At Margie’s Wellness Center, we give the appropriate attention to those of our clients that have the been diagnosed with Fibromyalgia, reinforcing the importance of adding activity to their daily routine, supplements, medications along with their massage. In an article written by Erik Dalton Ph.D. clearly explains what are some of the benefits massage has contributed to those suffering from Fibromyalgia.
Calming Fibromyalgia Pain
As with many chronic diseases, the symptoms of fibromyalgia often wax and wane. Therefore, pain management therapy should be considered as an ongoing process, rather than management of a single episode. Flare-ups often exacerbate the client’s underlying stress. Furthermore, stress can also precipitate flare-ups of fibromyalgia. In my opinion, the first line of defense for relieving basic fibromyalgic symptoms should be body therapy and exercise. Although pain from this condition primarily manifests in specifically designated areas the trained manual therapist must refrain from chasing the pain and instead, seek to restore whole body function by testing for ART: asymmetry; restriction of motion; and tissue texture abnormality.
Tissue texture abnormalities must be closely evaluated in clients presenting with fibromyalgic symptoms. Boggy, leathery, fibrotic, contractured, and spasmodic tissues are potential pain generators, with each requiring a uniquely different hands-on approach. Post isometric relaxation cervical routines such as those demonstrated in the above video seem to be beneficial in recovering lost range of motion to fibrotic spine related tissues such as joint capsules, ligaments, and paravertebral myofascia. Any deep tissue technique that calms central nervous system hyperactivity and lowers sympathetic tone will greatly benefit those with fibromyalgia.
While it is tempting for the client to relax and not move joints and muscles that are hurting, moving them is one of the best preventive and curative measures found so far to alleviate the painful symptoms. Traditional massage techniques are helpful in desensitizing hyperexcited cutaneous (skin and fascial) neuroreceptors. However, deep-tissue techniques that incorporate active client movements (enhancers) during the hands-on work add additional therapeutic power by calming pain generating articular (joint) receptors. Intrinsic muscles and joints are inseparable; what affects one always affects the other. Therefore, a more holistic approach to treating fibromyalgia and myofascial pain syndromes should include soft-tissue techniques that create extensibility in contractured tissues; tonify weak muscles; and decompress impacted, motion-restricted joints and their supporting ligaments.
Exercise … gooood!
Incrementally, the more exercise clients are able to do, the better they will feel. It doesn’t matter what kind of aerobic exercise — swimming, biking, jogging, walking, dancing — as long as they hit their target heart rate for at least 30 minutes a day. Some clients report feeling better as they gradually increase their exercise programs to 30 minutes twice a day.
Why do clients suffering fibromyalgia improve with vigorous exercise? One notion suggested is that aerobic exercise beefs up the body’s supply of endorphins, a natural pain dampening and sleep-deepening substance. Exercise increases levels of serotonin and growth hormones, the exact pain reducing, muscle-repair hormones that people with fibromyalgia may lack. Exercise also increases blood flow to the muscles. It is well documented that people with fibromyalgia do have slightly less blood flow to their muscles, which might also contribute to pain. Exercise and bodywork together are often just the answer for helping reverse this oft-debilitating condition.
As the research rolls in and causality is eventually decided, it is in the client’s best interest to immediately begin routinely scheduled bodywork sessions in conjunction with a specialized exercise regime… regardless of origin. Well structured manual therapy sessions and individualized rehabilitation programs appear to be the treatment of choice for this chronic and sometimes disabling condition that affects an estimated 2 million Americans each year.
In my now almost 13 years of working as a massage therapist I have treated several clients that complained from low back, hip, elbow, knee, and so many more pains and discomforts due to their many years of golf practice.
Treating Golf Injuries by Erik Dalton
In the right hands, the swing of a golf club can inspire awe. It is a complex whole-body movement that generates power to propel a golf ball great distances with extreme accuracy. In professional golfers, highly coordinated sequencing of muscle activation allows for a fluid and reproducible movement. This split-second swinging maneuver requires such precision and uses so many muscles that it’s no wonder the golfer’s body is a ticking time bomb for acute low back injury. Tiger Woods recent injury is indicative of this common problem.
