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In this video, Dr. Borten will describe the impact of the ways we use and hold our body. He will also discuss the influence of diet on chronic pain.
[post_title] => Live Pain Free Video Blog Part 3
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CLICK HERE TO CHECK OUT OUR NEW 'LEARN HOW TO MASSAGE' COURSE ***
From the beginning, Briana and I agreed that if The Dragontree could be well known for anything, we wanted it to be that our therapists are absolutely top notch. We’ve felt especially qualified in guiding The Dragontree’s massage program, since we have both worked professionally at performing and teaching massage.
Our friends often tease us when one of us has a massage interview planned. “Oh, it must be so hard,” they chide, “having to get massages all the time.” But I assure them, when I’m receiving a massage as a means of evaluating whether to hire someone to represent my business, it’s not usually a relaxing experience. I am constantly evaluating their technique, and I am pretty picky.
We try to check out other spas and get treatments whenever we travel, and, for better or worse, it can be hard to turn off my inner critic (especially when they only give me 50 minutes for my “one hour” massage). When you know how good a massage can be, you’re always hoping that every massage will be that. One year, on my birthday, I was receiving the worst massage of my life, and I actually ended it after fifteen minutes – something I had never done before. The therapist was clearly taken aback when I sat up and said it wasn’t working for me. When he defensively responded that he had plenty of clients who love his work, I realized, most people don’t know what to look for in a good massage. And that’s what I’m going to teach you.
It’s always worth remembering when you have an unsatisfying massage – or any other kind of service – that not every two people are compatible. It could be that the professional – whether a graphic designer, massage therapist, or hair stylist – is skilled at what they do but they just don’t do it to your liking. So, I hope to provide you with some criteria that will make the evaluation process a bit more objective.
I realize that by writing this, I am setting up The Dragontree to meet some very high standards, but I believe I’m also setting up our practitioners for some very big tips. And, I hope that I’m arming you with ways to be constructive about a massage that falls short of your expectations.
Ideally, you can communicate to your therapist during the massage if it isn’t to your liking, and it can be improved on the spot.
If you just like receiving massage, these criteria may help you identify if a particular therapist is right for you or not. If you are an amateur or professional massage therapist, you might find something here to improve your skills. These are, in my opinion, the six most important factors in a good massage.
1. Confident Touch - The first moment a massage therapist lays their hands on a client’s body, something is communicated. When the touch is not confident, the communication is something like, “Hmmm... let’s see... err... maybe this way... no, wait. Oh, I have an idea... uh, maybe not.” As the client, it is difficult to relax and trust the therapist’s skills. When touch is confident (and I don’t mean firm , but something less tangible), the communication is, “I know what I am doing, and I’m here for you.” Confident touch makes us feel like the therapist has a plan. Every touch feels purposeful. This encourages us to relax and open ourselves to the therapist’s therapeutic intention.
2. Continuity of Touch - Every time the therapist removes their hands from the body, there is a disruption in the continuity of sensation and connection. Occasional disengagement from the body is sometimes necessary. But when it happens very frequently, and especially if the therapist’s hands are more off the body than on the body, there is a choppy or jumpy, discontinuous feeling to the massage. It impedes our ability to relax. Conversely, therapists who maintain nearly continuous contact with the body help us stay in a relaxed state.
3. Complete Strokes - When a therapist is working along a natural line on the body, it generally feels best to a client if this line is followed to its completion. There are some techniques that are exceptions to this rule, but when doing long strokes, if a therapist stops short of the natural end point of a stroke, it feels incomplete to the recipient. For instance, if a therapist is performing a stroke down the spine, and they stop a few inches above the base of the spine, or if they working along a limb and they stop before reaching the joint or the end of the limb, it usually doesn’t feel as satisfying as when a therapist continues the stroke to its natural end.
4. Entering the Tissue at the Right Speed and Depth - Some therapists are enthusiastic about getting hard and deep into people’s muscles, but they fail to perceive the body’s unwillingness to let them in. When a therapist tries to go too deep too fast, we tense up and the whole thing becomes counterproductive. When a therapist “listens” well to the body, they enter the tissue at a rate whereby it is able to accept increasing amounts of pressure and depth without tightening up and pushing back. If the body does tighten up, the therapist feels this, backs off, and re-enters more slowly or in another way. If the area continues to be excessively reactive, the good therapist may leave it alone entirely, and work complementary areas instead. This doesn’t mean that good massage must be painless, but at no point should it feel like the therapist is fighting with the client’s body.
5. Sensitivity and Responsiveness – As I alluded to in the previous section, a sensitive therapist is able to perceive how their touch is being received by the client. They also check in verbally from time to time to be sure the client is getting what they want out of the massage. Then, a responsive therapist adjusts their technique to suit the client’s needs. Some therapists with good sensitivity do minimal verbal checking in and still succeed at making appropriate adjustments throughout the massage, but even a seasoned therapist should know that they can fail to read a client’s feelings, so they should always be humble enough to ask.
6. Devoted Presence - A devoted therapist conveys throughout the treatment that the client has their undivided attention. The client never feels that the therapist’s needs are “in the room.” Thus, a devoted therapist rarely starts conversation during a treatment. Some clients like to talk a lot. While there is nothing wrong with this, the therapist who is really devoted to their art recognizes that this may diminish the benefit of the treatment, and they will often gently guide the client back to relaxing and feeling what is going on in their body. Another mark of a devoted therapist is that they are open to receiving criticism, because they want the client to have the best possible experience. That said, when we’re clients, if we really want the best outcome, we’re likely to get it by offering any criticism in a kind way.
