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Low Back Pain and Massage

Online June Elective

June 15 and 16

Low Back Pain

• Will affect at least 80-89% of Americans at some point in time

• 90% will get better with or with out treatment within 6 weeks

• $90 billion spent annually on care

• $30 billion spent on medical care

• Chronic (3+months) less frequent (20%)

This Photo by Unknown Author is l icensed under CC BY-SA-NC

Low Back Pain• Poor Posture

• Poor footwear

• Poor support (furniture, etc.)

• Poor Body Mechanics

• Overuse

• Overweight

• Smoking

• Stress and Strain play a big factor • Concentric versus Eccentric

forces

This Photo by Unknown Author is l icensed under CC BY-SA-NC

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Sensitivity

Spine – joints

• Amphiarthrodial joints

• Intervertebral discs

• Diarthrodial joints

• Gliding – facet

• Ligaments

• Supraspinous

• Intervertebral

• Posterior longitudinal

• Anterior longitudinal

Thoracolumbar Fasciae

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Thoracolumbar fasciae & Latissimus Dorsi

Erector Spinae Group

Transversospinalis &Quadratus Lumborum

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Transverse abdominus & Rectus Abdominus

Internal Oblique & External Oblique

Pelvis

• ASIS and PSIS

• 0 – 10 degrees anterior tilt

• Lower cross syndrome

• Concentric

• Erectors, psoas, RF

• Eccentric

• Abdominals

• Gluteals

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Hamstrings & Rectus Femoris

Low Back Pain

• What you may see

• Hyperlordosis

• Flat feet

• Guarding

• Stiffness in movement

• What to ask

• Pain

• Dull achy stiff

• Sharp shooting tingling burning

• Trauma or injury

• Recent activities

Low Back Pain

Use active engagement

Contract

muscle

Have client

slowly let

muscle relax

Stroke with

intention

Fortunately, we already know some basic techniques that with a few adjustments will work

well for most LBP

Work strokes

with out oil

be aware of

tissue

changes

Ask about

pressure

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Massage

• Low Back Pain can be psychological as well as physical

• Use your therapeutic presence

• Work slowly

• Adjust pressure often

• Work with Breath

• Work with intention

Thoracolumbar fascia and erector spinae group

• 1. Stroke from medial to lateral (push, push)

• Be aware of tissue and depth

• Work with breath

• 2. Stroke from iliac crest to shoulder

• Use forearm with awareness

• Have client hike opposite hip then relax

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Quadratus Lumborum• 1. Find lateral edge of

erectors

• Gently sink in medially

• Repeat previous movement while addressing area of iliac crest to 12th rib

• 2. From opposite side while client has leg in “figure 4” stroke from medial to lateral

• Have client push hip into hand then relax ( stoke on the relax)

• An Irene Favorite

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Gluteals and Hamstrings

• 1. Stroke along gluteals medial to lateral –address trigger points if necessary

• 2. Stroke along Hamstrings, distal to proximal

• Have client contract then relax knee flexion

• 3. Address intermuscular septum proximal to distal

• 4. Fan out from center

• Gentle cross fiber friction to ischial tuberosity if tolerated

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Plantar fasciae

• Stroke from calcaneus to ball of foot

• Address 1. medial, 2. lateral and 3. middle fasciae

• Flex, then extend toes12

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Rectus Femoris

• 1. Stroke from distal to proximal

• Client flexes hip then relaxes

• 2. Fan out from center with same movement

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Psoas

• Palpate for ASIS

• Sink in going supra medial

• May take 45 seconds – use breath

• Client flexes then relaxes hip

Trigger Points

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Lumbar facet syndrome

• Facet joints – bilateral

• Superior facet to inferior facet

• Gliding diarthrodial joint

• Flexion and extension, some rotation/lateral flexion

• About 20% weight bearing

• Anterior tilt/hyperlordosiscause greater weight bearing

This Photo by Unknown Author is licensed under CC BY-SA

Lumbar Facet Syndrome

• Deep achy pain close to spine

• Radiating, hip thigh, rarely lower

• Acute injury, immediate onset of pain

• Often chronic, biomechanical stress

• Extension, hyper extension, sitting

• Pain worse in morning, may get better with movementThis Photo by Unknown Author is licensed under CC BY-SA

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Lumbar facet syndrome

• May see hyperlordosis

• Deep palpation in lamina groove may elicit tenderness

• Pain on AROM for hyperextension/lateral flexion as it puts compression on joint

• Massage to address spinal muscles/trigger points, structural problems

• Be aware steroid injections common medical treatment

This Photo by Unknown Author is licensed under CC BY-SA

Herniated disc

• Intervertebral disc-amphiarthrodial joint

• Nucleus pulpous - gel like

• Annular fibrosus – layers of collagen

• Shock absorption and weight bearing

• Protrusion, prolapse, extrusion, sequestration

This Photo by Unknown Author is licensed under CC BY-SA

Herniated disc

• Can be present without pain

• LBP, radiating to hip, thigh, calf, feet – sharp, shooting

• Usually unilateral

• Gradual wear/tear

• Lifting heavy objects with twisting

• Poor posture/sitting

• Lying down decreases pain

• Genetics/smoking

This Photo by Unknown Author is licensed under CC BY-ND

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Herniated disc

• No definitive signs, watch for postural signals/ no weight on affected leg

• Pain may be aggravated in any AROM including lateral flexion towards or away from affected side

• Straight leg test/slump test

• Medical exam to determine degree

• Massage should not aggravate symptoms, caution in LB massage

This Photo by Unknown Author is licensed under CC BY-SA

• Defined as Radiating Pain involving back, buttocks, posterior leg

• 40% of population may experience, 5% at any given time

• 40-60 years old

• Unilateral

• Neuropathic- it is a nerve issue

• Nerve compression, tethering, sensitization

Sciatica

Sciatica

Type one

• True sciatica

• Axial skeleton and

nerve roots

• LBP present

• Posterior thigh and

buttock pain

Type 2

• Psuedo-sciatica

• Soft tissue distal to

nerve roots, example

-Piriformis syndrome

• LBP usually not

present

• Posterior thigh and

buttock pain

• Pain at night

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Type One - Causes

• Lumbar vertebrae pathologies – spondylolisthesis, scoliosis

• Bulging/herniated disc (probably accounts for 4% of LBP)

• Spinal stenosis

• Tumor, infection, cancer

• Trauma/injury to nerve roots

• Pregnancy

Type Two contributors

• Sitting on wallet, driving (occurs in 80% truck drivers)

poor seat support

• Leg length differences, hip rotation, over pronation of

ankle

• Pregnancy

• Trauma

• Overuse –repetitive strain or poor posture

Thank yous• Anatomy Trains, Thomas Myers

• Orthopedic Assessment in Massage Therapy, Whitney Lowe

• Mayo clinic – Back Pain

• National Institute of Health – Low Back Pain

• Irene Gauthier – Incredible Teacher

• AMTA – IMRTC Low Back Pain and Massage

• Research Perch – podcasts

• International Journal of Therapeutic Massage And Bodywork

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