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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 Gary W Addis, LMT on
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Stacey, I disagree with you on so many levels, you and I probably won't reach agreement about anything.
Firstly, no one is predicting the outcome of a particular surgery. However, based on her personal knowledge, and experience working with victims of "failed surgeries," Therese made a generalization to her friend Gordon-- to Gordon, not intended for worldwide dissemination. Certainly undeserving of your personal attack.
Scar tissue is a natural reaction, just as you say. Scar tissue can also become restrictive, which you must not have known. So much so that follow up operations sometimes must be performed in order to restore even partial ROM.
Adhesions and trigger points absolutely do exist. Slipped discs don't slide out of alignment due to, say, a sneeze. But they do happen. Impacts in an accident causing severe, sudden wrenching movements can overpower the erectors' ability to maintain spinal stability. The majority begin, however, with one trigger point that results in the development of helper trigger points up and down the spine. That you deny the existence of trigger points reveals a gaping hole in your education and experience. Those who are skilled in locating and eliminating trigger points can accomplish more for their clients in 2 or 3 sessions than MDs with their drugs, PTs with their exercises, and DCs with their adjustment tables can get done in months. Granted, to those who cannot find a trigger point even on themselves even if they flashed neon red when they were touched, trigger point therapy can seem like witchcraft-- especially when it is done as artfully, as painlessly, as quickly as a therapist of Gordon Wallis' caliber.
Stacey L Brown said:"Can you imagine what surgery would do??? All that scar tissue and fascial adhesions on top of the trigger points.."
I'm interested to know how it is you can predict the outcome or assume an outcome of a surgery that has not yet happened? What are you basing your observations on?
"Scar tissue" is a natural reaction to tissue damage and in-and-of itself is not a pathological situation. It sadly has become one due to many years of manual therapists projecting "scar tissue", "adhesions" and "myofascial TrP" as things to rid the body of.
Which creates quite the ethical conundrum of perpetuating a presumed problem where none exists. But it does keep us relevant and employed as manual therapists and it seems to satisfy patients who don't know any better and who depend on us for help with managing their pain.
Adhesions, trigger points, and slipped discs for that matter, have not been found to exist in the human body, in the way we understand them to be. (Via, MRI scans and postmortem observations)
I've said this ad nauseum before, until we as MT's are willing to be open to new developments in the field of pain science research and open to the idea that we don't know many things about what it is we *think* we are doing, we will not be taken too seriously in the healthcare field.
Therese Schwartz said:As I was reading this I was thinking extensor muscles in the forearm! Can you imagine what surgery would do??? All that scar tissue and fascial adhesions on top of the trigger points...so totally unnecessary!
More good work, Gordon!
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Permalink Reply by Gordon J. Wallis on
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A client the other day came in, reffered from someone else, with the diagnosis of Plantar fascitis in both feet. I could tell by looking at him that he was very doubtful of any positive thing coming out of his massage session. It was a 25 minute session. He has been to a Foot doctor that examind him and gave him Orthotics. I asked if the Orthotics helped.. He looked at me and said NO. His left foot bothered him the most. I palpated both feet and found No pain points on the bottom of both feet. However i did find a handful of Pain points on the extensor muscles of both legs, and on the lateral sides of each foot and ankles. Im talking like 5 or 6 pain points on each leg from the knee down with a couple of them located on each ankle and lateral side of his foot. I did my best to deactivate all of the pain points. He seemed surprised that he had those Pain Points. End result after he got up off the table was.... and he looked shocked and happy. His right foot was completely pain free, and his left foot still hurt, but not as much. He has hope now. If you guys want. Go to www.triggerpoints.net and check out Pain on the ankle and lateral top of the feet. He has those. The bottoms of his feet are fine( no pain points ).
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Permalink Reply by Therese Schwartz on
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Gary, thanks for your comments. I've been round and round with myself about how to address Stacey's comments. I'm still not sure I have a good way, but here's what I have right now.
Stacey, my "assumption" about a surgery that hasn't happened yet is actually an "educated guess" based on personal experience and that of my clients. Of course scar tissue is a natural response to healing and isn't pathological in and of itself. What is pathological is what the scar tissue can do to people - John Barnes says it can pull on surrounding tissues with up to 2,000 psi of force. That's potentially going to cause problems, and it's the problems I'm interested in addressing.
You said: "Scar tissue" is a natural reaction to tissue damage and in-and-of itself is not a pathological situation. It sadly has become one due to many years of manual therapists projecting "scar tissue", "adhesions" and "myofascial TrP" as things to rid the body of.
