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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: 7208
Replies to This Discussion
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Permalink Reply by Dr. Ross Turchaninov on
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I think that sports massage issue is also greatly misunderstood. In the sports medicine world there is no place for deep tissue work as it frequently practiced. As a mater of fact the the real sports massage optimizes athlete's performance through the great speed of strokes and great variety of applied techniques especially kneading. Those who use deep tissue massage and think that they are doing sports massage do more harm. Without knowledge it is very tricky to apply sports massage correctly because it suppose to be very precisely embedded into the fabric of entire athelete's training.
Dr. Ross Turchaninov
Stephen Jeffrey said: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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Permalink Reply by Boris Prilutsky on
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absolutely.no doubt that at the time of pre-event sports massage during this 30 minutes you have particular goals such as to awake vasodillattion reflex, muscular relaxation ,to accelerate venos blood drainage,to free/ activaterelease acetylcholine etc.therefore there is no room and no time for compressions.but in generally speaking, question is what is it deep massage?is it a separate discipline?my view is that any clinical work have to include deep tissue mobilization because we would like and have to stimulate deep layers of tissue too. but does it take vigorous pressure? of course not. In most cases when one applying vigorous pressure one triggering muscular protective constriction reflex,and goes absolutely no deep but traumatizing. and more pressure awakening more protective muscular reflex,therefore more trauma is inflicting.
this site is offering great opportunity to discuss issues that everyone can learn from it. Only this discussions already allow us to learn a lot. I'm really glad to see that Dr.Ross joined us at this site.for many years I know him and know that he will be able to contribute great deal of opinions that everyone will be able to learn. It is really pleasant surprise to see your post.
Best wishes.Boris
PS.Almost forgot. From prospective of how much pressure one should apply?pressure could be significant but not to activate pain analyzing system. When obvious due to pressure one triggering muscular protective constriction reflex one did activate pain analyzing system.because pain is subjective,when client said that this is too much pressure then you did pain analyzing system. Also let's consider that threshold of pain could be different at different human body segments.in such a cases pressure should be adjusted accordingly.
Dr. Ross Turchaninov said:
I think that sports massage issue is also greatly misunderstood. In the sports medicine world there is no place for deep tissue work as it frequently practiced. As a mater of fact the the real sports massage optimizes athlete's performance through the great speed of strokes and great variety of applied techniques especially kneading. Those who use deep tissue massage and think that they are doing sports massage do more harm. Without knowledge it is very tricky to apply sports massage correctly because it suppose to be very precisely embedded into the fabric of entire athelete's training.
Dr. Ross Turchaninov
Stephen Jeffrey said: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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Hi Stephen.
you said:"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. "
I agree with you but additionally to" great deal of time and patience to deliver hands on techniques correctly" one have to be trained.as much as I know not every physical therapy school's curriculum including hands-on massage training.
Best wishes.
Boris
Stephen Jeffrey said: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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Permalink Reply by sandy macdonald on
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I totally agree with you Gordon... About the schools that is..
Gordon J. Wallis said:
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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Permalink Reply by Therese Schwartz on
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I really think so! I hope she listens before she hurts someone permanently.
Dr. Ross Turchaninov said:
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 Gordon J. Wallis on
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Basically,,, I dont care what kind of massage you are doing.... A good massage feels freakin good... Deep tissue or whatever.. Deep tissue means working more specifically... not just deep till its painful...Good massages feel good or hurt good , period. Thats it... Therapists need to get out of their heads, and into their client. Easy weezy Japaneezy. This pressing intellectually really hard on someone is ridicules. Good massages feel freakin Good.
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Hi Gordon.in general I absolutely agree with your statement . I mean massage have to be pleasant procedure in general and not traumatizing .but is it only about, "feels good"?. to my great satisfaction many times you personally talked about clinical outcomes. In my opinion sometime we can inhibit pain which means client will feel better but treatment will be not adequate treatment, and sometime it can be even dangerous. Dr. Ross in his statement mentioned extremely difficult and lifetime exhausting non-reversible painful pathology,myogelosis. No doubt that trauma by excessive pressure can initiate it, but not adequate trigger point therapy can also to convert( inhibit) acute trigger point to sleeping trigger point andt if will be reactivated numerous time to acute conditions can start development of myogelosis.I believe that based on clinical prove science of massage allow us to avoid harm to our clients as well to reach real and sustained results. I hope you will agree with me that proposed article on trigger point therapy is very easy to read and understand as well providing a lot of practical knowledge. Therefore I am proposing to adapte two equally important principles in our occupation A)one shall not harm B) therapy by means of massage is about sustained and adequate results.thank you for initiating this important discussion.
Best wishes.
