Hello to all of you who are following my blog! I really appreciate the support and I am happy that my posts and articles have been helpful to you. For 2016, I am simplifying my writing life and choosing one … Continue reading
Women are consistently told to “do your kegels” and how they are beneficial for the proper function of the pelvic floor. Well even through my 3 pregnancies and beyond, I don’t always remember to do them. Here is a great article by Nicole … Continue reading
This article comes after a colleague and friend was in a car accident recently. Her car was hit from the side which is one of the most dangerous of impacts. Don’t get me wrong, all impacts do their own damage on the soft tissue of the body whether it is a car accident, football tackle or fall. However, side or lateral impacts wreak havoc on the body when left untreated, or worse, when treated incorrectly.
For a massage therapist treating a client with recent muscle strain, it is important to initially let the specific area of the strain heal and rest. R.I.C.E. Rest Ice Compression Elevation is always a good option. A massage therapist SHOULD NOT massage an over-lengthened and aggravated muscle strain!!
This may sound like common sense but so often in the massage therapy world a client will complain of specific pain and convince the massage therapist to rub on it. Plenty of therapists out of fear of losing a client will oblige and inevitably lose the client anyway when the massage doesn’t “work” and the client still has the pain or ends up with even more pain. So before you go into hiding and immobilize yourself for fear of making your pain worse I must tell you that there is hope…there are massage therapists out there that have the knowledge and experience to work with clients with recent trauma or injury.
Though it is difficult to generalize with so many different body types and body history out there, I would like to touch on proper massage therapy treatment for those who have had recent impact trauma. The main thing to remember is that there are more areas (soft tissue) of your body affected by impact than you realize. There will be pain and swelling in specific muscle strain and tear points, but there are also compensation and protective reflexes in the functional muscle chain that need to be addressed. So in the case of a side impact, one side of the neck will most likely be over-lengthened and strained while the other side will lock itself short as a protective reaction. Just as when you are startled by someone jumping out at you, your muscles “flinch” in reaction.
This is where as a massage therapist, it is important to leave the strained muscles alone to heal but to gently unlock the reacting muscles on the opposite side. With a proper assessment, a massage therapist can follow the functional lines away from the acute injury site and help relieve pain from the outside in so to speak.
For those of you who read my blog or know me at all, I have a fascination with fascia. It is fascia and it’s connective functional lines that contribute greatly to muscle pain and dysfunction. And when there is trauma or impact on the body, the whole fascial web is affected. Therefore, a massage therapist can never go wrong by giving initial treatment at the most distal (furthest away) points of the body and then working slowly towards the injury points in a functional manner.
As a client, it is important to know the difference between successful massage therapy and unsuccessful. The best way I know to describe this is to say that if you keep going to get bodywork for muscle pain in the same location time after time, then your massage therapist is working in the wrong areas. Especially for chronic pain, the squeaky wheel should NOT always get the grease. Most often, the root cause of chronic pain is from muscle imbalance and dysfunction elsewhere in the body.
If you have recently been injured or are dealing with chronic pain and would like to find a qualified massage therapist in your area, please contact me or check one of the links below.
Understanding Your Fascia
Fascia may be the missing piece for your lingering injury
By Julia Lucas As featured in the June 2011 issue of Running Times Magazine
You’ve got this injury you just can’t shake. You take time off. You ice and stretch and do all the right things but you’re still limping home. You spend too much time trying to articulate your particular brand of hurt to those loved ones who still put up with you. You follow referrals to physical therapists and massage therapists and you’d go to an aromatherapist if it’d help you run again, but nothing does. You diagnose yourself on WebMD: You’re a structurally flawed human being for whom recovery is impossible.
DON’T GIVE UP YET
The answer may be right under your fingertips. About 2mm under your fingertips, to be precise. Under your skin, encasing your body and webbing its way through your insides like spider webs, is fascia. Fascia is made up primarily of densely packed collagen fibers that create a full body system of sheets, chords and bags that wrap, divide and permeate every one of your muscles, bones, nerves, blood vessels and organs. Every bit of you is encased in it. You’re protected by fascia, connected by fascia and kept in taut human shape by fascia.
