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Massage Treatments and Chronic Pain and Disease

     When someone asks me why I became a massage therapist, I just say - "I wanted to be passionate about my career." Then it became, "I want to help people manage pain. " Then I honestly wanted to share my joy and the usefulness I've found in manual therapy within anyone who would listen - at one point we were 'chastised to get a bullhorn and shout it from the street corners,' so this is my version of doing just that.

    Integrative Health and Medicine current offers a comprehensive prevention-based approach to effectively treat chronic disease and enhance health. This should include the use of soft tissue therapy and treatments to leverage CAM health care appointments. All appointments from health practitioners such as naturopathic doctors, chiropractors, physical therapists, acupuncturists, nurse practitioners, nurses, midwives, and nutritionists and orthopedic surgeons can benefit from pre- and post- healthcare appointments from a CMT/NMT. To fully embraces a multi-disciplinary team of licensed health care providers working at the highest level of their scope of practice, massage and neuromuscular therapy provide extensive preventative at pre-tax savings, as well as effective knowledge of soft tissue details .

These health care practitioners have been lumped into the term complementary and alternative medicine (CAM) providers, and if we use the term Integrative Health and Medicine professionals with distinct licensed professional certifications, CAM can be used in the traditional and there is no need to “discover” a new model of care.  Patients who work with Integrative Health and Medicine practitioners are already achieving basic wellness goals 1) are healthier, 2) have lower health care costs, and 3) report extremely high levels of patient satisfaction. Through a collaborative approach to health care, integrative health care solutions contribute improved health care every day.

How does the interrelated way in which the contributions of licensed Massage Therapy professionals can help reduce health care costs and fit into the existing Health Care system?

Without disruption, Massage therapy can be used prior to ALL appointments to soften, warm and prepare tissues in areas like the spine, or head and neck to leverage existing services  and make them more than previously identified.  Like corporate Wellness programs, Massage Therapy aims to help get people healthier to prevent big-ticket chronic diseases, like the seven preventable chronic diseases: cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental illness. The cost of these chronic and life threatening heath issues, costs the U.S. economy $1.3 trillion annually, including the cost of lost productivity, treatment in the form of insurance reimbursement and medication. Combining the diversion of caregivers with the costs of absenteeism and ‘reduced workload’, the total impact of chronic disease already exceeds $1 trillion a year, including more than $100 billion in California alone.

While healthy lifestyle change requires investment from more than just the health care arena, health-oriented providers play a critical role. CAM users were 64% more likely to report that their health had improved over the last year.  Not only are prevention and health promotion fundamental cornerstones of CAM, integrative health and medicine practitioners including Massage Therapists can consistently provide additional resources and avenues into conventional providers. Because CAM creates better outcomes, contrary to the common critique that there is a lack of evidence, thousands of studies, including randomized controlled trials published in top medical journals which highlight research demonstrating the ways naturopathic medicine prevents cardiovascular disease and metabolic syndrome at a cost less than prescribing a pill!                                                                      

European countries, in which general practitioners are co-trained in integrative approaches, have incorporated CAM into national health care systems based on studies showing better outcomes and lower costs. Keeping costs low by keeping care simple and adhering to a common-sense therapeutic order, allows individuals to make a choice on healthy alternatives that have a longer lasting impact. With back pain alone, the cost to the health care system is 60% less with CAM treatments and largely due to expensive, often ineffective diagnostics and surgical procedures.

Massage therapists are experts in administering less invasive, low-cost treatments that support the body while it heals itself, and that serve as effective substitutes for riskier modalities such as prescription narcotics. An approach to treatment that begins with low-force, non-addictive, low-cost care options that feel good just makes sense. Reduce costs up front through complementary, alternative, and integrative therapies. Many people have the impression that the use of CAM creates substantial add-on costs for health care systems and individual payers. The myth that patients are draining their bank accounts on out-of-pocket costs associated with CAM looks like actual costs – $33 billion – which is pocket change compared to the $268 billion spent out-of-pocket on conventional care in the same year.  

