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I had a new client the other day for an 80 minute massage. I asked him if there is anything that he wanted me to know.  He told me that he suffers from a herniated disc that he has had for a few years. He has constant low back and right hip pain that at times radiates down the back of his leg to his knee. He told me that he has had two injections in his low back and has to stay on anit- inflamtory medication.  Anything to avoid surgery. The pain is always there. I asked him if he ever saw a chiropractor for his pain.  He said yes.  But the adjustments hurt his hip so bad that he could not continiue.  So here is a guy that thinks he is on the verge of surgery. I knew that there was a very strong probubllity that was not the case. The vast majority of pain people experience is nocioceptive pain( soft tissue- muscle, tendon, ligament, facia).  MDs and Chiropractors see pain as neuropathic pain( nerve pain).  With that asumption they give the wrong treatments and therapies.  Now there is no denying that at times injections and surgery is needed. Not denying that.   But most of the time - NOT.  70% to 85% of all pain comes directly from trigger points.  Anyway I showed my client a testimonial from a client that I was able to help out of a very painful condition that she had delt with for a couple of years. I showed him that testimonial because all pain has a psychological eliment too it. I wanted him to start thinking maybe he is not on the edge of surgery.  I palpated his entire back upper torso, both hips, and right leg. I found a very painful spot on his right L5 erectors.  Another very painful spot on his right greater trochantor.  A painful spot in the middle part of his lower right hamstrings.  And also a tender spot on the right spinous of L3.  I knew that if Iwas able to eliminate all those painful palaptory spots that I would most likely eliminate his pain problem.  Because a healthy body had no painful spots even with deep massage.  Ive been hunting and eliminateing trigger points for thirty years now.  He walked out of the massage room pain free. He was pain free for the first time in years. All those other professional people misdiagnosed him because they assume neuropathic pain over nocioceptive pain.  I assume the other way around.  I'm a Massage Therapist.  

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Hey Gordon!  There's an interesting article about this (placebo effect and manual therapy) coming out in Massage and Bodyworks soon.  When it's out, I'll let you know (unless you get the magazine, in which case look for the article).  I'm not sure exactly when it will be published.

That might be an interesting read? We will have to look out for it.
I don't think there is anything I do that's evidence based? Why after 30 years would I advance to the point of placebo effect?

"Reality and perception. -- There is a difference:

- The world

- Our reaction to it
Question? Is anything we do as massage therapists or bodyworkers considered evidence based?
The other day I met a person that said she suffers from sciatica. Her massage therapist told her that she needs to see a doctor. She gave me permission to check her out. She didn't have sciatica. She had two trigger points. One in the Gluteus Medius, and another in the Vastus lateralis. She was very surprised to find her Sciatica pain gone in about 40 seconds. Both or one of those muscles are often responsible for the misdiagnoses of Sciatica. Another muscle often responsible for a mis diagnosis is the Infraspinatus. That trigger point sends pain all the way down the arm. A Deltoid trigger point is often associated with it. Those two are often diagnosed as nerve pain coming from the neck. There is often a pathology that backs up the diagnosis of Sciatica or nerve pain of some sort. Arthritis or a narrowing of disc space. They may very well have those pathologies, but that's not necessarily what's causing their pain.
People that are hurting, and see other health care providers are rarely palpated. And even if they are, as in the example of the lady mentioned above. Her massage therapist didn't even realize it. She had been suffering for six months. Another group of trigger points that cause a lot of misdiagnosis are the trigger points of the extensor and flexors of the forearm. Those often cause the misdiagnosis of carpal tunnel. All the mentioned trigger points are easy to discover. Worth taking note of. Some of the muscles mentioned are in the attachments. And you can see by their pain patterns why they can easily cause a misdiagnosis.
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In the above paragraph I said Gluteus medius. It could be medius or minimus. Lateral Glute muscle.
A while back I had a patient with the complaint of burning pain from her lower neck down her arm to her elbow. It was really bad at night. There was also some discomfort when she turned her head.
To make a short story shorter, here is what I found.
Two trigger points. A Levator Scapula and a Deltoid trigger point. When palpated, she flinched. After I released those two trigger points the pain was gone, and she could turn her head without discomfort. Did I give her long term relief? I don't know yet. But those two trigger points were definitely causing her pain and discomfort..
As a side note, I compared left Deltoid and Levator to the right Deltoid and Levator. The trigger points were only on the one side. More conformation that they are responsible for causing the pain.
Check the attachments out, and you will see her pain pattern.
Attachments:
A while back, a new patient came into the clinic with severe abdominal pain. She has been dealing with this for many years. She has had several abdominal surgeries in the past. According to her current doctor, after throughly reviewing and studying her latest MRI, it was determined that her intestines and another ( can't remember which one ) internal organ have fused together do to improper healing. Its been suggested that she needs another surgery. She has intense flare ups, and that's when she came into the pain clinic for the first time. The Dr. I'm working with sent her to me, to see if I could help her. This doctor is cool, he believes in me. Unlike these evidence people that call me a charismatic charlatan. Anyway, she was literally bent over crying, shaking and could barely walk as I escorted her to my treatment room. I'm not exaggerating. I'm a trigger point guy, but I had a gut feeling that this was not a trigger point thing. But I started off with that mindset. Which quickly failed. While lying on the table she was crying clutching her lower right abdominal quadrant shaking with pain. This women was really hurting.
I'm telling this true story because the power of touch is incredibly powerful. I thought to myself. Ok, this is a good time to test the Gate Theory of Pain. See if it really works. I've done it before with fibromyalgia people, but this was different. Some kind of internal organ problem that this women has dealt with for years.
Anyway, I turned the lights off and began lighting caressing her body. Just lightly stimulating the tactile sensors in her skin. Not near enough to directly effect muscle tissue. Her right lower quadrant was where her pain was. The left hemisphere of the brain controles the right side of the body. So the left hemisphere was up regulated compared to the right hemisphere which was down regulated. There was much more electrical activity going on in the left hemisphere. So I lightly caressed the left side of her body for the vast majority of the time in order to stimulate the right hemisphere, and bring balance to the hemispheres and nervous system. The brain functions best in balance, just like the structural body. After 45 minutes, with tactile touch, in the dark, she was breathing calmly, and not crying. She told me that she has never experienced any form of medical care or therapy that got her out of that excruciating pain so quickly. I didn't know if it was going to work. Up to the half hour point she was still crying and in pain. But after 45 minutes it did.
Now I have no fantasies that I cured her. But maybe with repeated ongoing treatments, some longer term or down grading of intensity or lessening of frequency can be had? Maybe that's wishful thinking. But I know one thing for sure now. The Gate Theory of Pain is real. And it can be initiated with the power of light touch. I had a pretty lousy day up until that point. That was way cool. In the attachment is a diagram that illustrates what I did.
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