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A typical experience

I had a new client the other day for an 80 minute massage. I asked him if there is anything that he wanted me to know.  He told me that he suffers from a herniated disc that he has had for a few years. He has constant low back and right hip pain that at times radiates down the back of his leg to his knee. He told me that he has had two injections in his low back and has to stay on anit- inflamtory medication.  Anything to avoid surgery. The pain is always there. I asked him if he ever saw a chiropractor for his pain.  He said yes.  But the adjustments hurt his hip so bad that he could not continiue.  So here is a guy that thinks he is on the verge of surgery. I knew that there was a very strong probubllity that was not the case. The vast majority of pain people experience is nocioceptive pain( soft tissue- muscle, tendon, ligament, facia).  MDs and Chiropractors see pain as neuropathic pain( nerve pain).  With that asumption they give the wrong treatments and therapies.  Now there is no denying that at times injections and surgery is needed. Not denying that.   But most of the time - NOT.  70% to 85% of all pain comes directly from trigger points.  Anyway I showed my client a testimonial from a client that I was able to help out of a very painful condition that she had delt with for a couple of years. I showed him that testimonial because all pain has a psychological eliment too it. I wanted him to start thinking maybe he is not on the edge of surgery.  I palpated his entire back upper torso, both hips, and right leg. I found a very painful spot on his right L5 erectors.  Another very painful spot on his right greater trochantor.  A painful spot in the middle part of his lower right hamstrings.  And also a tender spot on the right spinous of L3.  I knew that if Iwas able to eliminate all those painful palaptory spots that I would most likely eliminate his pain problem.  Because a healthy body had no painful spots even with deep massage.  Ive been hunting and eliminateing trigger points for thirty years now.  He walked out of the massage room pain free. He was pain free for the first time in years. All those other professional people misdiagnosed him because they assume neuropathic pain over nocioceptive pain.  I assume the other way around.  I'm a Massage Therapist.  

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Permalink Reply by Gordon J. Wallis on March 8, 2014 at 12:37pm

Remember 70% to 85% of the pain people run to the doctors, physical therapists, and chiropractors for is in or shows up in the soft tissue.  The other type of pain is much less often  and occurs 15%-30% of the time.  As massage therapists( soft tissue people) we have the potential to help and cure the vast majority of the population of their aches and pains( mild, moderate, to severe).  Muscle pain is very very often misdiagnosed. If you have read the entire thread and viewed the attachments. You know its just not me saying that.  So next time someone comes in for a massage.  Know that you can greatly effect the quality of their lives with just a little knowledge and understanding of somatic pain.  Like no other professionals we can actually touch their pain.

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Permalink Reply by Gordon J. Wallis on March 11, 2014 at 11:40am

When a client asks me what a trigger point is, this is what I tell them.  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.  The sarcoplasmic recticulum controles calcium flow within the cell.  When your brain sends an electrical signal to the muscle cell the sarcoplasmic recticulum exudes calcium from its membrain and that calcium mixes with other substances in the cell like myosin.  When thosee substances mix, there is a chain reaction and the  muscle cell contracts.  Now when there is an electrical  signal from the brain for the muscle cell to relax or lengthen.  The sarcoplasmic recticulum re-absorbes the calcium, seperating it from the myosin and the muscle cell relaxes.  Now do to stress( repetetive motions, one position too long, a blow from an accident, emotional stress) the sarcoplasmic recticulum can rupture.  When that happens calcium just leaks out and mixes with the myosin.  So any muscle cells that run through that area contract.  Even though there is no electrical signal from the brain for them to contract.  So you have an area of contracted muscle fibers within a relaxed muscle.  A knot, a trigger point or whatever you want to call it.   Now when you push on a knot, you push the calcium myosin mixture out of the area, back into the veinus system.  Then the muscle cell or cells can relax.   Now the cellular damage is still there.  But now the blood can flow into ther area and heal the tissues.  Thats why its important after a successful trigger point treatment not to exercise or stretch.  You want to let the tissues heal.   When not delt with trigger points can last for years.

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Permalink Reply by Gordon J. Wallis on March 11, 2014 at 11:47am

Here is  a perfect example of a trigger point lasting for years.  This client was in her 50s.  This is amazing to me.

