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Pain and the Zombie Apocalypse

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Pain and the Zombie Apocalypse

Whether it’s another exhausting election cycle or the impending zombie apocalypse, many of us are a bit more stressed and anxious lately than usual.  Intense times, it’s totally normal to start experiencing some physical symptoms that might feel abnormal if you don’t realize their source.  Some of your old injuries might start hurting again, your back or neck may become stiffer or achier, and if you’re already dealing with some kind of pain, that may become worse.

Stress and/or anxiety can increase or decrease normal pain thresholds directly or indirectly.  Prolonged stress will tend to decrease a person’s pain threshold so that the exact same physical stimuli might become more painful than usual, or something that didn’t used to hurt might begin hurting.  People with persistent pain are often aware of how a stressful day at work can cause a flare-up, but far fewer people realize that stress and depression are two of the biggest predictors of painful flare-ups in people with acute low back pain.

Stress can also decrease pain thresholds by influencing behavior.  Most of us know that a stressful day, week, or decade can make it harder to get to sleep or stay asleep.  Lack of sleep and non-restful sleep are significant risk factors in developing physical pain and prolonging it.  Being tired can also make it far more difficult to push yourself to get some of the physical activity our bodies need to stay happy and healthy.

In these stressful times, it’s perfectly normal to begin experiencing all sorts of symptoms that might seem as if they came out of nowhere.  That’s all the more reason to take care of yourself in all the ways you can.  Spend time engaging in meaningful activities, talk to the people you care about, make time to be mindful or to relax, practice good sleep hygiene, ask for and accept more help from others, and get in some movement where you can.  You’re not broken and you’re not falling apart—we promise.

By Matthew Danziger

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795524/?report=classic

https://journals.lww.com/spinejournal/Abstract/2018/03150/Do_Physical_Activities_Trigger_Flare_ups_During_an.14.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/

The Benefits of Manual Therapy- An Interview from the Knowledge Exchange

Benefits of massage therapyOur Massage Therapist, Matt Danziger sits down with the Knowledge Exchange to talk Manual Therapy or rather what manual therapy is NOT in this blog/podcast

One of the things we pride ourselves over here at Body Mechanics Orthopedic Massage is our devotion to science and giving people a real outlook on what massage can and cannot do. We are for the most part, for what its worth science based-ish with the understanding that minds do not change over night and therapists need room and time to grow. When Matt told us that this podcast blog post was coming out we immediately asked him if we could re-post it for the Knowledge Exchange.

If you have never heard of the Knowledge Exchange, they are a professional education group that runs courses and mentor ships on the BPS model of pain (that’s Biopsychosocial if your not up on your acronym’s).  They have some wonderful online resources and blogs you can check out and they specifically define what they do as:

“We don’t see our selves as educators but rather facilitators of ideas, discussion and critical appraisal. We do this because we aren’t satisfied with the status quo of health care and believe we can all do far better for our patients.”

I do not want to give too much away in what this podcast covers but it gives some great insight into how Matt sees the role of massage in terms of fitting into the BPS framework. Frequently, a massage therapist who uses this model is viewed as anti-manual therapy and that is not the case.

You are also going to get a great look into Matt’s personal journey as a massage therapist as well as his journey with pain.

Want to check it out? Go ahead and read their post by following this link to listen to the podcast.

You can check out this blog with Adam Meakins  by the Knowledge Exchange if you want to go further into the manual therapy rabbit hole.

If you want to book with Matt and his talented mind, you can read more about Matt’s Massage therapy her or book here.

To connect to Matt’s blog follow this. 

Body Mechanics Orthopedic Massage

1 W 34th St
#204,
New York, NY 10001
United States (US)
Phone: 212-600-4808
Email: info@bodymechanicsnyc.com

Don’t Tell Me to Relax

Relax….

You book the massage appointment. You take the risk. It is a financial stretch but you have to do something because you have not been able to manage on your own. You lay down on the table. The massage therapist says “Take a deep breath…Relax…”

In the last few years I have become very conscious of what I say to people. As I have gotten older I have given less ‘%#@’s’ about some things and more about others. One of the things I have given more about is how I might accidentally harm someone whom I am caring for. That fills two categories; people I treat, and the people I teach to treat.

I primarily work with massage patients in  pain. Frequently those people have the kind of pain that has been untreated, underestimated, and has fallen through the medical cracks. They are sometimes angry, vulnerable, difficult to deal with, as well as they are often generous beyond belief, humble, and full of hope. They come in all forms and shapes and sizes…but what they have in common frequently is they cannot relax. This may pertain to their whole body, or a single part…but if they could simply relax and gain control of whatever they are seeing me for, they would have done it long ago.

