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Should Massage Hurt?

Ask 10 therapists this question and you are likely to get 10 very different answers. Some therapists do not believe that massage should be painful, ever, and if you are in any sort of discomfort then you are being massaged too hard. Other are at the opposite end of the spectrum and if you are not squirming, squealing and wriggling as they beat the knots out of you then they are not going hard enough.

My answer….it depends.

If you are purely after relaxation massage at a day spa or for stress relief then you would be looking for a massage that is be blissful and pain free. If you have never had a massage before then this is probably the end of the pain spectrum that you can reasonably expect to receive.

You should not feel sore or uncomfortable that day (or the next morning) and any pain is an indication that the therapist wasn’t listening to you or your body.

However, I’m sure I gave one of those massage in 2004.

Deep Tissue massage of a woman's thighPeople who book in to see me are generally after remedial, deep tissue or sports massage and for this group of massage recipients then some degree of discomfort both during and after the massage should be anticipated. Sometimes you have to take one step back to move two forwards.

If you are suffering from a sore back or a stiff neck then myofascial restrictions and adhesive scar tissues need to be worked. Polishing the skin just isn’t going to cut the mustard even if it does calm the nervous system and relax the sympathetic nervous system. You need to get into the muscles (and other soft tissues such as ligaments and fascia) and disrupt their current condition in order to obtain the response that you are looking for.

Now although a deep tissue massage sounds as though it should be excessively painful, this is not necessarily the case. Deep tissue merely means working the deeper levels of tissue, working through superficial layers of fascia and muscle to achieve a change in the structure of the deeper tissues.

But while it needn’t be excessively painful, in reality it is almost always the case that it can be uncomfortable. Personally I do take issue with therapists who say that deep tissue massage should never hurt and feel that either they have never experienced genuine deep tissue massage or they are doing it wrong.

By the same token, though there are therapists who work at such a pressure and intensity that a client is literally bruised and in more discomfort than when they started the massage. “No pain – no gain” may the mantra of the therapist. This doesn’t sit comfortably with me but if it works for them and their clients then so be it. So long as they are genuine with their intentions, explain how they will work and warn their clients how they will feel after the massage then that’s ok with me.

It’s just not the way I work.

  
I like to work within the clients pain threshold so that whilst it may be uncomfortable and bordering on painful (when I consider it to be appropriate), it should never be so heavy that they are wincing and flinching on the table. By the way, the level of pain threshold does tend to increase the more massage you receive and arguments have been made that this isn’t necessarily a good thing (eg needing more and more pressure to achieve the same response is almost an addiction).

Ultimately it is up to you to find a massage style and therapist that suits you. If you have never had a massage before and you are in pain during the massage, then speak up. Similarly if you know what you want and the therapist is one of those who insists on not hurting you at all then maybe you need to find someone else who can give you the type of bodywork you are after.

By Richard Lane

PNF Stretching

PNF stretching is considered to be the most effective way to increase static flexibility and is a combination of static passive stretching and isometric stretching. PNF stands for Proprioceptive Neuromuscular Facilitation and was first developed as a treatment for paralysis patients.

PNF stretching is usually carried out with a partner who provides the resistance for the isometric contraction although it can be done without a partner (but generally will be less effective). If using a partner, then it is important that the partner be attentive and focused.

Pnf StretchingThe most commonly used PNF technique is the “Hold-Relax” which is sometimes referred to as the “Contract-Relax”. The muscle is stretched passively towards the limit of its range of motion and then the muscle being stretched is isometrically contracted for 5-15 seconds after which the muscle is relaxed for a couple of seconds before being subjected to a passive stretch which should be greater than the initial passive stretch. This stretch is held for around 10-15 seconds before repeating the PNF stretch one or two more times.

PNF Stretching Examples: Hamstring Stretch
For an example of a PNF stretch, then the person being stretched lies flat on their back with one leg bent at 45 degrees and the other leg extended straight. The partner lifts the straight leg until a comfortable stretch is felt through the hamstring (nb partner just supports the stretched leg and does not push). This stretch is held for 15 seconds.

The stretchee should then isometrically contract the hamstring against partner’s resistance for 5-15 seconds, relaxes and the partner gently guides the hamstring to a deeper stretch. This is repeated a few more times until there is no further increase in range of motion.

Brief PNF Physiology of Stretching
Muscles spindles cells located within the muscles, protect the muscle from injury. They sense how far and fast a muscle is being stretched and when activated produce a stretch reflex. This reflex causes the muscles to contract to prevent overstretching the muscle.

Located within the muscle tendon is another sensor called the golgi tendon which senses how much tension is being put upon the tendon. When the golgi tendon is activated then it relaxes the muscles (unlike the muscle spindle).

