Why are some clients sore after a Deep Tissue Massage and others are not?

Replies to This Discussion

Permalink Reply by Lolita Knight on July 6, 2011 at 4:05pm

Can you give your client's a choice of a full body massage OR a focus on their problem massage.  A client can't expect both in a 55 minute session and if you try to do all, the overall quality will suffer. Even when my clients book 90 minutes they don't get both, but they leave very happy as I have addressed what they wanted.  With the hearing problem, perhaps tell your client you will check with them occasionally about pressure and to keep conversation quiet can they give you a finger up for more pressure, finger down for less and thumbs up for just right. When I first started doing massage, I felt I had to fix everything the first time .  I was very frustrated as that was impossible.  I later thought it was a dis-service to have clients feel they can abuse their body for years and in 1 hour be totally fixed. Hope this helps. 

Daniel Cohen said:

Good point Lolita. Anytime you want an answer to a question you might not get a useful response with just yes or no. Making them search within for the response is much more useful.

Gary W Addis said:

Lolita, your method of querying about the pressure is a very good idea--I'll use it from now on.  But our school clinic limits us.  We work on clients in curtained cubicles, so we must speak in whispers, and my hearing is very bad even with two hearing aids.  I have to get within inches of their prone face in order to hear any response. 

In the clinic we are held strictly to the hour framework, 55 minutes or shorter of actual work.  If client requests extra work in a particular area, they likely won't get the full body worked.  This is frustrating for me and disappointing for the client, who may leave the table still feeling the pain of tight muscles and/or tense emotional state.

After I receive my certification (another year) I will probably go to work in one of the casino spas.  There, too, I'll be limited.  Clients pay from $120 to $285 for 1, maybe 1.5 hours depending on modality.  For the therapist it is one body off, five minutes to set up, then another body, back to back hurried massages for the entire shift,  Hard to imagine at this point in my career-- I put everything I have into a massage, emotionally at least, so it takes me a bit to reset.  (each massage is kinda like a competition with myself, trying to be better with this one than the last)  During a 4-6 hour clinic evening, I perform at most three massages.  But, yes, I know that I will by necessity have to become more businesslike and invest less emotional energy in a harried professional clinic setting.  I expect that this will deprive me of some of my enjoyment in giving massage.  Sigh.  

Lolita Knight said:

Think I am replying to both Gary and Gordon.  Gary, did you call to remind your clients of their appointments.??  Also, I often give 2 hour massages.  In fact, for me to give a full body massage takes 4 hours.  This is like a body tune-up massaging the sides of the fingers, the top of the fingers, the bottom of the fingers etc etc.  Plus  you have the option of giving a deep tissue followed by a relaxing massage or a facial/scalp massage.

Gordon--I try to not ask "yes or no" questions about pressure.  i.e. "is the pressure okay" as they normally say "yes" but could mean "no".  Instead I ask "Would you like the pressure lighter or deeper".  That way they have to think and tell you exactly what they want. cheers, Lolita

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Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 4:06pm

Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you. 

Stephen Jeffrey said:

Gordon's explaination from knot in muscle thread. =

Hmm.....How do I say this????  Well first off...I'm not trying to start any aguments in here...Or challenge anyone as to what they think.or whats real...Like my way or the highway... Im right your wrong kinda thing... But Ive been doing this kind work for 26 years now..So I think what I say should at least be considered. That's all...  Not saying that I might not change my mind later?...And Jody Hutchenson gave a really interesting answer, that made sense...But I came up with something comletely different?? I think they are both true.. And I will try to integrate  Jody's definition, in with mine..  Does that make sense?  Anyway ..  Hardly any massage school teaches what a knot in a muscle is, from what I can tell??   And I find that very very interesting..  Because when you consider that 85% of all pain is caused directly from trigger points( knots ) in muscles, and that trigger points are involved in 95% of all pain syndromes...Seems important to know? If you ask me??  Anyway..........

