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This becomes especially interesting in the context of back pain: a condition that affects most American adults at some point and a situation that drives many people to seek massage therapy. Sometimes this happens at the beginning of a journey toward wellness, and sometimes massage becomes a last resort when all other options have failed. This column focuses on a small part of the broad spectrum of potential contributors to back pain: bone-related problems. We will look at a couple types of inflammation (spondylosis and ankylosing spondylitis) and a bony anomaly (spondylolisthesis). This is not meant to be a comprehensive discussion of all the contributors to back pain; it leaves out disc and ligamentous injuries, for starters, and we won't consider postural issues. Further, it is important to remember that while tissue damage can initiate pain, for many people chronic pain is less related to a structural problem than it is to other pain-promoting factors like anxiety, depression, social support, eating and sleeping habits, exercise, and many others. This understanding has big implications for treatment options. ANATOMY REVIEW Readers will remember that the vertebrae are irregularly shaped bones with about a bazillion special landmarks. Each vertebra forms both synovial joints and cartilaginous joints with the vertebrae above and below. The cartilaginous joints between vertebral bodies are formed around intervertebral discs: complex structures that help us adapt to vertical, twisting, and shearing forces on the spine. The synovial joints join the postero-lateral aspects of the vertebrae at surfaces called 38 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 6 education PATHOLOGY PERSPECTIVES The Spondy Quandary Back Pain and Massage Therapy By Ruth Werner What is back pain? This question is more complicated than it sounds. Back pain is a recognized entity in health care. Low-back pain is an even more commonly used term. But these labels do not identify the types of pain, the sources of the pain, the persistence or contributing factors of the pain, or any of the myriad variables that influence how a person goes from feeling healthy and strong to feeling weak, fearful, and protective of their back. "Back pain" doesn't delineate between muscle spasm, ligament sprain, osteophytes putting pressure on nerve roots, cracked bones, or bulging discs. Furthermore, enormous controversy exists over what truly contributes to back pain or back injury. Traditional posture-related recommendations and ergonomic guidelines might not be as helpful as we thought. Small wonder then, that most research about treatment options for back pain are inconclusive. A rich discussion that has recently entered the world of manual therapies explores the distinction between biomedical causes of pain (specific structural entities that damage tissues) and a biopsychosocial model of pain that suggests pain is a response—not a stimulus— and that response is informed by many factors, including tissue damage, stress, personal history, social settings, and a host of other variables.

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