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Lifting heavy loads also puts high compressive forces on the intervertebral discs (Image 2, page 107), which can lead to disc degeneration and herniation. The eventual result of disc herniation can be nerve root compression and severe sciatic nerve pain. Acute herniation of intervertebral discs that are not already damaged is not very common.8 Most disc herniations occur from long periods of compressive load that have led to gradual disc degeneration. In many cases, chronic muscle tightness and muscular dysfunction of the low-back muscles increase compressive forces on discs. LUMBAR REGION TREATMENT Massage therapy is highly valuable in reducing the chronic, compressive loads that lead to disc injury. Techniques such as myofascial release, deep longitudinal stripping, and trigger point therapy are particularly helpful for addressing the chronic muscular overload experienced by nurses. When treating biomechanical overload in the lumbar region 3 There is extensive fascial continuity through the lumbopelvic region. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com. as the result of excessive lifting, an important consideration is the role of associated structures in the kinetic chain. There are fascial connections from the lumbar musculature through the gluteal region to the lower extremity. It is essential to address these fascial connections with your treatment approach. There is a continual chain of connective tissue from the Nurses are frequently bent over with excessive forward head posture as they treat patients who are lying in a bed. lumbar region through the lower extremities that is essential for generating power for proper lifting mechanics. The hamstring muscles connect with the sacrotuberous ligament, but that is not an ending point for those fibers. The fascial connections that blend with the sacrotuberous ligament generate tensile forces through the sacroiliac ligament complex (Image 3). There are also fascial connections with the gluteal muscles and the lumbodorsal fascia, which are intricately meshed with the low-back muscles. If the entire biomechanical chain of connective tissues is not addressed, imbalances may continue, leading to biomechanical dysfunction and subsequent injury. For example, if back muscles are treated, there is likely to be a change in the biomechanical relationships in the lumbar musculature. However, lifting mechanics require the integration of tension generated through muscles, tendons, ligaments, and fascia throughout the lumbopelvic and lower-extremity regions. If one of those regions changes biomechanical tension, but not the others, imbalances develop that could perpetuate pain problems or lead to other injuries. As a result, deep, specific work on the gluteal muscles, piriformis, and hamstrings are crucial aspects of treating low-back pain for those doing serious lifting activities, like nurses. Other factors have also been identified as causes of increased back pain for nurses. For instance, studies indicate a correlation between menstrual discomfort and the aggravation of low-back pain problems in nurses.9 The presence of a seemingly unrelated pain problem can compromise the integrity and function of low-back muscles and lead to earlier fatigue and the onset of other injuries. 108 massage & bodywork september/october 2012