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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The effects of trigger points and their referred pain have been well documented. Muscles with active trigger points will often refer pain to other areas of the body. But did you know that your internal organs, known as viscera, can do the same? Could the pain in your left shoulder actually be referred pain coming from your lungs and diaphragm? In this article we’ll take a closer look at the effects of visceral pain, as well as underscore the importance of staying on top of your health and going for regular check ups.

Very little is known about visceral pain and the mechanisms behind its manifestations. Apart from the occasional abdominal pain, which be could the result of indigestion or cramping for example, we give very little thought to what its true source may be. The most common example of referred visceral pain comes in the form of cardiac pain. Ischemic compression of the heart, whether it’s angina or the beginnings of a heart attack, could manifest as pain along the sternum, the left side of your chest, down the inside of your left arm, and up into your left jaw. This is a very specific and unique referral pattern and one that most of us would be alarmed by. But some visceral pain can be as insidious and commonplace as an ache or pain in your shoulder. This makes determining its root cause all the more difficult.

One of the many theories behind visceral referred pain is known as ‘viscero-somatic convergence.’ Surprisingly, there is a lack of dedicated sensory pathways linking your internal organs with your brain. Nociceptors, the sensory neurons that detect pain, in the viscera will often converge with signals coming from the sensory pathways of your skin and muscles. When this happens, the brain will perceive the pain as coming from a different area of the body. Let’s take a look at some of the most common referral sites for visceral pain and dysfunction:

Right neck and shoulder:

-Liver and gallbladder

Left neck and shoulder:

-Lungs and diaphragm

Sternum, left chest, inside of left arm, left jaw:

-Heart

Right lower abdomen:

-Appendix

Mid-back along the spine & just below your scapulas:

-Stomach

Right side of ribcage just below your pectoral muscle:

-Liver and gallbladder

Left side of abdomen just below sternum:

-Pancreas

Abdominals above navel:

-Small Intestines

Abdominals below navel:

-Colon

Lower back & abdominals, inner & outer sides of thighs:

-Kidneys

Pubis:

-Urinary bladder

Visceral_Pains

It’s important to remember that not all of your internal organs have pain receptors. The hollow organs such as the stomach, intestines, bladder, and uterus for example, are some of the ones that do. All of your organs however, have receptors that can detect pressure, ischemia, inflammation, and noxious chemicals. So in most cases, visceral dysfunction will often manifest first through the autonomic nervous system as a dull, diffuse, and hard to locate form of discomfort or pain.

So how does one determine whether the source of the pain is visceral or muscular? Without a yearly physical or regular checks up with your doctor, it can be difficult to determine. If the pain and discomfort is long-term and unremitting despite your best efforts to address it, whether it be massage, rest, or some other means, then it may be time to speak to your doctor.


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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