A Massage Therapist’s Thoughts On Lower Back Pain

Monday, July 20th, 2009

One of the things I got out of my massage therapy education was a boatload of information on low back pain. In fact, I miss working on back pain clients quite a bit. This article at MSNBC.com brought back a lot of memories.

Lower back pain is incredibly common. Chances are, at one point or another, you’ll have a debilitating bout of back pain. Might last a week. A month. Or two years.

Mine lasted a year.

And while it was horrible and frustrating, it was also a great learning experience. I spent hours researching back pain and reading up on the anatomy of the lower back and pelvis. It made me a better massage therapist. Well, once I could bend over again.

So, if you have low back pain, save yourself some grief and consider these suggestions.

1.Go to the doctor just to be sure nothing more serious is wrong. Most likely the problem is all muscular, so don’t be surprised if your doctor just shrugs and sends you on your merry way. However, on the off chance you have a pinched nerve or degenerative disease of the spine, it pays to get a diagnosis sooner as opposed to later.

2.Plan for 6-8 weeks of recovery. Even if you start to feel better. For whatever reason, low back pain tends to resolve before the injury, at least in the acute phase. Too many people think the lack of pain means they can return to normal activities, but your back is still weak and very susceptible to reinjury.

3.You can do whatever you want during those 6-8 weeks so long as you feel no pain. I’m serious. No pain. At all. Pain reinforces the injury or causes reinjury as well as inhibits healing. Low back pain is a different animal than other muscle injuries partly because there are a lot of nerves there and once they are aggravated it’s hard to get them to stop making your muscles spasm. You can’t work through or power through back pain without consequences.

4.Every time you do something that causes pain, the clock starts again on your recovery time and you risk making your pain chronic. (You don’t believe me, I know. Don’t worry, your back will teach you the error of your ways.) This dynamic is unique to back pain. A sprained wrist might flare-up a little bit with overuse, but won’t necessarily set the clock back to zero, and you rarely end up with a chronic problem.  The ability to go from acute injury to chronic pain seems to be specific to the back, which is why what you do in terms of self-care matters so much.

5.Read everything you can on www.spine-health.com. It’s a fantastic layperson friendly resource written by a variety of specialists such as doctors, physical therapists, and massage therapists.

6.Use hotpacks. (You can use cold and some people will even tell you to use cold, but heat loosens tight muscles and increases circulation, which, in the short run, may cause more pain, but, in the long run supports healing better than cold therapy. I have found heat to be more effective, but hey, if you try it and hate it and think cold packs offer more benefit, go with it. Do whatever works.)

7.Try massage. Look for someone who is certified in both Neuromuscular Therapy and positional release (a.k.a Orthobioinomy, Strain/Counter Strain, Positional Release, Myofascial Release–any of those are fine). Failing that, try physical therapy or go see a physiatrist–a doctor who specializes in muscles.

And a note on Neuromuscular Therapy, it can hurt but that’s okay. Trigger point pain is proactive. It may not feel okay as those points can be really tender, but it is a good pain and an exception to the no pain rule.

Also, don’t be surprised if part of the treatment involves treating abdominal muscles. Most low back pain involves the Psoas and the Quadratus Lumborum. These two muscles are on opposite sides of your pelvis and ‘fight’ like guests on the Jerry Springer show. If one is in active spasm, it sets off the other and their dysfunctional co-dependent relationship leaves you in a lot of pain. So massage may involve some abdominal work. I mention it as a lot of people get a little weirded out when someone starts digging around in their gut.

8.Find positions that don’t hurt and use them. This is sort of do-it-yourself positional release, which involves a lot of trial and error, but any position that is pain free for you should be used as often as possible. When you’re not in pain, you’ve proactively interrupted the pain cycle. This is a good thing because the nerve isn’t firing, the muscle isn’t spasming, and the body can attempt to revert to normal.

9.Maintain pristine neutral posture. Spend some time reading up on ergonomics and posture and then utilize the information. This means, no wallets in the back pocket because that makes your pelvis uneven when you sit. Avoid big heavy purses on one shoulder as this also affects the low back. No lifting and for the love of your back no twisting! NEVER twist and lift.

10.Recognize that unrelenting pain is depressing and can affect your mood. Be kind to yourself. Pain takes a lot of energy. You will be cranky. You might cry. That’s okay. Take a deep breath and don’t stop trying to find a way to relieve your pain.

11.Have patience. You will get better. I did. My dad did. My clients did. Yes, it takes way too long and it does often seem like finding a magician to saw you in half is a good solution, but your back really will get better. The only people who end up with lifelong pain are military vets with shrapnel in their backs or people who’ve been in serious car accidents/falls or those with degenerative diseases of the spine. Your average run-of-the-mill back pain WILL resolve at some point. Even the pain of pinched nerves (which can be horrific, I know) tends to subside. It’s all just a question of how well you take care of yourself and time.

Tags: back injury, back pain, back pain treatment, lower back pain, massage therapy, positional release
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