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If you’ve ever tried to soothe a crying baby or console a loved one, you know that one of the most helpful things you can do is to make physical contact and rock with them back and forth. This simple act has an incredibly powerful and calming effect on both the body and mind. It’s a comforting and reassuring gesture that’s practically embedded in our DNA. When you consider the fact that the average adult male is about 60% water, the adult female, 55% water, and a one year old infant is close to 75% water, it’s no wonder our bodies have adapted to this movement. Much like the tide, the inherent rhythms of our bodies have an ebb and flow.

The therapeutic benefits of rocking can be clearly seen in what Thai yogis refer to as the rhythmic, rocking dance. In Thai yoga massage, the practitioner moves their body in rhythmic and swaying fashion to help create an even distribution of pressure during the massage. And herein lies the key to getting a great massage that’s both therapeutic and extremely relaxing.

The principles behind rocking are rooted in Thai Chi. A Thai Chi master uses very little of his or her own energy to create their movement. Their bodies are never rigid or stiff but instead fluid and graceful. This is because their center of gravity is rooted in what Eastern body workers refer to as the Hara, which in Japanese loosely translates to “soft belly.” The area three finger widths below the naval is anatomically referred to as the solar plexus. It’s the location of the your 2nd chakra or sacral chakra. It’s also referred to as the Tanden or Dantien.           

When movement is initiated from this area, the practitioner is using their body weight instead of the force of their muscles to deliver the pressure. As a result, energy can move freely up and down the spine, through the practitioner’s limbs, and out their hands. When pressure is applied in this way, it feels great. The pressure is even and deep, never jerky or awkward. If the body is stiff and the practitioner is using their own strength to deliver pressure, the kink in the flow of energy will quickly tire them out and eventually affect the recipient. In other words, it’s not going to feel good.

There are three basic forms of rocking employed in Thai massage, the bamboo rock, the forward rock, and the whirlpool rock. The bamboo rock or side rock is used frequently during meridian work in Thai massage. The movement is a fluid side-to-side motion much like a bamboo reed being blown in the wind. The bamboo rock is a great way to gently stimulate the energy meridians throughout the body without causing pain in stagnant areas. The forward rock is often used during certain stretches and tractioning movements as an effective way of opening up the body. A traditional stretch can be painful if done too aggressively. The forward rock allows the body to relax during the entire stretch. The whirlpool rock can be looked at as combination of both the bamboo and forward rock. The circular motion of the whirlpool rock has a very meditative quality which can be employed anywhere from Hara work to range of motion movements of the limbs.

So far all the rocking techniques discussed have been movements the Thai yogi employs in administering a natural and even distribution of pressure. Another form of rocking, which is commonly used in Shiatsu but can be translated into Thai or even table massage is called kembiki. In this form of rocking, the recipient is lying in a prone position while the therapist is applies an oscillating motion to the torso and limbs. In kembiki the recipient’s body is in constant motion. Doing this creates an almost trance like quality which is deeply meditative and very relaxing.

Regardless of the form it takes, rocking is an effective tool in reducing tension and stress in the body. Unfortunately, it tends to be under employed in traditional massage. For those people that find a static table massage uncomfortable or painful for whatever reason, a little bit of rocking can be a transform a regular massage into a truly amazing experience.


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

Tennis elbow, clinically known as lateral epicondylitis, is a tendonitis of the forearm extensor muscles. This group of four individual muscles attaches to the outer part of the elbow via a common tendon. They work together to extend the wrist and fingers and assist in forearm flexion. The most commonly affected muscle of this group is the extensor carpi radialis brevis (ECRB). Pain from tennis elbow is most acutely felt along the outer part of the elbow, known as the lateral epicondyle of the humerus. Pain and tenderness usually comes on gradually and can be present even at rest. It can also be further aggravated by simple tasks such picking up objects or opening doors. In chronic cases, your grip may weaken and you may feel the pain radiate down the forearm and into the wrist, or up into the shoulder.

 

 

 

 

 

 

 

 

 

 

 

Tennis elbow is considered a repetitive strain injury. Think of a tennis player repeatedly hitting the ball with a backhand stroke. The repetitive loading and pull of these muscles over time creates micro-tears in the muscle and tendon, which ultimately leads to inflammation. Poor conditioning and poor mechanics can greatly increase your chances of developing the condition. But tennis elbow is not limited to only tennis players. Basically anyone who uses their hands in a repetitive way such as musicians, chefs, painters, writers, carpenters and even massage therapists are all at risk. Writers for example may develop what’s known as “writer’s cramp.” The constant contraction of the forearm extensors in addition to the cocking of the wrist, will over time lead to muscle exhaustion and eventually irritation of the tendon.

Recent studies have also shown that a single event, such as a direct blow to the elbow or a sudden overloading of the muscles, can precipitate a sudden onset of tennis elbow. The counterpart to tennis elbow is golfer’s elbow, also known as medial epicondylitis. By contrast, golfer’s elbow causes pain along the inner part of the elbow where the tendons of the forearm flexors attach. A common diagnostic test to confirm the presence of tennis elbow is to extend the wrist and fingers back with an out stretched hand. Think of doing the “police stop sign.” If maintaining this position is painful or uncomfortable, you may have lateral epicondylitis.

Treating tennis elbow may involve a two-week period of rest and a complete cessation of the offending activity. Massaging the area with ice 2-3 times a day for approximately 15-20mins will help decrease inflammation. Some find using a compression brace on the forearm just below the elbow helpful in preventing a further pull on the epicondyle. After the acute stage has passed, gentle range of motion exercises along with myofascial release and trigger point work to the forearm muscles can be done. If after several weeks of rest one can perform ten pain free isometric contractions of the extensors muscles, one can begin resuming regular activity.


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

How hand and foot massage can benefit patients with ACS by lowering anxiety.

While many view anxiety as solely a mental health issue, this condition affects far more than just the mind. Important functions like respiratory rate, heart rate, blood pressure and myocardial oxygen demands are significantly challenged by anxiety.

These functions all have one thing in common—they are indicative of cardiovascular performance, which means anxiety has negative consequences to what is arguably a person’s most vital organ. There is a great deal of research pointing to massage therapy as being able to help reduce stress, but a new study suggests that massage therapy’s ability to help people better manage anxiety could be imperative for the health of patients with acute coronary syndrome (ACS).

 

 

 

 

 

 

The Study

In a May 2018 study, researchers performed a single-blind clinical trial on 70 patients with ACS. The aim of the study was to test the effects of hand and foot massage on the anxiety levels of patients with ACS. Patients were randomly assigned to case and control groups. Anxiety levels were measured 30 minutes before treatment and 15 minutes after treatment. Additionally, vital signs of the patients were checked before, immediately after, 60 minutes after and 90 minutes after the treatment. The researchers then used SPSS software, statistics, independent t-test, paired t-test and chi-squared test to analyze the data.

The Results

While there was no observed difference before the treatment, levels of anxiety, blood pressure, heart rate and respiratory rate saw significant improvement after the massage treatment, suggesting massage therapy may benefit patients who have ACS. “Hand and foot massage can be a useful nursing intervention in attenuating anxiety levels and improving the vital signs in patients,” researchers wrote.

References

  1. Alimohammad HS, Arsalan K, Ghasemi Z, Morteza S, Shahriar S. “Effect of hand and foot surface stroke massage on anxiety and vital signs in patients with acute coronary syndrome: A randomized clinical trial.”Complement Ther Clin Pract, 2018 May 31.

Article reprint from Massage Therapy Journal, November 7th 2018


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

Thai yoga massage has been around for millennia. This very ancient form of bodywork uses elements of compression, rocking, stretching, and various yoga poses to create a therapeutic response. But there are a few key distinctions which set it apart from a traditional Swedish or deep tissue massage. If you’re new to massage or if you’re trying to decide which is best for you, knowing what to expect may make that decision a little easier to make. Let’s take a look at some of the main differences between a Thai massage and a table massage.

  1. No table: One of the main differences between Thai massage and a table massage is that Thai massage is done on a mat on the floor. A traditional Swedish/deep tissue massage is done on a massage table.
  2. No need to undress: Thai massage is done fully clothed wearing loose, comfortable clothing. A full body table massage is usually done with the client partially or fully undressed, underneath a sheet and cover.
  3. No lotions or oils: A Thai massage does not use any crèmes, lotions, oils, or gels. Whereas a table massage can use any of the latter in its application.
  4. Techniques: A Thai massage will often use elements or compression, rocking, stretching, breath work and range of motion to create its therapeutic effect. A table massage may also use elements such as these but mainly focuses on techniques such as kneading, stroking, effleurage/petrissage, and friction for breaking up of adhesions and knots.
  5. Energetic component: A Thai massage incorporates energy line work through the use of palming and thumbing of the Sen lines in the body. A traditional Swedish/deep tissue massage does not work these energy lines specifically.
  6. Stretching: As mentioned already, Thai massage uses a great deal of stretching to address areas of tension and to relieve energy blockages. A table massage may also incorporate stretching but not to the extent that a Thai massage does.
  7. Positions used: In traditional table massage, most will lie face down (prone position) or face up (supine position) for a majority of their session. On occasion a side-lying position is used for targeted work. In Thai massage however, in addition to both the prone and supine positions, the side-lying, semi-prone, and seated positions are used as well.

Given these differences, one form of massage may be better suited for you than the other. Although both have their therapeutic qualities, personal preferences and expectations may have a significant impact on how the work is received. Also, each practitioner may have his or her own unique style, which will influence the work as well. No matter which form of massage you choose, make sure to seek out a knowledgeable, well-trained, and licensed professional to ensure you’re getting the best possible work available.


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

It’s been widely speculated that the origins of reflexology date as far back as 5000 years to China. As part of Traditional Chinese Medicine (TCM), some form of hand and foot therapy was being practiced alongside herbal therapy, acupuncture and qigong. Its roots have also been traced back to ancient Egypt through pictographs dating to 2330 B.C. Commonly referred to as the “Physician’s Tomb” for its depiction of several medical procedures, the pictographs were found at the burial site of a high ranking official named Ankhmahor. One of the images depicts two practitioners applying pressure to the hands and feet of two other people, with the inscription loosely translating to “Do not let me feel pain” and the response, “I will act as you please.”

Other cultures such as those of India, Japan and the Native Americans, have also used some form of pressure therapy to the feet as part of their tradition. The Native Americans for example believe that because our feet make contact with the earth, that we are connected to the whole of the universe through the energies that pass through them. In Europe, a form of pressure therapy known as “zone therapy” was being practice as far back as the 14th century.

In 1898, an English Neurologist by the name of Sir Henry Head discovered what are now known as “zones of hyperalgesia” or “Head’s Zones.” In a series of experiments, Head was able to demonstrate a link between diseased organs connected to a specific “zone” of skin by nerves and a hypersensitivity to pressure in that zone of the skin. Around this same time the work of two notable Russians: Ivan Pavlov – a physiologist, and Vladimir Bekhterev – a neurologist & psychiatrist, made their contribution through what are known as “conditioned reflexes”. Pavlov and his work with classical conditioning were able to demonstrate a causal link between a stimulus and a response. Bekhterev’s work was very similar in nature to Pavlov’s, although he referred to this link as an “association reflex.” Bekhterev however has the unique distinction of coining the term reflexology in 1917.

The first instance of a “reflex action” being attribute to massage occurred in Germany in the late 1890’s. What the Germans referred to as reflex massage was being widely practiced as a way of treating various diseases. A German doctor by the name of Alfons Cornelius had experienced first hand the therapeutic effects of a reflex action while recovering from an illness. He noted that during his massages, focusing on the tender and painful areas helped to significantly reduce his pain levels and speed up his recovery time.

It wasn’t until the work of an American physician named Dr. William Fitzgerald, that the reflexology that we know and practice today took form. Fitzgerald was the head of the Nose and Throat Department at St. Francis Hospital in Hartford, Ct in the early 1900’s. Commonly regarded as the father of zone therapy, Fitzgerald discovered the anesthetic effects created through the application of pressure to the fingers and toes. A series of ten longitudinal zones for the hands and feet, where found to run the length of the body from the fingers and toes all the way up to the head. Through the use of clamps, pins and rubber bands which he used to apply pressure to the digits, Fitzgerald was able to map out the distinct areas on the body where the anesthetic effect took place. He soon realized that could relieve pain and the underlying causes of the pain using this technique. Fitzgerald became so skilled at this that he was able to perform small surgeries using his technique, which he referred to as zone analgesia. Along with colleague Dr. Edwin Bowers, Fitzgerald co-wrote the book “Zone Therapy” in 1917. In it they discuss the general principles behind this therapy. The idea being that areas of the body found along specific zones will be linked to one another through energy that flows through that zone. The zone therapy that’s used today in reflexology is largely based on Dr. Fitzgerald’s pioneering work.

Another physician by the name of Dr. Joseph Shelby Riley was so fascinated by Dr. Fitzgerald’s work with zone therapy, that he went on to refine and use his techniques in his own practice. Riley was the first to create detailed diagrams of reflex points on the feet. He also discovered the eight horizontal divisions governing the body. It was his assistant however, a physical therapist by the name of Eunice Ingham, that finally charted the reflexes we use today in reflexology. Ingham has been called the “Mother of Modern Reflexology”. It was Ingham who focused on the feet as a means of treatment. By applying the techniques used in zone therapy, she meticulously checked and rechecked the reflexes until she had created a detailed map of the body on the feet. After writing her first book, “Stories The Feet Can Tell” in 1938, she tireless promoted the practice of reflexology throughout the general public. Along with her nephew Dwight Byers, which she often practiced on, the two of them helped bring the modern practice of foot reflexology to the forefront.

Another key contribution worth noting came around the mid 1960’s. In 1965, Ronald Melzack and Patrick Wall published an article in the journal of “Science” entitled, “Pain Mechanisms: A New Theory”. In it they describe how the body transmits and inhibits pain signals through a gate response found in the spinal cord. This theory would go on to explain one of the possible ways that this anesthetic affect was being created in the body. The theory was called the “Gate Control Theory” of pain.

The body’s normal response to pain is to inhibit it through the use of endorphins; the body’s natural pain relievers. Endorphins are endogenous opioid compounds produced by the pituitary gland and the hypothalamus in response to strenuous exercise, excitement and trauma. And they are as strong as any opiate out there, including morphine. As a matter of fact, the word endorphin is actually an abbreviated version of “endogenous morphine”. When you stub your toe for example, pain signals are sent to the brain where they are processed by the thalamus. During this time, the first wave of endorphins is released into your system. But there’s a curious thing that happens along side this. Our immediate reaction is often to reach for the area in pain to try and soothe it. Ever wonder why that is? Somehow it helps to diminish the pain and the gate control theory can explain why.

The gate control theory states that a competing signal can essentially block pain signals from reaching the brain. Nociceptive pathways or pain pathways, have two different types of nerve fibers. A-Delta fibers are myelinated pathways that conduct pain signals to the spinal cord at approximately 40mph (fast, acute, sharp pain). C-fibers are unmyelinated pathways that carry signals at approximately 3mph, (slow, continuous, throbbing pain). Sensory neural pathways however, are myelinated but also larger in diameter, which essentially means they can transmit signals faster than both pain pathways. Basically, sensory information reaches the spinal cord faster and takes precedent over pain signals. This explains why rubbing your toe seems to miraculously help ease the pain. When the sensory input reaches the spinal cord it stimulates inhibitory inter-neurons, which act as gates that can close and suppress the pain signals. It’s a complex interplay and not an all or nothing phenomenon, which is why we still feel some pain. Interestingly enough, the theory goes a step further. Melzack and Wall also state that “the psychological condition and cognitive content of the mind” can affect our experience of pain. This includes emotions, thoughts and our overall outlook! This could explain why pain is such a subjective experience.

This last theory has wide implications for the therapeutic effects of touch therapy such as massage, Reiki and in particular, reflexology. Firstly, the sensory input created when pressure and movement are applied to the feet and hands help to close the gates, lessening the effects of pain. Secondly, the psychological effects of stress reduction can help generate feelings of ease and comfort, and ultimately give us hope that relief is within sight.


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.

Massage therapy is commonly used for relaxation and pain relief, in addition to a variety of health conditions such as osteoarthritis, fibromyalgia, and inflammation after exercise. Massage therapy can also be an effective therapy for aspects of mental health. Recent research suggests that symptoms of stress, anxiety and depression may be positively affected with massage therapy.

Here are some recent research findings which highlight the role of massage therapy in mental health and wellness, compiled by the American Massage Therapy Association.

