Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

Filtering by Tag: massage

How do I find a good massage therapist?

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

Reader Question_.jpg

My friends and colleagues often ask me questions, (or just email one), and one of the most common is "how do I find a good massage therapist in my city/area?"  It's a great question, and not a simple answer.  

First of all, what makes a "good" massage for you, i.e. what conditions must be present for you to feel relaxed and supported?  What type of pressure do you like? (Soft tissue, energetic work, craniosacral, deep tissue, structural integration, etc.)  A "good" massage depends on your body, your issues, your likes and dislikes, and a host of other factors, so there is no one bodyworker that is perfect for everyone!  Just because you loved one particular practitioner or session does not mean that your friend will, and that's ok.

What's going on in your body that is spurring you to seek a massage?  Are you overly stressed, in pain, working with a chronic pain or muscle issue, recuperating from a surgery, pregnant, dealing with chemotherapy, etc?  Are you just looking for a maintenance session to keep your body functioning well?

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed  an appropriate hair accessory.

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed  an appropriate hair accessory.

What do you want to accomplish in your session- is this a one time session or are you hoping for multiple sessions?  This can help your bodyworker best serve you, but also help you choose a practitioner as well.  

One of the big questions I struggle with as a movement teacher is are you treating the symptom of a movement based problem, or are you treating the problem itself? So let's say that you have shoulder pain- you can get a massage that focuses on the shoulder and chest.  This can be beneficial, but what caused the pain to begin with?  Was it something else like your daily use of your neck or spine or hips? Was it just a one time weird way of sleeping? Do you want a session that will help clarify what the problem is, i.e. should you see someone who is a physical therapist, or a bodyworker who does muscle testing or movement assessment?  Many bodyworkers who are not physical therapists also teach movement, whether as personal trainers, pilates teachers, etc., and finding someone who does both can help you identify where you have deficiencies and how you can address them through movement.

Next suggestion is to look beyond chain massage facilities-there are some great therapists at chains, but many times, recent program graduates with less experience are working at such places.  When reading someone's biography, look at how many years of experience they have to begin with.  What sort of the training do they have?  Most states have a comprehensive 750-1000 hour massage certification, but beyond that, many people will seek extensive continuing education, other certifications, or specializations. What sort of populations does this person serve or aim to serve? (older clients, those with special issues, etc.)  Do they have anything in their biography that indicates a focus on your specific issues, pains, etc.? If they don't say "focus on performing artists or focus on athletes" in their biography, it doesn't mean that they can't be of help, but it's something to also consider.  Some of my favorite massages (and personal training sessions) have been from people who used to play the violin, viola, or cello, and who very much can visualize what my issues are just from playing the instrument.  

With all this begin said, I personally like deep tissue work sometimes, as someone who is not petite and with a lot of muscle mass.  This is not good for everyone, and not good for me all the time.  I also appreciate bodyworkers who understand human movement more in depth, and who maybe have training in movement assessment strategies, such as the work of Grey Cook and the SFMA/FMS.  I also have had some really interesting success with NKT and P-DTR practitioners.  If you're working with a chronic pain issue that is undiagnosed (and you're not being treated for), I'd highly recommend seeing a medical professional, and working with a good physical therapist who does both manual therapy, movement screening, and correctives.  At the end of the day, finding a good bodyworker involves a certain amount of trial and error, to see if they're a good fit for you.

What is Scoliosis?

This image on the right shows a "normal" spinal curvature.

This image on the right shows a "normal" spinal curvature.

When I was a kid, we used to have these scoliosis tests in which the school nurse called you out of class, had you bend over, and then karate chop checked your spine for irregular curves.  I always remember wondering what would happen if you were found guilty of scoliosis-just being called out of class in groups was stressful enough, especially when your classmates were waiting in the same room with you.  But I digress.  

