Orthopedic   Massage

Answer

Return to Top

Answer

Scott, the pain triangle you are experiencing is the area of the quadratus lumborum muscle but I don't think it's that muscle causing your problem.  The job of heaving lifting would cause you to use core muscles most likely the psoas muscles. These attach to the lumbar spine in the area you describe as the pain triangle. The sitting you're now doing would allow those muscles to shorten causing the pain.  Most of the back stretches I've seen over the years do not include the most important, the lunge stretch.  Kneel on one knee (I recommend a small pillow under the knee), with the opposite leg reach out in front of you as far as you can comfortable.  Lean slightly forward making sure the ankle of the front leg is ahead of the knee of that same leg. You should feel as though you are doing the split and feel the stretch in the groin (sometimes in the low back).  At this point lean your upper torso back gently, hold for 2 seconds than lean forward releasing the stretch, repeat 10 times. I find that holding on to a stuffed sofa or chair helps with balance. Stretch both sides but you will find that one side is tighter then the other.  Spend more time on the tight side but don't neglect the other side. Continue this stretch 2 to 3 times a day for a couple of weeks, it's important to continue to stretch even after you're feeling better. Those muscles have the memory of being tight and it will take time to retrain that memory.  Let me know if this works for you.

Yours in Wellness,

Allan Drew

Return to Top

Answer

A groin pull would include one of the adductor muscles.  The most likely candidate would be the gracilis, a long, narrow (the diameter of a cigar) muscle that runs from the pubic bone to the lower leg.  Have your massage therapist work the area.   They should be able to determine which muscle is involved. Massage the area to loosen the fibers then stretch.  There are numerous adductor stretches, find the one that pulls on the tender area.  I believe in the two-second stretch, hold for a count of two, release and repeat.  If it is the gracilis the stretch that should work would be to sit in a chair with your feet on the floor.  Place your left ankle on your right knee; apply pressure to the left knee toward the floor.   You should feel the stretch on the muscle.  Again, hold for 2 seconds and release, repeat 10 to 20 times.  Stretch three or more times a day.  Keep stretching until you are 100%. I would not run for a week or two and then only run for a short distance - for you that might be a mile- if it feels okay, take the next day off before you run again.  Do not increase your mileage too quickly.  I understand how difficult it is for a dedicated runner to not be able to run but too much too soon would only delay your full return. Do some cross-training, cycling or swimming if it doesn't aggravate the injury.   

Yours in Wellness,

Allan Drew

Return to Top

Answer

Cathy, the fatigue and pain in the left arm has me concerned. Has your client had an examination by his cardiologist? Rule out the possibility that the heart isn't the cause.  Having ruled out his heart as the problem, begin muscle testing. First, test the deltoid, have him hold his arm to the side with the arm parallel to the floor; apply light pressure pushing his arm toward the floor while he resists.  If there is pain or a weak muscle response it's probably the deltoid.  Second, have him bend his arm to 90 degrees apply pressure to straighten his arm with him resisting.  Pain or weakness would suggest the brachialis or biceps is the culprit.   If neither of these tests produces significant discomfort then the problem is likely referred pain from the subscapularis. This is my bet as to where the problem lies, the subscapularis is an internal rotator. Work from a prone and a supine position also check the teres major.  And, yes, stay away from the site of the pacemaker and leads. Good luck.

Yours in Wellness,

Allan Drew

Return to Top

Answer

Carlene, The medical establishment considers RLS as idiopathic (cause not known) but label it as a neurological (having to do with nerves) disorder. As with the neuralgia case I wrote about (refer to Introduction to the right of this column), massage may deliver some relief although they claim there is no known cure.   My experience with this syndrome is limited but the results have been mostly very good using deep tissue massage.  One case concerns a pregnant woman where massage only helped temporally. RLS in pregnant woman seems to be a third trimester problem that dissipates after delivery.

