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98 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 6 technique SCIENCE OF NERVES DORSAL RAMI OF SPINAL NERVES Low-back pain is one of the most common complaints clients have. For this reason, nerve pain in and around the spine, particularly the low back, has been explored in great depth. In 1934, a groundbreaking research paper published by Mixter and Barr highlighted the presence of the herniated intervertebral disc and suggested it was a key reason for low-back pain and lower leg complaints. 1 When a disc protrudes, it is likely to press on the ventral branch of the exiting nerve trunk (Image 1). The ventral branches in the lumbar region, where most disc herniations occur, feed into the femoral nerve in the upper lumbar region and the sciatic nerve in the lower lumbar region. This condition is called intervertebral disc pathology; for decades this complaint took center stage as the focus and cause of back pain for many physicians. As a result, there were extensive developments in surgical strategies for attempting to rectify this boogeyman of back pain. It wasn't until many decades later and the development of more accurate high- tech diagnostic procedures that attitudes and understanding changed and began to move away from the focus on nerve roots and disc herniation as the underlying cause of low-back pain in so many cases. The high percentage of unsuccessful surgeries combined with the recognition that people with no back pain often had similar disc herniations indicated that just having a disc herniation was not necessarily painful and may not be the root cause of pain. Interestingly, some of the newest research on nerve pain suggests that it may, in fact, be the small nerve fibers, such as the dorsal rami, that are keys to low-back pain. Low-back pain, while also potentially radiating down the lower The Hidden Nervous System A Look at the Small Culprits By Whitney Lowe An extensive network of nerves courses throughout virtually every tissue in our bodies. If you look up information on nerve injuries in medical resources, you will find most of the attention focuses on the pathologies associated with the large nerves, such as the sciatic, median, or ulnar nerves. However, there are many small nerves that are also root causes of pain or injury complaints. These nerves are often ignored because they are smaller and/ or simply not studied in depth. Yet, many lie just under the skin and are affected—either positively or negatively—with massage. In this column, we take a look at a number of these important smaller nerves. You might have heard of some of them, but chances are others will be unfamiliar to you. We'll explore their location, pathway, and contribution to various pain complaints. Dorsal and ventral branches. Mediclip image © (1998) Williams & Wilkins. All rights reserved. 1 Intervertebral disc Ventral rami Dorsal rami Spinous process