Massage Therapy and Pain (Continued)

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Massage Therapy and Pain (Continued)

FullSizeRender (1)Massage Therapy and Pain

Working with Clients in the Pain Zone

This is a continuation of the last pain blog which offered some history on pain science and also some really general guidelines on massage therapy and pain.

If your client has no red flags in assessment and you have decided it is safe to touch, working with clients experiencing chronic pain not associated with an injury has its own challenges. For many people, pain has the distinct effect of stopping us from moving, regardless of its cause, and so getting your client back to a place where they feel that they can move can be considered a success. To work safely as a massage therapist with an understanding of this, you are going to want to switch from the treatment model where massage is passively received by a client into one where the client has full control of the experience, both physically and mentally.

First lets look at the physical aspects of a client having control

This can be challenging, especially considering that most massage therapy programs teach massage as a passive activity that is ‘done’ to the client. In this role the massage therapist acts more as a facilitator to touch. Consider that touch is not a one way experience and that every time you gently “rub” a muscle, you also have the ability to instead have that muscle and skin move gently under/against you. If someone is in pain, you have the option of saying “I am going to gently put my hand here on your back, why don’t you try breathing up into that feeling”, or “I will never press harder, why don’t you try pressing gently into me?”, or “I am going to hold your arm gently, why don’t you just tense the muscle a little and then relax or wiggle your fingers?”. There should be a direct relationship to the amount of pain present and the amount of control the client has. The more pain present, the more the patient should be in control of what is happening.

This does 3 things in my opinion:

1. Lowers the anxiety associated with treatment, and the anticipation of pain, and possibly dropping their pain level.
2. Facilitates change in the body by signaling normal function and behavior as the patient moves.
3.Protects you the therapist from stepping over a boundary. If the client has control, they only go as far as they want, and no further. 

I want to be clear that if you are using this kind of treatment with someone who is in pain, you never want to cause pain. Their may be pain associated with the treatment, but it should not be from a new stimulus you are providing, such as pressure or forced movement. The pain associated with treatments of this nature should be caused by a patient moving through their own pain signal. What does that mean? It means that if someone has had long standing neck pain, and they are completely cleared for treatments, with no red flags, you should never aggressively treat with traditional deep massage. Instead I should gently guide the person to the edge of their painful experience and create a safe, controlled, comfortable setting in which they can explore going further-if they choose to do so. If the feeling of pain does not abate, you should, discontinue and refer out, but often reducing the anticipation of pain and giving the client control is the first step in the pain management in Massage Therapy.

How do you do it?

It all sounds pretty simple-give the client the control and they might get past their pain, but its actually a bit more complicated than that, because you don’t want to be randomly trying techniques. I divide my techniques up into graded categories to help me organize the treatments.

  • Low pain– resisted eccentric/concentric contractions and dynamic stabilization, and holding the tissues muscle while the muscle moves beneath
  • Medium pain– gentle active resisted techniques, holding the skin while the muscle moves underneath, simple isolated muscle movements
  • Higher intensity pain– tense and relax exercises for muscles or groups of muscles, breathing exercises that activate accessory breathing muscles

You will notice the different categories of pain could also be explained as acute, sub acute, chronic, or you could use a pain scale to divide them up. The important thing is that you know where you with the person you are treating. I use LP, MP and HP for short hand charting proposes. Lets look again at that client with the neck pain so we can get a better idea of the application of these techniques for the different pain categories.

Lets look at some examples to make things clearer

Client with HP  neck –  This client is afraid to move and has pain on movement of any aspect of cervical spine or upper thoracic, with a history of whiplash. Does not go about normal activities.

Treatment– Is a gentle skin deep gliding massage. The goal is just to get used to the client getting used to touch. Once the client is relaxed we are going to begin graded breathing exercises to see if we can get them to reduce the bracing in the accessory breathing muscles. I isolate a muscle by gently touching it and say “can you make this expand and contract by moving air?” We go though each and every muscle that would be effected by breathing. Then we switch to tense relax and do the same. Isolate the muscle, or muscle group by gently touching it, ask the client to control it by tensing up and then relaxing. I finish by going back to very gentle surface treatment of gliding massage.

