Category Archives: Dealing with Medical Conditions

Taming the Tube

It had been a particularly busy Saturday, with lots of clients coming in for massage therapy at my office. After work, tired though I was, honey and I went over to the local promenade for dinner and walked along the cement boardwalk for quite a ways looking at the crowds and shops.

Usually we stop for a few moments to listen to the street musicians. This time I wanted to stop at the benches by the flamenco guitarist. We found a spot. Honey asked me what was wrong.

“My quad(ricep)s are numb,” I said. “It seems to go away when I sit down.”

After a few minutes we resumed walking. Again, the front of my legs above the knee went numb.

“What’s going on?” Sweetie asked.

“I don’t know, but I am going to find out,” I said.

We walked back to the car pretty slowly, my legs complaining the whole way back.

As massage therapists we are used to people having symptoms of things that might be a bit worse than just sore muscles. I know I have. It is easy to tell a client to go have it checked out. But do we forget how hard that can be?

My doctor wanted to know what was going on right away. He recommended a lumbar X-ray series and a lumbar MRI. The X-rays, no problem. I walked in to the offices of the local. The MRI?

Oh heavens. I’d had one years ago for my neck and shoulders, and I remembered being able to handle it as long as I kept my eyes shut. Starting in the hall outside the machine. I put the test off for a few days.

My doctor called to find out if I had the MRI yet. The X-rays showed suspected spinal stenosis. I needed to get in ASAP.

Spinal stenosis? I did what everyone else does. I looked it up on WebMD. By the way, never do that. By the time I went in for the MRI, I was convinced I would be disabled for life.

MRIs have not changed much, but I have. This time my arms hit the side of the tube, making me feel like I was being held. I couldn’t do the time in the machine. Two tries later I was sweating and resigned. I went to the local “open” MRI. Much better. Except for the train-wreck sounds. The tech had insisted I listen to some spa music. Thank heavens. It gave me something to focus on besides the noise of the MRI.

I was pretty tense when I went in for a consult with a neurosurgeon. The lady in the waiting room was about 30, in a wheelchair. She smiled at me. I thought about whether they have to measure you for a tongue stick. You know, the kind you use to paint watercolors because you are in a wheelchair for life.

In the exam room, I had high blood pressure for the first time in my life. “White coat syndrome?” the assistant asked.

Seeing a neurosurgeon. Egads. The assistant loaded the MRI onto a computer. I stared at the image. What was that? Lobster tail?

The discs and all were fine, but I do have spinal stenosis and a pinched nerve at the L4-L5 foramen. The doctor smiled at me and recommended a cortisone shot. “You should be fine,” he said. “That should take care of your symptoms. You need to strengthen your psoas and spinal erectors.”

Hmm. That last part sounded like what I find with many massage clients. I thought I could feel my blood pressure drop back to normal.

I took a breath, perhaps my first of the day. “I’m sorry. I have been pretty freaked out about this,” I said.

Time for a massage.

Wrapped Up in Fibromyalgia Massage

A recent study showed hyper nerve endings under the skin of people with fibromyalgia – the first “objective” sign that people with fibro are not just whining about their pain.

Well, we massage therapists are different from others in the treatment community who have doubted the clinical basis of fibromyalgia. The difference is fairly simple – when people tell us they hurt and where they hurt, we believe them.

For something to be so simple it is also hugely significant for people with fibro. They are often battered, doubted, maligned and otherwise felt to be somehow less legit than someone who has an X-ray proven injury such as a broken leg.

I have had clients who have been “fired” by therapists in other modalities because they can’t stick to exercise programs. Even though within a few weeks, even a few hours, exercise programs make fibro folks feel worse.

A recent client pointed it out to me in bright flashing lights. She does not look like she has fibro. She is young, thin, and fairly flexible and has no apparent history of trauma other than a car accident 5 years ago.

Several times she has tried to comply with strengthening programs only to have her head and neck pain increase – and her disability from fibro go wild. When she complained of increasing problems, her complaints are dismissed.

Figuring that the definition of insanity was proving true – Crazy is doing the same thing over and over and expecting a different result – she decided to do her own research.

She stumbled across some articles about trigger points and fibro and decided to try massage. I’m happy to say she is feeling much better.

Reminding us all that it never hurts a massage therapist to believe people when they report symptoms, nor does it hurt to use our skills to relieve those symptoms. It is our strength.

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Through the Sheets

Sometimes in the course of massage therapy practice, we will meet clients who want to have some delicate and sensitive areas relieved of trigger points and adhesions.

