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Response to "Knot in a muscle' post
Mr. Gordon J. Wallis in his post “Knot in a muscle’ raised very important topic and it seems that members expressed variety of opinions. Considering the importance of the subject I decided to open separate discussion and put everything in the scientific perspective.
There are two types of 'knots' you may experience in your practice.
First is called hypertonus and it is usually associated with active trigger point(s). The correctly used trigger point therapy protocol will be able to completely eliminate this abnormality. The second type of the 'knots' is called myogelosis and it is irreversible degeneration of the muscle fibers you feel like 'marbles' in the tissue.
The core of myogelosis will stay with your clients for the rest of the life if it is already formed. However by itself it is usually painless if there is no direct pressure applied to it. At the same time uncontrolled myogelosis is very painful and responsible for a lot of tension because core is direct cause of the neighboring hypertonuses to form around it. This drives your clients crazy.
By the way incorrectly applied Trigger Point Therapy in the form of senseless application of pressure without finding the Entrance into the Trigger Point, using Compass Technique, Stop and Go Approach etc. is directly responsible for the excessive damage of the muscle fibers in the area of hypertonus and later formation of the myogelosis there.
If readers would like to learn how hypertonus, trigger point and myogelosis form, how to differentiate and diagnose them as well as how to treat them correctly using scientifically sounded protocol of Trigger Point Therapy please read our three part article on Trigger Point Therapy in
March/April: http://scienceofmassage.com/dnn/som/journal/0903/toc.aspx
May/June: http://scienceofmassage.com/dnn/som/journal/0905/toc.aspx
July/August: http://scienceofmassage.com/dnn/som/journal/0907/toc.aspx
2009 issues of Journal of Massage Science. This article will answer ALL of your questions in every detail.
If you read the article and need any clarifications you may post your questions here and I will be happy to answer them.
Sincerely Dr. Ross Turchaninov
Views: 7236
Replies to This Discussion
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Permalink Reply by Gordon J. Wallis on
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Its a very important subject.. Just the other day a client came in wanting only a relaxation massage. I work in a spa...I asked her if she had any aches and pains I should know about...She said she has a rotator cuff injury and is under doctors care, and she may need surgery. I doubted that diagnosis right away..My experience is that more often then not, its a knot...lol She had gone through some grueling physical therapy, that did nothing but cause pain and discomfort...Anyway, I asked her where she felt the pain. She felt it in her left deltoid... I palpated the deltoid, but found no trigger points...She said she felt the pain was deep in her joint..Well maybe,,,but more likely it was referred pain from somewhere near by..She couldn't fully abduct her arm, and I know a trigger point in the infraspinatus muscle refers pain to deltoid area, and would restrict abduction...So preceded to giver her a nice rub down...She had scheduled an hour and a half session... After an hour of good massage. I told her... Ok now we are going to fix your shoulder...She fidgeted a little on the table when I said that...I told her not to worry, it wouldn't hurt. I palpated her infraspinatus,, and sure enough,,,Bingo !!! A big bad trigger point that referred pain to her deltoid.. So I rubbed pressed and worked the trigger point in a way that hurt good.. for maybe a min.. And guess what? When she got up off the table.. All her presenting symptoms were gone...No more pain, and full range of motion established. She is going to come in next week for a follow up session....All the time...I do this everyday,everyday, everyday...Did it twice today already.Im just home for lunch...So in the last two days so far, and Im not finished working today...I have fixed four people that thought they had serious problems that needed surgery. They were all suffering from long term problems...All were fixed in one session...Not trying to brag.. Anybody can do it....Ive studied trigger points sense 1983.... Sorry for any misspelled words.. But if you truly understand trigger points....You can dramatically change lives, almost every day.. You really can. Anyway,.its back to work for me. Dr. Ross, Thank you for seeing the significance of my post. Yours in health, Gordon
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Permalink Reply by Dr. Ross Turchaninov on
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Dear Gordon,
This is what the medical massage therapy is all about. It is extremely simple and very effective. Unfortunately traditional American medicine lost it as an important clinical tool and the patients are on the loosing side especially if unnecessary surgeries performed. Be sure to read article I provided links to. It will make even more effective. Keep doing great work and don't be afraid to challenge already established views.
Dr. Ross Turchaninov
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Permalink Reply by Therese Schwartz on
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Dr. Ross - I don't have time right now to carefully read the articles you posted but a brief scan of the issues caused by MT's using too much pressure has made me even more glad I quit trading with an MT who doesn't like to back off and thinks that pain and bruising is all part of the process. I had a bruise on my arm that lasted 2 1/2 weeks, and that wasn't the most painful thing she did in my last session with her. Now I'm really worried about what she's doing with her clients. I think I'll send her links to these articles and see if she gets it...Thanks!
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Yea, the biggest complaint you hear with clients that didn't like their massage was either it hurt too much, or it was too soft. I think the schools spend too much time teaching useless information , just so students can pass state, national exams...Instead of teaching whats really important. Seems weird to me?
