Source: Stuart Taws Issue 52, Nov./Dec. 1994, Page 30
Category: Technique
Author: Stuart Taws
Alleviating Low Back Pain Through Soft Tissue Release

An alternative to surgery and drugs
Chronic pain is a most misunderstood phenomenon. In our modern age of technological advancements, from fiber optics to laser surgeries, the remedy for chronic low back pain is a frontier still to be conquered.

Back pain affects more than three quarters of us during our lifetime. It is second only to the common cold as a reason for doctor visits, and is second only to childbirth as a reason for hospitalization.

These staggering facts led the U.S. government to sponsor a series of research projects over the past five years. Led by a team at the University of Washington School of Medicine and the VA Medical Center in Seattle, along with John Hopkins University, the research was notable for identifying treatments that do not work. These included the traditional approaches of bed rest, traction and corsets. Surgery for back pain was found to be often ineffective and appeared to be overused.

"In the United States, most doctors treat the pain, not the underlying disorder that caused the pain," said Dr. David Imrie, director of the Back Care Center in Toronto. In agreement with similar findings by the British Medical Association he stated, "There are almost 20 times more back operations per capita in the United States than Canada." Is this because the British and Canadians have stronger backs? No. As Dr. Imrie concluded, "Surgery is definitely overdone."

In the results of these ground-breaking studies, the experts concurred that:

• Between 70 and 90 percent (depending on the expert) of all low back pain is caused by muscles in spasm.

• A slipped disc, the traditional explanation for low back pain, actually accounts for less than five percent of all back injuries. (A by-product of excessive cat scans is the revelation that many people have disc abnormalities, but no pain from them.)

• About one percent of people with back pain require surgery.

• Ninety percent of the 31 million back pain victims’ pain is not caused by damage to the spine and vertebrae; not by bulging, slipped or herniated discs; not by tumors or any other dire diagnosis; but, rather, by muscles in spasm.

The relief of millions of pain victims rests in the hands of capable therapists who can skillfully and quickly take muscles out of spasm. We need to be skilled in the powerful techniques that quickly restore functional ability to the affected muscles and provide a pain-free world for former victims of incapacitating and excruciating pain.

A back pain sufferer leaves his doctor’s office clutching a prescription for anti-inflammatory drugs, muscle relaxants and pain killers. Three to six weeks later, still in pain, he is referred to a specialist. Stronger pain killers and anti-inflammatory drugs are prescribed along with a series of expensive tests, x-rays and MRI’s. If abnormalities in the vertebrae or a herniated disc are observed, surgery may be suggested. If nothing is found on film, physical therapy, medical treatments and home exercises are prescribed.

What if the pain persists?
Patients may receive psychological counseling for pain and then the ultimate sentence: "You will just have to learn to live with the pain."

This is simply not good enough. That statement means "I do not have the particular knowledge to take you to a pain-free condition." In a BBC documentary on low back pain a doctor stated, "We are not trained in the basic hands-on skills of those therapists found in sports medicine."

It is these powerful sports therapies that are proving to be one answer. Soft Tissue Release® is one of those therapies, a powerful rehabilitation technique that was developed exclusively with Britain’s finest athletes. (See sidebar, page 33.)

Now, as a consultant to a sports rehabilitation and pain clinic, a referring center for St. Joseph’s Hospital in Orange, California, I receive patients who are at the end of the line. They have tried everything available, even surgery, and are still in pain. In some cases, there has been noticeable improvement after rehabilitation, but still the pain persists.

A clear success
Jerry Huegle, an avid horsewoman from Tustin, California, was thrown from her horse and suffered a break in her mid thoracic spine. After extensive and successful surgery she was able to walk again. Her problem now was that she suffered such excruciating low back pain that on occasions she even considered suicide. This continued for five and a half years.

"The severe pain I have had since surgery has been in the lower back. After going to two orthopedic surgeons, they have told me there is nothing they can do for me. I will just have to live with the chronic pain for the rest of my life."

A friend who had a back injury referred Huegle to me. After just one Soft Tissue Release treatment, Huegle reported relief from her back pain.

The above-mentioned case is one of hundreds of successes I have found rewarding. Standard rehabilitation and physical therapy concentrates on strengthening the spine’s extensor muscles. In so many cases, however, pain experienced as lumbar reticular syndrome is referred pain from the quadratus lumborum or piriformis muscle, for example.1

In Huegle’s case, she was thrown from her horse and landed awkwardly in a side-twisting impact. Not only did she break her back, but she severely and directly impacted her piriformis and gluteus medius muscles on the right side. The resulting nerve entrapment referred intense pain to the sacroiliac region. In other cases, repetitive use syndromes severely affecting the quadratus lumborum refers pain along the crest of the ilium and the S.I. joint.

