05/29/2013
From e-book by Paul Ingraham, RMT and Tim Taylor, MD
Massage Therapy for Low Back Pain
Perfect Spot No. 2, in the thoracolumbar corner
Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle.
People usually don’t know about this spot … until it gets massaged! And then it’s like scratching an itch they didn’t even know they had. People say to me, “How could I have not known that was there?” Even when they have low back pain, most people are probably unaware that this spot is the source of so much of it — it often seems too high. But trigger points in this location tend to refer pain downwards, fooling us into thinking our low back pain is lower than it is.
This Perfect Spot lives in the “thoracolumbar corner,” a nook between your lowest rib and your spine — right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine.
Technically, they are quite different muscles. Practically, trigger points in both will feel like the same spot — Perfect Spot No. 2.
Important! This article is best for people with a minor low back pain problem. If you are having more serious or chronic back pain, please start with: Save Yourself from Low Back Pain!
The quadratus lumborum — “QL” for short — is an interesting flat sheet of a muscle, spanning the space between the ribs and the hips. The QL has three major jobs, which is why it often needs work: it acts as a prime mover, a postural muscle, and a respiratory muscle. Some people with back pain also experience significant discomfort when breathing, because a cranky QL resists elevation of the rib cage, and cramps up when pulling it down firmly on exhalation. You can imagine the sense of relief people experience when this is resolved!
The column of paraspinal muscle is not one muscle, but an impressive collection of muscle woven together almost like a thick rope. There is hardly a location anywhere in this muscle group from skull to sacrum that does not have the potential to be someone’s Perfect Spot … but there is almost always a significant trigger point in the thoracolumbar corner.
How does Perfect Spot No. 2 feel?
Sensation in this area can feel hot and burning if the trigger points are severe, and they can also feel breath-taking, so use caution. However, in the majority of people, a blunted or more gentle pressure will still produce the signature sensation of a Perfect Spot: a deep, “sweet” ache.
You just can’t treat this spot on yourself unless you are unusually flexible or have tools like a tennis ball … but it’s easy to find on someone else. Simply locate the bottom rib, and then work your way inwards towards the spine. Between the bottom rib and about an inch away from the spine is a corner or pocket where you can almost push underneath the rib.
Somewhere in there is the centre of Perfect Spot No. 2, but it may not be obvious at first, because this area is usually so densely populated with significant trigger points that pressure nearly anywhere is going to feel worthwhile. But keep exploring. Using thumbs or fingertips if it’s not too sharp, or an elbow or the heel of the hand for a blunter pressure, slowly push into that pocket, and press inwards and upwards. Keep trying different angles and you are likely to find something really attention-grabbing!
The vulnerability of the thoracolumbar junction
The 12th thoracic vertebrae often suffers crush and “burst” fractures. The spot is vulnerable because T12 is the lowest of the non-huge vertebrae, making it the weak link in the chain. The L1 breaks less, because it is more massive. T12 breaks instead because, as the lowest of the thoracics, it carries the most weight.
Further Reading
• SY Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much — Recent personal experience proves that a lot of sitting actually is as risky as I’ve been telling my clients all these years
• SY Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
Appendix A: Is trigger point therapy too good to be true?
Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.
But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable … but their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be “side effects” of a more basic problem. No one really knows.
What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.” Many patients can benefit from educating themselves.
The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it …
Not too good to be true.
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.
