|Posted by Katrina Koller on February 28, 2012 at 8:20 PM||comments (0)|
Sciatica is often confused as being a disease. However, it is actually a symptom of a disease commonly understood as compression of the sciatic nerve. This is mainly caused by a slipped or herniated (bulging) disc. Sciatic pain usually radiates from the lower back via one of the of buttocks, along the path of the sciatic nerve down the leg to the toes. Pain can be excruciating and can worsen on exertion. In severe cases, the lower back can also get "locked" in a sideways bending position.
Many other conditions can create this type of intense pain, since any number of nerves can become impinged or compressed by deep layers of soft tissue near the spine and in the buttocks, by mis-alignments of the spine, imbalances in the muscle groups (such as anterior muscles creating tension on posterior gluteal tissue and surrounding nerves) or fascial adhesions in the hip joint capsule. This can create similar symptoms (radiating pain, numbness, tingling). These conditions - much more common than true sciatica - involve compression of the peripheral sections of the sciatic nerve and are often equally painful and intense. Tension in the soft tissue of the piriformis, gluteal and other related muscles is usually the cause behind it.
Activities that can cause this condition are :
Sitting or standing for long periods
Protruding the head for peering at the computer screen
Sitting with a wallet in the back pocket
Sleeping in a fetal position
Driving (holding the foot on the car accelerator- which immobilizes the gluteal muscles)
Psoas minor and major are two muscles of the abdomen and pelvis that flex the trunk and rotate the thigh. These muscles are continually shortened by sitting for long periods in a reclined position in sloping chairs or sleeping in a fetal position. Tension in these muscles can activate trigger points in the opposing gluteal muscle group (muscles in the buttocks) causing sciatica-like pain.
The standard treatment for pseudo sciatica is similar to sciatic nerve treatment with more emphasis on stretching exercises, anti-inflammatory drugs and massages. Sciatica alternative remedies like clinical massages, yogic exercises, chiropractic manipulations and homeopathic treatment can play a pivotal role in treating pseudo-sciatica. All treatment is followed by correcting faults in the gait of the patient and occupational positions.
Recent studies published in peer-reviewed medical journals have confirmed that Therapy (Massage) combined with corrective exercises produces better long outcomes than surgery. A clinically trained massage therapist can support and hasten the work of a Dr., Physical Therapist, Rehabilitative Specialist, Chiropractor or other health professionals by restoring the health and balance of soft tissue in the body and reducing pain and inflammation. So don't make the mistake of relying on exercises (PT) alone. Get out of pain and stay out of pain by integrating the help of a skilled Massage Therapist.
Curious about the science behind massage? This article explains how massage actually works to reduce inflammation:
|Posted by Katrina Koller on February 26, 2012 at 11:55 PM||comments (0)|
I am seeing an increasing number of clients with Tendonitis and Carpal Tunnel Syndrome (CPS) so I thought I would post on this subject since seeking treatment through conventional pathways can be frustrating and often unproductive.
The first question to ask is: why are these conditions becoming more commonplace? Tendonitis (inflammation of the tendon causing pain and swelling) or “tennis elbow” typically results when a tendon becomes tight and inflamed due to overuse. Simple, right? Not necessarily. These nerve compression conditions can result from tension or overuse and can be exasperated by even relatively mild neck and shoulder conditions. Tendons and nerves in the extremities or in the peripheral joints (the elbow) become more vulnerable when the neck and shoulder are tense or when the brachial nerve complex (nerves that exit through the shoulder) becomes partially impinged - common with rounded shoulder posture and/or repetitive arm/shoulder movements. Electronic devices, desk work, occupations that require repetitive hand/arm/shoulder movement all contribute to rounded shoulder postures and neck/shoulder tension in general. Perhaps it is no surprise that with the increase in the use of electronic devices and texting that there is an increase in these conditions. Even a history of whiplash or cervical trauma can play a role in tendonitis or CPS. This is because the extremity portion of the nerve can lose its blood supply and nutrients and become more susceptible to injury and compression - a condition termed “Double Crush Syndrome” or “Multiple Crush Syndrome”. Multiple Crush Syndrome is now thought to be a causative factor in the majority of CPS and tendonitis cases (See the PubMed abstract below for a quick reference). Tense muscles in and around the joints can also overload joints (such as common with the thumb or elbow) leading to arthritis and a great deal of pain. Many of these conditions are avoidable and can be managed with precise soft tissue manipulation on affected tissue.