Your muscles are made up of bundles of cells.. They are long and skinny like the hairs on your head.  Wrapped around each muscle cell is an organelle called a Sarcoplasmic Recticulum.  One of the things the sarcoplasmic recticulum does is to control calcium flow within the cell...So when there is an electrical signal from the brain for the muscle cell to contract. The sarcoplasmic recticulum exudes calcium from its membrane, and that calcium mixes with a protein in the cell called myosin. That starts a chain reaction, and then the muscle cell( fiber ) contracts...Then when there is an electrical signal from the brain for the muscle cell to relax or lengthen ... The sarcoplasmic recticulum reobsorbs the calcium , seperating it from the myosin, and the muscle fiber relaxes.

Now do to stress. And stress is a big word( Emotional Tension,Repetitive movements, a blow from an accident, sudden movement ,or whatever) the sarcoplasmic recticulum can rupture or beak...And when it breaks, the calcium just leaks out,and mixes with the myosin thats present in the area.. So whatever muscle fibers run through that mxsture, they Contract.  And thats your Knot.. An area of contracted muscle fibers within a relaxed muscle..

Anyway, when you find a Knot, Trigger Point, Sore Spot or whatever you wanna call it...When you press on it, you are pushing that calcium myosin mixture out of the area.. Back into the venous  system.  Then the muscle fibers can open up and lengthen..Now the cellular damage is still there.  But now the fresh blood can get in and repair the damage(broken sarcoplasmic recticulum ) .. That's why trigger points tend to linger ,until they get stretched out or pressed out . The capillary flow is cut off... So that's what I figured out about massage as it pertains to do with knots in muscles.....  But  I don't hear that being taught in schools schools?    Not sure what that means?  .Considering that 85% of all pain is directly caused from knots in muscles..  And that's why I thought your answer was not correct.  But not saying I know everything.. Cause I know I don't     - Gordon.

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Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 4:07pm

 

Therese, be sure to read Gordon's!  Sure seems to make sense to me. 

Therese Schwartz said:

Gary, here's more info on lipomas:

 

http://www.healthy-massage.com/the-back-mouse/

http://www.massagetherapy.com/articles/index.php/article_id/602/The...

 

I know your instructor said he didn't think it was one, but this may help clarify things for you.

 

I've been confused about the TP, knot, adhesion thing you are asking about too.  So I'm hoping someone with more experience than I have will post an answer about all that!!

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Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 4:23pm

I did as you suggest, more or less.  The client said up front that he did want the full body but that he had problems in the neck area to work out.  I worked his neck, traps, scapula, scalenes, levaturs really well, and found HT spl capitis and a couple of TPS, which melted easily.  But on a hunch I checked the anterior serratus and the subscapularis, and found a big 'un in the serratus right next to the scapula.  Knowing they wouldn't be releasing very quickly and that time was short, I told him about them, that they might have been a cause of his recurrent neck problems, and gave him the choice of continue or move on.  They were...less tender but still there when I moved to the hips, and found the knot already mentioned, which consumed valuable minutes.  I had to work the legs quickly, so as an extra treat, I draped the gluteal cleft, leaving him open from scalp to feet, and used long flowing strokes--which he dearly loved.  A satisfied customer!

Lolita Knight said:

Can you give your client's a choice of a full body massage OR a focus on their problem massage.  A client can't expect both in a 55 minute session and if you try to do all, the overall quality will suffer. Even when my clients book 90 minutes they don't get both, but they leave very happy as I have addressed what they wanted.  With the hearing problem, perhaps tell your client you will check with them occasionally about pressure and to keep conversation quiet can they give you a finger up for more pressure, finger down for less and thumbs up for just right. When I first started doing massage, I felt I had to fix everything the first time .  I was very frustrated as that was impossible.  I later thought it was a dis-service to have clients feel they can abuse their body for years and in 1 hour be totally fixed. Hope this helps. 

Daniel Cohen said:

Good point Lolita. Anytime you want an answer to a question you might not get a useful response with just yes or no. Making them search within for the response is much more useful.

Gary W Addis said:

Lolita, your method of querying about the pressure is a very good idea--I'll use it from now on.  But our school clinic limits us.  We work on clients in curtained cubicles, so we must speak in whispers, and my hearing is very bad even with two hearing aids.  I have to get within inches of their prone face in order to hear any response. 

