Issue link: https://www.massageandbodyworkdigital.com/i/296580
Darren is a 34-year-old male who works in a big home-improvement store. His job involves restocking building materials and retrieving large orders for customers. Consequently, he does a significant amount of heavy lifting in his job and also drives a forklift. For several months now, Darren has been having some low- back tightness and pain extending down his right leg. At first, he brushed the problem off as something that comes with the job and he assumed it would be temporary. However, the condition has persisted. He is concerned that the problem is getting more severe and may affect his ability to keep working. He wants to try a noninvasive procedure like massage first, hoping that this will prevent a need for more serious interventions like back surgery. KEY CONSIDERATIONS Let's take a look at some of the key anatomical and biomechanical considerations in this area and then explore Darren's case in greater detail. A tremendous amount of low-back and lower- extremity pain originates from muscle overuse and dysfunction, so it makes sense to look at muscle structures as a potential cause. However, not all conditions have muscle tissue involvement, so it is always important to keep an open mind in the beginning. We know that Darren spends a lot of his day lifting heavy items. He is also frequently on a forklift, where he must turn his upper body around while in a seated position to look behind him as he is driving. These occupational motions and activities place a significant load on many low-back muscles. The key stabilizing muscles of the low back that are frequently injured from occupational overwork include the quadratus lumborum and the different divisions of the paraspinal lumbar extensors (Image 1). These muscles are not designed for power-lifting activities. They also respond poorly to being held in a static position for long periods. A key concern in Darren's case is the fact that he reports pain going down his right leg. In reports of radiating lower extremity pain, disc herniation and nerve root compression are often suspected. However, there are several conditions that produce similar symptoms, so deeper investigation is definitely required. Myofascial trigger points in the gluteus minimus closely replicate the neurological-type symptoms of sciatic nerve compression. It is common for these trigger points to develop in people who sit for long periods during the day (as Darren does when driving the forklift). Of course, massage therapy is one of the most effective ways to address 100 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 4 technique CLINICAL APPS Darren's Back and Leg Pain By Whitney Lowe Spinal extensors Quadratus lumborum Quadratus lumborum and spinal extensors. Image is from 3D4Medical's Essential Anatomy 3 application available on the App Store. 1 In reports of radiating lower extremity pain, disc herniation and nerve root compression are often suspected. However, there are several conditions that produce similar symptoms.