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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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http://www.aoasm.org/default/assets/File/OMED2016/Gerwin_TriggerPoi...
Here is some info on trigger points that I just found. I have not read it all. Some of you might find it interesting?
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All I can say is intense. I'm not even sure what I want to say? I'm talking about my new job, working in a pain management clinic. Sometimes I see the stress on my co-workers faces, but at times, I just want to go to my room and cry. Some people are really hurt. This doctor I'm working with is really amazing though. He will work till midnight sometimes helping people. I'm not use to it yet. I mean I don't work till midnight.. I'm just not use to seeing people in such pain. It's a busy clinic. I'm not even sure what I want to say now?
The doctor, or one of the PAs will come into my room and say Gordon, go into room seven and see if you can help this patient. I will go in there and see s guy laying on the treatment table, hands clenched , sweeting in pain. I'm totally useless. It's nothing Myofascial. Some of the people have trigger points. And I make em go away. I'm freakin good at eliminating trigger points. But even after I magically efficiently make the trigger points go away. It did nothing to diminish their pain level. Any trigger points I efficiently eliminate were very superficial. Really nothing. Sometimes somebody will be in pain, and they aren't quite sure if it's Myofascial or nerve. They will have me go into the room and Find out. So I help in the diagnosis in that way. As soon as I say, it's not Myofascial, they go from there. I saw a patient recently, in so much pain he could hardly walk. He had zero Myofascial pain. I spent twenty minutes just pressing on his head trying uselessly to dissipate his pain. He could barely talk he hurt so much, sweeting in pain. I helped him walk to the procedure room. I will describe it like a micro surgery room. It looks like the Starship Enterprise or something. After doing that I remember feeling kinda down. I told the doctor that I feel really sorry for that guy. He said, don't worry he is going to feel good soon. After the procedure I saw the man walking out of tha clinic smiling. When he saw me , he said thank you sir. But I did nothing.....I will attach a picture of the room that they did the procedure that made him walk out feeling ok. >
But despite all the failures I've had. As far as taking pain out of people. There have been a couple small miracles. Those people had Myofascial pain. Trigger points. One guy had , listen to this. Testicular pain for 13 years!!! The doctor called me into room, he was there with one of the PAs, and introduced me to the patient, discribed the guy's pain and what he thinks it is. And asked me Gordon, can you release the Psoas, because its clamping down on a nerve, and causing him severe pain. Otherwise they would do some kind of cortisone shot or nerve block procedure or something. He has had this for 13 years. I have my own room. The doc the PA the patient went in the room with me. In five minutes his 13 years of pain was gone. The patient was stunned happy. The doctor looked at me , smiled, said thank you. Then walked off quickly to see another patient. - Attachments:
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Permalink Reply by Gary W Addis, LMT on
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even an occasional success is great benefit to the victims of long-term chronic pain. MTs in spa environments know to be very careful touching "forbidden" areas of the body. The highly skilled do work-arounds to find the source(s) of pain that seem to arise in genital-anal areas-- like the testicular pain. Most LMTs wouldn't have considered that the intense pain centered in this man's testicles could have a myofascial origin-- and would have referred him away to an MD. For 13 years everyone had failed him. He finally by trial and error over a decade came to the right place. Expert medical doctors and expert massage therapist working as a true team to benefit those in severe pain.
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This is interesting. I'm writing in here, but I'm also talking to myself. I'm working in a different environment then I've ever experienced before. And that says a lot after thirty years of doing this kind of work.
I'm so serious about my work. To the point that it's unrealistic and probably not healthy. I'm talking about my mindset. I mean I will go home feeling melancholy, semi depressed, if I have a patient/client that I can't help. I hold myself to a high standard. I've had a fair amount of failures and a few successes sense starting my new job. When I say failures, I'm talking about not helping someone out of pain. When I say successes , I'm mean helping someone out of pain in a dramatic way.
The doctor wanted to see if I could help this particular patient out of pain, before he would have to do a more invasive treatment that probably would work. It was obvious to the doctor that she had Myofascial pain, trigger points. I'm an expert at eliminating trigger points. I really thought, as did the doctor, that I could help her.
She was in pain for two weeks. She was very much worried and stressed out about it. Her left hip was in intense pain, and the pain shot down the lateral leg. It stopped her from sleeping. She was extremely worried that it was nerve pain from her low back. Anyway, I found trigger points in all the Glute muscles as well as one in her Vastus lateralis. Despite my advanced skill set, I was only able to eliminate any of the trigger points except the Vastus lateralis trigger point( that one did go away ). She felt somewhat better after the session, but she still had a disappointed look on her face. I asked her how much better she felt after I worked on her? She said , Maybe 40%. To me that's not totally good, but good enough for follow up sessions. I'm guessing that after four or five follow up sessions, her problem would be over, maybe.? . But she is not happy, and I'm working in an advanced pain clinic with a really good doctor. So he takes her into one of his treatment rooms( she gave me permission to follow) where he did trigger point injections to all the same muscles I tried to release. I could tell it hurt. But after, she got up off the table happy and pain free. Just like that. Freakin amazing.
Another time, I'm in my room. I get a text from the doctor. "Can you come to room three, PLEASE."
He had done a procedure on a patient that un intentionally caused sharp pain in the guy's groin. The patient was very upset about it. When I got to the room ,the doctor explained the procedure , and that it inadvertently had caused a spasm of the Illiopsoas muscles that irritated a nerve causing the guy pain. The doctor asked me if I could release the Illiopsoas. I said yes. The patient looked very non believing. I took the patient to my room. Trust me, this patient did not think I could help him. Long story short. In two minutes his sharp Groin pain was gone. That was cool. This job is a trip.
