You are currently browsing the tag archive for the ‘Myofascial’ tag.

The following was a treatment plan submitted during our clinical training at the Swedish Institute in NYC. It provides detailed, step-by-step instruction on a western style, medical massage approach for clients dealing with severe rheumatoid arthritis. While it might be more on the technical side, it should underscore the amount of consideration taken in a clinical setting where massage is administered every week, for a 6-8 week period.

—-

Goals for treatment should include: increasing flexibility and range of motion (ROM); relieving aches and pains related to muscle stiffness; increasing circulation – especially in clients with cardiovascular issues; reducing inflammation and joint pain during chronic flare ups/remissions; reducing contractures and adhesions; reducing anxiety and depression related to RA.

Bolstering to the knees, hip/lower back, and cervical spine may aid in relieving undue stress at these joints. Staying within a client’s pain threshold and using care to not apply overpressure when performing ROM, should also be observed. Some clients may develop osteoporosis, so caution should be taken with the amount of pressure used during a session.

Starting in supine, so as to better perform ROM and stretching techniques, we would begin at the arms. Moving the shoulder joint through coronal abduction/adduction, flexion/extension, medial/lateral rotation several times in order to warm up the joints and increase ROM. Moving down to the elbow and performing flexion/extension, supination/pronation, and finally the wrist with flexion/extension, radial/ulnar deviation, and circumduction. Taking the client through these gentle movements is invaluable in breaking up any fibrotic changes that may have taken place.

Applying myofascial release with passive stretching to the wrist flexors, biceps at the forearm, and pectoralis major at the shoulder, is a great way to promote length along these potentially hypertonic muscles. Resisted isometric tests (RIT) to the clavicular and sternal fibers of pectoralis major, followed by circular friction, will help to open up the chest and promote deeper breathing in this restricted area. Trigger point work, especially to the flexors of the wrist, may help to break up adhesions and promote blood flow to the area. Passive extension of the digits of the hand along the MP & DIP joints will promote lengthening in flexor digitorum superficialis and flexor digitorum profundus, respectively. Care should be taken with any ROM techniques at the wrist and fingers, since arthritic flare-ups and local osteoporosis are very common in these areas.

At the knees and ankles, gentle ROM would be performed. Cross fiber friction along the patellar ligament and muscle stripping of the quadriceps would promote length in these muscles. Mobilization of the patella itself, if not too painful for the client, would help to break up any fibrotic adhesions related to joint degeneration. Muscle stripping the tendons of the plantar-flexors and peroneals, would promote length and increase ROM. Cross fiber friction to the tendons would help to realign any scar tissue that may be present. Deep effleurage and petrissage to the foot will help to relax the client and increase blood flow to the extrinsic muscles of the foot.

In prone, vibration up the paraspinal muscles, followed by some myofascial release, would promote a deep state of relaxation and provide a nice warm-up of the area. Circular friction along the attachments for levator scapulae and upper trapezius would help to separate and realign its fibers. Muscle stripping and cross fiber friction to the erector spinae would help to release any adhesions related to muscle imbalance. At the hip, deep petrissage and circular friction along the fibers of quadratus lumborum would help to increase circulation and alleviate any pain resulting from contracture of this hip hiker muscle. Finally, RIT to the Hamstrings followed by myofascial release along its fibers would increase inhibition and allow for a deeper stretch of the fascia and its fibers.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Rheumatoid arthritis (RA) is an autoimmune disease which causes chronic inflammation of the joints of the body. Systemic by nature, it can also affect surrounding structures such as muscles, tendons/ligaments, blood vessels, and organs. The most commonly affected sights, however, include the small joints of the hands and feet, elbows, ankles, and knees. Women are three times more likely to be affected and its onset commonly occurs between the ages of 40 and 60.

RA often impacts multiple joints in an insidious, bilateral fashion (that is, if the right wrist is affected, the left will be as well). Sufferers often experience episodic flare-ups followed by remissions, which can last weeks to years. During flare ups, symptoms can range from fever, chills, fatigue, muscle pain, loss of appetite, to joint inflammation (redness and heat) and joint stiffness – which in most cases gets progressively worse.

In extreme cases, the condition can lead to gnarled and distorted deformities of the joint, loss of range of motion (ROM), and chronic pain. Inflammation of organs such as the heart and lungs can cause serious cardiovascular disorders and invariably results in organ failure. It has also been known to cause a condition called Vasculitis (inflammation of the blood vessels), which if not treated properly, can lead to necrosis of tissue. Since RA is a degenerative joint disease, it is not uncommon for suffers to eventually develop some form of muscular atrophy and local osteoporosis surrounding the affected joints.

The causes of RA are unknown, although it is thought to be a genetically inherited condition. Triggers such as streptococcus infections, viral and other bacterial infections, as well as smoking in some cases, are all believed to play a part. For some unknown reason, the body’s immune system attacks the synovial membranes of the body. Antibodies (RA factor) and inflammatory mediators produced by lymphocytes and white blood cells are produced and proliferated throughout the joint spaces and synovial linings. An inflammation response ensues, causing the synovial lining to thicken and swell. A substance called “Pannus”, which is produced by the cells of the lining, slowly erodes away the joint capsule, the articular cartilage, and eventually the bone. As a result, scar tissue develops and forms an ankylosis. Whether it be a fibrotic ankylosis restricting the ROM of a joint, or a bony ankylosis which fuses the bones together, the results can be debilitating.

