Articles

What is chronic pain and why is it hard to treat?

A recent study by the National Institutes of Health found that more than one in three people in the United States have experienced pain of some sort in the previous three months. Of these, approximately 50 million suffer from chronic or severe pain.

To put these numbers in perspective, 21 million people have been diagnosed with diabetes, 14 million have cancer (this is all types of cancer combined) and 28 million have been diagnosed with heart disease in the U.S. In this light, the number of pain sufferers is stunning and indicates that it is a major epidemic. Continue reading

The Deep Tissue Confession

I have a confession to make…

I have been a Registered Massage Therapist (RMT) since October 2014, so for about a year and half now. Before that, I spent six months cramming as much clinically relevant musculoskeletal information into my brain as possible as I prepared to take the licensing board exams. And before that, I spent 2-years attending the West Cost College of Massage Therapy in BC in order to earn my Massage Therapy Diploma. Continue reading

Why Me as your RMT?

Part of the marketing workshop I’m making my way through asks me to answer this question. It encourages me to set my modesty aside, to be bold, to express myself fully. This is not an easy task, so I figured it’d make for an interesting article here. Why should you choose me over all the other equally qualified RMTs? What can I offer that another RMT may not offer? We all have similar educations, we must all pass the same competency-based board exams, and many have far more hands-on experience than I do. So what makes me a great choice for you, when you are selecting your Registered Massage Therapist (RMT)? Continue reading

Lesser Known Indications for BC RMTs

When I decided to become a massage therapist, I had no idea that this was such an involved and complicated field. When the word massage came to mind, it came with words like luxury, spoil, or indulge. Having completed the comprehensive massage therapy program at WCCMT, successfully completing the provincial board exams and establishing my own company, Aspect Health & Registered Massage Therapy, the word massage no longer resonates with such extravagant words. The word massage now emulates words like pain-reduction, relief, and health. Continue reading

Relax! It May Save Your Life

Karōshi is a Japanese word that translates to ‘death from overwork’. It is used to describe occupational sudden deaths, which occur most commonly by heart attack or stroke due to stress and starvation. We don’t have such a word in English and in general, stress is downplayed in our daily lives. Sentences like, “it’s just stress,” are common. So what is this stress that the Japanese revere so much that they have a word to describe death by it, and that we in the West seem to commonly brush off and ignore as so very minor? Continue reading

Trigger Point Release

I hear the words Trigger Point coming from just about every direction these days. The girl at the gym has a trigger point in her hip flexor that she just can’t reach, or so her health guru who administers her IMS has told her. The guy at physiotherapy has trigger points in his neck, caused by a motor vehicle accident he had years ago, which are continually reducing his ability to turn his head to shoulder check. And a new patient in my clinic asks if I can perform Trigger Point Therapy on her shoulder, like her last massage therapist did. Continue reading

Why do our muscles twitch sometimes?

You’re sitting in a meeting and your left eyelid is twitching uncontrollably. You wonder if the person opposite can see it, and why it’s happening.

Many people experience neurological symptoms that are quite normal for healthy individuals including cramps, pain, dizziness, numbness and muscle twitches. Light, involuntary muscle twitches are very common and can occur in any skeletal muscle. Continue reading

Muscle Wasting – Use It or Lose It

Fitness and health professionals alike will often talk about muscle atrophy or muscle wasting. Anyone who follows a regular fitness program and has taken a break from it for some time can attest to his or her own very quickly reduced abilities upon returning to fitness. In my case, I’ve been back to CrossFit twice now in the past week after spending just over 3-weeks pretty much in bed. Of course, I’m not actually doing the CrossFit Workouts of the Day (or WODs), but am instead concentrating on rebuilding and maintaining everything but my healing leg, with a program built specific to my needs by my very talented coach, Meghan.

It’s surprising to realize that my strength abilities have more than halved what they were before. While pre-accident I was able to do biceps curls with 30-35lb dumbbells, now, I’m using just 12lbs. I was able to do a standing shoulder press with a 60lb bar, while now I’m seated, using 12lb dumbbells. It’s not possible to lift the bar without weight bearing on my leg (even while laying on a bench your feet must somewhat dig into the ground to stabilize you), so we substitute with dumbbells. I can do less sit-ups and push-ups (on my knees of course, to leave the leg out of it). And while I have learned to row with one leg, it’s takes far less time for me to become winded.

Muscle atrophy is a very real thing and it happens very quickly. While I knew this intellectually and somewhat physically after say attempting to run a long distance for the first time in a long time, I can now, thanks to this injury show you what it looks like visually. In this photo you can see the atrophy in my left leg very clearly.

