Low-Back Pain Can Be a Pain in the Butt--Literally

Not only will 80–90 percent of the population have issues with low-back pain sometime during their adulthood but, in addition, back pain is one of the most common symptoms inducing people to visit a physician and is involved in almost a fourth of all occupational injuries and illnesses. In 2001, back injuries resulted in the highest percentage of short-term disability of all nonfatal illness and injury cases. In sum, back pain, especially low-back pain, is a big problem—for workers, employers, and insurance companies alike.

Part of the problem is that back pain can be difficult to diagnose, and physicians often overlook or misdiagnose trigger point pain (that is, localized areas of muscle soreness that refer pain to elsewhere in the body). This diagnostic difficulty can lead to treatments that don’t accurately address the problem, such as painkillers, which don’t necessarily rectify the problem but simply dull the pain. It is also worth mentioning that surgical rates for low-back pain are twice as high in the United States as in most other developed countries.

Often, to give a commonly occurring example, clients who are experiencing low-back pain actually have an issue with trigger points in the gluteal muscles, the piriformis muscle (which lies deep to the glutes), or even muscles as far away as the calf (the soleus muscle, to be exact). The piriformis, in particular, seems to be a major culprit when it comes to low-back pain. In my own practice, when I release knots in the piriformis muscle, I have had clients say they can feel the tension in their lower backs dissolve immediately. I even had one client say he felt his whole back realign when the tight spot in his piriformis let go.

Because low-back pain relief can be so close at hand—literally—it only makes sense to visit a knowledgeable massage therapist before trying something more invasive or simply palliative but not curative (such as pharmacologic “solutions”). And research is mounting to support this course of action. In one study, massage recipients reported less pain, depression, and anxiety, as well as improved sleep, and they showed improved trunk flexion. Stress hormones associated with chronic low-back pain were also reduced. A more recent study found similar results, with benefits lasting up to six months. And numerous other studies have shown massage to be helpful in relieving back pain.

Although reduction of stress hormones may come into play, in terms of how massage works to relieve low-back pain, as found in the one study, other researchers aren’t sure why massage seems to work. It may be that massage stimulates the muscle tissue locally or that it causes a response from the central nervous system. They also hypothesize that the reasons for improvement could be as simple as being in a relaxing environment or being cared for by a sympathetic therapist.

In any case, I agree with the chief author of the most recent study, who was quoted as saying, “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.” I would go one step further, though, and suggest that perhaps massage should be one of the first things you try.

Sources

Bagduk, Nikolai. 2004. “Management of Chronic Low Back Pain.” Medical Journal of Australia, vol. 180.

Bakalar, Nicholas. 2011. “Stubborn Back Pain? Try Massage.” New York Times, July 4 (http://well.blogs.nytimes.com/2011/07/04/embargo-july-4-5pm-for-back-pain-try-massage/?scp=1&sq=%22low%20back%20pain%22&st=cse).

Cherkin, Daniel C., et al. 2011. “A Comparison of the Effects of Two Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial.” Annals of Internal Medicine 155:1–9.

Deyo, Richard A. 1983. “Conservative therapy for low back pain: Distinguishing Useful from Useless Therapy.” Journal of the American Medical Association 250:1057–62.

Deyo, Richard A., et al. 1996. “Low Back Pain: A Primary Care Challenge.” Spine 21:2826–32.

Hernandez-Reif, Maria, et al. 2001. “Lower Back Pain Is Reduced and Range of Motion Increased after Massage Therapy.” International Journal of Neuroscience 106:131–45.

Papadopoulos, E. C., and S. N. Kahn. 2004. “Piriformis Syndrome and Low Back Pain: A New Classification and Review of the Literature” Orthopedic Clinics of North America 2004 35:65–71.

Simons, D. G., and J. G. Travell. 1983. “Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles. Postgraduate Medicine 73:99–105, 108.

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. 2004. Worker Health Chartbook 2004. Publication no. 2004-146. Cincinnati, OH: U.S. DHHS, PHS, CDCP, National Institute for Occupational Safety and Health. Fig. 1-38.

Cruisin', on a Sunday Afternoon

Not since I was a kid have I had the leisure to ride a bike simply for the fun of it. I bike to work. I bike to run errands. I bike to dinner parties. I enjoy all of those excursions, but there are almost always time constraints or, at least, substantial distances to cover. Consequently, I've been riding bikes that can go, baby, go! Skinny tires, multiple gears.

