Skeletal vs. Muscular and how we can help

[Mtbodyworks]

Hello
So I have a client who thought he maybe threw out his lower back about 3 weeks ago lifting something. I did some extra work on his lower back into the glutes during his massage and he came back today saying he felt great afterwards up until today when he in fact thinks that playing 18 holes of golf as well as tennis aggrivated the area. I however believe that it's not muscular though, and may in fact be a bruised sacrum/or maybe even a slipped disc or pain from simple misalignment because the pain is essentially on his coccyx and not muscluar at all.
I'm curious though, if it is in fact a skeletal issue of sorts, how would massage necessarily have helped him last time? It's such a bony area (on this man atleast). I understand massage increased circulation last time and maybe relaxed the muscles, but I don't think that would have relieved him of any pain because of the aggrivated area.
I suggested ice and continuous stretching as he has been doing (and gets no relief from) and said that his next step should maybe see a chiro and get some x-rays to make sure there isn't anything slipped or misaligned.
You think that's the best move?

[kathryn]

It's never a bad idea to suggest your client get checked out by a physician. I've seen folks with pain in the tailbone and coming in saying they've "thrown out the back", usually it stems from QL and glute stress. The QL especially will seize up the low back and I've had folks almost crawling into my office. The nerves around there become "stressed" out if the client currently (or in the past) performs a lot of twisting activities. Or from sitting for long periods with the body in a twisted position. The superior & inferior gluteal nerves refer pain to the tailbone and they feed the glute muscles. There may also be some nerve irritation anywhere from mid-back down into the hips creating the pain, it's the aggravated nerves that will cause the muscle there to "lock up".

Your work obviously helped him, but he should be going easy on any activity that may overuse his low back and hips. He should also avoid sitting for long periods of time, getting up every 45 min or so and walking around the room will be helpful-- if applicable. Sounds like he just re-aggravated his back. Of course, I'm writing this under the assumption that nothing more serious is going on with his back.

[JasonE]

You mentioned "continuous stretching" but not what kind of stretching. It's possible that the stretching he is doing is ineffective or possibly inappropriate for his situation. I've seen poor stretching aggravate injuries, particularly passive static stretches that are held for 30 seconds or longer. I think referring him for further evaluation and additional treatment is a sound idea. As Kathryn stated, there is a number of possible explanations, and perhaps your work will be sufficient... but he may need guidance on how to prevent a recurrence as he builds back up to being able to resume "normal activity" levels.