Why didn’t anyone mention fascia earlier? Because not many people know that much about it. Fascia’s messy stuff. It’s hard to study. It’s so expansive and intertwined it resists the medical standard of being cut up and named for textbook illustrations. Besides that, its function is tricky, more subtle than that of the other systems. For the majority of medical history it’s been assumed that bones were our frame, muscles the motor, and fascia just packaging.
In fact, the convention in med-school dissections has been to remove as much of the fascia as possible in order to see what was underneath, the important stuff. That framed Illustration hanging in your doctor’s office of the red-muscled, wide-eyed human body is a body with its fascia cut away; it’s not what you look like inside, but it’s a lot neater and easier to study and it’s the way doctors have long been taught to look at you. Until recently, that is.
In 2007 the first international Fascia Research Congress, held at Harvard Medical School, brought about a new demand for attention to the fascial system. Since then fascia has been repeatedly referred to as the “Cinderella Story” of the anatomy world, speaking both to its intrigue and the geekiness of those who study it. While you may not share the medical and bodywork communities’ excitement over mechanotransduction and the contractile properties of myofibroblasts, think of it this way: Fascia is a major player in every movement you make and every injury you’ve ever had, but until five years ago nobody paid it any attention. And now they’re making up for lost time.
What exactly does it do? It wraps around each of your individual internal parts, keeping them separate and allowing them to slide easily with your movements. It’s strong, slippery and wet. It creates a sheath around each muscle; because it’s stiffer, it resists over-stretching and acts like an anatomical emergency break. It connects your organs to your ribs to your muscles and all your bones to each other. It structures your insides in a feat of engineering, balancing stressors and counter-stressors to create a mobile, flexible and resilient body unit. It generally keeps you from being a big, bone-filled blob.
“Fascia is the missing element in the movement/stability equation,” says Tom Myers, author of the acclaimed book Anatomy Trains. Myers was among the first medical professionals to challenge the field’s ignorance of fascia in the human body. He has long argued for a more holistic treatment, with a focus on the fascia as an unappreciated overseer. “While every anatomy lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing. The ‘illusion’ of separate muscles is created by the anatomist’s scalpel, dividing tissues along the planes of fascia. This reductive process should not blind us to the reality of the unifying whole.”
BUT, THAT’S THE OLD NEWS
What rocked the medical community’s world was this: Fascia isn’t just plastic wrap. Fascia can contract and feel and impact the way you move. It’s our richest sense organ, it possess the ability to contract independently of the muscles it surrounds and it responds to stress without your conscious command. That’s a big deal. It means that fascia is impacting your movements, for better or worse. It means that this stuff massage therapists and physical therapists and orthopedists have right at their fingertips is the missing variable, the one they’ve been looking for.
WHAT DOES THIS HAVE TO DO WITH YOU?
Grab hold of the collar of your shirt and give it a little tug. Your whole shirt responds, right? Your collar pulls into the back of your neck. The tail of your shirt inches up the small of your back. Your sleeves move up your forearms. Then it falls back into place. That’s a bit like fascia. It fits like a giant, body-hugging T-shirt over your whole body, from the top of your head to the tips of your toes and crisscrossing back and forth and through and back again. You can’t move just one piece of it, and you can’t make a move without bringing it along. Now, pull the collar of your shirt again, only this time, hold onto it for eight hours. That’s about the time you spend leaning forward over a desk or computer or steering wheel, right? Now, pull it 2,500 times. That’s about how many steps you’d take on a half-hour run. Your shirt probably isn’t looking too good at this point. Fortunately, your fascia is tougher than your shirt is, and it has infinitely more self-healing properties. In its healthy state it’s smooth and supple and slides easily, allowing you to move and stretch to your full length in any direction, always returning back to its normal state. Unfortunately, it’s very unlikely that your fascia maintains its optimal flexibility, shape or texture. Lack of activity will cement the once-supple fibers into place. Chronic stress causes the fibers to thicken in an attempt to protect the underlying muscle. Poor posture and lack of flexibility and repetitive movements pull the fascia into ingrained patterns. Adhesions form within the stuck and damaged fibers like snags in a sweater, and once they’ve formed they’re hard to get rid of. And, remember, it’s everywhere. This webbing is so continuous that If your doctor’s office were to add a poster of your true human anatomy, including its fascia, fascia is all you’d see. Thick and white in places like your IT band and plantar fascia, less than 1mm and nearly transparent on your eyelids. And within all that fascia you have adhesions and areas of rigidity. You likely have lots of them. But, this isn’t bad news. Every bit of the damage you’ve caused your fascia is reversible, and every one of the problems it’s caused you were avoidable. You take care of your muscles with stretching and foam rolling and massage. You take care of your bones with diet and restraint. You never knew that you needed to take care of your fascia, but now you do. You may just shake that nagging injury after all.
