Do you have Low Back Pain?

Sacroiliac Joint Pain Relief Through Massage

Lower back pain is a common ailment often seen by massage therapists. It can also be one of the most difficult when it comes to determining the cause. Sacroiliac joint pain is frequently the culprit, especially in women who have been pregnant, individuals who have to sit for prolonged periods of time and in those who have unequal leg lengths. Learn more about the sacroiliac joint, what causes that aching back, as well as how to ease a client's pain.

by Linda Fehrs, LMT

When a client comes in for a massage to ease lower back pain, the cause needs to be determined. Several pathologies present with similar symptoms, and careful intake - as well as postural analysis - can help narrow down the culprit. Sacroiliac joint disorder (SJD) is one of the most common causes of lower back pain and can be difficult to both diagnose and treat by healthcare professionals.

Sacroiliac Joint Anatomy and Physiology
There are two sacroiliac joints (SIJ) in the human body. They are located at the junctions where the ilium (on pelvic bone) meets the upper lateral section of the sacrum (the bottom portion of the spine). The SIJs are L-shaped joints which move together as a single unit. The sacral surface of the joint is covered with hyaline cartilage; the ilial surface has fibrocartilage. While there are no muscles attaching directly between the sacrum and the ilium, the piriformis and gluteus maximus do cross the joint and connect the sacrum to the femur. The SIJ's stability is reinforced by a combination of its shape as well as strong intrinsic and extrinsic ligaments.

Early in life, during infancy and toddler stages, the SIJs are gliding synovial joints with flat articulating surfaces. As the body ages and physical stress is placed upon them, they evolve into a more angular surface with fibrous joints. This stress is caused by walking upright and results from the torso's weight as it transfers from the upper portion of the body, through the spine, into the pelvis and lower extremities.

The joints themselves have little movement, usually less than four degrees of rotation and two millimeters of shifting. The main function of the SIJ involves weight bearing and spinal function in the central, or axial, body. It also is a vital part of the movement involved with walking.

Signs and Symptoms of SIJ Dysfunction
SIJ dysfunction is sometimes hard to distinguish from other lower back problems, including piriformis syndrome and sciatic pain. However, there are several things typically associated with SIJ problems:

• A dull, unilateral (one-sided) low back pain which worsens when rising from a seated position, or climbing stairs.

• Pain may be referred to the hip, groin or upper portion of the leg.

• Pain and stiffness of the lower back, usually on one side, increasing with prolonged sitting or walking.

What Causes SIJ Dysfunction and Pain?
Like many joints in the body, the SIJs have cartilage which allows for some movement and acts as a kind of shock absorber between the articulating bones. If the cartilage wears away or is somehow damaged, causing the bones to rub directly against each other, osteoarthritis develops and results in pain. Other conditions affecting the SIJ include:

• Pregnancy - Giving birth also has a link to SIJ disorder. The hormone, relaxin, is released during pregnancy, easing the tension in ligaments as a preparation for delivery. This, combined with the added weight and altered gait associated with pregnancy, contributes to problems with the SIJ.

• Having one leg longer than the other can cause problems with the SIJ. This condition causes an abnormal walking pattern which, in turn, increases stress on the joint. This can often be addressed by the use of orthotics (special shoes or shoe inserts prescribed by a podiatrist).

• Trauma, such as falling hard on the buttocks, can often result in SIJ dysfunction.

• Various disorders that involve joint inflammation, such as gout, rheumatoid arthritis and psoriasis may also affect the SIJ, causing pain.

• Ankylosing spondylitis, an inflammatory arthritis of the spine, affects the SIJ. In early stages it is very painful but, as the condition progresses, the SIJ fuse together, resulting in no movement and no more pain.

The pain caused by the SIJ can result in the surrounding muscles tightening, splinting and spasming in an attempt to increase stabilization. Most often the affected muscles include the piriformis, the upper gluteus maximus, the erector spinae and transversospinalis.

Diagnosing SIJ Dysfunction
Only a physician or physical therapist can definitively diagnose SIJ dysfunction. They may use a combination of intake, palpation and X-ray or computed tomography (CT) scan. Magnetic Resonance Imaging (MRI) or bone scans may also be used in certain cases where a subtle fracture or bone abnormality may be suspected.

There are some passive stretches that can be done as a preliminary assessment by a massage therapist. If pain occurs, then SIJ dysfunction is likely the culprit and a physician referral should be considered.

• Straight Leg Raise - This is performed with the client in a supine position. The practitioner assists in flexing the hip joint with the knee fully extended. This is done one leg at a time. Pain associated with SIJ dysfunction may occur on either side.

