Sciatica is not a condition as such, but a symptom which can be caused by numerous conditions. The common sciatica symptoms involve pain that starts in the back and radiates down one (or both) of the legs. It is quite a common complaint and sciatica pain is caused by pressure on the sciatic nerve which runs down into the leg. The medical term is acute nerve root compression or radiculopathy.

The cause of pressure can be varied from a slipped disc (also known as a herniated or prolapsed disc), disc degeneration to muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths (stenosis) and infections.

A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has ‘slipped’ out of place. Intervertebral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.

They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting. However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.

The intervertebral discs are filled with a gelantinous substance in the middle called nucleus pulposus and when a disc prolapses this jelly-like centre squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.

Depending on where the sciatic nerve is pinched will determine where you feel the pain which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged. On the illustration below, L4 and L5 are the bottom two Lumbar vertebrae at the base of the spine. S1 is the top of the Sacrum.

Sciatica Symptoms

• Acute low back pain (not always present, especially in piriformis syndrome)
• Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness
• Sciatica pain is often triggered by a minor movement such bending over to pick something up
• Pain may be worse by sitting, lifting, coughing or sneezing
• Pain is usually relieved by lying down, often on one side
• Pain is often better in the morning after a nights rest
• There may be muscle spasm in the lower back
• Tenderness in the lower back when pressing in
• Pain on the straight leg raise test which is not apparent when just stretching the hamstring only

Causes of Sciatica

Lumbar herniated disc
A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) of the disc and irritates the contiguous nerve root as it exits the spine. In general, it is thought that a sudden twisting motion or injury can lead to an eventual disc herniation and sciatica. However, most discs weaken over time due to repetitive stress, eventually resulting in herniation. A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve, and sciatica is the most common symptom of a lumbar herniated disc.

Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Spinal stenosis. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots as they exit the spine, causing sciatica pain.

Degenerative disc disease
While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the area (including the nerve roots). This is truly not a disease despite its name, it is part of the natural aging process.

Isthmic spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another vertebral body (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched as it exits the spine and cause sciatica.

Piriformis syndrome
The sciatic nerve can also get irritated as it runs under the piriformis muscle in the rear. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.

Sacroiliac joint dysfunction
Irritation of the sacroiliac joint – located at the bottom of the spine – can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain. The leg pain can feel the same as sciatica caused by a nerve irritation.

Pregnancy
The changes that the body goes through during pregnancy, including weight gain, a shift on one’s center of gravity, and hormonal changes, can cause sciatica during pregnancy.

Scar Tissue
If scar tissue compresses the nerve root, it can cause sciatica.

Muscle Strain
In some cases, inflammation related to a muscle strain can put pressure on a nerve root and cause sciatica.

Spinal Tumor
In rare cases, a spinal tumor can impinge on a nerve root in the lower back and cause sciatica symptoms.

Infection
While rare, an infection that occurs in the low back can affect the nerve root and cause sciatica.

It is important to know the underlying clinical diagnosis of the cause of sciatica, as treatments will often differ depending on the cause.

Sciatica Treatment

For severe or ongoing flare-ups of sciatic nerve pain, the condition may need to be treated so that it does not get worse over time.

• For most, readily available nonsurgical remedies and regular exercise will go a long way to relieving their pain.
• For others, when the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may offer the best approach to finding pain relief and preventing or minimizing future flare-ups of sciatica.

Non-Surgical Treatment for Sciatica

Non-surgical sciatica treatments encompass a broad range of options, with the goal of relieving pain caused by compressed nerve roots. One or some combination of the treatments below are usually recommended in conjunction with a specific exercise program.

Heat/Ice
For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated.

Sciatica Pain Medications
Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can be helpful in reducing the inflammation that is usually a contributing factor in causing sciatica pain.

Epidural Steroid Injections for Sciatica
If the sciatica pain is severe, an epidural steroid injection can be performed to reduce the inflammation. An epidural injection is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), and it does not work for everyone, an epidural steroid injection can be effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.

Chiropractic/Manual Manipulation
Spinal adjustments and manual manipulation performed by appropriately trained health professionals (such as chiropractors, osteopathic physicians, physical therapists) are focused on providing better spinal column alignment, which in turn should help to address a number of underlying conditions that can cause sciatic nerve pain. Manual manipulation done to address the right indications by appropriately trained health professionals can create a better healing environment and should not be painful.

Acupuncture
The practice is centered on the philosophy of achieving or maintaining well being through the open flow of energy via specific pathways in the body. Hair-thin needles (that are usually not felt) are inserted into the skin near the area of pain. Acupuncture has been approved by the U.S. FDA as a treatment for back pain, and the National Institutes of Health recognized acupuncture as effective in relieving back pain, including sciatica.

Massage Therapy
Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers).

For most people, the good news is that sciatica usually will get better on its own, and the healing process for most will only take a few days or weeks. Overall, the vast majority of episodes of sciatica pain heal within a six to twelve week time span. Following initial pain relief, a program of sciatica physical therapy and exercise should usually be pursued in order to alleviate pain and prevent or minimize any ongoing sciatic pain.

There are a number of types of non-surgical spine care professionals who specialize in treating sciatica symptoms, including chiropractors, physiatrists (physical medicine and rehabilitation specialists), pain medicine specialists, and physical therapists, all of whom have specialized training to provide pain relief and to help prevent future recurrences of sciatica. It is always advisable to have a qualified medical professional oversee any type of sciatica treatment.

Back Pain and Massage - 

Karrie Osborn

Whether it’s a pulled a muscle from yoga class or an afternoon basketball game, or a long-term pain caused by injury,most of us will come to know the beast that is called back pain. In fact, when it comes to low-back pain specifically, researchers say that 70-85 percent of the population will experience it at some point in their lives.

