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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 Gordon J. Wallis on March 6, 2017 at 11:09pm
I found this interesting. A client came in for a massage. A young healthy looking women. When I asked if there was anything she wants me to know. She told me that her neck and shoulders have a lot of tension in them, as well as her back in general. I asked her if the tension was more then normal. She said yes, her neck is hurting and she has to see a chiropractor for it. She went on to tell me that she gets therapitic massage along with chiropractic adjustments when at the clinic. I asked her how that's going for her? She told me that it hasn't helped. I didn't ask how long she has been in Therapy. I told her that there is a very good possibility that I could help her. And that if she let me do some assessment and check on a few things , I would have a good idea if I could help her or not. She said go for it. I wish somebody could help me.
Her main complaint was her neck. As she was supine I palpated her neck. I found a few vague tender points, but they didn't seem intense enough to be causing much of a problem. But ya never know, and the neck is s sensitive part of the body. One notable thing was, the minor tender areas were all located on the right side. I had her turn over and palpated her back and hips. There was a big difference between left and right. The right side was much more sore then the left. And the tender points were very noticeable, unlike the vague ones on the neck. Her right hip was also a little sore along with her same side hamstrings and calf. Her left hip and legs were fine. That's a big imbalance between left and right. Basically the entire back right muscle chain, or as Tom Myers calls it, the Superfical Back Line.
On more specific palpation she had numerous trigger points on her right paraspinals from L5 up to T1. And when palpating her spinous processes , almost every other spinous was tender on the right side with no palpatory pain on the left. No wonder her neck hurt. The way I look at the body the right neck muscle runs all the way down the back over the hips down the hamstrings behind the knee through the calf to the foot. That entire right back muscle is contracted. Now because of the righting Reflex the brain wants the eyes parallel to the ground. So she feels it in her neck.
I explained all this and more to her. And what I would do about it if she wanted out of pain. I released every lateral spinous tender point from T1 to L4. And there were a lot. She was surprised. I also released a few of the right paraspinall trigger points. Not all of them. Didn't want to overwhelm the nervous system with too many releases, plus I wanted to give her a massage for the rest of the session. After the session she told me that she wants to come see me for her back and neck pain. She however has a vacation planned and will schedule to see me when she gets back.
She has a big imbalance between left and right side of her body. The left hemisphere of the brain controls the right side of the body. The right hemisphere the left. Her left hemisphere is unregulated compared to her right hemisphere. The right hemisphere is down regulated compared to the left hemisphere. To help with her recovery I'm going to massage the left side of her body for about 15 minutes in order to stimulate the down regulated right hemisphere of her brain, before I start the trigger point work on the right side of her body. I feel confident about helping her. I emailed her more information on trigger points and my approach to helping her. She felt better and was really happy when she left the spa. In one attachment you will see an illustration of both right and left muscles that are out of balance, and in the other attachment you will see an illustration of the possible muscle causing all her lateral spinous pain.
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Permalink Reply by Gordon J. Wallis on March 6, 2017 at 11:50pm
As usual I made the usual spelling and typing errors. In the last paragraph early on I said her left hemisphere is unregulated compared to the right hemisphere. I ment to say up regulated compared to the right.
Permalink Reply by Gordon J. Wallis on March 11, 2017 at 3:23am
A client came in with the complaint of a nagging pain near her right shoulder blade and spine. She complained about really noticing it when Inhaling or taking a deep breath. I asked her how long its been bothering her. She said three weeks. She wanted it gone.
While assessing her back with broad palpation, using my palms, it was easy for her to tell that the right side was more sore then the left. There was also a rather large involentary flinch, that didn't hurt, when pressure was applied over the right paraspinals at the T11,T12 area. Although that flinch didn't hurt. It indicated that her right side paraspinals where very hypersensitive. The left side was normal, with no noticeable pain. Also on broad palpation her right hip was sore, her left not.
On specific palpation she had three very sore paraspinals TPs or what could have been Rhomboids on the edge of the scapula at about the T3, T5 and T6 levels. I also found the right lateral spinous of T1 and T2 to be sore. All other lateral spinouses, both left and right were pain free. She did have an L5 trigger point on both the left and right close to the spine. Her right hip had a Gluteus Medius, PSIS, and Piriformis that were very noticeable. She was surprised to find out her right hip was so sore.
