More on Scars and Massage

Scars.  We all have them, but what are they, what happens when we get them and how does massage fit in?

Scar tissue forms as a result of (1) an inflammatory response to damage to soft tissue, (2) long-term immobilization and (3) paralysis or lost or impaired voluntary movement.  They occur in all soft tissue – skin and other organs, muscles, ligaments, tendons, connective tissue and nerves.  There are many kinds of scar tissue and each is defined by both individual and similar properties.  Of the various kinds, today’s discussion involves adhesive scar tissue, contracture scarring and adhesions.

Scar tissue is not the same material as the original damaged tissue.  Rather, it is a matrix; a mixture of collagen fibers and glue provided by cells in order to effect repairs.  The matured matrix has approximately 80% of the strength of the original tissue, so cells really pile it on to make sure it holds.  Unfortunately, due to the differences between the original tissue and that of the scar, restrictions and limitations are often placed on the tissue.  Elasticity is reduced, discoloration occurs, range of motion may be affected particularly where scars and joints are close together, and the area becomes devoid of hair, pigment, melanin, sweat glands, blood circulation (after healing is complete) and other features.

The scars we are most familiar with occur in the skin and they are made up of adhesive scar tissue.  When a break in the skin occurs (more than a minor cut), the body floods the area with all kinds of things, although all we see is inflammation.  Cells throw down the collagen matrix helter skelter, rather like an unstacked wood pile.  This continues until the body decides there’s enough of the new matrix to close up the injury.

Interestingly, the bright redness that occurs in the new scar appears because certain cells actually build in-roads (capillaries) to provide a route for other cells to deliver repair materials to fix you up! Like public works, when the job is done, they leave the area (including abandoning the capillaries) and the scar eventually loses pigment and becomes pale compared to the surrounding tissue.

Contracture scar tissue forms much the same way, but occurs to connective tissue at or near joints, including joint capsules.  Because scar tissue is not as pliable as the original tissue (which isn’t very pliable to begin with), the surrounding original tissue becomes painful before a full range of motion can be reached.

Adhesions form between structures, whether it is between two soft tissue structures or soft tissue and bone.  Adhesions further limit movement by not only being non-pliable, but by attaching to other structures than the original injury.  Imagine placing your finger on the skin of the back of your hand and moving the skin surface without moving anything below it.  An adhesion between skin tissue and muscle tissue beneath it would not allow you to move that so easily.  It further limits the range of motion and pliability of tissue.

Many massage techniques are useful toward reducing pain and tension on structures, breaking up adhesions, remodeling and softening scar tissue, restoring mobilization of the affected tissue.  These include cross-fiber friction, bowing, stretching, skin rolling, fascial spreading and massage cupping.  The skilled massage therapist will use a combination of these techniques and none should create more than mild discomfort when done correctly and for the proper amount of time.

Golgi Tendon Organs Are Your Friends

Golgi tendon organs are your friends. They are proprioceptors located in your muscle/tendon junctions and tell your brain how much strain is being placed on your muscles. Why do you care? Because without them, muscles would contract or release with with the same velocity whether you picked up a fork or a car!

Imagine picking up a forkful of food and having it come at your face with the same force that you use trying to lift up a car! You couldn't duck fast enough to get out of the way of the incoming tines and you'd probably shatter your hand on the table bringing the fork back down to your plate.

Proprioceptors are microscopic cells that give your brain information about what you're doing and how you're doing it.  There are many kinds of proprioceptors and each do their own thing.  Golgi tendon organs or GTO's monitor muscle activity at the muscle fiber level.  They are positioned in series with muscle fibers in such a way that muscle goes into the organ and tendon comes out.  GTO's don't actually connect muscle to tendon; they're just involved at that junction.

What you would want to know about GTO's is that they can be reset both automatically and manually.  Notice, for instance, a weightlifter's arms.  Even when the arms are relaxed, they appear flexed, bent at the elbow, as if they were hugging a redwood tree or something.  This is because the contracted state of the muscles is such that there is constant tension on the arm flexors.  GTO's reset automatically over time to stop telling the brain the muscle is contracted and, instead, that this muscle is normal and in a relaxed state.  If, from that relaxed state, a weight was placed in the hand of the weightlifter, the muscles would stretch, the elbow would extend, and the GTO's would report the strain placed on the muscle even though the weight wasn't being lifted.