When professional golfers take the club head back, they turn their shoulders away from the target while keeping the pelvis relatively stationary. This motion creates torque, which leads to increased power. Then, throughout the downswing and follow-through, the pros’ hips lead the way. Amateurs, on the other hand, rotate their shoulders and hips almost in unison. “A golfer like Tiger Woods has very little hip rotation and a lot of upper torso rotation,” says Conrad Ray, head golf coach at Stanford University. “That’s how he’s able to create speed and distance.” (Fig.1) However, many professional coaches downplay the role of the hips in big-time swingers like Tiger Woods. Many believe the spinal rotator muscles are the primary factors in producing the type of power Tiger displays. No doubt, spinal rotation and core stability are very important features in golf swing execution, and vital to the prevention of overuse injuries. Yet, it’s difficult to envision how the body can produce enough spinal rotation to drive a ball 425 yards, as Tiger Woods did at the 2008 Mercedes PGA Championship.
How is such power possible? As functional training guru Gray Cook says,“Think movement – not muscles!” Tiger has developed a sophisticated whole-body musculofascial maneuver that allows him to drive a ball with surprising velocity. By viewing slow-motion You Tube videos, it appears that Tiger’s fast-twitch global muscles and elastic fascia work together to propel energy up the kinetic chain, while his slow-twitch deep spinal rotators act as stabilizers to store and release the energy.
The secret to Tiger’s power lies in his highly refined musculofascial spring systems. To demonstrate how golf swing efficiency relies on these spring systems, we’ll borrow three slightly modified force transmission systems, first described by Andry Vleeming, Ph.D. – the stirrup spring system (SSS), posterior spring system (PSS), and anterior spring system (ASS).
During the backswing, right-handed golfers like Tiger lift the clubhead as far back as possible while maintaining weight on the right foot’s medial arch. As the arch flattens, the tibia internally rotates, which serves to help tighten the SSS (Fig. 2). At the top of the backswing, muscles of the left ASS and left PSS eccentrically contract to slow the clubhead, and with help from fully tensed fascia, these muscles are pre-loaded and storing potential energy in preparation for the downswing (Figs. 3A and 3B).
As the two diagonal fascial springs reach their elastic barrier, the golfer’s deep spinal rotator muscles, spinal ligaments, and facet joints are also fully coiled. With the lumbar spine side-bent left and rotated right, energy is lightly, but securely, stored deep in the spinal engine and ready for release.
To initiate the downswing, instead of moving the body down to the ball, the golfer moves the hips forward toward the target. As weight shifts from right foot to left, the coiled lower body begins to unwind. The forward thrust of the left rotating pelvis produces an effortless and impressive release of stored potential energy. With the help of the deep spinal rotators, the golfer’s spinal engine continues to unwind, causing the shoulders, arms, and hands to powerfully drive the clubhead through the ball and then eccentrically contract to stop the swing’s momentum (Fig. 4).To prevent injury, golfers must possess a learned sequencing ability that allows them to contract and relax muscles fluidly and flawlessly. However, it is rare for humans to move one muscle at a time along a single plane. Modern science reveals the brain does not recognize individual muscle activities due to lack of practical purpose. Instead, the cerebral cortex maps movement patterns and coordinates the neuromyofascial net to meet the specific activity.
Ischemic Nerve Damage
The length of time nerve tissue can survive oxygen deprivation varies, but eventually, all ischemic tissue becomes necrotic. Fortunately, restoration of blood supply usually minimizes the damage, but not always. Notice in Figure I, how the application of an arm tourniquet not only compresses large arteries and surface veins, but also small capillary beds surrounding the radial nerve. In some cases of thoracic outlet syndrome (TOS), similar nerve trunk compression can lead to oxygen deprivation, loss of nerve nutrition and vague dull, diffuse ache in the shoulder, arm and hand. Postural abnormalities, especially the rounding forward of the shoulders, decrease the costoclavicular space, which can cause compression of the brachial plexus and blood vessels (Fig 2).