The emotional and psychological implications of the condition are commonly fraught with chronic pain and daily limitations. During flare-ups, sufferers often experience pain in the morning and after prolonged periods of inactivity. This fact makes getting up in the morning and facing the day a particularly daunting task. As a result, sufferers tend to group their errands and tasks into as few activities as possible – so planning and forethought is of major importance. Socially, people with RA tend to curtail their interactions and engagements with others out of sheer necessity. Dancing, playing sports, or even going for a stroll, take on a whole new meaning. Emotionally speaking, this decrease in contact with others can take its toll on some.

Common treatments for RA can include taking aspirin and cortisone to reduce inflammation to anti-biotics and physical therapy for long-term sufferers. Immunosuppressants such as methotrexate have become popular in preventing further joint degeneration. NSAIDS, gold salt injections, and various other anti-inflammatory drugs have been used to alleviate pain. And as we will see, a treatment plan during periods of remission to help increase circulation, ROM, and decrease stiffness and pain at the affected joints.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

There are certain aches and pains that arise over time due to repetitive movements that can occur on the job, at the gym, or even at home. And whether we realize it or not, these aches and pains can be the result of a multitude of micro-tears to muscle, fascia, or tendon. These soft tissue structures become comprised from over use and eventually lead to inflammation. Let’s take a look at some of the contributing factors involved in this syndrome.

A lot of overuse injuries occur on the job. They can affect just about anyone from a manual laborer to an office worker. Whenever we perform repetitive actions such as in typing at the keyboard, lifting heavy objects, standing or sitting for prolonged periods, we run risk of overtaxing the soft tissue structures involved in those actions. Carpal tunnel syndrome for example can be the result of faulty mechanics, such as in prolonged extension of the wrist and hands while at the keyboard. It can also occur from micro-trauma due to repetitive movements done over time, such as in those who use power tools, paint, play an instrument or racquet sports — the list can be extensive. The median nerve which passes through the carpal tunnel of the wrist becomes compressed and inflamed, which can then lead to tingling, numbness, weakness and pain in the finger and wrists.

Another place where over use injuries can occur is at the gym or while playing sports. Athletes are notorious for developing tendonitis and stress fractures due to repetitive movements and over use. Runners for example are prone to developing conditions such as Achilles tendonitis, plantar fasciitis, and shin splints, especially in those who are poorly conditioned. People who play racquet sports or golf are susceptible to developing shoulder tendonitis in any of the rotator cuff muscles, golfer’s elbow (which is tendonitis of the forearm flexors attaching on the inner part of the elbow), or tennis elbow (which is tendonitis of the forearm extensors attaching on the outer part of the elbow). People who play soccer, basketball, volleyball, or any sport that requires starting and stopping, cutting movements, sprinting, or jumping can see overuse injuries ranging from patellar tendonitis (i.e. jumper’s knee, runner’s knee), to ITB friction syndrome which is caused by a tight iliotibial band frictioning the outer part of the knee. Chondromalacia Patella or Patellofemoral Syndrome occurs when the patella does not track properly in the patellar groove when the knee is extended under load. Think of doing squats or climbing stairs. The articular cartilage eventually gets worn away, resulting in pain and inflammation along the inner part of the knee.

These types of repetitive use injuries are not limited to the job or the gym. Most of us have hobbies that involve repetitive movements. Playing an instrument is a good example. Think of the muscles involved in playing the piano or the violin. Hours and hours of practice can eventually lead to pain and inflammation of the fingers, wrists, elbows and shoulders. How about gardening? Pulling up weeds or potting flowers can require us to maintain certain positions which can stress our knees, hips and low back. There’s even a condition known as blackberry thumb or gamer’s thumb. De Quervain’s syndrome, its clinical nomenclature, is a tenosynovitis (a tendon sheath inflammation) and repetitive use injury (RSI) of two key tendons attaching on the thumb. It usually results from an over use of the thumb and wrist while texting or playing video games.

Now that we’re familiar with some of the most common manifestations of repetitive use injuries, here are some of things we should consider as part of a preventative care plan:

  • Most over use injuries stem from muscle imbalances. Are we pushing ourselves too far, too fast in our training before we’re properly conditioned? Are we using good form when performing certain movements?
  • Certain jobs may require us to perform repetitive movements at work. If this is the case, are we taking periodic breaks? Can we switch sides so we’re not using the same hand, arm, or shoulder? Are we using faulty equipment to perform these tasks? Developing an awareness of these mitigating factors can go a long way in preventing an injury.
  • Warm ups and stretches. Whether we’re going out for a run or getting ready to play an instrument, a little warming up goes a long way. Gentle range of motion of the joints and targeted stretching of key muscles will help reduce the likelihood of a strain by increasing blood flow and oxygen to the area.

Signs and Symptoms:

If you think you may be dealing with a repetitive use injury, here are some common signs and symptoms:

Localized pain: Whether its Achilles pain, knee pain or shoulder pain, you’ll feel it acutely at the site of inflammation. The pain may be brought on from use of the inflamed muscle or tendon, as in an isometric contraction. It can result from stretching the inflamed tissue. And in advanced cases, the pain may be constant even while at rest.

Tenderness: Minimal pressure to the area can often induce pain. In cases of acute tendonitis, the whole muscle may feel sore to the touch.

