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A typical experience
I had a new client the other day for an 80 minute massage. I asked him if there is anything that he wanted me to know. He told me that he suffers from a herniated disc that he has had for a few years. He has constant low back and right hip pain that at times radiates down the back of his leg to his knee. He told me that he has had two injections in his low back and has to stay on anit- inflamtory medication. Anything to avoid surgery. The pain is always there. I asked him if he ever saw a chiropractor for his pain. He said yes. But the adjustments hurt his hip so bad that he could not continiue. So here is a guy that thinks he is on the verge of surgery. I knew that there was a very strong probubllity that was not the case. The vast majority of pain people experience is nocioceptive pain( soft tissue- muscle, tendon, ligament, facia). MDs and Chiropractors see pain as neuropathic pain( nerve pain). With that asumption they give the wrong treatments and therapies. Now there is no denying that at times injections and surgery is needed. Not denying that. But most of the time - NOT. 70% to 85% of all pain comes directly from trigger points. Anyway I showed my client a testimonial from a client that I was able to help out of a very painful condition that she had delt with for a couple of years. I showed him that testimonial because all pain has a psychological eliment too it. I wanted him to start thinking maybe he is not on the edge of surgery. I palpated his entire back upper torso, both hips, and right leg. I found a very painful spot on his right L5 erectors. Another very painful spot on his right greater trochantor. A painful spot in the middle part of his lower right hamstrings. And also a tender spot on the right spinous of L3. I knew that if Iwas able to eliminate all those painful palaptory spots that I would most likely eliminate his pain problem. Because a healthy body had no painful spots even with deep massage. Ive been hunting and eliminateing trigger points for thirty years now. He walked out of the massage room pain free. He was pain free for the first time in years. All those other professional people misdiagnosed him because they assume neuropathic pain over nocioceptive pain. I assume the other way around. I'm a Massage Therapist.
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Permalink Reply by Gordon J. Wallis on
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I stopped off at a bar after work to drink a beer and unwind a bit before going home. As I was drinking my beer I over heard the lady next to me talking about her low back pain that she has been experiencing lately. She lives out of state in California where she sees a chiropractor for the low back pain. I heard references to pinched nerves and so on during her conversation. I interrupted and told her that there was a good chance that I could greatly down grade and maybe even completely eliminate her low back pain right here in the bar. She looked at me kind of stunned when some one that happened to know me said. Yea, this guy has helped a lot of people. I asked her if I could touch her low back. And she said yes. I palpated one really bad trigger point in her right QL where it connects to the Illiac crest. The trigger point was gone in seconds. The next day she sent me this email. It's in the attachment below.
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Permalink Reply by Therese Schwartz on
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That is fantastic, Gordon!!
Gordon J. Wallis said:I stopped off at a bar after work to drink a beer and unwind a bit before going home. As I was drinking my beer I over heard the lady next to me talking about her low back pain that she has been experiencing lately. She lives out of state in California where she sees a chiropractor for the low back pain. I heard references to pinched nerves and so on during her conversation. I interrupted and told her that there was a good chance that I could greatly down grade and maybe even completely eliminate her low back pain right here in the bar. She looked at me kind of stunned when some one that happened to know me said. Yea, this guy has helped a lot of people. I asked her if I could touch her low back. And she said yes. I palpated one really bad trigger point in her right QL where it connects to the Illiac crest. The trigger point was gone in seconds. The next day she sent me this email. It's in the attachment below.
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Recently a new client came in specifically because of sciatica. She said it's getting worse and thought a massage might help. I didn't ask her if she had seen anyone else for her sciatica or if it was an official diagnosis. She has had it for two months. She discribe her pain as starting in her right low back radiating into her hip ,down the back of her leg and sometimes into her calf. Certainly sciatica like symptoms. But in the spa, I rarely see real sciatica. After 21 years of working there maybe only one person. Her pain was real, but as ususal it was fake sciatica. She had a right QL trigger point where it connects to the Illiac crest. A painful L4 sinuous. A pain point on her right PSIS. A trigger point in one of her hamstring muscles just below her pelvis on the right side. In addition she had T1 and T2 spinous pain. She left the massage room without her sciatica. It was trigger points as usual.
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Permalink Reply by Gary W Addis, LMT on
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actually, IMO any pain running from hip down leg is sciatica-- and about 99% of the time it is due to impingement of the sciatic nerve by muscles of low lumbar spine and hip. But, as this case points out, one trigger point often recruits helpers in muscles not directly involved with trigger pointed muscle. The thoracic tps, likely formed due to postural protective guarding due to the restricted muscles in low back and hips? Like you once told me, anything that affects one part of the body affects the rest of the body at least a little bit, right?
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I've always been under the impression that sciatica is from an irritated sciatica nerve usually caused by disc compression in the lumbar spine. At least that's what all the sciatica clients that I've ever worked on thought they had. . But regardless of what the exact definition of what sciatica is, it's most often trigger points, in my experience. And I don't know what the connection of the painful T1 and T2 spinous would be to her other trigger points? I've read that painful spinous on those vertebra could possibly indicate heart and or lung problems. Which is interesting. See the attachment below.
