Fountain of Youth II: Skeletal Alignment and Muscle Pain 2

July 22, 2009 at 8:15 AM | Posted in Fountain of Youth, Health and Fitness | 4 Comments
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Alright, and now the promised (and probably not-so-anticipated) second part of this article. In this part, I’ll attempt to hit most of the really big spots on the lower body and show you how to fix them. Even if you suffer from shoulder or neck pain, DO THE LOWER BODY. Problems in your lower body that you probably don’t even know about could be the cause of your upper body problems. If you don’t believe that, you’re just dumb.

Because of the pulley-rope nature of the muscles that keep you standing, sitting, lifting or whatever it is you do, you can imagine that the slightest bit of tension imbalance can cause some problems, right? It’s actually quite amazing to me that people don’t end up with incredible imbalances more often than they do. It is definitely possible for it to happen, and it is more likely to do so when you become a creature of habit (which we all are). For example, if you sit at your job, your hip flexors are tight/short, your hip extensors are weak and inhibited, you are more prone to spinal disc degeneration and you could end up with a short leg. Crappy stuff, eh? There are all other kinds of imbalances that can cause tons of problems, too, so let’s get started.


We need to start here because most people have a tilt in their pelvis, and they ought not to. Lower back pain is one of the preeminent causes of lost time at work, loss of quality of life and so on. In fact, many people just assume that as we age, we MUST suffer from lower back pain: that’s a crock. I can almost guarantee you that you have some kind of hip imbalance, even if you don’t think you do.

There are two kinds of pelvic tilts you can have: anterior or posterior. Anterior pelvic tilt (APT) is the most common because of the sedentary nature of our lives. In APT, your hip flexors are tight and your glutes are weak. Here’s a picture.

The pelvis appears to look down.  Note the excessive curvature of the lumbar (lower) spine and the gut appearance.

The pelvis appears to look "down." Note the excessive curvature of the lumbar (lower) spine and the "gut" appearance.

Just for completeness, a posterior tilt is when the pelvis appears to be stuck “looking up.” I can’t find a decent picture right now, so I’ll come back to that later. Anyway, in posterior tilt, your lumbar spine is flattened out. This can look like and/or cause disc degeneration and premature aging of the spine.

It is also possible for one side of your hips to be in anterior tilt, one to be neutral, one to be posterior and so on and so forth – any number of combinations is possible. If you have unilateral asymmetry (one is different from the other), you’ve got serious problems. You’re probably suffering from a functional short leg and a compensating shoulder. Alright! So how to fix it.

If you’ve been stuck like this for a while, I HIGHLY suggest getting a hip adjustment done after your self-massage/tennis ball sessions. It’s almost impossible to reset stubborn hips on your own. Let’s get down to business. I hope you did your homework: the tennis ball is necessary and if you’ve read the articles I linked to last time, you’re in good shape. We need to begin by releasing all of the muscles.

Start with your quadratus lumborum. If this thing gets tight or angry, you’re going to be in a world of pain ALL down your leg. The picture below shows quadratus lumborum.

The quadratus lumborum (QL) has attachments on the 12th rib and the iliac crest of the pelvis. It aids in stabilizing you from side to side. The x's represent trigger points.

You can see that this muscle is extremely powerful because of its location. It attaches to the ribs, the pelvis and the lumbar vertebrae. It is possible for this muscle alone to cause functional scoliosis, functional short leg and a HOST of other problems. The red spots represent areas of referred pain and the X’s mark the location of the trigger points commonly developed in the muscle.

To release the muscle, begin by laying on your back. Bring your knees up so that your legs are in a bent position. Now, position the tennis ball above your butt but below the beginning of your ribs. This wall of muscle is dense, and QL is rather deep, so it may take some poking around. Even if you aren’t feeling any pain from this muscle, you’ll probably feel a good deal of release by working with it. I find that the most effective spots to hit are the attachment at the ribs and along the spine, but it is possible to develop trigger points near the pelvis as well, so hit them all and see where yours are. Remember to keep the tennis ball pressure on the tender points until you can feel it release (read: the pain lessens).

