There is nothing better than a person who is health and wellness minded coming to me for massage. You don’t really have to convince them of the benefits or teach them about its affects on their body because they are already informed and on board. Instead, as you work with them, they learn more about their body’s movement patterns and underlying stored tensions, making release and corrective care all the more possible. After a series of sessions they will be right at home in their new state of being and come to you for follow ups whenever they feel the need for them. Sigh…if only all client situations were like this.
One client that I have been working with now for a few weeks fits the model client moniker to a tee. He comes in with stories and updates on the results of his last session and what his activities/work/lifestyle have procured for me this time around. I share him with another therapist. We both approach his motley crew of issues with different perspectives and techniques, but always end up with some kind of change/result. This weekly challenge is such a learning process for myself. Having to get creative in order to circumvent limitations and other obstacles takes me away from my usual approach to a particular muscle issue and brings back the spark of why I got into this profession in the first place. It also makes me hungry for more education, which (lucky me) New York State is going to require in just a few short months to renew my license. I do my little happy dance post session, when I can see the effects of the work; a little less rounding of the shoulders, an arm fully flexing up to one’s ear, a little pain free spring in one’s step. It’s a great feeling.
In contrast to the model client, is the problem client. They come in many forms, sometimes seeking out massage on their own or having it forced on them by a health care professional or a loved one. They almost never feel comfortable with anything you may try out to address their issue(s), that is if they can pinpoint what it/they are in the first place. They don’t communicate their feelings easily or over communicate as in “choreograph” the entire massage session. On the one hand, I welcome clients being specific about where their trouble spots are and what they prefer me to do; however, one has to be a little reasonable. After all, there is a flow involved with a good massage and jumping back and forth between body parts, over flipping from supine to prone or over working a particular region or muscle kind of kills that vibe.
A funny thing happened a few weeks ago with one such problem client. After a handful of sessions where said client answered all my intake questions with shrugs and my inquiries on our work with a down-tempo “it’s ok” I had become a little more than frustrated. I was starting to gas out completely and couldn’t count down the minutes until our session ended. No longer client centered and feeling drained, I stopped focusing and sort of mindlessly moved about the tissues and musculature I was addressing. My zombie massage was, to me, the worst massage I could ever give a person. However, in this state, my problem client finally let go. In my daze, I heard a comment on how sore the front of their thighs were. At first, I thought the voice came from the inner recesses of my head…or the television blaring in the client’s family room. When it dawned on me that the client was actually communicating with me, I snapped out of my zombie mind and asked where they felt the soreness might have stemmed from (activities, diet, etc.) In three minutes, I received more feedback than in all the weeks I had been working with this individual. My crappy massage was this person’s saving grace. I know now to start off in a general way with said individual and allow them to lead me where they need. This problem turned out to be a model – a learning experience to challenge my approach to different personality types. Sometimes the egg can be cracked without too much force or effort. Take that, brain!!
During the mid-point of my massage education, one of my professors described a technique known as Structural Integration. Falling under the alternative medicine umbrella, structural integration aims to put the body back into proper alignment by manipulating connective tissue (i.e. fascia) to release areas of restriction based on how the client has been moving and holding their body in space. This manipulation is done to affect the deepest level of the musculo-skeletal system (we are talking right down to the nerves) which might feel quite intense in the moment, but over time can reduce pain caused by improper movement patterns. In tandem with the work, the client is re-educated in how to move properly in order to maintain the results of the treatment.
One of the most popular modalities of structural integration is Rolfing. I was familiarized with this when a close friend, who suffered traumatic injuries from an accident, received this bodywork along with her physical therapy. She went from being unable to walk all the way to full on modern dancing within a year. I recall her saying it hurt – A LOT. Intrigued, I did some research to see what it entailed. Created by biochemist Dr. Ida P. Rolf, who recognized that the body’s systems were all interconnected through a seamless network of connective tissues, it was originally meant for the chronically disabled to help improve their mobility. However, she soon learned that her method of postural release also applied to people with chronic pain, stress and/or who put intense physical demand on their bodies. Hmm…sounds like somebody familiar, e?
