Massage Tutorial: "I threw my back out!" (myofascial release for low back spasm)
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- Опубліковано 3 січ 2016
- My new book is out! It's called Massage Is Weird: massagesloth.com/book/
If you get a client whose back has "gone out," it can be a difficult situation. Too much direct interaction could worsen the spasm. Is there anything you can do to help?
In this video, we're going to address spasm in the lumbar/sacral region. I hope to address upper/mid back spasm in the future-just keep in mind that it can be difficult to deal with in the acute stage. With low back spasm, however, I find that I can prompt a reduction in symptoms pretty frequently. 60% of the time, it works every time.
Before you start, you may want to place a pillow under the client's hips, right at the level of the anterior superior iliac spines. This can be especially helpful for larger clients, and for those with a more pronounced lumbar lordosis. Ask the client to adjust the level of the pillow.
Once they're supine, an extra pillow under the knees can also increase comfort. Basically, we're trying to keep them closer to a fetal position during this massage. And yes, side-lying could definitely work well here!
The protocol for this massage is to start slow and broad, and to gently introduce more interesting stimuli as the nervous system acclimates to your contact. Because the area is likely "guarding," or recruiting other local muscles to protect the area of perceived danger, we need to soothe those as we gently start making contact with the area of greatest pain. Think of steam-rolling, or ironing the area out.
Check in with your client as time passes. Ask about pressure frequently, and make sure that the back isn't tightening up in response to your touch. If that's the case, it may be wise to discontinue work in the area for that session. It's just too reactive.
Other tips: Try pressure that goes superiorly toward the SI joint, starting from the posterior thigh. For some clients, this pressure will feel like more of a relief than the downward strokes that I demonstrate. Avoid rocking, especially at first. Pressure directed toward QL might be too much for this initial session, but it's something that could be addressed in the future.
Finally, consider working with the hip flexors in future sessions, and offering stretches for hip flexibility in all planes. I'll have a video on that soon.
Thanks for watching! Let me know if you have any tips, tricks, or protocols you'd like to share in the comments. Happy 2016 :)
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Excellent! As always I love the contrast you make between the "make it submit" approach and the "convince it things are not as bad as they think" communicating with the nervous system approach. This is very helpful for explaining to clients that more pressure is not always what they need. Thank you!
Oh how I have missed you, Massage Sloth. You always show back up just when I need you...
I am halfway through massage therapy school and I am now addicted to your tutorial videos! You are bringing a lot of things together for me that I was struggling with only a few weeks ago. Thank you so much! My instructors are great, but I think you are a born instructor also!!😊
Thanks so much!
I think have made this comment before on another video, but it's worth saying it again: I am not a LMT, but these videos have made me a much more informed "consumer" of massage. I can better articulate to my therapist what is bothering me when I know more about my own anatomy and how my tissues interact. They've also helped me be more mindful of my posture and how I'm using my muscles one daily basis. Keep up the great work!
+justicegirl1028 That's awesome :) Thanks for taking the time to comment, it's neat to think that this could influence clients' fluency with their own body.
+Massage Sloth why do you call yourself massage sloth- just curious? I was just in Pensacola- i would have made an appointment with you! Next time!
+eileen correia Hi Eileen! I hope you do next time :) And "Massage Sloth" is my general philosophy: Massage should be slow and easy. It's kinder to the therapist, and it can translate into an excellent client experience.
+Massage Sloth ahhh duh on me. of course! it took me over a year to slow down my massage strokes lol. ADHD i guess. i should have adopted a sloth for my studio for inspiration.
Perfect observation, in London I work with massage and I do the same. Is good for the patient and for the therapist review your knowledge
Awesome job! It's exactly how I approach low back pain, I mean almost identical technique. My clients always feel lots of release and pain relief.
I really do love the way you explain going slow because you are interfacing with a person's nervous system. I have neuromuscular issues from neurological disease/spinal cord damage that come hand in hand. I have had a physical therapist just jump into deep work without warming up or slow work (as in she wanted to get it done ASAP) and I locked right up later that day. Slow work helps every time, massage is one of my best tools to treat it.
