What to expect with a trigger point massage.

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.


CTS Warning Signs


Headaches are REALLY common! In fact, two out of three children will have a headache by the time they are fifteen years old, and more than 90% of adults will experience a headache at some point in their life. It appears safe to say that almost ALL of us will have firsthand knowledge of what a headache is like sooner or later!

Certain types of headaches run in families (due to genetics), and headaches can occur during different stages of life. Some have a consistent pattern, while others do not. To make this even more complicated, it’s not uncommon to have more than one type of headache at the same time!

Headaches can vary in frequency and intensity, as some people can have several headaches in one day that come and go, while others have multiple headaches per month or maybe only one or two a year. Headaches may be continuous and last for days or weeks and may or may not fluctuate in intensity.

For some, lying down in a dark, quiet room is a must. For others, life can continue on like normal. Headaches are a major reason for missed work or school days as well as for doctor visits. The “cost” of headaches is enormous—running into the billions of dollars per year in the United States (US) in both direct costs and productivity losses. Indirect costs such as the potential future costs in children with headaches who miss school and the associated interference with their academic progress are much more difficult to calculate.

There are MANY types of headaches, which are classified into types. With each type, there is a different cause or group of causes. For example, migraine headaches, which affect about 12% of the US population (both children and adults), are vascular in nature—where the blood vessels dilate or enlarge and irritate nerve-sensitive tissues inside the head. This usually results in throbbing, pulsating pain often on one side of the head and can include nausea and/or vomiting. Some migraine sufferers have an “aura” such as a flashing or bright light that occurs within 10-15 minutes prior to the onset while other migraine sufferers do not have an aura.

The tension-type headache is the most common type and as the name implies, is triggered by stress or some type of tension. The intensity ranges between mild and severe, usually on both sides of the head and often begin during adolescence and peak around age 30, affecting women slightly more than men. These can be episodic (come and go, ten to fifteen times a month, lasting 30 min. to several days) or chronic (more than fifteen times a month over a three-month period).

There are many other types of headaches that may be primary or secondary—when caused by an underlying illness or condition. The GOOD news is chiropractic care is often extremely helpful in managing headaches of all varieties and should be included in the healthcare team when management requires a multidisciplinary treatment approach.

What is a Migraine? What can I do about them?

A “migraine” is an intense throbbing headache that may be accompanied by nausea, vomiting, and sensitivity to light or noise. Adult women are three times more likely than men to experience migraines. The frequency of migraine headaches usually peaks between age 30 and 40, and attacks decrease thereafter. The onset of a new migraine headache after age 50 is rare.

Migraine headaches are caused by a combination of nerve irritation and enlargement of the blood vessels in your brain. Migraines tend to run in families and sufferers have inherited a sensitive nervous system from their parents. Patients who are overweight or have other vascular risk factors are more likely to suffer from migraines.

Migraines are set off by “triggers” and the headache occurs when the number of triggers reaches a critical threshold. This can be likened to a glass of water that overflows at a certain point. Known triggers include: neck tightness, stress, smoking, strong odors (i.e. perfumes), bright or flickering lights, fluorescent lighting, too little or much sleep, head trauma, weather changes, motion sickness, cold (ice cream headaches), lack of activity or exercise, overexertion, fatigue, eyestrain, dehydration, hunger, fasting, and hormonal changes, including menstruation and ovulation. Certain medications, including hormones or oral contraceptives are known triggers. A detailed list of foods that trigger migraines is provided below.

About 20-33% of people who get migraines have warning symptoms, called an “aura”, before their actual headache attack. Aura symptoms develop slowly over five to 20 minutes and can last up to an hour. The most common aura is a band of absent vision with an irregular shimmering border. Some patients report numbness or tingling in their arms or face. Be sure to tell your doctor if you experience any confusion or decreased consciousness with your headache. Other signs to watch for include: abrupt headaches that develop and peak very quickly, headaches that develop following a head injury, light-headedness, dizziness, difficulty speaking, difficulty swallowing, difficulty walking, fever, rash, or any “new” headache that is significantly different from your prior headaches.

Many patients benefit from the types of treatment provided in this office. Research has shown a “significant reduction” in migraine frequency and intensity through chiropractic care. Your home management will focus on avoiding “triggers” and stress. You should begin keeping a headache diary to help you track and eliminate triggers. Patients who experience migraines are more susceptible to other types of cardiovascular disease, like heart attack and stroke. Be sure to choose a “heart healthy” diet (i.e. limit sodium and fats) and keep your weight controlled. Eat at regular intervals and stay well-hydrated as hunger and dehydration are known triggers.