Limited ROM: Your mobility of the affected area may be limited and painful. Lifting your arm above your head for example may be hard to do in certain cases of shoulder tendonitis.

Swelling: Inflammation can lead to swelling and heat in the affected area.

Crepitus: Clicking or creaking sounds may be heard during certain movements of the affected area.

Treating over use injuries can require several approaches, not least of which is time to heal.

Treatments:

R.I.C.E.: If you’re not familiar with this acronym, then it maybe one of the only things you should remember when dealing with acute injuries.

  • Rest: In some cases as much two weeks may be indicated. The body needs time to mend the damaged tissue.
  • Ice: applying ice is a great way to reduce inflammation.
  • Compression: wrapping the injured area with and ACE bandage or brace will provide added support and help keep you mobilized.
  • Elevation: In cases of acute trauma and inflammation, elevating the area will help to reduce the swelling.

Proximal massage: Massaging the area directly above the injured site, for example the calf muscles in cases of Achilles tendonitis, will help to increase circulation and drainage to the injured site.

Range of motion exercises: Moving the affect area in a pain free and gentle way after the acute phase has passed, will prevent muscles and tendons from tightening up from under use.

Ice massage/Contrast bathing: Depending on where you are in the healing process, ice massage to the affected area will help reduce pain by decreasing inflammation. Later on in the healing process, heat can be introduced in conjunction with cold applications to create a pumping affect. This is excellent for removing waste byproduct trapped in the affected area.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In this article we’ll consider the various manifestations of hip pain and what could be at the root of some of these aches and pains. But first we’ll need an understanding of the anatomical structure of the hip itself.

Each hip bone is comprised of three smaller bones: the ilium, the ischium, and the pubis. At birth these three bones are joined together by cartilage. By the time we reach our mid-twenties, they fuse together through a process known as ossification. The two hip bones are joined together by the sacrum and coccyx to form the pelvis.

The sacrum is also formed by unfused bones, namely five vertebrae, which begin to ossify by our late teens. The tail end of the sacrum, or what’s known as the tailbone or coccyx, is formed by 3-5 boney segments. Together these two bones join the two hip bones into what’s known as the sacro-iliac joint (SI joint).

Hip

All the bones of the pelvic girdle are held together by strong fibrous ligaments. The weight of the upper body rests on top of the pelvis and is then transferred diagonally into the hip sockets and down the legs. Although the SI joints are limited in movement, the two hip bones are designed to rock forward and backward independently of one another as we walk. On occasion the SI joint can get locked in place, whether due to injury or constant tension in the hip muscles, and prevent the natural movement to transfer up the spine. Since each hip bone can move independently of one another, it’s also possible for them to get locked into an anterior or posterior tilt, creating a leg length discrepancy.

The hip is capable of six different movements: flexion, extension, abduction, adduction, medial and lateral rotation. The hip joint is considered a ball and socket joint, which affords it the unique ability to move on so many planes. As mentioned in a previous post, there is what’s considered a normal degree of movement or “range of motion” for each plane.

Flexion:           80-90 deg w/extended knee — 110-120 deg w/flexed knee

Extension:      10-15 deg

Abduction:      30-50 deg

Adduction:      30 deg

M. Rotation:   30-40 deg

L. Rotation:    40-60 deg

Each movement in turn is performed by a series of muscles. Some of these muscles are known as primary movers, while others are known as synergists – that is, they assist the primary movers in their function. Flexion is done with a total of 10 muscles, extension – 6 muscles, abduction – 5 muscles, adduction – 6 muscles, medial rotation – 6 muscles, and lateral rotation – 8 muscles. When the hip is functionally optimally, all these muscles and joints work free of pain and with a normal range of motion. But as we’ll see, age, injury, and normal wear and tear are just some of the factors which can contribute to hip pain.                                  

Hip Injuries and Conditions

Of the many muscles that cover the hip and allow it to function, there are a number of them that also cross over into the low back and down into the legs — any of which can become strained. There are also a number of ligaments and bursa (fluid fill sacs) in and around the hip which can become lax or inflamed due to overuse. The exact placement of the pain therefore becomes an important factor in determining what the source of the pain could be. Here are several of the most common forms of hip pain. (For nerve pain that affects the hip, see a previous post on sciatica).

Anterior/Medial (Front & Inside) Hip Pain:

Adductor Strain (aka: Groin or Rider’s Strain)

The adductors are a group of five individual muscles located on the inner part of the thigh that move the hip and leg towards the midline of the body. Pain associated with an adductor strain will present itself as a sharp, stabbing pain in the groin area. An injury to any of the muscles that originate on the pubis is the most common cause. Irritation of these muscles can also lead to inflammation. On occasion, bruising and swelling may occur several days after the injury. If not addressed properly, an injury to any of these muscles can lead to chronic pain. Abduction of the hip (swinging the leg away from the midline of the body), will stretch adductors and elicit the pain.

Quadricep Strain (aka: Rectus Femoris Strain)

The quadriceps muscles are found along the front, inner and outer parts of the upper leg. They are considered primary movers in knee extension. The quadriceps get their name from the fact that there are four individual heads. Only one of these heads however crosses both the knee joint and the hip joint – that muscle is called rectus femoris. It is the most central head of the quadriceps and by far the most commonly injured. This is due in part to the fact that it contracts both concentrically and eccentrically, and is the only head of the quadriceps which assists in hip flexion. As a result it can become easily fatigued and overused in sports involving kicking, cutting (side to side), and start & stop movements.