What is scoliosis?  Simply put, it's an irregular curve of the spine to the side.  We look at the human body through anatomical planes of movement (sagittal, horizontal, frontal), and the spine naturals orients its curves in the sagittal plane, but scoliosis will create curves in the frontal plane (i.e. sideways curves).  While scoliosis can correspond with certain diagnoses (sometimes called nonstructural scoliosis, correlated with cerebral palsy, muscular dystrophy), most causes are unknown, and may be a combination of genetics, injuries, habits, or other causes.  Scoliosis is defined as an abnormal spinal curvature that deviates in the sideways plane, or frontal plane.  Kyphosis and lordosis are exaggerations of the existing spinal curves (front to back- sagittal plane) either from habit (high heels, asymmetrical instruments.), genetics, aging (osteoporosis and bone degeneration) or other diagnosis.

Notice that scoliosis is a lateral curve deviation , whereas the other two examples exaggerate the native curves of the spine.

Notice that scoliosis is a lateral curve deviation , whereas the other two examples exaggerate the native curves of the spine.

So why care about scoliosis?  Well, many musicians have scoliosis but don't do much about it until the pain it causes is quite severe.  Doctors haven't agreed whether the muscles and soft tissues caused the misalignment or whether the bones pulled the muscles out of alignment, but the result can be discomfort, particularly on the side where the spine is pulled (in the images, the spine is pulled to the right side). When applied to musicians, one has to take into consideration any asymmetrical postures or movement habits, whether it's playing the violin which might exaggerate a curve to the left or playing the flute. Some musicians were diagnosed with scoliosis as a child and have adapted accordingly, whereas others have found that their body adopted a non structural scoliosis as they've aged.   (Side note: medical professionals divide scoliosis into structural, meaning the spinal curvature is difficult to reverse, and nonstructural, meaning that the spine works semi-normally, but with a curvature.  I would add that even in severe scoliosis, change is possible with medical treatment/physical therapy, because of the body's ability to adapt)  What also makes scoliosis more difficult to address is that the curve deviation is to the side, but it usually alters the curves in the sagittal plane, meaning that a lateral deviation could exaggerate a kyphosis in the upper back, or limit the natural lumbar curve.  Although scoliosis is often defined as a simple lateral deviation of the spine, the dynamic curvature of the spine makes scoliosis a more complex spinal deviation.

In the image above, the woman with scoliosis might have serious right sided pain due to the tension of the tissues on the right side, but will also have certain movement restrictions, whether in daily life or athletic endeavors.  In the old days, those with severe scoliosis got a steel rod implanted, which not only hurt immensely but also restricted all normal movement of the spine.  The steel rod is less common, though many older individuals still have it from their youth.   No one has fully "cured" scoliosis, meaning that few people return to a fully "normal" spinal curvature, but there are many ways of allaying pain, discomfort, and the effects of scoliosis.  As always, seek the insights of a medical professional if you're working with scoliosis, and make sure that any movement professional, bodyworker, or instructor understands scoliosis and how to best assist you.

1.  Therapeutic movement: work with someone who can see your patterns and help to balance out the musculature strength and weaknesses.   Going to a traditional yoga or pilates class might not help until you know your own tendencies-certain postures will be easy because they're on the good side, others less so, and to exaggerate the "good side" postures is not helpful in the long term.  Looking to balance out the sides, strengthen weak and unbalanced muscles, and decrease the discomfort is key.

here's my model skeleton with some right sided scoliosis.

here's my model skeleton with some right sided scoliosis.

2.  Ditch the high heels (and probably the spanx too).  I played a concert with an operatic soloist whose scoliosis was apparent through her gowns, and when she wore her 5 inch heels, the curve was definitely exaggerated, and probably painful.  (It was difficult to watch and wonder how that affected things.)  Remember that high heels cause spinal misalignment in the sagittal plane and can increase neck pain, low back pain, etc.

3.  Bodywork: Seeing a rolfer, a deep tissue manual therapist, and NKT practitioner...all can be really valuable.  These folks will hopefully work a bit more on the restricted side (if the spine deviates to the right, the tissues on the right may be weaker, painful and less forgiving), and help to restore a feeling of balance in the long run.

4.  Self-massage: Using therapy balls to work on your own misalignment can be empowering and pain killing, which is terrific.  Combining self massage with therapeutic movement and bodywork would be a great way to work with pain and restriction.