Even if the source of the pain is correctly identified, how is it that Soft Tissue Release seems to effect freedom from pain so quickly? Because, as many other powerful therapies do, Soft Tissue Release evokes the body’s own spectacular healing abilities. When these natural powers are released, the results seem miraculous.

Anatomy of an injury
Consider again what happens when injury occurs. Whether induced by direct trauma, repetitive use injury, or by stress and anxiety, the body’s reaction is the same. There is a powerful inflammation response. This inflammatory response at the site of injury produces a cocktail of chemicals which forms an inflammatory exudate in the interstitial spaces. This response serves to combat infection, prevent further hemorrhaging and shorten muscle length to prevent further injury. Combined with powerful clotting agents, the end result of cell death and tissue debris results in areas described as "capsules of congestion."

These encapsulated areas of adhesions and fibrotic tissue tie up a large percentage of the muscle fibers, so that the muscle cannot return to its original resting length. The decreased nerve and blood flow contribute to keeping the muscle in a toxic state, further shortening the muscle length. If the muscle is attached to a vertebrae, a subluxation can occur, pinching off the nerve root. This soft tissue dysfunction can mimic a much more serious pathology.

The relief of millions of pain victims rests in the hands of capable therapists who can skillfully and quickly take muscles out of spasm.

Even if standard physical therapy and rehabilitation is used, this concentrates on strengthening the previously damaged and now shortened muscle. The shortened and still damaged muscle becomes stronger, but is still inflexible and prone to further injury. This would explain the recurring back injuries patients have all their lives and the "failed surgical back syndrome."

Once the capsule of congestion has been addressed and the muscle returns to its original resting length, then strength conditioning and rehabilitation are most effective.

Many of the excellent P.N.F. and neuromuscular techniques involve placing the patient in a position so that the damaged muscle can be contracted against a resistance supplied by the therapist. This minimal resistance is maintained five-to 10 seconds, after which exhalation and further relaxation is accomplished. Repetition of this technique, slightly increasing the effort and duration, engages new barriers until a release is achieved.

The technique
Incorporated into the Soft Tissue Release system is a state-of-the-art stretch technique, Specific Stretch®. Instead of engaging the affected muscle, the patient is placed in a particular position so that the muscle begins to stretch in a very specific direction or plane. The exact location of the injury has been defined and a determined pressure is applied directly into the affected tissue or along a specific line of injury. At the same time, depending on whether passive or active techniques are being used, the patient is given a set of instructions that now engage the antagonist of the muscle or muscles involved. The muscle is extended from a fixed position in a determined direction under the pinpoint of pressure. This is repeated in every plane of movement. There are three levels of this. The first level of stretch is very passive, leading up to the third level which is very active. At this level, the instruction involves the patient totally, so they are now "doing all the work," and the therapist is minimally involved.

The combination of the Specific Stretch, a precise pinpoint compression through an exact plane of movement, along with strong patient involvement can produce an immediate release. The art is in finding the specific direction in which the injured muscle can be moved to achieve a freeing up of previously fibrotic areas and the engaging of muscle memory.

The role of bodywork
Although the results over the last three years of using Soft Tissue Release on chronic low back pain are anecdotal, the consistency of the results is overwhelming. Interestingly, excited patients have gone back to the same doctors and surgeons with enthusiastic tales of recovery. This has led to a growing respect, albeit begrudging in some cases, for the powerful work of massage therapy. This is why, more than ever, there are wonderful opportunities for massage therapists. There is a wind of change blowing in the attitudes of many in the established medical world.

One of my main concerns about our industry is the physical toll our work can have upon us. We all need to work smarter, and learn techniques that work powerfully but with less stress on us. Normally, working on the deep gluteal muscles and lateral rotators would require a great deal of strength and result in fatigue and exhaustion. Soft Tissue Release requires little or no effort from the therapist.

Soft Tissue Release was developed with world-class athletes in England – with gold medal victories as the result. For me, being able to help so many people – taking them from chronic, debilitating pain to a pain-free condition – is the real gold. Today’s powerful techniques are going to raise massage therapy to new heights of recognition and respect.

Stuart Taws is a sports rehabilitation therapist originally from England who graduated from the London School of Sports Massage. Taws also founded the British Institute of Sports Therapy, which specializes in teaching Soft Tissue Release to therapists and athletic coaches.

References
1. Chaitow, Leon. Myofascial pain & dysfunction, Vol. II. "Soft Tissue Manipulation". Pgs. 28, 150.

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