• Nachlas Test - With the client in a prone position, the client's knee is flexed and the ankle brought as close to the same-side buttocks as possible. This movement should not be forced if the client is unable to complete this assessment because of tight muscles in the thigh or hip, or if there is a significant knee injury.

• Yeoman's Test - Similar to the Nachlas test, the client is in a prone position and the knee is passively flexed. The practitioner places his or her hand under the knee and actively lifts the thigh into extension, while stabilizing the same-side PSIS.

Reducing the Discomfort of SIJ Dysfunction
SIJ dysfunction is not a condition that can be actively prevented. It occurs as a result of normal aging, pregnancy, natural misalignment or inflammatory disease. Physical therapy can help to alleviate pain through the use of stretching and exercises that increase stability of the joint.

The pain of SIJ dysfunction can be reduced through the occasional use of anti-inflammatory medication and oral steroids prescribed by a physician. In extreme cases, surgery may be advised, but has shown mixed results. The client should refrain from any activity that increases pain, including prolonged periods of sitting.

Yoga, qigong and Pilates are all good exercise systems for strengthening the muscles surrounding the SIJ and can be an adjunct to other therapies.

Massage therapy can also help to reduce the pain associated with SIJ. It is especially helpful in reducing the pain of the musculature around the joint.

Fall is upon us

This is the time of the year when we start to go inside. Our bodies want to calm down, slow down and getting a massage can be very healing. Touch can help us stay grounded and be in our bodies. We just cycled off the Summer Season. In the summer we are active and OUT there. It is only natural (by nature) that we want to come inside and contract a bit as it is Fall Season. Winter is ahead where we want to hibernate and become still in the darkest months of the year. Give yourself the gift of touch, slow down and breathe your way back into your body.

Summer is here-good health!

Everyone loves a little sunshine, outside adventure and summer days when the sun sets later in the evening; all seems to give us all more energy. Remember to hydrate, keep your blood sugar, balanced and wear sun protective clothing. Our Pets need to stay hydrated also!

Using Tiger Balm, Traumel or Salon Pas on achy muscles at the end of your day will help you feel more rested the next morning. And what could be better than relaxing in a peaceful, quiet, calm environment and getting your muscles relaxed?

Take care of yourself at least once a month by giving yourself a gift of massage, chiropractic or acupuncture; some sort of body work that allows you time to be quiet and give your self attention.

Take care of yourself and and find that balance EVERY day.

Core Strength Exercise while Healing from Surgery....

My dear friend and body worker, Christine Fazio, suggested this mindful exercise to help me heal from my pelvic surgery I had last month. My surgery was on May 10th, 2011. I am plan to be back at work, July 1st.

I have been concerned about my ability to work my full load as my work is so" physical", I need my core strength.

Here is the exercise. I am certain my belly can do this at this stage of healing, I wanted to share it with you all.

This may help with bringing your core strength back.

Have you heard of the *clock* exercise?

You can do it lying on the floor or bed with your knees up and feet on the floor. You focus on your belly button being 12:00 and pubic bone being 6:00. To the right and left you choose which is 3:00 and 9:00. Now you have the clock image.

Focus on pulling your core in and down to 6:00 then 3:00, 12:00, and 9:00 slowly and gently. Clockwise two times and counter clockwise twice.

This is a mindful exercise so breathe and concentrate. It wakes up the deep core muscles and really helps strengthen your deep core. Most people have a hard time at first feeling 3:00 and 9::00.

Don’t worry, it will come in time. Simply doing this exercise daily (if you can) will begin to wake these core muscles up.

I suggest to touch your belly in these spots first to wake up the signal to your brain before you begin. Even massage for a few seconds will help them fire when you engage

Mindful Touch

A Gentle Mindful touch can mean the whole world to a body that is not feeling well.
people and animals both thrive on touch. Have you touched someone today with kindness and mindfulness? It could be more profound for someone than you will ever know. Go do it now....

Embrace the Moment, Finding Peace

Embrace the Moment

Finding Peace in the Here and Now

By Jody Ellis-Knapp

Originally published in Body Sense magazine, Spring/Summer 2006.
Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.

By focusing on the small, even trivial facets of our daily activities, we gain more personal satisfaction and don't lose ourselves to tomorrow.

The American Dream. This phrase draws people to our country by the thousands. The idea that greatness can be achieved, even when starting with nothing, is the touchstone of our Western culture. We live in a society where great value is placed on the external, somewhat elusive notion of "success."