Like any effective form of bodywork, Rolfingis a holistic approach, taking into consideration the individual and what their needs might be to adjust the treatment accordingly. Adjustment is key also in the depth of manipulation of their connective tissues as well as the mobilization of their joints. Some of us, although mentally psyched for it, find that our bodies will fight back. As a therapist, you have to know how to knock on the door in order to be invited into a particular area of the body. The client needs to feel safe, comfortable and trusting of your touch, especially when the work will be painful. The end goal is free and fluid movement. Usually this will be done in 10 sessions; however some people feel very dramatic changes to their posture and movement right after their first session. (See the diagram I posted in the header for an idea of what happens)
Now that the benefits and technique have been laid out for you, there is the task of finding and working with the right Rolfer. A therapist cannot claim they Rolf unless they have been Certified by The Rolf Institute of Structural Integration, the only organization worldwide that educates and certifies Rolfers. You can search for and check a therapist’s credentials via the Institute’s website Verification link. Certification aside, a therapist’s approach can and will vary. It is important to find a practitioner that communicates effectively and listens to your feedback in a constructive manner. Another friend of mine received the technique and found that her therapist would not ask her questions or address her comments regarding the work. She left the experience feeling she was treated like a body, not a whole person. That is never a good thing in any form of bodywork and usually does not produce results. If you are open to being Rolfed, take the time to research your practitioner and/or get referrals from those who have been privy to this treatment. Dramatic change is priceless.
For more information on the latest in Rolf techniques and research:
Iliopsoas is a term used for the combo platter of muscles that is Iliacus and Psoas Major. These muscles call the posterior abdominal wall home, where they attach the lumbar spine and pelvis to the hip. This trajectory makes iliopsoas not only an important postural muscle (you need it for standing and walking) but also a strong flexor of the hip joint. Sprinting and running with high knees (i.e. hips and knees are flexed above a 90 degree angle) really recruits this muscle complex along with the usual suspects of Quads, TFL and Sartorius. Also, a wonderful calisthenic exercise known as the Mountain Climber is good for strengthening this muscle for the same reason that it flexes the hip beyond 90 degrees. We need our iliopsoas to be strong in order to keep that back straight and supported through all our daily activities outside of just exercise. Too much sitting shortens and weakens this muscle complex, causing an exaggerated curve in the lower back known as lordosis, which in turn tightens the muscles of the lumbar spine causing pain and instability. Another cause of weakness is inefficient recruitment, like say, if you were a long distance runner. Iliopsoas just goes along for the ride when your knees and hips stay below 90 degrees because you are running at a slower, more methodical pace. Even though you are maintaining a good level of fitness, overtime iliopsoas will weaken because it is not really being strengthened. Add old age to the equation, which naturally reduces muscle strength and viability, and you have all the factors that directly affect this muscular unit. Well, almost. What else is located in the deep recesses of your belly? Your guts.
Aside from your abs, the iliopsoas (specifically psoas major) keeps that lower abdomen flat, preventing the intestines from pushing forward as it creates a kind of long shelf for them to rest in. In times of elevated stress and emotional issues, your psoas major tightens and is less efficient at keeping your guts at bay. Primordially tied into our “fight or flight” nervous system, the psoas is our true “gut” muscle, stabilizing and destabilizing at the will of our environment. Digestion and other non-essential activities cease when we are on high alert leading to a buildup of toxins, inflammation and other muscular disturbances. And speaking of said disturbances, also located in the lower right corner of your abdomen in the region of iliopsoas is a valve known as the ileocaecal valve (IVC). It is where digested food passes from the small intestine into the large intestine, so that water and vitamin absorption can occur and toxins can be eliminated. This valve is designed to open for the above function and then close to prevent back-up. Any number of factors including stress, diet, parasites and irritation of the nerves that power the valve can cause it to stay in either a closed or open position. This leads to a buildup of toxins where they do not belong. The body responds with fluid retention and a host of symptoms such as joint and muscular aches/pains, circulatory problems, pinched nerves or even whole body arthritis. How does this affect iliopsoas? One of the most common symptoms is low back pain that comes on suddenly and with no explained cause. Picture yourself sitting one minute, then getting a sharp, stabbing pain in your lower back upon getting up. This low back pain is due to the close relationship iliacus has with the valve. Any dysfunction refers to this muscle, which in turn destabilizes the lumbar spine and affects the surrounding musculature in the back and hip. Chiropractors, Massage Therapists who specialize in Applied Kinesiology and Naturopaths can all address this issue effectively through a variety of changes to one’s diet, exercise and with soft tissue manipulation to name a few techniques. Do not underestimate the importance of this muscle complex. Its betrayal by either pathological and/or other causes can have severe repercussions in the whole body. Keep your guts and back in perfect alignment and they will take care of you.
