Workplace Injury

What to expect from a trigger point massage

~ bryancobb ~ Leave a comment

ession Description

 

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

 

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

 

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

 

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

 

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

 

After treatment, it is usually recommended that the client apply moist heat to the area treated.

 

Trigger points in the trapezius muscle.

~ bryancobb ~ Leave a comment

The trapezius muscle is a large diamond shaped muscle that travels from the neck to the mid back. It originates on the nuchal ligament, and the spinous processes of C6-T12. It has its insertion on the scapular spine, acromion process, and distal clavicle. The upper fibres of this muscle work to elevate the shoulder, and rotate the glenoid fossa upwards. The lower fibres assist this motion, and the middle fibres are strong adductors of the scapula. This is the number one muscle in the body tp get trigger points. Trigger points in the lateral upper edge refer pain in the lateral neck and temples, a common cause of headaches. Points in the middle and lower fibres refer pain into the posterior neck and shoulder.

A treatment with Bryan Cobb RMT.

~ bryancobb ~ Leave a comment

Session Description

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

After treatment, it is usually recommended that the client apply moist heat to the area treated.

 

What the Heck Is a Trigger Point?

By Bryan Cobb, Advanced Remedial Massage Therapist

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce, at some time in your life.

TP’s were first brought to the attention of the medical world by Dr. Janet G. Travell. Dr. Travell, physician to President John F. Kennedy, is the acknowledged Mother of Myofascial Trigger Points.  In fact, “Trigger Point massage, the most effective modality used by massage therapists for the relief of pain, is based almost entirely on Dr. Travell’s insights.”2  Dr. Travell’s partner in her research was Dr. David G. Simons, a research scientist and aerospace physician.

Trigger Points are very common. In fact, Travell and Simons state that TP’s are responsible for, or associated with, 75% of pain complaints or conditions.1 With this kind of prevalence, it’s no wonder that TP’s are often referred to as the “scourge of mankind”.

Trigger Points can produce a wide variety of pain complaints. Some of the most common are migraine headaches, back pain, and pain and tingling into the extremities. They are usually responsible for most cases of achy deep pain that is hard to localize.

A TP will refer pain in a predictable pattern, based on its location in a given muscle. Also, since these spots are bundles of contracted muscle fibres, they can cause stiffness and a decreased range of motion.  Chronic conditions with many TP’s can also cause general fatigue and malaise, as well as muscle weakness.

Trigger Points are remarkably easy to get, but the most common causes are

•

TP’s (black dots) can refer pain to other areas (red)

Sudden overload of a muscle

• Poor posture

• Chronic frozen posture (e.g., from a desk job),  and

• Repetitive strain

Once in place, a TP can remain there for the remainder of your life unless an intervention takes place.

Trigger Points Not Well Known

With thousands of people dealing with chronic pain, and with TP’s being responsible for — or associated with — a high percentage of chronic pain, it is very disappointing to find that a large portion of doctors and other health care practitioners don’t know about TP’s and their symptoms.

Scientific research on TP’s dates back to the 1700’s.  There are numerous medical texts and papers written on the subject.

But, it still has been largely overlooked by the health care field.  This has led to needless frustration and suffering, as well as thousands of lost work hours and a poorer quality of life.

How Are Trigger Points Treated?

As nasty and troublesome as TP’s are, the treatment for them is surely straight-forward.  A skilled practitioner will assess the individual’s pain complaint to determine the most likely location of the TP’s and then apply one of several therapeutic modalities, the most effective of which is a massage technique called “ischemic compression”.

Basically, the therapist will apply a firm, steady pressure to the TP, strong enough to reproduce the symptoms.  The pressure will remain until the tissue softens and then the pressure will increase appropriately until the next barrier is felt.  This pressure is continued until the referral pain has subsided and the TP is released. (Note:  a full release of TP’s could take several sessions.) 

Other effective modalities include dry needling (needle placed into the belly of the TP) or wet needling (injection into the TP).  The use of moist heat and stretching prove effective, as well. The best practitioners for TP release are Massage Therapists, Physiotherapists, and Athletic Therapists.  An educated individual can also apply ischemic compression to themselves, but should start out seeing one of the above therapists to become familiar with

the modality and how to apply pressure safely.

1 Simons, D.G., Travell, D.G., & Simons, L.S. Travell and Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual.

Vol. 1.  2nd ed. Lippincott, Williams, and Wilkins, 1999.

2http://www.muscletherapyworks.com/MTW%20Biography%20T%20&%20S%2001.htm 

Lumbar Radiculopathy? That sounds ridiculous!

~ Dr. Robert Speirs DC ~ Leave a comment

Your nervous system is basically a big electrical circuit. Your spinal cord transmits all of the electrical nerve impulses between your brain and lower back. From there, individual nerves emerge from your spine then travel to supply sensation and movement to a specific area of your buttock, legs and/or feet. This allows you to move and feel sensations like touch, heat, cold and pain. Anything that

interferes with this transmission can cause problems.