This is from just 3.5 weeks of non-weight-bearing, in other words not using these muscles at all. The difference between each leg is huge and I thought worthy of sharing with you. Contrary to what it may seem, this wasting is not caused by the cast itself or malnutrition to the area, nor is it a direct result of the injuries to the leg. This is fully due to non-use. And while I’ve been given small exercises to do for my ankle by the surgeon, simply flexing and extending my ankle, I have very little motion and what I do have is extremely difficult to do. Here’s a short video clip showing just that:

This goes to show one of the reasons why it’s so difficult to start any sort of physical activity after being sedentary for any length of time. Fit people aren’t simply better than you at fitness as so many of us would like to believe. Stop beating yourself up with this line of thought! Even the fittest of people had to start somewhere too, and it’s always with difficulty. It’s not strength that makes a person fit. Instead it’s persistence, self-acceptance (it’s ok if you can’t run as far as the next guy, or lift as much as the girl in front you can – yet, you will!), and dedication that makes a person truly fit. And with fitness comes strength!  Once you get over the first few hurdles to becoming fit, what happens is a great thing fueled by endorphins, and it makes becoming fit far easier, even pleasurable for you.

Endorphins are hormones that get released with extended exercise. They are much like an athletes drug as they make you feel great (during exercise and for long after), and they are addictive. Endorphins however, are an addiction that’s actually good for you! If you really want to be more fit take the first few steps, grit your teeth through the first few struggles and before you know it you will be just that and it will become much, much easier!  And it happens quicker than you’d think.

After October 22, when I see the surgeon again who will presumably tell me I am allowed to start weight bearing again, I will show you the full extent of this leg’s wasting, and the progress I make building my leg back up!

I started writing this entry thinking of it as an update on my condition, but as I wrote I found there is a lot of information that is more beneficial to you and thus more important to share. So before I close I’ll give you a quick update on what’s happening personally with my recovery, in addition to the CrossFit attendance I mentioned above.

I’m doing well. The pain while still there is changing in nature. I can feel the screws and acute pain around my ankle joint. My skin often feels like it’s burning, especially around the surgical incision, where it’s most bruised still and in areas where the cast compresses it. I still don’t have normal sensation in my big toe or on the bottom arch of my foot. The pain is worse at night and first thing in the morning. During the day it seems to let up and I’m able to move around a fair bit more so long as I’m sure to take rest in-between with my leg elevated. I have not had to take any narcotics for a few days now and I’m hoping I won’t have to take anymore at all. For the pain, I am managing with just Tylenol & Robax – and even that I am usually able to hold off until nighttime.

I am getting a little better on the crutches and I’m generally feeling a whole lot better about my recovery. I have had the chance to get a full body massage treatment and I have had a Manual Lymph Drainage Therapy treatment as well. This has helped with my general soreness and the swelling around my ankle immensely!

And of course… My dedicated furry friends are still spending as much time with me as possible.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is compression of the median nerve as it passes through the bony canal (or carpal tunnel) of the wrist.  Symptoms are very similar as those found in Pronator Teres Syndrome, where the median nerve is compressed between the heads of the pronator teres muscle.

Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is often seen in people with occupations that require repetitive movements of the wrist.  Some of these professions include massage therapists, check-out clerks, office workers who type a lot, and string musicians.  The median nerve passes through the carpal tunnel of the wrist with various other tendons and vessels. The carpal tunnel may be narrowed by bony callus formations or other bony changes that may occur with system conditions like rheumatoid arthritis.  Space occupying lesions like cysts or ganglia may also cause the carpal tunnel to narrow.  The structures that pass through the carpal tunnel may increase in size due to inflammation or irritation, swelling (as often seen in pregnant women), fibrosis, or scar tissue due to wrist related trauma.  In addition, carpal tunnel syndrome can be acute in nature when secondary to trauma, with infection, during an acute episode of rheumatoid arthritis, or a new activity requiring repetitive wrist movements.  Sometimes, there is no known cause of Carpal Tunnel Syndrome.

Signs & Symptoms
Carpal Tunnel Syndrome patients often complain of numbness and tingling felt in the palm of the hand, through the thumb, pointer and middle fingers.  Pain and burning sensations may also present.  The symptoms are often worse at night or in the early morning and will increase with repetitive use of the hand and wrist.  There may be heat and inflammation, tenderness and a boggy feel to tissue at the wrist.  The muscles of the forearm may be hypertonic and fascial restrictions may be present.  With Carpal Tunnel Syndrome, the pain may wake the patient from sleep and relief from all symptoms is usually sought out by elevating and shaking the hand or immersing them in warm water.  In chronic conditions there may be autonomic losses like sweating, redness and dryness of the skin and the muscles of the thumb may appear to have wasted.

Orthopedic Assessment
Some of the typical orthopedic assessment techniques a massage therapist may use are:

  • The patient may be asked to perform active & passive resisted ranges of the wrist.
  • The patient may be asked to perform resisted muscle strength testing of the muscles that cross the wrist joints.
  • Phalens and Reverse Phalens testing may be performed. This is where the patient is asked to hold their hands in a flexed position (for Phalens) against each other, or an extended or prayer position (for Reverse Phalens) for 60 seconds and report on symptoms.
  • Tinel’s test may also be performed. This is where the therapist taps along the nerve path to try and determine where the compression site is.

Massage Treatment Goals
Massage therapy can be used as a tool to help decrease sympathetic nervous system firing, pain, numbness, tingling and burning sensations. In addition, it can be used to help reduce swelling and inflammation while preventing tissue adhesions.  Therapeutic massage should be aimed at maintaining or improving joint and tissue health as well as muscle strength and preventing cyanosis.

