Unexpected usefulness of certain massage protocols
Several weeks ago, I received a 53 years old male client who was suffering from what was introduced to me as sciatic nerve neuralgia. He had reported all classical symptoms of this disorder, including pain in the buttocks with irradiating to the leg. This wasn’t his first episode; during the last five years the pain was on and off. The MRI examinations showed, 4mm disc bulging on the level of L4-L5, and 5 mm disc bulging on the level of L5-S1. When I asked him slightly to bent forward, he could do it without experiencing increase in pain intensity.
During these five years of suffering through the pain, he tried many different therapies including epidural injections with no real progress.
As usual in such cases I started palpating lower back area, buttocks, hamstring muscles, investigating for tension within muscles and fascia, discovering trigger points, etc.
There was much indication that Piriformis Muscle Syndrome could be responsible for all the difficult clinical picture. However when I have investigated gluteus muscles by slight compressions, especially area of sacrotuberous ligament, my client immediately complained on experiencing intense irradiating pain in penis and testicles. The pain was disappearing once I was stopping the compression.
I have immediately checked the tension in hamstring muscles. Their resting tone was noticeably high alone with the apparent limitation in range of motion and containment of numerous trigger points. I told him that these muscular syndromes, if addressed appropriately and in detail, would not only help him alleviate pain and limitation in the range of motion, but also can increase his erection during intercourse.
The client, who happened to be a urologist, immediately asked me about how I deduced him having the erectile dysfunction.
I explained him that the clinical symptoms he experienced often caused by chronic lower back disorders, which also cause hamstring muscles tension. Hamstring muscles tension, is transmitted to sacrotuberous ligament, resulting in irritation of pudendal nerve. Since pudendal nerve provides innervation to sex organs its irritation produces pain in penis and testicles, and diminishes one’s ability to maintain erection. Therefore my treatment that included releasing tensions in muscles and addressing trigger points could have improved his sexual potentials.
After six treatments all clinical symptoms of sciatic nerve neuralgia were almost gone, but I have continued providing massage treatment, including trigger point therapy to hamstring muscles, paying special attention to gluteus muscles, and area of sacrotuberous ligament.
With decreased pain, my client could report feelings of warm sensation in penis, and was amazed at how his erectile potential has improved.
Altogether I’ve provided this doctor with 14 treatments, on the basis of three-times a week. Treatment included, connective tissue massage/fascia release, muscular mobilization, trigger point therapy, as well as post-isometric relaxation techniques. This step by step protocol I present on my instructional DVD#1
In fact he was so impressed with the result that he referred to me three of his patients, who had suffered similar symptoms.
As of today my urologist client is discharged. We are staying in touch. He feels great, and happy and this is a source of great pride and joy for me. His patients – all three of them are improving, including improvement of their sexual potential. This is another example of how appropriately applied medical massage protocol makes a huge difference in difficult cases compromised health manifested by complex clinical symptoms.
Clinical incidences could be educational
Recently I had a rather stormy discussion in one of the user groups regarding my article “Body cells carry emotional memories.” This theory doesn’t have existing scientific explanation, only a working hypothesis. But this hypothesis has such a frequent support in everyday clinical experience that I felt it cannot be ignored. Turning around the discussion in my head I remembered the incident that perfectly fit as the supportive argument for this hypothesis.
This one lady (let’s call her Ann just to preserve her anonymity) was referred to me by her primary care physician. Eleven years prior to this referral took place, after giving birth to a beautiful baby girl, Ann developed clinical depression, frequent episodes of anxieties, muscular pains and aches and sleep disorders. As her health was declining she was diagnosed with postpartum depression. During all this years, she received clinical psychological and pharmacological treatments. Nothing was working and symptoms were getting worse.
The referring physician, requested to provide her with medical stress management massage. During the first session, as I was attempting to massage her right side upper back, shoulder area, and pectoralis muscles, she sprang out and with convulsive movement deflected my hand away from her. To my inquiry about the reason for such reaction she was quite vague. But having been familiar with similar behavior before in my practice and suspected an emotional trauma, similar to the one I described in my article “Body cells carry emotional memories.”
