Took one of your classes in Salt lake City 2 yrs (?) ago. It changed the way I look at massage now. I review something, anything, whether it's thru your flashcards or the book everyday. And when I do massage, I am going over actions of the muscles, assessments, different treatments available, etc....it's made me more in tune with what I'm doing. I need to take a few more of your classes. Coming back anytime soon?

Hi Choice,

I am very glad to hear this!
Actually, I am set to return to SLC the weekend of June 26th and 27th. As soon as the dates are definitely set, I will post them on my website. The workshop will be given through Steiner Educational Group.

BTW, have you seen my Palpation Book and the new 3rd edition of The Muscular System Manual?

I look forward to seeing you in SLC.

Joe, I do have the Palpation book and it is amazing. I don't have the Muscular System Manual. Where can I order it? I'll definitely put those dates on my calendar.

If you go to my website (www.learnmuscles.com) and go to the books page, there is a link to the publisher. Otherwise, Amazon or Barnes and Noble would have it too. Make sure that you order the 3rd edition...

I will place a topic out there for anyone to comment on...
Regarding treatment of myofascial trigger points (TrPs), I would like to throw out the idea that deep stroking massage is preferable to sustained/ischemic compression techniques. Looking at the underlying pathomechanism of a TrP, sustained compression does not make as much sense as deep stroking massage.
Clair Davies felt this way. Travell and Simons 2nd edition stated this on pages 40 and 41. Most importantly, given ischemia as the cause, it makes more sense! And yet, most everyone is still using sustained compression...?
Take a look at my mtj article on TrPs at the "Books" page of my website (www.learnmuscles.com).

Thoughts and comments?

I remember a discussion you had at the Salt Lake City seminar (at the convention) during one of the breaks on this very subject. It made sense, at least to me, what you said. I now use the deep stroking massage for trigger points. My clients seem to think it feels better than holding a point.

Yes. Beyond the underlying mechanics of it making sense pathophysiologically, most clients prefer it, and my thumbs prefer it!

Hi Joe, I got in! Yes, I agree with you about the deep stroking. NASM's decision to use the SMR foam roll was primarily a business decision. Not all Trainers are Manual Therapists. SMR might still be good "homework" for clients to use in between sessions.

Discount for my and other Mosby books. Paste the following link into your browser:

http://portals.elsevier.com/portal/massageprofessionals

Thanks for that info Joe....I'm going to get both the 3rd ed of the Muscular System and the Kiniesology book.

Your workshop in Salt Lake....topics picked yet?

Yes. Assessment and Treatment Techniques for the upper extremity.

Hi Joseph, you have said Clair Davies "felt this way" I'm a big Clair Davies fan as you know, did you meet him ?
I started the debate on your article in the triggerpoint group http://www.massageprofessionals.com/group/triggerpoints?groupUrl=tr...
so will only comment futher that deep stroking followed by ishemic compression is not just for the TPs, the "stillness" of compression signals to the brain to make significant/subtle changes towards a better/stronger mind body connection.
The longer the clients chronic condition, the more important its use.
Regards steve

Hi Steve,

Yes, I took a weekend workshop with Clair and Amber. We went out to dinner together afterward and had a very nice conversation. Then Amber and I had a number of conversations afterwards. I greatly enjoyed meeting and working with them!

All research that I am aware of so far shows that a TrP is NOT mediated by the nervous system. It is due to local ischemia that results in a decrease of ATP molecules resulting in an inability to break the cross bridges and an inability to resorb the calcium ions that are already present. Given this, then what value would causing and "holding" further ischemia have?
The goal of the deep stroking (or the release perhaps of the sustained compression) is to decrease the ischemia, not to increase it.
See also pages 40 and 41 of the second edition of Travell and Simons.

Hi again all, here is a quote from Boris Prilutsky's article

6. Ischemic compression as a method of trigger point therapy has been proven by at least 4 decades of massive utilization as a safe and effective method.

7. Ischemic compression techniques are applied by gradually increasing pressure, thus excluding the possibility of doing harm to the patient and to the therapist.

Please see the full article http://www.articlesbase.com/alternative-medicine-articles/trigger-p...