But in Michigan, on vacation, time is a little more free form and we're not in much of a rush for anything. So I decided to try my gal's cruiser. I love the look of cruisers, but they've never been especially practical for my purposes. On vacation, though, with lots of leisure, there was nothing to hold me back, so I hopped on Kathy's cruiser. And unlike when I'm riding in the city, with cars and people and other bikers everywhere, I didn't even worry that I didn't have on a helmet or that I was riding with flipflops. What a freeing experience!

A Jury of My Gears?

Jury duty is not only a civic responsibility: it's an honor and a privilege. Sometimes, though--much like having a job--it gets in the way of things. Like exercise.

Recently, I received notification that I was supposed to report to jury duty in Maywood, IL. Jury duty doesn't start that early in the morning, but counting in travel time and all, I was pretty sure I'd end up forgoing my exercise that day because I can no longer get up before dawn.

But then I had the bright idea to see whether it was bikable. And it was! So I biked from my house in Chicago, through Oak Park and River Forest and on into Maywood. I'm pretty sure I've never even been through the latter communities by car, so it was a lot of fun seeing completely new things.

And I'm fairly certain I was the only one who biked to jury duty that day.

Intersection of Terror!

I can see the previews for the movie version now: don't go into the intersection! Cars turning from the wrong lane--enter at your own risk.

Yeah, as movies go, that one would stink. But despite my hyperbole, it is a scary intersection: Ashland/Armitage/Elston. And so my letter to Transportation Commissioner Gabe Kaplan....

August 6, 2011

Gabe Klein, Commissioner

Department of Transportation

City Hall

121 N. LaSalle Street

Chicago, IL 60602

Dear Commissioner Klein,

First, I want to thank you for all your advocacy on behalf of cyclists and pedestrians. As a regular bicycle commuter, I know the perils—and pleasures—of cycling on Chicago streets, and I very much appreciate all you’ve done to make such travel a little easier for Chicago’s citizens.

Now I’d like to direct your attention to an intersection that plagues me on a daily basis, that at Armitage, Elston, and Ashland. Going southbound on Elston on my bike, travel through that intersection goes without a hitch, but when I am going northbound, it gets a little dicey at the juncture between Ashland and Elston. Even when I am in the center lane, indicating, I would think, my intention to stay on Elston, cars routinely cut in front of me to turn right onto Ashland. Sometimes it is more treacherous than others, depending on how closely they cut me off.

What I’d like to propose is that the lanes on Elston south of Armitage be painted to indicate that those who intend to travel north on Ashland be in the right-hand lane and those traveling north on Elston be in the center lane; the far left lane is already marked for left turn onto Armitage. North of Armitage, I suggest that one of the two lanes that continue to Elston be turned into a bike lane. Ideally, I’d love a protected bike lane, but at this point I’d take anything that helped give bicyclists a clear right of way! Since this may be hard to understand in the abstract, I’ve created some drawings to illustrate what I mean.

Current Intersection

Proposed Intersection

In the picture at right [above here, in the blog], I’ve used purple to show what I think should be painted onto the road.

If you have any questions about my concerns or suggestions, I hope you will feel free to contact me. I know everything can’t be attended to at once, but I hope this is a matter that you can investigate and resolve quickly.

Sincerely,

Brave Heart, Chicken Liver

Beginning with Pipi Longstocking and on up through Amelia Earhart, I have always loved the idea of adventure. However, after probably age 9 or 10, my own brave heart gave way to my chicken liver and I have contented myself primarily with reading about adventure, whether fiction (as with Patience and Sarah and a hundred other books whose titles are just now escaping me) or nonfiction and biography. I've especially loved reading about brave, adventurous women, but sometimes, especially when there are shared interests involved, the derring-do of men has attracted my attention, as with The Lost Cyclist, by David Herlihy.

I had started reading this book months ago, but then had to return it to the library. When the LGRAB contest came up (see at right), it seemed like a splendid time to resume reading that book. The Lost Cyclist chronicles the round-the-world bicycle ride of Thomas Allen and William Sachtleben and the attempt by Frank Lenz to accomplish that same feat in the opposite direction about a year or two later, in 1892-93, under the auspices a periodical called Outing.

I'm not going to do a "book report," as my lovely spouse Kathleen keeps calling it, but I do want to mention a couple of the things that particularly struck me. Lenz's racism--referring, for example, to the Chinese people he hired to help him as "coolies"--was really jarring. But in the main, the accounts of his junket were fascinating. For instance, he had to use rail beds for travel (owing to the general impassability of roads), which required him, on at least one occasion, to hang from a railroad overpass, his bike in the other hand, when a train surprised him.

