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What are the implications??? or I don't understand?
I had a new client today. She told me that her right shoulder always hurts...She had surgery on it last year, but it still hurts, and that nothing changed sense the surgery. I said well where does it hurt.. She said they operated on the front of her shoulder but she always felt it was coming from the back of her shoulder... I palpated her infraspinatus and she had a huge nocioceptive response..she jumped and let out a loud OUCH...I asked her if she had any type of therapy prior to the surgery last year... She said that she had four and a half months of chiropractic and massage with no results..same pain..nothing changed... I asked her if any of the massage therapists or the chiropractor that worked on her ever touched her there... She said NO. I asked her if the Medical doctor touched her there..She said No. I asked her if after the surgery if she had any physical therapy..She said yes...I asked her if the physical therapist ever touched her on that spot...She said yes. I asked her if she jumped and screamed like she did when I touched that spot..She said yes. I said what did he do about it... She said he just gave her exercises to do. I released that infraspinatus trigger point in 30 seconds.. On firm re palpation it wasnt there any more...she didnt jump or flinch.. She said I feel no pain. Its gone. I will see her again next week. But its gone.
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Permalink Reply by Gordon J. Wallis on
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Wow Linda....You know whats interesting...We are both into massage. But I really never feel anything so much in the tissues , with what I do. Thats what I like about being in this profession...Learning never stops big time...Never.. All Im saying is I dont know what you know. I can tell just by reading your words..Im way different..I think its cool...Some people frown on anything thats not done the way they were taught...And your above comment about the MD attitude towards massage is pretty right on...I have doctor friends..and doctors have helped me, and referred clients too me...But in general, they dont know what we have to offer. My work is really simple...find sore spots and eliminate them...And if there are no sore spots.. Then they just get a damn good massage at the perfect pressure.. I like this job. Even better now then ever.
Linda LePelley, RN, NMT said:Hello Gary!
(How are you! Hope you are doing well! J )
I frequently find problems in the hips (and all areas) that affect nerves. Have you ever noticed that a person with hip pain seems to have a thickened pad within the local tissues, palpable over the joint and area? Sometimes it feels gristly, or firm and rubbery, sometimes hard and brittle. As you feel around it you can differentiate the borders from the normal, pain-free tissues. As these secondary formations develop, and over the passage of time, they become more and more dense, sometimes becoming indistinguishable from bone. These pads accumulate with whatever nerves in the area trapped within their matrix. When this happens, our clients can sit the wrong way, or move a certain way, or experiencing even the slightest jostle, and that pad shifts position. The engulfed nerves are unable to slide and glide as they normally would, they get tugged and wrenched, resulting in often excruciating pain. While these pain-causing secondary structures may not show up on imaging, they are palpable, and restorable.
It is my experience, working with musculoskeletal pain, that wherever there is pain, there is tissue that is elevated in density, and it is palpable. This client in question has widespread elevated TD. Gordon’s treatment reduced or resolved it, and because the nerves were released from their entrapments, she experienced complete relief.
Gary W Addis said:If they knew, would it make any difference in their treatment? A few, yes--some do refer regularly to MTs.
But, yeah, that lady's doctor likely is_______. After all, the Mayo Clinic's description of labrum tears of the hip doesn't mention pain radiating into leg as a possible symptom. How could problem in the illiofemoral joint impinge a nerve? The path of the nerve is inches from the joint. Closer to the SIJ, but still not likely to interfere with the nerve.
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Gary, trigger point pain is often misdiagnosed as nerve pain or deep pain..and so on...I hear it a lot with people that think or have been told they have rotator cuff injury..They complain of it hurting deep in the joint...But when you palpate that joint you will often find it not sore under even firm palpation...then go check the infraspinatus, and there it is.. a trigger point...The client will often verbalize or give some sort of gesture to let you know it hurts. Of course always being careful palpating... Ive found that if you can eliminate that sore spot or trigger point..Then all the clients presenting symptoms just go..vanish....Thats just what Ive found to be true...But Linda is into her work, and has a completely different approach... Gosh there are so many ways to approach massage. I think thats part of the problem. We have a lot of diversity. Martial arts has a lot of diversity too....Its interesting. Learning never stops.
Gary W Addis said:Linda, yes, what you say is true. In Gordon's case, I think, as he reports, the multiple trigger points (maybe just one of them, the others firing "in sympathy"?) caused her pain. Actually, what is a trigger point but muscle disability due to muscle contraction putting pressure on a nerve?