Causes of Pain

Experts say the cause of back pain can be the result of several factors. High on the list is stress. When our body is stressed, we literally begin to pull inward: the shoulders roll forward and move up to the ears, the neck disappears, and the back tightens in the new posture. “It’s an armoring effect,” says Angie Parris-Raney, a Denver-based massage therapist who specializes in deep-tissue massage and sports therapy. “That protective mode, with the muscles in flex, can even result in visceral problems,” she says, where the pain also affects internal organs.

In addition to stress, poor posture, bad ergonomics, lack of exercise, arthritis, osteoporosis, a sedentary lifestyle, overexertion, pregnancy, kidney stones, fibromyalgia, excess weight, and more can contribute to pain.

Geoffrey Bishop, owner of Stay Tuned Therapeutics in Flagstaff, Arizona, says mechanics is the main cause of back pain that he sees in his practice. “It’s mechanics, including repetitive use and ignorance about preventative postures, and neglect by employers and employees to provide rest and recovery.” The past also plays a part, he says. “Old injuries and traumatic events, left untreated and unresolved, seem to dictate where stress lands in the back as well.”

Massage Offers Hope

Those who suffer with back pain know there are no easy answers for chasing the pain away. Physical therapy has proven effective for some sufferers, as has chiropractic and acupuncture, but massage therapy is also making a name for itself when it comes to providing relief. In fact, research has shown that massage can be a great friend to the back-pain sufferer.

“Massage therapists have long treated low-back pain safely and effectively,” says Les Sweeney, president of Associated Bodywork & Massage Professionals. “They have done so less expensively and less invasively than is possible with other treatments.”

In fact, a study by the Group Health Research Institute in Seattle found that massage was more effective at treating low-back pain than medication. Patients who received massage once a week for 10 weeks were more likely to report that their back pain had improved, and improvements were still present six months after the study. Other research from the University of Miami School of Medicine and the Touch Research Institute showed that massage can decrease stress and long-term pain, improve sleep and range of motion, and help lower the incidence of depression and anxiety that often accompanies back pain.

For Parris-Raney’s clients, the length of pain relief provided by massage therapy varies depending on the condition they are experiencing. Getting on a regular massage schedule, however, has really helped her clients manage the back pain, she says. When they go past their normally scheduled appointment, “their bodies know it’s time to get a massage again.” Whether it’s just helping clients get through the day, or reminding the stressed-out office worker to breathe, Parris-Raney says massage can play an important part in back pain relief.

Whitney Lowe, owner of Oregon’s Orthopedic Massage Education & Research Institute, says the benefits of massage for back pain depend on the primary cause of the pain. “If it is predominantly muscular pain, then massage has a great deal to offer in reducing pain associated with chronic muscle tightness, spasms, myofascial trigger points, or those types of problems. If it’s something caused by a joint alignment problem or compression on a nerve, for example, then the role of massage might be somewhat different, such as helping to address the biomechanical dysfunctions, but not really being able to get pressure off the nerve itself.”

Massage Works

When it comes to back pain, there are a lot of options out there. Ultimately, massage, and its myriad benefits, might be a viable answer. For back pain sufferers, Parris-Raney says massage can work wonders. “Massage can help relax the body, relax the psyche, and improve a client’s range of motion and circulation to the affected tissues,” she says. Not only can massage help directly with the pain, but it can also make life a little easier, too. “Massage lets you tap into the parasympathetic system,” she says, “and tap into all the good hormones that help you sleep better and help you handle stressors along the way.” All of that helps in building a healthier back and a happier you.

Benefits of Massage

From stress relief to skin rejuvenation, the benefits of massage are extensive. When it comes to managing back pain, however, there are some specific benefits touch therapy can offer:

–Improved circulation. With increased circulation comes faster recovery time for sore, overworked muscle tissues.
–Increased release of endorphins. The prevalence of these natural painkillers is boosted every time you have a massage. This can only help in managing pain.
–Improved movement. Range of motion and flexibility both get a boost with massage.
–Increased relaxation. When you relax, your muscles relax, thereby calming the pain.

Nicholas Bakalar for  The New York Times, Feb 6th 2012

A massage after vigorous exercise unquestionably feels good, and it seems to reduce pain and help muscles recover. Many people — both athletes and health professionals – have long contended it eases inflammation, improves blood flow and reduces muscle tightness. But until now no one has understood why massage has this apparently beneficial effect.

Now researchers have found what happens to muscles when a masseur goes to work on them.

Their experiment required having people exercise to exhaustion and undergo five incisions in their legs in order to obtain muscle tissue for analysis. Despite the hurdles, the scientists still managed to find 11 brave young male volunteers. The study was published in the Feb. 1 issue of Science Translational Medicine.

On a first visit, they biopsied one leg of each subject at rest. At a second session, they had them vigorously exercise on a stationary bicycle for more than an hour until they could go no further. Then they massaged one thigh of each subject for 10 minutes, leaving the other to recover on its own. Immediately after the massage, they biopsied the thigh muscle in each leg again. After allowing another two-and-a-half hours of rest, they did a third biopsy to track the process of muscle injury and repair.

Vigorous exercise causes tiny tears in muscle fibers, leading to an immune reaction — inflammation — as the body gets to work repairing the injured cells. So the researchers screened the tissue from the massaged and unmassaged legs to compare their repair processes, and find out what difference massage would make.

They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.

Dr. Tarnopolsky, a professor of pediatrics and medicine at McMaster University in Hamilton, Ontario, said that massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. Many people, for instance, pop an aspirin or Aleve at the first sign of muscle soreness. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.”

