The saying ‘a pain in the neck’ is used in many contexts these days but for many people the discomfort of pain in the neck is a very real and daily occurrence, particularly if they have recently or at some time in the past suffered a whiplash injury.
If a whiplash injury has occurred – and bear in mind something as seemingly innocent as stepping hard off a kerb or somebody bumping into you can trigger a whiplash – and subsequently settled, it can be reawakened by awkward posture when sleeping, carrying out a particular or repetitive activity or another trip, fall or other impact.
Because of the nature of whiplash, where the soft tissues of the neck are suddenly wrenched into an unnatural stretch, there is also the possibility of damage to the bone and this should always be checked out before seeking hands-on therapy. Once fractures have been ruled out it is recommended to seek treatment during the ‘sub-acute’ phase – not immediately after the trauma but from 48 hours to 7 days after, where gentle mobilisation can start to encourage the muscles back into a state of relaxation and healing.
As we touched on in ‘Shoulders up to your ears?‘, tight muscles around the shoulders can have great impact on your neck leading to headaches, jaw pain, ear pain, facial pain, dizziness and greatly reduced range of movement – particularly noticed in driving when trying to look over your shoulder.
As well as the muscles we looked at previously there are the scalenes and sternocleidomastiods to consider – those at the sides and front of your neck. The scalenes in particular are susceptable to shortening and tightening if good posture has been compromised and can lead to all of the above pain patterns. In addition to the discomfort from the muscles themselves the cervical (neck) spine can become out of alignment which results in similar pain patterns.
There is a condition known as Wry Neck, or Torticollis, which literally means ‘twisted neck’. This can due to other factors but it commonly occurs where people wake up with a painful, still and twisted neck from sleeping awkwardly or after spending long periods of time working at a computer or games console while sat at a bad angle with inadequate body suport. Wry neck can ease and settle in a few days with rest and painkillers but gentle mobilisation exercises and massage can help greatly in the acute stages.
Pain in the neck area can be very specific, or localised, or it may feel vague as it is referred from what are known as trigger points on the muscles – tight areas which feel knotty and tender that can be released through trigger point therapy. As the tight muscles shorten, putting tension onto the tendons and ligaments of the structures they are attached to, this can cause severe localised pain. It is important therefore to not only work on the points that feel sore but to check the rest of the muscles and surrounding soft tissues for tightness.
A combined approach to release the soft tissues and realign the spine is an effective way to treat this kind of neck pain. The Spinal Release treatment would assist in the early acute stages to encourage the tissues to relax and restore range of motion – important for the healing process – then the Dorn Method and Massage Therapy would also be appropriate to assist further release and correction.
The Jaw Release treatment targets all these areas from the top of the shoulders, the whole neck and jaw itself to release tight muscles and feel for spinal imbalances. It is proving highly effective with results being achieved quickly – in some cases a major difference is being felt after the first session.
All the above treatments are available with Natalie at Ananda Clinic in Tonbridge.
For the first time in weeks my spine feels totally free – free from tension, free from discomfort, free from compression. And what has happened to enable that? A weekend in Brighton with The Jing Institute of Advanced Massage refining my understanding of spinal restrictions and receiving some rather fabulous bodywork as part of the learning process!
Many bodyworkers (with the exception of course of osteopaths and chiropractors) have a great fear of working with the spine. I remember some of my early massage training where it was emphasised that you don’t work directly on the spine (what, is it going to fall apart if you touch it?!) and it took some years of tentative exploration and gentle experimentation to convince me that actually the spine is a pretty robust bit of our design.
I have since learnt some great massage structural release work as well as undertaking advanced Dorn Method training and am now using direct spinal work in many of my sessions.
The spine is a very complex structure which has evolved in a very specific way to allow us a wide range of movements and great degree of flexibility. However, as it contains numerous joints and interconnecting parts it is also vulnerable to postural stresses and trauma through injury. These factors can lead to soft tissue imbalances, rotation and/or displacement of the neck, pelvis or vertebrae, locking of the sacrum and sacroilliac joint and rib displacement.