In the clinic we are held strictly to the hour framework, 55 minutes or shorter of actual work.  If client requests extra work in a particular area, they likely won't get the full body worked.  This is frustrating for me and disappointing for the client, who may leave the table still feeling the pain of tight muscles and/or tense emotional state.

After I receive my certification (another year) I will probably go to work in one of the casino spas.  There, too, I'll be limited.  Clients pay from $120 to $285 for 1, maybe 1.5 hours depending on modality.  For the therapist it is one body off, five minutes to set up, then another body, back to back hurried massages for the entire shift,  Hard to imagine at this point in my career-- I put everything I have into a massage, emotionally at least, so it takes me a bit to reset.  (each massage is kinda like a competition with myself, trying to be better with this one than the last)  During a 4-6 hour clinic evening, I perform at most three massages.  But, yes, I know that I will by necessity have to become more businesslike and invest less emotional energy in a harried professional clinic setting.  I expect that this will deprive me of some of my enjoyment in giving massage.  Sigh.  

Lolita Knight said:

Think I am replying to both Gary and Gordon.  Gary, did you call to remind your clients of their appointments.??  Also, I often give 2 hour massages.  In fact, for me to give a full body massage takes 4 hours.  This is like a body tune-up massaging the sides of the fingers, the top of the fingers, the bottom of the fingers etc etc.  Plus  you have the option of giving a deep tissue followed by a relaxing massage or a facial/scalp massage.

Gordon--I try to not ask "yes or no" questions about pressure.  i.e. "is the pressure okay" as they normally say "yes" but could mean "no".  Instead I ask "Would you like the pressure lighter or deeper".  That way they have to think and tell you exactly what they want. cheers, Lolita

• ▶ Reply

Permalink Reply by Gordon J. Wallis on July 6, 2011 at 4:33pm

I explain to my clients what a knot in a muscle , and how massage makes them go away( most of the time).  I tell them my explanation that Stephen Jeffrey re-posted...Then I explain to them what a healing touch feels like..Its a combination for real intense soreness mixed in with a really good sensation...I tell them that the part that hurts is their body telling them that something is wrong..And that part that feels good is their body giving them feed back that what they or their therapist is doing is healing. Or that good part wouldn't be there.. If you press too hard, it just hurts( no good part)..And although that can release the trigger point, it also damages the healthy tissue(post massage soreness).....I make sure they never let me press beyond the hurt good...Thats why I never have or worry about pressure... never.. I educate my clients, and they take responsibility on how hard or soft they want me to press. They know what it feels like, not me.  Easy............If they educated people about massage in these massage schools there wouldn't be any confusion on anything...Seems to me they only teach confusion...   Gary, I love your enthusiasm. .Just know that sometimes  truth is hidden.

 Hi Gary,

good area's to palpate as example's of differences of densifications .............or call them what you like.

 

Fibrosis with embedded myogelosis. Upper thoracic ES between shoulder blades.

Palpates as rock hard groups of individual fibers that grate/crunch against one another (calcification). Reversal of fibrosis is possible, but myogelosis will remain (rock hard dead "nucleous" in the center of worst sections of fibrosis ) 

 

Fibrosis in  almost, the full length of lateral fibers of QL = responds well to cross fiber then "ishemic compresson"

Palpates as guitar string "twang" .

 

Adhesions   Medial knee ligament and tendon attachments, where they cross the joint to become the pes anserinus area,

Palpate as gum like thickening that interfere with the propioception potential and golgi organs hindering biomechanical function of the whole knee joint. Responds well to crossfiber and inline friction technique's. Yes a little painfull but very effective:) 

 

These are just a few examples of where the different densifications = TP's fibrosis, myogelosis, adhesions ect are most likely to be found.

 

 

Gary W Addis said:

My instructor said he didn't think it was lipoma, but that makes as much sense as a locus--whatever that is.  I had one of those on my glutes, years aback.  Dr cut it out...looked like feta cheese.