Anti-inflammatory medications, cortisone injections and then surgery are the standard medical recommendations for tendonitis/tendonosis (“tennis elbow” and Carpal Tunnel Syndrome with usually little or no mention of therapeutic massage or soft tissue manipulation as a treatment option. None of these treatments address soft tissue dysfunction – a primary cause for the vast majority of these conditions. Many hand/finger/wrist conditions get thrown into this condition category without specific identification or investigation of root causes. For example, a cortisone injection may address symptoms only, and only if that pain is actually caused by inflammation. In many cases, inflammation is not even a factor. Severe pain often exists without actual inflammation. Furthermore, injections and surgery while sometimes effective temporarily, can leave scar tissue causing even more nerve or tissue damage and more pain in the weeks, months or years following surgery. Unfortunately, I usually end up seeing clients weeks or months after they’ve seen doctors or physical therapists or following surgeries -many of which provide temporary results or produce other problems in the nearby nerves or tissues due to surgical scarring.
The good news is that these conditions are very easy to treat by an appropriately trained massage therapist or bodyworker. Look for a therapist with specific clinical training in rehabilitative or therapeutic massage. Substantial pain relief is typically realized in the initial session. The source of the pain can often be traced up the arm, shoulder, neck or all three and unhealthy tissue can be addressed directly and the area will heal permanently. If caught early, treatment can be in as few as 1-3 sessions. More severe cases may take 6 sessions or more. Even in severe cases clients are usually able to resume their daily work activities during the treatment. It would seem that this is a much better deal than being out of commission entirely following surgery for 6-8 weeks with no guarantee of permanent relief. Unless of course you really would LIKE to be out of commission entirely :-)
Interested in learning more? For a scientific peer-reviewed article abstract explaining why surgical treatment may not relieve symptoms, go to this link:
|Posted by Katrina Koller on February 9, 2012 at 12:25 AM||comments (0)|
Finally, long overdue research is published explaining precising how massage affects your muscles (and other soft tissues) at the cellular level. In a nutshell, the article explains biomechancially how massage reduces inflammation (in the biopsied test subjects). It goes on to make the point that massage reduces pain AND enhances recovery while popular anti-inflammatories (NSAIDs) like Advil and Ibuprophen are effective in reducing pain and inflammation but do nothing to enhance or speed recovery of soft tissue (muscles, tendons, ligaments and fascia). So what's the better long term investment for your injured or stressed tissue? Massage - hands down. Curious? Read the full article by clicking on the link below
|Posted by Katrina Koller on February 4, 2012 at 10:40 PM||comments (0)|
According to top medical authorities including Mayo Clinic and the American Association of Neurological Surgeons, more than 90% of back pain resolves with conservative treatment. It is also widely known that physical conditioning or exercises that strengthen the muscles and structures that support our spine are essential in both preventing and treating back pain.
Simple solution, right? Just exercise your way out of pain OR undergo 6+ weeks of Physical Therapy and poof - your pain goes away. Well, anyone who has experienced debilitating back pain knows how difficult this path can be. All too often, back pain leaves us in so much pain that we can barely make it off the couch, or find a way to sleep comfortably. How can Physical Therapy, exercises or even Yoga be practical?
This is where Orthopedic (structural) massage can play a key role. A well trained massage therapist can identify causative unhealthy tissues (muscles, tendons, ligaments and joint/spine stabilizing structures) through palpation and work methodically to restore the health of those structures to get you out of pain and moving faster. The key of course is to reduce pain enough to allow you to return to your daily activities including a healthy exercise regime or, depending on your level of pain - Physical Therapy. More healthy, balanced tissue supporting the spine = better alignment and less pressure on adjacent nerves. Unlike a spa massage, a well planned Structural Massage session that helps you understand your condition and how to prevent it is an investment in your health, not a habit forming luxury.
For the athlete, runner or physically fit individual, back pain symptoms and muscle imbalances go unnoticed until a spasm occurs. This is actually just as common in active individuals (for example runners with tight hip flexors, or weight lifters focusing on too much of the wrong muscle groups) or those sitting or standing for long periods when abdominal core muscles become short and tight overpowering the long and overstretched muscles supporting your spine. A muscle imbalance can set your back up perfectly for a spasm (knife like stabbing pain) with the simple motion of getting out of a car or bending over to reach something.
|Posted by Katrina Koller on February 4, 2012 at 10:15 AM||comments (0)|
I see plenty of clients in my practice who have wasted weeks, months or years getting the wrong treatment and diagnosis for their hand pain or numbness. Many find themselves seeing multiple medical specialists, getting injections and sometimes wasting time undergoing unproductive Physical Therapy Treatment while their pain stays constant or worsens. All too often people diagnosed with Carpal Tunnel Syndrome (CTS) have surgery only to find that their symptoms have not improved or they return a few years after the surgery.
