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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 Gary W Addis, LMT on June 16, 2014 at 10:42pm

they don't know tps, and had to call it something.  Lucky for her that they hadn't labeled it serious ligament tears or even bone damage that need hip replacement surgery.

Permalink Reply by Gordon J. Wallis on June 17, 2014 at 12:25am

Well she may have had a torn labrum.  But when the the trigger points were gone. So was her pain.

Gary W Addis, LMT said:

they don't know tps, and had to call it something.  Lucky for her that they hadn't labeled it serious ligament tears or even bone damage that need hip replacement surgery.

Permalink Reply by Gordon J. Wallis on June 17, 2014 at 10:21pm

Sciatica.  I hear that so much.  Its usually not the case.  I fix that diagnosis all the time.  Because the diagnosis is wrong.  If somebody really had Sciatica, I could'nt help them.  Sooth them maybe..But not cure them.   I had 15 minutes before my first massage.  I had set the room up and was just waiting for my first client.  I decided to relax in the waiting area of the spa for a few minutes.  There were three tourist ladies that had just finished getting manicures and were chatting as their nails dried.  One asked me if I worked in the spa.. I told her yes and that I was a Massage Therapist.  She asked me if I do deep tissue massage because she has Sciatica and was told that might be helpful.   She has seen Physical Therapists and is doing all the exercises but her right hip , groin and side of her leg hurt still hurt.  I told her that I'm quite sure she hurts, but that I seriously doubted if she really had Sciatica.  She said but it hurts and runs down my leg.  How can you say that?  I said Well If I say that to 100 people with that diagnosis, id be wrong only 10 times.  lol    I told her that I had ten minutes before my first appointment and that I would proove it too her..  I got her on the table and in a few seconds palpated a very painful Gluteus Minimus  and a very painful Vastus Lateralis.   I was able to deactivate both within the short amount of time.   I know she had more TPs but I had no time.   She got up off the table and looked stunned.  She said my hip does not hurt?  I'm not use to this?  And she started swinging her hips and legs around.. I stopped her right away.  She said those are the exercises they told me to do and it doesnt hurt when I do them now?  I told her that those exercises were the most perfectly wrong thing to do for her condition.  She said whats my condition?  I said  Myofacial Pain Syndrome.  In other words you have Trigger points.   I asked her how long she would be in Anchorage.  She said one month.  I told her that is more then enough time to eliminate her pain.  She booked an appoinment before she left.

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Permalink Reply by Gary W Addis, LMT on June 18, 2014 at 12:12am

True sciatica-- spinal nerve entrapment-- it stands to reason will involve bilateral hip and leg.  The sciatic nerve is conjoined throughout its travel down the spinal column, so what affects one leg and hip will affect the other.  Therefore, it stands to reason that if the pain is only on one side of the body...if it radiates down only one hip and its leg, then the etiology of the pain must be entrapment of that side's sciatic nerve.  The nerve has already left the confines of the vertebral column, so any painful entrapment must be by one or more muscles of the hip or, rarely, thigh.  Piriformis, as we all know, is the most common culprit in the painful dysfunction wrongly called sciatica, or rightly piriformis syndrome.

I don't have access to nerve induction testing, but I consider the above just plain commonsense.

Permalink Reply by Gordon J. Wallis on June 18, 2014 at 5:02am

The disc could bulge on one side of the spine irritating that side nerve root and cause a radiating pain down one leg and not the other.  Its just that trigger points causing hip and leg pain are way way more common then then radiating nerve pain that runs down the leg.    I also hear the term pinched nerve often.. Heard it today.  Its way more often then not, a trigger point. 

Gary W Addis, LMT said:

True sciatica-- spinal nerve entrapment-- it stands to reason will involve bilateral hip and leg.  The sciatic nerve is conjoined throughout its travel down the spinal column, so what affects one leg and hip will affect the other.  Therefore, it stands to reason that if the pain is only on one side of the body...if it radiates down only one hip and its leg, then the etiology of the pain must be entrapment of that side's sciatic nerve.  The nerve has already left the confines of the vertebral column, so any painful entrapment must be by one or more muscles of the hip or, rarely, thigh.  Piriformis, as we all know, is the most common culprit in the painful dysfunction wrongly called sciatica, or rightly piriformis syndrome.

I don't have access to nerve induction testing, but I consider the above just plain commonsense.

Permalink Reply by Gary W Addis, LMT on June 18, 2014 at 8:28am

But what may be the cause of a bulging disc? Trigger points pulling the lateral-superior of the vertebra.  The muscles of the spine are crisscrossed-- an X-- so if one of those wee strands is hypertense due to trigger points, it'll pull the top edge of that vertebra down, over time forcing the disc to squirt out the back side. Seems to me that the only other possible cause of a bulging disc would be sudden force trauma powerful enough to rip those small strands of protective muscle-- the spinal vertebrae are well protected, and still the most mobile joints in the body.. The crisscrossed layered muscles are designed to be very quick to form protective trigger points, to lock that vertebra down, trying to prevent extreme, damaging movement of that one vertebra.  If it hurts to move the spine a certain way, so you stop moving that way...over time the constant pull on the top lateral attachment of a vertebra will force the disc out the back side. And as you have taught me, where there is one tp, there's likely to be another then another then another.

