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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 February 26, 2017 at 4:19pm
I wanna add something here. About the example of the plantar fasciitis client and other client experiences I've talked about in here. A few people have comented or implied that I'm egotistical and all about myself and bragging in here. I don't mean to come off that way. I'm writing in here to empower other massage therapists. After 30 years I do have a lot of confidence and a skill set to help a lot of people. But I think a lot of massage therapists can help those people, they just don't realize it. Take for example the plantar fasciitis client I just comented on. Any good or experienced therapist could, in time, get her out of that plantar fasciitis. I work with a lot of therapists, and here is what I've heard, almost on a daily bases when I see a client leaving the room after getting a massage from another therapist. The therapist says. "How does your hip feel now? " The client answers. "It feels way better. I can walk and it doesn't hurt. " Then the therapist says. "Oh I'm so glad. You have a wonderful day." And that's the end of it. The client probably goes home and feels great for an hour, day or a week or more, then the pain comes back. The client thinks that massage is only temporary, and that she has a more serious problem and that nothing can be done. Now if that was my client. I would point out the fact that a major portion, if not all, of her pain is myofascial. And the way she feels now is the way she can feel all the time. I would tell her she needs some follow up visits, and that there is a very good chance that she can feel way better in the near future. Perhaps something to think about?
Permalink Reply by Gordon J. Wallis on February 26, 2017 at 8:58pm
A client came in for a relaxing massage. She told me that she got permission to get a massage, but I was not to touch her neck. I asked her what's wrong with her neck. She said "Well, it's a pinched nerve." I didn't ask her who told her that or who she is seeing or has seen for her pinched nerve. If I was documenting for insurance I would have, but in the spa, that information is not necessary. I asked her to describe her pinched nerve. She told me that it's a burning pain. As she was discribing her pain she touched from the middle of her Deltoid to the top of her shoulder (trap) up to the base of her skull( occipital area).
Long story short...I found a middle Deltoid TP, an Upper Trapezius TP, a Supraspinatus TP, and an Occipital TP at the base of her skull. All on the same side. They all deactivated and she left the spa without her pinched nerve. She was really happy. The diagram of the Deltoid TP is not the correct TP. In reality it was more medial. No diagram for the Occipital TP.
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Permalink Reply by Gordon J. Wallis on February 27, 2017 at 2:09pm
https://www.haasemyotherapy.com/
This guy is coming to Anchorage in April I believe. People think I'm bragging in here, but listen to what he claims his course teaches. And he has a money back guarantee. Basically what I've been saying I do, in this entire thread. Getting people out of pain fast. And I don't doubt what he is saying at all. Read what he says his course will teach. Think about it this way. If you can do what he says he can teach you. Why would anyone have to go to a Chiropractor?. I've said in here many times...Muscles Move Bones. There is really no reason for us to be third tier providers. I mean politically it might take some time to render that obsolete. But in reality, it's soft tissue work all the way. We already have the relaxation thing down when compared to everyone else. But if you know what you are doing, when working with people that are in pain....Advanced sophisticated soft tissue work trumps spinal adjustments. It does. The most advanced chiropractors I've met, do soft tissue work. It's all within our license.
Unfortunately I won't have the time or money to attended this guys seminar, but I have plenty to study. I was up late last night drinking coffee and studying. And I learned a lot. I've come up with some new ideas and concepts I'm excited to check out.
Unfortunately because of that I'm tired this morning, and the work day awaits me. But Im still excited to check my ideas out on real people. My concepts are such that the worst thing that could happen, is nothing.
If any of you guys have interesting client/patient stories. Tell us about them in here. It wouldn't have to be specifically about pain. Anything really.
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Permalink Reply by Gordon J. Wallis on February 27, 2017 at 10:21pm
Pueppi, I understand what you are saying. I do. But there is hardly a week that goes by, were I don't meet someone with a relatively easy pain problem that has been seeing or been seen by other types of health care providers for weeks, months, and sometimes years. These providers are billing huge amounts of money to insurance companies and even the patients themselves. I will meet them accidentally, or long after the insurance companies have refused to pay for more services. And I will have them out of pain in a few days to a couple weeks. Now I'm not saying I can cure or help everyone I meet that's hurting. But I tell you what... If I fail, I fall fast. There are no endless treatment plans that just go on forever and forever with no clinical results. I see that going on a lot. I'm like blown away when I hear how long these people have been in therapy.
Now I know there are good people in those other fields, because I'm learning from them. But they are not all that common.
Example.. Why would you treat someone twice a week for over a year for a rotator cuff problem when the patients problem is not improving at all and getting worse? I could go on and on and on with examples. I'm not talking isolated cases. Gosh, if I'm working on somebody and there is no clinical improvement in six or seven sessions. I'm not the therapy for them. I meet people every week with what I find are relatively easy pain problems that have been in therapy for months.. Huge huge money involved. Here is another deal. I walked into a restaurant a year ago. Saw two other types of health care practitioners that HI- fived each other because one of them saw 100 patients in one day. Give me a break. What kind of quality patient care is that? And on top of that. I have gone to different types of health care providers with a fake injury.. guess what.. they showed me my problem on Xrays. I did that three times. I could do it again, but I don't want all the radiation. It's like I said. There are a lot of people I can't help. But I know it fast. . I want to qualify myself here again. There are good people out there in every field, I know that. But finding ethical ones is harder then one thinks. The dollar is King.
And kinda on the same subject. When it comes to hands on manual medicine. Soft tissue work rules. Whether it's done by a chiropractor, physical therapist, osteopath, or a massage therapist. But when manual medicine, of any kind ,doesn't work, it should be realized fast. And lay people trust their providers.
Pueppi, if I hurt my shoulder, I'd rather see you for sure, then the guy that sees 100 people a day.
PS- trust me. I like being a massage therapist, and I read books written by smart people that work in other fields. But still.....there is a lot going on that's not right.
That's one of the reasons I'm writing in here.
Permalink Reply by Gary W Addis, LMT on February 28, 2017 at 12:36pm

