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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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Replies to This Discussion
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Permalink Reply by Gordon J. Wallis on
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The ones that do soft tissue work do....
Frances Churchill said:It seems we do our jobs and we amaze ourselves and our clients. Funny that PTs and MDs can't seem to relieve pain the way we do.
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Permalink Reply by Gary W Addis, LMT on
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You know, there in AK without the regs you might could find a student or two to teach on your own--sort of like private tutoring. By the time Alaska gets around to regulating, your students would have enough time in to get grandfathered.
Gordon J. Wallis said:I have several medical doctors as regular clients....They refer their friends, but no patients...But they are like anesthesiologists, and have little patient referral potential... And there are therapists in town that get referrals..But those therapists only take insurance referrals...In the spa where i work... they dont wanna deal with that stuff. And I dont wanna deal with it anymore... Did that for ten years....I prefer my own business or a spa at this point in my career...Im 58.. I plan on teaching when Im 62....But who knows the future? I dont? lol
Therese Schwartz said:Gordon, that's quite a letter!
I don't know what is going on with the medical community that they can't relieve pain. Others have posted here that they have doctors that refer patients to them for massage; I am hoping that gets to be more widespread. I have one DO here in town who said he'd refer people to me but I was still in school when we talked about it and I never have had a serious conversation with him about it. To be honest, I'm busy enough without referrals from a doctor. My clients refer enough friends and family to me to keep me booked up! :)
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Oh I will teach...but not yet...Im still in the work force... I will wait a while...People are already asking me too.. Not quite ready. Im still learning...But when I do teach...It wont really be teaching... I will just tell people what I know..
Gary W Addis said:You know, there in AK without the regs you might could find a student or two to teach on your own--sort of like private tutoring. By the time Alaska gets around to regulating, your students would have enough time in to get grandfathered.
Gordon J. Wallis said:I have several medical doctors as regular clients....They refer their friends, but no patients...But they are like anesthesiologists, and have little patient referral potential... And there are therapists in town that get referrals..But those therapists only take insurance referrals...In the spa where i work... they dont wanna deal with that stuff. And I dont wanna deal with it anymore... Did that for ten years....I prefer my own business or a spa at this point in my career...Im 58.. I plan on teaching when Im 62....But who knows the future? I dont? lol
Therese Schwartz said:Gordon, that's quite a letter!
I don't know what is going on with the medical community that they can't relieve pain. Others have posted here that they have doctors that refer patients to them for massage; I am hoping that gets to be more widespread. I have one DO here in town who said he'd refer people to me but I was still in school when we talked about it and I never have had a serious conversation with him about it. To be honest, I'm busy enough without referrals from a doctor. My clients refer enough friends and family to me to keep me booked up! :)
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Ok, believe it or not.. Another similar situation happened today... A client came in to see me this afternoon... She told me that the docs said she needs surgery? They wanted to schedule her Ok She said she wants to try massage first...They told her make sure he doesn't injure you more.?? She has a torn Labrum? Whatever that is? Can someone tell me?...Im not even sure if I spelled it right? But thats what she told me.. Anyway when they tell me this stuff...I just take it with a grain of salt...All I do anyway is check for sore muscles regardless....I asked her where she hurts...She said.. Her right hip down to the bottom of her foot.. It hurts her to walk... So I did my palpation exam, looking for sore spots and areas.. I found a really sore trigger point on the right side of L5 on the spinal correctors..Another sore area on her SI joint, PSIS area right side...and a really sore trigger point on her Piriformis right side..and a sore trigger point on the arch of her right foot(not sure the name of the muscle). At the end of the massage she felt NO PAIN.. NONE... At the front desk when she checked out...its amazing I feel no pain at all, not even my foot...Thats the truth.. Her pain was gone......I told he to reschedule for a follow up. But she rescheduled two weeks from now.. I forgot to tell her she needs to come in again withing a week..... Im going to have to call her tomorrow and have her get back withing four days...That needs to be followed up quickly sense it was so effective......Anyway....If she has no pain after one massage session....I dont think she needs surgery? A massage cant fix a torn anything? Ive been in this business for a long time...Im starting to speak out about this crap now...If someone needs surgery for pain...There is no way that person could be pain free after a massage? But whatever...I want someone to explain that too me?????????? what is a torn labebrum...?? They want to do surgery on her hip....her foot was sore because of a trigger point...Not some kind of weird nerve pain pattern. Im thinking if someone really needs surgery..There is no way my massage is going to make the pain completely go away...No way...But whatever... I will see her again soon...see how she feels.. WTF are they going to operate on?????? Im 58 years old..I dont understand what they want to operate on and why??? That was one client today...She was surprised she felt no pain..So am I...I did make the trigger points go away though.