The bundle of nerves that form in the well protected sacral vertebra emerge from the stability and protection of the sacrum as two separate sciatic nerves, one for each hip and leg.  

With muscles and ligaments and sacrum removed, the sciatic nerve of the right side of the body.

I haven't spent much time thinking this through, but this scenario about how/why discs bulge seems probable to me.  Wouldn't it take a tremendous force to damage the five fused vertebra within the sacrum?  So, it seems to me that the sciatic nerve--after it forms within the sacral protection-- is the least likely to be affected by impingement by bulging discs.

Permalink Reply by Gordon J. Wallis on June 18, 2014 at 1:36pm

Well what gets me is that I can tell if someone really has Sciatica or not.   I can tell that in seconds.  Maybe a minute.   The reason everyone is told they have Sciatica any time there is pain radiating down their hip and leg is because no one knows the reality of trigger points.  Its very easy to palpate the difference.  Its easy to palpate the difference between nerve pain and trigger point pain.  They get it often wrong because trigger points are so common, yet never calculated in their equation to begin with.  Travells biggest worry was the mis diagnosis of pain.

Gary W Addis, LMT said:

But what may be the cause of a bulging disc? Trigger points pulling the lateral-superior of the vertebra.  The muscles of the spine are crisscrossed-- an X-- so if one of those wee strands is hypertense due to trigger points, it'll pull the top edge of that vertebra down, over time forcing the disc to squirt out the back side. Seems to me that the only other possible cause of a bulging disc would be sudden force trauma powerful enough to rip those small strands of protective muscle-- the spinal vertebrae are well protected, and still the most mobile joints in the body.. The crisscrossed layered muscles are designed to be very quick to form protective trigger points, to lock that vertebra down, trying to prevent extreme, damaging movement of that one vertebra.  If it hurts to move the spine a certain way, so you stop moving that way...over time the constant pull on the top lateral attachment of a vertebra will force the disc out the back side. And as you have taught me, where there is one tp, there's likely to be another then another then another.

The bundle of nerves that form in the well protected sacral vertebra emerge from the stability and protection of the sacrum as two separate sciatic nerves, one for each hip and leg.  

With muscles and ligaments and sacrum removed, the sciatic nerve of the right side of the body.

I haven't spent much time thinking this through, but this scenario about how/why discs bulge seems probable to me.  Wouldn't it take a tremendous force to damage the five fused vertebra within the sacrum?  So, it seems to me that the sciatic nerve--after it forms within the sacral protection-- is the least likely to be affected by impingement by bulging discs.

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Permalink Reply by Gordon J. Wallis on June 18, 2014 at 2:17pm

People are misdiagnosed all the time when it comes to that type thing.  Functional pain, or whatever you want to call it?  Often, if I meet somebody that says they have Sciatica or Carpal Tunnel or any type of pain in the body.  They don't believe that I can help them.  Odds are I can just based on statistics.  If I show them a testimonial, that helps.  But ya know, being a lowly Massage therapist does not trump( in their eyes) a Chiropractor, MD or whoever else they are seeing.  Or they will say, I tried massage , or Im already getting massage in my Chiropractic office.   But unless you have someone thats specifically knowledge about trigger points, they don't get well.  Then often tiimes they are seeing several different kinds of practioners that are actually perpetuating the trigger points through their therapy.  Just the other day one of my Sciatica clients came in for her 3rd or 4th visit.  This last one was only 15 minutes long.  She had two or three TPs in her right hip.  And it hurt when she moved.  She loves to run and work out.  A young healthy women.   She believed me when I told her that I could help her. I cant remember exactly what or if she had been or was seeing anyone else for her pain?  I will find out.  She stopped working  out for a couple of weeks.  Now she is symtomatic free.  However on palpation she still had two very tender spots on her right hip. On the border of her sacrum.  She still has two trigger points that are now inactive.  Latent trigger points.  And this is dispite the fact that she has started working out again. Sense in her eyes she was healed.  But she did notice the pain on palpation and is coming in next week for a short follow up.  Soon they will be totally gone.  If she stopped working out completely.  They would be gone sooner.  But she is healthy and symtomatic free now, so it seems to be alright for her to exercise.   Maybe have to see her three more times.. Guessing.   Not everyone hurting has trigger point pain.  Just a lot.