Unless there is a genetic or surgical reason why the spine has been set in such a way it is usually possible to effect some sort of release and realignment through soft tissue manipulation and gentle mobilisations. These techniques can also be used for acute muscle spasm and chronic pain patterns as they help release the muscles that are protecting the injury or weakness which allows range of movement to be restored and thus aids healing.
Rehabilitation exercises between sessions enhance the treatment and aid recovery. Come and try a Spinal Release Treatment and see for yourself how it works.
Reproduced with kind permission from The Jing Institute of Advanced Massage Training:
The Seven Secrets of highly successful Bodyworkers
New article by Meghan Mari and Rachel Fairweather (with acknowledgements to Steven Covey for his inspirational book: The Seven habits of Highly successful people)
What makes a really GREAT bodyworker?
During my fifteen year love affair with bodywork I have practised, taught, studied and received massage in many diverse parts of the world including the UK, USA, Europe and Thailand. I have known bodyworkers from many different disciplines and walks of life, from the extreme ends of the “New Age” to the resolutely scientific. I have experienced people working with muscles, bones, auras, Qi, cranial rhythms, Sen lines, meridian lines, manipulating organs, fascia, using movement and stillness. I have seen healing happen through working on the body, off the body and in the deepest layers of the body.
From all of this it has become apparent to me that some bodyworkers “make it” – they are successful, happy, have the practice they desire, feel like they are travelling their life path, and are financially content in whatever way that means to them. Others never quite seem to get there, their practises don’t flourish, clients don’t come back to them, they are scraping a living emotionally and financially.
So what is the difference? What makes a truly great bodyworker? It seems no single quality alone will suffice. I have seen highly gifted and intuitive therapists burn out rapidly as they become overwhelmed with the practicalities of running a business. I have seen therapists who are successful business people and know their anatomy inside and out but who have no sensitivity of touch or ability to relate to clients.
This article attempts to distill the essence of some of those qualities I have observed in the therapists who are living and loving their life and work to the full – the Seven Secrets of Highly Successful Bodyworkers.
Secret One: Enthusiasm
“Nothing great was ever achieved without enthusiasm” Emerson
“Nothing is so contagious as enthusiasm; it moves stones, it charms brutes. Enthusiasm is the genius of sincerity and truth accomplishes no victories without it” Bulwer-Lytton
Great bodyworkers LOVE what they do. They are excited, animated and energised by their work. They love to talk about it, read about it, let others know how great bodywork is. And their enthusiasm doesn’t just stop at the bodywork; they are energetic about all aspects of their practice; how they can make their clinic room the most restful and appealing to their clients, how they can design a great business card or leaflet, how they can find the best clinic or colleagues to work with. Enthusiasm is contagious, your clients want to know that you believe in what you do, they want a piece of what makes you buzz. If you are bored by your work, your clients will know and, lets face it, who wants to be around someone who is jaded .
One of my first teachers said to me “I have to constantly find ways to stop myself getting bored with massage”. That is what good bodyworkers do- they are fascinated by the body, always finding new ways to achieve better results with their clients, looking for new techniques. If you are still doing the same routine you learned five years ago, chances are you will be bored. So if you are jaded with your work, go and get some training, find new ways to work, move, break out of the box. Find a colleague to swap with and learn some new techniques. Read a great bodywork book. Surf the internet for inspiring bodywork sites. Rediscover your passion for your work and watch your practice grow.
Secret Two: Perseverance
“Victory belongs to the most persevering” Napoleon
“ I never did anything worth doing by accident, nor did any of my inventions come by accident, they came by work” Edison
“ If people knew how hard I worked to get my mastery, it wouldn’t seem so wonderful after all” Michelangelo
Like these famous characters, successful bodyworkers know the value of hard work and perseverance. Great therapists “keep on keeping on” when things are not going their way, pick themselves back up after mistakes and failures. No matter how talented you are, building a successful practice takes time, work and perseverance. Don’t expect the phone to just start ringing when you qualify; you need to put in effort and good old fashioned elbow grease to get those clients. Remember the old adage “If you love what you do you’ll never work another day in your life”. So love your vocation, work hard at it and enjoy the journey.
