So many clients come and see me with low back pain. One of the common factors between clients is a sedentary job – long hours spent sitting in front of a computer.  If you’re like them, you might have some low back pain, too.

While it sure does feel good to have one’s low back massaged – I know I enjoy having done to me, too – very often the culprit to that low back pain isn’t the back muscles, but the hip flexors.  The hip flexors? I can hear you asking that question.

But yes, and specifically, the iliacus and psoas (pronounced “so-az”) major muscles, collectiviely called the iliopsoas, the deepest muscles in the body.  The job of the iliopsoas muscles is to flex the hip, which is what happens every time we take a step.  Since the legs can be heavy, these muscles need to be very strong.

You can see in the illustration that the psoas major (and in about half the population, psoas minor) attaches on to the front surface of the lumbar vertebra, travels down through the ilium before attaching on the femur at the lesser trochanter.

Why the hip flexors?

Our bodies adapt to the situation in which we put them.  If you sit all day, you are keeping your hip flexors in a shortened state.  Sitting position is nearly fully flexed for these muscles.  So, the body adapts to this situation and starts to “think” that short is the normal state.  The problem with this is when you have to stand up – the muscle starts to lengthen and the body wants to return the psoas to it’s “normal” state – shortened.  Meanwhile, the erector spinae muscles in the back, which extend the spine, keeping it upright, are contracting to get the body to stand up.  The iliopsoas and the erector spinae muscles get into a tug of war within your body, and the back muscles usually lose this battle, and ouch!  Back pain.

Release the KrakenPsoas

This is where skilled bodywork can really help.  The massage therapist works from the front, slowly massaging deep into the hip toward the navel.  The massage therapist coaches the client in breathing and works out the tension in the iliopsoas muscles.  As these are the deepest muscles in the body, and there are many structures, like bursae, lymph nodes, the intestines and the femoral artery very near to the psoas, this work is performed only by therapists with training in releasing the psoas.

Releasing the hip flexors is one of the most important strategies in relieving and eliminating low back pain.

Book Now with Paul Brown Massage Therapy Pain Relief Center Today!

Sciatica… just hearing the name evokes a sympathetic shudder.  That deep pain in the buttocks that radiates like burning lightning down the leg to the knee (and sometimes into the calf).  It’s a fairly common pain with people, and there are several causes, and and fortunately a number of treatments that can really help relieve, manage, or even eliminate sciatic pain.  Let’s talk about it!

Sciatic Nerve

Sciatic Nerve from Gray's Anatomy

The sciatic nerve starts in the Lumbar and Sacral parts of the spine in the lowest part of the back.  It travels laterally from the sacrum out into the posterior hip deep to the piriformis muscle.   The sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot.  As you can see in the drawing to the left, the sciatic nerve travels out into the buttock and down the thigh to the knee, where it splits into the tibial and common peroneal nerves.  I’ll write about them in another entry.

Anyway, the sciatic nerve is huge – about as thick as your thumb, and when it becomes impinged or pinched, the results can be quite arresting.  Pain like a deep burning, throbbing ache deep in the buttocks, sometimes with paralyzing burning, electrical pain down the thigh.   I’ve seen firsthand what a sciatic attack looks like when the leg become paralyzed, and it looks like one of the most intense pains to have to endure.  It’s no wonder that so many people with sciatic pain often resort to powerful pain killers.

What causes Sciatica?

There are a number of possible causes of sciatic pain

• Piriformis Syndrome
• Spinal disc herniation/compression
• Pregnancy
• Spinal Stenosis
• Trigger Points
• Behavior

Let’s talk behavior first.  Sitting on a wallet can eventually lead to entrapment of the sciatic nerve beneath the buttocks, pinching the nerve by the piriformis muscle.  This is easily prevented by not carrying your wallet in your back pocket, and especially not sitting on it.  Also, standing for long periods at a time or carrying a heavy tool or utility belt can also cause sciatic pain.  Sometimes standing or wearing a belt will make the pain seem to come behind the knee, as the biceps femoris muscle become hypercontracted and traps the sciatic nerve in the thigh.  These are the most preventable forms of sciatic pain, as they can be mitigated by behavioral changes.

So I’ll just say this to my male readers:  STOP WEARING YOUR WALLET IN YOUR BACK POCKET!  There, I feel better already.

Next up, Piriformis Syndrome.  About 15 percent of the population has a sciatic nerve that runs through the piriformis muscle instead of beneath it.  These people are more likely to get sciatic pain because the muscle surrounds the nerve instead of sits atop it.  In these cases, release the tension in the piriformis muscle can be very helpful it managing the likelihood of sciatic pain.  And for them, it’s even more important to not wear a wallet in the back pocket.

