Low Back Pain
Massage for Low Back Pain
Tight musculature and fascia in addition to trigger points help create the dull ache in the low back. Keeping a posture of a flexed trunk and anterior pelvic tilt in the pelvis also tightens the musculature in the back.
1. Fascia – 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 often becomes tightened if there is no movement. Fascia is a colloid which means that as it heats up, it loosens. This may also explain why damp heat on the low back often relieves some of the pain.
2. Musculature –
a. Iliopsoas. This muscle is actually on the front of the lower vertebrae and is very deep to palpate. This muscle is a prime mover in flexing the trunk and lifting up the thigh. This muscle often becomes tight and changes position if you are someone who sits all day – for example at a desk. To get to it, the thigh needs to be flexed and the client relaxed. I would then approach it from the front through the abdomen. It can feel very invasive, but we check in with my client often and make sure they are comfortable and relaxed.
b. The quadratus lumborum 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 are often present in the quadratus lumborum.
c. Lower erector spinae muscles. These muscles run along the entire back from the base of the skull to the sacrum. Often these muscles need attention in addition to the quadratus lumborum and the iliopsoas.
How massage can help –
1. Massage can loosen the fascia through applied myofascial release techniques along the lower back and sacrum. I often use damp heat prior to working on the area (as said above, fascia is a colloid so it loosens as it is heated). Myofascial release is done with little to no lotions, applying a lead (“creep”) and then following through with the stroke. It is slow, and I work at my client’s pain level to make sure they are comfortable.
2. Swedish strokes – effleurage and petrissage are used to warm up the tissue more after myofascial release is done. These help bring healthy blood to the area and warm it up for deeper work. The strokes are done with lotion. Effleurage is a technique in which long, gliding strokes are used. Petrissage encompasses other 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 when you work from attachment to attachment of the muscle. (So where it starts as a tendon and where it ends as a tendon). Muscles attach to bones through tendons. Muscle stripping brings healthy blood flow to that specific band of fibers of the particular muscle you are working on.
4. Trigger point therapy – this technique is where you find the problem trigger point or area of pain/tenderness and apply pressure, often shortening the muscles around it to make it more comfortable to the client. Shortening the muscles is when you bring the origin of the muscle to it’s insertion, mimicking a muscle contraction even though it is passive and no force is required. Trigger points can also be “satellite trigger points” in which they refer pain to other trigger points. They also can refer pain in the area surrounding the trigger point. So release can help alleviate pain in the actual trigger point and the surrounding areas.
If you have low back pain and are wanting to find relief, we suggest massage therapy and chiropractic. They often either come in for a 30 min session in which I only work on the back, neck and shoulders or they come in for an hour full body massage, with a focus on the lower back.