Friday, December 23, 2011

Trigger Points & Performance


If you have talked therapeutic massage with me, then there’s a pretty good chance you’ve heard me mention trigger points.  Why?  Because I have a love/hate relationship with them.  I HATE the things they can do to me and my muscles, but I LOVE how big of a difference it can make to have just one released.  By definition, a myofascial trigger point is a hyper-sensitive spot in a taut band of tissue.  The tissue in question is either muscles (hence “myo-“) or connective tissue called fascia (hence “fascial”).  The other vitally important attribute of trigger points are their “referral zones.”  A trigger point doesn’t necessarily hurt where it is.  A trigger point in the calf can cause pain further down the leg, in and around the Achilles tendon and the heel.  Usually the referral zones are in some sort of logical line of movement/musculature, but not always.  Referral zones are always consistent.  With little variance, they tend to form in the same places in a given muscles and have the same referral zones, from person to person.  So much so that there are charts, and even smartphone apps to help you locate and cross-reference them with their referral zones.

If the trigger point is “active,” then the pain in the referral zone is present, even when the trigger point isn’t being actively aggravated by touch, contraction or stretch.  A trigger point is known as “latent” if it only causes referral pain upon palpation or other aggravation (such as contracting the muscle it resides in).  If a trigger point is cause referral pain that is bad enough, then it can also wind up causing a satellite trigger point, which lives within the first trigger point’s referral zone.  How “meta.”   I think that pretty well covers trigger points, so how about performance? 

Well…pain can inhibit performance.  But you already knew that, right?  So, the trick is that because trigger points have entire referral zones, the pain they cause can be indistinct in terms of “where” it hurts.  Then you don’t know what to stretch or ice or do self-massage on, and even if you target the whole area, you can miss the trigger point.  Then the pain continues to worsen as the trigger point gets more entrenched and nobody is having a good time except Mr. Grinch Trigger Point.  By extension of this, when you engage the muscle that the trigger point is in, you can aggravate it, and increase the referral pain, even just momentarily.  But even beyond the pain, if the trigger point is holding on, then it means that the taut band of muscle fiber it’s connected to isn’t being allowed to release, either.  Often, the release of a trigger point will ease the release of the rest of the muscles around it.  This is partly because the trigger point is constantly trying to recruit the muscle fibers surrounding it to join in on the excessive contraction it’s engaged in.  Troublemaker. If the trigger point is allowed to continue to do this, then it’s holding the muscle in a state of contraction, and not allowing the muscle its full range of motion or maximum strength through some or any of that range of motion.  This is the most direct impact of the trigger point on performance, and it can happen even with a latent trigger point.

So, trigger points equal a general, and possibly extreme, pain that’s tough to pinpoint and self-treat, plus inhibited muscle fiber performance.  The good news is that we have treatment protocols for them, and this is where my LOVE of trigger points comes in.  By releasing a single trigger point, a coworker of mine dispatched my migraine last week!  A SINGLE trigger point.  Migraine headache (that I’d been fending off for 2 weeks, I might add).  What I love about this is the enormously profound and immediate relief of releasing an active trigger point.  It’s such a powerful thing.  But it’s definitely work – for both the therapist and the client.  When you’re using that foam roller in the gym and you roll over a part of a muscle that’s really painful, there’s a decent chance that’s a trigger point – particularly if it’s always there, every day.  Try to hang out in that spot on the roller for a while and don’t forget to BREATHE through it.  After a few full breaths, it’s likely that it will begin to release and the intensity will subside for you.  Congratulations, you’re self-treating a trigger point, and this is MUCH easier said than done.  I could not have worked through my migraine trigger point on my own.  No way.  Too painful  So I’m really glad I had a massage therapist to help me out.

