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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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Replies to This Discussion
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Permalink Reply by Gary W Addis, LMT on
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this a good article too!
Gordon J. Wallis said:The massage box intersects with the chiropractic box in this AMTA article. http://www.amtamassage.org/uploads/cms/documents/st_john_advances_i...
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Permalink Reply by Gordon J. Wallis on
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This I thought was interesting. A guy came in with minor yet nagging neck pain when he turns his head to the left or right, but it's worse when he turns to the left. It's been like that for a couple months. He is fit and works out a lot, and it started from some kind of minor workout strain. He told me that he got a massage last week and it seemed to help. So he is getting another one. I asked him if he had any other aches n pains. He told me that he herniated a disc in his lumbar spine two years ago, but it has sense healed. But every once in a while he has a weak kind of a weird feeling in that area.
Like I have mentioned before, often times when there is a problem in the low back there is an imbalance or problem in the neck as well, and vice verse. After showing him one of my video clips and telling him that I will soon be working with an anesthesiologist, he got excited and told me to do the trigger point thing. He wanted to get ride of this neck pain once and for all. It's interesting, percentage and efficiency wise, I'm getting much better and quicker results when I tell them that I will soon be working with an anesthesiologist. Placebo effect and expectation really help. Now he had what I call PAIN ON MOTION. The way I have learned to work on things as a massage therapist. There are three kinds of pain. There is the INCOMING COMLAINT PAIN( my low back hurts, my shoulder hurts, or I have a headache, and so on). Then there is PALPATORY PAIN( trigger points). Then there is PAIN ON MOTION( it hurts when I do this). What I wanna do is get ride of the incoming complaint pain. Often times if I get ride of the palpatory pain(trigger points), I will get rid of the incoming complaint pain. But sometimes that won't work with pain on motion. I have to treat that differently.
Anyway I palpated this guy from his hips up to the occipital area of his neck. I found only one trigger point on the right lateral spinous of T1. It was very noticeable to him. I also found a weird uncomfortable feeling in his left low back area when the palm of my hand pressed down partially on his iliac crest and low back musculature. I did a release for his low back and that weird uncomfortable feeling went away. He said he could feel his back very much relaxed. I had to release his T1 right lateral spinous twice during the session. He had an 80 minute massage.
After the massage, (I allowed a few minutes time) I had him sit up and turn his head both to the left and right to see if there was any improvement in his condition( INCOMING COMPLAINT PAIN). He said it was much better. No pain at all when he turns to the right, and only the slightest pain at the very end of his range of motion when he turns to the left. So what I did was a release for the posterior neck and upper T spine. I held that release as he tuned his head to the left. When he did that, there was no pain at all when he turned his head to the left. I had him repeat that movement as I held the release 8 times in order to reset his muscle memory. After that I had him turn his head to the left on his own. And there was no pain. He gave out a chuckle, and said " That was cool." In the attachment is a diagram of the kind of trigger point that was on the right lateral spinous of his T1 vertabrae. - Attachments:
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The traffic runs in spurts. Look at the counts. This thread has been read, and commented to about a gazillion times since Gordon Wallis began it. But it, like all Forum posts, are open to all who wish to comment or ask questions.
Welcome to the forums
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There is only a small handful of people that ever comment in here, on any thread. Personally, writing in here helps me think on things and process my work. Also I think I have a different perspective on things that maybe helpful to other therapists, sense I haven't been locked into the parameters of the massage therapy continuing education box, until now, for over 30 years.
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Lynne, nice to have you in the forums. I've been commenting in here for a few years. The educators you mentioned are the massage therapy continuing education box.
Alaska is now a licensed state. Now I'm forced to learn within the box. Prior to now, I practiced in Hawaii for ten years or so. They never required continuing education to maintain my license. When I was in New Zealand for two years, they didn't either. And for the twenty years I've practiced here in Alaska, continuing education was never required until recently. I studied what I wanted with no parameters. But now I'm forced to spend money on stuff I'm really not interested in or don't need. There are some really good books on Amazon dot com that I'd rather spend my money on. Continuing education sounds good. And it is for new therapists. But it's limiting, and controlling. Weather it's meant to be or not. It's kinda like seeing the world though the eyes of one religion or political party. I know I might sound a bit weird and radical to most people. And I know learning never stops, but my money is precious, and there is very little within that massage box that I wanna spend my money on. But, like I said, for thirty years I could study what I wanted, and as such, it's given me a unique perspective on things. Which is cool.
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Ah, Lynne, Gordon and I and a few thousand other advanced MTs who understand the connections between muscle and nerve and bone ARE science-based therapists. Although watching Gordon Wallis in action in one of his youtube videos, it loks quite magical, it is not magic, it is not relying on the hovering hands of TCM or the lasers of pseudo-science, Gordon Wallis' advanced techniques are based on intensive study of the human body.
Whitney Lowe, Til Luchau, Ruth Werner, Ben Benjamin et alial all accept the reality of trigger points as a primary cause of myofascial pain; in their training videos, while palpating the client on the table each of the named has encountered and commented on the presence of a TrP. I'm assuming I don't need to provide you with a definition of the term trigger points. If you don't understand the nature of trigger points, I suggest you research before passing judgment.