And the slower the BETTER. Clients are extremely sensitive on these areas especially if they are sore! ❤️
I have just completed my diploma of remedial massage and have found these videos so helpful and informative, it reinforces how i need to slow down and relax. I always have the urge to rush. thanks so much for these videos
Myofascial release is so effective! I suffered lower back pain (because of scoliosis) for many years and nothing worked (M.D., Chiro, Osteopathic, etc.). Finally, a therapist in Milwaukee, WI took me on and within a couple of sessions I finally found relief! I still need occasional treatments but, hey, it worked for me! Very informative video!!! Thanks so much for sharing your information with us!
Wonderful, thank you. Great to see the slow and gentle approach.
Just finished a massage and it worked great. A car accident smoshed my shoulder so I need to be mindful . I am digen your advice. 28 years and still loven learning🙋🏽👯👯👯
Watching your videos and reading your books have really elevated my techniques as a massage therapist you're amazing. Thank you
That's so kind, Uriel, thank you!
Love all your videos! I am a LMT in PA and these have helped immensely!
Always enjoy your vids. Ray
Wonderful video!
thank you for your extensive information!
Great work and explanation
Very informative! I glean a lot from your videos!
Great video... I can see this video being played in massage schools all around the country 🙋
I just love you!!!!! keep on coming with great vids, my clients are very happy. You make it look so easy and the way you explain the techniques...awesome. Wish I would have attended your classes instead.lol
love the video's, as a therapist this helps a lot
Love your technique!!!!!
The back stretching is everything!!!
Glad you are back!!
+mici eva Glad to be back! :)
+Massage Sloth possible back to back series?
Thank you for sharing your expertise!
Thank you for this fantastic video! I will be using this technique in the future.
Great job as always. I use some of the same techiques only now will incorporate more of the hips.
you rock thank you for these videos!
So inspiring..
Sometimes massage therapy does "fix" things. I have TMJ disorder due to clenching, and it got so bad at one point that my traps swelled up to 3 times their size, and I had muscle spasms in the back of my neck that were extremely painful. I went to the ER and got muscle relaxants which didn't help right away, and since I couldn't move my neck at all (completely blocked), I took a taxi to my massage therapist. It took her close to 2hrs but by going easy on me she was able to unlock my neck and make the spasms stop. I'm forever grateful and massage therapy has been the most natural, efficient solution I've tried so far. The problem is that I clench so much that I need massage therapy weekly, so I'm going to try Botox. Just wanted to share how amazing massage therapy can be in a crisis situation when you have a qualified practitioner looking after you!
thank you so much for your teaching... I'm a massage student starting clinic in a few weeks... I'm a bit nervous, but your videos have help me a lot.. thank you so much
Congrats on your next step! And it's okay to be nervous. I sure as heck was. It gets better :)
Thank you ❤
Absolutely incredible. Thank you so much. I have used so many techniques from these videos. My clients are so happy.
Great to hear, Natalia! 😊
You have such relaxing voice
Agree 💯 we don't fix people, we help assist them in healing
When I was getting chiropractic care he avoided massage therapy and heat during that time if the month. I think the way he adjusted my back during that time changed too.
Oh your self massage frozen shoulder helped me a lot to.
+Dina Metaweh That's awesome, so glad to be of help :) Keep kicking butt!
if someone have a lot of pain , i lwould start with lymphatic massage and acupressure then the pian can be less in about 50% then i do some swedish or deeper tissue i just liked to share this here because you said you let the clients wait untill the pain is gone and then work on tightnes , dont get me wrong i love the video and channel and your work thanknj you for the videos and time
I appreciate how you said that the superficial is connected to the bone
nice one! Now self massage tutorial pls :))
hi Ian im wandering if you would ever consider doing a massage on lumbar bulging/herniated disc
I will modify some of the moves,my shoulder doesn't like to pull towards me. It make a crackling sound.Push pull looks like it might hurt,but I love the way it looks and will give it a try
+Dina Metaweh Definitely modify to suit your own body. For the moves that look like pulling, see if you can get your shoulders over your client a little further (possibly going up on tip toes), so that any motion toward yourself is done by using your body weight rather than your muscles. Let me know how it goes!
