Massage & Bodywork

MAY | JUNE 2023

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disc's shape. Due to nearby restraining ligaments, the disc typically protrudes in a posterior-lateral direction, often compressing the lumbar nerve roots. Degenerative disc disease (DDD) is another term for lumbar disc pathology, usually associated with age-related disc degeneration. As we age, the discs lose water content, causing them to shrink and the adjacent vertebrae to move closer together. The reduced space between vertebrae narrows the intervertebral foramen, the opening through which the nerve roots pass, potentially compressing the nerves. Common symptoms of lumbar disc pathology and DDD include low-back pain, radiating pain or numbness in the legs, and increased discomfort in certain positions. Poor posture and prolonged periods of compressive load on the lumbar spine can exacerbate these symptoms. People with lumbar disc pathology often report relief when moving and discomfort when maintaining static postures. Physical examination signs, such as shooting nerve- type pain down the lower extremity and a positive straight- leg raise test, may indicate the possibility of lumbar disc pathology or nerve compression caused by DDD. However, high-tech imaging such as MRI is needed for a more accurate diagnosis. It's worth noting that lumbar disc herniations are frequent among asymptomatic individuals, which means that disc protrusion on MRI doesn't necessarily correlate with pain complaints. Nonsurgical treatments for lumbar disc pathology commonly include physical therapy, pain medication, and chiropractic care. Surgery is less frequently used today because of poor outcomes and moderately high recurrence rates. Although massage does not directly affect disc protrusions or DDD, it can still effectively address these problems. For instance, treating tightness in the lumbar muscles may reduce disc compression because when they are hypertonic, these muscles' angle of pull can contribute to disc compression. Massage also reduces overall pain, providing greater freedom of movement, an essential part of effective treatment. When developing a rehabilitation protocol for lumbar disc pathology, keep in mind several considerations. The primary focus of treatment is to reduce compression on neurological structures. Massage therapy can be performed concurrently with other traditional conservative treatments, such as manipulation or mobilization, and it is especially valuable if performed before those treatments. Reducing muscle and soft-tissue tension allows these other techniques to be applied with greater ease and less resistance. Movement reeducation to reduce postural stress is also an important aspect of treatment and can be performed along with massage. Which techniques will be most helpful for lumbar disc pathology depends on the pathology's location, how sensitive the local tissues are, what movements aggravate the pain, and how long the condition has been present. Treatment strategies to reduce tightness in the lumbar muscles are generally beneficial. Especially valuable are techniques that target the quadratus lumborum and paraspinal muscles because they often increase disc compression forces (Image 1). The main concern for massage treatment is whether the therapy can aggravate an existing disc condition or further press on the affected nerve roots. Although the protruding disc and affected nerve root are both anterior to the transverse processes of the spine (Image 2), minor amounts of movement of the individual vertebrae can occur as one applies pressure to the lumbar spine. If a disc protrusion is severe, that spinal movement could be enough to slightly move the nerve and disc against each other and aggravate L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 23 2 Nerve roots anterior to transverse processes Proximity of nerve roots to transverse processes. Image courtesy of Complete Anatomy.

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