Self-Care (For Massage Therapists And Clients)

Copyright © 2009, by Doug Alexander

In my opinion, treating our own TrP’s is pretty difficult; however, it can offer some short-term relief until the issue of pain and dysfunction—caused by muscular-imbalances—is addressed as a whole, by a trained professional. I say this because I have my own issues and find it hard to help myself most of the time—and this is what I do for a living.

There are so many options out there on the World Wide Web… From stretching techniques to tools galore. But what works and what doesn’t? Unfortunately, I can not really answer that question, but I can offer up the following information based on my own experiences, and those of my clients after hearing their experience with the suggestions I have expressed over the years.

With that said, I would like to bring to your attention an Electronic Self Care Manual that was created by Doug Alexander and his team at TouchU, located in Ontario, Canada. I had the pleasure of somewhat-meeting Doug via e-mail a couple of years ago, and through corresponding with him, I luckily ended up with this awesome manual (the above image is just one page out of 73) at my finger tips; handing out particular portions to my clients as a professional courtesy. This manual happens to be full of great advice; including information on types of injuries, stretching exercises (yes, with pictures), breathing techniques, postural improvements, etc. This .pdf is available to both therapists and non-therapists. If you are not a client of mine, please contact TouchU directly for a copy. If you are a client of mine, there is no need to contact them directly as I have it readily available for you.

In regards to tools for self-care, one I highly recommend is the Original Backnobber II, made by The Pressure Positive Co. My husband, and every client I have recommended this to, loves it. I have several clients that even take it with them during business trips because it breaks down into two pieces, making it easy to put in their carry-on luggage. Another great tool from this company is the Knobble II. I have actually laid right on top of this as a way to address TrP’s that I have had in my back, shoulder blades, etc.

Well, folks… That’s all for now. This was a pretty short post, but I hope you still found the information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

The Psoas Major: A Major Player In Back Pain

Have you ever had back pain or know someone who has? If so, this post is for you, my friends!

There are many muscles that could cause back issues, but today I’m going to focus on just one, that being the psoas major; mainly because I’ve come across too many new clients whom never had them treated before… And this surprises me. Another reason is because I’ve noticed that many people think that only back muscles should treated because it’s their “back that hurts”. Believe it or not though, there are muscles in the front of our body that have an effect on back pain as well. Before I go on though, let’s go over the anatomy…

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Transverse processes and bodies of lumbar vertebrae.
Insertion: With iliacus into lesser trochanter of femur.
Action: Psoas major and iliacus, acting together, flex thigh at hip joint, rotate thigh laterally, and flex trunk on the hip.
Innervation: Lumbar spinal nerves L2-L3.

NOTE: Some people refer to this muscle as the “iliopsoas” because the psoas major and iliacus share a common tendon and end-point, but they are in-fact two separate muscles, which is why I’m only going to refer to the psoas; however, they do work in-conjunction, in some circumstances.

The function of the psoas is to increase flexion of the thigh at the hip. It can either bring the femur towards the spine or the spine towards the femur; just depends on what movement is taking place. An example of when it would be active—or contracting—is when you swing your leg forward during walking or running. The psoas is also a strong lateral flexor and stabilizer of the vertebral column (ipsilaterally—same side); as in when you bend to one side or the other.

How do you know when the psoas could be influencing back pain? Well, let me share a few examples—which also happen to be indicators for treatment—with you…

  • You have back pain when lying on your back; without a pillow under your knees
  • You have back pain that is vertical, but is relieved when in the reclining position
  • You have difficulty straightening after prolonged sitting

Taking it one step further, let me share some additional indicators for treatment with you…

  • An increase—or possible decrease—in your lordotic curve
  • You stand with your weight off the affected psoas side
  • You have unexplained pelvic floor pain (neural entrapment issues)
  • You have rotational distortions of the spine (Scoliosis)
  • You have groin pain

Please keep in mind that muscles have synergists and antagonists, so even though you have this information at your fingertips, there are other muscles not mentioned in this post that can cause a person pain and dysfunction in the back; anywhere in the body, really.

As always, I hope you find this information to be informative!

IMPORTANT NOTE: The psoas is a deep muscle in the abdominal area and great caution should be of utmost concern when treating this muscle. I mention this because of the possible presence of an AAA—Abdominal Aortic Aneurysm—which would be a serious contraindication for treatment, due to the fact that it could have potentially disastrous consequences.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Referred Pain At-A-Glance

Before I go on with my post, I would like to first state that I have inserted Wikipedia’s links for the following conditions in case some of you are unfamiliar; however, please keep in mind that they do not mention PNMT—or any specific modality of massage—as an option for pain-relief, aside from the brief-mention of “massage” in the carpal tunnel and piriformis syndrome links under Treatment. Traditional medicine is basically the main focus, which is one of the reasons why I felt it was important to start this blog. At the end of the day, PNMT is extremely beneficial for pain and dysfunction caused by muscular imbalances within the muscular-skeletal system. What’s even better is that it is non-invasive!

Referred pain is a phenomenon used to describe pain perceived at an area, adjacent to or at a distance from, the site of an injury’s origin. For example, carpal tunnel symptoms can be caused by muscular imbalances in the shoulder and/or upper arm. These imbalances can throw off the alignment of muscles and tendons down the arm. The result is not necessarily pain in the shoulder, but instead, pain that is similar to carpal tunnel. Interesting, huh?

