Medical Massage Seminar on Chronic Low Back Pain

Let's Talk About Pain!

Onset of Pain
Character of pain

Question: How would you describe the pain you have or had (sharp, aching, burning, pulsating)?

Sharp pain
Sharp pain in a patient is the most difficult to differentiate because it can be caused by various reasons from nerve compression by the herniated disk to muscle trauma and active periostal trigger points.

Aching pain
Aching pain is more frequently associated with hypertonic muscular abnormalities (hypertonus, trigger point, myogelosis). Other examples are Osteoarthritis, Fibromyalgia, and referred pain from abnormalities of inner organs (e.g. pain in the right upper shoulder in patients with liver diseases).

Burning pain
If the patient had or has even short episodes of burning pain, the practitioner can be 100% certain that the nerve that innervates this part of the body is under pressure.

Pulsating pain
Usually pulsating pain is accompanied by two major conditions: acute inflammation and venous stasis as a result of insufficient drainage.

Type Of Pain?
Local Or Radiating 

Visceral Pain
Internal pain/ Send to the doctor for treatment

Time of Pain

  • Morning Pain? Typically related to muscle tension. The heart is at rest overnight and does not pump as much blood.

  • Late Afternoon/Evening Pain ? More likely related to a mild herniated or bulging disk. As the day progresses the vertical compression on the disk affects the spinal nerve, hence increasing pain and discomfort.

  • Night pain? If the client is tossing and turning all night it is sign of severe muscle spasm or pressure on the nerve. Usually continuous night pain means that we are dealing with a more difficult case.

Correlation of the Pain with Movement
Pain increases with movement
Pain decreases with movement
Movement has no effect on the pain intensity 

Pain Intensity/ 1-10

Evaluation of Sensory and Motor Abnormalities 

Lumbago/Lumbalgia
Lumbago is the result of acute bulging  or herniation of the intervertebral disk with the resulting irritation or compression of the spinal nerve.

Spondylolysis
In spondylolysis, a crack or stress fracture develops through the pars interarticularis, which is a small, thin portion of the vertebra that connects the upper and lower facet joints.

Most commonly, this fracture occurs in the fifth vertebra of the lumbar (lower) spine, although it sometimes occurs in the fourth lumbar vertebra. Fracture can occur on one side or both sides of the bone.

Spondylolisthesis
If left untreated, spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis.

In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. In children and adolescents, this slippage most often occurs during periods of rapid growth—such as an adolescent growth spurt.

Five major causes of Lumbalgia

Lumbosacral Spondylosis,trauma or chronic overload, Sacroiliitis,chronic visceral disorders and Fibromyalgi
Today we are going to focus on low back pain caused by Sacroiliitis and tension in the Quadratus Lumborum (QL) muscle.

The QL was called The Joker Of Low Back Pain by Travell and Simmons(1983). The pain from this muscle can be identical to that of a disk herniation. Clients will complain of intense pain in the low back area. The QL is very important in humans as it is a key muscle responsible for our vertical posture. Animals do not have a QL muscle or have it in a very minor form.

By its unusual anatomy you can see how it affects many different parts of the body. Hips ,lumbar spine and ribs are all involved in its movement.

Erector Spinae Muscles

These muscles originate from the iliac crest, the sacrum and the spinous processes of the lumbar and thoracic vertebrae. The erectors assist with extension and lateral flexion of the spinal column,

 Iliopsoas

The Iliopsoas muscle is a combination of the psoas and Iliac muscle.The psoas is attached to the transverse processes of T12-L4 vertebrae. They join together inside the hip and attach at the lesser Trochanter of the Femur.


What is the Quadratus Lumborum?

What is the QL? Is it that little square box with the strange designs inside? No that would be a QR code.

The QL is short for Quadratus Lumborum. The quadratus lumborum is a muscle of the posterior abdominal wall. It is the deepest abdominal muscle and commonly referred to as a back muscle. It is irregular and quadrilateral in shape and broader below than above. There are many cases of low back pain(Lumbalgia) and some are due to tension in the QL muscle

The QL is attached to the spinous processes along the lumbar spine L1-L5 and forms a box in between its attachment to the twelfth rib and the iliac crest or top of the hip bone (picture)?
The QL plays an integral role as one of the key muscles that support our vertical posture. It also forms a cushion for our kidneys.
The QL is bilateral on either side of the spine. In many instances, if one side is dysfunctional it can cause a spasm on the opposite side
 
With bilateral contraction, the QL provides vertical postural support and extends the vertebral column. If the erector spinae muscles are weak it puts more pressure on the QL.
Since the QL has an attachment on the 12th rib it also plays a large role in our respiration while assisting in our inhalation and forced expiration. Many people with chronic respiratory disorders can develop tension in the QL.

The Ql also assists our lateral flexion and rotation of the vertebrae. In short our bending and twisting muscles. If you have done excess raking, shoveling, bending, moving and lifting boxes chances are you have aggravated your QL muscle. 
The QL does a lot of work and affects many corresponding muscles when not performing correctly.

Don’t suffer needlessly. If you are in pain, please come in for a clinical evaluation. We can diagnose the problem and develop a treatment plan for the QL or many other conditions. Feel free to call anytime with your questions or comments.

Can massage help with Edema or swelling of arms, legs and/or feet?

Yes. The use of Lymphatic Drainage Therapy  (LDT) is a technique commonly used by massage therapists in the treatment of lymphedema. LDT consists of specific movements that are used to lightly push lymph through the system, helping it to drain out of the tissues and move throughout the body. Lymphedema can be caused by heart problems, wearing tight fitting clothing, and injuries like sprains and fractures. It also sometimes happens as a side effect of chemotherapy treatments and cancer surgeries where the lymph nodes are damaged or removed.

During an LDT session, a massage therapist gently presses and moves his or her hands along the body in specified directions using light pressure strokes. This is an attempt to “reverse” the flow of lymph away from the area of swelling. This treatment is generally used together with other treatments, like exercising to promote circulation, compression therapy, anti-inflammatory drugs, and ice packs. Ask your therapist if this treatment may be right for you.