And so, it really bothers me when people say ‘relax‘. It has become somewhat of a trigger word because, what I hear is the response: “Don’t you think I would if I could? I booked an appointment specifically because I need HELP relaxing, and here you are telling me to relax, when I have admitted, I can’t”. In fact, in my case being told to relax, specifically makes me more anxious. I am pretty sure every dentist I have ever known has said “take a deep breath and relax” right before he has done something awful.

I think in terms of massage therapy, the word relax is old, is loaded and full of harm. It is like a brand that has ceased to have meaning to us, and yet has become the only word we use. For people looking for a spa day, it may have no connotation, but for many it could be one of the worst things I say to them all day.

While it is hard to watch your words all the time, I have tried to omit relax completely from my massage practice. I had to think for a bit on what exactly should take its place. Frequently I am communicating a lot with people on how an area feels to them, and I will ask whether or not they felt a tone drop in an area or if that is my perception- ie ‘should I move on? Do you feel more comfortable now? And then, of course, the old stand by word “release” pops up. I am not a big lover of the “release” description either. What has been released? Certainly I am releasing nothing…something might be relaxing…but then there is that word again!

Neither word is the correct thing I want to say to anyone, but those two words are flung about, both of them holding too much meaning, and way too little at the same time. What I want is to give someone an actionable word or words, that they have control of, something that removes my hands from the picture, other than to bring awareness. The words I want to use need to suggest that they have self efficacy in a process that I am creating a space for. And so for the moment, I have settled on “Let go” or “Be heavy”.  As in, “I am going to be gently moving you around for a moment, and so there is no resistance, I would like you to try to let go of that area/practice being heavy, but if you cannot, that is okay…we can just move together for a little while and it will be just as good.”

 

Helpful links on Pain and the Body

You’re with your body all day, so it’s pretty important to you.

Let’s look at some places you can get more information on Pain and the Body

I wanted to put together a list of places to look for good information on subjects pertaining to massage, movement, pain, and the body. This is by no means comprehensive, but it is a place to start. Navigating the health care world as your own advocate can be hard. I could have a ticker tape parade with the number of times I have written key search words or links on the back of a napkin.  Without a background in science, it can be hard to tell plausible from implausible.

Soooo… that being said, I’ve compiled, all in one place, some links to some subjects that we end up sending out most. We  think these links are pretty helpful.

Why am I in pain?

Most people coming to see us are in pain. Pain can be scary…but what happens when you have been cleared by your doctor as healthy, and you still have pain? Or chronic pain? Or you have no pain but are diagnosed with a problem?

Do we advocate for those people to get checked again? Absolutely. But we also want them to know that pain is normal. That their body’s number one job is to protect them, and they can do a lot to manage that pain by understanding the basics of it. For that, we usually send them home with this video on pain by Lorimer Moseley. Not only can it be understood by professionals and lay people, it’s also really entertaining.

If you really want to learn and possibly change how your body feels about pain, take a look at this course by the ‘Retrain Pain Foundation’.  Each module takes just 2 or 3 minutes and can really make a difference in your life.

If you enjoyed the last one, and want more detail, we also recommend this handy video on pain. This is put out by the Hunter Integrated Health Service which delivers evidence-based pain care in Australia.

Is it my body posture?What to do about pain

The next question that inevitably comes up is, “Where did the pain come from? Since I don’t have an injury, is it my posture?”.  For various reasons, there is a LOT of misinformation out there on posture.  Posture certainly can affect you. For instance, we have all felt the pain of sitting in one position too long, but for the most part, your posture is probably fine. You could spend your whole life trying to whittle yourself into the perfect posture or way of moving. To help you understand the posture bunk we really like Paul Ingram’s blog pain and posture. It is very user-friendly and a really great place to start a search on a number of physical problems. Take a peek through the topics and you will see he touches a little on everything. A lot of the information he provides is the kind that can keep you from throwing good money after bad. So it is WELL worth reading through some of his work.

 

Do I need to foam roll or self treat?

People ask a LOT about foam rolling. Sometimes it’s in this hushed voice, like a secret, “You know I don’t foam roll…should I be?”. Look, it feels great to massage yourself. It also feels great to do something for yourself. But do you NEED to foam roll? A better question is, do want to?  The easiest thing is to probably do a little reading on what foam rolling actually does and to answer that, we usually provide Tom Hardgroves great blog piece on “How foam rolling worksand let you decide for yourself. His work is decidedly more technical but if you have a keen interest, it’s not out of reach. He also has a phenomenal book on movement you might check out. Sadly, we rarely have it in the office because we keep sending it home with patients.

