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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 Gordon J. Wallis on
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Just to add to this thread, is something that happens often enough. After thirty years I have a very good idea if I'm going to be able to help somebody or not. In other words, if I'm going to be clinically effective for their pain problem. I'm not always right of course, but with maybe 80% accuracy I feel confident in my prognosis of the situation. This has happened more then once. That's why I think it's important to coment about
it in here. I have had clients, that I have worked on say a couple of times that I feel excited and happy with the clinical results I'm getting with their pain problem that they have had for weeks, months and sometimes years. I will see them two times with very good results only to never see them again for six months to a year later with the same problem they came in with a year earlier. They will schedule for their third appointment only to cancel it later. When that happens. And it has happened enough times to make me coment about it in here. I'm thinking, they had some weird bad reaction to the treatment or the pain came back, and they thought it wasn't working. But what I'm finding out is that what I'm doing is working, but the client is not following through like I suggest they do. As an example.. The other day a client that I saw only two times for chronic hip pain came back in six months later with the same problem.. When I asked her how come she did not follow through with her third session, here is what she, as well as others have said. Well Gordon, I was completely pain free after the second massage..so canceled my next appointment because there was no need! And I have been completely pain free until a few days ago. But what they don't realize or know is... That they may not be symptomatic anymore, but the trigger points are still there, only in a dorment state.. No longer an active symtomatic trigger point but a latent none symptomatic trigger point.. If they would have come in for that third appointment, even though symptomatic free, on palpation the trigger points would have been painful. So it's really important that they follow up even if symtomatic free in order to have a perminent or longer lasting results. The other reason this might happen is because I'm working on a cash basis. If insurance pays for it, they will often times come in for many many sessions even without clinical results. I just thought I'd coment on that. Uhm, the attachment below has nothing to do with this coment, but it points out what most of us know already. That if someone comes in with say a shoulder problem, you want to treat the whole body..The shin bones connected to the knee bone kind of thing.
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Ok the attachment didn't attach, so here it is.
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This is cool. I had a client come in just to relax of course. She told me that there was a lot of tension in her neck. She said when she lays down to relax her neck twitches. She said that I would see and feel it. I asked her if it hurt. She said no. She said it's very bothersome because it's hard to relax with her neck twitching and moving her head all the time as a result. The weird thing is that when she is up walking around or whatever, it doesn't twitch. Only when she wants to lay down and relax. When she told me this I wasn't quite sure what she was talking about. But about four minutes into the massage, as she was lying prone, her head started twitching around. Maybe about an eighth of an inch random twitches from the extensor muscles of the neck. She had no control over it. I decided to treat the back of her neck just like I would if it was trigger pointed. Pain, tickling, itching, and twitching must follow the same neural pathway to the brain. So I initiated a procedure that relaxes the extensor of the neck by stimulating it's antagonist muscles in the front of the neck. And low and behold, the twitching stopped. She was amazed. I asked her how long has she been dealing with this neck twitching. She said over twenty years. Anyway, she got to lay there for forty minutes without her neck twitching. She said that she never experiences that and was amazed. Then I had her turn over on her back, and when she did that her neck started twitching again. I then again released the extensor muscles. And her neck did not twitch for the remaining ten minutes of her massage. Now did I resolve her twitching problem? I doubt it. But in time I believe it's a good possibility. Maybe after four or five sessions we will know that answere for sure. But the fact after twenty years her neck stopped twitching for as long as it did was cool.
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The lady with the neck tremmers in the above paragraph. I'm working on her for free. Because I want to learn. Continuing education classes are valid and good. But every day, I have a continiuing education class for me. Her tremmers came back that night. I saw her for a second time the other day. I stopped her tremmers immediately with a specific release of the occipital muscles. For twenty minutes while lying on the table , no more trembles. She was amazed. So I think, there is a way to solve her problem. It's like every once in a while you have to reset your smart phone. Every once in a while, the body needs to be reset. Erase muscle memory and so on..So I think, or hope, that after a few sessions, her nervous system or muscle memory will be reset? Continiuing education is every day.