Because my touch didn’t cause her to sprang out and deflecting my hand when I was massaging the other parts of her body, I have convinced her to allow me to massage her right side upper back, shoulder area, and pectoralis muscles. Also I have advised to her to release any emotions, if she’d experience any at the time of massage, including crying if she’ll have felt like it. And so she did cry it out.
Eventually, after the fifth treatment, she told me what caused this anxiety. Actually, all these years she didn’t realize that it was poisoning her life. During the treatments, and the related emotional releases what was deeply plunged in her subconscious mind, somehow came out and became obvious.
The story went back to the incident that happened while she was in her early teens between her and her boyfriend who was two years her senior. It was what was supposes to be their first sexual encounter. In the moment of truth the boyfriend saw her thirteen year old breasts. The gentleman that he was, he sneered at them, pushed her against her chest, and told her that she needs to grow up before he would yield his manhood to her undeveloped femininity. When she start crying, he had pushed her few additional times, including area of right side upper back, shoulder area, and pectoralis muscles. Thus these regions became bookmarks of emotional scars. Surely, in the moment of tight dramatic tension, these were the chain of events that left a heavy emotional scar to all her life. Although Ann is quite a beautiful woman, happily married and looks spectacular for her age, somewhere in the depth of her subconscious mind the burn of this rejection haunted her all her life. She complained that during intimate moments with her husband, she always felt tormented, whenever the action was coming to her breast region.
I said and recommend to her since all this incident got conscious realization just to get rid of it. I also stated that her ex-boyfriend was not only rude and stupid, but most likely had some serious emotional problem himself. At that moment she started laughing as well, because as she explained the person, who used to be that boyfriend of hers, indeed today has some serious psychological problem.
We were laughing together for some time, especially Ann who seemingly couldn’t stop. I have no doubts in my mind that this laugh was her additional emotional release and a cure, because the next five times we’ve met she had no more problems with me massaging pectoralis and as she admitted, first time in all her life she fully enjoyed the intimate moment with her husband.
As many stories like this accumulated over my more than 40 year old practice, I can all but shrug when I hear how someone, with the righteousness of scientific purist, denies the connection between body regions somehow linked with emotional traumas. While purists like these wait another fifty years until such connection would be proven by the official Western science, many therapists could help very many suffering people armed with only working hypothesis and a bit of common sense.
Common concept: Massage therapy /chiropractic procedure
Back in 1987 one Russian neurologist, the specialist in sports medicine, has invited me to participate in a pilot experiment for chiropractic medicine educational program. He was hired by Medical College at city of RAMAT GAN at Israel to develop and to supervise this program for further approval by the Department of Education. At the time I was already experienced medical massage practitioner but knew little about chiropractic medicine.
This offer was too good to refuse: free education, flexible schedule, and the opportunity to learn x-rays readings from a well known neurologist, an expert in x-ray readings.
He knew how to extract real and useful data from x-ray shadows. To teach chiropractic adjustments techniques college hired one American chiropractor, and one from UK. In my opinion both of these doctors, where quite knowledgeable in spinal pathologies. They thought us that facet joint subluxations is the main cause of back pain. Thus elimination subluxations through adjustments practically restores the normal function, such as no pain, normal functional activities conditions, etc.
At the time both of them have thought us, that main cause and preconditions for facet joint subluxations are myofascial dysfunctions, which are tensions within muscles and fascia. When I asked in which way adjustments addresses this soft tissue dysfunctions, they had no answer to that. Indeed there could not be such an answer, because dysfunctions originated on the level of soft tissue could only be addressed on that level.
Approximately at this same time the “new” Manual therapy theory came about. This theory stated that facet joint maneuvers – a modality similar to adjustment techniques – is the ultimate “remedy” thus eliminating the need to address soft tissue by means of massage. This approach had a devastating effect on the entire medical massage therapy field in Europe, and, of course, has proven that adjustment only, do not lead to sustainable results.