Prolonged scalene spasm from injury or overuse can also cause problems as they tug on the first rib pulling it up against a ‘drooping’ clavicle. When the brachial plexus gets squashed between the clavicle and rib, a condition known as costoclavicular syndrome arises. This disorder is thought to be one of the leading causes of TOS. Repetitive stress of local soft tissue from overuse, results in collagenous remodeling, inflammation, and nerve enlargement. Changes in shape of the nerve bundle may promote greater entrapment and a pain-spasm-pain cycle.
Provocation tests such as the Adson maneuver (scalenes), ‘Hands-up’ (pec minor), Allen (radial pulse) and the Elevation maneuver for costoclavicular canal impingement may be useful in identifying the pain-producing site. These assessments may or may not reproduce symptoms, but are sometimes helpful in ruling out other causes, which may produce similar symptoms. Due to the overlapping of symptoms, it’s often difficult to make a definitive assessment using provocation tests. If in doubt, start treating proximally (neck & upper ribs) and release all possible impingement sites through the arms and hands.
Commonly seen muscle imbalance patterns such as Vladimir Janda’s upper crossed syndrome (Fig. 3) play a major role in the formation of entrapment neuropathies. As tight pectoral muscles roll the shoulder girdle forward on the ribcage, the clavicles drop onto the first thoracic rib causing brachial plexus compression. Anterior displacement of the humeral head (tight pecs and lats) is also an area of impingement associated with upper crossed patterns. Fortunately, many illusive TOS cases are easily corrected using manual therapy techniques such as those shown in the video below.
Include home-retraining exercises such as the the “Wall Angel” (Fig. 4) to help open the chest wall and strengthen the scapular stabilizers.
This is an excellent Upper Crossed test and retraining exercise to evaluate mobility and flexibility in the chest, shoulders, lats and upper back muscles.
TEST: Place your client in a position to have three points of contact against the wall: top of glutes, thoracic (upper back) and back of the head. Test to see if client can keep the forearms from the elbow to the back of the hand against the wall while maintaining wall contact. Arms at 90/90, contract core abdomen to keep ribcage against wall and allow arms to rise staying against wall.
TRAIN: Have the client slowly move the arms together against the wall. When the elbows won’t extend any further, ask them to bring the arms down towards the ribcage, trying to squeeze the shoulder blades in and down at the same time.
We wanted to share an article of how scars affect the function of organs and how massage can restore tissues flexibility.
Scar Remodeling, Adhesions, and Nerve Pain
Restoring Function to Inflexible Tissues
By Erik Dalton, Ph.D.
Scar tissue is nature’s response to tissue damage (Image 1). This fibrous material of human healing is composed of the same protein (collagen) as the tissue it replaces, but lacks the ultraviolet absorption, circulation, and flexibility of the original tissue. Instead of the random basket-weave design found in normal tissue, scarred collagen forms a mangled alignment of crosslinks that bind themselves in a single direction.1
Nerves live for motion and relish the ability to slide and glide. If a nerve runs through impaired muscle, fascia, or visceral tissue, the entwined nerve can be pinched or pulled by the fibrous scar, causing pain signals to be sent. For example, scars sometimes grow long, tentacle-like strands called adhesions. It’s not uncommon for the adhesions from a Cesarean-section scar to entrap nearby hypogastric and pudendal nerves feeding the bladder and urethra (Image 2). This, in turn, may cause referred nerve pain that mimics, and is often treated as, cystitis. Consequently, when a woman’s fingers press firmly on a C-section scar, she may experience urethral burning, urgency, or frequency. That’s why it’s important to remember that pain caused by a scar may be referred far from where the scar is located. Moral of the story: don’t chase the pain.
In workshops, I find it helpful to use a paintbrush as an example of scar tissue crosslinking. The brush starts out as a soft, supple, parallel group of bristles that can bend easily in many directions. If the brush is cleaned and stored appropriately after use, it stays soft and can be effectively used for a future project. But, if the paint-covered bristles dry, they bind to one another and the brush loses flexibility and function. At this point, more care is required to rehabilitate the brush and get it back to work—which is why I encourage clients to have a scar-tissue injury assessed promptly, so effective treatment can begin.
