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!

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!


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

The Importance Of Water

Drinking plenty of water daily is important, especially during the first 24 hours before and after a massage.Surprising to most people, water is the only fluid that properly hydrates the body. Everything else that comes into the body registers as food and files accordingly. Drinking plenty of water daily is important, especially during the first 24 hours before and after a massage. But why is it so important?

Water Before A Session

Massage actually dehydrates muscles by moving fluid out of the muscle to the spaces between. Drinking water before a massage creates hydrated muscles, providing an easier session for the therapist to perform deep work and the client to receive deep work. Hydrated muscles are easily manipulated. Beginning a session in a state of dehydration causes muscle cramping during the session. This is not only painful to experience but time is lost working the cramp out vs. achieving smarter work around the body.

Water After A Session

Massage stimulates circulation in the body while flushing water, salt, and other minerals from muscles. Our circulatory system carries away waste materials generated by cells. Massage also pushes out a high amount of toxins into the system. Drinking water post-session forces released toxins to move and be carried out of the body. Without the follow-up of water, toxins can pool within the system, causing muscles aches, soreness, swelling, and discomfort.

What’s With The Warm Water?

Why do I insist on handing out room temperature water after a massage session? Drinking water right after a session helps bring people back to alertness. After a massage it is typical to feel “spacey” and disoriented. Having a glass of water helps to bring the body and mind back to the present and allows the brain and mind time to slowly return to the real world. Warm water, specifically, performs this action in a soothing way. Cold water is shocking and causes an immediate reaction inside the body. Warm water goes down smoothly and effortlessly, causing the least trauma in the system, thereby helping to acquaint the client to the present.

See you on the table!

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.


  • 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