How to Care for Your Fascia
MOVE IT OR LOSE IT: Sticky adhesions form between fascial surfaces that aren’t regularly moved, and over time these adhesions get strong enough to inhibit range of motion. Take a few minutes first thing in the morning to roll around in bed and really stretch out, head to toe, just like a cat after a nap.
STAY LUBRICATED: Just like every other tissue in your body, your fascia is made of water. It works better, moves better and feels better when it’s wet. So, drink!
STRETCH YOUR MUSCLES: When your muscles are chronically tight the surrounding fascia tightens along with them. Over time the fascia becomes rigid, compressing the muscles and the nerves.
STRETCH YOUR FASCIA: Once your fascia has tightened up, it doesn’t want to let go. Because the fascia can withstand up to 2,000 pounds of pressure per square inch, you’re not going to force your way through, so stretch gently. Fascia also works in slower cycles than muscles do, both contracting and stretching more slowly. To stretch the fascia, hold gentle stretches for three to five minutes, relaxing into a hold.
RELAX! If you spend all day tense and tight at a desk, ice baths may not be the best thing for you. Fifteen to 20 minutes in a warm Epsom salt bath can coax tight fascia to loosen up, releasing your muscles from their stranglehold. Make sure to follow it up with 10 minutes of light activity to keep blood from pooling in your muscles.
USE A FOAM ROLLER: Like stretching, using a foam roller on your fascia is different than on your muscles. Be gentle and slow in your movements, and when you find an area of tension hold sustained pressure for three to five minutes. You may practice self-massage with the same rules.
RESPECT YOUR BODY: If you’re attempting to run through an injury, or returning from one with a limp, beware: Your fascia will respond to your new mechanics and, eventually, even after your injury is gone, you may maintain that same movement pattern. That’s a recipe for an injury cycle. It’s better to take some extra time than to set yourself up for long-term trouble.
SEE A FASCIAL SPECIALIST: If you have a nagging injury, or just don’t feel right lately, see if your area has a fascial or myofascial therapy specialist. There are different philosophies and methods, ranging from Rolfing, which is very aggressive, to fascial unwinding, which is very gentle. Some methods are similar to massage, while others concentrate on long assisted stretches. Talk to the therapist to see what you need and want. Some osteopaths, chiropractors, physical therapists and massage therapists are beginning to embrace fascial therapies, so ask around.
SEE A MOVEMENT EDUCATION THERAPIST: The Alexander Technique and the Feldenkrais Method are the two best known of this sort of therapy, long embraced by dancers and gymnasts. They use verbal cues, light touch and simple exercises to lessen unconscious destructive movement patterns that may be irritating your fascia.
Many of you now realize the poor effects that sitting at a desk has on your body. It’s a good thing that there are many options now available. Unfortunately, some of them (like a stand-up desk or treadmill desk) are quite expensive…not to mention dangerous for folks like me shouldn’t multitask to that degree.
I have posted previously on how the psoas muscle is shortened while seated and how it is important to stand up whenever possible in order to prevent it from locking short and creating back pain. Here is an easy option for those of you spending too much time in front of a screen.
Kneeling is an option to open the hip joint and still work at your computer. Now I’m sure I am not the only person who has taken over the dining room table as their home office but you can do this at most desks as well. I use a box to raise my laptop when I use the BOSU to kneel on, but you may also kneel on a folded blanket or towel to pad your knees.
This is VERY different for your body so it is best to start this in short bouts, around 15-20 minutes at a time. Eventually, your body will get used to the change and you can use it as long as your knees can tolerate it. I am also a big fan of using a fit ball as a chair to incorporate some pelvic motion throughout your day.