Typical Massage Treatment
The entire upper limb and neck may be treated in instances of Carpal Tunnel Syndrome. The double crush theory suggests that in cases of Carpal Tunnel Syndrome there may be multiple areas of compression, none of which on their own are causing the symptoms, but instead symptoms are caused by the collective effect of each compression site combined.  Manual Lymph drainage techniques may be used to help reduce edema. General Swedish massage and fascial techniques may be used on the arm, pectoralis muscles and neck to help maintain tissue health and prevent tissue adhesions. Attachments release may be performed and trigger points may also be addressed in the arm, shoulder girdle and neck.  Passive and active stretching of the wrist may also be incorporated into therapeutic massage treatments.

Massage Contraindications & Precautions
Patients suffering Carpal Tunnel Syndrome may have sensory impairments. No extreme hydrotherapies or pressure depths should be used.  If muscle atrophy is present the treatment will have to be modified accordingly.  Blood flow to the hands and fingers may be impaired which may lead to tissue fragility in extreme cases. If edema is present the patient should be positioned for proper drainage.  And the therapist should not use any techniques that would cause further compression of the median nerve.

Typical Suggested Homecare
The patient may be asked to perform pain free passive stretches to the wrist, shoulder or neck, as well as squeezing and gripping exercises of the hand as necessary.  Contrast arm baths may help increase circulation while warm arm baths and/or heating pads on the forearm flexor muscles may help reduce symptoms. The patient may be asked to refrain from or reduce certain activities that overuse the wrist and hand.  It may be suggested that the patient wear a splint while sleeping or doing things that require a lot of hand movement, and/or perform self massage. If edema is present, it may be suggested that the patient use a cold compress to help reduce swelling.

Intercostal Neuralgia (Shingles)

Intercostal neuralgia is a neural pain along the nerves that travel between the ribs.  A common example of intercostal neuralgia is caused by the herpes zoster virus, known as Shingles or Post Herpetic Neuralgia.

Causes of Intercostal Neuralgia
One of the more common causes of intercostal neuralgia is the herpes zoster virus. This is the same virus that causes Chicken Pox in children.  Any person, who has contracted the virus by contracting Chicken Pox or through receiving the vaccine, has the herpes zoster virus dormant in their system and is at risk of contracting Shingles.  Rheumatism, fibromyalgia or diabetes may also cause intercostal neuralgia.  Trauma, including vertebral or rib subluxation, and prolapsed thoracic discs are other potential causes.

Signs & Symptoms
Patients presenting with intercostal neuralgia will have a sharp, stabbing pain along the affected nerve. This is usually a unilateral pain.  They may or may not have nodules along the ribs near the affected nerve.  They may be hypersensitive to pressure, and they may be suffering a reflex spasm of muscles because of the pain.  Pain will inhibit active range of motion that may lead to consequential atrophy (wasting) of muscles.  Patients may also present with shallow, apical breathing as deep breaths may also increase pain.

Orthopedic Testing
Some of the typical orthopedic assessment techniques a massage therapist may use are:

  • Active range of motion of the thorax within pain-free ranges.
  • Rib expansion test – the therapist will measure multiple areas of the rib cage as the patient is asked to breath in and out.
  • Breath count – the therapist will monitor the number of breaths per minute the patient takes.

Massage Treatment Goals
Massage therapy can be used to help reduce the sympathetic nervous system firing, increase circulation, reduce muscle spasm and hypertonicity of affected musculature, including the diaphragm, all of which will in turn help reduce pain.  Massage can be aimed at increasing thoracic mobility, avoiding further neural irritation, and maintaining pain-free passive ranges of motion as well as progressively restoring pain-free active ranges of motion and strength.

Typical Massage Treatment
During the acute stage local massage is contraindicated. General Swedish or relaxation massage may be performed to other areas of the body.

During the chronic stage General Swedish techniques may be used to stimulate circulation. Compressions, stroking and fine vibrations may be used to help relieve muscle spasm.  Diaphragmatic breathing, diaphragm release, and abdominal massage may be implemented to help decrease the hypertonicity of the diaphragm.  Myofascial release techniques, rib springing and/or rib raking and vertebral mobilization may be used to help maintain thoracic mobility if there is no muscle spasm present.  The massage therapist may use attachment release, or address trigger points when these modalities are within the patient’s pain tolerance.  Functional strength may be assisted with stimulating ROOD’s techniques, and muscle spasm may be reduced using sedating ROOD’s techniques.

Massage Contraindications & Precautions
Local massage during the acute stages is contraindicated.  The patient may be on strong pain medications and there is a potential for sensory impairment and/or easy bruising.  Pressure should be monitored and no extreme temperatures should be used.  The patient may also be intensely sensitive to cold.  The massage therapists should avoid stretching or dragging an inflamed nerve as this may aggravate the condition.  Trophic skin changes may be present.  Massage treatment should be discontinued if the pain increases instead of decreases.

Typical Suggested Homecare
It may be suggested that the patient apply mild heat to the ribcage to help increase circulation and reduce pain.  When the nerve is not inflamed, the massage therapist may suggest diaphragmatic breathing and or intercostal stretching.