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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 May 26, 2014 at 5:03pm

I added a diagram that shows that light tactile touching and carressing of the skin over a period of time( half hour) will 

down grade intense pain signals to the brain.  In her case it down graded her pain enough for me to start touching and releasing the trigger points without her jumping off the table too much.  The problem I have is that often times people that have suffered pain like her for a long time, often have a defeated attitude because of what they have been told about their condition and the failure of other therapies. That they think that  me softly caressing their body is a waist of time and their money.  I may not have explained the mechanism of how light tactile touching down grades intense pain signals to the brain correctlly in the paragraph.  But it is an effective technique.  Something to keep in your massage technique tool box.

Gordon J. Wallis said:

I'm going to talk like I know it all now.  But I just know what I know from my experience.  I've had many clients diagnosed with fibromyalgia.  Unbelievably some have just had a few trigger points here and there.  And I just wonder who in the hell gave them that diagnosis.  A couple good massages with a little trigger point focus and its all taken care of.  But some with that diagnosis really do need a diagnosis of some kind.  They hurt all over.  One example I remember earlier this year.  A new client came into the spa on a gift certificate for an 80 minute massage.  Somehow she got me.  When she came into the room I asked her what she needed from this massage.. She said just to relax, I have fibromyalgia.  She has had painful massages that didn't do anything for her, and she just wanted to relax.  I asked her where she hurt.. She said all over.  When she layed down on the table and I started palpating her. Just about everywhere I touched on her body she would jump and would vocalize pain.  Im talking calf up to her neck.  However, dispite that.  I was able to determine that she had much more pain on her right side then her left.  Now the right hemisphere of the brain controles the left side of the body.  And the left hermisphere of the brain controles the right side of the body.  So her left hemisphere was upregulated comparred to her right hemisphere.  The left hemisphere was much more active and agitated compared to the right hemisphere.  So I wanted to balance that out.   So I could either upregulate the the right hemisphere or down regulate the left hemisphere.  I chose to upregualate or stimulate the right hemisphere in order to bring it in more of a balance with the over active left hemisphere.  So I did that by turning down the lights.  Sitting down next to the left side of the table and her body as she was laying on her stomach.  And with her body covered by the sheet only, I lightly carresed the left side of her body from her sacrum to her upper shoulder in one light tactile continius motion.  One hand after the other.  I did that for a half hour without loosing contact with her body.  Very light tactile carressing.  A full half hour.   Light skin touching sensations travel to the brain on wide neural pathways.  Nocioceptive(hurt pain) travels to the brain at a much slower speed because it travels on a very narrow neural pathway.  It gets complicated to explain.. but.. basically Im stimulating the understimulated part of her brain by only stroking the left side and Im flooding the brain with light tactile sensations that travel I think four times as fast as the painful sensations to the brain.. Anyway some how that helps block some of the very painful nocioceptive pain to the brain.  Thats the same principle as the Tens Units that use to be so popular.   Then after a half hour I was able to start eliminating the trigger points.. Now the vast majority of her trigger points were on the right side from about T6 or T7 to around L3.  It was like a chain link of trigger points.  She had trigger points on other parts of her body.  But they were spread out and not near as intense.  She had been seeing medical doctors and others for six years.  On meds and not improving.  The docs wanted to start injecting her spine with something..  It took seven sessions to completely eliminate all her Trigger points.  I had to use the half hour of tactile carressing maybe three of those sessions.   Then the rest of the sessions I didnt need too. Anyway her fibromyalgia completly went away.   I saw her a few months later and it was still gone.  She got a regular massage with no TP work.   All my experiences with that diagnosis has been Trigger Points.  And their nervous system is in such a hightend state because of the pain.  Initially she jumped everywhere I touched even though there was no trigger point there... After I was able to calm and balance her nervous system out some.  I was able to individually start cleariring out the trigger points.  One of my main weapons in her case , sense her pain was primarily on her right side was to stress and contract the spinal muscles on the left side of her body, utilizing the reciprocal inhibition reflex.  If you side bend each side of the spine is an antagonist of the other.  So you make the brain start sending signals of relaxation to the inflamed side.  Well anyway she got well and I got a big hug from her.. The other fibro people that Ive worked on were different.  But it was all trigger points.   So my perspective I just assume its trigger points.  And as a massage therapist thats pretty much what I can take care of most of the time anyway.  So if  it's ever anything else?  Well then I don't know?

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Permalink Reply by Therese Schwartz on May 27, 2014 at 11:02am

Gordon, your post about this has been really helpful to me with one of my clients.  She does fine with CST because of the light pressure involved, but sometimes a person needs a massage!  She struggles with that, and having this knowledge has helped a lot.

