Foam Rolling

One of the most frequent things I recommend as a massage therapist is foam rolling. Foam rollers are cylindrical pieces of hard foam that people can use to perform self-massage; most frequently they're used to self-massage the back, legs, and hips, but especially dexterous folks can use them on the chest and shoulders. Of course individual results may vary, but foam rolling is generally painful as hell on the iliotibial bands, the swaths of connective tissue that run down the sides of the thighs. That's because the IT bands are generally tight as hell, and need to be released. These nasty dudes love to screw up everything from the low back, the hips, the hamstrings and quads, and the knees.

How do? Here's a good Youtube instructional video on how to foam roll the IT bands. One thing that it leaves out that I would personally advise is to warm up beforehand. That can mean foam rolling after you work out or after you take a warm shower; whatever you can do to make your body physically warm before you try to foam roll. That'll make it less tight, easier to release, and less painful.

Another place that is great to foam roll is the back, particularly the erector spinae group that run on either side of the spine. Here's a decent video that demonstrates this technique, though I would add that when rolling on the thoracic spine it's especially helpful to bring your arms in front of you. That really helps to get into those upper back muscles between your shoulderblades.

Remember, warm up beforehand, and if it hurts then you're probably doing it right! Foam rolling sucks! But it's super-helpful! Ugh!

Reader response: Hey, I just bought a TENs unit for backpain. Can you give me more information about the safety and what you use? I have unbearable menstrual pain but cant take bc, and end up missing work for 2-3 days because of it.

For those who don’t know, TENS units (short for Transcutaneous electrical nerve stimulation) are little zappy things that stimulate your muscles. After they’ve been stimulated for a while, muscles automatically relax as part of the body’s effort to recover from the recent exertion. TENS units do that artificially via electrodes, which is why chiropractors, PTs, and massage therapists use them to help an overly-hypertonic or spasmed muscle to relax. I only bought my TENS unit recently. This is the model that I purchased from Amazon for about $30, which has several different settings and a dial on top to turn the voltage up or down, along with a manual that tells you how to use it safely. It requires a 9-volt battery, so while you can hurt yourself using it, you can’t do all that much damage even if you crank it up all the way; still, the smaller the area of the body that you’re applying the stimulation to, the lower the voltage you want to use. If you’re applying it to your trunk, like your lower back, you can maybe go up to a 3; on your hand, a 1. The trick is to start low and slowly crank up the voltage until you hit the spot you want to be at.

The best way to use a TENS unit, in my experience, is to put one electrode near one end of a muscle and the other at the other end. That way the current runs down the whole length of the muscle. Obviously, however, this depends on you knowing or being able to figure out the anatomical position of a muscle’s origin and insertion points.

So really, the layman’s best bet of using a TENS unit is to slap the electrodes on the general area that hurts (don’t let them touch each other!) and turn it on low. You won’t get the pinpointed stimulation of the muscles that will help you most, but it’ll still relax the general area, and it feels good, too. Sorta like a vibration.

I can’t speak to using it for menstrual pain, so I do encourage you to seek out additional resources before you give that a shot.

I hope this helped!

Reader Response: As a massage therapist, could you give a rundown on what you would recommend for a client? What exactly are the benefits of Thai vs shiatsu vs deep tissue?

Well, first off: Thai and shiatsu are both deep tissue massage. All that “deep tissue” means is that it’s having an effect on the deeper tissues of the body beyond the initial layer of skin, connective tissue, and maybe the top layer of muscles. There are LOTS of muscle layers in the body–at any one point in the body there are maybe 3-7 muscle groups lying on top of one another. The abdominals, for instance, are actually four layers deep (transverse abdominus at the bottom, internal oblique, rectus abdominus [the 6-pack muscle], and the external oblique on top). Lighter-pressure massage like Swedish or myofascial release tend to focus on the top layer of tissue to improve circulation, release connective tissue, and promote relaxation. The “deep tissue massage” that you’re probably most familiar with is a combination of Western techniques: long gliding strokes from Swedish, pinpoint pressure on “knots” as in Trigger Point therapy, and probably some cross-fiber friction. Depending on the therapist’s training they might incorporate a whole bunch of different stuff from different modalities, but usually when a Western person talks about “deep tissue massage,” they’re describing a combo of Western techniques that have become the definition of that type of massage b/c that’s what people in the West are most familiar with.