This can sometimes make life seem like a big competition -- a race to the finish line of achievement, with the focus on who has the nicest car, the best career, the most perfect body, and so on. We spend our time seeking that end goal, striving toward the future, always looking for tomorrow, and restlessly just getting through today.

How many of us stop to take a breath in the moment and just enjoy the getting there? It's so easy to get caught up in our very fast-paced lives, when what we really need to do is slow down for a minute and learn to find peace in the here and now. I know I am guilty of this all the time. I am a fairly avid runner and usually say I only enjoy my runs when they are over. I focus on my time, mileage, and pace, seldom thinking about much more than getting it over with and not really finding value in the sheer movement of my body. In daily life, it seems like I am always seeking to accomplish and complete my endeavors so I can move on to the next thing, constantly keeping one step ahead of myself.

The Buddhist practice of mindfulness is one that is well-known to many people. Simply put, it consists of putting the idea of enjoying the moment into everyday life. By focusing on the small, even trivial facets of our daily activities, we gain more personal satisfaction and don't lose ourselves to tomorrow. Studies have shown a correlation between enjoying the moment and stress reduction, as well as increased creativity in the workplace and a lower risk of burnout. Simple meditation and relaxation techniques have been shown to decrease symptoms of various health conditions as well, and there are indicators that mindfulness can increase longevity.

While we know there are many positive reasons to focus more on the moment, and the idea sounds like a good one, putting it into practice is another thing entirely. How are we supposed to make time to slow down when all around us people are passing us by? But it doesn't take any special methods to find one's mindfulness. There are simple tactics available that will help us learn to concentrate on finding satisfaction in all the little things we do each day. By implementing some of these easy tips, we can find peace and fulfillment in the time spent on seemingly mundane things.


Rethink Exercise
Most of us already know that exercise is invigorating and an absolute requirement for good health. But during exercise, are you really feeling it, or just looking for that end result? Close your eyes for a moment during your workout. Breathe in and out, feeling the expansion of your lungs. Feel the power and pull of your muscles as you lift that weight or do that sit-up. Actually thinking about your body and its function while you are exercising will help you embrace the moment and find satisfaction in the workout itself, not simply seeking to finish it and get on with things. Try taking a completely different road with your exercise regimen. For example, if you run, walk instead. If you go to a Pilates class, switch it out with yoga. If you like intense, advanced yoga classes, go to the beginner's class on occasion and slow down. Slowing down and not rushing to complete things is a key to finding yourself in the moment and enjoying it.


Savor Stillness
Next to slowing down, making ourselves be still on occasion is probably one of the more difficult tasks we can accomplish. I always feel guilty if I sit down for too long, and when I do sit for a minute, my mind can't seem to stop. I keep thinking about all the things I should be doing. But in finding our way toward living in the moment, we have to learn stillness. Sit down on the couch or lie on the bed. No television, no radio, no phone, no Blackberry, no computer. Tune out the forces of the outside world and tune in to yourself for a minute. Close your eyes and breathe calmly. Try to think only of the feeling of your closed eyes and your breathing. Block out what you need to do later, and focus on the sensations of sinking into the couch -- the relaxation of your muscles and the silence around you. Try to let it envelope you. Start small, five minutes a day. Work yourself up to 20- or 30-minute increments. Yes, you have time for it. In giving ourselves those moments of stillness, we not only become more in tune with our bodies and minds, we become more open to existing in the here and now.


Focus and Feel
Often, we are so preoccupied with the future, we not only don't "feel" what we are doing, we don't even remember it. Remember what you had for dinner last night? What you wore to work three days ago? What the weather was like last week? Sure, these are all little, unimportant things. But noticing those little things and focusing more on them brings us back into the present, rather than putting one's focus on just seeking completion of our goals.

Take time to feel the little things. Enjoy the sensation of the warm water running over your hands when you wash them, the scent of clean laundry as you take it from the dryer, the warmth of the sun as you step out into your day. Make sure you experience everything you do, from your daily shower to your evening meal. Just taking the time to actually focus on what you are doing, rather than the end result, will give you satisfaction and enjoyment and will reflect itself in other areas of your life. You will see yourself begin to focus and feel not just at home, but at work too.