At the third International Fascial Research Congress in Vancouver, Canada, Raul Rodríguez, PT, DO, presented a fascinating clinical video of himself treating a bullfighter who had suffered a nasty scar when he was gored through the thigh. The audience of 800 gasped as they watched layers of fibrous, crosslinked connective tissue give way for the first time, as Rodríguez’s trained hands manipulated the adhesive layers, allowing them to once again glide on one another.
Through real-time sonoelastography imaging, Rodríguez was able to visually demonstrate the process of manual scar remodeling and how it can be effectively used to guide massage and bodywork treatments. Although many clinicians in the audience were well acquainted with the palpatory sensation of restoring local elasticity to injured and sometimes painful tissue, witnessing the process in action was spellbinding. According to a 2013 study conducted by Rodríguez and Galán del Río, fascia is the “skeleton of muscle fibers organized as a network and may be responsible for the pathophysiology and healing process of all muscular injuries.”2
But injury is not the only cause of scar tissue. In clinical practice, we commonly palpate fibrous connective tissues associated with plantar fasciitis, tennis elbow, and rotator cuff pain. When scar tissue arises near a nerve root, it is referred to as epidural fibrosis (Image 3). This is a frequent occurrence in those experiencing failed back surgeries.
Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together. When the scar extends from one tissue to another, usually across a virtual space such as the peritoneal cavity, the body deposits fibrin onto the injured tissues. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion. At the sites where abdominal adhesions occur, scar-tissue tentacles sometimes grab a piece of the small intestine. As internal pressure causes the intestine to twist and tangle on itself, peristaltic action is stalled and the putrefaction process begins.
Adhesions require treatment because the body has no mechanism for mobilizing these strands of scar tissue naturally. Although the body can sometimes adapt and tolerate a certain amount of adhesive scar tissue, it will fail to function optimally, predisposing itself to repeated injury. There are many types and styles of manual therapy for the treatment of adhesions. Clearly, the sooner therapy begins, the more effective it will be. Semifresh scars respond more quickly to treatment, but hope still exists for old injuries, too, as seen in Rodríguez’s brilliant sonoelastography demonstration.
The goal is to restore function to inflexible tissues and normalize cellular and organ metabolism. Much like the stretching and torsional maneuvers used by Rodríguez on the injured bullfighter, hands-on modalities using varying degrees of pressure and depth may also help soften and functionalize tough, fibrous connective tissues resulting from an abdominal scar.
In Images 4 and 5, fingers and thumbs search for underlying adhesions and slowly work to free entrapped nerves responsible for referred pelvic pain patterns. To speed recovery, teach your clients how to perform these simple techniques at home.
- 1. Jonathan A. Sherratt, “Mathematical Modeling of Scar Tissue Formation,” Department of Mathematics, Heriot-Watt University (2010).
- 2. Raúl Martínez Rodríguez and Fernando Galán del Río, “Mechanistic Basis of Manual Therapy in Myofascial Injuries. Sonoelastographic Evolution Control,” Journal of Bodywork and Movement Therapies 17, no. 2 (2013): 221–34.
Investigators recently set out to measure the therapeutic effects of a manual therapy protocol on improving pain, pressure pain thresholds, quality of sleep, function and depressive symptoms in both men and women and men with fibromyalgia syndrome.
Eighty-nine patients were randomly assigned to experimental or control group, according to an abstract published on www.pubmed.gov. The experimental group (24 female, 21 male) received 5 sessions of manual therapy and the control group (24 female, 21 male) did not receive any intervention.
Pressure pain thresholds (PPT), pain, impact of FMS symptoms, quality of sleep and depressive symptoms were assessed in both groups at baseline and after 48-hours of the last intervention in the experimental group, according to the abstract.
Among the results:
• Manual therapy protocol was effective for improving pain intensity, widespread pressure pain sensitivity, impact of
FMS symptoms, sleep quality and depressive symptoms.