My most recent experience was with a client who had gone into a full-body clench during a car accident, braced with both feet on the brake pedal as the vehicle did a dervish and ended upside down.

It is almost a cliché to say that people who are unaware they are about to have an accident are better off. They don’t have time to react in terror, they don’t have the cascade of hormones and the emotions of fear.

The ones who see it coming, if they brace with arms and legs can end up with not only their accident injury, but a cascade of spastic muscles from jamming into the brake pedal, steering wheel and seat belt.

In addition to the usual back and neck pain, this client developed rectal and vaginal pain referred from injuries to the adductors, hamstrings and glutes.

As a therapist, the last thing I want to do is trigger more trauma to these areas with massage techniques.

First I like to talk to the clients about what areas are involved and could be helped by massage. Then I suggest making sure the client knows he/she is in control and are able to tell me to stop or lighten up at any time.

With these areas, because they are near areas of vulnerability I feel need some special security, especially for female clients. The clients are always draped with a sheet, and if they want they can also wear their outer clothes and underwear. The layers make the massage methods such as trigger point less invasive.

That said, I have always found that it is better to be cautious about client comfort when dealing with delicate areas.

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New Tricks

Sometimes I visit people at home for massages instead of at my therapy office, usually for convenience but sometimes because they are not able to travel. Folks who cannot travel to the office tend to be in recovery from injuries or in a fragile state.

Usually they are getting plenty of homecare from their relatives, visiting therapists, etc. but they are not getting the one thing that might help them feel better faster: nurturing touch.

In addition to the feel-good effects of massage, I like to give folks a few “new tricks” to help them navigate around the home. When you are there solely to make people feel better they tend to be listening and also more likely to remember a few easy steps.

Falling is the biggest danger and worry for people coping with infirmities of age or injury. That leads to Trick Number 1:

When a person has been sitting or lying in bed for a while, the psoas flexor has trouble adjusting to a standing position. Massage therapists know this is the only muscle in the body that works backwards, by controlled lengthening. When arising from a sitting or lying position, stand and give yourself 15-30 seconds for the psoas to adjust before starting to walk. Those few seconds will allow the psoas to kick in and steady those first few steps.

Trick Number 2: Sitting down requires effort, too. Sometimes people find themselves “falling” into a chair rather than sitting down and this can create more injury. Try placing the feet further to the sides than usual, the toes turned slightly out. Then squat to sit, a bit like sitting on a horse. This helps stabilize descent, avoiding the flop!

The “new tricks” added to a home visit has made my massage therapy practice more satisfying both for myself and my clients.

Massage as Rehab

This massage therapist loves a challenge, and I frequently get them. Yet sometimes I wonder if I am doing the “right” thing. You know, the right thing as in “Do the Right Thing.”

Massage therapists are darned good at shaving a few points off a golf game. We excel at getting rid of the post-lunch headache. I’ve never met a trigger point I couldn’t conquer.

But what happened the other day got me good and flummoxed.

Here’s what happened: A new client with a long record of running lots of Ironman triathalons came in for relief from back pain from two crushed discs – so he can continue to compete in many more Ironmans.

I have to admit I asked a good many questions. And the bottom line came back to competition. He has to be able to go back to compete. If massage won’t help, he plans to take a year off to have back surgery (even the surgeon told him he didn’t need it) so he can go back to racing. It is that important.

What is the right thing? Frankly, the client is “the decider.” Yes, I am unqualified to decide what another person wants or desires or what is right for them. I can ask questions, I can offer ideas, but it is the client’s choice. It was time to pull up my big girl panties and see what I could do to help this client.

How would you deal with this?

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Blinded by the $10 Grand Solution

Folks with big troubles like this client – blinding headaches and vertigo – shop around for help. This massage therapist has been working with this client for a while. Her headaches get better with massage and heat packs but it never seems quite enough to make them go away.
This client has tried injections, acupuncture, a full course program at a pain management clinic and a few other things. Some treatments don’t work; some work a little and some have proven really toxic dead-ends.

The latest sojourn was to new clinic advertising a low-level electro-magnetic treatment. The client went to a presentation and tried a free treatment. The full course of therapy requires treatment every weekday for a month. Cost upfront $10,000. No insurance coverage.

The treatment seemed fine at first, the client said, then it seemed like her headache suddenly got worse. She told the technician administering the treatment. “She said no one had ever complained before,” the client said.

The treatment continued, although after she complained again, the technician turned the machine down some.

And then there was the $10,000.