Hi Ian! I've learned so much from your vids. This is completely off topic, but I need help. One of my very loyal clients has been seeing me for about 3 years. She has a horrible job and is constant turning her head in an awkward position at her desk. She's always in pain. Her levator and scalene muscles are constantly inflamed. The slightest touch hurts. My go to is always ice. That doesn't help. We tried heat. Loosened her up and made her feel better at that moment, but the pain was back the next day. I told her to see a doc and he did X-rays. Nothing abnormal. Maybe a little arthritis. No headaches. No arm tingling. And a few months back I told her that I want to refer her out because I think her first rib is elevated. She went to a Chiro and that's exactly what it is. However, she only wants me. I am at a loss because I can't help her pain. Advice???
+Miss Mash Honestly? I think you're the therapist for her. I know you don't have a trick to fix her neck/rib/etc, but neither does a chiropractor or osteopath (joint manipulation has mixed results in the literature, and some clients don't respond at all). Chronic pain caused by repetitive use can be managed through many different modalities, but don't psych yourself into thinking that her improvement has plateaued because of something you're not doing. Unless she's able to make some changes to her daily routine, it's likely that she'll keep having pain and dysfunction, and her sessions with you are one way that she's fighting back against that.
Even if you were just doing standard Swedish, you'd still be reducing inflammation and muscle tone, reducing local hypersensitivity, and helping her maintain her range of motion. Heat was helpful, so that sounds like a good treatment to pursue. You've already referred her out for medical imaging and chiropractic, so you've done your due diligence. I know it stinks when you hit a wall with client improvement, but I bet you ten bucks she'd be much worse without her sessions with you.
Basically, keep it up, and gently try to direct her to make some changes to her work environment. If you haven't already, experiment with more work with her chest, lateral thoracic region, and rotator cuff. If she experiences a further increase in symptoms, certainly encourage her to try the medical route again. Other than that, keep doing your thing. She sounds like a happy client.
Wow, thank you! Yes I've worked on her thoracic and cervical spine, pecs, rotator cuff...everything. And she always feels great when she leaves. But a day later she's in pain again. So I just don't know :-( But thank you so much for your encouraging words.
Do you have anything about spinal alignment with PNF?
i love watching your videos....i currently attend the florida school of massage...i start clinic soon and im nervous!
I'M SO JEALOUS. I miss FSM so badly (did you know that's my alma mater, or is this just a coincidence?). Just remember that it's okay to mess up and not know what to do all the time. Every massage makes your movements more smooth and confident, and every opportunity to communicate with clients will make future intakes easier and more informative. Have fun with it, and good luck!
Thank you so much!!!! In one of your videos you mentioned Karen ball and I was like noooo waaaay! No wonder why I gravitated towards you!!! There are soooo many massage video out there and for some reason, I chose to watch yours the most and subscribed...not a coincidence that is for sure!!!
Mad Max and
What are some self care tools we could prescribe to a client?
I throw out my back about once a year and it's always middle or upper back. Right now, I have one right lower end of my rhomboids. I have absolutely horrendous posture.
Hi Ian, thanks for the info.
I have a client that has referral pain to QL. I worked out her Gluts and hamstrings, SI joint dysfunction is my clinical impression. Joint mobilization to sacrum and hip fractioning helped. What else can I do? Sandra
Hi Sandra! Sounds like you're doing a good job, and approaching it the same way I would. Work with hip flexibility (how are their external rotators?) and encourage them to incorporate some movement into their day (stretching, walking, etc). While we can accomplish much on the table, the client's habits are always the final piece of the puzzle.
Hi Ian, me again. Just wondering, what is it about the Thorasic region that makes it unreceptive to work during acute spasm, as applied to the lumbar region which can he helped? Thanks again for all the great content. CC
Hi Betty! I... actually have no clue. That's my personal experience across many clients, but I wouldn't be surprised if other massage therapists have had a different one. That said, it has been pretty consistent across my career, despite many changes and tweaks I've made. If this is a real difference, I'd speculate that upper back spasm tends to involve paraspinal and intercostal muscles while low back spasm tends to be based in the hips. Why does this make a difference? I... have no clue :)
Thanks Ian. It’s Chrissie, Betty is my dog and I actually forgot I was using her channel to comment. She said it’s fine, although she has very little interest in thoracic or lumbar back pain herself.