Massage Therapy for Depression in Individuals With HIV

Research published in The Journal of Alternative and Complementary Medicine indicates that massage therapy can reduce symptoms of depression for individuals with HIV disease. The study lasted eight weeks, and results show massage significantly reduced the severity of depression beginning at week four and continuing at weeks six and eight. American Massage Therapy Association President Winona Bontrager says of the study, “This research suggests that regular therapeutic massage could be a useful tool in the integrated treatment of depression for patients with HIV.”

Massage Therapy to Reduce Anxiety in Cancer Patients Receiving Chemotherapy

Research published in Applied Nursing Research shows that back massage given during chemotherapy can significantly reduce anxiety and acute fatigue. “This research demonstrates the potential value of massage therapy within the full cancer treatment spectrum, particularly during the often mentally and physically exhausting chemotherapy process,” says American Massage Therapy Association President Winona Bontrager.

Massage Therapy for Reduced Anxiety and Depression in Military Veterans

Research published in Military Medicine reports that military veterans indicated significant reductions in ratings of anxiety, worry, depression and physical pain after massage. Analysis also suggests declining levels of tension and irritability following massage. This pilot study was a self-directed program of integrative therapies for National Guard personnel to support reintegration and resilience after return from Iraq or Afghanistan.

Massage Therapy for Nurses to Reduce Work-Related Stress

Research published in Complementary Therapies in Clinical Practice shows that massage for nurses during work hours can help to reduce stress and related symptoms, including headaches, shoulder tension, insomnia, fatigue, and muscle and joint pain. “This study affirms the important role massage therapy can play in the work setting, in this case to ease stress for health care providers who, in turn, can better provide optimal patient care,” says Bontrager.

Article reprint from amtamassage.org, research roundup.


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.

One of the major underpinnings of Thai yoga massage is its deep roots in Ayurvedic medicine. This Indian healing practice approaches health from a point of living in harmony with life and what is. The word itself, Ayurveda, is derived from two Sanskrit words meaning life (ayur) and knowledge (veda). By applying this life knowledge we can create harmony and restore optimal health. Ayurvedic principles can be applied to just about all facets of daily living, from diet and exercise to our mental and emotional habits. In Thai yoga massage for example, a person’s dosha (doe-sha) will determine the intensity and speed of their session.

A dosha refers to one of three primary energies that are believed to circulate through the body. We all have all these three energies coursing through our bodies, but one tends to dominate. This dominant energy is our natural, default dosha, which ultimately determines our overall temperament and constitution. According to Ayurvedic tradition, the universe is made up of five elements: earth, fire, water, ether and air. Everything in the universe, including our bodies, is made up of these five elements in various degrees. The tridoshas are the five elements represented in the body. Ether and air combine to create the vatta dosha or air principle. Fire and water form the pitta dosha or fire principle. And finally earth and water come together as the kapha dosha or water principle.

Since these energies are in constant flux, it’s important to understand the general characteristics of each dosha in order to restore balance. Too much of one energy for example, can create a particular set of symptoms while too little of another will create a different set of symptoms. Most of us will recognize elements of each dosha in ourselves but we all tend to lean more towards one.

Vatta: The elements of ether and air form the vatta dosha (air principle). Vatta types are active and energetic. They can lean towards nervousness and generally tend to avoid confrontation. Physically, they’re either short or very tall. Vatta energy creates movement in the body through the nervous system and energetic body. Most western type diseases come form an imbalance in vatta energy. Here are some other general characteristics of vatta types:

  • thin bodies
  • dark complexions
  • dry, rough, cracked skin
  • coarse hair
  • light sleepers
  • get cold easily
  • tire easily
  • quick thinkers
  • sensitive, alert
  • restless minds

Pitta: The elements of earth and water form the pitta dosha (fire principle). Pitta types are passionate and assertive. They can be warm and friendly but can also be very competitive. They tend to be of medium frame and moderate build. Pitta energy is responsible for circulation and relates heavily toward metabolism and digestion in the body. Other characteristics include:

  • medium, muscular bodies
  • reddish complexion
  • thin hair
  • moist skin
  • hot/sweaty body type
  • passionate
  • big appetites
  • detail oriented
  • easily angered
  • short tempered

Kapha: The elements of earth and water form the kapha dosha (water principle). Kapha types are stable and grounded individuals. They are generally calm and consistent and lean towards inactivity. Physically, they have heavyset bodies with a broad chest and shoulders. Kapha energy is very water-like and associated with the lymph, phlegm and moisture in the body. It’s known for binding and holding things together, physically and mentally. Here are some other key characteristics:

  • Strong, stout build
  • fair or pale complexion
  • smoothe or oily skin
  • lush, thick hair
  • slow digestion
  • sound sleepers
  • excellent stamina
  • patient and slow to anger
  • stable body & mind
  • happy & healthy

The doshas are often in one of three states:, balanced, over-active, or depleted. In order to create balance we must first determine which dosha we are and then tailor our lifestyle accordingly. Too much air or vatta energy can lead to mental, nervous or digestive disorders, low energy and weakness. An overabundance of fire or pitta energy can lead to inflammation or infection. An excess of water or kapha energy can lead to an over-production of mucus, edema, and being overweight. Pitta types for example can suffer from heartburn from an over-indulgence of spicy foods. Adding more alkaline-based foods such as broccoli, kale or other leafy greens can create balance. The important thing to remember is that like energies will create excess and opposing energies will restore balance.


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.

These days digital media consumes so much of our attention that we’re no longer noticing the subtle signs our bodies are sending us. Whether its checking email, responding to texts, updating social media, you name it, logging in all this screen time has now become the new norm. And love it or hate it, it’s having an affect.

Neuroscience has shown that the brain cannot tell the difference between an image it sees in the physical world and one that it sees in our mind’s eye. They essentially affect the same regions of the brain. If we stop and think about it for a moment, the implications of this are profound. Let’s imagine we’re out on a hike. It’s a beautiful day, we’re out in nature, and then we spot a bear off in the distance. What happens now is our body kicks into fight or flight. Our senses become heightened, our heart starts to race, and our breathing changes. These are all normal physiological responses to a life or death situation. Now close your eyes and imagine that same scenario playing out in your mind’s eye. If you really put yourself there, you’ll notice that your breathing will become shallow and your body will tense – essentially the same physiologic response, albeit a less intense one, as the real deal!

This fight or flight response releases a cascade of hormones and neurotransmitters designed to kick your system into overdrive. You either fight off the potential threat or if that’s not possible, you flee. This stress response was not meant to be a chronic and ongoing thing. The longer these stress hormones remain in your system, the more deleterious their effects become on the body over time. So what does this imagined scenario have to do with body awareness and learning how to develop it?

Whenever we check in with our bodies we develop a capacity to pickup on these often overlooked signs. Are we holding ourselves unnecessarily? Is our breathing shallow or labored? Are we feeling an ache or pain somewhere? Paying attention and listening to the body takes us out of our heads and away from all the noise of daily living. The quickest and most effective way to do this is to pay attention to the breath. By noticing the breath we can tune into the body’s autonomic nervous system. This branch of the nervous system regulates our heart rate, blood pressure, our digestion, and of course our breathing. All of these are critical functions of the body, which for the most part go unnoticed. And the breath is the only one that we can actually influence directly. This is why sages have referred to the breath as the bridge between the body and the mind.

Developing body awareness can take on many forms. Most common of course is meditation. Creating a daily practice of introspection has been scientifically proven to be effective in lowering blood pressure, reducing stress levels, and generating an overall sense of happiness. But it can also take the form of physical activity, such as running, cycling, yoga, and swimming. Obviously, some of us may have more limitations than others. But even if it’s just walking, the effects are a boon to our physical and mental well-being. Receiving bodywork is another way of developing body awareness. How often have we gone in for a massage and discovered how sore and tight certain areas were? Areas we had no idea were holding on to tension.

The body has an amazing capacity to adapt. If we’re tense our bodies are tense. Where this manifests in the body is different for every person. This is why cultivating a practice of body awareness is so helpful in staving off the effects of stress, not only of the body, but the mind as well. Setting aside some time for oneself can be a challenge in itself, so start small. Pick three opportunities throughout your day to pause for a few seconds, and take one conscious breath. Ahh… For those few seconds, place your full attention on your breath. Notice how the breath feels coming into the body. Make sure to breathe with your whole body. Allow the abdomen and chest to expand as you fill your lungs with air. Then with the same focus, notice how the body naturally contracts as the breath leaves your body. This ingoing and outgoing of the breath is the basic rhythm of life. The yin and yang of existence. All this, in one conscious breath! Make this your practice throughout the day and before long you’ll start feeling its positive effects on body and mind.


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.

Thai Yoga Massage (TYM) is an ancient form of bodywork that combines elements of yoga, Tai chi, and massage. Its origins are rooted in Ayurvedic medicine and date back 2500 years to India and the Buddhist temples of Thailand. Often referred to as “Assisted Hatha Yoga,” the practice is performed on a mat on the floor with the client wearing loose comfortable clothing to facilitate ease of movement. Practitioners guide the client through various yoga poses and stretches while palming and thumbing the energy lines of the body, known as Sen lines. The slow, rhythmic movements used in TYM create a flow that gently balances the body’s energy lines, while increasing range of motion, improving circulation, and relieving chronic muscular tension.

The founder of Thai Yoga Massage was an Indian, Ayurvedic doctor by the name of Jivaka Kumar Bhaccha. His renown for treating kings and noblemen led him to become the Buddha’s personal physician. The Buddha’s teachings eventually became a huge influence on Jivaka and his work. When Buddhism spread to Thailand, the practice of yoga and Ayurvedic medicine also followed. TYM, also known as Nuad Boran in Thailand, took shape in the Buddhist temples of Thailand and was passed down from master to apprentice through oral tradition. Because Buddhist philosophy is so enmeshed in the practice of TYM, practitioners view it as the physical application of “metta,” which translates into – loving-kindness.

Thai Yoga Massage has since evolved into two main styles, the northern and the southern. The Old Medical Hospital in Chang Mai, Thailand has become the main hub for the northern style and Wat Pho in Bangkok, the center for the southern style. Although the two share a lot in common, they differ in how the energy lines are worked. The northern style involves palming and thumbing of the Sen lines and is generally a bit more active with its stretches and yoga poses. The southern style is more relaxed in its approach and uses a technique known as plucking to stimulate the energy lines via the nerves. These days, more and more practitioners are combining elements of both styles making it harder to distinguish between the two. In addition to these techniques, practitioners of both styles will often use their forearms, elbows, knees and feet to work the body.

There are a few other key distinctions worth noting between the different styles of Thai massage, namely the pacing and amount of pressure used. These elements do have a stylistic component to them but more often than not are influenced by the individual practitioner. Some may choose to use a quick and vigorous pace to work the energy lines of the body, while others will work in a slower, more deliberate manner. The other element is how much pressure is used during a session. Originally, Thai massage was widely administered as a form of medicine for various types of malaise throughout Thailand, so relaxation was not considered its main objective. In the hands of a few master practitioners however, the application of pressure could vary greatly from a light to deep touch depending on the client and the area being worked on. Working in this fashion takes into account both our physical and energetic bodies and becomes meditative in nature.

Traditional TYM focuses a good amount of time on the legs and lower body. The reason for this has to do with how much time Thai people spend on their feet. A majority of them spend their day working on their feet. By contrast, most westerners spend most of their day sitting in a chair in front of a computer. They also tend to be taller and heavier and have more upper body issues. At Brooklyn Reflexology a form of northern Thai massage, which addresses both the lower and upper body is used. An emphasis is placed on flow and fluidity of movement to help create a deeply therapeutic affect on the body, mind and spirit.


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.

When considering muscular imbalances in the body, it’s important to remember that some muscles are mechanically predisposed to being short and tight, while others are prone to being weak and inhibited. It’s no coincidence then that most people complain of neck and shoulder tension, while you never hear anyone say, “my abs are feeling too tight…” For this reasons, muscles tend to fall under two main categories: postural and phasic.

Postural muscles by their very nature are designed to keep us balanced and upright. A perfect example of this is the paraspinal muscles. These long, mound-shaped muscles on either side of the spine have to work continuously to keep the spine erect. These muscles are built for endurance and have a high threshold for sustained contraction and fatigue. But like everything else, they have their limit and can easily fall victim to over use.

Phasic muscles on the other hand were designed primarily for movement. The glutes for example, help to extend the hip and leg when we’re walking. So if we lead a fairly sedentary life, these muscles can easily become weakened and atrophy. Phasic muscles are easily fatigued and don’t have the endurance that postural muscles have. To understand why this is, we have to consider something known as “fast-twitch, type II muscle fibers” and “slow twitch, type I muscle fibers.”

Phasic muscles contain a high density of fast-twitch muscle fibers. They rely primarily on anaerobic metabolism to fuel their contraction and for that reason, can easily be fatigued. Anaerobic simply means, without oxygen. So whenever these muscle fibers are recruited, they’re relying primarily on a metabolic process that does not use oxygen, such as the body’s glycogen stores. As a result they produce waste by-products, which can impair muscle contraction, which in turn leads to fatigue. Fast-twitch muscle fibers are usually involved in rapid and intense movements of short duration. Think of weight lifting, throwing a ball, or sprinting.

Postural muscles are imbued mostly with slow-twitch muscles fibers. These slow-twitch fibers rely on aerobic or oxygen-based metabolism and have a high threshold for fatigue. Low to moderate intensity activities such as walking or jogging rely heavily on the aerobic nature of these slow-twitch muscle fibers. Any activities involving endurance, whether it be walking or running a marathon, require oxygen as fuel. This is why we become fatigued even during low to moderate activities done over a prolonged period of time. As oxygen stores become depleted during our workouts, we start relying more on anaerobic metabolism as a fuel source.

There’s a third type of fast-twitch muscle fiber that uses oxygen as a fuel source and is resistant to fatigue, much like the slow twitch muscle fibers described above. To distinguish between these two very different types of fast-twitch muscle fibers, they’re often referred to as “fast oxidate, type IIA” and “fast glycolytic, type IIB” – which is described above. In the order of recruitment, these fast oxidate, type IIA muscle fibers are often called upon last to do their job (the first being the slow twitch type I, and the second being the fast glycolytic type IIB). Another distinction worth noting amongst these different types of muscle fibers is their color. The slow- twitch, type I are rich in oxygen and are therefore red in color. The fast-twitch, type IIA are red to pink. And the fast-twitch, type IIB are white/pale due to their low oxygen stores.

Imbalances between postural and phasic muscles can become pronounced leading to a condition known as “upper crossed syndrome” — when it involves the upper body, and “lowered crossed syndrome” — when it involves the lower body. These syndromes are a result of short and tight muscles going unchecked by their weak and inhibited counterparts. In the case of lower crossed syndrome, we have an exaggerated forward tilt of the lumbar spine, something known as a hyperlordosis, created by tight lower back muscles (erector spinae & quadratus lumborum), in addition to tight hip flexor and adductor muscles (iliopsoas, rectus femoris, tensor fasciae latae, adductors). The weakened abdominals, glutes and hamstrings are no match for these strong postural muscles. To bring balance here, one would have to focus on strengthening the weakened muscles and stretching the tightened muscles.

upper-crossed lower-crossed

Below is a list of key postural and phasic muscles:

Postural Muscles (prone to tightness):

Gastrocnemius, Soleus, Tibialis Posterior (lower leg)

Hamstrings, Rectus Femoris (upper leg)

Iliopsoas, Tensor Fasciae Latae, Piriformis (hip)

Erector Spinae (cervical & lumbar), Quadratus Lumborum (lower back)

Upper Traps, Levator Scapulae, Sternocleidomastoid, Scalenes, Suboccipitals (upper back and neck)

Pectoralis Major (chest)

Flexors of the upper limb (i.e. Biceps)

 

Phasic Muscles (prone to weakness):

Peroneals, Tibialis Anterior (lower leg)

Vastus Medialis, Intermedius & Lateralis (upper leg)

Gluteus Maximus, Medius & Minimus (hip)

Rectus Abdominus (mid-section)

Serratus Anterior, Rhomboids, Lower Traps (shoulder & upper back)

Short cervical flexors (i.e. Longus Capitis & Longus Cervicis)

Extensors of the upper limb (i.e. Triceps)


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.

Some Recent Research: Massage Therapy for Reducing Pain, Anxiety, and Muscular Tension in Cardiac Surgery Patients.

A study published in The Journal of Thoracic and Cardiovascular Surgery reported that during a randomized trial, researchers found massage therapy was more beneficial for cardiac surgery patients who were experiencing pain, anxiety and muscular tension when compared to cardiac patients who were involved in the same study and received an equal amount of rest time.

