Sherlock Holmes and the Painful Low Back

Sherlock Holmes Cartoon

By Emma Maaranen

We see many athletes each week with back pain. Some of these clients have disk, joint or nerve injuries that cause their pain, but more times than not, back pain does not come from a diagnosed injury or pathology. However, just because there isn’t a diagnosed problem does not mean that this pain is not real, debilitating or needing to be solved. Although we feel for your pain, we love these cases! It allows us to practice our detective work and help to solve the mystery of back pain!

It is a rare person who gets through life without experiencing a bout of back pain at some point. You may experience constant soreness, a biting pain that prevents you from standing, or momentary stabbing pain when you twist. The pain may last for a period of a few weeks to a few months, and it may be a one-time ordeal or a recurring theme. After serious injury has been ruled out as the cause of pain, we at Focus Bodywork put on our detective hats and get to work.

I hate to break it to you, but your lower back is not perfect. Each low back has a slight deviation from anatomical perfection: a small tilt in the pelvis, too much (or too little) curve, micro-scoliosis, tiny bone spurs, thin discs, extra-fat nerve sheath, etc. These deviations may not cause any grief and, if “fixed”, may actually cause a lot of new pain! In fact, when MRI’s are taken on people with no back pain and no history of back pain, the MRI’s often reveal bulged discs, arthritis or degeneration. (Click here for a nice NPR story about this.) Currently the spinal orthopedic world is revisiting commonplace spinal surgeries, such as fusions and micro-discectomies, and finding that for some patients these surgeries are not alleviating their pain and may in fact be making it worse. It could be that for these individuals, the pathology seen on an MRI was not the cause of the pain. Back pain is frustrating!

We love to search for clues to back pain. We start by watching you move (sitting down, standing up, walking, squatting, lunging, twisting, balancing on one foot, etc.) to spot odd patterns of motion. For example, we may notice that one hip does not rock back when you sit down. Or perhaps your low back is very stiff, and we notice it causing your mid-back to overcompensate by doing too much of the motion. Or maybe your gluteus muscles are too weak to stabilize your hip when you balance on one leg, which forces excess load onto your spine.

Clues to back pain can also be found in your story. An athlete’s training plan, if too strenuous, may not to allow tissue to heal. For others, a new diet plan to get to race weight may not provide sufficient nutrients to support tissue repair. Often insufficient (or absent) warm-up and cool-down procedures are suspect.

In addition to our eyes and ears, our hands are our top-secret tool for solving these mysteries! Through palpation (feeling your low back and surrounding tissues) we often detect adhesive scar tissue, taut fascia bands and trigger points in muscles that are contributing to low back pain. Now we know enough to set a trap to catch the culprit!

Focus Bodywork therapists are able to address problems in soft tissue that are contributing to low back pain, but often we need to call in experts from other fields to put away the problem for good. Depending on what we have uncovered in movement patterns, your story and palpation, we may recommend a manual physical therapist to manipulate joints, a movement practitioner to retrain faulty posture, a sports nutritionist ensure you meet your diet goals without compromising your health, or an acupuncturist to reduce nerve pain.

Just as Sherlock Holmes leaves no stone unturned, we are determined to guide you in solving the mystery of your low back pain.

One Of My Favorite Clients And Why

By Emma Maaranen

I work with athletes of all flavors: a stay-at-home Mom  training for her first marathon to lose baby fat and carve out some time for herself, a professional Extreme skier trying to keep his spine healthy as he drops 80-foot cliffs, and a 14-year-old US Figure Skating Team member who trains more hours in a day than I am even awake for.  I love the variety of motivations my clients have to be athletes.  I am regularly introduced to new sports (like skeleton) and constantly dive into medical journals to learn how to meet each of these clients’ novel sport and injury needs best.  Recently I have met my biggest challenge.  Her name is Micah, and we can all learn a lot from her about injury psychology, trusting the healing process and the importance of “homework” to get back to the things we love.

Micah is a runner and, through some poor footwear decisions, developed pain in her feet.  Because she was unable to continue running, she saw several specialists to diagnose her foot pain.  Many doctors, MRI’s, and cortisone injections later, she did not have a diagnosis or relief.  She was recommended to rest and hope that the problem resolved itself; it did not.  It soon became painful for her to even walk.  Months of limping soon made her hip painful.  This is the point where I started working with Micah and her medical team.  An insightful podiatrist radically changed her footwear, which  changed how her heels interacted with the ground until finally she showed signs of improvement in her feet.  However, as her feet improved, her  hips got worse.  I surmised that all the gait alteration to escape the pain in the feet required new and novel uses for her hip joints.  I released the tight and overused muscles in her hips, stimulated the muscles that were not pulling their weight, did gentle joint gliding for the hips and lower back to encourage synovial fluid production (lubrication for joints), and introduced lateral movement into Micah’s rehab work to strengthen her atrophied muscles.  I was glowing as a therapist after this first session.  Micah was in the least amount of pain that she had been in for months, and she was finally hopeful she would return to racing on the trails again.

