Put It On Ice

What’s the first thing you do when you get hurt? When you twist your ankle, bonk your head, pick up a big box the wrong way and wrench your back? I mean, what’s the first thing you do after you say a whole bunch of words you really hope Mom didn’t hear?

You assess the damage, of course, usually by touching the injured area, tentatively at first, and then gently rubbing it. That helps, first in making sure nothing is broken besides your dignity, and then also to assist the movement of blood and lymph into the area by impromptu massage.

After that you will want to do something that really helps, and that’s to ice the injury. Unless there is blood flowing from the site like the Trevi fountain, the most effective first aid for any injury is to seriously chill it out.

Prolonged application of subfreezing cold to human tissue immediately causes vasoconstriction, the shrinking of blood vessels, which means less blood flowing to the site. After 9 to 16 minutes, that effect is reversed, and there follows 4 to 6 minutes of vasodilation, bringing new blood to the site and pushing the cold blood out, in the body’s attempt to warm the affected area. After that, if the cold persists, vasoconstriction occurs once more, followed by another episode of vasodilation. This slow but strong pumping action, called the hunting response, not only brings needed oxygen, platelets, and other reconstructive materials to the injury site, but carries away damaged cells and other waste and toxins caused by the trauma. In addition, the cold will shut down nerves, desensitizing the area and reducing pain signals to the brain.

However, you don’t want to overdo it, because ice will also freeze tissues with prolonged exposure, so no more than 20 minutes continuous use is ever recommended.

You don’t need a massage therapist to put an ice pack on you, though I have put ice on clients who came in with recent injuries, or simply with spasmodic twitch that I could not reduce any other way, and there is something called ice massage that looks quite interesting but that I never have done.

On the other hand, I could be the cause of your needing ice, if for instance you come to see me with your back so jacked up that I have to jam my elbow an inch deep in your lower erector just beneath the last rib in order to quell a particularly stubborn trigger point, which is something I had to inflict on a guy last night.

What I do never is intended to hurt or harm, but sometimes I have to break a few muscle spindles in order to make a smooth, non-clenching-like-a-fist muscle omelet. So if I do have to go deep, I will always tell a client to use ice on the area later if it hurts.

And of course trauma and that mean old massage therapist aren’t the only causes of injury that can use cold therapy. If you overdo it at the gym, not necessarily pulling or spraining anything, but just an ache down to the bones from overuse, I would treat that as an injury and ice it as well.

Sometimes I go overboard myself, working too deep for too long on someone, and wind up with aching fingers, so you might see me in the break room, ice cubes wrapped in a washcloth clutched in both hands.

Try not to laugh, okay?

That is all.

Mark out.


Which Is Worse? Left Or Right?

No, this is not a political rant, and I promise to spare you any of those, no matter how stupid politicians act. It’s about the difference between left- and right-handed individuals, from a massage therapist’s point of view.

One thing I have noticed, amongst the myriad things I have noticed in the past couple of years studying the human body up close and personal, is that most people are right handed.

Okay, that isn’t really what I noticed in the past couple of years. What I did notice is that most people, and by most I mean 99.9% of my clients, have knots and trigger points and quite a lot of hypertonic muscles between their scapulae, their shoulder blades, because that’s where they store their stress, whether left or right handed.

You get stress in your neck moving your head, no matter what you do – even when asleep – and that stress tugs on the muscles between the shoulders.

You get stress doing whatever you do with your hands and arms all day – driving, typing, hammering nails, drawing mustaches on pictures of models in magazines, whatever it is you use your arms and hands for, and that stress all winds up in the middle of your back, between your shoulder blades, because your shoulder muscles move every time your arms and hands move.

And then also, because those big, fat erector muscles that run all the way from the base of your skull to the base of your spine pass right between your shoulder blades, you get all the pulling and the stress from below when you move your hips and legs.

This is why I usually spend a great deal of my time in any massage working between and around the shoulders. That’s where most of the body’s stress is, and where the client will feel the most relief when I squash knots, release trigger points, and unclench hypertonic muscles.

But to return to my main point, one might think that there would be more knots and kinks and trigger points and all that stuff on the right side of the spine in right handed people, because that’s where most of the right handed person’s activity is.

By now you have figured out that this is NOT the case, otherwise I wouldn’t have any startling revelation to reveal. No, fellow grasshoppers, most right handed people are significantly more jacked up (that’s a technical LMT term, by the way) on the left side, in the rhomboids, trapezius, often the teres minor, sometimes the deltoid, and even the erectors, often down as far as the sacrum.

