A swim through the Lats - UpNorthExplorer.com: Columnists

A swim through the Lats - UpNorthExplorer.com: Columnists

Case Report: Can Myofascial Release increase Cervical Flexion

The subject of my most recent case report is: Can myofascial release increase cervical forward flexion?
This client was in an accident several years ago. She suffered a head injury and still has headaches (mostly on the top of her head) and difficulty flexing her chin toward her chest.

Goniometers are tools used to measure range-of-motion.

The plan is for the subject to rate her pain on a scale of 1-10. I will then measure the ROM pre-treatment, apply myofascial release to the appropriate muscles, then re-measure to see if any change has been made.

All measurments and procedures used, and for what duration will be recorded in the first and subsequent sessions. The client will refrain from other treatments such as PT and chiropractic during this time. The duration for this study will be 1 30-minute session, 1x/week for 4 weeks.

Photo courtesy of ABMP

When your Child has Pain: Massage for Children

A lot of people lately have been asking “Gina, do you work on children?” I do. I enjoy providing massage for children, pediatric massage as some refer to it. I’ve worked with many, many children over the years; providing massage to aid the recovery from sports injuries or cope with the pain from other conditions. Most children enjoy massage, and really like the deeper pressure work. I thought I would share a few examples here of how children I've worked with have benefitted from therapeutic massage.

·         A football player who after repeated collisions developed whiplash-like symptoms: headaches and restricted motion in his neck

·         A competitive dancer with leg, foot and low back pain

·         A young man with cerebral palsy. Walking into the office his arms and hands were clenched tight, knees knocked inward. After sessions, he was visibly more relaxed with a more normal gait.

·         A young woman with scoliosis, a curvature of her spine, and another teen with rheumatoid arthritis both expressed significant relief after treatments.

·         A soccer player who had pain and sought to be faster, more confident and perhaps more attractive to colleges

·         A collegiate swimmer with shoulder pain. He was referred by his coach who wanted him to stay in his game.

·         And the yoga instructor’s daughter who wanted a massage as her reward after getting a great report card. While it’s not pain relief, how could I say no to that?

These are just a few examples of the kinds of conditions I’ve worked with. Do any sound familiar to you? If your children complain about pain, consider giving them a therapeutic massage treatment from a licensed massage therapist.

Low Back Pain.: A look at Structural Shifts in the Pelvis

So many patients in my center in Washburn, WI seek massage for relief from low back pain. Pain that isn't getting better with the standard treatments. Many are surprised to find out that where it hurts may not be why it hurts. I wrote this post for those of you who have back pain that isn't getting better, or have back pain that keeps coming back. This is for people who want results! .And maybe for peopl;e who want to know why this kind of massage is pain relief that works on the source of pain, not just the symptoms.This is part I and it deals with a structural shift called anterior inclination (or rotation) of the pelvis. There are other distortions that we will look at such as unilateral flexion, torsion, and pelvic shear, but they are posts for another day.

Lets take a look at one of the most common structural shifts that causes back pain: anterior inclination of the pelvis. This shifting, commonly an anterior rotation or flexion of the pelvis, can wreak havok on the muscles of the back that are trying to checkrein the flexing of the spine.   

As you can see in this illustration, when the hip flexors tighten (I call this tight short, or adaptively shortened), pulling the anterior superior iliac spine or ASIS (the ledge or bump that you can see on the front of your hip bones) downward it can cause a postural distortion that influences pain, disc degeneration, and wear and tear on the soft-tissue in the low back.

What do the muscles in your core have to do with back pain? Looking at the psoas major muscle below, observe its attachment to each vertebrae on the front of the lumbar spine, see it merge with the iliacus, and attach again on the femur, the largest and strongest bone in the body. If you think of  muscle as a rope that connects Point A to Point B, then tie a knot in the rope, it will make the rope shorter. Now you understand what we mean by a shortened muscle. If the shortened muscle is the psoas, which connects your deep abdomen (core?) to your thigh bone, it can create a postural distortion that causes a lot of back pain. 

In addition to the psoas, the rectus femoris and sartorius muscles may also be strong contributors to your postural distortion. These muscles attach on the hip bone and below the knee, making them hip flexor as well. 

Below, the pictures show what happens to the front of your body as well as the back when the hip flexors get too tight, or "adaptively shortened" as I like to say. Anterior inclination of the pelvis from shortened hip flexors can cause an increased lordotic curve, or lumbar curve, thereby tightening the back muscles. 

Anterior inclination of the pelvis from shortened hip flexors can cause an increased lordotic curve, or lumbar curve, thereby tightening the back muscles.