The next morning I received a panicked phone call from her mother.  Micah was worse, much worse! I reviewed the therapy I had done with her and was completely confused; at worst she should have had no change in her pain but be a little touch sensitive in the muscles I released.  We talked further and I learned that Micah felt so fantastic after my work that she promptly ripped around in the foothills with her friends that evening.  She believed that since she felt good she could go back to doing everything she did before, right away. Even though I explained to her during our session that she would feel better, a slow and methodical return to activity was essential.  This often is ignored by clients as the thrill of experiencing some improvement is seductive.  There are muscles to strengthen and movement habits to change that will take time and practice, plus some tissue healing that will take about six weeks to complete.  We set up an immediate follow-up session.

During our second session I spent considerable time with Micah teaching her the strength and movement exercises necessary to properly restore her hip biomechanics, showing her which tight muscles could benefit from self-massage, and some stretches to promote a full range of motion.  After our session I believed Micah understood the process to get her hips healthy again and a realistic time-line for returning to sport.

A few days later I received another call from Micah’s mom.  This time, Mom was laughing!  Mom shared with me that I must have gotten through to Micah as she was going out of her way to show her the exercises she was doing, and was doing them almost every chance she got.  Relieved, I saw Micah again to further therapy.  This time Micah had to show off.  She spun in circles demonstrating the lateral movement exercises I had asked her to practice; she did a forward fold placing her head between her legs to open up her hips, then went over to a piñon tree and pressed her hip into a knobby branch she obviously had pruned so she could do some self-therapy.  I was amazed;  Micah is a horse!

Micah Getting Therapy

It has been a bumpy road, but Micah is back to racing around the trails with the heard.  Even though Micah is a horse, her healing process from a frustrating injury is the same as yours and mine.  Injuries can be tricky to diagnose.  It often takes a few visits to various health care providers to figure out how to get an injury healed, and often there are multiple factors contributing to the pain. Often it takes a team of “experts” to come up with a plan.  When finally we see some improvement, it is difficult not to overdo it and set ourselves back.  Patience!  Being an active participant by doing your “homework” and becoming educated about your injury and healing process is essential.

Me, Teaching Micah Her “Homework”

Micah is my first equine therapy client, and it has provided an incredible learning experience for me.  I am available for other equine sessions; call Focus Bodywork if you would like to know more about my credentials, what is involved in a session and rates.

Olympic Fever Possibilities

By Emma Maaranen

I am an athlete.  I am on go-go mode 95% of the time.  I hate sitting still.  But, for two weeks this summer, I couldn’t leave the sofa.  I didn’t have time for laundry or groceries, let alone distance training!  I had… Olympic Fever.  And I was not alone.  During the Olympics it seems like everyone is addicted to watching the TV feed: weekend warriors, spectators, and soccer moms.  Even kids are into the Olympics.  A five-year-old from my neighborhood nearly knocked me down while sprinting the length of the sidewalk yelling. “Usain Bolt coming through!”

I love sports, I love being an athlete.  I’ve even been known to play a team sport here and there, but I do not regularly follow sports on TV.  The Olympics, however, mesmerize me.  Like every girl growing up in the ‘80s, I wanted to be Mary Lou Retton and get a perfect 10, I was shocked when Tanya Harding made the desire to win a criminal act, and I noticed being an athlete might be risky with Greg Louganis’s infamous platform dive.    It is the combination of these things that makes the Olympics special to all of us.  Every single athlete there is AMAZING – yes, every single one of them!  On top of overcoming political turmoil, discrimination, financial obstacles, and homesickness, many of these athletes have overcome physical assaults that should keep them from being on the world stage doing their sport.  Did you see the swimmer who is missing a leg, the runner on two prosthetic legs, and the 47-year-old woman gymnast competing for her third country and sixth summer games?

Oscar Pistorius inspiring all of us!

No doubt Olympic athletes are great.  Heck, they may be mutants!  But they have a secret.  They know that our bodies are capable of unfathomable feats of repair and resilience.  They know that the mind, when put to task, can create things previously unknown.  They are not confined by what is expected or what has happened in the past.  These individuals ask, “What is possible?”  With this belief there is no reason to expect you can’t return from injury completely.  In fact, you should believe you will actually be better than before.  Jared Campbell, who returned to ultra-running after an Orthopedist told him that he never would, has a great outlook on injuries. “Injury is an opportunity for my body to adapt to the activities I love.”  With an attitude like that it’s no surprise that Jared is one of the most successful Ultra Marathoners out there for the past 10 years!

Now that my TV is collecting dust again, I am going to be an Olympic athlete in my heart and just see what is possible.

I Love Being Called This, But It Gives Me Big Shoes To Fill…

By Emma Maaranen

“The Leg Whisperer”

In this blog post (click on the blue link above) are some very kind words from Jay Aldos, a gifted ultra runner and Focus Bodywork client about how sports massage has become an essential part of his training. Thank you Jay!

