Treating Low Back Pain

Over $26 Billion Dollars Costs Attributable to Low-Back Pain

Low Back Pain Affects Nearly 80% of All Adults

It’s no surprise that low back pain (LBP) affects 80% of us at some point in our lives, it’s the most common cause of job-related disability, the most common reason we visit doctors, and a leading contributor of missed work in the US.

 After treating LBP for the past  sixteen years, I have learned from experience that, in most cases, it’s not possible or wise to do the same treatment on every client presenting with low back pain, or most other problems, because every client and condition is different.

The most successful outcomes and effective protocol for treating my clients with LBP, or most any malady presented, is  tailoring the session to their specific needs, using modalities and techniques that are most relevant, and as a result I am able to more successfully treat a more diverse clientele.

LBP is referred to as non specific low back pain, over 99% of LBP is idiopathic, without a known cause, much of it stemming from musculoskeletal soft tissue problems, usually a sudden pain from physical overload of the back without strong supporting core muscles. If the pain resolves after a few weeks, intensive tests are usually not indicated. However, low back pain can also be symptomatic of a more serious problem, requiring a visit to your primary medical professional.

 Because muscles are a primary source of LBP, most typical complaints can be resolved with conservative treatments such as clinical therapeutic massage and bodywork.

 Treatment:Therapy focusing on structural integration, helps the body return to structural and functional postural alignment by removing tensions and restrictions in tight areas, and is an integral  part of my LBP treatment. My clients are instructed to further balance myofascial relationships,  normalize dysfunctional postural alignment patterns  throughout the entire body, and to maintain muscle balance.

 Prevention:  Exercise for LBP is an effective form of treatment as well as an indispensable mode of prevention. Research demonstrates the effectiveness of proper training for the relief and reversal of chronic LBP. Overall physical conditioning, stabilization and core exercises, which involves little or no movement of the spine, have proven effective for strengthening of the core-stabilizing muscles and pain relief.

Flexibility exercises, including static, active, and dynamic stretches within the pain-free range of motion, for the lower extremity and hip, can help relieve stress on the lower back by allowing for greater pelvis mobility.

Treating Tennis Elbow (lateral epicondylitis)

9537915_mMany of us have had, at one time or other, a painful bout with tennis elbow (TE) that stubbornly persists no matter what we do for relief. It limits our activities and can be debilitating. Like many painful soft tissue problems, TE usually resolves itself without treatment in due time, but most folks prefer seeking help to minimize the healing process.

 It has been reported that 40% of tennis players had problems with their elbow, 24% of these athletes under the age of 50 reported that symptoms were severe and disabling while 42% over 50 reported that symptoms were severe and disabling.

 Stedman’s Medical Dictionary for the Health Professions and Nursing defines: Epicondylitis – Infection or inflammation of an epicondyle, or of associated tendons and other soft tissues, particularly the medial or lateral epicondyle of the humerus.

R.P.Nirsch, Tennis Injuries in the Journal of Sports Medicine, used the terms tendinosis and angiofibroblastic degeneration to describe the pathophysiology of epicondylitis as micro-tears in the tendon with a poor healing response.

Tennis elbow is an overuse injury occurring in the lateral side of the elbow, involving the extensor muscles (top side of forearm with palm down) that originate on the lateral epicondyle (boney protrusion on the outside of the elbow area).

Tennis has been one of the activities most commonly associated with the disorder because of the constant stress on the weak wrist extensors (top hairy side of forearm), as the player makes contact with the ball repeatedly during the backhand stroke, causing micro tears in the tissue over time. The problem is that the two sides of our forearm, the extensor & flexor muscles, are out of balance. Our short, contracted flexors (the strong palm side of the forearm) are overpowering our weak and taut extensors. Both muscle groups must be addressed to properly treat the condition.

 Racquet sports enthusiasts aren’t the only group at risk for TE, overexertion and repetitive use in a number of vocations and hobbies, as well as trauma such as direct blows to the epicondyle, a sudden forceful pull, or forceful extension, and unaccustomed strenuous activity can produce painful and disabling TE.

Treatment: First, the interosseous membrane between the ulna and radius of the forearm is released with Myofascial Release, and then the tight and short flexor muscles are lengthened, and the taut extensors are relaxed. Next, a resisted range of motion test determines specific location of muscle strain, usually in the muscle-tendon junction, and then treated with multi-directional friction and eccentric scar tissue alignment that recruits deeper layers of collagen into alignment.

