Saturday, February 20, 2010

MRI Results. There's good news, and bad news.

After some wrangling with the imaging office to get them to fax reports where I wanted them, phone rings yesterday around 1:30pm. Chiropractor on the phone. "I've got good news and some bad news." "The good news is there's nothing really that wrong with your shoulder. The bad news is that there's nothing really that wrong with your shoulder, so we're still a little stumped as to how to get you feeling better."

BUT, there was some excitement. MRI revealed I am the proud owner of a Buford Complex shoulder anatomical variance. What is Buford Complex you ask? Great question, as my chirporactor (and probably my GP as well) asked the same thing when he read the report. He had to look it up before calling me. Buford Complex is considered a rare but normal variance in shoulder structure, consisting of a small or often non-existent superior anterior shoulder labrum, along with a thick, cord-like middle glenohumeral ligament. To the untrained eye, it looks like an avulsed labrum, but turns out I was born with it. Interesting thing is that it looks (and in my case FEELS) like a SLAP lesion, as my shoulder anomaly is exactly in the spot where a SLAP lesion occurs. So it's not that I've torn any cartilage, I just don't have any there, and something I've done has irritated it. A lot. Since it's not an injury per se, my chiro and I are a bit stumped as to what I can do about it other than what I've been doing. Resting, NSAIDs, and possibly some cortisone injections, if that's what my GP thinks. Haven't talked to him yet.

In addition to the Buford Complex, I have some sub-deltoid buristis, a Type 1 AC joint separation that has already tightened back up, and some inflammation of my supraspinatus tendon (one of my rotator cuff muscles), which incidentally attaches in the same neighborhood as the missing labrum part of my Buford Complex.

Good news, surgery doesn't sound like it's successful or necessary with my shoulder conditions, and MRI report states explicitly that I have no tear. Bad news, there's not some simple, subject-verb-object "do this" kind of fix for it either. I had taken myself off the big guns NSAIDs my GP put me on, namely because I don't like the potential risks associated with that class of drugs. But now that I know that inflammation is a key part of my problem, I put myself back on. Now I have proof that those pills may help my shoulder rather than guessing at it.

All this aside, I'm thrilled to have a shoulder anatomy that only 1% of the world's population has, and I think it's fun being different. Plus, it's been an excellent learning opportunity to look up, research and study something that I would otherwise never have known even existed.

So that's the news that's fit to print here. I said I'd update when I heard results of MRI, so here I am. Buford in the house! Woot!

Til next time,
Nat D, LMT

As an LMT I am not able to diagnose nor treat any illness or physical condition, and I am not a replacement for medical care.

Tuesday, February 16, 2010

Do as I say, not as I do. Put another way, taking my own advice.

When embarking on a career such as massage therapy, you never suspect that you might become one of "those" therapists who gets hurt "in the line of duty" per se. Yet, here I am, lingering shoulder injury for over a month now, MRI scheduled for tomorrow. Hopeful to find answers, wary of diagnosis and recovery instructions. I've been in the self-diagnostic gerbil wheel that comes with having anatomical understanding-- I know a whole lot of what it's not, but not certain of what it is. In keeping with my somehow always being interesting and odd, both my chiropractor and GP are stumped. Though I haven't fallen, been blitzed or tackled, I somehow have a shoulder injury congruent with someone who has. Separation, AC strain, and/or possible labrum tear. Big question remains, HOW?!?

Diagnostic fisticuffs aside, it really hit me that I have not done a very good job of caring for myself or heeding the therapeutic protocols and advice I know I would dispense to my clients were they in this predicament. Rest, don't use it as much as possible, rest, rest, ice, anti-inflams, if it hurts don't do that, and did I mention REST? Somehow I've been telling myself that being a "professional" I somehow get a "get out of jail free" card in this regard. Turns out I am wrong.

There is that whole real-life thing about being self-employed and needing to earn a living, so necessity mitigates a precarious balance between rest and work requirements, but even with that, I could (and should) be doing a better job of caring for myself in the way that I care for my clients. It took a dear friend-- who bless him, has come over to my house *every* morning to tape and stabilize my AC joint before I go to work-- challenging me on the schedule I've insisted on maintaining. As he put it, "Nat, you need to step outside yourself and talk to you like you were one of your clients. And if MT you were dealing with CLIENT you, you'd say, 'I hate that client! She doesn't listen!'" Now, for the record, I don't hate any of my clients, but his point was well taken.

So, my homework is to treat me like I treat my clients, and take care of this insert-injury-diagnosis-here shoulder issue. I commit to spacing out my work hours appropriately, to rest whenever possible, and to trust that my clients will be understanding if I need to spread their sessions out. Reminding myself that it doesn't do them any good if I break myself further by working too much. They lose out in the long run too.

MRI scheduled for 10:30am tomorrow, will update as soon as I know more... Keep your fingers crossed for me that this isn't one of those nebulous injuries that hides from an MRI scan. Choosing to believe that will not be my luck!

Making today a "Practice what you preach" day. Yours in health....

-Nat D, LMT

Note: As a licensed massage therapist I cannot diagnose or treat any illness or physical condition, and am not a replacement for medical care.

