back pain

Can Massage Therapy Help Your Back Pain?

Massage for Back Pain

Can Massage Therapy Help Your Back Pain?

For most of us, the answer is probably ‘yes’, since massage is non-invasive and considered very low risk for most people. In addition to physical benefits, certain types of massage have been shown to help psychologically via relaxation and increased production of ‘feel good’ chemicals that the body naturally produces (endorphins)–helpful for people with both acute back pain and chronic back pain. This post describes why massage may be right for you.

Benefits of Massage
Massage therapy is becoming more widely accepted in the medical community as a credible treatment for many types of back pain and/or as an adjunct to other medical treatments. Research shows that massage therapy has several potential health benefits for back pain sufferers, including:

Increased blood flow and circulation, which brings needed nutrition to muscles and tissues. This aids in recovery of muscle soreness from physical activity or soft tissue injury (such as muscle strain).
Decreased tension in the muscles. This muscle relaxation can improve flexibility, reduce pain caused by tight muscles and even improve sleep.
Increased endorphin levels–the “feel good” chemicals in the brain. This mood enhancer can ease depression and anxiety, which can help reduce pain and speed recovery–particularly important for those suffering from chronic back or neck problems.

Massage Therapy May Help Numerous Back Problems

Many healthcare providers say they will encourage their patients to pursue massage therapy in addition to medical treatment. If appropriate, you may want to ask your physician for a referral to a massage therapy professional in your area. Additionally, the American Massage Therapy Association website has a directory of trained and licensed massage therapy professionals at

There are numerous back problems that may benefit from massage therapy, including:

Muscle strain in the lower back or upper back/neck. Most episodes of acute lower back pain are caused by muscle strain, such as from lifting a heavy object, a sudden movement or a fall. The low back pain can be very severe and last for several hours, several days or even a few weeks. When back muscles are strained or torn, the area around the muscles can become inflamed. With inflammation, the muscles in the back can spasm and cause both severe lower back pain and difficulty moving. The large upper back muscles are also prone to irritation, either due to de-conditioning (lack of strength) or overuse injuries (such as repetitive motions). Upper back pain may also be due to a specific event, such as a muscle strain, sports injury, or auto accident. Massage can help work out the spasm/irritation and improve range of motion.

Osteoarthritis of the spine. Spinal arthritis is the breakdown of the cartilage between the aligning facet joints in the back portion of the spine. The facet joints become inflamed and progressive joint degeneration creates more frictional pain as bone rubs on bone. Therapeutic massage can help reduce osteoarthritis pain by improving circulation and reducing stress and muscle tension. However, it is important to find a professional who is specifically trained in treating people with arthritis.
Fibromyalgia can affect people differently, but is usually characterized by pain, stiffness, fatigue and/or non-restorative sleep. The patient typically feels both widespread pain and pain in specific “tender points” as evidenced by physical examination. Massage can target both the tender points and the more broadly distributed pain and stiffness.
Although massage is relatively safe, it is always advisable for patients to first check with their doctor before beginning massage therapy or any other treatment. There are some contraindications for massage therapy, such as (but not limited to): recent surgery; infectious skin disease, rash, or unhealed wound; varicose veins; and osteoporosis.

Massage Therapy Treatments for Back and Neck Pain–What’s Involved

One question patients often ask is: What kind of massage should I try? For overall relaxation and circulation, many patients find the Swedish massage technique helpful. This technique is characterized by long gliding strokes and kneading motions. For specific pain points, such as a lower back muscle strain, the American Academy of Pain Management recognizes neuromuscular therapy (also called trigger point myotherapy) as an effective treatment. Shiatsu massage is a popular technique that utilizes some of the elements of neuromuscular therapy.

With neuromuscular therapy, the therapist applies alternating levels of concentrated pressure (10-30 seconds) on the areas of muscle spasm. The patient will feel some pain or discomfort from the pressure, but the muscle spasm should be lessened after the massage. Any soreness from the pressure should fade in 1 to 3 days, and the muscles that were worked should be less tight for a week or two afterwards. A typical massage therapy program for muscle spasms consists of four sessions over 6 weeks.