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One of my co-workers has a trigger point between her shoulder blades on the left at about the T4 level. It's a bad one. She has had it for a couple weeks. Despite my advanced skill set, I have failed to make that trigger point go away. To top it off, she has been a client of mine for four years. In the past, I've been able to make her trigger points go away during her spa massage. Anyway, one more try today. If still unsuccessful, she will get a trigger point injection.
At the same time I had a patient the other day with over ten years of inguinal pain, despite medical intervention. Her pain was gone in two minutes. Her pain was in the right groin area. I found trigger points in the left lower quadrant, a really bad one in the right lower quadrant about where the Illiocecal valve is located, a very tender right ASIS, and another trigger point in her right Pectinius muscle. They all deactivated with my Holographic Acupressure procedures. She was completely pain free after the treatment. Amazing. So happy she was crying. That was way cool. Made my day. I wish I could make my co-workers trigger point go away though.
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I think I made progress on my co-workers trigger point. It was totally gone after I eliminated it today. We will see how it is Monday? If it's back in a bad way, it's trigger point injection time. Then I will get to see how that works? In the past, I've always thought that unnecessary?
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I'm not super busy yet, because I'm still waiting to become credentialed by all the various insurance companies. But at times, it gets kind of hectic in the clinic. I had just finished doing trigger point work on a patient, and in the middle of documenting my treatment notes, when one of the medical assistants came to my room and told me that the doc wanted me to go into one of the treatment rooms and see if I can help the patient. She told me the room number, but like I said, I was in the middle of finishing my treatment notes.
A minute later I walked down the hallway, went into the room where I was happily greated by the scribe and the patient that told me her left shoulder hurts. I found two upper Trapezius trigger points, a Levator Scapulae trigger point and two posterior neck extensor trigger points that I quickly deactivated. The patient was so happy. Thanked me profusely.
When I walked out of the room, the medical assistant was upset that that I didn't go into the room and see the patient that I was suppose to see. And that patient got tired of waiting and left.
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Some of you might find this site interesting?
https://r.search.yahoo.com/_ylt=AwrSbmdOTqhZZyEAslRx.9w4;_ylu=X3oDM...
As far as tender points go. From my way of thinking ..... They unnecessarily over complicate things. Like, if you find a tender point, is it a trigger point or not? My answer is.... Who cares? What difference does it make?
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This is interesting, I think? More then once, I've been accused by many to be a lier, a con man, or a nut case, and so on by many. Including medical doctors, physical therapists, lay people, and even other massage therapists.
I knew what the answer would be, but I sent a video of me working on a patient to this website that's run by a medical doctor, and asked her what she thought. http://www.skepdoc.info/
Here is the video I sent her. https://www.youtube.com/watch?v=rWDML1jqGo8&sns=em
In the attachment below is her answer. Now in all fairness, ten years ago if I saw one of my videos, I'd think it was a bunch of bull myself. Other professional massage therapists have accused me of being one of those that's responsible of giving massage therapists a flakey reputation to the medical community, as well as negatively influencing young massage therapists. So what do you guys think? In the attachment is her letter. - Attachments:
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Permalink Reply by Therese Schwartz on
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Hey Gordon! Just because there aren't a lot of clinical trials doesn't mean the work isn't effective. However, the placebo effect is really important. It is NOT and I repeat NOT about people fooling themselves into feeling better. Anything we can do to engage people's innate healing abilities (possibly a much more accurate description of the placebo effect) is tremendously worthwhile. Trust in the practitioner has a lot to do with that.
What she says about clinical trials and follow ups is valid. However, in manual therapy it's difficult to do sham treatments which is what is required to do random, controlled studies. They are starting to be conducted, though, with favorable results for skilled manual therapy.
Remember that for some people there will never be enough scientific evidence to change their minds. We aren't dealing with science versus "quackery". We are dealing with belief systems. And changing people's beliefs is damned near impossible, unless they are willing to be wrong. That goes for us too, BTW. We have to be willing to understand that maybe what we are doing has more to do with placebo effect than us actually changing tissues. The people on the table can change their tissues, though. It's a powerful thing, to be a catalyst for someone's change like that.
Gordon J. Wallis said:This is interesting, I think? More then once, I've been accused by many to be a lier, a con man, or a nut case, and so on by many. Including medical doctors, physical therapists, lay people, and even other massage therapists.
I knew what the answer would be, but I sent a video of me working on a patient to this website that's run by a medical doctor, and asked her what she thought. http://www.skepdoc.info/
Here is the video I sent her. https://www.youtube.com/watch?v=rWDML1jqGo8&sns=em
In the attachment below is her answer. Now in all fairness, ten years ago if I saw one of my videos, I'd think it was a bunch of bull myself. Other professional massage therapists have accused me of being one of those that's responsible of giving massage therapists a flakey reputation to the medical community, as well as negatively influencing young massage therapists. So what do you guys think? In the attachment is her letter.
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Trigger points are real; they restrict ROM, cause very real pain. The release of a trigger point by a skilled, highly trained manual therapist is not a placebo effect-- the therapist feels the knot melt, the client experiences immediate pain relief.
But, yes, placebo effect does play a part in any kind of medical intervention. If they want to get better, and believe in their caregivers, they probably will feel better, temporarily...even when treated with "flaky" treatment protocols. On the flip side of that coin, however, we've all had clients who seem to cling to their disability, who emotionally, for whatever personal reason, just cannot let go of their pain.
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Gary, you saw that video. You in the past you have been skeptical of Cranial Sacral Therapy. What you see in that video is not classical Cranial Sacral Therapy. But I did touch her cranium and the Coccyx pain vanished. Is that placebo or? That question goes for anybody, not just Gary.
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