Illness and Conditions, Integrative Medicine, Massage Techniques Explained

Light Therapy: Baking the pain away

Let the sun’s rays bake my pain away…

I am FINALLY on vacation after a long, hard year of doing what a New Yorker does best – hustling! Gratuitous amounts of massage meant that business has been very good, but inevitably that overwork had its downside a.k.a tendonitis. My workouts helped me push through and past my ¨magic number¨ of massages per day, but with all that repetative movement it was inevitable that I would develop an overuse injury. Nevertheless, in the weeks that led up to my Mediterranean vacay, I had been laying out in the sun every morning before work to both settle my mind and develop a ¨starter¨ tan. The added bonus was the heat of the sun hitting directly onto my upper back and shoulders really dissipated a lot of the pain and tension I felt from the previous day´s physical demands. Unbeknownst to me this heliotherapy I was giving myself is actually a therapeutic technique dating back to antiquity. A number of ancient cultures had an idea of the healing properties of light. Hippocrates, the father of modern medicine, prescribed sitting in the sun to heal a variety of illnesses. Herodotus, the ancient Greek historian, preached that the sun could help heal nerves and muscles. Many ancient Greeks built roofless buildings for the purpose of exposing themselves to the sun´s rays. Outside of ancient Greece, the Egyptians took it a step further and practiced bathing themselves in various colored light to cure diseases. Thousands of miles away in India, medical texts dating back to 1,500 BC also note the healing properties of light for skin disorders. Go even further to China and their medical texts from over 2000 years ago detail a range of color and light therapies for skin and mental illness.

A woman receiving light from a modern light therapy i.e. phototherapy box

So, seeing that the ancients had an inkling of what the sun could do for one´s health, modern medicine didn´t get the memo until the early 19th century, where Niels Ryberg Finsen, a Danish doctor of Icelandic decent, studied the medicinal affects of light rays. His impetus was the severe metabolic disease he suffered from whose symptoms  he experimented with sunbathing to relieve. He died a year after winning the Nobel for a phototherapeutic device he created that simulated sun light to treat several skin conditions. Thirty years later, scientists realized a lack of Vitamin D produced in the body by exposure to sunlight, was the main cause of a disease known as ¨Rickets¨ which leads to the weakening and softening of bones. Twenty years after that, researchers in Hungary used soft laser light to relieve arthritis pain. In later years, NASA scientists did a plethora of research on the manner that LED light affects plant biology in an effort to understand how to grow plants in space. What they found was a very small spectrum of light provided most of the energy needed to grow plants. From this research, more strides were made in the understanding of the healing properties of light within animal and human cells. Currently, two forms of phototherapy exist; Non targeted light therapy that comes from a box, like in the image of the woman above and targeted light therapy, which is administered by a laser. These forms are used with much success in the treatment of such skin disorders as psoriasis, non-severe acne, vitiligo, eczema, atopic dermatitis, polymorphous light eruption and lichen planus. They have also been effective at treating mood and sleep disorders like SAD (seasonal affective disorder), non seasonal depression and circadian rhythm disorders like delayed sleep phase disorder. Further medical research is being done with light therapy to address accelerated wound healing and pain management, which brings me back to my tendonitis. My experimentation with light therapy from its natural source (the sun) elicited the following note. On the days that I did not lay out because weather did not permit me to, I found that the pain and weakness in my anterior shoulder and neck would become mildly worse and last the full work day. The days that I did get about 45 mins of sun exposure, it felt more like a dull ache and only after doing 6 hours of massage at the end of my day. It is clear to me that the sun does heal. In the two weeks I will be bathing in its Mediterranean glory, my hope is to eradicate most of the pain and heal those weary tendons. I am looking forward to the day when the medical community finally approves its use for pain management. We need more natural and ancient approved manners to heal our bodies and minds.

Fitness - Inside and Out, Massage Techniques Explained

The Magic Number

What’s your magic number?

How many massages can you do in a day?

This is a popular question posited to me by many a new and regular client. You can never be fully honest for obvious reasons. You don’t want to seem tired and overworked, even if you are, because now the client is thinking they will get a shitty massage or feel guilty that they are number (insert double digit) of the day. If I am in the spa setting, I usually make a joke and say that I am “strong like bull” in a mock Eastern European accent and tell them not to worry. If I am in a clinical setting, I distract them back to the matter at hand – their condition, thus dismissing the question altogether. If they bring it up again, I then tell them these clinical massages are shorter and more focused, so don’t worry about me. Let’s focus on you!