I’ll add pictures as soon as my new digital camera arrives. Until then, work with me. Now, you’ve got the all-important QL released. You should be feeling surprisingly loose in your legs. Nevertheless, it’s time to hit the big spots on the leg. You guys will remember me talking about the psoas. It is important to keep this thing at its correct length, otherwise you’re in for a world of hurt. The picture below again shows areas of referred pain, the most common trigger points and the muscle location. You’ll note that at least two of the three trigger points cannot be reached using a tennis ball (I suggest using a softball for this one), and these must be located by an expert – say a chiropractor who knows what he/she is doing or a massage therapist. Still, you can get good release by this method.

The psoas, or iliopsoas if you include the wall of muscle next to it, is an important hip flexor. While it is not the most powerful, it does need to be released in order for your hips to move correctly.

Alright, so to release the bulk of the psoas, you’ll need to get into a hands and knees position. Now, place the ball below you (I really recommend the softball). You’ll need to lower yourself onto the softball or tennis ball, and you want the ball to be about 2 inches to either side of your navel. Lower yourself onto the ball, and once you can bear that amount of pain (you may not feel much at all, really, depending on how tight you are), lift yourself up with your hands like a seal. This will put more pressure and allow the ball to dig deeper into your abdomen, releasing the soft tissue adhesions (fascia) and allowing the psoas to move again.

This one can take a little bit of getting used to. It’s probably one of the most painful, but don’t worry: you’ll feel infinitely better once it’s done. You need to get used to the pain if you are going to make progress. You’ll know if you do something bad, like hit a nerve or something you weren’t supposed to. In the event that this happens, simply back off the pressure and relocate.

Now that we have the QL and the psoas released, you should be feeling a good deal looser. It’s possible that you might be developing soreness in those muscles if this is your first time: this is a good sign. When trigger points freeze up a muscle, the lactic acid that causes muscle soreness builds up in them. By eliminating trigger points, soft tissue adhesions and scar tissue, you’ll be releasing metabolic waste products (lactic acid is one of the many) and allowing them to be transported from the tissue. We still need to get the primary hip flexors released.

The two that should worry you the most are the rectus femoris and the tensor fascia lata (TFL). These guys are POWERFUL muscles and have the ability to wreck your posture if you let them shorten. The picture below shows the TFL and its tendon, the IT band.

The TFL connects to the IT band.  The IT band is not muscle, but a massive connective tissue band (fascia).  It is the tendon for the TFL.

The TFL connects to the IT band. The IT band is not muscle, but a massive connective tissue band (fascia). It is the tendon for the TFL.

Don’t be fooled by the TFL’s apparent lack of size. It is positioned to be the PRIME hip flexor, with its tendon connecting to the knee and beyond. The more alert among you will note that the IT band also connects to the glutes and the huge mass of fascia above it. That means this thing is a REALLY important structure.

You can foam roll the sides of your legs and dominate the IT band. It’s going to hurt though. It’s important to loosen the IT band itself because if it gets tight, it can cause you to lean to one side, or it can pull your knee out of alignment (this has been called runner’s knee). The IT band can also adhere to the sides of vastus lateralus (the outer quad muscle) and cause it to malfunction. I suggest foam rolling the IT band for beginners and doing concentrated tennis ball work for advanced trainees.

That said, the TFL itself can be loosened by using the tennis ball directly on the meat of the muscle. It’s not too difficult. Lay on your side and position the tennis ball about where you think TFL is. It’s not hard to find it, just put the ball on the outer upper portion of your thigh and start rolling around. TFL is prone to getting trigger points and you’ll know when you hit them. If you’re having trouble locating the muscle, follow the IT band all the way up until you get to the muscle belly. Roll around on the ball and eliminate trigger points with pressure for extended periods of time. This one is probably going to hurt the first time, so stick with it.

Once you’ve gotten TFL loose and rid of trigger points, it’s time to hit the last one. The rectus femoris, while not as pivotal as your TFL, is probably tight and has significant control over the pelvis. The picture below shows rectus femoris with its trigger points.

You can see that, on normal individuals, rectus femoris makes up the bulk of the front thigh.  In more developed individuals, it may be slightly more difficult to locate due to the extra mass of the quads surround it.

You can see that, on normal individuals, rectus femoris makes up the bulk of the front thigh. In more developed individuals, it may be slightly more difficult to locate due to the extra mass of the quads surround it.

Rectus femoris is actually quite easy to release. Simply lay on your stomach, position the tennis ball about where you think the trigger point is and go from there. It REALLY helps to foam roll the entire upper thigh before hitting the trigger points here. If you don’t have a foam roller, then 1) get one and 2) roll with the tennis ball, although your results won’t be AS good.