A voluntary contraction during a stretch increases the tension on the muscle, activating the golgi tendon organs more than the stretch alone. So when the voluntary contraction is stopped the muscle is inhibited from contracting against a subsequent stretch. PNF stretches uses this to take advantage of the sudden vulnerability of the muscle and its increased range of motion by using the period immediately following the isometric contraction to train the stretch receptors to get used to this new, increased, muscle length. This is accomplished by the final passive stretch.

Some General Recommendations for PNF Stretching

•Leave 48 hours between PNF stretching routines
•For each muscle group complete 2-5 sets of the chosen exercise
•Each set should consist of one stretch held for 10-15 seconds after the contracting and relaxing phases
•PNF is not recommended for anyone under 18 years old
•A 5-10 minute thorough warm up is recommended before performing PNF stretching as a separate exercise session.

While most of us could obtain benefit from the improvement in flexbility that PNF stretching can bring, there is some conjecture amongst sports professionals about the effective of stretching in general to reduce the risk of injuries and to improve performance. Although there is some conflicting evidence reported, on balance research literature reviews such as reported by Thacker et al (1) support the hypothesis that routine stretching has little impact on reducing total injuries amongst competitive or recreational athletes.

  
However, research has also found that pnf stretching may lead to improvements in running mechanics. Caplan et al (2) concluded from studying rubgy league players that stretch training at the end of regular training is effective in improving running mechanics during high velocity running.

As with all stretches, only take a PNF to the limit of what feels comfortable. Pain is an indication that you are overstretching.

In addition, there are advantages and disadvantages of PNF stretching and it may be worthwhile discussing these with a suitably qualified sports therapist.

(1) Thacker SB, Gilchrist J, Stroup DF, Kimsey CD., Jr. “The impact of stretching on sports injury risk: a systematic review of the literature”. Med Sci Sports Exerc. 2004;36:371-378
(2) Caplan N, Roggers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res, 2009, 23: 1175-1180

By Richard Lane

Massage and Back Pain
– Research Findings

There are many reasons why people book in for a mobile massage in Sydney with us. It can be purely to de-stress and wind down. It can be as a reward for working hard. It can be part of a sportsman training regime to include a regular sports massage. However, the majority of people that we see are suffering from physical discomfort and they are looking for remedial therapy to help them reduce the pain and tightness they are experiencing.

Massage for back pain reliefNeck /shoulder pain and headaches are probably the top of the list for the reason why people book in for a remedial massage and many people know that massage is a great way to deal with these problems. The next most popular reason for getting a remedial or deep tissue massage is for lower back pain and there is some good news that recent research has found that massage may very help is dealing with the pain and suffering that lower back pain can cause.

When suffering from lower back pain many people seek out medications from their doctor to treat the pain. Others try exercise regimes from physiotherapist. However, a significant proportion of experiencing and secondly as a form of preventative maintenance once they are relatively pain-free. Researchers set out to ascertain whether massage compared favourably against usual medical intervention for treating lower back pain.

In the study (1), carried out by researchers from the Group Health Research Institute, Seattle, Washington, the study participants were randomly assigned to receive either a relaxation massage, a structural (remedial/deep tissue) massage or usual medical care without massage. Their symptoms had been assessed and also recorded was the impact of the back pain on their daily life.

Those in the massage groups had a one hour session weekly for 10 weeks.

The symptoms of those in the study were recorded after completing the massage program, at six months and finally a year after they initially began the massage.

The results obtained were encouraging for the massage industry. After the 10 week assessment, the researchers found that those who had received massage had lower levels of pain and they were able to perform daily tasks better than those who had only received the usual medical care. These results were similar regardless of which type of massage they received, be it relaxation or structural.

Whilst the benefits did not remain after one year, there was still a significant difference with the results obtained after 6 months and so it may be reasonable to conclude that massage can be an effective treatment for those who are suffering from lower back pain.

(1) Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA. “A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial.” Ann Intern Med. 2011 Jul 5;155(1):1-9.

By Richard Lane

Carpal tunnel, pregnancy and massage

Carpal tunnel can be an extremely painful and uncomfortable condition that can affect anyone. However, during pregnancy the chances of suffering from carpal tunnel syndrome are greatly increased, particularly in the latter stages of pregnancy. The reason for the greater incidence of carpal tunnel syndrome during pregnancy is that there is greater retention of fluid (due to varying hormones during pregnancy) and that relaxin can soften the ligaments that form part of the carpal tunnel.

Carpal tunnel and pregnancy massageCarpal tunnel syndrome will normally manifest in the form of pain, numbness and/or tingling in the outside three fingers of either hand. In more extreme cases, the compression on the nerve through the carpal tunnel can lead to the forearm feeling numb. The fingers and the hands will feel weak and have poor grip strength and pain may radiate up the arm as far as the shoulder.

For pregnancy induced carpal tunnel syndrome the symptoms will be worse either during the night or first thing in the morning due to greater fluid retention as the arm is relatively inactive.

