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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 January 15, 2017 at 11:33pm
Had a couple of interesting clients the other day. Both, like everyone else, came into the spa expecting nice relaxation massages. After speaking to them briefly before their massages, I found out both had medium to long term pain problems. One was a young women, the other a more mature women. After another brief conversation, both gave me permission to focus all my attention on eliminating those pain problems.
I will start with the younger women. She told me that she has chronic left low back pain. She has had that for several years. She had gone through a series of massages in the past and that helped, but did not totally resolve the problem. Also, I don't think I've mentioned this before? But every time I have a young female client, I nearly always ask if they have painful periods( dysmenorrhea ), especially when low back pain is involved. And a surprisingly high percentage of them say yes. Ok so...she has chronic left low back pain and suffers with painful periods. Here is what I found. To my surprise I found no trigger points in her lumbar muscles on either side. So I figured referred pain. That's most likely the hips, and in her case the left hip. And sure enough, she had some. Two Gluteus medius trigger points, a PSIS trigger point. Actually I think what I call a PSIS trigger point( because of its location) is actually another Gluteus medius trigger point. Anyway, so she had three of those. She also had two Piriformis trigger points. One where it connects to the sacrum, the other in the belly of the muscle. Anyway all those trigger points deactivated. Also, to my surprise, she had several very noticeable trigger points in her upper T spine between her shoulder blades, as well as one on the right neck at about the C5 level. Anyway all those trigger points deactivated. Remember her other problem was painful periods. So when she turned over I palpated her abdominal wall. Usually yong women that suffer that problem have tender points around their belly buttons. Those tender points don't create the painful periods, but they exasperate the symptoms. Anyway I found a very painful point just above the pubic bone( the Pyramidalis muscle ). That tender point deactivated. I spent the rest of the time massaging her feet and head. She walked out of the spa pain free. I told her it's best if she schedules a short follow up session and not to work out, stretch or test the areas. Just chill and eat high protein meals. Protein is needed to repair damaged muscle tissue. And that's what trigger points are on a cellular level. Damaged muscle tissue. I tell the same thing to all my trigger point people. Anyway, that was cool.
Now for the mature women. A couple months ago she had taken a rather severe fall while walking her dog. She stumbled on a crack in the sidewalk and fell on her right side, actually hitting her face. She sustained a slight hairline fracture in her skull. She also had bruising on the right side of her body. The bruising has gone, but ever sense she has had severe pain on the right side of her body that radiates from her lower shoulder blade to her arm pit. It's excruciating in the mornings. She went to the medical docs and got imaging done. They found nothing and told her that she brushed her muscles. Here is what I found. A mild trigger point just below the inferior angle of the shoulder blade as well as another mild trigger point on the Infraspinatus. The big nasty trigger point that was causing all the symtoms was on the Serratus anterior just below her arm pit. Also, kinda surprising to me, but not really, was very tender right spinouses at both T4 and T5. Both of those spinal segments inervate the Serratus trigger point area. She had no trigger points on the rest of her body. All those trigger points vanished. She got up off the table 90% pain free. She was very happy, and said she was definitely coming back for a follow up. That was cool. In the attachments I will post a couple muscles involved with those clients.
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Permalink Reply by Gordon J. Wallis on January 16, 2017 at 12:09am
Just thinking now. And this is interesting. The young lady in the above paragraph had a C5 trigger point on the right side. The C5 spinal segment has a special relationship to L1 spinal segment. They move in a synchronized manner during walking. L1 is the spinal segment that inervates the Pyramidalis muscle that was trigger pointed. That's why it's wise to check out the entire body for any pain problem. Because there can be wide spread connections through out the entire body even for seemingly specific localized pain. Check the attachments.
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Permalink Reply by Gordon J. Wallis on January 18, 2017 at 12:16pm
This is interesting. Not sure but pretty sure. A new client came in the other day. She was 60 years old, and never had a massage in her life. After briefly talking to her I found out she is a migrainer. She has been suffering with headaches sense her 20s. I asked how often she gets her headaches? She told me often, about two times a week. I asked her if she had a headache now? She said that she had a bad one today, but didn't want it to ruin her massage, so she took her pain medicine. I didn't ask her the name of the medicine. I asked, when you take this medication your headache goes away? She said yes. She told me that she sees a neurologist. I asked her what the neurologist does for her. She said prescribes medication. I asked her where she feels her headache when she has one. She told me that 90% of the time only on the left side of her head. And that the worst part is at the left base of her skull( occipital area ). She commented that she always digs in there and it hurts. I asked her if the neurologist ever touched her neck or head ? She said no. I asked her if she ever heard of trigger points? She said no.
Ok, now here is the deal. She is on her medication that stops her chronic headaches. I don't know what the medication does so...? If she came in with the headache I could hunt for trigger points, eliminate them and see if her headache goes away. So anyway I go ahead and begin her massage. I was doing general Massage on her back, with firm but not deep pressure , when she commented " wow that is sore. It was on the inferior angle of the left shoulder blade. I put my thumb there. And talk about twitch response. That was a big trigger point, I usually don't try to feel things, I find that too subjective, but I could feel that. It fluttered under medium to light pressure. She said it was really sore. I deactivated it. I then palpated between her spine and left scapula and found two more trigger points. Not as big and nasty as the first one, but noticible trigger points never the less. I deactivated those. Her levator and traps were fine, but that wasn't the case with the left side of her neck. Trigger points on the transverse processes of C5, C3, and C2. Along with with one on the base of her skull on the right side. All other areas on her back neck and face were fine. Oh, she also had two trigger points in her abdominal area. One in the Upper left quadrant, one on her illiocecal valve on the lower right quadrant. Abdominal trigger points are quite common for those suffering long time pain and headaches. They can indicate internal organ stress. All those trigger points I've mentioned deactivated. Remember she is on this pain medication, so any of those trigger points that show up on medium palpation have to be pretty nasty. I explained to her about trigger points, and emailed her a bunch of info on trigger points. Next time she has a headache she is going to come in and we will see what happens to her headache after I deactivate those trigger points? Let's see....Left side headache, left side trigger points? I think her headache will go away.
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Permalink Reply by Gordon J. Wallis on January 18, 2017 at 12:39pm
Slight mistake. The big bad trigger point that I said was on the inferior angle of the left shoulder blade, was actually on the lower lateral side of the left shoulder blade. A slightly different spot.
Permalink Reply by Gary W Addis, LMT on January 18, 2017 at 2:49pm