PS – Jay went on to win the Zion 100 last weekend.

A Note on Therapy from the Far East

Poster in a Medical Clinic in Beijing

By Emma Maaranen

While in China for the better part of March, I experienced as much and as varied bodywork as I could. I wanted to see how Eastern philosophies of medicine worked in practice, experience Chinese modalities and get some work done on my post-op ankle that has hit a healing plateau. Armed with a translation app on my iPhone, an open mind and a sense of humor, I tried a new modality daily.

In China bodywork is a part of the medical system.  Therapists are typically based in medical clinics, but in tourist areas I occasionally saw practices with “massage” translated under the Chinese characters on their signs.  I had sessions of reflexology, shiatsu (pressure point massage to balance your energy), cupping, ear candling, abdominal massage (for my organs), and even a massage by a blind therapist.  Each treatment was unique, but the compassion and thorough care I received left the biggest impression.

Me, after a Shiatsu session. Apparently the energy left my head as if I had stuck my finger in an electrical socket.

On my first full day in China I walked into a medical clinic and realized that no one spoke English and that my tiny rehearsed mandarin phrases were not understood. Finally I pointed to my ankle and was promptly ushered to a large room where a practitioner wearing a lab coat looked at my ankle.  He examined my swollen ankle and healing scars to which he made a cutting gesture acknowledging my post-op state.  I nodded, and he quickly left.  The practitioner returned with a bucket of very hot water steeping with herbs. As he soaked my feet (a practice I later learned that almost every clinic performs), I had to resist all urges of jumping out of the almost scalding broth.  While soaking my feet he started massaging my shoulders.  Although I wondered if my ankle would get more attention than scalding water, I was relieved to have my shoulders addressed because they did not weather the flight to Asia well.  My therapist quickly located the culprit muscles, released them through massage and in a simple fashion adjusted my neck.  This was a feat.  I will not let Chiropractors adjust my cervical spine (a future blog post), but this therapist simply moved my neck in a strange position and put the smallest pressure on my head, and I was adjusted.  It was so simple and effective that, given the opportunity, I would let him do it again!

Now that my shoulders were back on track, he went to work on my foot.  I must stress the point that we could not exchange a single word, and my ankle injury (a subtalar dislocation) is a rare one to which every physician/therapist I have seen in the US has mentioned that they have read about this before but never seen it.  My Chinese therapist felt my ankle, gently took it through a range of motion, tested the strength of the healing ligaments, then performed the most precise and effective manual therapy treatment I have had to date.  I completely trusted this therapist to manipulate my ankle because he took the time to explore what was swollen, tight and atrophied.  He understood where my injury was in the healing process and what the next step was to further my recovery.

The most profound part of this therapy session was how I was approached as a client/patient.  In the US, my orthopedists take x-rays, MRI’s and CT scans to see how my healing is progressing, and my therapists look at the diagnosis in my chart and evaluate my healing by the time elapsed since injury. Images reveal structural repair (if the ligament completely knit back together), and comparing the functionality of a patient against research subjects gives good measures of normal or abnormal healing.  My Chinese therapist, on the other hand, used only touch to assess my injury and its healing progress.  Hands-on evaluations like this show how tissue responds in dynamic situations (like if a ligament is too tight to allow motion).  I feel a combination of all of these evaluations will provide practitioners with the most insight to guide their patients care.

Clinician after clinician in the states has told me that my recovery will take time.  I have been reassured that the structural damage is well repaired, but have not been given much insight as to what to do to improve the functionality of my ankle or what to expect down the road. My Chinese therapist did not seem daunted by an unusual and slowly healing injury.  He devised a treatment and revised what he was doing by what was working and what was not.  I appreciated my Chinese therapist being creative, and I think he was even having fun trying to understand how to help an atypical injury on a patient with whom he couldn’t verbally communicate with.  In the West, it is easy to rely on research and standard protocols, but I don’t think this honors the intelligence of the clinician and the practice of medicine nor is this complete care for the patient.

Going to a clinic and seeing a doctor/therapist is scary.  My experiences with Chinese medicine showed me that treating the whole person, not just the injury creates a wellness environment that alleviates a lot of fear. I am going to make sure I have this at the forefront of my practice.  No matter what type of medicine is practiced or the flavor of therapy provided, I believe compassion for the person in the room will guide the best outcome.

I had to try this out. My therapist was indeed blind and performed a thorough full body massage to rival any I have had at a spa.

Congratulations Jay!

By Emma Maaranen

This past Saturday, Dec. 17 Jay Aldos broke the 100 mile World Record for Men age 50-54.  At the Desert Solstice Ultra Marathon Invitationals Jay ran 100 miles in 13:52:29 – that is an average pace of 8:19 per mile.  My feet hurt just thinking about that.  Read Jay’s report about the race, his training strategy for this unique event and how reflecting on the support of his friends and family helped him push through physical and mental fatigue.