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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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Replies to This Discussion
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Permalink Reply by Maryshka on
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Agree with you Gary. We learned about TrPs but NOT to dig in, NOT to cause bruising, NOT to make client jump up off the table (which is counter productive IMO) and to warm up tissues first. I have found, in real life, that many clients believe in the "no pain no gain" motto to their problems. I tell clients I want their muscles to like me so that they will let me work on them. There's usually a chuckle but they get it. I'm not big enough to wrench on people like they seem to want, esp. the big men 250#+, so I need a more effective treatment protocol -- like I'm learning from Gordon and y'all.
Gary W Addis, LMT said:My business card reads "Gary Addis, LMT, and beneath that "Neuromuscular Therapist".
Schools that even mention the trigger points teach brutal ischemic compression-- dig in till the client nearly jumps off the table and hold the pressure for up to ten minutes. Gordon steered my self-study in the right directions. Today, I know better, quicker, less painful methods.
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Permalink Reply by Gordon J. Wallis on
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Telling you what exactly to do to your client without me actually being there is impossible. However there are certain universal truths that you can utilize to make your work more efficient and much more effective. Sadly these truths are naught taught in any massage school. Here is one that may help?. When one mucsle gets tight another muscle gets loose. When one muscle chain gets tight another muscle chain gets loose. There is no escape from this truth. Otherwise the body can't move. Its hardwired into the system. Its called Reciprocal inhibition reflex. When one side of the bone gets tight, the other side of the bone gets loose. Your client has massive trigger point activity in the lateral hip and leg muscles. If you can figure out how to make the inner thigh and leg muscles contract(get tight) then the brain or nervious system will send signals to the lateral hip and leg muscles to relax( get loose). Now if you are just pressing on a trigger point.. Fine and dandy, because that can work as you know. Thats what all the trigger point people are teaching.. But....if your left hand rests on say the inner knee while your client gently contracts against your pressure(5% of her strength) the inner thigh and leg muscles contract. That meanss the lateral hip and leg muscles have to relax( the trigger pointed area on your client). If you are pressing on the trigger pointed area the same time , then you have the nervous system assiting you. Its like swimmg down stream compared to swimming up stream. Things are not always so simple. But there is NO Escape from that Reflex.
Somebody showed it to me, and I found it myself - LEW WELCH
Therese Schwartz said:Gary, I think that's what has happened for this poor woman - the formation of more TrP's. She's in so much pain all the time! I told her I'd email her if it was recommended by people who know more about trigger points than I do to stop exercising.
I just couldn't believe how many she has. I'm not exaggerating the number at dozens per leg; that may be conservative. And the density! They are almost on top of each other! It's unreal. I felt really out of my depth having that many to deal with, with no formal training.
Gordon, thanks! I appreciate everything you can tell me. She won't be back until next Monday; she's once a week.
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I saw this cleint again today. It only took six minutes to find the one trigger point left. Originally( i forgot) but she had atleast sixy to 80 trigger points on her body(massive amount). And it took me one hour to find them, and down grade or deactivate them.. . She has one final appointment a few days from now. Then I will teach her how to stretch and maintain a trigger point free body. Its so cool.. She is happy.
Gordon J. Wallis said:Saw this client again today. She has six trigger points left. All on the lumbar paraspinals. She had over 60 when I first met her.
Gordon J. Wallis said:One of my clients that has had chronic back pain for years, has just completed her 5th session. She has been coming in every two or three days. When I first worked on her it took an hour to clear out her trigger points. This last session it only took 12 minutes to clear out all the trigger points. She told me her back feels much better now. Her next session will be in five days. Each session there are less and less trigger points.
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Permalink Reply by Gary W Addis, LMT on
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Great advice, and you explained it very well. Hell, it would have taken me 10,000 words to say the same thing.
Gordon J. Wallis said:Telling you what exactly to do to your client without me actually being there is impossible. However there are certain universal truths that you can utilize to make your work more efficient and much more effective. Sadly these truths are naught taught in any massage school. Here is one that may help?. When one mucsle gets tight another muscle gets loose. When one muscle chain gets tight another muscle chain gets loose. There is no escape from this truth. Otherwise the body can't move. Its hardwired into the system. Its called Reciprocal inhibition reflex. When one side of the bone gets tight, the other side of the bone gets loose. Your client has massive trigger point activity in the lateral hip and leg muscles. If you can figure out how to make the inner thigh and leg muscles contract(get tight) then the brain or nervious system will send signals to the lateral hip and leg muscles to relax( get loose). Now if you are just pressing on a trigger point.. Fine and dandy, because that can work as you know. Thats what all the trigger point people are teaching.. But....if your left hand rests on say the inner knee while your client gently contracts against your pressure(5% of her strength) the inner thigh and leg muscles contract. That meanss the lateral hip and leg muscles have to relax( the trigger pointed area on your client). If you are pressing on the trigger pointed area the same time , then you have the nervous system assiting you. Its like swimmg down stream compared to swimming up stream. Things are not always so simple. But there is NO Escape from that Reflex.
