The Mind of Chronic Pain

“A man’s spirit can sustain his broken body, but when spirit dies, what hope is left?” — Proverbs 18:14

Syncline by Kim Buck.

Syncline, Artist Kim Buck

Chronic pain is a peculiar condition because it’s two-sided in nature. Like two halves of a coin it reels its nefarious head on one hand, yet allows space for considerable growth on the other. There is an acute response when chronic pain hits. Thoughts such as:

  • “What if I can’t get through this meeting?”
  • “What if I can’t get up out of this chair? People will see, they’ll think I’m a freak!”
  • “I can’t stand here much longer. Can they tell? They don’t seem to notice. What if I just dropped to the floor right now.”
  • “What will I wake up to today? My schedule is too full to be down.”
  • “If I cancel on them again I won’t be invited anymore but I can’t fake my way through this today.”
  • “If people knew about this they’ll just think I’m a wimp and can’t handle pain.”

The mind races when chronic pain flares. Panic sets in for a moment. It feels like you’re alone, as if nobody sees what you’re going through… or cares for that matter. The moment passes, and you carry on, wave it away, hoping to get through the day. That, by the way, is the built-in survival mechanism we have as people. But truly, going through this alone means you’re very strong!

The malicious thing about chronic pain is it strikes at the very personality of a person. Someone who has every intention and history of being friendly, reliable, consistent, responsible, now can’t help but miss out on a party or cancel a plan last-minute when pain takes over. A once outgoing and personable person begins to turn inward, withdrawn, unsure. Feelings of being slightly neurotic set in along with guilt. “People think I’m rude. I’m a disappointment.” It’s a horrible feeling being misunderstood.

And let’s be honest, society struggles with people in chronic pain. Society is about momentum and velocity. There’s not time to stop. There are plans to carryout, experiences to enjoy. Funny that “experiences” seem to be lumped into an arena of Fun and Play. Life IS experience. It’s All Experience. The chronic pain you’re experiencing right now, dear reader, Is Your Experience. Are you feeling ignored or passed by? Take the time you have – it’s a precious commodity these days – and capitalize on it. Use the solitude to your advantage to create something you otherwise wouldn’t have.

So there’s a flip-side to chronic pain: it really is a tool if you know how to wield it. Those who fall in the chronic pain camp share company with fertile, creative, witty, and dynamic comrades. Overcomer’s who have used their isolation to their advantage: Cynthia McFadden, Kathleen Turner, George Clooney, Doc Holliday, Robert Louis Stevenson, George MacDonald, A.E. Knoch, and many more. Whatever your opinion of these people they didn’t succumb to their condition mentally. They used it to their advantage. Does this seem sadistic? Perhaps. But as John Watson said to Sherlock Holmes, at least in the movie version, “This game is designed to hurt.” That statement seems to summarize the human condition. Nature reinforces this if you look all around. From plants to animals to humans, any type of growth comes from a hardship. Typically we are told to feel “full of life” for most of our years. Yet we are the human machine all designed with programmed obsolescence, some just have parts running differently than others. Anyone who goes through a hardship or trauma emerges on the other side speaking of the growth and increased wisdom and understanding they now have. The isolation of chronic pain affords the “sufferer” that very gift: introspection. For it really is a gift. In this super fast-paced lifestyle we have, who has time to stop and simply, think? For those who don’t suffer from chronic pain, I’ve heard them comment about those they know that do with such thoughts as, “They seem wise beyond their years” and “they have a quiet strength about them.” A hard price to pay, but it seems this is what Life is about – growing mature in wisdom and understanding to be better equipped with compassion for your fellow human. At least, I’d like to think that is not an outdated notion.

Carmen Satre, LMT, CMMT, CMLDT, OMTSo what’s the point of this entry? None really. This isn’t about quick fixes or solutions or processes. No, I simply want you to feel understood and heard. To know that when you come in my door you are seen and appreciated for who you are. Don’t apologize for what you have. Don’t make excuses. And by all means don’t try to hide it! I know, I understand, and I experience. As a friend of mine said to me once, “You’re so much more fascinating than those conditions. It’s a part of who you are, but it isn’t who You are.” The hour booked in a massage space is about more than muscle work. It’s one hour of serenity out of a stressful life where you unplug, are understood, and take sixty long minutes to just rest and be a little restored inside and out. That’s all.

See you on the table, dear one!

Trigger Points: What Are They?

Massage Therapy is a very confusing field now. Not being covered under insurance leaves the door wide open to what falls under the heading. A given massage therapist practices anything from spa relaxation to physical therapy type work.

To clarify what I do, the type of massage therapy modality I specialize in is “Neuromuscular Therapy” or “Trigger Point Myotherapy.”

What’s a Trigger Point & Why Work It?

“Trigger points” (TrPs) are tender points in soft tissue that radiate or refer pain to distant areas. These are found all over the human body usually in the belly of a muscle. Once formed, they radiate pain out from the belly similar to a wrinkle in a sheet or a ripple on the water, this is the referred pain felt. Trigger points are produced by muscle stress, such as overwork, repetitive motion, or sudden excessive stretch.

There are four types of trigger points:

  1. Active TrP – one that is spontaneously producing referred pain.
  2. Latent TrP – one that produces pain when pressure is applied during palpation.
  3. Primary TrP – one that is caused by muscle stress.
  4. Satellite TrP – one that is produced secondarily by a primary trigger point.

How Do They Go Away?

Trigger points generally stay inside the muscle until manipulated away. Get rid of them today with medical massage therapy in Des Moines Iowa.Trigger points generally stay inside the muscle until manipulated away. In layman’s terms, when a muscle is over-stressed it feels compromised and immediately protects itself. This tightening process forms TrPs within the muscle. Muscles are very stubborn and don’t forget experiences easily, hence the term “muscle memory”. Muscles will hold on to this protection until a manual process occurs which tells the brain to send a signal to the muscle that it’s safe to relax and return to a normal resting length. This is what I do.

Pressure is placed directly into a tight or sensitive trigger point area, which often causes radiating pain, and held until the tenderness disappears. This process repeats running along the rippled path of the TrPs. There is a delicate balance between applying enough pressure to release it and applying so much pressure that the TrP worsens. Releasing the points encourages increased circulation to the area allowing the underlying tissue to soften. This is the point when clients say, “I didn’t even know that hurt until you found it! How did you know that was there?”

