Compressed disks

[Fariz]

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.

 

[Eat Beef!]

Compressed disks

Just my copied resonse from your other post at Herniated Discs...clients all over.

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.



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 scenario.

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.



09/10/11 - corrected for typos

 

[Edward]

Compressed disks

Just my copied resonse from your other post at Herniated Discs...clients all over.

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.



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.

Excellent post!!! Thank you!!! Where did you get your training in orthopedics and evaluation?

Do any other MT's have anything to add?

 

[marshell]

Compressed disks

Excellent post!!! Thank you!!! Where did you get your training in orthopedics and evaluation?

Do any other MT's have anything to add?

I did my work for the DABCO (DC-based training).

I have heard good things about James Waslaski's classes (you can search some of that on the forums here) & I believe some other people at MassagePlanetL know of a few other Ortho related instruction courses.

 

[Christopher H]

Compressed disks

Whitney Lowe offers an excellent distance-learning course on orthopedic assessment for massage therapists.

James Waslaski teaches excellent hands-on seminars on relieving pain with a variety of massage methods applied intelligently.

 

[arcticpuppet.]

Compressed disks

Couple of thoughts...I would do a lot of side lying work for a tight QL. And with pain of the Lumbar spine I also do deep ab work. And chances are the last 2 ribs have lots of ADH's, I find issues with the lower ribs can cause pain from the waist down.

And on a side note I personally can't stand working on current and former bodybuilders