How Many Repetitions Are Enough?

Clients often ask me how many times they should be doing an exercise to build strength. Often they are coming from a more-is-better place - the gym - and they are confused.

I don’t always feel comfortable answering that question, either. How many repetitions of an exercise are fine may well depend on what the point of the exercise is – strength? size? flexibility? What about function? If the muscle is a core muscle, does that change the formula as opposed to those muscles we like to see flexing in the mirror?

And what do I, as a massage therapist, really know about exercise? Do I need a course in physical exercise to answer that question? What if I say something different or conflicting from what the trainer says?

I would like to know how other massage therapists handle this question.

Of course, in the meantime, I’ll give you an idea of how I handle that question. I touch people all day, and I get a feel for muscle health in terms of its aerobic state, lymph circulation, and flexibility. Over the years I have learned to trust my hands when they tell me something. I know that granular, adhesed muscles won’t stretch or exercise very well.

After some massages and stretching, they may be ready to perform. The nervous system, truly, is in charge. If the parasympathetic system is not engaged, change is not about to take place.

If that sounds like a massage therapist’s answer to another massage therapist, it is. And it’s way too complicated for clients. I usually go simple and easy.

I tell clients like to do three slow, pain-free repetitions. Three isn’t many, but I say three because everyone ignores the slow, pain-free parts. If those reps go okay, then I’ll do something else and then do another set of three. Three reps, three sets.

That is a lot less than the standard gym advice of three sets of fifteen, done in succession. It’s so way off from what most people are told that it does get their attention.

For me the bottom line is that muscles need to be relaxed and pain-free to exercise in a healthy way. If something is too tight or hurts to move, the body will protect it by substituting another muscle or group, or the muscle will be injured. Repetitions that feel good generally are going to help. Wobbly, strained, borderline-painful repetitions are going to make problems worse.

Sometimes the biggest change I can get from people is to stop instead of pushing through a pain. Shoving through pain only works if you are in the NFL. They have a good pension plan.

Cheeky Little Ligament!

Being my alter ego as I often am, Superwoman, I hate to admit I went "Wii!" -- and Wii!-ed myself right into a lot of pain.

Yes, there are lots of warnings on the box, and yes, I am not 16 anymore. But it was so much fun hitting fake homeruns and beating the girls at bowling, I didn’t stop, warm up, hydrate or anything else.

Next morning, I had some serious fun trying to do massages.

It felt like something between a groin pull, a hamstring pull and a possibly serious symptom of visceral disease in the pudendal area. The act of sitting down hurt. Sitting hurt. Standing hurt. It hurt to touch the gas pedal. It hurt to move my foot to the brake. It hurt to lie in bed. It hurt to toddle off to the bathroom. It DEFINITELY hurt to use my feet to push during a massage!

That night I spent a few hours soaking in Epsom salts, trying to treat myself. The groin was painful, but the adductor magnus, gracilis, and the hamstrings were at my “normal” length. The piriformis wasn’t sore, nor were the glutes or low back. Psoas had my normal range. Puzzled, I slathered Epsom lotion on the medial thigh for the overnight cure: eight hours of sleep.

Next day I was no better, if not a little worse. Lately my massage trading buddy and I had been too busy for our weekly trade. Now I begged for some table time.

My trading buddy, who thought my predicament moderately hilarious, had me go prone on the table. Some palpation of the sacrum, the hammies and pretty soon he had found where the pain lived. In the inside lower cheek, just above the leg and next to the gluteal fold. He gently pressed the area, and I felt the pain flood my groin.

“Aha! The sacrous-spinal ligament!” he said. “That recreates the pain!” I said.

After about 10 minutes of trying to remember the name of the muscle also possibly involved – go-gos, Gemmullus? Obturator? – we are both kind of old hands – he called it out – quadratus femoris!

“Forcible lateral rotation of the foot!” he said. Sounded like Wii bowling to me. Somehow when putting some extra English on one of those bowling ball deliveries I’d managed to nail the right foot into forcible external rotation – and I had missed guessing at the cause by a mile. It wasn’t a groin injury at all.

Later that evening, with some relief finally setting in, I checked the internet and found some interesting citations. First, I found a paper on surgical decompression of the ligament in a woman with a long history of intractable sciatica. Lo and behold, the sciatic nerve toodles right on by that the sacrous-spinal ligament and the quadratic femoris, and might just be really annoyed by sudden torsion or injury. Another citation fingered the ligament as a cause of pudendal pain in women. Another paper blamed the sacrous-spinal ligament as culprit in people who have symptoms of disc disease, but don’t have any findings upon X-ray.

