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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 Therese Schwartz on
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Very true!
The best definition of an adult I've heard is "someone who practices making simple things complicated".
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Permalink Reply by Gordon J. Wallis on
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Just as a follow up. I saw this client the other day for the 3rd time. Three of the trigger points are now gone. The two L5 TPs, and the QL TP. Only the upper sacrum one remained. And I was able to greatly down grade that TP this last session. They are short 15 minute sessions. Usually if I'm able to eliminate all the TPs, the clients symptomatic complaint goes away too. In her case, low back pain. And I have a real good way to gauge the success or lack of success by the number of TPs each session. She started with four, now she has only one, after three sessions. After this last sessin she says she can feel the difference and it feels good. If I can't eliminate the TPs and or symptoms after a few sessions I tell them I can always massage them but I won't be able to help them with their pain problem.. Im not going to rip anyone off with endless sessions with no improvement. There should be noticeable improvement after four to six sessions in order to justify additional appointments in my opinion.
Gordon J. Wallis said: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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Another follow up. I saw her again today. It was her fourth visit. When she came in she told me she has been pain free sense her last session. And when I palpated her. There were no more tender spots. The last session only the sacrum trigger point was left. Now its gone along with her low back pain. This big medical clinic she went to told her she needed surgery. Give me a break! I wonder how many people they have told that too? She is going to write a testimonial about her experience with her back pain. And I will be able to show that to other clients. But Truth Remains Hidden. And I think it always will. In the attachment below is a diagram of a muscle cell. It shows the sarcoplasmic recticulum that controles calcium flow within the muscle cell. When the sarcoplasmic recticulum is damaged, a trigger point forms.
Gordon J. Wallis said:Just as a follow up. I saw this client the other day for the 3rd time. Three of the trigger points are now gone. The two L5 TPs, and the QL TP. Only the upper sacrum one remained. And I was able to greatly down grade that TP this last session. They are short 15 minute sessions. Usually if I'm able to eliminate all the TPs, the clients symptomatic complaint goes away too. In her case, low back pain. And I have a real good way to gauge the success or lack of success by the number of TPs each session. She started with four, now she has only one, after three sessions. After this last sessin she says she can feel the difference and it feels good. If I can't eliminate the TPs and or symptoms after a few sessions I tell them I can always massage them but I won't be able to help them with their pain problem.. Im not going to rip anyone off with endless sessions with no improvement. There should be noticeable improvement after four to six sessions in order to justify additional appointments in my opinion.
Gordon J. Wallis said: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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I find trigger points involved in even the most benign of pain complaints. Had an example of that the other day. A new client came in for a massage. I told her that my massage is not any better then any one elses, but that I have a high skill set when it comes to getting people out of pain. I showed her one of my testimonials. She said no pain what so ever. Never needed to see a medical doctor or anyone for any kind of pain issue. But sometimes my low back is sore when I first wake up in the morning. As she was telling me that she placed her right hand on her right upper hip. She then said that after she moves around for a few minutes its gone and never bothers her for the rest of the day or night. I told her that I would take one minute before starting her massage and check her low back out I told her that I would palpate from her hips up to her mid back looking for a tender spot that she may not be aware of. I found what I suspected I would find. A latent trigger point in her right gluteus medius She was unaware of it until I palpated it. The same spot on the left hip was not sore at all. She had an hour and a half massage. Plenty of time to deactivate one latent trigger point. After the massage I repalpted her right gluteus medius and that spot was no longer tender. I also showed her a picture of her gluteus medius pain pattern. The same one in the attachment below. Even minor pain problems are often the result of a hidden trigger point. Her pain issue was so minor that I didn't suggest she reschedual for a follow up session. But she thanked me for showing her that trigger point picture, which explained her every once in a while morning low back pain.
