factors in back pain - world massage...

10/8/2015

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A B M P B a ck Pa i n S u m m i t

With Clint Chandler

FACTORS IN BACK PAIN Framing the Discussion from a

Clinical and Anatomical Perspective

FACTORS IN BACK PAIN in t roduct ion

Back pain affects 8 out of 10 people at some point in their lives.

Back

Pain

27%

Facial

Ache or

Pain 4%

Neck Pain

15%

Migraine

Pain 15%

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Americans spend at least $50 billion each year on back pain.

31 million Americans experience low-back pain at any given time.

Most causes are mechanical and not caused by a serious pathology.

Low back pain is the

leading cause of Years

Living with a Disability in

45 of 50 developed

countries.

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Massage Therapy Makes

a Difference!

This Session

Part1: The Dynamics of Soft-Tissue Injury

Part 2: Back Pain – The Big Picture

Part 3: Treating Non-Specific Low

Back Pain

PART 1: THE DYNAMICS OF SOFT-

TISSUE INJURY

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Part 1: The Dynamics of Soft-

Tissue Injury

Forces that Load Tissue

Tissue Deformation

Tissue Strain

Mechanical Strength

Factors in Tissue Failure and Tissue

Damage

TISSUE LOAD The amount of stress soft-tissue

structures are under due to forces.

FORCES A force is something that causes the

movement of the body to change or

body structures to deform.

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FORCE Tissue Load

Body Tissue

GRAVITY

COMPRESSION

TENSION

SHEAR

TORSION

BENDING

FRICTION

Gravity Adductor longus Adductor magnus

Erector spinae group Gastrocnemius

Hamstrings Iliopsoas

Levator scapula

Pectoralis major Piriformis

Quadratus lumborum Rectus femoris

Soleus Sternocleidomastoid

Upper trapezius

DISTORTED

POSTURE

Displaced

Center of

Gravity

Hypertonic

Postural

Muscles

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COMPRESSION A force in which the tissue is loaded when

structures are pressed together.

Example: Football players collide; contact at the crown of the head causes the

cervical spine to be compressed between the head and torso.

TENSION A force in which the tissue is loaded when

two ends of a structure are pulled apart.

(Tensile Force)

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Example: If the tensile force exceeds the strength of the

soft tissue structure and its ability to elongate, tears or

ruptures result in the structure.

SHEARING A force in which parallel forces that act perpendicular

to a structure load the tissue by creating tensions

that pull in opposite directions.

Example: A head-

forward position

causes shear stress

in the lower cervical

vertebrae.

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TORSION A twisting force (also called torque)

that occurs along a shaft or axis.

Example:

Asymmetrical

contractures of the

muscles on either

side of the spine can

cause torsion in the

spine in which

vertebrae rotate

slightly in opposite

directions.

Shoveling snow: The

spine is flexed and

rotated placing both

shearing and torsion

loads on the spine.

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BENDING A force where the inner surface experiences

compressive force while the outer surface

experiences tensile force causing a structure to bend.

Example: Spinal

deformities like

scoliosis displace the

vertebral discs in a

way that subjects the

body to constant

bending forces.

FRICTION A low magnitude force where resistance is created

when one structure of the body contacts another as

the structures move in opposite directions.

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FORCE Tissue Load

Body Tissue

GRAVITY

COMPRESSION

TENSION

SHEAR

TORSION

BENDING

FRICTION

.

. . .

.

.

.


Tissue Injury


Tissue Deformation

Tissue Strain

Mechanical Strength


Damage

.

Tissue Deformation:

The change in shape a

tissue undergoes when

subjected to a load.

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TISSUE STRAIN The amount of deformation

experienced by the tissue.

TENSILE LOAD TENSILE STRAIN

COMPRESSIVE LOAD COMPRESSIVE STRAIN

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Mechanical

strength: The

amount of force

a tissue can

absorb or resist

before failure.

TISSUE FAILURE

When a tissue is deformed by a load past

the point where it can absorb or resist

and breaks down.

FACTORS IN TISSUE FAILURE

LOCATION

MAGNITUDE

RATE

DIRECTION

POSITION

FREQUENCY

DURATION

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LOCATION Where is the force applied?

MAGNITUDE How much force is applied?

RATE How quickly is the

force applied?

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DIRECTION

& POSITION Where is the force directed and

what position is the body in when

it experiences tissue loading?

DURATION Over what period of time is the

force applied?

FREQUENCY How often is the force applied?

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FACTORS IN TISSUE FAILURE

LOCATION

MAGNITUDE

RATE

DIRECTION

POSITION

FREQUENCY

DURATION . .

.

.

. . .

TISSUE DAMAGE

When tissue is deformed (strained) by loads

(forces acting on tissue) past the point where it

can absorb or resist the load (stress), it fails,

and tissue damage results.


Tissue Injury


Tissue Deformation

Tissue Strain

Mechanical Strength


Damage

.

.

.

.

.

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This Session




Back Pain

.

Part 2: Back Pain - The Big Picture

Conditions that Cause Back Pain

Structures That Fail

Back Pain Tissue Failure Scenarios

CONDITIONS CAUSING BACK PAIN

Terminology related to back pain can be confusing!