What Is Neuromuscular Therapy?

Neuromuscular Therapy is also called Trigger Point Myotherapy. This technique alters the length muscles to teach them how to operate correctly. Muscles are manipulated back into the shape originally intended. Less is more during this treatment session to avoid bruising and soreness. This type of therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm to release the lactic acid from the muscle, resulting in increased blood flow and oxygen. Fascia is also stretched to keep the body loose. If the shell of the body is loose, the muscles can loosen and relax back into their natural form.

Causes of Trigger Points

The common cause of trigger points results from various forms of trauma, ranging from a direct injury, excessive stretching, heavy lifting and twisting, or even emotional stress. These sensitive regions will often activate pain in referring areas. Once we eliminate the trigger point, massage aids in removing the waste products and restore circulation to the area.

Some trigger points will be more severe than others and patience is the key factor during the session. Less severe TrPs will release almost immediatley. More severe ones need worked longer. The reason the experience is so worth it, however, is that there is an immediate relief as soon as the TrP dissipates. There’s no waiting 3-5 days to see if the session was a success. You know right away.

Some severe trigger points can reform after a session. I always recommend icing the area worked after a session. The ice will increase circulation to the area and decrease inflammation, minimizing the odds of the TrP reforming.

Carmen Satre, LMT, CMMT, CMLDT, OMTDr. Janet Travell is the person most often associated with trigger point therapy. She’s quoted as saying, “Active trigger points cause pain. Normal muscles do not contain trigger points. Individuals of either gender and of any age can develop trigger points.” Simple enough. Another great reminder that you don’t have to live with the pain. Come in and get those stinkers gone so you can feel good in your skin again.

See you on the table!

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a painful medical issue with painful medical procedures, but certain techniques of massage can bring pain relief, reduce inflammation, and decrease healing time. There is much controversy among physicians and diagnosing this syndrome is very difficult. It is often confused with carpal tunnel syndrome, brachial plexus syndrome, rotator cuff syndrome, and bursitis.

What Is the Thoracic Outlet?

Massage therapy is highly effective in treating thoracic outlet syndrome.The term “thoracic outlet” refers to the entire area defined by scalenes and the first rib, or to the passage between the anterior and middle scalenes. On their way to the arm, the axillary (subclavian) artery and brachial plexus pass between these two muscles, then between the first rib and the clavicle. They can become entrapped at some point in this area by tightness in the anterior and middle scalenes. It is sometimes difficult to distinguish pain referred by the scalenes from pain resulting from entrapment of the brachial plexus.

How Do I Know if I Have Thoracic Outlet Syndrome?

TOS is impingement of the brachial plexus nerve bundle and the blood vessels going to and from the arm. As a reminder, a syndrome is a collection of specific symptoms that is not a true pathological condition.

Symptoms include:

  • Edema
  • Numbness
  • Tingling sensations
  • Weakness of the upper limbs
  • Paresthesia (pins and needles)
  • Shooting pain
  • Feeling of fullness
  • Possible discoloration in the area due to diminished circulation

To diagnose this problem, a doctor or therapist will have you move your neck and shoulders in specific directions, which may result in a nerve entrapment or pinching sensation. They will also ask you to lift your hands above your head and open and close them for a few minutes. If you feel pain, numbness, or heaviness, you may have this disorder.

What Causes TOS?

Massage therapy is highly effective in treating thoracic outlet syndrome.There are various causes that produce symptoms of pressure on structures such as nerves (in the brachial plexus) and blood vessels that exit from the thorax (posterior to the clavicle) to enter the limbs:

  • Cervical or rib misalignment
  • Tight muscles
  • Spasm of neck muscles (scalenes) or other muscles such as the pectoralis minor lying close to the structures passing through the outlet
  • Atrophied muscles, muscle degeneration
  • Herniated intervertebral disk
  • Spondylosis (a bone spur at the nerve root)
  • Whiplash
  • Postural changes during pregnancy
  • Any activity that causes enlargement (weight lifting or weight gain) or movement (exercise or injuries) of the muscles in this area

So Can Massage Help?

Massage IS indicated for TOS if muscle tightness or spasm causes the impingement. If there are any causes other than muscular tension, massage is contraindicated for that local problem area.

Massage helps by:

  • Relaxing the area
  • Increasing circulation
  • Reducing inflammation
  • Speeding up the healing time

Massage therapy is highly effective in treating thoracic outlet syndrome.During a session, focus is on the muscles of the neck, shoulders, arms, and upper back. The upper chest and arm area is also a focus. Overall treatment for TOS includes specialized exercise routines, massage therapy techniques, possible physical therapy, and in some severe cases, surgery.

If symptoms do not diminish with massage, impingement may be due to another cause and such clients should be referred to their healthcare professional to get a diagnosis and treatment plan. While the condition is present, avoid being in prolonged positions with the shoulders and arms, such as sleeping on arms, changing desk orientations to increase ergonomics, and so on.

Again, you don’t have to live with the pain. Choose to start the healing process today.

See you on the table!


Introduction to Massage Therapy, second edition, Mary Beth Braun, BA, MT, NCTMB & Stephanie J. Simonson, BS, MT

The Massage Connection: Anatomy & Physiology, second edition, Kalyani Premkumar, MBBS, MD, MSc (Med Ed), CMT, PhD

Thoracic Outlet Syndrome & Massage,

The Truth About Whiplash

After being evaluated by a physician, massage and bodywork is one of the most recruited modalities to help soft tissue injury heal from whiplash.Whiplash is a modern problem. Whiplash is also a very misunderstood problem. It comes in many forms and becomes a long-term condition if not treated correctly. After being evaluated by a physician, massage and bodywork is one of the most recruited modalities to help this soft tissue injury heal. When applied carefully and skillfully, massage therapy for whiplash can help clients find relief and prevent or begin reversing chronic pain. The information below will hopefully clear up some long-held confusion about living with whiplash and how to treat it.

