Dana Tavares 4/19/2018

One of the first things I was taught in massage school was not to simply focus on where our patients felt their pain as it could very well be originating from another area altogether. And if we were to focus just where they felt their pain we would likely only provide temporary relief instead of completely resolving their issue.

Though this is a very broad and complex subject however I will attempt to keep this simple and show why this is important for you, as well as your therapist, to know.

Most people come to me because they have pain and discomfort and want it resolved. Often times spending a hour working out the knots and spasms in the area will take care of it just fine. Other times, especially if its a recurring or chronic issue, we need to take a more integritive approach.

The example I am providing here is just one example of many possible issues. The patient presents with low to mid back pain that is worse sitting, standing from a seated position, and walking. It started after a hike in the woods the previous weekend with no specific incident acredited. She has had this type of pain before and happens every so often. Sometimes her pain radiates down her left leg into her ankle and foot.

First, please bear with me, lets get a basic picture of what is involved here. Then I'll discuss some simple methods of supporting your body to correct this.

 Your brain is the master controler of all systems in your body, including the neurological and musculoskeletal systems. Your body, at every moment, is striving for harmony and balance in all systems. When your muscles and skeletal alignment are in balance there is the correct amount of tension and positioning of each of the joints. It is totally amazing how your body maintains this regardless of moving, lifting, sitting, sleeping. But when something happens to throw this delicate balance out of balance (injury, stress, trauma, hormone imbalances, overwork, over use, etc) your body has to go into action to either rectify the imbalance, or compensate for it. And your body lets you know about this via its communication channels such as pain, inflammation, and limiting use. Its important to listen to the messages your body is trying to relay and know how to respond appropriately to support proper resolution. Unfortuantely our medical system is more about surpressing the response (medications) instead of working to identify the precipitating factors and support the body in its inherent ability to heal itself.

That being said, lets take a look at one possible scenerio to get an idea of how this works.


Lets return to our hypethetical patient. She was hiking in the woods the previous weekend and didn't experience any significant event to realate to her current complaints of low to mid back pain. She is a healthy active person with a desk job but likes to be active on the weekends. Although she is fit and regularly active, it was a nice day and she was enthusiactally climbing up and down hills and over fallen trees while wearing a backpack. Though she wasn't feeling undu physical stress, she was nonetheless fatigued at times requiring a short break to rest up.

So to illustrate a potential issue to focus on lets take a quick look at some basic anatomy involved.

    Here is our reported area of pain, lower left back.








Essential Anatomy 5

  Now look at the lower right hip, see Piriformis. Piriformis is a hip rotator muscle deep below the large gluteal muscles. There is one on each side. The muscles attach at the sacrum (tail bone) and insert onto the femur. It is possible when our hiker was stepping over logs and climbing hills with the extra backpack weight that the large gluteal muscles that perform the bulk of the force were a bit overwhelmed from this unusal demand and therefore piriformis, the hip stabilizer/rotator, kicked in to aid the effort putting a strain on this muscle and causing spasming or trigger points (that result in shortening the muscle fibers). The resulting shortening of the right piriformis then throws off that harmony and balance we were discussing earlier thus putting a slight tourque on the sacrum to the right. This tourque causes a slight tension imbalance on the SI joints with a slight tendency to raise the right hip. However, the body with its inherent wisdom and duty, responds by tightening up the left Quadratus Lumborum muscle. The stronger QL muscle can easily overpower the Piriformis and over compensate by acutally raising the left hip causing an imbalance in the posture and gait. Standing from a seated position or getting up out of bed could push this already tight /spasming muscle group to again over compensate causing significant pain in the area.

There are times no pain is felt in the piriforms but the resulting trigger points in the quadratus lumborum refer pain to the hip as indicated in this drawing. (actually, in our example this would be happening on the left side). So in this case we have right piriformis causing left quadratus lumborum spasm and trigger points refering pain to the left hip (but also feeling the pain of the muscle spasm in the left lower back.



Another possiblity is if right piriformis develops trigger points and a pain pattern on the right hip (and could also include the scenero above at the same time).

These are just a few examples of how pain can be percieved in one area but needs to be addressed in multiple areas for complete resolution. The same could be true if overworked hamstrings, or over worked paraspinals altered the dynamics between the abdominal and quadriceps (anterior thigh) resulting in a tilted pelvic girdle. This is exactly why it's important to have, as your massage therapist, a good detective in routing out the issues involved.

So, what to do if this is you. 1st, give me a call and lets get a handle on this as soon as possible before additional compensations create more layers to address. Massage therapy combined with neuromuscular work (trigger points) will help break the pain/spasm cycle, bring in fresh blood and oxygen to the tissues compromised with a lack of circulation due to the tightness, stretch out the tightened tissues, relax the nervous system response, and help support full resolution of the issue. I also use hot stones with massage to help facilitate the above goals and healing oils to aid in tissue restoration and to calm a overactive inflammation cycle.

Home care involves rest and repair. Walking, gentle stretching, drinking plenty of water, hot epsom salt bath may be beneficial, and being careful not to over tax the muscles while healing.

Stretches (right click-open in new window)

So, there you have it. Hope this helps. One final thought, regular massage helps keep your muscles from being in a constant state of hyperactivity and tightness, flushes out metabolic waste, brings in fresh blood and oxygen, and calms the nervous system. All this goes a long way to preventing injuries in the first place. This is exactly why most all top athletes have regular massage, to keep them at the top of their game, just like you want to be in your daily activities. So why not make massage therapy a regular self-care for yourself by calling me today at (207) 563-2737 and setting up your next appointment.