Once you’ve eliminated all of the trigger points in all of the muscles and released the fascia encasing them, you need to stretch each of the muscles so that you can begin to lengthen them back to where they belong. Some of these stretches are going to seem weird, but do them. This is the final touch on feeling AMAZING.

Once again, I’ll update these pictures as soon as I have my camera, but here are the ones I could find for now.

QL stretch: use a belt or a towel if you can’t quite reach like she can. This one will probably be pretty uncomfortable, but you have to do it.

Ive found other stretches, and all you need to do is google it, but this one seemed to be the only effective one for me.

Psoas stretch: This one is hard. Not only is it difficult to get into position, but it’s just a new kind of feeling all around. If you don’t like this one or you can’t do it, I suggest googling some less intense ones.

Like I said, there are other, less intense stretches that you may find more doable, but this is the one that works for me. I am rather flexible and still an athlete, so I probably need more extreme things than a sedentary person.

Alright, onto the TFL and rectus femoris. Both of these can be stretched in the same stretch. It’s rather difficult to get a REALLY good stretch for TFL without the help of a partner, but this one will do for beginners. Basically, just do as the picture shows.

This one is pretty basic. Chances are youve done it before. You can tense your glutes on the lower-knee side or turn your body the opposite way to intensify the stretch.

Of course, for those of you more able-bodied folk, there are better hip flexor stretches out there. Google it.

That’s about it for pelvic tilts. Once you’ve got everything loosened up right, you should see about getting a hip adjustment done to make your legs the same length. If you get an adjustment but your muscles are all really tight and cased up in fascia, you’ll be throwing your money away.

Now, onto some other problems you might be experiencing with your lower body.

External Hip Rotators

You’ve probably never even heard of your hip rotators. There’s a set of muscles located deep below your glutes and they control the external rotation of your femur. Say what? Ok, so stand up for me real quick, relax, and take a look at your feet. Do they point straight ahead, inward or outward? They SHOULD be pointing straight ahead. If they aren’t I’d bet your toes are pointing outward. This is external rotation of the femur, and almost everyone has this problem to some degree (especially older folks). Here’s a picture of your external rotators. Keep in mind this is below the glutes, so deep muscle.

Youll have to pardon the fifth-grader look...I couldnt find anything better.

You'll have to pardon the fifth-grader look...I couldn't find anything better.

Of these, the biggest is probably the piriformis. In fact, you may have heard of something called piriformis syndrome. It’s fancy talk for trigger points in the piriformis and the referred pain it can cause. While the problems external hip rotators can cause are many, the solution is actually quite simple.

I suggest first rolling the glutes. That done, get your tennis ball and maybe a towel to bite down on…this is going to hurt. You’ll need to support most of your weight on your hands, but basically get into a sitting position on the floor with your hands behind you (lean back onto them). Now, lower yourself carefully onto the ball right about at the meat of your butt. Roll around – you’ll know when you find piriformis and its friends. When you do, I know it sucks, but stay there. As the pain subsides, put more pressure on the muscle. This is releasing deep trigger points and fascia. This is extremely important, so keep at it. You probably won’t get this all at once…you’ll have to retreat and return another time, and that’s ok. Just do as much as you can. Then stretch it out (google the stretch, I’m running out of space here). If you keep doing this, in about a week or so you can have your feet reset to neutral (pointing straight ahead), or at least much closer.

Knee Problems

If you suffer from runner’s knee or some other kind of knee pain, you can loosen up the muscles surrounding the knee and free it. First, take a look at the knee musculature. I’d like to point out a few things around it.

The kneecap's position is controlled by the tension of the tendons and muscles surrounding it.

I know it’s a pretty girly leg, but if I showed you mine you’d get lost ;). No, just kidding. Anyway, there are several key players on the kneecap. First off, if your IT band (the outside) is too tight, you’ll have outward migration of the kneecap and a lot of tension pulling it out. This is runner’s knee. A side effect is that the vastus medialis oblique (VMO) shuts down. You can’t see it from here, but it’s a deep component of your knee – basically the inside. It gets trigger points because it’s being pulled on and you won’t be able to use it. Furthermore, you’ve got several muscles in your calves that can cause some pretty mighty knee pain – namely the peroneals. Finally, your rectus femoris can pull up on your kneecap pretty hard – but you’ve fixed that, right?