As they say in professional wrestling, school was out. With 15 years beside the massage table, I had yet another epiphany about the body, it’s complicated anatomy and my own enthusiasm for winning at any cost. Yes, I too have Gung-Ho Disease.

Lessons learned:
1. Don’t expect to be able to spot the problem when treating yourself.
2. No slacking on the weekly massage schedule.
3. Leave the Wii! world championships to people who are less competitive and more flexible.

Walk, Walk, Walk

This morning when I was helping my friend Margaret move some furniture around her house, I almost stumbled over a pair of dusty aerobics steps. “Hey,” I said, “I think Leslie has some of these things, but hers are inclined, so you don’t really have to step up, just slightly up and out.” Margaret found this extremely amusing: “Leslie this, Leslie that, Leslie says . . . you’d think you guys were really close.” “Well we are,” I said stubbornly, but laughing along with her. “She told me this morning how glad she was that I took time for myself today.” Leslie, you see, is not actually a “friend” I know to talk too; in fact, she wouldn’t know me from Eve. Leslie is Leslie Sansone, and she and I walk together three or four times a week in my living room.

I really hated exercise growing up. Exercise was not fun. It was used as punishment (go run around outside: you read too much); as humiliation (middle school P.E.: anyone for a friendly game of War?); and most importantly as prevention for, GASP!, “getting fat” (go ride your bike or you’ll grow up and get fat and no one will want to take you to dances and such). Now that I’m older, I still see how much torture and guilt exercise generates for the normal person, and it makes me sick. And it literally makes some clients sick, especially when they get struck by guilt, and—being out-of-shape—overwork themselves in the gym. So generally, I’m big on recommending swimming because it’s such good movement with so much less stress on the joints, etc. And of course, water aerobics is just mad fun. The only part I personally hate about swimming is either having to have clothes to change into, or driving home in a damp swimsuit, especially in this climate.

I also love walking, but moving to Seattle fixed that for me. To be fair, walking in Arkansas can be miserable in the in the summer, but at least you have long evenings and a cool-down at dusk where walking can be enjoyable. But no matter what the season in Seattle, rain is rain, and here it’s cold rain to the bone and all kinds of lovely gray things to look at on your promenade. Still, I realized this summer that I needed to move my body for my body’s sake, so I needed to look for something that I could do that I could both enjoy and keep up with. Leslie Sansone’s Walk Away the Pounds book caught my eye, and even though I wanted to walk-in the health benefits more than the walk-away-the-pounds benefit, I fell in love with this six-week, journal-based, down-to-earth program and the normal, positive-but-not-freaky, non-anorexic, woman-next-door-type guru who invented it.

I bought my book at our local Fred Meyer, and although I could order dvds from Leslie’s http://www.walkathome.com/, I usually get them at about a third of the cost from discount dvd websites. Frankly, I don’t think Leslie would be hurt that I purchased my dvds from another seller; as weird as it sounds, I think she really means it when she says the important thing is to do something good for yourself and “just stay in motion.” She’s client -based, and so am I, so I think I trust her more than some of these other work-out girls. Here are a few other reasons I like the Leslie Sansone Walk At Home Program so much:

1. She looks like an attractive 40-something woman. Which she is. She does not look like a plastic surgeon’s fantasy project who secretly wants to look 20 again. In other words, “regular’ people can relate to her.

2. She talks like a normal person. She has her own unpasteurized dialect, and if she’s nearly choking on the word walk (how many times can you say it while walking without needing a serious drink of water?), she never shows it.

3. She’s encouraging, but not preachy. She seems honestly more centered on health than just weight.

4. She doesn’t try to be a diet idiot: she sticks to what she knows.

5. She doesn’t try to sell you a bunch of useless crap; have good shoes, can walk.

6. Her materials are true to their levels. Beginner is beginner and advanced is advanced.

7. She isn’t lying; not only did my heart perform better in testing after her program, but we did all my measurements before and after, and I did indeed lose an average of 2.25 inches all-around.

