This is a story of massage for lower back pain not working (but there’s a lesson).

Casey was crippled because of his lower-back pain. And nothing worked.

In fact, after 4 injections his pain got a lot worse. He went from lying face down on my table to lying on his side to sitting up to not coming in.

The last time he came in, we used a wheelchair to get him in and out of the office.

I was 99% sure that Casey was heading for the knife.

A few weeks after Casey stopped coming in to see me, I met Dr. Charlie Johnson, a PT who specialized in back pain. I thought Charlie might be able to help Casey, and Casey agreed to see him if I came along.

When I went to pick Casey up for the appointment, I expected to see a slumped over, broken man. But what I saw was Casey close to how he used to be pre-back pain.

What the hell?!

Did the nerve compression ease up?

Did the inflammation go down?

Wait…I’ve been down this road before…these questions imply that pain is only a product of tissue damage.

But research shows that pain is not simply a tissue damage event.

Pain is an experience.

I Can Heal You (NOT)

When I opened my neuromuscular massage (NMT) practice in early 2000, I thought I had the playbook for correcting things like lower-back pain.

I’d go through the NMT evaluation protocol, identify the eccentric and concentric muscle issues, add in trigger point therapy, and BAM!–pain get ready to get your butt kicked.

But massage for lower back pain and other issues produced inconsistent results.

I soon became frustrated and started to look for answers elsewhere.

So for the next ten or so years, I studied and wrote about back pain.

At this time, a new view of pain and how it should be treated was just starting to emerge.

The old way for understanding pain was that pain is strictly a matter of tissue damage. The new way for understanding pain was that pain is complex and is influenced by social, emotional and conditional factors.

When I think about Casey’s back-pain story, it makes more sense to view it through the new lens.

Here’s what I mean.

Casey’s Lower-Back Pain

When Casey hurt his back, he stopped working. And as it got worse, his world got smaller, so small that he wouldn’t even leave his house.

By five months, he was basically incapacitated.

But then things started to improve as he approached the 6 month mark.

Interestingly, 6 months marked the time short-term disability would be cut off and Casey would have to go back to work. If he didn’t go back to work, they’d fire him.

I’m not at all suggesting that Casey was faking his back pain. I was there and it was real—to the point where he lost leg functionality.

I’m saying other factors played into Casey’s experience of back pain.

The Other Parts of Back Pain

In his book, Itty Bitty Book About Lower Back Pain, Charlie the PT explains that “pain does not equal damage or injury…it is simply an experience created by the brain when it thinks your body is in danger.”

 

He goes on to say that it takes 3 – 6 months for ligaments, muscles, nerves and discs to heal in your back. After that if pain persists it could be that your sensing system is revved up and you’re brain “is still sensing danger.”

Now, let’s back up to when Casey hurt his back. A physical event happened in his back, like a tear or strain or rupture or impingement or something.

About a month post injury, he was doing better. Then things suddenly got worse. At the time, he was still seeing a personal trainer and my hunch is that the personal trainer was having Casey do something that aggravated his back condition.

Then Casey started injections. Each injection helped for a very short period of time, but then the pain returned and eventually got worse. During this time he had some falls and could’ve re-injured his back.

But eventually, the potential back-pain, perpetuating factors were eliminated–no more falls and he stopped seeing the personal trainer. So he was healing and feeling better, right? Actually, no. The pain now was the worst it had ever been!

Why?

Maybe because there were things revving up his sensing system, like:

Casey HATED his job because his boss stressed him out!

According to the research Charlie sites in his book, if you hate your job, you’re likely to experience more pain than someone who likes her job.

In addition, it’s been shown that memories can impact pain. Casey constantly talked about his boss as being psychotic.

Memory of Psychotic Boss + Thought of Going Back to Work = Stress Hormones Shooting Up.

Okay, but you could argue that Casey’s stress level should’ve gone down because he was away from the hostile work environment while on disability.

True, but Casey also knew he’d be fired if he didn’t return to work after 6 months of disability.

