Lower Back Pain

Getting results with lower back pain

We all know someone with back pain; have probably experienced it ourselves at some point; and our clinics are filled with patients seeking relief from longstanding and chronic back conditions. Indeed the statistics on the personal and societal cost of lower back pain are shocking. According to the British Occupational Health Research Foundation back pain:

– Affects 40% of the population
– Causes the loss of 50 million working days
– Costs about £5 billion (or £200 for every employee) in sickness absence costs

Source: Clinical Standards Advisory Group

Being able to treat lower back pain effectively is a must for any practitioner who wants to do their best for their clients and have a full and thriving practice. Using a method of combined soft tissue techniques as trigger point, myofascial release and advanced stretching that works effectively alongside your existing bodywork skills to reduce client pain in 1-6 weekly treatments.

Causes of lower back pain

A big factor in most cases of lower back pain is soft tissue damage. The muscles, ligaments and fascia can be adversely affected by sudden injury or trauma, chronic repetitive misuse or habitual poor posture. As these more subtle “soft tissue issues” cannot be diagnosed via X rays or MRI’s they often escape the medics’ attention leading to unnecessary long standing pain that can in most cases easily be resolved.

The role of trigger points

Studies suggest that trigger points (contraction “knots” in soft tissue) are a component of up to 93% of the pain seen in pain clinics and the sole cause of such pain as much as 85% of the time. (Gershwin; Fishbain quoted in Travell and Simons: Myofascial Pain and Dysfunction: The trigger point manual Volume 1)

Trigger points are known to cause or contribute to lower back pain, carpal tunnel symptoms, tennnis elbow, neck pain, migraines, jaw pain, and many kinds of joint pain mistakenly attributed to arthritis. They can cause sinus pain and congestion, nausea, chronic dry cough and are thought to contribute to fibromyalgia.

The key factor about trigger points is that they typically cause pain in a site distant to where the trigger point is located.

Lower back pain can come from trigger points in unusual places such as the buttocks, stomach muscles or even the calves! If you don’t know where to look for the source of the pain your ability to help your client is severely limited.

The muscles most often riddled with trigger points in lower back cases are:

  • Erector Spinae,
  • Piriformis – which when tight can often mimic “sciatica”.
  • Psoas- an anterior deep muscle
  • The Gluteus group
  • Quadratus Lumborum – According to Travell and Simons “ The Quadratus Lumborum muscle is one of the most overlooked muscular sources of lower back pain and is often responsible, through satellite gluteus minimus trigger points for ‘pseudo disc syndrome’ and the ‘failed’ surgical disc syndrome’.”

Fascial Restrictions

The fascia is connective tissue that encases every structure of the body like a 3- dimensional body stocking. If there is a pull or a snare somewhere in this powerful fabric, it causes greater tightening in other areas causing pain and decreased mobility.

Recent research has pointed to the role of the lumbar fascia previously almost unregarded in back pain research.
The lumbar fascia is densely innervated by potential pain receptors. During inflammatory processes in the lower back area, the sensitivity is considerably enhanced [1]. Histological studies suggest that micro injuries within the lumbar fascia are a frequent cause for back pain [2]. These and similar studies could “disburden” the intervertebral discs as a cause for back pain in several cases [3].

How to Treat Lower Back Pain ?

This approach looks at using a tried and tested combination of the best advanced soft tissue techniques available to enable the therapist to gain maximum results quickly and easily. In our experience, using a creative combination of techniques is the best way to achieve effective results; for example trigger point therapy is a fantastic technique, but will gain even better results if combined with fascial release and stretching in a treatment. The concept of a Gestalt – “the whole is greater than the sum of it’s parts” nicely illustrates our philosophy – the combined effect of these skills is magically greater than would be gained through the individual sum of these techniques alone.

Acute and chronic pain and the appropriate use of hot and cold.

The use of hot and cold is a vital tool in the treatment of pain. It should be our first step in treatment. Basically speaking, cold therapy such as ice packs, ice massage or cold stones are applied in the acute stages of pain. And heat, such as warm moist packs or hot stones for chronic pain conditions.

Fascia – Fascial techniques are used first to release restrictions in the fascial system

Muscles – All the muscles around the affected joint are treated for trigger points

Acupressure –  We believe in an integration of Eastern and Western techniques and in our protocols we incorporate local acupressure points that help reduce pain in specific areas

Stretching – Advanced stretching techniques such as PNF, active isolated stretching or soft tissue release are used to integrate the work

Self care – Self- care suggestions are given to enable the client to feel in control of their own health. These may include stretching, strengthening, self trigger point work etc.

There is nothing more rewarding and powerful than to feel that you are truly helping people out of pain.

 

1. Tesarz J, Tachuchi T, Mense S. Die Fascia thoracolumbalis als potentielle Ursache für Rückenschmerzen. Manuelle Medizin 2008; 46: 259


2. Schleip R et al. Letter to the Editor concerning “A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction” (M. Panjabi). European Spine Journal 2007; 16: 1733-1735
 Article (PubMed)


3. Interview mit Schleip R. Rückenschmerzen, Faszien und Rolfing. BR2, Wissensredaktion. ARD Mediathek. (Interview beginnt nach ca. 3/4 des Podcasts)
 Interview – in German (ARD Mediathek)