Boris
Gordon J. Wallis said:
Basically,,, I dont care what kind of massage you are doing.... A good massage feels freakin good... Deep tissue or whatever.. Deep tissue means working more specifically... not just deep till its painful...Good massages feel good or hurt good , period. Thats it... Therapists need to get out of their heads, and into their client. Easy weezy Japaneezy. This pressing intellectually really hard on someone is ridicules. Good massages feel freakin Good.
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Permalink Reply by Daniel Cohen on
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Let's differentiate between brief pain that results in reducing or eliminating the pain or correcting an injury the client came in about and pain that is injurious. Can we agree that the massage will not always feel good every minute? Most clients will recognize the "good pain" as a sign that when released they will feel better. Sometimes they even yell "Deeper, Harder, More!". A Therapist must be able to feel the appropriate depth and pressure. This is why palpation skills, seeing with your fingers, are so important. We should know from our touch what response the body under the touch is getting. Verbalization is good for client involvement in their own session but knowing from the body response is much quicker and will avoid injury during strong deep work. I think one of the best compliments you can hear is, " I was about to ask you to lighten up a few times if you had gone deeper but each time you stopped before it reached that point. That's amazing, how do you know?". It is a skill we develop. Of course the best compliment is "The pain is gone, and I can move".
Keep developing the palpation skills to "see" through your touch. Fingers, Knuckles, Forearms, Elbows, Knees, Shins, Feet, they are all tools and they can learn to see. This I believe is one of the most important things we can impart to students and beginners. How does one test this in an exam? We are in the business of touch for well being. Practical experience and practical review is appropriate.
Boris Prilutsky said:Hi Gordon.in general I absolutely agree with your statement . I mean massage have to be pleasant procedure in general and not traumatizing .but is it only about, "feels good"?. to my great satisfaction many times you personally talked about clinical outcomes. In my opinion sometime we can inhibit pain which means client will feel better but treatment will be not adequate treatment, and sometime it can be even dangerous. Dr. Ross in his statement mentioned extremely difficult and lifetime exhausting non-reversible painful pathology,myogelosis. No doubt that trauma by excessive pressure can initiate it, but not adequate trigger point therapy can also to convert( inhibit) acute trigger point to sleeping trigger point andt if will be reactivated numerous time to acute conditions can start development of myogelosis.I believe that based on clinical prove science of massage allow us to avoid harm to our clients as well to reach real and sustained results. I hope you will agree with me that proposed article on trigger point therapy is very easy to read and understand as well providing a lot of practical knowledge. Therefore I am proposing to adapte two equally important principles in our occupation A)one shall not harm B) therapy by means of massage is about sustained and adequate results.thank you for initiating this important discussion.
Best wishes.
Boris
Gordon J. Wallis said:
Basically,,, I dont care what kind of massage you are doing.... A good massage feels freakin good... Deep tissue or whatever.. Deep tissue means working more specifically... not just deep till its painful...Good massages feel good or hurt good , period. Thats it... Therapists need to get out of their heads, and into their client. Easy weezy Japaneezy. This pressing intellectually really hard on someone is ridicules. Good massages feel freakin Good.
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Hi Daniel.
I always enjoying discussions with you , in most cases agree with you, and this time is not different but,
my question is:” as you proposed to share knowledge with others will work for all? Is it enough this type of guidance as you proposed? Please keep in mind that in general I do agree with all you have said.
In many and most cases of disorders, human body offering to us, objectives, in skin, muscles, fascia etc.
This objectives is reflex zones abnormalities that must be detected and accordingly addressed by specific and different techniquesotherwise treatment will be not adequate treatment and results of it will be not sustained . Drs.Glezer and Dilixo did for us really crazy work, that's making our lives much easier and allow us to learn not by intuition only. I'm talking on Glezer / Dilixo maps.
Will take liberty and will recommend to everyone to purchase Dr.Ross’ text books where you can find
not only all this maps, but instructions how to detect by hands this reflex zone abnormalities as well in details Ross proposing specific techniques for different tissues. Using the opportunity would like to declare that I have no financial interest in distributions of Dr.Ross’ text books. I am recommending it because this is great source to study medical massage .It was many years ago at Ukraine. Once I have told that some new gypsy camp out of town and one old lady does with her hands miracles when treating back and limb disorders. I went to see what she did. To my great surprise this not educated women with no being aware of it performed, orthopedic massage protocols. I mean she performed connective tissue massage(facia release techniques) in great way using petrissage mobilized muscles, specifically addressed skin, as well performed good variation of trigger points therapy. All this she did by intuition. I know this exists, but how many of us is gifted like she is? Not a lot. Otherwise we wouldn't talk that many of our colleagues aggressively pressing and injuring and all this happened because they are desperate and don't know what to do better than compress crazy, or they trained not good enough by instructors who had this “ intuition”or maybe they using own wrong intuition. Having said this I agree with you again in regards of necessity to develop sense of touch, but most of us not all but most need foundation in order to develop this sense of touch.
