What is S1 Radiculopathy?

Common Causes of Lower Back Pain:

• Spondylosis of the Lower Back – refers to degenerative changes in the facet joints and eventual ankylosing of the joint.  Spondylosis also refers to the degenerative osteoarthritis of the joints between the center of the spinal vertebrae and/or neural foramina.
• Slipped Disc / Disc Herniation – is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings. This causes pressure on the spinal nerve roots which in turn causes subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.
• Lumbago – general, non-specific term for low back pain
• Sciatica – or lumbar radiculopathy, is a set of symptoms including pain caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve—or by compression or irritation of the left or right or both sciatic nerves. Symptoms include lower back pain, buttock pain, and pain, numbness or weakness in various parts of the leg and foot. Other symptoms include a “pins and needles” sensation or tingling and difficulty moving or controlling the leg. Symptoms usually manifest on one side of the body.

Lower Back Massage: 

Types of Lower Back Pain – Symptoms:

1.  With lumbar degenerative disc disease, pain is noted across the lower back and hips, occasionally into the legs. It is worse with activity. There is a history of back injury.
2.  With lumbar disc herniation, the pain is deep and poorly localized. With a lower lumbar disc lesion, it starts centrally at the level of the affected disc and over time moves laterally and increases in intensity. Eventually spreads down the back, into glutes, down the thigh, leg, and foot.
3. A nerve root impingement in the lumbar spine can lead to bladder and bowel dysfunction and numbness across the low back ( depends on what nerves are impinged), glutes, and hips.
4. With Piriformis Syndrome, there is pain and paresthesia in the posterior thigh, (sometimes calf, foot). Pain is usually just on one leg. Weakness in abduction, flexion, and internal rotation of the affected hip.

 Lower Back Massage:

OBSERVATION:

• With Degenerative Disc Disease in the lumbar spine, whether a hyperlordosis or flatback posture may be noted. The client may slouch, placing the lumbar spine in flexion. ( Disc breaks posterolaterally first )
• With acute herniation in the lumbar spine, a decrease in lumbar lordosis may be present. In the posterior view, a leg length discrepancy or scoliosis may be noted.
• With sciatica, guarding of the affected limb, ataxic gait due to pain, difficulty sitting/standing prolonged due to pain

Lower Back Pain Assessment:

 Orthopedic Tests:

•  With DDD, AFROM and PRROM reduced lumbar flexion and extension. Pain may be present. ARROM may reveal a weakness in affected mm with later stages of degeneration.
• • With acute herniation, AFROM and PRROM reveal ranges limited by pain and muscle spasm. AF flexion may have a deviation to one side, as the client attempts to move away from the painful side.

Special Tests:

•  Motor and sensory testing reveal weakness and abnormal sensation is distributed for affected vertebral level
•  Deep tendon reflexes for mm innervated by affected nerves are reduced
•  Valsalva’s, slump, kemp’s, kernig’s, SLR may all be (+) Take note of the differences of the test… space-occupying lesion, nerve root involvement, etc.

Motor Testing:

• L4 – Tibialis anterior ( dorsiflexion and inversion) ( heel walking)
• L5 – extensor dig longus, ext hall longus) ( toe extension)
• S1 – ( gastrocs, soleus, peroneals) ( plantarflexion, eversion)( toe walking, inner foot walking)

Sensory Testing:

• L4 – medial foot, the big toe
• L5 – top of the foot, middle 3 toes
• S1 – lateral foot, little toe

Reflex Testing:

• L3- L4 –patellar tendon
• L4-L5 – tibialis posterior tendon ( need to do plantarflexion and inversion to pop out)
• L5-S1 – semimembranosus tendon ( the most medial hamstring tendon)
•  S1-S2 Achilles tendon

Lower Back Massage Therapy Treatment Goals:

• Decrease Sympathetic Nervous System firing
• Reduce compression on the disc and nerves
• Reduce pain and spasm, hypertonicity, and trigger points
• Maintain tissue health

Lower Back Massage Contraindications:

• with saddle anesthesia (loss of sensation to buttocks and perinea) and bladder weakness, refer to a medical doctor
• if no comfortable position can be found, refer to a medical doctor
• No position that aggravates symptoms
• do not mobilize hypermobile joints
• with acute herniation, do not remove protective muscle spasm
• modify pressure on the area of atrophy

Tight muscles in Lumbar Spine DDD:

• Hyperlordosis: Quadratus Lumborum, hip flexors, hips, Iliotibial band, quadriceps femoris, tensor fascia lata
  • Joint play and traction: hips, sacrum
• Flatback/ Posterior Pelvic Tilt: Quadratus Lumborum, hamstrings, Quadriceps femoris, calves
  • Joint play or traction: hips and sacrum

Lower Back MASSAGE Therapy TREATMENT:

For Lumbar Spine Disc Disease: Herniation, Lumbago, Spondylosis, Slipped Disc:

• Heat to tight areas
• position for comfort, pillow to support
• Massage to reduce edema, spasm, and pain in muscle crossing herniation
• Myofascial Release, Swedish techniques to treat hypertonicity and trigger points  to the affected area
• Treat postural dysfunction  (likely and Hyperlordosis and Flatback for Lumbar spine DDD)
• Joint play to adjacent hypermobile vertebrae to relieve pressure on the affected area
• GTO release, petrissage, passive stretching, fascial work to tight muscles

For SCIATICA: Lower Back Massage

• Heat to tight areas
• GTO release, petrissage, passive stretching, fascial work to tight muscles
•  Ligaments- sacrotuberous ( ischial tuberosity to the sacrum) to release sacrum.
•  The entire gluteal area treated using fascial work and petrissage
• Treat glute max thoroughly so piriformis can be reached. Treat glue medius and minimus.
• Treat piriformis using origin and insertion,  finger kneading, muscle stripping, ischemic compressions to piriformis trigger points – follow up with piriformis stretch
• Passively rotate patient’s hip internally and externally while applying pressure to piriformis using the fist or elbow

Lower Back Pain Self Care

• Find pain-free positions, with posterior herniation, maintain lumbar lordosis. Lie prone, progress to propping up on elbows
• Hydrotherapy -cool to reduce spasm and pain
• Back extension exercises
• Strengthen muscle crossing affected area
• Teach correct lifting
• Pain-free ROM
• Avoid sitting with knees rolling out to the side
• Sleep with a pillow between knees to avoid internal rotation of the hip ( stretching the piriformis for too long will irritate it, better to be in neutral)
• Take breaks from aggressive activities/ running to stretch
• Chiro adjustment for SI joint displacement