Neuromuscular Therapy

This is a great, succinct piece defining Neuromuscular Therapy (a.k.a. Trigger Point Therapy), how it works, and its benefits. Definitely worth a read!

Neuromuscular Therapy | oakworksblog.massagetables.com:

'via Blog this'

Myofascial trigger points

Imagine this: you feel a deep, spreading pain at your right shoulder. It feels better after a good night's rest, but as your day progresses, the knot-like feeling creeps up on you without invitation. The pain is sometimes very intense and sometimes moderate. And you note that sometimes it travels to different areas of your body.

These annoying little knots in our muscles and connective tissues are called myofascial trigger points. The "myo" part of the word means muscle and "fascial" refers to the elastic, connective tissue that runs throughout the body.

There are two basic types of trigger points: active and latent. Latent trigger points don't cause pain except when pressed. When latent trigger points become triggered and awakened by stress or injury, they become active. Active trigger points radiate (or refer) pain from muscle or fascia in a characteristic pattern. For example, trigger points in the shoulders often send pain and tension throughout the shoulders and up into the lower neck. Likewise, trigger points in your buttocks can refer pain down the leg just as in sciatica.

Two doctors, Dr. Janet Travell and Dr.
David Simons, revolutionized our understanding of trigger points. They mapped out the entire body and standardized a pain referral pattern for each muscle. Trigger points usually follow these maps, though some people have unusual pain patterns. In either case, deep breathing, stretching, applications of heat or cold, and massage can help.

A case in point

Travell and Simons say that the shoulders are the area most affected by trigger points. The levator scapula muscle connects your shoulder blade to your neck and is responsible for elevating your shoulder blade. It is especially prone to trigger points, and can refer pain to the neck, around the shoulders and down into the mid-back. Note the picture of the shoulders to the left. If you have pain in the shaded area, you may have trigger points (indicated by the X's) in the levator scapula.

To help relax this muscle, focus on the shoulder area. Breathe deeply and begin to let go of the tension with each exhale. Then inhale, shrug your shoulders up toward your ears, squeeze, and hold them to the count of three. Release them completely on the exhale. Repeat three to five times, then relax and breathe slowly and deeply.

Glossary of Massage and Bodywork Techniques

First: I did not feel the earthquake. I was in the backyard playing with my dog when I heard a rumble and a rattle that must have been my gutters/porch/entire house. I thought it was weird, and my dog heard it too. I don't think he felt it. We just looked at each other and I shrugged. I'll bet he would have, too, if he could. Then I quickly forgot about it. Just a few minutes later I got a call from my mom, whose first words were, "Are you okay?" Um, what? She felt it in Pittsburgh. But we're all okay here at the Haddock house. I hope you are, too.

Second: Follow the link below for a great resource on different bodywork modalities, from the popular to the obscure. I haven't even heard of half of them. Enjoy exploring!

Glossary of Massage and Bodywork Techniques

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.

Least favorite massage

A client once asked me what my least favorite massage is to give. Of course, not wanting to paint massage in any kind of negative light, my immediate response was, "Oh, I love it all! It doesn't matter to me if the client wants this, that or the other thing ... I'm happy to do any modality I know how to do!"

Then I realized I had only thought about giving massage to a client on a massage table. And I truly don't have a most favorite or least favorite. But, I had forgotten about the massage chair. So after my all-massage-is-so-great-to-give attitude, a few seconds later I added, "Well, I guess, actually, chair massage is my least favorite."

The truth is, giving massage to a client in the chair is different than giving one to a client on the table. You're holding your arms up higher than you might be used to. Your leverage is different. It puts more pressure on your hands. You still use your legs to create pressure, but you have to more actively lean into someone to get deep into the soft tissue. On the other hand, when a client is on a table, you can let gravity do some of the work for you. I find I tire more easily when giving chair massage. I enjoy going to health fairs and expos and giving demo massages in the chair to potential clients, but I find I have to take frequent breaks and am usually more drained after giving 4 hours of chair massage than if I gave 5 or even 6 hours of table massage.

Chair massage is still great, though. From a business perspective, its overhead is low. All you need is the chair. For clients, it's quick and less intimidating to someone who wants bodywork but doesn't want to be undressed and under a sheet. It just tends to wipe me out as a therapist.