yep, with you on the job I think her headaches will shortly be a historical anomaly she will remember but never feel again.

Gordon J. Wallis said:

This is interesting. Not sure but pretty sure. A new client came in the other day. She was 60 years old, and never had a massage in her life. After briefly talking to her I found out she is a migrainer. She has been suffering with headaches sense her 20s. I asked how often she gets her headaches? She told me often, about two times a week. I asked her if she had a headache now? She said that she had a bad one today, but didn't want it to ruin her massage, so she took her pain medicine. I didn't ask her the name of the medicine. I asked, when you take this medication your headache goes away? She said yes. She told me that she sees a neurologist. I asked her what the neurologist does for her. She said prescribes medication. I asked her where she feels her headache when she has one. She told me that 90% of the time only on the left side of her head. And that the worst part is at the left base of her skull( occipital area ). She commented that she always digs in there and it hurts. I asked her if the neurologist ever touched her neck or head ? She said no. I asked her if she ever heard of trigger points? She said no.
Ok, now here is the deal. She is on her medication that stops her chronic headaches. I don't know what the medication does so...? If she came in with the headache I could hunt for trigger points, eliminate them and see if her headache goes away. So anyway I go ahead and begin her massage. I was doing general Massage on her back, with firm but not deep pressure , when she commented " wow that is sore. It was on the inferior angle of the left shoulder blade. I put my thumb there. And talk about twitch response. That was a big trigger point, I usually don't try to feel things, I find that too subjective, but I could feel that. It fluttered under medium to light pressure. She said it was really sore. I deactivated it. I then palpated between her spine and left scapula and found two more trigger points. Not as big and nasty as the first one, but noticible trigger points never the less. I deactivated those. Her levator and traps were fine, but that wasn't the case with the left side of her neck. Trigger points on the transverse processes of C5, C3, and C2. Along with with one on the base of her skull on the right side. All other areas on her back neck and face were fine. Oh, she also had two trigger points in her abdominal area. One in the Upper left quadrant, one on her illiocecal valve on the lower right quadrant. Abdominal trigger points are quite common for those suffering long time pain and headaches. They can indicate internal organ stress. All those trigger points I've mentioned deactivated. Remember she is on this pain medication, so any of those trigger points that show up on medium palpation have to be pretty nasty. I explained to her about trigger points, and emailed her a bunch of info on trigger points. Next time she has a headache she is going to come in and we will see what happens to her headache after I deactivate those trigger points? Let's see....Left side headache, left side trigger points? I think her headache will go away.
Permalink Reply by Gordon J. Wallis on January 18, 2017 at 3:16pm
I have a strong feeling that's the case. Of course you never really know? However, to the extent that those trigger points are contributing to her headaches, they won't any more.

Gary W Addis, LMT said:

yep, with you on the job I think her headaches will shortly be a historical anomaly she will remember but never feel again.

Gordon J. Wallis said:

This is interesting. Not sure but pretty sure. A new client came in the other day. She was 60 years old, and never had a massage in her life. After briefly talking to her I found out she is a migrainer. She has been suffering with headaches sense her 20s. I asked how often she gets her headaches? She told me often, about two times a week. I asked her if she had a headache now? She said that she had a bad one today, but didn't want it to ruin her massage, so she took her pain medicine. I didn't ask her the name of the medicine. I asked, when you take this medication your headache goes away? She said yes. She told me that she sees a neurologist. I asked her what the neurologist does for her. She said prescribes medication. I asked her where she feels her headache when she has one. She told me that 90% of the time only on the left side of her head. And that the worst part is at the left base of her skull( occipital area ). She commented that she always digs in there and it hurts. I asked her if the neurologist ever touched her neck or head ? She said no. I asked her if she ever heard of trigger points? She said no.
Ok, now here is the deal. She is on her medication that stops her chronic headaches. I don't know what the medication does so...? If she came in with the headache I could hunt for trigger points, eliminate them and see if her headache goes away. So anyway I go ahead and begin her massage. I was doing general Massage on her back, with firm but not deep pressure , when she commented " wow that is sore. It was on the inferior angle of the left shoulder blade. I put my thumb there. And talk about twitch response. That was a big trigger point, I usually don't try to feel things, I find that too subjective, but I could feel that. It fluttered under medium to light pressure. She said it was really sore. I deactivated it. I then palpated between her spine and left scapula and found two more trigger points. Not as big and nasty as the first one, but noticible trigger points never the less. I deactivated those. Her levator and traps were fine, but that wasn't the case with the left side of her neck. Trigger points on the transverse processes of C5, C3, and C2. Along with with one on the base of her skull on the right side. All other areas on her back neck and face were fine. Oh, she also had two trigger points in her abdominal area. One in the Upper left quadrant, one on her illiocecal valve on the lower right quadrant. Abdominal trigger points are quite common for those suffering long time pain and headaches. They can indicate internal organ stress. All those trigger points I've mentioned deactivated. Remember she is on this pain medication, so any of those trigger points that show up on medium palpation have to be pretty nasty. I explained to her about trigger points, and emailed her a bunch of info on trigger points. Next time she has a headache she is going to come in and we will see what happens to her headache after I deactivate those trigger points? Let's see....Left side headache, left side trigger points? I think her headache will go away.
Permalink Reply by Gary W Addis, LMT on January 18, 2017 at 3:24pm

my stepdaughter suffered with migraines from early childhood.  So bad, she'd be shut up in her room for 1 sometimes 3 days Drugs were a temporary help, but never completely eliminated the pain.  In her early thirties, I learned how to work trigger points and before long became quite good at treating headaches of all kinds.  Several times I stopped a migraine in its tracks-- easier if I caught it as it began, before she tensed up and made it worse.  Now, eventually the headaches flared up again.  (I think something to do with nerves to her eyes... or the nerve train from a spinal issue in L3-L5).  But everytime, a few minutes of TP treatment stopped them cold.   

After family illness caused me to move away from her, for relief she had no choice but undergo operations for the spine.  Three operations later, she has an implant beneath the skin, electrodes attached to the nerves.  The back no longer hurts often, and when it does, she presses a button on her remote control, and her built in TENS unit deadens the pain by overloading the nociceptive pain circuit with barely noticeable sensory tingling. 

But this hasn't stopped her from getting migraines.  On a visit to her MI home for Thanksgiving, she got one, and in five minutes I made it go away with the TP therapy skills you helped me develop. 

Who the hell knows what causes migraines to flare up, why some get them and most people don't.  I've relieved the pain (albeit temporarily) of every migraine headache I've encountered.  TPs may or may not be the origin of the migraine, but releasing the TPs does temporarily end the pain.