You can see in the picture of increased lumbar curve that there isn't a lot of space for the muscles, nerves and fascia to all communicate and move freely.

In these pictures, the hip flexors and their assistants are tight short. Trigger points in these muscles can refer pain to these areas of the low back as well. 

What are trigger points? They are areas of constricted tissue that can refer pain to the same location or further away from the source.
These charts show common trigger point referal patterns in the psoas and low back.

 The red areas show where the trigger points refer the pain. Trigger points in the psoas or quadratus lumborum may be one reason that when the back pain is treated directly it never seems to go away.

If you are seeking results-oriented massage for back pain and make sure your massage therapist performs a solid postural assessment and can perform results-oriented work to:
1.restore the right muscles to a more normal resting length,

2.release the trigger points, and

3.get your body back into neutral balance alignment.

Thanks for reading and good luck on your journey back to a pain-free lifestyle!

Endurance Running: A Look at Anatomy, Foot Pain and the Plantar Fascia

Most of the the runners and running groups in my neck of the woods are training for the Whistlestop full or half marathon in Ashland, WI. As a massage therapist who specializes in pain relief and improved range of motion, many of my patients and friends who run ask what I would recommend for the treatment of foot pain, heel pain and plantar fasciitis. Left untreated or caught too late, many have had to dial back on their training because of unchecked pain and inflammation. I wanted to use this post to talk about the anatomy of the lower leg, and share some techniques that people can use.

One of the most common complaints I hear of in runners is pain on the bottom of the foot, near the heel, or plantar fasciitis. People are often surprised to hear that the problem isn't always where its felt. I mean, yes, the fascia is tearing off the heel bone, but it is usually started with a problem further up the kinetic chain. In fact, by working directly on the plantar fascia, the problem seldom goes away. While I do work on the foot, so much of the heel pain is improved by a serious calf treatment. I try to lengthen the gastrocnemeus and other calf muscles with very specific and precise manual muscle manipulation.

In the illustration, you can see that the more superficial calf muscles merge into the achilles tendon which in turn attaches to the calcaneus, or heel bone. (The deeper calf muscles also attach to the calcaneus after wrapping around the medial ankle.) You can almost see the big strong gastrocnemeus and soleus,  the deeper muscles, and the surrounding fascia, getting too tight and pulling up on the heel. What if over time, the soft-tissue of the calf became adaptively shortened or "gummed-up" and ended up in a tug-of-war match with the plantar aponeurosa  at the front of the calcaneus? The action of the calf muscles is to pull the heel up, but the action of the plantar fascia is to stabilize the arch. The next image shows the bottom of the foot and its muscles. You can see where the plantar fascia attaaches on the sole of the foot at the heel. If it was involved in a tug-of-war  with the calves, which muscle would win? Where is the most likely place for strain to occur? No wonder it can feel like its ripping apart off the heel!

Quite often, by restoring the posterior compartment (calves) of the leg to a more normal resting length, the strain is taken off the bottom of the foot. If you are seeking medical massage for treatment of heel pain, be sure to also have your therapist check your pelvic angle as a tight rectus femoris (one of the quadriceps) or other hip flexors may also contribute to this problem recurring (but that's another can of worms for another day). Right now, here are a couple of videos that you, both runners and other massage therapists, might enjoy watching. This first video is Douglas Nelson treating a patient who has plantar fasciitis. Doug is the founder of PNMT, the method that I use most often to treat painful conditions.
 http://www.youtube.com/watch?v=QDRMVGH33pQ

I also like Erik Dalton's anatomical description of the foot and plantar fascia in this one:
http://www.youtube.com/watch?v=8bh5I50q5ck

If you are involved with a running group in Ashland, Washburn, or Bayfield, WI, I teach a workshop covering anatomy of the foot and leg, as well as sports massage techniques you can do with a partner to help keep the calf muscles loose.

Run strong!
Gina

Different Strokes

As a massage therapist working in Washburn, WI, I have to say how wonderful it is to be surrounded by amazing colleagues. If you have ever been to the Chequamegon Bay or the Apostle Islands region of Lake Superior, you probably noticed the dense concentration of artists, musicians, and...massage therapists.

If you are looking for a damn good massage or bodywork session after your adventure at sea or on the trails, you’ve come to the right place. I’ve seen all kinds of massage from Accupressure to Zen Shiatsu offered between Ashland, Washburn and Bayfield, WI. They all have some similarities, but they are different, too. The method I use most is called Precision Neuromuscular Therapy, or PNMT.

That reminds me of something that happened to me a few weeks ago. I was giving massages to cyclists after the Superior Vistas Bike Tour.