Friday, December 9, 2011

Massage & Soft Tissue Injury



I think it’s probably safe to assume that we’ve all had a soft tissue (muscle or tendon, for the sake of this blog) injury at some point, to some degree or another (hopefully it’s a lesser degree for most of us).  We’ve probably all heard the acronym R.I.C.E., at some point, too.  For those who haven’t heard this before (or who have forgotten), R.I.C.E. stands for Rest, Ice, Compression & Elevation.  In some way, or another, each of these things aides the body in reducing inflammation and circulating waste out of the injury area, while most efficiently delivering nutrients to the site for repair of the damaged tissues.  But let’s not put the cart before the horse, just yet.  There is a purpose for the inflammation that happens, as well.  The inflammation will help to somewhat stabilize the injured area, and it does indicate an initial rush of additional blood and nutrients to the area, to get it started.  So, if you can’t rest your injured bits right away, it may be best the let the inflammation hang out, a little.  “Rest” comes before “Ice” in that acronym, after all.

Sunday, November 27, 2011

New blog subscription options & gift ideas.


I have changed my RSS subscription feed, and it now supports subscribing via email, so all new blog entries can be delivered to your inbox! Click one of the links to the right to subscribe to the feed with your favorite reader, or by email.

When shopping for your friends and family this year, remember that I have gift certificates, and massage punch cards for sale.

Gift Certficates are available in any dollar amount and can be redeemed for massage service, like cash.

Punch cards are prepaid massage services, bought at a discount.  They are available in 2 or 5-hour, and able to be redeemed in multiples of 30-minutes.  2-Hour Punch cards are $109 and 5-Hour Punch cards are $249.  I can support sales via phone and email, if you would prefer.  I can be reached at eric@squaremassage.com or at 404-425-9593.

Happy Holidays!

Thursday, November 24, 2011

Happy Thanksgiving...now go run! (and then stretch)


I’m typing this blog entry the day before Thanksgiving, and I’ll be running the Gobble Jog 5K with my Crossfit on the Square friends tomorrow.  I’m dreading it. Well, I’m dreading how my calves are going to feel, I should say.  They are already hurting me, so getting them loosened up is going to be a challenge, but getting them to recover without hobbling me will probably prove to be the real challenge.  My calves have a tendency to cramp up, and develop taut bands.  It’s a chronic, and constant struggle for me, and I thought that with a couple runs around the Atlanta area tomorrow, there must be more runs elsewhere, too.  With all that running, I’m bound to have more company in this calf cramp camp, so, what better time to address it, than now? 

I know I’ve said it before, but it’s terribly important to stretch.  Stretch, and do a little dynamic warmup before your run, or workout (I know, I’m going to post this a little too late to help in pre-race prep for folks tomorrow morning).  But after your run, and a little cool-down, you should be doing some stretching. For that entire run, you were telling your calves to “contract, contract, contract” (yes, I’m just going to assume that everyone has the same issue as me, and focusing solely on the calves).  You were never telling them that it was OK to rest, and even lengthen.  So you finish the run, and they keep contracting, thinking that’s what you want of them.  If you’re unlucky, they will contract hard and fast, and go into a spasm, which can be really painful.  But it can also be broken by stretches, much of the time (and you probably already know this, intuitively and from experience even as a kid), so that’s cool.  If you are lucky, the muscles will just go into a lighter, steady contracting, holding on to some degree of contraction, shortening the resting length of the muscle.  This is troublesome because it just makes us feel stiff, but also a little sore.  Some of that soreness can also come from build up of lactic acid which can’t be flushed out because your muscle is holding onto a contraction, and impeding circulation.   Luckily stretching can also help break this type of resting contraction, and help restore some circulation to the muscles, this speeding your recovery time.

When you are stretching your calves, be sure to do some stretches with your knee straight, and some with your knee bent.  You may notice a difference, with one giving you a “better” stretch than the other.  This is because some muscles cross the knee and the ankle joints, so bending the knee will take them out of the stretch, and put the focus on the ones that only cross the ankle.

If you are truly in my boat, then you are dealing with trigger points, and stretching may not fully do the trick for you (for me, it’s a trigger point in soleus – the muscle that stretches more with a bent knee).  This is where I was going to define a trigger point, but I’m keeping the Turkey-day entry short, so I’ll address them in a couple weeks.  If you suspect you’re having trigger point issues, and would like to get to the bottom of it, definitely let me know.  We can figure out if it’s trigger points, and I can help you work them out.

So, I hope you’ve had your run, that you’re recovering well, and that you’re about to go have seconds or thirds of your delicious thanksgiving meal!

