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When heat is not enough

Hi All:

I have been using heat packs in the past to help loosen up tight muscles before I go in. I know a tiny bit of myofascial work, but that's about it. Right now I have two clients that even with heat, the muscles (erectors and longissimus) take forever to yield. One has so little change, I'm thinking of not even using them (the packs)  in the future.

Maybe I'm being unrealistic in my expectations, but I'm not satisfied with the results thus far. Anyone have any suggestions that I can use that so I can avoid plowing my clients into oblivion in a fruitless effort?

Thanks in advance!

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Permalink Reply by Gordon J. Wallis on August 20, 2013 at 11:29pm

At any rate. If it is the psoas causing the back pain.  Its easy to determine and easy to release. And if its the lumbar erectors or QL.  Thats also easy to determin and release.   When I say easy.  I mean usually.  More often then naught. Most of the time.  Or 85% of the time.  And if the client has no complaint of pain pain or discomfort.  Then there is no problem. And they just need a good massage.  I mean I know people that have very noticable scoliosis and have no pain what so ever.  So my perspective. Just because a muscle is tight. Doesnt mean you have to fix it.. or un tighten it.

Permalink Reply by Gary W Addis, LMT on August 21, 2013 at 12:11am

Gordon just reminded me of a far more likely cause of tension in the erectors.  Weak abdominals are the number one cause of sore mid backs.  Large breasts in sedentary women are the number one cause of their shoulder/neck pain.  Likewise, the big belly hanging low on the front of male and female bodies stresses the hell out of their erectors. 

Permalink Reply by Gordon J. Wallis on August 21, 2013 at 12:49am

Trigger points in the abdominals refer pain to the low back.  Ive found that in clients from time to time.  If the client is complaining of low back pain, but its not palpatable, then its usually refered from the psoas or abdominals.  But any  way.  The original post by Joyce never mentioned pain.  For me, if the client has no presenting symptoms or complaints of pain or discomfort.  And I find no palpatable pain.. Then there is no problem.  Like I said above. I know people with very noticable scoliosis that have no pain what so ever.  So just because a muscle is tight doesnt mean we have to fix it.  

Gary W Addis, LMT said:

Gordon just reminded me of a far more likely cause of tension in the erectors.  Weak abdominals are the number one cause of sore mid backs.  Large breasts in sedentary women are the number one cause of their shoulder/neck pain.  Likewise, the big belly hanging low on the front of male and female bodies stresses the hell out of their erectors. 

Permalink Reply by Kay Warren on August 21, 2013 at 9:58am

The other major contributor to low back pain in certain populations is trigger points in gluteus medius and minimus. From abdominals to psoas and glutes, all of it is better treated in a side-lying position.

Permalink Reply by Gordon J. Wallis on August 21, 2013 at 1:20pm

Hmm, I hardly ever work side lying. 

Kay Warren said:

The other major contributor to low back pain in certain populations is trigger points in gluteus medius and minimus. From abdominals to psoas and glutes, all of it is better treated in a side-lying position.

Permalink Reply by Gordon J. Wallis on August 21, 2013 at 2:12pm

Maybe side lying is better if you are directly working on the affected muscle or trigger point.  But I never do that any more. I utilize the Ricprocal Inhibition Reflex thats hard wired into the nervous system. No escape from it.  The nervous system controles everything. And by not directly working the injured or trigger pointed muscle, there is no colateral damage. Client is often healed between two to four sessions.  For fibromyalgia people maybe longer, but relatively quickly. Gluteus Minimus is a good example.  If there are trigger points in the gluteus Minumus I would have the client move their effected leg off the edge of the table so they can use the edge to isometrically contract the inner leg muscles(antagonists to the gluteus minumus) while I rest one hand of finger on the trigger point(Im not pressing on the trigger point). While the client is isometrically contracting the inner leg muscles(at 10% of his strength) im karate chopping the innner leg tendons above and below the inside of the knee. (When you tap the tendon of a muscle, it contracts).  I do that for say 20 seconds. Then have the client relax. Repeat that three times.  Then use a Cross body distraction technique to repattern the leftt and right brain from its association with the pain in that area. Have the client wiggle their left toe then wiggle their right ifnger. Then go back and repalpate the gluteus medius trigger points. Most of the time(90% of the time) they are gone.   