 Prevention:  Optimal exercise and stretching protocols are effective for maximizing flexibility, limiting resistance to power production and stabilization. These, muscles must also be trained to function eccentrically (backhand stroke) to allow for adequate stabilization of the elbow and wrist, minimizing stress on the tendinous insertion.

Medial epicondylitis, known as Golfer’s elbow is located on the opposite side of the arm, and is not as common as lateral epicondylitis.

Treating Trigger Finger

Lengthening the Fascia of the Palm

Spreading the Fascia of the Palm

Tami Photos Dec 08006

Tami Photos Dec 08007

Trigger finger (TF) is a painful condition causing our finger or thumb to catch or lock when bent, requiring assistance with the other hand to straighten it to full range of motion.

Tendons are tough bands of connective tissue that join muscles and bones and are responsible for moving our arms, hands, and fingers. A healthy tendon usually glides easily through a tubing (sheath) aided by a lubricant (synovial fluid) surrounding the joint. Sometimes a tendon becomes inflamed and swollen from overuse, for example, by grasping a power tool with a firm grip for an extended period of time, resulting in a reduced sheath diameter clearance for the tendon to pass through. When this happens, moving the stuck finger or thumb can produce a snap or popping sound.

Typical clients presenting with trigger finger usually have jobs that repetitively overwork their thumb and fingers—farmers, industrial and construction workers, musicians, massage therapists, chiropractors, and computer operators. Even smokers who repeatedly flick their lighter are at risk of getting trigger thumb. TF is more common in women than men and is most prevalent in those 40-60 years old. Clients with arthritis, gout, and diabetes are also oftentimes afflicted.

One of the first symptoms of trigger finger is soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when bending or trying to straighten the finger. This sticking tends to get worse after resting the finger or thumb, and responds more positively with movement. In some cases, as the condition worsens, the finger or thumb locks in a bent or straight position and must be gently repositioned with the other hand.

No X-rays or lab tests are used to diagnose trigger finger. Your MD may treat your TF by putting a splint on the finger to keep the joint from moving, may prescribe drugs to fight inflammation, or inject steroids into the tendon sheath, and eventually recommend surgery.

My treatment for TF is simple and conservative, consisting of first lengthening the soft tissue and balancing the muscles in the upper and lower arm, compressing the forearm flexor muscles to provide increased blood flow, removing fascial restrictions with a gentle sustained stretch, removing possible trigger points, lengthening the flexors, and then working in and around the palm finger tendons, the ones that make the fingers move.

A palpable nodule or two at the base of the trigger finger is treated with sustained moderate pressure, eventually breaking into smaller pieces or dissolving completely, and restoring full free motion to the stuck finger.

Comprehensive Care – Bodywork & Personal Training

Plank on a ball  strengthens the core

Plank on a ball strengthens the core

Many of my clients require additional coaching to strengthen weak muscles after we lengthen the opposing tight ones, align and balance the structure, improve posture, and provide greater ease of movement. Strengthening, in addition to removing tensions and restrictions, is an essential part of structural integration and a successful outcome—unfortunately, one that is too often ignored by both therapists and clients.

For example, individuals presenting with rounded shoulders and a forward head posture usually have tight pectoralis major (chest muscles) and opposing weak rhomboids (upper back between scapula and spine). Unless the weak and taut rhomboids are not strengthened after I lengthen the tight pectoralis major and bring the shoulders back where they belong, they will not stay there unless the rhomboids are strong enough to keep them there.

It’s the reason that I recently became certified by the National Academy of Sports Medicine to complement my clinical massage and bodywork practice, with two specialties:

Corrective Exercise Specialist (CES) – A system of training that uses corrective exercise strategies to help improve muscle imbalances and movement efficiency to decrease the risk of injury. The process requires knowledge and application of an integrated assessment process, corrective program design, and exercise technique. The three-step process is to identify the problem (integrated assessment), solve the problem (corrective program design), and implement the solution (exercise technique).

Senior Fitness Specialist (SFS) – Helps older adults improve the quality, and potential quality of life by providing safe and effective exercise programs and advice about healthy lifestyle choices. Exercise and stretching programs improve balance, mobility and minimizes the risk for falls, and it’s possible to slow and even reverse the structural deficits responsible for the decrease in functional capacity. Exercise programs focusing on stabilization, strength, and power training facilitates the needs of the older adult population.