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Treatment Tools

By Debbie Roberts, LMT

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Multi-Layered Therapy

You know sometimes the simplest things are the most powerful. When I was going to school, I was lucky enough to have Michael Shea as one of my instructors. I was frustrated one day at school because they didn't seem to be addressing the physical therapy type of massage therapy I had wanted to learn. I asked Michael, "Where can I go to learn more than what they are teaching me here?" He quietly said, "Debbie never under estimate the power of a Swedish Massage. The simple gentle approach is more powerful than we really give it credit." I never have forgotten those words. I still keep this thought in the back of my mind with any therapy I do. As massage therapists, we have a tendency to always be looking for the next new tool and/or the next new thing. I want to share with you how one client spent three years in pain and how she was able to start to regain the quality of her life back in just one gentle hand's-on session.

I also want to address the common thread between chronic pain and adrenal exhaustion which played a big role in this client's life.

Years of Pain

Let's take a look at the client who presented to my office suffering three years of chronic pain in the right flank. She tried chiropractic, massage, and exercise and all did nothing but make her feel worse. She had recently lost her mother and had been sitting by her side for weeks. She had been juggling her own life with a 10-year-old son and husband, plus a three hour commute to see her mother.

multi-layered therapy - Copyright – Stock Photo / Register Mark She relayed the original injury was caused on the tennis court when she rotated and lunged for a ball. From that moment on, she had started developing right flank pain and it had begun getting worse during her mother's illness. She thought by laying off the tennis the issue would resolve itself but it hadn't. She even had tests done on her gallbladder and kidney just to rule out any medical conditions because no one was coming up with answers that were giving her any significant relief. She presented that day in my office extremely sad, depressed, crying, pointing and rubbing all up and down the right flank.

Tool #1: Your Ears

The emotional roller coaster of watching someone you love passing makes a constant demand on your adrenal glands which contributes to pain and exhaustion. The act of sitting by someone's side for months interrupts the firing order of the core musculature. Quadratus lumborum becomes hyperactive and psoas forgets how to do his job as a spine stabilizer. There will be no contribution from the gluteal muscles because of the lack of physical exercise, which is not helping the center of gravity and positioning of the pelvis. The injury is three years old and combine that with the lack of activity, and the result is less elastic fascia. The fascia is becoming more plastic and hypertonic.

The well intended massage therapist who previously treated her tried too hard to work out the knots. Going deeper on this client just set off more alarm buttons, increasing the pain levels instead of decreasing them. Remember the Arndt-Schultz Law: Weak stimuli activate physiological processes. Very strong stimuli inhibit physiological responses.

Tool #2: Your Eyes

Her emotional state is elevated. For weeks, she has been chest breathing and not breathing through her diaphragm and core. This will make a significant change in the thoraco-canister needed for spinal stabilization. During the squat screening, she shifted away from the side of pain. She could not perform the toe touch screen because of the fear the right flank pain would grab her which it would do on occasion. Left side bending caused her mild discomfort. There was guarding of movement in rotation. Watching which movement directions cause your client pain is very important in helping you find a reproducible starting and ending point.

Tool #3: Your Hands

This is a rotational injury you will need to do palpation, movement and manual muscle testing to find out if you can manually reproduce the pain, so once again you have a clear beginning, middle and ending piece to your therapy session.

With the client in a prone position doing resistance to opposite arm and opposite leg at the same time, I was able to reproduce her pain. This became my marker during the session to see if the treatment was the right one for her. This is not a time to stretch the tissue because you can set off the stretch reflex and send her into the spasm she had previously described. With very slow movements, I brought the tissue together in short intervals to switch off the stretch reflex even further. Knowing I needed to address the myofascial component of this injury and resolve the cross crawl pattern, I got out my cupping machine and used the biggest massage cup available. I set the machine to an extremely light pull and began going from the right lower flank to the left upper back and then the same pattern on the other side. I performed this myofascial release like I had a four way stretch material gently moving in all directions. I applied heat for five minutes and repeated the MM test. She was improved didn't feel the discomfort like before, but there was some residual.

I repeated the entire procedure one more time and retested. This time, she didn't feel a thing and there was no twinge of pain.

Now we needed to address the poor firing of the core musculature. She had practiced yoga previously in her life so doing the deep diaphragmatic breathing was something she was familiar with. She admitted she didn't think she had taken a deep breath since her mother was diagnosed. I placed a hot pack on her belly for added relaxation and asked her to perform deep diaphragmatic breathing and engage the use of her pelvic floor muscles. With my hand underneath her back and the other hand under the hot pack, I gently rocked her while she continued to breathe. I could feel the rigidity in her lumbar region start to dissolve and within about five to eight minutes, her back musculature felt relaxed. To help encourage the psoas to step back up to do its job, we finished with some gentle isometrics directed at the psoas.