“This is important research, because it is the first to show that massage can reduce pro-inflammatory cytokines which may be involved in pain,” said Tiffany Field, director of the Touch Research Institute at the University of Miami Medical School. She was not involved in the study. “We have known from many studies that pain can be reduced by massage based on self-report, but this is the first demonstration that the pain-related pro-inflammatory cytokines can be reduced.” she said.

Getting a massage from a professional masseur is obviously more expensive than taking an aspirin. But, as Dr. Field points out, massage techniques can be taught. “People within families can learn to massage each other,” she said. “If you can teach parents to massage kids, couples to massage each other. This can be cost effective.”

Dr. Tarnopolsky suggests that, in the long run, a professional massage may even be a better bargain than a pill. “If someone says “This is free and it might make you feel better, but it may slow down your recovery, do you still want it?” he asked. “Or would you rather spend the 50 bucks for a post-exercise massage that also might enhance your recovery?”

Here is a list of the most common running injuries ranging from knee pain, upper leg injuries, lower leg injuries, foot, ankle and heel and hip injury. Each person reacts to the same type of shoes, running surface and other variables differently. Therefore, each is required a different course of treatment and the length of time for recovery will vary as well. When confronted with an injury, it is always better to take a conservative approach towards managing and treating it. After all, we would rather be not running for a few days than a few weeks, or even months.

Knee Pain

Runner’s Knee

Pain around and sometimes behind the knee cap. You knee moves up and down inside a nifty design in your thigh bone. When your legs are working efficiently, your knee moves inside this track smoothly. But when the knee cap moves out of its track or rubs against its sides, every step transforms into pain. Your thigh muscle holds your knee cap in place. When your thigh muscle is weak, it causes the knee cap to move out of place. Running tends to work on the muscle on the back of your legs (hamstring) rather than that in the front (quadriceps). Your hamstring is probably stronger than your quadriceps muscle and therefore results in an imbalance. Runner’s knee is sometimes aggravated by overuse. If you suspect runner’s knee is your problem, try taking a few days off and rest and ice the knee. You can use a commercially available ice pack or put a wet towel in the freezer and wrap it around your knee. If you choose to continue running, reduce your mileage and back off from hill work and speed work. Avoid running on banked surface which effectively has you running with a longer leg and puts additional stress on your knees. Try incorporating some grass or trail in your route since they absorb shocks better and thus reduce shocks to your knees. When you finish running, ice your knee immediately for 15 minutes to reduce the inflammation and lessen the pain. Continue icing for a few weeks after your pain has gone away. Stretching your quadriceps will help relax it and prevent your runner’s knee from returning. It is also advisable that you go see a podiatrist who can evaluate whether your foot is giving proper support to your knee. He may suggest orthotics or shoe insoles designed for athlete to correct the problem. The good news is that this is a highly treatable injury with some patience so don’t rush through the recovery process.

Illiotibial Band Syndrome (IT Band Syndrome)

Pain on the outside of the knee. This is primarily an overuse injury. The IT band is a band of tissue that starts from the outside of your hip all the way down to the outside of your knee. Overtraining can put stress on this band of tissue and shorten it. It then starts to rub against the outside of the knee and causes pain. This injury could take some time to heal ranging from days to months. Since overuse is the main culprit, it is a good idea to reduce your mileage. Ice the affected area frequently and immediately after your run. Try working on your hip by doing leg raises exercise and IT band stretch. Some runners can also benefit from some deep tissue massage.

Patellar tendonitis (pain below the knee)

This is an overuse injury that affects the tendon connecting your kneecap (patella) to your shin bone (tibia). The patellar tendon plays a pivotal role in the way you use your legs. It helps your muscles extend your lower leg so you can kick a ball, push the pedals on your bicycle and jump up in the air. Patellar tendonitis occurs when you place repeated stress on your patellar tendon, often when you suddenly increase the intensity or frequency of your workouts. Stress causes tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, your body can’t keep up, causing the inflammation in your tendon to worsen. Pain may be infrequent at first, but with continued stress and damage to the patellar tendon, the pain of patellar tendonitis can become a constant ache. Treating this injury could take some time. Icing the affected area is always helpful. You may find that you need to stop running. When you resume running, try using a knee strap that wraps around your leg just below the knee to redistribute force to the strap rather than to the knee. Weak thigh muscle also contributes to this injury. Try the quadriceps stretch to loosen this muscle.

Quadriceps tendonitis (pain above the knee)

This injury is similar to patellar tendonitis except that it affects the tendon connecting your kneecap (patella) to your thigh bone (femur). Generally, following the same treatment plan for patellar tendonitis in addition to rest and ice will usually help ease the pain.

Upper Leg Injuries

Hamstring pull

This is a stretching or tearing of the hamstring muscles, which are located at the back of your thigh. A hamstring injury occurs when muscle is torn due to injury or when it’s stretched too far. Hamstring injuries are common in such sports as running, water skiing and cheerleading. This injury could also be a result of overuse. You might have extending it too far or too much such as doing too much interval training or running downhill. The good news is that this is an easily treatable injury. In fact, you may find that you can continue to run. Ice the hamstring after each run and ease into your run slowly and take shorter steps. Try not to run on banked surface which effectively gives you one long leg and one short leg. Doing hamstring stretch will also help relax and loosen the hamstring as well.

Quadriceps pull

A strain to the quadriceps muscle will result in a dull ache while a tear will give you an intense pain. This is almost always as a result of the muscle imbalance between your hamstring and your quadriceps. Running tends to work the hamstring muscle and therefore overpower the quadriceps muscle. Fortunately, this is an injury that is rather easy to deal with. You may be able to continue running, just have to take it easy. Ice the affected area after each run and do the quadriceps stretchto help relax the muscle. Be careful to ease into the stretch and not force it.