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Permalink Reply by Gary W Addis, LMT on
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A myofascial pain can originate from a muscle or tendon tear-- extremely rare. Or it can originate from a trigger point...a blockage of nerve signal and / or nutrition and oxygen to a muscle's sarcomere-- very common. This is just plain commonsense, and it is borne out every time we get someone on our tables. We all have trigger points, little niggling pains that, like your lady client, are ignored until they become too painful to tolerate. TPs breed like rabbits; a dysfunction in one microscopic sarcomere invariably leads to TPs in every agonistic and antagonistic muscle even remotely connected to the troubled muscle.
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I look at trigger points as a tear in the muscle cell( damaged muscle cells). A lot of my clients seem shocked or dismayed when I tell them not to streach or exercise after a successful trigger point treatment. Because if they have had any massage or TP work in the past for pain issues, that's what they were instructed to do.. Stretch and work out. All the trigger point books and massage books out there have stretching and working out as a major part of their therapy. If you ask me, thats why its so ineffective. It's wrong. Worst thing to do. If you have a crack in the corner of your mouth. If you open your mouth wide to eat a hamberger or something. It only cracks more. Keep your mouth closed as much as possible, it heals faster. . Its like if you get a cut, you don't keep poking the cut to see if its healing.. You leave it alone and let it heal. It goes against the grain of all the trigger point and orthopedic massage books out there. But I've found my work to be much more effective by not having the client stretch and work out after therapy. You want to rest , eat a high protien diet, and let the tissues heal( protien is the only thing that re-builds damaged muscle tissue). Then you can do those things that help prevent trigger points after they have healed. Like stretching and so on.
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Yea thats right. A trigger pointed muscle is a shortend and weakend muscle. Other muscles have to compensate ( work extra hard) in order to make sure your eyes are parallel to the ground. And those other muscle develope TPs themselves. One of my clients, after about the fourth session, had to re-adjust her car seat and rear view mirror when she got into her car. Her posture changed so much.
Gary W Addis, LMT said:A myofascial pain can originate from a muscle or tendon tear-- extremely rare. Or it can originate from a trigger point...a blockage of nerve signal and / or nutrition and oxygen to a muscle's sarcomere-- very common. This is just plain commonsense, and it is borne out every time we get someone on our tables. We all have trigger points, little niggling pains that, like your lady client, are ignored until they become too painful to tolerate. TPs breed like rabbits; a dysfunction in one microscopic sarcomere invariably leads to TPs in every agonistic and antagonistic muscle even remotely connected to the troubled muscle.
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When I first started this thread. I was not sure what to title it. I came up with A Typical Experience, because it is. Because the reality is, a huge percentage of the population that suffers mild, to medium, to severe pain, are mis diagnosed. Now most people with pain issues run to their medical doctors, chiropractors and or physical therapists.. Now I work in a spa. So most of the people that run to me are having a birthday, or its a Christmass present, or maybe its mothers day. But there is not one day that goes bye, that I don't have a Typical Experience. Not too long ago a lady came in just to relax. After showing her one of my testimonials. She told me that she does have chronic low back pain , and has had it for years. I didn't ask her how many years. After some time dealing with this pain she went to a medical clinic. They diagnosed her with a Compressed Lumbar Spine and Dysfunctional Sacroiliac Joint. Like thats suppose to help?.. Eventually they sent her to physical therapy. I asked her how long she went to physical therapy and if it helped her.. In her words she said.. A long time. And it didnt help. She quit on her own. I palpated her low back and hips. I found an L5 TP on the left side of her spine, and two Gluteus maximus TPs on the right hip. I asked her if any of the medical doctors or physical therapists touched her low back and hips... She said no. I asked her what the physical therapists were trying to do. She said re-align her spine? Any way. I was able to deactivate those three trigger points and that mysteriously eliminated her low back pain for the first time in years. This is a typical experience. .. Obviously those people she went to, know nothing about Myofacial pain. And if you have read this entire thread.. You know I'm not the only one saying this. But for some mysterious reason. Truth Remains Hidden. Even though the information has been out there for decades. The attachemts below were her compressed lumbar spine and dysfunctional sacroiliac joint that she had delt with for years. No one palpated her area of complaint except me. They just use diagnostic imaging or something? . Well she had gotten massages, but she was just rubbed and her complaint was never addressed. Reality is. Most of the pain that people run to the doctors for is Myofacial pain. Which is seldom recognized or understood by the medical comunity. There are many medical texts and books on the subject. . However, its still not common knowledge for the Medical comunity or the general public or even for massage therapists.