The following is a good read posted on LinkedIn.  Posted here without comment, but inviting discussion.  The article centers on, but isn't confined to, Tom Myers' CEU classes and videos.  Also discussed is fascia and the CNS' interactions with it.


New Muscle Activation Techniques

  • Published on February 28, 2017




Paula Nutting

Paula Nutting


Musculoskeletal specialist means that I can give you the BEST outcomes for your body!


New muscle activation techniques proven to reduce musculoskeletal pain used in the massage industry.

Tom Myers went to exhaustive lengths to establish the links or lines of the fascial system and how they are so important in functional mobility of the musculoskeletal system. By stripping cadavers of all but their unique fascial systems he has hypothesized that there are 7 major lines or “anatomy trains” as he has coined them. Joseph DellaGrotte also pondered the tensegrity of the connective tissue and how the Central Nervous System has an impact on it.

The smooth and fluid movement of the body is founded upon these lines working both dependently and interdependently with each other; both as single units but as a shared fascial web which propels us forward, backward, twisting turning in all planes. It has become evident that when the fascial tensegrity of the body becomes imbalanced then the musculoskeletal, nervous and endocrine systems, and in fact our general homoeostasis is compromised. Joints altered in normal arthrokinematics leading to denegation at their articulating surfaces, tendinosis through added strain to the attachment points, ligamentous micro-stress leading to predisposition to sprains and tears. The body misalignment (though minute) still alters the neutral position of the vertebral column and the normal afferent and efferent signaling of the nerve roots upon entrance of sensory and exit of motor information. This creates altered signals to the muscle, joints, skin and the viscera on a global scale.

At the 1st International Fascia Research Congress, 2007, held at the Harvard Medical School in Boston, fascia was discussed at length in the forms of abstracts, expanded abstracts, plenary’s and original papers.