The only thing a client should be focused on…

Truthfully, there is a magic number of massages a therapist can perform consecutively before burn out happens. Of course, this number is different for all of us. I weight train and exercise at least three times a week; therefore I am “strong like bull.” Despite this strength and stamina, I know that if I do 5.5 hours of consecutive massage, I am at my body’s limit for the day. I learned this from the rare times I had done 7 or even 8 hours of consecutive massages. The next day, I could barely make my hands into fists coupled with the ache in my forearms and shoulders. Now, for those of you who may say, “You work a 6 hour shift? That’s so part time.” Let me take a moment here and define what consecutive means in this context. These massages are occurring literally back to back. Once the one client is off the table, there are between 5 to 7 minutes to get the room changed over, grab a sip of water, then run to get the next guest without looking like you ran to get them. This is usually what happens in a spa setting, as the booking is done to maximize profitability; not to consider the physical demands made on the therapist. So, you see how 5.5 hours of continuous physical work plus the added cardio of running up and down stairs for guest pick up, drop off and supplies is enough of a full work day for me. You cannot compare it to a 9-5 p.m. desk job, which exhausts many in a different manner (i.e. from holding their bodies in poor sedentary posture and mentally focusing on a screen with few breaks).

Burnout of a different kind…

I recall working an event where another therapist boasted at the amount of clients they could take on in a day. Observing their body mechanics, I assessed that within a few years this therapist would surely burn out. Chronic Tendonitis is a common occurrence in any profession that requires repetitive movements over long periods of time. Taking breaks to stretch, hydrate and regroup mentally and physically allow this career to last beyond the statistical death knell of 3-5 years. I’m not ashamed or scared to say NO when asked to go above and beyond my limit at this 3 year mark of my professional career. After all, I want to be able to straddle both physical worlds – the demands of my fitness regimen with those of my profession. I feel blessed that I know what my magic number feels like, as it makes me a better practitioner for my current and future clients. As for the rest of my fellow LMT’s, may yours pop up sooner than later.

Fitness - Inside and Out, Illness and Conditions, Massage Techniques Explained

What Are You Running For?

After the runner’s high fades…ouch!

It’s marathon season in the Northeast. Thousands of people participated in the ING NYC Marathon on November 3rd . For those who may not know, the race traverses all corners of New York City’s 5 boroughs covering a distance of 26.2 miles (never forget the .2). Three years ago, I volunteered to provide post marathon massage to members of the FDNY; all of whom took part as a charity effort, competing against the NYPD‘s team. I think the firefighters made the better time that year – gotta love them!

Outside of marathon training, many New Yorkers whose favored form of exercise is running describe themselves as runners and only runners. I found this fascinating, for as much as I train in Thai kickboxing, I never call myself a kick-boxer. Other people I know who incorporate Olympic lifting into their workouts also will never call themselves Olympic Lifters. So why do people who run become so defensive about their running. When told, Oh, so you like to run? their immediate reaction is No, no…I’m a runner. I run (insert mileage/distance covered) every day, such and such times per week followed by accolades like and I’m about to do my third marathon.

After the initial defense, to which you nod and note their determination and dedication, they begin to list their assorted musculoskeletal injuries. This is where my mind really gets blown. Is it normal for a thirty four year old non-athlete to have had multiple knee and a hip replacement surgery? Answer is no; however their injuries  are worn like metals of honor. What I have also come to realize is the more they are able to run through the pain, despite their cartilage and tendons fraying to strands, the prouder they are. The only way you would know that something was off would be by observing their running gait (professional eye helps in that department) and the appearance of their knees and hips post run.

A little self massage of the Plantar Fascia…

Since many of my clients in the last two weeks have been runners, I decided to share with you all some of the more popular injuries experienced amongst this group. Blisters, weakened toe nails and callouses aside, feet suffer from the manner in which the individual runner pounds the pavement. Plantar fasciatis is an inflammatory condition that affects the connective tissue sheath that covers the sole of the foot. This inflammation leads to heel pain that radiates to the center of the foot. We test for it by pressing a thumb into the base of the great toe and extending the entire foot.  Most clients that I have had with this condition feel it more acutely in the belly of their arch into the medial/inner side of their foot. In normal walking gait, our heel strikes the ground first followed by a rolling out of the balls of our feet from left to right to push off for the next step. Running gait sends the strike further up into the middle part of the foot. In the case of plantar fasciatis, the runner is usually putting too much roll/strike into the inner arch of the foot, which leads to the inflammation they experience and related pain pattern.

