Steamrolling the QL

   

The tough part of massage therapy long-term back pain is chasing trigger points in the quadratus lumborem.  This is one of those muscles that not only keep clients awake at night; it keeps the therapist up, too.

           

I have done prone QL massage, prone with approximation, prone with stretch.

          

I have massaged the QL sideline with the olecranon. Sideline with directed relaxation. Sideline with directed breathing. Sideline with heat and a tennis ball.

          

It feels sometimes, that I have done everything except roller-skate to get those pesky points.

           

Does some massage therapist, somewhere, have a quick and easy method for releasing the QL?

           

Not to pick on the QL. The multifidus and the longissimuss and iliocostalis contribute to the problems of repeating lumbar pain. I find that if those muscles are skipped, they can recruit the QL back to tension and TrP.

           

And the opposing muscle, the psoas, can be just as equally weak as the QL is knotted. Bilateral weakness of the psoas and I will definitely have to roll my sleeves up. It is going to be a bumpy ride.

           

It is some consolation to know that QL problems tend to fester, painless and subclinical for years. The massages are unwinding years of QL spasticity making up for a lack of core strength.

           

That is a little comforting, I guess. Time to sharpen my elbow.

Massage School Memories

 Going to massage school, this massage therapist learned a lot about dealing with “tense” situations and people. The other day my local association asked for some massage schools memories and it made me laugh.

Warm Fuzzy? More like shrieking students levitating on the practice tables.

 My first scream came during the first class. We were supposed to practice a simple effleurage of the leg. My practice partner, whom I had just met, swooped up my inside leg, aimed right for my crotch and at the last possible second – and I mean the last possible second – swooped laterally to finish the stroke.

 “That was very uncomfortable,” I recall saying.

“I have to do the whole muscle,” she said.

That night our first student quit. He didn’t want to take off his necklace for a demo, and the teacher said he had to.
“I never take it off,” I recall him saying, as he backed out of the room, never to be seen again.

 

Some classes later, what was left of us were learning face massage. My practice partner this time was a very talented Asian man who had been doing acupressure for years and was kind of annoyed by the namby-pamby Swedish stuff we were learning.

Suddenly two hands formed a V and thanars pushed straight across and down across my cheeks, with what felt like the full weight of his upper body. The next day I had a business meeting in Los Angeles. I felt like I had a fiery helmet glued to the front of my sinuses. I did not think harmonious thoughts of world peace.

I will admit I performed some of the mayhem as well. Something large, rubbery and unmoving presented itself in the upper trapezius of my victim. I pushed on it with my ulnar, steamrolling down toward the spine of the scapula. Move, I thought. Move!

My practice partner’s shoulder came up off the table and pushed back right into my arm.

“What’s going on?” I asked.

“I have a right to protect myself,’” she said.

Somehow, come graduation about 18 months later, our hardy group was able to stand and walk to the stage to get our certificates. Our horrors had become vignettes.

“Remember that time I said your stomach was just like Play dough?” one of my classmates whispered to me.

“Yes,” I said. “Just remember, next time I do an effleurage on your leg, I might just ‘have to do the whole muscle.’

Blinded by the $10 Grand Solution

Folks with big troubles like this client – blinding headaches and vertigo – shop around for help. This massage therapist has been working with this client for a while. Her headaches get better with massage and heat packs but it never seems quite enough to make them go away.
This client has tried injections, acupuncture, a full course program at a pain management clinic and a few other things. Some treatments don’t work; some work a little and some have proven really toxic dead-ends.

The latest sojourn was to new clinic advertising a low-level electro-magnetic treatment. The client went to a presentation and tried a free treatment. The full course of therapy requires treatment every weekday for a month. Cost upfront $10,000. No insurance coverage.

The treatment seemed fine at first, the client said, then it seemed like her headache suddenly got worse. She told the technician administering the treatment. “She said no one had ever complained before,” the client said.

 The treatment continued, although after she complained again, the technician turned the machine down some.

 And then there was the $10,000.

 “For $10,000, I want to know that the treatment will work. That’s a lot of money,” she said.  Oh yes indeedy. There were too many red flags for her, from a lack of concern about her feedback to the big price tag etc.

 Then the big question.
“What do you think?”

