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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 July 26, 2016 at 11:46pm
YToday was a cool day for me. I think I did some of the most advanced soft tissue work on the planet a few hours ago. Of course I don't know that for sure, and I may be deluding myself, but it was for sure some of the coolest investigatory pain relief work I've ever done. I'm excited about it. Because I don't think I could have done this a year ago. And another thing that made it cool was the fact that I did some intense study last night, just randomly, that ended up directly connected to the to the work I ended up doing today.
A new client came in today that was reffered to me by a chiropractor. Now that's an amazing deal in and of itself. I've been working in this spa for 20 years and that's only happened once before. When I went to greet her in the waiting room I could tell by her demeanor that she was not excited. She was some what melancholy, which is not untypical of some one that has been dealing with pain for a while. In her case, three months. She told me that she has always had various aches and pains through out her life, but this time it's really bad and getting worse. Her right hip hurts. The pain is concentrated around her right trochanter. She poked her fingers right on the worst spot and told me it's a stinging pain. It aches at night so bad she can't hardly sleep, especially if she lays on her right side. She told me that she has bulging discs at L2 and L3, and that some times( infrequently )she feels it shoot down the lateral right upper thigh. And her right foot tingles now. It didn't a couple weeks ago. She has been told that it's an obvious pinched nerve because of the bulging discs.
Now I'm thinking. Could be a pinched nerve? But statistically it's most likely trigger points( 85% of the time ). I palpated her right hip as she lay prone on the table. I found one mild Gluteus medius or minimus( probubly minimus because if active it refers pain down the lateral leg). In addition I found two really painful trigger points on two different spots near her Trochanter. The Gall Bladder meridian pretty much runs through those three trigger points. I was able too turn off the both Trochantor trigger points temporarily by manipulating the tissues around Gall Bladder 40. And I turned off the Gluteus minimus trigger point by manipulating the tissues near Gall Bladder 26. I palpated her low back and found no pain points. I did find some pain points on her neck on the left side around C3 and C4. Those areas are related to L2 and L3, which controles most of the right hip. I was able to turn those trigger points off as well. I palpated down her right leg and found no tender points until I got to the bottom of her foot and found a pain point very near Kidney 1. I checked the exact same spot on her left foot and found no tender spot. Remember the tingling in her foot? I was able to turn that trigger point off by manipulating the tissues around Ki 3,4 and 5. At this point I had thought I had solved the whole deal. All those trigger points made sense considering her symptoms. But when she turned over her right hip started hurting again. Not wanting to immediately start poking around on her right hip again I checked out her lower right leg( thinking about her tingling foot). I found two very noticeable tender points on her Tibialis anterior which I was able to turn off by manipulating the tissues around Gall Bladder 38 and 39. Anyway, after releasing all those trigger points her Trochantor ones came back again. And that's ok. Even if the pain points vanish only temporarily, that proves the pain is muscular(trigger points). Any pathology like arthritis or or bulging herniated disc, joint or ligament problem is not going to vanish through soft tissue work( at least in my experience ). But I could see that in order to get her to know that I think I can help her, and because it was bugging me that the Trochantor pain came back, I wanted to try and do something about it. Now the spinal segments that controle the Trochantor are L2 and L3. So as she was laying on her back I reached under her body to massage the tissues in that area. But when I did that the pain in her Trochantor increased. In addition the L2 and L3 area hurt as well. Now when she was prone, when I palpated the L2 and L3 area no pain was elicited anywhere. So position makes a difference when investigating pain. Now I'm thinking. Remember I said I was studying last night? So here is the situation. When she was on her stomach I turned off her Trochantor trigger points. I palpated her low back and there was nothing. When she lays on her back and I palpated her low back( L2,L3 ), both the low back and Trochantor hurt. Hmm.....That ment that L2 and L3 had a lot to do with her pain problem, and they do inervate the hip. And here is the cool part. What inervates L2 and L3 ?
Answer T9 and T10.. That's what I studied last night. Basically what spinal segment inervates what? So with my one hand pressing on her L2 and L3 area, that was initiating pain in both L2, L3 as well as the Trochantor , I manipulated the tissues at T9 and T10 with my free hand, and all the pain vanished, in both the low back and Trochantor. So her main problem was coming from disfunction of the tissues at T9 and T10( maybe). Now when she got off the table she still had some tenderness in her Trochantor. But everything deactivated long enough from my perspective to know that there is a good chance that I can help her. And it deactivated enough for her to reschedule. The minor trigger points on the bottom of her foot and the Glutius minimus as well as the neck I'm not worried about. T9 and T10 may be the key? As well as supine position. I'm not saying I going to cure her. That's my goal. Or that I'm doing the best therapy for her. I just wanted to give you guys an idea how I think. It's different. I'm not just thinking fascia. In the next few attachments will be charts that relate to this post. This attachment is the Bladder meridian. It goes right over the Trochantor.