Pain is usually felt in the front and inner parts of the thigh where the muscle originates on the hip. With first degree or mild strains, your gait will not be affected – but it will be with more severe strains. Stretching the muscle by flexing the knee and extending the hip will elicit the pain, as will contraction of the muscle through hip flexion and knee extension.

Iliopsoas Strain

The iliopsoas is considered a strong hip flexor and primary mover in hip flexion. In reality, the iliopsoas muscle is actually two muscles — the psoas and the iliacus. The psoas originates along the lumbar spine and the iliacus along the front of the pelvic bone. They blend together to cross the hip joint and attach on the femur. Pain from an iliopsoas strain will be felt in the groin area – that is, the front and inner part of the thigh. In severe strains it may be difficult to stand up straight without causing pain. The iliopsoas is most commonly injured when the hip is forced into extension from a maximally flexed position.

Since the muscle attaches itself along the inner part of the femur, abducting the hip (swinging the leg out), extending the hip or internally rotating the leg will stretch the muscle and cause pain. Contracting the muscle through hip flexion will also be painful.

* Pain associated with any pathology of the hip joint itself is typically felt in the groin and antero-medial aspect of the thigh.

Posterior (Back) Hip Pain:

Hamstring Strain

The hamstrings consist of 4 individual heads located along the back of the thigh. Three of these heads cross both the hip and knee joints – two along the medial aspect of the thigh and one along the lateral aspect of the thigh. The 4th head is found along the lateral aspect of the thigh but does not cross the hip joint. The lateral head that does cross both joints is known as biceps femoris. It is this part of the hamstrings that’s most commonly injured.

Since three of the hamstrings including the biceps femoris originate on the ischial tuberocities (aka: your sitz bones), the pain associated with a hamstring strain is usually felt at this insertion point. The hamstrings can also be injured at their insertion points on the inner and outer aspects of the knee, but more often than not the pain will start at the sitz bones and radiate down the leg. If not treated properly, a hamstring injury can become a chronic problem.

The hamstrings are primarily involved in hip extension and knee flexion. They’re also involved in medial and lateral rotation of the leg. They’re most commonly injured in sports involving running, kicking, or any activity that suddenly over stretches them. The pain can be exacerbated by sitting, fast running or stretching.

Ischial Bursitis

Located between the sitz bone and the gluteus maximus is a small fluid filled sac known as a bursa. Bursa are found around the joints of the body. They provide cushioning and reduce the amount of friction muscles and tendons exert as they glide over the boney prominences of a joint. The ischio-gluteal bursa as it’s known can become irritated from prolonged bouts of sitting – although this is not usually the cause of inflammation. This inflammation can on occasion irritate the sciatic nerve and cause pain down the leg.

The pain resulting from ischial bursitis however is pin point and con-scribed to the area around the sitz bones. It can come on suddenly and make sitting or sleeping on the affected side rather painful. Coughing, sneezing or any bearing down can exert pressure on the bursa and cause pain. People with ischial bursitis will often shorten their stride as they walk or lean away from the affected side while sitting to help alleviate the pain.

Lateral (Side) Hip Pain:

Abductor Strain

The most commonly strained muscle in an abductor strain is the gluteus medius muscle. Located on the outside of the hip, the gluteus medius is partly buried beneath its bigger brother — gluteus maximus. The other half of the muscle is superficial and easily felt along the pelvic bone toward the lateral and anterior aspect of the hip. The gluteus medius does a little of everything. Its primary function is hip abduction (swinging the leg out), but segments of this muscle are also involved in  flexion, extension, and medial and lateral rotation.

One of the most important functions of this muscle is stabilization of the hip. As the weight of the body shifts onto each leg as we walk or run, the gluteus medius must contract and exert enough force equal to twice our body weight! If this key muscle becomes weakened or strained from overuse, it will loose its ability to stabilize the hip and allow it to buckle while weight bearing.

There are several factors which could strain this muscle. Being overweight can exert more pressure over this muscle than it can bear. A cross-over gait or running on banked surfaces can also overload this muscle. Over time the weakened side will force the opposite hip to drop and adaptively shorten, causing a functional shortened leg.

Pain from an abductor strain is felt along the lateral, outside aspect of the thigh. The pain can be particularly acute while running and often mimics the pain of trochanteric bursitis. Stretching the abductors by swinging the leg inward will cause pain, as will contraction of the abductors (swinging the leg out).

Trochanteric Bursitis

An inflammation of the three bursa found around the hip socket is known as trochanteric bursitis. The bursa can become inflamed due to arthritis, obesity, or a strain of any of the hip or lower back muscles. This in turn can lead to faulty postures and abnormal gaits. Shortening of these strained muscles can contribute to chronic tension along the hip socket and eventually irritate the bursa.

The pain from trochanteric bursitis can be a deep, dull pain or a sharp ache along the outside of the hip that extends down the lateral part of the leg. The pain is usually worse at night and can make it difficult to sleep on the affected side. A cross-over gait while running can lead to irritation of the bursa, as well as a leg length discrepancy or a pronated foot.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Myofascial release is a form of bodywork that helps to relieve soft tissue restrictions by engaging the layers of fascia within the body. The work usually involves slow, broad, deep strokes, with the use of little to no oil. The purpose of this is to create a certain amount of “drag” and resistance within the tissue, which can then be used to slowly release trigger points and other fascial adhesions. Some people find myofascial release very relaxing and highly effective. But in order to understand why, there are a few things we need to know about fascia.

