Monday, October 30, 2017


Cold vs Hot

Let’s begin by introducing the technical terms for this subject.  Cryotherapy is the use of cold in treatment of an injury and Thermotherapy is the use of heat in the healing process.  Many of our clients come to us either with an acute injury, or because of a chronic condition causing pain or musculoskeletal dis-ease in the body. 

We will discuss cryotherapy first because it is the first response to Acute injury.  An acute injury could be a fall or a sprain, a broken bones, surgery, or even just a strained muscle during a workout, and the acute phase for treatment is the first 24 to 72 hours.  This is usually associated with the acronym R.I.C.E.- Rest, ICE, Compression, and Elevation.   Compression and elevation are passive parts of the post injury Rest phase.  If the injury is on a limb it is typically easy to wrap an ACE bandage around your wrist or ankle, that is the compression aspect and then raise the limb above your heart and prop it up to properly Elevate and Rest, this is the time to introduce Ice.  Ice helps to decrease pain and ease acute muscle spasms, it constricts blood vessels which decreases swelling, and decreases the inflammatory response.  Most conditions ending in –itis, arthritis, bursitis, tendonitis, the –itis indicates inflammation and ice can be helpful for these conditions. 

Conservative use of ice can protect against frost bite or nerve damage from over icing an injury and never use ice on an open wound or areas of poor circulation or neuropathy.  Ice packs whether gel or ice cubes should always be wrapped in a damp towel to increase conduction and protect the skin.  Time increments will vary based on the body part however areas with little muscle or tissue, feet, hands, ankles, and wrist are especially vunerable to frost bite so rounds of 5-10 minutes at most with 10-15 minute rest intervals in between ice is critical.   For the back, legs, and hips 15-20 minutes of ice is recommended with 10-15 minute rest intervals in between.  Your massage therapist may recommend using ice following a particularly intensive session of deep tissue work causing tenderness or inflammation from the work releasing chronic muscle adhesions or ‘knots’.

Chronic pain is typically defined as ongoing and lasting for more than six months.  Most chronic pain comes from initially from an injury or illness and is aggravated from persistent stressors, poor self care or general repetitive lifestyle hazards such as long commutes, poor posture, and sedentary work life 8 plus hours a day.  Massage is the best way to help the body maintain balance with the stressful demands of our busy lives, in between sessions thermotherapy can be a great way to help the body cope with the daily tension.  Heat acts to increase circulation, reduce stiffness and decrease muscle spasms.  It is great way to help relax tight muscles before stretching and during massage.  Conditions that respond well to heat include tension headaches, chronic shoulder or low back pain, frozen shoulder, and sciatic pain.  The most important thing is the find a way to work it into your daily routine.

My favorite recommendation for quick rounds of heat therapy is to use the little bean-bag packs you can
microwave, an easy as home “life hack” is to fill a single sock at least three quarters full of rice, tie the sock closed and toss it in the microwave for 45 sec, toss it over your shoulder for instant relief. Try warming it at work and using it on your commute home or while you are sitting at your desk in the morning checking emails. Most electric heating pads have auto off switches now and it is easy to keep plugged in next to the couch or bed and use at the end of the day when you finally get a chance to stop moving. For large muscle groups like legs, hips, and back at least 20-30 minutes is a good start and no more than 45 minutes using low heat, let the area rest by moving the heating pad to a different body part for 15-20 minutes then, if desired, a second round of heat on the first area.  If you have access to a hot tub, sauna, or even your home bath are all great options for adding heat therapy into your pain management routine.  I also recommend Epsom salts in the bath tub following a massage or for self care any time your body is feeling the strain.  Contraindications, meaning when heat is NOT recommended, include deep vein thrombosis, some neuropathy or circulation conditions, or when an infection or malignant tumor is present.  Always consult your physician before using a hot tub, sauna or Epsom bath if you have certain cardio/pulmonary conditions.  Discuss your specific conditions with your massage therapist, utilize our training as a resource for your questions and help maximize your healing with our suggestions for daily, self care using of cryo- and/or thermotherapy.