There are two types of contractions in muscles -- concentric, which is the muscle control you use when bringing a fork up to your mouth, and eccentric, which is the muscle control you use when lowering your fork back down to the plate.  What's being reported in our weightlifter is an eccentric contraction.

Now, after the weightlifter lets go of that weight, the muscles automatically contract again and put that flex back into the elbow because the GTO's think that's where normal is.  Of course, we all know that may be normal for apes, but not for humans.  So when the weightlifter decides he doesn't want that flexion in the elbow anymore, he goes to his favorite massage therapist and they work on helping his arm relax the musculature crossing the elbow joint.  They work on both the belly of the muscle where the contraction is taking place and at the junction where muscle becomes tendon...that's right, where the GTO's are located.

As his biceps brachii, flexor and extensor carpi radialis, brachialis and others cease contracting so much, the GTO locations are also worked.  Eventually, if all is acceptable to the musculature, much less contractile tissue holds tenion in the muscle belly and the GTO's are manually reset.  After several sessions, the weightlifter's arms hang more normally, even though there is still obviously tone in the arms.

So what does a weightlifter's ape-like problems have to do with you if you're not a weightlifter?

The same things happen to everybody.  They may not seem so evident as our weightlifter's arms, but only because we get used to seeing ourselves daily.  Then, one day, we notice perhaps in a store window reflection that our heads are craned forward on our neck.  We never noticed that before...how did that happen? Well, maybe from spending too much time on the computer or leaning down looking at our text messages on the cell phone.  Could be because we lie in bed reading with our heads propped up vertically on a pillow so we can see our books while the rest of our body lies horizontally.

Perhaps one shoulder is noticeably higher than the other.  Maybe you walk with your toes pointed in or out.  Could be you notice a big curve in your lower back that never used to be there.  Or someone asks you why your hands are balled into a fist while you're just sitting and talking with them.  You might bend over to tie your shoe or pick up the baby and feel a strain in the back of your legs.

All of these are the same kind of thing.  There's a contraction going on in one or more (rarely is it just one) muscle that, over time, has accepted tension as normal.  The GTO's in those muscles have reset themselves so the brain stops hearing your muscles complain about being tight.  What to do?

Do the same that the weightlifter did and go to a good massage therapist.  We're trained to work on releasing these muscles and resetting GTO's so your body will return to the way it's supposed to be.  Muscles are supposed to be soft and supple and should never hurt when felt under pressure.  If they do, you have contractions going on in there and your body needs help in letting that go.

There's another thing GTO's do -- they protect our muscles from dangerous overloading.  Let's say you're standing at the store checkout counter and the bagger has placed all your heavy items into one bag, then they hand it to you.  Your arm, back and pelvic structural muscles go into action, taking up the slack in your relaxed muscle state to immediately try to hold the load.  If that load is too much, your golgi tendon organs will yell at your brain that there's too much weight and your muscles will never survive if they try to hold it.  Your brain will instantly tell your muscles to release, relax and let go and that bag of heavy stuff will head for the deck.  I hope your feet are quick!

Golgi tendon organ proprioceptors are ingenious little guys.  They protect our muscles from overloading.  They tell us how fast to bring that fork up to our mouths or how slow to lower a baby into a crib.  They can set and reset themselves according to the conditions our bodies live in so our brains aren't bombarded with constant complaints of muscle pain.  Sometimes, that's good and sometimes not.  It makes us adaptable to varying conditions, but it can also render us out of balance.

See your massage therapist soon.  Get that tension out and get those GTO's back to normal.

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Music and Massage

Today's topic concerns how and why massage therapists use music during their sessions.  Well, I can't really speak for all therapists, only myself.  But parallels can probably be drawn between us in the business.

Two main reasons come to mind as to why.  First, music serves as a distraction from the silence you'd otherwise hear during the course of your session.  Second, music (or sounds) are used to play on your nervous system to help calm you and your muscles to relax.  How this works is thought to happen in your brainwave activity.  A faster, more pronounced wave is associated with alertness, cognizant increases, focusing, etc.  A slower wave indicates a more relaxing set of activities.  The type of music you listen to triggers different brainwave patterns and your body, physiology and mood alter accordingly.