Many health and nutritional experts say that breakfast is the most important meal of the day, but I beg to differ. Let me draw your attention to the period of time that precedes that meal. A time that should be spent in a state of deep restfulness. Doing without this form of nutrition will set your body up for certain demise. Sleep is the meal that should never be skipped.
Our appetite for sleep is programmed into a part of the brain known as the hypothalamus, which is the regulating center for the various biological drives that keep our bodies functioning. When we are infants, the part responsible for sleep and wakefulness is out of control. Think of how many babies sleep all day and are up all night or those that have short bouts of sleep spread out over an entire day. The reason for this insane sleep schedule is the immaturity of the internal clock that sets daily functions to the rhythm of 24 hours. Human beings have it, as do plants, animals, fungi and certain bacteria. Dubbed our Circadian Rhythm, sleep and wakefulness is dependent on exposure to light and dark. The first few months of life are pivotal in establishing this internal rhythm, but some babies take as long as a year to sleep a solid 8 hour night. Once the rhythm is established, your body will function on a 24 hour cycle. When in the presence of darkness, our brain’s pineal gland, which is light sensitive, produces a hormone melatonin that helps to make us sleepy. Desire for sleep is strongest during the darkest hours between midnight and 6 a.m. and to a lesser extent in the mid-afternoon. In American culture, this is the 2-4 p.m. slump when most people grab themselves a coffee and/or some kind of energy boosting snack. In Europe and Latin America, this would be your afternoon nap-time otherwise called the “siesta.”
Sleep itself is a highly involved process consisting of 4 stages that each have a physiological affect on the body and brain. The first three stages are part of what is called Non-REM or quiet sleep, a state where thinking and most physiological activities slow down, but movement can still occur, and a person often shifts position while sinking into deeper stages of sleep. Unless something disturbs the process, people will pass through these 3 stages of sleep smoothly. The fourth stage of sleep is called REM or dreaming sleep, a state where the brain is very active, but the body is paralyzed. Normal sleep cycles alternate between quiet and dreaming, with most deep sleep occurring in the first half of the night. During the second half of the night, dreaming sleep gets much longer and alternates with the second stage of quiet sleep. More on these stages now…
During the first stage of sleep, dubbed drowsiness, your brain no longer receives visual stimuli from your shut eyes, body temperature begins to drop, muscles relax, and eyes often move slowly from side to side. Although you may start to lose awareness of your surroundings, you can very easily be awakened. In the second stage of sleep, known as light sleep eyes remain still and breathing and heart rate are much slower. The brain starts to show irregular electrical patterns of slow waves and short bursts of activity. The brain can also respond to outside stimuli, like someone whispering your name, which scientists believe could be a built in vigilance system to ready you for awakening if necessary. Half of a good night’s sleep is spent in this stage. Once you enter the third stage of sleep, known as deep sleep, your body undergoes some important cellular changes. Blood flow to the brain decreases and it stops responding to outside stimuli, making it difficult to wake up the sleeper. Breathing becomes regular, blood pressure falls and the heart slows to 30% of its waking rate. The pituitary gland releases growth hormone at the beginning of this stage which stimulates tissue growth and muscle repair. Proteins in the blood that activate your immune system also increase, helping build the body’s defenses against illness and infection. Interesting side note here: People in young adulthood have many stretches of deep sleep, while those over 65 have none.
Enter now the fourth stage of sleep or dreaming sleepwhere the eyes dart back and forth rapidly behind your closed lids ( this is where the acronym REM comes from standing for “rapid eye movement”) and the brain races with thoughts and “dreams. Your body temperature and blood pressure rise, and your heart rate and breathing speed up to daytime levels. What is interesting is that the sympathetic nervous system, our fight-or-flight response, is twice as active as when we are awake. Despite all this activity, the body hardly moves, except for intermittent twitches. The rest of the muscles not needed for breathing or eye movement are essentially paralyzed. A normal night’s slumber consists of 3 to 5 approximately 90 minute periods of REM, but as we age they get shorter. Many scientists feel this is the time when the mind restores itself, which is important for cognition and memory. Early research into the role of REM sleep in-utero indicated that the rapid firing of nerve cells during this period was important for the growth and development of nerves. Subsequent studies on adult humans found that REM sleep deprivation led to poor performance on a variety of recall tests or logical tasks. In addition, memory loss occurred when sleep was deprived on the same night or two nights after the material had been learned and especially when subjects had been selectively deprived of one of the first two or last two REM episodes of the night. In other studies, REM cycles were found to increase after complex material had been studied, indicating that the brain uses this time to sort and process information into its memory banks. Other scientists suggest that REM sleep functions to dispose of unwanted memories through a mechanism called reverse learning. Reverse learning operates during this period of sleep to prevent the brain from being overloaded with massive amounts of information stored during wakefulness. A fine explanation for the insane dreams one may have, but testing this is pretty difficult, so it’s just a theory.