There are a number of steps to you can take to reduce the impact of the condition. These include:

  • Avoiding any task or action that causes pain
  • Elevate the affected arm to attempt to reduce the amount of oedema and swelling
  • Be aware of your posture. There is a tendency amongst pregnant women (+ office workers + people who drive a lot etc) to have their neck protracted ie their chin juts out. Even a little can add compression to the lower cervical vertertae so try to keep your chin back in a more neutral position.
  • Try to keep your wrist in as neutral a position as possible (some physiotherapists recommend the use of splints to maintain a neutral wrist while you sleep. If you are suffering from carpal tunnel from breast feeding then remember to bring the baby to the breast rather than move the breast to the baby and again be aware of your wrist position.
  • Some professionals may suggest modifying your diet (and/or lifestyle) to reduce your body’s general propensity for swelling

Massage for Carpal Tunnel Syndrome During Pregnancy
An effective massage for carpal tunnel syndrome is primarily aimed at reducing the amount of swelling in the arm through lymphatic drainage techniques and, when performed by a therapist who has a good understanding of the condition, it can be a highly effective treatment.

Routine for Carpal Tunnel Pregnancy Massage
This routine can be considered as being relevant for during pregnancy and also post-partum when the new mum can have wrist problems when breast feeding.

Start at neck with little or no lubrication and work very and gently. The movement of lymph at the level of the skin is the objective for the routine. Always proximal to distal with the order of the strokes but work each individual stroke in a distal to proximal direction. Stretch the skin and work down the arm all the way down to the hand. Again need to reiterate that the pressure should be very light as working deeply can be ineffective.
Repeat this series of strokes a few times.

  
Perform a lymphatic compression on the arm – scooping up and then hold each compression for a count of about 10. Pressure is still very light.

Compressive tissue release – keep wrists neutral and stroke down the forearm (both top and botton of the forearm) using thumb and fingers whilst applying traction to the wrist. This stroke can free up the nerve sheaves through the carpal tunnel.

If you feel that you need to stretch the fascia of the palm make sure that you keep the wrist in neutral. Work the joints of adjacent fingers in opposite directions.

By Richard Lane

Soaking Away Your Aches and Pains
Do Epsom Salts Work?

For many people, soaking in a relaxing bath at the end of a busy day is a great way to reduce stress and relieve any muscular aches and pains. Some people claim that the benefits can be enhanced by adding Epsom salts to the bath but others have questioned whether there is any real health benefits that are provided by including salts whilst you soak.

epsom salts in the bath

The proponents and supporters of Epsom salts can that the benefits have been known for hundreds of years and that bathing in Epsom salts is one of the easiest ways to reduce stress and ease muscular pains. Other specific claims are that it relaxes the nervous system, provides benefit for the skin (such as treating Athlete’s foot), helps prevention of hardening of the arteries, makes insulin more effective and that it eliminates toxins from the body.

However, the amount of rigorous research that would support these claims varies and, if you pardon the pun, they should be taken with a pinch of salt (particularly any claims associated with removal of toxins and heavy metals from the body as these are likely to be particularly spurious in nature).

It should be mentioned at this point that if you are pregnant then you should always talk to your doctor before considering an Epsom salt soak. If you have any other diseases, conditions or concerns then it might be a good idea to raise the use of Epsom salt baths the next time you speak to them.

Chemically Epsom salts are hydrated magnesium sulphate and there is no doubt that magnesium is important mineral for many health functions in the body. For example, some cramps have been attributed to lack of magnesium in the diet and when cramp sufferers begin to take magnesium supplements then the pain and intensity of their cramps may drop within a relatively short time. (For more information about the importance of magnesium as a mineral check out this article).

Despite all the benefits and claims that you may find if you research Epsom salts, a recent online article has questioned whether or not they do actually deliver. The article itself is a fairly lengthy piece discussing this topic in some details (click here if you wish to read it).

The jist of the argument is that for many years we have “known” that a soak in a Epsom salt bath is good for relieving muscular stress, pain and tension. However, when you look at the science and research that has been carried out then there is very little supporting evidence. In particular, the claim that the body absorbs the magnesium sulphate through the skin is in doubt and the author questions whether there is a plausible mechanism how Epsom salts can have an impact on muscle tissue and function. Osmosis can be ruled out as osmosis, by definition, is the movement of water molecules through a semi-permeable membrane.

  
However, the author does refer to a study performed by Dr R Waring from University of Birmingham in UK who found that people who soaked in an Epsom salt bath had raised levels of magnesium and sulphate in their blood after the bath, although the mechanism of transfer was not determined.

Despite the scepticism about whether a soak in an Epsom salt bath is effective, there are many who frequently resort to a lengthy soak at the end of a stressful or physical day. And as a recent facebook contributor wrote:
“Works great for me, if Epsom doesn’t work for you then it sucks to be you. ;-)”


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