Your doctor may talk to you about supplements like Feverfew (125mg/ day), Riboflavin (400mg/ day), Magnesium (400-600mg/ day) and Co-enzyme Q10 (100mg 3x per day) that have been helpful in preventing headaches for some migraine sufferers. The American Headache Society recommends that patients avoid overuse of medication to control their headaches, (no more than 2 doses per day, 2 days/week) as this can lead to more frequent “rebound” headaches. Do not begin or discontinue any new vitamins or medications without talking to your doctor first, especially if you are nursing or pregnant.

Is Surgery Always Required?

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy—that is, it’s the most common place to trap a nerve in the extremities (arms or legs). CTS affects 6-11% of adults in the general population, and it occurs in women more often than men. The cause is often difficult to determine but the most common reasons can include trauma, repetitive maneuvers, certain diseases, pregnancy, being over the age of 50, and obesity.

So, is surgery the only answer? The short answer is NO! In fact, in a recent randomized clinical trial published in the Journal of Pain, researchers observed similar improvements in function when they compared the outcomes of patients who underwent surgery vs. those who received manual therapies (such as those performed several times a day at chiropractic clinics around the world) at both six months and one year later. The improvements included increased strength, function, and decreased hypersensitivity in both the surgical and non-surgical groups. Interestingly, the manual therapy group did BETTER at the one and three month assessments when compared with the surgical group (again, with no difference at six and twelve months)!

The median nerve, the culprit behind CTS, starts in the neck and travels down through the shoulder, elbow, forearm, and finally through the carpal tunnel, which is made up of eight small carpal bones that form the arch of the bridge. Entrapment of the median nerve occurs when the normally tight quarters within the carpal tunnel combine with the inflamed nine sheathed muscle tendons that push the nerve into the floor of the tunnel (a ligament), which results in CTS! The goal of therapy—both surgical and manual therapy—is to reduce the pressure within the tunnel and free up the compression of the median nerve.

Manual therapies focus on joint mobilization and manipulation to reduce joint fixations, muscle release techniques in the forearm and hand, stretching techniques, and at-home exercises that emphasize a similar stretch, the night brace, and management of any underlying contributing factor. These “underlying factors” might include diabetes, hypothyroid, taking birth control pills, weight management, and inflammatory arthritis.


CTS SUrgery

CTS at Night.

For those who have carpal tunnel syndrome (CTS), it’s no surprise that CTS is frequently most expressive during the night, often to the point of interrupting sleep and/or making it difficult to fall back to sleep. So why is that?

The primary reason for nighttime CTS symptoms has to do with the wrist, as it is very difficult to sleep with the wrist held in its “ideal” or least irritating position. In fact, most people favor “curling” the back of the hand under the chin or bending the hand/wrist backwards under the head. When the wrist is bent in either direction, it can increase the pressure inside the wrist, which can generate the various symptoms associated with CTS.

One study evaluated the pressure inside the carpal tunnel while participants slowly moved their wrists. The researchers found many movements didn’t need to exceed 20 degrees before the pressure increased enough within the carpal tunnel to generate symptoms.

Because it doesn’t take a lot of movement to build up excessive pressure in the wrists of those with CTS, many doctors recommend the use of a “cock-up splint” for the non-surgical treatment of CTS in order to help keep the wrist in a neutral position.

Wrist posture is also an important factor during the day. One study looked at typing on a tablet PC, which allowed people to work in non-traditional settings. As screen size reduced, the posture required to type became more limited and accelerated the usual rate of pain onset in the neck, elbows, and wrists.

This study also looked at three different positions used when working on touch-screen devices: desk, lap, and bed. The healthy subjects completed six, 60-minute typing sessions using three virtual keyboard designs: standard, wide, and split. The researchers monitored the position of the wrist, elbow, and neck while the participants typed and followed up each session with questionnaires designed to measure discomfort.

The research team reported that typing in bed required greater wrist extension but resulted in a more natural elbow position than typing at a desk. The angled split keyboard significantly reduced the wrist deviation vs. the standard or wide keyboard designs. All three regions—the neck, elbow, and wrist—exhibited more movements (13% to 38%) towards the end of the one hour sessions, which correlated with a significant increase in pain in every body region investigated. Overall, using a wider keyboard while sitting at a desk was the most tolerable position among study participants.



A Few Sleep Tips From Us To You


Your mattress and the position you sleep in may affect your spine.

Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.

Here are a couple of tips to help you get in and out of bed more comfortably:
To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.

If you find that you wake up sore then you may be suffering from any number of conditions that get worse overnight.