It seems like this is an intelligent adaptation of a reflex we all know works - if something hurts, rub it, because the pressure signals get to the brain more quickly than the pain signals.  BUT, for people who can't tolerate any pressure, this engages a similar response but in a way they can tolerate.

Now that I think about it, I'm not sure it is the same reflex.  What you are doing here isn't beating the pain signals to the brain, but actually downgrading them.  For the sake of the discussion, I'll leave all of my thoughts intact instead of editing them.

Permalink Reply by Gordon J. Wallis on May 27, 2014 at 1:28pm

Yea it down grades the pain, as shown in that diagram.  And light tactile touch does travel at a much faster rate to the brain then nociceptive pain.  That may have an effect too.  One can study the details I guess.  But all I know is that it works.

Therese Schwartz said:

Gordon, your post about this has been really helpful to me with one of my clients.  She does fine with CST because of the light pressure involved, but sometimes a person needs a massage!  She struggles with that, and having this knowledge has helped a lot.

It seems like this is an intelligent adaptation of a reflex we all know works - if something hurts, rub it, because the pressure signals get to the brain more quickly than the pain signals.  BUT, for people who can't tolerate any pressure, this engages a similar response but in a way they can tolerate.

Now that I think about it, I'm not sure it is the same reflex.  What you are doing here isn't beating the pain signals to the brain, but actually downgrading them.  For the sake of the discussion, I'll leave all of my thoughts intact instead of editing them.

Permalink Reply by Therese Schwartz on May 27, 2014 at 1:55pm

It's easy to get bogged down in details!  Some people like that, but adding complication never makes things work better.  I just want to understand it enough to be intelligent about what I'm doing, and be able to explain it to people.  My clients like to know how/why things work, which I think is great.

Permalink Reply by Gordon J. Wallis on May 27, 2014 at 6:26pm

http://m.youtube.com/results?q=gate%20theory%20of%20pain&sm=1                  You can learn a lot from youtube.  From watching this youtube clip.  You can see that if the muscle cell is damaged and calcium mixes with the other substanses in the cell.  You have an area of contracted muscle fibers within a relaxed muscle.  A trigger point.  Thats why deep work is most often times a no no when it comes to deactivating a trigger point.  Most of the time that will only cause more damage.  It would be very much like digging on a cut in order to make it heal faster.  It doesnt work.  Deep tissue work does not mean brutalizing your client.  It means specific work.  Detailed work.  And for sure it should never be more pressue then hurt good.  This is just information from my experience. I use to work very deeply, and prided myself on it.  And I did help some.  But Im way more efficient now and Im only useing a fraction of the pressure that I use to in the olden days.  Also thats why I don't want my clients stretching and exercising after a successful massage treatment( if they are a pain client).  You want to let the tissues heal.  But again, this is only my truth, my thoughts based on my experience.  

Gordon J. Wallis said:

When a client asks me what a trigger point is, this is what I tell them.  Your muscles are made up of bundles of cells.  They are long and skinny like the hairs on your head.  Wrapped around each muscle cell is an organelle called a sarcoplasmic recticulum.  The sarcoplasmic recticulum controles calcium flow within the cell.  When your brain sends an electrical signal to the muscle cell the sarcoplasmic recticulum exudes calcium from its membrain and that calcium mixes with other substances in the cell like myosin.  When thosee substances mix, there is a chain reaction and the  muscle cell contracts.  Now when there is an electrical  signal from the brain for the muscle cell to relax or lengthen.  The sarcoplasmic recticulum re-absorbes the calcium, seperating it from the myosin and the muscle cell relaxes.  Now do to stress( repetetive motions, one position too long, a blow from an accident, emotional stress) the sarcoplasmic recticulum can rupture.  When that happens calcium just leaks out and mixes with the myosin.  So any muscle cells that run through that area contract.  Even though there is no electrical signal from the brain for them to contract.  So you have an area of contracted muscle fibers within a relaxed muscle.  A knot, a trigger point or whatever you want to call it.   Now when you push on a knot, you push the calcium myosin mixture out of the area, back into the veinus system.  Then the muscle cell or cells can relax.   Now the cellular damage is still there.  But now the blood can flow into ther area and heal the tissues.  Thats why its important after a successful trigger point treatment not to exercise or stretch.  You want to let the tissues heal.   When not delt with trigger points can last for years.

Permalink Reply by Gary W Addis, LMT on May 27, 2014 at 7:45pm

great information. thanks.  that one link led  me into a large series of similar videos, and they in turn branched off into other directs.  good info on the lymphatic system too.

