How I Fixed my Severe Ankle Pain (or Maybe it just Went Away.)
So evening before last I became aware that my ankle was hurting. A lot. I’d just come home from doing a massage. So far as I knew I hadn’t done a thing to it, though I had set my table unusually low, and hence been doing a fair amount of my work kneeling. Dropping to a kneeling position puts the ankle rapidly into extreme flexion; it wouldn’t be that surprising if I’d hurt myself, either by over-flexing the ankle or by the eccentric contraction of the calf muscles.
But the pain surprised me, because it was superficial and localized. Right on the point of the lateral malleolus, what civilians might call “the bump on the outside of the ankle.” As if I’d whacked it on something. Maybe I had whacked it on something, but you’d think I’d remember whacking it that hard. Man, it hurt.
So it was like trigger point pain in that it appeared rather mysteriously, without what Paul Ingraham (of SaveYourself.ca) so accurately calls “an Oh Shit moment” – a moment when you know you’ve been injured. But it was unlike trigger point pain in being very localized, and tender to the slightest touch.
Okay, well, this is my area of expertise, right? Physician, heal thyself. So I did the obvious sweep, carefully stripping the peroneals (along the outside of the lower leg.) Wow. That might be a trigger point, in the peroneus tertius. Reproduced the referred pain. Or did it? Well, maybe not. Hard to tell. Do I even have a peroneus tertius? Some people don’t. Maybe that’s the peroneus brevis. All this time studying anatomy, and mine in particular, and I’m not even sure which muscles I have.
Well, look it up. Oh! Yeah. I should definitely check the soleus (deep calf muscle, under the bulgy ones).
Whoa! Hurts like hell. Work on that sucker, for sure.
Okay. Does that feel better?
Well, I don’t know. It might. Is this really trigger point pain at all? Maybe I actually tore something in the ankle. Sometimes you get too clever, in this business. Sometimes the pain is exactly what it seems like, exactly where you feel it. Or maybe I really did whack it. No sign of bruising, though.
So sleep on it. Next day – yesterday – the pain was still impressive – in fact now it felt very like a sprain, and I felt it throughout the joint; I had a pronounced limp — and the point of the ankle just as tender. I worked the points several times.
Today the pain almost gone. I rode my bike to work quite happily. Almost certain not to have been ligament pain, then – they don’t get better that quick. And surely if I’d whacked it, I’d have seen a bruise? So I think I fixed it. With that trigger point on the peroneus tertius, unless it’s the peroneus brevis. Or the soleus one. I can still get a ghost of the pain if I flex my ankle all the way.
My point here is how very vague and provisional all your conclusions are, as you’re working on pain. If I had a different personality type, I might be trumpeting to the world how magnificently I just treated my ankle. And I’d rail against physical therapists, who would have told me to stretch (disastrous!) and train up (even worse!) the peroneal and soleus muscles, and physicians, who would have told me maybe I have bursitis or tendonitis or arthritis, and given me drugs to poison my liver.
But, being who I am, I’m acutely aware of the fact that I just don’t know. Maybe stretching and exercising it would have been just the thing – maybe they would have fixed it a day earlier. Maybe there was never a muscular problem at all: maybe I bruised my ankle and it just never showed up on the skin. Maybe I irritated a ligament but it got better quick, and ibuprofen would have spared me even yesterday’s pain. Nobody will ever know. Did my trigger point work fix my ankle? Was Napoleon poisoned on Elba? Did human beings wipe out the Neanderthals? I don’t know. Neither do you.
I do know that since learning that most of this sort of pain is muscular, and heals up really quickly if you know what to do, I’m much less intimidated by it. Pain drops on me out of the blue, as it does on anyone my age, but I meet it aggressively, with a bristling arsenal of methods and ideas. I have confidence I can make it go away. I have heat, I have contract-release methods, I have trigger point, I have visualizations, I have deep breathing, I have mobilizations, I have stretches, I have meditation, I have drugs. By God, something I throw at this pain is going to faze it.
And I have by now a history of recovering from chronic disabling pain, and helping other people recover from it. The back pain I had in my thirties, the debilitating knee pain Martha used to have – these things can go away, completely, as if they had never been. The model I used to have of the human body, as a machine made of delicate irreplaceable parts that wear out, one by one, has been replaced by that of an organic system that is so tough and vigorously alive that it even reproduces kinks and snags like trigger points, infinite loops (to drop into programming jargon) that sometimes you have to break forcibly to keep them from running forever.