In Washington state, where CAM health care providers of every discipline have been a mandated part of the health care system for nearly 20 years, data show that patients who see CAM providers have lower prescription drug costs, hospitalization costs, and total costs, despite starting out in poorer health and incurring the “additional” cost of the CAM provider’s services. Because CAM providers – including Massage Therapists offer therapies that are less expensive than those provided by other health care professionals, they not only reduce costs, but also may increase access through “first contact points of entry,” reaching people who are unwilling or unable to access the conventional health care system.

So, when you look at what we do, and why being a massage therapist is 'life changing,' not only for ourselves, fellow therapists and our clients...It can be for everyone in the health care system.

 

 

Posture and Impact on Pain

Your spine is strong and stable when you practice healthy posture. But when you slouch or stoop, your muscles and ligaments strain to keep you balanced — which can lead to back pain, headaches and other problems. In addition to physical pain, there is a physiologically efficient posture, and everyone knows that, right?  Okay, maybe you did not.

If most people understand what their posture does to there mind (as well as their body) then most people would also understand the value of Massage (all types no favorites). Here is how to use massage to prevent and maintain balance throughout the body in muscles, structural system and nervous system.

Natural Spine Curve

A healthy back has three natural curves:

  • An inward or forward curve at the neck (cervical curve)
  • An outward or backward curve at the upper back (thoracic curve)
  • An inward curve at the lower back (lumbar curve)

Good posture helps maintain these natural curves, while poor posture does the opposite — which can stress or pull muscles and cause pain.

Physiological Efficient Posture

Loss of an upright Physiological Efficient Posture makes the relationship between posture, psychology and pain more transparent.  'Bad' or inefficient posture can adversely affect all the systems of the body. I take for granted that I was used as bad example in class a lot (thank you to everyone who noticed), but I even I was unaware of ALL my postural faults: shoulder, hips, foot.

Think of the impact to cardiovascular, digestive, endocrine, energetic, excretory, fascial, immune, integumentary, lymphatic, muscular, nervous, respiratory, reproductive, skeletal and urinary systems when there is a constriction or reduced space within the structural system. This generally happens when you slouch over a desk, stay sedentary for 8-10 hours at work (my developer friends will appreciate this) and/or playing video games AFTER you get home from sitting in front of a desk all day your body does have the opportunity to 'move.'

Muscles were designed to move, by simply changing these habits and limiting sitting, walking regularly throughout the day and minimizing 'technology use' for 1-2 hours - then anyone can reduce the risk and long term negative affects of inefficient posture.

When you do have to work at a desk, "sitting up with good, tall posture and your shoulders dropped is a good habit to get into," says Rebecca Seguin, PhD, an exercise physiologist and nutritionist in Seattle.

This can take some getting used to; exercise disciplines that focus on body awareness, such as Pilates and yoga, can help you to stay sitting straight, Seguin says. Make sure your workstation is set up to promote proper posture.

Client’s mood and physical process in ALL the system above have all been shown to improve when an upright Physiological Efficient Posture is restored. Furthermore, bad posture and/or bad mood can be cyclical- they can improve and decline without effort or mindfullness. More importantly loss of the Physiological Efficient Posture moves people away from Homœostasis and further into Allostasis. These affects can be reversed through strengthening, massage/structural integration or psychological ‘restoration’ of movement. 

The Primary Alignment is the relationship between the body's Center of Gravity (Core) and its Counterweight. To understand more about the importance of a Physiological Efficient Posture and the Primary Alignment follow discussion on the philosophy of Somatics and Feldenkreis manual therapy (both related to the mind-body connection). 