Client with MP neck -Client has some movement but feels very limited by their pain. Range of motion is reduced to about half, and some of the ranges are less quality than others. Goes about normal activities but has stopped participating in any sports or anything unnecessary to their day.

Treatment– General massage with light to medium pressure. Once the client is comfortable I begin holding isolated areas skin in areas of pain and asking the client to gently pull away from me. If the client experiences pain we go back to the above treatment. We reverse the technique and this time I isolate muscles and have the client push into me (essentially bowing the muscle) If the clients pain level keeps dropping we then move to full simple isolated muscle movements. I hold the muscle and they run though a full rang of motion. (Video example of type of activity)I often do this by saying “ok now try to squish my fingers with your neck”. I correct any movement where they are recruiting another unnecessary muscle to complete the movement or avoid moving through the whole range. At the end of the treatment we return to gentle massage.

Client with LP neck-This client has pretty much full range of motion, but experiences pain at the end range. In their words “I just feel I can’t get past the final stage of the injury”. They are going about their daily lives, and participating in sports with occasional flairs. (this is the client you should most often be treating and seeing unless you are an advanced practitioner)

Treatment–  A general massage with light to medium pressure. You can use any of the above mentioned techniques to warm the tissues. As the treatment progresses, I move to holding the muscles firmly while they go through a range of motion. If no pain is present I ask the client to gently resist the movement for the selected muscle. (Video example of activity)If still no pain is present, I ask the client to resist with movement and move on to eccentric concentric moments. All of these activities are still gentle (the client need only meet you with enough force to activate the muscle)We end the treatment with the same general massage. If at any point the pain or the tone of the muscle rises, we go back to a previous treatment plan.


But we have gotten ahead of ourselves…before you can do any of this cool stuff, you have to talk to your client about exactly what you will be doing with them and why you think it is the best choice!!!! And that’s exactly what we will go over next time.

Strength & Conditioning for the Cyclist


By Ivan Garay LMT/CPT

Strength training can improve a cyclist’s performance and protect against injuries. Research on endurance athletes shows that strength training improves the three most important predictors of endurance sports performance[1]: economy (the ability to do a certain amount of work using as small amount of energy as possible), velocity/power at maximal oxygen uptake (How fast you can pedal on your endurance races), and velocity at maximal anaerobic running threshold (How fast you can sprint before burning out at top speed).

When designing a strength training program.You must first focus on correcting any imbalances in posture and movement patterns. The prolonged bent over position on the bicycle and miles of pedaling create common muscle imbalances in cyclist. They include tight/shortened muscles, the calves, psoas, quadriceps, hamstrings, lumbar spine, pectorals, upper trapezius, and neck flexor muscles. Along with these shortened muscles,there are weak/lengthened muscles, the tibialis anterior, gluteus maximus, abdominals, rhomboids, middle and lower trapezius, and neck extensor muscles.

Below is a sample routine that will balance muscles and improve cyclers posture:

First release tight muscles with foam rolling or active stretching:
Calves, psoas, quadriceps, hamstrings, lumbar spine, pectorals, upper trapezius, neck flexor muscles.

Follow by strengthening the weak muscles with resistance exercise:

  • Ankle Dorsiflexion with Cable or Tube Resistance
  • Barbell or Dumbbell Deadlift
  • Bridges
  • Dumbbell Rows with Shoulder Blades Squeezed (this exercises will reduce middle and upper back pain and soreness from long rides)
  • Neck Extension in a Quadruped Position (It will reduce neck pain from prolonged forward head position)
  • Planks
  • Side Planks

Brace your abdominals with every exercise. To perform an abdominal brace, pull your bellybutton toward your spine, tighten your abs without moving your body (as if you were about to be punched in the stomach).

Perform each exercise for 2 sets of 12-20 repetitions for muscular endurance.