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Permalink Reply by Gordon J. Wallis on July 26, 2016 at 11:47pm
Remember her tingling foot. In this attachment is the Kidney meridian.
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Permalink Reply by Gordon J. Wallis on July 26, 2016 at 11:49pm
In this attachment is a Dermatome chart.
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Permalink Reply by Gordon J. Wallis on July 26, 2016 at 11:51pm
Ya don't need to crack backs to influence spinal nerves.. Muscles move bones as indicated in the attachment below.
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Permalink Reply by Gordon J. Wallis on July 27, 2016 at 12:20pm
https://m.youtube.com/watch?v=S8eRtJjfktI
My intention about writing in here is to empower massage therapists, our profession. We get paid a fraction of what other types of health care professionals make, yet a lot of them are doing the same thing we do. As far as manual medicine goes it's soft tissue work all the way. Especially when you think about trigger points and all the new stuff about fascia. In the above video a chiropractor demonstrates the effectiveness of Active Release. He knows that his spinal adjustments aren't going to do much for this guys pain problem. Active Release is a soft tissue modality. It was actually invented by a British sports massage therapist. The massage therapist combined Active Isolated Streaching with soft tissue work and called it Soft Tissue Release. It avoids the stretch reflex, which allows it to be highly effective. There are variations of it. Maybe you have heard of Pin and Stretch. Anyway, I've always said the best chiropractors are the ones actively doing soft tissue work. Reason being is because soft tissue work is highly effective in eliminating pain and dysfunction. This type of soft tissue therapy never mentions trigger points. But it physically eliminates them. I'd suggest googling British sports massage therapy/ Soft tissue Release. It's the same thing as Active Release. The original actually. You can get the DVDs at a fraction of the cost that it takes to go through the hoops of Active Release that's run by chiropractors. Our education system is keeping our incomes down. We can do high level effective work. And indeed some of us are.. Watch the video, it's soft tissue work. Here is the link to Soft tissue release. Actually it's smoother then Active Release. That guy invented it. It's good stuff. http://britishsportstherapy.com/
Permalink Reply by Gordon J. Wallis on July 29, 2016 at 1:16am
Every book I have or have had that has anything to do with trigger points or therapeutic massage, stretching and or exercise is part of the therapy. All the physical therapists and chiropractors give take home stretching exercises for their patients to do as part of their therapy. It's just a universally excepted concept.. That's where I am different.. Now for sure excercise and stretching are healthy activities. But I have found that, often times, those very activities are what's perpetuating the pain problem. And what makes it challenging for me is to get pain clients to stop working out and stretching. It's almost university built into the psyche to stretch and workout in some way if you are hurting. They just can't stop doing those things for a couple of weeks in order too see if my therapy is going to help them or not. Im sure that in some cases it might be the best thing. But I have seen it to work in reverse enough times to be very cautious about excercise and stretching when the major problem is trigger points. Now the client I just talked about. The one refered by a chiropractor( I saw her again ) told me that she felt better after her first session with me. I told her then that I recommend not stretching or working out in any way while she goes through these trigger point sessions with me. Because that will often times reactivate the trigger points we erase. So the next day she goes to her yoga class.?. Completely undoing the work we did the first session. She told me that she realized that it was a big mistake when her pain came exactly perfectly back after her yoga class.. ..... I had one guy that was covered with trigger points, but he would never stop working out. After about four sessions I told him why doesn't he just write me a check for a hundred dollars and mail it to me every week? You are wasting your money. I can massage you no problem, but if you want to see if there is a chance for this therapy to work,you have to stop working out for at least a couple weeks. He said that he could not do that. I said ok. He came back one more time and I erased 15 or 20 trigger points, then I never saw him again. The therapy was working I think. But it was impossible to ever know for sure. He was doing these heavy duty brutal workouts. Anyway, I'm not telling anybody what to do in here with whatever therapeutic work you may be doing. This is just how I think and what I do. Like I said... All the trigger point books have stretching as a major part of their therapy..But I back up what I'm saying by the attachment below..
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Permalink Reply by Gordon J. Wallis on August 2, 2016 at 5:33pm
Yet again. A new client came in with the complaint of low back pain that has been getting worse dispite the fact of three weeks of physical therapy twice a week. They had her doing various exercises in order to balance her hips. In addition they gave her exercises to do at home between appointments. Of course they did not check for the presence of trigger points. I did. I found a total of four trigger points. One in each QL where it attaches to the iliac crest. And two in the paraspinals on each side at the L5 level. They all deactivated quickly. She was very surprised not to feel her back pain any more. I told her to stop doing the exercises and not to go to her yoga class until we eliminate those trigger points once and for all. It's like I know top secret information that's hidden in plain sight.
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Permalink Reply by Gary W Addis, LMT on August 2, 2016 at 6:57pm