If we look at the drawing to the right, we can see the piriformis in relation to the other deep muscles in the buttock.  Which the piriformis, which means pear-shaped in Latin, is the most important muscle relating to sciatic pain, the other lateral hip rotators – the deep six, as they are sometimes called, can also be implicated in sciatic pain.  These small but mighty muscles can become very tight and make it difficult for the sciatic nerve to glide along its pathway during movement.

When a spinal disc is compressed or herniated, the material that makes up the disc can bulge out and compress on the root of the nerve, which can send pain shooting down the nerve.  Twisting while bending and lifting is a common way to injure vertebral discs, so it’s critically important to be mindful of how we lift or otherwise use our backs.  Also, losing weight if one is overweight will put less compressive force on the spinal discs and will help to relieve the potential for sciatic pain.

Trigger points, which you might think of as knots in the muscles, in the low back and deep hip muscles like the quadratus lumborum in the back, the piriformis or gluteus minimus muscles in the hips can cause sciatic nerve pain because of how they distort the surrounding tissues – the QL muscle attaches to the top of the hip, the lumbar vertebrae, and the floating rib, and when it’s tight, it can cause the vertebrae to be compressed to the side of that muscle, which in turn can cause impingement of the sciatic nerve.  The piriformis or gluteus minimus muscles can also cause the nerve to compress, referring pain in the buttocks and down the leg.

In each of these situations, receiving deep, focused massage can help manage and even eliminate signs and symptoms of sciatic pain.  When muscles are relaxed and at their full resting length, greater space is opened up for the sciatic nerve to reside and the nerve can be untrapped and unimpinged, which in turn will allow for any inflammation of the nerve or its sheath to be relieved.

You don’t have to be in pain!

I am very experienced in relieving sciatic pain, and have developed through my years of practicing massage a highly effective treatment protocol for clients.  While each clients is unique, and all treatment sessions are tailored for your specific needs, knowing where to apply bodywork brings the best result for you, the client.

Wouldn’t you rather get on with your life instead of sitting on the sidelines, trapped by sciatica?

Call me now at 916-534-8772 for my Sacramento Massage Pain Relief Center – or book online now!

Do your heels and the soles of your feet hurt when you first step on them when getting out of bed in the morning?  If so, you may have the most common form of heel pain, Plantar Fascitis.

I should note before we start that none of this is intended to be a diagnosis of plantar fascitis, and if you are experiencing heel pain, you should have your physician examine you to determine what’s going on.

What is the Plantar Fascia?

The plantar fascia (also called the plantar aponeurosis) is a thick band of connective tissue on the plantar surface (underside) of the foot.  It originates on the medial tubercle of the calcaneus bone (a particular landmark on the underside of the heel bone), and continues beneath the other bones of the foot out towards base of the toes.  The plantar fascia is made up of collagen fibers that run mostly along the length of the foot, although some move in other directions as well.  The job of the plantar fascia is to support the bones of the arch of the feet by acting as a tie-rod.  From a mechanical perspective, the plantar fascia supports up to 14% of the load the foot has to bear as we move.  So as you can see, it is one of the most important structures in our feet!

What goes wrong?

There are several reasons why plantar fascitis occurs, but a major cause is overpronation of the foot.  The foot pronates, that is, it rolls toward the center line of our body, as a normal function of our stride.  In overpronation, the foot rolls excessively inward.  You can see if you overpronate by looking at your shoes.  If the outer sole of the shoe tends to wear out near the inside of the ball of the foot, you’re probably a pronator.  If the outer edge of the sole of the shoe, you’re likely a supinator.

There is also an indirect relationship between the calcaneal (achilles) tendon and the plantar fascia, especially in adolescents and younger adults.  There are fibers of collagen that connect these two structures together, but as we age, those fibers disappear.  Nevertheless, tight calf muscles and calcaneal tendons can be a contributing factor to plantar fascitis, by providing excessive plantarflexion of the ankle and increasing tension on the plantar fascia.

Another factor in the severity of plantar fascitis is obesity.  The heavier we are, the more weight the feet have to bear, and this can cause considerably more strain on the foot and fascia than our bodies can handle.

A final factor is in wearing shoes too long after they have worn out.  Shoes that are ill-fitting or old and no longer providing the proper support for your stride type (pronator/supinator) can contribute to the symptoms of plantar fascitis.

Where does it hurt?

The classic symptom of plantar fascitis is significant heel pain upon first rising from bed – those first few steps to the bathroom in the morning.  Typically the pain decreases as the foot warms up from walking around, but often there is a low-level of pain throughout the day.  The pain tends to be most severe right at the heel bone where the fascia attaches to it, and then radiates toward the toes.

