A Great Exercise to Erase Low Back Pain

Check out the following short article about correctly picking something up off the floor. And then watch toddlers as they move around. They do it all correctly - and it's all instinct. We actually get worse as we age, even though no one tells us to. Teach your kids to ignore adults in this regard and to move as they already do based on instinct - their gut feeling is right!

A Great Exercise to Erase Low Back Pain:

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Bone Basics: What You Should Know About Your Skeleton

It's so easy as a massage consumer, or even as a massage therapist, to forget that muscles are only part of the body's story. With out the skeleton, muscles would be pretty useless. The skeleton and muscles fit together to make up one large system of pulleys and levers. One without the other would go no where fast. Your muscles move your bones (the pulleys); your bones provide the structure your muscles need to move (the levers). And, just like your muscles, your bones need care. They need to be strong so your body as a whole can be strong. They too need nourishment in the form of nutrition and exercise.

Read this excellent article below, and don't forget those that truly make you stand tall!

Bone Basics: What You Should Know About Your Skeleton | The Daily Muse:

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Sciatica & Massage

If you have sciatica, or leg pain, consider massage therapy. It's such a natural, relaxing way to find relief!

Remember, though, that sciatica is a symptom of something else, and not a medical condition itself. It simply refers to leg pain, numbness or tingling caused by compression or injury to the sciatic nerve, the largest nerve(s) in our bodies. (We have one on each side; they start at the end of our spinal column and run through our hips and down our legs.)

Compression of the sciatic nerve is sometimes due to tense musculature. Hmmm ... what could help relieve tense muscles, I wonder?

Read this good blog post. Sarah Minen, LMT describes it quite well and has a clear illustration: Sciatica Massage Salt Lake City, Utah | Sarah Minen LMT - Salt Lake City Utah Massage Therapy.

For more information on sciatica itself, click here.

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Pathology and Massage: Anterior Shin Splints

What are shin splints?

Shin splints is a blanket term for a number of lower leg problems. It causes pain and sometimes swelling on the lower leg. Shin splints is an inflammation of the periosteum (the membrane that lines the outer surface of all bones) and the attached muscle fibers. The muscles attached to the tibia are tearing loose. Generally, when someone gets shin splits, it is due to excessive or repeated pounding, or “impact loading”, on hard surfaces during athletic activities, such as running or tennis. The condition worsens with the actions the affected muscles do. Other technical terms a doctor might use when diagnosing shin splints are idiopathic compartment syndrome, acute and chronic exertional compartment syndrome, periostitis, traction periostitis, tibial fractures, and medial tibial stress syndrome. These different titles account for location of pain and severity of the condition. Most commonly, shin splints are medial or lateral. Lateral shin splints are also called anterior shin splints, because the anterior muscle compartment is lateral to the tibia.

Which muscles or other structures are involved?

Principally, the tibialis anterior muscle and the tibia are involved in anterior shin splints. Tibialis anterior originates along the lateral  surface of the tibia. Tibialis anterior is responsible for dorsiflexion (flexing your foot toward your leg) of the ankle and sustains tears along the tibia when overused or constantly impacted. It’s possible the interosseous membrane could also be involved as tibialis anterior also originates there.

How are shin splints assessed?

Chances are, if a client had shin splints, I would know. For instance, if they stood up and grimaced and then proceeded to gingerly walk across the room. They may even limp or hobble a bit. Walking would be uncomfortable for anyone with shin splints. If you superficially massaged the anterior leg muscles, it would probably feel tender, but good; a deeper massage would most likely be uncomfortable or painful. Lesser muscle injuries would not be visible on the leg, nor would they be palpable, but more severe injuries would exhibit red, hot puffiness around the tibia. Pain along the tibia is an indication, and may be superficial or deep, mild or severe. The location of the pain would indicate the injured muscles. Someone with anterior shin splints may describe the pain as an ache that runs the length of the lateral tibia.

How are shin splints treated?

