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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 Maryshka on July 31, 2014 at 8:56am

Thanks Gordon for your posts. I have several clients with long-standing taut bands and TrPs from MVC's years ago and chronic mom-stress where soft tissue work was not done. Sometimes I think I'm failing cuz I don't feel the taut bands disappearing even though the clients report they feel better and I see ROM improvement. Are there times that the taut bands don't go away because they've become fibrotic?

I've incorporated hot stones on specific sites and can feel the tissue give way that allows me to go deeper into the tissue. I suppose it will take time. One of my clients owns a PT office with her husband (where they have a MT) but client comes to me for bodywork... so I bow in respect to you and what you share with us. It's helping me become a better MT.

Permalink Reply by Gordon J. Wallis on July 31, 2014 at 11:43am

Uhm, I don't try to feel anything.  Taut bands or whatever.  Out of the thousands of massages I've done.  Everyone feels different.  I've gone to several massage therapists with fake injuries.  And guess what. They could all feel where my problem was coming from. I just find that( feeling the tissues) to subjective. Maybe others have that skill set, but I don't need too. The client tells me where the trigger point is( during my palpation).  And they tell me when the trigger point is gone .  And if they get up off the table with less pain and or a greater range of motion. Thats all I'm concerned with. Those are positive clinical results.  If they get up off the table and say.   I think I'm better. Or there is no improvement on range of motion( greater range of motion or less pain on motion). Then I didn't help them and need to re-think about my approach.  And if I can't help in a noticeable way after four sessions.  I tell them I can always be their massage therapist, but I won't be able to help them with their specific problem.

Maryshka said:

Thanks Gordon for your posts. I have several clients with long-standing taut bands and TrPs from MVC's years ago and chronic mom-stress where soft tissue work was not done. Sometimes I think I'm failing cuz I don't feel the taut bands disappearing even though the clients report they feel better and I see ROM improvement. Are there times that the taut bands don't go away because they've become fibrotic?

I've incorporated hot stones on specific sites and can feel the tissue give way that allows me to go deeper into the tissue. I suppose it will take time. One of my clients owns a PT office with her husband (where they have a MT) but client comes to me for bodywork... so I bow in respect to you and what you share with us. It's helping me become a better MT.

Permalink Reply by Gordon J. Wallis on July 31, 2014 at 12:08pm

I have one client maybe two, that I might not be able to help.  I've seen them a couple times now.  Another client that came to me with shoulder and neck pain and headaches at night.  Had been seeing a physical therapist for a year with no improvement in her condition. I saw her for two 25 minute sessions and she is now symptomatic free. No pain, no headaches.  She was that way after the first session.  But she still had a few latent trigger points on her follow up session.  She will just need a couple more follow ups.  Her problem was a few trigger points.  I know and see when I'm helping some one.. And I know and see when I'm not.  Some seem not able to do that.  For whatever reason?

Gordon J. Wallis said:

Uhm, I don't try to feel anything.  Taut bands or whatever.  Out of the thousands of massages I've done.  Everyone feels different.  I've gone to several massage therapists with fake injuries.  And guess what. They could all feel where my problem was coming from. I just find that( feeling the tissues) to subjective. Maybe others have that skill set, but I don't need too. The client tells me where the trigger point is( during my palpation).  And they tell me when the trigger point is gone .  And if they get up off the table with less pain and or a greater range of motion. Thats all I'm concerned with. Those are positive clinical results.  If they get up off the table and say.   I think I'm better. Or there is no improvement on range of motion( greater range of motion or less pain on motion). Then I didn't help them and need to re-think about my approach.  And if I can't help in a noticeable way after four sessions.  I tell them I can always be their massage therapist, but I won't be able to help them with their specific problem.

Maryshka said:

Thanks Gordon for your posts. I have several clients with long-standing taut bands and TrPs from MVC's years ago and chronic mom-stress where soft tissue work was not done. Sometimes I think I'm failing cuz I don't feel the taut bands disappearing even though the clients report they feel better and I see ROM improvement. Are there times that the taut bands don't go away because they've become fibrotic?

I've incorporated hot stones on specific sites and can feel the tissue give way that allows me to go deeper into the tissue. I suppose it will take time. One of my clients owns a PT office with her husband (where they have a MT) but client comes to me for bodywork... so I bow in respect to you and what you share with us. It's helping me become a better MT.