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Gosh I have an interesting case now. Its unusual. She was a referal from another massage therapist that I use to work with. I don't know if I can help this women, but I think I can. Her complaint was. One side of her face feels thick. And that she can't close her eye all the way. Most of the way, but not all the way. It was her left eye and side of her face. I asked her if there was any pain. She said yes. I explained to her that I was going to hunt for sore spots on the left side of her face and neck. I found a tender spot in her Masseter, and SCM. Also the Zygomaticus Major, and the Occipitalis in the back of her head. And a couple of very tender spots on her Orbicularis Oculi. Also tender spots behind the ear and in her Pterygoideus. There might have been a few more tender spots but I can't remember. But they were all on the left side of her face and referred pain to her eye area. It was a lot of tiny muscle work.. Way cool. Anyway she commeted that she could close her eye all the way once I released some of those trigger points. I forgot to ask her how long she has been dealing with this. But Im sure it has been a good amount of time. I worked 35 minutes on her. She also complained of lateral leg pain on her right leg. I found a Piriformis tender spot and a Gluteus maximus. Also a very tender spot on her lateral leg Vastus laterealis. She kept making these weird stretching movements with her jaw and neck. I kept telling her don't do that because she would re-activate those tender spots.. I explained to her that the tissues are still damaged but we have released most of those tender areas, and she has to let them heal. Of course she was told to stretch and work out. But I have found that not to be a good idea. Its like a crack in the corner of your mouth. You open your mouth wide and stretch it around, it only cracks more. When the trigger point dissappers its not all find and dandy. The tissue is still injured. You have to let it heal. Then you can stretch and strengthen the muscles. Anyway, that was cool working on her...In the attached files are some of the trigger points involved. There is not enough room to show pictures of all the involved muscles.
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I was really curious to see how her eye and face were doing. When she came in for her follow up visit she emmediately told me her leg was more sore. And that she did what I said. No exercising, stretching, working out and so on. But her leg hurt worse now. I said Oh, I'm sorry. How is you eye and face. She said.. Oh thats fine now. But my leg hurts.. But its different now.. I said, What do you mean Different? She said.. Oh it doesnt hurt on the side any more, but it hurts on the back of my leg now. I said ok lets start out by checking your face just to make sure all the tender spots are gone. I found only two very mild tender spots on her obicularis oculi. When I checked her leg, none of the trigger points I worked on in her previous vist were there. I found two tender points in the middle of her hamstings on the same leg. I didnt notice or find them on her first visit. Anyway I deactivated the two trigger points on her eye and the two on her hamstring. She said her leg felt good when she left. She seemed a bit anoyed when I reminded her not to stretch or exercise at least until after her next visit a few days from now. Hopefully her leg will be better on her next vist. There was a dramatic difference with her eye and face. Actually her leg too. Even though she didn't see it that way.