Secret Three: Be open to new learning
“As for me all I know is that I know nothing” Socrates
“ To be conscious that you are ignorant is a great step to knowledge” Disraeli
The fascinating paradox is that great bodyworkers “know their stuff” yet at the same time are comfortable with “not knowing” and are always striving to learn more. Taoist sages claim that “one who does not know actually knows, and one who knows really does not know”. To be empty, to recognize how little we know is to be abundant. Successful bodyworkers are always open to new learning, and recognise we are always beginners with so much to learn. There is a wonderful story in the book “ Beyond Shiatsu” by the inspirational bodyworker and teacher Ohashi as follows
“In the 1970s I gave some sessions to the late prima ballerina Margot Fonteyn. After one of them she said she was attending ballet classes for beginners. I asked her “ Why are you- a famous, top ballerina- taking a beginners basic course with 18 year old kids. She said “If I don’t take this class every day, I can tell it in my performance; and if I don’t take this class for 2 days my choreographer can tell and if I don’t take it for 3 days, an experienced audience can tell”. This is the essence of mastery – to always be open to new learning, to seek out inspirational teachers and mentors, to use their experience to give you shortcuts to the success you desire.
Secret Four: Great Touch
“ Good bodywork is 90% perception and 10% technique: (Christophe Somer; Rolfer)
Successful bodyworkers have great touch. Their work has focus, sensitivity and connection. The term “listening touch” coined by Rollin Becker describes this perfectly. Good listening touch is different than knowing lots of techniques- skills are important but if they are carried out with lack of focus and feeling, your work will be ineffective. It doesn’t matter whether you are doing sports massage, relaxation massage, aromatherapy, shiatsu, craniosacral work or Thai massage, the therapists who get good results and retain clients have great touch. This doesn’t mean they were just born with it: like everything else, good touch and sensitivity comes from application, focus and experience. Good teachers will teach you not just technique but how to touch – how it feels to palpate a tight muscle, restricted fascia, stagnant energy or the gentle tide of the cranial rhythm. Receiving bodywork yourself will teach you what feels good and what doesn’t. Cultivate your sense of touch by being fascinated by the body and its hidden rhythms and find yourself a good teacher whose touch thrills your senses.
Secret Five: Outcome orientated treatments
Successful bodyworkers are focussed on the outcome of their treatments not just what style or techniques they offer. If a client wants to relax, a good therapist doesn’t just launch into the same old tired routine but digs into their toolbox of techniques and finds what they can use to make this unique individual relax. This may well be entirely different from what will be needed to enable the next client to achieve deep relaxation. At Jing, our medical massage courses look at how to reduce pain within 1-6 treatments from a combination of advanced techniques including trigger point, myofascial release and stretching. Being outcome orientated builds practices and retains clients as they know exactly what they can expect to achieve from the treatment or series of treatments. Being outcome orientated also relies on good consultation and assessment skills so you know what your client needs and expects.
Secret Six: Graceful Body mechanics
“ The energy is rooted in the feet, developed in the legs, directed by the waist and expressed trhough the fingers” (Tai Chi classics)
You can spot a good bodyworker a mile away from the grace and ease of their bodies when they work. They are focussed and at one with their work. Just watching them makes you feel relaxed. At Jing, we place primary importance on teaching our students great body mechanics. You will learn to move with ease and fluidity and to avoid techniques that place strain on hands, necks, backs and wrists. Learn the dance of massage, moving according to the principles of Tai Chi, using breath and energy and from a firm rooted foundation.
