“Lower cruciate syndrome is one of the most common functional disorders in the musculoskeletal system. It is expressed in a characteristic muscle imbalance in the lumbo-pelvic region", explained Tsvetelin Angelov - master kinesitherapist and rehabilitator, part of the team of "Sofia Physio Center".
He obtained an educational-qualification degree "Bachelor", majoring in "Kinesitherapy" at MU - Sofia. After that, he continued his professional development by enrolling in a master's degree in "Kinesitherapy in Orthopedics and Traumatology" at Vasil Levski National Academy of Sciences. A second master's degree in "Public He alth and He alth Management" follows at the Faculty of Public He alth at the MU - Sofia.
Postural disorders are associated with a change in the normal curves or position of the spine, and a corresponding disturbance in muscle balance. However, unlike permanent spinal misalignments, inappropriate and incorrectly learned postures can be much more easily corrected with appropriate exercises. The lower cruciate syndrome is one of the most common disorders in the musculoskeletal system.
The main reason for its appearance is usually considered incorrect posture, as a result of which there is an imbalance between the muscles that keep the pelvis in a neutral position. Daily movement habits also contribute to deepening the curve at the waist.
The most common causes and risk factors for increased lumbar lordosis are:
• Characteristic muscle imbalance (especially weak abdominal muscles and/or shortened hip flexors).
• Frequent walking in high heels etc.
To counteract the lower cruciate syndrome, the following change in movement habits is necessary:
1. Whether your occupation involves prolonged standing or sitting, take short breaks more often to stretch the long muscles of your back.
2. When walking or standing, try to keep the abdominal muscles slightly tight and the stomach tucked in.
3. Do not deliberately deepen the curve in the lower back (for women) and do not try to push your chest forward as much as possible (for men).
4. The position during sleep is difficult to change, but if possible, avoid sleeping on your stomach, as this position deepens the lordosis. If you can't change this, try placing a small pillow under your stomach. Better options are sleeping on your side, with a pillow between your legs, or on your back.
Kinesitherapy aims to restore the balance of muscle tone by improving the mobility of the spine. Exercises to strengthen the abdominal and gluteal muscles, and stretching for shortened muscles are included. Massage has a beneficial effect on tight muscles by relaxing them and improving blood supply, but by itself, it is not enough.
First group of exercises: to strengthen weak muscles:
Exercise No. 1. Plank
Exercise No. 2. Abdominal presses
Exercise No. 3. Raising the pelvis from the bed
Exercise No. 4. “Kicks” from knee support
Second group of exercises: to stretch shortened muscles
Exercise 1. Stretching for the hip flexors
Exercise No. 2. Self-massage of the hip flexors
Exercise No. 3. Yoga position "Child"
Exercise No. 4. Self-massage of long back muscles
Caution! Additional guidelines and exercises to avoid:
1. In general, you should avoid exercises that put a lot of stress on shortened muscles. This does not mean that you should not train the lower back, but you should limit for a while the intense loads on the erectors
2. Limit back exercises without lumbar support as this will increase spasm of the long back muscles
3. Avoid all variations of sit-ups where you curl your body toward your legs because the pelvic flexors also take a large part of the load. For the same reason, avoid classic sit-ups
Piriformis syndrome is a neuromuscular condition
The pear-shaped muscle (m.piriformis) is located in the back of the hip joint and the buttock, explained rehabilitator Tsvetelin Angelov. In the anatomical position of the human body (standing upright), its function is related to the rotation of the femur outwards (external rotation), which means that it is an important stabilizer in the area of the hip joint and pelvis. It also participates in the provision of the so-called "central stability" allowing coordinated and correct movements of the upper and lower limbs.
Knowing its anatomical location helps to understand how the so-called "Piriformis Syndrome" and why lower back or leg pain can originate in the gluteal region.
The main function of the piriformis muscle is to stabilize the head of the femur in the hip joint, but in everyday life it is also actively involved in movements, such as:
• In a sitting position, performs abduction (taking to the side) of the TBS, for example, when moving from one chair to another, without standing up.
• Ensuring the resistance of TBS when rotating (turning) the body.
• Stabilizing the pelvis, for example when getting up from a seat in a moving bus.
In about 10-15% of people, the sciatic nerve (all or part of it) passes through the piriformis muscle, not under it, before going down the leg. This circumstance can cause the relatively rare "syndrome of m. piriformis".
The change in the tone of the muscle (hypertonus) affects the conduction of the nerve pressing the sciatic nerve passing under it, which is a prerequisite for complaints such as tingling, burning and numbness in the buttock area. As the condition progresses, this feeling can develop into pain spreading along the course of the nerve - down the leg and also up to the lower back. The pain is often accompanied by a reduced range of motion in the hip joints. Other causes of the syndrome can be sitting on a purse in the back pocket, prolonged running and walking, as well as frequent kneeling. Complaints usually subside completely or partially after lying on the back.
Piriformis syndrome can often be confused with injuries to the ischiocrural musculature (posterior thigh muscle group) and radicular (referred) pain from compression of a nerve root in the lumbar (lumbar) region of the spine.
The treatment is completely conservative, with kinesitherapy (physiotherapy) playing a leading role. Means aimed at reducing muscle hypertonicity are included:
• Neuromuscular Relaxation Techniques
• Manual therapy, massage, stretching
• Proprioceptive exercises in the area of TBS, body, etc.