The term “myofascial,” was first used by Dr. Janet Travell in the 1940’s in her work with trigger points. If we break down the word, myo means muscle and fascia means elastic band. In actuality, fascia is a thin layer of connective tissue that covers all the organs and muscles in the body. Think of it as a continuous web of tissue that connects all your muscles, organs, bones, blood vessels and nerves together. There are three layers of fascia within the body. The first layer is called “superficial fascia.” This topmost layer lies directly below the skin and subcutaneous tissue. The second layer, known as “deep fascia,” surrounds and is interwoven into the muscles, bones, blood vessels and nerves. The third and final layer is called “deepest fascia.” This layer is found within the dura of the cranium. If we stop to consider the fact that all three layers are connected to one another, then it’s easier to see how a myofascial stretch applied in one area of the body (i.e. the foot) has the potential to affect a very different area of the body (i.e the head).  In reality, releasing fascial adhesions in one area will affect tension within the whole fascial system.

Fascia is made up of collagen fibers suspended in a ground substance. Normal, healthy tissue will have a certain amount of extensibility and elasticity due to something known as “critical interfiber distance.” Collagen fibers must maintain a certain distance from one another or they begin to stick together and eventually form fascial adhesions. The ground substance, which holds these collagen fibers apart, does this by retaining water. Therefore the more hydrated it is, the better it is at maintaining this distance.

Another element of fascia, and the one that makes myofascial release effective, is something known as thixotropy. Thixotropy is a property of fluids and gels that allows them to become less viscous (less stiff) and more fluid when stress is applied. In the context of a massage, the depth and direction of the stroke is the stress which melts the fascial adhesion and makes the surrounding fascia more fluid. There are many factors which can affect the thixotropic nature of fascia. Injury, stress, and inactivity are just a few of the most common. Damage to the ground substance can lead to fluid depletion and a build up of metabolic waste, which can eventually lead to soft tissue restrictions.

Another important aspect of fascia is that, within this continuous system of connective tissue, are meridians or “trains” of fascia than run in very specific directions. In his book “Anatomy Trains,” Thomas Myers describes several meridians that run at various lengths throughout body, stopping at boney landmarks along the way. Myers lists 11 distinct meridians that criss-cross the body from different angles. But for the sake of this article, we’ll take a look at two.

The image below is depicts the “superficial back line” or SBL. The “tracks” run from the plantar surface of the feet, up the back of the legs, into the glutes, along the spinal muscles, and around the top of the head to your forehead. The “stations” are the boney prominences the fascia runs over. In this case it’s the heel bone, sitzs bones, sacrum, skull, and brow ridge.

SBL_0001

This second image shows the “superficial front line” or SFL. See how it runs from the tops of the feet to the backs of the ears.

SFL_0001

These meridians clearly illustrate how a muscle strain or adhesion in one area of the body can create tension all along that fascial line. Myofascial release endeavors to meet that restriction and stretch it past its barrier to create a release. It’s normal for certain areas to be more tender or sore than others depending on how bound the tissue is. This can also be a sign of a trigger point, which can at times relay it pain signals along this fascial network. Freeing up trigger points and adhesions along these meridians can have a dramatic affect on the whole “train.”

One final note on this fascial network should help to underscore the continuity of the body as a whole. From a classical anatomy perspective, muscles and bones are given separate names and functions. Bones act as the struts and levers, and the muscles, tendons and ligaments as pulleys and stabilizers. However, due to the presence of this fascial network, the body act more like a “tensegrity” structure than anything else. The word tensegrity is a combination of the words “tension” and “integrity.” It describes a structural unit whereby its integrity is created by an even distribution of tensional forces throughout the system. So your skeletal bones are no longer viewed as the framework your whole body rests upon, but rather, as “spacers” “floating” within the body. This radical perspective is more in line with how the body truly acts than the conventional machine-like paradigm we’ve grown accustomed to. So this means that tension (whether traumatic or therapeutic) applied to an area of the body will be absorbed and distributed throughout the whole body. It kind of makes you wonder what’s really causing that headache or pain in your foot…


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Chances are we’ve all experienced the painful effects of a muscle cramp. Some can be mild and annoying and others can stop us dead in our tracks. Whether we’re out for a jog in the morning, sitting at our desks at work, or sound asleep in the middle of the night, muscle cramps can strike suddenly and without warning. So what exactly causes a muscle cramp? What are some of the risk factors that predispose us to cramps? And what can be done to break a cramp when it occurs?

A cramp is an involuntary and sustained muscle contraction that can last anywhere from a few seconds to a couple of minutes. Commonly referred to as a “Charley Horse,” these sudden and painful spasms cause a noticeable hardening and bulging of the affected muscle(s), and can at times leave some residual soreness once they’ve passed. It’s not uncommon for a cramp to strike multiple times before it’s completely resolved. Let’s take a look at the different types of cramps and what’s behind them.

