Getting the Right Massage for Low Back Pain

Massage therapy can provide substantial healing and pain relief for people suffering from low back pain caused by muscle tension and strain, if the correct muscles are targeted.

I asked certified massage therapist Kate Fish, who works at in a chiropractor's office, to explain how she helps heal her clients' pain with massage.

See Chiropractic Treatments for Lower Back Pain

She explained that isolating and rejuvenating the main back muscles that can have the biggest effect on low back pain caused by stressed muscles.

See Pulled Back Muscle and Lower Back Strain

Kate stresses that two important muscles, the quadratus lumborum (QL) and the gluteus medius, may play a bigger role in causing pain than most people realize, saying, "If you strain either of these muscles, the pain can be severe and debilitating.

Dysfunction in these muscles (the QL and the gluteus medius) can lead to severe and debilitating low back pain." Tweet this to share on Twitter.

Kate recommends that you specifically ask your massage therapist to spend 60 minutes on these two muscles.

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1. Quadratus lumborum (QL) muscle massage

Ask your therapist to massage the QL muscle while you lie on your side for 20 minutes on each side (40 minutes total).

The QL muscle, which connects the last rib to the pelvis, is responsible for pelvic stability and structural alignment. It is a common source of low back pain.

See Back Muscles and Low Back Pain

The muscle can become irritated when the lower body is engaged while the upper body is still. For example, activities that could irritate the QL muscle are:

See Office Chair, Posture, and Driving Ergonomics

See Running and Lower Back Pain

• Lifting that requires leaning over something (such as getting groceries out of a trunk)
• Leaning over a sink while doing dishes
• Sitting slumped in a chair
• Running on uneven pavement

Sharp, stabbing pain, urgent pain in the low back is a symptom of a hypertonic (tight) QL.

This muscle must be stretched and massaged simultaneously by your therapist in order to reduce lower back pain. Typically, clients can get relief by combining treatment of the QL muscle with 20 minutes of massage on the gluteus medias.

Back Strains and Sprains Video

2. Gluteus medius massage

After working on the QL muscle, ask your therapist to focus on the gluteus medius for 20 minutes.

The gluteus medius is a posterior hip (or buttocks) muscle that frequently causes pain when the QL muscle is irritated. The gluteus medius becomes inflamed as it tries to compensate for the QL’s dysfunction. Your massage therapist should focus on simultaneously stretching and massaging the gluteus medius as you lie on your stomach.

Kate has been able to provide significant pain relief to numerous clients by using these massage techniques in only one session. She recalls,

"One of my clients had experienced severe low back pain for 3 months. After his doctor ordered an MRI, he was worried he would have to have surgery. He visited the chiropractor where I worked as a massage therapist, and I assessed that his QL was ischemic (so tight that the blood supply got cut off). Working on these specific muscles, I loosened them and increased their blood flow, and the client was pain-free after one session."

See Pulled Back Muscle Treatment

Most likely, your massage therapist is well-versed in the muscles that cause back pain, but don’t hesitate to speak up and specifically request this type of massage if you suspect your pain is due to muscle dysfunction.

This article originally appeared on Spine-Health.com and was written by Allison Walsh.

What is Pain and What is Happening When We feel It?

What is pain? It might seem like an easy question. The answer, however, depends on who you ask.

Pain doesn’t originate at the site as most think, it’s created by the brain so we protect the area that’s in danger.

Some say pain is a warning signal that something is damaged, but what about pain-free major trauma? Some say pain is the body’s way of telling you something is wrong, but what about phantom limb pain, where the painful body part is not even there?

Pain scientists are reasonably agreed that pain is an unpleasant feeling in our body that makes us want to stop and change our behaviour. We no longer think of pain as a measure of tissue damage – it doesn’t actually work that way even in highly controlled experiments. We now think of pain as a complex and highly sophisticated protective mechanism.

How does pain work?

Our body contains specialised nerves that detect potentially dangerous changes in temperature, chemical balance or pressure. These “danger detectors” (or “nociceptors”) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain.

When you’re injured, the brain makes an educated guess which part of the body is in danger and produces the pain there.

Pain is not actually coming from the wrist you broke, or the ankle you sprained. Pain is the result of the brain evaluating information, including danger data from the danger detection system, cognitive data such as expectations, previous exposure, cultural and social norms and beliefs, and other sensory data such as what you see, hear and otherwise sense.

The brain produces pain. Where in the body the brain produces the pain is a “best guess scenario”, based on all the incoming data and stored information. Usually the brain gets it right, but sometimes it doesn’t. An example is referred pain in your leg when it is your back that might need the protecting.

It is pain that tells us not to do things – for example, not to lift with an injured hand, or not to walk with an injured foot. It is pain, too, that tells us to do things – see a physio, visit a GP, sit still and rest.

We now know that pain can be “turned on” or “turned up” by anything that provides the brain with credible evidence that the body is in danger and needs protecting.

All in your head?

So is pain all about the brain and not at all about the body? No, these “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain.