“Fascia and its involvement in force transmission from one tissue to another, having major implications in explaining how the body functions, and how manual methods” (Stecco et al., 2008) can be used to influence distant tissues. “Mechanical forces, including those associated with manual treatment, influence cells and molecules via mechano-transduction, producing changes in intracellular biochemistry and gene expression” (Ingber, 2008; Wipff and Hinz, 2008) were some of the many profound realizations discovered.

Josef DellaGrotte put forth a paper on postural involvement using core integration to lengthen myofascia. “Summary. Postural organization is controlled by the central nervous system in conjunction with the skeletal, muscular, and fascial systems”. This paper explores the effects on static and dynamic postural misalignment and treatment via neuromotor re-education intervention. DellaGrotte hypothesizes six core-integration pathways or vectors of force which use the principles of functional movement used by pioneers such as Ida Rolf, Moshe Feldenkrais and Tom Myers.

The six pathways are based on common planes of movement (up-down, Sagittal, rotational and lateral movement), these pathways are defined by the following criteria:

It contains a vector of force, direction, and myofascial tensegrity.

It passes through the centre of gravity and represents the most efficient expenditure of energy.

It has specific anatomical features, and can be ‘tracked’ through specific joint angles, actions of levers, muscle chains, and fascial tensile spread.

It requires lengthening by virtue of mechanical levering and the physiology of myofascial actions.

Muscles in the sequential contracting-lengthening phase stimulate tensile fascial spread.

DellaGrotte had designed a map of how the CNS can track and facilitate every movement through the 6 primary core pathways, secondary pathways and their sectional body components. These can also align with Myers 7 myofascial trains and as they both allude, it is the identification of the path, assessing movement and posture, tracking how movement is transmitted and determining through client response whether CNS takes on and adopts the data or whether there is a break in the system which will lead to soft tissue problems we as therapists observe.

Therefore it is most probable that not only do these lines have a specific roles within the body but when they are in correct function will minimize stresses and damage; conversely when they are out of “sync” secondary pain syndromes will occur which are associated with overuse and strains on bones, joints, muscles, tendons, nerves and fascia. The body has a set of somatic markers housed within the bony stations, which offer feedback continuously along the trains via the fascial attachments, it also uses the neuromotor myofascial pathways to continuously monitor the body’s posture and functional movement tensegrity. If the therapist has an understanding or at the very least acknowledgement the presence of these markers it is more easy to understand how primary area of pain can arise in any area where there has been a break in the neuromotor transmission or a de-railment of a Myofascial train line. Treatment of imbalances of the paths as noted by Myers and DellaGrotte include myofascial release techniques to lengthen the fascia. Using many well known treatment strategies from Rolf and Feldenkrais, the stress vectors within the pathways are normalized. This is where the astute therapist can be most profound in their treatment and I will give assessment options further in this article.

There are however many other remedial massage techniques to affect these lines to improve balance in the vector of force, direction, and myofascial tensegrity. Muscles must fire in the sequential contracting-lengthening phase stimulating tensile fascial spread and this is assessed by muscle firing sequences (Chaitow). When the muscle firing sequence is incorrect I have observed that the phasic (doing) muscles will lengthen and the postural (stabilising) muscles shorten and this creates the imbalance within the anatomy trains. Gracovetsky provided a paper at the 1st Fascial Congress on “Lumbodorsal fascia” and its role in the function of the spine. He states that it is perhaps the most important structure insuring the integrity of the spine, the viscoelastic property of its collagen has a direct impact on the way the muscles are used and forces are channeled from the ground to the upper extremities. The viscoelastic property of collagen means that it is not possible to continuously load collagen material. “To circumvent the problem of collagen stretching, a cyclic mechanism of alternatively loading and unloading collagen and muscle must then be implemented. Such an oscillation permits tissues to sequentially rest, recover and maintain core stability” (Gracovetsky). The most important outcome should be the relief of pain, reversal of dysfunction and the restoration of control of normal patterned movement, this intern should improve normal lordosis which implies restoration of balance of the innominants and sacrum along with balance of functional leg length.