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.

Chiropractic Care and Massage Therapy

Last fall I wrote a short article on combining chiropractic care and massage therapy for pain relief for a health expo's guidebook. Personally, I am a believer in chiropractic. Professionally, I have seen amazing results for clients who received massage before a chiropractic adjustment. They didn't just get pain relief, they got it quickly. I have also seen clients who have plateaued in their massage treatment quickly take their pain relief to the next level when they added chiropractic care.
 
Millions of people seek chiropractic care or massage therapy to relieve or prevent pain and limited mobility. These two complementary therapies, especially in combination, form a powerful healing approach to relieve pain and increase your body’s mobility and resilience. Over time, they offer an effective way to support your ongoing vitality and well-being.

What is Chiropractic?
Chiropractic is a natural approach to health that is based on the relationship between the nervous system and the function of all the body’s glands, organs and systems.  It recognizes the fact that the human body is a self-healing, self-regulating organism that is inherently designed to be healthy.

The nervous system is the body’s master control system and it holds the key to the body’s ability to heal and express itself. Chiropractors understand that the body is continually striving to achieve a state of balance with its environment. Stressors to the body affect its ability to function optimally, causing weaknesses and imbalances. By finding and correcting these imbalances through chiropractic, the body can be restored to health. Some indicators for chiropractic care are headaches, back pain, athletic injuries, whiplash, carpal tunnel syndrome, shoulder problems, TMJ syndrome, sciatica and more.


What are the benefits of massage?
Throughout human history, massage was used for everything from stiff, painful muscles to chronic disease. In China, medical texts refer to it as early as 3000 B.C.

Today massage therapy is being used by a wide range of people as a pain reliever, antidote to stress, and enhancer of athletic performance.

Recent research has shown that massage lowers blood pressure, increases circulation, relaxes muscles and improves range of motion. What's more, it reduces the effects of stress and can ease the impulse to tighten in response to pain. Because of these results, many people are finding that massage helps them heal faster from injuries and disease.

Studies also demonstrate that the benefits of regular massage tend to accumulate, easing long-term tension, conditioning tissues to help prevent injury, and enhancing your ability to breathe more deeply and relax more fully.


Total well-being is the goal
Chiropractic and massage are compatible holistic therapies that share the goal of your total well-being, not simply an absence of illness. Both offer natural, hands-on, drug-free techniques. They can be used as preventive as well as restorative therapies. Both work to resolve the cause of your pain rather than treat isolated symptoms. Used in combination, massage and chiropractic can help you maintain optimum health by relieving pain and stress and enjoying life to the fullest.

Swedish: Massage's Foundation

In the United States, Swedish massage is by far the most popular form of bodywork. Most people are thinking of Swedish massage when they think of massage. In my opinion, this makes "Swedish massage" a redundant phrase. It is the classic and most basic of all massage modalities. In fact, in Europe, it is called "classic massage", and is hardly referred to as Swedish. As such, Swedish massage is also the foundation of most other forms of massage.

Petrissage

A Brief History

Per Henrik Ling (1776-1837) is often credited as the father of Swedish massage. This is actually false. Ling created a movement therapy, essentially calisthenics and resembling physical therapy rather than massage therapy. Ling's methods became known as the Swedish Movement System. Descriptions of the methods and movements were interpreted later by readers as being similar to the techniques of what we call Swedish massage. Those techniques were actually developed and named by Dr. John Georg Mezger (1838-1909), a Dutch physician.

Early researchers on the subject noticed similarites between descriptions of Ling's techniques and the terms used by Mezger. These terms were applied to Ling's methods. Because he practiced long before Mezger he received the credit for developing and naming the techniques. Somehow the Swedish Movement System became know as the Swedish Massage System. (It's worth noting here that Swedish massage was actually developed by a Dutchman who named his techniques in French.)

Not only did Mezger develop and name the basic techniques of  "classic" massage, he also brought massage into the scientific commnunity. It makes sense that Ling wouldn't have, since he was developing something else. So Mezger is truly the father of Swedish massage.

In the 1850s, Swedish massage was brought to the United States by New York physicians Charles and George Taylor. During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes. Massage was used up until the 1960s and 1970s by nurses to help ease patients’ pain and help them sleep.