Best wishes.
Boris
Daniel Cohen said:
Let's differentiate between brief pain that results in reducing or eliminating the pain or correcting an injury the client came in about and pain that is injurious. Can we agree that the massage will not always feel good every minute? Most clients will recognize the "good pain" as a sign that when released they will feel better. Sometimes they even yell "Deeper, Harder, More!". A Therapist must be able to feel the appropriate depth and pressure. This is why palpation skills, seeing with your fingers, are so important. We should know from our touch what response the body under the touch is getting. Verbalization is good for client involvement in their own session but knowing from the body response is much quicker and will avoid injury during strong deep work. I think one of the best compliments you can hear is, " I was about to ask you to lighten up a few times if you had gone deeper but each time you stopped before it reached that point. That's amazing, how do you know?". It is a skill we develop. Of course the best compliment is "The pain is gone, and I can move".
Keep developing the palpation skills to "see" through your touch. Fingers, Knuckles, Forearms, Elbows, Knees, Shins, Feet, they are all tools and they can learn to see. This I believe is one of the most important things we can impart to students and beginners. How does one test this in an exam? We are in the business of touch for well being. Practical experience and practical review is appropriate.
Boris Prilutsky said:Hi Gordon.in general I absolutely agree with your statement . I mean massage have to be pleasant procedure in general and not traumatizing .but is it only about, "feels good"?. to my great satisfaction many times you personally talked about clinical outcomes. In my opinion sometime we can inhibit pain which means client will feel better but treatment will be not adequate treatment, and sometime it can be even dangerous. Dr. Ross in his statement mentioned extremely difficult and lifetime exhausting non-reversible painful pathology,myogelosis. No doubt that trauma by excessive pressure can initiate it, but not adequate trigger point therapy can also to convert( inhibit) acute trigger point to sleeping trigger point andt if will be reactivated numerous time to acute conditions can start development of myogelosis.I believe that based on clinical prove science of massage allow us to avoid harm to our clients as well to reach real and sustained results. I hope you will agree with me that proposed article on trigger point therapy is very easy to read and understand as well providing a lot of practical knowledge. Therefore I am proposing to adapte two equally important principles in our occupation A)one shall not harm B) therapy by means of massage is about sustained and adequate results.thank you for initiating this important discussion.
Best wishes.
Boris
Gordon J. Wallis said:
Basically,,, I dont care what kind of massage you are doing.... A good massage feels freakin good... Deep tissue or whatever.. Deep tissue means working more specifically... not just deep till its painful...Good massages feel good or hurt good , period. Thats it... Therapists need to get out of their heads, and into their client. Easy weezy Japaneezy. This pressing intellectually really hard on someone is ridicules. Good massages feel freakin Good.
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Boris could you give more bibliographic information on the Ross book? I am unable to find it. Also thank you for relating the story of the Gypsy woman. You illustrate well the need to balance both the scientific knowledge and the intuitive nature of our work.
Thank you.
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Daniel. I am glad that you liked our discussions and agree in balance both the scientific knowledge and the intuitive nature of our work.more information about Dr. Ross and his works at his site www.aesculapbooks.com
Best wishes.
BorisDaniel Cohen said:
Boris could you give more bibliographic information on the Ross book? I am unable to find it. Also thank you for relating the story of the Gypsy woman. You illustrate well the need to balance both the scientific knowledge and the intuitive nature of our work.
Thank you.
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It is completely correct that palpatory skills are very important for any practitioner. However there are much more tools the practitioner may use. The pain itself is very important diagnostic as well as treatment tool. Thus during let say trigger point therapy (TPT) the practitioner must activate pain receptors while applying pressure but he or she must do it correctly. The first critical step in successful elimination of trigger point is elimination of the condition of hyperirritability of pain receptors or in other words calm receptors down. As long as this condition remains the patient will resist treatment and it makes it longer and less successful. The restoration of the normal threshold of pain receptors activation and elimination of hyperirritability require careful 'playing' with these receptors while working in the affected area. The fluctuation in pressure, electric vibration, observation of patient reactions, evaluation of palpatory information, activation of central control trigger etc. allows to achieve stable clinical results quickly.
In regard to 'good massage suppose to feel good' concept. It is completely correct when the practitioner deals with healthy clients or stress accumulation. At the same time for the patient with chronic (sometimes for years) pain as a result of mistreated somatic condition the 'feels good approach' far from enough. For those clients even moderate application of pressure is very painful procedure. At the same time the restoration of the normal threshold of pain receptors is a first must component and unfortunately pain receptors never 'happy' about it especially at the beginning. The practitioner's job is to explain to the patient all details of the therapy before it starts.
Dr Ross Turchaninov
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