• Gender differences were observed in response to treatment: women and men get similar improvements in quality of sleep and tender point count, whereas women showed a greater reduction in pain and impact of FMS symptoms than men, but men reported higher decreases in depressive symptoms and pressure hypersensitivity than women.
The research was published in the Clinical Journal of Pain and was conducted by investigators with the Department of Nursing, Physical Therapy and Medicine, Universidad de Almeria, Spain †Department of Physical Therapy, Universidad de Granada, Spain ‡Servicio Andaluz de Salud. Family Medicine Specialist. Granada. Spain Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain, and Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain.
Article by: Massage Magazine
by Erik Dalton, Ph.D. Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. When we eat, food travels down the esophagus passing though a small opening (hiatus) in the diaphragm, before entering … Continue reading
Grand Re-Opening of wellness center to benefit and improve the health ofDavie’s Community
The press is invited to attend the grand re-opening of Margie’s WellnessCenterto take advantage of the offers on Therapeutic treatments or facials! The grand re-opening will be at our new location at5400 S University Drive, Suite 110inDavieon November 9th from 12:30pm to 3:30pm. The event will feature the benefits, the products and testimonials of each treatment the center has provided to our community. You will also have the opportunity to meet other professionals that make up the concept our wellness center is based on.
For the list of all our services please visit our website at www.margiesmassage.com. For more information or to RSVP by November 7, 2013 please call (954)665-0424 or email email@example.com.
Margie’sWellnessCenterwas established back in 2001, earning the 2013 Best of Hollywood, Massage Therapist Award. After seven successful years of business in the city ofHollywood, Maryuri Velazquez was presented with the opportunity of expand and move her current practice to the city ofDavie. Maryuri Velazquez brings with her more than 12 years of experience in the bodywork and therapeutic treatment. In those “Good Works Prepared”, Margie’sWellnessCenteris thriving and looking forward to another successful endeavor in this prosperous and hard working community.
Massage Therapy Helps Keep Dancers on Their Toes
They can glide with ease across a dance floor or perform amazing acrobatics. With years of practice behind them, endless hours of exercise and rehearsals, dancers make the difficult seem easy. Just like professional athletes, all that hard work also means having to keep in tiptop shape. Additionally, it means injuries are part of the job. Learn how dancers can maintain and even prolong their professional careers through the use of massage therapy.
By Linda Fehrs LMT
Whether it is television’s “Dancing with the Stars,” professionally produced stage shows such as “Riverdance” or “Cirque de Soleil,” or live performances of classical ballet, we have come to see professional dancers as the athletes that they really are.
Often starting when they are very young in local competitions, the stars we see on stage or the dance floor already have years of lessons, training and rehearsals behind them. With all that work the body gets a daily workout which cannot only strengthen muscles but strain them as well, leaving the dancer with aches, pains and injuries that can adversely affect the next performance.
Dancers as Clients
Having seen how helpful massage can be, many dance companies now employ a full-time massage therapist. In some cases one or more of the dancers has attended massage school and is certified in massage; in other cases it is a physical therapist or physiotherapist who is also trained in massage. Some dance troupes may hire a massage therapist as needed, or have a massage therapist on call as an independent contractor.
Some massage therapists, while not associated solely with a particular company, may opt to specialize or focus their practice on dancers. This could include not only the highly trained professionals, but also amateur competitors – those who just love to dance on weekends or even individuals just starting out with dance lessons.
Common Dance Injuries
Dance injuries are similar to what would be considered sport injuries. Just as athletes, they run, jump and endure long periods of high energy activity. For those few minutes of actually performing on stage, they may have rehearsed or exercised for six to eight hours a day, or even more, several days a week. In addition to the physical movement part of the profession, in some cases, like Broadway shows, the dancers may have to wear heavy costumes or other gear both in dress rehearsals and actual performances. This means extra stress on joints, ligaments and muscles not only in the arms and legs – yet also in the neck and back muscles, too.