Gordon J. Wallis said:

Hmm, I hardly ever work side lying. 

Kay Warren said:

The other major contributor to low back pain in certain populations is trigger points in gluteus medius and minimus. From abdominals to psoas and glutes, all of it is better treated in a side-lying position.

Permalink Reply by Gordon J. Wallis on August 21, 2013 at 2:25pm

As a side note. But an important one. I never have my client go home and stretch.  You want to let the effected muscle heal and rest.  Then they come back on a follow up in two or three days. Sometimes the trigger points will come back, but at a much lower intensity then before.  Usually two to four visits(short visits) its over.

Gordon J. Wallis said:

Maybe side lying is better if you are directly working on the affected muscle or trigger point.  But I never do that any more. I utilize the Ricprocal Inhibition Reflex thats hard wired into the nervous system. No escape from it.  The nervous system controles everything. And by not directly working the injured or trigger pointed muscle, there is no colateral damage. Client is often healed between two to four sessions.  For fibromyalgia people maybe longer, but relatively quickly. Gluteus Minimus is a good example.  If there are trigger points in the gluteus Minumus I would have the client move their effected leg off the edge of the table so they can use the edge to isometrically contract the inner leg muscles(antagonists to the gluteus minumus) while I rest one hand of finger on the trigger point(Im not pressing on the trigger point). While the client is isometrically contracting the inner leg muscles(at 10% of his strength) im karate chopping the innner leg tendons above and below the inside of the knee. (When you tap the tendon of a muscle, it contracts).  I do that for say 20 seconds. Then have the client relax. Repeat that three times.  Then use a Cross body distraction technique to repattern the leftt and right brain from its association with the pain in that area. Have the client wiggle their left toe then wiggle their right ifnger. Then go back and repalpate the gluteus medius trigger points. Most of the time(90% of the time) they are gone.   

Gordon J. Wallis said:

Hmm, I hardly ever work side lying. 

Kay Warren said:

The other major contributor to low back pain in certain populations is trigger points in gluteus medius and minimus. From abdominals to psoas and glutes, all of it is better treated in a side-lying position.

Permalink Reply by Gordon J. Wallis on August 22, 2013 at 3:11am

People need to think.  What I just said in the above statements , is not taught in any massage school or ceu credit class.. I showed you.  Now you can learn on your own.  I  fix people FAST.   Im not on this site any more. Think, dont just do what you are  told.   THINK

Gordon J. Wallis said:

As a side note. But an important one. I never have my client go home and stretch.  You want to let the effected muscle heal and rest.  Then they come back on a follow up in two or three days. Sometimes the trigger points will come back, but at a much lower intensity then before.  Usually two to four visits(short visits) its over.

Gordon J. Wallis said:

Maybe side lying is better if you are directly working on the affected muscle or trigger point.  But I never do that any more. I utilize the Ricprocal Inhibition Reflex thats hard wired into the nervous system. No escape from it.  The nervous system controles everything. And by not directly working the injured or trigger pointed muscle, there is no colateral damage. Client is often healed between two to four sessions.  For fibromyalgia people maybe longer, but relatively quickly. Gluteus Minimus is a good example.  If there are trigger points in the gluteus Minumus I would have the client move their effected leg off the edge of the table so they can use the edge to isometrically contract the inner leg muscles(antagonists to the gluteus minumus) while I rest one hand of finger on the trigger point(Im not pressing on the trigger point). While the client is isometrically contracting the inner leg muscles(at 10% of his strength) im karate chopping the innner leg tendons above and below the inside of the knee. (When you tap the tendon of a muscle, it contracts).  I do that for say 20 seconds. Then have the client relax. Repeat that three times.  Then use a Cross body distraction technique to repattern the leftt and right brain from its association with the pain in that area. Have the client wiggle their left toe then wiggle their right ifnger. Then go back and repalpate the gluteus medius trigger points. Most of the time(90% of the time) they are gone.   