Music therapy is said to be a growing aspect of alternative health care because of the results of research in this area of neurological study.  Although both music and sounds are being studied, music seems to be the primary focus, though sounds do have certain responses in patients studied.

Typical massage music encourages slower brainwave activity.  When this happens, the autonomic nervous system is eventually affected in the following ways: client's breathing and heart rate slow, their relaxation response is triggered, internalized stress levels drop and neurons connecting muscles to the brain slow-fire, allowing muscles and other soft tissue to relax.  A positive state of mind is induced biochemically preventing the stress response, particularly corticotropin and cortisol (although other markers were not as conclusive).

Having said all this, individuals are different as night and day.  What calms some, drives others crazy according to their taste in music and sound.  What works for you is what's important when it comes to your massage session.  It's important to have a dialog with your therapist concerning which music will be played during your massage.

Music is NOT played for the benefit of the therapist! While it gives both parties something to listen to in an otherwise quiet room for an hour or two, your session is all about YOU!

My clients are encouraged to bring any music they wish to listen to during their sessions.  I always ask my clients if the music playing is good for them.  If not, I have a selection of other music or sounds they may choose from or they may bring their own if they prefer.

While part of this blog got kind of technical, I find it pretty interesting stuff.  I hope you enjoyed it, too.  Stay well and play that relaxing stuff at home!

Till next time!

How To Choose A Massage Therapist

Fewer people have given any thought to choosing a massage therapist than they have any other healthcare provider.  I think that's because people often don't think of their therapist in the same terms as, say, their doctor, dentist or chiropractor.  But the truth is, we provide therapeutic work intended to improve your health.  That's the bottom line.  Being placed in such a position, I believe that an equal amount of consideration ought to be given to who you want working with you on maintaining your health.  So, how to go about picking the best therapist?

First and foremost, the therapist you choose should fit you, your schedule, your price range and your healthcare goals.  As part and parcel, your therapist should have experience with your specific concerns, education in the types of therapy that would best suit your concerns and be willing to not just work ON you, but to work WITH you to bring around the results you are looking for.  The right therapist should fit you like a glove.  A client would want to look forward to seeing their therapist and vice versa.  Similar or interesting personality, an earnest, caregiving attitude.

Secondly, the surroundings in which your therapist practices should be inviting, pleasing, relaxing.  How many people think about their impending dentist visit and DON'T think about the sound of a drill or smell of flouride in the air? Color schemes used in most massage practices are inviting, quieting, comforting specifically for that purpose.  Your therapist wants you to walk in and go, "Aaahhh..."  If you don't feel that way, your defenses are still up.

Thirdly, cleanliness and sanitation would be high on your list.  Dirty carpets, old-looking, oil-stained table linens, sickly plants, unattended-to restrooms all say bad things about an office.

So, how do you find the right massage therapist that you know you'll really click with? Well, as with most providers, you may have to visit a few before finding THE one.  Your best bet is to take the recommendation of a trusted friend or family member.  If you know them, like them, trust them, are much LIKE them, you may well find yourself recommending the same therapist to others again! In fact, we therapists are ALL about working with referrals.  Many of us have some kind of reward program for referring clients as part of our marketing.

Next, do a little homework.  Call the therapist and speak with them on the phone to get a feeling of how they relate to you and your concerns.  Don't be afraid to ask if they have experience with your particular issues and ask them to be specific about their plans for working with you.  Ask about their education, amount of time as a therapist, how long they've been in business.  Don't ask us if we can give you any references -- we can't.  That'd be a breach of confidentiality.  We can't even talk about your spouse's visits or issues.  But we might have testimonials listed somewhere, such as our website, a newsletter or other public venue.

One of the biggest concerns of the therapist is NOT to transfer what's going on in our lives to you.  If you visit a therapist who ends up talking about their problems or having a bad day or a problem with a client, then you don't want to go to them.  Your session isn't about the therapist; it isn't about another client; it certainly isn't about their business loan or a recent car dent! Don't get me wrong.  Massage therapists have problems just as anyone else does.  The good therapist knows they are having a problem with transferrence and will call their appointments ahead of time, though, to reschedule them.