Massage and Posture

In order to find out how Postural Alignment can be influenced by Massage Therapy practices, use assessments that focus on Orthopedic Testing and Bio mechanical assessments (HOPRS), Core Integration (Structural Integration -Rolfing) and Postural Alignment in corrective exercise to provide safe and gentle changes. These processes can help people with:

Many of these ailments ar a direct (and negative result) of posture that is not efficient and positive for the human body Alkylosing Spondylitis, Anxiety, Arthritis, Asthma, Back Pain, Balance Problems, Breathing Impairment, Depression, Digestive Problems, Fatigue, Foot Problems, Frozen Shoulders, Headaches, Insomnia, Jaw Problems, Joint Pain, Knee Problems, Kyphosis, Learning and Behavioral Difficulties, Lordosis, Low Energy, Menstrual Problems, Migraines, Multiple Sclerosis, Neck Pain, Pins and Needles, Poor Posture, Problems during and after Pregnancy, Recurrent Infections, Repetitive Strain Injuries, Scoliosis, Sciatica, Sinus Problems, Sports Injuries, Stress Management, Tension, Visual Disturbances, Wellness Care, Whiplash Injuries and more.

Postural Alignment does not treat or cure any disease or symptom. It is primarily concerned with creating a healthy, balanced state on all levels by helping people back towards homœostasis. Pilates and yoga are great ways to build up the strength of your "core"—the muscles of your abdomen and pelvic area. These muscles form the foundation of good posture, and a strong core can have many other benefits, from improving your athletic performance to preventing urinary incontinence. In addition to helping to increase body awareness and core strength, yoga is an excellent way to build and maintain flexibility and strengthen muscles throughout your body. Check in daily with your body's needs and listen to it's requirements.

How to Identify which Massage Techniques are Best for You

I've had many people come in an specifically asking for a modality based on what they read on the website, and yes Trigger Point therapy, or Myofascial Release or Clinical Deep Tissue can help relieve pain.  Client expect these sessions to make them uncomfortable, because If it's a good pain, it's okay right?  Other professionals like Athletic trainers I work with think Active Release Techniques are the best, because, "won't the stretch and movement will be more effective for athletes who need to release the adhesion or contracture," and they can continue training, right?  Of better yet, if Physical Therapy can't address the issues, then it's more serious than a Massage Therapist can resolve - and the next step is surgery?  Finally, my most favorite question was 'will this machine (refers to electrical stimulation)' help my body with cellular renewal, and relieve my pain?

 As I stand there looking at you, I'll be doing a mental assessment. My first impression is that you are here - to see a massage therapist, because you either have no idea where  to start, or at the end of your rope, because no one else has been able to address your concerns.  My review of the situation is 'an assessment or an educated evaluation of a client’s condition and physical basis for his/her symptoms in order to determine a course of treatment” (Clinical Massage Therapy: Rattray and Ludwig). Here's what you'll here me ask:

Do you have a history of pain/injury?

  • If I'm observing structural imbalance, physical differences between right/left side and movement challenges  - is their pain?
  • If there is a postural difference, can you tell me about that 'x?'
  • If you have any reduced ranges of motion/movements that make it more difficult for you to do 'something?'
  • If you have any diagnosis or input from other medical professionals (Chiropractors, Physical Therapists, etc conduct orthopedic or special tests) in order to identify or diagnose you issues?

Why all the questions? Because clinical assessment for massage therapists is usually divided into five areas, which you can remember by the acronym ‘HOPRS’. I am also incredibly interested in why my clients come in asking for specific treatments, and if they self-diagnose through Google or Web MD - call me nosy:)

H – Health history questions (usually known as your case history or medical intake)
O – Observations (i.e.: of posture)
P – Palpation (of soft tissues including muscles and fascia)
R – Range of motion testing (of movements at joints)
S – Special Orthopaedic Tests (specific tests that help us to identify problems more precisely)

There are many misconceptions and misunderstanding of how Massage Therapy can help clients. My job is to make the best use of the time that you pay for...unfortunately there is no 'set recipe, process, protocol' or magic technique. What is missing from questions about best modality, most effective techniques - is the goal for the session, or what they are trying to accomplish. Unless the client communicates what they want to change versus the 'fix' or the 'magic technique,' the story is incomplete. I would never tell my clients they are wrong. They are just misinformed.

Massage can help in all of these situations...you need to be clear about the issues and goals before you select the technique. And to my instructors, I was listening when you said, ' less (pressure) is more (of a benefit)!'