Understanding Whiplash

After being evaluated by a physician, massage and bodywork is one of the most recruited modalities to help soft tissue injury heal from whiplash.Whiplash injuries are basically simple. During a collision (vehicle, contact sport, a bad fall), the head and torso are thrust in opposite directions in a very short period of time. The neck itself makes a whip-like motion bending first towards and then away from the point of impact. An S-shaped curve forms during the early phase of impact where the upper cervical spine flexes as the lower cervical spine extends. The most abnormal motion happens at the C4-C6 spinal segments and damages the longus colli and sternocleidomastoid muscles (muscles used to tilt the head or turn from side-to-side). Therefore, it is not surprising that most of the symptoms of whiplash center in that part of the body between the head and the torso – the neck – but can radiate into other areas forming long-lasting and highly uncomfortable issues if left untreated.

Aside from nasty spills and participating in contact sports, most people experiencing whiplash do so during motor vehicle accidents. Nearly one-third of accidents are rear-end collisions, and it is this type that is responsible for most whiplash injuries. The pain may or may not be felt immediately after impact and could take up to two or three days. Researchers show a 97% rate of neck pain after whiplash injury in chronic patients, onset of neck pain occurring in 65% of patients within six hours, within 24 hours in an additional 28%, and within 72 hours in the remaining 7%. Ben Benjamin, Ph.D., a massage therapist who holds a doctorate in education and sports medicine, explains that this delayed onset is because it takes time for scar tissue to manifest in the sprained or strained muscles and ligaments. And because scar tissue is more adhesive than regular tissue, people experience it as stiffness in the injured areas.

Symptoms of Whiplash

The number one symptom of whiplash, of course, is neck pain. Headaches are the second most common symptom and result from slowed circulation to the head caused by the swelling in the injury. The head generally possesses about 10 lbs of inertial mass. Compressive G forces can range from 1.0g to 1.5g in collisions at just 4-5 mph. When adding the weight of the head already exerting a 10 lb. force, this very low-speed collision could result in possible loads of 20-25 lbs. Additionally, many patients with whiplash injury are taking medications for pain. Ironically, overuse of analgesics for pain are a well-documented source of headaches. Chronic headaches, if left untreated, are unlikely to go away on their own, as some patients still have symptoms many years after the injury. Massage therapy (soft tissue manipulation and trigger point work) for whiplash can immediately work to reverse and unlock this pain pattern in muscles.

Additional symptoms of whiplash can include the following:

  • Tightness, stiffness and soreness in your neck
  • Swelling, bruising, redness and/or tenderness
  • Pain in the shoulder or between the shoulder blades (sometimes called “coat hanger pain”)
  • Low back pain
  • Pain or numbness in the arms or extremities
  • Discomfort or stiffness in the chest
  • Dizziness and pain when moving your head
  • Hoarseness and difficulty swallowing and/or chewing
  • Paresthesia
  • Headache, ringing in the ears, blurry eyesight
  • Trouble sleeping, concentrating, or carrying out everyday activities

The Québec Task Force came up with a classification for whiplash, used as a tool for determining the severity of acute or chronic symptoms:

GRADE 0: No whiplash. No complaints about neck, no physical signs.

GRADE 1: Neck complaint of pain, stiffness and tenderness only, no physical (musculoskeletal or neurological) signs.

GRADE 2: Neck complaint of pain, stiffness, tenderness. Musculoskeletal signs of decreased ROM and point tenderness. Injury to muscles, tendons, ligaments and joint capsule serious enough to cause muscles spasm.

GRADE 3: Neck complaint of pain, spasm, stiffness and tenderness. Neurological signs including decrease deep tendon reflexes, weakness, sensory defect. Injury to Nervous system is due to mechanical injury or secondary to inflammation.

GRADE 4: Neck complaint with fracture and dislocation.

Other symptoms that can appear in any of the above grades:
Deafness, dizziness, dysphagia, headache, memory loss, TMJ pain, tinnitus

General Stages of Whiplash (Does not apply to some clients):

Acute: 1-2 weeks
Early sub-acute: 3-4 weeks
Late sub-acute: 4-5 weeks
Chronic: 6+ weeks

A Pattern of Chronic Whiplash

Experiencing the trauma of any accident or impact creating a whiplash injury is a frustrating process usually creating unnecessary stress from the following sequence of events:

  1. A whiplash accident occurs with soft-tissue injury.
  2. Patient is thrust into confrontations with the insurance company.
  3. Physicians, relying on x-rays and MRI’s that do not point out myofascial injuries, discharge the patient as “normal”.
  4. Stress from interactions with the insurance company exacerbates the pain symptoms,
  5. Resulting in chronic physical and psychological symptoms.
  6. Friends, co-workers, or relatives may have a difficult time understanding why the pain hasn’t “gone away on its own” and think the patient is “making it up.”

As an aside, recent studies now show that it is very difficult for an ingenuine person to fake a profile typical of a whiplash patient and that financial compensation does not effect a cure and that despite settlement, a substantial proportion of patients suffers persistent pain and distress.

So Why Doesn’t Whiplash Go Away On Its Own?

After being evaluated by a physician, massage and bodywork is one of the most recruited modalities to help soft tissue injury heal from whiplash.Many people walk around every day with whiplash symptoms and don’t realize it. They may simply associate their pain with “that’s just life” or “my bed is getting old”. Middle-aged adults who played contact sports in high school fall into this category. Some people experienced bad accidents in their youth but shrugged it off, not realizing that some of the chronic pain experienced into adulthood stems from these experiences. Whiplash injuries can have both a short and long-term impact on the accident victim. The first concerns involve the mechanical injury to the muscle, bone, ligament, nerve, and tendon tissue and the resulting pain, inflammation, and muscle guarding. Management of inflammation and pain is the main focus for mainstream medicine. Most attending physicians will prescribe anti-inflammatory, pain-killer, and muscle relaxant medications and send the patient on their way. The long-term concern is the effect of the neuromuscular guarding that can become neurologically habitual, causing health and postural problems years after the date of injury.

An example often used to illustrate these kinds of neurological habits is the act of “grocery getting.” Have you ever walked around with an arm load of heavy groceries for 20 minutes or so, and after you set it down you can not quite straighten your arm out? This phenomenon is known as temporary sensory-motor amnesia (coined by Thomas Hanna). The cerebellum temporarily recalibrates the range of motion (ROM) based upon the range used while loaded. If you do nothing you will regain your normal range of motion after a few moments because it is temporary. If you contract muscles for hours a day in a limited ROM the cerebellum will eventually recalibrate and make this the new default ROM leading to permanent limitations.

