“How To” Format: Your Opportunity to Contribute

One way to contribute to the Mind Set/Skill Set conversation is to post a “How To”.

How to posts should break a skill or thought process into small parts that can be described in one page.  If it takes more than one page of normal text it probably is two or more skills and can be broken down even farther.

A How To should include instructions so that can be followed to execute the skill.  Skills can be beginner, intermediate and advanced.  The goal is to make the instructions simple and clear.

Contribute your most effective massage techniquesin the comment section.

Massage Techniques: Understanding the Healing Process

The video below is a short (20 min) class on the relationship between massage, injury, inflammation and the healing process.  The material is integrated with slides that present the client experience and the benefits of quality soft tissue therapy.

Please leave a comment and let me know if you find the class helpful or have any suggestions for making it better.

https://skydrive.live.com/embed?cid=51698D2E85641E19&resid=51698D2E85641E19%21858&authkey=ANDY1unze5fS2t4

Thanks for your time and input.

Don Miller, MA LMT

How to do a more effective neck massage using the Turtle

The video below is a 2.5 min demonstration of the Turtle.  I developed this simple tool for massage a couple of years ago.  I use it everyday in my practice and have grow to like it more and more.

Occasionally, I need to do a massage in another setting (away from my office) and don’t have the Turtle.  Then, I really am aware of how helpful it is.  It makes doing effective, quality neck massage easy.

Check it out.

Massage Techniques: What to Do when the Greater Trochanter is Posterior and Internal Rotation is Limited

I’ve noticed a fairly common occurance with my clients. One hip will present (with the client prone) as more posterior. The evidence is that, on palpation, the greater trochanter will be more posterior and higher off the table. This is usually accompanied by an internal rotation limitation of the hip. What to do?

Alow me to introduce Jerry Hesch. Jerry is a PT in Henderson, Nevada. I have watched his YouTube videos for several years and have picked up some valuable insights and techniques for understanding the pelvis and the SI joint. Check out these videos on the condition discussed above. The first video shows the hip assessment and discusses the treatment. Then, following treatment, the second video shows the outcome of the treatment. I have several clients that I know have benefited from this simple passive correction. Here is Jerry’s website. www.heschinstitute.org

 

 

Check out some of his other videos too.

Also, the palpation of the tone in the greater sciatic notch is a useful assessment.   Jerry touchs on this briefly in the video.  The lateral rotators are deep in the is area and the glute maximus is superficial.  Think of this area as a triangle bordered by the greater trochanter (laterally), the sacrum’s inferior lateral angle and the ischial tuberosity.  The firm structure between the ischial tuberosity and the inferior lateral angle of the sacrum is the sacrotuberous ligament.

Specific soft tissue work on the lateral rotators can be very beneficial.  With the client prone, palpate the greater trochanter and work inferiorly along the posterior aspect of the femur.  From superior to inferior the muscles are in this order: Piriformis, Gemellus Superior, Obturato Internus, Gemellus Inferior, Quadratus Femoris.  On most clients this row of muscles will cover about three inches on the back of the proximal femur.

By interanally and exteriorly rotating the femur you can work the attachments of the lateral hip rotators.  Slide medially off the femur and you are on the lateral rotators.   The most prominent and easiest to palpate is the quadratus femoris.  It is a short thick muscle, about 1″ square,  that is very strong and exerts a powerful influence on the hip’s actions.  The piriformis gets all the press but the quadratus femoris is very important.

Wolf Schamberger has a lot to say about this type of alignment issue and its functional implications. His book The Malalignment Syndrome: Implications for Medicine and Sports is a must read for serious manual therapy professionals. But, that is the topic of another post.

Don Miller, MA, LMT
http://donmillermassage.com

Massage Techniques: How to Use Fascial Anchoring to Assess Rotational Movement of the Thoracic Spine

Fascial tracks are continuous from head to toe and influence our movement and our sense of stiffness. Understanding how fascial tracks can contribute to or limit movement is helpful for effective hands on treatment.