Alternatives to Hands-on Massage
What if periodic appointments with a massage therapist just aren’t practical for you? Due to things like busy schedules, travel times to a good massage therapist in your area, or personal privacy, getting a hands-on massage may just not work for your lifestyle. While not an exact substitute for human touch, there may be alternatives. There are many therapeutic products available for use in the home, such as hand-held massagers and massage pillows, which are designed with the goal of mimicking some of the techniques used by massage therapists. For people who have experienced significant pain relief from massage and are interested in investing in a product that delivers overall, massage-like benefits, a massage chair may be an option. Most massage chairs are designed to mimic the Shiatsu and Swedish massage techniques, making them potentially helpful for specific pain points in the back or neck and for overall relaxation.

Final Thoughts
Patients with severe back pain should be checked by medical personnel before beginning massage therapy, and patients should always obtain an accurate medical diagnosis for the cause of their back pain prior to beginning a new treatment such as massage therapy to rule out potentially serious conditions. Many massage therapy professionals will work as part of an interdisciplinary healthcare team for patient evaluation and treatment.

Does the Epidural always work for Pain?


When Do Epidural Steroid Injections Work for Back Pain?

by: Sylvia Marten

For most people suffering from back pain, surgery is scheduled only after all other options have been exhausted.

One non-surgical approach to pain relief is epidural steroid injections. They are only intended for temporary pain relief, but steroid injections coupled with therapeutic exercise may allow patients to postpone or even avoid surgery altogether.

Epidural injections deliver steroid medication directly to the source of pain.

Epidural steroid injections are most often used to treat low back and leg pain associated with sciatica, which is pain caused by a pinched nerve in the low back that radiates down the leg.

  • Sciatica can result from a number of conditions, including a herniated disc, degenerative disc disease, or spinal stenosis.

Epidural Steroid Injections Video

Many Spine-health readers have had epidural steroid injections and have shared their results with us:

  • There were many people who did experience relief, if only temporarily.
  • In several instances, injections helped our readers reduce their pain while they waited for their scheduled surgery.
  • There was also indication among our readers that a series of 3-4 shots provided the most relief, while anything more than that had little effect, or even made pain worse.
  • A select few were awarded complete relief and were able to return to normal activities.
  • For as many of our readers who have had success, there were just as many who experienced little to no relief from epidural steroid injections.

Fluoroscopy, or live X-ray, has been shown to be the most effective way to deliver the medication most accurately to the epidural space.

The most common reader complaints were centered on the side effects associated with steroids. Many reported significant weight gain and bloating, swelling of the face, feet and ankles, and headache and nausea.

Another concern for some readers, especially those with diabetes, was the rise in blood sugar associated with steroids.

Efficacy of epidural steroid injections

There is no conclusive evidence that epidural steroid injections work better for one condition than another. Success rates are different for each individual. For those hoping to postpone surgery, injections may provide enough temporary relief.

Steroid injections may also effect enough pain relief to allow you to begin a physical exercise program. Many people have gained enough pain relief through an exercise program to avoid surgery.

The most important thing is to find a doctor that you trust, and who will adequately answer any questions you may have regarding your condition or the injection procedure.




Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Take 2 aspirin & call me in the morning doesn’t cut it with chronic pain

5 Realities of Living with Chronic Pain
by Stephanie Burke

Living with chronic pain is challenging enough because of the obvious reason—the pain—but there are other factors that go along with this condition that make life even more difficult.

If you live with chronic pain, consider sharing this blog with your loved ones so they can better understand what your daily life is like.

Chronic pain may persist even after a condition, such as spinal stenosis, is addressed through surgery.

  1. Pain is rarely “all in your head.”

People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas, for the vast majority the pain is real and present. It is not made up. The problem is that chronic pain is often caused by anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray).

Fortunately, most in the medical community are now trying to understand and appreciate that chronic pain is real and needs to be treated and managed differently.

  1. Pain is not the only problem—it breeds other health problems.

Thoughts and emotions related to chronic pain also can both aggravate and alleviate the pain. For example, depression, which is a serious disease, can worsen the pain. Sleep problems, again caused by the pain, can also make the pain worse. And increased pain usually leads to increased sleep problems.

Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.


  1. Pain is deeply personal.

Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels intense burning pain that is unresponsive to conventional treatment. It is also not uncommon that no anatomical cause of the pain can be detected.

Why is this point important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

  1. Chronic pain is its own beast.

Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail—better move my foot!), chronic pain does not have any useful function. It just is.

Often, chronic pain is caused by nerves that continue to send pain signals to the brain. When dealing with chronic pain, one of the most frustrating things is that there is nothing to “fix.” It just exists in your body.

  1. Chronic pain is LONELY.

After awhile, many people with chronic pain—especially pain that is caused by a condition that cannot be seen—begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations.

Having a clearer understanding of how chronic pain works, as well as the central role that the mind plays in the experience of chronic pain, is becoming more mainstream in the medical community. Patients who start to gain more understanding of their own chronic pain may also benefit in terms of gaining increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of their minds to assist in coping with the pain.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Back Pain Getting on your Nerves?

Types of Back Pain  –  Ralph F. Rashbaum, MD

It’s important to have a general understanding of the major different types of back pain, because the type of pain dictates the treatment options.

Nociceptive Pain and Neuropathy

The medical community usually classifies pain in one of two general categories: neuropathic pain and nociceptive (somatic) pain.

  • Nociceptive pain is pain that is sensed by the “nociceptor” sensory fibers after an injury to a muscle, soft tissue (ligaments, tendons), bones, joints, or skin (or other organs). Nociceptive pain is often characterized as a deep aching, throbbing, gnawing, or sore sensation. Common examples of nociceptive pain related to back pain include: pain after trauma (e.g. back pain after a car accident or a fall), pain after back surgery, and arthritis pain. Nociceptive pain is usually localized and gets better with healing.
  • Neuropathy or neuropathic pain is pain caused by damage to nerve tissue. Neuropathy is often characterized as burning, severe shooting pains, and/or persistent numbness or tingling. Common examples of neuropathic pain related to back pain include sciatica, pain that travels from the spine down the arm, pain that persists after back surgery.

It is thought that in some cases prolonged nociceptive pain may progress to neuropathy, and a patient may have both nociceptive pain and neuropathy at the same time.

Acute Pain and Chronic Pain

It’s also important to distinguish between acute pain and chronic pain, as the two types of pain are very different in form and function.

  • Acute pain- With acute pain, the severity of pain directly correlates to the level of tissue damage. This provides us with a protective reflex, such as the reflex to move your hand immediately if you touch a sharp object. This type of pain is a symptom of injured or diseased tissue, so that when the underlying problem is cured the pain goes away.

Acute pain is a form of nociceptive pain.

  • Chronic pain – In chronic pain, the pain does not have the same meaning as with acute pain – it does not serve a protective or other biological function. Rather, the nerves continue to send pain messages to the brain even though there is no continuing tissue damage.Neuropathy is a form of chronic pain.


Anatomy Of Nerve Pain

The spinal cord is the main part of the body’s central nervous system that conveys signals from the brain to the nerves throughout the body. Nerves coming from and leading to all parts of the body enter and exit the spinal cord along its entire length.

How Nerve Pain Occurs

Peripheral Neuralgia Video

There are 31 pairs of spinal nerves that exit the spinal cord through openings between the vertebrae. The point at which the nerve exits the spinal cord is called the nerve root, and where it branches out into many smaller nerves that control different parts of the body is called peripheral nerves. For example, a nerve that exits the lower back has peripheral branches that extend all the way down to the toes. Peripheral nerves comprise the peripheral nervous system.

The peripheral nerves include both motor nerves and sensory nerves:

  • Sensory nerves are nerves that receive sensory stimuli, such as how something feels and if it is painful. They are made up of nerve fibers, called sensory fibers (mechanoreceptor fibers sense body movement and pressure placed against the body, and nociceptor fibers sense tissue injury).
  • Motor nerves lead to the muscles and stimulate movement. They are made up of nerve fibers called motor fibers.