If your sleep is going to be interrupted, you do not want it to be during your stage 3 and stage 4 cycles. Overtime, deprivation of these levels of restorative sleep will take a toll on your outward appearance and your internal health, mentally and physically. Dermatologists have noted that collagen production increases during sleep, strengthening the bond between your exterior and deeper skin layers and allowing for the water retention necessary for suppleness. Also, growth hormone gets released in deep sleep, as mentioned earlier, which builds and repairs tissue. Without it, water evaporates from the skin leading to a dry, sallow complexion and the appearance of fine lines. Keep it up and skin could react with rashes and eczema. Lack of deep sleep increases the amount of inflammatory proteins in the blood and decreases immune system response. The more deprived you are, the more likely it will be that your body will react to pathogens and itself. The increased inflammatory proteins can lead to such conditions as heart disease and overall, research has indicated that people who get less than 6 hours of rest a night tend to have a higher mortality rate than those getting the recommended 7-8 hours. If you are a person who weight trains or exercises a lot, the lack of deep sleep does not allow for muscles to repair themselves and grow properly. This negates the affects of the workout and leaves them prone to injury. Outside memory loss, deprivation of REM sleep can lead to a diminished awareness of one’s surroundings, a severely reduced response time and an inability to perform tasks that are highly involved, such as driving or operating machinery. Far beyond drinking and drug use, lack of sleep is responsible for most of the accidents that occur on America’s roadways.
If you are having trouble getting to sleep at night, some of the obvious culprits could be stress, use of electronic equipment before bed, drinking too much caffeine and eating a big meal or going to bed hungry. Those have easy solutions, relatively speaking. You can get a massage, meditate or do some yoga to relax your body and bring your mind down from its stressful state. Have your coffee earlier in the day and cut down on the amount. No eating of large meals or snacks within 2 hours of going to bed, so you have ample time to digest. Shut the computer and the television and get them away from the area dedicated for sleepy time. Plunge yourself into darkness (remember that melatonin) and relative warmth, and sleep should come to you. However, there are some not so obvious culprits for disturbance of sleep. Check these out:
Taking a B vitamin supplement before bed – The B’s are super important for stimulating the nervous system, so popping supplements before bed can lead to fidgeting and constant awakening because the brain is way too “ON” to enter deep sleep.
Having a few drinks in your system – While it might get you to sleep faster, alcohol impedes the natural cycling of sleep stages, plunging you into what feels like deep sleep right away, but wearing off in the second half of the night when your REM cycles start kicking in. Since you never get to REM, you wake up more often than not feeling groggy, achy and depending on how much you drank, possibly still drunk.
Taking Prescription medications – Consider that sleep disturbance is a common side affect of some high blood pressure pills, birth control pills, steroids (including asthma inhalers), diet pills, antidepressants and cough and cold medications.
Smoking – Nicotine is a stimulant like caffeine so depending on how much you smoke and for how long, sleep can be dramatically reduced.
Working out at night – Some work schedules do not allow for morning or midday exercise, so many people will go to the gym after work. Exercise raises epinephrine levels in the blood, which makes us more alert and overall body temperature. These 2 factors can prevent sleep.
Hormonal changes – Long before menopause has kicked in, many women find they wake up in the night numerous times. This is due to fluctuating levels of estrogen and progesterone. Some younger women suffer from erratic sleep patterns before or during their menstrual cycles due to imbalances of these hormones.