It is necessary to extend this understanding to severe spinal pain centered in the neck. Head forward posture due to muscle guarding after sustaining a whiplash injury is extremely common, if not the rule. It has an immediate negative effect on posture and the efficiency of musculoskeletal balance. If the guarding muscles are not addressed in treatment the effect of the neurological habits may well be life-long establishing permanent sensory-motor amnesia.

The longer one ignores the dysfunctional neurological habits, the more pervasive they become. Over time the compromised structures involved can actually change the shape of bones and discs. Most conditions involving disc degeneration, and arthritis, are sites of earlier trauma. The effect of the permanent increase in muscle tension from unrelenting muscle guarding reduces the range of motion and tissue health over time eventually leading to degenerative disc disease, stenosis, and even spinal fusion.

Untreated whiplash injuries can lead to: Cervical Spondylosis and premature Degenerative Disc Disease (even five years post injury), disc herniation (primarily C4-C6), Thoracic Outlet Syndrome (happening 67% of the time on the same side as the seatbelt shoulder strap), TMJ Disorder, Carpal Tunnel Syndrome (from gripping the steering wheel, bracing the hands on the dashboard during the collision, or injury during airbag deployment), Horner’s Syndrome (blurred vision or other visceral disturbances), dysphagia (difficulty swallowing), dizziness and vertigo, insomnia, and chronic headaches.

Ironically, research consistently shows that women are at a higher risk of developing chronic whiplash pain than men, possibly due to differences in anatomy or seating position.

The Anatomy of a Motor Vehicle Accident

According to researchers, the less a car is damaged or crushed in a collision, the higher the acceleration of the struck vehicle and the greater the risk of injury. Engineering tests show that an occupant in a low-speed collision with no damage to the vehicle may be at a significantly higher risk of injury than an occupant in a collision with a damaged vehicle. The collision scenario posing the highest risk of whiplash injury is when the vehicle is hit at an angle and the occupant is unaware as the collision takes place.

Anatomy of a Car

Many improvements have been made to cars within our lifetime and since nothing is “perfect”, let’s look at the key areas of injury within a car.

  1. 90% of head restraints are adjusted improperly. Head restraints are mistakenly thought of as “head rests.” The restraint should be positioned so that the back of the head touches it. Another common problem is that seats in cars are set back at an angle and many people drive leaning forward. In this situation, the head can fully hyperextend, even with a head restraint. But, the question is: If all modern passenger cars are required to have head restraints, and head restraints protect occupants from whiplash injuries, why do we still have so many whiplash cases? The answer is simple: head restraints are not designed to offer the best protection. Volvo researchers are working on this problem, and focusing on the entire seat/head restraint/shoulder belt structure itself to reduce the risk of injury.After being evaluated by a physician, massage and bodywork is one of the most recruited modalities to help soft tissue injury heal from whiplash.
  2. We all know the law: Buckle Up! Literature is quite clear that seatbelts lower serious injuries and fatalities from high-speed, frontal collisions. It is also clear that seatbelts increase the risk of cervical spine injury in rear-end collisions. A dirty little secret nobody wants to talk about. Injured areas include: breast area and fat necrosis, heart and sternal injuries, thyroid injury, laryngeal trauma, carotid artery injury. An advanced massage therapist treating whiplash will assess the myofascial areas involved to provide a complete and thorough recovery process, along with the neck muscles.
  3. Airbags were developed to save lives, and, like seatbelts, in serious head-on collisions they do so. The types of injuries that can be caused by airbags become obvious when we look at the force with which the airbags open. The velocity of deployment averages 144 mph with maximum velocities of 211 mph reported (velocities of the airbag itself, irrespective of the severity of the collision). Injuries sustained include: from the module cover itself, occurring primarily in shorter drivers sitting closer to the steering wheel; injuries from the force of the airbag itself including eye injuries, broken arms, and facial injuries; and lastly, a link has been found between airbag deployment and TMJ injuries and pain.
  4. Anti-Lock Brakes are significantly less likely to rear-end another car. However, cars with ABS are 30% more likely to be rear-ended themselves.

Treating Whiplash: Speed Up the Healing Time

Massage therapy provides relief for thoracic outlet syndrome, first rib fixation syndrome, and frozen shoulder.Healthcare professionals now say the best way to treat early whiplash pain is mobilization, not rest or a cervical collar. It is important to wait a few days after the accident to seek treatment. This allows the initial scar tissue to knit, which is an important part of the healing process. If there is a chance of a fracture, a concussion, any disc problem or other serious injury, the client should make sure to see a physician first. Myofascial damage is by far the most common source of neck pain in whiplash injuries. Therefore, a multidisciplinary approach is often the best and safest way to treat whiplash. With direct soft-tissue manipulation, massage therapy provides a quicker recovery process, avoiding a lifelong pattern of pain. Chiropractic treatment shows effectiveness in treating acute neck pain.

A client who has neck pain following a motor vehicle accident must first be seen by a physician to rule out serious injury. In addition to soft tissue damage, doctors must determine if the whiplash has caused a concussion or nerve-root compression. Once massage therapy is deemed safe, bodyworkers must assess the injured musculature involved to formulate a treatment plan. In addition to taking a detailed history of the accident, muscle resistance testing can help the bodyworker pinpoint the muscles most in need of release. Massage therapy is one of the most effective therapies for releasing muscle tension and restoring balance to the musculoskeletal system. Massage therapy can help relax the muscles, increase and maintain range of motion, decrease stress and tension, increase circulation, and prevent and breakdown scar tissue formation.

Myofascial Release
Myofascial release techniques can free restricted neck muscle and fascia to help restore fluidity, thus relieving the stiffness of whiplash. Additionally, myofascial unwinding can unlock dysfunctional fascial holding patterns established at the time of injury.

Static Compression
Applying static compression to affected trigger points creates an influx of oxygen that relaxes the contracted musculature. Since myofascial trigger points often develop in the cervical muscles following a whiplash injury, this treatment prevents prolonged muscular dysfunction that can linger for months or years after the initial trauma.

