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Pain reduction for MVA victims

Hi, I am a massage therapy student and I am preparing for a case study I will be doing over the next year. My study is a survivor of two MVA's and lives in chronic pain from her injuries. My goal is simply to reduce her pain and attempt to improve her ADL's, such as sleeping. I am leaning toward incorporating fascial work into the regime, with alternating treatments. Has anyone found this successful in treating chronic pain?  Any viewpoint is appreciated, as it is all an excellent base for learning or jumping off from.

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Permalink Reply by Erika Han on March 7, 2017 at 1:27pm

We also have few customers repeatedly visiting our spa with chronic headaches.   We provide acupressure massage for about an hour,  mainly concentrating on hot meridian spots at back of head, shoulders and neck area and it results in the temporary relief.  I see your case study great help for many people suffering with pains.   I will keep watching your post to enhance our service.   Thank you.

Permalink Reply by Gordon J. Wallis on March 7, 2017 at 2:05pm

You might want to check for hot meridian spots in the low back hip and sacrum, as well as the abdominal area, especially the right lower quadrant( illiocecal valve ) when dealing with headache pain. Often enough, if working the head neck and shoulders only brings temporary headache relief, the problem is elsewhere.
Eric Ahn said:

We also have few customers repeatedly visiting our spa with chronic headaches.   We provide acupressure massage for about an hour,  mainly concentrating on hot meridian spots at back of head, shoulders and neck area and it results in the temporary relief.  I see your case study great help for many people suffering with pains.   I will keep watching your post to enhance our service.   Thank you.

Attachments:
Permalink Reply by PAM LAWSON on March 7, 2017 at 3:16pm

Thank you for your responses!  My client does have cervical degeneration and lumbar spondylolisthesis. She also had shoulder surgery resulting in a fair amount of scar tissue in her GH area. As a result, she cannot tolerate too much deep work in her head neck and shoulder region. While I plan to address trigger points in the areas she is willing to let me treat, do you feel that easing some of her fascial restrictions may help?  I don't want to get too ambitious yet and of course , I can always modify my treatment plan as I learn more tools of the trade.  I just know this poor woman is in so much pain and gives constantly of herself to others; I want to benefit her as much as I can.



Pueppi Texas said:

Hello,

Congratulations on making it to the point where you are now doing case studies!   :)

I see you are in Canada, so you are probably getting a magnificent massage education.

Not knowing the client's particulars, it's hard to say, but many times, if you have the opportunity to work with the client fairly frequently (1-2x/week), you'll likely be able to help her with pain reduction.   

But, what I highly suggest for chronic pain issues, is to give her the key to helping herself.  She can do this through Somatics. And, it looks like Essential Somatics (http://essentialsomatics.com/fundamentals-hanna-somatic-education-t...) will be hosting a seminar about 2½ hours from your town in June of this year (2017).  I have been searching for a good somatics movement seminar/course for a number of years now, and this is the course I finally decided on.  I was very happy with my decision. 

Here's a thread on that...  (http://www.bodyworkonline.com/forum/viewtopic.php?f=23&t=42931) which is a long thread, because I kept adding updates to the styles of coursework, and also intermittent goodies in the following posts.  The very last post will have the most current movement list.

I hope this helps.  :)

Permalink Reply by Gordon J. Wallis on March 7, 2017 at 4:06pm

I personally can't relate to fascial restrictions myself? Cant relate to the word. So? Can't answer that question. I just look for painful palpatory areas and try to make them go away, no matter if they are fascia restrictions or what. Sometimes working a tender area seemingly unrelated to the pain complaint, helps a great deal.
PAM LAWSON said:

Thank you for your responses!  My client does have cervical degeneration and lumbar spondylolisthesis. She also had shoulder surgery resulting in a fair amount of scar tissue in her GH area. As a result, she cannot tolerate too much deep work in her head neck and shoulder region. While I plan to address trigger points in the areas she is willing to let me treat, do you feel that easing some of her fascial restrictions may help?  I don't want to get too ambitious yet and of course , I can always modify my treatment plan as I learn more tools of the trade.  I just know this poor woman is in so much pain and gives constantly of herself to others; I want to benefit her as much as I can.



