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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: 7220
Replies to This Discussion
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Permalink Reply by Boris Prilutsky on
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Hi Daniel.
I would like to apologize for me previously asking you not to follow after Vlad/Christopher attempt to distract important clinical discussion and especially that I have offered video footage that actually should be the subject of discussion. In any case today I had the opportunity to read again your post and must to admit that you offered very good points at your post, and didn't follow distractions attempt. Again my apologies. On the other hand at this time this Vlad’s/Christopher attempt to distract was positive.
at least we could learn importance of reference at the time to know (examples with pharmaceuticals recalls) that sometime reference is not really reliable. We also all had have an opportunity to learn importance of clinical data that one proposing. I mean I asked Vlad simple questions ,and if one knows answer one will consider power of proposed techniques. Most in my practice I am utilizing scientifically developed and clinically proven methodology but never would question obvious things like energy work
in case of apricot and no matter if science cannot explain this phenomenon.
I hope that I clear up my previous post to you, as well I hope that you understand my good intentions. Up front thank you.
Best wishes.
Boris
Daniel Cohen said:
If we based doing something for apparent positive results on scientific evidence, it is likely the human race would have perished thousands of years ago waiting for remedies.
I see at least every other day someone who benefits from abdominal massage. Many have been medically diagnosed and others have not. Based on diagnosis by Physicians I can say that abdominal massage does help with the above conditions even when medications failed and surgery was recommended. In fact many more conditions could be listed. Causes of illness are often up to debate because it is theory. I choose not to debate theories. I am too busy helping people get well based on traditional healing theories.
I realize that the evidence base group does not like statements of theory presented as fact. But this seems to be a case of shooting the messenger when the message has value but is not worded specifically enough. Can't we get beyond the days when we had to be so careful how we stated what we do because one slip up resulted in revoking a license. We still have to be careful how we caused a spine to release because many state boards protect Chiropractors from losing business to us.
It would be nice if this was just about sharing methodology that has benefit rather than turf wars and business.
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Permalink Reply by Gary W Addis, LMT on
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Thank you, Boris.
Boris Prilutsky said:
Hi Gary.As you described symptoms, it looks like neurological picture(ASM syndrome possible), but also cardio diseases can produce the same symptoms. Differential diagnosis by qualified MD must.I believe that primary care physician could be good for it. In regards of :"feels faint when the arm is hanging".it could be just anxiety but also some heart insufficiency. In any case he must see Dr. first.
sooner is better.in some cases like this and especially when left arm involved ER should be option. after Dr. will excluded
heart dysfunction or else this is our case.
hope I was helpfulBest wishes.BorisGary W Addis said:An unrelated question. A friend who lives in another city reports that when arm is hanging down from the shoulder, he loses pulse and gets feeling of numbness in it; it is relieved somewhat when arm is held horizontal; lifted overhead, the symptoms return to a lesser degree.
Is this TOS and if so, where is the compression likely to be? Could it be CVD, even tho not affecting leg circulation at all?
= Gary
PS: today the friend reports that he sometimes feels faint when the arm is hanging. My instinct was to advise him to visit a cardiovascular guy, that to my knowledge TOS wouldn't cause lightheadeness way up high above the brachial plexus Am I correct in that assumption?
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Initial evaluation is a “must do “ step for successful treatment outcomes.
By Boris Prilutsky.
Some of us believe that ”techniques“ are the more important component for successful outcome of treatment. Some of us also believe that vigorous pressure is the way to achieve results. There are many other opinions on what is the most important component for successful treatment. Certainly, I have my opinion as well.
- Yes, techniques play important role for successful outcome
- NO vigorous pressure, shouldn't be applied, and can result in injury,
- A sense of touch, including incorporation of energy work, would contribute to successful results
- An understanding of what we are doing with our hands is important contributor for successful treatment.
In order to put the success ”puzzle” together, first of all, a therapist has to conduct an initial evaluation. An initial evaluation allows us to create a correct strategy and treatment plan. Always, before starting initial evaluation, as a part of this process, we have to request our clients to fill out questionnaire. If you will have interest to view questionnaire that I offer to my clients, please visit www.medicalmassage-edu.com and then click on “free video clips.”
At the top of the page you would find a link to questionnaire, which you welcome to download for personal use.
The link below is to the video, where I am extending on initial evaluation procedure. I hope it will be helpful .
http://www.youtube.com/watch?v=DWi841wtOgE
If you would have any questions please feel free to post it as a YouTube comment. I will try to answer it in the front of a camera, in such a case it will be much more effective.