Study methods: There were 152 adult patients recently admitted for cardiac surgery involved in the study. The participants were randomly put into two groups: one received massage therapy after surgery while the control group was simply offered rest time. Of the 152 patients who participated, only 146 of them went on to receive rest time or massage due to complications, such as cancelled surgery or being waitlisted.

Pain, anxiety, relaxation, muscular tension and satisfaction were measured with visual analog scales. Prior to day one of the study and after its conclusion, participants’ heart rate, respiratory rate and blood pressure were also measured. Researchers gathered additional information by holding focus groups and listening to the participants’ feedback.

Protocol: Participants were given a total of four massages or rest time sessions over a six-day period, beginning on day three or four and then again on day five or six after surgery.

Results: For those volunteers who received massage, there was a 52 percent reduction in pain in comparison to the participants who received an equivalent amount of rest time, who saw no major improvements.

On day three and four, participants receiving massage therapy reported a 58 percent reduction in anxiety, and this reduction increased on days five and six. Both groups saw significant improvement in relaxation on days three and four, but only massage was effective on days five and six. Additionally, a 38 percent reduction in pain was also noted on days five and six in the massage therapy group.

This trend continued throughout the study, with massage patients reporting greater relaxation scores and a 54 percent reduction in muscular tension. Participants offered rest time did see a reduction in muscular tension on the third and fourth days, however the results were not the same on days five and six.

References

Braun L.A., Stanguts C., Casanelia L., Spitzer O., Paul E., Vardaxis N.J., Rosenfeldt F., Massage Therapy for Cardiac Surgery Patients—a randomized trial. The Journal of Thoracic and Cardiovascular Surgery. 2012 Dec; 144(6):1453-9, 1459.e1. doi: 10.1016/j. jtcvs.2012.04.027. Epub 2012 Sep 7.

Article reprint from Massage Therapy Journal, Fall 2013


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.

If you’ve ever gone for a deep tissue massage only to be let down by the amount of pressure used, then you’re not alone. A majority of people equate ‘deep tissue’ with ‘deep pressure.’ The opposite can also be said of a Swedish massage. If you’re someone who likes only light to moderate pressure, then chances are you’ll go with a Swedish massage. So why is it that people get less than what they expect from their massage? The reasons can be as varied and as simple as: your therapist’s individual style or strength; your therapist’s training and experience; the amount of communication between therapist and client; and not least of which, some common misconceptions.

Just about everyone expects a firm touch when they go for a deep tissue massage. The term ‘deep tissue’ though can be a misnomer. A deep tissue massage is designed to target the deeper layers of muscles in your body and not necessarily to deliver deep pressure uniformly. This is misconception number one. The amount of pressure used in a deep tissue massage can vary greatly, from a light, superficial stroke designed to warm up the muscle, to a deeper, more focused application of pressure used to release adhesions. This is such a common misconception that even some therapists fall into the trap of using more pressure than is needed. By contrast, a Swedish massage is designed to target the superficial layer of muscles, which in some cases may not require as much pressure. So how do you ensure you’ll get the best massage for your money? The key is communication.

Another common misconception is that it’s better to remain silent for the sake of propriety. “The therapist knows how much pressure to use, even if I’m silently screaming in agony.” You may be thinking…, not me! But you’d be surprised at how many people suffer in silence. Your therapist should establish those lines of communication by asking you your preferences and checking in with you periodically throughout the massage. Some areas may require more pressure than others, so it’s at these moments when communication is crucial. There may also be a disconnect between what your body is saying and what your expectations are. Some therapists may use your body’s reaction to guide them in the amount of pressure they use. If you tense up or your breathing becomes shallow and subdued, then chances are the amount of pressure you’re getting is at or beyond your threshold.

Since pain is such a subjective matter, one person may prefer that feeling and another may not. The question of how much pressure to use has now become more complicated. From a purely therapeutic standpoint, the body never lies. If your muscles are splinting and tensing up, it’s your body’s way of saying ‘enough!’ Of course, depending on the circumstances, that may change and often does. If for example, you’ve recently strained a muscle or are dealing with chronically tight muscles, your body may react to ‘too much pressure, too fast’ by tensing up. In cases such as these, it may be a matter of warming up the tissue sufficiently or using a different technique, which can then allow you to go deeper. But generally speaking, trying to push through this resistance with a ‘take no prisoners’ approach may actually do more harm than good.

Some therapists may have a system they use to help modulate the pressure to your liking. Some may not. The important thing to remember is that you speak up and let your therapist know what your preferences are. If you clearly communicate this and you still don’t get what you’re looking for, then it may be a matter of finding the right therapist. In light of all these variables, not everyone is a good match. Do your research and find the therapist that suits your needs.


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.

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.

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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.

Whether it’s the changing of the seasons or more long-term, chronic feelings of anxiety and depression, recent research is showing that massage therapy can help improve mood and reset circadian rhythms, which can lead to better sleep and more energy.

Improved Mood

A randomized study of 34 women with stage 1 or 2 breast cancer examined how massage therapy impacted depression and anxiety levels. The massage therapy group received a 30-minute massage three times per week for five weeks, which consisted of stroking, squeezing and stretching techniques to the head, arms, legs, feet and back. The control group received no intervention. Study participants were assessed on the first and last day of the study, and assessment included both immediate effects measures of anxiety, depressed mood and vigor, as well as longer term effects on depression, anxiety and hostility, functioning, body image and coping styles. A subset of 27 women also had blood drawn to examine additional measures.

The immediate massage therapy effects included reduced anxiety, depressed mood and anger. Longer term effects included reduced depression and hostility, as well as increased serotonin values, NK cell number and lymphocytes. Serotonin, a neurotransmitter with functions in various parts of the body, works to regulate mood, appetite, sleep, memory and learning.

Better Sleep

In another study examining the effect of massage therapy on the adjustment of circadian rhythms in full-term infants, researchers measured the rest-activity cycles of infants before and after 14 days of massage therapy, starting at 10 days old and again at six and eight weeks of age.

Rest-activity cycles were measured by actigraphy, and 6-sulphatoxymelatonin excretion was assessed in urine samples at six and eight weeks of age. The concentration of 6-sulphatoxymelatonin in urine correlates well with the level of melatonin in the blood, and melatonin is what helps control sleep and wake cycles.

At 12 weeks, nocturnal 6-sulphatoxymelatonin excretions were significantly higher in the infants receiving massage therapy than those in the control group, suggesting that massage therapy can enhance coordination of the developing circadian system with environmental cues.

References

Hernandezreif, M. 2004. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. Journal of Psychosomatic Research, 45–52.
Ferber, S., Laudon, M., Kuint, J., Weller, A., Zisapel, N. 2002. Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. Journal of Developmental & Behavioral Pediatrics, 410–415.

Article reprint from Massage Therapy Journal, Spring 2016


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 some cases, the affects of heel pain may have a different source. As previously mentioned, tight calf muscles can often predispose you to developing plantar fasciitis. A byproduct of this are trigger points. Trigger points are tiny contractions in the muscle fiber which form as a result of over-use, strain, trauma, or shortened and tight muscles. Trigger points refer pain to other areas of the body. In the case of the lower leg, there are several muscles which could be referring pain to the heel and long arch of the foot – the same area where plantar fasciitis pain occurs. Let’s take a look at the first image below.

Soleus TP

This image depicts a trigger point in the middle of the soleus muscle. The soleus is a large calf muscle that plays a major role in plantar flexing your foot. The muscle is accessible half way down your lower leg and attaches itself to the foot via the Achilles tendon. If the muscle is tight, it will keep your foot plantar flexed (toes pointing down) and limit the amount of dorsiflexion (toes pointing up) available. This limitation will invariably put a strain on the muscles and fascia of the foot.

Quadratus Plantae TP

This second image shows a trigger point in the quadratus plantae muscle — a deep intrinsic foot muscle. Pain from a trigger point in this muscle can be a sharp, stabbing pain preventing you from putting your full weight down on your heel.

Gastrocnemius TP

And lastly, another common site of plantar fasciitis pain is along the medial arch of the foot. A trigger point in the medial head of the gastrconemius muscle can often refer pain to this area. Your gastrocnemius muscles are the superficial muscles found on the upper part of the lower leg. These muscles are very strong, powerful muscles which also attach to the foot via the Achilles tendon. They are often recruited in activities such as sprinting and jumping due to their capacity to lift your entire body weight.

It’s important to remember that while true plantar fascitiis takes time to heal, the effects of trigger points in these muscles could perpetuate pain in the area long after the condition has resolved itself. Along with treating the symptoms of referred pain, trigger point therapy has the added benefit of addressing tight calf muscles, which could be contributing to the condition. So whether you’ve been diagnosed with plantar fasciitis or are dealing with foot pain of some kind, in addition to your conventional treatments, trigger point therapy in combination with reflexology should be a part of your recovery plan.


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.

We rely on our feet to take us just about everywhere. So if heel pain is causing you to curtail your daily activities, this can be a huge problem. In the first half of this article, we’ll look at the most common form of heel pain — plantar fasciitis.  In the second half, we’ll consider how the effects of trigger points in the lower leg muscles can be a contributing factor and/or the cause of your heel pain!

Plantar fasciitis is a fairly common condition that causes pain and inflammation in the fascia which cover the bottoms of your feet. These tough bands of connective tissue run from your heel bone to your metatarsals and provide a good amount of arch support. Micro-ruptures can form due to repeated pulling, stress, and/or trauma to the area. If not treated properly, the condition can become chronic and lead to the formation of a heel spur, which can then cause further irritation and pain.

Plantar fasciitis typically affects those who have relatively: high arches (pes cavus), flat feet (pes planus), tight calf muscles, or tight, ill-fitting shoes. It can also occur in people who spend most of their day on their feet, those who are overweight, and runners who suddenly increase their activity level. Excessive pronation of the foot, running on sand or uneven surfaces, and inadequate arch support from worn out shoes can also be contributing factors.

The major signs and symptoms include:

– Pain at the heel when weight bearing

– Morning stiffness and pain that decreases with activity

– Tenderness along the medial arch when pressure is applied

– Pain when standing on your toes and /or walking on your heels

– Numbness along the outside of the foot

– Occasional swelling over the heel

– X-rays that reveal bone spurs where the fascia attaches on the heel bone

If you’ve been diagnosed with plantar fasciitis, chances are that most conservative methods should help alleviate the condition in a majority of cases. Such remedies may include:

– Rest, along with an over the counter NSAID to help with pain and inflammation

– Ice and myofascial massage to the affected area

– Orthotics and/or new shoes with good arch support

– Stretches for lower leg and foot muscles

– Night splints

In severe cases when the condition is particularly chronic and debilitating, your doctor may prescribe cortisone shots. While the shots may help to manage the condition, they are not a cure. It is crucial to be proactive and stave off any possible long-term effects by doing your homework. This will help speed up the recovery time significantly.


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 part one of Anatomy of the Foot, we covered the basic structure of the foot — from the three sections and three arches, to the bones and their ligaments. In part two, we’ll get into the muscles and tendons that make the foot move.

Tendons

Like the ligaments of the foot, there are numerous tendons that attach the muscles of the lower leg to the foot. Tendons are the cord-like structures that attach muscle to bone. Here are a few key tendons along with some common forms of tendonitis.

Achilles Tendon: One of the most recognizable tendons of the body, the Achilles tendon is located at the back of the heel and attaches the calf muscles of the lower leg to the calcaneous. This tendon helps to flex the foot downward and propel you forward. Achilles tendonitis can result from overuse of the tendon while running or jumping or from a tight shoe, which can put pressure on the back of the heel.

Peroneal Tendons: There are two peroneal tendons which attach the lateral muscles of the lower leg to the foot. These tendons run underneath the lateral malleolus (the boney knob on the outer ankle) and when overused, can often times lead to peroneal tendonitis. The pain is usually felt along the lateral malleolus and heel, and can also be related to a high arch or a supinated (rolled in) foot.

Tibialis Posterior Tendon: This tendon attaches one of the deeper lower leg muscles to the foot. The tendon runs underneath the medial malleolus (the boney knob on the inner ankle) and when overused can lead to posterior tibial tendonitis. Common amongst runners or people with hyper mobile or pronated feet, pain and swelling can occur along the inner part of the ankle.

Anterior Tibial Tendon: The tendon of the anterior tibialis muscle, located in the front of the lower leg, runs over the top of the ankle to attach itself to the bottom of the inside of the foot. Pain and swelling along the top of the ankle and foot could be a sign of anterior tibialis tendonitis. This can result from excessive downhill running.

Bursa and Bursitis: Bursitis is an inflammation of the bursa sacs which lie under tendonous joints and are designed to reduce the friction against bone. One of the most common sites for bursitis on the foot is just behind your heel under the Achilles tendon. Often referred to as a “pump bump,” this bursa lies underneath the Achilles tendon and can be irritated from a tight shoe. Retrocalcaneal bursitis, as it’s called, usually develops over time and is often more acute and localized than the pain associated with Achilles tendonitis.

Muscles

Of the twenty intrinsic muscles found on the foot, only two are located on the dorsal (top) part of the foot. Seven muscles are found on the plantar (bottom) part of the foot. And the other eleven (the interosseous and lumbricals) are found between the metatarsal bones.

Dorsal foot muscles: The extensor digitorum brevis and the extensor hallucis brevis are short toe extensors. The latter extends the big toe and the former extends the other four toes.  The interosseous muscles lie between the metatarsal bones and help to move the toes from side to side and also aid in flexion and extension. There are actually two set of these interosseous muscles. The dorsal component has four muscles and the plantar component has three. Technically these muscles lie between the metatarsals, but because they’re most easily accessible from the top of the foot, they’re usually considered dorsal muscles.

Plantar foot muscles: The plantar surface of the foot is home to three layers of muscle.

First Layer: The first and most superficial layer contains three muscles. First on the list is the flexor digitorum brevis muscle which lies directly in the middle of the foot and attaches the heel to the toes. This muscles aids in flexing (curling) the four smaller toes. The abductor hallucis muscle lies along the medial longitudinal arch and helps to abduct or rather, move the big toe away from the other toes. The abductor digiti minimi muscle, found along the lateral longitudinal arch, helps to move the little toe away from the other toes. These last two toe abductor muscles are crucial in making the minor adjustments necessary to keep your balance.

Second Layer: This layer contains five muscles. The quadratus plantae muscle attaches the heel bone to the tendons of a long flexor muscle. This configuration makes it a strong aid in flexing the toes. The deeper lying lumbricals, of which there are four, lie parallel to the metatarsal bones. These tiny muscles help to flex the 2nd-5th toes.

Third Layer: This third and deepest layer has two big toe muscles and one little toe muscle. The two big two muscles are the adductor hallucis and the flexor hallucis brevis muscles. The adductor muscle moves the big toe closer to the other four toes and the flexor muscle bends the big toe downward. The last muscle in this layer, the flexor digiti minimi brevis muscle, helps to flex the little toe.

Covering all these layers of muscle are two bands of fascia that run for the heel to the ball of the foot. When irritated, it can lead to a fairly common condition called plantar fasciitis – an inflammation of the fascia.

Movements of the Foot

Finally, let’s discuss the four major planes of movement of the ankle and foot. The foot is capable of making numerous adjustments along its 33 joints, all of which are necessary for maintaining balance. For the sake of simplicity, we’ll consider the movements of the ankle joint, which move the foot.

The four major planes of movement are: dorsiflexion, plantarflexion, inversion and eversion. Each of these planes has a degree of movement that is considered part of the normal range of motion (ROM) found at the ankle.

Dorsiflexion: When you lift your foot so that your toes are pointed upward, this is called dorsiflexion. About 20 degrees of dorsiflexion is considered normal.

Plantarflexion: Flexing your foot so that your toes point downward is considered plantarflexion. Typically, 50 degrees of plantarflexion is about average.

Inversion/Supination: When your foot rolls inward so that your toes are pointed toward the midline of the body, this is referred to as a supinated or inverted foot. There tends to be more variability in this plane of movement than the previous two, so a normal range is usually between 45-60 degrees.

Eversion/Pronation: This occurs when your ankle rolls outward and your toes point away from the midline of the body. Similar to inversion, pronation of the foot falls within a normal range, which is typically 15-30 degrees. This is notably less than inversion/supination.

As one can see, there’s quite a bit to consider when discussing the feet. Hopefully this short anatomy lesson will give you some working knowledge and better equip you in making informed decisions about the care of your feet.


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.