Sleeping in on the weekends – It’s good for the circadian rhythm to awaken and go to sleep around the same times each day, but many of us tend to stay up later and sleep in more on days off. This throws off your internal clock, making it harder to fall asleep and awaken when faced with your normal schedule. Doctors suggest to sleep no longer than an hour more than you normally would in order to maintain the cycle.
Lastly, if you are chronically deprived of sleep despite your best efforts you should really think about visiting a doctor and/or finding a sleep clinic in your area to better assess and diagnose your problem. Now, go get a heaping helping of rest please!
If the above image gives you the impression that a group of assassins are ready to fire on you, stay with that feeling. No one is immune. They hide in your muscles and sinews waiting for something or someone to activate them. Some gather in groups while others migrate to new territory, but more often than not they refer their pain elsewhere to trick you. They are trigger points.
A trigger point is defined as a hyper irritable spot within a taut band of skeletal muscle that elicits pain locally when compressed, but can also refer it elsewhere or be accompanied by muscle spasm. When touched, these spots can feel like hard nodules ( i.e. the “knots” we so often refer to in our backs and other body parts). It was Dr. Janet Travel, physician to the late president John F. Kennedy, that first came up with the term when she noticed that these points of pain tended to happen in predictable patterns that could be mapped out on the body. Her maps can be found in the 2 Volume book she wrote with David G. Simons, “Myofascial Pain and Dysfunction: The Trigger Point Manual.”
How do you know if you have one or more of these bad boys lurking in your tissues? There are a few characteristic symptoms which include sensitivity to pressure in a muscle, stiffness accompanied sometimes with a pulling sensation emanating from a particular point in the muscle, pain that refers from the point compressed to another area of the body and pain that has a dull, aching or burning quality to it. Other symptoms sometimes experienced are various autonomic phenomena like dizziness, sweating and fever as well as headaches, numbness, loss of range of motion and dysfunction of the muscle involved. While the cause of trigger points remains a much disputed medical topic, it is safe to say that they most commonly occur when muscles are chronically overloaded, as in the case with occupational and exercise overuse, injury and poor posture. Also, chilling of a muscle (i.e. catching a draft or having an air-conditioner blow on you) and the position in which you sleep can also create these points. Sometimes these points are even triggered by emotional and stress related events.
Any qualified massage therapist (ME!) possesses the skills needed to deactivate these points and treat the surrounding tissues. In my opinion, your first course of action should be massage therapy. Thereafter, if the points do not resolve within a few treatment sessions, you should be referred to a chiropractor, osteopath or physical therapist, all of whom employ more aggressive treatment measures. The protocol used to address trigger points via massage is a combination of sustained compression of the point followed by cross fiber friction and deep strokes in the direction of the muscle fibers to clear out metabolic wastes and encourage the flow of blood into the affected area. I am a huge fan of a myofascial technique known asskin rolling. It literally involves me picking up your skin and rolling it along different angles between my fingers, almost like cookie dough. This is an important diagnostic tool for me to find these stuck points, especially if a client is unsure of the location of their discomfort. The sustained compression of these points temporarily stops the pain signal coming from the brain and the flow of blood to the area, so that when it is released, blood literally floods the point and washes wastes away. The first compression is always the worst because the pain level will be greatest then. It is super important to breathe through the 8-10 second count, as the point is held. On a scale of 1 to 10, the pain/discomfort should be around an 8. With each subsequent sustained compression (about 4 in total) the pain level will dissipate while the force of compression stays about the same. During these compressions, many clients will break into a sweat or become hyperemic (flushed) in the area of the trigger point. Sometimes there are twitches in the muscle or surrounding tissues near the point being worked on. Even stranger, the point can move while I am compressing and I literally have to chase it through its migratory path until I shut it down. Once the compressions are finished, the point is rubbed vigorously in a cross fiber pattern between 1 to 5 minutes and then all the fibers of the muscle get treated to a nice and slow, deep rub down. I like to then apply a bit of heat in the form of a heated dry towel (no more than 10-15 mins on) or a topical irritant like Tiger Balm.
Best case scenario, trigger points will get resolved in one intense session, but more often than not, multiple sessions are needed to deactivate years of evil. It’s extremely important to assess what is going on or has happened in your life, both physically and emotionally that, although your brain might have dismissed, your muscles and tissues beg you to notice. This awareness will help you focus your attention back onto yourself and deal with the baggage at hand because trust me, your muscles have better, more productive things to do than carry the weight of the world in their nooks and crannies.