Gordon J. Wallis said:

Hmm, I hardly ever work side lying. 

Kay Warren said:

The other major contributor to low back pain in certain populations is trigger points in gluteus medius and minimus. From abdominals to psoas and glutes, all of it is better treated in a side-lying position.

Permalink Reply by Joyce Young on August 22, 2013 at 2:09pm

whoa guys! Sorry I didn't mean to start a p*ssing match on the board!

(Please forgive me if I'm not clear in my explanations)

Ok, so I will get a client complaining about shoulders/mid back pain. Fine, I work all my regular stuff, but will notice that the longissimus/erectors are extremely tight - however QLs seem not to be too bad. Now, this isn't all the time, but I do have two client that have this area very,very tight. For client #1, the complaint is upper traps and shoulders. For client #2 it's the same thing, but there is a language barrier so some times I have to do hunting since I don't speak her language very well.

I will take the suggestion of trying to work in side lying , which I admit, I don't utilize enough.

Permalink Reply by Gary W Addis, LMT on August 22, 2013 at 8:26pm

serratus posterior compressing longissimus; rhomboids and their antagonist serratus anterior may also be contributing.  I'd certainly advise the client to exercise lumbar erectors; muscle strength imbalance can cause the thoracic paraspinals to work harder to counter the pull of weak abdominals, etc already mentioned. 

Permalink Reply by Kay Warren on August 22, 2013 at 8:39pm

Joyce, 

Ok if it's upper back we're talking about, you will definitely need to work the chest.  The pectoralis minor is a nasty little unsung culprit in many upper back cases.  This gets right to the heart of antagonistic muscle systems. According to Janda (pronounced  "yanda" ) Pectoralis minor is a postural muscle, meaning it tightens as it's stressed.  The lower traps are phasic, meaning they stretch when stressed. A quick way to check if they're part of the problem... have your client lie face up. Stand at the end of the table with their head on it.  Make a fist, with the thumb pointed up. Now, without pressing down on the table, glide your hands forward on the table so they come in contact with the shoulder at about the point of the shoulder socket. How close your hand comes to fitting under the shoulder structure will tell you how big a problem pecs minor really is.  I've had a few clients that i could get my entire fist under the edge of the shoulder. Hypertonic pectoralis minor also pulls the head forward, significantly increasing the amount of work required to hold it stable and move it around.  When it's pretty far forward, the sub-occipitals are also over worked to keep the eyes flat & level.  Erik Dalton wrote a couple of excellent articles on the subject, check his website and see if they're readily available.  If not they may be accessible on the ABMP archives.

Best way to work it, again, side-lying.  If they are female, breast tissue will naturally fall out of the way. (YAY) Come in from the underarm, and glide right up under pecs major. This will always be a sensitive spot, but gliding in under pecs major will help.  If it's not sensitive, they may not be human. *snicker*

As for Gordon and his suggestions.  The brain really does control everything. Techniques utilizing reciprocal inhibition work very well, and I support therapists getting trained in these techniques and adding it to their toolbox.  I don't necessarily agree with his particular methods, but it's his clients, and his choice. I'll tell you that if someone were tapping on my tendons to make muscles let go, it would not be comfortable for me, at all. I probably would not go back.  I do trigger point, AIS, MET, reciprocal inhibition and stretching, and Kinesio Tape to name a few.  I find that AIS stretching does quite a lot to re-pattern the muscle's firing patterns.  In most cases, I can get someone out of pain in 1-2 30 minute sessions, and if they will do their homework, they don't generally have a recurrence unless they are overdoing whatever got them there in the first place.

As you progress in your practice, language barriers will get easier to deal with. Some continuing ed, and regular classes talk to you about giving your clients physical cues that help transcend language barriers. When language is a problem, I tend to use MET stretching over AIS because it's easier to explain. I feel AIS works a little better, but MET is also more gentle.  Gentleness when a language barrier is involved is very helpful.  I hope this gives you a little more direction.

