Eight out of ten people experience back pain at some point in their lives. Pain can be in the upper back and shoulders – often focused between the scapula, in the mid back along the rib cage, or in the lumbar region (low back). Back pain can be from postural habits, lifting heavy objects, repetitive movements or from sitting or standing for long periods of time.
Reducing or eliminating back pain can take a complex, integrative approach as symptoms are often brought on by a variety of factors. If pain is severe, due to an injury or does not go away within a few days, you should consult your physician. Diet, exercises such as yoga or stretching, and massage therapy can offer relief from many cases of back pain.
Causes of Back Pain
When assessing back pain in a client it is important to do a thorough intake, gathering information that may indicate a reason for back pain that is not necessarily muscular. Kidney stones, kidney infections, a ruptured disk and arthritis in the spine may all cause back pain, yet are not muscular in nature. Lifestyle factors including poor posture, obesity, and sitting or standing for several hours at a time may cause back pain. Even wearing bad shoes can be a trigger.
Certain occupations and activities may create situations that lead to chronic back pain: police officers often have low back pain as a result of wearing a heavy belt with equipment and weapons; hair stylists may have upper back and shoulder issues as a result of working with arms up at shoulder height for hours at a time; new mothers can experience low back and hip pain on one side or pain on one side of the upper back as a result of holding and nursing the new baby on one side more often.
Massage Techniques for Back Pain
Pain in the upper back tends to be in the area between or just above the scapula. After a warming up of effleurage, deep gliding strokes with elbows and fists can soften the upper trapezius, levator scapula and rhomboids. Follow this with cross-fiber or with-fiber friction as necessary to release very congested tissue or trigger points. When releasing pain in the upper back, don’t forget to open and lengthen pectoralis major and minor, which can cause the shoulders to roll forward, putting strain on the upper back and neck.
Mid-back pain is usually the result of tightness and trigger points along the erector spinae muscles, but can also result from trigger points in the serratus posterior muscles. In fact, pain from trigger points in serratus posterior can often be felt in the chest while breathing, making this extremely painful. Sometimes there will be restriction along the intercostal muscles and these can be worked by running splayed fingers between the ribs. Again, after warming up this area with effleurage, deeper gliding strokes can soften the muscle, followed by friction as needed to reduce tension and restrictions and release trigger points. Be careful with deep pressure when working in the mid-back, especially near the lower floating ribs.
Up to 80% of people experience low back pain in their lifetime and it can be caused by many things: sitting too long, standing too long, poor shoes, foot and knee problems, stress and weakened abdominal muscles. When addressing the low back it is wise to focus work from mid-back through the knee as there can be pulling from either above or below the lumbar region. Pay special attention to the gluteal muscle group, as well as the deep rotators. Piriformis is notorious for its roll in sciatic and low back pain. Often, shortened and tight hamstrings will result in pain in the low back, but keep in mind that shortened quadriceps and hip flexors can also contribute to pain in the low back. Shortened quadriceps and hip flexor muscles are common among those who sit many hours a day. As with other back pain, warm up with effleurage, then proceed to work deeper, lengthening muscle tissue and using friction and compression as needed to release trigger points and tight areas.
Another Common Cause of Low Back Pain
Another common cause of low back pain is the quadratus lumborum (QL) muscle, deep in the low back between the lower rib and the top of the iliac crest. This muscle is often best worked in side-lying position, as side-lying allows greater access in front of the erector spinae muscles. Use pillows and bolsters as necessary to ensure the client is well supported and work very slowly as this muscle can be extremely painful.
There are many massage techniques that can be used to address back pain, depending on the location and cause of the pain, the exact musculature involved and client preference and tolerance. Ultimately, each therapist must make decisions about how they are going to approach the work on a case-by-case basis.
Exercise for Back Pain
Almost all exercise will reduce tension, strengthen muscle and improve overall function and movement – but there are two approaches to exercise that are especially helpful for back pain in general.
- Strengthening the abdominal muscles: Strengthening the abdominal muscles is crucial to reducing back pain as the abdominals play a huge role in keeping us supported and upright. Be sure to choose exercises that work all the abdominals: The transverse abdominis which stabilizes the trunk, rectus abdominis which runs between the ribcage and the pelvis, and the external oblique and internal oblique muscles which twist the body from side to side. Pilates offers a great systematic approach to working abdominals but is by no means the only approach to strengthening these muscles.
- Stretching: Another fantastic approach to resolving back pain is through stretching and increasing flexibility overall. Yoga and Thai Chi are excellent for this as they provide a guided, systematic approach to stretching and gentle strengthening that is balanced for the entire body. Stretching can be done without either of these traditional approaches; just be sure to stretch the full body – front and back as well as side to side – in order to address restrictions and limitations in every area.
Foods to Help Reduce Inflammation
Back pain is typically the result of injury and tightness of muscle that is sending pain signals, and there is almost always a component of inflammation involved. Eating foods that have been shown to reduce inflammation may aid in reducing pain. We certainly want to avoid foods high in fat and sugar that increase inflammation. Caffeine as a stimulant can also increase back pain.
Foods to eat include fish and olive oil which are jam packed with omega-3s, nuts and seeds which contain B vitamins, fruits and vegetables which are full of antioxidants, vitamin C and anthocyanins (berries), as well as foods with vitamin D. Many spices reduce inflammation, too, such as garlic, ginger, turmeric and rosemary.
Back pain is extremely common as it can result from so many activities, conditions, lifestyle factors and injuries. Most of us will experience back pain at some point. However, attention to diet, exercise and posture can greatly minimize risk or speed recovery.