She had a fifty minute session. I was able to find and eliminate all those tender points, including the involentary flinch barely within the fifty minute time frame. It took me longer then usual because I was testing some new techniques, and because of that I had to go back and forth a few times looking at chats before finally eliminating the trigger points. Also three of them were quit stubborn. One of the Rhomboid ones in the area of her initial complaint, PSIS, and the Piriformis. Those took a while. I had to release those multiple times before they were gone.
The interesting thing for me about this is. If you just listened to her incoming complaint, you would of thought it was just a Rhomboid problem. That's where the symptom was that brought her in for the massage. But as often times it is, there was a lot more involved. The shin bones connected to the knee bone kinda thing.
She left feeling happy and way better. I'm a bit worried though , because of the extra time spent on releasing the Rhomboid , PSIS, and Piriformis, that it might cause some post session soreness. I warned her about that possibility. Because it does happen sometimes, even though my work is fairly subtle. Ya don't keep poking on a cut to make it heal faster. I could have left those bad ones for a short follow up visit. But she couldn't come in for a follow up. So I went for it.
Permalink Reply by Gordon J. Wallis on March 11, 2017 at 11:13pm
This is interesting. At least for me. She was a new client. When I asked here what she needed from the massage, she told me that she has a herniated disc in her neck. And because of that she can't take a deep massage, especially on the neck. She told me the last massage she got was very painful, and that she was bruised and in worse pain for a full week after. When she told the therapist to lighten up, and that she can't take it. The therapist told her that it was the only way to get ride of her knots. And when the client was telling me this. I could tell by her face and body language that she was very concerned and a bit apprehensive about her massage. I assured her that I would not hurt her, and that whoever the therapist was that gave her that last massage, didn't know what they were doing. And that it upset me to hear about it.. I assured her again that the massage will feel very good.
Thinking about her herniated neck, I asked her to tell me how long ago did it happen. She said years. I then asked her to turn her head to the right.. She did. I then asked her to turn her head to the left.. She did. I then asked her to look up and down.. And she did. I watched her move her neck full range of motion. I asked her if it hurt during those movements. She said it was a little bit sore. She then added that she hopes to avoid surgery. Now I know I'm not a doctor or anything. But her neck looked fine to me. She said that she was in a plain crash, and later in an auto accident. I asked if she gets headaches, and she said yes. They start at the very base of her skull and go to behind her eyes. I asked her if she has a headache now. She said no.
I won't mention all the trigger points I found. But there were several. As I often see, there was a big imbalance between the left and right side of her body. The right paraspinals and hip were very sore, the left really nothing at all. The only tender areas on her neck was in her occipital muscles.
After the session she was smiling and said that her neck feels so loose. So again, the area of complaint doesn't necessarily mean that's where the main problem is. That's where the problem is felt. In her case the neck. And even though she had the pathology of a herniated or bulging disc. That was not causing her pain. That disc has long sense healed. It was trigger points. Basically her right back muscle chain was trigger pointed, hence contracted. In the attachment below you can see that muscle chain run right up to the occipital area that was sore. The occipitals were trigger pointed on both the left and right.
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Permalink Reply by Gordon J. Wallis on March 14, 2017 at 9:54pm
I had one client lately that I believe has been misdiagnosed. But she is under doctors care, and in my opinion, getting inappropriate therapy. I'm just glad I'm going to be working with a medical doctor that knows trigger points. That is cool. He does trigger point injections, so he knows them well.
But anyway I'm going to write about a recent case, a none serious case, but it was interesting. She said that she had a lot of tension in her upper shoulders and neck. When I did my general assessment I found out that she was sore in her left posterior neck ( transverse processes), left upper trap, , upper lumbars both sides, and in both hips. She moaned when those areas were palpated. After we figured out where her pain was, I told her those are the areas we need to fix in order for that tension she is feeling in her neck and shoulders to be gone. She had an 80 minute session so I planned on massaging her for a good amount of time before I started the trigger point work.
Anyway, after I had massaged her posterior body, it was trigger point time. Found two very noticeable upper lumbar trigger points, one on each left and right Paraspinals. Really bad Piriformis trigger points one on each hip. One left upper trapezius trigger point. And two left posterior neck trigger points. I was able to shut them all off. Then I had her turn over and gave her a good head massage for 15 minutes. But before she left, I wanted to check those trigger pointed areas again, to make sure they were gone. They were all gone except the right Piriformis one. I had to eliminate that one again. But anyway, that was cool. Even though she came in with the complaint of general shoulder and neck tension. There was significant distal trigger point activity causing it.
Permalink Reply by Gary W Addis, LMT on March 14, 2017 at 10:28pm

