Issue link: https://www.massageandbodyworkdigital.com/i/1102144
CLINICAL E XPLORATIONS Because we now realize that asymptomatic people can have disk herniations, it is likely you work on people with these conditions without even knowing it. However, it is important to recognize that sometimes disk pathology is a primary part of someone's pain complaint, and we want to make sure we don't exaggerate their pain with inappropriate soft-tissue treatment. Back or neck pain can come from a wide variety of sources. A disk pathology is one possibility, but just because it exists, it doesn't mean it is the sole source of their pain. Massage therapy cannot change the amount of disk herniation, but it can play a very helpful role in managing some of the neurological sensations that perpetuate pain problems. If a client presents with relevant symptoms or a diagnosis of disk pathology, use caution in treating the area and be particularly attentive to avoiding anything that increases symptoms. Massage therapists are sometimes wary of working on people who have disk herniations because of a fear of pressing directly on the location of nerve root compression. Keep in mind that the most common locations for nerve root compression are anterior to the transverse processes of the spine, and we cannot actually press on those areas. Another interesting factor about disk pathology is that recent research has shown that many disk pathologies involving herniations can spontaneously regress and symptoms be resolved simply through time and appropriately protected movement. If you can reduce the offending activities and noxious pain sensations, it is possible that spontaneous regression of the disk and pain resolution may occur in some cases. A potential benefit of massage treatment is that working on affected muscles in the area of a disk herniation may help reduce compressive loads exacerbated by hypertonic muscles. This, in turn, can decrease overall muscle tightness and compressive loads even further. The soothing sensations that massage produces also decrease discomfort and help in pain management. The importance and value of the pain reduction massage produces should not be underestimated when addressing the symptoms of disk pathology. The best guideline is to use gentle and soothing techniques, whatever they may be, that help encourage relaxation and ease in the area without being too invasive. These strategies can help a wide variety of disk pathologies, and your client will be very thankful for the strategies you have used to help them manage their life and get out of pain. Notes 1. David F. Fardon et al., "Lumbar Disk Nomenclature: Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology and the American Society of Neuroradiology," Spine Journal 14, no. 11 (2014), https://doi.org/10.1016/j.spinee.2014.04.022. 2. W. Brinjikji et al., "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations," American Journal of Neuroradiology 36, no. 4 (2015): 811–16. https://doi.org/10.3174/ajnr.A4173. 3. W. Brinjikji et al., "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations." Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Massage therapy cannot change the amount of disk herniation, but it can play a very helpful role in managing some of the neurological sensations that perpetuate pain problems. Imaging Finding 20-year-old 30-year-old 40-year-old 50-year-old 60-year-old 70-year-old 80-year-old Disk degeneration 37% 52% 68% 80% 88% 93% 96% Disk height loss 24% 34% 45% 56% 67% 76% 84% Disk bulge 30% 40% 50% 60% 69% 77% 84% Disk protrusion 29% 31% 33% 36% 38% 40% 43% Annular fissure 19% 20% 22% 23% 25% 27% 29% PERCENTAGE OF PEOPLE WITH VARIOUS DISK PATHOLOGIES BY AGE GROUP Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 93