According to a 2020 study, low back pain affected 619 million people globally. Experts estimate that the number of cases will increase to 843 million cases by 2050. Although back pain can affect people of all ages, women between the ages of 50-55 seem to suffer the most. It’s statistically likely that all massage therapists will see clients experiencing back pain at some point in their careers. That’s why it’s critical to understand the common causes and the benefits of massage therapy for back pain.
Recommended course: Pathology of Chronic Conditions for Massage Therapists
What causes lower back pain?
Low back pain (LBP) is discomfort or pain in the region from the lumbar area of the spine to the gluteal fold at the bottom of the hips. There are two types of pain:
- Specific Lower Back Pain, which can be contributed to a particular pathologic condition
- Non-specific Lower Back Pain, which cannot be contributed to a particular pathologic condition
Non-specific LBP accounts for 90% of cases. Back pain can be further broken down into Acute LBP or Chronic LBP. In the case of Acute LBP, a client’s pain would resolve after 1-2 weeks over a three-month period. In the case of Chronic pain, the client would be suffering for longer than 3 months.
Benefits of massage therapy for back pain
Massage therapy has long been used to manage the discomforts of lower back pain. According to a study from the Canadian Medical Association Journal, those who received massage had improved function, less intense pain, and a decrease in the quality of pain compared with those who did not receive massage.
Critical to any massage therapist looking to help clients with LBP is an understanding of the muscle groups that make up the lower back. Here is a brief review of the major muscles.
Quadratum lumborum
This muscle is in the lower lumbar portion of the back. It attaches to the posterior hip bone, transverse processes, and the 12th rib. Given its attachments, when the muscle becomes tight and shortened, it can hike the hip up on the one side creating an imbalance in the lower back.
Iliopsoas
This group of muscles consists of the iliacus and the psoas major/minor. These muscles are responsible in large part for flexing the vertebral column as well as flexing the hip.
Given its attachments on the anterior vertebral column and the lesser trochanter, it can cause a “pulling “on the lower back when overly tight.
Gluteal muscles
The three gluteal muscles span the buttock region of the body. Their attachments on the side of the sacrum and coccyx as well as on the femur can create a tightening in the low back.
Quadriceps
The quadricep muscle group is located on the anterior portion of the thigh. Rectus femoris is a particularly important muscle to work because of its attachment on the pelvis. When this muscle is tight, it can pull on the pelvic bone, which in turns creates lower back pain.
Hamstrings
The hamstrings are located on the posterior thigh. These muscles can influence the back in the lower back when tight. Their attachments to the bottom of the pelvis can create a chain reaction of tension with the gluteal muscle.
Erector spinae
The erector spinae muscle group runs parallel to the spine from the sacrum all the way up to the head. When tight, these muscles not only cause lower back pain but can also trigger pain anywhere along their pathway.
When working with these muscles, it is good to have a knowledge of opposites and actions. For example, the quadricep muscles are going to perform opposite actions of the hamstring muscles. When one set of muscles is shortened the opposite set of muscles is going to be lengthened.
An effective way to help with this condition would be to release the tension in the tight muscles and strengthen the opposite muscles that are weak. When a massage therapist works this way, it gives the body the best opportunity to stay in anatomical alignment.
Other conditions
In other cases, conditions such as a herniated disc or stenosis in the lumbar vertebrae can contribute to lower back pain. In these situations, a compressed nerve causes pain. If a massage therapist suspects that a client has one of these conditions, it is best to get confirmation from their health care provider. Be sure to ask clients about these conditions before a massage so the session can be adjusted accordingly.
References
- GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29.
- GBD 2019: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. https://vizhub.healthdata.org/gbd-results/.