Pueppi Texas said:

Hello,

Congratulations on making it to the point where you are now doing case studies!   :)

I see you are in Canada, so you are probably getting a magnificent massage education.

Not knowing the client's particulars, it's hard to say, but many times, if you have the opportunity to work with the client fairly frequently (1-2x/week), you'll likely be able to help her with pain reduction.   

But, what I highly suggest for chronic pain issues, is to give her the key to helping herself.  She can do this through Somatics. And, it looks like Essential Somatics (http://essentialsomatics.com/fundamentals-hanna-somatic-education-t...) will be hosting a seminar about 2½ hours from your town in June of this year (2017).  I have been searching for a good somatics movement seminar/course for a number of years now, and this is the course I finally decided on.  I was very happy with my decision. 

Here's a thread on that...  (http://www.bodyworkonline.com/forum/viewtopic.php?f=23&t=42931) which is a long thread, because I kept adding updates to the styles of coursework, and also intermittent goodies in the following posts.  The very last post will have the most current movement list.

I hope this helps.  :)

Permalink Reply by PAM LAWSON on March 7, 2017 at 4:48pm

I think we are on the same train of thought, Gordon.  Fascial restrictions (as I am learning) are points in the layer of tissue surrounding our muscles and under skin etc that can decrease ROM and cause pain in the body. One study I have read found that cervical flexion affects the deep fascial layer in our gastrocnemius. I am intrigued by the possibility that this may help my case study. 

Permalink Reply by Gordon J. Wallis on March 7, 2017 at 5:30pm

Take a close look at the diagrams in the attachment. Can you see a connection between the lower legs and the neck? It is possible to work the area of complaint and get long lasting results. But there are connections. And often times they are very important for a long term resolution to the pain problem.
PAM LAWSON said:

I think we are on the same train of thought, Gordon.  Fascial restrictions (as I am learning) are points in the layer of tissue surrounding our muscles and under skin etc that can decrease ROM and cause pain in the body. One study I have read found that cervical flexion affects the deep fascial layer in our gastrocnemius. I am intrigued by the possibility that this may help my case study. 

Attachments:
Permalink Reply by Gordon J. Wallis on March 7, 2017 at 10:13pm

As you can see by looking at the attachments the arms as well as the lateral body can also effective the neck and the headache. Treating the area of pain may give temporary relief, but really, for any pain problem, the body needs to be looked at in total, as one integrated unit if you want better longer more permanent results. Pueppi s suggestion about Starting out out with a Swedish massage for your client case study maybe your best starting approach.
Gordon J. Wallis said:

You might want to check for hot meridian spots in the low back hip and sacrum, as well as the abdominal area, especially the right lower quadrant( illiocecal valve ) when dealing with headache pain. Often enough, if working the head neck and shoulders only brings temporary headache relief, the problem is elsewhere.
Eric Ahn said:

We also have few customers repeatedly visiting our spa with chronic headaches.   We provide acupressure massage for about an hour,  mainly concentrating on hot meridian spots at back of head, shoulders and neck area and it results in the temporary relief.  I see your case study great help for many people suffering with pains.   I will keep watching your post to enhance our service.   Thank you.

Attachments:
Permalink Reply by PAM LAWSON on March 8, 2017 at 6:40pm

Thanks, Pueppi.  I am nearing the end of my first year of study.  I can provide a great Swedish relaxation massage , but have also learned some "advanced" techniques, including fascial release, joint mobilizations, trigger point release, and others. My tool belt while a beginner, is growing every day, and I am not afraid to use hem. We have not yet learned specific assessments or many specific pathologies, however, I have access to my client's health records so know her conditions.