The popular  Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists work by Tom Myers presents the notion of continuous fascial tracks connecting the body in an integrated system of tension and balance. Movement restriction anywhere in the system affects every other part of the system. Specifically, restriction along fascial track, like the superficial back line, will have an influence on the rest of the line.

For example, the superficial back line is a continuous line of fascia running from the bottom on the foot, up the posterior body, to the top of the head. Restriction along this line may include what people experience as tight hamstrings, stiff hips, restricted rotational movement of the Thoracic spine or limited motion in the neck.

A sense of tightness is often blamed on muscles and stretching is thought to be the answer. Stretching is often focused on isolating a specific muscle with little attention to the integrating fascial structures. By expanding our perspective to include fascial structure we may more accurately see the cause of the stiffness.

For this skill building tip we will focus on trunk rotation and examine how fascia and muscles interact to generate or limit motion. Trunk rotation is used to evaluate proper motion of the thoracic spine on the lumbar spine. We also look at how the hips, pelvis, shoulders and neck influence T-Spine movement.

Try these movements and note the results. For each movement, note the rotation quantity in terms of degrees for all movements and observe any asymmetries from side to side. Asymmetrical movement, greater rotation to one side than the other, may be a more important finding for function than limited motion that is equal on both sides.

Note the quality of the movement in terms of ease of movement and any asymmetries or movement compensations. Compensations may include side bending, head and neck rotation, scapular protraction. Movements should be performed slowly and with control.

Also get feedback from the client on their sensations. Ask about what they feel when making a movement. What stops the movement? Is there any pain or discomfort? Is there any sense of spasm?

1. perform seated trunk rotation in both directions with arms crossed in front of the body and hands on opposite shoulder. Note the quality and quantity of the movement.
2. perform seated trunk rotation in both directions with a dowel across the anterior shoulders and arms crossed to hold the dowel on the opposite shoulder. Hips and knees should be in line and the ankles uncrossed
3. perform the same movement as #2 with a foam roll or yoga block held between the knees. The gentle contraction required to hold the foam roll in place between the knees will anchor the hips and pelvis. The body can no longer borrow movement from the hips and pelvis to accomplish trunk rotation.
4. perform the same movement, without the dowel, with the elbows raised and hands behind the head
5. perform trunk rotation with shoulders flexed to 90 degrees, arms extended in front and palms touching in prayer position
6. perform trunk rotation with the head projected anteriorly in an exaggerated head forward posture
7. experiment with other combinations of restrictions and movement

Gather client feedback in terms of the sensations perceived while performing the rotational movements. Clients may note tightness, stiffness, restriction, pain, mild discomfort, or spasm. Note the location of the sensation. Possible areas of sensation include neck, shoulders, erectors, low back and hips.

Client feedback is useful and may lead to identifying areas of restriction limiting motion. If there is motion restriction in this controlled setting there is certainly restriction going on in normal life.

Functional movement limitations can show up distant from the actual restriction. When the body works around a restriction to create movement in another way we call it “compensation”.

Compensations can lead to other complaints at some distance from the actual limitation. For example, T-Spine rotational limitation can lead to exaggerated scapulothoracic movement. The body creatively borrows movement from the shoulder to make up for what is lacking in the T-Spine rotation. The client may present with shoulder protraction, instability and pain because the shoulder is trying to do a job it is not intended to do.

These are not diagnostic or orthopedic tests but they do provide lots of useful information. Question: What do you feel when you stretch a healthy muscle? Answer: Nothing. The sensations and locations can help us identify areas that need some quality body work and/or some corrective exercise.

The foam roll mechanically anchors the hips and pelvis and limits the body’s ability to recruit these structures to increase rotational movement. The raised elbows and shoulder flexion limit the interaction between the scapulothoracic joint and thoracic spine rotation.

When allowed to perform trunk rotation without anchoring, the body will recruit movement from areas distant from the rotational segments. As the body encounters tissue resistance to rotation it will compensate by “stealing” movement from indirectly related areas. The reality of this is demonstrated in the restricted movement clients experience when mechanical anchoring is implemented with the foam roll and shoulder movement.