When you consider the fact that each human foot is comprised of 26 individual bones, 20 intrinsic muscles (located on the foot), 11 extrinsic muscles (located on the lower leg but operate the foot), 33 joints, over 114 ligaments, and two pea-sized sesamoid bones, you probably don’t give your feet much thought… until they start to hurt. The foot is an extraordinarily complex and rugged structure, perfectly designed to keep you upright and mobile. Let’s take a closer look at the anatomy behind the foot.

Bones

The foot is subdivided into three sections:

Hindfoot: This area consists of 2 bones: the talus, which articulates with the tibia and fibula bones of the lower leg to form the talocrural, or ankle joint; and the calcaneus, which forms the heel of the foot and bears the brunt of your body weight.

Midfoot: The five bones of the midfoot help stabilize and support your body and form the arches of your feet.  You have 3 cuneiform bones (medial, intermediate, lateral), a navicular and cuboid bone.

Forefoot:  The forefoot is comprised on 19 bones. There are 5 long metatarsal bones which attach to the five toes. Each toe consists of 3 phalanges except for the big toe, which only contains two.  That’s a total of 14 phalanges or smaller bones in your toes alone.

The Three Arches

The foot consists of three distinct arches: the medial and lateral longitudinal arches, and the transverse arch.

The medial longitudinal arch is the highest and most prominent of the arches. It extends from the heel on the inner part of the foot to the ball of the foot along the first three metatarsals.

The lateral longitudinal arch is relatively less pronounced and closer to the ground than its medial counterpart. It runs from the heel on the outer part of the foot along the 4th and 5th metatarsals.

The transverse arch runs across the metatarsal heads along the ball of the foot.

Together, these three arches form the shape of your foot and determine to a large extent how your weight is distributed across its surface.

Ligaments

The arches of the feet are formed and supported by the smaller intrinsic muscles as well as its numerous ligaments. Ligaments are tough bands of tissue that attach bone to bone and provide stability and protection to the area. Of the hundreds of ligaments found in the foot, there are a few which are of particular importance.

The Deltoid ligament: (also known as the medial ligament) This ligament originates on the medial malleolus (the large knob on the inner part of the ankle) and fans out to attach itself to the calcaneus, talus and navicular bones. The deltoid ligament is actually comprised of several ligaments designed to protect the inner part of the ankle from undue medial stress.

The Spring ligament: (also known as the calcaneo-navicular ligament) This ligament is located on the inner side of the foot and attaches the calcaneous to the navicular. This tiny little ligament is crucial in maintaining the medial longitudinal arch of the foot.

The Collateral ligament: (also know as the lateral ligament) This ligament, found on the outer part of the ankle, is also comprised of several ligaments. The purpose of this ligament is to protect the outer part of your ankle from undue lateral stress.

The Calcaneo-cuboid ligament: This tough band of tissue attaches the cuboid bone to your calcaneous on the outer part of the foot. This ligament plays a role in supporting the lateral longitudinal arch of the foot.

Ankle Sprains: A sprain is an injury to a ligament and its surrounding structure. You may have also heard of strains. A strain is an injury to a tendon (and/or its muscle), which attaches muscle to bone. There are two common forms of ankle sprains: Inversion and eversion sprains. Let’s start with the most common.

Inversion Sprains: 90 percent of all ankle sprains are inversion sprains. An inversion sprain occurs when the tendons and ligaments of the outer ankle are over-stretched. This usually occurs when the ankle rolls down and inward. In inversion sprains, the most commonly affected ligaments are the anterior talofibular and calcaneofibular ligaments of the collateral ligament and the calcaneo-cuboid ligament. Pain and swelling may occur along the outer ankle.

Eversion Sprains: Although eversion sprains are less common, they tend to be more serious. An eversion sprain occurs when the ankle rolls up and outward. Commonly affected tendons are the deltoid and spring ligaments. Pain and swelling typically occurs over the inner ankle and top of the foot.

In the second part of Anatomy of the Foot, we’ll discuss the various muscles and tendons that operate the foot and some of the conditions that can affect them.


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.

Nowadays the amount of stimuli and stressors we have to contend with in our day to day lives can be overwhelming. When you consider the fact that over 80% of all disease and illness is stress related, it becomes clear how crucial lowering stress levels can be.

It’s important first of all to make a distinction between ‘good’ stressors, which can be useful and productive, and ‘bad’ stressors, which can be harmful and destructive. A certain amount of tension in the body is necessary to prepare us for life’s challenges. Exercise is an example of a ‘good’ stressor. As long as we can manage the stressor, then it can have a positive effect on our lives. When the stressor becomes chronic or overwhelming however, then it can have the opposite effect.

Hans Selye first made popular the idea of a ‘General Adaptation Syndrome’ or ‘G.A.S.’ in his book, “The Stress of Life.” In it he describes the three stages we go through during a stress response. The first stage is the ‘alarm stage.’  It is here that the body’s ‘flight or flight’ response kicks in via the sympathetic nervous system. Under stress, the body prepares itself to take action by contracting muscles, dilating pupils, elevating glucose and oxygen levels, increasing circulation, and diverting energy stores away from low priority areas, such as the digestive and urinary systems. During the alarm stage, the hypothalamus releases two important neurotransmitters that make these changes possible: epinephrine and norepinephrine.

The second stage is known as the ‘resistance stage’ or adaptation response. During this phase, the body continues to fight off the stressor long after the alarm stage has passed. With the help of the hypothalamus, the pituitary and adrenal glands release cortisol and other corticosteroids into your system. These hormones help to increase blood pressure, cardiac output and gastric secretions by elevating the body’s blood sugar levels. Cortisol has an anti-inflammatory effect but it can also suppress the immune system in varying degrees.

The third and final stage is known as the ‘exhaustion stage.’ Exposure to long-term stress can have damaging effects on the body. If the stress response does not abate, cortisol levels can accumulate in the body and eventually start to weaken the heart, kidneys, adrenals, and blood vessels. The prolonged presence of cortisol can also inhibit the formation of new bone and lead to muscle wasting. It is during this time that the body becomes vulnerable to stress related disorders. Here are a few common stress related disorders:

– Asthma

– Irritable Bowel Syndrome

– Constipation

– Insomnia

– Rheumatoid arthritis

– Gastritis or Ulcers

– Hypertension

– Autoimmune disease

– Ulcerative Colitis

– Eczema

– Depression

– Coronary disease

– Crohn’s disease

– Psoriasis

– Headaches

– Stroke

So how does one maintain a normal and healthy stress response and prevent these conditions from taking hold? The key lies in a preventative care approach to health. Preventative care can take many forms, such as:

– Regular exercise

– A well balanced diet

– Meditation

– Rest & relaxation

– Adequate sleep

– Psychotherapy

– Massage

– Yoga

All these are positive ways in which we can cope with the stresses of our everyday lives. A preventative care approach to health helps create an awareness of our mental and physical well being. It brings balance into our otherwise busy lives.  When we’re in touch with how our bodies feel, we’re better able to detect when something is off or doesn’t feel quite right. This awareness is key. The quicker you can catch something, the quicker you can prevent it from taking hold.


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.

Zone therapy is often considered the foundation for the theoretical and practical application of reflexology. In the late 1800’s, an English neurologist by the name of Sir Henry Head discovered through a series of experiments that there was a link between a diseased organ and specific areas of skin on the body. These areas often displayed a heightened sensitivity to pressure and touch that other areas did not. Twenty to thirty years later, an American doctor by the name of Dr. William Fitzgerald would take these findings and refine them into the practice of zone therapy used by reflexologists today.

Fitzgerald discovered that there were ten longitudinal zones on the feet and hands, which ran the length of the body. Five zones on either side of the body, with each zone corresponding to a section of the foot and hand that lead up to each toe and finger. See the diagram below. By applying pressure to these zones, Fitzgerald was able to create and observe an anesthetic effect in that part of the body. He became so adept at doing this, that he was able to perform small surgeries using his techniques.

zone therapy

Over the years reflexology has evolved into a finer application of these findings, but the underpinning of it has always been zone therapy. The practical application of zone therapy in a reflexology session can serve several purposes. If an area of the foot displays a heightened sensitivity to pressure, zone therapy can be used as a diagnostic tool for the organs and systems in that region of the body. Someone who is prone to chronic neck and shoulder tension for example may find that the toes, base of the big toe, and 5th metatarsal joint (pinky toe joint) are particularly sensitive. The good news is that applying systematic pressure to these zones will create an analgesic effect in the part of the body, essentially reducing tension and pain levels.

In addition, visual cues can provide a wealth of valuable information for what’s occurring in an area of the body. Bunions, calluses, and dry skin are just a few examples of these cues, which could ultimately signify a longstanding condition in a particular part of the body. The use of zone therapy can therefore help reflexologists ‘zone’ in on specific reflexes that may need extra attention. Having an open dialogue between the therapist and the client is also an integral part of the therapy. The simple reason fort this is that reflexology, or any form of bodywork for that matter, does not have to be painful experience to be effective. Research has shown that touch alone helps to release a flood of endorphins which the body uses to relieve pain. Staying within an individual’s pain threshold helps to relax the body while still creating the desired effect. The feet truly are mirrors of the body. And if we listen to them carefully and treat them accordingly, the health benefits could be immeasurable.


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 5th and final post on the major muscle groups of the body, we’ll discuss muscles of the lower leg, the back of the thigh, and hip.

The lower leg can be divided into three compartments, the anterior (front), lateral (side), and posterior (back). There are a total of eleven muscles in the lower leg, all of which operate the foot. These muscles are referred to as extrinsic muscles, while the muscle located on the foot itself are referred to as intrinsic muscles. There are three in the front, three on the side, and five in the back. We’ll focus on two of theses muscles, which form the superficial layers of the calf.

Gastrocnemius: Located just below the back of the knee, the two bellies of the Gastrocnemius are what give the calf muscles their contoured shape. They descend about half way down the lower leg and are easily the most superficial and accessible muscle of the lower leg. Due to the fact that Gastrocnemius crosses both the knee and ankle joint, it can just as effectively flex the knee as it can plantarflex the foot. The lower portion of the muscle blends with another lower leg muscle known as Soleus to form the Achilles tendon. The Gastrocnemius is a powerful muscle capable of lifting your entire body weight, making it most active when running or jumping.

Gastrocnemius Soleus

Soleus: Sometimes referred to as the body’s “second heart”, the Soleus muscle plays a very prominent role in pumping blood back to heart. The upper portion of the muscle is buried beneath the superficial bellies of the Gastrocnemius, but its lower half is easily accessible and palpable. Although Soleus does not cross the knee joint, it does blend with Gastrocnemius to form the Achilles tendon. The main function of this muscle is to plantarflex the foot. Unlike the Gastrocnemius, which is known for its short bursts of power, the Soleus is a workhorse muscle, essentially working anytime you’re on your feet.

Hamstrings: The hamstrings as they’re commonly referred to, are the major muscle group found in the back of the upper leg and thigh. There are three distinct and individually named muscles, which surprisingly occupy less space at the back of the leg than one would imagine. The lateral portion of the Quadriceps and the medial Adductors fill in a big portion of the posterior thigh. Yet these three slender muscles are capable of performing several actions that affect the hip and knee in variety of ways.

Hamstrings

  1. Biceps Femoris: The most lateral of the hamstrings, Biceps Femoris has two distinct bellies. One belly originates at the sitz bones and the other shorter head, starts half way down the femur. Both heads then blend together to form a common tendon, which crosses the knee joint to attach on the fibula. This portion of the hamstrings can: flex the knee, laterally rotate the knee (when flexed), extend the hip, laterally rotate the hip, and tilt the pelvis posteriorly.
  1. Semitendinosus & Semimembranosus: The only major difference between these two muscles, which happen to form the medial hamstrings, are their insertion points. They both originate on the sitz bone and they both perform the exact same functions. Semitendinosus overlies the deeper Semimembranosus, but they both cross the knee joint. Instead of blending together to form on common tendon and one insertion point, they each maintain their tendon and attach at slightly different points on the tibia. The Semis can: flex the knee, medially rotate the knee (when flexed), extend the hip, medially rotate the hip, and tilt the pelvis posteriorly.

Moving up the leg and into the hip, we come to an area with many layers of muscle collectively referred to as the ‘glutes’. There is of course Gluteus maximus, which is the most superficial layer of the glutes and one that we’re all familiar with. Beneath this muscle however, lie two other muscles named “gluteus”: Gluteus medius and Gluteus minimus. Both these muscles are key players in moving as well as stabilizing the hip. Then we have the deep six’ lateral rotators – a grouping of six slender muscles that fan out around the head of the femur in the hip socket. As the name implies, they laterally rotate or roll the leg and hip out. One of these lateral rotators is called Piriformis.

Piriformis: If you’ve ever had sciatica or experienced sciatica-like pain, then you’ve probably heard of the Piriformis. The reason for this is that, out of the deep six lateral rotators, the Piriformis is the only one the runs directly over the sciatic nerve. The other five lie beneath it. If for some reason the Piriformis becomes strained or inflamed from overuse or trauma, that extra bit tension could compress the sciatic nerve causing an entrapment.

The Piriformis muscle originates on the sacrum and attaches to a part of the femur called the greater trochanter. As mentioned, it’s a strong lateral rotator of the hip and leg. When the leg is stationary, it can also rotate the body to the opposite side. For that reason, an activity or sport that involves quick cutting or twisting movements could potentially cause trouble for the Piriformis.

Piriformis

Iliotibial Band: Although technically not a muscle, this thick band of fascia covers the outer part of the hip and thigh and serves as central tendon for two muscles: Gluteus maximus and a muscle called Tensor Fascia Lata (TFL). The vertical fibers of the IT band originate and are an extension of both these hip muscles. This thick tendon like structure runs the length of the outer leg and inserts just below the knee on the tibia. The IT band essentially transmits the power of the Gluteus maximus and TFL to help move the hip and leg. More importantly, the IT band helps to stabilize the hip and knee when standing, walking, and running.

IT Band


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.

This month we’ll continue on with another set of important muscles located in the front of the body.

Abdominals: Nowadays so much focus is placed on strengthening our core and sculpting those “washboard abs”. The advantage of having a well toned midsection however goes much deeper than that sought after look. Stronger abdominals will mean better support for the spine and back, which can in turn lead to a better overall posture.

The abdominals are comprised of four individual pairs of layered muscle. They work together to help flex, twist, and side bend the torso.

  1. Rectus Abdominis: The most central and superficial layer of the abdominals. Rectus Admoninis runs vertically down the mid section. Its segmented muscle fibers are what give you the washboard look. It originates on the pubic bone and attaches below the sternum to the 5th-7th ribs.
  1. External Oblique: The next layer beneath Rectus Abdominis is the External Oblique. Originating along the side of the torso and the lower eight ribs, it runs down at an angle to attach to the front the pelvic bone. The External Oblique, unlike Rectus Abdominis, is a broad and flat segment of the abdominals.
  1. Internal Oblique: This thin segment lies deep and perpendicular to the External Oblique. It originates along the front of the pelvic bone and attaches to the lower three ribs and its surrounding fascia.
  1. Transverse Abdominis: As the deepest layer of the abdominals, the Transverse Abdominis runs horizontally across the midsection. It originates along part of the hip bone, the lower six ribs, and surrounding fascia to attach along the midsection line known as the Linea Alba.

Rectus Abdominis        External Oblique    Internal Oblique      Transverse Abdominis

Rectus AbdominisExternal ObliqueInternal ObliqueTransverse Abdominis

This unique criss-crossing configuration provides plenty of support for the spine and the organs of the abdominal cavity. The abdominals are instrumental in both normal and forced exhalation and provide plenty of exerting power in actions such as vomiting, defecation, and urination.

Quadratus Lumborum: Often referred to as the Q.L., this muscle is considered by many to be a low back muscle when in reality it’s one of the deepest muscles in the abdomen. The muscle originates along the back of the hip bone and attaches itself to four of the five lumbar vertebrae and the 12th rib. Q.L. is also known as a “hip hiker” muscle for its ability to lift or tilt the pelvis side to side. Its other actions include extension of the spine, and aiding in forced exhalation.

Psoas & QL

Psoas: This deep hip flexor muscle is often referred to as the Iliopsoas. The reason for this, is that part of its muscle fibers blend with another muscle that lines the inner side of the pelvic bone called Iliacus. Since both perform virtually the same function, they’re often referred to together.

The Psoas lies deep to the viscera of the abdomen. It originates along the lumbar spine and travels down to the pelvis where it blends with Iliacus. From there the two muscles descend past the groin to attach on the inner part of the femur.

