My most effective sessions treating clients presenting with stubborn problems like frozen shoulder, plantarfasciitis, or carpal tunnel, for example, include modalities, focusing on  structural evaluation and clinical massage & bodywork, relaxing, softening and lengthening muscles to balance the relevant soft tissue around a joint, and pertinent corrective muscle stretching and strengthening techniques to maintain the muscle balance and  joint alignment for pain free status, usually resulting in pain relief and increased range of motion, .

The power of touch is also a major ingredient of this holistic treatment. Massage therapists are individuals and most of our work tends to be eclectic—not cast from a single mold. Even therapists, who have been trained identically, add their own intuitive style and personality to their craft, imparting an effective personalized hands-on signature for a positive outcome. At the University of Miami’s Touch Research Institute,Tiffany Field, PhD, says,  The healing power of touch extends across the life span, from helping babies grow and children concentrate at school to decreasing chronic illness and disease. Therapeutic massage & bodywork can be much more than an indulgence.The most mysterious and powerful of all human interactions—touch.  Dr. Ken Dychtwald

Clients are generally unaware of the power of intention, and how much it can influence  their treatment—positively or negatively. When a person believes that they can improve their condition, chance of recovery is tenfold, as compared with one who has been so conditioned to their pain and body dysfunction that they don’t believe it’s possible to get better. Belief that your body is in the process of healing, and that you don’t have to live with your pain any longer, is a powerful ingredient for healing that you bring to the table. You are most likely a part of the 97% majority of chronic pain sufferers whose primary problem is soft tissue dysfunction that can be resolved if you believe it can, seek professional help, and are motivated to follow through with home self-care. In fact, your belief and motivation is more important than any type of treatment you receive. Scientific research by Candice Pert, PhD, Molecules of Emotion, has proved that our thoughts can actually change pain.

Not only is the human nervous system capable of becoming aware of the information and energy of its own quantum field, but because human consciousness is infinitely flexible through this wonderful nervous system, you are able to consciously change the informational content that gives rise to your physical body. You can consciously change the energy and informational content of your own quantum mechanical body, and therefore influence the energy and informational content of your extended body—your environment, your world, and cause things to manifest in it.   Deepak Chopra, The Seven Spiritual Laws of Success

Occasionally a client will being in their physician’s diagnosis and x-rays, asking for my opinion, not being aware that diagnosis or medical opinions are way beyond my scope of practice as a therapeutic bodyworker. Their lengthy esoteric medical diagnosis for low back pain, for example, that could have just as well been written in a foreign language, dashes hopes for many clients of ever living a symptom free life again, making it difficult for them to believe that relief could possibly be achieved simply by treating several crucial muscles contributing to the pain, or simply by resolving muscular imbalance in the pelvis, and on either side of the spine.

Oftentimes a simple approach to a seemingly difficult problem is the best solution. It’s possible a session or two by a structurally trained massage therapist/bodyworker can effectively resolve a stubborn problem, and profoundly affect the quality of life of a person who has been conditioned for years to accept their painful existence. However, some of them discount a simple soft tissue approach because they don’t believe it could possibly produce a positive outcome for their condition, which they think is special and unique, and much too complicated for a simple approach.  Unfortunately too many decide to live with their status quo.

When a client presents with knee pain from a recent injury (acute condition) exhibiting inflammation, heat, redness, or swelling, or a hypermobile knee due to excess ligament laxity, I refer them to their physician for further evaluation.  After taking a client intake history and doing a complete assessment on those who qualify for my treatment, which is a structural approach to pain management, I always begin treating knee problems by stabilizing the pelvis because many muscle groups that originate in the pelvic area affect the knee. Imbalances in the hips due to tight muscles can create additional joint tension and rotational forces of the femur and tibia, which can result in degeneration of the knee joint structures.

Further evaluation determines if the knee problem is due to myofascial restriction, muscle-tendon tension, trigger point tension, strained fibers, scar tissue or damage to structures in the joint such as the ligaments or meniscus. The treatment focuses on the contracted structures that limit pain-free movement and create tension and imbalance in the knee. Meniscus damage can also be determined with a simple compression test; a distraction test would more likely indicate the medial or lateral collateral ligaments rather than the medial or lateral meniscus.