I look at my Massage Techniques much the same way that we saw 'bodymaps' presented in the movie Dr. Strange. They are all slices of the same canvas - the human body. None of the philosophies is exclusively right (or incomplete) when compared to the others: Energy meridians from Traditional Chinese Medicine and Thai Massage can be compared to the energetic understanding from Trigger Point Therapy and Cranial Sacral flows in the body (think Laws of Thermodynamics)...it's all about the energy. It exists, it has to flow, it tends toward equilibrium - and when it doesn't there is a problem. Then there is the whole description of Biopsychosocial Model - people are influenced by their environment. However you want to look at the universe, closed systems of organisms tend to be the exception, not the rule. Once you step into a massage room, there is a partnership that should exist - and effectively address whatever the goal of the session is.

So what does that have to do with massage? Think of energy transfer (or for those who are allergic to the term energy, how about friction and/or heat) between the hands of the massage therapist and their client's body. Think of the messages and signals that the therapists fingers pick up during palpation, because it's all part of what makes ANY massage effective....it is specific to what you body needs, and how I interpret (or anyone else) what will help address the adhesion, trigger point, contracture or block in the flow of 'chi.' Orthopedic assessment helps therapists understand what the body is telling us, and gives us a framework - reducing all the information down to the right path.

If you ask which massage modality is best for me? I'm going to ask, "What do you want to accomplish in the next 30-90 minutes of your life?"

Why Active Release Techniques is Different (from massage)

Most of my friends thought that adding Active Release Techniques to our services was crazy. For one it was developed by Chiropractors...who are not typically as comfortable with soft tissue dysfunction as massage therapists. Fortunately for my clients, they have benefited from my lack of attention to 'background noise.'

When looking at Active Release Techniques (ART) treatment I was immediately drawn to the philosophy - and the ability to sufficiently define and 'diagnose' soft tissue dysfunction. Active Release is a hands-on, touch based and case management process that allows a practitioner to treat soft tissue injuries and provide preventative care. The soft tissue that I deal with primarily refers to muscles, tendons and/or ligaments, fascia and nerves. The specific injuries that it can be addressed through these treatments include repetitive strains, adhesions, tissue hypoxia and/or Delayed Onset Muscle Soreness (DOMS), and finally joint dysfunctions.

ART was initially developed like other forms of Myofascial Release - in fact that was one of the original names. However, the technique has evolved and been redefined due to it's inclusion of peripheral nerve entrapment, and a lot of 'resistant muscular issues' can be treated more effectively when including nerves in the manual treatments.

Although ART gained attention as part of the Ironman Triathalon treatment process for Hawaii athletes (1995) it is now a fundamental treatment process for the preparation for all Ironman events throughout the world, as well as other professional and collegiate sports competitions. Stanford University is one of the current organizations that uses it for all Athletes during season.

Additional applications for ART in work-place injuries started even earlier (1990). Today ART is approved by OSHA (Occupational Safety and Health Agency) as an efficient treatment for preventative care for repetitive motion injuries, and cumulative trauma disorder (CTD) throughout the United States.

Active Release appointments are different at four specific levels:

1) tissue position without tension, passive patient

2) tissue position with tension, passive patient

3) tissue lengthened after contact, passive patient

4) tissue lengthened after contact, passive patient.

Like most massage it is most effective with correct anatomy and kinesiology of the muscles treated. Appointments tend to be shorter (20 min on average), as there are only 3-5 passes required to affect change on the muscle. Over a week there can be as many as 3 appointments, which is strictly based on the tolerance of the patient. Benefits can be seen immediately.

Finally, the use and application of ART as part of training and recovery cycles is remarkable. Better posture and support along with movement retraining and corrective exercise instruction can bring great dividends. Learning to relax musculature after and between repetitions is key to reducing the total insult (breakdown) of issues. Correct movement and postural alignment is fundamental to reducing the re-occurrence of lesions and soft tissue adhesion.

So...now you know the secret, it integrates massage, corrective exercise techniques (PT) and postural alignment in all treatments without creating the core change to the proprioception of the body (ie. body awareness - where Awareness of the body and its relationship with the surrounding environment is mediated by sensation) created by deep tissue massage.

