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. Also remember to like this video, to
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