I have complained about it to the Russian neurologist, who like myself, had witnessed the destruction of Russian Medical Massage field. He agreed with me, but explained that these chiropractors where hired, before him, and program was already approved and not much he could do.
I’m not regretting completing this program, since I have learned some very viable stuff but I know and knew then, that without quality soft tissue mobilizations it is impossible to reach and sustain results such as less pain, a greater range of motion, a sensation of well-being, etc.
We, as massage therapists, have to educate chiropractors in regard to massage related concepts, and capabilities to reduce tension in muscles and fascia, to address trigger points, to manage side effects of stress, etc.
From my observation when treating people with painful orthopedic disorders, it is practically impossible to reach sustained results if stress management massage is not incorporated in the treatment. Stress side effects can initiate painful disorders, worsen a condition, and then, if not managed, prevent obtaining sustain results.
Chiropractic procedure is also about obtaining results. But chiropractic results are different than achieved by massage therapist. As a result: they need us and we need them. The best for clients and patients if we work together having one concept, massage therapy and adjustment.
One can say that for years we already has been working in chiropractic offices. Yet this is not the same as having a common concept? Usually when chiropractors hire massage therapists they instruct them on how massage should be performed. For example “to press hard and strong.” The point here is that chiropractors are not trained in massage therapy and don’t really understand the importance of performing massage before adjustments, of post-adjustments of trigger point therapy, and other techniques.
To have a common concept is to educate and to convince on the importance of reducing the size of lymphedemas, releasing the tensions in fascia and muscle, eliminating trigger points by ischemic compression before adjustment, as well as on the importance of continuing to provide orthopedic massage after a successful adjustment/elimination of subluxation.
I believe that soon enough more and more hospitals will start massage programs and it will make us recognizable methodology of treatment.
Chiropractors are out of hospital services, and will have much greater interest to work with us, because work in the hospital based settings would command their respect. In any case on the common concept – we have to educate doctors of chiropractic medicine. Soft tissue mobilization by means of massage is different discipline, requiring expertise. The chiropractors must be informed that it is practically impossible to reach sustained results if stress management massage is not incorporated in the treatment. Stress side effects can initiate painful disorders, worsen a condition, and then, if not managed, prevent obtaining sustain results in cases of painful skeleton muscular disorders.
Increase in blood supply triggered by massage
The existence of Vasomotor Reflexes /increase of blood supply triggered by massage therapy was originally shown by Prof. Zabludovsky (1913) who used a plethsymograph to register the phenomenon.
10 years ago I have repeated the same protocol at Beverly vascular laboratory. Pulse Volume Recording (PVR) Photopletismograph and Termography were used to compare arterial blood circulation. The largest changes were registered in PVR. What is important about this study is that all measurements were conducted in the lower extremity opposite to the massaged one.
Let’s review the data from one of the subjects. The original value of PVR in the lower right extremity of the subject was 0.73. I have provided massage to the subject for 15 minutes and the PVR almost immediately started to climb. At the end of 15 minutes PVR on the lower extremity was 1.22. Thus arterial blood perfusion was almost doubled compared to the previous value of 0.73. I have stopped procedure but, PVR continued to climb, and at the end of the second hour it was 1.63. It means if we provide massage to people who suffer from extremity fractures, or after surgeries on extremities, by massaging the extremity not affected by surgery or fracture, you are significantly stimulating the healing process, preventing self infections, reducing the duration of hospitalization and days of disability. A clinical prove is necessary. Otherwise any theory, however beautiful it might seem, will remain just that and die as such. The other side of this statement is also true. i.e. It doesn’t really matter if the theory was established 100 years ago. Al long as it is proved clinically – it is good.
What separates a good therapist from a great one?
A sense of touch is a demarcation line that sets apart a good therapist and a great one. The greater therapist being the one who constantly delivers better results. In order to be able to deliver better results, it is very important to understand physiological effect of massage on human body. In the following clip hopefully would answer these questions. The definition of massage