5.  Take a moment to look at how you sleep, especially if you're a side sleeper.  There has been some involved research about long term changes from sleep patterns, and if you always sleep on the good side (or bad side), you might be increasing your pain and discomfort unknowingly.

6. Know your curve.  Figure out where in the spine your deviation is, what movements hurt (or don't hurt), where you have pain, and what you need to work on.  Taking agency for your own body aids other practitioners in helping you more effectively.

*Oh, and quick point, if you teach very young children, watch to see how they stand and sit.  Try to gently guide them to upright positions so as to avoid spinal misalignments down the line.  Scoliosis is technically idiopathic (don't know the cause), but when instruments like violin/viola and brass instruments favor one side and children start early, there's a possibility of long term adaptation, especially given how malleable bones and soft tissues are in our youth.*

What is a Muscle Knot?

Last week I mentioned the importance of getting bodywork to target muscle knots- I imagine that few people see muscle them as literal knots, but what are they exactly and how do they exist?

There are a few words to know first- trigger points and fascial adhesions.  I mentioned trigger points last week, but "a skeletal muscle tissue trigger point is a hyperirritable focal area of muscle hypertonicity (tightness) located within a taut band of skeletal muscle tissue." (Joseph Muscolino)  These areas of tightness often cause pain and discomfort, especially in those overused musician areas of the upper back.  The word trigger point came to use in the 1940's because of a Doctor Janet Travell (yes, an awesome woman pain doctor in the first half of the twentieth century!) and her research into myofascia, trigger points, and pain.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

It is not something subjective, not something of which the patient complains. It is an objective physical sign in that it is disclosed by physical examination of the patient. Then, the trigger point is identified as a localized area, a spot of deep tenderness in a firm band of muscle that can be readily felt. Usually the palpable band parallels the muscle fibers; occasionally it feels like a button, or a nodule. At the spot of maximum tenderness (the trigger point), if the band is snapped briskly (transversely), and is thus mechanically stimulated, it contracts; this we have called a ‘local twitch response.’ The examiner can feel and see the line of contraction of the band, and can judge which muscle harbors it.
— Janet Travell, Basic Principles of Myofascial Pain, 1984
Remember this image from  last year's fascia post?  Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

Remember this image from last year's fascia post? Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

In some of Janet Travell's other writing, she talks about how the trigger point affects muscle strength and reflexivity, joint mobility, and radiates pain to surrounding areas.  (She was also a general badass and way ahead of her time in many other ways!)   There is a fair amount of disagreement about what causes trigger points, though we can all agree overuse, misuse, and abuse are contributing causes.  Carry a large purse on one side of your upper back and chances are, your trapezius will tighten up and eventually form a trigger point that could radiate into your forearm and neck, like the picture below. 

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Now what's a fascial adhesion and is there a difference between that and a trigger point?  Andrew Biel writes that a consistently shortened or lengthened muscle will cause change within the muscle and the fascia, which may grow "dense and fibrous.  The excess connective tissue can result in fascial adhesions that affix one muscle to another, limiting range of motion."  (Trail Guide to Movement, 12)  Remember that fascia is everywhere in the body, like the white stuff in a citrus fruit giving structure to the juice within.  Your fascia can be dehydrated (think gross grapefruit!) or overgrown from a trauma or from overuse/underuse.  Adhesions address fascia, according to some folks, and also address scar tissue and an abundance of collagen from healing.  For example, if you had tendonitis in your forearm when you were younger, you may have some scar tissue lingering in that location- it might not be extremely painful but it might be hindering your ability to use your forearm and hand.  Trigger points are generally thought of as more muscular/myofascial in origin, though to be frank, your body's network of muscles and fascia is continuous!  There is a fair amount of disagreement in the manual therapy world about what causes what, and how things cause pain, and why they arise in the body, so this is just a general survey.

How can you help both your trigger points and your adhesions?  Well, go get some bodywork and talk to your bodyworker about what they find and what tissues they find acting abnormally.  Consider getting on the self-massage train and start excavating these issues yourself, and look into different types of bodywork.  Cranio-sacral vs. rolfing vs. deep tissue vs. graston technique.  Get curious!

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