Gina McCafferty giving a chair massage to a cyclist at Superior Vistas Bike Tour in Washburn, WI

A female cyclist approached me and told me about the neck pain, headaches and vertigo she had been experiencing as well as occasional pain and tingling down her arm. I noticed that she, like so many other cyclists, had some head forward position happening. She sat down and I immediately started to work on her sternocleidomastoid muscle, the SCM for short. For those of you who are curious about anatomy, that's a muscle that runs from the mastoid bone behind the ear diagonally to the clavicle and sternum. Clinicians sometimes use the angle of the SCM to determine head forward position. The shorter the angle of the SCM, the more forward the head position.

As I continued to work on her SCM, she suddenly exclaimed “That’s it!” “That causes the headache!” I had to clarify so I asked “When I compress this muscle in your neck, you feel the pain in your head?” “YES.” I told her that we were working with a common trigger point in the SCM that is capable of producing a headache. I continued to work on it until the “headache” dissipated.

Trigger points in the SCM can cause tension headaches and dizziness.

Then I worked on some other muscles in the front of her neck. I worked on her anterior and middle scalenes (after checking for arterial contraindications) and found a spot that seemed to refer the nerve-y tingling down her arm. Once that had been relieved, I finished up with a little myofascial streching over her platysma, another anterior neck muscle. Her platysma didn’t hurt. It was an effort to help restore her neck muscles and posture to a more normal resting length.

When her time was up, she told me that what I did was remarkable. In just 15 minutes, I found out what was causing her pain, thoroughly treated  it, and still had time to address her posture, her head forward position. She went on to say that she does get regular massage from a very good practitioner back home. She always leaves his office feeling wonderful, but said he has never touched the front of her neck. “Well”, I said, “the anterior musculature of the neck is often overlooked in traditional massage therapy because it’s not very relaxing.”  I also told her that he’s doing a great job of keeping her healthy and his gift is probably that he can really reduce stress. He's probably an expert in relaxation and stress management. Everyone needs that and more people should seek it for themselves.  She leaves (both of us) feeling wonderful and if her neck pain, headaches, vertigo, and arm tingling go away, that’s great news for her.

I guess my gift is pain relief.  I like to be challenged, solve the postural puzzles, and improve the quality of life for people with pain. Everything I do during a massage has to do with improving the condition of my patient. Everything. There’s really nothing “relaxing” about it. Sometimes it hurts.

I think its important for we massage therapists to remember that we all offer something different and unique to our clients. We’re offering a part of ourselves and different people will need our different types of touch at different times. 

Pain Relief for racers at Bayfield Race Week!

My colleague, BeckySue, and I are providing massage for the racers during Bayfield Race Week 2012 in Bayfield, WI. As a pain relief specialist I want to know how I can best help them. To answer my own questions, I thought about what kinds of pain people who sail might have. I thought more and I tried to mimic some of the repetitive actions used in sailing to get more ideas. I researched pain associated with sailing. I even interviewed someone from the Wayzata Yacht Club.

What I found out was that most people have pain between their shoulder and their neck. Many have forearm pain in an area that we massage therapists call the "wad of three," (For more information about forearm pain, please read my blog post entitled Tour De Cycling Anatomy). Still others have low back pain and knee pain.
There is a famous quote by Ida Rolf, a founder of the structural integration types of bodywork. It goes: "Where you think it is, it ain't." I want to relieve pain by correcting postural malalignment, breaking up adhesions, restoring muscles to a more normal resting length and freeing nerves that may be entraped by soft-tissue.

When Bayfield Race Week racers come to me for their massage, I will provide a brief but solid assessment: Is one shoulder higher or lower? More anterior? Do they stand with a forward bend?When they stand, do I see the back of the hands? These types of observations give me clues about the kind of pain they may be experiencing.  For example, if I see a high shoulder on the right, I can lengthen the muscles that elevate the shoulder. On the low side, I can restore the shoulder depressors to a more normal resting length. Similarily if I see a lot of the back of their hands, I know that the "medial rotators of the humerus" will need some TLC. If they bend forward when standing, I can lengthen the muscles that flex the hips, thereby taking some strain off the muscles that are stuck check reining the spinal flexion.

So... you might be wondering what does all of this mean to the Bayfield Race Week racers, in English?  It means that I use Precision Neuromuscular Therapy techniques to address structural shifts, restore muscles to a more normal resting length, relieve trigger points that can refer pain, and free nerve entrapments. People LOVE the way they feel when they are closer to neutral balance alignment and the work feels GREATwhile it is being performed!

Thanks for reading and have a remarkable, pain-free Bayfield Race Week!

Gina McCafferty, LMT
Pain Relief Specialist