Good bodyworkers also understand that “less is more” and use graceful body mechanics to move from a position of ease:
“ Over and over again people come to me and they tell me, you just don’t know how strong I am. They say “strength” and I want to hear “balance”. The strength idea has effort in it; this is not what I am looking for. Strength that has effort in it is not what you need; you need the strength that is the result of ease” (Ida Rolf, founder of Rolfing)
Secret Seven: Know your worth
Successful therapists know their worth and charge appropriately for what they do. They understand that money is just a unit of energy and that if you are not charging appropriately for what you do, this is a quick route to exhaustion and resentment. Good bodyworkers are able to feel confident about re-booking clients as their treatments are professional, appropriate and outcome oriented.
The Jing Institute of Advanced Massage Training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Based in Brighton, we offer courses around the country. Our courses include longer qualifications in advanced massage including our revolutionary BTEC Level 6 (degree level) in Advanced Clinical and Sports massage and 1-2 day CPD courses in Hot Stone Fusion, trigger point, myofascial release, stretching, pregnancy, on site, living anatomy and many others. Please call or check our website for further information and course dates.
Tel: 01273 628942
Copyright Jing Institute of Advanced Massage . Text Rachel Fairweather.
This has got to be one of the most commonly presenting areas of pain and discomfort that I’ve seen in the clinic since I began practicing massage therapy. It is not uncommon for clients to arrive with their shoulders literally up to their ears – and in a great deal of pain because of it.
The largest muscle in this area is the trapezius – a key postural and movement muscle – and sitting underneath this is the levator scapula, a deeper muscle that allows the upward movement of the shoulder blades.
The trapezius muscle is a broad muscle which attaches to the base of the skull, lays across the back of the neck, down to the upper shoulders then extends down to your mid back. The upper part is one of the most likely muscles to get sore knots or “trigger points” if you are under stress or have been carrying heavy loads.
Pain originating in the upper trapezius may be felt as a burning sensation in a particular area on the muscle itself but also commonly refers up the neck, into the jaw, along the side and into the front of the head causing a tension band headache.
The levator scapula runs from the lateral (side) processes of the upper vertebrae of the neck (C1 – C4) to the inner ‘corner’ edge of the shoulder blade. Its function is to allow the raising of the shoulders and also sideways bending of the neck. Pain in the levator scapular is often felt as a sharp pain in the top of the shoulders or up near the base of the skull and it may feel gristly and knotty around the shoulder blades. There may also be soreness in the side of your neck.
So why do these muscles hurt? Your head can weigh around a stone - and is balanced on top of the small column of bones that make up your neck. The muscles supporting it are constantly working to keep your head in a neutral position that causes the least stress on the whole area. Now imagine what will happen to that fine balancing act if your head is frequently tilted forward or to one side. Or you repeatedly carry a heavy bag on the same shoulder. How much stress would that place on the muscles at the back and side of the neck?
Postural stress is one of the commonest causes of upper trapezius pain, especially for computer users who have a tendency to jut the chin forward to better view the screen and those who regularly ‘cradle’ the phone between their ear and shoulder. Over time the muscles become shortened so mobility becomes restricted. This can lead to minor tears when they overstretch and subsequent scarring in the soft tissue - this is the gristly knotty bit you can feel in a tight muscle. The surrounding muscle then tightens to protect the injury site and before you know it a large part of the muscle has shortened, tensed up, and you have a large and painful knot protecting the original injury.
So how can this be prevented? Well, the first thing is to check your posture and eliminate any bad posture or habits that are placing unnecessary stress on your upper body. Check the height and alignment of your computer screen, ensure your car seat is the correct height so you don’t have to lean forward, get a hands-free headset if you spend long periods of time on the telephone. Swap your single strap bag for a rucksack, or if you really can’t bear to part with it frequently swap it to the other shoulder.
Massage therapy is by far the most beneficial way to reduce muscle tension as the hands-on manipulation of the soft tissues boosts circulation, releases muscle holding patterns, breaks down scarring and knotty areas and realigns the muscle fibres so they can once again glide smoothly and freely the way they are designed to. Also for this area the targeted Jaw Release treatment is highly effective especially for the referred pain patterns mentioned above. By working directly on the soft tissues and spending time gently releasing and lengthening the muscles, the body is able to re-balance and find a more neutral way to be.