Thursday, November 10, 2011

Prepaid Massage Cards & Gift Certificates now available

I'm pleased to announce that I am now offering Prepaid Massage "punch" cards.  Available in 2- or 5-Hour cards, and redeemable in any division of 30 minutes (for instance, a 2-Hour card may be redeemed as four 30-minute sessions or as two 60-minute sessions, etc.)

Prices are $109 for a 2-Hour Card (a $21 savings) and $249 for a 5-Hour Card (a $76 savings).

In anticipation of the upcoming holiday season, I am also now offering gift certificates.  Purchase a massage as a gift for a loved one and let them know they are worth the gift of wellness, not just another 6-pack of tube socks!

Gift certificates and punch cards can be purchased during a regularly scheduled session, and as always, all credit cards are welcome!

Wednesday, November 2, 2011

Yoga for increased range of motion and better resting mucle length

I was chatting with another massage therapist last week who said something which caught me by surprise, in a big way. He said that he doesn't believe that yoga is all that useful for stretching or increasing range of motion, and that if one wants to improve those things, they ought to simply do "traditional" stretching.  I happen to disagree with him.  Based on personal experience.  Allow me to be clear - I believe that just regularly stretching a couple times a day, using established stretching techniques can probably do a wonderful job of helping one gain flexibility and range of motion.  So, if that works for you, then go for it.

But I still think that yoga is likely to work better for many people.  For starters, I think that because most people are likely to do yoga along with a video or in a class, there are some fringe benefits.  I think that since there is structure, many folks are more likely to stick with it.  Because there is an instructor (even on video), there is a better chance that poses or stretches are done correctly.  And, assuming that the instructor is making the right efforts, there can be a better chance for the ego to be taken out of the equation, hopefully lessening the chance that one pushes themselves too far or hard and hurts themselves.

But on a physiological level, I have a reason to believe that yoga is not only effective, but potentially more effective than what many consider "just stretching."  That reason is

Friday, October 28, 2011

Solid Foundations

I'm going to issue a challenge to you...

at the end, silly...

My good friend, Mario, over at Crossfit on the Square posted an interesting question and image on Monday, along with the workout of the day.  The image is of the effects to the lower leg and the body when wearing high heels - particularly if you wear them on a daily basis.  I want to expand upon this concept a little, because it's not just high heels, and it's not just the feet - it's any sort of foundation within our body, and it's a 2-way street.

Here's the image Mario shared:

If you look at the top right corner of that image, you can see how the altered foot position in high heels creates postural compensations throughout the entire body.  These postural compensations can develop into postural deviations that last well after removing the shoes, if you wear them habitually.  When you're out of alignment, you are also at greater risk for injury (as Mario mentioned).

Postural deviations can begin almost anywhere the body, but especially occur in areas I consider "foundations," such as the hips/pelvis and the shoulder girdle/neck area.  If you sit on a wallet, or on a desk chair with an improperly positioned seat or back, if you twist a little to see your computer monitor...you can develop postural deviations.

While the lower foundations tend to have more of an effect on the structures atop them, this transfer of imbalance can work in both directions.  An imbalance in your shoulders may create an abnormal pull (and pain) as your back tries to correct the imbalance.  As muscles and the fascia of the back connect to and around the hips, they can transfer that pull into the hips, which can then become painful and possibly even continue the transfer down into the knees and feet.  As I mentioned in the TMJ post, the jaw is directly connected to the neck and shoulders.  You can see how improper footwear and your jaw pain might be somehow related.

So, my challenge to you: figure out what in your life might be creating a postural deviation for you.  Is it the wallet, monitor position, shoes, chair....?

Friday, October 14, 2011

Myofascial release....Myo-whaaaaa?

I'm going to try to type this entry up with no specific references, no agenda, no outline of where I want the post to go.  Will I wind up tying it up into a nice little package or will I wind up in a long rambling rant?  Or perhaps I'll wind up typing it all up, then going back and proofreading it, editing it and publish something completely different than I began with.  In all likelihood, it means this one will be epic, since I like to explain things too thoroughly...