Permalink Reply by Gary W Addis, LMT on July 31, 2014 at 4:16pm

Gordon is the best.  Thanks to his guidance, I am a far better, more advanced therapist than I probably would have become in a decade of practice w/o his help. 

We work differently, however, just as you work differently from the MT in the next treatment room.  By "taut band"
I'm assuming you're referring to a pinch or a handful of rock hard muscle, upper traps for instance.  Latent trigger points may not be even locally tender to pressure.  But something is the cause of that hypertonicity.  I treat  those "taut bands" as if there is a trigger point even though I can't feel a knot and the client doesn't report pain.  I clasp the muscle and apply pressure-- not killer pressure!-- and usually within a few seconds that hypertonicity relaxes in the entire muscle (upper traps in this instance.  

Now, since the "normal" signs were missing, some will say it wasn't a trigger point at all-- who cares, it's results we're after, right?  But I'd also through scan that muscle's antagonists, which may contain very active, very painful trigger points.  As you know, a trigger pointed muscle will quite often cause one or more of its antagonist muscles to contract in order to counterbalance the pull made by the trigger pointed muscle. 



Maryshka said:

Thanks Gordon for your posts. I have several clients with long-standing taut bands and TrPs from MVC's years ago and chronic mom-stress where soft tissue work was not done. Sometimes I think I'm failing cuz I don't feel the taut bands disappearing even though the clients report they feel better and I see ROM improvement. Are there times that the taut bands don't go away because they've become fibrotic?

I've incorporated hot stones on specific sites and can feel the tissue give way that allows me to go deeper into the tissue. I suppose it will take time. One of my clients owns a PT office with her husband (where they have a MT) but client comes to me for bodywork... so I bow in respect to you and what you share with us. It's helping me become a better MT.

Permalink Reply by Gordon J. Wallis on July 31, 2014 at 5:15pm
Emotional tension is different. The muscles are tight not because of cellular damage or adhesions, but because of unconcious emotional stress. The tight emotional muscle does not have to be sore on palpation. And if the tightness is from say emotional trauma from childhood. There can even be long term postural distortions, like a caved in chest( low self asteam) or raised shoulders( fear ). That has become locked into the body. With pressure or touch, those tissues can relax( and you can feel it relax), but it's only temporary. The emotional trauma has to be delt with( serious psychotherapy ). Also emotional tension can cause trigger point activity.
Permalink Reply by Gary W Addis, LMT on July 31, 2014 at 6:58pm

All true, certainly.  Some people go through life highly stressed.  In some, it settles into neck and shoulders.  Others, the stress results in recurring digestive distress.  Treating it as I outlined-- as if it is indeed due to a trigger point-- will relax that tension.  Sure, it may recur during their drive home from the treatment room.  I can't do diddly about their emotional life, but I can provide at least a few moments of relief.  And, the stress leads to even more stress in a vicious cycle.  Could be that a few moment's relaxation is enough of an interruption in the stress cycle that it might also help them psychologically.

Gordon J. Wallis said:

Emotional tension is different. The muscles are tight not because of cellular damage or adhesions, but because of unconcious emotional stress. The tight emotional muscle does not have to be sore on palpation. And if the tightness is from say emotional trauma from childhood. There can even be long term postural distortions, like a caved in chest( low self asteam) or raised shoulders( fear ). That has become locked into the body. With pressure or touch, those tissues can relax( and you can feel it relax), but it's only temporary. The emotional trauma has to be delt with( serious psychotherapy ). Also emotional tension can cause trigger point activity.
Permalink Reply by Gordon J. Wallis on July 31, 2014 at 7:04pm
For sure Gary. The healing benefits of massage are many. Truth Remains Hidden.
Permalink Reply by Gordon J. Wallis on August 6, 2014 at 11:55am

A client, a tourist here for about a month told me that she has chronic pain in her hips, and needs surgery. Thats what the Docs told her.  Well... I worked on her only two times now and she is smptomatic free.  No more pain.  She had the usual trigger points in the Glute Med, Piriformis, and PSIS areas.  The right hip was worse then the left because there was no Piriformis TP on the left.   I will see her maybe four more times to make sure there are no latent trigger points waiting for reactivation.  Gosh, I wonder what they were going to operate on?  Its sickening to me when I think about it.  Sadly, this is a Typical Experience.  I mean if somebody really needed surgery.  I would not be able to help them.  