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Introduction to Pain Science
Understanding your pain

Pain can be debilitating.  Chronic pain brings 30 million people to the doctor yearly in the U.S.  50% of those in pain are unexplained.  In other words, the doctor agrees it is chronic pain but MRI’s, blood work, tests, or x-rays don’t show a cause for the pain, which brings us to the topic of pain and your brain.  Pain science has become increasingly popular in the manual therapy world.  A whole new way of approaching pain comes to light as more research and publishing’s on the topic arise. 

Pain is weird.  Pain is not caused by any ONE thing.  We need to stop thinking of pain in terms of a single cause, “It’s all coming from the knee surgery" (or you fill the blank).  Pain is not a reliable sign of what’s really going on.  Chronic pain is a bag of different factors, which are complex.  Pain always has a layer of brain-generated input, which can be helpful but also hindering.  In the worst cases, the pain system can malfunction in several remarkable ways, causing pain that is much more intense than just a symptom.  Sometimes, for many people pain is the problem. 
  •  When pain persists, the danger alarm system becomes more sensitive

From an early age we are taught that pain signals are a protective mechanism our body gives so we stop doing whatever is causing the pain.  This is easy to grasp if we’ve broken a bone or touched a hot stove.  It’s not so easy to understand when a person’s body is giving them pain and doctors can’t find anything wrong.  Or physiologically the bone is completely healed and therefore should not cause pain anymore. But pain is not FAIR.  It is a product of: tissue damage, perceived threat and personal history.  Pain can occur without identifiable tissue damage or it can outlive recovery so that even where tissue has healed, the pain persists.  For those in chronic pain, this becomes a self-sustaining pattern.  When pain persists, the danger alarm system in the brain becomes more sensitive.  When the alarm system becomes more sensitive you feel pain more because the body’s response systems and your thoughts and beliefs contribute to the problem.

·       Pain doesn’t always match tissue damage

Dr. Lorimer Moseley tells an entertaining story of a snake bite on his TED talk “Why things hurt” which illustrates pain can be an illusion and personal history has a big part in pain.  In this story he was walking along a trail and felt a scratch on his left leg near the ankle and thinking nothing of it, keeps walking.  It turned out it was a snake bite and he almost died.  Years later while walking in the same type of environment he felt a scratch on his left leg near the ankle where excruciating pain immediately ensued.  That time it really was just a stick that scratched his leg but his brain was telling him, “remember last time you felt this you almost died, this is an emergency!”  This example shows pain you perceive doesn’t always match the amount of seriousness or tissue damage. When something happens to our body, receptors send a signal to our brain to say “something just happened.”  Within seconds the brain decides for us if we should be worried about it based partially on past experience.  

·       Once a danger message arrives at the brain, it has to answer a very important question: “How dangerous is this really?” In order to respond, the brain draws on every piece of credible information — previous exposure, cultural influences, knowledge, other sensory cues — the list is endless.

Everything in your body that hurts involves a conversation between the central and peripheral nervous systems. I love this example from Pain Science.

It could go like this:
Got problems here! Bad problems! Red alert!

Yeah? Hmm. Okay, so noted. But you know what? I have access to information – sorry, it’s classified but
It suggests that we don’t have to worry about this much.
I’m telling you, this is serious!
Nope, I don’t buy it.

Look, I may not have access to this “information” you’re always talking about, but I know
tissue damage, and I am not kidding around, this is a credible threat, and I am going to
keep telling you about it.

Actually, you’re having trouble remembering what the problem is. You’re going to send me fewer
messages for a while. Also, these aren’t the droids you’re looking for.

Uh, right. What was I saying? Gosh, it seems like just a second ago I had something important to say,
 and it’s just gone. I’ll get back to you later I guess …

I want to be very clear that this is not suggesting the pain people feels is all in their head and isn’t real, rather by explaining the way the brain works we can reassure people that the danger implied by pain maybe exaggerated.