Whatever it is, I promise that what you will wind up reading will develop organically this time around.  I couldn't tell you why I decided that I want this entry to develop that way, except that maybe I feel that it should unfold in a similar way as a session of myofascial release ("myo" = muscle ; "fascia" = the web of connective soft tissue found all throughout the body, surrounding muscles, tendons, bones, organs, ligaments...).  At least one approach to myofascial release (the John Barnes approach), allows for a session to play out intuitively, through the therapist's ability to empathize and intuit the client's needs, as well as read physical cues.  The combination of cues and intuition can lead therapists to apply their myofascial "holds" in ways that are remarkably relevant to clients' often unspoken physical needs.  I have been on both ends of this process, and it is

Tuesday, October 4, 2011

One of my favorite things

I know I said I was only going to post once every 2 weeks, but I just had to post a little something about this wonderful little gadget, the Thera Cane. If you are a member of the CFSQ family, you may have noticed that Mario has recently added one to the box of goodies for self-care (along with the lacrosse balls, peanuts and rollers).  This has rekindled my affection for this little dear.  If you haven't already played with it, do so the next time you're in and have an "owy."

The Thera Cane gives you a unique way to do self massage on specific areas of the body with a good deal of pressure.  The highlight is that it lets you work hard-to-reach areas like the back, with a good deal of pressure. It even comes with a handy instruction manual to help you figure out what all those li'l nubbins can do!

Nothing's as good as having someone else do the work, but this thing is a close second!

Friday, September 30, 2011

TMJ, TMD and massage


“Click.  Click.  Click.”  Is that the sound your jaw makes as you chew, or even talk?  Is it uncomfortable?  Do you clench your jaw when asleep, or in times of stress?  Do you have headaches frequently?  It’s possible that you are suffering some degree of temporomandibular dysfunction (TMD). It’s suspected that a great percentage of us have some degree of dysfunction in our temporomandibular joint (TMJ), but that it’s only severe enough in a handful of people that treatment is necessary. Personally, I suffer some degree of TMD, and I know that it is tied into my headaches (even migraines), and general neck and shoulder tension.  The temporomandibular joint is a unique (and uniquely complicated) joint, connecting our lower jawbone (mandible) to our skull (at the temporal bone). Technically, it’s a pair of joints, as there’s one on each side of the jaw, but we will refer to them as “a” joint.  

Often, TMD is a combination of issues in the TMJ, and a result of muscular imbalances.  In such a

Friday, September 16, 2011

After your workout: A 3-part plan (plus a bonus step).

I was at the gym Monday, and after our workout, one of my colleagues asked "so, what should I be doing now?"
What a simple question.  What a tremendously important question.  I have a 3-part plan for you, beginning from just after your workout through the rest of the day.  This plan will address clearing metabolic waste, and addressing the resting length (or tension) of muscles.
In my last post, I addressed the importance of removing metabolic waste from muscles. If a muscle is holding too much tension, it is like holding a squeezed sponge-you can't get any more old stuff out, or any fresh new stuff in.  So, we need to get the muscles to stop holding on to their tension to allow for better circulation (muscle tension holding patterns create countless other postural and systemic problems, but I'm solely focusing on recovery right now).  Your 3-part plan, post workout:

1. Cool Down - Do a little cool down...jog a little, do some air squats, go through some lift movements with a PVC pipe.  Don't work hard...just keep the muscles lightly working for, say 5-7

Thursday, September 1, 2011

Benefits of massage for athletes: The Basics.

Let's start at the start with this blog...what are the benefits of massage? Since most of you (my clients) are athletes, or at least weekend warriors, I'll address this in a way that speaks to the athlete in us. That is, I'll address how it can assist your recovery (and ultimately your performance).

When muscles are used in a workout, chemical reactions result in lactic acid, which eventually builds up faster than it can be removed from the muscle. Additionally, microtears occur in the muscle. So after a workout, it's easy to see that there's waste in the muscles which needs to be cleared away to make room for nutrients to heal the microtears. How does massage help?


Monday, August 29, 2011

Down the rabbit hole...

Here’s to what I hope is the beginning of a wonderful project!
I’m going to begin blogging about massage and wellness related topics which I think may interest you, my clients.  I will base the topics on new information I’ve come across, questions I am frequently asked, conversations I’ve heard, or anything else that I think may be useful to you, or which may help you to understand different massage modalities or benefits (or limitations) of massage.
Some examples of topics I have in mind…