If these pain patterns sound familiar then why not try some massage therapy and see if it can help you feel more comfortable.
Continuing with the back pain series we are moving up to the shoulders, looking at problems that can occur with tightness around the shoulder blades.
The shoulder blade (scapula) is covered in a muscle group known as the rotator cuff. This is a group of 4 muscles that help hold the humerus (upper arm bone) into the shoulder socket and facilitate the wide range of movement that such a shallow joint allows.
These muscles need to have a certain tightness to allow them to hold the joint in a stable position, but when the rotator cuff becomes excessively tight the muscles can shorten and become easily strained or torn.
This can lead to problems such as localised pain or deep dull ache, feeling tight and uncomfortable in the back and front of the shoulder and across the collarbone or down the arm, numbness, weakness and restricted movement of the shoulder and arm. Left untreated this can develop into what is commonly known as ‘frozen shoulder’ where the surrounding muscles tighten, the joint capsule ‘locks’ and movement becomes severely restricted and painful.
Tight rotator cuff muscles generally respond extremely well to massage and physical manipulation, although working them can be somewhat painful. The opposing muscle group to the rotator cuff are the Pectoralis (pecs) muscles at the front of the upper chest, running below the collar bones. These can get tight due to lifestyle and poor posture – sitting at a computer for long periods, carrying heavy bags always on the same shoulder, sitting hunched fowards etc – and when these tighten and shorten they pull the shoulders forward into a round shouldered posture which places the already hard working rotator cuff group under additional strain.
Treatment for pain in the rotator cuff should therefore also include examination and work on the upper arm, shoulder and pectoralis to release the whole area in a balanced way. Gentle stretches and strenghening exercises will then continue to release tension or build strength where needed.
To prevent overusing the rotator cuff, practise engaging the larger and stronger surrounding muscles to assist with shoulder strength – the latissimus dorsi that wraps over the lower part of the shoulder blade and down towards the ribcage, the rounded deltoids of the outer ‘corners’ of the shoulders and the large percotralis muscles of the upper chest. A simple exercise to help align the shoulders correctly and release tension is to draw the shoulder blades together towards the spine, then downwards. This also engages the larger muscles of the back to help with strength which can help rest the smaller muscles and avoid overstraining.
Also try laying on your back (with only a small or no pillow) and allow gravity to drop your shoulders backwards towards the floor which will gently stretch out the pectoralis muscles.
If you are struggling with pain in your shoulders or any of the pain patterns mentioned above come for an assessment and discuss what treatment options would be most appropriate for you. Both Massage and Dorn Method can be beneficial for such pain.
In this next installment of the Back Pain Series we jump up a little to the upper back and problems associated with tightness and misalignment in this area, and the similarity to the more localised Carpal Tunnel Syndrome.
Thoracic Outlet Syndrome
Most common in women between 20 and 50 years of age, Thoracic Outlet Syndrome (TOS) is an umbrella term to encompass pain in the neck, shoulder and arm. For this article we will look at non-specific TOS which is usually triggered by trauma to the upper body or repetitive strain/overuse injury.
The pain is usually a dull, aching pain felt anywhere from the neck, through the shoulder to the arm and hand. It originates from compression to the nerves and/or veins running between the neck and the upper ribs, through the clavicles (collar bones) and down through the armpit. The compression may occur along any of these points and pain or tenderness may be felt locally at the compression site or radiate down into the arm and/or hand. This may be accompanied by pins and needles or tingling in the 3rd and 4th fingers, the palm of the hand and in extreme cases a weakening of hand grip.
The pain associated with non-specific TOS usually worsens with activity and improves with rest. Physical therapies to help release overtight or strained soft tissues can be beneficial as can a programme of gentle stretching, strengthening and using hot and cold therapy. If poor posture is the cause then learning correct posture can improve symptoms by removing the stresses on the soft tissues. A postural assessment and necessary correction can also help by realigning the body and therefore reducing the presure on overcompensating areas.