Permalink Reply by Gordon J. Wallis on January 18, 2017 at 3:52pm
Well here is the deal. Real migraines, you might be able to temporarily stop or dissipate, but never cure. However, in this ladies case. I don't think she suffers from true migrain headaches.. She had none of the migrain symptoms. Nausea, having to avoid light and so on. Just pain in her upper neck that radiates over the left side of her head. in her case, it's trigger points. She has never had soft tissue work. I'd bet my left arm on it. Those trigger points were big and bad. There is a very good chance that if I treat her four or five times those trigger points will go away along with her chronic headaches. I've worked on migrain people before. She was different. Hopefully she will come back, and we will find out.
Permalink Reply by Gordon J. Wallis on January 19, 2017 at 2:23pm
Continiuing with the migrain client I talked about in the above entries. I emailed her a lot of information on trigger points along with testimonials from other chronic pain clients that I have been able to help. She emailed me back and is very excited about her next session. I told her that I could help her. I said that based on a lot of experience, and I do have great confidence in my skill set. But do I really know for sure that I can help her? I'm pretty sure I can, but the answer is no. I took the time to send her a lot of information on trigger points , and testimonials in order to end her CATASTROPHIZING and get the PLACEBO EFFECT on my side. And I accomplished that. Now I have even more confidence I can help her. I dont mean to give false hope, or lead people on. But the mind is a powerful thing when it comes to healing. And I need that on my side if there is any chance of helping her out of this long term pain problem. It's kinda like swimming down stream as opposed to up stream. If I fail, I fail fast. Probably know within four sessions. If I do, I will refer out. I will be working with an anesthesiologist, a pain management doc, in a couple weeks. I also know a chiropractor that has a very different and unusual technique that may be able to help her. But she's got trigger points. That's my thing. The attachments fit with my thinking. I got them from a book I have on pain.
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Permalink Reply by Gordon J. Wallis on January 19, 2017 at 11:33pm
Massage therapists think differently then chiropractors when it comes to anylyzing patient/client conditions. Chiropractors are considered 1st tier providers. Massage therapist aren't. Because of our education system , schooling, continuing education system and so on, massage therapists are trapped, with few exceptions, into a very limited way of thinking. Trapped into the massage box. I've found it very helpful to think outside the massage box. Especially when you consider the fact that MUSCLES move BONES.
I've mentioned several times on this thread about the neck low back relationship and its implications. For instance say a client suffers from headaches. And you discover a painful Massiter muscle. The Massiter muscle is partially inervated by the C2 spinal segment. That spinal segment has a relationship to the L4 spinal segment. And the L4 spinal segment just doesn't mean possible low back problems. L4 controls a good portion of the lower leg and foot from the knee down. There are possible full body implications to a trigger pointed Massiter muscle. Now Myofascial release, Deep tissue massage and all the other modalities we study as massage therapists are all fine and good, and we can help a lot of people. But when you start thinking outside the massage box, you add another demention to your abilities. You can think outside the massage box and still stay with your license. After a all....MUSCLES move BONES. I'm not telling anyone what or how to do things. I'm just telling how I think.
The attachments and link can get you thinking just outside the edge of the massage box and perhaps just inside the border of the chiropractic box? http://blog.wellnesstips.ca/blog/?p=198
Attachments:
Permalink Reply by Gordon J. Wallis on January 19, 2017 at 11:51pm
The massage box intersects with the chiropractic box in this AMTA article. http://www.amtamassage.org/uploads/cms/documents/st_john_advances_i...
Permalink Reply by Gary W Addis, LMT on January 20, 2017 at 2:18pm

great article, brother.

Gordon J. Wallis said:

Massage therapists think differently then chiropractors when it comes to anylyzing patient/client conditions. Chiropractors are considered 1st tier providers. Massage therapist aren't. Because of our education system , schooling, continuing education system and so on, massage therapists are trapped, with few exceptions, into a very limited way of thinking. Trapped into the massage box. I've found it very helpful to think outside the massage box. Especially when you consider the fact that MUSCLES move BONES.
I've mentioned several times on this thread about the neck low back relationship and its implications. For instance say a client suffers from headaches. And you discover a painful Massiter muscle. The Massiter muscle is partially inervated by the C2 spinal segment. That spinal segment has a relationship to the L4 spinal segment. And the L4 spinal segment just doesn't mean possible low back problems. L4 controls a good portion of the lower leg and foot from the knee down. There are possible full body implications to a trigger pointed Massiter muscle. Now Myofascial release, Deep tissue massage and all the other modalities we study as massage therapists are all fine and good, and we can help a lot of people. But when you start thinking outside the massage box, you add another demention to your abilities. You can think outside the massage box and still stay with your license. After a all....MUSCLES move BONES. I'm not telling anyone what or how to do things. I'm just telling how I think.
The attachments and link can get you thinking just outside the edge of the massage box and perhaps just inside the border of the chiropractic box? http://blog.wellnesstips.ca/blog/?p=198

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