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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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Sometimes people don't want to be helped. In those cases, we do what we can for them and allow them to make those choices...Not easy because we really do want people to get (or be) better!
Gordon J. Wallis said:Sometimes I leave work a little bit frustraighted. Even though it was a successful day on many levels. I often meet clients that have a particular pain problem that I'm quite sure I can help. Yet the client won't let me. And its not the clients fault. I will ask them if there is anything they want me to know.. Or what they need from the massage. And as an example, they might tell me that they have a shoulder problem and have been seeing Osteopaths or Physical Therapists for the issue. Now they have just gotten into the room and are standing in their spa robe. I would then ask if its ok if I touch their shoulder, or whatever area their problem is, and just tell me if I touch a pain spot. Then I will palpate around the area and find several pain points all in the right places. I will then ask them how long they have been getting therapy for the problem. And I often here something like three months or another long period of time.. Sometimes even a year. Then I will say.. Would you like me to fix that problem.. I should be able to help you based on my experience and the short time palpating your shoulder.. Now some people say go for it if you think you can help... do whatever you need to do. But others will say.. No, I'm already getting care. I just want a good massage. So I give them a good massage. After the massage they are happy... Because gosh, who doesn't love a massage. After the massage I will ask them if they have ever heard the word trigger point. And they will shake their head and say no? So it just leaves me a little frustraighted. Even though the client leaves happy. I'm learning to not let that bother me as much now. But it still does a little bit.. lol If you are an experienced therapist. You have a pritty good idea who you can help and who you can't. You know you won't be right all the time.. but still. This is one of the reasons ,,THAT TRUTH OFTEN REMAINS HIDDEN. LIKE A SHADOW IN DARKNESS.
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Permalink Reply by Gordon J. Wallis on
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A new client came in the other day for an 80 minute massage. She was hurting. That was the whole reason for her scheduling a massage. She said her entire back hurts, but the worst area is her left shoulder, the teres muscles. She has gone through some physical therapy without improvement. She got a massage not too long ago where the therapist did a lot of stretching that she found very painful both durring and after the massage. I explained to her my trigger point work. Letting her read a testimonial and viewing a short video clip of my work. She said go for it. During the trigger point work, some of the trigger points vanished, yet I could tell she was not responding in the way I felt she should. After I had cleared out some trigger points in the teres, latissimus, serratus areas( her worst area ), she would still move uncomfortably and complain about that area still hurting. A half hour had gone by and I could tell that the trigger point work was not working. So I reverted back to what I use to do twenty years ago when I worked on someone that was in pain. I call it Specific Deep Rubbing. I use my four fingers and cross fiber or go with the fiber with the right pressure, adjusting to what feels best to the client. She loved it. It was in her words a very sore wonderful feeling. It was not uncomfortable like the stretching massage she had a few weeks ago. It was a hurt good feeling. Thats a healing touch. The part that hurts is your body telling you that something is wrong (Duh), but the part that feels good is your body telling you that what you are doing is healing, and to keep doing it. Her worst area and the one that hurt good the best was her Serratus Anterior. We worked on other areas of her body as well. Low back, neck... But anyway she got 50 minutes of my deep rubbing and felt much better after the session. My only concern is if she is really sore the next day? But she will be back in on a follow up in a few days, and I will find out. There are only three possibilities after doing theraputic work for a pain client. They are better, worse, or the same from whatever you did. So if she felt great after the massage, but was very sore that night or the next day. Thay means we did the right thing but we did it too long. If she is way better after the massage and the next day. That means we do the same thing as the last session. If there is no change in her pain levels. That means we will work more aggressively then the previous session. This is just how I think.. Not telling anyone what to do or anything like that. But this is one of the rare times my trigger point work didn't work. However, I think we found an approach that will help her.
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A client came in the other day limping. He said he thinks he needs to see a chiropractor. I'm thinking, hmm, unlikely. Because I know Muscles Move Bones. His left hip hurt when he takes a step. He doesn't know what it is? I palpated and found two trigger points. One in his Gluteus medius, and another very painful one in his Tensor faciae latae. He left the spa not limping and feeling only slight discomfort.