The main actions of the Psoas are to flex the hip, laterally rotate the hip (turn leg outward), and adduct the hip (bring leg in, closer to the body). It also helps to raise the upper body into a seated position when lying down. The Psoas is a major player in stabilizing the hips and the low back and is an often an overlooked cause of low back pain when trigger points are involved. If you have pain or difficulty standing up straight, the Psoas may be to blame.

Quadriceps: As the name implies, the Quadriceps are made up of four individual heads which cover the front, outer, and part of the inside of the upper leg. They’re the biggest and most powerful muscle in the human body. Their main function is knee extension. The bulgy part of the muscle that runs down the front of the thigh is known as Rectus Femoris. The other three heads are named for their position in relation to the femur. Vastus Lateralis covers the lateral or outer part of the thigh. Vastus Medialis covers the medial or inner part of the thigh. And Vastus Intermedius, the deepest layer of the Quads, lies beneath the other three heads.

QuadsVastus Intermedius

The Quad, namely Rectus Femoris, is also capable of hip flexion. Anatomically however, Rectus Femoris is the only head of the Qaud to cross the hip joint. The other three heads originate on the femur but do not actually cross the hip joint. All four heads however converge into one tendon to cross over the knee joint.


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.

Let’s move on to some of the major muscle groups found in the front of the body. In this post we’ll discuss the location and action of four muscles: Pectoralis Major, Pectoralis Minor, Biceps Brachii, and Serratus Anterior.

Pectoralis Major: The “Pecs” as they’re collectively known are the large, broad muscle of the chest. Its muscle fibers are divided into three segments: upper (clavicular), middle (sternal), and lower (costal). All three segments help to: adduct the shoulder, medially rotate the shoulder, and aid in forced inhalation by lifting up the ribcage. Its upper and lower segments however are capable of performing opposing actions. The upper fibers can flex and horizontally adduct the shoulder, while the lower fibers can extend the shoulder.

When the Pecs are tight they can create a whole host of undesirable side effects. Tight Pec muscles can pull the shoulders forward putting the muscles of the upper back on a perpetual stretch. This can lead to a rounded shoulder posture and can force the head and neck to pitch forward, creating a further postural imbalance. This upper crossed posture has been known to compress nerves, constrict blood vessels, restrict breathing, and lead to chronic head, neck and jaw pain.

Pectoralis Minor: Underneath Pec Major lies the smaller Pec Minor muscle. This muscle originates along ribs 3-5 and converges upward to attach on a part of the scapula known as the coracoid process. As a result Pec Minor acts predominantly on the scapula. It serves to: depress the scapula – moving downward along the ribcage, abduct the scapula – moving it away from the spine, and tilt the scapula anteriorly – shifting the scapula forward. Pec Minor also assists Pec Major in forced inhalation.

A tight Pec Minor can also contribute to a rounded shoulder posture. More importantly it can constrict the major blood vessels and nerves that supply the arm due to its direct placement over them. This type of neurovascular compression can lead to shooting nerve pain, numbness and tingling, and weakness of the arm and hand.

Front of Body

Biceps Brachii: Just about everyone knows where their Biceps are. From an early age when we’re taught to “make a muscle”, we automatically flex our Biceps. And as the name implies, the Biceps consist of two muscle bellies – the long head, which is the outermost belly and the short head, which lies closest to the chest.

Both heads of the Biceps help to: flex the elbow, flex the shoulder, and supinate the forearm – that is, turn the forearm so the hand is face up. The Biceps also play a big part in stabilizing the shoulder joint. Without the biceps, the shoulder joint would not be able to maintain any significant weight without being pulled apart.

We rarely feeling pain along the Biceps themselves, but when they’re in trouble, fully extending the elbow with hand face down can be difficult and painful. Trigger points in this muscle will most often refer pain to the front of the shoulder joint and along the elbow crease.

Serratus Anterior: Although not as well known as the Biceps, Serratus Anterior is often very well developed in superheroes. Yes, superheroes! Located just below the armpit along the side of the ribs, its serrated ends are distinctly outlined in some of our most beloved action heroes. One end of the muscle attaches to the underside of the scapula, while the other end attaches to the upper nine ribs. It’s this small portion of the muscle which is actually visible, most of it lies hidden beneath the scapula, the Lats, and Pec Major.

Serratus

Despite its placement, Serratus Anterior is a shoulder muscle. It serves to abduct and depress the scapula. It also helps to stabilize the scapula and aid in forced inhalation. Runners may be familiar with the all too common “side stitch” pain, which can result from a spasming of this muscle.


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 the last post we covered four key, well-known, yet superficial muscles of the back and arms. In this post, we’ll delve a little deeper into the musculature to discuss four other key muscle/muscle groups which lie deeper to these muscles.

Erector Spinae: You may not know them by name, yet they are one of the most distinguishable muscle groups of the back. Located on either side of the spine, the Erectors are a densely layered group of muscles that run from the hip bone to the back of the head. Their mound shape appearance creates a natural trough between the spine and the closest of their muscle fibers. You can see a segment of them on the right side of the back where the superficial muscles have been reflected in the image below. Although they are partially hidden beneath the Trapezius and the Lats, they are still considered a superficial muscle group because there is yet another layer of spinal muscles beneath them!

There are three layers to the Erector Spinae (not distinguishable in the image below):

Spinalis, Longissimus and Iliocostalis — the former being closest to the spine and the latter being farthest away. As a whole, the Erectors are a postural muscle group helping to keep your spine erect and providing balance for the upper body. Their main function is to laterally flex the spine to either side and extend the back bilaterally. They’re also involved to some extent in actions involving forced exhalation, such as coughing and sneezing.

Rotator Cuff Muscles: There are four individually named muscles that comprise the rotator cuff muscles. Each one originates and covers an area of the scapula and attaches to the very top of the Humerus in the shoulder joint. Each muscle performs its own action, which helps to mobilize the shoulder and arm. The three visible rotators in the image below are: Supraspinatus, Infraspinatus and Teres Minor. The fourth rotator cuff, Subscapularis, is located on the front side of the scapula and is therefore not visible.

1. Supraspinatus: Hidden beneath the upper fibers of the Trapezius, Supraspinatus helps to abduct the shoulder and stabilize the shoulder joint.

2. Infraspinatus: Below Supraspinatus and partially hidden beneath the lower fibers of the Trapezius, is Infraspinatus. This muscle is capable of performing several actions.

  • Lateral rotation of the shoulder
  • Adduction of the shoulder
  • Extension of the shoulder
  • Horizontal adduction of the shoulder
  • Stabilizer of the shoulder joint

That’s quite a workload for one muscle. Its key action however is lateral or outward rotation of the shoulder. Without this action, you would not be able to raise your arm above your head!

3. Teres Minor: Although similar in name and in close proximity to Teres Major, Teres Minor is a complete synergist to Infraspinatus. That is, it basically assists Infraspinatus in all its actions.

4. Subscapularis: This last rotator cuff muscle covers the front side of the scapula. Due to its placement, only a small portion of the muscle is truly accessible and palpable along its lateral border. This muscle is an antagonist to Infraspinatus. It medially rotates the shoulder and stabilizes the shoulder joint.

Back Muscles

Rhomboids: Located between the medial border of the scapula and the upper thoracic vertebrae are the Rhomboids. Named for their geometric shape, they are segmented into major and minor fibers but perform the same actions.

  • Adduction of the scapula (moving it closer to the spine)
  • Elevation of the scapula
  • Downward rotation of the scapula
  • Stabilizer of the scapula

Actions that require moving the shoulder and arm back behind the body, such as throwing a ball or rowing a boat, can easily over tax these muscles. The military stance with the spine erect, chest forward, and the shoulders back, require the Rhomboids to fully engage.

Levator Scapula: This next key muscle originates on the side of the cervical spine and twists its way down to attach itself on the upper portion of the scapula. Levator Scapula is mostly hidden under other muscles but is easily palpable and accessible. You may not have heard of this muscle by name, but when it spasms it will prevent you from turning your head to the side. This is another muscle which is capable of performing several actions.

  • Elevation of the scapula
  • Downward rotation of the scapula
  • Lateral flexion of the head/neck
  • Rotation of the head/neck to the same side

 As a pair they help to extend the head and neck back. This is one of those muscles that can be easily over taxed and cause a lot of issues for many people. It’s most vulnerable action is elevation of the scapula. People who are prone to anxiety, emotional distress, or high levels of stress may find their shoulders held up high, forcing this muscle to be in a perpetual state of contraction. Other factors such as poor postural habits, side sleeping without proper support, craning the head and neck, or even heavy backpacks can all cause trouble for this muscle.


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.

We have close to 320 pairs of muscles in the human body. That means we have a staggering 640 named muscles in total throughout the body! Up until the 18th century however, muscles were not given a nomenclature but assigned a number as a way of identifying them. Two anatomists by the name of William Cowper and James Douglas are credited for changing this.

Some muscles are better known within the context of a group, such as: the rotator cuff muscles, the hamstrings, and the quadriceps. But in fact, each of these muscle groups contain four individually named muscles. While it’s not important to know every named muscle in the body, there are key muscles and muscle groups that everyone should be familiar with. The first part of this article will focus on four of the key muscles depicted in the diagram. We’ll cover these superficial and easily accessible muscles first before delving into the slightly deeper layers of muscle beneath them in part two.

Back Muscles

Trapezius: One of the most superficial of the upper back muscles. The “traps” as they’re often referred to are a flat, shawl-like muscle that cover the back of the neck, tops of the shoulders, and middle of the back. When you place your hands on top of someone’s shoulders to give them your best shoulder rub, you’re predominantly grasping the upper fibers of the trapezius. The word “trapezius” is Greek for “small table,” which reflects its four-cornered shape (the right trapezius in the diagram has been removed to show the deeper layers). The muscle is segmented into upper, middle and lower fibers, each capable of performing several actions. All segments of the muscle perform retraction of the shoulders as their main function.

The upper fibers perform:

  1. extension of the head and neck
  2. lateral flexion of the head to the same side
  3. rotation of the head and neck to the opposite side
  4. elevation of the scapula
  5. upward rotation of the scapula/arms

The middle fibers perform:

  1. stabilization of the scapula

The lower fibers perform:

  1. depression of the scapula
  2. upward rotation of the scapula/arms

The upper traps play a big role in supporting the weight of the head and neck during all its movements. So poor postural habits that keep the head and neck pitched forward can greatly over-tax these muscles. The middle traps are strong stabilizers of the scapula when we have our arms out in front of us.

Deltoid: Much like the trapezius, the deltoids are also a segmented muscle which cover the outer shoulder like a cap. The name comes from the Greek letter “delta” which resembles the shape of a triangle. The deltoids have an anterior, lateral, and posterior set of fibers. It’s for this reason that they’re usually referred to in the plural form, “deltoids.” Also like the traps, each segment is capable of several actions. All fibers, especially the lateral fibers, perform abduction (moving the arm up and away from the body) as their main function.

The anterior fibers perform:

  1. flexion of the shoulder
  2. medial rotation of the shoulder (moving the arm into the “handcuff” position)
  3. horizontal adduction of the shoulder (with the arm out in front, moving the arm across the front of the body to the opposite side)

The posterior fibers perform:

  1. extension of the shoulder
  2. lateral rotation of the shoulder (with the elbow bent, moving the arm into a “stop sign” position)
  3. horizontal abduction of the shoulder (with arm out in front, moving the arm away from the body)

Triceps Brachii: As the name implies, the triceps have three individual heads: long, medial & lateral. Each of these heads originate on a different part of the arm but ultimately converge into a thick tendon at the elbow. Since they’re the only muscle found at the back of the upper arm, they’re the muscle solely responsible for straightening out the elbow (extension). The head closest to the body, the long head, is also capable of extending the arm back and moving it in close to the body (adduction).

Latissimus Dorsi: The “Lats” as they’re commonly referred to are the broadest of the back muscles. Their name translates into “broad back muscle.” In bodybuilders, well-developed Lats will give the trunk a “V” shaped appearance. Considered a superficial and easily accessible muscle, the Lats originate along the low back, then fan upwards along the sides of the trunk where they insert into the upper arm. Surprisingly, the Lats do more to move the arm than they do the back. Their main functions include:

  1. extension of the arm/shoulder
  2. adduction of the arm/shoulder
  3. medial rotation of the arm/shoulder

Another muscle worth noting along with the Lats is muscle called Teres Major. The muscle originates along the outside of the scapula and then blends in with the Lats to attach at the same point. Teres Major which translates into “big, round muscle” is often referred to as “Lat’s little helper,” as it’s a complete synergist with the Lats — that is, it performs the exact same movements. Although the Lats do perform one vital function, which Teres Major does not: forced exhalation. Due to its placement, its broad muscle fibers can compress the trunk to aide in quick respiration. The best way to remember their collective actions however is to think of them as the “handcuff muscles.” In order to get your arms behind your back as if to be arrested, both the Lats and Teres Major must contract.


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.

The idea that one can relieve chronic muscle pain in less then two minutes seems almost too good to be true. The technique known as “strain/counterstrain” (SCS) was originally developed by an osteopath by the name of Lawrence H. Jones, DO. Often referred to as “spontaneous release by positioning,” “positional release therapy,” or “fold and hold,” its effectiveness is based on a surprisingly simple idea… move in the direction of ease.

The story goes, a client of Dr. Jones had come to him with a case of acute back pain. The pain was so severe that it prevented him from standing up straight and made sleeping nearly impossible. After having gone through two chiropractors, various remedies and still no success, Dr. Jones decided to work with him. Eight weeks worth of treatments later, there had been very little progress and the client was still in pain! One day, frustrated and tired from a lack of sleep, the client merely asked the doctor to help him find a comfortable resting position so he could lie there and sleep for a few minutes. For twenty minutes Dr. Jones moved him into various positions, checking and re-checking, until they found an optimal position that provided the most relief. He stepped out for the remainder of the session and upon his return, found his client standing fully erect and pain free! Somehow his patient had been miraculously cured. But how exactly? What Dr. Jones hadn’t fully realized yet was that he had inadvertently stumbled upon the secret behind the neuromuscular technique he came to call “strain/counterstrain.”

The technique works with the body’s own self-correcting reflexes to help relieve pain and discomfort. Sometimes a reflex, for all intents and purposes, can get caught in a loop. When this happens the body mistakenly perceives a stimulus as a threat and continuously engages the self-correcting reflex, which in turn perpetuates the problem. The body is trying to right itself, but unsuccessfully. We probably never give this any thought but whenever we contract a muscle, its opposing muscle must relax and lengthen in order for movement to happen. This is what’s known as “reciprocal inhibition,” and it happens all the time.

Whenever we flex our biceps, the triceps must relax so that our elbow can move. If the triceps were to lock up and spasm, movement would not be possible. Protective muscle spasms can occur when an opposing muscle is quickly and suddenly over-lengthened. As a result, a reflexive contraction occurs due to tiny propioceptive neurons located in the belly of a muscle known as “muscle spindle organs.” These MSOs are designed to detect changes in muscle length and contract as a means of protection. Once the threat has passed, the reflex should reset itself. On occasion however a reflexive contraction can be misperceived by the sympathetic nervous system as a continuous threat. The nervous system gets thrown off and maintains an elevated level of tone in the muscle. This maladaptive spasm is often very painful and only adds to the perceived threat. If the contraction becomes chronic, the muscle may be duped into thinking this new shortened state is its actual neutral position. And the cycle continues.

SCS can break this reflexive cycle and help reset MSO activity. How? By moving in the direction of ease. SCS does not involve any forceful movements, cracking or popping of joints, or painful stretches. These techniques only provide temporary relief at best and do not address the underlying cause of the problem. When you slacken a spastic muscle and allow it to relax for approximately 90seconds, you minimize the stimulation, which is actually triggering the reflexive contraction. The sympathetic nervous system in turn will perceive this new, comfortable position as non-threatening and allow the muscle to soften. Then when the muscle is moved back into its original resting length, a re-education of the MSOs takes place and the reflexive contraction is broken.

SCS is safe, gentle and always about moving into greater comfort. Although there are self-care techniques we can do on ourselves, the technique is most effective when done passively by a practitioner. There are several reasons for this. First, whenever we move our bodies into different positions we are contracting muscles in order to do this. It’s this constant contraction of muscle however that often perpetuates the protective spasm. Allowing someone to move us passively makes it that much easier for us to relax into these slackened positions. Being touched also has the added benefit of releasing endorphins, which act as powerful pain blockers.

There are four essential steps in performing SCS:

1) Find a tender/painful spot: Often times it’s these overly sensitive and hypertonic spots where the reflexive contraction is occurring. It’s important to locate these painful points and monitor their sensitivity as you perform SCS.