 

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Physiotherapy vs. Neuromuscular Massage

Physiotherapy is a health profession concerned with helping to restore physical well-being to people who are suffering from an injury, pain or disability. Using knowledge from our extensive scientific and clinical background (Masters or Doctorate of Physical Therapy), and they are Chartered Physiotherapists or managed by a professional association. They can assess, diagnose and treat conditions and illnesses that affect people of all ages and social groups.

Chartered Physiotherapists, or Physical Therapists, use manual therapy including manipulation, mobilization and myofascial release as well as complementary modalities including electrotherapy and Medical Acupuncture & Dry Needling. In recent years pain management education and counselling techniques have also become integral in most treatment programs. The Chartered Physiotherapist also utilizes prescriptive exercise as a rehabilitative tool to help patients achieve their full potential. While traditionally, Physiotherapy and/or Physical Therapy was regarded as rehabilitative and mainly hospital-based, the profession has expanded greatly into other health care areas. 

Neuromuscular therapy (NMT) is a specialized form of manual therapy that integrates specific massage techniques, flexibility stretching and home care practices to eliminate the causes of neuromuscular pain. NMT theory explains how injury, trauma and other factors can destabilize nerve transmission, making the body vulnerable to pain and dysfunction.

Through neuromuscular therapy training, students learn to manipulate muscles, tendons and connective tissue to restore balance to the central nervous system.

Neuromuscular therapy examines five elements that cause pain: ischemia (lack of blood flow), trigger points (more about trigger point therapy), nerve compression, postural distortion and biomechanical (movement) dysfunction. During an initial session, neuromuscular therapists interview patients about their health history, current physical condition, lifestyle, and stress levels and devise a treatment plan that addresses their pain syndromes.

Using fingers, knuckles or elbows, neuromuscular therapists apply concentrated pressure on areas of pain until they reach a trigger point, usually a spot that’s extra tender or numb. At this point, they’ll begin a stronger, more localized massage to relax the muscle. Relaxing muscles in this way releases lactic acid, increasing blood and oxygen flow, which, in turn, enhances the function of joints, muscles and movement.

Although both are forms of manual therapy, and they deal with the soft tissue of the body - Neuromuscular therapists can be more preventative - since they may see clients with varying degrees of discomfort. The appointments can also be used in conjunction with many other types of treatment including chiropractic visits, acupuncture, physical therapy and orthopedic rehabilitation (post surgery).

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Stress Management using a Stillpoint

The Stillpoint and Relaxation techniques

Specific effort to counter and manage stress daily can help us reach a place of absolute calm where the mind is truly quiet. Further discussion and evaluation in use of stillpoint to reset or downregulate muscle relaxation and massage is important. What is actually known about ‘the stillpoint’ and how to achieve it?

Stress relief practices such as meditation, tai chi, and yoga counter the harmful effects of stress. Another method, the stillpoint technique, can help us reach a place of absolute calm where thoughts are stilled and the mind is truly quiet, which is supported by deep and measured breathing to oxygenate and

Robert Harris is a stress expert and one of Canada’s leading craniosacral therapists. He explains, “By finding your stillpoint, you can sink into calmness naturally and quickly, enabling you to identify and sustain the ultimate Shavasana (diaphragmatic breathe).” This is the ability to completely detach yourself from all thoughts.

What is a stillpoint

The term stillpoint has its roots in osteopathy and craniosacral therapy (CST). The latter is a gentle, non-invasive, hands-on therapy. CST theory and practice is based on the concept of the continuous subtle movements of the cranial bones, which are understood to be in constant motion in response to rhythmical cerebrospinal fluid fluctuations within the spinal cord and brain environment. The goal and challenge is to change, reduce or 'still' these movements to positively affect the parasympathetic nervous system - and thereby change pain symptoms in the body.

The gentle stillpoint technique is used to help shift the central nervous system from its usual state of alertness to one of calmness (similar to sleep, where the mind shuts off and lets muscle recovery begin). The natural rhythm that is always occurring within the craniosacral system eases into a therapeutic standstill. Recipients report the experience as a feeling of deep peace pervading the body. This sense of peace and tranquility indicate that the fight-or-flight responses of the sympathetic nervous system have stepped down.