Feel free to share your creative options for getting your computer work done!
There is hope for anyone with chronic pain from being a Desk Jockey, finding professionals in the field of chronic pain relief and physical therapy is possible.
For those of you who would like to take a more proactive approach, please check out Balance Biomechanics and talk to your Human Resources Manager in order to bring in professionals to teach the whole office about their bodies and preventing chronic pain!
Here is another great article written by someone who suffers back pain himself.
Try this stretch if you have mild to moderate lower back pain. But BE CAREFUL!
Muscle of the Monday: LATISSIMUS DORSI or “Lats”
Chronic Pain Connections: Weak Latissimus Dorsi, or Lats with tissue adhesions, most often play a role in chronic Shoulder pain but it may also contribute to Elbow, Wrist, and/or Hip pain.
Primary Actions: Extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.
Favorite Exercises: For Strength – Chin-ups and Pull-ups. For Stability – Plank Hold, Side Plank, Reverse Table Top.
I have ran into many questions lately regarding c-section scars and the ability for women to get back to a flat belly. But it’s not all about a flat belly! I tend to ask further questions on if they are having any pain or pulling in their abdomen or low back as it may be a sign of adhesions from the scar tissue. Often, by working on myofascial adhesions and correcting muscle function, women find they are able to use all layers of the abdominal muscles with greater function which in turn may create a flatter belly as a side effect.
Here is an amazing article describing the importance of massaging your c-section scar whether right after surgery or years later.
I have been doing this on myself for nearly 6 years (since my daughter was born) and I also work with my massage therapy clients with past c-sections as well. Please feel free to contact me with any questions. With more involved cases I suggest doing a search in your area for a Massage Therapist specialized in Myofascial Massage or Maya Abdominal Massage.
This article can be found at pregnancy.org here.
Massage Your C-Section Scar
by Lynn Leech
Much of the recovery process after a c-section birth feels out of your control. Really, other than “taking it easy,” patients are given little information on how they can help avoid painful issues down the road. However, despite getting very little press from physicians or other resources, there is one simple activity that can aid in both your recovery and long term prognosis — massaging your surgical scar.
When Should You Begin Massaging Your Scar?
Once you get the okay from your doctor that your scar is well healed, usually at your six-week check up, you will want to begin massaging your surgical scar. Beginning sooner may slow the healing process and is not advised. After you have clearance, however, don’t delay to garner maximum benefits! Also note, whether it has been months or even years since your c-section, it isn’t too late to achieve improvements. Trust, this is worth your time to learn more.
Why Should You Massage Your Surgical Scar?
When scar tissue forms it lays its fibers down very haphazardly in all different directions. It also may adhere to tissues you don’t want it to, mainly the fascia and organs. The fascia is a band of connective tissues covering or binding together parts of the body, such as muscles or organs.
In the abdomen it can cause adhesions. Adhesions are bands of scar tissue that bind together body parts that are normally unconnected. Any tissue it comes into contact with may stick to it. With c-sections it’s very common to have an adhesion on your colon, ovary or between your bladder and uterus. Think of these fibers as a tangled mess of yarn that has bounced around your room, wrapped around everything but where it should be! Scar tissue needs to be shown how to lie down properly.
The “training method?” Massage your surgical scar!
What Happens If I Don’t Massage My Scar?
Many women were never told to massage their surgical incision. “Healing” instructions are often limited to the outer appearance — to avoid redness, watch for signs of infection, etc. Years down the road these same women may endure numerous medical concerns. Without having a more in-depth physical exam, they may not even associate it with their previous c-section.
The most common issue is lower back and pelvic pain. The scar tissue adheres to all the tissues directly in front of the sacrum. The sacrum is the triangular bone located at the base of your spine that joins to a hip bone on each side and forms part of the pelvis. The sacrum needs to be able to bend forward and backwards with all of our movements.
There is fascia that runs from the pubic bone around the bladder, uterus and colon and attaches back to the sacrum. There is also an uterosacral ligament, (another major ligament of the uterus), that can get tight from scar tissue that inhibits the sacrum from moving as freely as it needs to when we bend, twist and walk. This restricted tissue mobility causes limited sacral mobility and is what leads to low back pain. In layman’s terms: Ouch!