2) Fold the body over the tender spot: The next step is to maximally slacken the muscle involved. If you already know how to stretch key muscle groups, then moving in the opposite direction will essentially slacken the muscle.

Let’s consider the biceps again. To effectively stretch the biceps, you must a) rotate your forearm so your palm is face down, b) extend your elbow fully, and c) extend the shoulder back by extending the whole arm behind you. This creates a maximum stretch for the biceps. So to slacken the biceps, you take everything in the opposite direction. And this is where the importance of having someone perform these movements for you becomes obvious. For to do it ourselves, requires muscle contraction – the opposite of what we want. Consider these next steps for slackening the biceps as though you were performing them on someone else a) rotate the forearm so the palm is face up, b) flex the biceps by folding the elbow, and c) flex the shoulder by moving the upper arm to the head. This will maximally slacken the biceps.

So what do we do if we’re not sure what precise movements will maximally slacken a muscle (this will probably be the case in most instances)? From here we need to think of creating a cave around the tender spot. If you bring the two ends of a taut piece of rope together, the rope will slacken. The same holds true for muscles. Move the ends of the surrounding tender spot as close together as possible.

3) Hold the position for at least 90 seconds: Once you’ve maximally slackened the muscle with the tender spot, the next step it to hold this position for at least 90 seconds or until you feel the muscle soften. Having a finger or two on the tender spot will allow you to feel when the tension has decreased. This can take as little as 90 seconds or in some cases, a few minutes. The position being held should be relaxing and comfortable in order for this to happen. Doing this allows those propioceptive neurons (MSOs) to recalibrate themselves to this new, non-threatening position. One should also start to notice the decreased sensitivity of the tender spot.

4) Release slowly, back to a neutral position: This next step is critical and often overlooked. This is where the re-education in the sympathetic nervous system takes place. The once shortened and painful muscle has now softened and slipped back into place. The stimulus perpetuating the maladaptive reflex has ceased and the cycle is broken. Some gentle rocking or jostling by the practitioner will help to “remind” the body of its true resting position.

There is a whole school of thought dedicated to this unique form of neuromuscular bodywork. Position Release Therapy uses the concepts behind SCS and works with the body’s inherent self-correcting reflexes to help relieve muscle pain. If you’re interested in experiencing the effects of this relaxing yet effective technique in your next massage, ask for it by name.


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.

How does one know they’re getting a reflexology session and not just a foot massage?

In some cases it can be quite obvious. Even if you’ve never experienced a professional reflexology session before, if you’re getting the same three techniques for the entirety of your treatment, chances are you’re just getting a foot rub. And although there is some overlap with massage, a reflexology session typically includes a fair amount of detailed work aimed at targeting the ‘reflexes’ on the feet. This is usually done with a technique called ‘thumb walking.’ Reflexologists use their thumbs to outline and work along specific areas of the body represented on the feet via their reflexes.

One of the first things you should inquire about is the therapist’s qualifications. Are they ARCB certified? The American Reflexology Certification Board (ARCB) is the national governing board that oversees the certification of professional reflexologists. Although massage therapists are qualified to do reflexology, the training in most massage therapy programs is limited in scope and practice. The ARCB requires an additional 200 hours of training in order to become a nationally certified reflexologist.

Since one of the aims in a reflexology session is to target specific areas of the body via their reflex zones, your therapist should speak with you before your session to determine which areas are in need of attention. Just about every part of the foot corresponds to a specific organ, gland or body part. And in most cases the reflex zone is very much a circumscribed area on the foot. For example, if you’re having digestive issues and need specific work along your descending colon reflex, the corresponding reflex is about 1” – 1.5” on lateral aspect along the bottom of your left foot. Or if you’re having sinus congestion and could benefit from having those reflexes worked on, the toes should be given particular attention during the course of your treatment.

Of course it always helps to have a rudimentary understanding of the reflexes and where they are located on the feet. But even if you don’t know or are uncertain, ask your therapist. A knowledgeable therapist won’t hesitate to answer your questions and help provide you with a safe and effective reflexology treatment.


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.

What is considered good posture? According to the Physical Therapy Dictionary, good posture is defined as “the state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which the structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded the thoracic and abdominal organs.” By contrast, the American Academy of Orthopedic Surgeons defines poor posture as “a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.”

To better understand the implications of this, let us consider how the position of the head can have an effect on the muscles of the neck and shoulders. The average human head is said to weigh approximately 10-11lbs. When it rests squarely upon the neck and shoulders, the weight is translated down the spine placing little to no strain on the muscles of the head and neck. According to physiatrist Rene Cailliet, MD, the weight of the head is effectively increased by a factor of ten for every inch of displacement. If your head pitches forward by 2 inches for example, you’re essentially adding an extra 20lbs of pressure to the surrounding structures! Doing so places the muscles of the neck and shoulders under tremendous strain. Research has shown that faulty postures can lead to bone and soft tissue changes, which in turn can create a whole host of other issues — such as chronic neck & shoulder tension and headaches.

The spine is made up of 33 individual vertebrae. Nine of these vertebrae fuse together through a process known as ossification by the time we reach adulthood – 5 in the Sacrum (S1-S5), and 4 (sometimes 3-5) in the Coccyx or tailbone. That leaves 24 moveable vertebrae: 5 – cervical, 12 – thoracic, and 5 –lumbar. The spine has what is known as primary and secondary curves. Primary curves are the curves in the spine that we’re born with; namely the thoracic and sacral curves. These curves are formed in the developing fetus and are structural in nature. Secondary curves on the other hand are formed in response to muscle strengthening and develop a little bit later. The cervical curve for example takes shape as the newborn learns to lift his/her head. The lumbar curve develops after this as the child begins to sit up. Because of the nature of secondary curves, they are more susceptible to being over and underdeveloped, and as a result can lead to faulty postures. Let’s take a look at some examples.

The first image in the diagram below depicts what is considered “good posture.” The plum line suspended along side the lateral view of the body serves a reference point for the head, shoulders, hips and feet. As you can see in the first image, the head sits squarely on the shoulders so that the ear is in front of the line. The shoulders are then evenly aligned with the plum line so that they don’t round too far back or too far forward. Make note of the gentle curves in the spine in relation to the faulty postures. When we get down to the hips, we see a natural tilt that is approximately 30 degrees. This is considered normal. An anterior pelvic tilt will show an increase of more than 30 degrees and posterior pelvic tilt will show a decrease of less than 30 degrees. As the line continues down to the feet, we can see that the anklebone sits just behind the plum line.

Faulty Postures

As we move on to the various types of faulty postures, we must first consider the degrees to which these deformities take shape. There are three classifications of postural deformities.

1st degree deformities: Also known as postural or functional deformities. These variations in posture are a result of muscle imbalances. There are no structural or boney changes and the person can self correct.

2nd degree deformities: Also known as transitional deformities. These are also due to muscle imbalances formed from soft tissue contractures. There are no structural or boney changes, but because these have become so entrenched, the person cannot self correct.

3rd degree deformities: These deformities are structural in nature. There are definite boney changes, which are congenital in nature or born out of degenerative changes. A person cannot self correct.

Faulty Postures

A) Here we see a relaxed faulty posture. Notice the increased angle of the pelvis. This is considered a 1st degree deformity and through strengthening of key muscle groups and postural re-education, this type of posture can be corrected.

B) A kyphosis is the result of an exaggerated, posterior curve of the thoracic spine. There are two different types:

  1. Kyphosis Arcuata: This considered a 1st degree deformity. Both the shoulders and the upper back are rounded forward. The front of the shoulders are rolled inward and the head and neck pitched forward. Poor postural habits as well as psychogenic causes (i.e. emotional and psychological) can lead to this muscle imbalance of the upper body.
  2. Kyphosis Angularis: This is considered a 3rd degree deformity. Also known as a “hunchback” deformity. This exaggerated posterior curve of the thoracic spine is often caused by osteoporosis or Pott’s disease – a tuberculosis of the spine.

The counterpart to a kyphosis is a lordosis. A lordosis is an increased or exaggerated anterior curve of the lumbar spine. This means that the forward tilt of the pelvis is greater than 30 degrees. This is considered in most cases a 1st degree deformity. Some common causes could include obesity, pregnancy, or some form of muscle imbalance due to poor postural habits.

C) A sway back posture occurs when the angle of the pelvis is greater than 30 degrees and there is a forward shift of the pelvis, forcing the hip joint into hyperextension. As a result, a long kyphosis of the thoracic and upper lumbar spine develops. Considered a 1st degree deformity, this posture is usually the result of a muscle imbalance due to poor postural habits.

D) A flat back is the result of a posterior pelvic tilt (less than 30 degrees) which flattens out the normal curve of the lumbar spine. If not addressed properly this first-degree deformity, caused by a muscle imbalance and poor postural habits, can lead to a flattening of the thoracic spine.

E) A round back posture can either be a result of a kyphosis arcuata or a kyphosis angularis. In this representation, a flat back in the lumbar spine accompanies a kyphosis of the upper back. The angle of the pelvis is less than 30 degrees creating a roundness to the back. Notice the angle of the upper back in relation to the kyphosis represented in B. Notice also how the knees and lower legs are hyper extended.

Scoliosis: Another deformity of the spine not represented in the diagram is what’s known as a side bending or lateral curve of the spine – a scoliosis. A scoliosis can develop in the cervical, thoracic and lumbar segments of the spines. If the scoliosis occurs in only one part of the spine, it’s referred to as a “simple curve” or “C curve.” On occasion it can develop in several parts of the spine creating a “double/compound curve” or “S curve.”

There are two primary types of scoliosis. A postural scoliosis is considered a 1st degree deformity and is often the result of a muscle imbalance. An idiopathic scoliosis has no known cause, is considered a 3rd degree structural deformity, and is the most common form.

Developing good posture

For most of us, developing good postural habits can be a bit of a challenge. Some habits have become so entrenched and so much a part of who we are, that changing them will require some work. But the benefits are well worth the price.

Tight, contracted muscles have a way of restricting oxygen and nutrient rich blood flow to our cells. As a result, metabolic waste can accumulate in the tissue creating pain and imbalance. Chronically contracted muscles also burn up more energy and place an undue strain on the joints of the body. Over time these conditions can lead to illness, fatigue, and arthritis. Let’s not forget the psychological effects our posture plays in our lives. Walking around with our shoulders and our heads hanging low may initially be a way of coping with social anxiety or poor self esteem, but over time these postural habits can actually influence our state of mind. On the other hand, walking with our shoulders back and our heads held high has a way of creating and conveying confidence.

It all starts with awareness. Developing a certain amount of body awareness is crucial for any kind of change to occur. How many of us walk around stiff as a board and completely tense…without realizing it?! Check in with yourself a couple of times a day. Doing so will train your mind to catch moments of tension and contraction in the body before they set in below the level of awareness. Taking a break from the computer or office desk to get up and move around is a great way of doing this.

Exercise is the great equalizer. Whether it’s a full blown work out at the gym or a 20min walk in the park, getting your heart rate up and your body moving is a great way of breaking up stagnant energy and increasing blow flow to your muscles. And the powerful practices of yoga, tai chi, and Pilates can all help strengthen and stretch key muscle groups and create balance in our bodies.

Here are a few other tips to keep in mind.

When standing:

  • Make sure your feet are shoulder width apart
  • Keep the weight of your body on the soles of your feet
  • Keep your shoulders square with your body
  • Pull your head back and tuck in your chin
  • Stand so that your spine is erect, your head rests comfortably on your shoulders and your arms hang loosely by your side

When sitting:

  • Sit up straight with small of your back pressed up against the back of your chair (doing so will help prevent slouching)
  • Adjust the armrests on your chair so that your arms rest comfortably at an angle of 75-90 degrees
  • Both feet should rest on the floor so that your knees are bent at approx a 90 degree angle
  • If you’re in front of a computer, make sure the monitor is placed at comfortable viewing distance to prevent eye fatigue and neck strain. Avoid angles that force your head to pitch up or down or crane to the side. Using ergonomically designed keyboards and chairs are a great way to start.

With the advent of social media and mobile devices, we now have a tendency to constantly be looking down at our phones and tablets to check emails, update our facebook page, send texts and tweets, etc… This is creating unprecedented amounts of head, neck, and shoulder issues. To avoid making this potentially harmful and rudimentary mistake, always make sure to hold your device UP so that it’s at eye level. And don’t forget to breathe….


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.

Feet come in all shapes and sizes. Some have well balanced arches with minimal callusing and a healthy appearance, while others deal with chronic foot pain due flat feet, high arches, and bunions – just to name a few. While most of us fall somewhere in the middle, it’s been reported that 80% of all adults will suffer some foot disorder during the course of their lives. Heredity can be a significant predictor of your overall foot health, but so can factors such as — the types of shoes you wear, the amount of time you spend on your feet, and whether or not you’re overweight. Add to this your mental and physical health and well being, and we start to get a clearer of picture of what your feet are saying about you.

The feet are the mirrors of the body. And since every part of the body is represented on the feet via its reflex, the appearance and sensitivity of those reflexes can hold a wealth of information about our health. Calluses and corns for example, tend to develop in areas of high friction – it’s the body’s way of protecting itself by adding more cushioning. But they could also be an indication of congestion or some other imbalance in that part of the body. Where it appears and to what extent can be of significant importance.

Bunions for example, form around the first metatarsal joint, just below the big toe. It’s true that some people inherit them from their parents, but it’s equally as true that tight, uncomfortable shoes can lead to bunion formation. When we consider the area where bunions form, we have the upper thoracic spine and neck reflexes. Could our choice in footwear be contributing to upper back and neck issues…? Whether the imbalance starts in the body or whether it starts on the feet, no one can truly say. What can be said is that there appears to be a strong connection between the two.

Flat feet and high arches are other fairly common foot conditions. The relative height of your medial arches can have a significant impact on how your weight is distributed on your feet. Most people with flat feet will have their weight shifted to the insides of their feet, while people with high arches bear their weight along the outer parts of their feet. This could have an impact on your posture and the proper functioning of the spine. People with low back pain should start with a pair of comfortable shoes with good arch support.

The tips of the toes represent the head and brain reflexes and the sides correlate to the sinuses. Issues such as hammertoe, claw toe, rigid toe, or any deformity of the toes, could create congestion in those areas but could also be representative of some imbalance that’s already present. People with high arches and those that wear open toed shoes such as sandals, are more likely to develop hammertoe.

Skin conditions such as plantar’s warts, athlete’s foot, eczema, or even just dry skin, could be used as an indicator for that part of the body’s overall health. Again, the placement and extent of the condition is key. Toenail problems such as ingrown toenails, thickened toenails, or fungal infections, could be an indicator of a poor diet or vitamin deficiency.

Pain anywhere on the foot is of significant importance and should be attended to with care. Whether it’s pain resulting from arthritis, gout, bunions, heel spurs, neuromas, or plantar fasciitis, any painful areas on the feet should be considered in relation to the whole body. The feet are our first and primary contact with the earth and the ground beneath us. Establishing a firm and secure foundation should be a top priority in our lives.


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.

It’s been said that where attention goes, energy flows. Whether our attention is directed inward, for example on a thought or emotion, or outward such as listening to a friend or watching a movie, the things we pay attention to affect us in a very real way. In certain situations we may have little say over the things that require our attention. Work, family, school, are just a few of things that demand our attention on some level. And despite our best efforts to manage all these facets of our lives, we often wind up feeling overwhelmed by it all. Our psyches become so cluttered by all the demands on our attention, that very little is left over for ourselves. As a result, the body and mind fall into disrepair. We get sick, we suffer an injury, we become depressed, and the list goes on and on.

The body and mind need our attention if they are to remain healthy and vibrant. And what is attention other than, energy. Reiki is one word we can give this energy but it’s also been referred to as ‘Chi’ in China, ‘Ki’ in Japan, and ‘Prana’ in India. These words point to the life force inherent in all things. It’s in the foods that we eat, the liquids that we drink, the air that we breathe. It’s the very essence of who we are. We transmit this energy to others every time we speak to someone, look at someone, touch someone, or even by listening and giving our attention to someone.

Reiki is but one way of channeling this energy for the purpose of healing. There are three guiding principles a Reiki practitioner follows: Gassho, Reiji-Ho, and Chiryo.

Gassho literally translated means “two hands coming together”. In India this is known as “Namaste”, which means, “I greet the divine within you”. Before any healing session, a Reiki practitioner will enter a meditative state as a means of quieting the mind and focusing attention. With eyes closed, the hands are placed together in front of the chest. Attention is then focused on the point where the two middle fingers meet.