The Techniques

There are five basic techniques to Swedish massage.

1. Effleurage: Long strokes with an open palm.
2. Petrissage: Kneading and lifting, almost like working dough.
3. Friction: Firm, deep, often circular rubbing.
4. Tapotement: Brisk tapping or other percussive movement.
5. Vibration: Rapid shaking of specific muscles.

Effleurage

The Purpose

Swedish massage is intended to increase oxygen in the blood and flush metabolic wastes, like lactic acid, from the body. This is done by applying pressure to surface muscles with the above techniques, always moving toward the heart. The result is improved circulation, reduced stress, reduced pain, increased flexibility, a relaxed state and greater overall health and wellness. Swedish massage also reduces recovery time from muscular strain and stimulates as well as soothes the nerves.

The nervous system is actually divided into a couple of different systems. One such division is sympathetic versus parasympathetic. The sympathetic nervous system is our body's "flight-or-fight" response, with decreased blood flow to non-essential systems such as digestion, increased heart rate, and increases in hormones like adrenaline and noradrenaline. The parasympathetic nervous system is the rest and rejuvenation function. It regulates blood evenly throughout the body and thus allows for proper function and healing. The sympathetic response is meant to be temporary. In today's busy way of living, however, many live in a state of sympathetic dominance, which leads to exhaustion. Swedish massage restores the body to a parasympathetic state, the way you are supposed to be. Parasympathetic dominance is a key in on-going good health.

Swedish massage can be performed as a full body protocol, or it can be applied to only specified areas of the body. Usually, Swedish massages are full-body massages, perhaps with an area of focus that gets some extra attention, such as the neck or shoulders. The amount of pressure can be as light or deep as the client prefers.

Tapotement

"Fluff and Buff"


As I mentioned at the beginning, Swedish massage is not just a type of massage, it also serves as any massage student's foundation. You learn these techniques first before learning other modalities. This is because Swedish techniques are well suited to warm and prepare the soft tissue for deeper or more involved work, such as deep tissue or sports massage. Working too deeply too quickly leads to bad things for the client. Even after massage school though, practitioners should not abandon this foundation. I've come across fellow MTs who dismiss Swedish as "relaxation massage" or "fluff and buff" and it shocks and upsets me. They don't think it's worth their time, that it's boring, that it's not "real" massage and that "everyone needs deep tissue".

Well, not everyone "needs" deep tissue. Not everyone likes deep work and should not be pressed to go past their comfort level. Also, massage is massage. All techniques are "real". Swedish or relaxing or full body work or however you want to think of it is still incredibly beneficial. And, I can bet you that those dismissive therapists are at least using the Swedish techniques of effleurage and petrissage when they begin any massage involving deeper work. And if they aren't, they are risking hurting their client. Not properly warming the soft tissue for deep work and working too fast is what leads to pain, bruising or injury to the client.

Swedish massage deserves respect by practitioners and consumers alike. Without the advent of this classic massage method in the United States, there might not be any MTs practicing any type of massage here today.

Healing Stone Therapy

I finally have stones at my massage practice! I have the smooth basalt stones for hot stone massage (what most people think of when they think "stones" and "massage" together). But, I also have marble stones for cold stone massage.


Now, if a client came to me and wanted a full body hot stone massage for relaxation, that wouldn't be out of the ordinary. But I wouldn't perform a full body cold stone massage. Rather, I combine the hot and cold stones. This is perfect for deep tissue work, for a client who really wants to release tension in the soft tissue. I alternate between the hot basalt stone and cold marble stone. The hot stones promote flexibility and suppleness, while the cold stones reduce inflammation and pain. This combination flushes the muscles, detoxifying them. It also allow the soft tissue to release tension.


For example, when a client needs deep work to their shoulder, I usually stretch and sculpt the scapula (shoulder blade), working the rhomboids (in between your scapulae) and subscapularis muscles (sub= under, scapularis=scapula). On a client who is very tight in this area, I might not be able to get under the scapula. But, if I flush the muscle by applying alternating hot and cold stones, I can take the flat disc of a cold marble stone and slip it completely under the scapula. And the client doesn't feel any pain or discomfort. They just feel relief!

Pricing is available at www.stephaniehaddock.com