recommend
that you seat, you cross the leg, if you don't have any problem in the hip or
knee you'll be able to do this position. And then you go forward, lean forward,
keep going down, down, down, when you reach the maximum position, take a deep breath
count to ten: one two three four five six seven eight nine ten Take another deep
breath and go down: one two three four five six seven eight nine ten.
Take another deep breath: one two three four five six seven eight nine ten. Come
back slowly and repeat the exercise now with the other side, go the maximum that
you can go here, take a deep breath: one two three four five six seven eight nine
ten, another deep breath: one two three four five six seven eight
nine ten. One two three four five six seven eight nine ten. Come back slowly,
you should feel stretching in this area here. The other type of exercises that I
recommend, you need to find a flat surface, a hard surface preferably with a
mat to be comfortable, and then you can do these exercises. We're going to do
exercises for the gluteal muscles, so there are three types of gluteus muscles:
the gluteus maximu,s medius, and minimus. We're going to combine the exercises and do this
for all of them at once. So lying down flat on your back, what I
recommend you to do first is bending one leg, you're going to pull the other leg.
Don't pull here because you put a lot of strength in your knee, and you don't need
to put a lot of force in the knee. So pulling back here you're going to pull
this knee towards this shoulder, the same side shoulder, and again take a deep
breath and go: one two three four five six seven eight nine ten. One two three
four five six seven eight nine ten. One two three four five six seven eight nine
ten. And relax. Now, the other one. The same thing: one two three four five six seven
eight nine ten. One two three four five six seven eight nine ten.
One two three four five six seven eight nine ten. Go back slowly. Then the second
one. You're going to bring this knee to the opposite side, like pointing to the
opposite shoulder, so when you do this try to bend. Youe going to feel
the stretch here and go: 1 2 3 4 5 6 7 8 9 10. 1 2 3 4 5 6 7 8 9 10. and 1 2 3 4 5 6 7
8 9 10. Come back slowly, Now to the other side, bring this knee towards this
shoulder ,you can put your hands here take a deep breath 1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10. 1 2 3 4 5 6 7 8 9 10. And the last one here is bringing
both together, bring close to your chest, take a deep breath 1 2 3 4 5 6 7 8 9 10,
pull a little bit 1 2 3 4 5 6 7 8 9 10, 1 2 3 4 5 6 7 8 9 10, remember not to do this,
don't hold your breath, and don't do this, just relax your neck when you are doing
this exercises.
All the exercises that we did so far, they are stretching exercises, and we
need to do S S A R. So now we're going to do some strengthening exercises for
those muscles that I mentioned, So the first one is going to be the quadratus
lumborum. So the first exercise that we're going to strengthen is the
quadratus lumborum and how do we do that? So that is a side
plank, and if you have never done this, the easiest way of doing a side plank is
putting the force of your body in the knees, and your shoulder and elbows
are aligned here, like the elbow is under your shoulder, and you just raise and
hold it for as long as you can, so if you have never done this you may try to hold
for 15 seconds, if you can try to hold for 30 seconds the ideal is and you can
hold this for a minute.If this is too easy for you, if you are experienced in
doing this, then you can then put the force on your ankle, so you're going to
raise your whole body with the force going in the ankles, so again remember to
put the elbow under the shoulder, and let's do, go up: one two three four five
six seven eight nine ten, then you go down you may feel a lot of a strength
here in the shoulder, but actually you're using the quadratus lumborum, and the
muscles in your lumbar spine, the abdominal muscles to go up, so try to
think about the muscles that you are contracting when you go up. So let's try
again: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20. So that was about twenty seconds, and the idea is that you do this, and try
to increase the time that you can stay in that position, the idea is that you
can do that for one minute, 60 seconds, that's called a side plank,
and it's strengthening for the quadratus lumborum muscle. So now that we are in
this position we are going to do a front plank. And a front plank is similar to
the side plank but it is your whole body so what we're going to do is: we're going
to stay here, again the elbows aligned with the shoulders, and we're going to go
up, and you're going to try to hold this position for fifteen seconds to start.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15. If that's too hard for you you can try on
your knees, and do the same thing, and if that's too easy,
you can try to hold for thirty seconds or 60 seconds. And if that is too easy,
you can try to do some reaches while you are doing your plank.
When we talk about strengthening the muscles, it's also important to talk
about abdominal muscles, because in myofascial pain syndrome of the lumbar area,
usually the abdominal muscles are very weak, and they are also important in the
stabilization of the lumbar spine, so the best exercise, we all know, to do
strengthening of the abdominal muscles, are the crunches, and this is how I
recommend people to do the crunches. If this is new to you, you're not used to do
this, just you can straight your arms, that's easy or this, and just raise from
the flat surface, stay there for 10 seconds come back and do this, and do
this 10 times, if that's too easy you can try to bend the the arms here,
and try to do the same thing and stay there, in repeated 10 times and if that's
too easy then you can try to put the arms here,
and do the same thing and repeat 10 times if you can, you can try to go up
all the way up, and down but it's not necessary, because just doing this you're
already contracting all the abdominal muscles here, and that's very good.
And another exercise that is important to do is the strengthening of the gluteus
muscles here. And we can do this in this position as well, we'll do a bridge, and
the bridge is, you just open the legs, the knees, and just go up, and you stay
there for her as long as you can. Start with 15 seconds and then you start
progressing, you can go to 30 seconds, 60 seconds, and stay there you are
strengthening the abdominal muscles, the quadratus lumborum, the gluteus muscles,
all at once, when you do a bridge. And another exercise that is to
strengthen the muscles in the back, the paraspinal muscles, is the Superman
position. So you just go flat on your stomach and then you go up arms and legs,
and you stay there for as long as you can. Again if you can tolerate 15 seconds
the first time that's perfect, if you have never done this, that's very good,
but if you start doing this more regularly, you'll be able to hold it for
30 seconds, and then the ideal is 60 seconds. So you can start taking notes of
your progression, how you progress with these exercises, your routines, and then
you start taking notes of how many seconds you can hold each position, and
you see that you are getting better. So I recommend people to do these stretching
and strengthening exercises three times a week, you see this routine of exercise
doesn't take too long, and if you incorporate in your routine three times
a week, that would be perfect, but don't forget we also have the other types of
exercise. We have to do the aerobic exercises and that may include walking,
running, jogging, biking, swimming, dancing, and I recommend that people do moderate
to vigorous aerobic exercises, or cardio exercises, at least 150 minutes a week
that can be like three sessions of 15 minutes each time, and you can alternate,
you don't need to do the aerobic exercise the same days that you do your
stretching and strengthening routine. And don't forget the relaxation exercises.
Relaxing the muscles, relaxing the mind. I recommend people to do this many times
during the day, and it can be short like five minutes relaxation exercise, and if
you do when you are stressed, or when you are in the car, or even when you get home,
when you wake up, in the morning, those relaxation
exercises will help to relax the muscles, and there and keep them in good shape.
So, hope you remember that for myofascial pain syndrome of the lumbar spine, it's
important to engage in a regular physical activity, that's basically what
I do every day, every week, and I have to say that for the past two-three years, I
have not had another episode of acute back pain, and I think that's because I
engaged in this regular physical activity that I was not doing before.
Before I had those episodes of low back pain. So thank you for watching this
video today. Remember that this video is only for educational purposes, it's not
supposed to replace medical advice, if you think that you have myofascial pain
of your lumbar spine, please consult your physician, and they will be able to give
your diagnosis, in a proper treatment plan for you.
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