Assuming you would agree, I’ll go ahead and get a little more specific, using sciatica as another great example. In my experience, it appears that many people aren’t aware of specific muscles in and around the buttocks that can mimic true sciatica. The piriformis, gluteus minimus, and hamstrings being perfect culprits. Most people are told that sciatica is directly related to the sciatic nerve; generally caused by compression of the lumbar nerves L4 or L5; sacral nerves S1, S2, or S3; or by compression of the sciatic nerve itself. There is also another diagnosis called piriformis syndrome. This is when the sciatic nerve is compressed or irritated by the piriformis muscle due to it being in the shortened position or from spasming. (Please read the portion on Davis’ Law in this post if you are unfamiliar with “shortened” muscles and how they occur.) Not only can muscles in the shortened position entrap or compress nerves, but they may also contain TrP’s that replicate nerve-related pain, such as the carpal tunnel and sciatic-type symptoms I mentioned, among others. (Please read this post for more detailed information on TrP’s.)

I know it may sound crazy that muscles could actually be the root cause of the above mentioned problems, but I promise you it is indeed very possible. If you have tried other options out there, up to and including surgery, but have had no relief or it was short-lived, I encourage you to look into this form of medical massage. If you live in the Cincinnati, OH area and are interested in reading some testimonials from my clients, please click here.

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Range Of Motion And Optimal Measurements

Range of motion (also known as ROM) refers to the distance and direction a joint can move to its full potential. If ROM is restricted, the joints ability to function normally becomes limited. Each specific joint has a normal ROM that is expressed in degrees, which can be measured using a goniometer; with the help of another person as well.


Below is a list of optimal measurements for certain areas of the body, but first, I’ve included what the mentioned movements mean in case you weren’t already aware…

Flexion – When the angle of a joint decreases, as in bending your arm at the elbow.
Extension – When the angle of a joint increases, as in straightening your arm at the elbow.
Rotation – When you turn your head, as in checking your “blind spot” while driving.
Lateral Flexion – This usually refers to the spine and would happen when you are holding your cell phone in between your ear and shoulder or bending your torso while running your arm down your leg.
Abduction – When you move a limb away from the midline of the body, as in raising your arm up perpendicular to your body.
External (Lateral) Rotation – Rotation away from the body, as in rotating your leg out so your toes point outward.
Internal (Medial) Rotation – Rotation towards the center of the body, as in rotating your leg in so your toes point inward.

According to my PNMT training manuals, the optimal measurements are as follows, but not limited to…

Cervical ROM:
Flexion – 40°
Extension – 75°
Rotation – 80°-90°
Lateral Flexion – 35°-45°

Shoulder ROM:
Flexion – 165°-170°
Extension – 50°-60°
Abduction – 165°-170°
External (Lateral) Rotation – 80°-90°
Internal (Medial) Rotation – 55°-60°

Lumbar Spine ROM:
Flexion – 60°
Extension – 35°
Rotation – 8°-10°
Lateral Flexion – 20°

Hip ROM:
Flexion – 140° (passive)
Extension – 30° (passive)
Abduction – 50° (passive)
External (Lateral) Rotation – 60° (passive)
Internal (Medial) Rotation – 40° (passive)
* Passive meaning the examiner moves the joint without assistance from the person being examined. 

As always, I hope you find this information informative! I’ll be MIA for a couple of weeks, but plan to have something good to write about for my next post.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Just A Couple Shoulder Pathologies

There are so many things I want to write about, but since I mentioned a muscle related to the shoulder joint in a previous post (The Infraspinatus), I figured I might as well continue with the same theme.

To start, pathology is the precise study and diagnosis of disease, which I obviously do not specialize in. Pathologies can cause individuals a lot of distress and here are just a couple linked to the shoulder that I have come across with clients in my own practice…

Impingement Syndrome – Also known as rotator cuff tendonitis. This syndrome is one of the most common causes of shoulder pain and dysfunction. Repetitive movements of the arm in over-the-head positions (i.e. baseball, tennis, lifting weights, swimming, painting, carpentry work, etc.)—or holding the arm in the same position for a long period of time or a direct blow or stretch injury—can cause continuous pinching of the rotator cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor). This can then cause inflammation and result in pain. If movement is continued despite the pain, a tendon may degenerate near the attachment and ultimately tear away from the bone resulting in a not-so-welcome rotator cuff tear.

Torn Rotator Cuff – This injury is pretty self-explanatory, but nevertheless, is diagnosed when one or more of the rotator cuff tendons tear away from the head of the humerus. OUCH, not so funny if you ask me—pun intended! Most tears of this nature occur in the supraspinatus muscle and tendon, but other muscles and tendons can be involved as well.

Do you have shoulder problems? Have you been diagnosed with one of the above mentioned ailments? If so, PNMT can help! It won’t mend an actual tear, but it will lengthen shortened muscles, thus relieving tension on the tendons and increasing range of motion.

All in all, before taking the surgery route followed by lots and lots of post-op rehabilitation—unless of course it’s absolutely 100% without-a-doubt necessary per a medical professional—I highly recommend giving this non-invasive option a whirl.

NOTE: Due to a much anticipated upcoming vacation, I may not be posting on here for 2-3 weeks.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me