 

Surprising to me that the trigger points on one client melt as soon as you glance at it; on another, they require long minutes of work  Perhaps you can help me straighten something out in my mind.  Fernandez says in Deep Tissue Massage Treatment that knots are not TPs (although they are often bordered by trigger points); in Trigger Point Therapy Workbook, Davies repeatedly refers to TPs as knots.  Then there's the...knot, for lack of better word, that rolls away from pressure.  My understanding, that those are adhesions.  If not, I'm not sure that I understand yet how to identify adhesion. Sometimes those "knots" are small, sometimes they are long and sinuous like a snake.  Classroom is always so busy, the instructor on a schedule or distracted by seemingly hundreds of questions.  Help?

 

 

Stephen Jeffrey said:

Hi Gary

yes isn't fantastic learning about the human body whilst learning theraputic affect.:)

 

The cyst may have been a lipoma (benign fatty tissue).

 

Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.

This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.

  
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.

Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)  

 

 

   
Gary W Addis said:

Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues.  Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about.  When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness.  With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis.  I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands. 

 

I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied.  Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist.  Gawd! I love learning this stuff!

 

Thanks to all for the input.

• ▶ Reply

Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 5:44pm

Yes, there's a lot of difference in instructors.  My first instructor was bubbling enthusiasm.  He holds a Phd in counseling, but fell in love with massage and changed careers.  He gave us a taste of many modalities...taught us the book way, then taught us to ignore it and do what feels right at the moment.  Conversely, another instructor is somewhat indoctrinaire-- massage here, move to there, flip the client, always ALWAYS begin on the other side of the same leg.

Gordon J. Wallis said:

I explain to my clients what a knot in a muscle , and how massage makes them go away( most of the time).  I tell them my explanation that Stephen Jeffrey re-posted...Then I explain to them what a healing touch feels like..Its a combination for real intense soreness mixed in with a really good sensation...I tell them that the part that hurts is their body telling them that something is wrong..And that part that feels good is their body giving them feed back that what they or their therapist is doing is healing. Or that good part wouldn't be there.. If you press too hard, it just hurts( no good part)..And although that can release the trigger point, it also damages the healthy tissue(post massage soreness).....I make sure they never let me press beyond the hurt good...Thats why I never have or worry about pressure... never.. I educate my clients, and they take responsibility on how hard or soft they want me to press. They know what it feels like, not me.  Easy............If they educated people about massage in these massage schools there wouldn't be any confusion on anything...Seems to me they only teach confusion...   Gary, I love your enthusiasm. .Just know that sometimes  truth is hidden.

 Hi Gary,

good area's to palpate as example's of differences of densifications .............or call them what you like.

 

Fibrosis with embedded myogelosis. Upper thoracic ES between shoulder blades.

Palpates as rock hard groups of individual fibers that grate/crunch against one another (calcification). Reversal of fibrosis is possible, but myogelosis will remain (rock hard dead "nucleous" in the center of worst sections of fibrosis ) 

 

Fibrosis in  almost, the full length of lateral fibers of QL = responds well to cross fiber then "ishemic compresson"

Palpates as guitar string "twang" .

 

Adhesions   Medial knee ligament and tendon attachments, where they cross the joint to become the pes anserinus area,

Palpate as gum like thickening that interfere with the propioception potential and golgi organs hindering biomechanical function of the whole knee joint. Responds well to crossfiber and inline friction technique's. Yes a little painfull but very effective:) 

 

These are just a few examples of where the different densifications = TP's fibrosis, myogelosis, adhesions ect are most likely to be found.

 

 

Gary W Addis said:

My instructor said he didn't think it was lipoma, but that makes as much sense as a locus--whatever that is.  I had one of those on my glutes, years aback.  Dr cut it out...looked like feta cheese.

 

Surprising to me that the trigger points on one client melt as soon as you glance at it; on another, they require long minutes of work  Perhaps you can help me straighten something out in my mind.  Fernandez says in Deep Tissue Massage Treatment that knots are not TPs (although they are often bordered by trigger points); in Trigger Point Therapy Workbook, Davies repeatedly refers to TPs as knots.  Then there's the...knot, for lack of better word, that rolls away from pressure.  My understanding, that those are adhesions.  If not, I'm not sure that I understand yet how to identify adhesion. Sometimes those "knots" are small, sometimes they are long and sinuous like a snake.  Classroom is always so busy, the instructor on a schedule or distracted by seemingly hundreds of questions.  Help?