Haha, hi Chrissie. A sloth and a dog talking on UA-cam... what an age we live in :)
Hello!
Are you using oil for this? I always feel like I might be hurting my client with too much friction if i'm not using any oil. Should it be fine?
Dang, I always forget to mention the oil! I'm using a small amount of jojoba oil in all of my videos. If I want a lot of traction I just use a little (a few drops). If I'd like enough glide to make it pseudo-Swedish, I use a good bit more. Do keep in mind that many myofascial practitioners use no lubrication whatsoever, so that is a fine choice. It's just a very slow process :)
Would you totally avoid all deep tissue work for a back in spasm and save that for a follow up treatment?
+Renee Newman For upper/mid-back spasm? In that case, I explain that I don't expect a dramatic change in symptoms. If they'd still like to try the massage, I would do slow and gentle myofascial work that gradually makes its way toward the most painful area, while never really getting specific. Some clients have gotten limited relief from this strategy. All in all, I'd prefer that they return once the acute stage is over.
I've gotten massive relief from spasms thanks to massage therapy in the acute phase. Back spasming heavily before the session, no more spasms after. I guess everyone is different but I think if you go easy on your client you can relieve them a lot
Hi where are you located ? Please I need a massage therapist that help if you help me please.
I work at a chiro. that is mainly MVA and WC. I find my self using my thumbs in small areas, it gets the job done, but it's starting to weaken my thumb pressure. I have tried changing my technique but I go back to my old habits... sometimes without noticing and sometimes because it's what works best. Do you have any suggestions on what I can do to have the best thumb pressure without hurting myself.
+Adriana Mendoza It's definitely a hard habit to break! To be honest, the biggest changes in my technique have come following an injury. I'd hurt a thumb, and suddenly I'd have to make due with all sorts of replacements. While it felt awkward at first, these experiences taught me that I could do good work with my knuckles and fingertips. So, my suggestion: Take a thumb vacation. Use fingertips, fists, and elbows to get into those tight spaces. As you do so, reinforce your tools as much as you can: Stack your hands so that you're using 8 fingers instead of 4. Keep a flat palm nearby to help you feel the surface under your fists. Same when using your elbow tip.
As you start to reintroduce your thumbs, think of how you can reinforce them. Where can you use two thumbs instead of one? Where can you apply some fingertips in addition to the thumb tip? Also think about where your power is coming from. Instead of using the small (but mighty) muscles in your hand to control your thumb as you massage, use those muscles as stabilizers. Create the desired hand shape first, and then apply that to your client, letting the power come from your body weight. Check out my "shoulder rub" video for an example of using your thumbs as an extension of your hand: ua-cam.com/video/ocioXi-8TY4/v-deo.html
Good luck, and let me know if you have any follow-up questions!
+Massage Sloth thank you so much...this has been a great help :)
While the client is in a supine position I like to place a supportive relaxed hand beneath the clients sacrum so it feels to the client as though the sacrum is floating and then placing a comforting hand directly above the lower hand on the clients draped lower abdomen and asking the client to breathe calmly and deeply. I hold this for a few minutes until it feels as though there has been a subtle release or shift. Just curious if you use any techniques such as this?
I haven't recently, but the fact that I'm doing fewer moves like that these days makes me think that I've forgotten my roots! A lot of what we did at my alma mater was heavily influenced by craniosacral and polarity therapies, and the kind of contact that you're describing would fit right in. It sounds like excellent work! Ever consider starting a massage channel on UA-cam? :)
Hiya Ian, thanks so much for your thoughtful reply. And yes it is definitely something I would love to do hopefully sometime...
Just on a side note what do you think of the idea that in the future there will be a fusion of all body work modalities where the best and most effective of all of these practices will come together to form one regulated body of practitioners? For instance allopathic medicine was not an organised practice before the 1800's it was seperate people working with a whole lot of different practices and theories.