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Permalink Reply by Gary W Addis, LMT on March 11, 2014 at 4:21pm

excellent description of a trigger point formation.  Thanks, Gordon. 

Permalink Reply by Gordon J. Wallis on March 17, 2014 at 9:58pm

James Waslaski will be in Anchorage April 4th through 6th.   I'm not going.   But he is a highly experienced therapist.  Check the attachment.

Therese Schwartz said:

Gordon, that is amazing, what you were able to do for her.  It makes so much sense!  I have been able to use heated bamboo to get into areas that were too sensitive for manual work.  Not quite the same thing, but it's worth remembering that when people have a strong reaction, deeper is not better!  Lymph work can help too, but again it's light touch repeated over and over.  And lymph work will definitely shift the CNS, helping people relax.

I've had more people than usual lately need really light touch work; heavier work hasn't been useful to them.  I'm trying to get it really ingrained into my whole system that lighter is better - and I don't do really deep work because it's hard on my body.  Anyway...

The article is at least interesting in some of what it has to say.  I agree with them that CBT is useful, but then again I think everyone would benefit from CBT!  As a result of doing CBT on my own years ago, I simply don't have depression any more (after something like 25 years of real trouble!).  As you know, I do have a lot of physical pain and it is easier to deal with these days.  I saw this in the article:

Certain factors may inappropriately trigger a person's stress response and contribute to the development of fibromyalgia, including:

  • Infections (Epstein-Barr virus, Lyme disease)
  • Physical trauma (such as a car accident)
  • Emotional stress
  • Hormonal changes (such as an underactive thyroid gland)



I have all of those!  EBV, tons of physical trauma from many, many horse accidents (my leg is 99% now, more than a year later!), tons of emotional stress from all angles, and low thyroid (and other hormonal changes that are equally challenging).

So I think what I need to do is find a really interesting CE class in Anchorage and then come see you a couple of times while I'm there!  I'm really considering that quite seriously.

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Permalink Reply by Cari Diaz on March 21, 2014 at 7:42am

That is awesome !   You rock !

Permalink Reply by Gordon J. Wallis on March 22, 2014 at 11:34am

Not everybody I work on thinks they are on the edge of surgery or has fibromyalgia.   Most people have just a few aches and pains.  Not enough to make them run to a doctor or even get a massage for.  But its always trigger points.  The other day a lady came in for a massage.  Id never seen her before.  I asked her what she needed from the massage, and I got the usual answer.  Just to relax.  Then I showed her a testimonial like the ones I posted on this thread.  Then she said.  Well I do have a back problem.  I asked her if she saw anyone for her back problem.  She said oh no, its not that serious.  Every once in a while I might have to take an Alieve or something, and that takes care of it.  My back did hurt this morning, but it feels fine now.   I told her I would take two or three minutes before the massage to examin her back for any tender areas. She said ok.  I found two tender spots on the  para spinals on each side of L5.  And a tender spot on the paraspinals at T10 left side, and another at T9 right side para spinals.   She had four latent trigger points.  They were un noticed until palpation and had no radiation patterns.  I took a few moments to eliminate those sore spots, then carried on with the massage.  Before the end of the massage I re palpated to see if those trigger points were still there.  They were not.   Of course everyone feels good after a massage.  But I have a real observable way to gage the success of my massage work.  And the client notices too.  I dont think I helped her.  I know I helped her.  And the client knows too.   