Further the above only referes to the last 4 decades but I'm sure a little research into accupressure ( weather for Tender points/accupuncture points/triggerpoints ) will surely reveal its use in china for many thousands of years ?

Ultimately for every therapist, whatever the technique ! the truth of its effects are written in the tissues of those we treat, not on paper.

I value and rejoice in any therapists application of effective technique I would hope you can all value and rejoice with me in mine ?

Regards steve

Hi Steve and all,

Please don't get me wrong, I am not saying that sustained/ischemic compression does not work. I believe it does. I have seen it work with my patients. I learned it 25 years ago and did it for a number of years. I am just saying that "perhaps" deep stroking massage works just as well, or even better.
I believe that most people do sustained compression because they learned it from their instructor, who learned it from their instructor, etc. etc.
Personally, I found with my patients that even though sustained compression worked, that when I started off of the TrP and then gradually made my way on to it, i.e., deep stoking massage, the patient seemed to relax and allow it better. I just began to use it based upon the efficacy I found in my practice, without thinking about the research/what was written on paper. It was when I took Clair and Amber Davies' workshop that Clair came out unequivocally for deep stroking massage over sustained compression that I began to think about it. Then I bought the second edition of Travell and Simons and read it page by page and found that they backed deep stroking massage as the best method to deactivate central trigger points and that there is no reason to cause any further ischemia given that the TrP is already ischemic (again, pages 40 and 41). Then I looked at the science of it, and the mechanism of increasing blood flow via deep stroking massage seemed to make much more sense than holding a sustained compression. So, for all those reasons, I am trying to ring the bell for people to consider an alternative to sustained compression. :)
Joe

Joe, this is exactly the argument you were making in Salt Lake with a couple of other therapists. A couple of them were struggling with your explanations. You say it better than I ever could, but that is the reasoning why I do deep stroking massage on trigger points. And, with my health issues, anything that makes it easier for me to work is a plus. It is/was difficult for therapists to sometimes accept change or a different method/technique simply because that is what was taught to us in school. I can look back at a lot of massage "myths" that we learned without any explanation given on why we were learning them. We just followed.

Steve,
Thanks for sending the link to Boris Prilutsky's article. Excellent article! It really explains the theory, physiology and application of trigger point therapy very well! Very much how we practice this method...I use some corrective cross-fiber technique followed by passive stretches after releasing trigger points as well to help detoxify and oxygenate the muscles. Patients get excellent results and that tells the story. Well written article, I've been looking for an article that explains it in detail like that. Thanks again!

I have read through the article too. Thank you for sending it Steve.
Kinesiology is the "study" of motion. As such, we look to study the neuro/musculo/fascial/skeletal system. In so doing, we question why things are done. And as new information comes to bear, we sometimes find that either the reason that we thought we were doing something is different, or perhaps we should not be doing something, or perhaps what we are doing IS good, but another therapy might be more productive.
There are many reasons why we might choose to employ a certain technique.
One is science, or paper, as described earlier in this thread. I am a great believer in research and science, but I am also aware that there are certain limitations to a scientific study in which one one parameter is isolated and there is room for faulty methods and interpretation as well. For that reason, it can be best to wait for a number of studies to be done. We can employ a technique because it was taught to us, perhaps by people who we respect a great deal. As Whitney Lowe calls it, the "Sage on the Stage" scenario. Certainly authorities often are authorities because they have earned it with great study and foresight. But, following an authority can be risky too. They are so often proven wrong, or what they say is improved upon later. And we might employ a technique because it works. The "proof is in the pudding." But perhaps other puddings might taste just as good, or even better, if we try them.
All of these reasons are good reasons, but none of them are fullproof. One reason that I will add is to look at what is being done and try to figure out if it makes sense. Does it fit with the principles of anatomy and physiology as we understand them to be. Granted, we do not know all that there is about A and P, but we are gradually increasing our knowledge.
With ischemic compression, I just feel that all the sensory input from the pressure that I believe makes it valuable can be achieved with a series of repetitive strokes instead, and the further benefit of the deep stroking will be to increase the blood supply, i.e., decrease the ischemia, which is the perpetuating factor for a myofascial TrP.
I welcome people to try deep stroking massage, not just because I say it, and Travell and Simons say it (oops, it was page 141: "This method is probably the most effective way to inactivate central TrPs when using a direct manual approach."), and Clair Davies said it,...but because it is a viable alternative, and it makes sense, given all the research that has been done.
If a TrP is ischemic, then reducing the ischemia should be a top priority.
And causing further ischemia would not make sense (T&S, page 140: ""...when applying digital pressure to a TrP to inactivate it, there is no need to exert sufficient pressure to produce ischemia...there is no reason to believe that additional ischemia would be helpful.") Each stroke of massage can help to do decrease ischemia. Holding a sustained compression would not do this as effectively.
I hope we all keep questioning what and why we do what we do, and keep looking for alternative therapies.