Grinning.  Must be top secret since so few of PTs, DCs and MDs and our very own MT gurus know anything about them.

Hell, after the Pt treatments her next stop would have been in an operating room

Permalink Reply by Gordon J. Wallis on August 3, 2016 at 5:07am
Yea, it's mind blowing to me after 30 years of doing this. It's like no one knows.. She is not the only one. Amother client today.. Twenty years of upper back pain..She came in for a relaxing massage. A gift certificate thing. Now, think about her perspective? Twenty years of back pain..when I asked her what she needed from the massage today. This is what she said. Just to relax I guess. When they say I guess, there is something else. Anyway, as usual, she had trigger points in all the right places.. I didn't cure her after one massage. But she was blown away. Seriously, 20 years of needless pain. I'm 62 years old.. It's a joke at this point. Gary, I don't agree with everything you say in here.....But what you just said in the above paragraph..... Is the absolute truth..

Gary W Addis, LMT said:

Grinning.  Must be top secret since so few of PTs, DCs and MDs and our very own MT gurus know anything about them.

Hell, after the Pt treatments her next stop would have been in an operating room

Permalink Reply by Gordon J. Wallis on August 4, 2016 at 12:57am
I recently had a breakthrough with a client. I had seen her four times already with no success. She has low right back and right sacrum pain. I had palpated and eliminated several trigger points in the right areas. But as soon as she moved to get off the table the pain would hit her as if I did nothing. This went on for four sessions. She almost canceled her 5th appointment because she felt no improvement in her condition what so ever. She was a bit melancholy when she walked into the room. I had her lay down again on her stomach and started to do my thing, when I realized this is not working. I asked her when she lays still, if anything hurts. She said no. It's when she starts to move that it hurts. I'm thinking ok. This is pain on movement. I was finding and dealing with palpatory pain( trigger points). 90% of the time that's all I have to do to solve the pain problem. She told me that when she lifts or moves her right leg the pain kicks in. She feels it mostly in her right sacrum. So now I'm thinking pain on movement. I had her turn on her back and asked her to bring her right knee up towards her chest. That movement emediatally eliceted the pain. L1 and L2 inervate that part of the body. I positioned my hand in a specific way on the L2 part of her paraspinals then asked her to bring her right knee up towards her chest again. When she did, it did not ellicit the pain. I had her repeat that movement ten times as I held the release in order for her brain to see that she could move that way without pain. I could see a definite smile on her face. When she got up off the table it did not hurt as in the past. It's not over yet. But that was a major breakthrough for her. And I think we are on the right track now. You gotta be like Sherlock Holmes sometimes when dealing with chronic unresolved pain. It took me a while to realize pain on movement. I will be thinking on things. But that was cool.
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Permalink Reply by Gordon J. Wallis on August 9, 2016 at 2:06am
Wow, I've done a lot of good trigger point work sense my last entry in here. I'm literally shocked almost on a daily basis about the nearly total lack of knowledge about trigger points. Here is just one recent example. A women came referred to me because of her chronic back, hip, and leg pain. The pain she feels is in her right hip all the way down into her calf. She mentioned the word sciatica. I asked her how long she has been suffering? She said years. And understandably, I could tell she was depressed. Another thing she told me, and I here this all the time, was one hip is higher then the other. She said it like that explains her problem. Uhm? So obviously she has gone to professional people that diagnose that type of thing. But even though they diagnose or look for that, it does no good as far as bringing a resolution to her pain problem. Another therapist she went too told her that she must have a herniated disk. But no one checks for the presents of trigger points.. They don't even mention the word trigger point.. They see one hip higher then the other... One of the main problems of our profession( my opinion ) is this universal constant obsession with structural imbalance. I