C-section scarring can cause frequency of urination. Unbelievably, this symptom can delay until 10 to 15 years after your surgery! You will find yourself feeling like you have to pee every 15-20 minutes, even though you just urinated. Relatively young women may be horrified at this loss of bladder control and stressed by their need to either stay within a fast dash to the toilet or wear Depends™.
So what’s happening? The scar tissue from your surgical incision in the lower abdomen is inhibiting the bladder from expanding fully. Once the bladder tries to expand and it hits the scar tissue it sends a signal up to the brain telling it you need to empty your bladder. The more scar tissue you have, the less the bladder can expand, and the more you will have to go, go, go!
Don’t give up hope! This isn’t like that extensive exercise routine that you can’t seem to become motivated to do. A few minutes of effort on your part of good scar tissue release work will have you back to urinating normally, which is every two to three hours.
Two of the most painful difficulties scar tissue creates are pelvic pain and pain with intercourse. Adhesion on the organs in the pelvis generates tremendous pain. Our organs are very sensitive structures. When their mobility is limited, pain is inevitable. With intercourse the uterus needs to move superiorly out of the way. If scar tissue inhibits this motion, deep thrusting during intercourse can be downright agonizing. This often leads to almost complete avoidance which is likely to cause a strain on the best of relationships for both parties involved.
Infertility issues: Finally, of grave concern to those desiring more children in the future, they may discover that these adhesions have produced infertility issues. Hopes are often dashed on providing a sibling without surgical intervention that may or may not work.
While massaging your c-section scar may not prevent all instances of these issues, it is shown to lessen the risks and/or impact of these matters for your future health in both long and short term! In other words, what are you waiting for?
How does massaging Your Scar Tissue Work?
When you massage your scar you help the scar tissues learn where to lie down and relieve it from growing in unwanted places like on the fascia and surrounding organs. Massage can facilitate increased blood flow, which is beneficial for healing the area. Massage aids in smoothing out thick scars and can help stop the scar from growing larger during the initial phase of healing.
A scar heals in two phases. The first phase, immature, the scar has just initially formed and healed together. During this phase the scar can be itchy, painful or sensitive as the nerve endings within the tissue heal. While the scar will look red initially, it eventually will fade to normal flesh color with maturation. You can get the most effect with exercise, massage and heat application during this phase.
The second phase is a mature scar. With c-sections, scar tissue can form for up to two years. When scar tissue is no longer being produced then the scar is considered mature. At this point, massaging is still beneficial but requires a more disciplined and vigorous approach. Remember, it is never too late to gain some benefit from massaging your surgical scar!
What is the Best Way to Massage Your Surgical Scar?
As soon as the scar is no longer open and considered well healed you can begin gentle massaging. While the scar is in its immature phase you will want to take a mild approach when massaging. Initially the scar may be really tender, red and painful. In this stage it may be best to work around the scar, focusing on the tissues immediately above and below it. As the scar becomes less sensitive you can follow this procedure with your fingers on top of the scar.
Place your fingertips so the pads of your fingers lay just above your scar line. You will want to think of the abdomen as having three layers, though there are many more but we are simplifying things here.
The first layer is the superficial skin. You lightly put your fingers on the skin and see how mobile the skin is in moving up and down and side to side. Think about placing your fingers on a keyboard and you’re checking to see if all the keys move equally in all directions.
Work in the direction of resistance. You may feel it moves down more than it does up so you will want to work more in the upward direction to regain movement in that area. Does it move easier to one side than the other? If so, work more in the direction of resistance, taking the skin till you feel a gentle stretching in the tissue. Hold it there until you feel a release or the tissues melting.
To recap, the movements you want to do are up, down, side to side and also little circles. Start by working the tissues around the scar and, in time, progress to doing it on top of the scar as your pain and tenderness allows. Eventually you will want to be able to roll the scar between your fingertips.
The second layer just below the skin is the muscular layer. Allow your fingers to melt deeper into your abdomen where you feel the abdominal muscles. Check to see how this layer of the tissues moves. Does one side move less than the other side?
I usually find one end of the scar is more restricted than the other side. My theory, which I haven’t proven yet, is the more restricted side is the side the surgeon stood on during the operation. Does that hold true for you?
