A Orthopedic Massage blog for Manual therapists. Orthopedic manual work is more than just massage, it is a way to assess, test, and structure work to get medically relevant results. I will discuss step by step treatments, how to's, and information I have learned working in the medical industry as a medical massage therapist, a prenatal care expert, and as an orthopedic manual worker. Information might range from really basic to advanced...we all are on our own journey.
By Beret Kirkeby
Body Mechanics Orthopedic Massage
Manual experts for your body. Life is too short for limits.
What is it? Lower Cross syndrome is a condition that runners (or anyone who is inactive or sits for long
periods) can develop from using the same muscle groups again and again, such as during running. It refers to the over-tightening of the hamstring, low back and the weakening of the deep belly and glut muscles.
How do I get it? Essentially the muscles on the back of the body such as gluts and hamstrings are supposed to balance the ones on the front like abs and quads, however, some activities don’t use all of those muscles so when you do them repeatedly you are training for weakness in certain areas. For runners who are focusing on keeping their strides short for training, the leg will never swing above hip level…which is exactly the motion needed to train those deep belly muscles. Over time, this repeated action of small flat strides builds up hamstrings and quads but does not address the gluts and belly.
How do I know if I have it? Lower cross syndrome can be insidious, and build over time. Symptoms can be low back pain, ITB tightness/pain, and hamstring tightness/pain. Lower cross syndrome in itself in the beginning may not be a huge problem for runners, but the secondary problems that comewith it can defiantly sideline a runner big time. Chronic shortened hamstrings and ITBs can lead to some unpleasant secondary problems for runners. Short hamstrings put you at risk for strains and hamstring pulls which are notoriously slow healers. Having short ITBs can cause friction at the knee from overuse and knee tracking issues. Ever hear that knee problems usually come from the hips? This is exactly what they are talking aboutso you can see how one problem can spiral into many.
How do I fix it?Well, you need to strengthen the weak parts and lengthen the tight ones. Often just being involved in another activity can help bring balance into your life. Boot camps, Yoga, Cross fit, climbing…anything that brings your leg up to 90 degrees extension (about hip level) and puts you into some squatting positions can be helpful. In general, moving through a whole range of motion rather than a partial one is considered very healthy for your body. You may also want to consider Massage therapy to alleviate some of the pain associated with problem, and working with the secondary condition associated with it. If you are concerned you might have this condition you should consult a Physical Therapist, trainer or someone adept at physical assessment to help you check. In general, however, erring on the side of caution by bringing some full range of motion exercises into your life can help you be a more well rounded person and better runner.
So many of us in the athletic world are preparing for marathons
right now or at least gearing up our runs. It is a good time to remember that many running problems can be insidious. I hear from runners all the time that they NEVER had a knee, glute or hamstring problem before, and that this problem just showed up. It's really important from a rehab point of view and a running point of view to understand that injury is often cumulative. When you are doing something like running a marathon, where you are constantly stressing the SAME muscles over and over, that much like your training, small increments can lead to larger ones. Take for instance a hamstring irritation. Every day you run, and you are in your arc before your taper. Things are great! But you are running after work and you're pretty tired. Now you never had pain exactly--however, every day you did a longer run, you noticed your hamstrings were super tight and even tighter in the morning. Like a good runner who is invested in their home care, you made sure to stretch them out.
Now--I would never tell someone not to stretch at all. However, if the hamstring tightening is the result of micro-tearing from overuse, muscle imbalance,and fatigue, it is a signal that your hamstring is saying “hey, back off! I am trying to grow new hamstring here!!’. So when you stretch that site, you are pulling the fibers away. What happens is the micro trama from friction and repeated overloading causes inflammation at the site of the ishial tuberosity (usually just under the butt). That inflammation is a direct chemical signal to your body to build new tissue in order to support the damaged ones. So now each time you run, it gets tighter and tighter…Ouch! What a pain in the butt! Now its hard to run at all and you are nervous about a long run.
So what went wrong? Well, maybe nothing. Or, maybe a little of everything. Don’t take the injury personally. You can't predict the future and there are many races coming down the line. So much can go into a hamstring strain--fatigue, overuse, muscle imbalances, the wrong shoes….the list goes on. It could be you did not warm up properly. It could be that you tripped and pulled it without realizing. It could be that the evening runs were not ideal for your healing because your circulation slowed down at night. Or it could be that there was no reason whatsoever other than that your body reached a point where it could not recover. The problem is, there is a tipping point for all people and many small ignored problems can add up to a larger one. You can help yourself by following a few guidelines.
Recovery is a pre-game event. Stretching and foam rolling really help, but it's best to use them preventively before you are scrambling. You should also really understand RICE protocol. That’s Rest (which runners hate) Ice, Compress, and Elevate….and they all have to be done together. You can’t just stick an ice cube in your sock and hope for the best.
So now what? Your hurt, but you want to run. My first suggestion is to see a physical therapist and find out what they say. Strains are categorized by severity and you really need to see if you're doing permanent damage to yourself. If they give you the all-clear, there are some things you can do for yourself after you run it past them.
Injury treatments that are not acute often include contrast baths. You submerge the offending limb in warm water and then cold, and then repeat. The ongoing cycle causes vasodilatation and contraction, which aids in recovery and flushes out the area. This technique can also be used for general recovery. This is old school, serious recovery.
No one advises running on an injury, but if you do, you might use a compression sleeve to limit the inflammation. Runners often use this sort of device for injuries that are older and come back with a vengeance. You can also use KT tape or Rock Tape to help support and increase circulation to the area. These two treatments are slightly different in approach, as KT tape lifts the skin a bit to increase lymph and blood flow to the area, while compression does the exact opposite. So how do you choose? With compression, you are saying, “I know this is going to swell up, I am going to minimize this." When you choose tape, you are saying, "This might swell a little but not too much and I am am taping preventatively". The tape can also be used in places no compression garment can go.
Above all, listen to your body and bear in mind that the number one thing you can do for yourself is rest. No runner likes to hear it. Even if you make it through your big race on your injury, afterwards you will still have to take that break (and by then you will really deserve it). Boy, what a pain in the butt. For more information on recovery please see For more information see our sports massage program in NYC