If the lateral line or basic lateral path is interfered with, it can and often does create stress and pain in the neck, lateral rib region along with lumbar discomfort. This is due to the myofascial connective tissues having no real stretch, joints becoming compressed as postural muscle loses its normal resting length. Another example of a disruption of this line or path and can be noted with patients presenting of lateral leg and/or medial knee conditions and symptoms created from the medial distraction and/or lateral compression of the knee. DellaGrotte describes the basic lateral path as responsible for the earliest evolutionary developmental movement as in the dorsal movement of the fish our earliest Darwinian ancestors, with an imbalance of lateral movement so to will the patient complain of stiffness of the torso in general and more specifically, joint-jamming of vertebra and ribs, myofascial tissues and compression of the discs.

Compression of the Lumbar facets with disruption in the Lateral line is commonly a predisposing factor to both Sciatic and Pseudo sciatic pain, many authors will note that there is a reduction in neural proprioception and therefore susceptibility of instability with possible falls. Myers also suggests that this line begins in the middle of the medial and lateral arches of the foot so it is understandable that the plantar fascia can become compromised creating plantar-fasciitis. This hypothesis can be further cited by Hammer, W. when he discusses at length in his paper that the related kinetic chain must be addressed when dealing with the plantar fascia and there is often restricted dorsiflexion and fascial restrictions all along the kinetic line. Hammer produced a paper on “The effects of mechanical load on degenerated soft tissue” (2008) which was as a direct response to the Boston Fascial Congress of 2007.

As therapists’ using this theory we should activate muscles most commonly involved in the stability during lateral movement, it is most commonly observed at the pelvic level with hip drop or a positive Trendelenberg test. Applying concentric muscle activation of the Gluteus Medius on the unstable, positive side and possibly activation of the synergistic Adductor group on the contralateral leg should offer a re-establishment of pre-dysfunctional muscle tension of the myofascia.

Two more of Myers Anatomy Trains include the functional back line and superficial back line; when these are combined they mimic the back path as hypothocised by DellaGrottes biomechanical and CNS model. These pathways provide strength and support of the Sagittal plane, the muscles and connective tissue are the body’s main pillars of support and movement. When working together efficiently they provide strength of the core and all related structures along the back, but when there is a breakdown of the neuromotor myofascial pathway’s and the subsequent imbalance of the muscle firing sequence as suggested by both DellaGrotte and Myers then pain, injury and dysfunction will eventually occur. The deeper small muscles of the vertebral column i.e. the multifidii and rotatores take on much of the load and therefore pain will often present close to the spine in the sacrum, lower back, thoracic region and neck. When the pelvic innominants misalign then the potential for either Upper and or Lower Cross Syndromes can arise producing cervicogenic headaches, cervical, suboccipital and generalised back pain including shoulder pain and potential rotator cuff imbalances. Shortening of the hamstrings and calves is also noted in the Lower Cross syndrome, (Chaitow L.,2003). The evidence of anterior or posterior ilial rotations, sacral torsions and subsequent leg length changes are a common phenomenon with the functional back line or back path when unilateral cross syndrome is present.

By applying the same techniques of re-establishment of individual muscles within these lines to re-establish the neuromotor sequencing then the application of low load muscle activation to individual muscles is absolutely necessary. Either the activation of the Gluteus Maximus or the Latissimus Dorsi is needed to diffuse the Cross Syndrome pelvis, similarly by improving the quality of the Hamstring contraction this will take the load from the stabilising muscles within the spine including the Erector Spinae. The therapist needs to use a keen eye to assess anterior or posterior innominants and the subsequent leg length discrepancies.

