You wake up one morning with back pain, spend all day driving and your shoulders ache.  You book a treatment with the physio/osteopath/soft tissue therapist.  They ask what the problem is and you don’t really know where to start. Does this sound familiar?

To discover the source of the pain think about how your body is connected.  Skeletons show you bones, muscle maps show muscles, but what else holds you together?  The answer is ‘fascia’.

What is it, and, what is the connection to shoulder and back pain.

Wikipedia defines it like this:

‘A fascia is a structure of connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together, while permitting others to slide smoothly over each other.

I would add to this a totally non-technical description which may enable you to picture it better.  If you look at a joint of meat, it’s likely to be held together at least in part by tough a white covering which clings to the meat but is not fat.  This is fascia.

Back in your body, there is fascia connecting your muscles to each other in various ways.  The ones I am going to focus on are those connecting your shoulders to your lower back.  The thoracolumbar fascia which is a direct link from your shoulders to your lower back.  If your shoulder muscles tighten following a long drive, your shoulders rise and pull everything upward.  In doing this your fascia is pulled tightly. (similar to making a bed with the bottom sheet not being straight causing a pull diagonally across the bed)  If you pull one end of most things it will cause tension at the other end and the fascia in your back is no exception.  The other end of the shoulder fascia is at your lower back.  The fascia is pulled, so the muscles of the lower back are stressed and they tighten.  Then your lower back hurts too.  Equally the scenario can be reversed, the lower back muscles may tighten leading to shoulder pain.

The question is how to check this, and how to get it treated.  I would use bio mechanic testing to see whether there is muscle spasm in the shoulders or pelvis. If this is present it is likely that there will be tightness across the fascia.

 Once this is established a series of bio mechanic releases can be performed to encourage the muscle to release.  If a release of the pelvic muscles gives more movement in the shoulders it would indicate a connection which is worth persuing.  A gentle but firm massage over the back from the pelvis up to shoulder will enable the fascia to release and loosen its hold on the muscles. Working into the fascia you may feel it loosening during the treatment.  I sometimes introduce deeper massage into muscle tissue along the line of the shoulder (upper trapezius) and the pelvic line (gluteus medius) but this will depend on the individual I am treating. 

This is not a simple one treatment solution even if you can identify what causes the problem.  Frequently a combination of lifestyle and posture are at least partly to blame for this tightness and, both are worth addressing to reduce the symptoms. If it is a case of managing the tightness I would recommend following up with work to the deeper muscles and continued bio mechanic anti spasm exercises done at home in between treatments.  In my experience two/three treatments combined with home exercises and a monthly massage is enough to manage the muscle and fascia tightness caused by the stress of everyday life.

If you have experience of this as a recipient or a therapist I welcome comments and feedback.