I also loved that Lenz was swarmed in every town and city, so rare were bicycles in those days--though not so rare that there were bicycle clubs in most large cities, including female members. I can relate to the excitement he generated--when I'm on the bakfiets (cargo bike). Seldom do I venture out on the cargo bike without getting shouts of "nice bike!" and without getting stared at.

And I couldn't help putting myself in Lenz's place as he traveled through Japan and China without speaking a word of those countries' languages. While it's true that I went to St. Petersburg, Russia, without knowing a word of Russian, I went there as part of a writing seminar and was therefore hardly on my own. I can't imagine how frightening it must have been for him, all on his own, especially back then when foreign countries were truly foreign to most people.

I would say "spoiler alert" if it weren't for the fact that the title Lost Cyclist pretty much clues the reader in at the start that all does not go well for Lenz. I will read on now with trepidation, wishing my good thoughts could alter his fate.

Massage Can Quiet Some of Dementia's Demons

“There are hardly any age-related conditions that cannot be improved with a weekly half-hour massage,” claims Sharon Puszko, owner of Day-Break Geriatric Massage Institute. Even a cursory look at current research on massage will verify the truth of that contention and, in fact, might suggest that there are few conditions, period, that wouldn’t be made better with massage. The value of massage as an intervention is especially high for conditions for which effective treatment continues to confound practitioners of conventional medicine, such as Alzheimer’s and other forms of dementia.

The loss of memory and, sometimes, speechlessness that characterize these conditions are a source of frustration for all concerned, both those afflicted with the condition and their caretakers. For those actually suffering from this condition, however, the frustration can result in agitation, of both a verbal and physical nature. Traditionally, such agitation has been managed either chemically (that is, with medication) or physically, with restraints, but neither of these methods has been shown to be especially effective.

The past decade, however, is distinguished by an increased interest in studying alternative treatments, including massage, for managing symptoms of dementia. These studies have made use of salivary (measuring levels of a stress-related amino acid protein), psychometric, blood pressure, and observational measures to assess the effects of massage on people with dementia. The treatments generally involved soft massage or therapeutic touch to hands or feet for short periods of time (10–20 minutes), accompanied by, in at least one study, the inclusion of aromatherapy.

Massage, in all cases, was found to have one or more of the following effects on the symptoms typically exhibited by people with cognitive impairment:

o reduced stress level

o less wandering/pacing behavior

o reduced physical agitation/aggression

o reduced verbal agitation/aggression

o lowered pulse rate

o less inappropriate behavior

o less resistance to being cared for

Study of the effects of massage on those troubled with dementia is still relatively new, however, so it’s hard to know exactly how powerful the calming effects are. But the results are definitely promising. In the meantime—until more research has been conducted—since none of the existing studies have found massage to have any negative impacts on those with Alzheimer’s or other forms of dementia, massage seems like a useful nonpharmalogical tool for helping to cope with some of this impairment’s most disruptive symptoms.

Also, if you are inclined to believe the old adage An Ounce of Prevention Is Worth a Pound of Cure, listen up! A recent study found that those suffering from depression may nearly double their risk of developing dementia later in life. Lead author of the report, Jane Saczynski, says, “While it’s unclear if depression causes dementia, there are a number of ways depression might impact the risk of dementia. Inflammation of brain tissue that occurs when a person is depressed might contribute to dementia. Certain proteins found in the brain that increase with depression may also increase the risk of developing dementia. In addition, several lifestyle factors related to long-term depression, such as diet and the amount of exercise and social time a person engages in, could also affect whether they develop dementia.” But as I discussed in my article “Turn That Frown Upside Down: In a Massage Face Cradle,” massage has been found to help regulate some of the biological causes of depression.

Massage may also be able to intervene in the onset of dementia is helping individuals maintain their overall health: a study published this week in Neurology provides evidence that when small health problems are added up, a person’s risk for dementia increases. In fact, for each small complaint a person has as they age—from sinus issues to hearing problems and bad dental health—the risk for dementia increases by 3 percent. For instance, those who had no health complaints at the start of the study had an 18 percent risk of developing dementia over the next ten years, whereas someone with eight minor health complaints had a 30 percent risk and those with a dozen complaints showed an increased risk of 40 percent.

Massage, of course, can’t insure that someone won’t develop dementia. But given that massage has been shown to improve a variety of mental and physical health conditions, it can certainly be another tool in your arsenal to help maintain your health. So after you have that apple today to keep the doctor away, get on the phone and schedule a massage!

Sources

Hansen, N.V., T. Jørgensen, and L. Ørtenblad. 2006. “Massage and Touch for Dementia,” Cochrane Database of Systematic Reviews, no. 4.