You have been diagnosed with a “Lumbar Radiculopathy”. This means that one or more of the nerves emerging from your lower back has become irritated or possibly pinched. This often results in pain, numbness or tingling in the specific area of your leg that is supplied by the irritated nerve. The term “Sciatica” is often used to describe this condition, because most (but not all) “lumbar radiculopathies” involve the sciatic nerve which supplies the back & outside of your thigh and calf. Symptoms of a lumbar radiculopathy may vary from a dull ache to a constant severe sharp shooting pain. Your symptoms are likely aggravated by certain positions or movements.

To solve this problem, we will treat the source of your nerve irritation. It is important for you to follow your treatment plan closely and be sure to tell us immediately if you experience any progression of your leg pain, numbness or weakness.

Lumbar Spondylolisthesis

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Your spine is made up of 24 individual vertebrae all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components: the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of

the vertebral arches on its way from your brain to your tailbone. The term “lumbar isthmic spondylolisthesis” describes a condition where your arch has broken free from its anchor on the vertebral body, allowing the vertebral body to slide forward. Lumbar spondylolisthesis typically affects the lowest lumbar vertebra, L5, or occasionally the second lowest, L4.

The condition is sometimes caused by trauma, but more often follows a “stress fracture” involving the arch of the vertebra. This break and slippage is thought to result from repetitive movements, especially hyperextension (arching back) and rotation. The break usually happens during childhood but does not always cause symptoms when it occurs. Many times, the condition will lie dormant until later in life. Lumbar spondylolisthesis is present in six to seven percent of the population and affects males twice as often as females. The problem is more common in those who participate in sports. Some sports predispose children to this “break and slip”. Athletes who participate in gymnastics, rowing, diving, football, wrestling, weight lifting, swimming, tennis, volleyball, and track & field throwing sports (i.e. discus, shot put, etc) are at greatest risk.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards, especially during heavy activity. Some women report increased symptoms during the later stages of pregnancy. Be sure to tell your doctor if you notice pain, numbness or tingling in your groin, a loss of bowel or bladder function, fever, night sweats, pain extending beyond your knee, or weakness in your legs.

Your doctor will “grade” your spondylolisthesis based on the percent of the vertebral body that has slipped forward. Your doctor will try to determine if your spondylolisthesis is “active”, meaning a recent break or “inactive”, referring to a long-standing problem. If your doctor has determined that your spondylolisthesis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly. Patients with a long-standing “inactive” spondylolisthesis may benefit from a combination of treatments including stretching and strengthening. You should limit leaning backwards or sleeping on your stomach. Females should avoid wearing high heels.

Lumbar Spondylo-what?

~ Dr. Robert Speirs DC ~ Leave a comment

Your spine is made up of 24 individual vertebrae, all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components- the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of the vertebral arches on its way from your brain to your tailbone.

The term lumbar spondylysis describes a condition where a part of the arch breaks free from its anchor site on the vertebral body. This condition most commonly occurs during adolescence while bones are hardening. When we are young our bones have taken shape but they have not yet become hardened. Think of this as a clay coffee mug that has not yet been fired in the kiln. During adolescence, our bones transform from this softer clay to a more brittle bone.

The condition is sometimes caused by trauma but more often is a “stress fracture” to the arch of the vertebra. This defect is thought to result from repetitive movements, especially hyperextension and rotation. The condition is more common in people who were born with a small or weak arch- think of a coffee mug handle with a very thin brittle attachment.

Lumbar spondylolysis usually affects the lowest lumbar vertebra- L5, or occasionally L4. Most patients are 10-15 years of age when they are diagnosed with the condition, although sometimes symptoms do not present until adulthood. It is more common in those who participate in sports. Some sports predispose children to this problem. Athletes who participate in diving, wrestling, weight lifting, track, football and gymnastics have the highest incidence of spondylolysis.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards. You should limit movements that involve hyperextension, like leaning backwards. Females should avoid wearing high heels.

Your doctor likely performed x-rays or an MRI to make the diagnosis of spondylolysis. If your doctor has determined that your spondylolysis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly.

What is Lumbar Stenosis? 

~ Dr. Robert Speirs DC ~ Leave a comment

Stenosis.png

The term stenosis means “narrowing” of a tube or opening. Spinal stenosis means that the tube surrounding your spinal cord and nerve roots has become too small, and your nerves are being compressed. Stenosis can arise in different ways. Sometimes, people are born with a spinal canal that is too small. Other times, the canal may have been narrowed by surgery or conditions like disc bulges. Most commonly, spinal stenosis arises from chronic arthritic changes that narrow the canal. This type of stenosis usually develops slowly over a long period of time, and symptoms show up later in life.

Patients with stenosis often report pain, tingling, numbness or weakness in their legs. Lower back pain may or may not be present, but leg symptoms are usually more bothersome. You may notice increasing symptoms from standing or walking and relief while sitting because the available space in your spinal canal decreases when you stand, walk or lean back and increases when you sit or flex forward. Walking down hill is usually more uncomfortable than walking up hill. You may notice that when you walk with a shopping cart or lawn mower, you are more comfortable, as this promotes slight flexion. Sleeping on your side in a fetal position with a pillow between your knees may be most comfortable.