could care less and never look for any structural imbalance. I look for the pain in the soft tissue.. Wether it's palpatory pain or pain on movement. A trigger pointed muscle is a shortend muscle. Muscles pull on bones, distorting posture, causing other muscles to pull on bones, causing more trigger points and on and on. Anyway I palpated her from T11 down to her toes, also checking her neck because of its connection to the low back and hips, and leg Inervation . Here is what I found. Three really painful trigger points in her right Quadratus Lumborum. A right mild Gluteus medius trigger point, a mild right Piriformis trigger point, a very painful right Biceps femoris trigger point where it connects at the Glutes, three trigger points in her right Gastrocnemius, as well as one Right posterior neck trigger point at the C4 level. The main ones were the Qudratus Lumborum and Biceps femoris trigger points and to a lesser extent the ones in her Gastrocnemius. Those trigger points totally explain her years of symptoms and pain. She felt noticeably better after her session. She rescheduled. Can I fix her? I think so. The only way I'd fail, is if I can't make those trigger points go away for good. Of course one hip is higher then the other. The whole right back muscle chain is trigger pointed and contracted. That's a structural imbalance.
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Permalink Reply by Gordon J. Wallis on August 12, 2016 at 2:56pm
A follow up on this client. I've eliminated all the trigger points. She no longer has the burning pain down her leg. Yet when she moves her leg it hurts in her lateral hip. All the trigger points are pretty much gone. But unfortunately that's not her total problem. So I'm referring her to a pain specialist. But still. Often times when I eliminate the trigger points, I eliminate the problem. And trigger points are nearly always involved when someone is hurting..

Gordon J. Wallis said:
Wow, I've done a lot of good trigger point work sense my last entry in here. I'm literally shocked almost on a daily basis about the nearly total lack of knowledge about trigger points. Here is just one recent example. A women came referred to me because of her chronic back, hip, and leg pain. The pain she feels is in her right hip all the way down into her calf. She mentioned the word sciatica. I asked her how long she has been suffering? She said years. And understandably, I could tell she was depressed. Another thing she told me, and I here this all the time, was one hip is higher then the other. She said it like that explains her problem. Uhm? So obviously she has gone to professional people that diagnose that type of thing. But even though they diagnose or look for that, it does no good as far as bringing a resolution to her pain problem. Another therapist she went too told her that she must have a herniated disk. But no one checks for the presents of trigger points.. They don't even mention the word trigger point.. They see one hip higher then the other... One of the main problems of our profession( my opinion ) is this universal constant obsession with structural imbalance. I could care less and never look for any structural imbalance. I look for the pain in the soft tissue.. Wether it's palpatory pain or pain on movement. A trigger pointed muscle is a shortend muscle. Muscles pull on bones, distorting posture, causing other muscles to pull on bones, causing more trigger points and on and on. Anyway I palpated her from T11 down to her toes, also checking her neck because of its connection to the low back and hips, and leg Inervation . Here is what I found. Three really painful trigger points in her right Quadratus Lumborum. A right mild Gluteus medius trigger point, a mild right Piriformis trigger point, a very painful right Biceps femoris trigger point where it connects at the Glutes, three trigger points in her right Gastrocnemius, as well as one Right posterior neck trigger point at the C4 level. The main ones were the Qudratus Lumborum and Biceps femoris trigger points and to a lesser extent the ones in her Gastrocnemius. Those trigger points totally explain her years of symptoms and pain. She felt noticeably better after her session. She rescheduled. Can I fix her? I think so. The only way I'd fail, is if I can't make those trigger points go away for good. Of course one hip is higher then the other. The whole right back muscle chain is trigger pointed and contracted. That's a structural imbalance.

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