 

 

Stephen Jeffrey said:

Hi Gary

yes isn't fantastic learning about the human body whilst learning theraputic affect.:)

 

The cyst may have been a lipoma (benign fatty tissue).

 

Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.

This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.

  
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.

Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)  

 

 

   
Gary W Addis said:

Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues.  Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about.  When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness.  With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis.  I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands. 

 

I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied.  Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist.  Gawd! I love learning this stuff!

 

Thanks to all for the input.

• ▶ Reply

Permalink Reply by Massage Gnome on July 6, 2011 at 6:02pm

Hi Gordon,

You mention that this is not taught in schools but it is in all the textbooks I have seen.  Was this not in yours?
Gary W Addis said:

Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you. 

Stephen Jeffrey said:

Gordon's explaination from knot in muscle thread. =

Hmm.....How do I say this????  Well first off...I'm not trying to start any aguments in here...Or challenge anyone as to what they think.or whats real...Like my way or the highway... Im right your wrong kinda thing... But Ive been doing this kind work for 26 years now..So I think what I say should at least be considered. That's all...  Not saying that I might not change my mind later?...And Jody Hutchenson gave a really interesting answer, that made sense...But I came up with something comletely different?? I think they are both true.. And I will try to integrate  Jody's definition, in with mine..  Does that make sense?  Anyway ..  Hardly any massage school teaches what a knot in a muscle is, from what I can tell??   And I find that very very interesting..  Because when you consider that 85% of all pain is caused directly from trigger points( knots ) in muscles, and that trigger points are involved in 95% of all pain syndromes...Seems important to know? If you ask me??  Anyway..........

Your muscles are made up of bundles of cells.. They are long and skinny like the hairs on your head.  Wrapped around each muscle cell is an organelle called a Sarcoplasmic Recticulum.  One of the things the sarcoplasmic recticulum does is to control calcium flow within the cell...So when there is an electrical signal from the brain for the muscle cell to contract. The sarcoplasmic recticulum exudes calcium from its membrane, and that calcium mixes with a protein in the cell called myosin. That starts a chain reaction, and then the muscle cell( fiber ) contracts...Then when there is an electrical signal from the brain for the muscle cell to relax or lengthen ... The sarcoplasmic recticulum reobsorbs the calcium , seperating it from the myosin, and the muscle fiber relaxes.

Now do to stress. And stress is a big word( Emotional Tension,Repetitive movements, a blow from an accident, sudden movement ,or whatever) the sarcoplasmic recticulum can rupture or beak...And when it breaks, the calcium just leaks out,and mixes with the myosin thats present in the area.. So whatever muscle fibers run through that mxsture, they Contract.  And thats your Knot.. An area of contracted muscle fibers within a relaxed muscle..

Anyway, when you find a Knot, Trigger Point, Sore Spot or whatever you wanna call it...When you press on it, you are pushing that calcium myosin mixture out of the area.. Back into the venous  system.  Then the muscle fibers can open up and lengthen..Now the cellular damage is still there.  But now the fresh blood can get in and repair the damage(broken sarcoplasmic recticulum ) .. That's why trigger points tend to linger ,until they get stretched out or pressed out . The capillary flow is cut off... So that's what I figured out about massage as it pertains to do with knots in muscles.....  But  I don't hear that being taught in schools schools?    Not sure what that means?  .Considering that 85% of all pain is directly caused from knots in muscles..  And that's why I thought your answer was not correct.  But not saying I know everything.. Cause I know I don't     - Gordon.

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Permalink Reply by Gordon J. Wallis on July 6, 2011 at 6:52pm

I hope it is in a text book...Ive never seen it in a text book.  Well not a massage book..  Travells Myofacial Pain and Dysfunction is where I got that or figured it out from back in the eighties.  I have asked many many therapists if they can tell me what a knot in a muscle is....Im talking hundreds of therapists.. Probably weakly sense 1986.. lol    They dont know this.. So , I hope it is in a text book...Trigger Points are crucial to understand, if you want to be a massage therapist..Crucial. 