Nerve Injury and Neuropathy Pain

While it has not been firmly established, it is thought that injury to any of the above types of nerve tissue can be a possible cause neuropathy pain.

The part of the nerve cell that is damaged by a neuropathy is the axon (the inner information pathway of the nerve cell) and/or its myelin covering (the fatty outer sheath that protects the nerve cell and assists in conveying information throughout the nervous system).

When neuropathy pain occurs by damage to the above structures, neuropathy is sustained by abnormal processing of sensory input by the peripheral nervous system and the central nervous system.

Most pain is a signal to the brain that there is damage or an injury to the tissues or structures of the body, and is known as nociceptive pain. Neuropathic pain is caused by an issue with the nerves themselves.

Dr. Daniel Heller and Dr. David Kim, here at Blue Ridge Orthopaedic & Spine Center are incredibly skilled at treating all types of pain and your well-being is their priority. If you are experiencing any of these  types of pain or you just aren’t sure what’s happening but you’re suffering, please don’t hesitate to contact us and make an appointment. 


Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

It’s NEVER a stupid question. Always ask.


40 Questions to Ask Your Surgeon Before Back Surgery Stephanie Burke

Before you decide to have the surgery

1. What type of surgery are you recommending? Why?
2. What is the source of the pain that is being addressed? How do you know this?
Exploratory surgery is never done on the back.
3. Please explain the procedure in great detail.
The amount of information depends on your personal preferences. Some patients want to know everything, some not so much!
4. What are my non-surgical options?
5. What is the natural course of my condition if it is not surgically addressed?
6. What would you recommend if I was your friend, wife, sister, or daughter?
7. How long will the surgery take?
8. What are the side effects, potential risks, and potential complications?
9. Please explain the risks and how they relate to me personally.
For example, different risk factors like smoking, being overweight or having grade 3 spondylolisthesis, etc, will affect surgical outcomes.
10. What if, during my surgery, you encounter a different spine issue than you expected?
11. Do I need to donate my own blood? If yes, why?
For most types of back surgery, blood does not need to be donated ahead of time.
12. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications?
13. Who else will assist you in the operation? What are their background and qualifications?
14. What are the long-term consequences of the proposed procedure?
For example, will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine? Questions about the surgeon
15. How many times have you done this procedure?
Generally, when it comes to surgery, “practice makes perfect,” so more experience is better. However, if the doctor is recommending something that is not often done, such as multi-level fusions, more experience would not necessarily be better.
16. Are you board eligible or board certified?
You can usually look on the wall and see a certificate.
17. Are you fellowship trained in spine surgery?
This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
18. If I want to get a second opinion, who would you recommend?
The recommendation should be someone not in the same practice.
19. Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?
20. Can I talk to other patients who have had a similar procedure?
The patient will have to sign a HIPAA release form, but typically, happy patients want to share their success stories.

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

21. What kind of pain should I expect after the surgery and for how long?
22. How long is the hospital stay?
23. May a family member spend the night with me in the hospital?
24. How do you manage the pain in the hospital?
25. Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?
26. Will you know before the surgery if I will need a back brace afterwards? If so, will I be fitted for one before the surgery?
27. Will I need any other medical equipment (like a walker) when I go home?
28. Who can I call if I have questions after the surgery? What is the process for communication?
29. How often will I see you after my surgery?
30. What symptoms would warrant a call to your office?
31. What symptoms would warrant immediate medical attention?
32. What limitations will I have after surgery and for how long?
33. How long should I wait to bathe?
34. How long will I be out of work? School?
35. What kind of help will I need when I return home?
36. When can I drive again?
37. When can I resume normal (light) household chores?
38. What expectations do you have for my recovery?
39. When is it safe to resume sexual relations?
40. How soon after the surgery can I start physical therapy?

One thing we pride ourselves on here at Blue Ridge Orthopaedic & Spine Center is our willingness to listen to you and answer all the questions you may have about a procedure. Back surgery is scary stuff and it’s not taken lightly, often it’s the last resort when treating the injury. Please do not hesitate to bring these, or any other questions to the table if
you are looking at having spine surgery. We welcome it.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.