Types and Causes

Muscle cramps can occur anywhere in the body. True cramps, as differentiated from tetany, dystonic cramps, or even smooth muscle cramps (i.e. menstrual cramps), are cramps that affect voluntary skeletal muscles. Some commonly affected areas include the hands, ribcage, abdomen, thighs, calves, and foot muscles.

Cramping that occurs during or after exercise or physical activity is considered a fairly normal occurrence. Muscle fatigue and over-exertion, such as in writer’s cramp or long distance running, are the likely culprits in cases such as these. But more often than not, the exact cause may be hard to identify since there are so many contributing factors. Here are some other leading causes:

  • Chronic muscle tension
  • Poor circulation
  • Dehydration
  • Overuse
  • Injury
  • Vitamin deficiencies
  • Drug side effects
  • An overly facilitated nervous system
  • Myofascial trigger points
  • Restless Leg Syndrome
  • Insufficient stretching before or after exercise
  • Increased levels of lactic acids and metabolites
  • Medical conditions such as: diabetes, cirrhosis of the liver, thyroid disorders, kidney disease, MS

A muscle spasm can develop in any of the voluntary muscle groups as a protective mechanism against further injury.

Repetitive use of certain muscles can lead to muscle fatigue, which in turn can cause cramping.

Resting cramps, such as those that occur while we’re sitting or lying down in awkward positions, are more likely to occur as we age.

Dehydration, either from a lack of proper hydration or excessive perspiration, can increase the chances of cramping due to sodium depletion; so can diuretics, which are medications that promote urination.

Severe vitamin deficiencies have also been associated with muscle cramping. B1, B5, B6, magnesium, potassium, and calcium are all important for proper muscle functioning.

Leg Cramps

Leg cramps, such those that affect the front and back of the thigh, as well as the calf and foot muscles, are usually at the top of the list of afflicted areas. Cramps that occur while walking or running can be the result of poor circulation caused by muscle tension in the lower leg. The gastroc/soleus complex, the two prominent muscles of the lower leg, is an integral part of the venous return to the heart. The soleus muscle in particular has the unique distinction of being called the “body’s second heart.” The reason for this is that the soleus contracts both while shortening and lengthening, making it very efficient at pumping blood back to the heart. If the muscle is chronically tight and shortened due to trigger points or poor conditioning, it can impede blood flow and therefore be an indirect cause of calf cramps.

Muscle tension on the top of the foot, whether due to tight footwear or trigger points in the interosseus muscles, can cause numbness, swelling and cramps on the top of the foot. The poor circulation resulting from this is likely to promote trigger points in the area.

Nocturnal leg cramps can also be the result of trigger points in the lower leg muscles. Vitamin deficiencies, such as magnesium and potassium, can be a significant factor in such cases. Calf cramps that occur in the later stages of pregnancy may be considered normal to some, but can often be the result of a calcium deficiency.

Poor circulation can lead to decreased levels of oxygen to the muscles. In some cases a condition known as claudication, which causes pain and/or cramping in the lower leg or thigh, is a result of inadequate blood flow to the leg. The pain is typically felt while walking or running, when oxygen is needed the most. It subsides while at rest and is sometimes referred to as “intermittent claudication” for that reason. Claudication can be a symptom of a more serious condition known as peripheral artery disease (PAD). Atherosclerosis, which is hardening of the arteries due to high cholesterol and an accumulation of plaque in the arteries, often begins in the arteries furthest from the heart. The pain associated with claudication however does not necessarily come from a muscle cramp, but from an accumulation of lactic acid and other chemical byproducts held in the tissue.

Cramp Relief

There are a few things that can be done when we’re in the throes of a cramp. Most of us will gently massage and/or stretch the affected muscle until the cramp subsides. This is an instinctual reaction to an acute attack of pain. And for most of us, is all that it takes. Here are some alternate ways of breaking a cramp.

Sustained compression: Hold the cramped muscle with steady pressure until it subsides. This is an especially good technique when dealing with multiple cramps.

Ice/Heat Application: The numbness caused by icing a cramped muscle will inhibit nerve impulses and help to break the cramp. Although it may take longer, it will aid in reducing post cramp soreness and may be a good option when a muscle cramps multiple times. Heat is also a great way of soothing and relaxing cramped muscles. A twenty-minute soak in a warm bath with Epsom salt or applying moist heat compresses should suffice.

Reciprocal Inhibition: Muscles work in opposition to each other. In order for one muscle group to contract, the opposing muscle group must relax. For example, in order for the calf muscles to flex, the shin muscles must relax and give to a certain degreee. This neuromuscular technique uses the inhibition naturally created in the opposing muscle group to stop the cramp. If the cramp occurs in the calf muscles, place the opposite (non-cramping) foot on top of the cramping foot to provide resistance, and try to lift your toes against the resistance. Flexing the shin muscles of the cramping leg against resistance will create reciprocal inhibition in the calf muscles. Although this technique is a bit more involved and requires some forethought, the relief it provides is often immediate and well worth the practice.

Muscle Spindle Approximation: This other neuromuscular technique uses a set of proprioceptive cells found in the belly of a muscle to provide relief. This technique is ideally suited for large, graspable muscles such as the quadriceps, hamstrings, and abdominals. Grasp either end of the cramping muscle and squeeze the ends together. If the quadriceps are cramping, grasp just above the knee with one hand and just below the pelvis with the other hand and bring the ends together.