In the end, everyone likes something a little different, and there is no single massage therapist who is perfect for everyone. If you ever have a massage experience here at the Dragontree that doesn’t quite meet your expectations, please feel free to talk to us about it. We’d love to hear your input and are eager to find ways for you to have the blissful experience you deserve.
Be well,
Dr. Peter Borten
All rights reserved © 2015 Peter Borten
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A couple weeks ago, I wrote about the differences between acupuncture and “dry needling” to alleviate pain, and in that article I explained a bit about the phenomenon of myofascial trigger points. After I said I believe these are the cause of most of the physical pain humans experience, a number of readers asked me to explain more. For the science lovers out there, I’m going to dive deeper this week.
Besides the most common forms of pain, like lower back and headaches, I’ve had patients with digestive problems, sinus congestion, chest pain, ear ringing, numb hands, painful intercourse, acid reflux, vision changes, and other health issues that were eventually discovered to be due to myofascial trigger points. I believe everyone should know about them and how they work – it could save us a lot of time and worry.
Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state, making the muscle fibers taut . This can cause reduced muscle strength and range of motion, pain, numbness, itching, and other forms of dysfunction. Sometimes a trigger point feels like a palpable nodule or “knot,” but to untrained fingers they’re often tricky to find.
A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. For instance, there’s a trigger point that can form in the soleus muscle of the calf that’s capable of producing pain in the lower back. For this reason, the work of Janet Travell, MD and her colleague David Simons, MD, was groundbreaking. For each muscle in the body, they mapped where trigger points tend to form and what kinds of symptoms they cause.
If you were experiencing pain along the outside of your leg, you might assume that something was wrong with that part of your leg, perhaps with the often-tight iliotibial band (IT band). But this diagram might be helpful. The X’s show where trigger points can occur in a muscle called gluteus minimus above the hip socket. The red shading shows the potential areas of pain that can result. You might not suspect this muscle because, as you can see, there’s no pain at the site of the problem!
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. Most often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way.
This is especially common when someone works out without warming up; when someone does a very ambitious workout after not having exercised for a long time; when someone makes a sudden movement (like reaching out to catch something or trying to stop oneself from falling); and especially when someone does any of the above when in a state of diminished resilience (e.g, when stressed, upset, sleep deprived, eating poorly, etc.).
Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years. One possible mechanism is known as the “Cinderella hypothesis.” During static muscle exertion – holding a position for a long time, as dentists, musicians, typists, and others engaged in precision handwork do – the body tends to engage a certain group of small muscle fibers, called Cinderella fibers because they’re put to work first and are the last to be disengaged. Even though they’re not doing heavy lifting, these muscle fibers (often in the neck, shoulders, back, and forearms) are continually activated and overworked, which makes them susceptible to trigger point formation.
Whatever the cause, the result is that eventually the muscle never completely relaxes. Muscles are composed of numerous parallel fibers that work together to shorten (contraction of the muscle) and lengthen (the return of the muscle to its relaxed state). Within each of these fibers are many end-to-end contractile units called sarcomeres , and in the case of a trigger point, a group of sarcomeres gets “stuck” in a shortened state. This makes the affected fibers taut and often “stringy” feeling.
To make matters worse, the contracted region clamps down on tiny blood vessels causing local ischemia (inadequate blood supply), reducing in-flow of fresh, oxygenated blood and out-flow of toxins. This leads to a localized hypoxic state (not enough oxygen). The tissue pH changes, local metabolism is impaired, and fluid and waste products tend to build up in the area. This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less.
Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance. Finally, with longstanding trigger points, the body may deposit gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
The good news is that there are now books, charts, online tools, and practitioners that can help track down likely trigger points that may be implicated in your discomfort. I have such a tool in my online pain relief course, Live Pain Free , and I teach many approaches for deactivating trigger points.
The most basic methods involve simple mechanical disruption of this holding pattern. First, drink some water if you’re not well hydrated. Second, you or a friend can methodically feel around (ideally guided by a trigger point chart) for points that are sore, and ideally that reproduce the very sensation you’ve been experiencing. Third, maintain firm pressure on the epicenter of the point (with a finger, elbow, ball, or other tool) for about half a minute, consciously breathing into the area and intending to let it go, until there’s a palpable release. Then move on to all the other nearby points that are tight and tender and do the same.
This approach is called ischemic compression . By compressing the tissue enough to block blood flow, the body responds with reflex vasodilation , meaning it opens these vessels and flushes the tissue with a dramatic increase of blood. This will usually produce a significant improvement in the pain or dysfunction, though it will typically return sooner or later. These points tend to go from being active trigger points to “latent” trigger points, which have a certain “memory” (not the good kind of muscle memory) and are capable of getting reactivated. For this reason, persistence is important. The best results come from working on a trigger point consistently – usually from one to several short sessions per day (or less frequent if the sessions are intense) – and continuing for a while even after everything seems better.
As I said, this is a most basic approach, and while it’s often effective, sometimes a more nuanced intervention is required. There are many techniques that build on compression. We can replace fixed pressure with slow, deep strokes in the direction of the muscle fiber, as if re-lengthening this segment. We can work the trigger point back and forth across the direction of the muscle fibers. We can combine pressure on the trigger point with engagement of the affected muscle or antagonistic muscles. We can combine manual work on trigger points with topical herbs and/or internal herbs and nutrients that improve circulation and reduce inflammation. We can utilize release p oints on the same acupuncture meridian as where the trigger point occurs - or complementary points on other parts of the body. And more.
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free , where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
While I said I believe trigger points are the cause of most of our physical pain, I think it’s worth mentioning there are usually even deeper causes, such as stress and withheld emotions, poor body mechanics, dehydration, and an inflammatory diet. Holistically addressing these issues will lead to a more complete resolution of the condition. Always look at the big picture.
Be well,
Dr. Peter Borten
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