Joe :)

Or is the pain coming from nerve endings in the blood vessels and sweat glands? Interesting new line of thought on pain @ http://www.sciencedaily.com/releases/2009/12/091208083524.htm

Great insight. Thanks.

Joe, I particularly like your comments about "why we do what we do."

It's broad and respectful.

Agreed Susan

Hi Eric, great article ! what with this, and many more revelations via Fascia Congress its getting harder to take all this in ! =" why we do what we do"

Hi Susan and joseph
I've really already covered my perpective of ishemic compression except to say its use marks a pivitol time in my session where movement stops and energy "reiki" work begins....stillness.

Respectfully yours steve

Hopefully more people will join this debate.

Hi Steve,

Very good point. There can be many reasons for doing what we do. The "stillness"of a session can have value for other reasons beyond the ischemia/circulation of a TrP.

BTW, on the issue of neural control of a TrP, certainly there is sensory input from a TrP (it hurts, so we must be sensing it). Regarding the motor control, not that we cannot be adding to the perpetuation of the TrP by telling it to contract (pain-spasm-pain cycle, etc), but the motor control/input is not necessary. They have found myofascial TrPs that continue in rat muscle, even after the muscle has been entirely denervated. As long as the local tissue becomes ischemic (which usually does follow from an initial contraction that cuts off the muscle's own arterial circulation), the loss of ATP does not allow the cross-bridges to break and the Ca++ ions cannot be reabsorbed (this plays out in rigor mortis in a dead person's musculature), and the TrP perpetuates. Certainly, many factors can play into this, but it would seem that eliminating the ischemia would be job #1, if not one of many necessary factors.

Hi Joe,

I really enjoyed your article on TrPs. I found it very informative and the illustrations were excellent.

Our colleague, Raymomd Nimmo, D.C., once said (in response to criticism for practicing a soft tissue method in lieu of osseous manipulation), "is doctrine and dogma more important than freeing a forlorn brother of pain?" We should always keep our minds open to new ideas and methods for helping patients get and stay well.

Yours in Health,
Michelle

It is so amazing how Nimmo is not known outside of the world of chiropractic, and Travell is famous. They both developed the same idea at the same time. Travell published; Nimmo didn't! As they say, "publish or die!"
Joe

Joe, your group is picking up steam and members....it seems to be very active....and with good reason.

Hey Joe> There's lots of Nimmo fans out here. He lived down the street from my Aunt and Uncle in Ft. Worth in the late 70s. At that time, he was kinda of secretive about teaching his 'receptor-tonus techniques' due to harsh criticism from the broader chiropractic community (probably why he didn't publish). It's a shame his wonderful body of work went so underappreciated. I still teach his old "corkscrew" technique for splenius capitis/cervicus but Nimmo used the same hand position to do middle and posterior scalenes. Thanks for bringing him up...a true ledgend.

Hi Erik,

Very cool! You are the first person who is not a DC I have ever met who knows who Nimmo is!

Hi, Joe - Happy to join your group. There's always more to learn!

What about all those people who studied with St. John? Surely they must know that his work evolved out of what he learned from studying Nimmo...

Yes, Whitney, St. John mentioned in his seminar that no bone can move unless a muscle moves it and no muscle moves a bone unless a nerve impulse reaches it, so he was familiar with Nimmo's work. Nimmo's original work is still being taught by Dr. Sheila Laws, of Quincy, Illinois, one of his students who has taught Receptor-Tonus Technique since 1968. And your welcome Erik, I am happy to bring up Nimmo and I am glad he has influenced your work also.... he was a true pioneer.