As you know I don't have scads of experience as you two do to base an opinion on, but it seems reasonable to assume, as Gordon and I think Daniel believe, that a trigger point large or tiny lies at the heart of every hypertense muscle-- if it ain't an inflamed or torn ligament or spinal compression, it's muscle that cannot relax w/o help. And based on my meager experience and schooling and (more importantly) the guidance of experienced therapists I've met online--you, Daniel, Stephen, my mentor Gordon--the quickest, easiest method to achieve that muscle relaxation is trigger point therapy.
In this lady's case, to me it is obvious that a tear deep within the joint (the acetabular labral tear her MD reports) could not have caused the sciatic nerve compression that radiated pain into her posterior thigh. In fact, the labrum is connective tissue, not muscle, so it also lacks blood supply. Joints have to be free to move with severing a nerve or blood vessel.
I like your idea about always referring back to your clients' MDs. SOAP notes as I was taught to write them wouldn't impress them. Art Riggs in his Deep Tissue textbook presents his way of writing SOAPs...more a detailed letter written with the doctor in mind than a schoolboy-level SOAP hurriedly drafted between clients in a clinic setting.
I'll follow your suggestion whenever I can.
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I just added my explanation(Attachment) as to what a trigger point is...its from an earlier thread...some argued that its not true..but it makes sense to me from all my studies. But it doesn't matter what it is...If I can make them go away. There is often good clinical results. I educate my clients that need to know.. I find it helps clients heal faster when they understand their pain and what Im doing..
Gordon J. Wallis said:Gary, trigger point pain is often misdiagnosed as nerve pain or deep pain..and so on...I hear it a lot with people that think or have been told they have rotator cuff injury..They complain of it hurting deep in the joint...But when you palpate that joint you will often find it not sore under even firm palpation...then go check the infraspinatus, and there it is.. a trigger point...The client will often verbalize or give some sort of gesture to let you know it hurts. Of course always being careful palpating... Ive found that if you can eliminate that sore spot or trigger point..Then all the clients presenting symptoms just go..vanish....Thats just what Ive found to be true...But Linda is into her work, and has a completely different approach... Gosh there are so many ways to approach massage. I think thats part of the problem. We have a lot of diversity. Martial arts has a lot of diversity too....Its interesting. Learning never stops.
Gary W Addis said:Linda, yes, what you say is true. In Gordon's case, I think, as he reports, the multiple trigger points (maybe just one of them, the others firing "in sympathy"?) caused her pain. Actually, what is a trigger point but muscle disability due to muscle contraction putting pressure on a nerve?
As you know I don't have scads of experience as you two do to base an opinion on, but it seems reasonable to assume, as Gordon and I think Daniel believe, that a trigger point large or tiny lies at the heart of every hypertense muscle-- if it ain't an inflamed or torn ligament or spinal compression, it's muscle that cannot relax w/o help. And based on my meager experience and schooling and (more importantly) the guidance of experienced therapists I've met online--you, Daniel, Stephen, my mentor Gordon--the quickest, easiest method to achieve that muscle relaxation is trigger point therapy.
In this lady's case, to me it is obvious that a tear deep within the joint (the acetabular labral tear her MD reports) could not have caused the sciatic nerve compression that radiated pain into her posterior thigh. In fact, the labrum is connective tissue, not muscle, so it also lacks blood supply. Joints have to be free to move with severing a nerve or blood vessel.
I like your idea about always referring back to your clients' MDs. SOAP notes as I was taught to write them wouldn't impress them. Art Riggs in his Deep Tissue textbook presents his way of writing SOAPs...more a detailed letter written with the doctor in mind than a schoolboy-level SOAP hurriedly drafted between clients in a clinic setting.
I'll follow your suggestion whenever I can.
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Whats a trigger point.jpg, 141 KB
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Permalink Reply by Gary W Addis, LMT on
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Gordon, an excellent definition of what is happening in a muscle that cannot relax.
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Permalink Reply by Kathy Mackay on
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Hi Therese. Just saw your response and wanted to say "Hi". Glad you are doing excellent work. :0]
Therese Schwartz said:Kathy, you are so right!!! I really agree with you. I have nothing to add to what you said - you put it very well.
Gordon - I've helped a dozen people with sciatica in the last couple of years. They don't have pain any more. And one of my clients came to me the first time with hip pain she'd had for 4 years. She didn't want to go to a doctor (she's a breast cancer survivor so she knows doctors too well!). It started after having some kids sit in her lap with her legs crossed. I released her TFL and the pain went away. It took 5 minutes! Maybe less...I'm not bragging, just recognizing what we can do for people by eliminating soft tissue problems. I did have one lady I couldn't help; she ended up getting knee surgery but she knew that I did everything I could, including learning some new stuff to try and help her. We aren't perfect, as you say routinely. But we really can do good things for people!