Before you remind me, it's true that the named CEU providers don't apply direct pressure on encountered trigger points. One very good reason is that the method taught in 100% of massage therapy schools today is to apply painful compression till the client clenches then hold it till the pain goes away. Seminars and instructional videos would be quite boring and unpopular to their LMT customers if each trigger point encountered were held for up to three minutes. Therefore, when by chance they encounter a TP, they normally ignore it altogether and move along. The reputations of respected CEU providers Lowe, Luchau, Benjamin rely primarily on Structural Integration (which is based on the teachings of Ida Rolf). But, like chiropractic and physical therapy, success for the client using SI usually requires a long course of biweekly treatments extending months.
I submit that there is a better way. The AMA acknowledges that 85+% of all pain is myofascial in origin. Overwhelmingly, the formation of trigger points in muscles and their tendon attachments to aponeuroses and bones are the cause. While the old tried-and-true direct pressure on a trigger point certainly does work, advanced techniques employed by a highly skilled few are far less painful to the client, more effective and less time consuming. These advanced techniques utilize Lovett Reactor and the built-in CNS reflexes of the body. For instance, to release a rhomboid trigger point, I utilize the reciprocal inhibition reflex to release the painful and restrictive trigger point literally in a couple of seconds; for a trigger point in the cervical spine C3, referring to the Lovett Reactor chart, while maintaining pressure on the TP, with my free hand I manipulate in/near vertebra L3.
Useful lengths:
https://api.ning.com/files/3oOh0daNY6NL-W8h9gMbClgtukrZiE0paxrv42Q0...*53wQl55mDVVki2AMOlZc1MoEF3P*7V-Gq6XEi7/IMG_0727.PNG If that link doesn't work google "Lovett Reactor"
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Hmm, I like to think that everything I do is science and evidence based, but it's not.
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Gordon, if you try it several times on different clients and it works, I think it IS evidence based. :-)
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Well evidence based means that it's scientifically vetted with rigorous criteria, control groups and so on. Along the same lines, most of what I do is based on what I deemed from acupuncture charts and books. I don't follow their dogma or reasonings, but I've learned a lot of practical knowledge from those books. But that was because I wasn't looking at those books and charts from a Chinese medicine point of view. What I'm saying about being fortunate not to be trapped in the massage therapy continuing education box, also goes for not being trapped into the acupuncture continuing education box, or any other education box for that matter.
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I don't think either of us waits for an official acceptance from one of the gurus of massage before we experiment with a technique we've discovered that is clearly stated, makes sense to us based on our own experience and logical thinking, and can't possibly cause harm to a client.
Nay, if there is the slightest chance a method MIGHT work for me, I "take it for a test drive". And if it works, helps me relieve a client's pain and restore their ROM, I add it to my repertoire. IOW, I don't require official endorsement. To me, the only evidence that means anything is my success using a modality or technique. I mean, if magazine articles and "studies" galore proclaim a thing to be the bestest massage technique on Earth,...if in my professional opinion after trying it out I deem it useless or potentially harmful to clients, I close that magazine or book and never ever use it again.
Gordon J. Wallis said:Well evidence based means that it's scientifically vetted with rigorous criteria, control groups and so on. Along the same lines, most of what I do is based on what I deemed from acupuncture charts and books. I don't follow their dogma or reasonings, but I've learned a lot of practical knowledge from those books. But that was because I wasn't looking at those books and charts from a Chinese medicine point of view. What I'm saying about being fortunate not to be trapped in the massage therapy continuing education box, also goes for not being trapped into the acupuncture continuing education box, or any other education box for that matter.
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This is interesting. I had a client come in based on another clients referral. This guy has been suffering from low back and right sacrum pain for many years. Tons of physical therapy, acupuncture, chiropractic, and was finally diagnosed with Lumbar Spinal Stinosis by the medical docs and got a laminectomy from Orthopedic surgeon.. All of it to no avail. His pain remains the same. It's worse after he sits for a long time. He still randomly sees physical therapists and even started demonstrating to me the exercises they tell him to do. I made him stop. I reminded him of what he told me, that he is no better off then when all this started, and that those exercises are not stopping his pain.
Before I worked on him, as he was standing before me in his spa robe, I asked him if he felt his pain. He said yes, he always feels it. I got him prone on the table and palpated. This is what I found. A right L4/5 Spialis TP, a right L4/5 Longissimus TP, and a right Piriformis TP. As a side note, when he was describing his low back pain he held his upper right hip. After I released those three trigger points I had him get up , so he could asses how he feels. His answer was. It feels a little bit better. When I here that, I know I'm not really helping any one. So I had him get back on the table. I gave him a back massage, a firm one, then re-checked the trigger points. The L5 Spinalis one was still there. The other two were gone. I released that trigger point again. This time after he got up off the table he was pain free. That was cool. Now if those trigger points can stay away, his problem is over. He is going to have a few more follow ups. And we will see if we can keep those trigger points away? Ya never know? But the fact that he felt no pain after the session, is clinically significant. - Attachments:
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Here is a follow up on the client I just talked about in the above entry. I've seen him three times. He is pain free when he leaves the spa, but it only lasts for 15 minutes. It's one trigger point at L5 , on the right, close to the spinous. The fact that after I eliminate that trigger point, he is pain free for 15 minutes is clinically significant, in my way of thinking. I'm going to be working with an anesthesiologist in a couple months. He does trigger point injections. Hopefully that would kill the trigger point? So I'm going to refer him to the doc. There is usually not a trigger point I can't eliminate once and for all. But just usually.
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