Harris describes the stillpoint experience as “relaxation so deep that one not only feels their mind going quiet and staying quiet, but eventually there is the feeling of becoming liquid. In this liquidness we access the potential for great surrender and release of chronic tensions.”

How to find your stillpoint

A stillpoint can be achieved with relative ease by contacting two very particular spots at the back of the head – beneath the Occipital ridge. Even the slightest pressure in this area can create slack or release within the connective tissues of the brain. When this happens, there is a neurological recognition and response. The tensile nature of these tissues eases off, and the nervous system goes into temporary suspension.

These two spots lie opposite the pupils of the eyes along a horizontal plane at the back of the cranium. Along this plane there is an internal divide between the upper and lower brain, marked by an inwardly folded membrane called the tentorium cerebelli.

Trained craniosacral therapists use a gentle hands-on method to help patients achieve the kind of release described above, and the goal is to identify and affect the rhythms of the human body (ie. Identified through touch). However, through years of working with clients, it can be shown conclusively shown that it can be empowering for people to be able to access stillness for themselves, easily and quickly, whenever they need to.

With this in mind, many therapists recommend two Tennis Balls taped or wrapped in a sock (tied at one end), and these these soft rubber balls are designed to be adjustable, allowing individuals to lie on them comfortably in a position that gently cradles their head at the exact spots where the relaxation response becomes activated.

 

Enhance yoga practice

If yoga or meditation is your chosen approach to relaxation, and you are having difficulty finding and maintaining a relaxation response, discovering your stillpoint may help.

During stillness, the mind is settled and less distracted; it has better focus and heightened sensory awareness. By using pressure on the occiptal area at the back of the skull, your position may accompany a relaxation of muscle tone and a release of soft tissue restrictions.

As a result, your yoga practice can become more directed. You can execute postures with greater ease and flexibility, and you can experience a deeper, longer, and more rewarding Shavasana.

Yoga instructor Leslie Howard describes what a stillpoint experience is like for her. “Going into stillness at the end of my yoga practice is like lying back into the ocean … the oceanlike wave lulls me back to source, to a place where I am just hanging, suspending,” she says. “I return with less anxiety, more clarity and calmness.”

She also observes that inducing a stillpoint during her yoga practice has enabled her to “listen and accept those around her with greater ease and understanding.” This is a crucial element for stress reduction, on or off the yoga mat.

It has been shown that spending time, even just a few minutes a day, in a state of stillness can have a profound effect on stress. Every time our stress cycle is interrupted it takes a little longer to re-establish itself, and the body gets better at restoring a healthy balance between the sympathetic and parasympathetic nervous systems.

We can’t eliminate stress completely from our lives, but fortunately, we can find some relief. Connecting with your stillpoint will help you reach the ultimate relaxation, when and wherever you need it.

To find a massage practitioner, you can search for a craniosacral therapist who practise the stillpoint technique at: NCBMTB and AMTA  and ABMP websites:

1)      http://www.ncbtmb.org/tools/find-a-certified-massage-therapist

2)      https://www.amtamassage.org/findamassage/index.html

3)      https://www.abmp.com/public

 

Promising research on Stillpoint in Medical Treatment

I.                     Dementia: A small study examined the effects of the stillpoint technique on nine older patients with dementia. Treatment was given daily for six weeks. Even post-treatment the patients had reduced physical aggression and verbal agitation. They were more cooperative with caregivers and had more meaningful interactions with family and caregiving staff.

II.                   Sleep: In another small study researchers investigated the effects that cranial manipulation, specifically the CV4 technique, had on muscle sympathetic nerve activity. In the first study of its kind researchers showed that this technique was able to alter sleep latency (the time it takes to go from full wakefulness to sleep) in healthy subjects.

While this study provides insight into the possible physiological effects of cranial manipulation, it doesn’t explain how these changes occur.