Current research recommends that to increase cycling performance heavy strength training at maximal velocity[2] should be performed with multiple leg exercises for periods of greater than 6 weeks [3]. During a cycler’s off-season, high volume strength training should be performed two to three times a week and each exercise should be done for two to three sets for four to ten repetitions. You should rest two to three minutes between sets. Maximal results usually occur after an 8-12 week cycle of training. During competitive season your training volume should be reduced to 1 session a week with a lower volume of exercises but with the same high intensity to maintain strength gained from your off-season program[4].

Pick a heavy weight with each exercise and move as fast as you can during the concentric phase (lifting phase) and slow down during the eccentric phase (lowering phase of the exercise).

Off-Season Routine

  • One-Legged Squat
  • Barbell DeadliftDumbbell lunges
  • Standing Calve Raises
  • Barbell Rows
  • Seated Calve Raises
  • Chin-Ups
  • Bench Press
  • Barbell Shoulder Press
  • Dips
  • Dumbbell curls
  • Back Extensions
  • Planks
  • Side Planks

Competitive Season Routine

  • Barbell Front Squat
  • Standing Calve Raises
  • Barbell Rows
  • Bench Press
  • Dips
  • Dumbbell Curls
  • Planks

See Reference Page for article citation

See Reference Page for article citation

See Reference Page for Article citation

See Reference Page for Article citation

Running Season– Treating Plantar Fasciitis

Exercises for Plantar Fasciitis

Plantar Fasciitis is one of the most common foot complaints. Technically what is happening is the plantar fascia is being over stretched or over taxed
Beret Kirkeby, “Treating Plantar Fasciitis”


Exercise for plantar fasciitis should reduce excessive strain on the plantar fascia and correct biomechanical faults that contribute to plantar fasciitis. Common biomechanical faults include over-pronation, flat feet, a tight Achilles tendon (especially from tight soleus muscles), excessive weight, and a high-arched foot. These imbalances are corrected with the right mix of stretching and strengthening exercises that bring the foot and ankle into correct functional alignment and movement. First, a general exercise routine for all people suffering from plantar fasciitis will be explained; followed by corrective exercise routines for specific common biomechanical imbalances.

General Routine

Before discussing targeted corrective exercises, most everyone with plantar fasciitis will benefit from relieving the strain from a tight Achilles tendon.  But because the body works as a whole, it’s important to not only stretch/work the muscle that directly attach to the Achilles tendon, but also the rest of the posterior chain muscles. (please see link for graphic) Treatment would start at the gluteal muscles, hamstrings, and then the calf. The figure below is the posterior chain of muscles that connect to the Achilles tendon. If you are seeking treatment for plantar fasciitis, it is important to note that it it begins in the hips. It is a common misunderstanding that it is the feet causing the issue. While the feet clearly play a role, the focus of treatment is not specifically the feet unless you are utilizing orthotics or working on foot mobility.


Imbalance or dysfunction in any segment of the posterior chain can produce excessive tightening of the Achilles tendon, so it is important to stretch each segment individually first and than end with a full posterior chain stretch like the Downward Dog yoga pose.
The following exercises are recommended in this order:

First, Stretch the Soleus (lower calve)soleus

Second, Stretch the Gastrocniemius (upper calve)

Third, Stretch the Hamstrings
Fourth, Stretch the Erector Spinae

End with the Downward Dog Pose (will also treat the gluteus muscles)

It’s best to use the Active-Isolated Stretching technique on each segment and end with holding the Downward Dog pose for 30-60 seconds. If you are unfamiliar with Active-Isolated Stretching, visit:

Exercises for Specific Biomechanical Faults

To understand biomechanical faults, let’s first look at the walking cycle. In a perfect walking stride, the person’s arch elevator muscles of the leg (tibias anterior, peroneus longus and tibialis posterior) work in perfect harmony with the plantar-flexors (gastric, soleus, etc.) to absorb, distribute and release stored kinetic energy. On heel strike, the arch elevators must fire eccentrically to decelerate and dissipate ground reaction forces via foot pronation and internal tibial rotation.

