Archive

Case Study: “Harold” - Part One

Published on April 6, 2008 in Case Study. 0 Comments

Client is an 81-year old man who woke up in the middle of the night with chest pains. After the doctors determined that he was not having a cardiac episode, they prescribed a bunch of pain meds and muscle relaxants. The meds gave him bad constipation and he lost his appetite and 20 pounds, which on him was far too much weight to lose, so he was keen on finding a non-medical solution to his pain.

He experienced pain and/or limited range of motion in shoulder flexion, abduction, lateral rotation, protraction and retraction. Was unable to upwardly rotate shoulder. Extension, adduction, medial rotation, retraction were within normal limits. After assessing his range of motion, we began the session.

Working on the elderly requires a very deft and gentle touch. Their skin is very fragile and easily torn, and it is important to work to create a comfortable group of positions for them to recline, as their joints are often painful and makes difficult prone or supine positions for very long.

This particular man required trigger point work in his subscapularis and serratus anterior muscles, which have insertions on the anterior surface of his scapula, which means going in through his axilla to access the muscles. Also, his infraspinatus, supraspinatus, levator scapula were all very tight and required work as well. Using very slow, gentle pressure, I was able to get the subscapularus trigger points released, as well as relaxing the posterior rotator cuff muscles and levator scapula.

Recommended a weekly appointment for the next four weeks to continue making progress.

Massage-A-Thon

Published on February 13, 2008 in AIDS/LifeCycle and Massage. 0 Comments

From today until the May 31st, I will be donating $10 for each massage I do! That’s right, you can come and get on my table AND make a donation to my AIDS/LifeCycle fund raising efforts.

So, why not Book Now!  Want to just make a direct donation?  Click here for my ALC Page.

Line of Force, Hierarchy of Power

Published on February 3, 2008 in Body Mechanics, Massage and Science. 0 Comments

One of the rules of body mechanics for massage therapists is Line of Force. This rule stipulates that all of the transfer of movement from the body of the massage therapist to the client is done with the therapist’s body in a single line of force. This is done by aiming the hips in the direction of the movement, as well as shoulders, elbows, wrists, hands, and fingers. Stacking the joints, as it were.

Continue reading ‘Line of Force, Hierarchy of Power’

Balancing Hips, Abdominals, Glutes and Back

Published on January 13, 2008 in Anatomy, Massage and Relationships of Muscles. 1 Comment

A client and I sat down to talk about some test results he recently received and how that would impact our work moving forward. I am concerned about doing certain kinds of spinal movement on him, and changed my strategy of today’s session as a result. One of my favorite things to do to a client is a Thai Cobra.As seen in this photo from www.teamsugar.com, the therapist kneels on the client’s hamstrings and glutes and extends the spine and shoulders. Well, I do an entire series of moves while I knee upon the client’s body like this and culminate in the cobra move. With this client, this sort of spinal extension is contraindicated for the time being.

I did some psoas release work on this client to help balance out the interplay between erector spinae and iliopsoas. I am going to have to do some work on the muscles that do ankle plantar flexion, as well as glutei minimi and more abdominal work, although I did do a decent amount of abdominal work on this client today before I did the psoas release.

The psoas and abdominal muscles are sometimes antagonists and sometimes synergists, and it’s important to keep them in balance. Having a six-pack can actually be unhealthy for a person. It’s not uncommon for people with really tight abdominal muscles and psoas muscles to be chronically constipated, as tight psoas muscles can impinge upon the lumbar plexus, which controls the intestines. As well, overtight abdominals can restrict breathing, as the ribcage is pulled down and forward, and also can cause the body to waste energy by engaging the erector spinae in having to work harder to keep the body upright to counterbalance the abdominals’ flexion motion of the spine.

As the iliopsoas muscles are rotators of the femur, the glutei minimi can also be very tight, as they are antagonists in rotation as well as synergists in hip flexion. So it’s important to get them to relax as well when doing a release of the psoas muscles.

With good attention to detail, balance can be brought to this important system, and a dramatic reduction in back pain can be introduced. The flexibility of the pelvic region cannot be stressed enough in maintaining a high quality of life as we age, and psoas release techniques, combined with work on the abdominals, glutei minini, and plantar flexors will help keep us pain free.

Trigger Points and Sciatica

Published on December 12, 2007 in Health, Massage and Science. 0 Comments

Trigger points in the piriformis muscle, a deep lateral rotator muscle in the pelvis, was shown to be responsible for the vast majority of sciatic pain (sciatica), and was able to be successfully treated without back surgery, a 2005 study by the Cedars-Sinai Institute for Spinal Disorders revealed.

In the study, 239 patients were evaluated - these patients either had not improved after diagnosis or treatment for a herniated or damaged disc. 7 of the patients were found to have torn disc related conditions, such as annular tears, and were successfully treated with spine surgery.

The 232 patients who remained underwent a new kind of magnetic resonance technology called magnetic resonance neurography to evaluate the sciatic nerve. 69 percent of the patients - 162 - were found to have piriformis syndrome (where the piriformis muscle traps or irritates the sciatic nerve), and the remaining 31 percent had a number of other nerve, muscle, or joint conditions in varying locations that were not seen by a standard MRI.

Only 62 patients needed surgery to correct the piriformis syndrome - such surgery included Open MRI guided imagery, where the MRI scanner guides a deep injection of a pain medication into the muscle or nerve. This treatment corresponds with what Janet Travell and David Simons recommend in their groundbreaking book, Myofascial Pain and Dysfunction - the Trigger Point Manual. In the book, they recommend a physician inject a local anesthetic into the location of a trigger point, causing its release.

The other patients in the study received manual therapies, such as physical therapy and exercise, and had successful outcomes as well.

A massage therapist who is trained in releasing trigger points can effect the kinds of changes brought on by the Open MRI guided imagery, as well, by using ischemic compression and other techniques. The beauty of science research is that for over 70 years, medical professionals thought that sciatica was caused by damaged or herniated discs. Now we know that the vast majority of cases are muscular in origin, and that other methods of treatment are as or more effective than surgery.

Cedars-Sinai Medical Center (2005, February 2). New Way To Diagnose Sciatica May Point To A Different Cause. ScienceDaily. Retrieved December 12, 2007, from http://www.sciencedaily.com­ /releases/2005/02/050201192443.htm