Stretching: Although stretching is one of the most common ways of breaking a cramp, caution should be used as stretching during a severe cramp can make it worse. For lower leg/calf cramps, gently point the toes up and down until the cramp subsides. Stretching before and after exercise is an excellent way of reducing your chances of getting a cramp. For those who suffer from nighttime cramps, some gentle stretches before going to bed should be part of your routine.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Sciatica is commonly referred to as pain that affects the low back, hips, buttocks, and backs of the legs due to compression and irritation of the sciatic nerve. An injury or impingement of the sciatic nerve can lead to a neuritis (inflammation of the nerve), neuralgia (pain along the course of the nerve), or a radiculopathy (nerve root involvement). Although sciatica can sometimes be the result of a herniated disc, there are other causes and contributing factors that can cause or mimic symptoms of sciatica. Such factors may include postural deviations, piriformis entrapment, and trigger points in the gluteal muscles, all of which are fairly common causes of sciatic pain.

The sciatic nerve is considered the largest nerve in the human body. Segments of the nerve are formed between L4 & S3 in the sacral plexus. The nerve, which is actually comprised of two divisions — the peroneal and tibial, travels through the greater sciatic foramen of the pelvis, under the piriformis muscle, and down the back of the leg to the foot. The peroneal branch and the tibial branch travel down the back of the thigh together until they reach the back of the knee. At this point, the peroneal branch splits from the tibial branch and travels down the back of the lower leg, around the inner ankle to the bottom of the foot. The tibial branch, once at the back of the knee, will wrap around the fibula bone and bifurcate once again into two other branches – the deep peroneal nerve (DPN) and the superficial peroneal nerve (SPN). The DPN travels down the front of the lower leg between the shin muscles and the tibia to the top of the foot. The SPN will travel down the lateral or outside part of the lower leg.

Piriformis

With the exception of the front and inner parts of the thigh, the sciatic nerve innervates all the other muscles of the leg. This includes the hamstrings and all the lower leg and foot muscles. The femoral nerve operates the hip flexors, namely the quadriceps, and the obturator nerve controls the adductor muscles. Due to the sciatic nerve’s origin and wide distribution, it can cause pain and discomfort in the low back, sacro-iliac joint, buttock, hip, back of the leg, and foot.

Signs & Symptoms:

  • Symptoms may be insidious or have a sudden onset
  • Unilateral in presentation
  • Radiating pain that can extend from the low back and buttock area, down the back of the leg, and into the foot
  • Paresthesias (i.e. burning, pins and needles, numbness), weakness, and muscle spasms anywhere along the course of the nerve
  • Pain can be a constant, dull ache or a shooting pain down the back of the leg
  • Pain may increase while sitting and diminish while standing or lying down
  • Coughing or laughing may exacerbate the pain
  • Standing in antalgic position: Depending on the site of the irritation, a person suffering from sciatic pain may hunch over and to the side to help alleviate pressure on the nerve

Causes:

  • A disk lesion, such as a protrusion or herniation at L4-L5 or L5-S1. The disk pushes into the nerve root and sacral plexus causing a radiculopathy
  • Stenosis: a narrowing of the vertebral canal in which the nerve passes through
  • Postural deviations: An anterior pelvic tilt, such as one that occurs during pregnancy, can decrease the space in the sciatic notch through which the nerve passes through. A posterior pelvic tilt can shorten the muscles the sciatic nerve must travel under
  • Piriformis syndrome: When this hip muscle shortens and begins to spasm, it can put direct pressure over the nerve
  • Sitting for extended periods of time with an object in your rear pocket, such as a wallet, can put direct pressure on the nerve. This is known as “back pocket sciatica”
  • Trigger points in one of the gluteal muscles can mimic sciatic pain
  • Joint dysfunction of the lumbo-sacral area
  • Inflammation of the nerve due to an infection or tumor

Another predisposing factor in the development of sciatica is the course the nerve takes once it exits out of the greater sciatic foramen in the pelvis. This congenital variance may explain why some people are more susceptible to developing sciatica than others.

In a majority of the population, the two branches of the sciatic nerve will exit out of the pelvis, through the greater sciatic foramen, and under the piriformis. This is true in about 85% of people. In approximately 10% of the population, one branch of the nerve passes through the piriformis, and the other underneath. In yet another small percentage, approximately 3%, one branch passes over the piriformis, and the other underneath. And finally, in less than 1% of people, both branches pass through the piriformis.

If the sciatica is a result of piriformis involvement or trigger points in the gluteal muscles, the pain may be more conscribed and only reach as far down as the knee. In a vertebral impingement the pain may be more widespread, radiating into the back and all the way down to the foot in severe cases.

Glute Medius TP

Diagnosis:

A history of unilateral low back pain that extends down the back of the leg is usually the defining symptom. A CT scan or MRI may show a disc herniation in the lumbar spine if one is present. The straight leg raise test, also known as Lasegue’s Sign, can be performed to determine the origin of the pain. On occasion, the pain may be due to a glute or hamstring strain. Other times, the pain may be due to some pathology of the lumbar spine or sacroiliac joint. While lying flat on your back, one leg is passively raised until the pain is elicited. Sciatic pain usually presents itself between 35 – 70 degrees of hip flexion.

Treatments:

If the sciatica is a result of a disk herniation, infection, or tumor, you should consult a doctor as to the appropriate form of treatment.