Massage Gnome said:

Hi Gordon,

You mention that this is not taught in schools but it is in all the textbooks I have seen.  Was this not in yours?
Gary W Addis said:

Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you. 

Stephen Jeffrey said:

Gordon's explaination from knot in muscle thread. =

Hmm.....How do I say this????  Well first off...I'm not trying to start any aguments in here...Or challenge anyone as to what they think.or whats real...Like my way or the highway... Im right your wrong kinda thing... But Ive been doing this kind work for 26 years now..So I think what I say should at least be considered. That's all...  Not saying that I might not change my mind later?...And Jody Hutchenson gave a really interesting answer, that made sense...But I came up with something comletely different?? I think they are both true.. And I will try to integrate  Jody's definition, in with mine..  Does that make sense?  Anyway ..  Hardly any massage school teaches what a knot in a muscle is, from what I can tell??   And I find that very very interesting..  Because when you consider that 85% of all pain is caused directly from trigger points( knots ) in muscles, and that trigger points are involved in 95% of all pain syndromes...Seems important to know? If you ask me??  Anyway..........

Your muscles are made up of bundles of cells.. They are long and skinny like the hairs on your head.  Wrapped around each muscle cell is an organelle called a Sarcoplasmic Recticulum.  One of the things the sarcoplasmic recticulum does is to control calcium flow within the cell...So when there is an electrical signal from the brain for the muscle cell to contract. The sarcoplasmic recticulum exudes calcium from its membrane, and that calcium mixes with a protein in the cell called myosin. That starts a chain reaction, and then the muscle cell( fiber ) contracts...Then when there is an electrical signal from the brain for the muscle cell to relax or lengthen ... The sarcoplasmic recticulum reobsorbs the calcium , seperating it from the myosin, and the muscle fiber relaxes.

Now do to stress. And stress is a big word( Emotional Tension,Repetitive movements, a blow from an accident, sudden movement ,or whatever) the sarcoplasmic recticulum can rupture or beak...And when it breaks, the calcium just leaks out,and mixes with the myosin thats present in the area.. So whatever muscle fibers run through that mxsture, they Contract.  And thats your Knot.. An area of contracted muscle fibers within a relaxed muscle..

Anyway, when you find a Knot, Trigger Point, Sore Spot or whatever you wanna call it...When you press on it, you are pushing that calcium myosin mixture out of the area.. Back into the venous  system.  Then the muscle fibers can open up and lengthen..Now the cellular damage is still there.  But now the fresh blood can get in and repair the damage(broken sarcoplasmic recticulum ) .. That's why trigger points tend to linger ,until they get stretched out or pressed out . The capillary flow is cut off... So that's what I figured out about massage as it pertains to do with knots in muscles.....  But  I don't hear that being taught in schools schools?    Not sure what that means?  .Considering that 85% of all pain is directly caused from knots in muscles..  And that's why I thought your answer was not correct.  But not saying I know everything.. Cause I know I don't     - Gordon.

• ▶ Reply

Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 8:14pm

Nothing wrong with my textbooks, nor with my instruction.  But no, the cause of TP creation was not mentioned in as clear a manner as Gordon presented it.  What textbook did your school use that did?  I've studied extensively online in addition to my course materials. I've watched a number of educational videos by Benjamin, Luchau, Myers, et alial; I've attended several webinars.  And I've never before read a reference to the spilling of calcium within muscle cell as the etiology of trigger point creation.  Please point me toward your source.

Massage Gnome said:

Hi Gordon,

You mention that this is not taught in schools but it is in all the textbooks I have seen.  Was this not in yours?
Gary W Addis said:

Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you. 