Symptoms of Thoracic Outlet Syndrome are similar to those more commonly associated with Carpal Tunnel Syndrome:
Carpal Tunnel Syndrome
Another repetitive strain/overuse injury, Carpal Tunnel Syndrome (CTS) also presents with pain, numbness, tingling and pins and needles in the hand, thumb and 1st and 2nd fingers. It is usually caused by compression to the medial nerve in the front of the wrist. This runs through a small compartment called the Carpal Tunnel and if this becomes inflamed due to overuse it reduces the space for the nerve to pass through and pinches it. Due to the similarity in symptoms of CTS and Thoracic Outlet Syndrome it is important to check the neck and shoulders on any client presenting with these symptoms even if the pain is felt locally at the hand/wrist.
Rest is often advised for CTS with the wearing of a splint to keep the wrist stable and prevent overuse, however this may in turn lead to loss of muscle and strength in the arm and wrist which can lead to further problems.
Cold packs can be applied to help reduce inflammation of the wrist and massage of the arm, shoulder and neck can help to relax muscles that may also be involved. Depending on the level of inflammation, gentle massage directly over the carpal tunnel area may also help to release, soften and stretch out the soft tissues that are contributing to the compression. This can be particularly beneficial in the very early stages before the swelling becomes too bad.
As with any symptoms that persist or worsen there is no substitute for medical advice and you should check with your GP if you are concerned about your health.
In this second part of Lumbar problems we are looking at the more serious conditions of Degenerative Disc Disease, Osteoarthritis and Spinal Stenosis.
Degenerative Disc Disease
The term Degenerative Disc Disease sounds frightening and permanent. However, it is not as serious as it may suggest. As we get older our spinal discs start to degenerate. For some people this will result in chronic pain, most commonly in the lower back or neck, yet for others there will be no physical discomfort at all. The ‘degeneration’ occurs as the disc’s water content reduces and it starts to lose its spongy quality and shrink. This subjects it to greater pressures from the vertebrae which can lead to tears and the build up of scar tissue.
There is some debate within the medical community as to the actual cause of pain with this condition, with some suggesting that the pain is due to inflammation of the soft tissues surrounding the damaged disc, and others looking more to the vulnerability of the nerve roots in the affected area. The pain pattern reported is often a persistent low to moderate ‘baseline’ pain with intermittent high pain flare-ups (described as the back ‘giving out’) following particular activities. Acute episodes can last a few days to a few weeks before settling back into the low level chronic state. The pain may stay localised in the lower back or there may be pain, numbness and/or tingling down the leg. This makes it a very difficult condition to identify as the pain pattern can be similar to Sciatica and Piriformis Syndrome.
This seems to be a condition that is more common amongst the 30′s and 40′s age group, and whilst the disc will continue to deteriorate the pain usually does not get any worse over time.
Treatment for Degenerative Disc Disease includes physical therapy such as Dorn Method and McTimoney Chiropractic, both of which gently help realign the spine and rebalance the body to help minimise irritation to the surrounding soft tissues and nerves.
Osteoarthritis of the spine is a more serious and permanent condition, most common in people over 50. It is associated with Degenerative Disc Disease as the stresses placed on the vertebrae of the affected area can, over time, develop into osteoarthritis. The under-lubricated joints rub against each other leading to damage of the protective cartilage and the formation of painful bone spurs. That is not to say however that one will automatically lead to the other.
Symptoms commonly include pain and stiffness in the affected joints which can also lead on to secondary muscular tension and restricted mobility. Lower back pain is typically worse first thing in the morning aftar prolonged immobility overnight, easing off during the day with normal movement and then worsening again as the day goes on and the joints become inflamed.
Risk factors for osteoarthritis include ageing, being overweight and physical trauma or prolonged stressing of the joints over time. There may also be a genetic disposition.
Osteoarthritis also occurs in the facet joints of the spine, small joints that assist with flexibility and stability of the spinal column wihch can lead to Spinal Stenosis.
