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Archive for Education for Massage Therapists

Super Simple (and fun) Guide to Increase Range of Motion

I’ve had the honor and privilege of teaching creative movement and writing in women’s prisons for the last twelve years. (Wondering what this has to do with massage therapy? Read on!)

One of the units I volunteer in is the Female Sex Offender Treatment Program (SOTP). Yes, there are female sex offenders. When I first learned about SOTP I was immediately drawn to facilitate workshops there.

I approached the program director and she loved the idea. Since most Texas prisons have a strict “No Touch” policy, The SOTP program is strictly cognitive based therapy. The program director knows that these women hold tremendous trauma in their bodies and fervently believes that creative movement classes allow their bodies to speak. . (Nearly 100% of female offenders have been sexually abused in childhood.)

I always start my classes with fun icebreaker exercises. I put on some fabulous African drumming music and have them write their name with their tail bones, their belly buttons, elbows, nose, chin – anybody part will do! Before long, everyone is smiling and laughing and magic is happening behind bars.

Create some magic in your office/clinic! Encourage your clients and yourself to move in novel ways like I described above. The body loves circular and spiral movement which stimulates different parts of the brain and gets us out of linear, sagittal plane movement. When we move in a variety of ways different parts of our nervous system are stimulated, giving us a new sense of ourselves, a fresh identity.

I regularly suggest to my clients to put on their favorite music and imagine there’s a paint brush attached to the body part we’re working with and do the following:

  1. Rotator cuff/shoulder injuries: write your name in script with your elbow. Bend elbow and Place fingers lightly on shoulder. For those with limited ROM, start in the pain free range (example 30 degrees of abduction).
  2. Neck: write your name in script with your chin and top of head.
  3. Hips/lower back: write your name in script with your belly button and tail bone.

GUIDELINES

  • Stay in the pain-free range until the body feels ready to perform the movements with more volume
  • If it hurts, make it smaller. Micro-movements are a great start.
  • It should feel good and be fun!

BENEFITS

  • Increases range of motion
  • Introduces novel sensations in the body
  • Increases proprioception
  • Releases endorphins
  • A wonderful alternative to traditional exercises

Super Easy Guide to When NOT to stretch your clients!

As passionate as I am about the value of skilled stretching, I’m equally zealous about when NOT to stretch. A common misconception in the bodywork, fitness and yoga fields is “All muscles should be stretched”. Let’s put that to rest right now. All muscles do not need to be stretched.

One of my clients came in last week with severe rhomboid/middle trap pain on her left side. When I asked her about what she thought caused it, here’s what she told me:

“My mother gave me a gift certificate for a relaxation massage which I used last week. The therapist had just taken a Thai*massage course and wanted to do some stretches before the massage. She did one where she pulled my arms away and across my body, one at a time. When she did my left, I could feel something give and it started hurting about an hour after the massage. I could kick myself for letting her stretch me!” (*I am not dissing Thai massage! I love it and get them often.)

This client is quite savvy and educated about her body. She has weakness in her left scapulae retractors (rhomboid/middle traps) because of an old shoulder injury. She manages it with regular bodywork and carefully chosen stretching and strengthening exercises. Her scapulae retractors do not need stretching. Most people’s do not. Most of the time they need strengthening.

Let’s take a brief and general look at postural and phasic muscles:

Postural muscles: also known as tonic or local muscles have an anti-gravity function – they are heavily involved in the maintenance of posture. They tend to be shortened and tightened. Another way of saying that is they tend to be overly-activated.

Phasic muscles: also known as global muscles have primarily a movement role. They are usually more superficial than postural muscles. A shortened, tight postural muscle generally results in inhibition of its associated phasic muscle which becomes weakened as a result. Think pec major and rhomboids.

Let me emphasize that this chart is a general guideline of common muscles that usually benefit from stretching (postural) and those that do not (phasic). Like everything in life thee are exceptions.