Hawranik, Pamela, Pat Johnston, and Judith Deatrich. 2008. “Therapeutic Touch and Agitation in Individuals with Alzheimer’s Disease,” Western Journal of Nursing Research, 30:417–34.

Holliday-Welsh, Diane M., Charles E. Gessert, Colleen M. Renier. 2009. “Massage in the Management of Agitation in Nursing Home Residents with Cognitive Impairment,” Geriatric Nursing, 30:108–17.

Moyle, Wendy, et al. 2011. “Exploring the Effect of Foot Massage on Agitated Behaviours in Older People with Dementia: A Pilot Study,” Australasian Journal on Ageing, April 26.

Puszko, Sharon. 2007. “The Marvelous Benefits of Geriatric Massage,” http://www.thehealthyplanet.com/june07_the.htm.

Rowe M, Alfred D. 1999. “The Effectiveness of Slow-Stroke Massage in Diffusing Agitated Behaviours in Individuals with Alzheimer’s Disease,” Journal of Gerontological Nursing, 25:22–34.

Saczynski, J. S. 2010. “Depressive Symptoms and Risk of Dementia: The Framingham Heart Study,” Neurology, 75:35–41.

Smallwood, J., et al. 2001. “Aromatherapy and Behaviour Disturbances in Dementia: A Randomized Controlled Trial,” International Journal Geriatric Psychiatry, 16:1010–13.

Song, Xiaowei, Arnold Mitnitski, and Kenneth Rockwood. 2011. “Nontraditional Risk Factors Combine to Predict Alzheimer Disease and Dementia,” Neurology, 77:227–34.

Suzuki, Mizue, et al. 2010. “Physical and Psychological Effects of 6-Week Tactile Massage on Elderly Patients with Severe Dementia,” American Journal of Alzheimer’s Disease and Other Dementias, 25:680–86.

Turn That Frown Upside Down: In a Massage Face Cradle

Anyone who has ever had a massage can probably attest to how good it makes you feel, both physically and psychically. So the assertion that massage is helpful in combating depression may seem intuitive. But of course, depression is more serious than simply being grumpy or having a bad day: clinical depression, according to the National Institutes of Health’s Medline Plus, “is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time” (emphasis mine). In that light, claims of massage being beneficial in treating depression should not be made lightly.

But it would seem that there is a growing body of research to support this belief. A group of researchers from a university in Taiwan examined seventeen studies on depression and massage and concluded that, while further study is warranted, “massage therapy is significantly associated with alleviated depressive symptoms.” If you’re wondering how massage alleviates these symptoms, it may have to do with, at least in part, the apparent influence of stress.

Research suggests that stressful experiences might deplete such neurotransmitters as dopamine and serotonin. Serotonin modulates mood and emotion, while dopamine plays a role in emotional response and the ability to experience pleasure and pain. Given the types of signals these chemicals transmit across the nervous system, it is easy to see how having less of them might lead to depression. Also, stress increases production of the hormone cortisol, not coincidentally often referred to as the stress hormone. Current research has found that high levels of cortisol are involved in the development of certain depressive disorders, though the mechanism for that development is as yet not understood.

When you get a massage, you can feel the stress melting away. But as you might have gathered by this point, this sensation is not simply psychosomatic. Studies that have analyzed blood and/or urine samples have found that dopamine and serotonin amounts went up and cortisol levels were lower following massage. In addition, massage causes the body to release oxytocin—also known as the “trust hormone”—which would give depression sufferers, among others, an enhanced sense of security.

Studies to date have not researched whether massage would have to be ongoing in order for the benefits to persist. But it’s almost impossible to get too many massages, so it certainly couldn’t hurt to err on the side of caution and get massages as often as time and budgets allow!

Sources

Anisman, Hymie, and Robert M. Zacharko. 1982. “Depression: The Predisposing Influence of Stress.” Behavioral and Brain Sciences 5:89–99.

Field, Tiffany, et al. 2005. “Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy.” International Journal of Neuroscience 115:1397–1413.

———. 2004. “Massage Therapy Effects on Depressed Pregnant Women.” Journal of Psychosomatic Obstetrics and Gynecology 25:115–22.

Hou, Wen-Hsuan, et al. 2010. “Treatment Effects of Massage Therapy in Depressed People: A Meta-Analysis.” Journal of Clinical Psychiatry 71:894–901.

Sher, Leo. 2004. “Daily Hassles, Cortisol, and the Pathogenesis of Depression.” Medical Hypotheses 62:198–202.