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Permalink Reply by Gordon J. Wallis on August 6, 2014 at 7:48pm

Wow It was a very good day.  I was able to help all my clients in a dramtic way.  When I ask people what they need from this massage.  Most of the time I hear. Just to relax I guess.  Or just to relax.  After they read one of my testimonials, then they start telling me about where they hurt and a history of the hurt.  They were all new clients except for one.  She had a shoulder problem for years.  I only saw her one time, and she was pain free for the first time in years, but it only lasted three days.  The trigger point returned.  As can be expected.  This was only her second visit and she was very excited. That pain had been in there for a long time dispite a few years of other therapies.  It was one of  the paraspinals about the T4 level on the left side.   She left the spa pain free again.   Her problem should soon be over. Maybe four more visits? She brought her young teenage daughter that has a very definate scolliosis.  The daughter has had a very painful spot for years in her right side about the level of L3 on the lateral paraspinals.   That was a really sore spot on palpation for her.  She also had tender spots on both sides of her spine at the L5 level.   She left the spa pain free.  She was maybe 18.  She was amazed.. No pain.. Now Im sure it will come back in a couple days.  But if I deactivate that TP four five or six times.   It might be history.    Another client.. Gosh...has been seeing a chiropractor for two years with no improvement.  She was riddled with trigger points. At least 70.  The worst on her right side lumbar area.  She did not leave totally pain free. But she left noticably better.  And reschedualled.  It was a dramatic difference.. It was not like... I think I feel better... She did feel better.  She reschedualled.  All her trigger points vanished except her right lumbar ones.. Now she was very sensitive and flinched with the lightest of touch.  Like she was anticipating pain.  Ive seen people like her with a diagnosis of fibromyalgia.  I may have to use some desensitizing techniques like I described earlier in this thread.  But I think? Her problem is almost over.  I will know after four sessions.   It was a good day for me.  The smiles on their faces alone.  They did not expect what they experienced.  I feel good.  PS- sorry for any mis spelled words.  I'm not very good at that.

Permalink Reply by Gary W Addis, LMT on August 6, 2014 at 9:04pm

spelling? Not a problem.  I'm a pretty good speller (or was, when I was 50 years younger), but my typing is turrible, I often get ahead of myself typing faster than the mind can relay the message to the fgingers -- see what I mean?.

Great work today as usual, Gordon.

Gordon J. Wallis said:

Wow It was a very good day.  I was able to help all my clients in a dramtic way.  When I ask people what they need from this massage.  Most of the time I hear. Just to relax I guess.  Or just to relax.  After they read one of my testimonials, then they start telling me about where they hurt and a history of the hurt.  They were all new clients except for one.  She had a shoulder problem for years.  I only saw her one time, and she was pain free for the first time in years, but it only lasted three days.  The trigger point returned.  As can be expected.  This was only her second visit and she was very excited. That pain had been in there for a long time dispite a few years of other therapies.  It was one of  the paraspinals about the T4 level on the left side.   She left the spa pain free again.   Her problem should soon be over. Maybe four more visits? She brought her young teenage daughter that has a very definate scolliosis.  The daughter has had a very painful spot for years in her right side about the level of L3 on the lateral paraspinals.   That was a really sore spot on palpation for her.  She also had tender spots on both sides of her spine at the L5 level.   She left the spa pain free.  She was maybe 18.  She was amazed.. No pain.. Now Im sure it will come back in a couple days.  But if I deactivate that TP four five or six times.   It might be history.    Another client.. Gosh...has been seeing a chiropractor for two years with no improvement.  She was riddled with trigger points. At least 70.  The worst on her right side lumbar area.  She did not leave totally pain free. But she left noticably better.  And reschedualled.  It was a dramatic difference.. It was not like... I think I feel better... She did feel better.  She reschedualled.  All her trigger points vanished except her right lumbar ones.. Now she was very sensitive and flinched with the lightest of touch.  Like she was anticipating pain.  Ive seen people like her with a diagnosis of fibromyalgia.  I may have to use some desensitizing techniques like I described earlier in this thread.  But I think? Her problem is almost over.  I will know after four sessions.   It was a good day for me.  The smiles on their faces alone.  They did not expect what they experienced.  I feel good.  PS- sorry for any mis spelled words.  I'm not very good at that.