You’ll notice infraspinatus is considered a postural muscle because it’s part of the rotator cuff –a stabilizing structure. Infraspinatus is notorious for being weak, inhibited and locked-long. It rarely needs stretching. You’ll notice I do not include a stretch for it in Stretch Your Clients.

Another example is the cervical extensors. With everyone on their devices these days, do those extensors really needs stretching?

I hope this article helps you make informed decisions when to stretch and when not to stretch. Let me know what you think!

The proper way to cough!

I was teaching a Stabilizing the Core and SI Joint seminar recently and learned a valuable cue from a pelvic floor specialist. In the MET correction for and upslipped innominate (when the ilium slips out of the SI joint), the client is asked to perform a hip-hike for eight seconds and cough and let go of the hip-hike. Why the cough? Good question! There are a few reasons: coughing activates the pelvic floor muscles, the transverse abdominis, the anterior multifidi, the diaphragm and the attachment of the quadratus lumborum to the 12th rib. The QL stabilizes the 12th rib during forced exhalations, such as coughing and sneezing. Ever had a client with low back spasms say “I bent over and sneezed!”?

The pelvic floor specialist noticed that the model’s belly pushed out when she coughed. Allowing the belly to push out weakens the pelvic floor and abdominal group. She suggested to cue clients that when they cough the belly should go in towards the spine to properly activate all the core muscles.

This is one thing I love about teaching for PESI REHAB – the interaction with professionals from other disciplines.

Hope this is useful!

Save Your Body!


Bodywork is hard on the body! Sounds almost like an oxymoron doesn’t it? Lower backs, arms, wrists, thumbs and feet can all scream for a massage or at least a hot Epsom salts bath at the end of the day. Here’s some tips and tricks to help you respect your ecology of movement. And remember, every time you find a stance or position that is more aligned with good body mechanics, that sensation is immediately transferred to your client. Every time you take care of you, you are also serving your clients.

1. Sit down whenever possible

2. I remember taking a workshop with the late, great Bob King and being amazed that he never flexed his spine. He always hinged at the hips.

3. The three L’s: lunging, leaning and leverage

4. Need to exert more pressure? From a lunge position, lean into your back foot. This one is a bit counter-intuitive because our impulse is to lean forward which stresses the arms, shoulders and back. Leaning into your back foot allows the marvelous mechanism of leverage to achieve more pressure.

Speaking of saving your body, my newest book, Stabilizing the Core and the SI Joint is coming soon. Incorporating the six core assessment tests and muscle energy technique corrections featured in the book before I do my deep tissue/trigger point work completely changed my practice. The tissue was more responsive to my work and I could work smarter, not harder. Stay tuned for more details.

Stabilizing the Core and the SI Joint

Stabilizing the Core and the SI Joint

The Obstinate Pectoralis Minor


The obstinate pectoralis minor (PMI) can produce a hailstorm of problems throughout the body especially in the shoulders, arm, neck and respiration. Working with it effectively goes a long way in helping you help your clients with neck and shoulder issues, breathing restrictions and even wrist and elbow pain. If the iliopsoas is the hidden prankster of low back pain (Travell and Simons), the PMI is the hidden trickster of the shoulder girdle. This article reviews the anatomy of the PMI, common pathology and suggestions for working with it.

Imagine three long fingers extending on an inferior and medial diagonal path from the coracoid process to ribs 3-5 (attachments have been found on ribs 2 and 6 on some folks). This multitasking stabilizer connects the shoulder girdle (scapula and clavicle) to the thorax. The PMI seems to glory in pulling the coracoid process towards the ribs (whether it needs it or not) causing a profusion of myofascial and bio-mechanical distortions. PMI drags the glenohumeral (GH) joint with it as it pulls the coracoid process towards the ribs.