Deep Tissue Massage
Once the superficial muscles relax, deep tissue work can liberate contracted deep fascia, adhesions and scar tissue. Making sure to stay within the client’s pain tolerance level, deep tissue massage can free tissue that had tightened around local nerves.

The goal is to get the patient to a pain-free state and moving normally again. The sooner the fascial treatment begins – that is, before chronic changes occur – the better. However, if treatment begins years later, massage therapy can still help the body heal the “memory of injury.”

Whiplash is traumatic and should be addressed soon after the injury to avoid any chronic problems. In the end, chiropractic manipulation and massage therapy are simply more effective than medical treatment in speeding up recovery, increasing quality of sleep, reducing the amount of sick leave needed after the incident, and relieving post-accident anxiety.

Certified in whiplash recovery through NMT Midwest, I also work directly with clients and the auto insurance companies to determine if treatment is covered under the driver’s policy. If so, I handle the medical billing as well so reimbursement can be sought.

See you on the table!


The Complete Guide to Whiplash, Michael R. Melton, Body-Mind Publications, 1998, Whiplash – How to Heal a Pain in the Neck, Hope Bentley, Associated Bodywork and Massage Professionals, 2008, A Whiplash Guide For Massage Therapists, Nicole Cutler, L.Ac., Institute for Integrated Healthcare Studies, September 23, 2008, A Massage Therapist’s Quick Reference Guide, Massage for Whiplash: A primer for Physicians, Therapists, and Medically Savvy Patients, BJ Erkan, Bothell Integrated Health LLC

Neck & Shoulder Pain: Why Won’t It Go Away?

Massage provides relief for first rib fixation syndrome.There are those of you suffering from chronic pain or spasms in your neck, shoulder(s), or mid-back. You’re beyond frustration. You’ve tried several healthcare providers, including chiropractors and physical therapists, all issuing different treatment plans but nothing has helped. You’ve even tried massage but that provided nothing more than temporary relaxation. X-rays and MRI results are normal. What is going on and why can’t you find relief? The answer could be First Rib Fixation Syndrome. A lot of people haven’t heard of this and don’t realize they have it.

What Is First Rib Fixation Syndrome?

Doctors tend to overlook this syndrome as part of their first examination and diagnosis. It’s easy to miss, which is too bad because an elevated first rib can cause a plethora of symptoms and complications, leaving someone to suffer unnecessarily for years. This syndrome can be a long-held issue developed over time. Common causes include bad posture, long hours at the desk, over exercising, moving heavy objects, having a physical job, or possibly sustaining an injury.

Massage provides relief for Upper Crossed Syndrome symptoms.Over time, a muscular imbalance occurs known as The Upper Crossed Syndrome which elevates the first rib. When this happens, shoulder muscles (the subscapularis and infraspinatus) load up with trigger points, resulting in weakness and pain. With muscles now compromised, the shoulder is unable to move normally. People then tend to compensate for the pain by rounding the shoulders forward and jutting the head out further from the neck. The neck muscles (scalenes, serratus anterior, and sternocleidomastoid) overcompensate and develop more active trigger points. Referred pain from these new trigger points manifests as what may seem like random, erratic symptoms. Since these muscles attach to the first rib, even more elevation occurs. The trapezius muscle in the back then goes into immediate self-protection mode, resulting in tightness and spasm. This has a tendency to compress the brachial plexus and subclavian artery to eventually throw the person into a possible state of Thoracic Outlet Syndrome. Vicious, isn’t it?!

Sleeping habits play a large part in the development and treatment of this syndrome. Elevated first ribs typically occur in stomach sleepers. Some sleep with one arm tucked under their head, or sleep with minimal or multiple pillows. These now compromised muscles work extra hard if the person spends long hours working in front of computers using a mouse or has an intense job with repetitive movements. Changes in sleep style post treatment speed recovery and help prevent trigger points from reforming.

Also, all athletes should be evaluated as an elevated first rib is common in that type of lifestyle, particularly tennis players and weight lifters.


  • Shoulder pain
  • Neck pain
  • A heavy hurting feeling or throbbing in the arm
  • Dull achy pain and tightness in upper back and shoulders
  • Headaches
  • Trapezius spasm
  • Radiculopathy (a neuropathy)
  • Jaw pain
  • Mid-back pain
  • Paraesthesia (tingling, prickling, or burning)
  • Chest & sternal pain

Treatment: Can It Go Away?

Massage therapy provides relief for thoracic outlet syndrome, first rib fixation syndrome, and frozen shoulder.So what do I do that’s different than others? When someone presents a certain set of physical complaints that resemble this syndrome, I palpate effected areas for tenderness, spasm, and edema. A person will automatically jump or pull away when an elevated first rib is touched. Through various soft tissue mobilization techniques (MFR, PNF, ART, TPT, Gua Sha, Massage Cupping) active and latent trigger points in almost all of the muscles listed above are manipulated until pain ceases. This can take as little as one treatment for someone to experience immediate relief but can take up to a handful of sessions for more aggressive cases (those with repetitive work related movements that reform trigger points). These sessions are different than “typical” massages as the entire time can be spent on removing and breaking up the trigger points. This is aggressive and intense so I am sure to only work within the person’s tolerance level.

If this sounds familiar, please contact me. I also strongly recommend visiting your chiropractor for them to adjust the first rib(s) back in place. Again, this is a great example of the kind of pain you don’t have to live with. Let’s knock it out so you can feel good in your skin again.

See you on the table!

Massage Therapy 101: The Mysterious “Myofascial Adhesion”

Myofascial adhesion (MFA) is a term rarely used outside of the massage therapy industry. They are a major contributor of pain to most of the world’s population yet the average person is not aware of the term.

The longer chronic pain exists, the longer the rehabilitation period. As a rule of thumb, for every year of chronic pain, it takes at least a month of rehabilitation to restore balance to the body. For this reason, chronic pain is often never relieved. The body adapts and we accept living with the pain.