Permalink Reply by Gordon J. Wallis on August 7, 2014 at 8:26pm

LOL...  Ok, I won't worry about spelling so much.

Gary W Addis, LMT said:

spelling? Not a problem.  I'm a pretty good speller (or was, when I was 50 years younger), but my typing is turrible, I often get ahead of myself typing faster than the mind can relay the message to the fgingers -- see what I mean?.

Great work today as usual, Gordon.

Gordon J. Wallis said:

Wow It was a very good day.  I was able to help all my clients in a dramtic way.  When I ask people what they need from this massage.  Most of the time I hear. Just to relax I guess.  Or just to relax.  After they read one of my testimonials, then they start telling me about where they hurt and a history of the hurt.  They were all new clients except for one.  She had a shoulder problem for years.  I only saw her one time, and she was pain free for the first time in years, but it only lasted three days.  The trigger point returned.  As can be expected.  This was only her second visit and she was very excited. That pain had been in there for a long time dispite a few years of other therapies.  It was one of  the paraspinals about the T4 level on the left side.   She left the spa pain free again.   Her problem should soon be over. Maybe four more visits? She brought her young teenage daughter that has a very definate scolliosis.  The daughter has had a very painful spot for years in her right side about the level of L3 on the lateral paraspinals.   That was a really sore spot on palpation for her.  She also had tender spots on both sides of her spine at the L5 level.   She left the spa pain free.  She was maybe 18.  She was amazed.. No pain.. Now Im sure it will come back in a couple days.  But if I deactivate that TP four five or six times.   It might be history.    Another client.. Gosh...has been seeing a chiropractor for two years with no improvement.  She was riddled with trigger points. At least 70.  The worst on her right side lumbar area.  She did not leave totally pain free. But she left noticably better.  And reschedualled.  It was a dramatic difference.. It was not like... I think I feel better... She did feel better.  She reschedualled.  All her trigger points vanished except her right lumbar ones.. Now she was very sensitive and flinched with the lightest of touch.  Like she was anticipating pain.  Ive seen people like her with a diagnosis of fibromyalgia.  I may have to use some desensitizing techniques like I described earlier in this thread.  But I think? Her problem is almost over.  I will know after four sessions.   It was a good day for me.  The smiles on their faces alone.  They did not expect what they experienced.  I feel good.  PS- sorry for any mis spelled words.  I'm not very good at that.

Permalink Reply by Gordon J. Wallis on August 7, 2014 at 8:49pm

A new client, not too long ago, came in for a relaxation massage.  After she read one of my testimonials she told me that her

medial collateral ligament( MCL) is injured.  I asked her to tell me if she has seen or is seeing anyone else for that injury.  She told me that she went to an Orthopedic clinic for an examination. She got an MRI and everything.  The doctors could not find anything wrong with her knee and sent her to physical therapy.  I asked her if the MRI indicated any kind of ligament damage or tear.  She said the ligament was fine.  I asked her how long she went to physical therapy.  She told me twice a week for six weeks.  It cost her out of pocket $5,000.00 and the knee pain never went away.  I told her that the MDs had ruled out all the mean nasty injuries, and that the Physical therapists don't really know what they are doing when it comes to this type of thing, but I do.  They seem to know very little about muscle pain, and usually do the exact wrong kind of therapy.  I've seen this over and over and over again.  I palpated two tender trigger points on the anterior medial side of her knee.  Down graded those two trigger points in less then a minute. Goodness.  She is going to come in for a 15 minute follow up session. It might take two or three or four times before her problem is over. Just charging her $15 sense she got ripped off big time prior to accidently seeing me.   Not much of a problem from my perspective.  They were making her do strengthening exercises.  Worst thing to do for an injured muscle( check the attachment, You've seen it before).  Its like if you have a crack in the corner of your mouth.  The worst thing to do is stretch and work your mouth out.  Keep your mouth shut for a while and it will heal fast.  Its the same concept.  Its cellular damage in the muscle. 

Truth is often hidden....like a shadow...in darkness.

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