Stephen Jeffrey said:

Gordon's explaination from knot in muscle thread. =

Hmm.....How do I say this????  Well first off...I'm not trying to start any aguments in here...Or challenge anyone as to what they think.or whats real...Like my way or the highway... Im right your wrong kinda thing... But Ive been doing this kind work for 26 years now..So I think what I say should at least be considered. That's all...  Not saying that I might not change my mind later?...And Jody Hutchenson gave a really interesting answer, that made sense...But I came up with something comletely different?? I think they are both true.. And I will try to integrate  Jody's definition, in with mine..  Does that make sense?  Anyway ..  Hardly any massage school teaches what a knot in a muscle is, from what I can tell??   And I find that very very interesting..  Because when you consider that 85% of all pain is caused directly from trigger points( knots ) in muscles, and that trigger points are involved in 95% of all pain syndromes...Seems important to know? If you ask me??  Anyway..........

Your muscles are made up of bundles of cells.. They are long and skinny like the hairs on your head.  Wrapped around each muscle cell is an organelle called a Sarcoplasmic Recticulum.  One of the things the sarcoplasmic recticulum does is to control calcium flow within the cell...So when there is an electrical signal from the brain for the muscle cell to contract. The sarcoplasmic recticulum exudes calcium from its membrane, and that calcium mixes with a protein in the cell called myosin. That starts a chain reaction, and then the muscle cell( fiber ) contracts...Then when there is an electrical signal from the brain for the muscle cell to relax or lengthen ... The sarcoplasmic recticulum reobsorbs the calcium , seperating it from the myosin, and the muscle fiber relaxes.

Now do to stress. And stress is a big word( Emotional Tension,Repetitive movements, a blow from an accident, sudden movement ,or whatever) the sarcoplasmic recticulum can rupture or beak...And when it breaks, the calcium just leaks out,and mixes with the myosin thats present in the area.. So whatever muscle fibers run through that mxsture, they Contract.  And thats your Knot.. An area of contracted muscle fibers within a relaxed muscle..

Anyway, when you find a Knot, Trigger Point, Sore Spot or whatever you wanna call it...When you press on it, you are pushing that calcium myosin mixture out of the area.. Back into the venous  system.  Then the muscle fibers can open up and lengthen..Now the cellular damage is still there.  But now the fresh blood can get in and repair the damage(broken sarcoplasmic recticulum ) .. That's why trigger points tend to linger ,until they get stretched out or pressed out . The capillary flow is cut off... So that's what I figured out about massage as it pertains to do with knots in muscles.....  But  I don't hear that being taught in schools schools?    Not sure what that means?  .Considering that 85% of all pain is directly caused from knots in muscles..  And that's why I thought your answer was not correct.  But not saying I know everything.. Cause I know I don't     - Gordon.

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Permalink Reply by Massage Gnome on July 6, 2011 at 9:22pm

These are the two textbooks that we had at school.  We had a 6 month course total to learn massage and spa modalities.  I still have my books and I think that you will find that it has the info you are looking for.  The only difference is that it refers to the buildup causing the TP as waste products or toxins instead of calcium.  Tho, I fail to see why it makes a difference what you refer to being inside the muscle since the treatment would remain the same.  I have not read any of the titles you have mentioned and have not heard of them, tho I have read many others.  Hope this helps.  If not you can also look in Wikipedia for the same information.

Mosby's Essential Sciences for Therapeutic Massage : Anatomy, Physi...

Mosby's Fundamentals of Therapeutic Massage, by Fritz, Enhanced 3rd Edition 3

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Permalink Reply by Massage Gnome on July 6, 2011 at 9:41pm

Gary,

Adhesions will not roll when you apply pressure.  An adhesion is formed when the skin and the fascia of the muscle bond together much like scar tissue and feels like ripples under the skin, as if there is a honeycomb embedded under it forming immobile tissue.  It takes a completely different technique to release and can often be painful.  Trigger point technique will not release an adhesion.  Myofascial release, Cupping therapy is very helpful tho or a technique called graston which is often done by a chiropractor but can be learned by an MT as well.  If there is a cyst you should not engage it with TP or DT work as it will only irritate the area.  These must be surgically removed by an MD.  If the rolling area is a thin and long like a rubber band most likely you are seeing either a tendon or if it is thicker then it is a muscle that the fascia has constricted compressing the muscle itself.