Fascia is a connective tissue within the body. Think of your entire body wrapped in fishnet hose both internally and externally including each individual bone, nerve, and muscle. Over time, fishnet hose get entangled and need adjustment. If not, you develop an impingement. Fascia works in the same way. Knots develop over time known as Trigger Points. The greatest MFA is scar tissue. MFAs occur for many reasons: injury, illness, inactivity, lifestyle, job type, nutrition, dehydration, and the aging process all play a contributing role in their development.

The natural emotional response to a MFA is to develop a guarded nature from the pain. However, this only encourages further development of the adhesions. Movement is essential to breakdown the adhesions.

Massage therapy relieves adhesions by warming and relaxing the body to create an environment for most manipulation with least pain. This is particularly effective in addressing the guarded cause. Adhesions begin breaking down, there is a restoration in flexibility, reduction in nerve impingement and nourished blood flow throughout the body further facilitating the healing process.

There is no quick fix to breaking down MFAs. However, a regular regimen is the likely solution for permanent relief once they develop. Drink lots of water, stretch and exercise regularly, be conscious of your eating habits, enjoy life but weigh the consequences and be aware that moderation may avoid injury.

A body that receives massage therapy on a regularly basis feels entirely different from a body that doesn’t. The primary difference is the level of myofascial adhesions present.

See you on the table!

Reference:, November 19 , 2010, Braxton Dutton

Why Stretch?

Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy.I am a nag about people’s daily stretching routine. More times than not I learn that people have good intentions to include stretching in their day but “don’t get around to it.” We are all guilty of this! But why is stretching so important? There is a science to it.

What Exactly Does Stretching Do?

Stretching your muscles on a regular basis can improve the range of motion and flexibility. Keeping muscles at a proper length takes unnecessary tension off tendons, which lessens damage and helps recover from injury. Stretching also allows for more muscle tone; muscle will be larger in volume without becoming bulky.

Stretching allows the body’s muscles to gently loosen. Increased flexibility of the neck, shoulders, and upper back improve respiratory function. Keeping upper and lower legs as well as the glutes stretched prevents plantar fasciitis and loose fluid movement in the lower back.

Without stretching, the body becomes stiff and tight. Stretching helps to push fluids and oxygenated blood throughout the entire body, increasing range of motion and improving posture. Remember, stretching is not relaxation (although that is a natural side effect); stretching is elongation!

Even if you do not have a regular exercise routine, stretching daily has many benefits. As our bodies age our muscles tighten and we lose some of the range of motion that we once enjoyed. Stretching can reverse these signs of aging by continuing to allow you to do the tasks that you expect. It doesn’t take a large time commitment, and the benefits far outweigh the effort. Start small and work your way into more stretches.

So What’s Stretching Have To Do With Massage?

Stretching is very important following a massage session. During the massage I am removing/releasing trigger points, or areas of built-up tension, within the muscles. Tension builds by: repetitive movements, gravity, moving around within our environment with a compromised gait pattern, exercising without stretching, the list goes on. Muscles kneaded and worked during the massage remove trigger points. When this happens, the brain sends a signal to the muscles to return to their natural resting states. The body does not feel tight any longer and fluids and chemicals flow freely inside the body.

So the person leaves the massage and returns to their daily life, right? Exactly, and then two weeks later they’re back in the same situation of pain and tightness. Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy!

The other important result of daily stretching in regards to massage sessions is Less Pain! An inflexible and tight body experiences a more painful session with slower progress. Better muscle tone + increased flexibility = less painful massage sessions. This is now when the person receives regular monthly massage sessions as maintenance to enjoy a “well-aging” body vs. someone who can’t seem to “kick the pain,” having massage sessions only last them a week or two. Make sense?

Ok, Then What Is the Proper Way To Stretch?

  • Strengthen Then Stretch – I come from a ballet conditioning background, ballet being the most efficient way to strengthen the human body, and learned immediately that the fastest and healthiest result of balanced muscle tone is to first strengthen the muscle, then stretch it. Football players and professional athletes can attest to this – yes, they’re doing secret ballet conditioning, shhh! DO NOT STRETCH A COLD MUSCLE! This causes injury, tears, and frustration as flexibility is not found. Walk first, do a few movements first, then stretch. I stretch multiple times during the workout to constantly elongate the muscles. When you do this, you will not be sore the next day after workouts! The key to knowing when your body has achieved a healthy state of strength and flexibility is when you can get out of bed in the morning and immediately reach the same level of flexibility you have after a workout, be it touching your knees, ankles, or toes.
  • Form, Form, Form – every stretch performed must have proper form to avoid injury and hyper-flexion. If you are unsure of proper form, look it up on the internet or have me demo the stretch for you.
  • Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy.Protect the Lower Back – for any stretch done standing it is crucial to keep knees slightly bent and pelvis tilted forward to protect the lower back. Otherwise, as you’re getting a wonderful stretch in the target muscle, you compromise the lower back and scratch your head why your back feels like it’s “ready to go out” a few days later.
  • BREATHE – it is a natural reaction to hold in our breath when we feel tension. This is the opposite of what the muscles need. While holding each stretch, breathe deeply! The science to this breathing mechanism is the pump. As we breathe deeply during our stretches, oxygen is physically being pumped into the muscles, allowing our bodies to extend, relax, and as a result, gain flexibility.

I do believe there are good stretches and bad stretches for the body. For more information, talk with me during your next session. I will help you choose the right stretches for your troubled area and create a customized protocol for you.

See you on the table!

Heat or Ice – Which Is It?

I hear a lot of confusion in the massage room about when to use heat over ice. Of course heat feels amazing but sometimes icing an injury feels good too. The use of heat and ice are equally important in the self-care process of muscle management. They each have specific uses but need applied at the right time or they could exacerbate an issue.

Heat vs. Ice

Icing, or cryotherapy – is for injuries except for low back pain
Heat, or thermotherapy – is for muscles

Icing, or cryotherapy, is for injuries except for low back pain.Choosing ice over heat for injuries is very important as icing calms damaged and inflamed tissues. These tissues are already swollen and carrying heat, a normal process for the body, although painful. Adding heat during this time feels great initially but only creates increased pain
and swelling. Not what you need in a time of trying to resume daily activities.