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Yea awesome work...Its like we can help them or we cant. They know and we know...There is no question about it... Often these people diagnosed with carpal tunnel, sciatica, rotators cuff injury , or whatever.. actually have fake carpal tunnel, fake sciatica, and fake rotators cuff injury. Its often muscle, not a pinched nerve or damaged joint... Often. GOOD JOB Therese !!! Sometimes I forget Im not the only one helping people...lol
Kathy Mackay said:Hi Therese. Just saw your response and wanted to say "Hi". Glad you are doing excellent work. :0]
Therese Schwartz said:Kathy, you are so right!!! I really agree with you. I have nothing to add to what you said - you put it very well.
Gordon - I've helped a dozen people with sciatica in the last couple of years. They don't have pain any more. And one of my clients came to me the first time with hip pain she'd had for 4 years. She didn't want to go to a doctor (she's a breast cancer survivor so she knows doctors too well!). It started after having some kids sit in her lap with her legs crossed. I released her TFL and the pain went away. It took 5 minutes! Maybe less...I'm not bragging, just recognizing what we can do for people by eliminating soft tissue problems. I did have one lady I couldn't help; she ended up getting knee surgery but she knew that I did everything I could, including learning some new stuff to try and help her. We aren't perfect, as you say routinely. But we really can do good things for people!
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Permalink Reply by Therese Schwartz on
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Hi Kathy! Thank you so much!! :)
Gordon, thank you too!! On the note of helping people, I've had a friend for years now who's a Vietnam Vet (Special Forces). He figured out while I was still in massage school that I was good at this stuff! He's been a once-a-week client for years; for the last year it's twice a week. He was 5 feet away from a grenade or two when they went off during a Viet Cong raid of their camp. So you can imagine the extensive damage he had! Well, for the last 30 years he's had severe leg cramps when he gets overheated and/or dehydrated. Given that he never holds still, this means pretty much all summer long he is miserable. I took the Chickly Institute's Lymph Drainage 1 class about 6 weeks ago. I worked on Richard the day after I got back. Since then he's had one 10-second moderate leg cramp and one two-minute moderate leg cramp. I'd say that qualifies as an overwhelming success! I really do love what I do! And I never quit learning. I'm only 4 years into this gig and I'm so excited about the future and what else I can learn...
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Permalink Reply by Stephen Jeffrey on
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Nice one Therese, its the best gig in town :)
I've found doing CE's (CPD in UK) always pay off in the end, sometimes its slots right in with what we do and other times it might even be a year or two before we can make proper use of what we have learned.
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Hi Stephen! I bet things are mad in your part of the world!!
Thanks! It really is the best gig in town. Many times I'm amazed at what I'm able to do, and I hope that never goes away. It changes me as well as my clients - I'm so much better off than I was before I started this line of work!
I know what you mean - the Lymph Drainage was seamless to incorporate whilst I still don't have my head around some of the amazing things I learned in my Pelvis, Hip and Sacrum class with Til Lucau last year!
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Therese, I am envious. I'd love to take both the lymph drainage and Luchau's. Not many providers travel to southern MS, however, and travel is a budget killer. Someday.
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I had a client yesterday that has had low back pain for nine months ,as well as right hip and knee pain...I was able to remove all his back and hip pain completely..and down grade his knee pain by 50% He will come back for a follow up..He took a bunch of my cards....He couldnt get that seeing the other types of providers out there... Thats why I think massage therapists need to be educated to take over the common ache and pain industry.. We are best equipped too. I have a high art..Im a professional massage therapist.
Therese Schwartz said:Hi Stephen! I bet things are mad in your part of the world!!
Thanks! It really is the best gig in town. Many times I'm amazed at what I'm able to do, and I hope that never goes away. It changes me as well as my clients - I'm so much better off than I was before I started this line of work!
I know what you mean - the Lymph Drainage was seamless to incorporate whilst I still don't have my head around some of the amazing things I learned in my Pelvis, Hip and Sacrum class with Til Lucau last year!
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GAry..once you start working and get a few bucks... Luchau's DVDs are very good.. For me..DVDs work best...you can rewind them...watch em , watch em...Easier for me to learn then a seminar...for me anyway.. cheaper too.
Gary W Addis said:Therese, I am envious. I'd love to take both the lymph drainage and Luchau's. Not many providers travel to southern MS, however, and travel is a budget killer. Someday.
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