 

What else can I do?

Well, it turns out you can do a lot. While doctors, physical therapists and massage therapists might help you with some aspects of your health and recovery, there is a lot you can do on your own to manage. Two videos by Dr. Mike Evans cover some of the excellent general things you can do for your physical and mental health to manage pain. Both are short, watchable and entertaining.

The first video talks about the research behind being active with your body and the health benefits that has. It is a great video on the benefits of moderate physical activity.

The other video that pairs nicely covers the topic of stress and your health.  Together, both of these topics are very important for helping you manage pain and function long-term. Do we recommend you see a doctor? Absolutely! But there is a lot you can do on your own too, without falling down the rabbit hole of unattainable results.

 

As more people ask questions we will add to this list. Good luck!

 

 

 

 

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.

Wait!!!

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.

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.

How to know what pain to not ignore. Pushing yourself to the limits.

As athletes we constantly push our bodies to the limits. Runners want to run longer and faster, lifters want more weight, yogis go for advanced positions, and some of us just do it all. We constantly test our mind and endurance by pushing beyond our comfort zones, and we have learned that often that push comes with a little pain. For most of us that means that when we feel uncomfortable-when we are at that edge where it hurts-we are celebrating our success at fighting the good fight. But if pushing it hurts, how do you know if you are really hurt?

Injuries often come in two forms: sudden injuries such as falls, collisions or tears; and insidious over-use injuries like tendinitis, plantar fasciitis, or knee-tracking issues. Whatever the cause is, its important as an athlete to know when you are really hurt. You should always check with your doctor about any issues you are unsure of, or any complications from pre-existing problems.

Here is how to tell the difference between a little pain and something that will take you out of the game.

1. If exercise makes it worse, not better. Wait, though, you think that sounds straight-forward, right? Well, this also applies to injuries that feel fine WHILE you exercise but begin to hurt a few hours later. Many serious over-use injuries DO NOT hurt while you are performing the activity but only after it is too late. The reason is the tissues warm up and lengthen, causing a deceptive pain feedback. As the muscles cool later in the day or overnight, and begin to lay down tracts of scar tissue, the fibers will contract and cause pain. Injuries like these are a catch-22 as exercise often makes them feel better for a short period of time. Check in with yourself, keep a journal about when and where the pain is occurring. If its always the same….watch out!

2. Pain that is point tender and gets worse while you exercise. Let’s be honest, folks, it is one thing to feel the burn, and totally another to have pain that grows and grows and grows. If your pain is progressive, it is a problem. Pull up; it just is not worth it. Ever hear that phrase “on your last nerve?” Well, you quite literally can be, and some things can’t be fixed. Get it checked.

3. Any time you feel numbness, tingling, or strange sensations in your limbs. Nerves are squirrely, when they are damaged it is not cut and dry. They may report LESS feeling or MORE feeling, but either one is a bad sign. If you are having any neurological systems its time to hit the Doc, not the gym.

4. Anything that hurts so bad the next day that an Advil won’t take care of. Many a great athlete has arrived in my studio hopped up on pain meds looking for relief through a massage, only to be booted out. If the pain is so bad you are digging through your cupboards for pain relief then you need to haul it to a Doc.

5. Injuries that come with a lot of heat and swelling. A little heat and swelling often come with extreme workouts like marathons, but most of you won’t be able to see it or feel it. Normal inflammation that comes with working out will resolve itself shortly after the workout. If it does not, or if you can visibly see swelling and feel the heat, it’s best to get it checked, and refer to your RICE protocol.

6. Any injury that comes with an audible noise. We all pop and grind occasionally, however any injury that comes with a noise and then pain, or alternately a noise and then LACK of feeling, is likely very serious. Be cautious, many muscle tears come with no feeling at all. The nerves are damaged and report back nothing, but you will likely hear the noise and it is accompanied by heat,swelling and sometimes a visible gap in the tissue. If muscle tears are to be repaired surgically , it must be done right away. Don’t wait if you suspect you have a problem.

If you are pushing it to the edge constantly, invest in preventive care or a trainer who can help you navigate this territory. It’s a good idea to get a yearly check up, and see someone regularly who has at least some medical training. You should also invest in an athlete’s emergency kit. No one ever said, “I am sure glad we did not have any band aids or ace bandages on hand for that”. And if you are competing, consider being a local hero and taking a first aid/CPR course at your local Y or community center. For many injuries early intervention is key, and your knowledge could save someones life. Now that is team spirit.