That worried him A LOT. By the way, if you’re sad or worried you’re likely to feel more pain than someone who’s happy and relaxed.

OMG, no wonder the poor man couldn’t sleep! And, yes, bad sleep habits equal more pain.

Can you feel the pain intensifying?

Casey (Massage for Lower Back Pain) Revisited

“Pain is an experience” makes complete sense to me. Casey’s lower-back pain fits this view to a T.

If I could have a do-over, here’s how I’d try to help Casey now.

First, I’d let him know that the injury to his back will heal in 3 to 6 months. This should ease some immediate anxiety regarding his back pain.

Next, I would jump into action once I heard Casey repeating things.

For instance, each time I massaged Casey while he was in back pain, he told me (and I could see) how stressed out he was. But I didn’t appreciate the significance of what stress can do to the experience of pain.

If I had really gotten this, I would’ve pestered Casey endlessly to get counseling or find a professional who could teach him how to meditate.

Lastly, it doesn’t matter how well I listen to a client and recognize a need if I don’t have someone good to refer her to.

With Casey, I learned that my referral list had holes in it.

This became apparent when Casey filled me in about the back doctor he was seeing. I was not impressed. For one, the doctor gave Casey more injections than most other doctors would and he never used imagery when injecting.

But I didn’t have an alternative for Casey to see at the time. If I had known about Charlie, I would have sent Casey to him.

Old Dog, New Trick

Here’s how I’m gonna fix my referral list. I’ll talk to people in the health and wellness industry who I trust. I’ll get their recommendations, then I’ll vet their recommendations. Here’s how I vet.

Also, going forward, this is big, I promise to NOT take stress or any other factor that influences the experience of pain, for granted—ever, ever again.

And, if things are looking bad because the pain won’t go away, I’m going to remember that in 3 to 6 months most back issues have healed.

Maybe there’s something revving up the pain system.

Time to look with a magnifying glass.

P.S. When Casey went back to work, he had a new (and nice) boss:-)

Need more help with your back pain clients?

Check out Common Sense Ways to Treat Sciatica.

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Good news! You don’t need to be certified in medical massage to treat sciatica. You don’t even need to know the latest myofascial technique.

In fact, you can do a lot of good with sciatica if you just understand some basic physiological mechanisms and back research which surprisingly (or not) correlates to common sense.

What is Sciatica Really?

Sciatica is a symptom, not a condition. The symptoms are pain in buttock and/or down the leg. The cause is irritation of the sciatica nerve.

We’ve been conditioned to think that most of the time nerve irritation has to do with the spine, like a herniated disc. To this day, I’m guilty of this.

Aadila came in telling me that the doctor said she had sciatica. Her pain was in her buttock and half way down her hamstring.

My first question was: Do you have back pain?

No.

Have you ever had back pain?

Yes.

Where?

(She points to her mid-back.)

I see…how about your lower-back?

No, not that I can remember.

Are you sure?

Pretty sure.

No stiffness?

Nope.

How about when you get up in the morning..?

Well, on occasion…

Aha!

Hold on there, Wilbur! You’re proceeding as if sciatica is a condition—specifically, an impinged nerve at the spine.

According to science writer Paul Ingraham, I’m actually barking up the wrong tree. He says most sciatica arises from muscle “knots” not nerves impinged by a disc or by the narrowing of a vertebral foramen.

That’s fantastic—for us. If it’s not a nerve issues due to a spinal condition, we’ve a better shot at helping a client’s sciatica improve.

Which brings us to good vibrations.

Good Vibrations

I have to tell you, I don’t always trust something that just “feels right.” Why? Because what “feels right” is usually influenced by experiences and knowledge. And those two things can seriously bias objectivity.

Here’s an example of how trusting your gut can go really wrong.

Scott Hornoff was a detective who like his fellow detectives trusted his gut. But then one day, his fellow detectives, trusting their guts, were convinced that Hornoff was the person who murdered a local woman.