Best wishes.
Boris
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Permalink Reply by Dr. Ross Turchaninov on
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Hi everyone
We observed so many misunderstanding in regard to trigger points and trigger point therapy that we decided to address them all at the same time in special article in the new issue of Journal of Massage Science: 'Ischemic Compression: To Be or Not To Be?' We hope that this article will explain a lot of misunderstandings.
Here is link: http://scienceofmassage.com/dnn/som/journal/1110/toc.aspx
Dr. Ross Turchaninov
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Doc, the link above takes one to an August exchange in the thread, not to the article. However, when I copied/pasted into browser, it works. So the address as written is correct, but the link is wrong.
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Hi Gary,
Sorry but I think I am less efficient with computers than I thought. Another way is website itself: www.scienceofmassage.com and click on Journal of Massage Science
Dr. Ross Tutchaninov
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Dr, I did visit the website and read the new article. Great stuff backed up by extensive research. But the video links within the article failed to run--they loaded but wouldn't run, not for me anyway. Now that could have been the security measures in my computer that blocked me. But not concerned. The article explained itself w/o the videos.
Funny thing...After reading Muscolino's article in this issue of M&B magazine, I decided to contact you, but I procrastinate. In his article, Muscolino states that deep stroking--30 to 60 strokes is the best way to release a TP. Art Riggs agrees with that. But in NMT class my instructor taught the ischemic pressure. On my own I have tried the stroking method (on myself) and could not get a release. Ischemic pressure produces faster and more certain results. On really stubborn TPs, if I can't achieve release, I work elsewhere for a time, then come back to the area; still no result, I try positional release or hold 'n fold (which I am told are pretty much the same thing, though my only instruction in the trchnique is by youtube video clips). Sometimes that gets the release; sometime I have to work the point in other sessions. I use whatever works for the client. It may be my way of using Muscolino's method, but the stroking of TPS (deep or superficial, hard or light, just does not work, for me).
Have you or Boris a video clip on file showing the stroking method?
== Gary
Dr. Ross Turchaninov said:Hi Gary,
Sorry but I think I am less efficient with computers than I thought. Another way is website itself: www.scienceofmassage.com and click on Journal of Massage Science
Dr. Ross Tutchaninov
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Hi Gary
This is great that you are observer. It is foundation for being effective practitioner. As you noticed in the article we pointed out that solution is in the combination of approaches instead of stroking or compression only. Also if you have stubborn trigger points it means only one thing that you deal with mild to moderate irritation of the spinal or peripheral nerve which supplies the muscle which harbor active trigger point. Until nerve under the pressure it doesn't matter what practitioner uses the trigger point re-activates. Thus the only solution is to find the location of peripheral nerve entrapment on the upper (to the existed trigger point) level. When nerve is free the stubborn trigger points will melt away. This critical fact the proponents of local only theory of trigger point origin an treatment failed to understand.
In regard to video. You need to update your Media Player to play videos. If you go to technical support on the front page of www.scienceofmassage.com you will see frequently asked questions. There you will find the link to update Media Player.
Dr. Ross Turchaninov
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Thank you for the response, Doc. I have become a fan.
As I will be a student for about four more months, I cannot charge a fee, so there is seldom a time constraint on my sessions. So, I am free to begin anew as if seeing the body for the first time--with this one difference: every session teaches me something else about this particular body on my table.
If the client complains of issues in a particular area, I prefer to get to it right away. After a thorough warmup of the area (little or no lubrication at this time), I search for hypertonicity and trigger points within the tight tissue. I work proximal to distal, beginning at the spots closest to the spine. Working this way, quite often I find that satellite TPs I discovered during my assessment lower down dissolve without my touching them. If I find a "jumper" nodule, after I work the rest of the body I come back to it, employ a broader tool and MFR pin-and-stretch sweep of the area.
One of my favorite clients is 62 year old male. He is tall, and walks with a forward tilt to his head and thorax, and below, an exaggerated lordotic curl. During my first session with him I found a TP every couple of inches-- great experience for me. Took me five weeks to clear all the TPs and keep them from recurring, but today he called to say he was pain free for the first time in ten years. My friends Gordon, Boris, or Daniel could have brought the client along quicker, I'm sure. But the client is pleased, so I am pleased.
I'll update the video player plugin and try your website again.