Permalink Reply by Gordon J. Wallis on August 24, 2013 at 4:34am

Please check the dates on the attachments. I dont know it all, but Im experienced.
Uhm, I said I wouldnt come in here any more. Because I just get agrivated. Kay, I have know doubt that you are a good massage therapist. No doubt. Because you have been doing this a long time. Like me. Ive been a full time therapist for 30 years. I have studied all those styles and modalities you have. Trust me. When I talk in here Im sorry if I come accross as a Mr. know it all.  I just say what I know. I fix people , and never have them side lying. And you sayed you would never come back if I tapped your tendons.  You are asuming.  Ive never touched you before. Im at the highest level Ive ever worked at in 30 years. Thats for sure.  And I dont mean to come accross as a Mr. know it all.  And Iim sure I can learn a lot from you. Im over booked tomorow. People are coming back to see me, even though I tapped their tendons.  And tapping tendons is only a very small part of my total skill set after 30 years. I dont know what you know. But you do not no what I know. I just thought that I would  mention a technique that know one is talking about in here. Instead of the usaul myofacail this and that.  Im not selling anything in here.  Ok.  Lots of people come back to  see me. As Im sure they do you.  I will attach a couple references. pleasue note the dates.  I talk my truth when I come in here. People can take what they want from what I say.  Because I have lasted, like you, in a carreer field that nomally lasts for seven years.  Ive done this for 30 years. You don't have to agree with me. Just consider. Everyone consider what I say. Not as the law. But I have lasted.
Kay Warren said:

Joyce, 

Ok if it's upper back we're talking about, you will definitely need to work the chest.  The pectoralis minor is a nasty little unsung culprit in many upper back cases.  This gets right to the heart of antagonistic muscle systems. According to Janda (pronounced  "yanda" ) Pectoralis minor is a postural muscle, meaning it tightens as it's stressed.  The lower traps are phasic, meaning they stretch when stressed. A quick way to check if they're part of the problem... have your client lie face up. Stand at the end of the table with their head on it.  Make a fist, with the thumb pointed up. Now, without pressing down on the table, glide your hands forward on the table so they come in contact with the shoulder at about the point of the shoulder socket. How close your hand comes to fitting under the shoulder structure will tell you how big a problem pecs minor really is.  I've had a few clients that i could get my entire fist under the edge of the shoulder. Hypertonic pectoralis minor also pulls the head forward, significantly increasing the amount of work required to hold it stable and move it around.  When it's pretty far forward, the sub-occipitals are also over worked to keep the eyes flat & level.  Erik Dalton wrote a couple of excellent articles on the subject, check his website and see if they're readily available.  If not they may be accessible on the ABMP archives.

Best way to work it, again, side-lying.  If they are female, breast tissue will naturally fall out of the way. (YAY) Come in from the underarm, and glide right up under pecs major. This will always be a sensitive spot, but gliding in under pecs major will help.  If it's not sensitive, they may not be human. *snicker*

As for Gordon and his suggestions.  The brain really does control everything. Techniques utilizing reciprocal inhibition work very well, and I support therapists getting trained in these techniques and adding it to their toolbox.  I don't necessarily agree with his particular methods, but it's his clients, and his choice. I'll tell you that if someone were tapping on my tendons to make muscles let go, it would not be comfortable for me, at all. I probably would not go back.  I do trigger point, AIS, MET, reciprocal inhibition and stretching, and Kinesio Tape to name a few.  I find that AIS stretching does quite a lot to re-pattern the muscle's firing patterns.  In most cases, I can get someone out of pain in 1-2 30 minute sessions, and if they will do their homework, they don't generally have a recurrence unless they are overdoing whatever got them there in the first place.

As you progress in your practice, language barriers will get easier to deal with. Some continuing ed, and regular classes talk to you about giving your clients physical cues that help transcend language barriers. When language is a problem, I tend to use MET stretching over AIS because it's easier to explain. I feel AIS works a little better, but MET is also more gentle.  Gentleness when a language barrier is involved is very helpful.  I hope this gives you a little more direction.

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