I now can add Leslie’s Walk At Home program to my exercise recommendation list, and I feel really good about that. I know that my clients cannot hurt themselves doing it, especially since she regularly tells walkers to “slow down at any time” because “as long as you stay in motion, you’re doing something good for your body.” My only complaint would be that I prefer her solo dvds to the ones where she walks with a group of people. Why? Because she talks to them a lot instead of talking only to me, and frankly, that makes me jealous. My Leslie. Maybe I am getting a little too attached? Oh, well. Daily exercise is finally fun, and I feel I owe a debt of gratitude :-)

Seven Secrets THEY Don’t Want You to Know

My client, a teacher-in-training, was astonished when her fellow students ignored her first practice teaching class.

Her collegial group huddled over their laptops, tracking a package on UPS, reading e-mails, even one was applying to a competing college’s credential program.

Her carefully crafted first lesson was treated like a slow fly on a hot day.

She was dumbfounded, to say the least. What would happen if they had to put up with that behavior during their own first turn around the track, she asked. Could they at least pretend to be interested? How would they like to be treated like Charlie Brown’s teacher?

I sympathize, I empathize. In my own massage practice I had run into clients who don’t listen, employees who hated the least little coaching.

Ever helpful, I volunteered an idea. You know that guy who makes people pay for the chance to find out how they can power up themselves personally? They get to walk on coals and find their true destiny? Perhaps what we need is that marketing hook for all lesson plans.

Should learning be packaged like soap, electronics and political opinions? Can a shouting commercial pitchman make people pay attention? Order now and I’ll double this offer!

Well, aren’t people supposed to multi-task these days? Sure, we all do. But her cognitive learning course was basically saying that if people can’t focus and listen they can not learn.

Perhaps a good hook is what they need. Instead of cognitive learning 201, try:

“Trick Your Students into Testing Well”

“Five Principles of Successful Vice Principals”

“Teach Algebra While you Text!”

“Get a Teaching Credential Just for Showing Up!”

Taken to its logical thread – yes I do have one - how about marketing hooks for those folks on our tables?

“Never Have a Headache Again!”

“Feel 20 Years Younger without Getting a Divorce!”

“Look to the Left without Pain!”

“Discover Your Personal Power Ranger Within!”


Well, it was good for a few laughs. Perhaps it might make a good e-book.

Good Hands Are Good News for Headaches

Massage is the best therapy for tension headaches and migraines, and more people should be hitting our tables instead of reaching for drugs or other remedies, says Boris Prilutsky, a massage instructor and researcher in Los Angeles.

This article is the third in a series of articles about headaches and therapies. The first article is here.

Stress is a main cause of tension headaches. In addition, most people spend hours working on computers -- in static postures that accumulate muscle tension in the upper thorax and cervicals.

“In most cases we are addressing tensions in the neck , upper back, and TMJ muscles, so we are not just treating the symptoms of headaches but the cause,” says Prilutsky, a massage therapist and researcher with 38 years. He is an NCTMB continuing education provider.

A client presenting for treatment of headaches needs to be assessed carefully, Prilutsky said. Watch out for potential symptoms of other illnesses such as fever, or a sudden intense onset with no prior history of headaches. Those people need a doctor’s evaluation for infections or other serious conditions before trying massage.

But most clients will present with well-documented and already diagnosed headaches, he says. He advises not to be too concerned about the type of headaches and focus rather on the precipitating factors, such as constant muscular higher resting tones or pathological muscular tensions at neck, upper back and TMJ regions. Sternocleidomastoid headaches, trapezial headaches, irritation of the vertebral artery, etc. can be tracked back to our ever-growing population of people who spend too much time staring at screens, clicking or typing. A history of whiplashes, contact sports, or constant stress increases the intensity and frequency of these headaches, he says.

Boris says massage reduces the upper body tension immediately reducing headache intensity or “completely eliminating headaches.”

“To sustain these results clients need about 12 to 15 treatments. Also it is important to note that people diagnosed with migraines often actually have tension headaches,” Prilutsky said.

With true classic migraines, massage can alleviate most symptoms by balancing the sympathetic and parasympathetic systems, which leads to a normalization of blood vessel dilation believed to create migraine pain.

For some fabulous techniques to ban headaches, check out Prilutsky’s videos. YouTube ranks his as the most-watched self-massage videos. Techniques include acupressure, lymphatic, Russian sports massage and Swedish styles in the treatment of headaches. For a sample of his videos for massage therapists, try: http://medicalmassage-ceu.com/CLASS/

Little Women and Gentle Men

When it comes to face-down offers on the table, I thought women therapists would have the best stories. Oooh my, I was mistaken.