Plantar fascitis is self-limiting, meaning that it will generally go away on its own, usually in six to 18 months.

What treatment options are availble?

Physicians will generally prescribe NSAIDS (aspirin, acetomenophen, ibuprofen, etc) to alleviate the inflammation and decrease pain.  As well, they will direct the patient to stretch the calves, possibly do ice massage, and shoe inserts are sometimes also indicated.  All of these things are very useful in reducing the symptoms.

In more severe cases, night splints, casts, or even surgery are options for treatment.

However, I have found that self-care and detailed, thorough bodywork can do wonders in treating plantar fascitis.

Stretching

Two stretches are very important in reducing the pain of plantar fascitis.   The first is one you should do when you first wake up in the morning, and that is dorsiflex your ankles.  Dorsiflexion is the action performed by your shin muscles (tibialis anterior) – bring the dorsal (top) surface of your foot toward your knee.  This will stretch the achilles tendon and calf muscles (soleus and gastrocnemius muscles) and take some tension off of the plantar fascia, and it will help mitigate the pain of the first morning steps.  To do this stretch:

1. Inhale.
2. As you slowly exhale, dorsiflex your ankle by contracting the tibialis anterior.
3. Repeat several times, until you feel the calf muscles relaxing and stretching.

The other strech is another calf stretch, but this one done from a standing position:

1. Face a wall and place one foot approximately 6-8 inches from the wall, toes pointing toward the wall.
2. Place the other foot approximate two-three feet from the wall, toes pointing toward the wall.
3. Inhale.
4. As you slowly exhale, shift your weight from the back leg to the front leg.  Keep your heels planted on the ground.
5. Breathe normally, and hold this stretch for two to three minutes.  You will feel the calf muscles open up, and the tension on the calcaneal tendon relax.
6. Switch feet and repeat steps 1 – 5.
7. Repeat this stretch with the back knee bent for one round, and straightened for another round.  That way, you will target both the gastrocnemius (knee straightened) and the soleus (knee bent), and more thoroughly stretch the calves.

Ice Massage

Fill several 3 or 5 ounce paper cups with water and freeze them.  When frozen, remove a cup from the freezer and peel back an inch or so of the cup, exposing the ice.  Using the remaining cup as a handle, massage the heel and underside of the foot with the ice, in circular motions and with medium pressure, for 10 to 15 minutes.  You will have to continue to peel the paper cup back from the ice as it melts, and you’ll want a hand towel to blot the water as it melts, but this is a highly effective treatment for plantar fascitis.

You can combine ice massage and the second stretch I mentioned above:

1. Ice massage the plantar surface of the foot as directed.
2. Perform the second stretch listed above.
3. Repeat with other foot.

Another way of using ice is to soak the feet in a basin of water and ice cubes in the evening when you get home from work.  Soak the feet for 10 to 15 minutes in this icy bath and after ward, dry them off and do that stretch.

How can massage therapy help?

Highly targeted, therapeutic massage can help by relaxing and lengthening the muscles of the calves, the calcaneal tendon, as well as directly working on the plantar fascia and muscles of the underside of the foot.  This work can be very deep, but highly beneficial because through it, we can help to re-educate your legs and feet to retain their relaxed states.  Many clients see dramatic improvement in three to four weekly one-hour sessions, as the feet and legs receive detailed attention.  Pain can be reduced and eliminated with a combination of self-care and massage.

If you are experiencing the pain of plantar fascitis, massage and self-care can be a huge help!  Why not book a session with me today and get the ball rolling to a pain-free stride?

References:

1. Plantar Fascitis and Other Causes of Heel Pain: 1999 Barrett, O’Malley
2. Plantar Fascitis: Office Management: 2007 Patel, Holman
3. Treatment of Plantar Fascitis:  2001 Young, Rutherford, Niedfeldt

Repetitive motion of the hands, arms, and shoulders can lead over time to numbness, tingling, pain, and weakness in the arms and hands. These injuries are known by a collection of terms: Repetitive Stress Injury (RSI), Collective Trauma Syndromes, and by the most common term: Carpal Tunnel Syndrome.

While Carpal Tunnel Syndrome is a specific diagnosis, the term is sometimes inaccurately used to describe any RSI that affects the hands.

What is Carpal Tunnel Syndrome?