Somebody showed it to me, and I found it myself - LEW WELCH
Therese Schwartz said:Gary, I think that's what has happened for this poor woman - the formation of more TrP's. She's in so much pain all the time! I told her I'd email her if it was recommended by people who know more about trigger points than I do to stop exercising.
I just couldn't believe how many she has. I'm not exaggerating the number at dozens per leg; that may be conservative. And the density! They are almost on top of each other! It's unreal. I felt really out of my depth having that many to deal with, with no formal training.
Gordon, thanks! I appreciate everything you can tell me. She won't be back until next Monday; she's once a week.
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Permalink Reply by Therese Schwartz on
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Gordon, should she exercise? 1/3 mile on the treadmill and 2 miles on stationary recumbent bicycle.
Just so you know, she has a very hard time walking. Her legs do not respond correctly or normally. Her pelvis is torsioned in a way that I can't figure out, and her torso is also torsioned. She falls frequently, and many times has to rest a hand on the wall just to walk down the hallway. She has, understandably, a lot of pain issues and trouble sleeping.
Today, she just about fell asleep on the table. I guess I was doing just fine getting the TrP's to let go! Or at least lessen in severity. A good portion of her pain on palpation got better.
THANK YOU for taking the time to post all that good information.
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Read the attachment, and think on things.
Therese Schwartz said:Gordon, should she exercise? 1/3 mile on the treadmill and 2 miles on stationary recumbent bicycle.
Just so you know, she has a very hard time walking. Her legs do not respond correctly or normally. Her pelvis is torsioned in a way that I can't figure out, and her torso is also torsioned. She falls frequently, and many times has to rest a hand on the wall just to walk down the hallway. She has, understandably, a lot of pain issues and trouble sleeping.
Today, she just about fell asleep on the table. I guess I was doing just fine getting the TrP's to let go! Or at least lessen in severity. A good portion of her pain on palpation got better.
THANK YOU for taking the time to post all that good information.
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Also, you can't cure everybody. But think how she would feel if those trigger points were not there?
Therese Schwartz said:Gordon, should she exercise? 1/3 mile on the treadmill and 2 miles on stationary recumbent bicycle.
Just so you know, she has a very hard time walking. Her legs do not respond correctly or normally. Her pelvis is torsioned in a way that I can't figure out, and her torso is also torsioned. She falls frequently, and many times has to rest a hand on the wall just to walk down the hallway. She has, understandably, a lot of pain issues and trouble sleeping.
Today, she just about fell asleep on the table. I guess I was doing just fine getting the TrP's to let go! Or at least lessen in severity. A good portion of her pain on palpation got better.
THANK YOU for taking the time to post all that good information.
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Thanks Gordon! That explains why so many people get worse when going to physical therapy, or starting an exercise program. So far, other than TrP therapy, the only thing I know of that brings real relief is proper yoga (by that I mean not power yoga or hot yoga).
I'll pass this information along to my client.
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Yesterday I had a client that initially came in with 60 to 80 trigger points. Constant pain. I had her not stretching or working out during her therapy with me. She had about six of seven session before there was only one trigger point left. So she has one more appointment in a few days. Now she can start stretching and slowly integrate strengthening exercisess in if she wants. After that I will see her in a month. Exercise, stretching and yoga is good of course. But if you have a badly trigger pointed muscle. Its an injured muscle( cellular damage). If you have a crack in the corner of you mouth, and you keep opening and stretching your mouth wide.. What do you think is going to happen? Every freakin trigger point book teacher and guru out there has people stretching or working out during their therapy time. From my experience, thats a BIG Mistake.
Therese Schwartz said:Thanks Gordon! That explains why so many people get worse when going to physical therapy, or starting an exercise program. So far, other than TrP therapy, the only thing I know of that brings real relief is proper yoga (by that I mean not power yoga or hot yoga).
I'll pass this information along to my client.
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I saw one of my chronic pain clients for the 4th time today. When I first worked on her she had approximately 80 trigger points. It took me 60 minutes to clear most of them out. They were all over her body with the exception of her abdominal area. Today it took only 22 minutes to clear out all her trigger points. 2/3 of her original trigger points have been wiped out. Her daughter and husband have noticed the difference and will be coming into see me next week. Apparently they have ache and pain problems too. I'm looking forward to meeting them.
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http://www.pain-education.com/trigger-points.html
Some of you guys might find this link interesting. I don't agree with everything said, but.. lol
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