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.

Dr. 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!

TMJ Disorder – Do You Have It?

Countless people suffer from chronic pain stemming from TMJ Disorder. The symptoms are nagging and constant. But TMJ Disorder is a condition easily confused with muscle tightness in the jaw. Fortunately there is lasting relief from both types of pain with massage therapy. So what’s the difference between the two and how does someone know which they have?

What Is TMJ?

Massage therapy mixed with stretching and exercise frees the jaw of TMJD pain and discomfort.TMJ stands for the temporomandibular joint. Easy rule of thumb: everyone has TMJ, but not everyone has TMJ Disorder. TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, in front of each ear. These joints are flexible and allow the jaw to move smoothly up and down and side to side, allowing us to chew, talk, yawn, etc. The muscles attached and around the joint control the position and movement of the jaw.

What’s TMJ Disorder and Its Symptoms?

Temporomandibular joint disorder (TMD for short, thankfully) occurs as a result of problems in the joint (and disc) where the jawbone meets the skull. One of the common symptoms is clicking, popping, or grating sounds in the jaw joint when talking or chewing. Pain could be involved but not necessarily. Other symptoms include:

  • Pain or tenderness in the face, jaw joint, neck and shoulders. Pain could also occur in or around the ear when chewing, talking, or opening the mouth wide.
  • Inability to open the mouth wide.
  • Jaw becoming “stuck” or “locked” in either the open or closed-mouth positions.
  • A feeling as if the upper and lower teeth are not fitting together properly.
  • Swelling on the side of the face.
  • Possible toothache, headache, neck ache, dizziness, earache, hearing problems, upper shoulder pain, and tinnitus (ringing in the ears).

How is TMD Diagnosed?

There are many other conditions causing similar symptoms to TMD, therefore it is very important to have a dentist conduct a careful examination of the entire area. The dentist will look for specific limitations in range of motion or jaw locking as well as a wearing away of the joint. X-rays may be involved as well as CT scans or MRI.

What Causes TMD?

There are many causes of TMD such as injury causing whiplash, jaw abnormalities, and poor posture. Other causes include:

  • Constant teeth grinding or clenching, which puts pressure on the TMJ.
  • Dislocation of the soft cushion or disc between the ball and socket of the joint.
  • Osteoarthritis or rheumatoid arthritis in the TMJ.
  • Stress resulting in a constant tightening of the facial and jaw muscles.

What’s the Fix?

Some medical professionals may recommend surgery and orthodontics to correct the problem, however more natural solutions are long-lasting and much less invasive and expensive. The National Institute of Dental and Craniofacial Research recommends gentle stretching and relaxation exercises to increase jaw movement. Massage therapy mixed with stretching and exercise of the muscles involved significantly loosen up the entire area, freeing the jaw of pain and discomfort. After only one or two sessions people find such relief that many have put away their mouth guards and report a better quality of life.

What If It’s Only Muscle Tightness?

Massage therapy mixed with stretching and exercise frees the jaw of pain and discomfort.Outside of TMJ issues, the main muscles involved in everyday jaw tightness or discomfort are the masseter muscles. The masseter muscle is the primary chewing muscle. With regular talking, chewing, and stress these muscles develop “knots” (or adhesions) and trigger points just like any other muscle in the body. Most people don’t realize these muscles play a part in headaches, neck aches, and shoulder tension. After flattening out adhesions and removing trigger points the muscle loosens and returns to its natural resting length. It’s so fun to loosen these during a session and hear people say, “Wow I didn’t realize how tight I was in there. I feel so much better!”

I work on both conditions of muscle tightness and TMD daily with high success. With a specific combination of modalities for each, the jaw area immediately loosens up, decreasing stress and tension in the head and neck. After a session, I offer daily exercises and stretches for the jaw to keep the area from tightening.

Another wonderful sigh of relief that you don’t have to live with the pain, even if it’s only nagging. Feel good in your skin again today.

See you on the table!

References:
http://www.webmd.com/oral-health/guide/temporomandibular-disorders

http://www.livestrong.com/article/305729-tmj-exercises-for-jaw-popping/

http://www.mayoclinic.org/diseases-conditions/tmj/home/ovc-20209398

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!

References:

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, http://www.massage-education.com/thoracic-outlet-syndrome.html

What About Grandma?

Geriatric massage is about helping the person age better.

My beautiful grandmother resting from her hike in southern Germany.

Geriatric massage. What is it? Not many people talk about it but it is a rising demand in our society. The baby boomers are entering their most crucial stage of life in a healthcare sector trying to keep up. Put simply, geriatrics is the study of health impairments that happen because of changes within the body. Simple, right? Not so fast.

