Issue link: https://www.massageandbodyworkdigital.com/i/296580
I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 101 3 Transverse processes and intertransversarii muscles prevent direct pressure on nerve roots. Image is from 3D4Medical's Essential Anatomy 3 application available on the App Store. Transverse processes protect nerve roots Proximity of nerve roots. Image is from 3D4Medical's Essential Anatomy 3 application available on the App Store. Nerve root exits spine here, immediately adjacent to protruding disc 2 muscle injury that occurs from chronic overload or extreme tightness (hypertonicity), so if this turns out to be the primary issue, we can likely help him a great deal. The intervertebral disc is a key structure involved in low-back mechanics, and for many years was considered a primary cause of low-back pain, especially if there was pain radiating down the lower extremity. When exposed to high compressive loads over time, such as long periods of sitting or heavy lifting, the disc will partially flatten and protrude to the side. Unfortunately, the structures in closest proximity to the protrusion are the lumbar nerve roots (Image 2). Massage therapists might be reluctant to work on individuals with disc herniations because they fear further compressing the nerve roots. Further nerve root compression can result from movement in the spine due to treatment and it is advisable to be cautious when working in this region if disc compression is suspected. However, it would be very difficult to put direct pressure on the nerve roots where a disc is compressing them because this is prevented by the transverse processes of the lumbar vertebra and soft-tissue structures in this area (Image 3). Other conditions such as facet or sacroiliac joint dysfunction, where there is irritation between the contact surfaces of adjacent joints, may also produce similar symptoms. Piriformis syndrome, which is a compression of the sciatic nerve in the gluteal region, is another potential cause of these same symptoms. All of these conditions can produce radiating pain down the lower extremity that mimics sciatic nerve compression symptoms. Further investigation is necessary to identify which tissues are involved in Darren's problem, as our treatment will be different for each of these potential conditions. ASSESSMENT AND EVALUATION We established in the initial history that Darren was experiencing some low-back discomfort, but primarily pain down his right lower extremity. Yet, we also now know that this information alone is not sufficient to point us to the proper cause. A description of sharp or radiating symptoms could come from any of the possible causes described earlier. Consequently, physical examination is essential for determining if we can help Darren or if we need to refer him to another health professional. The physical examination will focus on his back and lower extremity regions. Our palpatory investigation reveals tight muscles throughout his lumbar and thoracic regions. There is also significant tightness in the gluteal muscles, hamstrings, and calf muscles. He also reports that deep palpation in his low-back region