The less you know, the scarier pain is. I used live in a very murky world of fear. What if my pain was a damaged nerve? Would that mean I would never get better? What if a disk slipped in my back and severed my spinal cord? What if this or that joint was just wearing out, cartilage disintegrating, connective tissue separating, never ever to heal? Seriously, I used to think all those outlandish things virtually any time I had back or neck or joint pain. It didn’t even have to be severe pain.
Sure, all these things are theoretically possible. They’re just all quite unusual, whereas trigger point pain is dead common. It was as if every time I had a cough I imagined I had tuberculosis. It is a possible explanation, no denying it; but it’s more likely to be a cold.
Showing posts with label TrP. Show all posts
Showing posts with label TrP. Show all posts
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.
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.
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.
Sunday, May 24, 2009
On the Soapbox
Massage careers are typically short -- three to four years, on average. There are two reasons for this. One is that it doesn't pay well, particularly if you're working for someone else; and the sort of people who are drawn to massage therapy are often not good business people, so that a lot of them -- who are perfectly good therapists -- simply can't get and keep a business going on their own. Keeping books, networking, and advertising; paying office rent and quarterly taxes; reckoning expenses and setting prices, are not in their skill set. They end up working at spas for fifteen bucks an hour, with no benefits, doing half a dozen massages a day. Which is hard physical labor, and not something many people are up to doing for long. And not what they had wanted to do in the first place.
Which brings us to the second reason most massage careers are short: people wear their bodies out. The most important thing I learned in massage school was nothing to do with massage techniques per se: it was simply learning how to do physical work without hurting myself. How to stand, how to let my shoulders settle, how to apply pressure with my weight, smoothly, from my center of gravity, rather than by pushing and jerking. I typically don't feel at all tired after a two hour massage: on the contrary, I feel light and energized and joyful. I'm grateful to East-West College for drumming body mechanics into me. It wasn't something they talked about every once in a while: it was something they emphasized in every class, every practical demonstration. All my instructors had been therapists for fifteen or twenty years -- three or four times the average career length -- so they all knew how important it was.
It has nothing to do with how big and muscled you are. I have clients who picked me because I'm big burly guy, and they imagine I'll give a strong massage. That's lucky for me, but it's nonsense, as anyone who's had a massage from one of those tiny, ancient Thai masseuses can testify: what matters is not your weight and muscle, but knowing how to use it. If I find myself straining, using my muscles hard, I know that I'm doing something wrong. It should all be easy. And the benefit runs both ways: a massage from someone who's working too hard doesn't feel right. It jolts and jerks. It doesn't feel safe.
The things I learned in school spill over into everyday life, of course. I sit differently than I used to. I don't use the backs of chairs much: I tend to sit on the edges of chairs now, with my belly thrust forward and my shoulders back, so my spine can have its natural curve. I noticed the other day that in the morning when I get up out of my bed, which is down on the floor, I no longer push myself up flat-handed, which is murder on the wrist. I use my knuckles, like any sensible ape, so that my wrist is straight. A straight wrist can bear a couple hundred pounds' force easily. A bent one can be injured by twenty.
The other piece of body maintenance is the trigger-point self-treatment, which I mostly learned on my own, first from Clair Davies' wonderful distillation, and then from Travell & Simon's wonderful book, his source. This has been a godsend. The general knowledge about what musculoskeletal pain is and how to fix it is abysmal, both among the public and among the medical community. Every day people tell me about how they've been diagnosed with ligament injuries, tendonitis, arthritis, carpal tunnel, and bone spurs. I can't legally object to these diagnoses -- that's not within my scope of practice, as a massage therapist -- but secretly I know that seventy-five percent of them are crap. Some of these people are in tremendous pain, and they've been told that nothing but general analgesics or dubiously effective surgery will help. Mostly they just have trigger points in the muscles, from bad sitting habits or muscle overuse or trauma. It all has nothing to do with deformations of bone, or connective tissue injuries. It's just muscle injury, and muscles, which are richly supplied with blood and designed to recover quickly from damage, heal up remarkably quickly, if they're given the chance.
What people don't want to hear is this: you have to let injured muscles heal, and you have to stop re-injuring them. It's mostly as simple as that. You can't sit stock still at a desk for ten hours a day, with your shoulders hunched and your back slumped and and your elbows unsupported, and expect your muscles to just take it. They won't. It's not because you're getting old, and it's not because you're fat, and it's not because you're stressed. It's because you're abusing your muscles. Muscles need to move often and freely.
