Herniated Discs...clients all over

[vchild1973]

I have had so many people asking me if massage would help them with their pain caused by herniated discs.  I remember reading somewhere that herniated discs are a contraindication for massage.  But with a doctor's note what can we do to alleviate their pain besides heat and ice?  Would performing derivative massage ease their discomfort?  Has any MT been successful with a heriated disc client?

[Texas-gal]

One thing to ask yourself, is it "their" definition of a herniated disc or an MRI showing a herniated disc that provided them with a diagnosis.  And is it really herniated or just buldging.  That can seperate out a lot of questions right there.<br><br>I have has some success with herniated disc clients, with only massage, but it is more of a paliative than anything else.  On occasion, an individual won't need surgical intervention, but it is truly on a case by case basis.<br><br>You'd do good to locate a chiropractor who practices flexion/distraction technique, a neurologist (as this is who these people regularly end up with -- strange but true), an orthopedic for the more structural cases and a neurosurgeon for the ones who need a little extra specificity of the hand if they need surgical intervention Then come up with a working arrangement for referrals of some sort with these people.<br><br><br>vchild, <br><br>You've been looking for a great way to market yourself.  Looks like you have come across a good one!  Helpful for you and the potential clients.  :)

[palpateit]

What the cleint states and what the doctor states can be quite diferent, AND, what the doctor states and what is really going in, might be quite different.  ???<br><br>There are many different terms to describe spinal disc pathology, and all are used differently by different health care practitioners. <br>Some examples of terms used to describe spinal disc abnormalities include:<br>Herniated disc (or herniated disk)<br>Bulging disc, ruptured disc, or slipped disc       <br>Disc protrusion <br>Disc degeneration (or degenerative disc disease) <br>Disc disease <br>Pinched nerve <br>Sciatica <br>There is no agreement in the medical field as to the precise definition of any of these terms.  :-/<br><br>In nearly all cases, massage is indicated for herniated discs,  not contraindicated.  The suggestion from texts or other sources that  massage is a contraindication, is based on incomplete understanding of anatomy and treatments, or from "hand me down contraindications" from instructors,  to students who later become instructors, who repeat information to new students.....the cycle continues.  :-/<br><br>First separate cervical from lumbar. <br>CERVICAL discs tend to make the neck muscles hyper reflexive - which means loosening up too much in a session may cause reflexive spasma or some other wierd symptoms. <br>Caution is advised, but the neck can be worked.<br><br>LUMBAR: <br>If it is truly a hernitead disc, the pain will tend to refer in a belt like pattern - into all the glutes,  and perhaps anterior or inferior.<br>If the pain continues, those muscles and ligaments will likely develop trigger points. These trigger points can then become a chronic pain syndrome which can last long after the disc condition has subsided (if it does subside).<br>MT"s can work the disc referral regions to prevent the development of trigger points.<br><br>If sciatica is a symptom...well one must address it on an individual basis. The sciatica may make the legs hypersentive (need to be very light), or make the legs  spasmed and achy (deep work appropriate)<br><br>All the above assumes the diagnosis was correct. <br>The cleints pain may instead arise from trigger points in the muscles and ligaments of the pelvis and back (or from several other conditions - facet syndrome, SI joint dysfunction, etc.)<br>If it is trigger points, that is where we come in to treat trigger points, (or in the case of a herniated disc, prevent).<br><br>

[Katykangaroo8]

Right on, Palpateit.  That's what I would've said.<br><br>It's not a contraindication - just communicate well during deep tissue because they're prone to spasm.  You might not be able to "cure" the problem, but you can do wonders for pain relief and mobility.<br><br>Remember to use a small pillow for low back support in conjunction with bolstering the ankles for low back pain clients while prone, and bolster knees while supine.<br><br>Many of my clients have disc issues, and many find relief through massage.<br><br>Katykangaroo

[dorraine]

get a release and call the clients doctor...the doc should give info on the situation...each case is different...some clients it does wonders for and some are contraindicated...depends on the doctor and the situation...

[klauss]

Does anyone else have some thoughts or suggestions concering this?

Found out my mother has 2 and will eventually need surgery. She does notwant to be dependent on pain meds, any thought are appreciated.

[BackBreaks]

Remember that compensatory postures can develop in people with herniated discs. Releasing that hypertonic lower back may leave your client immobilized if his/her body has come to rely on that compensation. Happened to me when I was a student.

A friend of the family with a years-old herniation (for which she ingnored PT and exercise prescriptions ) felt great relief during the session, but couldn't even get off the table after. We had to load her into a rolling chair and wheel her into the guest room for the night. She felt better the next day but, needless to say, the experience was very scary!

[coppertop098]

