Working Complex Chains: The Importance of Addressing More than the Area of Pain in Massage & Bodywork

Non-specific low back pain effects large swaths if the population and is the second leading cause of visits to primary care doctors. As helping people who are experiencing this challenge is a major part of my practice, I review research on this topic often. An article I read last week directly addressed the importance of combining core strengthening exercises with massage to most effectively recover from low back pain and regain full function.

Indirectly, it highlighted the importance of addressing all parts of a body complex when treating pain.

Clients who come to me with low back pain often want to spend their entire session working right on top of where they feel the pain. This is often unproductive for three main reasons. The first, working for an entire 75 minutes in the same area can over tax muscles, triggering guarding in the form of further tightening or aggressive inflammation which will both lead to increased pain. Not something you want to walk away from a massage feeling! Typically, a muscle will tolerate direct massage for no more than fifteen minutes.

The second reason is that our bodies do not work in isolation. To perform even basic movements requires firing of muscles synchronously and precisely all over or bodies. If we are truly going to tackle a musculoskeletal pain problem, we must then also balance the synergist and antagonist muscles involved in the compensation patterns we have developed while experiencing pain.

For example: low back pain primarily caused by an overactive right quadratus lumborum (QL) - a fairly common finding. As the body works to remain functional - because we are all stubborn He-Man and She-Ra - other muscles must pick up the slack. Your right hip will hike to reduce pressure on the lumbar. This simultaneously lengths the left abs and right hamstrings while shortening the right abdominals and left adductors. To counteract the imbalanced push/pull, those muscles will tighten or weaken in an attempt to maintain their optimal length. As your hips become more unbalanced, your pelvic floor will adapt, altering your intra-abdominal pressure and ultimately affecting your breathing and posture. Essentially, patterns that are typically a gentle see-saw become a really competitive tug-of-war.

Changes in our musculature can have effects on any area that is connected via the fascia lines - which is to say basically anywhere in our structure. Even without specifically accounting for the nerves, lymph, and circulation, that's a ton of alterations the body must undergo! The longer these compensations persist, the more likely it is they will stick even after the original imbalance is correct. When we only address the sit of pain, we miss correcting the compensatory patterns which can lead us back into pain even after the original imbalance is corrected.

Last, just because we feel pain in one place doesn't mean that's the source of the pain. For all of the training and tools your bodywork therapist as in their toolbox, asking "Why?" is the most fundamental. Why is the QL tight? What is it responding it that your nervous system believes this is the best position for it to be in? The answer to this question could be because it is supporting an under-active muscle. It could be because there is a stressful limbic associations that is expressing through your structure. It could be an instability in the spine or pelvic bones that are in tern caused by an imbalance elsewhere. When solving a pain puzzle (especially a chronic one), there are often more pieces in the box than you originally thought.

Ultimately, when your massage therapist moves into your hamstrings, your hips, or even your abdominals, it is all serving the purpose of getting you long lasting low back pain relief! And remember, if you are curious about your practitioner's reasoning you can always ask. It is your body and you get to know what's happening to it.

Does this make sense? Let me know your thoughts in the comments!

Ready to get to the root of your chronic pain? Book your first session here.