Ergonomically, the human form is a curious creation. We walk upright on two of our limbs, while a long curvaceous bony structure extends upwards to balance the head. By throwing gravity a couple of curves, the natural bends in the lumbar and cervical regions of the spine help maintain stability. Although this ingenuous structure characterizes our evolution and allows us to perform a vast range of functions, it also primes human beings for injury.
Acting as shock absorbers, intervertebral discs lie between each spine segment to cushion our movements. Known as herniation, these discs can create an enormous amount of pain when they deteriorate, are compressed or get pushed to one side. Technically, a herniated disc describes the extrusion of the soft inner core of the intervertebral disc (nucleus pulposus) through the disc’s outer fibrous core (annulus). Symptoms appear when this extrusion places pressure on the corresponding nerve root.
In the lumbar area of the spine, the most common sites for a herniated disc are between lumbar vertebrae four and five (L4-5) and between lumbar vertebrae five and the top of the sacrum (L5-S1). Herniations in these areas typically result in sciatica, where back pain progresses to pain and/or numbness radiating down the posterior and lateral leg, occasionally traversing the knee to the lower leg.
Assessment and Differentiation
Since a massage therapist is not qualified to diagnose the condition, it is important to have a physician determine the etiology of a client’s back pain. Attempting to work with a client in pain without knowing its cause can be dangerous when cancer, cauda equina, osteoporosis, fracture or infection is at the pain’s root. However, being familiar with signs of a herniated disc are helpful if the cause of back pain is unknown.
A challenging aspect of evaluating clients with symptoms of a herniated disc is differentiating between a low back strain and a herniated disc. According to the American Academy of Family Physicians, there is a general rule of thumb applicable to assessing back pain. Typically, pain caused by a low back strain is exacerbated by putting the affected muscles under stress (standing and twisting motions) while pain caused by disc herniation is worse in positions increasing pressure on the disc (sitting and bending). Inquiring about whether the client’s pain worsened while driving to your session may be a revealing question to pose to a client during the interview process. For safety purposes, even the most astute palpation and interviewing skills must be supplemented by a doctor’s evaluation.
Signs and Symptoms
Typically originating from a herniated disc at L4-5 or L5-S1, sciatica can cause both sensory and muscular abnormalities in the legs and thighs. Common symptoms of sciatica include:
- Deep, severe pain starting low on one side of the back
- A cramping sensation of the thigh
- Shooting pains from the buttock, down the leg
- Tingling, or pins-and-needles sensations in the legs and thighs
- A burning sensation in the thigh
- Leg or foot numbness
Additionally, people with sciatica may notice a worsening of their symptoms during movements increasing the pressure around the sciatic nerve such as squatting, sneezing, side-bending, laughing or coughing.
Massage professionals offer one of the most effective treatments for relief of a herniated disc. Two large government-funded studies released in November 2006 concluded that back surgery for painful herniated disks provided no greater benefit than other, less-invasive forms of treatment. Due to the side effects and risks associated with surgical intervention, this research supports the use of safe complementary therapies, such as Neuromuscular therapy, for disc herniation pain.
Neuromuscular therapy (NMT) is a style of massage that restores homeostasis between the central nervous and musculoskeletal systems. Ideal for addressing disc herniation, NMT can desensitize the extremely painful symptoms associated with this condition. Characteristics unique to NMT offer therapeutic relief for sciatica sufferers:
- The NMT technique of milking the nerve’s myelin sheath gives fast pain relief and reduces nerve inflammation. Nerve inflammation and pain are hallmark symptoms of sciatica.
- NMT alleviates involuntary muscle contraction and tissue congestion resulting from nerve conditions. Involuntary muscle contractions are spasms that typically accompany sciatica.
- NMT’s techniques can change chronic structural deviations of the body responsible for causing and perpetuating mechanical stress injury. A herniated disc causing sciatica is a structural deviation that can be affected with NMT.
- NMT prevents further aggravation of referred nerve symptoms. Through using trigger point locations for treatment, NMT helps relieve the referred pain defining sciatica.
When it comes to herniated discs, there is a tremendous demand for effective and safe therapy. Because our spine’s shock absorbers are prone to occasional misalignment, the skills to assess this common occurrence and apply appropriate treatment can make an enormous contribution to healthcare. NMT’s balancing of the nervous system with the musculoskeletal system makes it the logical choice when addressing sciatica.
Curnett, Michael, Mary L. Karlton, SciatiCare: Hands-On Technology for Healing Spinal Disc and Nerve-Impingement Conditions, Massage Magazine, January 2006.
www.aafp.org, Clinical Evaluation and Treatment Options for Herniated Lumbar Disc, S. Craig Humphreys, MD, and Jason C. Eck, MS, American Academy of Family Physicians, February 1999.
www.emedicinehealth.com, Sciatica, WebMD, 2006.
www.massagebyben.com, Neuromuscular Therapy, History and Uses, Peter Lane, CMT, CNMT, massagebyben.com, 2006.
www.mayoclinic.com, Herniated Disc Guide, Mayo Foundation for Medical Education and Research, September 2005.
www.news.yahoo.com, Studies: surgery no better for sciatica, Carla K. Johnson, The Associated Press, November 2006.