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:

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What IS a trigger point?

Follow the link below for an excellent description of trigger points. If you think your pain is from a trigger point, find a massage therapist who practices trigger point therapy, like me!

Mending Hands - Melissa Finley Massage Therapy Park Slope Brooklyn 11215 Swedish Institute: What is a trigger point?:

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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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Self-care for neck pain

Seven Self-Care Tips for Clients with Neck Pain

Above is the link to the full article, and I encourage you to read it as it goes into more depth on the causes of neck pain, which makes the preventive tips below make more sense. It also includes a list of references.  

1. Stress Relief - While stress will aggravate neck pain, relaxation can ease it. Suggestions for accomplishing this feat include deep abdominal breathing, meditation, visualization and other relaxation techniques.

2. Frequent Breaks - Even though sustained positions foster muscle tightness, this practice is deeply ingrained in our culture. If driving long distances or working long hours in one position, make sure to take frequent breaks. Breaks are best used to stretch, breathe deeply, take a sip of water and return to proper posture.

3. Exercises and Stretches - While some must be prescribed by a physical therapist, a massage therapist can suggest exercises and stretches for the neck as long as they don't cause pain. Exercises and stretches help reduce pain by restoring muscle function, optimizing posture to prevent overload of muscle and increasing the strength and endurance of the neck muscles. These can include shoulder blade rolls/squeezes/shrugs, cervical extension/flexion, rotation, stretching the front wall chest muscles, strengthening the shoulder muscles and isometric exercises.

4. Hot and Cold Therapy - Most practitioners suggest alternating heat and cold to help a stiff, painful neck. Reduce inflammation by applying a cold pack for up to 20 minutes several times a day. Alternate this approach with heat, either a warm shower or a hot pack, for up to 20 minutes. Heat can help relax sore muscles, but it can aggravate inflammation if the area is red, warm and swollen.

5. Evaluate Ergonomics - Adjusting home or workplace conditions to relieve unnecessary neck stress can go a long way in preventing cervical discomfort. This includes proper positioning of a desk, chair, computer and phone so the screen is at eye level, knees are slightly lower than hips, arms rest comfortably on armrests and the neck is in a relaxed neutral position while on the phone.

6. Sleep Deliberately - Since a lot of neck pain can arise from poor positioning during sleep, deliberately planning a sleep position can prevent a painful neck. Avoid sleeping on the stomach and use a pillow that supports the natural curve of the neck. Back sleepers are advised to use a rounded pillow (neck roll) under the curve of the neck, with a flatter pillow cushioning the head. Side sleepers should keep their spine straight by using a pillow that is higher under the neck than the head. The goal is to prevent overnight neck flexion.

7. Sock and Tennis Balls - A simple homemade device can be used for self-administered cervical acupressure. Put two tennis balls in a sock and tie off the sock so the balls are stationary. Place the tennis balls under the occiput (base of the skull) so they are pressing on the hollows under the skull on either side of the spine (Gallbladder 20) for about 10 minutes. Lying on this device can help relax taut, posterior neck muscles.

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.

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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Low Back Pain: Five Tips for Massage Therapy Clients

Massage therapy has been a coveted way to relieve low back pain for as long as historical documents on the subject exist. However, a new study commands an even greater level of respect for massage's effectiveness at helping this problem. As published in a July 2011 edition of the Annals of Internal Medicine, a study funded by the U.S. National Center for Complementary and Alternative Medicine evaluated the effectiveness of massage therapy for chronic low back pain.

In this study, over 400 participants with chronic low back pain either received weekly whole-body massages for relaxation, weekly massages that focused on specific muscle problems around the lower back and hips, or usual care. Those receiving usual care typically took pain medications or muscle relaxants, saw doctors or chiropractors, received physical therapy or simply did nothing. The researchers found that both types of massage therapy were much more effective at relieving low back pain than usual care. After 10 weeks of intervention, the following was reported:

• 36 percent of patients receiving weekly whole-body relaxation massage said their pain was nearly or completely gone.

• 39 percent of patients receiving weekly massage that focused on specific muscle problems around the lower back and hips said their pain was nearly or completely gone.

• Just 4 percent of patients receiving usual care said their pain was nearly or completely gone.

Tips to Prevent Back Pain
Massage therapy's ability to relieve back pain is rarely disputed, but therapists can also help their clients prevent low back pain recurrence. The following suggestions can help prevent low back pain from returning:

1. Quit Smoking - Smoking cigarettes seems to worsen just about every known health condition, including low back pain. Likely because smoking hinders blood circulation, experts assert that smokers are 30 percent more likely to suffer from back pain than non-smokers.

2. Get Up and Move - Whether behind a wheel, in front of a computer or just watching TV, sitting for extended periods of time is one of the worst positions for the low back. The spinal discs are spongy and cushion the vertebrae, but they naturally have poor blood supply. Upon getting up and moving, fluid circulates around the discs. On the other hand, sitting starves the discs of fluid making them vulnerable to damage.

3. Stretch and Strengthen Core Muscles - Most physicians agree that regular stretching and strengthening of the core muscles constitute the most important lifestyle practices for preventing back pain. Advise clients in a safe stretch and strengthen program with a focus on back, abdominal, oblique and leg muscles.

4. Lift Properly - Those who lift heavy objects for a living are well aware of the importance of body mechanics, but the rest of us may not be. Always engage abdominal muscles during a lift, bend the knees, keep back straight, don't bend at the waist, keep object close to the body, do not hold an item higher than armpits or lower than knees, don't move something over 20 percent of your body weight, don't pivot, twist or turn while lifting, point feet at the item being lifted, and only change direction with the feet (not the waist). These instructions will help prevent back muscles from being strained.

5. Wear Back-Friendly Shoes - Supportive, low-heeled or flat shoes are crucial for preventing back injury. Although high heels may be high fashion, they increase the arch in the low back. This spinal alignment change increases one's susceptibility to low back injury.

Source:

Low Back Pain: Five Tips for Massage Therapy Clients

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.

The cumulative effects of massage

Aah...you finally got in for your massage. As you relaxed, your headache or low-back pain receded. You also may have noticed your anxieties weren’t hammering at you like they were when the massage began. 

Like many of us, you may have experienced those times when a single massage provided amazing, short-term relief from pain or stress. But as you returned to your normal activities, the chronic pain and tension came creeping back over time, contributing to headaches or flare-ups of fibromyalgia, TMJD or old injuries.

Your chronic discomforts and conditions can actually improve long term with a series of massage sessions. With regular massage, you may also notice that you don’t feel the effects of excess stress as much or that, due to increased body awareness, you use your body in ways that cause less strain. You may observe that your old pain patterns aren’t kicking in to the degree that they used to. Gradually, you may enjoy an increased sense of overall well-being and the awareness of what it feels like to be truly relaxed.