WWTD - What Would Travell Do?

That darn knot was driving me crazy.

It was embedded in the rib cage, just below and under the lower vertebral border of the right scapula. It seemed to ease with heat, but no amount of myofascial release, Swedish, cross-fiber, trigger point or lymphatic or any of another half-dozen styles of massage I had tried would budge it.

Every week that darn thing was there. Everything else had budged, and my client, whose principal complaint was major migraines on the right side, had been getting better gradually as I worked to erase the right-sided pain pattern. This client is hyper mobile and thus negative on most of the muscle tests such as range of motion.

I had hunted down a huge serratus anterior knot and it bit the dust. A mondo masseter knot was opening up. I even felt the scalenes starting to slip back into the matrix.

Except for that darn knot. Instinct and experience told me it was a progenitor of the migraines. It must go. I was close to naming it – Jethro? – And I wanted it out. Bad.

I followed it as if it was from the multifidus, progressing up and down the spinal points trying to balance the tension on both sides. I followed the lines of the rhomboids, the serratus and the latissimus choo-chooing with the anatomy trains.

I must be missing something. I must be chasing the wrong thing. I can do this. And when in doubt, look it up.

Years ago, at relatively great expense given that I was a humble massage student, I had invested about $450 in a set of Travell and Simons, “Myofascial Pain and Dysfunction: The Trigger Point Manual” (it's a good deal on Amazon now - $215). I use the Travell flip charts of trigger points pretty much daily. It is, for the manual therapist, the reference books for what we know, what we don’t know and why.

I went back to the font.

There, hidden away in plain sight in the latissimus chapter, was a drawing of how to get that damn knot out. Approach from the lateral anterior, slip under the latissimus and locate the trigger point. Fix it with pressure from the hand under the lat to the exterior hand. Massage it and draw the point out laterally away from the body. Sweat was dripping down my face, and my client’s eyes rolled back, a bit like a shot of anesthetic.

I felt “Jethro” melt.

Janet Travell would have been 109 years old this past Dec.17 if she had not passed on at the tender age of 96. She got John F. Kennedy out of a wheelchair after WWII so he could run for president. She understood that people were people, even doctors, and worked to bring manual therapies back to orthopedics.

I hope all massage therapists and manual folks know her name and her books and charts. Shouldn’t we have some sort of Bodywork Hall of Fame?

The Twelve Days of Christmas (Massage-Style)

On the first day of Christmas, my true love gave to me,
A tub of rose-infused crème!

On the second day of Christmas, my true love gave to me,
Two eye-pillows, and a tub of rose-infused crème!

On the third day of Christmas, my true love gave to me,
Three salt lamps, Two eye-pillows, and a tub of rose-infused crème!

On the fourth day of Christmas, my true love gave to me,
Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the fifth day of Christmas, my true love gave to me,
Five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the sixth day of Christmas, my true love gave to me,
Six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the seventh day of Christmas, my true love gave to me,
Seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the eighth day of Christmas, my true love gave to me,
Eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the ninth day of Christmas, my true love gave to me,

Nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the tenth day of Christmas, my true love gave to me,
Ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the eleventh day of Christmas, my true love gave to me,
Eleven face cradles, ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the twelfth day of Christmas, my true love gave to meeeeeeee,
Twelve frozen shoulders, eleven face cradles, ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, AND A TUB . . . OF . . . ROSE-INFUSED . . . CRÈME!

Is It a Muscle or?

Every so often in massage you see someone who you think might be having visceral rather than muscular pain. Since my X-ray vision is on the blink, and my psychic abilities have never worked when picking next week’s lottery numbers, I tell folks who have a symptom that might be something else to go see the doctor.

Come to think of it, I’m sure most therapists have some opinions and probably a few good stories, about when to say “have you had that checked?”

I sent my granite guy to the urgent care for chest pains not because I didn’t think he had pectoral problems from lifting heavy granite all day, but because he hadn’t been to a doctor for 20 years. He was fine, by the way, and his pec’s felt like rock.

