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

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!

References:

The Complete Guide to Whiplash, Michael R. Melton, Body-Mind Publications, 1998

http://www.massagetherapy.com/articles/index.php/article_id/1107, Whiplash – How to Heal a Pain in the Neck, Hope Bentley, Associated Bodywork and Massage Professionals, 2008

http://www.integrative-healthcare.org/mt/archives/2008/09/a_whiplash_guid.html, A Whiplash Guide For Massage Therapists, Nicole Cutler, L.Ac., Institute for Integrated Healthcare Studies, September 23, 2008

http://www.massagetherapyreference.com/whiplash-massage/, A Massage Therapist’s Quick Reference Guide

http://www.bothellintegratedhealth.com/massage-for-whiplash/, Massage for Whiplash: A primer for Physicians, Therapists, and Medically Savvy Patients, BJ Erkan, Bothell Integrated Health LLC

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!

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

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!