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http://www.mayoclinic.org/diseases-conditions/sciatica/basics/defin... This is what the Mayo clinic says about Sciatica
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Gordon, I really hate it when I have to disagree with you, even a little. I firmly believe that when the pain is in only one hip and leg that its cause is trigger points in one or more muscles. In my short career I have and continue to treat a lot of seniors suffering from sciatic nerve pain: the cause has ALWAYS been trigger points, in muscle, of course. Remember, the sciatic nerve doesn't become the sciatic nerve until the myriad nerve fibers that form it have left the spine and meld into the thickest nerve in the body. Those fibers originate from L4-S3. But other nerves, the pudendal for instance,also originate from the same section of the spine. Why, then, isn't there talk among MDs that the cause of this or that disorder-- pain in the anterior thigh, for instance-- isn't also caused by nerve pinch by one or more vertebrae? IMO, they've bought into chiropractic argument about sciatica, and just aren't analytically, scientifically, examining all the possible sources of that pain-- such as trigger points, which very few MDs accept as real.
Therefore, I believe the Mayo Clinic and the medical profession are 100% wrong. To me, this is the deciding point: if the pain extends down only one leg, then the only logical treatment is what you and I and other skilled LMTs do-- seek and eliminate trigger points in piriformis and other muscles that can clamp down on the sciatic nerve.
Regarding the T1-T2 trigger points relationship to the sciatica. The dysfunction in the low back, hip and leg can aod very often does cause restricted movement from coccyx to atlas. Remember, the body will do whatever it needs to do to the rest of the body in order to maintain level eyes-- problems low or problems high in the spine can create a snake effect in the entire spine.
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I'm not sure what you are disagreeing on? There is only one person that I can remember ,not counting me, that I have ever met that had nerve pain running down their leg. All the rest with similar sounding symptoms had trigger point pain. I had a ruptured disc. The disc fluid leaked out( it's very caustic), and irritated the the various nerves from various lumbar discs that ran down my right leg and into my groin. The patterns shifted some. It was horrible dibilitating pain. No position offered any relief. I could not work for six months. I had no insurance.. Which ended up a good thing otherwise I would of had surgery. I hobbled for another six months. No massage therapist could touch me. The lightest touch on my spine would send a nauseating fire like pain that would make me scream. It took 14 months for a full recovery. Now I'm fine. The leaking disc healed up and the caustic fluid dissipated or was absorbed by the body. But the pain did only run down one leg. And it was not trigger point pain. I moved by dragging my body on the ground with my arms. But reguardless , trigger points are still the most common form of pain on the planet.
Gary W Addis, LMT said:Gordon, I really hate it when I have to disagree with you, even a little. I firmly believe that when the pain is in only one hip and leg that its cause is trigger points in one or more muscles. In my short career I have and continue to treat a lot of seniors suffering from sciatic nerve pain: the cause has ALWAYS been trigger points, in muscle, of course. Remember, the sciatic nerve doesn't become the sciatic nerve until the myriad nerve fibers that form it have left the spine and meld into the thickest nerve in the body. Those fibers originate from L4-S3. But other nerves, the pudendal for instance,also originate from the same section of the spine. Why, then, isn't there talk among MDs that the cause of this or that disorder-- pain in the anterior thigh, for instance-- isn't also caused by nerve pinch by one or more vertebrae? IMO, they've bought into chiropractic argument about sciatica, and just aren't analytically, scientifically, examining all the possible sources of that pain-- such as trigger points, which very few MDs accept as real.
Therefore, I believe the Mayo Clinic and the medical profession are 100% wrong. To me, this is the deciding point: if the pain extends down only one leg, then the only logical treatment is what you and I and other skilled LMTs do-- seek and eliminate trigger points in piriformis and other muscles that can clamp down on the sciatic nerve.
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As you describe what you suffered with, it was altogether dissimilar to the pain felt by most sciatica sufferers; the only similarity is the pain down one leg-. Unlike sciatica most of us have encountered, yours also extended into the groin? The sciatic nerve originates L4-S3, but so does the pudendal nerve, which enervates the groin. So, your vertebral problem wasn't just sciatic nerve pain.
You're fully recovered, thank the gods. I hope to never encounter anyone with such severe pain, and as you said, you couldn't tolerate massage of any kind. So, even advanced trigger point therapy wouldn't have helped you. I believe that trigger point therapy would alleviate 99.9% of what Mayo Clinic and chiropractic profession falsely equate with vertebral problems.
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I don't care one iota about your opinions, Ms Texas. Flame me as you wish. Nothing you say will affect me, for I have zero respect for you as human and therapist.