Choosing heat for muscles is great for muscle spasms or pain from knots and trigger points. Icing muscle spasms or trigger points can actually make them worse. Picture being surprised with someone splashing cold water on you or someone coming in from the cold outside and putting their hands directly on your skin – the entire body contracts. This is what happens when icing trigger points and spasms, both already in a state of contraction. Severe spasms and trigger points can feel like knife blades and it’s a common mistake to run for an ice pack. But icing these tissue issues causes the muscles to contract even harder, and the trigger points to burn more intensely. Trigger points and muscle spasms calm down with heat.

Heat also relieves psychological stress, which is a major factor in pain issues. At the end of a hard day’s work it’s a great idea to throw heat on tight neck and shoulder muscles or on leg muscles after a work-out.

What About A Muscle Strain or Tear?

This one is debatable but ice is generally preferred. If the muscle is truly injured, ice only for the first few days. Use ice to bring down the initial inflammation and help numb the severe pain. Once this phase is over replace with heat.

Always Cold or Over Heated?

Icing, or cryotherapy, is for injuries except for low back pain.It’s not a good idea to use heat if you’re already sweating or overheated. And ice will only make you feel worse if you’re shivering. The brain may misinterpret these situations as an excess and a threat. Shake things up to help out the brain. If you experience an injury but you’re already freezing, warm up in a hot shower and then throw an ice pack on the injury afterward. Or bundle up in a robe and blankets during cryotherapy. Same with heat. If your legs are cramping and you’re overheated from the work-out, jump in a cool shower then slowly turn up the heat to help relax the muscles.

Do Not Ice Low Back Pain!

Except for a direct injury from whiplash or a muscle tear where inflammation is definitely present, do not ice a low back injury. This is a common point of confusion even within the healthcare industry. Common low back pain, the feeling as if the back “is out”, is not from an injury or trauma causing inflammation. Painful trigger points, knots/adhesions, and the low back muscles being weak are the common causes of low back pain. When the low back feels like it’s out, icing will only make that feeling worse. Always Heat.

Hopefully this clears up some confusion. Using the above information as a guideline, choose the therapy that feels right for your body at the time and help speed up the healing process.

See you on the table!

Beat The Heat

Those of us living in four season states have a comedic annual ritual. The long winter drones on day after day… A break in the cold finally happens… The shorts and flip-flops come out of the closet and we take full advantage of the first weeks of hot weather and full on sun! It’s a fun tradition. What’s not so fun is overdoing it and feeling the awful effects of heat exhaustion, or worse, heat stroke. Whether you spend long hours in the garden or run more miles outside than you’ve been used to during the Winter there are a few tips to survive the heat wave outside. The key is to analyze the symptoms and then learn how to respond or better yet, prevent.

Heat Syncope
Symptoms include fainting and light-headedness that usually occurs at the end of the exercise.

  1. If you begin to feel faint, get out of the heat and rest in a cool place drinking cold water.
  2. Elevate your legs.
  3. Most likely you will experience “heat cramps” – tight muscles or spasms after intense exercise. To relieve these, massage and stretch the cramped muscle and drink more cold water.

Heat Exhaustion
Heat Exhaustion is similar to heat syncope but accompanied with nausea, vomiting, headache, fast breathing, and poor coordination. Most people in this state still try to get through their current activity but Don’t!

  1. Find a cool, shaded place to cool down.
  2. Remove as much of your sweat-soaked clothing as possible and use cold, wet towels to cool the skin.
  3. Elevate your legs and drink water or a sports drink to replenish lost electrolytes.
  4. DON’T jump into an icy bath as this cooling method is too rapid for the body to adjust.

Heat Stroke
Heat Stroke is the second leading cause of death in athletes yet totally preventable.  It’s a small step from heat exhaustion to full-blown heat stroke with symptoms being hysterical behavior, delirium, blacking out, and weakness.  It’s a myth that dry skin signals heat stroke – the sweating mechanism is still working.  If you see someone displaying this behavior do the following to help them:

  1. Cool the body as quickly as possible and call 911.
  2. While waiting for EMS, move the person to a cooler place and swap their clothing with ice packs, cold towels, etc.
  3. Massage in this instance is very effective in increasing circulation in the extremities.
  4. If the person starts to shiver, remove all cooling devices as shivering is our natural way to increase core temperature, which needs lowering in this moment.

Follow good prevention during the hot Summer by staying well hydrated, increasing consumption of good food made up of mostly fruits and vegetables, and exercising in moderation.

See you on the table!

Gua Sha What?

Various Gua Sha tools.

Various Gua Sha Tools

By now, quite a few of you have experienced the, some would say “interesting”, tools I use to create more effective and efficient sessions. The tool set needing further education fall under the technique called “Gua Sha,” the ancient art of body combing.

What Is Gua Sha?

Gua Sha (pronounced “gwa shaw”) is a healing technique used throughout Asia. Gua means “to rub or friction.” Sha is the term used to describe congestion of blood at the surface of the body. When friction is applied in repeated even strokes, the cha surfaces as small red petechiae (reddish, elevated skin rash). In minutes the petechiae fade into ecchymotic patches. The cha disappears totally in two to four days. The color and rate of fading are both diagnostic and prognostic indicators.

Why Do It?

The benefits of Gua Sha are many. I break out the tools when there is a stubborn knot, or adhesion, that needs broken up quickly. Gua Sha tools flatten the adhesion faster and more efficiently than using thumbs. It moves stuck blood, promoting normal circulation to the muscles, tissues, and organs directly beneath the surface treated. In the process it works simultaneously on the skin, lymph system, blood vessels, nerves, and brain. This in turn affects the entire body. The client experiences immediate changes in stiffness, pain, and mobility. Normal metabolic processes are restored by the movement of fluids as nutrients are carried to the tissues and metabolic wastes are carried away. As a fun aside, because Gua Sha mimics sweating, it even resolves fever!

Gua Sha cools someone who is overheated, warms a person who is chilled, nourishes those who are deficient, and clears the client who is experiencing an “excess.” Gua Sha is therefore considered an adaptogenic, or regulating, technique.