As the foot transitions from midstance into push-off, the toes begin to dorsiflex causing activation of the plantar fascia and associated muscles.

But if the muscles of the leg and ankle are imbalanced, the forces acting on the foot and ankle are not evenly distributed. This often results in excessive strain to the plantar fascia. Over pronation, a common problem causes excessive strain on the plantar fascia and often leads to flat feet.

Over Pronation and Flat Feet

If you are over pronating your plantar flexor muscles are often stronger and tighter than your arch elevator muscles. The arch elevator muscles of the leg (tibias anterior, peroneus longus and tibialis posterior) need to be strengthened. The following two exercises help to strengthen these weaker muscles.


An elastic band, rubber tubing, or cable machine are all good choices to provide resistance. Start the ankle inversion exercise in neutral and fully invert your foot slowly. Do 3 sets of 20 to 30 reps. The second exercise is for flat feet:


Sit on a chair so that your knees are at an approximate 90-degree angle with your feet on the ground. You’ll need a smooth floor so that the towel will glide easily. Spread the length of the towel in front of you and sit with your back straight and bare foot flat on the edge of the towel. The short end of the towel should be against the legs of the chair. Without moving your heel, contract your toes to bunch up the towel and draw it toward you (as shown) until you have done 2 sets of 10-20 repetitions of toe contractions or run out of towel. As the exercise becomes easier over time, begin adding a light weight to the end of the towel.

Excessive Supination and High Arch


Like the inversion exercise, a Thera-Band, tubing or cable machine will work well. Do 3 sets of 20 to 30 reps and move slowly throughout the range of motion. The second exercise for high arches involves a tennis or golf ball to release the muscles on the plantar surface of the foot.


Place the ball under your foot and move the ball back and forth 20-40 times. Repeat on other foot (Note: roll only on the non-painful part of the arch, if the entire surface of foot is painful, avoid this exercise).

If you have any questions or comments on this topic, make sure to post them on our blog or email us directly.

Fitness information provided by Ivan Garay, a personal trainer. To book an appoinment for personal training, please contact his website:

Why paying for luxuries like massages might actually save you money.

Preventative Care, Body Mechanics

Poor health costs the United States economy $576 billion dollars a year, says the Integrated Benefits Institute. That includes no-shows on the job, as well as when you go in but do not perform your best. If you are pushing papers poor performance might slow you down, but if you are driving a bus it could be disastrous. The CDC reports that 43% of U.S. workers don’t even get sick days, so most of them are going to work whether or not they are sick. Sickness from stress, obesity, and environmental factors are becoming epidemic. It is no secret that heart disease is the number one killer in the United States.

Most of us have a really hard time grasping the cost of $576 billion dollars, and for most of us, an unknown health threat like heart disease seems a distant problem. This kind of health threat is just not close enough to our daily lives to seem real unless a doctor has set us straight with a warning. After all, if we were focusing on the pitfalls around the corner constantly wouldn’t we be at risk for major depression? As part of the workforce most of us are focused on the day-to-day stuff. So let’s break it down to something we can understand, excluding major illnesses and other things that go bump in the night.

The average human, (that means you, more or less) gets between 2-4 colds per year. For each of those colds you will head off and buy an assortment of over-the-counter treatments, such as tissues, cough drops, aspirin, vitamin C and decongestant. We went to the pharmacy and added up some general costs. To grab a reasonably-priced bag of the above items would cost us around $33 each time. Over the course of the year that is $132, not counting unpaid sick days.

If even one of those colds sends you to the doctor’s office which many colds end up doing, you’re shelling out even more of your hard-earned cash. Blue Cross states that the average doctor’s office visit for such a thing costs between $130-$180, not including any prescriptions that are written out of the deal, and that’s just for one visit. So our total for four colds comes to around $312, that’s if only one gets bad enough to see a doc but does not need medication… Seems like a lot doesn’t it? And this does not cover other kinds of illnesses that can rise from a compromised system; this is only the common cold. From cancers to infections, the stronger your immune system is the less at risk you are.