When there is a sudden change in tissue environment – for example, it heats up, gets acidic (cyclists, imagine the lactic acid burn at the end of a sprint), is squashed, squeezed, pulled or pinched – these danger detectors are our first line of defence.

They alert the brain and mobilise inflammatory mechanisms that increase blood flow and cause the release of healing molecules from nearby tissue, thus triggering the repair process.

Local anaesthetic renders these danger detectors useless, so danger messages are not triggered. As such, we can be pain-free despite major tissue trauma, such as being cut into for an operation.

Just because pain comes from the brain, it doesn’t mean it’s all in your head. 

Inflammation, on the other hand, renders these danger detectors more sensitive, so they respond to situations that are not actually dangerous. For example, when you move an inflamed joint, it hurts a long way before the tissues of the joint are actually stressed.

Danger messages travel to the brain and are highly processed along the way, with the brain itself taking part in the processing. The danger transmission neurones that run up the spinal cord to the brain are under real-time control from the brain, increasing and decreasing their sensitivity according to what the brain suggests would be helpful.

So, if the brain’s evaluation of all available information leads it to conclude that things are truly dangerous, then the danger transmission system becomes more sensitive (called descending facilitation). If the brain concludes things are not truly dangerous, then the danger transmission system becomes less sensitive (called descending inhibition).

Danger evaluation in the brain is mindbogglingly complex. Many brain regions are involved, some more commonly that others, but the exact mix of brain regions varies between individuals and, in fact, between moments within individuals.

To understand how pain emerges into consciousness requires us to understand how consciousness itself emerges, and that is proving to be very tricky.

To understand how pain works in real-life people with real-life pain, we can apply a reasonably easy principle: any credible evidence that the body is in danger and protective behaviour would be helpful will increase the likelihood and intensity of pain. Any credible evidence that the body is safe will decrease the likelihood and intensity of pain. It is as simple and as difficult as that.

Implications

To reduce pain, we need to reduce credible evidence of danger and increase credible evidence of safety. Danger detectors can be turned off by local anaesthetic, and we can also stimulate the body’s own danger-reduction pathways and mechanisms. This can be done by anything that is associated with safety – most obviously accurate understanding of how pain really works, exercise, active coping strategies, safe people and places.

A very effective way to reduce pain is to make something else seem more important to the brain – this is called distraction. Only being unconscious or dead provide greater pain relief than distraction.

In chronic pain the sensitivity of the hardware (the biological structures) increases so the relationship between pain and the true need for protection becomes distorted: we become over-protected by pain.

This is one significant reason there is no quick fix for nearly all persistent pains. Recovery requires a journey of patience, persistence, courage and good coaching. The best interventions focus on slowly training our body and brain to be less protective.

This article was originally posted on https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040

For more information and audio recordings discussing pain, follow this link.

The Art and Science of Sports Maintenance Massage

"Sports maintenance massage" is performed when an athlete has reduced his or her training schedule, is not competing, or during the athlete's "off-season." A sports maintenance massage works with an athlete's strength, flexibility, coordination, biomechanics, posture, stress patterns, scar tissue and existing injuries.

It also allows the therapist and athlete to work together to create the greatest changes for the athlete.

Information used in sports maintenance massage is gathered from discussing the athlete's goals, watching the athlete's workouts or competitions, recording current or previous injuries and prior treatments, including massage, and setting specific goals for a sports maintenance massage program.

Sometimes, athletes do not perform well during a season because of a recurring injury. There is not time for massage, long rest periods and specific exercises for proper rehabilitation during the season, and most athletes do not want to miss playing because of injuries, so they return to action even though their injuries have not healed sufficiently. This is why sports maintenance massage is performed when the athlete is not competing or during the off-season.

For example, a sports maintenance massage might involve working with an athlete who has had a recurring hamstring problem. Some considerations for the application of massage would include looking at the athlete's biomechanics, posture, flexibility, strength, scar tissue formation, and other contributing factors. Athletes that suffer from low back pain will tighten their hamstrings to compensate for the injury. Working on the hamstrings will not eliminate the cause - it will only treat the symptom. If the problem is directly within the hamstring, the first consideration should be to determine if the injury is in the acute or chronic stage. An injury in the acute stage could be red, hot, swollen and painful, and working directly on the site of injury in this stage would be contraindicated.

When the injury is in the chronic stage, nonspecific compression of the site, range-of-motion movements and ice treatments would be appropriate. Advance to cross fiber friction with movement and ice treatments as the injury heals. Strengthen and stretch the hamstrings once the athlete can go through a full range of motion without pain.

Whatever the course of action in sports maintenance massage, an athlete must be allowed ample time to heal and incorporate the massage treatments into his or her performance. Sometimes it takes weeks to resolve a specific problem properly. Learning to apply sports massage properly is a never-ending process, and understanding the timing of the treatment is crucial to effective sports application. Sports maintenance massages are where the greatest changes can occur.