Reiji-Ho loosely translates means, “methods of indicating Reiki power”. From a Gassho position, the practitioner will ask for Reiki energy to flow through them. Then they ask for the recovery or health of the recipient on all levels. And finally, the folded hands are raised to the third eye in front of the temple and guidance is requested.

Chiryo means “treatment”. Once Gassho and Reiji-Ho are complete, the treatment can begin. A Reiki practitioner will then follow his/her intuition as they begin with the laying on of hands. There are many hand positions that can be used in each area of the body. Sometimes the hands are lightly touching the body; sometimes they are hovering slightly above. Dr Usui, the Buddhist monk who developed Reiki into a healing art form, had many techniques that he used in his treatments. The use of the breathe, the mind’s eye, symbols, and mantras, and of course the hands were all means he used of focusing the Reiki energy into the body.

Touch then becomes one of the most powerful and effective ways of transmitting this healing energy when done with the intention of healing. Unencumbered by words or concepts, communication through touch takes on transcendent quality. Instead of directing the energy through use of the mind, a Reiki practitioner’s hands become the conduit for it, allowing it go to wherever it is needed. It’s at this point the healing power of touch affects us in a very real way. Our attention is drawn to the hands and body, and the energy begins to flow.


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 the previous post we discussed the general anatomy of a stretch and touched on some pointers for stretching effectively. In this second part on stretching we’ll discuss several different types of stretches and get into more of the benefits of stretching safely and effectively.

There are two primary types of stretches: static and dynamic. The first we’re all relatively familiar with and the other is most commonly used by athletes before sporting events. The main difference between the two is the use of movement to achieve the stretch.

Static Stretches

Static stretches are done without any movement. A person will typically get into a stretch position for a targeted muscle and hold it for a given amount of time. This is the type we’re all familiar with. The goal is to hold the stretch until the muscle lengthens. Think of a seated hamstring stretch or reaching down to touch your toes. There are several ways in which static stretches can be performed.

1) Static Stretching: Static stretches are done alone without the aid of a person or device. As previously discussed, the stretch is held for a period of time until the targeted muscle is lengthened. This by far the most common form of stretching done by athletes and non-athletes alike. It’s also the safest form of stretching, making it a good choice for beginners and sedentary people.

2) Passive Stretching: During a passive stretch a person or device is used to perform the stretch. Similar to static stretching, an outside force such as a physical therapist or personal trainer is used to further the stretch. This form of stretching is commonly used in physical therapy while a person is recovering from an injury and does not yet have the strength or mobility to perform it themselves. Personal trainers can assist in passive stretches as a way of deepening the stretch and increasing range of motion.

3) Active Stretching: Performed without the use of an aid or outside force, an active stretch uses an opposing muscle or muscle group (antagonist) to stretch the targeted muscle or muscle group (agonist). For example, when you flex your quadriceps (antagonist) you also stretch your hamstrings (agonist). The advantage here is that contracting the antagonist muscle (quadriceps) will create reciprocal inhibition in the agonist muscle (hamstrings), allowing for a greater stretch.

4) PNF Stretching:  Proprioceptive Neuromuscular Facilitation is a more advanced form of stretching that involves both the stretching and contracting of a targeted muscle or muscle group. This type of stretching was initially developed as a form of rehabilitation to help improve muscle strength and range of motion. It uses both GTO and MSO activity to create this effect. It is usually performed with help of a physical therapist or personal trainer. There are several types of PNF stretches (which are beyond the scope of this article) that use both isotonic and isometric contractions.

a) Isotonic Contraction: The word isotonic means ‘of equal tension’. During an isotonic contraction the muscle maintains a constant tension against resistance as it lengthens (eccentric contracting) and shortens (concentric contracting). We perform isotonic contractions every time we go to the gym and lift weights (i.e. bicep curl), do squats, or even while walking or running.

b) Isometric Contraction: The word isometric means ‘of equal measure or length’. Unlike an isotonic contraction, a muscle performing an isometric contraction will not lengthen or shorten but instead maintain the same length against resistance. Common examples include holding the plank position to strengthen your abs or the standing ‘push against the wall’ calf stretch. Isometrics are a safe and popular form of strength training.

Dynamic Stretches

Dynamic stretches involve movements such as swinging, bouncing, kicking and lunging. This form of stretching, although less common than static stretching, is quite helpful in preparing the body for physical activity before sporting events. There are two different types of dynamic stretching.

1) Dynamic Stretching: During a dynamic stretch, a controlled, soft movement, such as the ones described above, is used to increase oxygen and blood flow prior to physical exertion or activity. Dynamic stretches are often used before sporting events because they help to warm up the target muscles without affecting their performance. Studies have shown that static stretches can have a detrimental effect on explosive movements and the strength output of a muscle. There is no forcing involved in a dynamic stretch. Instead, there is a gradual and controlled increase of movement that is gentle and safe. Dynamic stretching has the added of benefit of mimicking the movements used in a specific sport, raising your heart rate, and increasing your core temperature. Some examples include, shoulder circles, arm and leg swings, walking lunges, and high knee marches.

2) Ballistic Stretching: By contrast, this outdated form of stretching uses the same types of movements to force the muscle past its normal range of motion. Since the muscles aren’t given enough time to lengthen and can easily tighten up, the risk of injury is that much higher. As a result, this form of stretching has fallen out of favor amongst athletes and sports enthusiasts.

Benefits of Stretching

1) Improved Range Of Motion: Stretching helps to lengthen our muscles and increase their range of motion. It allows our limbs to operate over greater distances before damage can occur to the muscles and tendons.

2) Increased Power: An increase in muscle length has a direct impact over the distance our muscles can contract. This in turn equates to power. The more power we have available, the greater our endurance and overall stamina.

3) Reduced Post-Exercise Muscle Soreness: Muscle soreness is a result of micro tears that occur in muscle fiber. Lactic acid is a normal byproduct of these micro tears and can accumulate after physical activity. Stretching helps to alleviate next day soreness by increasing circulation to the muscles and removing these waste products.

4) Reduced Muscle Fatigue: After muscles have been contracting for a period of time, they tend to shorten as a result. Tight, short muscles use up more energy in a resting state and cause their opposing muscle group to work harder against this resistance.

Some other benefits may include, an improvement in posture, better coordination, and increase in energy.

General Rules for Stretching

1) Warm up beforehand: A 5-10 minute warm up helps to elevate the heart rate and increase the body’s core temperature. This in turn helps to loosen our muscles, making them more supple and pliable. It also helps prepare the mind and body for physical activity. An increase in heart rate and respiration aids in blood and oxygen delivery to the muscles.

2) Stretch before and after: Stretching beforehand will help to increase our ROM and prevent the likelihood of muscle strain or injury. Stretching afterwards helps to reset muscle fiber length, rid waste products such as lactic acid, and reduce next day soreness.

3) Stretch gently and slowly: Doing so will help bypass the stretch reflex and MSO activation which can create resistance.

4) Stretch to the point of comfortable resistance: Stretching should not be a painful endeavor. If you push beyond what is comfortable, you will engage the stretch reflex and increase your chances of a strain. Holding the stretch until the muscle lengthens, allows you to go further into the stretch.

5) Remember to breathe: Many people unconsciously hold their breathe while stretching. This creates tension in our muscles and prevents us from fully relaxing into the stretch.


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.

Love it or hate it, everyone has an opinion when it comes to stretching. Yet we all do it instinctually. Whether it’s the first thing we do in morning when we get out of bed or the last thing we do after being hunched over our desk for hours. The point of contention arises when stretching is done purposefully, as part of a regimen — either before or after an activity, or as a practice all its own. Whether you fall into this latter category or not, there are a few things we should know about stretching before we make up our minds on its efficacy. In this first post on stretching, we’ll be discussing the anatomy of a stretch.

Let’s face it, some people are naturally more flexible than others. Women tend to be more flexible than men. The young are more flexible and limber than their adult counterparts; and there are several reasons for this. As we age, we progressively loose flexibility as part of the normal aging process. Degenerative changes within the muscle and/or joint capsules (arthritis) can lead to an inactive lifestyle. Inactive muscles will adaptively shorten and eventually become weak. Stretching helps to maintain a certain degree of flexibility, which in turn improves our range of motion. Range of motion (ROM) is the degree of movement available for any given body part or joint.

What is stretching?

So what exactly does it mean to stretch? Stretching is the act of placing a specific body part into a position that will lengthen a targeted muscle, muscle group and/or soft tissue structure. Soft tissue structures come in two varieties: contractile and non-contractile. Examples of non-contractile structures include: ligaments, menisci, and joint capsules. This type of soft tissue was designed to provide support and stability. Their primary job is to limit or control the amount of movement across a joint. Other types of non-contractile soft tissue include fascia, skin and scar tissue. Muscle and tendons are the two primary contractile structures. Tendons attach muscle to bone, and by extension only transmit the force of the contracting muscle across a joint to create movement. Since tendons don’t actually contract themselves, that leaves us with muscles as the primary target for stretching.

Every joint in the human body has a range of motion that is considered normal for that joint. Let’s consider the hip as an example. The hip joint has six planes of movement: flexion, extension, adduction (swinging leg across the opposite leg), abduction (swinging leg away from the opposite leg), medial rotation (rotating leg so knee is pointing towards opposite leg) and lateral rotation (rotating leg so knee is pointing away from opposite leg). For each given movement there is a degree or range, which is considered normal.

Range of Motion Available at the Hip:

Flexion: w/extended knee = 80-90 deg, (w/flexed knee = 110-120 deg)

Extension: 10-15 deg

Adduction: 30 deg

Abduction: 30-50 deg

Medial Rotation: 30-40 deg

Lateral Rotation: 40-60 deg

Some people will fall below this range, others slightly above it. Hip flexion (w/an extended knee) for example tends to be the most limited movement of the hip for most people. Think of bending over to touch your toes. If you have trouble doing this, chances are tight hamstrings, as well as tight gluteal and calf muscles are contributing to this limitation. Those who have suffered an injury or lead a sedentary lifestyle might find themselves in this category.

Stretching can be done actively or passively with the help of an aid or an assistant. Depending on the joint where the stretch is performed, you can see a noticeable difference in the amount of passive ROM available. The neck is perfect example. You can yield a greater amount of ROM at the cervical spine if it’s done passively. This is not always the case for every joint however. The hip joint generally yields the same amount of ROM whether it’s done actively or passively.

Tight, short, stiff muscles have a tendency to limit this normal range of motion, as well as contributing to some other issues, such as:

– Chronic muscle and joint pain due to constant tension

– Interference of proper muscle functioning

– A loss of strength and power

– Restrict blood flow and circulation

– Increased muscle fatigue

– Muscle strain or injury

What happens during a stretch?

Muscles are comprised of thousands of tiny cylindrical cells called muscle fibers. Each muscle fiber contains thousand of ‘threads’ called myofibrils. These myofibrils are what give muscles their capacity to contract, relax and lengthen. Within each myofibril are millions of bands of sarcomeres. Sarcomeres are made up of thick and thin myofilaments containing contractile proteins called actin & myosin. When sarcomeres are regularly stretched to their end point, the number of sarcomeres increase and are added to the ends of existing myofibrils. This is what increases the muscle’s length and ROM.

There are two primary reflexes that are engaged when you do a stretch: the “stretch/ myostatic reflex” and the “golgi tendon reflex”.

Stretch/Mysotatic Reflex: During the first few seconds of a stretch (6-10 seconds), tiny proprioceptive cells called muscle spindle organs (MSOs) are activated. MSOs located in the belly of the muscle contract in order to protect the muscle. Their primary function is to detect changes in the length and speed of the stretch and contract accordingly.

Golgi Tendon Reflex: After the first few seconds of a stretch, another set of proprioceptive cells called golgi tendon organs (GTOs) are engaged. Located near the tendons of a muscle, GTOs detect the amount of tension being exerted over a joint and automatically stop contracting in order to protect the muscle from being overloaded.

Knowing about these reflexes can help us to stretch in a much more effective and safe way. Here are two keep points to remember when stretching:

1. Move slowly into the stretch: In order to mitigate the effects of the stretch reflex, it’s important to move slowly into the stretch and only to the point of comfortable resistance. If you move too quickly or stretch to the point of pain, you will activate the stretch reflex and create resistance within the muscle.

2. Hold the stretch for  at least 10 seconds: After this initial period, the MSOs will cease firing and the GTOs will kick in. GTO activity will create inhibition in the muscle, allowing you to stretch further to a new end point.

In part 2 on stretching, we’ll discuss several different types of stretches, the benefits of stretching, and more pointers on how to stretch safely and effectively.


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.

Reflexology:

The ancient practice of foot reflexology can be a surprisingly powerful tool in dealing with issues that are often beyond the purview of a regular massage. The thousands of nerve endings found in the feet and hands provide us with a unique access to the body’s nervous system. There are three main branches to the nervous system: the central nervous system (CNS), the peripheral nervous system (PNS), and the autonomic nervous system (ANS). It’s this last branch, the ANS, that is of particular interest to us. The ANS is in charge of controlling the involuntary actions that occur in our organs, glands, and certain muscles (i.e. the heart).

The ANS itself is divided into two branches: the sympathetic and parasympathetic. In moments of stress or activity, the “fight or flight” part of this system – the sympathetic branch – becomes active, initiating a series of changes in our body that increase our ability to deal with the issue at hand. Our heart rate increases, our lungs fill with air, our pupils dilate, and our muscles become primed for movement. The parasympathetic branch on the other hand has the opposite effect. The “rest and digest” branch of the ANS is in charge of regulating and establishing equilibrium once the stressful event has subsided. Things such as digestion, sleep, and the healing process in general, take place when the parasympathetic branch is active. And it’s this very branch of the nervous system that reflexologists stimulate via the reflexes found in the feet and hands. The positive changes that occur via manual manipulation of these reflexes have been well documented. An increase in blood flow to the organs, a lowering of stress hormones in the body, and a profound state of relaxation are just a few examples of these effects.

Since most headaches stem from tension found in the muscles of the shoulders, neck, and jaw, a visual assessment of the corresponding reflexes in the feet can provide us with a wealth of information. Are there calluses, corns, bunions, dry skin, etc… in and around the reflex? If so, it could indicate an imbalance or energy blockage in that part of the body. A vast majority of foot issues come from poor footwear. Choosing comfortable and properly sized shoes can have a remarkable impact on the health of your feet. Postural imbalances should also be taken into consideration. A functionally short leg, an over-supinated/over-pronated foot, or excessive medial/lateral rotation of the leg can over load certain muscle groups and lead to chronic headaches. The 12 meridians of the body also pass through the hands and feet. The liver, gallbladder and kidney meridians in particular, originate on the feet and pass through specific muscle groups that when tense or blocked, can contribute to the formation of headaches.

Reflexes for Headaches:

The reflexes that are of particular importance when addressing headaches are:

Head/Brain/Sinus/Jaw reflexes: All these reflexes are found in the toes of our feet. The big toe in particular contains several reflexes for: the pituitary gland  — which is considered the master gland in charge of regulating all the other glands; the hypothalamus – which regulates the autonomic nervous system; and the jaw – which when tight is a major contributor of headaches. The sinus reflexes, found along the sides of the toes, can be especially useful when dealing with sinus related headaches.

Neck/Shoulder reflexes: The neck reflex is found at the base of the big toe and the shoulder reflex, just under the pinky toe along the joint. Since a vast majority of tension related headaches come from excessively tight muscles in the neck and shoulders, working these two reflexes can be of great benefit. Unconscious guarding or holding patterns can often keep the muscles of the neck and shoulders in a perpetual state of contraction. In some cases an old trauma or injury that has long since healed, could be the underlying cause of this. Working these reflexes can help restore balance and lighten the load so to speak, of these workhorse muscles.

Kidney/Adrenal Gland reflexes: These two reflexes are found one on top of the other in the mid-foot. The kidneys regulate the retention of water and important minerals and filter toxins from the blood stream. Headaches arising from excessive alcohol consumption or dehydration are addressed here. The adrenals serve many functions. One of these functions is the release of adrenaline and noradrenalin, which work in conjunction with the sympathetic nervous system. Anxiety and over-stress can have a significant impact on the functioning of this gland.

Liver reflex: The liver reflex is found in the mid part of the right foot. The liver detoxifies the blood of contaminants such as drugs, chemicals, and alcohol. The liver reflex is of particular importance when dealing with medication overuse headaches (MOH), hangover headaches, and migraines.