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For some reason I can only upload one attachment at a time? Here is his main trigger point that caused him to hurt when he lifted his leg.
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A new client came in the other day for an 80 minute massage. When I asked her what she wanted from the massage she said, "Well, mostly to relax. But I have chronic right shoulder tension. When I get a massage the therapists always tell me that I have a lot of knots. But its so painful that I don't want a theraputic massage, even though I know its good for me. I also have on and off low back and hip pain, mostly on the left. But overall, I just want a relaxing massage." When I hear that, Ive got a complicated deal going here. I'm pretty sure that I can help her with her pain problems, however that takes cooperation between client and therapist( at least the way I do it ). It takes communication. And a relaxing massage, at least in the spa where I work, means no talking. And if I do trigger point work in a specific area of the body, I don't want to massage over that area. Its like you don't keep digging on a cut to make it heal faster. So I told her, here is what I think we should do, with your permission. I check your hips and low back out along with your right shoulder. If we find pain points, I will do some specific work, then leave those areas alone and flow into a relaxing massage where you can just zone out. However I'm not going to massage over the areas we did the pain point work on. She said that sounds good. We had 80 minutes so I figured that the trigger point work might take a half hour or less, and the rest of the time could be spent doing a relaxing massage. I also explained to her that in order to resolve her pain issues I would have to search every inch of her body for pain points which we are not doing today. Sometimes a pain point in the ankle might be causing in more distal places like the hip or shoulder to compensate and hurt. Anyway she understood. In her right shoulder I found and Upper Trapezius pain point along with a couple posterior pain points on the lower and middle neck. I also found two pain points on the Para Spinals between the shoulder blads on the same side. So there is her shoulder pain. All the pain points dissipated. On her left hip I found a very painful point on the PSIS and Gluteus medius along with two pain points in her Piriformis. When I touched the PSIS point she said it radiated accross her entire low back and upper Sacrum. On the right hip I found two Piriformis pain points. I was able to dissapate all the hip pain points as well. Then I carried on with her relaxing massage which lasted about an hour. I avoided massaging her hips, and only did light work on her right shoulder durring the hour massage. Did not want to over work those injured areas. Its always a challenge for me to balance between a zone out relaxing massage or trigger point work. A client comming into a luxurious spa environment has certain expectations of what a massage is, and they don't often realize that good bodywork can can resolve problems that they have had for weeks, months, or even years.
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This is interesting. A new cient came in the other day. I've seen him three times now. But the first time I saw him, I asked him if there was anything that I could do for him? He told me that he did not think I could do anything for him, but he was reffered to me, and that he would try anything. I said, You must be hurting? He said yes. At night he has a very difficult time sleeping. He is awaken throughout the night with right shoulder pain that radiates down his arm all the way to his thumb. He told me that has seen other people and is doing the exercises, but its been six months and its not getting any better. I asked him where he feels the most pain when its really hurting. He touched his deltoid. Anyway I palpated from his hips up to the top of his neck and dowh his right arm. Here is what I found. Three rhomboid pain points. One pain point in the extensor muscles of his arm along with a pain point on his thumb. But the worst two pain points were in his Infraspinatus. They all perfectly match up to his pain pattern. The exercises he was doing, with weights, to his right arm were only perpateuating his pain problem. I've seen him three or four times now. 15 minute sessions. He is now sleeping at night with only minor pain. Last night he was awoken only one time, but the pain dissapated quickly and he was able to go right back to sleep. He still has two rhomboid pain pain points. The extesor and thumb are only lightly sore now. I used soft tissue release for his forearm and plain old ordinary massage on his thumb to ease the pain in those areas. But the Infraspinatus pain points are now gone. Those were the main ones. Anyway, he is way better now. Not sure if its completely over for him, but he is 85% better after three or four short sessions and no exercise. I will attach the pain patterns for the muscles involved.
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here is the forearm one.
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rhomboids
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the main problem, his Infraspinatus.