Once I felt a little pebble in a client’s foot and sent him off to his doctor. It was some kind of benign but destructive tumor. He had it taken out.

I have no clue to what’s going on when I refer people for diagnostic work, but I do probe enough to at least find out if they have taken their symptom to the doctor at some point, especially if it has happened before.

That said, I’ve wondered sometimes if I’m playing Russian roulette. If someone who has aches and pains and never goes to the doctor okay? What if they’ve been through all that and been pronounced fine. Did they miss something? Who am I to say anything at all?

Plus the idea of mentioning the sawbones might just scare the fiddlesticks out of some clients. Some people don’t do well with the whole medical thing. Rather than scare the stuffing out of a client, I might say “it’s probably nothing, but you will be doing some good for the economy running up a bill.”

I’m careful not to mention what something might be, as that might be taken as diagnostic, which is doctor stuff.

On the other hand, if every time a client came in with a pain you sent the person away, we never get a massage done. There’s a balance somewhere, and I like to think I’m close to it.

A client who been dragged in by his wife said his “friend” told him that “you should never rub a sore muscle,” with a tone that suggested the Ten Commandments. I promptly told him that what I’ve been doing daily for the past 15 years. Massage therapists help people relax and let go of aches and pains. It’s just part of the landscape.

I added that I don’t rub fevers or road rash or hives, or something that looks red or swollen, but with good assessment before starting the massage I’ve managed to avoid killing people.

At the WAY other end of the spectrum referrals can be frustrating. I had a long talk with a client with a deep fear of doctors into taking the lump under her jaw line in to the clinic. She finally went to see a specialist and found out it was a benign salivary tumor. She started taking supplements to get rid of it.

As the tumor grew larger, I suggested that benign doesn’t mean it can’t do bad things by just getting bigger. She felt the tumor was getting smaller and would go away without surgery. Then she stopped getting massages from me. I saw her one day in the market. The tumor was the size of a grapefruit, and she had combed her hair, very unsuccessfully, over it.

Spa Olympics

Working at a spa is one of the most rewarding and challenging environments for a massage therapist – the pressures of running on time, keeping within guidelines and getting along with a bunch of other therapists – and their egos – all while trying to learn protocols and make a living.

I’ve always found spas a great learning laboratory when I worked in one and when I owned spas. What I found most interesting is how individual therapists perceive the spa environment as a challenge or an obstacle course. A case in point -

While operating a hotel day spa, one of the employees, a male therapist, showed great determination in developing a clientele. He worked mostly “slower” shifts and kept at it, despite the preference clients have for gender. After working a typically “slow” shift – Friday nights - for a good year, he had developed enough of a following that his Friday book was consistently full.

I, of course, was quite happy with this - it worked for him and for me to keep the books chubby and money rolling in. One of the other therapists saw the book and decided that the Friday night shift was rightfully hers. She called me to let me know that our male therapist didn’t want to work Fridays anymore and she would be happy to take that shift.

I thanked her for volunteering to take up the shift and told her I would think about it. Needless to mention, the moment I checked with the male therapist, I found out it was a ruse. After investing time and effort to build up that evening with steady clients, he was not interested in moving off it at all.

I was marveling about the chutzpah when I talked a confidant, the manager at the hotel’s restaurant.

Can you imagine someone just trying to shove somebody aside like that? I said.

“It happens in the restaurant all the time,” he said.

Really?

“Yes, I’ll have a new hire learning the restaurant and I’ll know if they will work out after the first full shift.”

OK I’ll bite. How?

“If they come up to me and complain that another server has all the best tables and they get the dregs, I know it’s not going to work. They’re just telling me that they don’t see how experience and focus pays off in tips. They assume there’s some magical reason why they are not doing as well as the server who has worked here for years.

“Now if they tell me they are going to work hard and try to emulate the good servers, until they get it, I know they’ll be fine.”

I must say that was a good lesson learned. Oh, and our “grabby” therapist didn’t work out.