Sunday, January 17, 2010

Should Deep Tissue or Structural Massage Hurt?

This is a question I hear countless times from clients and non-clients alike, over and over again. Although each practitioner is different, and each client's pressure preferences vary, this, in my opinion and training, is my take on it.

First, define "hurt." This is what I tell my clients when they first come to see me. If it feels like a "productive" hurt, and you are able to enjoy the feeling that your painful or stuck problem is easing up, then it's great. I'd call that a therapeutic hurt. The kind of hurt you get when you get a good stretch say, to your hamstrings. It may not be pleasant, but it feels "good." I tell my clients to let me know immediately if this kind of "good hurt" turns into a bracing, wincing, pull-away kind of "ouch"-- or a "bad" hurt. If that happens, it's time to back off to a more tolerable level, it's too much hurt. Let me tell you why.

The whole point of my practice is to help people out of pain, or injury, or stress, or insert whatever issue here. If you are on the table and are able to allow in the work, then therapist and client are in sync with the process and relaxation is achieved. That restful, relaxing, safe state then augments the work I can accomplish. Here's how. The client's brain is now involved, and amicable to the work. Tissues soften, I can work deeper. This is a synergistic process, so the next time they are on the table, the brain knows it's a good and safe place, and I can go even further into the tissues as a result. The "friend or foe" gates of the central nervous system open up to let me in and help clean the place up a bit. More relaxation, looser muscles and connective tissues, more work at deeper levels can be accomplished.

To the contrary, if the client on the table is bracing, wincing, or pulling away because the work is too painful or uncomfortable, just the opposite will happen. The brain will associate this experience with stress, pain, further injury and discomfort and all gates go up. Now, not only am I trying to work through whatever tight or scarred tissues are there to begin with, but also am having to fight through guarded, braced and tense muscles that are trying to protect themselves from further assault. Now therapist and client's nervous system are engaged in a non-verbal battle of the wills, and as you can imagine, it's not very productive. Client's not getting relief, therapist is working double hard to get the work done. Not an optimal nor healing scenario.

Now, of course, there are certain types of injuries that are inherently painful to rehabilitate. Rotator cuffs, hip flexors, and post-surgical scar tissue to name some of the most common culprits. In those instances, I am up front with my clients and tell them that the work they need can be uncomfortable, but that we'll go in short bursts, and to *still* let me know if it gets too intense, and remind them that they are in the driver's seat. This reassurance is usually all it takes to prepare someone for an uncomfortable release technique.

Will I be sore afterwards?

This is another question I hear often. Here is what I say. "You may feel sore to the touch, like a bruised sensation, but even with that, you should have better mobility, range of motion, and less overall pain to the complaint area. Bruising is not acceptable, so if you experience any discoloration, please let me know immediately. The post-session tenderness should resolve in 36-48 hours. Longer than that, also, please let me know."

The reason I bring this up, is I want people to understand that a bruise is an injury. You are bleeding on the inside. Defined like that, how can an MT giving you a bruise be considered beneficial or therapeutic? Of course there are the occasional cases where someone easily bruises and it wasn't due to excess pressure, but for a client to be told that "they needed that, and it's part of a theraputic regimen" is, in my experience, training, and opinion, utterly wrong. If discoloration occurs, in my book, it means that the therapist worked either too deeply, and/or too fast, meaning they didn't wait for the layers of tissue to melt before proceeding to the next deeper layer. Innocent mistakes from time to time, but "hard and fast" does not a successful deep tissue therapist make, in my professional opinion.

To put things into place and show a real-life example, I'm going to share a horror story. A woman who was not my client was training for a marathon, and was receiving weekly sessions from a prominent sports therapy clinic. Her husband was a client of mine. We ran into each other out after work one evening, and he told his wife to go to the ladies' room and show me what happened to her. It was a little awkward, and was clearly not on his wife's nor my list of things to do in a public bathroom, but he insisted and so off she and I went. Whereupon she showed me softball sized bruises on both glutes, both quads, both hamstrings, and multiple smaller bruising along her IT bands, and this was within just a few short weeks before her race. I was shocked. This woman is training for a marathon, has limited recovery time before the event, and has now been contused and injured on all of her major running muscle groups. I told her she needed to show that to her MT, and if the reaction is anything less than shock, she needs to run to a different therapist-- it didn't have to be me, but it shouldn't be whoever that was. This poor woman had no idea, as she said she knew it hurt pretty bad during that session, but had been told that it was acceptable and within therapeutic ranges. When I broke it down that bruises are internal bleeding, which set up swelling, and pull resources to heal rather than restore and strengthen the surrounding tissues, the light bulb turned on. She made an appointment with me to see if she could tell a difference in how I worked from what she was used to, and was astounded. She had no idea that effective didn't have to be brutal. We worked to gently flush out her legs to speed the healing of her injuries, and she completed the marathon without issue.

So, in summation, more is not always more. Our society is really attached to the "no pain, no gain" philosophy, and I present to you that in the world of structural bodywork and deep massage, this is not only untrue, but following it can cause further pain and injury.

Until next time....

Note: As a licensed massage therapist, I can not diagnose nor treat any illness or condition, and am not a substitution for medical care.