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Another client came in recently complaining of a four month tension headache. She has been seeing a Chiropractor and receives Cranial Sacral Therapy as well as massages from a professional and her husband with no effect. After each session she leaves with her tension headache in tact. I asked her where she feels her headache. She indicated her Occipital area as well as knots and tension in her neck, top of her shoulders, and between her shoulders. It's not bad enough to keep her from getting out of bed in the mornings, but its always there in the background. She lives out of town but remembers that I helped her ten years ago with a hip problem. She is in town with friends and had some time so she made an appointment. Her main reason for the Massage was to get help with her headache. I told her that she is already getting professional Massage work, so there is no use me giving her another massage. I don't know Cranial Sacral Therapy, but it has not worked anyway, so that's out. I told her we need to do someting different. I palpated for pain points from her low back up through her shoulders and neck as well as the rest of her skull and face. I found a pain point on the left lateral spinous of L4 as well as a pain point on the left lateral spinous of T2. I found three Paraspinal pain points on each side of the spine between the shoulder blades. They were pretty bad ones too. I found intense pain points in both Upper Trapezius near the neck shoulder junction. On the left side of her neck I found two pain points around C4 and C5. On the right side of the neck I found a really bad pain point on lateral side of C2. And just to the left of the Nuchal Ligament another very bad Occipital pain pain point. She also had a pain point on her right SCM and a pain point in both the left and right Temporalis. Oh, I just remembered I also found a very sore pain point on her right Serratus Anterior. Anyway, no wonder she has a tension headache. It took me a while, but I was able to deactivate every one of those pain points within her 50 minute massage. Now I doin't know if I ended her headache deal for good, but she did leave the spa headache free, and happy. Too bad she lives so far away. I'm sure she will need follow ups because some of those pain points will return. But as usual, its Trigger Points all the way.
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I have found that my clients get a great deal of relief when I work on the infraspinatus! It seems like magic to them. :)
Gordon J. Wallis said:the main problem, his Infraspinatus.
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The fact that she remembered you helping her 10 years ago speaks very highly of the work that you do! The fact that those other modalities didn't help her with her headache supports my belief that we as therapists need to have a wide variety of skills at our disposal. Yes I'm highly skilled in CranioSacral Therapy but it doesn't solve everything. I'm glad you were able to help her!
Gordon J. Wallis said:Another client came in recently complaining of a four month tension headache. She has been seeing a Chiropractor and receives Cranial Sacral Therapy as well as massages from a professional and her husband with no effect. After each session she leaves with her tension headache in tact. I asked her where she feels her headache. She indicated her Occipital area as well as knots and tension in her neck, top of her shoulders, and between her shoulders. It's not bad enough to keep her from getting out of bed in the mornings, but its always there in the background. She lives out of town but remembers that I helped her ten years ago with a hip problem. She is in town with friends and had some time so she made an appointment. Her main reason for the Massage was to get help with her headache. I told her that she is already getting professional Massage work, so there is no use me giving her another massage. I don't know Cranial Sacral Therapy, but it has not worked anyway, so that's out. I told her we need to do someting different. I palpated for pain points from her low back up through her shoulders and neck as well as the rest of her skull and face. I found a pain point on the left lateral spinous of L4 as well as a pain point on the left lateral spinous of T2. I found three Paraspinal pain points on each side of the spine between the shoulder blades. They were pretty bad ones too. I found intense pain points in both Upper Trapezius near the neck shoulder junction. On the left side of her neck I found two pain points around C4 and C5. On the right side of the neck I found a really bad pain point on lateral side of C2. And just to the left of the Nuchal Ligament another very bad Occipital pain pain point. She also had a pain point on her right SCM and a pain point in both the left and right Temporalis. Oh, I just remembered I also found a very sore pain point on her right Serratus Anterior. Anyway, no wonder she has a tension headache. It took me a while, but I was able to deactivate every one of those pain points within her 50 minute massage. Now I doin't know if I ended her headache deal for good, but she did leave the spa headache free, and happy. Too bad she lives so far away. I'm sure she will need follow ups because some of those pain points will return. But as usual, its Trigger Points all the way.
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