Back pain is one of the most common complaints among the clients that I treat. Up to 80% of people will experience back pain at some point in their lifetime. Low back pain is not a specific disease, or condition but rather a symptom arising from a variety of different causes, or surprisingly no known cause. In up to 85% of individuals suffering from back pain there is no specific cause that can be determined through medical examination as the source of their pain.
Causes of Back Pain
As mentioned earlier there can be a variety of causes of back pain. These involve disease or injury to the muscles, joints, and/or nerves of the spine. Sometimes back pain can arise from organs within the body. This is known as referred pain. Some common conditions originating in the organs causing referred back pain can include, kidney disease/infection, pelvic infections etc. These conditions need to be ruled out or diagnosed by a physician. Other sources of back pain can include, facet joint irritation, sacroiliac joint dysfunction, arthritis, degenerative disc disease, spondylosis, bone cancer, nerve root syndromes, herniated/bulging discs, or muscle strains. It has been found that 90% of back pain is the result of minor mechanical problems, essentially wear & tear injuries. Even though these minor injures can create intense pain, in several cases it is hard to detect the specific cause of the symptoms. The conditions that I deal with most often in my practice that are very common causes of back pain include nerve root syndromes, herniated discs, or muscle strains of the lumbar muscles.
Nerve Root Syndromes
Nerve root syndromes are caused when a nerve(s) is impinged by surrounding structures. Quite often a herniated or bulging disc in the lumbar vertebrae impinges the nerve. Pain arises from the compression of the pain sensitive nerves and nearby structures. Sciatica is a very common example of nerve root syndrome (impingement) in the low back. A nerve can also become impinged from other sources that reduce the space between the vertebra such as osteoarthritis, degenerative disc disease, osteoporosis etc. The pain experienced is often described as sharp, deep, or achy and is often accompanied with numbness in the area of the leg that the nerve supplies. Pain may not only be isolated to the low back but may also be felt in the leg.
In the spine the vertebrae are separated by cushion like discs. When these discs are put under severe amounts of pressure, or become thinner due to degeneration, the discs can bulge or rupture out of the central cavity. When this occurs the disc pushes against the nerve root causing pain and irritation. In low back injuries 98% occur between L4-L5, or L5-S1. The most common movements that can trigger a bulge or herniation are bending and twisting movements, which can occur with simple day -to -day tasks like shoveling snow, tying your shoe, or lifting a child. Single, or repetitive strains on the low back can also cause the disc to bulge or rupture. A herniation can occur at any age. However, between the ages 30-45 it is most common for a disc rupture to occur in the lumbar spine. Further men are affected more than women 3:2 by lumbar injuries.
A muscle strain is an overstretch injury to a muscle. It can occur when there is a sudden overstretching, or extreme contraction of a muscle. A muscle strain ranges in severity from a partial strain, to a complete rupture of the muscle from the bone. Contributing factors include limited flexibility, repetitive overuse or over stressing the muscle, prior injury, or altered biomechanics.
Back Pain Symptoms
· Pain may radiate down the front, side or back of the leg, or may just be localized to the low back
· Pain may be worse with activity, prolonged sitting, or bending forward
· With a herniation pain is usually worst first thing in the morning
· Reduced range of motion in the low back often due to pain
· Numbness and/or weakness in the part of the leg supplied by the nerve, this means you may have trouble standing on your toes or ability to raise the big toe
· Healing is slow due to the poor blood supply of the disc
· Tenderness at the site of the muscle strain, impingement, or herniation.
· Muscle spasms
Back Pain is Assessment
Before a registered massage therapist (RMT) will initiate treatment for your back pain, they will first assess you. This is to determine if your back pain symptoms can be relieved by a massage therapy treatment, or if your condition appears to be more serious and needs to be investigated by a medical doctor. To assess your back pain the RMT will go through a variety of health history questions to gain a better picture of your symptoms and possible source of the injury. Further, he/she will ask you to perform some range of motion movements of the low back. This is done to see if there are restrictions in your movement and if there is if it’s restricted by muscle(s), joint(s), or another cause. In addition, the RMT will likely perform some special tests to determine whether there is nerve impingement. This will involve testing different areas of your skin to see of there is numbness, as well as testing specific areas for muscle weakness. Further, the RMT will palpate the affected area looking for points of tenderness, trigger points, and signs of inflammation.
When You Should Seek Medical Care
1. Recent trauma such as a fall or car accident, especially those 50yrs old and older, even a mild trauma.
2. Persons with a history of osteoporosis
3. Inability to raise or lower your foot at the ankle, raise big toe, or stand on your tip toes
4. Loss of bowel or bladder control
5. Pain worse at rest
6. Prior history of cancer
7. Any person 70 yrs old and up
8. Unexplained weight loss
9. Pain that is unrelieved by positional changes
10. Anesthesia in genital area
Massage therapy is one of the many treatments an individual may choose to help relieve the painful symptoms caused by nerve root syndromes, herniated discs, or muscle strains. However, it is important to note massage therapy will not “cure” your symptoms. Most treatments for these conditions provide temporary relief but have no permanent physical effect. Back pain usually gets better over time with or without treatment. A massage therapy treatment for back pain caused by nerve root syndromes or herniated discs would focus on reducing compressive forces through proper positioning, reducing painful muscle spasms, swelling, and trigger points that may have formed in the surrounding muscles.
Ideally to get the most relief of symptoms treatment is recommended 2x/week for 3 weeks followed by a reassessment and then1x/week for 4 weeks. For a back strain, the focus is also on reducing painful muscle spasms, inflammation, and trigger points. Treatment for a muscle strain is recommended 2x/week for 1 week followed by 1x/week for 3 weeks.
· Modify activity and avoid activities that place additional strain or stretch on the back, however bed rest is not recommended.
· Sleep with a pillow between your legs if side sleeping, or under your legs if sleeping on your back for additional support and comfort.
· An over the counter inflammatory or muscle relaxant may help symptoms
*CHECK WITH YOUR DOCTOR OR PHARMACIST BEFORE DOING SO AS THIS MAY NOT BE RIGHT or SAFE FOR YOU*
· Ice affected area 10min on/10min off x3 several times throughout the day, this is important in the early stages of injury to help reduce inflammation and pain.
· Knee to chest stretches one leg at a time and held for 30sec x3 may ease chronic back pain symptoms