Well, OK, the female therapist who told me she was propositioned by the rabbi was a good one. It was during one of those long holiday weeks and there was a religious group staying at the hotel where she worked. Rabbis are pretty busy blessing food and saying prayers and other things, and then they get a break after everybody checks out. The rabbi came in for a massage and asked her what the difference was between massaging one area versus another…i.e. down there versus the shoulders…..then he tried the old “who would know?” God knows, she answered. I must say her story, for lack of another word, left me in titters.

The diaper change got me too. This lady who looked like about 70 dropped off her husband, who was 90-something, and said “Keep him here as long as you want. I need a nap.”

When the therapist came into the room to start the massage she noticed he was wearing a diaper. Halfway through what she thought would be a 90-minute to two-hour massage, the gentleman asked for some help achieving Nirvana. She told him you can’t always get what you want, but sometimes you get what you need. Tee-hee.

Heck, perhaps not so dramatic, yet it happens to pretty much every therapist. Someone hints, asks, propositions or demands items not on the menu. So I bravely asked some of my male therapist friends for their proposition stories. I figure they must have a few good ones.

One fellow who worked at a gym had a massage room in the male locker room, alleviating the need for modesty from the clients. A client asked him what he did for fun, in a way that begged the answer.

“I drill,” he replied, and he did just that for an hour.

I was shocked. “You drilled him?”

“Yes. I pushed on every trigger point in his body at plus-ten pressure. Guy didn’t even breathe.”

“Oh. I thought you meant something else,” I said.

A male therapist who worked at a spa said he had a female client asking him to come to her house. He was too afraid to say yes, knowing he could get fired. After about her fifth visit he figured she could not be a pro shopper, and he said yes.

“When I went to her house, she opened the door and laughed when she saw I had my table,” he said. “I thought she actually wanted a massage!”

It is different for men, I guess.

Body Dysmorphia: Spa for a Cure

I'm not sure what the number one killer of women is--in terms of physical diseases--this week. But I certainly know one of the top emotional diseases that kills women slowly over their whole lives and goes largely unchecked: Body Dysmorphic Disorder. And most women have it, to some degree. What is Body Dysmorphic Disorder? Very simply, it means that you think there is something wrong--often terribly, personally, unforgivably wrong--about part or all of your physical body. And every failed attempt to make your body into something it is not or do something it simply does not want to do tends to make you feel that--unlike the woman on the front of Glamour or Vogue or even Shape magazine--you are a freak of nature. And it just keeps going downhill from there.

As a massage therapist, I see evidence of this disorder ALL THE TIME. Or rather, I hear it in the nasty things women say about themselves. I once heard a comedian say something to the effect of, "If someone else said to you the things you say about yourself, you would have no choice but to try to take his life." It's funny, but it rings rather true, yes? And although many women know consciously that most physical self-slander is unfounded and ridiculous, they still really want to to look like one of those girls in an ad for body butter.

So what to do about this nasty problem? We probably won't be able to boycott the people who set up ads for Victoria's Secret or write those silly Cosmo quizzes. So instead, I'd recommend the occasional visit to your local women's spa, which is not only incredibly enjoyable and good for your health, but reminds you what real women look like.

Seriously. I don't go to stare, but unless your blind, cross-eyed, or looking at the ceiling, you're going to notice some of your surroundings. And your surroundings are utterly, unashamedly naked. Women of all colors, ages, shapes, and sizes . . . and I do mean all. It sounds cliche, but you can never really believe the stories about magazines and air-brushing until you see a full range of naked women, none of whom are going to appear in any ads without a make-up, lighting, clothing, and camera crew. Even if one of them might approach the kind of "beauty" touted in most advertising, she would still be wearing a shapeless cloth "hat," and trust me, no one looks hot in cheap cotton headwear.

When I was a pre-teen, my parents gave me a "sex book" called The Changing You. On the front, there is a little girl looking into a mirror and seeing herself all grown up as the Homecoming Queen. Now, I was very relieved, since I was terrified of becoming an overly-tall version of Little Orphan Annie. Wow! I was going to be the Homecoming Queen! Thank God! But I didn't, of course. And though I was lovely, I could never see it, because I didn't match those pictures. I wish I'D had a spa in my life; I might have been more sane. But I have it now; when it comes to having a healthy emotional life, it's never too late . . .