One reason for this is a phenomenon known as "Pseudo-Carpal Tunnel Syndrome." Another is "Double Crush Syndrome." Both are reversible soft tissue imbalances easily treated with myofascial release and a well planned orthopedic structural massage session. What is a soft tissue imbalance? It's when muscles, tendons, ligaments and fascia on one part of the body (or arm or neck in this case) begin to get overworked while another opposing group of muscles gets weakened and unhealthy. This imbalance can put undue pressure on joint structures and nerves ultimately cutting off blood supply to a nerve causeing pain, tingling or numbness. These types of soft tissue imbalances can occur anywhere in the body.
Pseudo-CTS happens when other muscles are tight along the arm, neck, or chest on the same side as the symptomatic wrist. A tight pronator teres, a muscle located near the elbow, can affect the median nerve, causing neurological symptoms in the wrist. So can the scalenes, a muscle group found on the front side of the neck. So can the pectoralis minor, located deep to the pectoralis major in the chest. When tight, any of these muscles can clamp down on the median nerve or the brachial plexus, a nerve bundle that supplies the median nerve. The client or patient may never actually feel pain in these areas, which complicates the diagnosis.
In the case of Double Crush, there may be a minimal impingement to the median nerve at the wrist, but sometimes not enough to create symptoms if only that one structure is involved. But add to this imbalance a tight pectoralis minor, or scalenes, or pronator teres, and that nerve is now crushed at two locations (hence the name "Double Crush"), creating enough impingement on the nerve to now create symptoms in the wrist. Take the pressure off one of these other structures, and the wrist is often no longer symptomatic. And after a course 4-8 Structural Massage sessions, surgery is often not necessary. Some milder cases can be addressed with as few as 3 treatments.
Because medical specialists are trained to focus on the area of complaint, they rarely investigate other non-symptomatic but causative structures, often leading to misdiagnosis and unfortunately, sometimes unnecessary surgery. Few will suggest soft tissue manipulation (massage) and even fewer are connected to well trained therapists that can treat their patients.
|Posted by Katrina Koller on January 23, 2012 at 9:40 PM||comments (1)|
A common topic among my clients is foam rolling. What is it? Should I do it? Will it help? For those of you new to foam rolling, it is a hard peice of styrofoam shaped like a giant rolling pin or cigar designed to allow one to self massage unhealthy tissue (knotted or painful tissue) using the weight of your own body balanced on the foam roller. They cost around $15-30 and can be purchased at any sporting goods, running, Physical Therapy, Relax the Back or larger discount stores.
I often see clients after they have foam rolled themselves into more pain, so perhaps I speak with some bias here but here's what I see: If used sparingly and mindfully for cases of mild muscle tension - foam rolling can be a life saver - especially if you can't always get in to see a good massage therapist when you are in pain. That said, one must consider the root cause and severity before going at it too hard with a foam roller (or a tennis ball for that matter).
Trigger points often form in weakened overstretched tissue (for example in upper back posterior shoulder, where tissue is weak and overstretched due to tight chest and bicep muscles and rounded shoulders) and when trigger points become chronic, they begin to cause fascial adhesions and unhealthy or "stuck" tight tendons near neighboring joints. Foam rolling will address the muscle belly while leaving the surrounding tendons and ligaments near the joint yearning for attention. This can leave your muscles feeling more irritated and painful in the end. The truth is, getting into the nooks and cranies of the joint structures (structural or deep tissue massage) will usually provide the lasting relief you need for moderate to serious muscle tension and trigger points.
Typical scenario: rolling feels great!! Yipee, I'm gonna roll the crap out of this trigger point! Ahhhh. That hurts sooooo goood! (Yes, I've been there!) 10 minutes later, pain returns with a vengeance. Now this is NOT always the case, but if you rely on foam rolling repeatedly rather than addressing the root cause of your pain, you may end up worsening your pain and really feeling desparate.
Here are some good rules to follow when using a Foam Roller:
1) GO SLOW! knotted tissue and trigger points hate to be pushed too fast - they like to be coaxed. You are not tenderizing a steak here...
2) Don't overdo it. Less is more.
3) Be mindful of how you can balance to moderate pressure before you tackle a really sensative trigger point and if you need instruction on foam rolling - click on the video below.
4) If pain persists, don't wait until you grow a huge "farm" of trigger points. Address the pain and get at the root cause. Try ice/heat therapy (click on the blog post here about ice and heat to learn more) and book a session with a skilled massage therapist. One session could end several weeks or months of needless pain and rolling.