Embrace Laughter
It's been called "the best medicine," and its benefits cannot be denied. Recent research from Loma Linda University in California indicates that laughter lowers blood pressure and reduces stress levels, as well as increases muscle flexion and bolsters the immune system. Finding time to laugh is imperative when it comes to mindfulness. Laughing heightens our awareness of being alive, because we physically cannot resist the sensation and enjoyment laughter brings. The next time you feel the urge to chuckle, let it roll into a big belly laugh. Your eyes will squint, your mouth will stretch, and every muscle will seize in joy. You will feel your blood vessels expand and your face flush. Let yourself experience it and revel in it. Don't try to stifle it or hide it. Laugh loud, long, and often. Start looking for reasons to laugh, looking for all those little moments in the day that are worth a touch of humor. It's good for your health and will make you so aware of everything around you, you will not be able to prevent yourself from being completely in tune with the present.

***

If we spend all our time worrying about what we need to accomplish tomorrow, and stress over what we did wrong in the past, we don't give ourselves time for today. As difficult as it may seem to break from the constrictions placed on us by societal expectations and our own drive to succeed, learning to live in the moment will actually bring more satisfaction and the potential for greater long-term success. Mindfulness will help you learn to love what is right about your life, rather than obsessing over how things should be better. So stop for a minute, and look around. Enjoy today. Live in it. Savor it. Tomorrow will come with or without our reaching for it, and the years will go by faster than we know.

I went for a run the other day. Halfway through, I turned the timer off on my watch. I closed my eyes and felt the wind in my hair, the breeze against my legs, and the power of my body as it worked its way up a hill. When I started to go back down the hill, I left my careful pace behind and let myself fly. I let go of my concerns over distance or improving my time. Running full force down that hill, I embraced the here and now, fully in it, fully alive. Living life -- isn't that what it is intended for?

Jody Ellis-Knapp is an Alaska-based freelance writer. She's also written for Consciousness, Common Swords ezine, Adoption Today, and Balance magazine.

Key to getting a great Massage

Therapeutic Communication

Asking for What You Want is Key to a Great Massage

By Mary Kathleen Rose

Originally published in Massage & Bodywork magazine, March/April 2010. Associated Bodywork and Massage Professionals. All rights reserved.

Receiving a massage is a time to rest and rejuvenate as you experience the deeply nourishing effects of skillful touch. As your muscles relax and your mind unwinds, do you ever wonder how to talk with your massage therapist or bodyworker? Here are some guidelines about what to expect regarding verbal communication before, during, and after a session.


Before The Session
Before beginning the hands-on session, you will usually fill out a client intake form with contact information, medical history, and your reasons for receiving massage. Your therapist will ask you, "Is there anything I need to be aware of?" Share any relevant information in order to ensure that you receive a session that is appropriate and safe for you. For example, if you have had recent surgery or an injury, it is important that the therapist know, in order to avoid causing further injury or discomfort. Your practitioner should also ask, "How can I help you?" This is your opportunity to tell your therapist what you need and to state your preferences for the kind of bodywork you like, and the parts of your body most needing attention. You can say what kind of techniques or degree of pressure you like. You can state your intention: "I need overall relaxation," or "My back is in a lot of pain. Can you focus on that?"


During The Session
As you receive the hands-on work of the session, your therapist will ask, "How is the pressure I am using?" Give your honest feedback. After all, the therapist wants to accommodate your needs and preferences. Do not hesitate to speak up if anything is uncomfortable to you. Specify if you want more or less pressure, more or less of a particular technique, or if you want specific attention to an area of your body.

A massage is a time to relax, so you can expect that your therapist will be quiet and attentive. If you find that he or she is more talkative than you like, it is OK to say, "I'd just like to enjoy silence during my session." On the other hand, if you like to talk, and it is helpful for you to talk--either about what you are experiencing in your body, or simply as a way of letting go of the stress of the day--that is also OK.

What is most important to remember is that this is your time to be nurtured. It is appropriate that the practitioner respond to your preferences. It is not a time for the therapist to carry on a personal conversation or talk in any way that detracts from your experience.


After The Session
Following the session, the therapist may ask, "How do you feel now?" or ask about a specific issue that was addressed in the session. Share anything that occurs to you that might be useful feedback. For example, you might say: "I feel great. Just what I needed!" or "I loved that work on my feet. Maybe next time, you could spend more time with that." This brings closure to the session and also gives an idea about what you might expect in a future visit.

It is important to know that bodyworkers provide their services based on their specific training. It is not appropriate for massage therapists to answer medical questions that are beyond the range of their knowledge and/or legal scope of practice. The value of therapeutic massage and bodywork lies in skillful application of appropriate technique, as well as the sense of ease that is created by quality, mutual communication.

Mary Kathleen Rose, BA, CMT, is a massage therapist and wellness educator, and the author of the textbook Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams & Wilkins, 2009). www.comforttouch.com.