Mild cases of sciatica will often resolve themselves over time. Ice and heat applications are a great way of addressing the inflammation and muscle spasms associated with sciatica.

Anti-inflammatories and muscle relaxants may be prescribed by your doctor to help manage the pain. And if the pain is particularly acute, steroid injections may provide relief for a period of time.

Women who develop sciatica during pregnancy as a result of an excessive anterior pelvic tilt, will find that their symptoms abate once they deliver and the pelvis returns to normal.

Those suffering from sciatica resulting from obesity or faulty postures, will find that losing the extra weight and strengthening key muscle groups in the low back and abdominals will help correct pelvic imbalances.

Sciatica caused from prolonged periods of sitting and/or back pocket sciatica is easily addressed and typically of short duration.

Those with piriformis syndrome and/or trigger points in the glute muscles can greatly benefit from direct massage to the muscles of the low back and hips. Trigger points in the piriformis can shorten and irritate this key muscle. These changes can cause the piriformis to place direct pressure over the sciatica nerve, which runs underneath it. Trigger points found in other gluteal muscles can often mimic sciatic pain. And although these muscles may not be directly over the sciatic nerve, their pain pattern is very similar to that of an entrapment – such as the one created by the piriformis. Targeted stretches in combination with massage will help to restore extensibility and length to these muscles and help alleviate the pressure over the nerve.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Frozen shoulder (FS) or adhesive capsulitis is a clinically diagnosed syndrome which affects the shoulder joint (glenohumeral joint), causing pain and a progressive loss of movement. Tissue changes and a low-grade inflammatory response can lead to a shrinking of the joint capsule, joint stiffness and immobility. The condition is self-limiting and in a majority of cases will resolve over a period of time.

Causes:

There are two primary forms of FS:

Primary FS: The most common type. This form of FS is idiopathic (of unknown origin) and is often caused by some unidentified stimulus.

Secondary FS: Often the result of some previous injury affecting the shoulder joint. Some common examples could include: direct trauma, fractures, surgery, arthritis, or infection. The disuse of the shoulder predisposes it to the pathological changes associated with the condition.

Incidence:

FS has been known to affect a certain demographic of the population:

  •  It primarily occurs between 40-70 years of age
  •  It usually affects the non-dominant arm
  •  Women are affected more often than men at a 2:1 ratio
  •  It’s most prevalent in insulin dependent diabetics

Pathological Changes:

1) With the disuse of the shoulder, the shoulder capsule shrinks; the synovial lining and surrounding tendons shorten and become inflamed.

2) Adhesions form in the capsule and in the surrounding rotator cuff muscles.

3) Eventually the humerus is drawn tightly into the thickened joint capsule and becomes attached to the bone.

4) The surrounding muscles become stiff and inelastic, preventing normal range of motion.

Signs & Symptoms:

  •  The onset is usually gradual
  •  Joint stiffness and immobility
  •  Pain is dull, constant, and aching
  •  Pain with movement of the shoulder (active or passive), most acute in midrange
  •  Pain is usually worse at night, especially if sleeping on the affected side
  •  Limited range of motion of the shoulder, especially external rotation. Activities such as brushing your teeth, combing your hair, or getting dressed become painful and     difficult
  •  Shoulder is usually held in a fixed position (internally rotated & adducted, w/ the elbow flexed)

Progression of the condition:

There are three stages to FS, each lasting approximately 6 months.

Freezing Stage: A painful, inflammatory stage characterized by constant shoulder pain and muscle spasms. During this stage the fibrosis of the joint is just forming. Limited ROM is mostly due to inflammation and spasms.

Frozen Stage: Pain is no longer constant at this stage. Resting pain begins to decrease and a dull ache is present during movement. There is however an increase in joint stiffness and a progressive loss of shoulder movement.

Thawing Stage: There is a gradual restoration of movement and a decrease in pain and discomfort during this stage. Functional activities return. ROM increases but some residual restrictions could remain.

Treatment:

During the freezing stage:

  • NSAIDS and analgesics are often used to manage the pain. In some cases, corticosteroids are used when pain is unmanageable
  • Pendulum exercises may be used to help traction the joint and aid in continued movement of the shoulder
  • Passive and active ROM exercises are used to help with the pain and prevention of adhesion formation
  • Massage around the joint capsule and rotator cuff muscles to help decrease muscle stiffness and pain

During the frozen & thawing stages:

  • Moist heat applications
  • Massage to hypertonic muscles and friction to adhesions in rotator cuff muscles
  • Gentle tractioning of the joint along with ice massage to rotator cuff tendons
  • Trigger point work and myofascial release to cervical, thoracic, and shoulder girdle muscles
  • Passive ROM along with gentle stretches

Due to the pathological changes in and around the joint capsule, it’s important to keep the shoulder muscles – especially the rotator cuff muscles – as flexible as possible. This includes doing passive and active ROM exercises, gentle stretches, ice & heat applications, and trigger point work to the surrounding muscles. Doing so can have a significant impact on pain management, mobility, and ultimately the expediency of  the condition. Towards the end of the thawing stage, physical therapy along with isometrics and other muscle strengthening exercises may be helpful in restoring the shoulder to full capacity.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

By Appointment Only

917-514-3175

Location

116 Clinton St, Brooklyn Heights
July 2020
M T W T F S S
 12345
6789101112
13141516171819
20212223242526
2728293031  

Reflexology Map