Shin splints require first and foremost, rest. Ice, stretching, strengthening and massage are also indicated.  Massage is only contraindicated if the condition is advanced: that is, if the leg looks and feels hot and swollen, or is extremely painful. Once the inflammation and pain begin to subside, massage is beneficial. If the condition does not improve within a couple of days, it could be a sign of a more serious condition and requires medical attention. Massage is an excellent treatment as it increases circulation and releases adhesions. Massage can also prevent shin splints from advancing into more serious complications, such as exertional compartment syndrome. Proper stretching is a necessary preventative measure. Plantarflexion (pointing the foot down) and eversion (pointing the foot in toward the mid-line of the body) will stretch the tibialis anterior muscle. Stretching the lower leg muscles can be difficult through exercise alone, but massage can work every inch. Regardless of where the injury is, all the lower leg muscles should be stretched and massaged. The feet should be worked as well, as the lower leg muscles insert into points throughout them. Myofascial Release is a desirable modality for shin splints, as it can release the fascia binding all four muscle compartments. Plus, as it works superficially, it would most likely be more comfortable than Deep Tissue techniques.


These pictures are from Trail Guide to the Body, Second Edition, by Andrew Biel, illustrated by Robin Dorn (both massage therapists) and published by Books of Discovery.

Anatomy Lesson: The Carpal Tunnel

Too many times in a week, or even a day, I hear clients, friends and people in general complaining that they think they have "carpal tunnel". Most people don't realize that the carpal tunnel is an anatomical part of the body. Sometimes I point out that, actually, everyone has two carpal tunnels, and it's compression or inflammation of the median nerve that runs through the carpal tunnel that is referred to as carpal tunnel syndrome.

The carpal tunnel lies at the radiocarparl (wrist) joint. The bones that articulate to make the wrist joint are the radius in the forearm and the proximal carpal bones at the heel of the hand. The radiocarpal joint is an ellipsoid joint. An ellipsoid joint is when an oval-shaped end of one bone articulates with the elliptical basin of another bone. This type of joint allows for flexion, extension, abduction (movement away from the center line of the body) and adduction (movement toward the center line of the body). In your wrist, the carpal tunnel lies on the palmar side.

You have eight carpal bones in the heel of your hand (this is your anatomical wrist). These form the "floor" of the carpal tunnel by creating an arch. You can feel the concave groove of this arch on the palmar side of your hand, at its heel. It's called the sulcus carpi.

Of the eight carpal bones, there are four that are very important to the carpal tunnel: the scaphoid, the trapezium, the pisiform and the hamate. These carpals are the attachment sites for the flexor retinaculum, a band of connective tissue that forms the roof of the carpal tunnel. As illustrated here, the tubercles and other bony landmarks of these four carpals are the exact attachment sites for this "roof".

These attachment sites are easily felt in the heel of your hand as bony protrusions (illustrated further below) and "anchor" the flexor retinaculum, creating, in effect, pillars on each side of your carpal tunnel.

So, to review, your carpal tunnel is a floor of carpal bones, bony landmarks on the sides holding up the connective tissue that forms the roof. Kind of like a tent.

In your forearm, you have two main muscle groups: the extensors and the flexors. The tendons of these flexor muscles (not the muscles themselves) pass through the carpal tunnel:

• flexor digitorum profundus (four tendons)
• flexor digitorum superficialis (four tendons)
• flexor pollicis longus (one tendon)
• flexor carpi radialis (one tendon), considered part of the carpal tunnel, although it is more precise to state that it travels in the flexor retinaculum, which covers the carpal tunnel, rather than running in the tunnel itself.

The median never is the only nerve to pass through the carpal tunnel, between tendons of flexor digitorum profundus and flexor digitorum superficialis.

The carpal tunnel is narrow and when any of the long flexor tendons passing through it swells or degenerates, the narrowing of the canal often results in the median nerve getting entrapped or compressed, and that is carpal tunnel syndrome.

Now you can school all your friends in the anatomy of the carpal tunnel when they claim to "have" it.

These pictures are from Trail Guide to the Body, Second Edition, by Andrew Biel, illustrated by Robin Dorn (both massage therapists) and published by Books of Discovery.

Reflexology: More than just a foot massage

I am often asked, "What is reflexology?" and that is sometimes followed up with, "Is it just a foot massage?"

The Reflexology Association of Canada defines reflexology as: A natural healing art based on the principle that there are reflexes in the feet, hands and ears and their referral areas within zone related areas, which correspond to every part, gland and organ of the body. Through application of pressure on these reflexes without the use of tools, crèmes or lotions, the feet being the primary area of application, reflexology relieves tension, improves circulation and helps promote the natural function of the related areas of the body. (From "Standards of Practice, Code of Ethics & Code of Conduct." Click to view the document.)

Reflexology seems to be a mystery to most people. My answer to their questions is that reflexology is the belief that the feet (and for some practitioners the hands and ears) mirror the body and that by working the feet, you are, in effect, working the entire body. Reflexologists believe every part of the body from the organs and glands to the spine to the sinuses has a reflex point on the feet and that you can effect these by applying deep pressure to those points. I always say that reflexology is a great modality for anyone who wants to try bodywork but is uncomfortable receiving massage as reflexology is done fully clothed with only your feet exposed and touched.

A brief history
Many civilizations worked on the feet to promote health. It is widely believed that reflexology originated in China about 5000 years ago, but there is evidence that it was also practiced in some form by Egyptians, Russians, Japanese, and Indians. The Cherokee nation of North America practices a form to this day that is passed down to each new generation.

The precursor of modern reflexology was introduced to the United States in 1913 by William H. Fitzgerald, M.D. (1872–1942), an ear, nose, and throat specialist, and his colleague, Dr. Edwin Bowers. Fitzgerald argued that parts of the body correspond to others and that applying pressure in one area had an anesthetic effect on other areas and called it "zone therapy". Bowers would demonstrate this theory by first applying pressure to the point in a person's hand that corresponded with a specific area of the face. Then, he would stick a pin into the same area of that person's actual face without that person feeling any pain.

Reflexology was further developed in the 1930s and 1940s by Eunice D. Ingham (1889–1974), a nurse and physical therapist who used zone therapy on her patients. She concluded that since zones ran throughout the body and could be accessed anywhere, some areas might be more effective than others. Ingham believed that the feet and hands were especially sensitive, and mapped the entire body into "reflexes" on the feet. It was at this time that "zone therapy" was renamed reflexology.

A mirror of the body
Below is a foot reflexology map from the book Feet First: A Guide to Foot Reflexology by Laura Norman. I like Norman's book because the language is simple. Anyone can pick it up and grasp the concept of reflexology and how to give a reflexology treatment, not just bodyworkers or those with a deeper knowledge of anatomy. I also think her maps are clearer than others and more logically laid out, making them easier to remember and follow. (I've found that not all reflexology maps are the same. Some chart the points in very different places. More on that to follow.)

 

See how all of the organs are arranged just as they are in your body? The brain is on the top of the toes, just like it's at the top or your head. The heart is in between the lungs and more left than right. The liver is on the right, the stomach on the left and they are below the diaphragm and above the intestines. There is one kidney on each side, etc. Click here for an interactive map.

The reflex points aren't just on the plantar surface, either. There are points on both medial (inner) and lateral (outer) arches, around the ankles and on the dorsal (top) surface. For example, the medial arch is considered "the spine" of the foot because its curvature mimics that of the spine.

  

Unlike massage, reflexology is not a manipulation of the soft tissue. Rather, the thumbs and fingers are use to apply static pressure. The practitioner may manipulate the foot to flex, rotate, or pivot it onto the thumb or a finger for deeper pressure. When the practitioner finds an area that is tender, they might work that reflex more by taking their thumb and applying pressure all around that area, and from several different directions and angles to be as accurate and effective as possible. It usually takes several sessions for recipients to notice any difference in how they feel if they have a chronic condition. Relaxation and serenity, though, can be achieved immediately.