Spinal reflex: Tension anywhere along the spine can easily translate into the head, especially along the thoracic and cervical vertebrae. The muscles of the neck and shoulders can have a direct impact on the alignment of the spine, as well as the positioning of the head. Maintaining good posture is at the core of reducing chronic headaches. The spinal reflex is located along the medial arch of the foot. The thoracic and cervical reflexes are on the upper half of this arch.

Solar plexus reflex: The solar plexus are a network of sympathetic nerve ganglia found in the abdomen. These nerves innervate a majority of the organs found here. It’s sometimes been referred to as our “abdominal brain” or “nerve switchboard.” The reflex, located along the transverse arch in the area between the first and second toe joints, can have a profound calming effect on people. For this reason, stimulating the reflex can have a significant impact on the breath and any nervous tension held in the body.

All the reflexes mentioned here can also be found in the hands and ears. Hand reflexology however, can be the most practical and effective way for people to administer self-care on a regular basis. Working the reflexes on the hand can be done practically anywhere. Here are few tips for addressing headaches via the reflexes in the hand.

Hand Reflexology for Headaches

hand chart

1)    Squeeze the fingertips to stimulate the head and brain reflexes. Pay particular attention to the thumb.

2)    Work the sides of each finger to alleviate sinus congestion or sinus headaches.

3)    Apply a gentle, circular pressure along the knuckle joint of the pinky finger, which corresponds to the shoulder reflex.

4)    Starting at the base of the thumb just above the crease of the wrist, apply pressure  along the outside aspect of the thumb all the way up to the top . This stimulates the spinal reflex.

5)    Located in the web between the thumb and index finger is a point in acupuncture known as large intestine 4. Stimulating this point for a minute or two is an excellent way to address tension held between the shoulder blades and helps provide relief when in the throes of a severe headache. It’s important to note that his point is contraindicated during pregnancy.

6)    Stimulate the kidney and adrenal reflexes found in the fleshy part of the base of the thumb.

7)    And finally, hold the solar plexus points located on the palm between the index and middle finger, with a light to moderate pressure as way of calming the nervous system.

Applying these self-care tips along with regular massage and reflexology sessions can be transformative when all else seems to fail. Over the long term, a holistic and preventative care approach may be just the investment you need to get you on the path to being headache free.


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 third installment on headaches, we’ll be discussing how massage and trigger point therapy to key muscles in the neck and face can help diminish the effects of a headache.

Massage

If you consider the fact that 90% of all headaches are tension related in some way, then reducing tension levels, whether it be physical or psychological, should provide relief for a vast majority of people. Even those suffering from chronic migraines, cluster headaches, and new daily persistent type headaches are greatly affected by excessive tension in the muscles of the head and neck. It’s no secret that maintaining a healthy lifestyle with a balanced diet, plenty of exercise and sleep will go a long way in reducing stress levels. There may however be other factors at play that could be contributing to your headache. Factors such as postural imbalances, repetitive movements, strained sleeping positions, cervical arthritis, or even whiplash – all of which could be at the root of tight muscles. The one thing all these factors have in common though, are trigger points. Trigger points develop in strained or chronically tight muscles and are often the hidden and undetected cause of most headaches. There are close to 26 pairs of individual muscles in the neck and over 30 pairs of muscles in the face, all of which could be harboring trigger points! The work of Travell & Simons has shown that trigger points are the ‘operational element’ in most headaches stemming from physical trauma and emotional tension. The irony however, is that most headaches arise from trigger points found in the jaw, neck and upper back muscles! Knowing this saves a lot time and energy, but it also allows for a more focused and effective treatment plan. Now, let’s take a look at the key players.

There are four primary muscles in the head and neck that refer pain to the temples, forehead and jaw, and play a significant role in the development of headaches. The first two muscles, the trapezius and the sternocleidomasoid (SCM), are considered neck muscles (segments of the trapezius are also considered upper back and shoulder muscles). The other two, masseter and temporalis, are jaw muscles and are located on the face and head.

Trapezius:

Trapezius Trgr PtThe trapezius is a flat, broad upper back muscle that functions to move the neck and shoulders. It also helps to support the weight of the head and is therefore particularly susceptible to postural imbalances, which can put undue strain on the muscle. A trigger point in the upper part of the trapezius is one of the primary causes of temporal headaches. The referral pattern of this trigger point includes the back of the head, sides of the temple, and angle of the jaw. It’s also been known to setup up satellite trigger points in these areas, which can lead to a deep pain behind the eye, toothaches, and TMJ. Stress and emotional tension can often keep this muscle constantly contracted and elevated on some people — as can wearing a heavy backpack or purse, a forward head posture, or tight pectoral muscles. Trigger points in the middle and lower half of the traps will often refer pain to the back of the neck.

Sternocleidomastoid (SCM):

SCM Trgr PtsThe sternocleidomastoid muscle, or SCM for short, derives its name from its points of attachment. The two branches of the muscle attach on the sternum, clavicle, and mastoid process — which is located behind the ear. Although these muscles rarely hurt themselves, trigger points found in the SCMs are usually at the root of frontal headaches and pain located on the face. This muscle serves several purposes. Much like the upper traps, it functions to rotate and laterally flex the head to the side, and is an accessory breathing muscle — helping to elevate the ribcage during inhalation. Its very functions however, make it susceptible to postural imbalances such as, a forward head posture, and shallow upper respiratory breathing arising from emotional and/or psychological tension. Triggers points in the SCM can also be a leading cause of a painless, stiff neck; a deep pain behind the eye, ear, and back of the head; tongue pain when swallowing; and a contributing factor in TMJ pain. Unfortunately these muscles are rarely worked on, despite their wide and primary effects.

The other two muscles are located on the head and face. Masseter is a chewing muscle found along the angle of the jaw, which provides the jaw with most of its power. Trigger points in masseter can restrict the opening of the jaw and lead to pan in the upper and lower teeth. It’s also one of the leading factors in the development of TMJ. Its referral pattern includes many points on the face such as, the cheek, above the eyebrow, along the jaw, deep in the ear, and can on occasion mimic the symptoms of sinusitis. Pain arising from masseter trigger points can be an underlying cause of frontal headaches. Temporalis, like masseter, is a chewing muscle. This flat muscle is located on the sides of the head just above the ears. Trigger points in temporalis refer pain to the area above the eyes and upper lips. They contribute to the formation frontal and temporal headaches and can sometimes lead to hypersensitivity in the upper teeth.  

Another set of muscles worth mentioning are the suboccipitals. These two pairs of four, short, individually named muscles are located at the base of the head and the very top of the neck. Pain from trigger points in the suboccipitals can feel like a band of tightness inside the head, starting at the back of the head and leading to the eye and forehead. This type of pain is commonly associated with migraine headaches. The suboccipitals are particularly vulnerable to emotional tension, as well as the effects of satellite trigger points coming from the trapezius. Research has discovered that one of these short muscles not only attaches to the occiput, but to the dura mater – the connective tissue that covers the brain. In light of this connection, it’s speculated that increased tension in this muscle can disrupt the normal fluctuations of cerebrospinal fluid and lead to headaches.

In some cases, focused work on these key muscles alone can have the added benefit of deactivating satellite trigger points that fall in their referral patterns. However, this is not always the case, especially in the more severe and long-term cases. The cascading effects of trigger points are one of the main reasons why some of them are so persistent and easy to miss. But once they are systematically treated and deactivated, relief is usually not far behind.

In the next and final post, we’ll see how reflexology to particular reflexes found in the hands and feet can help with headaches.


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.

Now let’s take a look at cluster headaches and new daily persistent headaches. Although relatively rare by comparison, they are nevertheless considered primary headaches.

Cluster Headaches (CH):

Cluster headaches are unilateral, vascular headaches of short duration that occur over a period of time. The pain is usually centered behind one eye (although it can also be felt in the temple, ear, neck or face) and is often described as an intense, burning, or piercing (not throbbing) pain. Cluster headaches have a sudden onset and can be extremely painful, often leading to watery eyes, a runny nose, and reddening of the skin on the affected side of the face. They can last anywhere between 10 minutes to 2 hours and reoccur 2-3 times a day for a period of 5-6 weeks (cluster). Attacks can occur at the same time, every day and are very common at night leaving you feeling restless. A person may have a pain-free period of weeks, months, or even years in some cases, before the next cluster occurs.

Causes:

There are no known causes for cluster headaches, but research has speculated that they may be due to a sudden release of histamine and serotonin in the brain. Abnormalities have also been detected in the hypothalamus during a cluster headache. Some perpetuating factors may include stress, overwork, and emotional trauma. In some cases medical intervention may be necessary as a means of managing the pain and stress of these reoccurring headaches.

Incidence:

Although cluster headaches are relatively rare, affecting 1 in 1000 people, they are most prevalent in men ages 20-50. They affect men more than women at a ratio of 8:1

New Daily Persistent Headache (NDPH):

Another form of primary headache worth mentioning is the “new daily persistent headache” or NDPH for short. Although relatively rare, occurring in 1 out of every 3500 people between the ages of 30-44, it is considered a primary headache syndrome with no underlying cause. NDPHs are classified as a form of chronic daily headache which is present for more than 15 days a month and for as least 3 consecutive months. It has an acute onset and typically occurs in people with no past history of headaches. The pain can be a dull, pressure-like sensation that affects both sides of the head but can also be unilateral in its presentation — being localized to one particular area of the head. The pain can fluctuate in intensity but is usually unremittant and daily.

NDPHs can be mistaken for other forms of chronic daily headaches (CDH) such as, chronic migraines (CM) and chronic tension-type headaches (CTTH) and can share similar symptoms. There are however a few key features that set them apart. Onset is usually abrupt and acute. People who suffer from CMs and CTTHs have a history of headaches and can often tell when a headache is about to come on, NDPH sufferers cannot. NDPH sufferers however can tell you the exact day their headache started. This is a signature sign of NDPHs. The pain begins acutely and reaches its peak within 3 days. The pain is not usually aggravated by routine physical activity,  although it can get worse throughout the day.

Diagnosis of NDPHs can be difficult and must first rule out secondary causes which could mimic its symptoms. Such secondary causes may include a cerebrospinal fluid leak, cerebral venous sinus thrombosis or minor head trauma. An MRI or CAT scan can rule out these conditions.

Causes:

As previously mentioned, NDPHs have no underlying cause but have been known to coincide with viral infections (i.e. Epstein-Barr, Lyme Disease, Herpes Simplex), flu-like illnesses, sinusitis, stressful life events, or minor head traumas, just to name a few. They have also been associated with medication over-use, which often leads to an analgesic rebound and a resultant headache. NDPH sufferers are particularly vulnerable to medication over-use as they try to manage the pain of their daily headaches.

Incidence:

NDPHs occur 2.5 more times in women than they do in men.

Conclusion:

Conventional treatments such as over the counter medications (OTC) and non-steroidal anti-inflammatory drugs (NSAIDs) may include: aspirin, ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and naproxen (Aleve). These are most commonly prescribed for tension-type headaches and some mild forms of migraine. Triptans and Ergots have been prescribed for those with severe, chronic forms of migraine. They constrict blood vessels and block pain pathways in the brain, but are not without their precautions and side effects. Most migraine sufferers learn to avoid triggers, such as stress, scents, loud noise, bright lights and certain foods that might set off a migraine. Cluster headaches are often treated with vasoconstrictors, oxygen inhalers and corticosteroids. NDPH sufferers have had successful treatments with Neurontin (gabapentin) and Topomax (topiramate) in cases that have lasted more than a few months.

Although these treatments may provide symptom relief and in some cases may be essential in managing the pain of a severe headache, caution should be used when using any drug or medication over a long period of time. Medication overuse headaches (MOH), commonly referred to as rebound headaches, can be a byproduct of an over-reliance on pain medication. The liver and kidneys are particularly susceptible to the effects of medication overuse. If you suffer from chronic headaches of any form, you may be well advised to consult your doctor. Keeping a ‘headache journal’ may be helpful in detecting patterns or triggers. Eliminating certain stressors, foods, or activities may go a long way in preventing your next headache.

 In the third post of this series, we’ll begin to discuss the benefits of an holistic approach to headache relief — namely massage and trigger point therapy.


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.

We’ve all suffered through a headache at some point in our lives. Some may get the occasional headache as a result of stress, illness, lack of sleep, or even caffeine withdrawal. Others may experience much more severe and episodic headaches that can be excruciating and extremely debilitating. Headache disorders are considered the most common disorder of the nervous system. Headaches are so common in fact, that the World Health Organization (WHO) has estimated that nearly half to three quarters of adults (18-65) worldwide have experienced a headache in the past year. In this four part series on headaches we’ll discuss the three main classifications of a headache, four different types of headache, and finally how massage and reflexology can help.

According to the International Headache Society, headaches are classified into three categories: primary headaches, secondary headaches, and cranial neuralgia/facial pain and other headaches.

Primary Headaches such as tension-type heaches (TTH) and migraines are among the most widely reported forms of headache. Cluster headaches (CH) and  new daily persistent headaches (NDPH) although less prevalent, are also considered primary in nature. These headaches typically exist independent of any medical condition or underlying cause.

Secondary Headaches are usually the result of some underlying cause or condition. Secondary headaches can be a symptom of things such as caffeine withdrawal, smoking, and alcohol consumption (hangover). Some common types include, sinus headaches and medication overuse headaches (MOH). They can on occasion be a symptom of a much more serious nature, such as a stroke or concussion.

Cranial neuralgia/facial pain and other headaches are the result of irritation or inflammation of one of the 12 cranial nerves that supply the head and neck. The most frequent example is trigeminal neuralgia, which affects the 5th cranial nerve.

Now that we’ve familiarized ourselves with these classifications, let’s take a closer look at  four different types of primary headache.

Tension-Type Headaches (TTH):

Also known as muscle tension or fibrositic headaches, tension-type headaches are by far the most common type of headache and account for nearly 90% of all headaches. The pain is usually bilateral, starting at the back of the head and neck then spreading to the temples and forehead. The pain can be a dull, persistent ache and feel like a band of tightness encircling the head. TTH are not usually debilitating but can be worse in the evening.

Causes:

-Chronic muscle tension

-TMJ Syndrome

-Neck/Jaw trigger points

-Psychological or physical stress

-Irritation of the cervical spine

-Sleep deprivation

-Grinding of the teeth (Bruxism)

-Injury to the coccyx or sacrum

 -Hunger

Other contributing factors:

-Mental or visual strain

-Holding your head in a fixed position

-Bright lights

-Strained sleeping position

-Noise

-Prolonged exposure to cold

Incidence:

80% of women and 67% of men are affected

Migraine Headaches:

The second most common form of headache, migraines are exceedingly painful events often accompanied by nausea, vomiting, blurred vision and hypersensitivity to light and noise. The pain is often described as a throbbing (not burning or piercing) type of pain that affects one side of the face. Some may experience pain bilaterally or behind one eye. Migraines are classified as a neurovascular disorder but their true cause is unknown. Some possible theories include, ‘leaky’ blood vessels, decreased serotonin levels, and involvement of the extra cranial nerves.

There are two main types of migraines: Classic migraines and Common migraines. They both share similar symptoms, however the classic migraine is accompanied by an aura.

There are four phases to a migraine. The first phase is known as the prodromal phase. This phase can occur hours or days before the onset of the migraine. Irritability, depression, fatigue, stiff muscles are some common precursors. The second phase, known as the aura phase (not present in common type migraines), immediately precedes the headache. Changes in vision such as flashing lights, dark spots, and double vision are often reported. The feeling of ‘pins and needles’ across the hand, arm and face followed by numbness is not uncommon. A person may experience confusion, trouble concentrating or may have difficulty communicating. In the third phase, the attack phase, the pain commences and can last anywhere from a few hours to a few days.  During this phase of the migraine, a person may be unusually sensitive to lights, sounds, and smells and for this reason may choose a quiet, dark, distraction-free environment to rest. Physical activity can often make the pain worse. The pain may be so intense as to cause light-headedness, nausea and vomiting in some. The postdromal phase is the final phase and can last a couple of days after the headache has subsided. A person may be left feeling sore, tired, weak or moody.

Causes:

Although there no known causes, there are some possible triggers for migraines:

-Hormonal or chemical triggers that occur during puberty, menses, and menopause

-Foods containing tyramine such as in wine, beer, and cheese

-Emotional and physical tension

-Allergic hypersensitivity

-Viral infections

-A family history

Incidence:

Migraines affect nearly 8 million people in the U.S.

18% of women and 6% of men are affected

In the next post we’ll discuss cluster headaches and new daily persistent headaches, as well as some conventional forms of relief.


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.

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