Massage Case Study- Back Pain Worse with Standing or Sitting

With any condition, treating the causes of the problem is the key to getting effective, long-term results. And as this Case Study shows, careful assessment and diagnosis is a crucial part of this.

Mary (not her real name) had a history of bad lower back and pelvic pain. Some years earlier she suffered a fracture of her sacrum (the bone between the bottom of the spine and the tailbone), and since then her pain there has been steadily getting worse and more frequent.

When Mary came to see us, she was experiencing strong pain in the small of her back at the L5-S1 level (where the bottom of the spine and the sacrum meet). The front of her left hip was also very sore and getting steadily worse, as a result of her walking differently to cope with her lower back pain. It is understandable that most people with this pain would expect a massage therapist to massage the sore area to relieve the pain. However, pain in this area can have many causes, and without treating what is causing the problem the pain will keep coming back.

Mary advised that her pain was at its worst when trying to stand or sit up straight, and was better when she bent forward or sat with her left leg crossed over her right. We performed various range of motion and other orthopaedic tests which verified this was the case. After a very detailed examination of her muscles and the quality of their movement, we decided that the problem was due to her sacrum not moving correctly, which was restricting her body being able to sit or stand up straight. The most common cause of this lack of movement of the sacrum is the Piriformis muscle, which is located very deep below the glute (buttock) muscles.

When we stand or sit up straight, our Piriformis muscles should relax and allow our sacrum to move forwards. Though Mary was not experiencing pain in her glute area, additional testing confirmed that her right Piriformis was not relaxing when it should, and instead was holding her sacrum backwards. This meant that her sacrum and spine couldn’t move in a co-ordinated way with each other, resulting in a ‘collision’ of the bones, and causing her pain.

Our remedial massage therapist started working on Mary’s right Piriformis, and after only 10 minutes her lower back pain had totally cleared. There was no need for any massage whatsoever where she had been experiencing her pain. The remainder of the massage session was spent releasing the muscles at the front of her hip, which had been compensating for her walking unevenly.

At her next visit, Mary reported that her sacrum and lower back pain had completely resolved, so we worked on other areas that were causing her discomfort instead.

This Case Study is a good example of the pain being in one area, but the cause being somewhere else. If our back pain treatment had only focussed on the area where Mary was experiencing her pain, it is likely she would have received only temporary relief (or maybe even no relief at all).