Gordon J. Wallis said:Yea its amazing..Shocking really...Sometimes I find my self feeling really angry about it..and other times laughing because its so freakin unbelievable. But there it is right in front of us...It continues... I dont think anything will change for a long time..I mean maybe in some science fiction future...its just to huge and convoluted. Any changes they make are within the same system... They need a whole new system in order for Massage Therapists to realize the real potential of their profession..And the schools to start teaching it. Well that's what I think,, Just seems obvious to me. Maybe Im crazy though? They say if you're crazy you dont know it? Is that true? I keep saying, Truth Remains Hidden.,,, hmm.
Kathy Mackay said:I totally understand your anger Gordon. I can't begin to describe how many clients have come in over the years after seeing doctors, surgeons, chiropractors and PT's still in pain. It has happened so often that I'm no longer amazed when they tell me about where their pain is and that no one up to that point has ever palpated the sore area. It is unconscionable to me that a person can be treated by a doctor or surgeon who never touches them. How can that possibly work?? Especially for soft tissue pain?
I now have a very loyal following of clients who come see me first to see if I can fix their pains. It is obvious that what I do works immediately or not -- there's not weeks and weeks of wondering or uncertainty.
This is why I have no interest in being part of the current healthcare system. It is corrupt. I do what I do, people pay me for the session and we all live happier lives. No insurance filing. No doctor, Chiro or PT telling me what to work, or how to work or how often a person should come in for the work.
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Labrum in the hip is ligament/muscle that rims the hip joint. Mayo Clinic describes the symptoms of "clicking, pain and limited ROM in the hip. I didn't think that this labral tear could cause sciatic pain down the leg. That doctor is a slimy SOB.
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Gary she left my massage table pain free...? Why would she need surgery...Are the docs crooks or stupid or can a massage temporarily make all the pain go away??? Anyway,,I dont care anymore...she tipped me big. I will see how she is next time I see her....Maybe she does need surgery? but one thing is for sure...Those MDs dont know anything about trigger points...Not one thing..Nothing...That I know for sure.
Gary W Addis said:Labrum in the hip is ligament/muscle that rims the hip joint. Mayo Clinic describes the symptoms of "clicking, pain and limited ROM in the hip. I didn't think that this labral tear could cause sciatic pain down the leg. That doctor is a slimy SOB.
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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...She may have a labrum tear....But the pain she was experiencing came from trigger points. No one takes into account trigger points. Her hip hurt...They saw the tear.. And that explains it for them...They are surgeons.
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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She cancelled her surgery.
Gordon J. Wallis said:Gary...She may have a labrum tear....But the pain she was experiencing came from trigger points. No one takes into account trigger points. Her hip hurt...They saw the tear.. And that explains it for them...They are surgeons.
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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Permalink Reply by Linda LePelley, RN, NMT on
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Hello Gordon!
I understand your incredulity and frustration, not only with the apparent misdiagnosis, but with the doctors warning against massage therapy as well. More often, and, to me, more discouraging; they treat the subject of massage therapy with disdain and say, “Sure, go ahead, it can’t hurt anything”, leaving the implication that it can’t help anything, either. When clients tells me they’ve reported improvements to their physicians, even dramatic ones, the response has been that either the medication or treatment the doctor prescribed finally worked, or they say that the client would have recovered on their own anyway. I know that there are doctors who appreciate the efficacy of massage therapy, but at this time, I believe they are outnumbered by those who regard us, at best, as well-meaning, touch-feely spreaders of good cheer. At worst, they look at us as charlatans.
The problem, as I see it, is widespread and multi-faceted, but I will generalize it into a couple of observations:
1) We don’t know everything. By, “we”, I mean not just lay people and massage therapists, but doctors and scientists as well. That is ok, we can all carry on, either doing research, or reading the research, or waiting to hear about it. The big stumbling block, in my opinion, occurs when “we” decide we know enough about something to declare rules and laws regarding it. Personal examples include my being taught to tell RA patients that massage couldn’t help RA; or, that we should never massage a cancer patient. These hard and fast rules have changed over time, but how many clients might have been better off if we hadn’t taken so long to come around? There is nothing wrong with following action pathways that appear to be best practices, but I think it is a mistake to adhere to a practice without leaving room to consider the possibility that all is not known. We need to be open to exploration without crossing the boundaries of client safety. In my practice I spent a number of years not helping some people with certain conditions because it couldn’t be done. It couldn’t be done because that is what I was taught and believed. and,
2) Massage Therapists don’t share results in a consistent and useful fashion. We express anger and frustration in counterproductive ways, by saying that doctors are either idiots or are intentionally keeping patients to themselves out of greed or malice. Many of us sell and promote alternative therapies and ideas without any form of evidence that they are effective. One of us may be very clinical, and the next barely distinguishable from a beautician. Doctors don’t know who we are or what we do.