Gordon J. Wallis said:Gosh I have an interesting case now. Its unusual. She was a referal from another massage therapist that I use to work with. I don't know if I can help this women, but I think I can. Her complaint was. One side of her face feels thick. And that she can't close her eye all the way. Most of the way, but not all the way. It was her left eye and side of her face. I asked her if there was any pain. She said yes. I explained to her that I was going to hunt for sore spots on the left side of her face and neck. I found a tender spot in her Masseter, and SCM. Also the Zygomaticus Major, and the Occipitalis in the back of her head. And a couple of very tender spots on her Orbicularis Oculi. Also tender spots behind the ear and in her Pterygoideus. There might have been a few more tender spots but I can't remember. But they were all on the left side of her face and referred pain to her eye area. It was a lot of tiny muscle work.. Way cool. Anyway she commeted that she could close her eye all the way once I released some of those trigger points. I forgot to ask her how long she has been dealing with this. But Im sure it has been a good amount of time. I worked 35 minutes on her. She also complained of lateral leg pain on her right leg. I found a Piriformis tender spot and a Gluteus maximus. Also a very tender spot on her lateral leg Vastus laterealis. She kept making these weird stretching movements with her jaw and neck. I kept telling her don't do that because she would re-activate those tender spots.. I explained to her that the tissues are still damaged but we have released most of those tender areas, and she has to let them heal. Of course she was told to stretch and work out. But I have found that not to be a good idea. Its like a crack in the corner of your mouth. You open your mouth wide and stretch it around, it only cracks more. When the trigger point dissappers its not all find and dandy. The tissue is still injured. You have to let it heal. Then you can stretch and strengthen the muscles. Anyway, that was cool working on her...In the attached files are some of the trigger points involved. There is not enough room to show pictures of all the involved muscles.
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I had another interesting new client the other day. I asked her what she needed from the massage. She had an 80 minute massage scheduled. She said she works seven days a week, she is burnt out, sick, and has had a headache for a few days. I could hear a deep caugh. She told me she got a massage three weeks ago, and said she was so sore the next day she needed help getting out of bed the next morning.. I asked her if the massage was painful. She said no, but the therapist worked extra long on her knots. I said Oh, You have a lot of knots. She said yea. I showed her one of my testimonials. She said You are the kind of person Im looking for. I sad Ok. What Im going to do is search your whole body for tender spots. If we find any. We will deactivate them. Because I have discovered that if Im able to remove all the tender spots. There are positive clinical results. Ususally the clients symptomatic complaints vanish. She said ok. I told her that I would start palpating on her hips and continiue through her whole body, front, back, and sides. And that she has to tell me if or when I touch a sore spot. Anyway I found and deactivated at least 40 trigger points on that young lady. None were so bad to make her flinch. But she clearly told me each time I got to one. No need listing all the trigger points. She had quite a few on the lateral spinous of her vertabrae. The ones closely associated to her headache were on her Levator scapulae, upper trap, and SCMs. Sense she was sick I expected to find trigger points in her abdominal area. That could indicate internal organ stress, and also the abbs tighten up during caughing. So I found two tender areas there. One in the lower left quadrent of her abdominal aea, and another in the upper right quadrent. Also found a tender spot on the bottom of her right foot. I was able to check her whole body out and deactivate the trigger points within an hour. With the remaining 20 minutes I basically gave her a nice back rub. Anyway when she left the table she was still sick of course. But her headache was gone. Oh, I forgot to mention that she had three lateral neck tender spots. Two on one side and one on the other that were directly contibuting to her headaches. Also tender spots on her pectoralis major I assume from caughing so much. She said she wants to see me every month. Then I will find out if she could get out of bed the next day.
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Permalink Reply by Maryshka on
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Thanks for this post. Helpful!
Therese Schwartz said:I had a new client Monday; 66 years old, just started having bad headaches earlier this year. They start in her neck and end in her left eye. She's been thoroughly checked out by two eye doctors, had a CAT scan and an MRI and been to a neurologist (who prescribed Neurontin for her. What?!? She didn't take it for very long - it made her feel terrible). So as much as possible, any underlying pathology has been ruled out. I asked her to tell me about any accidents; she had a cheerleading accident in high school where she landed on her head/neck, and then a couple of years later a bad car accident. She's managed to compensate in some way until recently, when she retired from decades of stressful jobs.
I started working on her neck and she could feel the tension in her eye (which I expected). By the time I was done, I could work on her neck with no tension/pain in her eye. She was very pleased and has rebooked for every week until we can get things under control (she has other things going on too).
I love my job! :)
Thanks for the continued posts and education. My clients and I are most definitely benefiting from what you have to say.
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