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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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have you checked for ligament impingement / damage in the hip? I'm thinking principally the ischiofemoral ligament, which becomes tight during abduction of any sort The iliofemoral ligament keeps the leg stable when standing, so it could be sending a lot of mixed pain signals.The latter one is deep to gluteus minimus.
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Permalink Reply by Gordon J. Wallis on
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You guys, I'm still at work. It's 7:30 pm here. And there is a time zone thing being in Alaska, so you guys might be sleeping when I coment in here. I have what I think is a good guess as to her problem.
Pueppi Texas said:Gordon J. Wallis said:
A follow up on this client.Yet when she moves her leg it hurts in her lateral hip.Hi Gordon,
I don't know the full health history on this client, so can only lightly suggest that an orthopedic consult may be useful (instead of, or in addition to a pain specialist). I have seen a number of people over the years with lateral hip pain which is generally ongoing by the time they get to me (though sometimes acute), which we find to be bursitis.
However, when looking for an orthopedic consult for bursitis issues, I highly suggest knowing and utilizing a conservative practitioner. I have a number of orthopedics that I cross-refer with (each for a particular reason).
If it ends up that there is a bursitis, I find that a much lighter work for the nervous system (something similar to DNM) becomes a nice compliment to any medication that they are started on. Sometimes, things don't sort themselves out and there is need for a cortisone shot and physical therapy, before full recovery. And, I have had one client that ended up going through all of the above with final and exceptional recovery coming after taking a few months of gyrotonic movement work.
I hope this helps.
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If she doesn't move, nothing hurts. So it's what I call pain on movement. Example.... If she is standing and bends forward, there is pain in her lateral hip. The little bit of trigger point activity that might be in her hip does not justify the intensity of the pain. When she is laying down prone,I can palpate a tender spot where the Biceps Femoris connects to the hip. But when she stands up and bends forward, that biceps Femoris tender spot is much more painful. If I do a release technique for the Biceps Femoris when she bends over. She can move a lot further before the pain starts. So I think the tendon of the Biceps Femoris is perhaps slightly pulled off the bone or something like that. And that radiates pain into her hip. She has had this pain for years. Her pain no longer radiates down the leg because we eliminated a bunch of trigger points..But the hip pain on movement remains. I'm seeing her one more time, but she needs to get checked out by an MD.
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Just a follow up on the above client. When lying on her back. When she moves her knee towards her chest the lateral hip hurts. When I move her knee towards her chest, there is no pain. At any rate, the trigger points are gone. And like I said ,the radiating pain down the leg is gone. But she still has that pain on movement in the hip..So she will see an MD.
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I've been sick the last couple days and haven't worked. Upper respiratory infection of some kind. Along with a bloated feeling in the abdominal area. Also , and this is the part that's interesting and somewhat ties into this thread, a lot of body aches and pains. The worst aching was in the right shoulder area , and right low back area on the iliac crest and just below. Those areas are controled by the spinal segments C4 C5(shoulder) and T11 T12( iliac crest and just below). C4 C5 also inervate Bronchi, lungs, and Esophagus. Which would account for my upper respitory cold. Also T11 T12 also innervate a lot of the internal organs including the Small intestines and Colon which would account for my bloated feeling. Each spinal segment controles a portion of bone ( scarlatome), muscle(myotome), skin( Dermatome) , internal organ ( enterotome). And when one of those tomes is in distress , the other tomes can be effected as well(Sense they are controlled by the same spinal segment). So when we massage people, we are not just affecting skin and muscle. By rubbing a sore muscle we are affecting a spinal segment and all its tomes. And that's kinda cool. Hopefully after tomorrow I will be able to go back to work.
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Not saying this is true with you or anyone else, but when I become constipated / bloated, within a day or so I develop muscle aches all over (just achy, not sharp TP type pains), and oftentimes also develop a low-grade fever-- flu like symptoms. Low grade, the kind of fever you feel internally but doesn't necessarily make the skin even warm to the touch, on a thermometer, maybe a degree or so registers. Doctor has me taking a daily dosage of mira-lax to keep my sluggish system functioning.
Getting old is not fun...but it is preferable to the only alternative to getting older (i.e., dying young while everything except the thing that kills you is working great).
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A new client came in today for a relaxing massage. She has been under a lot of stress lately. She also told me that she just came from her chiropractors office, do to left lower back and left hip pain. As she discribe her pain, I noticed that she touched her center to left upper sacrum area. She said she got immediate relief from her adjustment but still felt some pain from the adjustment. And requested deep tissue work in her low back hip area. She also requested no talking because she needs to zone out. I told her that I would give her her zone out massage for an hour and then do some specific pain relief work in her low back hip area of complaint but in order to do that effectively we would have to communicate. She said " Sounds like a plan." Here is what I found.. Left Tensor Fasciae Latae trigger point, left Gluteus Medius trigger point, left QL trigger point on the Illiac crest, left PSIS pain point, a very tender pain point on her upper left Sacrum, a very tender left L5 trigger point, and a tender L4 spinous. On the right side I found a Gluteus Max TP. I also found a trigger point in her left Latissimus Dorsi where it connects on the shoulder blade. I then checked her neck, because of the low back neck relationship, for trigger points and found two extensor trigger points on the right side , one at the C5 level the other at the C2 level. They all deactivated. When we finished the massage she told me that she felt no pain what so ever in her low back hip area. That was cool.
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Great job, as usual.
The right lat tp might have led to the rest on the left.... or those on the right developed trying to countermand the hypertonicity on the left. The body does whatever it needs to in order to maintain close to normal function. Ain't Life a grand design?
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Met another client that has been hurting for years. She has been recently sent to physical therapy. She tells me that she feels worse after the therapy. She has had many different diagnosises over the years. All I can tell you is that she is riddled with trigger points. Pretty much one every square inch on her body( worst is in her T spine ) ,with the exception of her neck and lumbar spine. Of course no one she went to checked for trigger points. If anyone did, they could easily have diagnosed Fibromyalgia or Myofascial Pain Syndrome. In theory I should be able to help her. It's challenging because there is a trigger point almost everywhere. But I think it's safe to say, that if those trigger points weren't there...Her pain wouldn't be there either.
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amen to that, brother Gordon.
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Well, it's not going to be easy. I think I will concentrate on her T spine and shoulders. She complains about those areas the most. Do about ten minutes of regular massage before heading into the trigger point work. I'm giving myself five sessions to make headway. If there is no improvement at that point then I'm not the therapy for her. What gets me is that some one thought that exercise would be the appropriate therapy for her. I my eyes, and I'm not always right, that's the absolute worst therapy for her.
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I saw her today.. She is feeling better. She felt noticible less pain then normal. But after three days some of her pain came back.. But she felt better rhen when we first met. So I'm feeling good. For her.. I eliminated trigger points. No one in years has attempted to do that.. I'm praying that after four sessions she feels noticibly better.. If that happens, it's cool. I go for trigger points.. And that's it ...In the attachment is a lady I helped a lot. Not the one above. A different person. She was not totally cured of her pain, but it was a noticible improvement. All I was able to do for her was eliminate some of her trigger points. Trigger points mean a lot.
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