Don Miller, MA, LMT

October 2011

Massage Techniques: Treatment of Psoas and Iliacus Muscles

As a follow up to my post on Muscle Testing of the Psoas Muscle, here is a video blog from a friend and collegue Patrick Ward.  Patrick’s video demonstrates how to do a soft tissue treatment of the psoas and the iliacus.

I find these muscles to be grossly overlooked in their role in low back pain.  Two recent clients are good examples.  One had experienced long term chronic back pain, over 40 years.  The other had experienced six months of pain that took her out of her normal life activities.

Both had sought medical treaments from a variety of health care providers.  Both had participated in multiple physical therapy sessions.  Both had been seen by other massage therapists.  They had one other thing in common; neither had received any soft tissue treatment of the psoas or iliacus muscles.  In my practice, I find this to be true of 90% of the clients I see with low back pain.

If you are a client, find a therapist that can do this work.  If you are a therapist become confident in how to do this work.  Your clients will thank you.

Below is a video from Patrick Ward’s blog.  He has lots of great infromation there.  Check it out. http://optimumsportsperformance.com/blog/

In addition to the treatment of the muscles, there is another key structure that is important to recognize. The iliac fascia is a substantial fascial layer that separates the iliacus from the rest of the pelvic contents. This fascia tends to get bound down to the iliacus.

Brielfly, here is a treatment strategy. The client is supine, the hip flexed, and the foot resting on the table. Therapist holds gentle pressure contacting the iliacus on the inside of the ilium. Hold this pressure to pin the tissues and have the client slide their foot down the table as if they were going to push it off the end of the table.

As their hip and knee straighten the client’s sense of stretch will increase. This will help to release any adhesions in the iliac fascia.

Caution: medial to this work is the femoral artery. If you feel a pulse when palpating the iliacus simply reposition by moving more laterally.

Don Miller, MA, LMT

September 2011

Massage Techniques: How to Treat Painful Scar Tissue Adhesions

Myofascial adhesions and scar tissue may be dysfunctional is the sense that they are painful on movement. Scar tissue attaches to neighboring tissue without regard to functional movement. Its job is to “close the gap” and adhere tissues together in healing a wound.

Although this adhesive quality may serve a purpose in the acute healing stages, as time passes and normal movement is desired adhesions may cause pain. The following technique is an effective way of dealing with these painful, motion restricting adhesions. This is not appropriate for young scar tissue in the acute or subacute phases of healing.

1. Identify the point of concern by using restricted motion. Contract using an isometric contraction to isolate the exact location of the pain. Ask the client to point with one finger to the place where the pain is felt as the isometric contraction is performed. The pain may be on an tendon-bone attachment site, a ligament or in the belly of the muscle. Note that if the person can not point to a specific spot but, instead describes an area of discomfort, the pain is more likely to be myofascial in nature and not the result of scar tissue developed from a previous strain or sprain.
2. Apply 30 to 45 seconds of multi-directional friction to the site. Use a finger tip or thumb with light to moderate pressure on the pain producing site. Multi-directional friction will look like an asterisk.
3. Passively lengthen the tissue by taking it through a range of motion without the client offering any resistance or assisting.
4. Eccentrically load the tissue by asking the client to resist lightly while you continue to take the tissue through a range of motion. This action asks the muscle to contract while lengthening. It places a functional stress on the tissue and challenges it to move in a functional way while contracting. Active resistance should only be done in the eccentric direction and at a level of pain-free motion.
5. Repeat number 1 above and identify any additional spots that produce pain and require attention. The combination of these actions may need to be repeated several times and possibly during several sessions to clear out all the specific fibers that are causing the adhesions and creating pain.

This process is very useful for forearm scar tissue resulting from minor tears found in the extensors, as in tennis elbow. Recovery from knee surgery is often troubled with ongoing chronic pain on movement near the end range of the knee flexion. This technique is very helpful for restoring full-pain-free range of motion.

Treating scar tissue adhesions in this manner does not remove scar tissue or change the nature of the tissue. It works to remodel dysfunctional scar tissue into functional scar tissue. Functional scar tissue still holds the wound together and it allows for pain-free movement.

My clients have labeled this technique “The Magic Trick” because of its profound effectiveness. Try it with your clients and let me know how it works for you.