• Back sprain

• Back sprain

• Discogenic low back pain

• Lumbar facet joint pain

• Mechanical low-back pain

• Non-specific low back pain

• Sacroiliac joint

dysfunction

• Sciatica

• Scoliosis

• Spinal stenosis

• Spondylolisthesis

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RISK FACTOR Risk factors are particular internal and external

conditions that increase the potential for an injury to

occur. Risk factors influence the mechanical strength of

the tissue and its ability to resist a load without failure,

and the frequency with which the body is exposed to

loads that could cause tissue damage.

RISK FACTORS THAT INFLUENCE BACK PAIN:

RISK FACTORS YOU PROBABLY

CAN’T CHANGE

• Being 50 or older

• Being male

• Having a family history of back pain

• Having spine problems since birth

• Having a history of back injury

• Being pregnant

RISK FACTORS YOU PROBABLY

CAN CHANGE

• Weak muscles and lack of flexibility

• Smoking

• Excess body weight

• Poor posture

• Stress and emotion

• Working conditions





.

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STRUCTURES THAT FAIL

BONES

CARTILAGE

LIGAMENTS

DISCS NERVES

MUSCLES

WHEN BONES FAIL

Pars Interarticularis Spondylolysis Spondylolisthesis

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Ostephyte

WHEN CARTILAGE FAILS

1. Collagen fibers break

2. Proteoglycans depleted

3. Cartilage softens and thins

4. Facet joints become misaligned

5. Bone on bone contact

6. Osteophyte formation

WHEN LIGAMENTS FAIL

Sprains are defined as

ligament failure caused

when fibers are

overstretched or torn due

to traumatic or repetitive

loads that twist a joint, or

force a joint to move

beyond it’s normal range

of motion.

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WHEN LIGAMENTS FAIL

THICKENING OF LIGAMENTS HYPERMOBILITY

SACRAL ILIAC JOINT DYSFUNCTION

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WHEN DISCS FAIL - Degenerative Disc Disease

Disc Herniation

WHEN MUSCLES FAIL

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Quadratus Lumborum (QL)

Erector Spinae

WHEN NERVES FAIL

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SCIATICA

PIRIFORMIS SYNDROME

BACK PAIN: It is likely that multiple tissues are being overloaded

and failing to varying degrees at the same time.

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STRUCTURES THAT FAIL

BONES

CARTILAGE

LIGAMENTS

DISCS NERVES

MUSCLES . . .

. . .





.

.

A Traumatic Event

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Motor Control System Caught Off Guard

Cumulative Trauma from

“Small Loads”

This Session




Back Pain

.

.

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Part 3: Treating Non-Specific Low Back

Pain

Non-Specific Low Back Pain Defined

Red Flags During the Health Intake

Process

Treatment Goals

Video Demonstration

Non-specific low back

pain is pain that is not

attributed to a

recognizable

pathology. It is pain

associated with muscle

strain, muscle tension,

sprain, hypermobility,

or joint fixation. It is

highly responsive to

massage therapy

intervention.

Where is the Low Back?

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Red Flags When

Evaluating

Low-Back Pain

Unresponsive Fever

with Back Pain

Significant Recent Trauma

Significant Recent Trauma

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Pronounced

Numbness and Prickly

Tingling

Loss of Bowel or

Bladder Function

Medical history of cancer, suppressed immune

system, osteoporosis, or chronic steroid use.

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Treatment Planning for Non-Specific Low Back Pain

Acute Sub-Acute Chronic

Injury up to 6

Weeks

Pain, achiness,

burning, sharp,

dull, and stiff

Unable to

straighten up or

walk without

increasing pain Recurrent

4 Weeks to 12

Weeks

Pain, muscle

tension, stiffness

localized

Decrease in

quantity/ quality

of movement

12 Weeks or

More

Pain quantity and

quality varies

Theory of central

sensitization


ACUTE TREATMENT GOALS ACUTE TREATMENT TECHNIQUES

• Decrease pain

• Decrease

inflammation

• Decrease muscle

contracture

• Maintain pain free

range of motion

• Lymphatic facilitation

• Passive Positional Release

• Strain Counterstain Strain

• Relaxation massage

• Energetic bodywork

practices (with client consent)

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SUB-ACUTE TREATMENT GOALS SUB-ACUTE TREATMENT TECHNIQUES

• Decrease pain

• Decrease inflammation

• Decrease muscle adaptation

• Increase range of motion

• Maintain core strength

• Soft-tissue manipulation

• Fascial release

• Trigger and tender point

release

• Post-Isometric Relaxation


CHRONIC TREATMENT GOALS CHRONIC TREATMENT TECHNIQUES

• Decrease pain

• Decrease residual

inflammation

• Restore range of motion

• Improve function

• Increase core strength

• Reduce scar tissue

• Soft-tissue techniques

• Cyriax Cross Fiber Friction

• Muscle Energy Technique

• Active Isolated Stretching

• Active Muscle Release

• Contract Relax Technique

DEPTH

DIRECTION

DURATION

A key component of all application of technique:

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CLIENT

SCENARIO

TREATMENT GOALS

• Reduce muscle contracture

• Release fascial restrictions

• Reduce adhesions

• Improve muscular balance

Part 3: Treating Non-Specific Low Back

Pain

Non-Specific Low Back Pain Defined

Red Flags During the Health Intake

Process

Treatment Goals

Video Demonstration

.

.

.

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S-Bends

Palmar Compression

Reinforced Fingertip Friction

Iliolumbar Ligament

Cross-Fiber (3 levels)

Passive Positional Release QL

Passive Position Release

(Lumbar Spine)

factors in back pain - world massage...

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