The Clinic
About Massage
Common Disorders
- Upper limb
- Shoulder
- Back & neck
- Pelvis & hip
- Knee
- Foot & ankle
© Donald Budge 2001
BACK & NECK
THE SPINE
The vertebral column comprises; 7 Cervical vertebrae; 12 Thoracic vertebrae; 5 Lumbar vertebrae; the Sacrum (5 fused vertebrae) and the coccyx (4 vertebrae fused in 2 pairs). Back pain is probably one of the most common complaints suffered by the general population. Lower Back pain, followed by neck pain are reported more often than in the thoracic area. In the majority of cases, pain is caused by musculo-skeletal disorders which can be treated successfully with Remedial Massage Therapy, Manipulative Therapy, Osteopathy or Chiropractic techniques depending on their severity or complexity. In all cases it is essential that the vertebral column is supported on a level, mobile and correctly aligned pelvic girdle. (See disorders of the Pelvis and Hip.)
LOWER BACK DISORDERS
The majority of lower back pain is commonly referred from only 5 muscle groups - piriformis , psoas, quadratus lumborum, gluteus minimus and medius (including tensor fascia lata) and the hamstrings (including gluteus maximus). Remedial Massage Techniques help to accelerate the body's own responses to restore correct muscle balance. In some cases Manipulative Therapy may be required to correct a vertebral dysfunction. This should always be followed up with a series of soft tissue treatments to avoid any re-occurrence. Maintaining muscle balance will help prevent further lower back musculo-skeletal disorders. Posture, activities involving lifting heavy loads, twisting whilst seated or even sleeping can bring about lumbar dysfunction and back pain. Strengthening of the back and trunk muscles will help prevent it. Other causes of lower back pain include; Spondylosis (disc degeneration), osteoporosis, spondylolisthesis and sciatica.
OSTEOPEROSIS.
Refers to a condition where there is a reduction of bone density. This does not bring about pain on its own, but associated fractures or the collapse of vertebrae can bring about considerable pain as will resulting muscle spasm. Mobilisation techniques, muscle spasm release and exercises to increase bone density is recommended. Care should be taken to avoid over-doing the treatment or exercises to cause a fracture
SPONDYLOSIS.
The discs which separate each vertebrae consist of a fluid filled nucleus surrounded by semi-elastic rings of cartilage consisting of collagen fibres. These discs act as shock absorbers and allow for multi-directional movement of the spinal column. Since the discs have no direct blood supply, they receive nutrition and excrete metabolic wastes by a process known as osmosis and diffusion. Movement is essential to aid diffusion and if these processes are hindered the discs will degenerate. Mobility is essential otherwise nerve entrapment and pain may follow.
SPONDYLITIS
This condition refers to a non-specific inflammatory condition which affects joint capsules , ligaments, intrinsic muscles and all other tissue around the joint. Discomfort, pain and stiffness may decrease mobility. It is essential that mobility is maintained through exercise and therapy otherwise other more serious disorders can develop, including deformity.
SPONDYLOLISTHESIS
This condition refers to a sliding of one vertebra, usually forward, upon the one below. It is an injury typically involving sport or work which involves a "snatch" type of movement. These are graded 1-5. Grades 1-2 can be treated using Advanced Remedial Therapy, but Grades 3-5 are contra-indicated.
SCIATICA
True sciatica refers to pain felt down the back and outer side of the thigh, calf and foot caused by compression of the lumbar spinal or upper sacral nerve roots. However, in the majority of cases, the sciatic nerve may be entrapped beyond the sacral plexus and can in most cases be treated successfully using Remedial Massage Techniques.
LIGAMENT STRAIN
Ligaments connect bone to bone, stabilise and limit joint movement. Hyper-flexion, extension or rotation can overload the ligaments and cause tearing of the fibres. In the lower back, strain in the ilio-lumbar ligament caused by twisting is not uncommon. Treatment will consist of muscle spasm relief, incremental mobilisation and rest.
THE THORACIC SPINE
A pair of ribs are attached to each vertebrae and limit movement and consequently provides some protection against dysfunction. Disc problems are rare in the thoracic region. Disorders are usually associated with vertebrae becoming "stuck" and immobile or ribs being displaced. Symptoms of thoracic vertebrae lesions would include pain, either locally or referred, restricted movement in one direction, or a deviation or flattening of the "normal curvature" of the spine. Disorders associated with the ribs usually indicate pain or discomfort during breathing. A cough or a sneeze can displace a rib and initiate muscle spasm. In many cases, Remedial Massage Therapy, to reduce muscle spasm and increase mobilisation, can be successful. However, Manipulative Therapy, Osteopathy or Chiropractic may be required in difficult cases. Some complex disorders involve the vertebrae at the junctions between the thoracic and the lumbar spine and thoracic and cervical spine (neck). It is worthy to note that the nerves supplying the internal organs exit from the thoracic spine. It is therefore advisable to ensure that mobility in the thoracic spine is maintained to minimise impingement of those nerves.
THE CERVICAL SPINE - the neck
Common disorders of the neck include stiffness, muscle tension and consequential headaches, Osteoarthritis in later years, spondylitis and dysfunction as a result of injury.
STIFF NECK and MUSCLE TENSION
Mobility of the cervical spine will help prevent many problems. Each vertebrae may become displaced relative to the other causing muscle imbalance between the vertebrae and restricted movement. Bad posture, pillows or a bad twist may induce this condition. Other larger muscles of the neck and shoulders may become involved and pull on the cranium causing headaches or migraine. Remedial Massage techniques can be employed to increase and maintain neck mobility. In some more stubborn cases of vertebral misalignment, Manipulative Therapy, Osteopathy or Chiropractic may be used, except on cases where osteoarthritis may be indicated.
OSTEOARTHRITIS
Osteoarthitis refers to the effect of wear and tear on the joints. Stiffness occurs and small outgrowths of bone, called osteophytes, develop. The vertebral arteries pass vertically through the cervical vertebrae to supply the brain. If strong manipulation is used these osteophytes may lacerate the arteries. Strong extension and flexion should also be avoided. Great care should therefore be taken with elderly patients. If prolonged extension causes dizziness or nausea, then the formation of osteophytes may be indicated. It is therefore important that osteoarthritic necks maintain good mobility.
WHIPLASH
Caused be hyper-extension of the neck due to sudden violent accelerations from behind. Damage to the structure and curvature of the neck can result coupled with overstretching of the major neck muscles. The jaw can also be effected. Treatment may be limited to rest and gentle massage until the acute period is passed. Mobilisation and massage can be increased as recovery permits.
WRY NECK (Torticollis)
Refers to a condition where the sterno-cleido-mastoid muscle is in spasm and the head is drawn forward towards the shoulder and rotated in the opposite direction. This condition may result from whiplash, repetitive strain injury or sleeping in a draft. Treatment involves reducing the muscle spasm and stretching.
ANTERIOR SCALENE SYNDROME
The symptoms of this condition include "pins and needles" tingling of the hands and fingers, clumsiness of movement and weakness. Sometimes there will be an ache in the hand and arm and may be worse at night. Treatment will involve "stripping out" the scalenes and/or ultrasound.