James Waslaski, http://www.orthomassage.net/, taught me this and other useful Orthopedic Massage techniques.

Don Miller, MA, LMT
September 2011

Massage Techniques: Self Care for SI Joint Pain

Let’s get normal. Simple steps to better back health.

Heard this one? “I threw my back out while reaching to pick up my keys. The pain dropped me to the floor.”

Many sore back episodes start with a simple low intensity movement. Often it results from normal activity; bending to brush your teeth, putting a dish in the dishwasher, reaching for a familiar object getting in or out of a car. Nothing heavy or strenuous.

What’s going on here? Back pain is very common with up to 80% of adults as members of the club. It is common and the cause can be hard to nail down.

There are also several different things that, in common language, are grouped together under the umbrella of “back pain”. These include lumbar spine pain, pelvic and sacroiliac joint pain, sciatica and hip pain. Trigger point activity in muscles can also create pain that mimics other conditions. All this can be confusing and difficult to sort out.

One of the most common complaints is SI Joint pain or pain in the sacroiliac joint. Some experts suggest that this pain is caused by a “subtle variation from normal”. This may explain why it is so common and hard to pin point the cause.

Here’s the logic: If SI Joint pain was a unique condition, something far from normal, it probably would not affect so many people. And, because of its uniqueness, it would be easier to screen for and to diagnose.

For example, when a car’s wheels are out of alignment there are subtle signs. The steering may pull to one side. Tire wear may develop an uneven pattern. Bad alignment causes problems. Bad alignment can develop slowly over time or it can be the result of a traumatic bump or pot hole. You know what that feels like.

Properly aligned, tires last longer. The tire shop has an alignment test to diagnose the problem. If alignment is an issue they can correct it. Frequently, we don’t even know our car has an alignment problem because it is a “subtle variation from normal”.

Let’s get normal. If SI Joint pain caused by a subtle variation from normal then how do we maintain normal so we don’t develop the subtle variation?

Robert DonTigney, a Physical Therapist and educator, has studied the SI Joint for 35 years and worked with over 8000 cases of SI Joint pain. He offers some easy self care suggestions to maintain normal. In my corrective exercise and soft tissue pain relief practice I introduce clients to his daily exercises. We think of them like a daily vitamin to maintain good SI Joint health.

These self care steps are a great way to maintain normal. No equipment is needed. They are easy to do and pain free. Variations of the exercises can be done lying down, seated or standing. I’ve found some clients like one position better than the others, but all can be effective.

Step 1 Glute Bridge: This exercise activates the posterior muscle chain and wakes up the extensors of the body. Start supine lying on your back. Bend your hips and knees to place your feet flat on the floor. Press your hips up toward the ceiling. Hold for 10 seconds. Repeat five times.

Step 2 Knee to opposite foot: This exercise helps to organize the alignment of the SI Joint and pelvis. Start supine lying on your back. Bend one leg at the hip and knee to place the foot flat on the floor. Press the foot down into the floor. Drive the knee downward and across toward the opposite foot. This will drag the hip off the floor slightly.

Step 3 Shoulder drop: This exercise provides a way to organize the SI Joint structures while standing. Start by standing with one foot up on a chair or bench. Bend at the waist and drop the shoulder (same side as raised knee) inside the raised knee and rotate the torso slightly away from the raised knee.

Step 4 Piston Knees: This seated variation provides an easy way to keep things aligned throughout the day. Start seated with knees at 90 degrees and feet flat on floor. Alternate moving the knees forward and back creating a piston action. Limit torso and shoulder action and focus the movement in the hips and pelvis.

These exercises help maintain proper alignment of the SI Joint structures and encourage things to be normal. They activate the proper muscles to maintain better muscle balance. All should be done pain free.

Correcting faulty movement patterns and cleaning up muscle imbalances produces better function. Sound functional movement patterns provide a good foundation on which to build normal daily activities and to increase performance capacity.

Don Miller teaches corrective exercise
and practices massage in his Scottsdale, AZ office.
Don Miller, MA, CES, LMT
http://DonMillerMassage.com
https://donmillermassage.wordpress.com