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

Kids Need Massage Too!

Massage for infants and children improve learning and development and reduce sickness.With school and sports being in full swing again now is a good reminder that massage therapy isn’t just for adults. Kids today are moving at incredible speeds. From early morning practices and rehearsals to a full day at school, followed by more practices and rehearsals, then homework, it’s amazing they have time to eat dinner!

Bodies and minds get pushed to the max. Intense practice schedules following a Summer period of less activity can create a condition called compartment syndrome. Compartment Syndrome is when the muscle grows at such a rapid rate the fascia (or casing) surrounding the muscle can’t keep up and acts as a restriction to the muscle. This is painful! Massage can help to loosen the fascia’s hold around the muscle, which reduces pain and restriction.

Massage is not only a natural for sport injuries and increasing performance, but also to keep those young bodies flushed of toxins, viruses, and infections.

Crazy Schedules = Stress, which then = Decreased Immune System Function

Even for kids not heavily involved in sports, massage will help keep them protected from colds and flu passed around from classroom to classroom. This is true for babies as well as those entering college.

Another common occurrence now is ADHD. Two recent studies conducted by the Touch Research Institute at the University of Miami reported that regular massage therapy is an effective treatment for kids with ADHD. Children are more focused in their schoolwork, fidget less, display longer-term behavioral improvement, and are happier. Massage also helps improve math computation performance, raises alertness levels, decreases depression, and increases mental focus.

I love working on kids of all ages. It’s a good idea to acquaint children at any age to the healing benefits and routine of massage therapy so they grow as centered and healthy adults. With littler bodies sessions are usually around 30 minutes; teenagers appreciate longer sessions as they’re bodies are developing and changing rapidly.

See you on the table!

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!

Massage Cupping: What Is It?

Massage suction cupping set.

Massage Suction Cupping Set

By now many of you have experienced the healing effects of massage cupping. A lot of questions arise when I break these little guys out so I thought I would address exactly what massage cupping is and why I choose to use the method. I prefer to use the Suction Cup technique, also known as Body Vacuuming, but there is also Fire Cupping, which uses heat to create a vacuum inside a cup using a combustible (alcohol), then quickly applying the cup to the skin. Both are ancient Chinese healing practices still in use today. Suction cups produce vacuums on the body’s surface by manually withdrawing the air through the suction gun, rather than the traditional way of burning up oxygen. If you think of massage in terms of positive pressure (pressing in on body tissues), then Massage Suction Cupping is negative pressure, drawing body tissues out from the body, to stimulate them with a reverse massage. The skin presses up into the cup, and there is usually a reddening of the area under pressure.

So when and why do I use this method? When I come across very stubborn adhesions (knots) and tight muscles cups soften the muscles, loosen adhesions, lift connective tissue, bring hydration and blood flow to body tissues, and drain excess fluids and toxins by opening lymphatic pathways more comfortably than sticking my elbow in the area for minutes on end. Cups multitask quickly and effectively, making your session that much more beneficial and healing.

Gwyneth Paltrow after a massage cupping session.

Gwyneth Paltrow After A Massage Cupping Session

Discoloration does occur after treatment and this is normal and a desired result, even though it looks scary. The marks show intense stagnation of body fluid and toxins in the area. This is not a bruise and will dissipate anywhere from a few hours to a few days. It is very important to up water intake after a session to ease elimination of toxins. Many are regularly experiencing the huge healing effects of cupping from celebrities to Olympic athletes. In fact, massage cupping is so safe it’s used on everyone from children to the elderly.

Conditions that respond to treatment especially include:

  • Whiplash
  • Fibromyalgia
  • Bursitis
  • Tendonitis
  • Sluggish Colon
  • Olympian Swimmer Wang Qun
  • IBS
  • Stagnant Lymph and Edema
  • Poor Circulation
  • Sciatica
  • Insomnia and Anxiety
  • Poorly Nourished Skin and Muscle Tissue
  • Lung Inflammation and Congestion
  • Sinus Infections, Pneumonia, and Bronchitis
  • CELLULITE AND FACE LIFTS! (That’s right ladies)
Olympian swimmer Wang Qun.

Olympian Swimmer Wang Qun

Massage cupping therapy is not an irritant to the skin or body and actually draws inflammation out, yet does not add to it. I do know that most people in a massage session prefer to feel hands on them most of the time. Given that, I only use massage cups as necessary when I find something particularly troublesome. Never be afraid to tell me of your preference, whether you choose not to have me use massage cups or to increase the use of them on trouble spots or cellulite. Remember, it’s your session.

See you on the table!

Michael Phelps shows off cupping marks at 2016 Olympics.

Michael Phelps 2016 Olympics

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