Permalink Reply by Gordon J. Wallis on April 16, 2014 at 10:01pm

Here is another experience that fits into this thread.  A new client. Initially she told me she just needed to relax.. After I showed her a testimonial from a client that I was able to help out of pain, she told me that she does have chronic lower back and hip pain.  I asked her how long she has had this pain she said, three years.  Ever sense the birth of her last child.  She said the pain is constant.  But she can live with it.  Her doctor told her that it might be from a uterus problem..  She went to an orthopedic clinic and they told her she needed surgery.. But she refused to sign all the paper work because nothing was guaranteed.   After she told me that.. I palpated her entire hip area( both hips) and back, all the way up to her neck.  What I found was a mild trigger point on her QL at the illiac crest border.. and a very painful trigger point on her upper sacrum just to the right of the sacral ridge.  And in addition two very painful trigger points on her spinal erector group on each side of her L4 L5 areas.  By the end of the session I had eliminated those trigger points as well as her chronic low back pain.  Most medical doctors do not understand muscle pain. Its more then obvious to me now.  Three years she sufferd, with the option of surgery? Uhm.  She was pain free when she left.. She told me..  Now she will need a couple of follow ups to make sure those TPs do not come back.. But her problem is over.  If you have followed this thread. You know that 80% of all pain comes from trigger points..  Anyway I will post a couple of attachments.. One is not very clear and does not show any pain pattern, but the QL one does.   Truth remains hidden.   So many are being ripped off and misdiagnosed.

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Permalink Reply by Gordon J. Wallis on April 21, 2014 at 12:37pm

When I say muscles move bones, in the attachment there is a real good picture of what Im talking about.  This would present itself as lateral spinous pain( on palpation ).
A trigger point in one of those little Rotatores muscles of the vertabrae.
Gordon J. Wallis said:

The introduction to this book (see attachment) pretty much says what I've been saying and experiencing.  That most pain is soft tissue pain( 75%) and that the medical proffession is not trained to deal with it.  

And its my opinion the chiropractors can't deal with it either( muscles move bones), unless they themselves do soft tissue work.  And very saidly, most massage therapists are not trained to realize the maximum potential of their profession.  

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Permalink Reply by Gordon J. Wallis on April 23, 2014 at 1:34pm

The other day one of my regulars came in for her massage.  She comes in every month or two and recieves an 80 minute massage.  She never has any complaints.  Its a non stop full body massage with no talking.  She is very happy after the massage and tips well.  But this time when I brought her into the room.. She said Gordon, Ive had this headache for a week so id like you to see If you can help that?  I also want my full body massage though.   I told her that we would start with her lying on her stomach as usual.  But before I start the massage i will do a check for sore spots( painful palpatory areas) from her mid back up to the top of her head.  I told her that there was bound to be a tender point or points somewhere in her upper body , head or neck area that was causing her headache..  I asked her where she felt her headache.  She told me the back of her upper neck, and forehead.  Anyway when she was on her stomach I found no painful areas.  Even in the back of her neck which was one of her symtomatic areas.. So I knew it was refered pain from somewhere else..  She wanted her massage so I carried on massaging her like I always did for an hour , as she lay on her stomach.  Then I had her turn over.  I told her we have twenty minutes left to find and eliminate the cause of her headache.   I repalpated the back of her neck again as she lay on her back.. again, no tender spots.  I palpated her forehead, and area where she felt her headache.. again no tender spots.. Then I palpated her right masseter.. she flinched and verbally said OUCH.. She said she can feel it in her forehead.. I palpated the reast of her neck and face.. SCM and all the rest.. None were painful..  So I knew her headache was coming from that right masseter.  So I told her to close her eyes and stick her tongue between her teeth.   She did.  Then I tapped and pressed right under her chin( mandible) on the myohyoid and all those muscles for about 30 seconds.  Then I told her to relaxe and open her eyes.. And I re checked her masseter.. and it was not near as sore.. She said her headache had greatly lessened.   So I said, lets do it again.. so we repeated the technique, re checked, and her headache and painful masseter were gone.  That technique works because the brain does not want to bite its own freakin tongue off.. lol  . So it weakens( relaxes) the muscles that could possibly do that, which is the masseter.  Also when you tap the tendons of a muscle it contracts or strengthens slightly.  And becasue of the reciprocal inhibition reflex that means the opposite muscles relax and weaken.  Which again is the masseter.   So that deactivated her headache that she had been dealing with for a week.   

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Permalink Reply by Therese Schwartz on April 24, 2014 at 7:49am

That is fantastic, Gordon!  Another success story, and another reminder to look for the cause of a problem instead of working on the symptoms. Thanks for posting the detailed stories - it really helps me, and my clients!

Permalink Reply by Gordon J. Wallis on April 25, 2014 at 1:48pm

What is simple, is simply seen.  And what is simple is rarely understood.

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