Lower Leg Injuries

Shin splint

Anterior shin splint is pain in the front and outside of your leg. Posterior shin splint is pain in the front and inside of your leg. Shin splint is most likely caused by tight calf muscles. You may feel pain when you point your toes down. It is further aggravated by running on hard surface or not wearing shoes with sufficient cushion. You may need to cut back your mileage significantly or stop running all together for a few days. In the mean time, ice the shin a few times a day. If you have severe pain on your shin, it is a good idea to obtain an x-ray from your doctor. It will reveal whether you have a stress fracture on your shin bone (tibia). A stress fracture is a small tear in your tibia. This tear may be small, but it will force you to stop running for at least a few weeks until the bone starts to heal. This is a serious injury so go to your doctor immediately if you suspect you have a stress fracture. Doing calf stretches will help relax the muscle and reduce the risk of future injury of the shin.

Achilles tendonitis

Pain on the achilles tendon that connects the calf and the heel. The tendon is inflammed probably due to overuse, overtraining or to much hill work. Having tight calf muscle puts additional work on the tendon and stretches it too much. To relieve the pain, ice the area a few times a day but especially after running. Lifting your heel towards your calf will shorten the tendon and avoid stretching it too much. You could also try heel inserts inside your shoes to lift the heels. This injury will probably force you to stop running for at least a few days to a few weeks. During this time, try to avoid stretching the tendon. When you return to running, slowly return to your normal intensity and mileage and try not to run on soft surface to further sink in your heel. After running, gently stretch your calf and hamstring to relax these muscles to prevent future injury.

Foot, Ankle and Heel

Ankle sprain

This injury usually happens when you step into a hole or running on uneven surface. You twisted your ankle and pain is shooting up your ankle and lower leg. When this occurs, you should stop running immediately until the pain goes away and this may take a few minutes. When you resume running, start slowing and pay attention to see if any pain is still there. If it dissipated, then it is probably okay to continue your run. Otherwise, you should stop immediately. Regardless, it is always a good idea to ice the ankle to reduce any possible inflammation. If there is no swelling or pain the next day, you probably only had a mild sprain. If you notice swelling or have pain, there is a chance that you might have sprained your ankle, or worse yet, broken it.

Plantar fasciitis

This is sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe, after long periods of standing or after getting up from a seated position. There are a number of possible causes for plantar fasciitis and they often work in combination. Tightness of the foot and calf, improper athletic training, stress on the arch or weakness of the foot are potential causes. Shoes that don’t fit, certain play or work actions or overuse (running too fast, too far, too soon) may hurt the plantar fascia. People with flat feet are at increased risk of developing plantar fasciitis. You may need to reduce your mileage so as to not further aggravating the pain. To give your arch some support, try arch taping. You can also try buying shoe insoles that provide arch support. Icing the affected area after each run will also help ease the pain. Make sure you stretch your calf before and after each run.

Heel spur

Heel spur has very similar symptoms as plantar fasciitis. However, pain in a heel spur injury is in the front of the heel and possible in the arch. Heel spur develops as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches can also develop heel spur. Women have a significantly higher incidence of heel spur due to the types of footwear often worn on a regular basis. You may ice the area after each run and try arch taping to give the arch some support. You can also try wearing heel pads in your shoes to give your heels some cushion. If pain persists, you should consult a podiatrist who can often treat heel spur effectively. Running with heel spur will only make it worse.

Hip and Back

Sciatica

The sciatic nerve is the longest nerve in the body. It runs from the pelvis through the buttock and hip area and down the back of each leg. It controls many of the muscles in the lower legs and provides feeling to your thighs, legs and feet. The term “sciatica” refers to pain that radiates along the path of this nerve — from your back into your buttock and leg. Sciatica isn’t a disorder in and of itself. Instead, it’s a symptom of another problem involving the nerve, such as a herniated disk. When the sciatic nerve is pinched, you could feel numbness all the way down the back of your leg. The pain can range from mild to severe. You usually can continue running if there is only mild pain and the pain will usually go away within a few weeks. If the pain is severe enough, you may need to stop running and consult a physician since sciatica could be symptom for more serious spine conditions.

Piriformis syndrome

The piriformis muscle is a small muscle in the groin that runs from the sacrum to the outer hip bone. If the piriformis muscle becomes tight or cramps it can put pressure on the sciatic nerve which passes underneath the piriformis muscle. Typically this pain increases when the muscle contracts, when sitting for an extended time, or direct pressure on the muscle. Pain in the buttock is also common. Piriformis syndrome is also a common cause of sciatica. Icing the affected area will help ease the pain. Try hamstring stretch and piriformis stretch to relax the muscle.

Pain on outside of the hip

The pain is usually at the hip joint. This is a basic overuse injury that is causing inflammation to the hip muscle or the fiber inside the joint. The cause of this injury varies from leg length discrepancy, running surface or an uneven pelvis. If the pain stays in the hip and is mild, you could try taking shorter strides, wearing more cushioned shoes or change your running surface to incorporate some softer surface. If the pain persists or gets worse, you should consult a doctor since it could indicate more serious lower back or spine conditions.

Have you ever felt the excruciating pain of a frozen shoulder? It is a very frustrating condition and can be very confusing to understand what it is and how to treat it. I would like to shed some light on this, or rather, hack at it with an ice pick for some better understanding. Curl up with your laptop and enjoy some dense reading…

Adhesive Capsulitis, or frozen shoulder, is a painful condition that results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury.  Intermittent periods of use may cause inflammation and adhesions to grow between the joint surfaces, thus restricting motion. There is also a lack of synovial fluid to lubricate the gap between the arm bone and socket that normally helps the shoulder joint to move. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from the less complicated condition known as stiff shoulder.
Anatomy

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). The shoulder joint capsule is a loose bag of tissue that completely surrounds the shoulder joint. The joint capsule is made up of ligaments that form this watertight bag. A ligament is a soft tissue structure made up of connective tissue. Ligaments attach bones to bones. Inside the bag there is a small amount of joint fluid that lubricates the joint surfaces. This bag that makes up the joint capsule has a considerable amount of slack, loose tissue, so that the shoulder is unrestricted as it moves through its rather large range of motion.