So the question becomes, why are more of us not investing in health care prevention? And what can you do? Well, some of us are, and it turns out, one of the easiest things you can do besides good diet and exercise, is get a massage. Most of us view massages as a luxury, however a study from Cedar Sinai, says differently. (See the study) The study compared subjects who were given ‘light touch’ to subjects who were given Swedish massage by licensed individuals. In the Swedish massage group, the subjects found a decrease in arginine vasopressin (the hormone that regulates blood pressure and water retention and is linked to the stress hormone cortisol) and increase in white blood cell production.

The study suggests that getting a massage has a real and distinct benefit to boosting the immune system on multiple levels. The American Massage Therapy Association says that only 15% of us in (2011) are getting massaged, while 50% of doctors are recommending them. Massage therapy has long been considered a luxury, and when you are opening your pocket book for a day at the spa, or a visit to your local massage therapist, what you should really be thinking is how you are actually investing in your health by boosting your immune system. Too often we are treating illness, which is too little; too late as well as far more costly, when paying for a few massages a year may actually SAVE you money in the long run.

For more information on what massage can do for you, check out our home page or email us at

Do you suffer from Carpal Tunnel? Self care you can do from your desk.

Body Mechanics Orthopedic Massage NYC demonstrates home care for carpal tunnel you can do at your desk, in between visits or at home. The demo covers symptoms, anatomy, stretching and self massage.

Everyone starts some where….

Body Mechanics

Hi and welcome to Body Mechanics Massage New York. Every one has to start some where and this is what we looked like before we opened. Actually, we had been looking for a space for over a year and a half before we settled on the Grand Central location. Turns out shopping for a massage space in New York City can be a little challenging!

We are however thrilled to be in this new location, after working from Bushwick for so long. We do things a little differently here at our location than at some of the other studios in NYC so you might want to take a peek at the rest of the website. We are committed to the practice of orthopedic massage therapy, the owner is a massage therapist, which means that your treatments are guided by someone who knows massage in and out. We consider ourselves and try to conduct ourselves as a medical practice, so even though we are not a doctors office you will find the same level of professionalism here. Another thing that makes us different is we are not a factory of massage, we do not book clients back to back, the goal is not to see as many clients as we can in a day, it is to create a great service with great results. Most of all, we are not just ‘rubbing’ at this location. We are highly trained professionals who will asses you using orthopedic testing and develop a treatment program for you that not only fits into your life but effects it. We are invested in our clients health and chart their progress from day one.

If you want more information on our services please feel free to contact us at

Your Posture Might be Killing You… Really….

(update: We no longer agree with the idea that your posture is bad for you…hey, science changes! But we are keeping this up here to prove that point)


Feel like you have a noose around your neck at the office? Feel like the stress is killing you? That might be exactly the message your sending yourself by nerve transmission. The neck is a complex structure that houses vulnerable and important components that act as the relay between the brain and the organs. While the dome of the scull protects the brain and its fluid within, and the ribs and spine protect the organs and the spinal cord, the neck is surprisingly vulnerable.

The majority of important structures are protected by bone, but 12 pairs of cranial nerves descend from the head and pass through the soft tissue of your neck and flow into your body. The longest of these, Cranial Nerve X or Vagus nerve controls most of your sympathetic nervous system. If you are not a science geek pull out that 8th grade biology and dust it off. The parasympathetic system controls much of your involuntary organ control.

So what exactly does that mean? Specifically what does that mean to you as you sit at your desk reading this??The majority of work these days seems to be computer work. The posture acquired from it is elevated shoulders, chin thrust forward as you scan your screen, eyes squinting, looking for mistakes. In this state, your breathing is naturally shallow as you concentrate, and you switch from a full breath to partial breath, leaving you in a state of chronic hyperventilation. If you were out doors and living wild, this same posture would have you hiding behind a rock, scanning the horizon for prey or enemies. Your body is saying “alert”, possibly danger is behind the next bush, but unless your empty Starbucks cup is out to get you, everything is fine. So why is your posture telling you this? Its all about the Vagus nerve baby. It’s Vagus.