Most common in the over 50′s, Spinal Stenosis occurs when extra bone is laid down as a reaction to physical repetitive stresses on the spine. When this is laid down between two vertebrae and where the nerve exits the spinal cord, then eventually the nerve is compressed and extreme pain on extension is felt .
The name comes from the Greek word meaning ‘choking’. In the neck (cervical spine) pain in the arms is experienced due to the nerve compression. In the lower back this can lead to sciatica and leg pain, which worsens when walking. The symptoms may fluctuate in severity, easing when at rest or when leaning forward - for example leaning on a shopping trolley to get relief from the pain is a classic sign of spinal stenosis.
Spinal Stenosis pain management includes ice for the inflammation and heat to help relax the surrounding muscles. Massage therapy is also very effective to help release the muscles associated with back and leg ache.
In the words of Gerry Pyves, NO HANDS Massage creator, a great reason for having a massage is NURTURANCE!
“From the moment of birth until our death we experience less and less touch. You could say that our ‘touch quota’ steadily reduces from the moment we are born!
Yet touch is one of the primal needs of every human being. Safe touch that demands nothing of us is probably the most powerful touch there is. That is why NURTURANCE is one of the major reasons to have a Massage. We all need to top up our touch quota.
There is nothing that soothes the mind or soul more powerfully than Massage. You can take all the therapies in the world and wrap them up in a sack and bung them into the river when it comes to finding anything that comes even close to the rich smorgasbord of touch that is Massage.
Massage quite literally represents a tsunami of sensory nerve stimulation to the body and mind. As a consequence of so many nerve endings being stimulated at the same time, we experience literallly hundreds of benefits.
Perhaps the most important reason for giving yourself the nurturing power of Massage and touch is simply getting a bit of extra support on this difficult journey called life. No matter how you look at it, being human is tough.
Massage can soothe your journey. Every human being needs and deserves the support that Massage can provide on life’s journey. It’s really that simple.”
If you need a reminder of how nurturing a Massage can be, or you want to try it for the first time, book yourself in for a NO HANDS Massage treatment with Natalie at Ananda Clinic. Click here for more details.
So, continuing with the Back Pain series, we move up to the sacrum – the large flat bone right at the base of your back and then up to the lumbar vertebrae, the five large flexible bones at the bottom of the spine.
The sacrum consists of five bones that are fused together to form a flat, triangular shape. This is a very important part of the spine as it is a connecting point for the back of the pelvis bones on either side, the base of the spinal column at the top and the coccyx below. There is little movement within the sacrum itself but each of the joints to the other bones are under a huge amount of stress as they form part of the pelvic girdle upon which our whole upper body is supported.
The sacrum is an attachment point for many of the deep muscles in the buttocks, particularly the gluteus group, the piriformis, the core stabiliser muscles of the lower back and the hamstrings of the back of the leg. As you can imagine, if any of these muscles tighten and shorten there will be an effect on the sacrum, often a tilting pattern that then puts the lumbar area under strain.
Pain in the sacrum may be a hot, sharp pain or it may feel more a dull ache. If the pain has been caused by muscular tightness – poor posture or a sedentary lifestyle can be contributors to this – then a physical therapy may be all that is needed to give those muscles a hand in releasing the tight holding pattern they may have got stuck in. Highly effective treatments include Massage, using a TENS machine or a regular exercise and stretching programme to encourage the muscles to release and relax back to ‘normal’ function.
Sacral pain may also be due to damage to the ligaments that hold the structures in place and keep the attachment points strong. The ligaments that connect the sacum to the illium of the pelvis – the sacroilliac joint – can be susceptable to the usual soft tissue injuries of strains, tears and inflammation. Sacroilliac joint pain commonly presents as pain in the very lower back, the buttocks and sometimes radiating down towards the knees. It may also refer as groin pain in the front of the pelvis. These type of injuries may be the result of a trauma such as a fall landing hard on one buttock, jarring or occur over time due to a leg length discrepancy or repeated, long term, poor posture.
The lumbar section of the spine has to be strong enough to support the weight of the body above as well as flexible to act as a shock absorber during movement, so these five lumbar vertebrae are larger than the rest of the bones that make up the spine.