I don't think anyone should work at a desk for a full workday. If you have to, then you must take care of yourself, by doing, at a minimum, this:
1) Take all of the breaks legally allowed you, and get the hell away from the desk. Stand up and walk away. Don't, for God's sake, spend your breaktime sitting. Walk, run, dance, do gymnastics, stand on your head. Lie down, if at all possible. Do anything but sit.
2) Make excuses to get up during your worktime. When I'm doing data entry at the Foundation, every fifteen or twenty minutes I need to print out a report of the commited data. Every time I hop up and walk the thirty feet to the printer to fetch the print-out. It's not efficient. I could let them pile up and fetch them all at once, and save myself five or ten minutes a day. I do it deliberately, though, to force myself out of the chair. I believe that the better blood flow probably makes me a smarter and more efficient worker anyway, so that it's worth it even in work terms, but whether it does or not, I'm going to keep doing it.
3) Pay attention to the ergonomics of your workplace, and experiment with changing it. Periodically bring your awareness to how your body feels when you sit this way or that way, try adjusting your chair higher or lower, try having your elbows supported, try having your keyboard and monitor in different places, at different heights. Try sticking a paperback book under one buttock or the other, & see if your spine likes that better.
If you're doing a full day of desk work, be aware that you're undertaking something that's very difficult for the human body. If you were digging ditches all day, or cutting down trees, or scything a wheatfield, you'd know that, and no one would find it remarkable that you wanted to lie down and rest, do something different, when you got a break. Desk work is supposed to be easy. We don't think of it as something that strains our physical abilities to their utmost. But it does. To do it and remain uninjured, over the long haul, requires a lot of attention and a lot of effort. It won't just happen. What will just happen is back pain, neck pain, spasms, cramps, searing pain in the wrists (elbows, knees, hips), aching eyes, and headaches.
Massage careers are typically short -- three to four years, on average. There are two reasons for this. One is that it doesn't pay well, particularly if you're working for someone else; and the sort of people who are drawn to massage therapy are often not good business people, so that a lot of them -- who are perfectly good therapists -- simply can't get and keep a business going on their own. Keeping books, networking, and advertising; paying office rent and quarterly taxes; reckoning expenses and setting prices, are not in their skill set. They end up working at spas for fifteen bucks an hour, with no benefits, doing half a dozen massages a day. Which is hard physical labor, and not something many people are up to doing for long. And not what they had wanted to do in the first place.
Which brings us to the second reason most massage careers are short: people wear their bodies out. The most important thing I learned in massage school was nothing to do with massage techniques per se: it was simply learning how to do physical work without hurting myself. How to stand, how to let my shoulders settle, how to apply pressure with my weight, smoothly, from my center of gravity, rather than by pushing and jerking. I typically don't feel at all tired after a two hour massage: on the contrary, I feel light and energized and joyful. I'm grateful to East-West College for drumming body mechanics into me. It wasn't something they talked about every once in a while: it was something they emphasized in every class, every practical demonstration. All my instructors had been therapists for fifteen or twenty years -- three or four times the average career length -- so they all knew how important it was.
It has nothing to do with how big and muscled you are. I have clients who picked me because I'm big burly guy, and they imagine I'll give a strong massage. That's lucky for me, but it's nonsense, as anyone who's had a massage from one of those tiny, ancient Thai masseuses can testify: what matters is not your weight and muscle, but knowing how to use it. If I find myself straining, using my muscles hard, I know that I'm doing something wrong. It should all be easy. And the benefit runs both ways: a massage from someone who's working too hard doesn't feel right. It jolts and jerks. It doesn't feel safe.
The things I learned in school spill over into everyday life, of course. I sit differently than I used to. I don't use the backs of chairs much: I tend to sit on the edges of chairs now, with my belly thrust forward and my shoulders back, so my spine can have its natural curve. I noticed the other day that in the morning when I get up out of my bed, which is down on the floor, I no longer push myself up flat-handed, which is murder on the wrist. I use my knuckles, like any sensible ape, so that my wrist is straight. A straight wrist can bear a couple hundred pounds' force easily. A bent one can be injured by twenty.
The other piece of body maintenance is the trigger-point self-treatment, which I mostly learned on my own, first from Clair Davies' wonderful distillation, and then from Travell & Simon's wonderful book, his source. This has been a godsend. The general knowledge about what musculoskeletal pain is and how to fix it is abysmal, both among the public and among the medical community. Every day people tell me about how they've been diagnosed with ligament injuries, tendonitis, arthritis, carpal tunnel, and bone spurs. I can't legally object to these diagnoses -- that's not within my scope of practice, as a massage therapist -- but secretly I know that seventy-five percent of them are crap. Some of these people are in tremendous pain, and they've been told that nothing but general analgesics or dubiously effective surgery will help. Mostly they just have trigger points in the muscles, from bad sitting habits or muscle overuse or trauma. It all has nothing to do with deformations of bone, or connective tissue injuries. It's just muscle injury, and muscles, which are richly supplied with blood and designed to recover quickly from damage, heal up remarkably quickly, if they're given the chance.