Restrictions in blood flow can occur—a portion of the axillary artery lies beneath PMI. Tingling and numbness (the distal portion of the brachial plexus passes deep to the coracoid process) can also result from the pec minor’s predilection for locking short. When the arm is abducted and externally rotated the artery and nerves are stretched around the PMI close to its coracoid attachment –hence the tingling and numbness.

A tight PMI restricts scapular mobility, interferes with the scapulo-humeral rhythm, cause limited humeral mobility and scapular winging. Humeral mobility depends on both scapular mobility and fixation of the scapula at the right time and place.

The GH joint follows the scapula. Wherever the scapula goes, the GH joint is sure to tag along. If the scapula is super-glued to the ribs GH joint movement is comprised. My mantra is “Restore scapula mobility and stability and you’ll go a long way to restoring GH joint function”.

Let’s do this kinesthetic exercise: Place one hand on the greater tubercle on top of your humerus. Now depress and protract your scapula (the actions of PMI). Can you feel how the head of the humerus went along for the ride? Next abduct the humerus to at least ninety degrees. Feels yucky, right? When the scapula is protracted and depressed the GH joint internally rotates and the greater tubercle moves anterior. That yucky feeling is the greater tubercle colliding with the acromion process. Repeated fender benders between the greater tubercle and the acromion process can result in impingement syndrome, impaired rotator cuff function, disturbances up the kinetic chain to the neck and down the kinetic chain to the elbows, wrists and hands.

One of my clients is a hairdresser who had chronic elbow and wrist pain for years. In addition to treating the plethora of trigger points in the flexors and extensors of her wrist and elbows, I treated her massively locked- short PMI, rotator cuff and serratus anterior to restore scapular mobility and weight/energy transfer throughout her upper body. She’s been pain free for several months. If I had just concentrated on her elbows and wrists the results would have been temporary. The moral of this story: always check out pec minor with any neck, shoulder, wrist and elbow pain!

My Releasing the Rotator Cuff book and DVD offers an in-depth protocol for releasing this stubborn muscle. Attract and retain awesome clients with stellar skills in working with the shoulders!

Stabilizing the Core & the SI Joint – A Manual Therapy Approach

I’m developing a new course with my colleague, Tracy Firsching, entitled Stabilizing the Core & the SI Joint – A Manual Therapy Approach. The longer I am in this wondrous field of bodywork I am convinced that leveling the sacral base and pelvis is crucial for addressing all kinds of misalignements in the body. Here’s some interesting facts about the sacroiliac joint (SIJ):

Each SI joint is comprised of irregular, articulating bony surfaces on the sacrum and ilium. They fit together like mirror images of a 3D puzzle. This provides stability, strength and restricts movement so that the considerable weight of the spinal column can transfer to the lower body. It also acts as a shock absorber. These surfaces lock into place during the push-off phase during walking to increase joint stability. The SIJ only slides 2-4mm and rotates 1-2 degrees via ligament stretching during weight bearing and forward bending. Movements are a combination of sliding, tilting and rotation. Although normal SIJ movement is small, it is essential for normal pain-free low back and pelvis function. A loss of this movement is common in people with low back and pelvic pain. Twenty-five percent of low back and pelvic pain involves SIJ dysfunction.

There are two forces that help to “lock” the SIJ: Form closure and force closure. Form closure relates to the form of the bones and how they cleverly fit together to create stability. Force closure is stabilization that result from myofascial contraction. The SIJ has NO muscles passing over the joint. Force closure is from muscles increasing tension on the ligaments. In other words it’s an additional system generated by the contractive action of core myofascial units such as the transverse abdominus, multifidi and thoracolumbar fascia/latissimus dorsi (opposite side), hamstrings and gluteus maximus (same side).
When the sacrum rocks forward into nutation, the ligaments around the SIJ and the muscles provide greater stability by force closure pulling the SIJ together. They also increase FORM closure by increasing tension on the ligaments.

Stay tuned for updates about this seminar!
Peace,
Peggy Lamb