By using a more specific and gentle approach, this client was on her way to recovery. Her homework was hot/cold applications, deep breathing, and return within the week.

The Nervous System

Let's look at her adrenal fatigue and what really happens in the nervous system. Adrenal fatigue is a very relatable factor in many chronic pain conditions such as fibromyalgia, chronic fatigue syndrome, arthritis, premature menopause and others. It can produce a host of unpleasant symptoms, from acne to hair loss.

What really happens in the nervous system that causes the adrenal glands to become overworked? Any upset of balance in the body is regulated by the endocrine and sympathetic nervous system. The sympathetic nervous system sends out an alarm or the "fight or flight" response. Your adrenal glands can be thought of as your primary shock absorbers against stress. They are there to help us have a healthy and sometimes life saving stress response, which wasn't designed to last very long. When the alarm goes off, the adrenals immediately increase the production of adrenaline and cortisol. This causes our heart rates to increase, our metabolism and digestion to slow down, and our senses to sharpen.

We need all of these systems supported during times of intense and immediate stress. These remarkable glands respond to every kind of stress: emotional, psychological, physical, environmental, and even infectious. When we experience chronic, unrelenting stress, (like a parent dying) our adrenals put on their superman capes and just don't give up on us. They keep producing what we need and then the domino effect in our body begins. The effects are fatigue, increased pain signals, weight gain, moodiness, hormone imbalance, thyroid imbalance, and inability to get a good night sleep.

The adrenal glands are two, triangular-shaped organs that measure about 1.5 inches in height and 3 inches in length. They are located on top of each kidney. Their name directly relates to their location. They release the chemicals norepinephrine, cortisol and DHEA that allow you to respond to the modern day battles of life, traffic, kids, money worries, relationships, etc.

The general adaptation syndrome (GAS) was first coined by Hans Selye, in 1936. The general adaptation syndrome has three stages: the Alarm Reaction, the Stage of Resistance and the stage of Exhuastion. He observed that the body used its hormonal system to quickly try to come back to homeostasis when challenged with any stressor. He also observed that the body had limits. Because of the response to stress and the utilization of stored glycogen, on-going and unresolved stress would send the body into the second stage, the stage of resistance.

In this second stage, the body must find another source of fuel other than glycogen. The body starts to break down its fats and proteins which can lead to muscle wasting. What happens is a chain reaction with the hypothalamus secreting corticotrophin-releasing hormone (CHR); followed by the pituitary secreting adrenocorticotropic hormone (ACTH); and this in turn, stimulates the adrenal cortex to secrete cortisol and other glucocorticoids. Cortisol promotes the breakdown of fat and protein into glycerol, fatty acids, and amino acids, providing the liver with raw material for gluconeogenesis.

In its normal function, cortisol helps us meet life's challenges by converting proteins into energy, releasing glycogen and counteracting inflammation. For a short time, that's okay. But at sustained high levels, cortisol gradually tears your body down. Cortisol is one essential we can't live without but unfortunately, too much of a good thing is not healthy. Sustained high cortisol levels can destroy healthy muscle and bone, it slows down healing and normal cell regeneration, co-opts biochemicals needed to make other vital hormones, impairs digestion, metabolism and mental function, interferes with healthy endocrine function and will weaken your immune system.

The final stage of exhaustion occurs when the body's grocery store of energy runs out. In order to avoid the final stage of exhaustion and chronic pain, we can help encourage our clients to limit the amounts and kinds of stressors to the body. We must educate our clients that the body does not recognize the difference between alcohol abuse, caffeine use, excessive physical activity, inactivity, poor sleep, or unhealthy eating habits. The response from the sympathetic nervous system will be the same with a flood of chain reactions crying out to bring the body back into homeostasis. Helping our clients find alternatives to these adrenal vampires is the key to their well-being. By using yoga, meditation, deep breathing, fresh air, causal walks, and less processed foods as examples.

Resources:

  1. Int J Neurosci. 2005 Oct;115(10):1397-413.
  2. U.S. National Library of Medicine National Institutes of Health. Cortisol decreases and serotonin and dopamine increase following massage therapy. Field T1, Hernandez-Reif M, Diego M, Schanberg S, Kuhn.
  3. Anatomy Physiology, The Unity of form and function, Seventh Edition, Kenneth S. Saladin, McGraw Hill education, 2015.
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