By Helgrit Howard, Ph.D., R.MT. and Tad Howard, R.M.T., P.T.
Throughout our practice of massage we often noticed that clients present particular problems more frequently at certain times of the year. For instance, within a few weeks several of our clients came to us with pains in their knees. Then there were month when no one seemed to have any problems with their knees. Other problems in the body, such as tensions in the shoulder and neck, lower back pain, swelling in the legs and feet and blocked sinuses, to name but a few, all seemed to present themselves predominantly in clusters.
When talking to fellow Massage Therapists we learned that many of them can relate to this experience. We often hear as the explanation for this clustering of problems that the universe is trying to teach us something. However, our observations suggest, that the underlying cause is much less mystical. After studying this event for many years we came to the conclusion that many of the common occurrences of physical problems can be explained by the seasonal changes in people’s habits and the seasonal effect of the environment. Here are some examples of the seasonality of problems we observed in Illinois:
- Winter and Spring: stiffness and/or pain in lower back
- June/July: sore and/or swollen knees
- August/September: sore feet
- October to Spring: shoulder and neck problems
After discussing their problems with our clients and working on their problems, we came to the following conclusions about each of above mentioned seasonal problem clusters:
During the colder month, clients who complained about stiffness or pain in the lower back tended to spend most of their waking hours sitting. Physical activity was limited to walking to and from the car, shopping, walking around the house and office. Not surprisingly, I noticed that those clients had very tight hip flexors; especially psoas was always very tight. If the person spent much time driving an automatic car, then the psoas muscle on the right hand side was usually tighter than the left side. Releasing psoas brought the most and longest lasting relive to the lumbar region of the back. Which is not surprising as psoas arises from the bodies of T12 through L5, runs anterior to the pelvis, posterior to the inguinal ligament, and inserts on the lesser trochanter. This large muscle plays a major role in hip flexing activities such as sitting and driving. If psoas is activated and shortened over a long period of time without relieve from stretching and exercise it will set in this pattern and consequently restrict the movement of the lumbar vertebrae and the hip. Of course, Psoas is not the only muscle in play here but it is one of the most influential ones and, unfortunately, it is often overlooked by therapists, because it is not an obvious, external muscle.
The shortening of muscles with certain activities is well documented by many researchers. For instance, in a study conducted in Turkey on patients with chronic low back pain (2), researchers found that chronic low back pain was connected to atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles.
In an Australian study, Hies et all (1) found in their assessment of trunk muscles during prolonged bed rest that bed rest resulted in selective atrophy of the multifidus muscle. Their results also suggested a shortening of the trunk flexor musculature (psoas, anterolateral abdominal, and rectus abdominis muscles). Some of the changes resembled those seen in low back pain and may explain the negative effects of bed rest seen in low back pain sufferers.
In an MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain, Hides et al. (3) showed clearly that asymmetrical use of the body leads to asymmetry of trunk muscles and deficits of motor control. For instance, the quadratus lumborum and lumbar erector spinae plus multifidus muscles were larger on the same side to the dominant arm and in the subgroup of fast bowlers with low back pain, the asymmetry in the quadratus lumborum muscle was the greatest. The internal oblique muscle was larger on the side opposite to the dominant arm.
If very contrasting activities such as prolonged bed rest and cricket can lead to a shortening of muscles, it is also very possible that prolonged sitting can achieve the same and consequently create a structural imbalance in the muscular-skeletal system. The stress caused by this imbalance is then experienced as stiffness or pain.
In Part 2, we will focus on the seasonal effect of the rest of the year.
(1) Spine. 2007 Jul 1;32(15):1687-92. Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg D, Richardson CA. Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia. firstname.lastname@example.org
(2) Diagn Interv Radiol. 2007 Sep;13(3):144-8. CT measurement of trunk muscle areas in patients with chronic low back pain. Kamaz M, Kireşi D, Oğuz H, Emlik D, Levendoğlu F. Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey.
(3) Br J Sports Med. 2008 Oct;42(10):509-13. Epub 2007 Dec 7. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. Hides J, Stanton W, Freke M, Wilson S, McMahon S, Richardson C. Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
(4) www.gesundheit –aktuell.de. Sport: Langsamer Einstieg in den Frühling