Repeat the same movements as with the skin — up, down, side to side, and circles. Once again, you want to do it all around the scar and even on top of the scar as pain/tenderness allows.
Feel free to work the entire lower abdomen. Adhesions can form way over on the colon located near your hipbones.
Once more, if you feel an area or direction that doesn’t move very well, encourage in that direction. Gently take the tissues to where they don’t want to go and carefully hold them there. You may feel a slight burning sensation, which is normal for stretching tissues. Hold the tissue at their end range of motion until you feel a softening or melting of the tissues. That is scar tissue releasing. It feels like butter melting under your fingertips.
If you work respectfully with your tissues, not forcing but encouraging the tissue to have more freedom of movement, you can attain that release or melting feeling. Avoid forcing, as the tissue may fight back and never release.
The third layer is the deepest layer working down at the organ level. Right below your scar line lies the small intestines where it rests on top of the uterus and bladder. The bladder sits right behind the pubic bone; the uterus behind and a little up from there.
To reach this level you need to be lying down with your knees bent up to allow the lower abdominal tissues to slacken. This lets your fingers dive deeper into the tissues and abdominal cavity. Not only do you want to do this massaging at your scar level but also lower near the pubic bone, you want to sink below the muscles and see if you can move these deeper tissues side to side and up and down.
This deeper level needs to be released to ensure you don’t develop low back pain or frequency of urination in years to come. Make sure one side feels as mobile as the other side. If it does not, focus your attention to increase mobility in the area of most resistance until you can’t move it any further. Gently hold this position until you feel the tissues melting and releasing under your fingers. Continue to recheck the tissues mobility and see if it matches from side to side.
How Long Do I Need to Continue Scar Massaging?
Initially, massage regularly until your tissues are freely moving in all directions within all three layers. Once you’ve achieved that mobility you will want to check in with the area every so often, whether it’s every other week to once a month for the first year or two after your surgery. If you find the tissues getting tight again return to a more regular massaging routine.
Whether your c-section scar is new, several months, or years old, performing this massage can help you avoid problems down the road. It may sound like a lot of work but spending just five minutes a day can do great things in releasing scar tissue and increasing mobility in your lower abdomen. If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should seek out a Women’s Health physical therapist for treatment.
Lynn Leech is a physical therapist with nearly 20 years of experience. She specializes in Women’s Health and Visceral Manipulation. If you’d like to talk to her about your issue or set up an appointment on her website.
Copyright © Lynn Leech. Permission to republish granted to Pregnancy.org.
What are we doing to our posture?
In this day and age of such wonderful hand-held technology we are de-volving our upright postures.
In a past post I have described why Sitting is the New Smoking and how sitting for long periods greatly affects body function and chronic pain. This postural problem is now reinventing itself with our youth and their use of smart phones, ipads, and other hand-held devices. Next time you are in a crowd of people, let alone teens & kids, take a look around at those using their smart phones. Are their heads on their shoulders? I doubt it, I’ve been guilty myself.
It is known that the weight of the human adult head is apporximately 12 pounds and it isn’t much less for kids. The postural kicker is that the strain on the neck and upper back muscles exponentially increases with each inch the head moves forward off the shoulders where is was designed to be. (See Figure A). With this forward head posture it begins to lengthen and “lock long” the muscles on the back of the neck and upper back and the muscles on the front of the neck and shoulders as well as the chest.
This posture is not new to any student out there sitting in classrooms and studying for most hours of the day, however with the addition of hand-held phones and tablets there is no longer a break for the body to work on bringing the spine back upright. Eventually, symptoms that begin with a stiff neck end up evolving into a variety of complex problems like numbness in the arms and hands, migraine
headaches, and even breathing problems.
The best solution for this is to avoid a head forward posture as much as possible. However, other solutions include:
Laying flat on the floor without a pillow to change the pull of gravity on the spine
Cable Rows in the gym to strengthen the upper back muscles that are over-stretched
Stretching and/or massage therapy on the chest and front of the neck to help unlock and lengthen those muscles
Do your best to be preventive and be more aware of your posture. Are you slouching right now? Hunching over a smart phone?