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Sleep and Muscle Relaxation

Beyond a sleeping position, research suggests that not just the sleep position, but sleep itself, can play a role in reducing musculoskeletal pain, including neck and shoulder pain. In one study, researchers compared musculoskeletal pain in 4,140 healthy men and women with and without sleeping problems. Sleeping problems included difficulty falling asleep, trouble staying asleep, low amount of sleep during the night, and waking early in the mornings without feeling 'rested,' and non-restorative sleep.

People who reported moderate to severe problems in at least three of these four categories were significantly more likely to develop chronic musculoskeletal pain after one year than those who reported little or no problem with sleep. One possible explanation is that sleep disturbances disrupt the muscle relaxation and healing that normally occur during sleep. Additionally, it is well established that pain can disrupt sleep, contributing to a vicious cycle of pain disrupting sleep, and sleep problems contributing to pain.

With many things, like neck pain, an ounce of prevention may be worth a pound of cure. It's true that some causes of neck pain, such as aging impact on the body, wear and tear on the neck and spine, stress are not under your control, finding the sleep position to support sound sleep is. On the other hand, there are many things you can do to minimize the risk of improper (read discomfort producing) positioning of the head, neck, shoulders and spine. One place to start is to look at how you sleep and what effect this may have on neck and shoulder pain.

What is the best sleeping position for neck pain?

Two sleeping positions are easiest on the neck: on your side or on your back. Of these two, sleeping on your back, puts less stress on the neck muscles, because you may not toss and turn as much throughout an average of 5-6 hours of sleep. If this is what you choose, find a ‘rounded’ pillow to support the natural curve of your neck…not too high (flexion and extension as it pushes the chin forward) with a flatter pillow ‘plane’ to cushion your head above. Any material will do, as long as this can be achieved by tucking a small neck roll into the pillowcase of a flatter, softer pillow, or by using a special pillow that has a built-in neck support with an indentation for the head to rest on (think bamboo or all natural fiber).

Additional tips for side- and back-sleepers:

If you try using a feather pillow, it will easily conform to the shape of the neck, but the feather pillows will collapse over time, and will need to be replaced every year or so. Thicker ones may push the neck up to far, and thinner ones may need to be ‘rolled’ which will not provide anything but a bolster to the neck (without support for the head).

Another option is a traditional ‘shaped pillow’ made of "memory foam,” which will conform to the contour of your head and neck. Some cervical pillows are also made with memory foam. Manufacturers of memory-foam pillows claim they help foster proper spinal alignment. You must find one that isn’t too high or stiff, so that it doesn’t keep the neck flexed overnight and can result in morning pain and stiffness.

If you sleep on your side, keep your spine straight by using a pillow that is higher under your neck than your head. Be sure to keep your neck inline with your upper back when lying down - and ensure that this is the primary position attempting to achieve (ie. not sleeping upright in bed).

When you are riding in a plane, train, or car, or even just reclining to watch TV, a horseshoe-shaped pillow can support your neck and prevent your head from dropping to one side if you doze. If the pillow is too large behind the neck, however, it will force your head forward. Resting with your 'head propped' up, should not be counted in your prone, sleeping position, as this is translates into incomplete sleep for the parasympathetic nervous system. The entire idea of rest to to remove as much of the influence of gravity on muscles as possible.

Side sleeping or on your stomach is tough on your spine, because the back is arched and your neck is turned to the side. Preferred sleeping positions are often set early in life and can be tough to change, not to mention that we don't often wake up in the same position in which we fell asleep. Still, it's worth trying to start the night sleeping on your back or side in a well-supported, healthy position.

 

 

Moist Heat and Muscle Soreness

Heat is commonly used following exercise to prevent delayed onset muscle soreness (DOMS). Most heat used in a clinical setting for DOMS are only applied for 5 to 20 minutes. This minimal heat exposure causes little, if any, change in deep tissue temperature. For this reason, long duration dry heat packs or organic hot/cold 'heat' packs used at home to slowly and safely warm tissue and reduce potential heat damage while reducing pain associated from DOMS.

Clinically, it has been shown that moist heat penetrates deep tissue faster than dry heat. Therefore, in home use heat packs along with moist heat may be more effective than dry heat to provide pain relief and reduce tissue damage following exercise DOMS. However, heat packs moistened with heat will only last for 2 hours compared to the 8 hours duration of chemical dry heat packs.

