Why Most Back Pain Treatments Don't Last — In Ema's Words

The most common back pain clients I see are people with sitting jobs. Desk workers, people who drive for a living, lorry drivers, forklift operators, people in the building industry who spend hours in vehicles. What happens is that sitting compresses the lower discs continuously, and over time you get tissue that becomes stuck. A small bit gets stuck, then the next bit gets stuck, and it all bunches together with the myofascia wrapping around it. In men this can become a very significant knot, sometimes as large as a walnut, occasionally bigger. In women, the same sitting pattern tends to create myofascial restrictions, often made worse by hormonal changes, bloating or weight changes that tilt the pelvis forward.

When this builds up over time, the quadratus lumborum, the big chunky muscle at the junction between the spine and the top of the pelvis, starts to compensate. Then the glutes, hamstrings and quads stop working together efficiently. The pain that started in your lower back starts affecting your shoulders, your neck, sometimes even your jaw. People grind their teeth. The body is compensating everywhere.

People often come to me after they have tried relaxation massage, deep tissue or sports massage. Relaxation massage is general and does not target the problem area. Deep tissue and sports massage can target it, but in my 25 years of experience, going directly too deep into a painful lower back causes the nervous system to tighten up. You might get a small release in that spot, but something else compensates. The quads, the hamstrings, the neck. Too deep too fast is not the answer. I learned this partly from having treatments myself and noticing I got better faster when the therapist built up to the worst areas more slowly, when my body and mind were relaxed enough to let go.

This is why my treatments combine general relaxation of the whole area first, then targeted myofascial work, then trigger point therapy, then back to general. I sometimes use hot stones, not as a full body hot stones massage, but targeted. Heat into the specific area helps the muscles relax so I can get deeper into the tissue without triggering the nervous system's protective response. Then the targeted work can actually hold.

Every back I work on feels slightly different, and chronic pain in particular builds up its own pattern over time. Under my hands, that often feels like a knot, with tighter, denser tissue forming around it. When I first place my hands on an area like this, the restriction is often felt across both sides of the body, even if someone has only been feeling pain on one side, and sometimes it's felt all the way across. As I work into the fascia, I can feel that tension and those knots begin to loosen. The tight spots themselves can feel like small, hard points under my fingers, and to the client that pressure can feel sharp, more like firm pressure than pain. I'm not trying to cause that, I'm trying to release it, and I read how someone responds as I work. If discomfort eases as I continue, that's the tissue responding well. If something feels too sharp, I'll change my approach or come back to it later in the session. By the end, the aim is for that area to feel smooth and freely movable again.

Posture Before Exercise

Most people with back pain get given exercises. The problem is that if you are moving incorrectly all day, sitting with crossed legs, driving with a tilted pelvis, standing with your weight shifted, those exercises are being performed on a body that is already compensating. The exercises won't hold because the daily habits keep pulling things back out of alignment.

Before I give anyone exercises, I work through how they move through their day. How you sit, stand, walk and sleep is happening for 16 hours a day. Exercise might be happening for 30 minutes. Getting your body stacked correctly, not bolt upright, but balanced so that your whole frame is working together without creating strain, is more important than any exercise I could give you. Once the daily mechanics are right, exercise builds on a solid foundation rather than reinforcing the problem.

Rehab builds progressively. Postural corrections first, then mobility work as pain improves, then strength work, often with resistance bands, when the body is ready for it. Those that do their homework get better faster. That is consistent across 25 years of practice.

Ema Gregory-Scott, BTEC Level 6 with Distinction, Advanced Clinical and Sports Massage