Straight Leg Raise, Headaches, and the Superficial Back Line

Posted: November 26, 2012 in Uncategorized

In the hierarchy of movement dysfunction, “by the book” correctives will tell you to first fix a dysfunctional ASLR (Straight Leg Raise) before moving on to fix the rest of a dysfunctional screen.

For a great tutorial on the Active Straight Leg Raise Test (FMS), here is a quick 6 minute video from Lee Burton:

From a clinical perspective, the ASLR is also part of the assessment. Most are familiar with using an ASLR for nerve tension signs, but it is also used as part of the breakout assessment for MSF(Multi-Segmental Flexion) as per SFMA protocol.

Recently, I have had a string of adolescent male patients (most often athletes) who present with a chief complaint of headaches. Upon assessment, they have had  a bilateral (1/3) in the FMS Active Straight Leg Raise and a DN (Dysfunctional Non-Painful) with MSF.

Is this purely a coincidence? If you are a believer in Anatomy Trains, then most certainly not.

As this picture illustrates, this  Superficial Back Line of fascia runs from the bottom of your feet up through the calves, hamstrings, low back, neck, and finally attached onto the skull. And, when you talk to these patients about how their headaches manifest and feel, they often describe it as starting in the back of the neck and working its way up behind the skull while they literally feel as if something is tugging on the back of their neck.

From a treatment approach, I have found that while initially treating the neck specifically, taking a more global approach can yield some pretty fantastic results.

First, starting with the manual treatment: I was treating an MMA fighter who was dealing with post concussive symptoms and presented to the office with a headache. Like I described above, he was also on a corrective program for ASLR and had a DN MSF. It is interesting to note that after his recent concussion, his MSF regressed a considerable amount from when I initiated treatment for a different complaint. I started by addressing his neck specifically, and his within session audit revealed a slight decrease in headache but still a DN MSF. Then, I decided to go south and address the rest of the Superficial Back Line. The result of this was pretty substantial. Not only did the headache almost vanish, but I saw a great change to the MSF. It seemed that addressing a larger portion of the fascial line made the biggest change.

His corrective exercise/homework was to simply continue with Leg Lowering Progressions with the goal of improving MSF and ASLR all while continuing to monitor the post concussive symptoms.

Later in the week, I will have a nice compilation of videos with some variations of Leg Lowering Progressions.

Stay Tuned!

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