The context of our case study is to create a treatment plan, focusing on a specific outcome, so that we can see the process start to finish. I will see her 10 times in the course of the case study, which will be about 4-5 months.  I am thinking weekly for the first 4-6 treatments and then space them so that I can take advantage of any further techniques learned in later terms. Our school tries to show us the importance of evidence based treatments.  I agree with the deep Swedish massage and plan to include relaxation as a part of my treatment plan, as my client is in a high stress lifestyle.  I was thinking to alternate upper and lower body fascial work in my treatments as my technique. There are many ROM issues to address.

We treat client's in the school's clinic for three hours a week(60 minutes) and also take part in outreach programs within the community ranging from hospice and MS clients to major sporting events, like marathons and cycling championships .  My client is very invested in this opportunity so I am quite comfortable in creating a long term plan.

I greatly appreciate your time, everyone!

Permalink Reply by PAM LAWSON on March 14, 2017 at 8:25pm

No worries! I really appreciate you taking the time to respond.  This case study is taking place within the time constraints of school's clinic setting so the 45 minute option sounds like a workable solution for me.  As part of our schooling, we are trying build a knowledge of specific techniques, and as we research there is a definite lack of information relating to massage techniques and outcomes.  I have seen my client once more and the upper and lower body massage will not work, as it beyond her comfort level. So I have changed my strategy and will be working on her back and neck. Fascia will be part of it, but I will mainly provide GSM and try to release trigger points that she has.  It is a little daunting I admit, but I believe I will see results. 

Pueppi Texas said:

When I provide this answer, please know that I am not discounting your idea!  Every therapist is different, and we all have different strengths.  So, this is a great way to find how things work for you.  How I work caters to my strengths and limits my weaknesses.  Mine are likely different than yours.  ;)

I find in my own practice, that if I have someone who needs both upper and lower body work, it is extremely rare that I alternate upper and lower body work between each session. I tend to do one of the following when someone presents with that need:

  • Full body sessions with some extra time in the upper and lower body regions that are most problematic.

    or

  • 45 min. concentration on one or two areas in the same region (skimming the rest of the body to make it feel like a full body session, even though it is not near as thorough in the rest of the body areas).  Once I begin to see improvement in the regional areas I was concentrating on, then I may begin to concentrate on a new zone (but always leaving time to get back to the original regions I began with, until those become non-problematic).


    And, as for ROM, I have a tendency to leave it out until I have made some headway with major muscular issues.
     


Again, my way is just one of many, it is only presented here to give you some other ideas.  Please don't forget to update us on how your client is doing!  :)

Permalink Reply by Gordon J. Wallis on March 16, 2017 at 12:47pm
I'm not sure if this is your case. But, if I have a client that is very sensitive and in pain, I want to calm down that sensitivity as much as possible before I begin using firmer or deeper pressure. If one side of the body is in more pain then the other that helps.
What you do is utilize the Gate Theory of Pain by stimulating the various mechanoreceptors in the skin. I usually do this through the sheet. Pick one side of her back. If one side is less painful then the other pick that. What you do is lightly caress that side of her back from her Sacrum to shoulder for a half hour. I usually sit down , with the lights down low and in the quiet. After that, they can usually take a firmer touch.
The light tactile sensations actually down grade the pain signals reaching the brain. Anyway, it's an idea. Check the attachment out.
Attachments:
Permalink Reply by PAM LAWSON on March 17, 2017 at 6:40pm

Thank you Gordon! That is, in fact, the case, and it is something I have been trying to work out.  I will try something similar in our next session and see how she likes it. 



Gordon J. Wallis said:

I'm not sure if this is your case. But, if I have a client that is very sensitive and in pain, I want to calm down that sensitivity as much as possible before I begin using firmer or deeper pressure. If one side of the body is in more pain then the other that helps.
What you do is utilize the Gate Theory of Pain by stimulating the various mechanoreceptors in the skin. I usually do this through the sheet. Pick one side of her back. If one side is less painful then the other pick that. What you do is lightly caress that side of her back from her Sacrum to shoulder for a half hour. I usually sit down , with the lights down low and in the quiet. After that, they can usually take a firmer touch.
The light tactile sensations actually down grade the pain signals reaching the brain. Anyway, it's an idea. Check the attachment out.

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