“For $10,000, I want to know that the treatment will work. That’s a lot of money,” she said. Oh yes indeedy. There were too many red flags for her, from a lack of concern about her feedback to the big price tag etc.

Then the big question.
“What do you think?”

“I think you made the right decision. A new treatment. New clinic. Big price and what sounds like an inexperienced staff. Plus people who know what they are doing never blow off a complaint with a comment like no one has complained before.”

I have to admit, though, that my inner wheels were turning. I wondered about offering the client a free massage every day for a month. If the headaches get lost, why not pay me $10,000.

Somehow, somewhere, smarter folks than I decided that paying only if treatment works is somehow unethical. I’m still looking that one up, but I’m pretty sure it is on the books as a no-no. Fudge crumpets. The idea of this lady getting better – and my spouse and I going on a Hawaiian vacation – was pretty tempting.

After she left, I had the mental picture of myself running after her car offering the deal.
“Waaaaiiitttttt….” Puff-puff-puff.

Fee for service is a major tenant of our profession, however, and one that other health professions may have been wiser to stick to.

Fudge crumpets.

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Family Matters

Holidays bring out the best in people – and the visiting relatives. I have just moved the office and the massage therapy room still looked a little bit like a MASH unit. My phone message, for a change, said I was off for two days before and after the holiday – but the calls just kept coming.

Despite a long history of scoliosis, this client had never had massage for the condition. She had enjoyed the occasional vacation massage here and there.

Holiday massages tend to be emergencies, anyways. This time I had a referral from a client. This was a young lady with mild scoliosis, who between funny positions on the couch and airplane rides and long conversations with the parents had woke up to find that turning to the left was impossible. O Joy.

While going over her intake, I suggested she do regular massage to keep discomfort in check and possibly to help prevent the scoliosis from getting tighter. “How do I find a massage therapist who specializes in scoliosis?” she asked. I felt a bit surprised by the question. I explained that so many massage clients have slight to mild scoliosis I consider scoliosis therapy part of the mainstream of therapeutic massage.

Perhaps look for a more therapeutic massage person, I suggested. I felt on thin ground. All massages, in my mind, are therapeutic, even the ones where intent is solely to relax the person while on vacation. That is a pretty awesome skill.

This client comes from an area of the country with very minimal requirements for massage licensing. It is also known for having lots of people who are into a kind of flower-child view of life and massage.

“I don’t really mind that stuff as long as it is not the only thing in the massage,” she said. “I would also like to get some work done on my problem spots.”

Oh heck, I might as well dive into the pool. “I understand what you are saying,” I said. “I’ve had those massages where the person giving them is off on their own trip and not that into why you are there. It is no guarantee, but if you look for someone with boards or more education than the minimum, you have a chance of getting someone into therapy.”

Good advice, I thought, for a person looking for therapeutic massage. But as a therapist, I felt pretty uncomfortable. Rarely, I have had great massages from people with little education or experience. But the norm is I get a bad massage from someone who has no idea what they are doing.

It is very controversial in our field. Is a great relaxation massage at a resort not therapeutic? Is a highly trained therapist capable of being clueless? What about those folks who chant and tap in to the energy of the universe? Are their skills just different?

The answer, I think, is client by client. If clients want a massage therapist to focus on their scoliosis, they need to find someone they believe will help them. Oh heavens, I’ve said the famous “good fit” cliché.

Clichés, however, tend to be a bit truthful. “Finding a massage therapist is like finding a dentist,” I told her. “You can do all the research, look at qualifications, get referrals, but you won’t know if you like them until you are sitting in that chair.”

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Parking Stones

Tailbone problems plague people – and massage therapists. The worst is the sideways curl, keeping hips, feet, lumbar vertebrae and cervical vertebrae all a-twist.

This massage therapist finds a lot of trouble in tailbones. They are really supposed to flex a bit when sitting, guide and balance while walking or running. Too may of my clients have stuckee tailbones, drifting off and away and leaving clients with everything from migraines to crabby personalities?

Oh my, I had a good one the other day. The rest of this client’s spine has been a challenge of momentous proportions. I have chased every symptom up and down the row and always been perplexed by this tailbone. It dips out and in. This tailbone defies gentle suggestion, firm guidance and repeated nudging.

It has been a full-court offense for this client. Weekly massages and regular adjustments, acupuncture and daily yoga. She has had coccyx cushions, ice packs, warm packs, you name it.

Funny thing happened the other day.

The client was doing the breathy hatha yoga, trying to open the diaphragm and get the energy moving. In the middle of the pose, her tailbone adjusted itself with a “POP!”