Over on another forum I just responded to an LMT who began a thread about the need to strengthen neck flexors in order to eliminate posterior neck pain.  Whoa, I replied.  I took a few paragraphs to explain that the lady's problem is not due to weak flexor muscles of the neck and upper body, but just the opposite.  Her neck is hurting, I explained, because the extensors are forced to remain hypertonic all the time in order to try to counter the stronger kyphotic pull of the flexors... that if she advised the client to strengthen-- not stretch-- the posterior muscles of neck, shoulders, and upper back-- that in a couple of weeks the underworked but overstressed extensors would quickly strengthen, and the pain would soon begin to dissipate.  Yes, I'm sure a few trigger points are involved, too.  But I didn't have that much space nor that much time to dedicate to the LMT's education.  Instead, I provided her with this  http://preview.tinyurl.com/hret77a.

You know, you'd think that by commonsense alone a caring, highly trained, licensed massage therapist would understand that weakness in posterior muscles will lead to forward head posture and stooped shoulders; they certainly ought to know that a weakened, over-stressed muscle is gonna tighten up and hurt in self defense.

  

Permalink Reply by Gordon J. Wallis on March 15, 2017 at 12:05am
I don't know Gary. I never think in those terms. For me, I can't relate to it. I find and eliminate posterior neck pain pretty much on a daily basis without doing any kind of strengthening of anything. I did today on two people. I did on the lady with the neck shoulder tension I talked about on my last entry.
The lady that wrote the testimonial in the attachment below came in with significant posterior neck pain. I had to see her for three 15 minute sessions three days in a row, before it was resolved.
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Permalink Reply by Gary W Addis, LMT on March 15, 2017 at 8:20am

Me too.  I got into the strengthening of the affected posterior neck muscles to counter the asinine comment the other therapist said.

Gordon J. Wallis said:

I don't know Gary. I never think in those terms. For me, I can't relate to it. I find and eliminate posterior neck pain pretty much on a daily basis without doing any kind of strengthening of anything. I did today on two people. I did on the lady with the neck shoulder tension I talked about on my last entry.
The lady that wrote the testimonial in the attachment below came in with significant posterior neck pain. I had to see her for three 15 minute sessions three days in a row, before it was resolved.
Permalink Reply by Gordon J. Wallis on March 16, 2017 at 12:15am
It was kind of a none trigger point day, but only kind of. A young lady came in just to relax. When I asked her if she had any aches and pains, she said "No just tension in the neck and shoulders." When I asked her if it was anything that she would consider seeing a chiropractor or doctor for, she said "Oh no, nothing like that."
Just common tension like pretty much anybody else. Even though she just needs a good massage. I'm still a trigger point guy. I'm sure a good massage and rub down would take out any trigger points involved in her neck and shoulder tension without me trying to find and eliminate trigger points. But I still like to do that. I get to test out any new procedures I may want to test out. And it allows the client a more specific look as to exactly what muscle or muscles are causing their tension. So right away I palpated from her upper T spine to her Occipital area. I found only two Right Upper Trapezius trigger points. I deactivated them quickly with a new technique I recently developed, and that was cool. That just took a minute, then I carried on with her massage. A good full body massage. I think I need one of those.
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Permalink Reply by Gordon J. Wallis on March 17, 2017 at 3:25pm
This is an interesting side note to things. I've noticed that people take me more seriously now, and results are more dramatic and/or effective, after I tell them that I will soon be working with an anesthesiologist in his pain management clinic.
Placebo effect and client expectations are powerful, and effective.

But you have to have confidence in what you are doing, in order for the client/patient to pick up on that. I think that's a big part of it as well. And that comes with experience.

And I think emotional content ( therapists intentions, enthusiasm ) comes into play as well.
Permalink Reply by Gary W Addis, LMT on March 17, 2017 at 8:02pm

True!

Permalink Reply by Gordon J. Wallis on March 17, 2017 at 9:00pm
A client came in with the incoming complaint of right low back pain. Bad enough that it keeps him awake at night, interferes with his work, and that he sees a chiropractor for.
He explained why he hurts. His hips keep shifting ( sounds like some sort of chiropractic lingo to me? ). This hip shifting apparently happens every one to two years. And it gets so bad that it's debilitating.
I checked his entire back out, lumbar to occiput. Even palpated his spinouses, and found no pain what so ever. But that was not the case when I checked his right hip. He had three big bad trigger points in his Gluteus Medius. In 60 seconds those were gone along with his shifted hip and it's low back pain. He was really surprised to feel pain free when he got up off the table.
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