James Waslaski, Integrated Manual Therapist, teaches orthopedic clinical massage internationally to massage therapists, athletic trainers, physical therapists, osteopaths, chiropractors,  physicians, occupational therapists, nurses. He claims that compression, accompanied with abnormal knee rotation, is responsible for a majority of clinical symptoms of the knee. In many cases when rotational patterns of the knee, like a laterally rotated foot, are corrected, the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) are brought into their resting positions, pain in those structures will disappear.

Evaluating painless active range of motion of the knee joint will determine which muscle groups are restricted and therefore preventing normal movement. Pertinent muscles are lengthened and strengthened to achieve joint balance. Medial and lateral rotators of the knee are also assessed and treated to eliminate abnormal stress of the knee.

 Patellar tendinosis (tearing of tendon fibers) is usually caused by overuse of the quadriceps, placing an excessive amount of upward pressure on the patella, which stretches and irritates the patellar ligament. The common cause of patellar ligament injury is muscle imbalance between the quadriceps and hamstrings.

Condromalacia is described as degeneration of cartilage on the underside of the patella, resulting in pain and a grating sensation.  Having an imbalance between a strong lateral and a weaker medial quadriceps muscles can also exacerbate this condition and lead to lateral tracking of the knee and chondromalacia. Torn muscles or tendons are treated last, after opposing muscle groups have been balanced.

Client self-care is essential for maintaining the new normal range of motion created during therapy. Clients must learn the stretching and strengthening techniques specific to their condition and perform them at home to keep the muscle groups balanced.

The above information is from James Waslaski’s Clinical Massage Therapy – A Structural Approach to Pain Management.

Combining Building Strength & Balance

Stretching Quadriceps and Developing Balance

Strengthening the Core

One day we look in the mirror and notice our gray hair, wrinkled skin, some flabbiness around the torso.  Our energy level has dropped, we aren’t able to bounce back from injury as quickly, and we no longer have as much resistance to sickness. For most of us, these are signs of old age, a gradual decline that doesn’t stem from our chronological age, but is instead the combined effects of inactivity and poor nutrition. The good news: Improved eating habits and regular exercise can help lower our biological age.

 Benefits: Reduced body fat, increased muscle mass, increased aerobic capacity, reduced risk of heart disease, diabetes, osteoporosis, and other age-related ailments.

 William J. Evans, PhD, former adviser to NASA and head of its nutrition, physical fitness and rapid rehabilitation team, now adjunct professor of geriatrics, Duke University Medical Center, Durham, NC, says our goal should be not to become immortal, but to remain healthy and vigorous for as long as possible, and to forget how many birthdays we’ve had, but instead consider how we stack up in terms of the ten key bio-markers he identified in his lab:

 1.   Muscle mass:  We lose almost seven pounds of lean body mass each decade, and it accelerates after age 45, leading to increased risk of heart disease and diabetes, reduced aerobic capacity and slower metabolism. The good news: Those who remain active lose little muscle tissue as they age.

 2.   Strength: Between ages 20-70, the average American loses about 30% of his/her muscle cells, and can lead to sarcopenia—a severe, debilitating weakness that makes independent living impossible. The good news: A weight-lifting regimen will compensate by boosting the size and strength of the cells that remain.

 3.   Metabolic rate: The average person’s metabolic rate drops about 2% per decade. Thus, the average 70 year-old needs 500 fewer calories a day than the average 25 year old. The good news: Eat fewer calories and get enough exercise to maintain your muscle mass

 4.   Body-fat percentage: The ratio of fat to lean tissue in our bodies can rise markedly over the years. Excessive fat leads to chronic disease and premature death. Excessive weight around the waist is far more unhealthy than fat on the buttocks or thighs. The good news: restrict calories and exercise to improve your body fat ratio.

 5.   Aerobic capacity: Our ability to process oxygen during exercise is an indicator of our fitness, and like other bio-markers often declines with age. Typically by age 65 it is 30-40% below our young adult level. The good news: Doing regular aerobic exercise—the kind that causes some heavy breathing, will raise our aerobic capacity no matter what our present age.

