What are the Causes of Low Back Pain
August 16, 2009 by whymassagetherapy
Filed under FAQ
Low back pain is one of the most common conditions treated by massage therapists. I have been asked by countless clients “what are the causes of low back pain?”, and I am afraid to say that there is no simple answer. The causes of low back pain are many, and it is important for clients to understand this, as appropriate treatment approaches differ as much as the causes themselves.
So common is low back pain that I decided to do a little research and try to get some statistics on it.
Here is what I found:
Back pain statistics from the Workers Compensation Board of British Columbia
So, that’s all fine and well, but while “back strain” appears to be the most common cause of low back pain, and quite a generic term, there are other causes of low back pain. It is very important to identify the cause and contributing factors to low back pain for successful treatment, otherwise clients may just end up wasting time and money.
Falling into each of these 4 broad categories, which I am going to name as causes for low back pain, are several different conditions which I have seen in my practice.
Low back pain cause – Muscle fatigue or strain
Also referred to as a “pulled muscle”, this happens when muscles are overused or is weak. Muscles can also be torn from an injury, and of course, the more serious the damage, the longer it will take to heal …
This is also the primary participant in “soft tissue injuries” – the effects of which insurance companies have lead people to believe are minimal. The reality is that soft tissue injury, and the chronic inflammation which may accompany the more severe injuries, often take longer to heal than the ballpark figure in the insurance tables. However, I digress …
Pain can also be caused by an imbalance of muscle development, or a lack of “extensibility” or “stretch” of the muscles. This is very easy to see, for example, in athletes who may overuse and overdevelop one muscle group. This muscle imbalance is stressful for the body and may cause pain and spasm in the opposing muscle group as the body tries to maintain homeostasis. This lack of balance can lead to “mechanical dysfunction” of the joints of the back (see below). Muscle imbalance, can, however, be treated at home if you know what to do.
Low back pain cause – Joint and bone dysfunction
This type of back pain is often referred to as “mechanical back pain” or “mechanical joint dysfunction” when referring specifically to the joints. What this means is that a joint is not able to move as it is meant to, either from injury to the bone or joint, or hypertonicity of the surrounding muscles (hyper meaning ‘too much’, tone means the amount of tension in the muscle). Unfortunately, this can lead to several other issues and can be a self-perpetuating cycle if left untreated, often causing seemingly unrelated problems.
Of course, bones and joints can also be affected by fractures, breaks, arthritis and a multitude of other conditions which is well beyond the scope of massage therapy to diagnose and in some cases, treat. Massage therapy can, however, be used to alleviate symptoms and assist in recovery.
Low back pain cause – neurological
Low back pain from a neurological source can be a result of a variety of triggers, all of which are related to either the intervertebral disc, spinal cord, or the “nerve roots” as they exit the spinal cord. This type of pain can be excruciating and very debilitating, as anyone with a “slipped disc” will tell you. (this is a bit of a misnomer, and will be addressed in upcoming articles). This type of low back pain usually presents as symptoms in the area which the affected nerve root supplies, so the location of the symptoms is really dependent on the nerve root “level” where the injury or restriction happened. (and often the level of the injury is determined by the presentation of symptoms.) Pain which occurs in one area but originates from dysfunction in another area is called “referred” or “referral” pain.
Low Back Pain – Neurological from Bulging, or Herniated, Disc
Low back pain cause – visceral referral
In some cases pain can be a result of a dysfunction or infection of an internal organ. This happens because the “nociceptors” (pain receptors) of an organ are irritated and the pain is either felt in the skin or tissue which is superficial to (or just above) the organ, or in a classic “referral pattern”. Pain caused by visceral dysfunction can be quite severe. A classic example is low back pain in the lumbar area which may wrap around a persons front, or extend down the sides of the thighs and into the groin. This is a referral pattern of the kidneys, and should never be ignored.
Remember, most low back pain is a result of muscle weakness or imbalance. However, if you are not aware of any activity or cause of the pain, the pain is severe, or if the pain has been present for any length of time, I would urge you to see a physician immediately to rule out anything more serious than a muscular cause for the pain. You may also want to check out more information I have found on WebMD.
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www.whymassagetherapy.com
All Rights Reserved.
Can Massage Therapy Treat Fracture Injuries?
August 6, 2009 by whymassagetherapy
Filed under Treatments
Massage therapy treatment can help maintain and improve tissue health in a fracture injury, enabling a person to regain his or her full function sooner.
Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.
Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.
Considerations for treatment
It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.
In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.
Before your massage therapist begins to treat you, he or she will want to verify the following information:
- your physician has approved massage therapy
- are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
- what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
- are there any open wounds which must be addressed? (i.e. with a compound fracture)
- Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
- is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
- do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
- the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
- have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
- muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
- tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue
As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.
Types of fractures
There are several basic types of fractures:
1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.
Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.
Finding the best massage therapist for you
It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.
© Copyright 2009
All Rights Reserved.