One more word about trigger points: many of my clients come to me after getting multiple injections to address trigger point pain. Injections may or may not treat the symptoms, and even your physician will tell you they won't treat the root cause. They will SOMETIMES treat inflammation (a symptom) - when inflammation is the cuase of the pain. More commonly the cause of pain is not inflammation but unhealthy soft tissue (tight muscles, tendons, fascia, and ligaments) which can cause nerve impingement, numbness and severe pain or pressure on your spine and joints.
Click on the link below for foam a foam rolling demonstration on youtube:
|Posted by Katrina Koller on January 21, 2012 at 1:25 PM||comments (0)|
A common question I get from massage clients is "what are these knots (also called "trigger points") and why do I get them?" Here are answers from some experts:
Janet Travell and David Simons are two physicians who, amongst others, have assisted in our understanding and treatment of trigger points. “In the core of the trigger point lies a muscle spindle that is in trouble for some reason. Visualize a spindle like a strand of yarn in a knitted sweater….. a metabolic crisis takes place, which increases the temperature locally in the trigger point, shortens a minute part of the muscle (sarcomere) – like a snag in a sweater – and reduces the supply of oxygen and nutrients into the trigger point". Lack of blood flow and nutrients over time produces pain and tension in the area.
Here are factors that can contribute to or enhance trigger point activity:
1. Nutritional deficiency, especially vitamin C, B-complex and iron;
2. Hormonal imbalances (low thyroid, menopausal or premenstrual situations, for example);
3. Infections (bacteria, viruses or yeast);
4. Allergies (wheat and dairy in particular);
5. Low oxygenation of tissues (aggravated by tension, stress, inactivity, poor respiration).
My own experience in the treatment of trigger points has helped me understand that it can be tricky. Since most trigger points occur in musclesor tissues that are overstretched, weak, overworked or injured, a therapist must use care when applying pressure so as not to further injure the area. Pressure can be productive if used on the right soft tissue structures and without putting the body into further spasm. The area must also be prepared or "primed" for best results. Muslces and other soft tissue structures like to be coaxed with variable pressure but not bullied into submission (that means beating on your body with tennis balls or foam rollers won't likely get you out of pain for more than a few minutes).
|Posted by Katrina Koller on January 20, 2012 at 12:15 AM||comments (0)|
One of the many symptoms we see regularly as therapists is known as "Carpal Tunnel Syndrome". It is pervasive in our modern computer driven data-entry world and is a subset of what is known as RSS or repetitive stress syndrome. This presents as nerve tingling ,pain and weakness in the arm and wrist- and is regularly misdiagnosed. The "problem" is the Median nerve, which leaves the Cervical Vertebrae ,moves through the shoulder and branches to become our nerve in question . The nerve winds through some tight areas ,down through the arm and elbow (where it is routed very close to the surface-giving you the "funny bone" reaction when bumped just right) then into the carpal area of the wrist. True Carpal Tunnel restriction does happen, however- in most cases the problem originates much higher up in the neck and shoulder....
|Posted by Katrina Koller on January 20, 2012 at 12:05 AM||comments (0)|
Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis (Tennis Elbow) in Computer Professionals
Ajimsha MS, Chithra S, Thulasyammal RP.SourceMyofascial Therapy and Research Foundation, Kerala, India; School of Physiotherapy, AIMST University, Kedah, Malaysia.
AbstractAjimsha MS, Chithra S, Thulasyammal RP. Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals.
OBJECTIVE: To investigate whether myofascial release (MFR) reduces the pain and functional disability of lateral epicondylitis (LE) in comparison with a control group receiving sham ultrasound therapy in computer professionals.
DESIGN: Randomized, controlled, single blinded trial.
SETTING: Nonprofit research foundation clinic in Kerala, India.
PARTICIPANTS: Computer professionals (N=68) with LE.
INTERVENTIONS: MFR group or control group. The techniques were administered by certified MFR practitioners and consisted of 12 sessions per client over 4 weeks.
MAIN OUTCOME MEASURE: The Patient-Rated Tennis Elbow Evaluation (PRTEE) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in PRTEE scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization.
RESULTS: The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<.005). Patients in the MFR and control groups reported a 78.7% and 6.8% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 63.1% in the follow-up at week 12 in the MFR group.
CONCLUSIONS: This study provides evidence that MFR is more effective than a control intervention for LE in computer professionals.
|Posted by Katrina Koller on January 13, 2012 at 7:30 PM||comments (0)|
Physical pain that is often chronic goes hand in hand with psychological depression. Often, clients who come for massage for pain relief also suffer from depression. Of course, as massage therapists we do not do psychotherapy. However, depression has major physiological and anatomical components; it is in this area that massage can truly have a significant and profound effect.
Read entire article here: http://www.massagetoday.com/mpacms/mt/article.php?id=13933