Ahhh my aching back! 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 low back pain are shocking. According to the British Occupational Health Research Foundation (http://www.bohrf.org.uk), back pain
o Affects 40% of the population
o Causes the loss of 50 million working days
o Costs about £5 billion (or £200 for every employee) in sickness absence costs.
Source: Clinical Standards Advisory Group
Being able to treat low 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. At Jing we have pioneered a method of combined soft tissue techniques using trigger point, myofascial release and advanced stretching that works effectively alongside your existing chiropractic skills to reduce client pain in 1-6 weekly treatments.
Causes of low back pain
A big factor in most cases of 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 low 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.
Pain in the low back 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 low back cases are:
o Erector Spinae,
o Piriformis- which when tight can often mimic “sciatica”.
o Psoas- an anterior deep muscle
o The Gluteus group
o Quadratus Lumborum.-According to Travell and Simons “ The Quadratus Lumborum muscle is one of the most overlooked muscular sources of low back pain and is often responsible, through satellite gluteus minimus trigger points for ‘pseudo disc syndrome’ and the ‘failed’ surgical disc syndrome’.”
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 . Histological studies suggest that micro injuries within the lumbar fascia are a frequent cause for back pain . These and similar studies could “disburden” the intervertebral discs as a cause for back pain in several cases .
How to Treat Low Back Pain – The Jing Method of Combined Soft tissue technique
At the Jing Institute of Advanced Massage training we have pioneered a simple yet highly effective approach to treating common pain conditions. We know this approach works as we have been using it ourselves in our own practices over the past 20 years with thousands of clients with pain conditions. 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- at Jing 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. This will have a huge effect on you and your clients. Your business will naturally grow and so will your confidence in your profession. Just this week, a client who had been coming to me for low back pain that he had been suffering with for 10 years said the most profound thing to me. After his 5th session, he said, “I never came here looking for a cure, only some relief, and now I am at the stage that I have forgotten I was ever in pain. My life is completely different.” I cannot put into words how that made me feel.
1. Tesarz J, Tachuchi T, Mense S. Die Fascia thoracolumbalis als potentielle Ursache für Rückenschmerzen. Manuelle Medizin 2008; 46: 259
Schleip R et al. Letter to the Editor concerning “A hypothesis of chronic back pain: ligament subfailure injuries lead to
2. 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)
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 including London, Edinburgh and the North. We offer several CPD courses in advanced soft tissue work suitable for Mctimoney chiropractors including myofascial release and trigger point protocols You can also check out the approaches discussed in this article in our DVD in advanced clinical massage techniques, downloadable from the website. Please call or check our website for further information and course dates. www.jingmassage.com
Tel: 01273 628942