Permalink Reply by Gary W Addis, LMT on June 5, 2014 at 1:06am

Current research suggests that fibromyalgia begins with one neglected trigger point that limits movement due to the pain, and this in turn leads to the formation of a bumper crop of satellite trigger points, which further reduces movement.  Eventually, systemic sensitivity develops-- a lover's touch, a breeze blowing the fine hairs on the arms, a slight change in the weather causes the sensory nerves to scream in agony. 

My sister in law has been suffering with FM for many years.  She had become so sensitized that even the touch of her clothing was painful.  Drugs helped, but only a bit, and they soon washed out of her body.  For years I had been pleading with  her to allow me to treat her.

On Mother's Day, a family gathering, she finally consented.  This was one of her good days; the trigger points were active but the sensory nerves were quiet.  I could touch her without her screaming.  Good thing, too, because a family dinner was scheduled at Mama June's Country Buffet.  After giving her a light, brisk, desensitizing effleurage massage, I went right to her most painful trigger points.  In about 15 minutes, through her clothing, I released trigger points along the erectors, in QL, in the glutes, a nasty one in semitendinosis, then repositioned her and released both psoas.  When she got up from the table, she moved freely, with very little stiffness, for the first time in years. 

I advised her to make the hour+ drive to me at least twice per week for at least six weeks, cautioning her that some or all of the tps would likely reactivate within a few days.  Two weeks passed; I called her, and she reported that the pain had not yet flared up again.  One session with me didn't cure a decade of FM, certainly, so her pain will return-- but in the meantime, she is enjoying a few weeks without discomfort.

Now, I don't have Gordon's skills, so when I treat trigger points there is some pain involved.  But thanks to the things I've picked up online and here in the forums, specifically in this thread from Gordon, the pressure I employ today is bearable for even a hypersensitive fibromyalgia victim.

While I'm on, I'll relate one more case.  This week I got a call from my daughter; she twisted her back somehow stepping out of one of those tall pickup trucks.  She couldn't straighten, she couldn't get off the bed, it was either an ambulance to an ER for Novocaine and cortisone followed by weeks of PT visits...or a 90 minute drive for me.

Again, through clothing, I released L4-L5 TPs, TPs in gluteus medius and piriformis all on the left side, and in adductors of the opposite leg.  She got up, moved about and announced with a smile that she wasn't hurting.  The next morning I checked all the TPs again; only one was active.  I saved her thousands of dollars in medical bills and months of misery, her only expense the price of a burger and fries.  

Now, I can't operate on a sprained ligament or adjust a crooked spine, and teaching a client proper exercise form is also outside my scope of practice.  But treating myofascial issues not involving broken bones or shredded ligaments ought to be outside MDs and PTs and DCs scopes of practice. We massage therapists happily stand aside while MDs excise brain tumors and perform colonoscopies.  But I urge all other medical professionals to consult with us before using drugs and stretchings and scalpels to treat something as easily fixed as a myofascial trigger point.

 

Permalink Reply by Gordon J. Wallis on June 5, 2014 at 1:58pm

In the last couple years I worked on three clients with that diagnosis.  Two of  them suffered with fibromyalgia for over 15 years.  The other six years.   They all went through the usual gauntlet of health providers with little to no benefit.  One even went to the Mayo clinic where  she recieved spinal injections.    The injections did not work.   I got her (in her words) 70% better in about nine sessions.  She had tons of trigger points.  When I say tons I mean at least 100.   The other client with years of fibromyalgia got way better in about seven trigger point sessions. She was able to dramatically reduce the frequency of her pain medication and at times feel in her words, normal. .  She wrote a testimonial about it.  The other client with that diagnosis for only six years got 100% better after eight sessions.  She is the one I wrote about earlier in the thread when I explained the light tactile carressing in order to down grade her pain enough to begin eliminating the trigger points.  I just gave her a regular massage a few days ago.  I was amazed at how relaxed she was and how supple her body was..This is almost a year later.  When she first came in she was almost shaking with pain.  Would flinch at the lightest touch.  Well I wrote about her earlier.  I was amazed at the difference.  Gosh she has less pain in her body then me now.  lol .  Before seeing me the doctors told her spinal injections were the next step.   Anyway they all had lots of trigger points.  Each one had over a hundred on their bodies.  All the other health care providers they went too for treatment never mentioned the word trigger point.   And each of those providers were unsuccessful with their treatments.  All had way way way more education then me.  But some how I know way more about Fibromyalgia then they do?  Thats why I keep saying.   Truth Remains Hidden.  

Permalink Reply by Gary W Addis, LMT on June 5, 2014 at 2:13pm

amen, brother.