Sharply related to the bottom of the foot is another condition known as Achilles Tendinopathy. The achilles tendon is a thick band of connective tissue that anchors the calf muscle’s two heads into the heel of the foot. Constant wear and tear from activity leads to degeneration and a weakening of the tendon, which makes it vulnerable to rupture. The areas that are weakened often feel tender to the touch and the tendon itself appears thicker looking. Much like with the plantar fasciatis, it is believed that an over rolling/striking into the inner arch of the foot can cause the achilles to become over strained, thus leading to the tendinopathy. The only way to heal both of these conditions is to reduce activity to allow for the collagen fibers to rebuild/repair themselves. Also, the wearing of insoles and a correction of one’s striking gait can help. However, many runners do not allow themselves this rest and repair time. At some point, it will become impossible to take even walking steps, let alone to run.

Achilles Tendinopathy in the left foot is clearly delineated by the black marker – thicker, misshapen and you bet, painful!

Moving further up the leg we have a condition that affects both the knee and hip known as Ilio-Tibial Band Friction Syndrome. Stats say that over 10% of runners will experience this condition at some point in their running life. Much like the other two overuse conditions mentioned, this one occurs from excessive training/activity. The locus of pain is on the outside of the knee over a bony prominence where the IT Band passes over each time the knee flexes and extends. It can radiate down into the shins or up into the hip, where the IT Band originates. It is super painful during activity and for some, even at rest, depending on how aggravated that huge strip of fascia is.  Stretching the glutes, especially the sides which encompass your little kickboxing muscle behind the pelvis known as the TFL, definitely helps as well as correcting, like the other two conditions, running gait and posture. But again, these conditions stem from pushing one’s limbs to their limits. In tandem with Ilio-Tibial Band Friction Syndrome, there is also “Runner’s Knee” or Chondromalacia Patellae. This condition is an inflammation of the underside of the patella or knee cap which leads to Patellofemoral Pain Syndrome.  This area is covered by smooth cartilage that normally allows the femur to glide easily when the knee is bent. However in runners, the constant friction causes the cartilage to get irritated which leads to thinning and softening, hence the moniker chondro (cartilage) and malacia (softening). Also, if one’s gait is out of alignment, the patella will not track properly and will also irritate the cartilage. A tight IT Band also relates to this condition as do the Lateral and medial quad muscles. Knees will crackle audibly with pain often felt in the front of the knee and on the condyles of the femur slightly above the knee.

If you wear all your cartilage away, surgery is the only route you will be covering.

Outside of physiotherapy, anti-inflammatory medications and icing one’s painful parts, taking the time to properly heal tissues, which should include massage to break up adhesions (i.e. knots or stuck points in tissues), clear toxins, build up the blood supply and elongate taut fibers will extend one’s running “career.” Let’s face it. If you are going to call yourself a runner and wear your battle wounds proudly, you should also invest in the care necessary to make your mileage count!!

Illness and Conditions, Massage Techniques Explained

Massage for a Broken Heart

This too shall pass…

One out of every three clients I encountered this past month was in the midst of a break up. Although February is nationally recognized as a time to celebrate love, thanks in part to the mass market holiday that Valentine’s has become, it seems that more and more people choose to end their relationships during this time. Break ups apply to all kinds of human connections like friendships, romantic partners, marriages or family members and illicit the same range of emotions one would encounter within the grieving process. Rather than swimming in the vortex of loss alone, these clients sought out massage as comfort. How is it that heartbreak “hurts” so much? The physical reaction to emotional loss can be explained through medical science.

When emotional stress is experienced, especially loss, our brains signal the release of stress hormones from the adrenal glands and certain proteins that constrict blood flow causing part of the heart to become temporarily enlarged and incapable of pumping well. The rest of the heart has to compensate by contracting more forcefully. The pain felt in one’s chest resembles that of a heart attack; however without the permanent damage associated with it. The heart is described as being temporarily stunned or rendered “helpless” which is an interesting choice of words given the sufferer’s mental state. This condition is known medically as stress cardiomyopathy (formerly takotsubo cardiomyopathy) but many doctors refer to it as Broken Heart Syndrome.

