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102 massage & bodywork september/october 2008
The LigamenTs of The sacrum
The Primary Cause of Low-Back Pain, Part 1
creDit: Putz/Pabst: sobotta, atlas der anatomie des menschen, 22nd edition 2006 elsevier gmbH, urban & Fischer, münchen WhaT are The LigamenTs
in The saCraL area?
ligaments stabilize the lower part of the term sacroiliac ligaments). This junction also suprasacral ligaments, which are an as well as so-called sciatic pain down into the thigh, lower leg, and foot.
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may manifest itself in many different patterns: an ache in the lowest part of the back; pain down the thigh, within the thigh, in the outer lower leg, or down the back of the leg and into the heel; and so on. To make matters more confusing, the iliolumbar ligaments and the supraspinous and interspinous ligaments of the L1 to L5 vertebrae may also be injured simultaneously, causing overlapping pains (see “The Mystery of Low-Back Pain,” parts 1 (December/January 2006), 2 (February/March 2006), and 3 (April/May 2006)).
of some of these structures and drawing on a live model, visit Massage & Bodywork’s digital edition 2008 DVD “Orthopedic Massage Series—The Low Back: Assessment and Treatment Strategies for Soft Tissue Pain and Injury” by Ben Benjamin (link available on ABMP.
com and Massageandbodywork.com).
OnseT PaTTerns
While the origination of back pain may vary a great deal from individual to individual, there are four basic patterns of pain caused by tears of the ligaments in the sacrum and posterior pelvis. In each of the following categories, pain in the lower back, buttock, thigh, and/or lower leg may appear either suddenly or slowly over the course of many hours or several days. (Note: the terms sciatica and sciatic pain are commonly used as shorthand for a referred pain down the thigh and/or the lower leg. Sciatica is not a diagnosis, but simply a general term like stomach ache. Referred pain down the leg can be caused just as easily by torn ligaments or muscles as by a nerve compression from a bulging disc.) category 1Periodically, the person is immobilized by severe back pain—with or without leg pain—or leg pain alone. The pain is intense and may come on after 104 massage & bodywork september/october 2008
person often goes to bed or just lies on the floor and waits for the pain to subside. This may take several days, a week, or a month. The pain may disappear (for no apparent reason) as suddenly as it came, or it may lessen slowly, until the individual is completely fine. This pain-free state may last a month or a year until the next attack.
category 2The person experiences the same pattern of pain as described above, but it is not severe; it may appear once or twice a week or several times a month. The pain may be brought on by certain activities that the person has learned to avoid, such as prolonged have come to believe that in most cases, may be felt straight across the low-back area or on one side of the low back, and from episode to episode. In these cases, unless one day it changes to the kind of pain described in category 1, 3, or 4.
this, indeed, is a difficult way to live.
(“deviated”) in a side-flexed position or UnderLying CaUses
is doubled over and unable to straighten with one hip raised. There is consistent question is what leads to these injuries, last for hours, days, or even longer, and usually abates slowly over many days. It precipitating event, such as a severe fall is often a frightening experience, for the body feels immobilized and distorted.
some of these individuals heal quickly and completely, others take years to get better or never really feel free of back pain again. And in many cases, the pain develops gradually without any obvious trigger. To fully understand massagetherapy.com—for you and your clients 107
improvements, these ligament problems so the pain referred to psychiatrists for psychogenic in these intractable cases. He taught us perspective about back pain forever.
one side raised or twisted. This seemed interesting, but not that impressive at Ben E. Benjamin, PhD, holds a doctorate in education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 40 in the ligaments on one or both sides of years and has taught communication skil s as a trainer and coach for more than 25 years. He dentist uses) to illustrate his diagnosis. teaches extensively across the country on topics including SAVI communications, ethics, and orthopedic massage, and is the author of listen to Your Pain, are Your tense? and treatment. He said that these sacroiliac exercise without injury and coauthor of the ethics of touch. He can be contacted at note: Massage & Bodywork is dedicated to educating symptoms, the patients’ ligaments were readers within the scope of practice for massage too loose for the bones to stay put.
therapy. essential skil s is based on author ben benjamin’s years of experience and education. the column is meant to add to readers’ knowledge, not to dictate their treatment protocols.
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Source: http://www.benbenjamin.com/pdfs/08SO.pdf