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Permalink Reply by Gordon J. Wallis on June 18, 2014 at 9:46pm

This is sort of unrelated but not.  I took a taxi home today after work.   The driver and I were chit chatting.  He asked me what I did for a living.  I told him I was a Massage Therapist.  He said do you work with Rotator Cuff injuries. I said,, Uh, yea?  He told me that he injured his shoulder two years ago helping lift an ellderly ladies luggage.  After work that day he was in pain and went to the emergency room.  They Xrayed him and told him he needed surgery.  He said how can you know that so quickly.  A few days later he went to an Orthoopedic clinic and they told her he needed surgery.  He then went to a family clinic and saw a GP medical doctor.  She said well.. Try not to use it reguardless.  We will put it in a sling to let it rest.  And every day move it some so when it heals you will have full range of motion.  Thats what he did.   Its two years later now. He is fine.. He says he is totally pain free and has a fulll pain free range of motion.   His taxi driver frined had a similar accident.  Got the surgery, and he is worse now then before he got the surgery.   Now if someone really needs surgery.  Well thats one thing.  But often enough.  Things are not as they seem.   If you have read this entire thread and viewed all the attachments.  You will see how this Taxi drivers story fits into this thread.   Truth Remains Hidden.

Gordon J. Wallis said:

People are misdiagnosed all the time when it comes to that type thing.  Functional pain, or whatever you want to call it?  Often, if I meet somebody that says they have Sciatica or Carpal Tunnel or any type of pain in the body.  They don't believe that I can help them.  Odds are I can just based on statistics.  If I show them a testimonial, that helps.  But ya know, being a lowly Massage therapist does not trump( in their eyes) a Chiropractor, MD or whoever else they are seeing.  Or they will say, I tried massage , or Im already getting massage in my Chiropractic office.   But unless you have someone thats specifically knowledge about trigger points, they don't get well.  Then often tiimes they are seeing several different kinds of practioners that are actually perpetuating the trigger points through their therapy.  Just the other day one of my Sciatica clients came in for her 3rd or 4th visit.  This last one was only 15 minutes long.  She had two or three TPs in her right hip.  And it hurt when she moved.  She loves to run and work out.  A young healthy women.   She believed me when I told her that I could help her. I cant remember exactly what or if she had been or was seeing anyone else for her pain?  I will find out.  She stopped working  out for a couple of weeks.  Now she is symtomatic free.  However on palpation she still had two very tender spots on her right hip. On the border of her sacrum.  She still has two trigger points that are now inactive.  Latent trigger points.  And this is dispite the fact that she has started working out again. Sense in her eyes she was healed.  But she did notice the pain on palpation and is coming in next week for a short follow up.  Soon they will be totally gone.  If she stopped working out completely.  They would be gone sooner.  But she is healthy and symtomatic free now, so it seems to be alright for her to exercise.   Maybe have to see her three more times.. Guessing.   Not everyone hurting has trigger point pain.  Just a lot.

Permalink Reply by Therese Schwartz on June 19, 2014 at 10:39am

That taxi driver was lucky - or diligent - in finding that doctor.  Most people don't have that experience.

Gordon, I wanted to let you know that your posts and attached photos are making a difference - I am learning from them, and making big differences for my clients.  I was doing good work before, but now it's even better and people are commenting on it.  I tell them I'm learning from you!

Permalink Reply by Gordon J. Wallis on June 19, 2014 at 11:05am

Well my protocal is very simple, reguardless of your approach or style.  Take note of the sore spots, especially the ones that cause your client to flinch.  And do whatever you can to down grade or eliminate those tender spots.  It may take more then one session.   But if those tender spots are still there.  So is the problem, usually.   Usually( example is one client that came in complaining of hip pain, sciatica.   Now she no longer has the symptomatic pain,  however she  still has a couple inactive (tender on palpation only)trigger points left to fully eradicate.   All my new clients with pain complaints I do a simple initial pain exam.  Only takes a few minutes.  I palpate for tender spots.  I may go over how I do that in the future.  But it gives you a pain map of your client.  And something to measure your progress with.

Permalink Reply by Maryshka on June 19, 2014 at 12:03pm

Do you palpate the entire body in a simple initial pain exam those few minutes or just the area of concern that the client mentions?

Sorry if this sounds remedial (it is)...

Gordon J. Wallis said:

Well my protocal is very simple, reguardless of your approach or style.  Take note of the sore spots, especially the ones that cause your client to flinch.  And do whatever you can to down grade or eliminate those tender spots.  It may take more then one session.   But if those tender spots are still there.  So is the problem, usually.   Usually( example is one client that came in complaining of hip pain, sciatica.   Now she no longer has the symptomatic pain,  however she  still has a couple inactive (tender on palpation only)trigger points left to fully eradicate.   All my new clients with pain complaints I do a simple initial pain exam.  Only takes a few minutes.  I palpate for tender spots.  I may go over how I do that in the future.  But it gives you a pain map of your client.  And something to measure your progress with.

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