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Low-Back Pain …Are you moving towards health or away from it? Would you like to “Roll Your Pains Away?”

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by: Peter Fuller (March 2013)

Massage therapy an appropriate measure for dealing with low back pain

Low back pain has been a serious health complication affecting more than 80% of the total population at some point in their life.  Statistics document: low-back pain accounts for the most number of disability claims which generally drag on to be the longest; and most number request(s) for sick leave.  As a result of this dramatic situation, massage therapy has subsequently been identified by many health professionals as an effective and preventative measure for low-back pain.  In basic terms, massage is defined as the treatment of superficial coating of connective tissues and muscles so as to enhance relaxation and functioning of well-being (Levine, 1999).

I am sure you have heard regular consistent exercise over the course of one’s lifetime helps alleviate pain and keep things moving.  To some extent, this statement does have some truth, exercise therapy is concerned with identifying and utilizing quality of life and potential movement; thus enhancing prevention, treatment, rehabilitation, or habilitation of health complications. However, based on research, massage therapy is more appropriate as compared to exercise therapy in dealing with low back pain.

This article will focus on deriving the most appropriate method of dealing with problems of low back pain.
Methods
To begin with, massage therapy has been categorized as one of the most effective preventive and curative measure for back pain among other health conditions.  Massage therapy is aimed at improving the circulation of blood by enhancing flow of oxygen and other nutrients to body tissues. The mode of administering massage therapy may vary as each therapist may intuitively employ one or more of the various acknowledged massage modalities.  In the professional arena, a normal massage therapy runs for about 40 to 90 minutes. In this situation, a preliminary consultation and review of the client’s conditions is done.  In the process of conducting a massage therapy session, the therapist or the health professional should carry out a concrete review of the medical history of the client as well as the lifestyles.  This will help identify the right procedures (Ernst, 199).  It is imperative to delineate and employ an appropriate therapy plan.

Examination of the painful lumbar region
During the clinical examination, pain may be aggravated by side-bending in the opposite direction.  This may be due to stretching of the dorsal cutaneous rami by this movement. Equally, rotation towards the painful side may make the pain worse.  Often, the skin and the subcutaneous tissues will be found to be hypersensitive in the dermatomes concerned.  This hypersensitivity can be demonstrated by a skin-rolling test.  Skin tenderness to pinching and rolling is normally thought to have a nonorganic basis, if it occurs over a wide and symmetrical area.  However, if the area is localized and confined to one side, pinch-roll tenderness may well be due to the irritation of a sensory cutaneous nerve.(1, 2)  The hypersensitivity observed may be interpreted as an antidromic stimulation of pain nerve fibers which leads to release of pain-enhancing substances into the skin.(3)

Myofascial trigger points (TPs) are frequently overlooked sources of acute and chronic low back pain.  An active myofascial TP is suspected by its focal tenderness to palpation and by restricted stretch range of motion.  The restricted lengthening of the muscle is due to the tense band of muscle fibers in which the TP is located.  The presence of a TP is confirmed by a local twitch response and by reproduction of its known pattern of referred pain, which matches the distribution of the client’s pain.  Only an active TP causes a clinical pain complaint; a latent TP does not.  Additionally, there are “traditional” and/or if you will…standard/known TPs as well as “non-traditional” TPs unique to an individual and their own personal life’s experiences; muscle memory.  The pain may be relieved by the stretch-and-spray procedure, ischemic compression, or precise injection of the TP with procaine solution.  Relief is usually long lasting only if mechanical and systemic perpetuating factors are corrected.

The most effective type of massage therapy for lower back pain is neuromuscular therapy. Neuromuscular therapy is also called trigger point myotherapy.  The American Academy of Pain Management recognizes this form of massage therapy as an effective treatment for back pain caused by soft tissue injury (such as a muscle strain).

Neuromuscular Massage Therapy Technique
Neuromuscular therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm. The massage therapy pressure is usually applied with the fingers, knuckles, or elbow. Once applied to a muscle spasm, the pressure should not vary for ten to thirty seconds.

Massage Therapy May Reduce Muscle Pain

Muscles that are in spasm will be painful to the touch. The pain is caused by ischemic muscle tissue. Ischemia means the muscle is lacking proper blood flow, usually due to the muscle spasm. This in turn creates the following undesirable process:

  • Because the muscle is not receiving enough blood, the muscle is also not receiving enough oxygen
  • The lack of oxygen causes the muscle to produce lactic acid
  • The lactic acid makes the muscle feel sore following physical activity.

After the muscle is relaxed through massage therapy, the lactic acid will be released from the muscle, and the muscle should start receiving enough blood and oxygen.

Neuromuscular therapy will feel painful at first, but the pressure of the massage should alleviate the muscle spasm.  At this point, it is extremely important to communicate with the massage therapist regarding the pressure – whether the pressure is too much, too little, getting better, getting worse.  The therapist should listen and respond accordingly.  The massage therapy pressure should never be overly painful.  In fact, most people describe the pressure as “good pain”.

What to Expect After Massage Therapy

Following a neuromuscular therapy massage, any soreness that may present itself should fade after twenty-four to thirty-six hours. The muscles that were tight should remain noticeably more relaxed for four to fourteen days, depending on stress, activity level, and severity of back pain prior to beginning massage therapy.

The muscle spasm should relax in response to the pressure applied by the massage therapist.  If the muscle does not relax in response to the pressure, there is usually inflammation present. Massage is not the best treatment option for inflamed muscles, and patients should consult their doctor for treatment for the inflammation.

Most muscle spasms require four to six massage treatments, usually over the course of six to eight weeks, to achieve the best effect.  If muscle spasms do not begin to respond to neuromuscular therapy within two or three massage therapy sessions, neuromuscular massage therapy may not be the best treatment option.

If you have severe lower back pain, it is advisable to be checked by medical personnel (Primary Care Physician) before beginning massage therapy.

Combining Massage Therapy with Other Treatments
Massage therapy may also produce the very good results when combined with medical treatments such as physical therapy, chiropractic, or physician care.  Many massage therapy professionals will work as part of an interdisciplinary health care team in overall patient evaluation and treatment.

Additional Information
For more information on massage therapy and/or the therapy services provided by Complete Health Fitness, checkout www.CompleteHealthFitness.com or give us a call at (916) 704-7873.
We look forward to serving you!

References

  1. Lynn B. Cutaneous hyperalgesia. Br Med Bull 1977; 33:103-8.
  2. Maigne R. Origine dorsolombaire de certaines lombalgies basses : rôle des articulations interapophysaires et des branches postérieures des nerfs rachidiens. Rev Rhum Mal Osteoartic 1974; 41:781-9.
  3. Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine 1980; 5:117-25.

Magazine Articles

Bowen Technique Massage Article Condensed

MASSAGE Magazine, by Vicki Mechner

Issue # 106 (Nov/Dec 2003) pp. 102-107

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