Issue link: https://www.massageandbodyworkdigital.com/i/68013
DEEP-TISSUE SCULPTING FOR LOW-BACK PAIN THE HOWS AND WHYS OF LOW-BACK PAIN Typically, clients complaining of low- back pain will present with lumbosacral misalignment, characterized by excessive (lordosis) or flattened lumbar curvature, anterior or posterior pelvic tipping, and/or rotations and uneven iliac crest heights. Observe your clients' personal tension patterns. Their spinal extensor muscles will usually appear as tight, wiry ridges next to the spine. The lumbodorsal fascia will feel bound to neighboring tissue layers. Your goal will be to relieve the lumbar spine compression that is the result of these chronically shortened myofascia. Often tight hamstrings and quadriceps, as well as hypotoned or hypertoned abdominals and iliopsoas muscles, contribute to low-back tension. Your clients will often appear to be so compacted at the lumbar level that their bodies' weight will not settle through the pelvis into the legs. It is almost as though the legs are not fully functioning as connectors to the ground; they seem, instead, to be the legs on a stick figure. They need posterior length, anterior to posterior balance, and continuity in function between their torso and lower extremities. This should be the other goal of your session together. Inefficient breathing patterns also exacerbate low-back pain. Shallow chest breathing and hyperventilation limit the amount and quality of spinal movement. Without the rhythmic waves involved in deep, abdominal expansion during full inhalation and exhalation, the spine can become rigid and inflexible. Because the crural attachments are intimately woven beside the psoas at the anterior lumbar spine, a tense diaphragm can transfer restriction and pain throughout the abdominal and lumbar regions. Conversely, lower torso tension can significantly limit breathing. Abdominal tension can prevent full excursion Photos by Al Gardner. of the diaphragm by minimizing room for the necessary expansion of the rib cage and displacement of the abdominal organs during inhalation. Other posterior muscles, including serratus posterior inferior and superior and levator costarum, influence respiratory depth and ease. When these smaller, more intrinsic muscles are restricted, the rib cage cannot expand to achieve its maximum posterior and lateral excursion. Of course, you will also need to consider any underlying conditions, such as muscular strains and sprains, damaged or stressed discs, arthritis, or other inflammatory conditions1 that may be present. And pregnant and postpartum women's backs are a story all their own.2 As you get your mind around an individual client's condition, remember these contributing factors and adapt your technique accordingly when working with these clients. CHRONIC MYOFASCIAL RESTRICTION So, how will you actually touch this client's needy body? A full-body or deep, localized Swedish massage? Passive and active resisted stretching? Extinguishing relevant trigger points? All these therapeutic approaches would possibly be effective, but for our purposes here, we are going to zero in on the use of focused compression, sustained sufficiently to soften and change both muscular and connective tissue of relevant structures. I call my style of this type of bodywork deep-tissue sculpting. Sculpting is a form of deep-tissue massage characterized by firm, constant compressions and strokes applied parallel to the muscle fibers. Like other myofascial bodywork methods, the techniques are intended to affect the deeper musculoskeletal structures, as well as the more superficial structures. In order to reach these deeper layers, you will use fingertips, knuckles, elbows, forearms, and heels of the hand, or any bony body part as tools. Pressure is gradually applied to a tight area until a resistance is met. You will maintain constant pressure while the tissue relaxes and until release is completed, or until you accept that no change is forthcoming. Any pain experienced by the client should not exceed pleasure, hovering at the borderline of pain. Don't use lubricants, so that the work can proceed slowly, allowing fascial softening and muscular lengthening. Generally, a minimum of 30–60 seconds is needed 62 massage & bodywork may/june 2009