Causes

The cause of this condition is largely a mystery. One theory is that the condition may be due to an autoimmune reaction. During an autoimmune reaction the body’s defense system that normally protects it from infection, mistakenly begins to attack parts of the body itself. The body thinks that the tissue it is attacking is foreign material. This causes an intense inflammatory reaction to the tissue that is under attack. The shoulder actually “freezes up” due to the severe inflammation of the joint capsule. The loose tissue of the joint capsule that usually allows a great deal of motion at the shoulder sticks together, limiting the motion. Why this should occur all of a sudden is a mystery.

Adhesive capsulitis may begin following other injuries where the shoulder is not moved around normally because of the other injury. A common example is after a wrist fracture, where the arm may be kept in a sling for several weeks. For some reason, this seems to start the process in some people. The condition has also been known to occur after surgical procedures for something unrelated to the shoulder and even after recovering from a heart attack.

The condition can begin while other shoulder problems are present. Sometimes, problems such as bursitis, impingement syndrome, or a partial rotator cuff tear can lead to a frozen shoulder as well. The pain from the first condition may cause you to decrease the use of the shoulder, and the underlying condition itself may lead to chronic inflammation. These two things combine to make a dangerous situation to develop adhesive capsulitis. Usually, the adhesive capsulitis must be treated first to regain motion in the shoulder before the underlying problem can be addressed.

Symptoms

The symptoms are primarily pain and a very reduced range of motion in the joint. The range of motion is the same whether your are trying to move the shoulder under your own power or if someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.

Diagnosis

The diagnosis of adhesive capsulitis is usually made on the history and physical examination. One key finding that can help differentiate adhesive capsulitis from a rotator cuff tear is how the shoulder moves. In adhesive capsulitis the shoulder motion is the same, whether the patient or the doctor tries to move the arm. In a rotator cuff tear, the patient cannot move the arm, but when someone else lifts the arm it can be moved in a nearly normal range of motion. X-rays are usually not helpful. An arthrogram may show that the shoulder capsule is scarred and contracted. This test is done by injecting dye into the shoulder joint and taking several X-rays. When this is done in the shoulder with adhesive capsulitis the first thing the radiologist will notice is that not much dye can be injected into the shoulder joint – the capsule of the joint is contracted and, thus, smaller than normal. The X-rays taken after injecting the dye will show very little dye in the joint.

As the motion increases in the shoulder, your doctor may suggest tests that look for an underlying condition, such as impingement, or a rotator cuff tear that may have initiated the condition. Probably the most common test used is the MRI scan. A MRI scan is a special radiological test where magnetic waves are used to create pictures that look like slices of the shoulder. The MRI scan shows more than the bones of the shoulder. It can show the tendons as well, and whether there has been a tear in those tendons.

Treatment

Treatment of the frozen shoulder can be frustrating and slow. Most cases will eventually improve, but it may be a process that takes months. Initial treatment is directed at decreasing inflammation and increasing the range of motion of the shoulder with a stretching program. Anti-inflammatory medications may be prescribed. It is critical that a Physical Therapy program be started and continued to regain the loss of motion.

An injection of cortisone and long-acting anesthetic, similar to novocaine, may bring the inflammation under better control, and allow the stretching program to be more effective. In some cases, injecting a long acting anesthetic along with the cortisone right before a stretching session with the Physical Therapist can allow the therapist to break up the adhesions while the shoulder is numb from the anesthetic.

If progress is slow, your doctor may recommend a manipulation of the shoulder while you are under anesthesia. This procedure allows your doctor to stretch the shoulder joint capsule, and break up the scar tissue while you are asleep. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course. It may be necessary to repeat this procedure several times.

Bodywork as a Key Therapy

by Cathy Ulrich

Jane had just been diagnosed with fibromyalgia. She was happy to have a name for the mysterious, traveling pain she had felt for some time, but she was still worried about how to deal with it. She’d done research on the Internet, but the information left her more confused. “There are so many causes and ways to treat it,” she said. “I don’t know what to do.” A friend of Jane’s recommended massage as part of her treatment plan. “She said it helped her,” Jane said, “so I’m willing to try.”

For fibromyalgia sufferers, muscle pain, tightness, and general body discomfort can all too often become a way of life. But what is fibromyalgia, and what can be done to help?

What is Fibromyalgia?

Fibromyalgia, which literally means “connective tissue muscle pain,” causes severe tenderness in multiple points throughout the body as well as persistent fatigue, morning stiffness, and non-refreshing sleep. Fibromyalgia is found in about 2 percent of the adult population, and women are five to seven times more likely to have it than men.

Theories about the cause of fibromyalgia include thyroid imbalance, sleep disorders, genetic predisposition, allergies, trauma–especially whiplash injuries–and possibly even viruses. Many who have fibromyalgia syndrome have other conditions as well, including depression, irritable bowel syndrome, chemical sensitivities, intolerance to exercise, restless legs syndrome, extreme sensitivity to cold, and seasonal affective disorder.

Factors At Play

Jay Goldstein, MD, a leading researcher and clinician, identified three common factors in people who are susceptible to fibromyalgia. It’s helpful to consider these factors when planning a treatment approach:

1. Biochemical factors, such as hormonal disturbances, allergies, frequent colds and viruses, and nutritional deficiencies.
2. Biomechanical factors, such as congenital deformities (one leg longer than the other or scoliosis, curvature of the spine) or functional conditions (poor posture, overuse syndromes, or poor breathing patterns).
3. Psychosocial factors, like depression, anxiety, or difficulty coping with stress.