Those anterior neck muscles that have tightened up ( scalenes and SCM) as you peer into the vast wilderness of your pintrest or tumbler screen, are compressing the Vagus nerve. The Vagus nerve in turn tells your breathing to accelerate, your digestion to stop, your metabolism to grind to a halt and your colon to freeze. You have officially entered the state of chronic panic that a lot of us are currently living in, which is the opposite of “rest and digest”. Living is this state is not normal, its meant to save your life not, be your life. Staying in it can lead to long term chronic problems as you can imagine. The short list includes, chronic headaches, dizziness, chronic fatigue, colon problems like ibs or constipation, weight gain, trouble concentrating, hot flushes, irregular heart beat, pain in your neck, and trouble swallowing with dry mouth. Sounds fun huh?

So what can you do? Well for one get up and move. Simply changing your posture has an effect. Try a post-it that reminds you to drop your shoulders, get some exercise, take a break, STRETCH! If you just can’t kick it, you might try getting a massage and let someone stretch it for you, often this is a great solution as you can fully relax, which breaks the cycle of stress. Someone who really knows what their doing as far as massage, can help you reactivate your scalenes as well. If you have a high intensity job, you might just have to commit to a program of your choosing as part of your ongoing health care. Yoga, massage, exercise, and acupuncture can all be beneficial….it does not matter which one you choose…just choose to take care of your self.

For more info there is a great Ted Talks by Amy Cuddly who talks about how posture is connected to your mental state. I have included the link

If you want to go it alone, try this anterior neck stretch and some self massage:

Take your left hand and grab the bottom of your chair and hold on. Lean right, away from the hand that is holding your chair. (your body should now be tilted to one side, away from the anchored hand) put the right hand on top of your head and gently pull it away from the left shoulder. Hold for 30 seconds By raising your chin very slowly and gently you can access the front portion of your neck.

Bloomburg and a Little Canadian Health Care


Today in the Metro there was a brief article about the Mayoral transition, that cited Bloomberg as warning that the next mayor needs to control pensions and health care costs for city workers, or risk pushing the Big Apple towards insolvency like Detroit.

What do you ask does this have to do with massage therapy? And why would I mention it? I worked in Canada for a number of years as part of their OHIP integrated care. Specifically, I was working for Unions and for workman’s comp claimants. The people on my table were not rich folk getting a rub down in the middle of their entitled days. They were factory workers on the line, doing things like boxing products and food management. These were true middle class, salt of the earth folks. I treated everything from tendinitis low back pain, to chronic fatigue in patients on the night shift. I saw them once a week on a regular basis, based on a prescription from their overseeing nurse or doctor, or until their condition resolved.

The amazing thing is by US standards these patients were also the same candidates for long term pain meds, and surgery, or disability, instead the government had shuffled them off for 10 treatments to see me. But why?

In Ontario the government pays for almost all the health care you need. I can’t speak for exactly what goes on behind OHIP (the health care ) doors but I imagine someone there had the bright idea to up the standards of massage, so that we could deal with the external medicine aspect of soft tissue disorders such as sprains, strains, overuse, aches and pains, while at the same time unclog the doctors offices so they could deal with the actual act of internal medicine . That same someone I imagine, hired a team of cost analysts to calculate the cost of having someone see me for early intervention, rather than sending them off for a costly surgery….that is if the surgery went well. If it did not go well the bill would be for recovery, temporarily disability, and perhaps long term disability. That’s one long list of government paid bills, rather than private insurance making bank on each transaction. And as to the pain meds? Well imagine if you over prescribe them? you might make a bundle up front on the profit, but end up in the red on the rehab. The point is, there is a social responsibility towards heath care there because of the system structure. We don’t have the same set up, but that does not mean that we cannot start taking preventive fiscal responsibility towards our care. Hit the gym, hit the mat, eat the right foods, don’t take short cuts. In the end it starts with you.