Massage & Bodywork

March/April 2012

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Even physicians and health-care workers who spend most of their time standing, with heads bent forward, experience excessive strain on the myofascial structures of the low back. prolonged static muscle contractions required for the basic bent-over position, which still leads to myofascial trigger points, tissue ischemia, and chronic dysfunctional tension patterns. The role of the spinal fascia is very important in low-back disorders, such as those affecting dental workers. Tension forces are transmitted through the extensive network of fascia extending throughout the entire lumbopelvic region all the way to the cranium. With the head held in a forward- flexed position for long periods, there are increased tensile loads on the fascia throughout the entire lumbar region. This increased pull on the fascia can lead to widespread low-back pain and muscular dysfunction. key Treatment Strategies. There are a number of treatment strategies effective for addressing low-back pain in dental workers. The soft-tissue therapist should focus on techniques that encourage tissue lengthening, especially in the quadratus lumborum and paraspinal muscles. The most effective work for chronic low-back pain will include deep longitudinal stripping methods. Many of the short, intrinsic spinal muscles, such as the multifidi (Image 3, page 108), are deep to the superficial low-back muscles and frequently get ignored, so it is important to address them as well. Myofascial release methods are also highly valuable for their stress reduction and lengthening effects on the fascial tissues. In many cases, dental workers develop lumbar muscle trigger points for which static compression techniques, along with tissue stretching, are valuable. Any of the work in the low-back region should be part of a comprehensive plan that also includes the upper back, neck, and upper extremities. Upper Back and Neck Biomechanical Challenge. Considering the postures they use, it is easy to understand why dental workers have neck complaints. Biomechanical evaluations demonstrate that every inch the head moves forward of the centerline of gravity adds approximately 10 pounds of weight that must be offset by the posterior cervical muscles. Correspondingly, holding this type of position for long periods puts cumulative stress loads on the muscles. The chronic tightness that develops in the cervical muscles leads to myofascial trigger point and headache pain, and may also contribute to neurovascular compression such as thoracic outlet syndrome. Long periods of chronically poor posture in the head and neck region can lead to dysfunctional postural patterns, such as upper-crossed syndrome (Image 4, page 108). In this pattern, there is chronic tightness in the posterior cervical and anterior shoulder girdle muscles, along with corresponding weakness in the upper back and neck flexor muscles. Upper-crossed syndrome is frequently identified as a cause of neck and headache pain complaints. key Treatment Strategies. The most common disorders are those of chronic muscle tightness—essentially disorders involving excess neuromuscular stimulation. Consequently, the most effective treatment approaches address overall hyperactivity of the nervous system and aim to decrease chronic muscle tension. Techniques such as myofascial release are highly beneficial in reducing neuromuscular tension and also decreasing excitability of the sympathetic nervous system. In general, techniques that emphasize elongation of the over- contracted muscles, such as longitudinal stripping, are the most helpful. A crucial factor to address with pathologies of this region is postural awareness and reeducation. The most effective and skillful massage techniques are rendered only temporary if an individual is not able to change chronic muscle-tightness patterns that led to the dysfunction in the first place. Shoulder Biomechanical Challenge. In most cases, dental workers can hold their shoulders in a neutral position. However, for some procedures the worker may need to hold the shoulders 2 Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 107

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