Also, tender areas do not always mean that something is wrong in the body. Just because someone has a tender heart reflex does not mean they have a heart defect. A tender area could be a foot problem, too, such as a bunion, bruise or scar tissue. Only doctors can diagnose. Reflexologists should only ever tell their clients what they are feeling in their feet, and it is up to the client to seek further attention from a physician. In Norman's book, I think she does a good job of explaining what reflexology is and isn't:

In plain language, it is not a foot massage and it not a medical treatment. First and foremost, reflexologists do no diagnose illness, nor do they practice medicine ... Neither does a reflexologist treat specific diseases. Even though most of my clients tell me what their problems are ... we never proceed as if a reflexology session is going to cure these problems. We spend extra time working the reflex area on the foot that corresponds to the body part that is troubled, but our work cannot be classified as medical treat as such ... reflexology works with subtle energy flows, revitalizing the body so that the natural internal healing mechanisms of the body can do their own work. As a matter of fact, people do attest to better health, even sometimes a marked reduction or even disappearance of the ailment. But it was not the reflexologist nor the session that cured. Only the body cures ... When practiced in conjunction with sound medical advice form your physician, reflexology facilitates healing.

She also encourages her clients to inform their physicians that they are receiving reflexology treatments because a relaxed body functions better. She mentions that she has had diabetic clients who, in consultations with their doctors, where able to reduce their insulin.

So, does it really work?
Reflexology, like any complimentary or alternative practice (CAM), has its detractors. Most doctors think it's New Age Quackary. They don't think any substantial evidence exists that proves efficacy. And, to be honest, it's hard to say, "Oh yes, this works" when different reflexologists or reflexology associations practice different methods and follow different foot or hand maps. Also, reflexology isn't regulated by a governing body. For massage therapy, almost every state has a different board that licenses, registers, or certifies practitioners. I am licensed by the state of Maryland. I cannot practice massage for pay without it. However, if I wanted to practice reflexology and only reflexology, I don't need any such credential.

But, a recent study at the Florence Nightingale School of Nursing and Midwifery, in London, England, set out to determine the effectiveness of reflexology in treating idiopathic constipation in 19 women. The result was 94% believing that their constipation was improved. Regis Philbin tells how Laura Norman saved him from having surgery to remove a kidney stone and helped him relieve a goiter.

And there are boards that provide certification, such as the American Reflexology Certification Board. The ARCB serves to educate the public and provide professional and ethical standards for practitioners. A reflexologist who is certified by the ARCB took an exam to prove their knowledge of the theory and practice of reflexology, lending credibility to what they do.

My answer to the question is that different things works for different people. I believe in massage and chiropractic because they have worked for me personally, but I don't think ear candling works. And I don't think traditional Western medicine always works, either. Medications are constantly discontinued because in the end they do more harm than good. Surgeons have a reputation of always ever recommending surgery, because that's what they do. I think that massage therapists, reflexologists, internists, surgeons, chiropractors and other health related professionals are the same as all other professional fields: some are great at what they do, and some just aren't. If you go to someone who isn't in it because they love it, then your experience will be negative.

If you really want to know if an alternative therapy works, you should try it. Maybe it will. Maybe it won't. They key is to go at it with an impartial mind. If you really, really, really want that reflexology session you are about to receive to clear your sinuses forever, you will convince yourself that it does. If you really, absolutely, no-doubt-about-it believe that the tincture your herbalist made up for you isn't going to do you a lick of good, then it will seem to you that it doesn't. And the same applies to traditional medicine: If you don't think you're going to feel better if you take this or that drug, you probably won't.

The human body is a mystery, and every one responds differently to the outside environment or stimulus. The only way to know what your body likes is through experience. So don't be shy. Put those feet forward and say, "Okay, I'm game!" If anything, your feet will feel great and you'll have a serene, blissful nap.

Anatomy Lesson: The Hip Joint

Recently, I interviewed at the Baltimore School of Massage for an instructor or teaching assistant position. As part of the interview process, I had to give a 20 minute mock lecture on a subject of my choice to some of the current staff. I chose Anatomy, because I aced it when I was student myself and am often giving short little "lessons" to clients. I was asked to lecture on the hip joint. I can tell you this: twenty minutes allows for only a nutshell explanation of the hip joint. So, here is the hip joint in a nutshell! (Click on the images to enlarge.)