Bodywork Can Help

Fibromyalgia is best treated using a multidisciplinary approach, and bodywork can be a key part of healing, recovery, and management. Depending on your specific needs, any or all of the following methods may be helpful.

Swedish MassageBecause stress is such a strong component of fibromyalgia, regular massages for relaxation and stress reduction can be beneficial to your program. Swedish massage is the foundation of training for most massage therapists. Its primary goals are to gently relieve muscle tension, improve circulation, and restore the balance between mind and body.

RolfingThis whole-body approach is designed to restore postural alignment and ease. Rolfing–and other related forms of bodywork under the umbrella of structural integration–helps to free soft tissue tightness and remove the structural imbalances that create stresses and strains on the body, restoring biomechanical function. Whiplash and other types of neck injuries are commonly seen in fibromyalgia cases. Rolfing aligns the body so the head and neck can rest more easily.

Lymphatic MassageThe lymph system is the body’s primary way of eliminating waste at the cellular level. When the lymph system is backed up, tissues can get bogged down and become irritated, inflamed, and swollen. Biochemical disturbances are a key factor in fibromyalgia, so restoring the mechanical function of the lymph system can be important. Lymphatic massage is a specific form of therapy designed to improve circulation, remove waste, and reduce swelling in the tissues. It’s often a good way to start a bodywork session.

Neuromuscular TherapyTrigger points–pivotal body points that hold and release pressure–become small areas of extreme tenderness and tightness for fibromyalgia patients. Neuromuscular therapy is a specific form of bodywork designed to free these trigger points along with the fiber in the surrounding tissues. Neuromuscular therapy encompasses many different techniques, but the system is designed to relieve the tightness in the deep soft tissues and to eliminate trigger points.

Considerations

Sensitivity to touch varies greatly for fibromyalgia patients. Some people prefer very deep work, while others are sensitive to the lightest pressure. It’s important that you establish good communications with your massage therapist so you can explain what feels comfortable to you and what doesn’t.

When you’re in an acute flare-up, limit your bodywork to more gentle techniques. When you’re feeling better, deeper work intended to eliminate trigger points or work on posture may be more appropriate. Partner with your therapist to find the best approach.

You may be sore after a session. A moderate level of soreness can be expected, but should only last about forty-eight hours as your body adapts to the changes. If it lasts longer or is more severe, bodywork may be too aggressive or the session may be too long. Start out slowly, learn what works best for you, and let your therapist increase the time or intensity as you progress.

Fibromyalgia is a soft tissue condition, and bodyworkers are experts at working with soft tissues. By including massage in your care, you can expect to manage and improve your fibromyalgia.

Understanding Whole-Body Connections

by Lori Ann Griffin

Centuries ago, Eastern cultures mapped and documented the intricate and deep relationship between the skin and the body’s organs and systems, noting that the skin displays clues as to what types of stresses or malfunctions may exist and persist internally.

Digestive System

The organs involved include the mouth, pharynx, esophagus, stomach, pancreas, intestines, gall bladder, and liver. The digestive system performs the function of nutritional uptake and absorption, and waste elimination. When this process slows, a backup occurs, which can stress all of the digestive organs.

Skin Manifestations

Externally, we may notice bloating in the stomach or abdominal region. But less obvious are signs on the chin that may show up as impactions, inflamed lesions, and abnormal capillary activity.

Eczema or related dermatitis conditions may be worsened along the high forehead and hairline. If the intestinal stress is longer term, wrinkles or lines may appear in both regions. Liver stress can produce puffiness, redness, and blackheads in the glabellar region between the eyebrows.

Reproductive System 

Another system of consistent focus is the hormonal, or reproductive, system. Organs involved in this complex tapestry include the uterus, ovaries, adrenals, and testicles, in addition to the pituitary and hypothalamus glands. Hormones are chemical messengers that have a potent effect on the body and are released into the bloodstream at fluctuating levels.

Skin Manifestations

High testosterone levels can cause or exacerbate acne lesions. This is especially true above, along, and under the jawline. Estrogen dominance often causes pigmentation in the upper lip, cheeks, and sometimes the lower forehead. Declining estrogen causes underactivity of the sebaceous glands, leading to dryness.

Immune System

This system includes the tonsils, spleen, and lymph nodes, and governs the skin’s response to invading foreign material, or perceived threats. It may respond with swelling, reddening, itching, burning, or rash, and the eyes and nose may also be watery and runny. Inflammation of the sinus passages, sore throat, sneezing, and coughing are the most common symptoms.

Skin Manifestations

Our poor eyes and upper cheeks take the brunt of this assault. Dilated capillaries, tenderness, and pressure, as well as swelling and stinging upon physical contact may also be present.

Respiratory System

The major organs involved here are the lungs and bronchial tubes. These passageways become constricted with adrenal distress and allergies, or exposure to bacteria, viruses, or smoke.

Skin Manifestations

The greater cheek area can present with breakouts, excessive capillary activity, flushing, and heat. The undereye area may exhibit half circles of gray, blue, or purplish tones.

Excretory System

The elimination system is also very important. In this system, the kidneys, bladder, colon, veins, and skin do most of the work. This fine-tuned orchestra removes bacteria, waste product, and toxic materials in an effort to protect the health and lives of our cells.

Skin Manifestations

Kidney stress may lead to hot, red, or pigmented upper ears. Bladder stress can deepen lines across the center of the forehead. And colon stress can contribute to cracked, pigmented, or dehydrated lips. The upper chin area can see an increase in micro-comedones and irritation.

Nervous System

No system will suffer more from disharmonies than our central nervous system. The vast array of nerve fibers, residing mostly along our spinal column, sends and receives signals to and from the brain. Many organs and glands are affected by stress, but the adrenals are often the first to respond.

