Working Complex Chains: Importance of Massaging More than the Area of Pain

Non-specific low back pain effects large swaths if the population and is the second leading cause of visits to primary care doctors. As helping people in this condition is a major part of my practice, I review research on this topic often. An article I read last week directly addressed the importance of combining core strengthening exercises with massage to most effectively recover and regain function.

Indirectly, it highlighted the importance of addressing all parts of a body complex when treating pain.

Clients who come to me with low back pain often want to spend their entire session working right on top of where the pain is felt. This is often unproductive for two main reasons. The first, working for an entire 75 minutes in the same area can over tax muscles, triggering guarding in the form of further tightening or aggressive inflammation which will both lead to increased pain. Not something you want to walk away from a massage feeling! Typically, a muscle will tolerate direct massage for no more than fifteen minutes.

The second reason is that our bodies do not work in isolation. To perform even basic movements requires firing of muscles synchronously and precisely all over or bodies. If we are truly going to tackle a musculoskeletal pain problem, we must then also balance the synergist and antagonist muscles involved in the compensation patterns we have developed to combine to function while experiencing pain.

Let's take the example of low back pain primarily caused by an overactive right quadratus lumborum (QL) - a fairly common finding. As the body works to remain functional - because we are all stubborn He-Man and She-Ra - other muscles must pick up the slack. Your right hip will hike to reduce pressure on the lumbar. This simultaneously lengths the left abs and right hamstrings while shortening the right abdominals and left adductors. Too counteract the unusual push/pull, those muscles will tighten or weaken in an attempt to maintain their optimal length. As your hips become more unbalanced, your pelvic floor will adapt, altering your intra abdominal pressure and ultimately affecting your breathing and posture.

Changes in our musculature can have effects on any area that is connected via the fascia lines - basically anywhere in our structure. Even without specifically accounting for the nerves, lymph, and circulation, that's a ton of alterations the body must undergo! And the longer these compensations persist, the more likely it is they will stick even after the original imbalance is correct

Leaving our bodies in their compensatory forms by not addressing the other affected muscles can lead us back into pain even after the original imbalance is corrected. Why? Because the longer these patterns persist, the more likely it is they will stick. And just as the QL tension first caused all of the other changes, allowing those changes to remain can cause QL tension.

So when your massage therapist moves into your hamstrings, your hips, or even your abdominals, ride the wave and know it is all serving the purpose of getting you long lasting low back pain relief!

Does this make sense? Let me know in the comments!