Ida Rolf once straightened up from the table in one of our classes to intone, "There's nothing new under the sun of manipulation". Nimmo, Rolf, Still, Barnes, Mattes, and all of us keep re-inventing what has gone before in different formats with different names. I suppose research might result in something truly new coming up. They seem inordinately fond of machines in the research world, and I believe that in the end they will find something irreducible in the human hand - 4 million years of on the job training! What is new is the view we take on the system - moving from reductionist particulate kind of thinking to a systemic and integrative paradigm will have us applying these old techniques in new and more effective (or so I believe) sequences.

Good luck with your new group - and your new book is fabulous (I would say that, I'm in the back!). What a lot of work these books turn out to be.

Thanks Tom, Michelle, Whitney, Choice, Steve, and everyone who has contributed so far. And thanks Tom for your generous contribution of the myofascial meridian figures and your knowledge for the 3rd edition of the Muscular System Manual!

Yes, we do a wonderful job of reinventing the wheel, don't we?
I once read a history book that described all approaches to knowledge content as being divided into "lumpers" and "splitters." The splitters split everything apart and look at all the wonderful separate individual parts and speak of the uniqueness of each one and how it should be examined separately. Then a generation later, the lumpers come along and lump all the pieces together into a whole and say, but no, look at the whole of the parts; see how they all really fit together and are one and really not separate. Then another generation later, the splitters reemerge and point out the differences of the parts, etc etc. Induction, reduction. There is always a truth to both.
Dealing with new students, although it is essential to point out the big picture, the whole usually needs to be divided into separate pieces so each bit can be learned and digested. But, then, they must be put back together again!

Look out for the next topic... (or someone create one for us) :)

Hi Joe, I have a suggestion for a new topic (you can start it whenever you want). Here it is: What are the vaious "models" for stretching and what do people think about them. For example, AIS, Kurz, PNF,FMR, Neural, Partner Assisted, Static, Active, Stretch to Win, etc. Also, what is the the Program Design, i.e., what is the reps, sets, speed, time under tension, times of day, times of week. How and when can it be integrated with Manual Therapy?

Hi Robert and everyone,
I would like to start a new topic on time as in session duration. Just look at the long list of stretching techniques Robert has listed, how best do we utilize an ever growing number of techniques ?........Is it time we threw out the 1 hr session and allocated 90 or 120 mins to each session. My 1 hr sessions with chronic clients never run to time or am I allowing myself to get carried away?

As for all the research Tom was talking about and "There's nothing new under the sun of manipulation"surley all thats going to happen is we have a scientific explanation of why the Romans had it right 2,000 yrs ago . = it takes a whole day of hot and cold baths, massage, mud packs, etc etc it will all go full circle!

Session time for everyone = a day at the spa !

Hmm... All bodywork leads to Rome?!! Sorry for being so corny. I couldn't help it!

I will wait before throwing in two cents on these two topics...

Joe

I will mention something regarding the first question about stretching techniques. In my Palpation book (if you are interested, see www.learnmuscles.com and go to the books page), I cover stretching, including "advanced" stretching techniques that include a neural inhibition component. It addresses a number of these questions.

To go on here, I will state that in my opinion, stretching is most always more effective when the client's tissues are first warmed up. That would mean in a session that stretching would best follow the massage to that region, or perhaps logistically at the end of the entire session.
Also, on stretching, I have a pdf of a number of research abstracts on stretching that I could attach to an email. Some of these studies definitely cast doubt on the proposed mechanisms and protocols that we have long considered to be the standard wisdom. If anyone would like these abstracts, send me your email address and I can send them to you.

I think a good place to start is to first define the models (see my below list and any other models that people want). After defining the models, I would like to start with the NASM static stretch model v. the Kurz model. This specifically addresses Joe's below post about a warmup. NASM now states that a warm up is not necessary. Kurz states that, "Gamma motor neurons, which regulate the muscle spindles' detection of the magnitude of the stretch, are stimulated by the cold center and inhibited by the heat center in your hypothalamus. Motor neurons Gamma are thus easier to activate when your body temperature is low and so your flexibility worsens then."

I also think that we should read Joe's pdf first if possible before posting. In the mean time we can help each other reach a consensus on the various models' definitions.