Perhaps the most common injuries are to the legs and back. With dance, whether bouncing up and down as in a Jive, Quickstep or Lindy-hop, or sliding across the floor in a Waltz, the legs and feet are constantly in motion, constantly enduring stress. The back often gets a workout with Latin dances such as Salsa, Rumba and Paso Doblè with all the hip shakes, twists and turns of both the upper and lower torso. Neck injuries, similar to whiplash, can occur with the fast snapping of the head as well as some of the lifts and jumps where one partner may jump over or slide under the other.
Less common are arm injuries or injuries to the face and head, simply because they do not receive the impact other body parts get exposed to. Arm injuries may occur in partner dancing when one partner flips or twists the other and the hold somehow gets stuck, while the partner moves on still holding tight. One partner lifting the other can also cause strains and stress on muscles in the arms, back and legs.
Helpful Massage Techniques
To help in the prevention of injury, dancers may do specific exercises and stretches, such as those offered in Pilates, a regimen designed to strengthen the body’s core muscles as well as maintain flexibility and develop good coordination. Yoga is also a good choice for being able to keep focused and limber. A good overall massage, used for relaxation and keeping the body in good health, would be Swedish massage. Dancing, as lovely as it looks, can be very stressful for professionals and amateur competitors. It must be cautioned, though, a relaxing massage should never be received the day of a performance as it can affect the dancer’s balance and coordination adversely. The very nature of a relaxing massage and its engagement of the parasympathetic nervous system is paradoxical to the needs of a dancer who has to be ready to move quickly and with precision.
Modalities such as The Feldenkrais Method help to reconnect the body to its natural movements, connecting the thoughts of the mind to the motion of the body. The Alexander Technique helps to re-educate and retrain the body away from harmful movement patterns and release unnecessary tension in the muscles.
What can be helpful on an almost daily basis are massage techniques learned from Sports Massage. Over the years the development of Sports Massage techniques have been proven to help keep muscles toned as well as speed up the healing process, so the athlete may return to playing as quickly as possible. Shorter massages, such as simply massaging the calf muscles may be helpful in limbering up before a dance practice session or removing toxin buildup after a performance.
Dancers and other performers should routinely be examined for hidden, yet painful, injuries that may indicate precautions for massage therapists such as shin splints, hairline fractures, broken ribs or severe muscle tears. Any neck injury should be thoroughly checked out by a physician before attempting any massage work. With most sprains, strains and painful injuries, it is usually better to wait a day or two – sometimes more – before massaging the area. When in doubt, get clearance from a doctor.
One of the requirements for a good and dedicated dancer is the need for intensive workouts, practicing routines and basic moves as well as maintaining a hectic schedule of performances. Days not dancing means the body can quickly lose tone, strength, flexibility and stamina. Massage therapy can be part of an overall program used to keep a dancer on her (or his) toes.
Alfaro, N. (2007, Dec). Health & Fitness. Retrieved from www.dancemagazine.com/issues/December-2007/Health-Fitness
Dance Informa Staff. (2011, April). Massage for Dancers. Dance Informa Magazine, DOI: www.danceinforma.com/magazine/2011/04/massage-for-dancers/
Field, T. PhD, Leivadi, S. PhD & Hernandez-Reif, M. Ph D., et al, (1999). 108 Massage Therapy and Relaxation Effects on University Dance Students. Journal of Dance Medicine & Science, 3(3), DOI: www.iadms.org
Petronio, S. (2011, Feb). Injury as Opportunity. Retrieved from www.dancemagazine.com/issues/February-2011/Injury-as-Opportunity
Stanyer, L. (2011, July 22). Importance of Massage for Dancers. Retrieved from www.laurastanyer.blogspot.com/2011/07/importance-of-massage-for-dancers.html
Sydney Essential Health Staff. (2010). Dance & Performance Massage. Retrieved from www.sydneyessentialhealth.com.au/Modalities/Mod_Dance_Performance_Massage.html
Wozny, N. (2010, May). Your Body: Magic Touch. Retrieved from www.dancemagazine.com/issues/May-2010/Your-Body-Magic-Touch