Research continually points to the link between poor core activation and the incidence of low back pain with lumbar instability, and the positive effects in reducing pain when restoring the postural equilibrium. The presence of functional front lines or paths both deep and superficial promote both core dynamic support and uplifting functions to the body. The muscle combinations of the core include the diaphragm, Psoas, Pelvic floor or Transverse Abdominus, and their anterior stabilising cohorts the internal and external Obliques along with the Rectus Abdominus, the inclusion of the functional front lines also adds small intrinsic muscles of the spine i.e. the multifidii, and will include some of the fibres within the Adductor groups. This is confirmed by the statement from DellaGrotte “Balancing this pathway also strengthens the thoraco-lumbar fascia and engages the spine through the multifidii as stabilizers and rotators. In addition, the mapping of the deep support system works well with the psoas [and adductor] complex, allowing the psoas to perform its major function as a dynamic mobiliser” . The remedial massage therapist, Musculoskeletal Therapist or Exercise Physiologist should have the skills to activate these core muscles and look for any imbalance between strength and length which would signify pelvic torsion potentials.

More recent empirical evidence comes from Finch K developer of Arthroneural Myofacilitation discusses a symptomatic picture which includes dysfunction of the mid thoracic region with associated neck pain, shoulder pain, thoracic and rib discomfort, Sacro Iliac Joint pain, groin pain and upper limb neural irritability. Myers and Finch agree that lateral leg and/or knee pain may be associated with imbalance within these anatomical lines.

DellaGrotte includes a turning path which can be included with the deep front line of Myers due to the 3 dimensional role it takes on. “This turning path is the ‘missing link’ in the leg>pelvis>spine pathway, and the key to effective CNS pre-programmed natural strengthening and supported upright posture”.

In my clinical practice I have observed that when these fascial trains are compromised then overtly excessive loads on the deep back muscles occurs and this creates premature firing of the internal and external obliques as the antagonistic groups. Back muscles become tighter, shorter and weaker, and this dysfunctional state may result in a posteriorization of the ilium and a short leg situation; it will inevitably involve dysfunction of the diaphragm function through reduction in accessing the thoracic turning path which then affects breathing and metabolic function. The therapist may decide to treat with conventional methods or may decide to awaken the agonist/antagonist groups of the Adductors on one side that the contralateral obliques of the trunk. An imbalance between these two opposing muscles of trunk stability will make detrimental influences in a) how the ilium sits with the fixed sacrum and b) how much medial torsion is present in the femur produced by shortening of the Adductors. Therefore Low load Recruitment of the Adductors and obliques in a side lying position will help re-set the firing order (as hypopathysed by Finch) should return the muscle tone and myofascial length to pre-dysfunction length. This will often result in reduced pain not only in the local area but other complaints both distal and proximal to the treatment area.

When a client presents with standing rotations of the Thoracic trunk or Pelvis it is prudent to also assess the diagonal spiralic path or spiral line which is involved with turning, twisting and elevating; these actions recruit the opposite or stabilizing leg as most commonly this is the thrust leg. This spiral line maintains secondary balance with the majority of other planes and assists to determine knee tracking in gait. If this pathway is disconnected or interrupted in force transmission through the spine then low back may be stressed (Hodges and Richardson, 1996) and gait negatively affected (Gracovetsky, 1988: Tandon et al., 2008), the symptoms of suboccipital tenderness, burning between the scapulae, coccyx pain and shin splints (Finch 2007) have been noted. If we continue to use the principle initiated by Gracovetsky then low load muscle activation should be performed on those muscles effecting the rotations e.g. Rhomboid Major and Rhomboid Minor, to correct the imbalances noted along the core pathways. By activation of muscles within the hip complex or shoulder complex we can minimize the undue torque through each vector, allow for return of tensegrity between the specific joint angles, which in turn will improve the actions of levers, muscle chains, and fascial tensile spread. The myofascial lines are equalized by virtue of mechanical levering and the physiology of myofascial actions.