Gordon J. Wallis said:

In the last couple years I worked on three clients with that diagnosis.  Two of  them suffered with fibromyalgia for over 15 years.  The other six years.   They all went through the usual gauntlet of health providers with little to no benefit.  One even went to the Mayo clinic where  she recieved spinal injections.    The injections did not work.   I got her (in her words) 70% better in about nine sessions.  She had tons of trigger points.  When I say tons I mean at least 100.   The other client with years of fibromyalgia got way better in about seven trigger point sessions. She was able to dramatically reduce the frequency of her pain medication and at times feel in her words, normal. .  She wrote a testimonial about it.  The other client with that diagnosis for only six years got 100% better after eight sessions.  She is the one I wrote about earlier in the thread when I explained the light tactile carressing in order to down grade her pain enough to begin eliminating the trigger points.  I just gave her a regular massage a few days ago.  I was amazed at how relaxed she was and how supple her body was..This is almost a year later.  When she first came in she was almost shaking with pain.  Would flinch at the lightest touch.  Well I wrote about her earlier.  I was amazed at the difference.  Gosh she has less pain in her body then me now.  lol .  Before seeing me the doctors told her spinal injections were the next step.   Anyway they all had lots of trigger points.  Each one had over a hundred on their bodies.  All the other health care providers they went too for treatment never mentioned the word trigger point.   And each of those providers were unsuccessful with their treatments.  All had way way way more education then me.  But some how I know way more about Fibromyalgia then they do?  Thats why I keep saying.   Truth Remains Hidden.  

Permalink Reply by Gordon J. Wallis on June 5, 2014 at 7:13pm

The other day a client made an appointment too see me for an 80 minute massage.  When I asked her what she needed from the massage.  She told me that she had bumped her head while working around the house and that the top of her left shoulder hurt all the way to the top of her neck   But besides that her whole body was tired,  so she needed a full body massage.  She added that she might go see a chiropractor for her neck.  Judging by the way she acted and moved I could tell that it was not a serious injury.  I told her that I would take a minute before starting her massage to look for sore spots from the top of her shoulder on up her neck.  Basically from the upper back up.  And that she was to tell me when I touched a sore spot.  And if we find any sore spots I would deactivate them and then carry on with the massage.  And before she leaves the room we would recheck to make sure those sore spots were gone before she left the table. Because sometimes massaging over those areas can actually reactivate the trigger point.  But her problem was not so severe that I worried too much about that.  If it was a more serious pain problem I would not massage over the area after the initial deactivation.   I found two trigger points.  One was on the left upper trapezius,  the other on the left lateral spinous of T1( perhaps one of the Multifidus or Rotatores muscles). They were not that tender.  I compared those same areas with the right side of her neck and shoulder where there was no tenderness at all.  So I knew those two spots were her problem.  If those spots were tender on the other side of her body, then maybe not. And I would look elsewhere.    The tender spots dissipated quickly and I carried on with her massage.   On rechecking after the massage they were no longer there.  She told me that she could no longer feel the sorness in her neck.   I see non-serious issues like this on a daily basis.  The attachment shows pictures of the trigger points responsible for her neck pain.  Now the Multifidus TP was on T1.   

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Permalink Reply by Gordon J. Wallis on June 8, 2014 at 11:46am