So, let's take my approach to working with people and your approach to working with people each to their logical conclusions. (If you are interested in what taking things to their logical conclusions looks like in more depth, I suggest reading Orson Scott Card's "Treason"; it's brilliant).
My approach, logical conclusion: more freedom of movement in all tissue systems.
Your approach: don't work on people because what they are experiencing is a natural occurrence.
I'm basing the logical conclusion to your approach on what you have posted here (BTW, the video you posted about pain was awesome and very useful). In general, you have criticized what we are doing and our approaches without offering any information on what we should do instead. I'm open to new ideas; I learn new things all the time. I will throw out entire philosophies and modalities and adopt new ones if they can be shown to work better or make more sense. If you have something better, please share it. We'll all be better off for it.
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very well said, Therese.
Therese Schwartz said:Gary, thanks for your comments. I've been round and round with myself about how to address Stacey's comments. I'm still not sure I have a good way, but here's what I have right now.
Stacey, my "assumption" about a surgery that hasn't happened yet is actually an "educated guess" based on personal experience and that of my clients. Of course scar tissue is a natural response to healing and isn't pathological in and of itself. What is pathological is what the scar tissue can do to people - John Barnes says it can pull on surrounding tissues with up to 2,000 psi of force. That's potentially going to cause problems, and it's the problems I'm interested in addressing.
You said: "Scar tissue" is a natural reaction to tissue damage and in-and-of itself is not a pathological situation. It sadly has become one due to many years of manual therapists projecting "scar tissue", "adhesions" and "myofascial TrP" as things to rid the body of.
So, let's take my approach to working with people and your approach to working with people each to their logical conclusions. (If you are interested in what taking things to their logical conclusions looks like in more depth, I suggest reading Orson Scott Card's "Treason"; it's brilliant).
My approach, logical conclusion: more freedom of movement in all tissue systems.
Your approach: don't work on people because what they are experiencing is a natural occurrence.
I'm basing the logical conclusion to your approach on what you have posted here (BTW, the video you posted about pain was awesome and very useful). In general, you have criticized what we are doing and our approaches without offering any information on what we should do instead. I'm open to new ideas; I learn new things all the time. I will throw out entire philosophies and modalities and adopt new ones if they can be shown to work better or make more sense. If you have something better, please share it. We'll all be better off for it.
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Thank you, Gary!
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The lady that gave me the really good review, I saw her today for a regular massage. She has no more Trigger Points in her body. And coincidently, no more pain in her body either? Hmmm?....I hear some say that Trigger Points arn't real? Well thats why I'm going to call them Painful Palpatory Spots from now on because so far nobody has told me those arn't real. When I first saw her it took me almost an hour to clear out all her Painful Palpatory Spots. I know they were real because she would flinch and vocalize noticeably when I touched them. She had at least 60 of those Painful Palpatory Spots on her body when she first came in. I saw her five times. Her last two sessions were only 15 minutes long because a lot of those Painful Palpatory Spots were no longer there. Now anybody that says those Painful Palpatory Spots aren't real would possibly be suffering from some kind of delusional disorder or something? Not really sure because thats not my expertise. Let's see.... Client comes in with chronic pain, and has 60 Painful Palpatory Spots on her body. After five sessions, client comes in with NO pain in her body and has NO Painful Palpatory Spots on her body. Trigger Points might not be real, but those Painful Palpatory Spots sure are( NO DOUBT WHAT SO EVER ).
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Trigger points is as good a name as any. Not perfect-- for Janet Travell who invented the term was wrong about many other things as well.
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If you are a bodyworker and have a pain client with Painful Palpatory Spots, and your style of therapy(Rolfing, Active Release, Myofacial Release, Trigger Point Therapy, Cranial Sacral, Voodoo or whatever )does not accidently or on purpose take out those Painful Palpatory Spots. You will be as successful as her Chiropractic and Physical Therapy visits proved to be.
Gordon J. Wallis said:The lady that gave me the really good review, I saw her today for a regular massage. She has no more Trigger Points in her body. And coincidently, no more pain in her body either? Hmmm?....I hear some say that Trigger Points arn't real? Well thats why I'm going to call them Painful Palpatory Spots from now on because so far nobody has told me those arn't real. When I first saw her it took me almost an hour to clear out all her Painful Palpatory Spots. I know they were real because she would flinch and vocalize noticeably when I touched them. She had at least 60 of those Painful Palpatory Spots on her body when she first came in. I saw her five times. Her last two sessions were only 15 minutes long because a lot of those Painful Palpatory Spots were no longer there. Now anybody that says those Painful Palpatory Spots aren't real would possibly be suffering from some kind of delusional disorder or something? Not really sure because thats not my expertise. Let's see.... Client comes in with chronic pain, and has 60 Painful Palpatory Spots on her body. After five sessions, client comes in with NO pain in her body and has NO Painful Palpatory Spots on her body. Trigger Points might not be real, but those Painful Palpatory Spots sure are( NO DOUBT WHAT SO EVER ).