The process is rapid and the most likely hypothesis from the author is via specific cell surface receptors called “integrins”. They bridge between the internal “cytoskeleton” of the cell and the external Extracellular Matrix. “They act as mechanoreceptors and are amongst the first to sense mechanical signals, the signal speed is transmitted rapidly through these load-bearing elements, in fact, much faster than chemical signals and the stress application to the surface integrin receptors results in almost immediate changes in molecular structure deep in the cytoplasm and nucleus, as well as activation of signaling events at distant sites almost as rapidly as those that occur at the cell surface.” (Ingber D). More on this type of transmission is important to understand but has no place in this article due to size restrictions.

What order we treat our clients is often subjective but if we follow some strong principles regarding return of hip height then the lateral path would be the first point of treatment. The femur needs to be in best position to maintain correct gait, leg length and if not achieved, the secondary neural/musculoskeletal conditions that arise from this will continue to hinder the healing process. The basic lateral path needs to function with the hip rotator cuff in balance and therefore low load recruitment of these muscles should be a first priority to the treatment plan. The need to return the pelvic balance and lumbar lordosis is also an early priority so that the hip rotators may need to be activated at a stronger level to achieve this task. Both movements are often used in Pilates though for the best results it is a requirement that the muscle must be fully unloaded. Generally movements performed at the rotator cuffs of the shoulder and hip joints appear to balance the pull of a de-railed train as Myers describes it. Finch K., uses seven “muscle activation techniques” and hypotheses that the gate theory is the cause of the rapid return to normal fascial balance though this is probably unlikely given that the ECM works at a much more efficient speed. These seven movements are mapped closely to both Pilates movements of core control and follow Grimaldi’s concepts of necessity for femoral and humeral position. The order of activation via low load recruitment from the Remedial or Medical massage therapist should be hip height balance via the Gluteus Medius, then re-establish pelvic rotations and leg length anomalies via efficient contractile muscle in the Gluteus Maximus, Latissimus Dorsi and/or Adductor Longus and Magnus. Trunk rotations should then be controlled via the Rhomboid and Rotator Cuff imbalances followed by the angonist and antagonistic imbalances of the fascia of the front and back superficial lines. Addressing tight Hamstrings and Pectoralis muscles and their union of tension can be unloaded by either myofascial release techniques or low load activation techniques with the latter being easier on both the client comfort and the therapist’s hands.

Hopefully the balancing of the Myofascia of the body can be achieved more readily and long lasting by applying these different technique choices so to produce far more efficient outcomes for our clients.

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Paula Nutting

Paula Nutting

Musculoskeletal specialist means that I can give you the BEST outcomes for your body!




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Permalink Reply by Gordon J. Wallis on February 28, 2017 at 2:02pm
Tom Myers book was fascinating. Lots of bodyworkers seem to be thinking in terms of fascia. But when I work on someone, I'm not thinking in terms of fascia. Because of the interest in fascia there seems to be a lot of focus on balancing posture and structure. If the body is balanced, there is no myofascial pain. I focus on trigger points. I think the emphasis on fascia and balance is because a lot of our leading educators are Rolfers. And because of that, there is too much emphasis fascia and structure. My opinion only.

Pueppi, you are one of the few that comment in here. If you have a client/patient that comes in say because of low back pain. Do you have some kind of perspective you go by? For me, I immediately start the process of finding trigger points. A fascia oriented therapist may do something else? I don't concern myself with hip height or leg length, like perhaps a structural fascia guy might?
Permalink Reply by Gordon J. Wallis on February 28, 2017 at 7:01pm

Just got home, read your reply. That was not vague at all. Just thinking on what you said about patient/client history. Because of working in a spa environment for 21 years, I only have maybe a minute for patient history at most. Because of that, over time, I have developed some very quick assessment procedures that I do during the beginning part of my massage work. The client usually doesn't realize I'm assessing their pain problem they may or may not have told me about. Ideally, I would take more time with patient history. But no choice. And I do see a lot of low back pain related to the Gluteus Medius.
Pueppi Texas said:



Gordon J. Wallis said:

Pueppi, you are one of the few that comment in here. If you have a client/patient that comes in say because of low back pain. Do you have some kind of perspective you go by?