Gua Sha helps to strengthen the immune system, cleanses the body of toxins, improves circulation and rebalance emotions. As a result, it provides relief for all sorts of different ailments as well as being a valuable preventative therapy:

  • pain associated with acute and chronic disorders
  • back, neck, and other musculoskeletal problems
  • coughs and colds
  • flu, bronchitis, and asthma
  • digestive disorders

Gua Sha is considered as a technique in any case of pain or discomfort, for upper respiratory or digestive problems, and for any condition where palpation indicates there is sha. Sha is raised primarily at the Yang surface of the body: the back, neck, shoulders, buttocks, and limbs. On occasion, Gua Sha is applied at the chest and abdomen.

How Is Gua Sha Applied?

Gua Sha relieves various types of issues.After lubricating the skin with oil or cream, the area to be treated is scraped (to client tolerance), until the Sha is drawn to the surface in the form of a mild rash. The marks are usually red, although their colour can range from pink to dark purple depending on the condition and the severity of blood stagnation.

Although the skin may look angry it’s not painful, although there may be a slight bruised sensation the next day. Within hours of treatment it starts to fade and a few days later is gone. The therapeutic effects can be dramatic. Even after the first treatment, pain is eased, mobility improves and life begins to feel good again. I’ve recently been working with a client experiencing chronic pain in her upper arm effecting range of motion for years. Countless types of therapy have not unlocked the pain. After a few sessions of Gua Sha the pain is moved out and she doesn’t think about that area anymore. What a relief!

After Gua Sha, the client should cover the area, avoiding wind and exposure to the sun or sudden change in temperature. Stretching is also recommended but not a heavy workout on the day of treatment. The Sha petechiae should fade in 2-4 days. If it is slower to fade, indicating poor blood circulation, the practitioner must find out whether it is deficiency of Blood, Qi or Yang, a deeper stagnation, or organ deficiency at the root.

How Safe Is It?

Gua Sha is a completely safe technique, but it is serious medicine. Knowing when to use it and what to expect from treatment is as important as good technique. People who live in chronic pain often have emotional defenses to cope or can feel completely hopeless. Having that pain ‘touched’ and relieved can be unsettling, even shocking. Because of this psychological involvement, it is good to be moderate in activity after treatment for the rest of the day, even rest.

What Do The Tools Look Like?

I use a few different types from a Chinese soup spoon to various shapes cut from water buffalo horn. As my father taught me at a very young age, life is all about having the right tool for the job.

See you on the table!

Fibromyalgia & Massage Therapy

Medical massage can provide significant relief to symptoms of fibromyalgia.

For the past few years I have worked with some wonderful and frustrated people experiencing the phenomenon known as fibromyalgia. We work together in sessions to help ease symptoms, each customized to the person’s tolerance level. Some want the deepest pressure while others need the lightest touch. Massage can help, but first, what is it?

What Is Fibromyalgia?

Fibromyalgia Syndrome (FMS) is one of the most controversial conditions in American health, affecting up to 4% of the adult population. There is ample information published, much of it not reviewed, untested, or unsubstantiated.

Is it an autoimmune disorder? If it is, it shares nothing in common with any other autoimmune system disease.

It does, however, often appear as a secondary response to an underlying autoimmune condition, especially Sjogren’s syndrome and inflammatory bowel disease.

Is it a form of arthritis? There is no documentation on joint inflammation as a part of fibromyalgia, although it often shows up in discussions of arthritis, and many people with arthritis also report having fibromyaglia.

Is it just superficial trigger points? The histology says no, although trigger points and tender points can occur at the same locations.

Is it all in these clients’ heads?… Maybe. But not in the sense of being “psychosomatic” or made up by malingerers hoping to get disability benefits.

According to the most recent and consistently accurate research, fibromyalgia is neither a musculoskeletal nor an autoimmune disorder. It is a central nervous system condition involving a phenomenon called central sensitization. This puts it in the same category as other serious chronic pain syndromes like postherpetic neuralgia (the intractable pain that sometimes follows an outbreak of shingles) and complex regional pain syndrome (a chronic pain problem that begins as an injury but becomes self-sustaining within the nervous system). The difference is that no outside force appears to trigger the beginning of the chronic pain signals.

Fibromyalgia patients and their health care teams need know the true origins of this condition in order to manage it successfully, regardless of treatment strategy they are contemplating. Some researchers are now testing which bodywork modalities have the best outcomes for FMS patients, ranging from myofascial release to lymphatic drainage and beyond.

Treating Fibromyalgia

Treatment for FMS begins with a good diagnosis, which is a challenge. This condition is typically diagnosed by ruling out other diseases with similar signs and symptoms, including Lyme disease, multiple sclerosis, rheumatoid arthritis, lupus, hypothyroidism, candidiasis, and several others. Several of these diagnostic differentials are also made by ruling out similar-looking conditions, and it is quite possible for a person to have more than one of these conditions at a time. Further, a long history of confusion between FMS tender points and myofascial pain syndrome (MPS) trigger points continues to cloud the issue.

For most people FMS is a lifelong condition. Treatment focuses on finding ways to manage the disorder so that the patient may lead as normal a life as possible. This includes patient education, careful exercise, and often cognitive behavioral therapy.

Drug therapies for FMS include mild antidepressants to reduce levels of depression and manage pain, to improve sleep quality. Painkillers are generally avoided, because they interfere with sleep and are habit-forming. An anti-seizure drug has been successful with pain management without some of the side effects that this class of drugs often involves.


  • Analgesics, including NSAIDs (have varying effectiveness)
  • Antidepressants to aid with sleep, pain and mood
  • Anti-seizure drugs to help with pain
  • Anti-parkinsons drugs

Fibromyalgia & Massage Therapy

Risks: People with fibromyalgia live with chronic, invisible, widespread and unpredictable pain. It is important that their pain not be exacerbated by massage that is insensitive or too aggressive.

Benefits: Massage has much to offer fibromyalgia patients in terms of pain relief, sleep quality, improved mood, and reduced anxiety. Massage as part of an emphasis on good self-care is often part of a successful treatment strategy.

Options: Research suggests that while many kinds of massage improve fibromyalgia symptoms, lighter and gentler work is more effective than deeper, more intrusive types of bodywork, especially for clients new to massage.

If you or someone you know needs relief of FMS symptoms I would be happy to talk more about how the therapy of massage can help.

See you on the table!

Ruth Werner, A Massage Therapist’s Guide to Pathology