I would recommend alternative methods of treatment before taking medication including: massage (deep), exercise (walking, aerobics, biking) and stretching.  Also, depletion of iron, magnesium and chronic diseases should be checked. The use of tobacco, caffeine and alcohol can be a contributing factor.

The best information I could find comes from the National Institute of Neurological Disorders and Stroke.  www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm

Please keep me informed about your results.  Does anyone out there have anything to add?  The more we share this kind of information the sooner we'll find ways to heal without the use of drugs.

Yours in Wellness,

Allan Drew

Return to Top

Answer

Ruth, RSD (Reflex Sympathetic Dystrophy) is a syndrome of abnormal and intense pain from an injury, surgery, or trauma.  This pain is usually associated with the sympathetic nervous system, the part of the autonomic nervous system that deals with the "fight or flight" reaction.  RSD is thought to be a severe reaction to the injury by this nervous system. The key word here is "thought."  There are still medical mysteries that have no clear understanding as to what, where, or why they occur, or how to cure them. Unfortunately, RSD is such a case. But RSD can be managed with sympathetic blockage using local anesthetic injections and pharmacologic intervention, i.e., corticosteroids, calcium channel blockers, alpha-adrenergic compounds, oral local anesthetics, anticonvulsants, and tricyclic antidepressants.

Basically, medical experts don't know for sure why so much pain is present. They try various techniques and compounds until they find a combination that works for you. 

Now to your question about whether massage will help or not, the answer is that I don't know. But any time you have a broken bone you also have soft tissue damage. That can be addressed by massage. Physical therapy should be included to assist in the movement of muscle tissue. Movement is very important in the health of muscle tissue - Use but Don't Abuse. What I mean is, don't overdo.  Yes, do get a massage.  After one treatment you'll have an idea of whether or not you feel better. The massage will help on two levels: (1) your therapist can work on the muscles of the lower leg and, through touch, determine the condition of the muscle tissue; and (2) the relaxation the massage produces may help settle the sympathetic nervous system.  I believe massage is worth a try.

Yours in Wellness,

Allan Drew

Return to Top

Answer

November 12, 2006

This week is not a letter, but a story about a client.  I saw Tim for the first time in 2000. He is a 46-year-old teaching tennis pro, able to play with his left or right hand. Tim had tennis elbow in both elbows and was fearful he would not be able to continue in his profession.  I suggested he choose to play either left- or right-handed so the unused elbow would have a chance to heal.  Tennis elbow (tendonitis) is the inflammation of the epicondyle of the humerus.  What I believe happens are that the muscles become so tight they pull on the tendon that attach to the bone, causing the pain.  I worked on both left and right arms equally.  The surprise was that the side he continued to use healed first.  He was playing with easy, not hard strokes, and I think the motion of using, but not abusing, the arm aided in the healing by putting the muscles through their range of motion. 

This not the end of the story.  Tim came to see me this past week.  He's continued to teach, but has continuing problems from some tendonitis of the elbow, and shoulder soreness due to over-use or repetitive movements. My approach this time was to look at the problem from an overall perspective, starting at the shoulder and working down to the arm.  What I found were tight rotator cuff muscles.  The tightest and most significant of these was the subscapularis, the muscle under the scapular.  When I worked this muscle, Tim felt the pain in his elbow.  After the session he said he felt less pain. I think I'm on the right track this time.

The lesson I continue to learn is to not allow myself to fall into a pattern of assuming that because my last client was helped by a certain procedure that it will help the next client.  It is necessary for me to keep an open mind and not become routine or complacent.  Perhaps that is a lesson we can all learn. 