I don't necessarily subscribe to all of the fascia or trigger point concepts.  I do however work with tight and tender areas.  My perspective is that history is about ~80% of the diagnosis.  So, if you come into me with lower back pain, we're going to talk about your history and go through that for about 20-30 minutes on your first visit. 

Also, it should probably be noted that although I am a DC, I am dual licensed as an MT. There are a lot of people who were actually offended that I got my massage license and stated it was "beneath me".  But, in a world where you never know what could happen next, I believe in getting the appropriate license for the appropriate techniques.  And the fact is, chiropractic allows me to be an excellent MT due to the extra knowledge, but it did not teach me the skills I needed to put together a fantastic massage.  Sure, we learned trigger point work, nimmo and some limited massage moves that could be done for the patient in 10-15 minute sprints.  But, it really is not the same as massage.

I keep two separate rooms.  One for massage and one for chiropractic.  Some massage clients are chiropractic patients, but many are not.  They also trust that I will not suggest chiropractic, unless I see that there is a real need.  Then, some chiropractic patients are massage clients.  They know that generally, I am going to suggest that they consider using me for their massage work.  But, if they already have a massage therapist, or don't want massage, I don't push.  I also don't make them feel bad about saying no, or telling me they use someone else.  In fact, I like to learn about other MT's people like.  It is beneficial for me, in case I need to refer to another therapist for some reason. 

It's really hard to answer your question, because each person is an individual and I do not use a cookie-cutter approach for everyone. I do find that a soft tissue issue which is causing lower back pain can many times present in a way that if I work with the paraspinals, glute medius, tensor fascia latae and hamstrings, I will get results rather quickly.   Sometimes there is a piriformis issue, but usually (at least in my practice, possibly because like refers like) I have more people that have glute medius issues.  And, many times there is more going on that what I've described, and those issues will also have to be addressed.

If I am not finding that a person is noticing some kind of relief (at least something around the 40-60% mark) within about 4 visits, I'm usually looking to see what else is going on, or if they need a referral.  I am also very big on referrals and knowing when and when not to take someone on as a client or patient.

Just last week I had a gentleman call, and after the vetting process over the phone, it was clear I was not going to be able to help him.  I have no problem letting someone know when I am not the right person for them or don't believe that I can help.  I don't want to waste their time or mine.  If they are adamant that they want to try my work, I will consider that.  But, generally, I know if I am not going to be able to do the job.

I know that all may seem fairly vague, but I hope it helps.

Permalink Reply by Gary W Addis, LMT on March 1, 2017 at 5:05pm

I find that imbalance within the body invariably results in trigger points-- and vice versa: one trigger point ignored invariably recruits either agonist or antagonist trigger points (often both)... thus, pulling the body out of balance

Gordon J. Wallis said:

Tom Myers book was fascinating. Lots of bodyworkers seem to be thinking in terms of fascia. But when I work on someone, I'm not thinking in terms of fascia. Because of the interest in fascia there seems to be a lot of focus on balancing posture and structure. If the body is balanced, there is no myofascial pain. I focus on trigger points. I think the emphasis on fascia and balance is because a lot of our leading educators are Rolfers. And because of that, there is too much emphasis fascia and structure. My opinion only.