= Gary
Dr. Ross Turchaninov said:Hi Gary
This is great that you are observer. It is foundation for being effective practitioner. As you noticed in the article we pointed out that solution is in the combination of approaches instead of stroking or compression only. Also if you have stubborn trigger points it means only one thing that you deal with mild to moderate irritation of the spinal or peripheral nerve which supplies the muscle which harbor active trigger point. Until nerve under the pressure it doesn't matter what practitioner uses the trigger point re-activates. Thus the only solution is to find the location of peripheral nerve entrapment on the upper (to the existed trigger point) level. When nerve is free the stubborn trigger points will melt away. This critical fact the proponents of local only theory of trigger point origin an treatment failed to understand.
In regard to video. You need to update your Media Player to play videos. If you go to technical support on the front page of www.scienceofmassage.com you will see frequently asked questions. There you will find the link to update Media Player.
Dr. Ross Turchaninov
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Permalink Reply by Gordon J. Wallis on
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Awesome Gary..You changed that mans life... You are not even out of school yet, and you have the ability to dramatically rid someone of nagging pain..And you are not even sure if you were doing it efficiently.. lol Trust me, there are a lot of experienced health care providers that couldn't of helped that man as efficiently or as effectively as you... We have a High Art.
Gary W Addis said:
Thank you for the response, Doc. I have become a fan.
As I will be a student for about four more months, I cannot charge a fee, so there is seldom a time constraint on my sessions. So, I am free to begin anew as if seeing the body for the first time--with this one difference: every session teaches me something else about this particular body on my table.
If the client complains of issues in a particular area, I prefer to get to it right away. After a thorough warmup of the area (little or no lubrication at this time), I search for hypertonicity and trigger points within the tight tissue. I work proximal to distal, beginning at the spots closest to the spine. Working this way, quite often I find that satellite TPs I discovered during my assessment lower down dissolve without my touching them. If I find a "jumper" nodule, after I work the rest of the body I come back to it, employ a broader tool and MFR pin-and-stretch sweep of the area.
One of my favorite clients is 62 year old male. He is tall, and walks with a forward tilt to his head and thorax, and below, an exaggerated lordotic curl. During my first session with him I found a TP every couple of inches-- great experience for me. Took me five weeks to clear all the TPs and keep them from recurring, but today he called to say he was pain free for the first time in ten years. My friends Gordon, Boris, or Daniel could have brought the client along quicker, I'm sure. But the client is pleased, so I am pleased.
I'll update the video player plugin and try your website again.
= Gary
Dr. Ross Turchaninov said:Hi Gary
This is great that you are observer. It is foundation for being effective practitioner. As you noticed in the article we pointed out that solution is in the combination of approaches instead of stroking or compression only. Also if you have stubborn trigger points it means only one thing that you deal with mild to moderate irritation of the spinal or peripheral nerve which supplies the muscle which harbor active trigger point. Until nerve under the pressure it doesn't matter what practitioner uses the trigger point re-activates. Thus the only solution is to find the location of peripheral nerve entrapment on the upper (to the existed trigger point) level. When nerve is free the stubborn trigger points will melt away. This critical fact the proponents of local only theory of trigger point origin an treatment failed to understand.
In regard to video. You need to update your Media Player to play videos. If you go to technical support on the front page of www.scienceofmassage.com you will see frequently asked questions. There you will find the link to update Media Player.
Dr. Ross Turchaninov
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I don't think there is any one method that works best for everyone. We are all so very different-- heck, even the patterns our hair grows in are as different as fingerprints. Most important lesson I have learned-- and it can't be found in a book or CD-- is to attune the inner ear to to the tissue. It can be quite vocal, can't it? :)
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Hi Gary.
Absolutely right, there is no silver bullet in our fields and inner ear/professional intuition is an important and useful tool . And as Dr. Ross said:” This is great that you are observer. It is foundation for being effective practitioner.” As well it is possible like Gordon said:” Trust me, there are a lot of experienced health care providers that couldn't of helped that man as efficiently or as effectively as you”. And there is no guarantee that I would be able to help your client quicker than you did. Honestly I like all this discussion because of practical outcome is absolutely obvious. Even if only you got some good understanding / foundations in regards of trigger points and trigger points therapy, I'm feeling very good. Of course possible that many other members also got benefits from our effort, they just not posting like you did.BTW. Thank you for doing so.
Best wishes
Boris.
PS I'm glad that you become Dr.Ross’ follower, can assure you you'll never regret it but opposite. He knows a lot, but also practitioner, who practice daily methodologies that he teaching.
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