“It was really loud,” she said. “I didn’t move for a few minutes. I wasn’t sure what happened.”

Well the pop heard round the block didn’t hurt, and now she is walking a lot better. My turn to ask: Do you remember hurting the tailbone?

Well she did, and funny thing was, she didn’t remember it until she popped. She was in a parking lot, age 12, and had tripped backwards over a parking stone and landed squarely on her tailbone. She saw stars and couldn’t move. The area hurt for a really long time and she never had it looked at because she was embarrassed.

Somehow that tailbone wasn’t broken, but it had been in a bad way for a very long time. And probably it was annoying the heck out of her spine every time she sat down.

“I think that pop was a good sign,” I told her.

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Adventures in Super-Mobile Massage

Nothing makes fear quake in many massage therapists than the entrance of the super, hyper-mobile client. I too, have experienced the fear, the trepidation and the surprise.

For the record, in Gumby folk symptoms of troubles are completely different than my true forte, people as stuck as me. What I would normally assess test with simple range of motion, these folks will cruise through with exceeding ranges. All orthopedic-based tests are useless. Symptoms are backwards, upside down and inside-out of normal trigger point problems.

The needle is not in the haystack. It may be on the next farm.

As much fun as working with ballerinas and gymnasts may be in terms of their fearlessness, I need a lie-down after they leave.

My latest venture involved a very athletic, very hyper-mobile volleyball player. Good heavens. The assessment symptom was a “cord” pulling the shoulder blade. Normally I would run to the rhomboids or the serratus, but oh no, here was a subscapularis that knew no bounds. She can do anything with these shoulders. They just hurt.

I figured out the problem by following my nose. What do volleyball players do a lot? Hit the ball. Hopefully with hands or forearms. It had to be subscap. Or I am going back to school to take auto mechanics.

And it was a subscapularis of epic proportions. Adhesed and anaerobic yet mobile. Gentle cross-fiber yielded whimpers, adding slow motion got a scream. Would I ever see this client again?

A week later she came back, admitting she wanted to kill me for the first two days and then she felt better. Oh good.

Then my next mobile-as-heck client came in. No sports, no exercise to speak of, just one horrible accident years ago with some seat belt bruising. “I feel like I have a cord pulling my shoulder,” she said.

Hey, it worked once. Gentle cross fiber. Motion added. “That hurts but it seems to be fixing it,” she said. Thank you, patron saint of the hyper mobile for the inspiration. I hope the ballet is not in town next week.

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How Massage Therapy can Benefit a Mesothelioma Patient

Mesothelioma patients experience a number of symptoms throughout the progression of their disease. Chest pain, difficulty breathing and anxiety are common, and coughing or reduced chest expansion may also occur. While a number of different treatmentscan help relieve these symptoms, massage therapy is one of the gentlest ways to keep them under control.

Massage therapy is considered a palliative mesothelioma therapy. Although it cannot cure the cancer, it is one of the effective therapies for the management of mesothelioma symptoms.

Therapeutic Massage for Mesothelioma Pain

Pain is one of the most intense mesothelioma symptoms, but it is also one of the symptoms that is most responsive to massage. Mesothelioma pain is often dull and located in the chest. As the cancer spreads, the pain can also spread to nearby parts of the body such as the upper shoulders. Depending on the location of the pain, gentle stimulation of certain pressure points can provide a great deal of relief. Some of the pressure points that can provide the most benefits for mesothelioma patients include:

· Central Treasury pressure point (for chest pain)
· Serratus Posterior muscles (for chest pain)
· Thoracic Paraspinal muscles (for a stiff spine and reduced movement in the chest)

To help prevent causing any additional pain, a trained massage therapist will avoid directly stimulating any areas of the body that are already tender from tumor growth.

Therapeutic Massage for Other Mesothelioma Symptoms

Therapeutic massage may also be able to improve breathing by relaxing the muscles along the back and the chest. Stimulating the Heavenly Rejuvenation point – located between the shoulders – can help boost lung function. Massaging the deep muscles of the back can also help reduce sharp pains that occur during breathing.

Additionally, massage can release stress and promote relaxation. Points such as the Heavenly Pillar below the skull and the Inner Gate on the arm are related to anxiety; stimulating these points can help release nervousness. Stress-related insomnia and fatigue may also be relieved by stimulating the Sea of Vitality pressure point.

Author bio: Faith Franz is a writer for the Mesothelioma Center. She combines her interests in whole-body health and medical research to educate the mesothelioma community about the newest developments in cancer care.

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