Therese Schwartz said:
Dr. Ross - I don't have time right now to carefully read the articles you posted but a brief scan of the issues caused by MT's using too much pressure has made me even more glad I quit trading with an MT who doesn't like to back off and thinks that pain and bruising is all part of the process. I had a bruise on my arm that lasted 2 1/2 weeks, and that wasn't the most painful thing she did in my last session with her. Now I'm really worried about what she's doing with her clients. I think I'll send her links to these articles and see if she gets it...Thanks!
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Uhm, Just to qualify myself , I also failed to help a couple people with their pain problems during the same time period....So, I don't want to sound like Mr. Perfect.. lol
Dr. Ross Turchaninov said:
Dear Gordon,
This is what the medical massage therapy is all about. It is extremely simple and very effective. Unfortunately traditional American medicine lost it as an important clinical tool and the patients are on the loosing side especially if unnecessary surgeries performed. Be sure to read article I provided links to. It will make even more effective. Keep doing great work and don't be afraid to challenge already established views.
Dr. Ross Turchaninov
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Permalink Reply by Laura Allen on
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Thank you for the articles. I recently gained a client who left their previous therapist, because of the pain the therapist was causing her. She said that every time she asked him to lighten up, his reply was "I can't, because this is what you need."
Just a reminder to us all that the client has the right of refusal, and that includes the option to tell us when we're hurting them. To those superior-minded people who think they are Mr. Perfect (unlike you, Gordon), all I can say is, thank you for the clients--because they'll eventually come to me or someone else who will actually listen to them!
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Gordon, I agree with you. The MT that hurt me sees the massage world as "deep" and "light". She is totally missing the operative idea, which to me is "effective". I don't need lighter pressure like she thinks I do, I need effective therapy. Unfortunately there in no one within an hour of me that can provide what I need. I will keep looking!
Laura, I tell my clients routinely that they are in charge of the pressure, and that it's totally up to them how much they deal with. For many of my clients that depends on the session and I always work with them. My attitude is that I am a facilitator for their healing and it's not my job to "inflict" anything on them.
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Dear Laura
Thank you for the post. Unfortunately you are correct. Yes, excessive pressure during any type of bodywork is the major problem which greatly hurt profession. Countless so called 'deep tissue massage classes' and courses continue to promote this myth. In the correct clinical environment the deep tissue massage means ability of the practitioner is to use as less as possible pressure to reach deep anatomical structure where it is needed.
Dr. Ross Turchaninov
Laura Allen said:
Thank you for the articles. I recently gained a client who left their previous therapist, because of the pain the therapist was causing her. She said that every time she asked him to lighten up, his reply was "I can't, because this is what you need."
Just a reminder to us all that the client has the right of refusal, and that includes the option to tell us when we're hurting them. To those superior-minded people who think they are Mr. Perfect (unlike you, Gordon), all I can say is, thank you for the clients--because they'll eventually come to me or someone else who will actually listen to them!
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Dear Therese
You will do great favor for the clients of your MT by forwarding her links to the article.
Dr Ross Turchaninov
Therese Schwartz said:
Dr. Ross - I don't have time right now to carefully read the articles you posted but a brief scan of the issues caused by MT's using too much pressure has made me even more glad I quit trading with an MT who doesn't like to back off and thinks that pain and bruising is all part of the process. I had a bruise on my arm that lasted 2 1/2 weeks, and that wasn't the most painful thing she did in my last session with her. Now I'm really worried about what she's doing with her clients. I think I'll send her links to these articles and see if she gets it...Thanks!
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Permalink Reply by Boris Prilutsky on
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Hi Dr Ross.
To all what you have said I would like to add that often MTs proposing “diagnosis”: “you having muscle knots “ and “let me help you get rid of it”. Very often this kind of treatment and up with vigorous pressure on so called “muscle knots”. In most cases this “muscle knots “ is a new formations that of course bulging and therefore one can feel it under fingers. Just using the opportunity would like to remind to everyone that this is contraindicated to press against any new formations that of course bulging including but not limited to lipomas, any other tumors, cystic formation etc. let's keep in mind if one will decide to press against mentioned above formations one can cause irreversible as well very significant damages.
Best wishes.
Boris
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Hi Boris,
Thank you for important addition
Ross
Boris Prilutsky said:Hi Dr Ross.
To all what you have said I would like to add that often MTs proposing “diagnosis”: “you having muscle knots “ and “let me help you get rid of it”. Very often this kind of treatment and up with vigorous pressure on so called “muscle knots”. In most cases this “muscle knots “ is a new formations that of course bulging and therefore one can feel it under fingers. Just using the opportunity would like to remind to everyone that this is contraindicated to press against any new formations that of course bulging including but not limited to lipomas, any other tumors, cystic formation etc. let's keep in mind if one will decide to press against mentioned above formations one can cause irreversible as well very significant damages.
Best wishes.
Boris
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Permalink Reply by Stephen Jeffrey on
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Good discussion Dr Ross
I think some MT's that start off in the sports environment allow themselves to become too heavy handed, not waiting for the tissues to melt/invite deeper palpation. Then when transition is required into the remedial or medical environment the MT performs deep tissue work (in sports client mode) that can harm the client and the profession as a whole.
It takes a great deal of time and patience to deliver hands on techniques correctly, PT's, physio's, etc are also delivering techniques incorrectly due to time constraints.
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