Hornoff was tried and found guilty. The problem was, he didn’t do it. And he spent 6 ½ years in jail before he was exonerated.

Most unsettling is that the detectives’ gut feelings never changed. Hornoff became a free man only because the real murderer confessed!

We’re still talking about massage here, right?

Yep.

When you have a muscle ache, you rub it back and forth. That feels like the right thing to do. But does this gut reaction actually help with the pain?

Our survey says…

It sure does!

Vibrating a muscle causes proprioceptive confusion. Ingraham says:  “If you move or shake the body at random, the brain gets a deluge of nonsensical proprioceptive data. The nervous system, overwhelmed by the random stimuli, effectively “gives up” and stops resisting the movement: providing you with deep, muscle loosening relaxation!” You can read his article here.

Here’s What I Do

Here’s my technique for vibrating muscles when someone comes in experiencing sciatica.

1. I locate a sciatica pain area.

Next I need to know how much pressure to use.

2. I press and hold the pain area.

This is the tricky part. Too much pressure can cause more pain. I have safeguards for not pushing too hard. One is the client’s reaction.

I’m looking for him to say “That feels good” or “The pain is lessening” as I press on the area.

If I don’t get one of those answers, I revert to using the pain scale. The short version is: on a pain scale of 1 to 10, I want to press until the client says it’s a 3 (or 4 it’s not acute sciatica). Here’s the longer version: Pain Relief Massage Video: How to Find the Right Pressure.

I hold the pain area until the pain starts to lessen. If it gets worse, I leave the pain area alone for awhile. Eventually, I circle back, but this time I’ll apply less pressure.

Then there’s the piriformis…it can be very reactive because of the sciatica nerve going under it (or in some anomalous cases, through it).

If the person feels zapping in the buttock or down the leg when I’m pressing the piriformis (or around it), I lighten the pressure. And if I’m using thumbs, I’ll try a broader body part, like fists.

If direct pressure is just too painful, I’ll try skin rolling.

Once I get the pressure down, then it’s on to…

3. Vibrate the pain area.

I gently pin the pain area and apply the appropriate pressure. Then I vibrate the pain area with a back-and-forth motion keeping my pressure consistent.

For a client with raging sciatica I don’t apply deeper pressure as I’m vibrating like I normally would when working a tight spot. This is sometimes tough for me to control because by nature I’m smidge-deeper-pressure pusher.

I vibrate the pain area long enough for it to feel good, but not so long that it feels annoying. I’ll cut it short when in doubt.

If I really think a smidge deeper pressure might provide more pain relief, I’ll go back to the area and I’ll do the vibration at a smidge deeper level.

And that’s it…well almost…

More Common Sense 

Heat is another low cost pain reliever. The heat acts a neurological sedative. When I worked for a chiropractor, we used heat packs from a hydrocollator. But you could simply use a heating pad.

Education can also help. If you’re client is experiencing sciatica, share this research with her.

It says that bed rest is no better than mindfully (pay attention to your back) going about your normal life. This tidbit of info could be HUGE for a person experiencing sciatica pain for the first time. For one, she can stop worrying about whether working is making her sciatica worse.

Fired Up! Ready to Go!

Don’t back down from sciatica.

You have a lot of treatment tools to use like vibration and heat. Not medically sounding enough to compete with the chiro next door who is using spinal decompression (formerly known as spinal traction)?

You can always say you’re using a proprioceptive confusion technique and a neurological sedative device, but you might be on shaky grounds when you whip out the $20 heating pad you had bought on Amazon.

If you’re looking for more info on treating sciatica, I talk about how to NOT make sciatica worse in this article: Don’t Wear a Fancy Red Tie When Treating Sciatica. I learned the NOTs the hard way—by actually making sciatica worse in some of my clients.

Hey, what can I say. There’s a learning curve.

I’m here if you want to talk about a particular case or if you have some sciatica techniques you’d like to share.

And if you want to know about new articles, videos, classes, etc., coming out, just enter your email below. You can unsubscribe whenever you want:-)

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