However, I'll bother this one time to respond to your asinine comment. Did I need to mention that I was referring specifically to the cases massage therapists are likely to encounter???? Not to those who know me, and my expertise. But, since you have proven yourself to be an attack beast, always seeking a sentence in a comment that you can dispute in order to elevate yourself, I'll spell it out for you. Like Gordon does, like Therese does, like all highly skilled massage therapists, whenever I am unable to help a client, I refer the client to a respected member of whatever other medical profession that seems appropriate-- DCs, MDs, PTs, Osteopaths, and -- yes-- other massage therapists.
Everyone else understood my comment, why couldn't you?
Pueppi Texas, I am not going to engage in another flame war with you: you just don't matter to me, or, I suspect, anyone else who really knows your combative personality.
Pueppi Texas said:
Gary W Addis, LMT said:I firmly believe that when the pain is in only one hip and leg that its cause is trigger points in one or more muscles.
Therefore, I believe the Mayo Clinic and the medical profession are 100% wrong. To me, this is the deciding point: if the pain extends down only one leg, then the only logical treatment is what you and I and other skilled LMTs do-- seek and eliminate trigger points in piriformis and other muscles that can clamp down on the sciatic nerve.I take issue with this. It is actually disturbing. Your opinion from your "short career" in massage when stating you "believe the Mayo Clinic and the medical profession are 100% wrong", does a disservice to yourself.
If you keep this rhetoric up, you are going to hurt someone someday. And, if they file a suit and then run across a post online where you have claimed that the medical profession knows nothing and you know everything, you will find it hard to defend these statements in a court of law.
If in the future, some therapist reads a post by you, and assumes you are correct, they too can likely do harm to a client, all because you wanted to try to make a point, instead of pointing out that in addition to discogenic pain, there can also be non-discogenic pain.
You simply cannot suggest: "To me, this is the deciding point: if the pain extends down only one leg, then the only logical treatment is what you and I and other skilled LMTs do-- seek and eliminate trigger points in piriformis and other muscles that can clamp down on the sciatic nerve.", without looking like a raving lunatic.
We all know that many times the issue is non-discogenic... coming from things like piriformis syndrome, sacroilitis, facet syndrome, a few types of bursitis, etc. --- and that many times there can be more than one underlying cause. And, we all know that it's generally more common to have a non-discogenic problem than a discogenic one. But, that doesn't mean they don't happen, and it doesn't mean one won't walk through your office doors someday. When it does, it may not be as obvious as the one Gordon described. You have to be open to that being a possibility.z
Logical treatment is having the understanding and knowledge that not every pain is due to a trigger point. There is a reason we need to know differential diagnosis.
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Dear, my by saying "short career" I was speaking in comparison to Gordon's 34 years as a massage therapist.
As a competitive bodybuilder beginning in 1977, I won the AAU Mr Georgia, the AAU Southeastern Mr. America, and the IFBB South American Bodybuilding Championship Masters Division. Having poor genetics, in order to become a successful competitive bodybuilder, I had to study the human body intensively. Because in gyms I was constantly bombarded with questions about kineseology, nutrition, and physiology of the human organism, I took the next step and became a certified personal trainer, which I maintained for sixteen years; my friend Chuck Norris was a workout partner and client. One of the services I extended to my clients was therapeutic massage. Licensing wasn't necessary in most areas of the nation until relatively recent, but legislation eventually made obtaining licensing necessary (as it did in Gordon's state of AK this very year). Therefore, in 2008 I enrolled in a two year degree program in therapeutic massage, graduating summa cum laude. So, Pueppi, my career has been "short" merely in comparison to my friend Gordon Wallis' formal and informal education and his vast experience.
I am 68, have been inquisitive, intelligent and a student of the human organism my entire life. As a consequence, I am better educated in human anatomy and human physiology and especially kineseology than the vast majority of massage therapists.
You push buttons, Pueppi: you make pronouncements based on your assumption that you know more than anyone who has ever practiced. Clearly, you do not.
Pueppi Texas said:
Gary W Addis, LMT said:Everyone else understood my comment, why couldn't you?
I'm sorry you don't want to or have the capacity to have an adult conversation. I don't think the misunderstanding was from just me though...
Gordon J. Wallis said:I'm not sure what you are disagreeing on?
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G...... I will coment on things this way. If someone has pain from the hips running down one or two legs..They are either suffering nerve pain perhaps from some pathology in the lumbar spine or they are suffering from trigger points. From my experience and everything that I've read on trigger points I think you can safely assume that out of a hundred people with sciatic type symptoms, 85 of them are suffering from trigger points and 15 of them are suffering from nerve pain with little or no trigger point activity. Travell was very worried about the mis diagnosis of pain. Because unfortunately a surprisingly large number of doctors are just not aware of trigger points. So they may see a patient with pain running down their leg , and after some imaging see some kind of pathology in the lumbar spine, like a narrowing of discs, then wrongly treat the person for nerve pain. When the pathology has really nothing to do with the pain. I know that happens because I have met and worked on many that were misdiagnosed. Those are the ones that write me the testimonials. However, all that being said, not all doctors are unaware of trigger points. I've read their books, and actually met a medical doctor a few weeks ago that was very aware of trigger points. I talked to him for two hours. So anyway. I gotta go to work.
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