Yours in Healing,

Allan Drew

Return to Top

Answer

Kelsey, what you have is an over-use injury. You asked your muscles to do more than they were use to doing. The muscle responds by tightening. My guess is that the tightening occurred over days or weeks until the pain began. I recommend you find a competent massage therapist, someone who works on injuries. The muscles involved are the soleus and the gastrocnemius.  The gastroc is a two joint muscle, meaning it assist in the flexion of the knee and plantar flexion of the ankle. The soleus flexes only the ankle. The attachments for the gastroc are behind and slightly above the knee and the Achilles tendon at the ankle. But, both muscles should be tested. One way to determine which muscle is tight is to stretch your calves, first with a straight knee, hold for 2 seconds, then let your knee bend and continue the stretch for 2 more seconds. The straight (or locked) knee stretches the gastroc, a bent knee stretches the soleus. Stretch the muscle that feels tight, or possibly, both muscles. I do recommend at least one session with a massage therapist. And, do a lot of stretching, several times a day. I believe in the 2 second stretch, hold and release then repeat.

To find a competent therapist ask them the question you asked me. If they have an understanding of the muscles involved, you may have found the right one. Working the calves can be painful. Remember, you are in control of your body, if it's too painful, ask them to use less pressure. There should be some discomfort but not flinching pain and that, you have the right to determine not the therapist.  

Yours in Health,

Allan Drew

Return to Top

Answer

Caitlin, I'm including a story from my book pertaining to neurophy. 
One of my clients, a doctor, came into my office with pain in the palms of his hands and the bottom of his feet. His doctor told him he had neuralgia (pain along the distribution of sensory nerves) and he was told to get used to it, and "...it will only get worse." He asked if I could help. I told him what I tell all my clients, "If it's muscular, probably." One week after the first session he returned, held out his hands and said, "It's working!" After three sessions, the pain was gone.

 There may be a way to ease the pain. I believe that in some cases the nerves may be trapped in or irritated by tight muscle tissue. With this client I worked the muscles of the lower leg; the calf muscles and muscles on either side of the shin. It might be worth a try with your grandmother. Find a competent massage therapist who does orthopedic or sports massage.

If the legs are too sensitive to massage the therapist could start out with very, very light pressure. What I have learned is that the body will adapt to the pressure if given time. Even laying the hands on the tender area gently can start the process. Don't give up.  If your grandmother is in this area I would be happy to see what I could do. Good luck and keep me informed.

Yours in Healing,

Allan

Return to Top

Answer

Nora, frozen shoulder is seen mostly, in woman 40 to 60 years old. One of the doctors I work with, who works in woman's medicine, believes there's a hormonal piece. What I have found is an emotional piece that may play into the mix. (See Monthly Update for October)

What you describe is not unusual. Often the pain dissipates with massage therapy but the Range of Motion (ROM) returns slowly. Check with your therapist, did they work the subscapularis, (teres major, and latissimus dorsi area)? The subscapularis is reached from the arm pit, a not so comfortable muscle to work. And one that takes very strong hands on the part of the massage therapist. Also, you need to stretch the shoulder the best way you can. The stretching should be uncomfortable but not painful. I suggest using the 2 second stretch, hold only for 2 seconds, and release than stretch again. I have a client that is continuing to heal. She is out of pain and is able to sleep better but, it has taken 4 ½ months. She went from 10% ROM to 40% and is continuing to heal.

Depending on the individual, full healing and full ROM can take time. Keep moving, use the arm as much as possible. Movement is healthy for muscle tissue, and stretch. As long as you are out of pain and you can sleep - be patient and if you are dealing with an emotional problem - deal with that as well. Another client's ROM returned in the same time frame as her emotional healing. Keep me updated on your recovery, good luck.

Addendum: 10/12/06 - I neglected to add: often with a frozen shoulder that has been immobile for a significant time there may be some ‘gumming up' in the joint from non-use. If this is the case it will be necessary to break-up the fibers in the joint by someone who knows how to do the procedure. I have the client bend their elbow 90 degrees. I hold the elbow while allowing their forearm and hand to rest against my shoulder in a relaxed manner. Placing my other hand in top of the clients shoulder I push from the elbow toward the shoulder with a twisting motion, clockwise and counter-clockwise. There should not be any pain. If there is restriction in the area it should begin to feel looser as you continue the motion. This should increase the ROM.

Yours in Healing,
Allan Drew 

Return to Top