What people don't want to hear is this: you have to let injured muscles heal, and you have to stop re-injuring them. It's mostly as simple as that. You can't sit stock still at a desk for ten hours a day, with your shoulders hunched and your back slumped and and your elbows unsupported, and expect your muscles to just take it. They won't. It's not because you're getting old, and it's not because you're fat, and it's not because you're stressed. It's because you're abusing your muscles. Muscles need to move often and freely.
I don't think anyone should work at a desk for a full workday. If you have to, then you must take care of yourself, by doing, at a minimum, this:
1) Take all of the breaks legally allowed you, and get the hell away from the desk. Stand up and walk away. Don't, for God's sake, spend your breaktime sitting. Walk, run, dance, do gymnastics, stand on your head. Lie down, if at all possible. Do anything but sit.
2) Make excuses to get up during your worktime. When I'm doing data entry at the Foundation, every fifteen or twenty minutes I need to print out a report of the commited data. Every time I hop up and walk the thirty feet to the printer to fetch the print-out. It's not efficient. I could let them pile up and fetch them all at once, and save myself five or ten minutes a day. I do it deliberately, though, to force myself out of the chair. I believe that the better blood flow probably makes me a smarter and more efficient worker anyway, so that it's worth it even in work terms, but whether it does or not, I'm going to keep doing it.
3) Pay attention to the ergonomics of your workplace, and experiment with changing it. Periodically bring your awareness to how your body feels when you sit this way or that way, try adjusting your chair higher or lower, try having your elbows supported, try having your keyboard and monitor in different places, at different heights. Try sticking a paperback book under one buttock or the other, & see if your spine likes that better.
If you're doing a full day of desk work, be aware that you're undertaking something that's very difficult for the human body. If you were digging ditches all day, or cutting down trees, or scything a wheatfield, you'd know that, and no one would find it remarkable that you wanted to lie down and rest, do something different, when you got a break. Desk work is supposed to be easy. We don't think of it as something that strains our physical abilities to their utmost. But it does. To do it and remain uninjured, over the long haul, requires a lot of attention and a lot of effort. It won't just happen. What will just happen is back pain, neck pain, spasms, cramps, searing pain in the wrists (elbows, knees, hips), aching eyes, and headaches.
Sunday, February 24, 2008
Rigor
People with knotted muscles are often -- almost always -- told to stretch and exercise by well-meaning people, including doctors and physical therapists, who don't entirely understand how muscles work. They are also told to relax, using various techniques. This is usually bad advice.
Or rather, it's mistimed advice. Stretching, exercise, and relaxation are wonderful for preventing knots. It's just that they are useless, or worse than useless, for undoing them.
I'm not talking about stiffness, here. We all know how wonderful it is to stretch out when you're stiff. I'm talking about trigger points. Trigger points don't feel wonderful when they're stretched. They hurt and they feel wrong.
It's commonly thought that we hold our muscles tightened, and so it's just common sense to think that if we let go, then they'll relax. It doesn't actually work that way. Once a muscle fiber is contracted, it actually takes an expenditure of energy to release it.
Consider rigor mortis. For several hours the muscles of a dead body clamp down into a tight contraction. They are not doing this because the dead person is worried about making his mortgage payment. And they will not be helped to relax by stretching -- they can't be stretched, they can only be torn. (Whether exercise would help, I don't think we'll ever be able to say.)
No. What happens is that the dead muscle, having been triggered into contraction, is no longer supplied with the energy required to release it. so it just stays contracted, until the whole system deteriorates and it becomes inert matter.
Now when your muscles are knotted, essentially what's happened is that a few strands have gone into rigor. They're not being supplied with sufficient oxygen to relax, so they're stuck in the "on" position. They will send very clear pain signals if you try to contract them further. They know they're in trouble. Forcibly stretching them will probably tear them. Relaxing your mind will indeed reduce the pain, and releasing the tension on the surrounding fibers may help somewhat, but what really has to happen is for oxygen to get to the locked muscle fibers. Presumably the mind of a dead person is as relaxed as a mind ever gets, but that doesn't release his or her rigor. Only the complete death of the tissue does that. Not the solution we're looking for.