I am also a yoga instructor and feel that there is such great scope to use all the knowledge I have gained through yoga and massage in treatments and in classes integrating that wonderful ethos you often discuss of treating/helping people think about the body as a whole rather then seperate parts.
warmest regards
How do you even get yourself to a therapist if your back is out and you can’t even walk without extreme being let alone get up like you’re crawling if you’re even lucky
my last massage sucked. I had bad hip pain and the massage person refused to work the area, I left with same pain and 80 bux lighter
Hi
Hey Ian, glad you're back... Looking around the 6:45-7:00 mark, your torso looks almost parallel to the floor, which seems like it would be tough on your LB.
That said, I have the same problem (extending too far away from my center when working on lower backs)
+Russell Fabry Good looking out, Russell! This is actually purposeful on my part: It allows me to keep my pressure at that 45 degree angle while staying directly over the client, keeping my pressure even from side to side. This doesn't hurt my low back because I'm giving all of my torso's weight to my client via my straight arms. It's a long slow lounge. If I wanted to give them even more pressure, I would step away from the head of the table, going into a "Superman" pose. If I wanted to give less pressure, I'd step to one side of the table and keep my torso at a less extreme angle, even if this might affect how equally distributed my pressure feels. Your body comes first, I say.
In any case, this is far superior to trying to suspend my torso's weight using my low back as a crane. If you're going to slouch or bend, try to do so only when you can donate your weight elsewhere.
As for standing up, I tend to either walk myself back up, alternating pressure with either hand; step to one side to give myself a mechanical advantage; or bend my knees and drag the thoracic fascia back toward myself. This last one is the only one that could potentially be detrimental to the back, so I only use it once in a while :)
+Massage Sloth I get your point--and maybe I'm just clumsier/less balanced than you--but I feel like I'm at risk of slipping when I try to put all of my weight onto the client.
+Massage Sloth Which brings up the question-- do you ever work while kneeling on the ground? I've tried it, and it feels safer while also putting more weight on the client. But I don't know if me being on the ground seems odd/weird/un-pro to them.
When I'm trusting my weight to my client, I only do so when I'm not using much lubricant, and only when I've got both hands available to stabilize me. Working from a kneeling position sounds just fine! I used to do that all the time when I had a cushier carpet to protect my knees.
I see a big draft running down the left leg from the unsecured draping...I do like your channel , subscribed long time ago but if I were to do that i might get into trouble...!
+Johny Hansen The reason that I don't tend to tuck under the hip is that a casual tuck comes undone or creates a "tent" too easily, causing me to have to fiddle with it repeatedly. A more assertive tuck, such as with diaper draping, is also something I like to avoid unless I need to do extensive limb movement, as this can feel invasive.
The triangle fold with the drape pinned at the sacrum feels secure to me, and I'm able to do it in one confident motion, which can be reassuring to clients. Some clients may not find this adequate, so this would be a good conversation to have with them. Thanks for bringing it up!
+Johny Hansen I've always done the triangle fold, even to my new clients and they seem to love it! If I do feel a bit insecure about the draping i'd secure it with my free hand. Cheers and great video Harvey!~
Fermin Andujar what is the triangle fold pls
Blue canary in the outlet by the light switch
Who watches over you
Make a little birdhouse in your soul
Hello Sir,
i am new to your videos and was very interested in this video for many reasons, having just completed a massage course myself i was concerned watching your hands disappear under the drape, i know that you said about having a good relationship with your client, but i think this is way too far. it was kind of awkward watching it, and NO UNDERWEAR? Whaaaaaaaaaaaaaat! i feel that the boundary is the drape and that should be it, if you needed to massage other areas the drape should be uncovered. i understand the reasoning to why u do what u do but i feel that there must be another way to achieve the desired outcome.
Had to just say this. maybe i am the only one but yea, t did not sit right with me, pardon the pun.
In other videos he mentioned you can do it through the drape but how would you give a full body massage without working on the glutes? Genuine question, I'm not sure what your hang-up is
good vid but its basically a repeat of another vid he posted on July 20 2014
That reminds me of the picky cannibal---he threw out his back.
It's called Sex Panther by Odeon. It's illegal in 9 countries... 😂😂 I'm just here for the puns, apparently.
+dawn landix I'm glad somebody caught that 😂
Geesss…..therapists hands under the sheets - a huge NO! Also, very poor body biomechanics re: wrists.
I prefer the Luo Dong approach: any problem start fist pounding the glutes!
Get to the point