What the cleint states and what the doctor states can be quite diferent, AND, what the doctor states and what is really going in, might be quite different.  ???<br><br>There are many different terms to describe spinal disc pathology, and all are used differently by different health care practitioners. <br>Some examples of terms used to describe spinal disc abnormalities include:<br>Herniated disc (or herniated disk)<br>Bulging disc, ruptured disc, or slipped disc       <br>Disc protrusion <br>Disc degeneration (or degenerative disc disease) <br>Disc disease <br>Pinched nerve <br>Sciatica <br>There is no agreement in the medical field as to the precise definition of any of these terms.  :-/<br><br>In nearly all cases, massage is indicated for herniated discs,  not contraindicated.  The suggestion from texts or other sources that  massage is a contraindication, is based on incomplete understanding of anatomy and treatments, or from "hand me down contraindications" from instructors,  to students who later become instructors, who repeat information to new students.....the cycle continues.  :-/<br><br>First separate cervical from lumbar. <br>CERVICAL discs tend to make the neck muscles hyper reflexive - which means loosening up too much in a session may cause reflexive spasma or some other wierd symptoms. <br>Caution is advised, but the neck can be worked.<br><br>LUMBAR: <br>If it is truly a hernitead disc, the pain will tend to refer in a belt like pattern - into all the glutes,  and perhaps anterior or inferior.<br>If the pain continues, those muscles and ligaments will likely develop trigger points. These trigger points can then become a chronic pain syndrome which can last long after the disc condition has subsided (if it does subside).<br>MT"s can work the disc referral regions to prevent the development of trigger points.<br><br>If sciatica is a symptom...well one must address it on an individual basis. The sciatica may make the legs hypersentive (need to be very light), or make the legs  spasmed and achy (deep work appropriate)<br><br>All the above assumes the diagnosis was correct. <br>The cleints pain may instead arise from trigger points in the muscles and ligaments of the pelvis and back (or from several other conditions - facet syndrome, SI joint dysfunction, etc.)<br>If it is trigger points, that is where we come in to treat trigger points, (or in the case of a herniated disc, prevent).<br><br>

I have recently acquired a client who has stated he has "right laterally compressed L3 and L5 discs where there is no fluid left in one and the other about half," "sciatica down the left thigh," "numbness down the entire lateral side of his right leg," "neuropathy in his feet" ( the last two possibly from compression of the femoral nerve?), and has localized pain at L3-L5 on the left. He has good posture and no major imbalances. He requests deep tissue.

He was a weightlifter at one time and he first injured himself some years ago during an 800 lb squat. He's further injured himself after two fairly serious falls. One of which was very recent. This also causes him some depression as he's a fairly young guy.

He is not currently under a doctor's care and has elected the "no surgery" option, but instead has chosen MT to help in the reduction of his pain and to increase his functionality, but sometimes has to rely on medication to manage it. An MRI was done. I haven't seen it yet, but I have requested it.

As a side note... he indicated that he has ordered some type of water filtration system which removes magnesium and calcium in hopes it will prevent calcification. To say the least, I'm dubious about this and have indicated that he will need to closely monitor his mineral levels due to the risk of osteoporosis.

He has had success with MT in the past and our first session went very well and it provided him with a good deal of relief. I combined a restricted number of deep tissue techniques, with an overall relaxation massage and some stretches (extension and probably inaccurately, flexion) and traction. Our second session a week later was equally beneficial for him (without flexion). Both were completed with a great deal of communication.

I obviously want to do the best job possible for this client and above all else do no harm, however I am a recently graduated LMBT (licensed June 2011) and other than what I've found here and other places online I am generally unfamiliar with how to treat the compressed disc condition and numbness. My instructors had indicated that a "herniated or bulging disc" is a strict contraindication but did not address "compressed" discs. Therapists here seem to suggest that MT may be beneficial on a temporary basis.

I was hoping to get some specific advice from experienced therapists on this topic.

[pueppi]

I have recently acquired a client who has stated he has "right laterally compressed L3 and L5 discs where there is no fluid left in one and the other about half," "sciatica down the left thigh," "numbness down the entire lateral side of his right leg," "neuropathy in his feet" ( the last two possibly from compression of the femoral nerve?), and has localized pain at L3-L5 on the left. He has good posture and no major imbalances. He requests deep tissue.

He was a weightlifter at one time and he first injured himself some years ago during an 800 lb squat. He's further injured himself after two fairly serious falls. One of which was very recent. This also causes him some depression as he's a fairly young guy.

He is not currently under a doctor's care and has elected the "no surgery" option, but instead has chosen MT to help in the reduction of his pain and to increase his functionality, but sometimes has to rely on medication to manage it. An MRI was done. I haven't seen it yet, but I have requested it.

<snip>

I was hoping to get some specific advice from experienced therapists on this topic.

If it were a new client who recently had a fall and has a past history of a laterally compressed disc, I would most likely not see the client until I had a script from their MD with an "ok" for massage work.

Granted, personally, I am pretty comfortable working with most folks who present for care - but, it really is still on a case by case basis. And, with the history you have provided about this client, I would want to at least try to cover myself, even if the script is only providing a minimal portion of that.

I absolutely understand that many people don't want surgery and that we can definitely help, but I feel like we still have to be careful regarding who we are willing to put ourselves out there for. If they are willing to go to the MD and get the script, then for my practice, I feel like they are at least a little more likely to pay attention to what I am going to say.

As far as I am concerned, not knowing the extent of the prior damage the spine has already incurred (you can only go by what the client tells you and not having even the slightest of orthopedic testing, leaves you guessing (if you are not experienced at this kind of work). Guessing, is not necessarily the best position to be in.

What will you do if the client can't get up off your table after a session? Do you know what to watch for? Have you asked them about their bowel and bladder functions? Do you have a plan of action? These kinds of things should be considered thoughtfully, if you plan to start working on this client. Since you know the client has already had depression associated with the back issues - I would put the client in the more "fragile" category to begin with. This is someone you may have to take extra care with. You must be prepared for the worst case scenrio.

I am always exceptionally careful with disc cases. I don't want to have a situation where someone has even the slightest notion to "assume" that because of the care I rendered, they now need surgery. If you have any questions in your mind at all, you should refer them out first. They can always come back with a referral or script. But, what you don't want, is someone who needs surgery and says you didn't care enough to send them through proper channels first. I would rather loose that person as a client to the surgery they need, than to have them talk bad about me because they feel I didn't refer them out. I am saying this as someone who is actually very good at orthopedics and evaluation. It's not about saying it to be conceited, I really do know my stuff. So, I don't say it lightly.

I hope this helps.