“I think you made the right decision. A new treatment. New clinic. Big price and what sounds like an inexperienced staff. Plus people who know what they are doing never blow off a complaint with a comment like no one has complained before.”

 I have to admit, though, that my inner wheels were turning. I wondered about offering the client a free massage every day for a month. If the headaches get lost, why not pay me $10,000.

 Somehow, somewhere, smarter folks than I decided that paying only if treatment works is somehow unethical. I’m still looking that one up, but I’m pretty sure it is on the books as a no-no. Fudge crumpets. The idea of this lady getting better - and my spouse and I going on a Hawaiian vacation - was pretty tempting.

After she left, I had the mental picture of myself running after her car offering the deal.
 “Waaaaiiitttttt….” Puff-puff-puff.

Fee for service is a major tenant of our profession, however, and one that other health professions may have been wiser to stick to.

 Fudge crumpets.

Loan Mod Trigger Points

I’m making it official: It is possible for massage therapists to map a stress pattern of trigger points related to home loan modifications.

Folks going through that process have had months of fruitless phone calls, waiting on holds, sleepless nights.

When they come in for massages, I have found they have the runaway stress trigger points of legend. I wonder if other massage therapists like myself have noticed this pattern, or any others.

#1 Super Mod Trigger Point: Serratus anterior superior.  This is the pain Julius Caesar must have felt when Marc Anthony shivved him. This trigger point, tucked away under the arm and in the middle of the ribs, appears to stem from hours of breathless holding on fruitless phone calls. When it lights up, you can crumple. I have been using lots of warm slow Swedish strokes just to get near it. I like holding the palm of my hand over it until the warmth starts to melt what feels like a half-softball of tense muscle. I note clients start to breathe after a minute or two.

#2 Granite Upper Trap: Yow! Never have I felt such a bolt of tension as in these upper traps. I have actually started rolling shoulders Ida-Rolf-like just to try and get these to move. Rolling the shoulder forward, gently pulling it back, then teeter tottering the entire arm to establish some movement. Standard kneading almost seems to reinforce the rock-like tension. I’m taking suggestions.

#3 Rusted Pectoralis Minor: And sometimes the pec major, too. I usually associate this muscle only in clients with frozen shoulder or heart disease (or retired major league baseball pitchers) – now I find it just stuck all over folks in modification muddles. Slow and steady I go; this area is the most tender of all. Go with moist heat and a little contract-relax PNF.

Working with an emergency loan mod client this past week I had to ask myself: Has the American Dream come to this?

I like to do a little bit of breath-work with clients in this situation. Folks need some self-treatment TLC tips for the next time they call the bank.

         

Family Matters

Holidays bring out the best in people – and the visiting relatives. I have just moved the office and the massage therapy room still looked a little bit like a MASH unit. My phone message, for a change, said I was off for two days before and after the holiday – but the calls just kept coming.

Despite a long history of scoliosis, this client had never had massage for the condition. She had enjoyed the occasional vacation massage here and there.

Holiday massages tend to be emergencies, anyways. This time I had a referral from a client. This was a young lady with mild scoliosis, who between funny positions on the couch and airplane rides and long conversations with the parents had woke up to find that turning to the left was impossible. O Joy.

While going over her intake, I suggested she do regular massage to keep discomfort in check and possibly to help prevent the scoliosis from getting tighter.  "How do I find a massage therapist who specializes in scoliosis?” she asked. I felt a bit surprised by the question. I explained that so many massage clients have slight to mild scoliosis I consider scoliosis therapy part of the mainstream of therapeutic massage.

Perhaps look for a more therapeutic massage person, I suggested.  I felt on thin ground. All massages, in my mind, are therapeutic, even the ones where intent is solely to relax the person while on vacation. That is a pretty awesome skill.

This client comes from an area of the country with very minimal requirements for massage licensing. It is also known for having lots of people who are into a kind of flower-child view of life and massage.

“I don’t really mind that stuff as long as it is not the only thing in the massage,” she said. “I would also like to get some work done on my problem spots.”

Oh heck, I might as well dive into the pool. “I understand what you are saying,” I said. “I’ve had those massages where the person giving them is off on their own trip and not that into why you are there. It is no guarantee, but if you look for someone with boards or more education than the minimum, you have a chance of getting someone into therapy.”