Many people with chronic pain want to “avoid pain” so they don’t do the movements that cause pain.  If pain weren’t complicated this would be a good idea but as we’ve discussed, pain has many areas involved so this approach isn’t the best and leads to limited activity and less quality of life.  For ideas of how to move with your pain reference Lorimer Moseley’s book, Explain Pain.  In a nutshell, the idea is to retrain your brain that you are safe and the movement is not causing you damage. An example of this would be if you have neck pain turning your head.  I’m not going to ask you to turn your head.  Instead I may have you sit on a swivel stool and look at a fixed spot on the wall while swiveling your body left to right.  You neck is still moving but your brain sees this as a safer movement therefore no pain!  For any body part the idea is to start with comfortable movements below the flare up line and always do more than you did yesterday, but not much more.  There will be a line where you flare up, but this line will slowly raise along with the amount of activity you can accomplish.   Here are a couple thoughts about moving within your pain zone. 

·       Be kind to your nervous system. Create pleasant, safe sensory experiences — positive inputs. Seek comfort.  If your brain thinks you’re safe, pain goes down — and pleasure feels safe. So be “nice” to your CNS in every way that you can think of.
·       Don’t be a pain drama queen.  When you exaggerate, talk about and dramatize your pain, you directly exacerbate the neurological end of the chronic pain problem. 

With a little education and understanding why your pain won’t harm you, you can overcome pain and return to doing the things you love by slowly adding smart activities to your life.  Be patient and purposeful in picking activities which feel good and kind to your body and your brain will follow.  You can master this.  The research shows that it works.  

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Monday, October 23, 2017


Strains Vs. Sprains
Two words that sound so similar but are actually completely different. Sprains and strains are often used interchangeably or incorrectly because a large amount of people do not know the difference between a sprain and a strain. Don't want to be one of those people? We got you covered!

What Are Strains?
A strain is commonly referred to as someone pulling a muscle, and it really is just that. A strain is the overstretching or tearing of a person's muscles or tendons. What exactly is a "tendon" some may ask. Well, a tendon, according to MayoClinic, is a fibrous cord that connects all of our muscles to the bones in our body. People most commonly find their lower back and hamstring muscle (muscle in the back of the thigh) strained.

What Are Sprains?
Sprains are more common and can happen in the strongest, most athletic of people and in people who have never even worn a pain of sneakers. A sprain is the overstretching or tearing of a person's ligaments. A ligament is a group of tough bands of fibrous tissue that is used to connect two bones together. The most common body part that is sprained is the ankle. Side Note:I just recently sprained mine!

Symptoms of Sprains and Strains
I bet you are thinking "Well, thanks for telling me what they are, but how do I know if I sprained or strained my -insert body part here-?" Great question! Almost all of the symptoms of sprains and strains are the same for both and can happen whether you sprain or strain. These symptoms include pain around the affected body part, mild to severe swelling, limited flexibility and range of motion, and limited strength while using the affected body part, according to Health Line. The symptom that is usually a good tell-tale sign of whether someone sprained or strained a body part is if there is bruising or spasms. If a person sees bruising around the hurt body part, then it is probably a sprain. If the person is experiencing muscle spasms of the affected area, then it is most likely a strain. Although this is usually a good indicator, always consult a doctor for proper diagnosis and treatment plan. 

Treatments of Sprains and Strains
For both sprains and strains, the treatment is generally the same unless it is clarified by a medical professional. RICE is going to be your best friend if you sprained or strained part of your body. RICE stands for Rest, Ice, Compression, and Elevation. Kids Health goes into more detail about RICE. To follow RICE, you must rest from any strenuous activity or standing for long periods of time until the pain is significantly less, ice the affected area 4-8 times a day for no longer than 20 minutes at a time, support the injured area with compression bandages for at least 2 days following the injury, and elevate the affected area above the heart as much as possible to reduce swelling. In some cases, more advanced treatment may be required under the supervision of a medical professional. We recommend that if there is severe pain to see your doctor and to not self-diagnose.

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