Seniors tend to fall into three basic groups:

  1. Robust – typical middle-aged clients free from serious health impairments leading healthy and physically active lives.
  2. Age Appropriate – those suffering from age related illnesses, such as diabetes, arthritis, Parkinson’s disease, and heart disease. Geriatric massage naturally improves circulation of lymphatic fluid and blood.
  3. Frail – seniors in this group look and feel fragile to the touch. They tend to fall and suffer from broken hips, deep bruising, and effects from being on a cocktail of medication. Massage work focuses on helping a weakened body maintain, or sometimes regain, functions essential for general well-being. In fact, this is a massage goal for any age group. This means that despite the many cautions to which massage is subject, there are very few true contraindications. Sessions are shorter in length for this population, usually 30 minutes.

I think about geriatric massage in this way: it is not so much about “fixing” issues as it is about helping the person “age better.” Massage increases comfort, decreases aches and pains, relieves highly annoying issues such as restless leg syndrome and keeps muscles long and loose. Not only does this help the overall body internally, touch also keeps people connected. The aging process is not fun in any way, it’s hard work, and tends to increase internal feelings of alienation and isolation as once proud people are examined, poked, and prodded at will.

My lovely grandma, pictured above, has since passed. She was a proud German woman with a ornery personality who was fiercely flirtatious and danced into the night. She was not a “touch” person. At the end of her time here her body ached as it was shutting down. She would have me massage her legs for great lengths of time, the only thing that helped her calm down inside and relax. Those were amazing bonding moments for us. Massage not only connected us on a deep level, it helped ease her into her passing. That’s powerful!

The senior community is a group near and dear to my heart. I enjoy working with them both in my place and on-site. Some struggle with mobility and it’s my pleasure to work with them where they are at, be it in a retirement home, their own house, or a hospice setting. Truly, every person benefits from massage, from babies in vitro to end-of-life adults.

See you on the table!

Getting A Massage While Sick – Is That Good?

Pros and cons to receiving a massage whilst sick.It used to seem like cold and flu season only hit in the winter time. Lately people are suffering from viruses year-round. A great question I hear regularly is, “I’m sick. Should I come in to have you push it out faster?” While it’s true that massage has wonderfully detoxing effects and enhances the immune system, getting a massage while in the throes of fever and sickness could be too taxing on the body. So what are some pro’s and con’s of receiving massage while sick?

Massage releases stored toxins in the system and flushes them out quickly. Sounds great, right? Absolutely, however during sickness, the body is already overloaded waging war on the virus. If the body then has to continue that war yet wage a new battle to remove newly released toxins, you could not only feel much worse in the short-term, but experience a longer recovery time. Based on whatever your work schedule is, the best thing could be to cancel the appointment, stay home and rest.

Each person is different depending on their history of how they handle being sick, the preventative healthy lifestyle being lived out, and the natural state of their immune system. The difference between a nasty head cold and full-blown flu symptoms are two different things. If a massage occurs at the onset of a bad cold, hang on – the cold’s intensity will happen in 3-4 days vs. spread out over 7-14 days. If your schedule can handle that then definitely have the massage quickly detox you. Massage works wonders clearing out the lungs and sinuses from all the mucus and drains the body of bacteria and virus. Massage brings relief to sore rib and back muscles fatigued with excessive coughing. Massage relieves sinus pressure and headaches. Illness can quickly feel isolating too. Massage instantly helps the body AND mind feel safe and protected as it engages in serious battle.

In massage sessions, I regularly use essential oils containing anti-viral and anti-bacterial properties. Applying these oils provide relief from symptoms as well.

On the con side, the other thing to consider is the spread of infection. Massage typically takes place in a small enclosed room running at a warmer temperature than usual. Viruses love that! Aside from small fans and the possibility of an air purifier, there are no open windows for ventilation. An hour session is a long time for a virus to spread not only to the therapist, but all the objects housed in the room. Clients coming in right after are then susceptible for being contaminated by the spreading of that same virus. Having said that, I regularly use antibacterial and anti-viral cleaning agents and oils after EVERY client to quickly minimize the spread of infection before the next session begins.

A Few Rules:

  1. If you have a fever – stay home.
  2. If you know you’re contagious – stay home.
  3. If you’re already nauseas, even slightly – stay home. Massage will only increase this feeling with the release of new toxins in the system.

Outside of these, come on in and we’ll hopefully have you feeling better quickly.

So What’s The Answer?

The best rule of thumb is be cognizant of what you have and decide accordingly. If your body is aching for touch and the schedule allows you for the possibility of being down in bed for a day or two afterwards, keep the appointment. If your skin is already sensitive to touch and fever is involved, a nice hot bath and bed rest may be the better option. I encourage both decisions because we all handle illnesses differently. I’ll be available, either way, because we’re all in this together.

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.

Medications:

  • 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!

Reference:
Ruth Werner, A Massage Therapist’s Guide to Pathology