Skin Manifestations

On the face, this may manifest as sweatiness and increased oil production over the brows and along the top bridge of the nose, with blotchy red patterns and heat on the lower neck and center of the decollete regions. Eczema is heightened around the base of the neck and may leave a long-term mask of hyperpigmentation.

Cardiovascular System

The cardiovascular system is tricky because it deals with not just the heart’s function, which is chiefly to pump blood, but also because of its connection to the circulatory system, which delivers nutrients, water, hormones, white blood cells, and oxygen to every cell in the body.

Skin Manifestations

When blood pressure levels fluctuate, blood-capillary dilation on the sides of the nose and nostrils can often be observed. Enlarged pores and hard comedones are also seen on the nostrils and tip of the nose when cardiac edemas and other cardiac diseases take hold.

Partnering for Health

Skin health can provide insight into whole-body health. Work closely with your esthetician to determine how best to treat the manifestations, and discuss prevention techniques as well. Remember, your skin care professional is not qualified to diagnose conditions, but your skin may be providing clues to what’s going on internally. And you may discover that your esthetician is an essential part of your care team.

Can Bodywork Sometimes Make You Sore?

Shirley Vanderbilt

You’ve just had a wonderful massage, and you go home feeling both relaxed and rejuvenated. But later that night you feel like you’re coming down with something. Or perhaps the next morning, you wake up with twinges of muscle soreness, maybe some fatigue, and you just don’t feel yourself. What happened? Chances are it’s the massage, and it’s perfectly OK.

Keith Grant, head of the Sports and Deep Tissue Massage Department at McKinnon Institute in Oakland, Calif., says, “It’s very much like doing a workout. If the muscles aren’t used to it, they often respond with some soreness.” Grant notes this should last for no more than a day or two. If it lasts longer, the massage may have been too intense, and the therapist should adjust for this in the next session. However, just as with exercise, when your body adjusts to having this type of workout, your physical response will also be less intense.

A professional massage is more than an ordinary backrub. Your massage therapist can find all the kinks that have built up from daily stress and too little or too much exercise. The whole point of a therapeutic massage is to release that tension, work out the kinks, and help your body relax so it can function at an optimal level. All of this work stretches muscles, pushes blood into them, and gets things working again.

A Closer Look

There are several theories, in addition to muscle function, as to why people sometimes experience after-effects from massage.

Massage can stimulate the lymph system, which is comprised of several organs (thymus, tonsils, spleen, adenoids), hundreds of lymph nodes, and a multitude of vessels that run throughout the body. These lymphatic vessels carry a clear fluid, known as lymph, that circulates around the body’s tissues, absorbing fluid, waste products, dead cells, bacteria, viruses, fats, and proteins from the tissue as it goes, while also giving passage to immune cells as they’re needed. Massage can sometimes stimulate the lymph system, helping to eliminate toxins from the body. And if the body contains a high level of environmental or dietary toxins, you could feel some mild, flu-like symptoms. While most people come out of a typical massage feeling nothing but relaxed, some people do report feeling a bit nauseous. If this is the case, make sure to drink plenty of water and perhaps take a slow walk. Movement creates a greater lymphatic response and will hurry the process along.

Grant points to another theory being closely examined by experts. Neurological sensitivity, or “sensitization,” looks at the “whole response of what’s going on in a person.” As Grant explains, massage provides a significant amount of input to the central nervous system and the body responds to that increased information. Pain and other occasional after-effects may be the result of a system that has received more information than it can handle at that particular time. And because the amount of sensory input we receive during any day or week is always fluctuating, sometimes we may be overloaded and other times not. It depends on the total stress (emotional, spiritual and physical) being experienced by the body at that moment.

Minimizing Overload

So what can you do to minimize the sometimes uncomfortable side effects? It’s important to communicate with your massage therapist regarding your expectations, as well as your current state of health. Your therapist can then tailor the massage to your personal needs and desires, and make adjustments in intensity or technique as the session proceeds. “I’d look at what’s being done,” says Grant. In some cases, a shorter or more soothing session may be more appropriate. In others, the therapist may need to change the kind of technique used. Much of this can be judged by how the person is feeling and responding during the massage.

In addition to communicating clearly with your practitioner throughout the session, following a few simple steps will help ease tenderness and maximize benefits:

- Understand that every body reacts differently: Your body is an organism made up of complex systems that react to a constantly changing influx of external factors.
-Maintain good health practices: This means keeping your mind free of negative clutter.
-Drink plenty of water immediately following your treatment: Continue to do so for the next day or two. This will rehydrate your tissues and ease the effects.
-Take it easy after your massage: Go home, relax and just allow your body to find its balance naturally.

Getting a massage can do you a world of good. And getting massage frequently can do even more. This is the beauty of bodywork. Taking part in this form of regularly scheduled self-care can play a huge part in how healthy you’ll be and how youthful you’ll remain. Budgeting time and money for bodywork at consistent intervals is an investment in your health. And remember: just because massage feels like a pampering treat doesn’t mean it is any less therapeutic. Consider massage appointments a necessary piece of your health plan, and work with your practitioner to establish a treatment schedule that best meets your needs.

Like exercise, making bodywork a habitual practice is good for your health. And if you wake up the next morning a little sore, it’s probably because you had a really good massage.

Exercise and Bodywork Keep Joint Pain at Bay

The word arthritis strikes fear in the hearts of older adults. It often signifies aging, pain, inactivity, and disability. However, new research shows moderate physical exercise can actually ease arthritis symptoms by decreasing pain and increasing a person’s likelihood of living a normal life.