This article originally appeared on massagetoday.com and was written by Michael McGillicuddy

Why The Foot Pain Is Connected To The Neck Pain: Your Movement Patterns Shape Your Body

In the yoga world, if we get pain somewhere in the body, we take it as a call to action and begin to stretch that particular area. This approach is often ineffective, because in the words of prominent physiotherapist Diane Lee “It’s the victims who cry out, not the criminals.” This statement requires a fundamental shift in perspective – just because something is hurting doesn’t mean that it is the source of the problem. Now why is that? Why does the old pain in your right foot eventually shows up as tension in the neck? This happens because of fascia.

Fascia is that cotton candy-like connective tissue, that for hundreds of years had been carefully scraped off by anatomists to expose muscles and bones, and considered irrelevant. In the last couple of decades, however, fascia has been reclaiming it’s role as a vital whole-body communication network.

So what is fascia and why should we, yoga teachers and practitioners, care about it? Fascia is the connective tissue that serves both as a bag that holds muscles , bones, organs, etc, and the packing material in between those structures. It is comprised mostly of collagen fibers. For example, when you look at an individual muscle, you will see that fascia wraps individual muscle fibers, groups of fibers and muscle as a whole, becoming more dense toward the end and forming a tendon, which then seamlessly blends into the fascia that envelops the bone.

“Without it’s [fascia’s] support, the brain would be runny custard, the liver would spread through the abdominal cavity, and we would end up as a puddle at our own feet.” (1)

So the fascial system is an all-pervading physiological network, as important as the circulatory and nervous systems. It is a vast and truly fascinating subject, if you are interested in how the body works. Here we will focus on two qualities of fascia – its continuity and its ability to transmit tension.

As yoga teachers we always concern ourselves with the idea of connection (hence the definition of yoga as “union” or “linking”), yet we often fall into the mechanistic view of the body as a system of levers and pulleys. We tell students that “this pose stretches this muscle”, as if anything in the body works in isolation. In the world of fascia the muscle is linked to the bone, which is linked to the ligament, which is linked to another bone, and then a tendon and another muscle, etc. It’s perfectly fine to study muscle action, characteristics of ligaments, etc. as long as we remember that they are all part of an interconnected fabric within the body and affect each other constantly.

Beyond linking everything to everything, fascia has an important role of communicating mechanical information by the interplay of pulls and pushes. Just like a snag on a sweater can run across the fabric, the tension is transmitted in the same way from one place in the body to another via a fascial net. A human body is a constant interplay of internal and external forces that need to be balanced and distributed. As a result, there are predictable patterns of tension throughout the body that are necessary to keep us upright and allow a wide range of movement. “Strain, tension (good and bad), trauma, and movement tend to be passed though the structure along these fascial lines of transmission.”(1)

To describe those predictable lines of tension, Thomas Myers had adopted the term myofascial meridians (not to be confused with acupuncture meridians – a bit different). A myofascial meridian basically describes a line of tension that runs through a sheet of fascia that connects and envelops several muscles. I can’t help but think of a silly cartoon from my childhood of a cat and a dog pulling on a sausage link.

It is kind of like that. The casing of the sausage link is like fascia, while muscles form the contents. When it’s pulled in the opposite directions, the tension is created that is transmitted throughout the entire length.

Let’s take a look at two “cardinal “ myofascial meridians: Superficial front line and Superficial back line. Just by looking at them it is obvious that SBL and SFL need to balance each other to support the upright position. If the SBL becomes too tight and shortens, you will end up with a “military” posture with some or all posterior (back) muscles shortened and bunched, and the anterior (front) muscles pulled and strained. Or the reverse can be true as well in a “collapsed” posture with a rounded thoracic spine and flattened lumbar curve. The military posture might come with tight hamstrings, but if you only focus on stretching the hamstrings, you won’t resolve the issue. This is where we need to look at the body wholistically (as a whole) and identify the patterns of tension that run throughout

Some patterns of tension are predictable because of body’s organization; others are unique because of the movement patterns, past injuries, etc. Basically, your body responds to the loads that you put on it. For example, one of my former students who spent 30 years driving a folklift in this position, developed his own unique pattern of tension that spiraled around his body and manifested as severe hip and sacrum pain. Just working on his hips wouldn’t be enough, since his hips were the “victims” of this entire unfortunate movement pattern.

In words of Brooke Thomas, “We become the shapes and movements that we make most of the time.”(2) And those patterns do not go away when we go to a yoga class. If a student of mine is used to hiking her right hip up while walking, she will do the same thing while attempting the tree pose. This is where awareness comes in. If we do our yoga practice on autopilot, we reinforce the patterns that we already have. If we pay close attention to what we are doing, we have a chance to overcome those habitual movement patterns. This is one of the reasons we repeat each pose a few times before we hold it – it gives us an opportunity to examine our movement patterns and correct them if necessary (read more about it).

RESOURCES

1. Thomas W. Myers Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists   – In-depth exploration of fascia and myofascial meridians with extensive list of references.

2. Brook Thomas Why fascia matters  – Free, down-to-earth, fun look at fascia and why it matters.

This aeticle originally appeared on sequencewiz.org and was written by Olga Kabel