The natural course of spinal stenosis is variable. Most patients notice their symptoms stay about the same over time, while others are divided into fairly equal groups who either improve or worsen. Be sure to tell your doctor if you notice that your legs become cold, swollen or change color. Likewise, tell us if you notice a fever, unexplained weight loss, flu-like symptoms, excessive thirst or urination, numbness in your groin or loss of bladder control.

While there is no non-surgical cure for stenosis, we offer potent treatments to help ease your symptoms. Treatment is focused on helping improve your mobility so that you can walk and function better. You will be given exercises to help with conditioning. You should avoid activities that increase your pain, including heavy lifting or those that cause you to extend your back, like prolonged standing or overhead activity. When you are forced to stand, you may find relief by slightly elevating one foot on a stool or bar rail. You may find relief while washing dishes if you open your cabinet door and alternately rest one foot on the inside of the cabinet to provide a little bit of flexion. Recumbent cycling is often a more tolerable alternative to walking or running. Some patients report relief by using an inversion table.

I’m getting old Doc… Getting old….

~ Dr. Robert Speirs DC ~ Leave a comment

Your lumbar spine (low back) is made up of 5 individual vertebrae stacked on top of a bone called the “sacrum”. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, these discs can wear and become thinner over time. This leads to additional changes, including bone spurs and narrowing of the opening where your nerves exit your spine.

This process is called “lumbar spondylosis”, or simply, “arthritis”. This problem most commonly involves the vertebra at the very base of your spine, which bear the highest loads.

Lumbar arthritis is exceptionally common, affecting people as young as 20 and becoming extremely likely by age 70. How quickly you develop low back arthritis is largely a trait you inherited from your parents. Other factors may play a role, including a history of trauma, smoking, operating motorized vehicles, being overweight and/ or performing repetitive movements (i.e. lifting, twisting, bending or sitting). Men seem to be affected slightly more often than women.

Symptoms often begin as back and buttock pain that gradually worsens over time. Stiffness may be present upon arising in the morning. Pain is relieved by rest or light activity and aggravated by strenuous work. Sometimes your nerves can become “pinched” in narrowed openings where they exit your spine. This can cause “sciatica” which results in pain, numbness, or tingling radiating into your leg along the path of the irritated nerve. Be sure to tell your doctor if you notice any weakness or if you have fever, abdominal pain, change in bowel or bladder function, or pain in your groin crease.

Arthritic changes can be seen on x-rays, but interestingly, the amount of wearing does not seem to correlate directly with the severity of your symptoms. People with the same degree of arthritis may have symptoms ranging from none to severe. Most researchers believe that the symptoms of osteoarthritis are not the direct result of the disease, but rather, from the conditions that preceded the disease and those that develop subsequent to it, like joint restrictions and muscle tightness. Fortunately, those conditions are treatable and our office has a variety of tools to help relieve your pain.

In general, you should avoid repeated lifting and twisting and take frequent breaks from prolonged sitting, especially in motorized vehicles. Avoid any position that causes an increase in radiating pain. Low-impact activities, like walking, stationary cycling, water aerobics, and yoga may be helpful.

Ouch! My Back Went Out!

~ Dr. Robert Speirs DC ~ Leave a comment

Your spine consists of 24 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is wrapped around the inner nucleus much like a ribbon wrapping around your finger. The term lumbar disc lesion means that your disc has been damaged.

Disc lesions start when the outer fibers of the disc become strained or frayed. If enough fibers become frayed, this can create a weakness and when the disc is compressed, the outer fibers may “bulge” or “protrude” like a weak spot on an inner tube. If more fibers are damaged, the nucleus of the disc may “herniate” outward. Since the spinal cord and nerve roots live directly behind the disc, bulges that are accompanied by inflammation will likely create lower back pain that radiates into the buttock or the entire lower extremity. This condition is called sciatica. If the disc bulge is significant enough to create a mechanical compression of your nerve, you may also experience loss of your reflexes and weakness. Be sure to let our office know if you notice progressive weakness or numbness, any numbness around your groin, any loss of bowel or bladder control or fever.

Surprisingly, disc bulges are present without any symptoms in about 1/3 of the adult population. Another one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems. The condition is uncommon in children and is most common between the ages of 40 and 60.

Researches have shown that disc bulges and sciatica may be successfully managed with conservative care like the type we will provide.

Put the shovel down and read this!

~ Dr. Robert Speirs DC ~ Leave a comment

Your low back consists of 5 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is a tough ligament that wraps around the inner nucleus much like a ribbon wrapping around your finger.
Your low back relies on discs and other ligaments for support. “Discogenic Low Back Pain” develops when these tissues are placed under excessive stress, much like a rope that frays when it is stretched beyond its normal capacity. Most commonly, disc pain is not the result of any single event, but rather from repeated overloading. Your lumbar discs generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Approximately one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems.

Symptoms from disc pain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Repeated injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” Over time, discs may dehydrate and thin. This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. Light aerobic exercise (i.e. walking, swimming, etc) has been shown to help back pain sufferers. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes.