I remember in my 30’s I had a reoccurring issue with my low back. There were acute back spasms, pain going down the leg, numbness and tingling on the shin. I was often in getting treatment and trying to figure out what was happening. I remember getting an x-ray done of my low back through a walk in clinic. I got the results and was told that I have some arthritis in my back. Honestly, it felt like it was the beginning of the end. Arthritis. They talk about how pain is a signal elicited by the brain if it feels like you are under a threat. This can be cause by tissue damage, visual, audio, tactile and many other stimuli. There is a good possibility that if I am told that I have arthritis in my back, and that is responsible for my pain then the pain can become chronic. I have learned to become careful in practice with the language that I use when talking about what I find or what they have found out about their pain/dysfunction. I found something interesting (below) that talks about how things like arthritis/ bulging discs/ torn rotator cuff and meniscus/ osteophytes may not be responsible for the pain being experienced. These different studies/ scans, in the study that I am attaching, were done on asymptomatic people. The result of the attached study is that there are all these people in the pool that have no symtpoms, yet here they are with torn this and that and bulging discs and arthritis ect. Maybe the Orthopedic world is looking too hard for something to be wrong or something to blame for the pain if they find something on a scan. Arthritis, for example, is a totally natural occurrence. Everyone gets it. Maybe in extreme cases of advanced arthritis or rheumatoid arthritis can perhaps cause some pain/stiffness, but for the most part it can be a perfect benign presentation. Maybe the symptoms are just from the way we are moving or sitting. Something that we can remedy easily and quickly. The picture below shows the studies, the number of participants and the results from the scans. There are lots of special tests to rule out and scan results like meniscus or rotator cuff, disc issues but we shouldn’t depend just on the scans to make determinations as to the source of the pain. It’s good to ask questions like “I see that I have a bit of a rotator cuff tear, but how can we know for sure that is what the issue is?”. When we see someone about an injury or pain we are feeling, we need to be part of the conversation.
With Massage Therapy, part of our focus is on the muscular system and maintaining good function allowing the client to reduce their pain and stiffness. In addition to releasing the muscle tightness/stiffness, it is also important to be able to determine why the muscles are tightening up. Often I find that a client may come in and say that they have been stretching and stretching but to no avail. This may be due to the tightness occurring when the muscles are activated to try to stabilize a part of the body that is too mobile. If you take, for example, the low back, the range of motion is limited by a few factors including the surrounding connective tissue. The connective tissue that surrounds the spine will stop you from bending too far backwards, forwards, side to side or rotation. Connective tissue is comprised of collagen fibres for strength and elastin fibers for flexibility. A certain part of the population, including me, have a little more elastin fibers to collagen fibers so we can bend a little more than everyone else. With a little less stability from the surrounding connective tissue, the muscles are recruited to work harder to stabilize our low back. If we use our backs too much, the muscles begin to fatigue and the brain says “stop what you are doing” and uses pain to get us out of the perceived threat. So the muscles are functioning overtime because of lack of stability. When our low backs begin to tighten and we begin to experience pain, we are inclined to stretch those muscles. If the muscles are short and tight, they will not want to lengthen as they are doing a job of trying to stabilize so they will respond to our stretching by tightening more. Our stretch becomes a tug-of-war and will ultimately end up not being successful. During the assessment portion of a treatment, I like to look at the joints and move them passively (without the client’s involvement) to determine if the motion in the joint is not enough or too much. If there is too much motion, the direction to go in is not to stretch the muscle but to help to stabilize the low back joints in the spine to reduce the need for the muscles to tighten so much. This is a much different approach from standard Massage Therapy where there is more focus on “releasing the muscles”. Make the body more stable and reduce the need for muscles to work so hard. Going back to my previous entry about movement patterns and pain/dysfunction it is also important that we learn to move around the joints that are strong and stable. The low back is a perfect example as really it is a very unstable structure. The spine is essentially a bone on top of a gelatinous disc on top of a bone on top of a gelatinous disc all the way to the top of the spine. We are not really designed to move mainly through the spine and especially not exerting a force. Keep the spine as still as possible and move through the two hip joints, for example. As someone that is hypermobile through my joints, this has been an essential component to maintaining a healthy, pain free back and I’m always happy to share with others what I found has worked for me.
The other component is that with most movement through the body, there are the muscles that move the joints and those muscles that help to stabilize the joints through that movement. It is essential that we maintain strength and function of the stabilizers to match the strength of the muscles that are primarily moving a joint (or group of joints). Someone once said, not having this support is like having a tree where the brances are stronger than the trunk. If the proper stabilizing muscles are not recruited, other muscles are activated that are much less efficient as stabilizing also producing and short, tight, fatiguing group of muscles and consequently pain and dysfunction.
So muscles that have tightened may not need to be stretched. Of course we work on those muscles during the treatment to reduce the reactivity and pain but we also help the client to support and improve the way they move in preventing pain the future. The courses that I have taken in Mat Pilates Teacher Training provide a really good base of support to create a strong, mobile, well supported body.