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I didn't mean for anyone to take my comment as criticism of Janet Travell. A brilliant lady. Hunger for knowledge led her to explore TCM; together with her own personal experience with her own patients, she discovered (rediscovered?) that almost all myofascial pain and dysfunction stems from recognizable, identifiable "painful palpatory spots", which she labeled "trigger points."
Gary W Addis, LMT said:Trigger points is as good a name as any. Not perfect-- for Janet Travell who invented the term was wrong about many other things as well.
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The other day a young man came in with a complaint of a pinched nerve somewhere? He said he thinks he needs to see a Chiropractor. But he had a gift certificate for and 80 minute massage at the spa. So he thought he would check and see if massage could help. I asked him where he hurts. He said his wrists hurt and his hands often have a painful tingling and sometimes numbing sensation. He said he is worried that he has Carpal Tunnel. On palpation he was very sore almost everywhere on his forearms, with the flexor muscles being by far the worst. The flexors near his left wrist being very very sore. He told me his left wrist is the one that experiences the most pain and tingling. His thumbs were also very sore( Flexor pollicus brevis ) on palpation. Unlike the client with the Tennis Elbow I wrote about earlier in the thread that had only one really bad Pain Point on the lateral side of her extensor muscles near her elbow, this guy was vertually sore all over with the flexors near the left wrist being the worst. Having 80 minutes I decided to check his body for Pain points from his hips up to the top of his head front back and sides before working on his forearms. He has been working physically hard so I figured he would have some Pain points that might indirectly be making his forearm pain even worse. I found several Pain points, mostly on the left side( remember his worst pain in his hands and wrist are on the left )in his Glute Medius, several in his upper T spine area( rhomboids and paraspinals ). And also a couple Pain points in each infraspinatus, upper traps, and lateral posterior neck. Also found a very painful( on palpation ) spinous of L2. No Pain points on the front trunk of his body. I was able to deactivate all those Painful points before working his forearms. On his forearms and thumbs I decided to use Soft Tissue Release to help clear out the pain and inflammation rather then Trigger point work. I spent most of the time oin his left flexors and both thumbs. While working on him he said if felt awesome. Sore but really good. He really commented on how good the thumb work felt. When I heard that I knew I was helping him because the sore part is his body was telling him something is wrong( duh.. ), but the part that feels good is his body telling him that what we are doing is healing. Otherwise it would not feel good. After the session he said he felt way way better. And that he can tell that its his muscles and not a pinched nerve thats causing his pain. He is going to buy a good electrical massager and work on himself every day and come in for a few more short sessions. This Carpal Tunnel thing( like a lot of pain issues )is very fixable with soft tissue work. He won't need any bone cracking.
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A new client came in the other day. A referral from another client that I had helped. She was in an auto accident and recieved shoulder surgery in March of this year. She has been in phyisical therapy for several weeks. The physical therapists were trying to establish full range of motion in her shoulder again. Checking her range of motion in the spa, she could only raise her arm parallel to the ground( 90 degrees ) before pain stopped her. I don't know the complete therapy the PTs were doing, or the frequency of visits, but it involved ultrasound and deep tissue massage and taping of her shoulder. It was her right shoulder. I found Pain Points in the Teres, Infraspinatus, Supraspinatus, the right spinous of T1, her upper and mid Biceps, Pectoralis Major, and two very painful ones - her Upper Trapezius, and Mid Deltoid( withdrawal reflex ). After twentyfive minutes she was able to lift her arm almost full range of motion, maybe 170 degrees without pain. The client was stunned and happy to say the least. Now its not over for her. But she knows that there is light at the end of the tunnel, and that her arm can move full range of motion once those Pain Points are totally eliminated. The Deltoid Pain Point is the main culprit.
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Just a comment to add to this thread. I remember when I worked in a Chiropractic clinic. We would have auto accident and work comp patients that would come in anywhere from once a week to three times a week for both Massage therapy and Chiropractic treatments. They would come in regularly for weeks, months, even up to a year or more. Hardly anyone would get well. They( patients ) would keep coming until their insurance ran out or they got a settlement. At that point, we never saw them again. But now that I work for cash. If I have a hurt client. Someone specifically coming in because they want out of pain. Boy there better be noticible clinical improvement happening by the 4th session, or you will never see them again.
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