 

Gary W Addis said:

My instructor said he didn't think it was lipoma, but that makes as much sense as a locus--whatever that is.  I had one of those on my glutes, years aback.  Dr cut it out...looked like feta cheese.

 

Surprising to me that the trigger points on one client melt as soon as you glance at it; on another, they require long minutes of work  Perhaps you can help me straighten something out in my mind.  Fernandez says in Deep Tissue Massage Treatment that knots are not TPs (although they are often bordered by trigger points); in Trigger Point Therapy Workbook, Davies repeatedly refers to TPs as knots.  Then there's the...knot, for lack of better word, that rolls away from pressure.  My understanding, that those are adhesions.  If not, I'm not sure that I understand yet how to identify adhesion. Sometimes those "knots" are small, sometimes they are long and sinuous like a snake.  Classroom is always so busy, the instructor on a schedule or distracted by seemingly hundreds of questions.  Help?

 

 

Stephen Jeffrey said:

Hi Gary

yes isn't fantastic learning about the human body whilst learning theraputic affect.:)

 

The cyst may have been a lipoma (benign fatty tissue).

 

Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.

This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.

  
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.

Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)  

 

 

   
Gary W Addis said:

Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues.  Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about.  When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness.  With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis.  I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands. 

 

I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied.  Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist.  Gawd! I love learning this stuff!

 

Thanks to all for the input.

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Permalink Reply by Gary W Addis, LMT on July 6, 2011 at 10:08pm

Oh, but it does make a huge difference-- it's not the same thing at all.  Calcium is natural to muscles--muscles cannot contract without it--indeed, the brain cannot send, receive messages without calcium.  Calcium, sodium, potassium and to a smaller degree magnesium are all needed for muscle contraction.  When a signal comes down to the muscle cell, calcium ions in the cytoplasm cause gates to be opened in the cell, potassium comes out, sodium moves into the cell, exciting it into contraction.  Immediately the body acts to restore homeostasis of the resting phase of the muscle; when the signal stops, sodium comes out, potassium moves in, cross bridges disappear, the muscle relaxes, clacium ions move back into the cytoplasm.  When the body is short of one of the electrolytes (or water), the muscles cramp, won't relax, or they quiver.  Therefore calcium is not a :"toxin"-- it is reactive as are all the electrolyes...as is the gas oxygen, as are several substances the body needs in the wrong concentrations.     

 

What Gordon explained is that injury to the sarcomere (possibly by overstretching or bruising?) has allowed calcium to "overflow" its boundaries, impeding the total relaxation of that portion of the individual muscle fiber.  I don't think anyone has ever been able to look microscopically into a working muscle cell inside a human body, so I guess it might be the fault of one of the other electrolytes...or maybe cellular debris you mentioned blocks one of the gates, the exits from the cell.  But calcium itself, no, I don't think calcium is the "toxin" referred to in your textbook.

 

You know, there's lots of arguments today re: lactic acid--what it is, how it acts.  Consensus seems to be growing that lactic acid is NOT a waste product of anaerobic exercise (as MTs are still being taught all over the country) but another form of muscle fuel, one that will be consumed in more aerobic movement and/or be reabsorbed back into the muscle in the form of glycogen.

 

Travell's textbook (Gordon referred to), written in 1942 I think, was the first to mention TPs, wasn't it?  But TP etiology, physiology still isn't fully understood.  My NMT textbook  was first published in 2004; I have the 2nd edition.  My DT textbook was written by Art Riggs.  Both are excellent textbooks.  As is Fernandez's little book "Deep Tissue Massage Treatment."  All three advance slightly different explanations of the phenomena.  One day we're gonna know all there is to learn about t he human body.  But I certainly won't live that long. 

 

Forgive me if I seem to be lecturing a therapist of your experience.  To the contrary, I'm seeking knowledge.  Wisdom and knowledge are not synonymous, evidently, because I sometimes open my mouth when I shouldn't.  Wisdom is knowing when to shut up and listen.  Maybe a couple hundred words too late, but...I'm shut, and listening.  :)  

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