 6.   Blood-sugar tolerance: Our ability to metabolize blood sugar declines with age. At age seventy, 20% of men and 30% of women are at an increased risk of diabetes, a potential killer. The good news: A low-fat, high fiber diet that restricts total calories combined with regular exercise will cut our diabetes risk.

 7.   Cholesterol ratio: An unhealthy ratio boosts our risk of heart disease. The ratio of total cholesterol to HDL (good) cholesterol is very important. For seniors the ideal ratio is 4.5 or lower, for example, cholesterol of 200 and a HDL of 50 or 200/50 = 4.0 is good. The good news: Stop smoking, lose weight, decrease intake of fatty foods, especially animal products, and exercise regularly to boost HDL levels.

 8.   Blood pressure: Rises with age especially in the USA where seniors tend to be both overweight and sedentary. The good news: Get the right numbers for you from your doctor, monitor your own blood pressure regularly, stay slim, don’t smoke, and get regular exercise to maintain healthy blood pressure.

 9.   Bone Density: Our skeletons get weaker and more brittle with age. The good news: Weight-bearing exercise, such as walking, running or aerobics that stress the long bones of the body will help keep bones healthy.

 10.  Temperature regulation: Our ability to control our internal body temperature declines as we get older due to a reduction in our ability both to shiver, which raises body temperature, and to sweat, which lowers it. This means that cold and hot weather pose a danger to elderly people. The good news: Regular aerobic exercise increases your blood volume, and drinking lots of water will make it less likely for us to overheat or dehydrate in hot weather.

 In addition to adding exercise to slow down the aging process, as indicated in each of Dr Evan’s ten bio-markers, he also suggest five additional everyday tips to add to our daily regime: practice stretching each morning, stand up straight, exercise at least 15 minutes a day, eat more fruits and vegetables, and reduce stress.

One of the benefits of a massage & bodywork session is that we are automatically transported into the relaxation response (RR), or parasympathetic branch of our autonomic nervous system, that is a protective mechanism against stress, brings about lower heart rate, metabolism, respiratory rate, and slower brain waves. Regular clients have described this feeling as blissful—happy, joyful, satisfied and with a general sensation of well-being.

The fight-or-flight response, is the sympathetic branch and opposite of the RR, where our minds and bodies make dramatic adjustments for what they believe is an ensuing emergency. Our blood pressure, breathing rate, muscle tension, metabolism, and brain waves all speed-up. Blood flow to the muscles of our arms and legs increase on an average of 300-400%. These are only a few of the many physiological changes that take place automatically when we are threatened.

Henry Benson, MD, a pioneer in mind/body medicine, is a Mind/Body Medical Institute Associate Professor of Medicine at Harvard Medical School and director emeritus of the Benson-Henry Institute.  More than four million copies of his eleven books have been printed in many languages.

His book, The Relaxation Response, was the best-seller and number one self-help book in 1986 that clinical psychologists recommended to their patients. Benson developed the Relaxation Response, a process which activates the parasympathetic nervous system, causing humans to relax. The Benson-Henry Institute at Massachusetts General Hospital teaches how to elicit the RR.  His book and website describe two essential steps—a simple word, phrase or activity repeated to keep the mind from wandering, and a passive attitude.

I recently tried his method of activating the RR to quiet my mind and fall asleep after awaking at 3:00 am, and it really worked well. Since then I have been using it regularly, not only for sleeping, but to quell my reaction to stressful situations. Invoking the RR immediately adjourns the board meeting chatter that is taking place in my head, and turns off the constant stream of thinking.

The simple drill for generating the RR is repeating a word or phrase, something that conforms to your own personality and beliefs. If you are a religious person, you can choose a prayer; if you are nonreligious, choose a secular focus. The Relaxation Response is evoked by repeating the word or phrase during slowly inhaling and exhaling. If an occasional interrupting thought tries to interfere, and it will, we consciously disregard it, and return to the focus.

Don’t believe what I say or disregard it until you have tried it for yourself. You have nothing to lose but, what the Buddhists call papanca, meaning monkey mind–our churning mental chaos, and you have much to gain if you try it—falling  asleep and becoming more serene in spite of what might be happening all around you.

The energy that is withdrawn from the mind turns into presence.      The Power of Now, Eckhart Tolle