The hip joint is made up of the pelvis and thigh. The pelvis is made of two coxal bones*, or hip bones. These are each divided further into the ischium, the ilium and the pubis. These three bones are fused. Each coxal bone articulates (joins with, meets) with a femur, or thigh bone. This articulation is known as the femoralcoxal joint**, or hip joint. So one coxal bone and one femur equals one hip joint.


There are two important bony landmarks in the hip joint, one on the coxal bone and one on the femur. On the coxal bone you have the acetabulum***, a bowl-shaped indentation where the ilium, ischium and pubis meet. On the femur, you have the head of the femur, shaped like a ball, which articulates with the acetabulum by nestling into its bowl. This type of joint is known as a ball-and-socket.

Ball-and-socket joints allow for several types of movement: flexion and extension, rotation (around an axis), circumduction (circular, all around) and abduction and adduction. Abduction is movement away from the midline of the body; think abd-, as in abdicating from the body. Adduction is movement toward the midline of the body; think add, as in "adding" something to the body.

The major muscles of the hip cross the hip joint and act as pulleys to the bones' levers to achieve all this motion. The pelvis is fixed while the femur moves. The head of the femur pivots around in the acetabulum.

Four quadriceps are located on the anterior (front) and lateral (outside) femur. The quads flex the hip, bringing the thigh to the torso.**** Three hamstrings muscles are on the posterior (back) thigh, and work to extend the hip, bringing the thigh out of flexion or hyperextending the thigh behind the body.

Three gluteal muscles shape the buttock. The gluteus maximus forcefully extends the hip and laterally rotates the thigh. Lateral rotation is when you turn the anterior thigh bone to the outside. Your foot will turn to the outside, too. Gluteus medius and gluteus minimus abduct the hip, moving the femur away from the body. They also medially rotate the hip, turning the anterior thigh bone to the inside (turning the foot to the inside, too).

Five adductors work to do just that: adduct the thigh, or bring it toward the body. These muscles sit in between the quads and hamstrings on the medial (inside) femur. Then there are six small, deep muscles beneath the gluteals called the lateral rotators. Can you guess what they do? The work with gluteus maximus to laterally rotate the thigh.

Flex, abduct, extend and adduct the femur and the result is circumduction, or a circular motion, like making circles with your arms in gym class.


So, the next time you are walking up the stairs, you'll know that you are alternately flexing and extending the hip joint, engaging your quads, hamstrings and gluteus maximus. Notice how the quads and hamstrings are directly opposite each other on the femur, and how they perform opposing actions. It's the same for gluteus medius and minimus, which abduct the thigh, and sit laterally on the hip. The adductors of the thigh sit medially. Opposite sides, opposite actions.

Enjoy your new understanding of the articulation of the coxal bone and femur!

These pictures are from Trail Guide to the Body, Second Edition, by Andrew Biel, illustrated by Robin Dorn (both massage therapists) and published by Books of Discovery.

*Two coxal bones make the pelvic girdle, and when you add the sacrum and the coccyx, you have the pelvic bowl. Pelvis is Latin for "basin".

**It is also referred to as the acetabularfemoral joint (acetabulum and femur), or the ilialfemoral joint (ilium and femur), or simply the coxal joint. Either way, the name tells you the location.

***Acetabulum (as-e-tab-u-lum) is Latin for "little vinegar saucer". The Romans would use vinegar daily and would keep it in large wooden saucers or bowls. These bowls would develop cracks, like spider veins. Scientists of the time refered to this bony landmark as a "little vinegar saucer" because of its bowl shape and how the articulation of the ilium, ischium and pubis looked like cracks.

****The quadratus femoris or "quads" muscle is so large that is actually made up of four different heads, each with its own name: rectus femoris ("upright" or "straight" and "femur"), vastus lateralis, vastus medialis, and vastus intermedius (vast = large, lateral = outside, medial = inside). And truly, only rectus femoris flexes the hip joint, as it's the 0nly head to cross it. The primary action of the quads is to extend the knee.