So, the best thing you can do for yourself is foam roll the hell out of your IT band. Even when you’ve been at it for a long time, like me, it still causes some pretty serious pain (and subsequent release). You can use a tennis ball to dig in deeper. But another thing you want to do is free up the inside of your leg. Lay on your stomach and put the tennis ball on the inside of your knee (vastus medialis in the picture). You’ll find A LOT of trigger points here, or at least substantial pain. This will free up that inner part of the knee and you’ll have a lot of release here.


Hopefully you’ve released and stretched your rectus femoris by now, so I’ll move onto the calves. Many people assume their calves are fine – there’s no pain. But there are latent trigger points, and a few that REALLY like to develop and make muscles stick together – in almost everyone. Even if you’re feeling no pain now, check them anyway.

First, a good foam rolling is in order. Foam roll the back, front and sides. Pay special attention to the outside – this is the location of your peroneal muscles and these can case significant knee pain. If you have problems with ankle mobility, you can bet this will help.

Here’s a picture showing the location of some common trigger points in the calves.

Pay special attention to TrP2 and TrP4 - these are the ones that can really own your shit.

Pay special attention to TrP2 and TrP4 - these are the ones that can really own your shit.

You can seek out trigger points simply by rolling your calves around on the ball. You probably are GUARANTEED to have TrP2 and TrP4. After one workout involving my calves I have these, even if they were perfect before. These are also the ones that can dominate your knees if you aren’t careful.

In addition to these, I’d recommend searching on the outsides of your calves too. You’ll almost certainly find points there as well. Shin splints can be fixed in one or two days by rolling the front of the calves. This condition involves the muscle fascia sticking to the bone, and all it takes is a good massage to get them working again. I’ll come back with pictures to put up so you can see what I mean in a few days.


Ok, and this is the last one for this post. The feet are actually a common source of pain for almost everyone. Plantar fasciitis, as it is called, is simply the pain from tight fascia in the feet. You know a foot massage sounds good right now.

This is probably the easiest one you’ll do. Simply stand on the tennis ball with each foot. You can hold onto a wall for stability. Roll around and feel the massage – it feels good and your feet will thank you. Remember the idea that fascia tight in one place causes tightness somewhere else, and your feet are no exception.

This post turned out to be pretty beastly, but I think it’s a pretty comprehensive overview of the lower body. You can take the tennis ball and foam roller and hit anywhere you can think of. I didn’t talk about everything, and there’s almost no limit to what you can massage by yourself. Hopefully, you’re a believer in the releasing power of these two simple instruments. I use them each day, and they are especially handy since I do a lot of lifting. Athletes in collegiate programs and professional sports use these tools to keep their muscles at the proper length and keep there posture decent – you can use them for the same purpose. If you find that a stretch you are doing simply isn’t producing results, try releasing the muscle first and then stretching. The results are much more lasting.

In the next post I’ll cover the upper body stuff. Seriously do this lower body work, even if you think your lower body is fine. If you have lower body problems, your upper body problems are never going to resolve completely. In the meantime, here’s the link I always give people when I talk about this stuff:



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  1. Hi

    thanks for such an informative blog. I work as a yoga teacher and incorporate trigger point awareness into my classes and combine them with yoga stretches and strengthening exercises and it has really been helping folk a lot. So many professionals still do not use them but then why would they, I have students who have used chiropractors who tell them they need at least 10 treatments to help align them and yet are no better by the end of the treatments.After coming to class and doing some home work they are much better.

    Keep up the good work, you have enough material for a book, go publish



  2. ‘~* that seems to be a great topic, i really love it :..

  3. what an exceptional blog. i have been a personal trainer for 19 years. i am constantly researching ways to help my clients with pain relief. this is the best information i have ever come across. it will be invaluable to me. thanks so much. i applaud your knowledge and writing skills. you made the info understandable and interesting. can’t wait to implement your terrific suggestions! tammy

  4. Thank you for this write up. Finding this has changed me! Years and funds spent on ART, chiro, massage. I did 10 minutes with a baseball and felt soo much better. For last few years I was told I had a curved spine then now hip impingement. Turns out it is hip flexor issue described here, and the diagrams and details you gave seriously saved me and made it so simple. So thank you. As a triathlete, it pained me as we dont slow down. We go above and beyond the pain. Now I feel relief and on my way to getting rid of this issue once and for all!!

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