Due to the extreme stresses this section of the spine is exposed to, it is a common area for back pain to occur. Muscularly, the quadratus lumborum and erector spinae take a lot of the strain and these often become extremely tight, or hypertonic. Muscle spasm frequently occurs as a protective reflex and the back ‘locks’ up. Massage is extremely effective at treating this, especially NO HANDS massage which gently helps these muscles to release at a deep level and find a more neutral holding pattern in their own time.
More serious problems of the lumbar spine include slipped (prolapsed) or herniated discs, spinal stenosis, arthritis, degenerative disc disease, infections and tumours.
Prolapsed discs occur when the disc, which acts as a cushion between the vertebrae, gets squeezed out of place - one article I read described it as being like a burger sliding out of the bun!! – and presses against the spinal cord. Herniated discs are similar but the strong outer casing of the disc tears and the soft tissue bulges out. Both can cause severe symptoms – including pain that spreads to the buttocks and legs, tingling or numbness, muscle spasms or weakness – but equally both can present no pain symptoms at all.
The severity of the prolapse or herniation will determine the treatment required – low level prolapse can be manipulated back into place through stretches or physical therapy such as Dorn Method or McTimoney Chiropractic. If more severe, surgical intervention may be required to repair the damage and prevent reoccurance.
As well as disc herniation and prolapse it is possible for the vertebrae themselves to slip, a condition called Isthmic Spondylothesis. We are lucky enough to have a guest blog from Caroline who has kindly written about her experience of this, the initial symptoms, the gruelling treatment that followed and finally the surgical intervention and life afterwards. Caroline has been a massage client of mine for a number of years now as well as receiving regular osteopathy, both of which help manage her pain and mobility. You can read the blog here.
In the next installment we will look closer at other pathologies of the lumber spine including degenerative disc disease, arthritis and spinal stenosis.
These are stretches I commonly suggest to my clients who present with Piriformis Syndrome. I have used these very successfully myself and continue to do so when I get a recurrence of this condition.
With all these stretches ensure you go into them slowly, hold the stretch without bobbing or rocking and slowly release. You are only looking to take the stretch to the point where you feel a gentle pulling or replicate the symptom – if any other pain occurs or the original pain worsens then stop doing that stretch.
Seated Piriformis Stretch
The simplest of these is to sit on a chair (dining chair is a good height) with your feet flat on the floor. Cross one ankle over the opposite knee and slowly start to lean forward until you feel a gentle stretch. Hold for 5-10 seconds then gently release. Repeat 2 or 3 times on each side. You may find that one side is more flexible than the other but it is important to always stretch both sides.
Laying Piriformis Stretch
Lay on your back with your knees bent and your feet flat on the floor. Bring the ankle of one leg up to rest over the knee of the opposite leg (as with the sitting version) and gently pull the thigh of the ‘knee’ leg towards your chest.
Hip Flexor and Hamstring Stretch
As well as the piriformis muscles it is important to stretch out the opposing muscle groups. This is easiest done with a small knee cushion in front of a chair seat for support. Kneel on the cushion with your left knee and place your right foot in front of you. Keeping your right knee directly over your toes (no further forward) gently slide the left leg backwards until you start to feel a stretch in the front of your thigh/hip. Use the chair or sofa arm to support yourself. This stretch can be extended by raising the arm on the side of the back leg upwards (eg left leg back, left arm reaching up).
Hold the stretch for 5-10 seconds and then place both hands on the floor either side of your front foot. Gently rock backwards (keeping your knee on the floor) to stretch out the back (hamstrings) of the forward leg. This is a very deep stretch so go into it slowly and gently. Repeat the whole stretch 2 or 3 times each side.
I would suggest trying to do these stretches at least twice a day after you have warmed the muscles up a bit – avoid stretching as soon as you get out of bed in the morning, move a bit first, walk around and get the muscles moving before stretching them out. Always work to your limits and go into each stretch slowly, hold still for 5-10 seconds and come out slowly.