Heat has been used therapeutically for thousands of years. It offers immediate pain relief and can increase circulation to speed the healing process after injury. For this reason, it is popular for use on many types of pain including joint and muscle pain as well as soft tissue damage.

The effect of heat on pain is mediated by heat sensitive calcium channels. These channels respond to heat by increasing intracellular calcium. This generates muscle action potentials that increases stimulation of sensory nerves and causes the feeling of heat in the brain. These channels have in common their sensitivity to other substances such as vanilla and menthol. These multiple binding sites allow a few factors to activate these channels. Once activated, they can also inhibit the activity of pain receptors, and are located in the peripheral small nerve endings . For peripheral pain, for example, heat can directly inhibit pain. However, when pain is originating from deep tissue, heat stimulates peripheral pain receptors which can alter what has been termed gating in the spinal cord and reduce deep pain.

Another effect of heat is its ability to increase circulation. These receptors along with noiciceptors, increase blood flow in response to heat. The initial response to heat is mediated through sensory nerves that release substances to increase circulation. After a minute or so, nitric oxide is produced in vascular endothelial cells and is responsible for the sustained response of the circulation to heat. This increase in circulation is considered essential in tissue protection from heat and repair of damaged tissue.

Heat is used in different modalities in the treatment of back pain and muscle soreness. Dry heat can be applied through either heat packs or techniques that warm tissue such as diathermy and ultrasound  Heat packs can be dry or moist. In Sports Massage Hydrocolator heat packs are usually at 165 deg F and are separated from the skin by 6 - 8 layers of towels and used only in clinical settings. Hydrotherapy (warm) uses water at 105 deg F and involves immersing a limb in the water. Hydrotherapy can include contrast baths or simply warm water immersion. A major problem with this type of heating is that it is usually used for short periods of time, for example, 5 - 20 minutes. There is also a combination of cryotherapy-heat therapy (10 min ice/10 min heat) which increases circulation and speeds muscle relaxation, generally used in minimizing pain and inflammation.

Moist heat, in most studies, appears to be advantageous in pain relief to many short duration dry heat modalities such as electric heat pads. But these heat modalities are used for short periods of time, for example, 20 minutes maximum. Many studies have shown that short duration of heat application results in poor heat transfer to deep tissues. Therefore, in deep injuries, heat application for short duration causes pain relief through the gate control theory of pain in the central nervous system and not through the peripheral nervous system. Long term application of heat, such as in chemical heat wraps, solves this issue by applying heat for hours to warm deep tissue gradually. But dry chemical heat wraps heat deep tissue much slower that pain relief is delayed by at least 30 minutes.

While moist heat penetrates deep tissues better than dry heat for warming. This is supported by research examining heat transfer from various types of heat modalities from skin to subcutaneous tissues. Moist heat modalities transfer heat much faster than do dry heat modalities and research shows that they cause much faster heat penetration than dry heat. Even air with high humidity transfers heat faster than dry air. But it is not just the type of heat but the duration as well that affects heat transfer into deep tissues.

For example, contrast baths use warm and cold water immersion that alternates within minutes in warm and cold baths. While this changes skin temperature, there is no evidence that it penetrates into deep tissues. Whirlpool heat penetrates quickly, but is used for only a short duration as are hydrocolator heat packs which provide moist heat but are left on for less than 20 minutes due to their high temperature. Someone with thick subcutaneous fat will therefore only see a small difference in deep tissue temperatures with these modalities.

To penetrate deep into tissue, lower temperature and long duration heat packs are often used. Long duration heat products (for example, chemical dry heat) offer the advantage of being safer and can be left on for hours to warm deep tissue and provide increased circulation and pain relief.  But the increase in tissue temperature is slow as is the onset of pain relief. Chemical moist heat lasts for a shorter duration than dry chemical heat packs, lasting between 30 minutes and two hours. For more information refer to Moist or Dry Heat for Delayed Onset Muscle Soreness, Journal of Clinical Medicine Research - J.Petrofsky, 2013

 

 

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Shoulder Hotpack

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