Thursday, November 12, 2009

Gas Pains and Swollen Glands

At Breitenbush, recently, I took an all day workshop on low back, hip, and pelvic work. In the morning I was feeling pretty on top of things, because I've long been aware of how often low back pain derives from trigger points in the gluteus medius. It's always suspect number one. (If you stick your hands into the back pockets of a pair of levis, the heels of your hands will be on the gluteus medius. It's tremendously important: it's the main muscle that holds you upright, when you're walking, while the opposite leg is off the ground.) I learned some new things about leg positioning, and how to work the piriformis -- generally the culprit in false sciatica -- but it wasn't till afternoon that we ventured into really new territory, and the reason I took the workshop.

The psoas major. I'd spent several frustrating sessions with one client, knowing perfectly well that the psoas had to be the source of his hip pain and difficulty walking, and making no progress at all. I just couldn't get to it.

image from Wikipedia

It's tricky. The psoas runs from the sides of the lumbar vertebrae down through the bowl of the pelvis, and attaches high up on the inside of the thighbone. It's the strongest hip flexor: that is, it pulls the thigh forwards and upwards. If you're in a marching band and the conductor tells you to get your knees higher when you step, he's telling you to contract your psoas more forcefully.

The psoas is suspect number two, or three anyway, in low back pain, and it had always defeated me. It's towards the back of the body, but it's no good trying to get to it that way: the thick spinal muscles and the QL are layered above it. You have to go in from the front, and push right into the belly, almost all the way to the spine. We'd spent a day working on this in massage school, and I never felt confident that I'd even located the damn thing, let alone worked it. I hate making people uncomfortable, and there's no way that rummaging around deep in someone's abdomen is going to be comfortable.

Still. If that's the muscle that needs help, that's the muscle you have to get to. So I was keen to try again. The teacher -- Robert Sirch -- was excellent, and my working partner was wonderfully patient and helpful. (She apologized a couple times, of course, for having a normal amount of adipose tissue for me to work through, as though it was a great moral failing to have a normally rounded belly. Sigh.) I was at least sure of where the psoas was and what it felt like, now. When we swapped places, and she was poking her fingers deep into my belly in turn, I was uncomfortable. It was tender: I felt like I was having gas pains. Did that mean she was doing it wrong, poking into the intestines, instead of getting the muscle?

It wasn't until later that night that it came to me. "Gas pains," what were these "gas pains," really? In a moment of sudden glorious illumination, I understood. The pain I'd learned to call "gas pains" had nothing to do with gas, nothing to do with intestines. It was nothing more sinister than a jacked psoas muscle. I'd shied away from that sensation, when in fact it was my best guide.

Back home, I worked it on myself. Lie on your back. Bring your knees up, and let them fall to one side. That lets the intestines fall away, and brings the psoas up a little. Poke in your fingers, about midway between the the point of the hipbone and the belly button, and let them sink deep, in the direction of the spine. When you get to it, It feels -- if it's jacked up, which mine was, on the left -- like a hot dog under your fingers. And when you work a trigger point in it, it feels like -- well, like a gas pain. A sharp wincey pain in the belly. If it's not jacked, you may not be able to find it or feel it at all. I made working it part of my routine for a few days, till the tweakiness in my low back was completely gone. (Caveat: if you're prone to constipation, IBS, or other bowel problems, know what and where the sigmoid colon is before you try this: you don't want to be poking an inflamed colon.)

This moment harked back to an earlier moment of illumination. I got the flu towards the end of my year in massage school. As I was getting better, I did lots of trigger point work on myself. Much of the misery of the flu is caused by how much it jacks the muscles. Nobody knows, incidentally, why it does this, but if you know how to resolve trigger points on yourself the wretchedness can end a lot sooner. So I was working away, and came to the SCM, the V-shaped pair of muscles on either side of the adams apple, which run from below the ears to either side of the top of the breastbone. You can grab them between thumb and finger and work the points out of them.

I had no sooner started when I thought -- uh oh. I've got hold of a swollen gland here, not muscle. I know this sensation! The glands under my jaw get swollen when I have the flu, always have. I'd better not work here.

There's some delay before the book learning rises to the surface. I had plenty of time, lying there on the couch being sick, to contemplate the phenomenon.

Glands? What glands? My anatomy books were to hand, and I pulled them out. Sure, there were lymph nodes under the jaw -- but not that far down. There could have been nothing between my fingers but muscle. Simply nothing else there. Again, the little light bulb pops on. "Swollen glands," indeed! It was a jacked SCM, nothing more, nothing less. I worked them again. Painful as hell: but I could feel my headache subsiding, even as I worked. By the time I was done it was almost gone.

It seems a pity to me that we teach virtually no practical anatomy in school. We teach a lot of things that are of little or no practical use -- when will you ever need to know, as an end-user, which side of the body your gall bladder is on, or whether the liver or the kidneys come first in the filtration process? Cell metabolism is fascinating, but it's not something you can easily get under the hood and monkey with. But knowing that "tension" headaches are usually caused by hypertonic neck muscles, that trouble turning the neck is probably due to shortened lev scap muscles, that low back pain most likely comes from jacked glutes -- everyone who owns a body is likely to need to know these things. There's a reluctance, in science, to study things on the gross level, on the level that you can see and touch. Which is unfortunate for two reasons: one, it's the level at which you can most often intervene and actually fix something that's going wrong, and two, it's the most compelling level. Everyone wants to know how their body works on that level. It's fascinating to identify the tendon that pops up on the back of your hand, and the muscle that bulges way up on your forearm, when you lift your index finger, and to be able to picture the mechanics of it. It's just plain cool. It engages the curiosity in a way that, say, blood lipids or alveolar transfer usually don't.

Our Bodies, Our Selves was, among other things, a great pioneering work in practical anatomy. We need more books like that, and we need to teach them in schools. You shouldn't have to wait until you're fifty years old and go to massage school to learn that your "swollen glands" are actually jacked neck muscles, and that you can actually do something about them. It's not just our private parts that are shrouded in ignorance and shame, and ruled by taboo and folklore. It's the whole body: this whole marvelous mechanism we inhabit, and depend on, and attend to, ordinarily, only when it's so badly injured or in such pain that we can't do our work any more. It's a fascinating large-print book in front of our eyes all the time: we really should spend more time reading it.

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