Low Back Pain

Massage Therapy for Low Back Pain: A Targeted Approach

Low back pain is extremely common and is one of the reasons many clients come and see us for massage therapy. Tight musculature and fascia in the lower back, whether it is due to working at a desk 6-8 hours a day, poor posture, or weak abdominal muscles can contribute to a dull ache, pain, inflammation and/or tenderness in the low back.

 
There are a few culprits we like to look at during assessment:

1. Thoracolumbar Aponeurosis (Fascia of the Lower Back) – in the lower back we have a thick band of fascia (the connective tissue of the body) called the thoracolumbar aponeurosis.  This thick broad band of fascia surrounds the musculature in the lower back and often becomes tightened when there is little or no movement.  We like to address this fascia through myofascial release techniques in order to make it more plyable and encourage more movement possibilities in the low back.

2. Targeted Muscle Release (Iliopsoas, QL & Lower Erector Spinae Muscles)

a. Iliopsoas: the iliopsoas muscle is a deep muscle that originates from the front of the lower vertebrae. This muscle is a prime mover of flexing the trunk and lifting up the thigh, and often becomes tight and contracted due to sitting for prolonged periods or poor posture.  This muscle can also contribute to an anterior pelvic tilt, which often causes low back pain if it is tight, so addressing this muscle is imperative.

b. Quadratus Lumborum (QL): the QL attaches the 12th rib to the iliac crest (the hip bone).  It is known as the “hip hiker” as it lifts the hip up to the side.  This muscle is often tight on one side with scoliosis and with lower cross syndrome, it is tight on both sides.  Trigger points in the QL and shortening of the muscle can contribute to low back pain and should be addressed to bring relief.

c. Lower Erector Spinae Muscles:  the lower erector spinae muscles run along the entire back from the base of the skull to the sacrum.  They are parallel to the spine and are often tight with or without adhesions present in those who suffer from low back pain. The goal is to elongate, relax and loosen these muscles through various medical and deep tissue massage techniques, which can help bring relief.

Massage Techniques to Help Lower Back Pain

1.  Myofascial Release: Massage can loosen the fascia through applied myofascial release techniques along the lower back and sacrum.  This technique is performed with little to no lotion by first applying a lead (a suggestion for the fascia to elongate in a certain direction), and then waiting for what is called “creep,” - which is where the fascia under the practitioner’s hands loosen naturally, and the fascia becomes more pliable and elongates on it’s own. Fascia is a colloid, which means when it heats up it loosens, which is why sometimes myofascial release techniques take a longer amount of time to perform, when performed properly.

2. Traditional Swedish Massage Techniques: Traditional swedish massage techniques including effleurage and petrissage are used to warm up the tissue and prepare it for deeper work by encouraging the flow of healthy blood to the area. “Effleurage” is a technique in which long, gliding strokes are used and “Petrissage” encompasses slightly deeper techniques such as hand over hand and “kneading” the muscle, similar to how you would handle dough when baking.

3. Muscle stripping: Muscle stripping is massage technique in which the massage therapist applies specific and exact pressure to a particular band of muscle fibers from the muscle’s origin to insertion, enhancing blood flow to that particular muscle.

4. Trigger Point Therapy: Trigger point therapy is a technique in which the massage therapist first locates a trigger point (an area within a muscle or fascia that produces either localized or referred pain) and then applies pressure to bring healthy blood flow to the area and encourage the trigger point to relax. Trigger points can be considered “satellite trigger points” in which they refer pain to other trigger points or they can refer pain just to the immediate surrounding tissues. Sometimes during trigger point therapy, the massage therapist shortens the muscle (brings the origin of the muscle closer to it’s insertion) to make the treatment less painful for the client.