Pain is the brain’s primal way of responding to trouble. That trouble can be caused by stimuli both inside and outside of the physical body. Sensory receptors known as nociceptors register these stimuli and in milliseconds return the signal of pain. When we are in a state of emotional distress, the brain’s blood supply is altered, sending more blood to the area responsible for regulating physical pain. This excess flow has been found in people with depression making them more peaked to pain. The emotions felt during a break up enact this physiological response, registering an ache or hollow feeling often felt within the organs of our core; not just in the heart. The state of pain also kicks in the sympathetic nervous system to respond, known as our state of “fight or flight.” The hormones and proteins released inhibit appetite which can lead to anorexic behavior, keep us over alert which translates into insomnia or disrupted sleeping patterns, constricts blood vessels causing headaches, stops digestive juices from being released causing tummy troubles and for some, their overabundance can lead to panic attacks and adrenal fatigue.

Brain and pain rhyme for a reason, kids.

One of the main things massage can do is kick into gear the parasympathetic (i.e. “rest and digest”) response. This is why it is so effective in stress management. Massage counters a lot of the physiological affects of a broken heart by switching off the sympathetic release of hormones and proteins related to emotional stress. In addition, it counters any muscular and postural imbalances that could develop from protective patterns of movement or the general feeling of wanting to cocoon into oneself. It also prevents the isolation and loneliness that creeps in after the shock, denial, guilt, anger and bargaining stages of the grieving process pass because it allows for touch from another that is warm, therapeutic and outside of any emotional attachment or expectation. It is a safe place to let go of emotions and come back into the body.  Some of us put names on slips of paper in the freezer, bury all the things ever given as gifts, move out of the apartment whose walls are saturated with the memory of YOU and THEM, cut or dye hair in all kinds of ways to deal with a break up. But giving yourself the love you once had for another person, which in the case of my clients was in the form of therapeutic massage, will have the most beneficial overall effect for all parties involved. Acceptance is a whole lot easier when you don’t have to HURT as much.

Integrative Medicine, Massage Techniques Explained

Jury rigged

One of the most valuable skills anyone can possess is the ability to temporarily fix things with whatever is available to you in the moment. There was a whole television series in the 80’s based on this skill, which I watched religiously. “MacGyver” was the perfect mixture of adventure and science to my young little mind and Richard Dean Anderson was so, so believable in his role. He cracked eggs from a chicken coup in South America over his car radiator to stop its leaking, so he could drive and escape the bad guys. Turned a coffin he was placed in, into a makeshift jet ski to escape “za Germans” — my hero!

MacGyver at work!

In classic American fashion, we use the term jerry rig to denote a patch job or temporary construction, which is incorrect. The proper term is jury rig, which is a nautical term stemming from makeshift masts and yards made in case of damage or the loss of the original mast. It’s a weak and temporary method; basically enough to help you steer your ship into the nearest port and get properly fixed. Same idea applies in everyday life. Jury rigged problems buy you time, but end up being a lot worse down the line if they aren’t addressed sooner than later.

In these precarious economic times, it’s understandable that jury rigging may be the only manner in which to address issues. However, keep in mind that a home is only as strong as its foundation. If the leg of your massage table is starting to come loose, it’s only a matter of time before the putty you used to secure it wears off and your client ends up on the floor. It may be worth investing in a new table. Believe it or not, there are affordable options out there, if you take the time to look. $108 dollars spent is better than a lawsuit. With respect to injury, trying to work through the pain of muscle spasms in your back by jury rigging your office chair is only going to get you out of work faster than if you take a personal day to get a massage, see the chiropractor and/or doctor to deal with it. Energetically speaking, if everything in your life is a patch job, you can never really move forward. Eastern theory indicates that the inability to think, plan and execute relates to the Liver and Gallbladder being out of balance.  They present with the following symptoms: muscular weakness in the limbs and back, irritability, sudden bursts of anger, migraines, indigestion, sinus issues and depression to name a few. For a more comprehensive list of symptoms, pick up a copy of Korngold’s “Between Heaven and Earth: A Guide To Chinese Medicine.” Acupuncture and Shiatsu massage both effectively address this type of imbalance and your practitioner can give you aftercare in the way of dietary modifications and stretches to support the work they have done. This is especially good if you cannot afford to do more than a few sessions. Life is too short and precious to be jury rigged. Do all that you can to permanently fix your problems, internally and externally.

Illness and Conditions, Massage Techniques Explained

Trigger Points – the baggage our muscles hide!

Is this your back?

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 as skin 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.

Additional reference available at:

http://en.wikipedia.org/wiki/Trigger_point

NOTE **Read personal trainer, running coach and kayak instructor, Jeanne Andrus’s post about her experience with Trigger Points. I think it to be a helpful read:

Trigger Points