CTS is a condition where the median nerve is compressed in the wrist at the carpal tunnel. The Carpal Tunnel is the space between the flexor retinaculum, a halter of connective tissues that protects and stabilizes the tendons of the forearms flexors and blood vessels and nerves, and the small bones of the wrist, which are collectively called the carpal (scaphoid, lunate, triquetral, pisiform, trapesium, trapezoid, capitate, hamate) bones. The Carpal Tunnel is small, and when the tissues that pass through it become inflamed, that inflammation can impinge the median nerve.

Area of hand innervated by median nerve.

As seen in the photograph, the median nerve powers the lateral half of the hand. Numbness, pain, and muscle weakness can sometimes be ascribed to impingement of the median nerve in the wrist.

When the median nerve is impinged in the carpal tunnel, symptoms  can make it very difficult to have good hand function.

Other RSI Injuries

The hand can have symptoms in the other parts of the hand not innervated by the median nerve.  For instance the medial half of the hand – that is the other half of the fourth finger, the fifth finger, and the palm not powered by the median nerve – are innervated by the ulnar nerve, and the muscles that move those two fingers and help bring the pinky finger against the thumb in opposition can exhibit similar symptoms to carpal tunnel syndrome.  The difference, though, is that the ulnar nerve does not pass through the carpal tunnel, and treatment of carpal tunnel syndrome will not have an effect.  The ulnar nerve can be impinged in the wrist in the ulnar canal, or further up in the elbow at the cubital fossa.

The radial nerve innervates the forearm extensors, as well as the nerve endings in the dorsal (back) of the hand.  The radial nerve also innervates the triceps in the upper arm, so impingement in the shoulder and neck can have an effect on the functioning of the upper arm and elbow as well.

The Brachial Plexus

The brachial plexus is the bundle of nerves that emerges from the sides of the vertebra in the neck upper chest between the vertebra named C4, C5, C6, C7 in the neck, and T1 in the chest.  The nerves pass through the anterior and medial scalene muscles in the neck before passing down between the first rib and the clavicle, and from there down into the arm  The scalene muscles are often tight from holding the head forward and still for long periods of time of sitting at a computer.   This tightness can cause the first rib to pull up against the clavicle, which can impinge the brachial plexus and subclavian artery.  When these nerves and arteries are impinged, they can cause some of the pain symptoms farther down the line of the nerves.  So it’s a good idea to get the entire nerve pathway checked out when there are pain and numbness in the arm.

How can massage help?

Massage can help by creating relaxation in the muscles along the route of the nerves of the arm.  In a study by the Touch Research Institute at the University of Miami School of Medicine, researchers found that massage was able to bring a significant reduction in pain and other symptoms of carpal tunnel syndrome.  Skilled massage can bring about relief from the numbness, pain, and tingling associated with carpal tunnel syndrome and other repetitive stress injuries.

A trained massage therapist can test of various nerve entrapment locations and craft the necessary treatment plan to release the muscle tension, and free the nerve.

A client and I sat down to talk about some test results he recently received and how that would impact our work moving forward. I am concerned about doing certain kinds of spinal movement on him, and changed my strategy of today’s session as a result. One of my favorite things to do to a client is a Thai Cobra.As seen in this photo from www.teamsugar.com, the therapist kneels on the client’s hamstrings and glutes and extends the spine and shoulders. Well, I do an entire series of moves while I knee upon the client’s body like this and culminate in the cobra move. With this client, this sort of spinal extension is contraindicated for the time being.

I did some psoas release work on this client to help balance out the interplay between erector spinae and iliopsoas. I am going to have to do some work on the muscles that do ankle plantar flexion, as well as glutei minimi and more abdominal work, although I did do a decent amount of abdominal work on this client today before I did the psoas release.

The psoas and abdominal muscles are sometimes antagonists and sometimes synergists, and it’s important to keep them in balance. Having a six-pack can actually be unhealthy for a person. It’s not uncommon for people with really tight abdominal muscles and psoas muscles to be chronically constipated, as tight psoas muscles can impinge upon the lumbar plexus, which controls the intestines. As well, overtight abdominals can restrict breathing, as the ribcage is pulled down and forward, and also can cause the body to waste energy by engaging the erector spinae in having to work harder to keep the body upright to counterbalance the abdominals’ flexion motion of the spine.

As the iliopsoas muscles are rotators of the femur, the glutei minimi can also be very tight, as they are antagonists in rotation as well as synergists in hip flexion. So it’s important to get them to relax as well when doing a release of the psoas muscles.

With good attention to detail, balance can be brought to this important system, and a dramatic reduction in back pain can be introduced. The flexibility of the pelvic region cannot be stressed enough in maintaining a high quality of life as we age, and psoas release techniques, combined with work on the abdominals, glutei minini, and plantar flexors will help keep us pain free.