My suggestion would be to, a) Keep an open and inquisitive mind. Understand why you follow whatever procedures you do, and within the boundaries of Best Practices and client safety, don’t be afraid to question “rules”, no matter how widely accepted they may be. And, b) Communicate the results of your work in a positive, consistent, and acceptable manner. Ask your clients for permission to report the results of their massage treatments to their doctors. It doesn’t have to be elaborate, record their name/date, reason for seeking massage, your findings before, what treatment you provided, and the results of that treatment. If you keep it simple it shouldn’t take much time to prepare, and send off to the doctor. It may be futile, but it also may change the way one doctor views massage. It may mean that the next time someone comes in complaining of pain the doctor can’t help, he/she may refer that client to a massage therapist, before they consider the surgical route.
I have decided to start reporting results to all clients doctors, with their consent, of course.
I just saw, Gordon, that your client has cancelled her surgery!! Congratulations, you have once again improved the quality of someone’s life!
Gordon J. Wallis said:Ok, believe it or not.. Another similar situation happened today... A client came in to see me this afternoon... She told me that the docs said she needs surgery? They wanted to schedule her Ok She said she wants to try massage first...They told her make sure he doesn't injure you more.?? She has a torn Labrum? Whatever that is? Can someone tell me?...Im not even sure if I spelled it right? But thats what she told me.. Anyway when they tell me this stuff...I just take it with a grain of salt...All I do anyway is check for sore muscles regardless....I asked her where she hurts...She said.. Her right hip down to the bottom of her foot.. It hurts her to walk... So I did my palpation exam, looking for sore spots and areas.. I found a really sore trigger point on the right side of L5 on the spinal correctors..Another sore area on her SI joint, PSIS area right side...and a really sore trigger point on her Piriformis right side..and a sore trigger point on the arch of her right foot(not sure the name of the muscle). At the end of the massage she felt NO PAIN.. NONE... At the front desk when she checked out...its amazing I feel no pain at all, not even my foot...Thats the truth.. Her pain was gone......I told he to reschedule for a follow up. But she rescheduled two weeks from now.. I forgot to tell her she needs to come in again withing a week..... Im going to have to call her tomorrow and have her get back withing four days...That needs to be followed up quickly sense it was so effective......Anyway....If she has no pain after one massage session....I dont think she needs surgery? A massage cant fix a torn anything? Ive been in this business for a long time...Im starting to speak out about this crap now...If someone needs surgery for pain...There is no way that person could be pain free after a massage? But whatever...I want someone to explain that too me?????????? what is a torn labebrum...?? They want to do surgery on her hip....her foot was sore because of a trigger point...Not some kind of weird nerve pain pattern. Im thinking if someone really needs surgery..There is no way my massage is going to make the pain completely go away...No way...But whatever... I will see her again soon...see how she feels.. WTF are they going to operate on?????? Im 58 years old..I dont understand what they want to operate on and why??? That was one client today...She was surprised she felt no pain..So am I...I did make the trigger points go away though.
Gordon J. Wallis said:Yea its amazing..Shocking really...Sometimes I find my self feeling really angry about it..and other times laughing because its so freakin unbelievable. But there it is right in front of us...It continues... I dont think anything will change for a long time..I mean maybe in some science fiction future...its just to huge and convoluted. Any changes they make are within the same system... They need a whole new system in order for Massage Therapists to realize the real potential of their profession..And the schools to start teaching it. Well that's what I think,, Just seems obvious to me. Maybe Im crazy though? They say if you're crazy you dont know it? Is that true? I keep saying, Truth Remains Hidden.,,, hmm.
Kathy Mackay said:I totally understand your anger Gordon. I can't begin to describe how many clients have come in over the years after seeing doctors, surgeons, chiropractors and PT's still in pain. It has happened so often that I'm no longer amazed when they tell me about where their pain is and that no one up to that point has ever palpated the sore area. It is unconscionable to me that a person can be treated by a doctor or surgeon who never touches them. How can that possibly work?? Especially for soft tissue pain?
I now have a very loyal following of clients who come see me first to see if I can fix their pains. It is obvious that what I do works immediately or not -- there's not weeks and weeks of wondering or uncertainty.
This is why I have no interest in being part of the current healthcare system. It is corrupt. I do what I do, people pay me for the session and we all live happier lives. No insurance filing. No doctor, Chiro or PT telling me what to work, or how to work or how often a person should come in for the work.
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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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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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