Fortunately, moving oxygen into the locked fibers is usually quite easy. First you find the knot -- it will be hard, like a pea or a bit of gravel in the middle of a band of tight muscle. Pressing on it will hurt. A lot. But it will also feel oddly good. Now you squeeze the thing, between your fingers, if that works, but usually by trapping it against a bone. And you just roll over it, as if it were a tiny sponge and you wanted to get all the fluid out of it. Do that seven or eight times, working in the same direction each time. It should hurt good. Seven, on a scale of one to ten, is what the books say; as much pain as you can relax into, but not more.
Then leave it alone for a couple hours. Don't stretch it, don't exercise it. Let it sit. Then repeat. Keep working it, every couple hours, until it doesn't hurt any more.
That's the simple scenario -- a single trigger point, recently acquired. Unfortunately, by the time people do something about it they usually have numerous interrelated trigger points. And often what hurts is not the trigger point itself, but a nearby joint. It takes some knowledge and some investigation to track trigger points down.
If you ask doctors about joint pain, they will almost invariably say it's arthritis, and that there's nothing you can do about it but take pain-killers. If they say this without manipulating the joint, or any of the muscles that move the joint, you'll know that they're simply -- like most physicians -- pig-ignorant about trigger points and myofascial pain. Sure, it could be arthritis. could be lots of things. The doctor's job is to find out, not to guess.
People with knotted muscles are often -- almost always -- told to stretch and exercise by well-meaning people, including doctors and physical therapists, who don't entirely understand how muscles work. They are also told to relax, using various techniques. This is usually bad advice.
Or rather, it's mistimed advice. Stretching, exercise, and relaxation are wonderful for preventing knots. It's just that they are useless, or worse than useless, for undoing them.
I'm not talking about stiffness, here. We all know how wonderful it is to stretch out when you're stiff. I'm talking about trigger points. Trigger points don't feel wonderful when they're stretched. They hurt and they feel wrong.
It's commonly thought that we hold our muscles tightened, and so it's just common sense to think that if we let go, then they'll relax. It doesn't actually work that way. Once a muscle fiber is contracted, it actually takes an expenditure of energy to release it.
Consider rigor mortis. For several hours the muscles of a dead body clamp down into a tight contraction. They are not doing this because the dead person is worried about making his mortgage payment. And they will not be helped to relax by stretching -- they can't be stretched, they can only be torn. (Whether exercise would help, I don't think we'll ever be able to say.)
No. What happens is that the dead muscle, having been triggered into contraction, is no longer supplied with the energy required to release it. so it just stays contracted, until the whole system deteriorates and it becomes inert matter.
Now when your muscles are knotted, essentially what's happened is that a few strands have gone into rigor. They're not being supplied with sufficient oxygen to relax, so they're stuck in the "on" position. They will send very clear pain signals if you try to contract them further. They know they're in trouble. Forcibly stretching them will probably tear them. Relaxing your mind will indeed reduce the pain, and releasing the tension on the surrounding fibers may help somewhat, but what really has to happen is for oxygen to get to the locked muscle fibers. Presumably the mind of a dead person is as relaxed as a mind ever gets, but that doesn't release his or her rigor. Only the complete death of the tissue does that. Not the solution we're looking for.
Fortunately, moving oxygen into the locked fibers is usually quite easy. First you find the knot -- it will be hard, like a pea or a bit of gravel in the middle of a band of tight muscle. Pressing on it will hurt. A lot. But it will also feel oddly good. Now you squeeze the thing, between your fingers, if that works, but usually by trapping it against a bone. And you just roll over it, as if it were a tiny sponge and you wanted to get all the fluid out of it. Do that seven or eight times, working in the same direction each time. It should hurt good. Seven, on a scale of one to ten, is what the books say; as much pain as you can relax into, but not more.
Then leave it alone for a couple hours. Don't stretch it, don't exercise it. Let it sit. Then repeat. Keep working it, every couple hours, until it doesn't hurt any more.
That's the simple scenario -- a single trigger point, recently acquired. Unfortunately, by the time people do something about it they usually have numerous interrelated trigger points. And often what hurts is not the trigger point itself, but a nearby joint. It takes some knowledge and some investigation to track trigger points down.
If you ask doctors about joint pain, they will almost invariably say it's arthritis, and that there's nothing you can do about it but take pain-killers. If they say this without manipulating the joint, or any of the muscles that move the joint, you'll know that they're simply -- like most physicians -- pig-ignorant about trigger points and myofascial pain. Sure, it could be arthritis. could be lots of things. The doctor's job is to find out, not to guess.
Saturday, January 26, 2008
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