Issue link: https://www.massageandbodyworkdigital.com/i/738894
C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 83 Doctors Make Mistakes, Too Doctors are not exempt from being perpetuating factors, either. Michael has been my client for 20 years. He manages his sciatica through massage, chiropractic, and light exercise and stretching. For the most part, he only has acute episodes once or twice a year. One day, Michael went to his general practitioner for a physical. His doctor told him he had a surefire way to get rid of his back pain for good. It involved back exercises, including trunk rotation exercises. Michael trusted his doctor and earnestly tried his suggestions, but the experiment failed miserably and set Michael back for a while. In retrospect, if Michael had asked his chiropractor or me what we thought of the doctor's plan, we would have voiced major concerns. Though well-intentioned, the doctor didn't have a historical understanding of Michael's sciatica like the chiropractor and I did. He thought that Michael needed to be pushed, but we knew that over the years Michael had fine- tuned his exercises so they wouldn't aggravate his sciatica. FIRST, DO NO HARM Sciatica clients benefit when we adopt the mind-set "first, do no harm." Here's how to "do no harm": Help the client find the most comfortable position on the table. Back off from doing aggressive techniques (deep pressure and extreme stretching) in the lower- back area. Make conservative stretching recommendations and postmassage suggestions. Help a client identify perpetuating factors by asking if anything in their work, home, or recreational life has changed before or at the onset of acute sciatica. As you strive not to be a perpetuating factor yourself, remember that other health/fitness practitioners working with your client can unknowingly be one. Be prepared to have that conversation with your client and/or other health/fitness practitioners if you think what they're doing is contributing to the sciatic pain. And take a minute to pat yourself on the back for going the extra mile and carrying out the often unnoticed work that helps your client get out of pain faster. Notes 1. Physiopedia, "Sciatica," accessed September 2016, www.physio-pedia.com/Sciatica#Definition.2FDescription. 2. WebMD, "Slideshow: A Visual Guide to Sciatica," accessed September 2016, www.webmd.com/back-pain/ss/slideshow-visual-guide-to-sciatica. Mark Liskey is a massage therapist, continuing education teacher, business owner, and writer. He shows massage therapists how to stay out of pain, make more money, and find their way at www.makethemostofmassage.com. his shoulder. Eventually, I discovered that he recently injured his shoulder when working out with heavier weights and that he was still trying to work out with the same intensity. Be Persistent Here's why I initially didn't pick up that Kishawn's workout was a perpetuating factor: 1. I assumed the new injury was an aggravation of an older injury. 2. I didn't have enough accurate information to formulate the right question. As far as Kishawn was concerned, his CrossFit workouts hadn't changed over the past six months—because he was always trying to add more weight and work harder. 3. Kishawn loved CrossFit and didn't want to stop. He was trying to ignore what he didn't want to know—that his workout caused his injury and that working out while injured was continuing to aggravate the injury. Once you have identified a potential perpetuating factor, you can make a suggestion to correct it. For instance, gardening, an activity that happens a few months a year and that can be demanding on the back, can aggravate sciatica. If you suspect gardening may be a perpetuating factor, have the client show you how they bend when working in the garden. My guess is that they're bending in a way that puts tension in their lower-back area. If that's the case, show them an alternative way to bend (e.g., take a knee when weeding). Health Practitioners Can Be Perpetuating Factors You can go out of your way as a massage therapist not to be a perpetuating factor, but that doesn't mean other health or fitness practitioners are doing the same. For instance, a chiropractor once sent me an acute sciatica client, Emily. Both the chiropractor and I were treating Emily when her sciatica pain started to lessen. She had steady improvement for a few weeks and was only taking one half dose of a painkiller instead of four or more at a time. Then, suddenly, her sciatica came back in spades. The next time I saw her, she reported that she had zero improvement after the chiropractor and I had worked on her. I drilled down on what might have changed in Emily's life to put her back in the acute sciatica phase. Eventually, I discovered that the chiropractor had given her a heel lift for her shoe just before the onset of the latest round of acute pain. When she took the heel lift out, the pain started to go away. Though they strive to do what's best for their clients, fitness professionals can sometimes be perpetuating factors, too. Sarah was referred to me by a personal trainer. She was in constant sciatic pain, and whatever I did had little to no effect on her pain. Sarah's trainer was doing very specific back exercises to help Sarah with her sciatica. I wondered if the exercises were actually exacerbating her condition, but Sarah was so invested in her trainer's philosophy of correcting her back that I couldn't get Sarah to stop doing the lower-back exercises. For the ensuing months, as I kept in contact with the trainer, Sarah's sciatica never got better. HOW NOT TO MAKE SCIATICA WORSE