Good advice, I thought, for a person looking for therapeutic massage. But as a therapist, I felt pretty uncomfortable. Rarely, I have had great massages from people with little education or experience. But the norm is I get a bad massage from someone who has no idea what they are doing.

It is very controversial in our field. Is a great relaxation massage at a resort not therapeutic? Is a highly trained therapist capable of being clueless? What about those folks who chant and tap in to the energy of the universe? Are their skills just different?

The answer, I think, is client by client. If clients want a massage therapist to focus on their scoliosis, they need to find someone they believe will help them. Oh heavens, I’ve said the famous “good fit” cliché.

Clichés, however, tend to be a bit truthful. “Finding a massage therapist is like finding a dentist,” I told her. “You can do all the research, look at qualifications, get referrals, but you won’t know if you like them until you are sitting in that chair.”

Moving Grumbles and Sage Advice

This massage therapist thinks she is organized. She thinks she has a good grip on where things are and handy when needed.

Ho, Ho, Ho, delusional again. 

Moving is a drag under the best circumstances. This circumstance was a Wednesday. I had clients on the book. Ho, Ho, Ho. Mistake again.

When we got to the new office, two blocks away. The furniture was dusty, and all the boxes were labeled “Mom’s dolls.” I had to work not knowing where anything was.

At least it wasn’t too hard to get the table up and find bins with sheets in them. I had the oil sitting in the front seat of my car, on top of my schedule book.

The clock was in one of the bins marked “Mom’s Dolls,” so I used my cell phone to track the time. In the middle of a massage, it started vibrating with an incoming call.

I could not find any of the aromatherapies either, so I took my plain oil and ventured forward. The fellows had to unpack the rest of the truck without me while I was in session, so I came out of the therapy room to a nice huge pile of boxes and stuff.

Pier One Imports had room dividers on sale. Eureka. I hid half the pile behind the divider and got back to work. Then I noticed there were two sheets of toilet paper left in the bathroom. Off to the market.

My phone kept buzzing. Everyone wanted appointments. I wanted to lie down.

At the hardware store later that day, I found a nice shower curtain to cover the rest of the pile. The clock was still in the pile somewhere. My phone rang again. Every time it rang I looked at it in terror.

Well, sometimes you cannot do too much about how the schedule goes. Rooms aren’t ready, landlords do demolitions, clients want in. I wondered how my clients felt about the jumble.

“I couldn’t wait to move out of my office,” my first client told me. “The landlord was a total pill, the place was too expensive and it didn’t fit my business anymore.”

I am lucky enough to have people who understand.

“By the way,” she added. “Don’t let any of the guys pick the paint.”

Sage advice, literally. We went With Mountain Sage and celery, with a celadon for my therapy room. And I found my clock - a week later.

Chopsticks: Catching the Posterior Scalene in Action

That’s a lot of old-fashioned chronic inflammation with the posterior scalene stretched far from its anatomical role. Those poor guys are stretched over the precipice and desperately pulling back. Adhesed, unloved, overworked and so far under the trapezius that even a deep tissue massage barely touches it, the posterior scalenes are crying for help.

Massaging many people with neck pain, I have developed a deep respect for the nefarious actions of overstretched posterior scalenes.

Most neck pain folks looking for massage come in with a history of working on computers, lots of driving and an old accident – usually whiplash or cervical strain.

Getting my teddy bear paws in the posterior scalene zone is a tough goal to achieve. First, the trapezuis acts like a prison. Going through from the back of the neck just plain hurts.

With the client supine, I like to flex the neck to the side slightly and slip soft fingers along the posterior scalene. Then I gently shorten the scalene until it can sense that a different way of life is possible.  With the scalene approximated for about 30 seconds, I add a light, slow cross-fiber crushing with soft fingers. (I said soft again didn’t I? Ever feel a hard touch on a scalene?)

Anyhow, if there is a hope of redemption here, the scalene should soften, going from concrete to something more like jerky.

I try to get clients to start chin retractions, pushing the chin back while keeping the head level. I find they can do it best on the table, against a wall or even better against the car seat headrest.

Three gentle (that pesky word again) chin retractions of above 5 seconds each, with a five-second relax in between. That should put the head closer to the anatomical position and take the posterior scalene off precipice duty.

It isn’t an easy path, but well worth it to get the neck feeling better. I then suggest the client stop playing piano with their nose.