Understanding Arthritis

The most common form of arthritis– osteoarthritis, or also known as degenerative arthritis–affects more than twenty million Americans. Osteoarthritis (literally meaning “bone-joint inflammation”) is caused by wear and tear on joint surfaces and most frequently involves the hips, knees, lower back, neck, and fingers. More than half of people over sixty-five have some evidence of osteoarthritis on X-rays, although it doesn’t always manifest as symptoms.

Many problems arise from a sedentary lifestyle. Joints lose flexibility and muscles lose strength, feeding the cycle of pain, inactivity, and more pain.

Exercise Offers Sweet Relief

Vigorous walking, swimming, and bicycling boost the release of powerful endorphins, the body’s natural painkillers. When done four to five days a week, these aerobic activities improve general cardiovascular health and aid in weight management (obesity is the single biggest risk factor for osteoarthritis).

Strengthening and stretching exercises targeted at maintaining joint flexibility and muscle strength–especially for at-risk joints–slow the progression of degenerative arthritis. Yoga classes and moderate weight lifting programs are excellent ways to improve strength and flexibility. Bodywork can also provide relief.

If arthritis is slowing you down, get serious with your exercise plan. Consult your physician, work with a professional trainer, physical therapist, yoga instructor, or bodyworker, and start a gentle, progressive exercise program. Your joints will reward you for it, and you’ll free yourself from arthritic pain.

by Hope Bentley

Getting rear-ended in traffic. Face-planting at the bottom of a ski slope. Tumbling over the handlebars on your bike. Whiplash comes in many forms and can become a long-term problem if not treated correctly. Fortunately, massage and bodywork can address the ache and discomfort that come with whiplash and prevent chronic pain down the road.

Understanding Whiplash

The term “whiplash” came into use in 1928. Doctors will sometimes use “hyperextension injury,” to describe it, but “whiplash” is a more visceral account of what has happened to the victim’s neck. The neck itself has made a whip-like motion bending first towards and then away from the point of impact. As the head moves rapidly in one direction, the muscles in the neck receive the message to contract. The momentum of the head can cause strain or sprain to the muscles and ligaments in the neck as the head reaches the end of its movement.

Car accidents are the most common causes of whiplash. The American Academy of Orthopedic Surgeons reported that about 20 percent of people who have been in rear-end collisions later report whiplash symptoms. Whether front to back or side to side, whiplash can affect muscles all the way into the victim’s back and arms. The most serious form of whiplash compresses nerves in the neck and cause multiple sprains of the ligaments.

The good news is, serious hyperextension injuries are in the minority, as whiplash usually comes in the less serious version of the injury. “Fortunately, about 95 percent of the time whiplash tends to be more superficial damage, like slight muscle strains and tears,” says Ben Benjamin, Ph.D., a massage therapist who holds a doctorate in education and sports medicine. But whether the pain is minor soreness or serious discomfort, massage can provide relief and prevent chronic problems in the long run.

Whiplash Symptoms

The symptoms of whiplash include neck pain and stiffness, headaches, pain in the shoulder or between the shoulder blades (sometimes called “coat hanger pain”), low back pain, and pain or numbness in the arms or extremities.

Often people who suffer whiplash do not feel the effects until two or three days after the injury-causing incident. Benjamin explains that this delayed onset is because it takes time for scar tissue to manifest in the sprained or strained muscles and ligaments. And because scar tissue is more adhesive than regular tissue, people experience it as stiffness in the injured areas.

Whiplash affects primarily the neck, but victims shouldn’t ignore the rest of the body. This injury can pull the long muscles on either side of the spine, which reach all the way to the tailbone and can cause discomfort along the way. Discomfort or stiffness in the chest and arms can also be due to whiplash. And headaches may be the result of slowed circulation to the head caused by the swelling in the injury.

Massage Can Help

Any massage that causes a general relaxation of the client’s muscles can help relieve muscular pain in common types of whiplash injuries. In addition, massage increases the amount of oxygen that reaches the healing tissues and opens those tissues so they can receive oxygen and nutrients, thus speeding the healing process.

In addition to relaxation massage, specific bodywork methods ease acute whiplash discomfort and help prevent chronic fallout. For example, myofascial approaches restore fluidity to the fascia–normally a slippery tissue that surrounds all the moving parts inside the body–allowing freer movement of muscles and ligaments. Friction-based massage helps break up scar tissue and relieve stiffness. Trigger point therapy works by releasing tension held in tight knots of muscle. And any type of bodywork that stimulates circulation helps ease and prevent headaches.

Finally, the incident that caused the whiplash in the first place, (a car wreck, for instance) can be traumatic. Massage helps relax a client’s psyche as well as their muscles, helping her or him work through the emotional issues induced by the accident.

Because the neck is such a delicate part of the body, it is important to proceed with caution. Benjamin advises waiting a few days after the accident to seek treatment. This allows the initial scar tissue to knit, which is an important part of the healing process. The initial treatment should be extremely gentle, and if there is a chance of a fracture, a concussion, any disc problem or other serious injury, the client should make sure to see a physician first.

Let the Healing Begin

It used to be that physicians would immobilize whiplash injuries with a cervical collar, but now health care professionals advise a more temperate course for their patients.

“I recommend gentle neck movement within your range of motion while lying on a pillow,” says Benjamin. Movement may help prolong the benefits of the massage by continuing to circulate blood, oxygen, and nutrients through the healing tissue. “Heat or cold, whichever feels better, can also help,” says Benjamin. “Soaking in a hot bath can also be beneficial.” Limiting physical activity for a few days and getting plenty of rest in the wake of a whiplash injury is also a good idea.

Whiplash is traumatic and should be addressed soon after the injury to avoid any chronic problems. If you or someone you love is suffering from the repercussions of whiplash, consider a bodywork session to ease the discomfort. Massage can help lessen muscle pain, induce relaxation, and ease the trauma often associated with whiplash. You’ll be back to your old self in no time.