Nearly everyone I work on has active trigger points along the medial edges of the scapula, where the rhomboids attach. Almost invariably these are more active and often more numerous on the left than the right, in right handed clients. The rhomboids themselves usually are stiffer and more hypertonic, and often even ischemic.

For a long time I explained this phenomenon to myself and sometimes to clients as some kind of compensation mechanism – the weaker left side trying so hard to keep up with the stronger right, that the muscles became overworked.

Now I have a better explanation, or at least an alternative one. I think it’s a matter of inactivity rather than overactivity. When a right handed person reaches for something he usually uses his right hand and arm rather than the left. Over time this preference for one motion over another makes the left shoulder area significantly less active than the right.

With fewer opportunities to stretch, the rhomboids especially become partially ischemic, that is, there is less blood flow, less oxygen and nutrients, and more tendency to become stiff, increasing the probability of active trigger points developing.

The reverse is not necessarily the case with lefties, because most left handed people have to be somewhat ambidextrous to get along in a right-handed world. Some even were encouraged, by which I mean forced in one case I know personally, during childhood to become right rather than left handed. The result is that most left handed clients I work on don’t have this issue. If they are jacked up, they are jacked up equally.

I have found that the same is true in those who exercise regularly and intensely. With a good exercise program, both sides of the body are worked more or less equally, so this phenomenon doesn’t occur as often.

So my suggestion to right-handed folks is to stretch more. Well, all right, my suggestion to everyone is to stretch more. Get both arms above your head, lean against a wall, hang from the monkey bars at the park, whatever you feel like, just to get the rhomboids on both sides tugged and stretched more often.

And take Epsom salt baths.

And come see me for a massage anyway.

Couldn’t hurt.

That is all.

Mark out.

Deep Tissue Massage

As with anything as personal as massage, there are no absolutes involved. One person’s too deep might be another client’s not quite firm enough, but the point for the therapist is to have an effect on the muscles.

In the photo above, you see that the therapist is using her forearm. (And also the client’s head is properly positioned for once, which is why I chose this picture from Photobucket.)

I can’t be sure, but it looks like the thereapist’s elbow is on top of what I call the spinalis, which is the stack of several muscles that run along both sides of the spine. A lot of tension is stored in these muscles, as one would reckon given that they are holding the back upright all day, so getting in to stretch, separate, and relax these thick muscle groups will naturally take some doing.

But digging an elbow right in anywhere on the human body should never be attempted without some kind of warm up, so even when a client insists on deep work, and even when it’s obvious to my fingers that she or he needs deep work, I always start out easy and ramp it up from there.

This not only warms the client’s tissues and helps the muscles start to stretch and separate, but also brings more blood and oxygen to the area so that when I do start seriously digging with my thumbs, knuckles, and elbows, the client’s body is prepared to deal with the onslaught.

And of course I go into onslaught mode only on muscles that really require that, such as trapezius muscles, the ones that stretch across the shoulders and upper back, that feel like sheets of armor plating.

A lot of that stiffness and tension is due to trigger points, of course, which I usually squeeze out with my thumbs to release the nerves that are causing the localized and sometimes distant tension, that ‘clenching’ feeling, and that also hurts a bit, but often in a ‘good hurting’ way, as I am often told by my clients.

It also matters a great deal where the deep tissue pressure is needed as to how much is enough. For instance I would never put the same kind of pressure at the base of the neck as I would in the gluteals, the butt muscles. The gluteals are wide and thick, and I can lean into those if necessary, while the neck muscles are much smaller and more fragile, and also very near to the spine and the spinal nerves.

So with very severe cases, I will use the side of my forearm on the lower neck sometimes, though I prefer to use my thumbs if possible. And then too, some people can’t take very much pressure in the gluteals, where most of us have at least some trigger points. Here too I am very good at finding the trigger points, and if the client is willing, mashing them out with my thumbs.

Usually this works because trigger points in the glutes most often are superficial, though not always. If they are very stubborn, the client often is used to deep work anyway, and can stand an elbow point jammed in there for a minute or so.

The other place that very often requires deep work is the lumbar region, the small of the back. If a client has any stiffness at all there, nearly invariably I find trigger points right in the lumbar curve, underneath the spinalis muscles in the quadratus lumborum, which is actually an abdominal muscle.

These are a bear to take out and I always ask permission to go after them, because they’re so close to the spine. They do hurt, squeezing these things away, but once they’re gone it truly does feel a lot better when it stops hurting.

I go deep just about everywhere on the body if necesary, but those are the main places on most of my clients. Athletes, runners, and weekend warriors often have leg issues in the hamstrings, calves, and quads, but they’re used to deep and hard sports massage, so I drop the table a little and really lean into them. They need it.

That is all.

Mark out.