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This was interesting. A new client came in telling me that she just wanted to relax. She looked tired and kind of burnt out. Just like anyone would look when you really need a massage. When I asked her if she had any aches and pains , she said yes..I have chronic low back pain. As she was telling me that she was touching her upper left hip( a clue?). She then went on to say that the pain can run down to her left knee , and her knee can hurt so bad that she can hardly walk at times. I asked her how long has she had this pain? Her answer was "years".. She works in the medical field and went to some good pain docs that could not find any pathology to explain her pain. She figures nothing can be done, and she has had theraputic massages before, so she just wanted to relax sense she works hard. I told her that I was an expert at what I do, and that there is a very good chance that I could take that pain out of her body. Now do I know that for sure? No of course not. But I know that there is no pathology that explains her pain. And I also know that trigger points are responsible for 80% of all pain on the planet. So if I tell a hundred people that, Im only wrong twenty times. I don't want to give false hope, but I want her to see my confidence so I get her expectations up and the placebo effect on my side. I explained to her a little bit about trigger points, and let her read a testimonial and watch one of my video clips.. She gave me permission to palpate for trigger points. Here is what I found. Two trigger points at the L5 errectors. Two trigger points in her upper sacrum. A left Gluteus Minimus trigger point. A very tender trigger point on her left PSIS. A very tender trigger point on her left Piriformis. And really painful trigger points on her lateral and medial and anterior left knee. She also mentioned that she has digestive problems. I found a trigger point on her lower left abdominal quadrant. All the trigger points vanished. She was very surprised about how good she felt after her session. She is going to reschedule for follow ups. That was cool. in the attachment is the pain pattern for only one of her trigger points.
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I said she had a trigger point on her anterior left knee. I meant to say posterior left knee. The Popletius.
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Permalink Reply by Gary W Addis, LMT on
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I worked for 2 hours yesterday with a 70+ year old FMS sufferer. Never had a massage, been going twice weekly to a DC for seven years for whatever relief he could provide. Mostly he was putting her on one of those oscillating massage tables for 2-4 minutes then sending her home, so, no, she wasn't getting much relief. After such a long time, she had developed systemic sensitivity-- her whole body hurt.
The worst case of FMS I've encountered-- a trigger point every two inches in her upper back; the rest of the body was true to the standard FMS diagnosis with TPs in the expected places. The "normal" tps released easily using the reflex release techniques I learned from you, Gordon. But trigger points in upper traps and infraspinatus and subscapularis and all three serratus and supraspinatus were deep beneath a thick, hard layer of fat; these required a long, painful hold using what the schools are teaching.
I did get the releases, so when we finished she left with a smile of relief. She will come in for follow ups for as long as it takes to get lasting pain relief, she promised-- and she is a close neighbor, and, because she is a retiree with money issues I'm working for whatever she feels she can afford to pay + hugs and smiles :-).
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A few weeks ago I stopped off at a bar for an after work beer. The lady next to me was talking to an obvious friend about her low back pain. They were here temporarily for work and lived out of state. I noticed a lot of chiropractic terminology during her conversation. I interrupted and said that there is a very good possibility that I could eliminate her pain right here at the bar. She laughed and looked at me like I was crazy. I showed her one of my video clips and had her read a testimonial. She gave me permission to touch her. I asked her to tell me exactly where she hurts. With her hand, she touched the right side of her low back just above her hip. I palpated there and found a very active trigger point on her Quadratus Lumborum, right where it connects to her Illiac Crest. Twentyfour seconds later, her pain was gone. The next day I received an email from her. It's in the attachment below. That was cool.
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This is interesting.. a new client came in for a relaxing massage.. When I asked her if she had any aches and pains, she told me that she has chronic hip pain. She had been seeing a chiropractor for almost a year, but had to stop because her insurance ran out. When I went to greet her in the waiting room, I could see her straining as she got out of the chair. She walked with a slightly forward bend. Like she couldn't quite straighten up. After talking to her she wanted me to do my trigger point thing. Ok, here is what I found. On the right hip. A gluteus medius trigger point, and a PSIS trigger point. On the left hip, a gluteus medius trigger point, and a Piriformis trigger point. She also had left and right paraspinal trigger points at the L5 level. Also, interestingly enough several painful trigger points between her spine and left shoulder blade, as well as two left posterior trigger points in her neck. All the trigger points deactivated that first session. The second time I saw her she was symptomatic free for the first time in a year. The only trigger points that were gone were, the PSIS on the right, and the Piriformis on the left. All the other trigger points had come back. But she was sympathetic free. After the fourth session only a couple of the trigger points between her left shoulder blade and one on her neck remain, as well as one at the L5 level. She is very happy, and remains symptomatic free. The hips are inervated by the lumbar spine. The lumbar and sevical spine have a relationship. A lot of the cervical muscles run down the T spine. Everything makes sense. But you don't even have to know that. Just get ride of the trigger points. Chiropractic for one year?