Feedback is extremely important to us and is extremely helpful for you.  The perfect match of therapist and client is that not a word needs to be spoken and everything transfers between the two as if they were joined at the brain.  That kind of thing probably happens only in the same place where kids eat all their vegetables and money grows on trees.  If something the therapist is doing -- whatever it is -- doesn't suit you, by all means, tell us.  We very well may be tuned in to you, but we're not mindreaders.  Feedback such as pressure, pain, tickle spots, places you don't want massage, sensitive points in your muscles or near an injury are all things you will want to relate to your therapist.  The session is all about you, so take an active part in making it a great session!

Feedback may be given at any point before, during or after a session.  If your therapist doesn't seem open to feedback or denies your concerns ("That shouldn't hurt!"), that's a red flag for you.  If it's a concern for you, it should be a concern for the therapist.  Everyone experiences pressure and pain slightly differently.  Some people enjoy a heavy pressure while others cannot tolerate it.  The good therapist will always ask, "How's this pressure?" Be truthful.  If you need more or less, say so.

In my work as a professional ship captain, I prefer my watchstanding officers to call me before they get into trouble.  My standing orders include the wording, "I'd rather be called 100 times too early than once too late."  Carrying this into your massage sessions, I'd rather be told that you don't like this or that about what I'm doing so that I can adjust my work right there and then than to lose you as a client and never know why.  What's more, clients tend to tell more people about a bad experience than a good one.  I'd like to keep those bad experiences to the absolute minimum...say, zero!

In most cases, my clients are results-oriented.  They come to me looking for relief from specific muscle pain.  The rest come to me for general relaxation -- also results-oriented, but not specifically.  With both groups of people, I try to educate them with their bodies.  We're taught so little about how muscles work and it's a fascinating science.  I take the time to explain what I'm doing and why so you can participate in your own healthcare and help me gauge results you're experiencing.  This is important to me.  However, it's not always important to my clients.  Some aren't bothered WHY things are happening or how, they just want it to go away and that's it.  If this is you, I'm good with that.  Not everybody thinks it's fascinating or even interesting.  Whichever you are, just let me know or ask questions to satisfy yourself.  Personally, I believe this is a good way to do business with a client.  My idea of good customer service.

So that's my bit on how to find a good therapist for yourself.  If it isn't me (and I hope it IS!), then feel free to use this information to help you find the person most suited to work with you for the long term.  Massage works great once, better twice and best routinely.

My new website will expand over time to include more educational information for my clients and prospective clients.  If there's anything concerning massage and the soft tissues of the human body you'd like to see me address in my blogs, videos or newsletters, please fill out a feedback form or send me an email.  I love it when people are interested in taking care of themselves for the long term.

My new website!

Temporary Move

Hi, Everyone ~

I've decided that, for the time being, I will see my clients at Merrick's new location.  The facilities there are nice -- much quieter and more comfortable than the S Maple building.  No more fitness center noise in the treatment rooms! Yay!

As my own practice grows, I will look for suitable space elsewhere.  Being able to personalize the surroundings in which I see my clients is an important part of the experience and I look forward to doing that in my own place.  For the time being, the rooms being alotted me in the Manchester Wellness Care Group's downstairs area to bring my clients is very nice.

Please do recommend my services to your family and friends, though, and grow with me!

New Location Soon

The Merrick Spine Center will move on or about January 29, 2011.  The new location is 70 Queen City Avenue in Manchester.  Merrick Spine Center is integrating its physical therapy (United Physical Therapy) segment with the wellness center, which includes chiropractic, nutrition and massage therapy.  That business already has 3 massage therapists employed there who work with their clients.  Merrick's longtime massage therapists, Barbara and Corinne, will move with Merrick and continue doing periodic work at the new location.

I'm not certain if new location is a good fit for my own clients, so I will make a decision over the next couple of weeks whether I will move with the Merrick therapists.

All outstanding gift certificates and those which were sold via my GiftCardCafe sight will still be honored and ordinary online appointments may still be made.  Should there be a problem with your appointment, I will contact you directly to make other arrangements.

Thank you for your kind attention and continued patronage!
~ Joel

Cyber Monday Special Deal!

Massage Special Deal is on again! Cyber Monday has prompted a one-day-only sale.  Buy the Special Deal to get great savings on therapeutic massage at Joel Kouyoumjian, LMT! Clock's a-running!