  • A couple months ago a young women came into the spa for an 80 minute massage.  I asked her if she had any aches, pains or problem areas.   She told me her shoulder is killing her.  It was her right shoulder.  I asked her to tell me exactly where it hurts.  She touched her right deltoid with her left hand.  She said at night its really bad.  It throbs all the way down her arm. She can hardly sleep at night.  I asked her how long she has had this pain.   She said six months.   I asked her if she saw anyone else for her shoulder pain.  She said she went to a chiropractor for a couple of months but got no relief.  I let her read a couple of my testimonials and asked her if she wanted me to specifically work to relieve or eliminate her shoulder pain.. She said yes, if you can.  I told her that I would palpate from her hips up to the top of her neck, and that she has to tell me if or when I come to a sore spot.  I told her that we were bound to find some tender spots on her body.  And that If Im able to eliminate those tender spots that her shoulder pain should be greatly diminished or eliminated all together.  Anyway I found a hand full of trigger points.  Some in muscles that could possibly cause shoulder pain like the upper trap, rhomboids, infraspinatus, the teres.   But they were all very mild.  None of them elicited a jump sign or pain response from her.  Almost benign.  Nothing that would cause throbing pain at night.  I asked her how her chest felt.  She said if feels fine and that the pain is in her shoulder and at night her shoulder and arm.  I palpated around the deltoid and the deltoid and her acromion process and her entire arm while she lay on her stomach and found nothing painful.  But I did deactivate some trigger points even though they were mild. And thats what I do.  So we finished up and told her to come back in two days and we will see how she is doing.When she came back in two days I aked her how she was doing.  She said the same.  Throbing radiating pain at night. I asked her how is it during the day.  She said not as bad but it hurts when she moves her arm.  I said well ok, and had her get on the table and palpated from her hips to the top of her neck.  Again finding a few minor( low pain level) trigger points on the way.  Nothing that would be causing throbing pain at night.  But I eliminated those few trigger points and told her to come back in two days.  She came back in two days reporting no change.  So this is the third visit now.  Again I found a few minor trigger points and told her to re schedual and come back in two days.   At this point Im thinking I cant help her.  But it was stilll bugging me so I reduced the cost of her sessions so she could afford to come back.  She came in for her fourth visit, still no change.  Shoulder hurts with throbing radiating pain down her arm at night.   Again I found a few very minor trigger points on the back of her shoulder.  I asked her a second time how her chest was.. She said its fine.  Doesnt hurt. Im thinking I can't help this person.  So out of desperation I said lets check the front of your body.  I palpated from her abdominal area up.  I found a tender spot between her breasts on the right sternal muscle.  She flinched a little when I  touched it.  I deactivated that... then I palpated right below her right clavicle and she about flew off the table , verbalized and was breathing deeply in pain.  I was startled.  I could tell it really hurt her.  I apolgized and said I was sorry.  She said thats ok.  I didnt realize I was hurting there.  Then I palpated below the clavicle just above her brest when again she had a tremendous withdrawl response.  Her hole upper body lifted off the table and she had to catch her breath.   I gently begain working those painful palpatory areas and was able to down grade the level of pain on palpation with more pressure.  I told her to come back in two days.   When she came back in two days I asked her how she was doing.   She said that night after I worked on her it was worse then ever and the next day she was in horrible pain.  I apologized and said I was sorry.  She said oh no thats ok.  I said at least we know the pain is coming from those two tender spots on her chest.  And this would be our last visit and if there was no improvement that she could go to a medical doctor and point out those two very painful spots.  Anyway I again was able to down grade the pain in those areas.   I could press much harder before creating any pain sensations.   And I told her to come back in two days.  She came back in two days and reported that she slept for the first time without pain.. But that the two spots were still very sore on palpation.  I again down graded those TPs even more and told her to come back in two days. That would be her sixth or seventh appointment.  She rescheduled.   I was really excited to see how she was doing the day of her next appointment.  The time came and she was not checked in.. I went to the front desk and was told that she called and canceled.  I got sort of depressed.  I figured that she got worse and decided not to come back.  I thought well at least she knows where her pain is coming from and perhaps the medical docs can help her.  But here is the cool thing..she came in to see me a couple days ago. This is a couple months later.   She scheduled a 50 minute massage.   She told me that after the last session she was completely pain free.  I asked her if I could palpate those two areas.. she said yea.  I did.  To my amazement.. No pain what so ever.. She had a big smile on her face.. So did I.   I went ahead and gave her a good massage.The attachments below show the trigger points involed.  My mistake was to listen to her when she told me her chest was fine.  Could have solved the problem in half the time.  

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Permalink Reply by Gordon J. Wallis on June 10, 2014 at 10:30pm

Not too long ago a client came in with back and neck pain.  I'd seen her a few weeks ago as a new client.  She had a gift certificate and was coming in to enjoy a good massage.  Every new client I show them one of my testimonials.  She was going to go see her chirpractor when she rememberd me.  She injured herself while walking dog some how.  She told me her entire back and neck hurt.  I told her that I would palpate from her hips to the top of her neck for tender spots.  And she is to tell me when I find one.  Then she can turn over and I will do some Cranial Sacral Like work for general neck relaxation( I don't really do Cranial Sacral stuff.  Just a few modified techniques that work).  Interestinly enough all her tender spots where on the right side of her body.  The worst one was on the crest of her hip.  Most likely the QL.  It was a burning pain.  I had to deactivate that twice.   I found another TP on her Erector Sinae around T7ish and a Rhomboid on a an inch or two higher.  I also found a tender lateral spinous at around T11(  I saw around biecause maybe it was T10, doesnt matter).  On her neck I found a very sore spot on her SCM and close to the neck an Occipitofrontalis TP in the back of the head.  I was able to deactivate all those.  At the end of the session I had her preform a Cross Body Distraction Techqnique in order to erase any muscle memory of her pain.  I will see her soon on a follow up.  I will add some attachments.  Oh PS-  I asked her how she felt after the session.  She said WAY BETTER. 

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