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This is interesting. A while back a client came in complaining neck pain that has been getting progressively worse over the last month. She had very limited movement in her neck in general, but it was much more painful when she tried to turn her head to the right. And the pain was starting to effect her left arm as well. She had a few Triigger points on the left posterior neck( 3 if I remember correctly). But the worst most painful trigger points were in her upper T spine on the left between her shoulder blade and spine. She also had one in her upper left deltoid. Only a minor few trigger points elsware on her body. Ok, now I'm going to depart from this client for a while. I still, on occasion, meet people in real life and online that think there is no such thing or proof that trigger points exist. To me they are like the flat earth people. Anyway, trigger points are contracted muscles fibers do to a damaged sarcoplasmic reticulum in the muscle cell. Because of the contracted tissue, heat is generated in the area do to the friction caused by capillary blood flow trying to enter and pass through the contracted tissues. As a result trigger pointed areas are hotter then the surrounding tissues. In the attachment below is an infrared image of the above client before I started working on her. Infrared cameras measure heat very accurately. You can clearly see her trigger pointed area. I saw her twice, and she is completely pain free. I have a really nice testimonial from her as well. The only bummer is, I lost my IR camera so I could not take an after picture. It would have clearly documented an improvement in her condition. The good news is, I have sense found the camera , so later on I plan on getting some before and after pictures. Remember the movie Predator ?
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Here is something that fits into this thread well. It just amazes me because I see this all the time. Frequently. And it's something that's very wrong. And for the life of me I just don't understand how this can be?
I recently met a fellow massage therapist that is in physical therapy for rotator cuff pain. Probably from his work( he is a new therapist). X-rays show his shoulder rotated forward. Pulled forward. I forgot the correct anitomical expression. Anyway he says that the exercises they are making him do are extremely painful. I asked him to show me. They have him adducting ( I think that's the correct term?) his shoulder(arm) against resistance. In other words contracting his pectoalis major. No wonder it's extremely painful. That's the muscle that is pulling his shoulder forward, and it has a Big Nasty trigger point in it. Give me a break. No one really knows trigger points. That's the truth. Read the attachment. You've seen it many times before on this thread. - Attachments:
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Just thinking about what the physical therapists are having him do , is actually the exact opposite of what they should be doing. Think about it. They have a weakened damaged contracted muscle. In this case the Pectoalis Major. And they are making it do physical work. They should be relaxing the injured contracted Pectoralis muscle instead of making it work. And stretching it is not going to be very good as well. It's like stretching a chapped cracked lip. It's not going to make things heal faster. Something I would be thinking about doing instead would be to make the injured muscles antagonist muscle contract a little bit. In this case , the Infraspinatus muscle. In order to utilize the Reciprocal Inhibition Reflex( when one muscle gets tight, another muscle gets loose ). I would do that by placing one hand on the back of his shoulder, while keeping my other hand or finger touching the trigger point (contracted injured area), and have him press the back of his shoulder into my hand with maybe 5% of his strength matching the pressure of my hand. It's not like a super strong isometric contraction. All you want to do is fire that infraspinatus muscle. Because then the nervous system is going to relax the trigger pointed , injured, contracted Pectoralis Major muscle. And the nervous system is going to be directed to the exact spot of contraction( injury) because that's where your finger is touching. I'd have him hold his breath while pressing his shoulder against my hand for 15 or 20 seconds. Then relax for five seconds, then repeat. I'd have him repeat that three to five times. That might be my entire treatment. Along with hot packs over the trigger pointed area in order to draw blood into the now relaxed injured tissues. I'd be thinking more along those lines instead of working out an injured muscle. But that's just me. Also, as a side note. Any time you can get nervous system on your side when trying to relax a tight, contracted ,trigger pointed ,or injured muscle. Your chances of success are greatly improved. It's like swimming down stream as opposed to swimming up stream. It's a lot easier. Most people as far as I can see, just dig and dig on damaged tissue, telling their client/patient to breath through it. It's like no pain no gain. Now not telling anyone what to do. But I have learned over the years,,,,that is not the smart way to do things. To me it's all common sense. But there are a lot of really smart people out there that some how, don't see things my way? Reciprocal Inhibition Reflex is a very good thing to have on your side. Here is what Wikipedia says about it. https://en.m.wikipedia.org/wiki/Reciprocal_inhibition. Again to qualify myself. This is just my way of thinking. I know there is more then one way to skin a cat( G that sounds terrible ). But still.
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