Pueppi, you are one of the few that comment in here. If you have a client/patient that comes in say because of low back pain. Do you have some kind of perspective you go by? For me, I immediately start the process of finding trigger points. A fascia oriented therapist may do something else? I don't concern myself with hip height or leg length, like perhaps a structural fascia guy might?
Permalink Reply by Gordon J. Wallis on March 1, 2017 at 8:10pm
Well, a trigger pointed muscle is a contracted muscle. And they pull on bones, other muscles compensate. Some of those muscles develop trigger points, and you get distorted posture.
This was crazy..... I had one client i was doing trigger point work on who told me that she actually had to change the rear view mirror and adjust the seat of her car after I worked on her. But like I said in an earlier comment I think a lot of people are directly or indirectly eliminating trigger points with their structural work. But I truely believe by focusing on trigger point elimination instead of structure, you will get much faster quicker results.
The other thing too. There is no way any of the fibromyalgia clients that I've helped in the past, could handle a Rolfing session. Now don't get me wrong, Rolfing has helped a lot of people. I've heard a lot of testimony to that end. But those people didn't have wide spread trigger point activity. Possibly they could of had say , chronic left hip pain ( isolated trigger point activity) that corrected itself after several Rolfing sessions ,because the postural imbalances were eliminated and the distortions that perpetuated the trigger points were no longer there.
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Permalink Reply by Gordon J. Wallis on March 2, 2017 at 1:46pm
Just commenting on things while I drink coffee in the morning.
Now this is just my thing. Doesn't mean that's how you are suppose to do it.
If someone is seeing me specifically because of pain. I want to see them two to three times a week for six visits. If there is no clinical ( noticeable ) improvement at that point, I might try one more session. But that's it. I'm not the therapy for them.
The exception would maybe be the elderly ( 70+ ), or some of the fibromyalgia people. I'd go eight to maybe ten sessions for those people before I'd make that determination. Usually, in my experience, there is a noticeable improvement after the fourth session. Now say they are feeling way better after the sixth visit, I will then see them maybe once a week for two weeks. Just to make sure things are holding. The visits will be shorter at that point, sense I'm going for trigger points, there won't be as many. After that, if they can go fourteen days symptomatic free, it's over.
Ideally that's how I'd want to do things. But in real life it doesn't always work that way. Maybe the client lives far away, and can only get in once a week, or can't afford it or otther things. But the longer between sessions, for my work, the longer it takes, if I can help them at all.
Of course a lot depends on their attitude , health, lifestyle, and so on. A challenging part is getting them excited about seeing me without leading them on or giving them false hopes. Some are burnt out because they have already gone through a gauntlet of different therapies that promised them an end to their pain and failed. I need them to dedicate six sessions before any decisions are made.
Some of them, after a couple sessions that I think are going great, never come back. So that means I cured them? I'd like to think that. But most likely things weren't going as great as I thought, At that point I have to think, what went wrong? How can I improve or learn to be better? I've had just enough successes to keep me facing that challenge.
Permalink Reply by Gordon J. Wallis on March 5, 2017 at 11:30pm
A client came in recently for a 50 minute massage. She said she was burnt out and feeling tension in her shoulders and low back. She mentioned that her low back always bothers her some, but not enough to see a doctor for. She said lately she has been getting headaches that start at the base of her skull. She feels she just needs a good massage more then ever because of extra stress in her life lately.
I did a quick assessment using Japanese massage techniques through the sheets. I found imbalances. Her left side was more sore then the right. Her left Rhomboid , Upper Trapezius, and left posterior neck being the worst. Her right hip was noticeably more sore then her left, which was not sore at all. I immediately begain looking for trigger points on her left neck. Found two, on the transverse processes of T5 and T4. She also had a very noticeable left Upper Trapezius trigger point at G21, for all you Acupressurists out there. I successfully deactivated all those trigger points. She also had three trigger points between her spine and left Scapula. Now knowing that she wanted a massage I decided to leave those trigger points be, figuring the massage would rub them out. I then went to the right hip where I found a Gluteus Medius trigger point as well as one on the PSIS area. I successfully deactivated those two trigger points as well. I spent the rest of the time doing general massage. And I was right. The between the shoulder blade and spine trigger points vanished using my general massage techniques. I ended with a really good scalp massage and a modified Cranial Sacral release for the muscles around her first two cervical vertebrae. She was pain free and felt rejuvenated after. That was cool.
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Permalink Reply by Morgan Arnold on March 6, 2017 at 7:01am

Massage Therapy is sometimes good medicine to remove body pain. As in the case you have mentioned above . Low body pain LBD is cured by massage therapy. Acupuncture Yonge & Eglintonis another good massage therapy to remove your Muscles pain. Acupuncture is a very ancient method to remove body pain.

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