Koda Integrative Therapy Group

Therapeutic Massage and Health Partners for Recovery and Performance

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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?"

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.