Assess & Address: Lumbar Muscle Strains by Whitney Lowe

Pathology Assessment & Evaluation Treatment Massage Techniques

Massage techniques
There are several important issues to address when working with muscle strains. Of primary importance is to reduce the soft-tissue dysfunction that has occurred. Where muscle fibers have been torn, scar tissue will be created to repair the fibers. However, if the area is not properly mobilized during the healing phase, scar tissue may inappropriately bind adjacent muscle fibers and prevent optimal function of the muscle.

The most effective way to enhance the production of a functional scar with massage is through deep transverse-friction techniques (see the figure to the left). The transverse pressure and movement is theorized to reduce the degree to which adjacent tissues bind to each other. To enhance the effectiveness of deep-friction techniques, stretching and other forms of soft-tissue mobilization should be used. These methods will help encourage the independent movement of the muscle fibers in the region of the injury.

In addition to specific work on the injury site, it is important to reduce tightness in the muscle as there is almost always some degree of reflex muscle spasm. Some of the most effective methods for reducing hypertonicity in the affected muscle involve deep longitudinal-stripping methods (see the figure to the right). Note that strains commonly occur in the musculotendinous junction in the lower margin of the erector spinae group.

Static-compression techniques may also be performed using a broad application of pressure, such as with the palm of the hand. As superficial levels of tension are worked through, deeper and more specific pressure can be applied to these hypertonic areas with the thumb, knuckle or various pressure tools (see the figure to the left). Keep in mind that referral zones for myofascial trigger points in the low back may give the impression of pathology in other areas such as the sacroiliac region, hip joint or the lower extremities.

Stretching procedures, performed along with these other techniques, are also helpful. Passive stretching of the spinal muscles may be a little difficult to perform on a massage table, but using a little creativity a practitioner can often find good methods for stretching the affected muscles. Facilitated stretching techniques are particularly helpful when it may be too painful to put pressure on the affected muscle with massage. These methods, which also go by the names of muscle-energy technique or Proprioceptive Neuromuscular Facilitation (PNF) stretching, can become a regular part of the therapeutic strategy, but they do require a working understanding of muscle function in order to perform them correctly. An example these methods applied to the quadratus lumborum muscle is demonstrated in the above figure.

In many cases, the term "muscle strain" is used to describe a wide variety of back-pain complaints. For example, a muscle spasm caused by fatigue or sudden eccentric loading will give many of the same symptoms as an actual strain involving torn fibers. However, in a muscle spasm there are no torn fibers, only chronic hypertonicity resulting from the injury. In addition, myofascial trigger points often develop in the affected muscles. If these areas were addressed with deep friction massage - the way you would work on scar tissue in a muscle strain - the results could be detrimental. The overall goal of reducing tension in the affected muscle may not be met. These problems would be more appropriately worked on with other techniques, such as longitudinal stripping or static-compression techniques.

Muscle strains are a common reason for people to seek the care of a massage therapist. Effectively addressing them requires accurate assessment and proper treatment protocols for the type and severity of the strain. Following the above guidelines will help therapists successfully address these common injuries.

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