Thai incorporates different yoga poses, use of hands and feet, and static pressure to perform deep tissue massage. There’s a ton of stretching, pressure on certain blood vessels to cause a vascular flush, and acupressure points (same as acupuncture except w/o the needles). Different people will get different things out of different modalities; but personally, Thai is great for my hips. I have a lot of scar tissue bound up over my sacrum due to falling on my tailbone when I was a young teen, and something about the pressure and stretch of Thai always helps that tissue release. As a therapist I’d recommend Thai for anyone with low back or hip issues, or joint issues in general.

Shiatsu uses static pressure with the fingers at particular acupressure points throughout the body to move energy (or “chi”) along certain channels (called “meridians”). Again, very similar to acupuncture except without the needles. There are particular patterns that the therapist works with; usually, they perform a thorough diagnosis first to assess the patient’s overall health…and I do mean thorough. Shiatsu follows the Traditional Chinese Medicine (TCM) system, and any TCM modality tends to take the patient’s whole scene into account: their physical, mental, emotional, and spiritual states can affect the treatment protocol. Because Shiatsu uses static pressure, it’s a great style of massage for people with heart issues, while other modalities can be deadly. Someone with heart failure, for instance, could actually be killed by having a Swedish massage. I’m going to repeat that: if you have heart issues, do NOT get a Swedish massage. Swedish is the #1 best massage to improve the circulatory system, and improved circulation can quickly overload a damaged heart. If you’ve got heart issues, Shiatsu is about the only thing you can do in terms of massage. (Same with blood clots. If you’ve got a thrombosis of any kind, do not get circulatory massage: the therapist can actually knock the clot loose and send it through the bloodstream to the brain, heart, or lungs, killing the patient.)

Any other modalities that you’re interested in knowing more about? There are hundreds! Personally, I perform Western-style deep tissue, myofascial release, Swedish, Ashiatsu, aromatherapy, and Tui-Na.

This is my life.

We Are All Ghosts (made of connective tissue)

"Doris Taylor doesn't take it as an insult when people call her Dr Frankenstein. “It was actually one of the bigger compliments I've gotten,” she says — an affirmation that her research is pushing the boundaries of the possible. Given the nature of her work as director of regenerative medicine research at the Texas Heart Institute in Houston, Taylor has to admit that the comparison is apt. She regularly harvests organs such as hearts and lungs from the newly dead, re-engineers them starting from the cells and attempts to bring them back to life in the hope that they might beat or breathe again in the living. Taylor is in the vanguard of researchers looking to engineer entire new organs, to enable transplants without the risk of rejection by the recipient's immune system. The strategy is simple enough in principle. First remove all the cells from a dead organ — it does not even have to be from a human — then take the protein scaffold left behind and repopulate it with stem cells immunologically matched to the patient in need. Voilà! The crippling shortage of transplantable organs around the world is solved."

Nature.com

Above is a "ghost heart," a pig heart that has been stripped down to its protein scaffolding. The reason that it's white is because that protein scaffolding is called connective tissue, and connective tissue is white. There is more connective tissue in the human body than any other type, period: bone, fat, blood, tendons, ligaments, the inner and outer lining of all our organs/nerves/muscles…ALL of that is connective tissue. Theoretically if you de-cellularized the entire body we would still hold our shape, just like this pig heart has done.

This is why, as a massage therapist, I emphasize care of connective tissue so much when I talk to my clients, and the number one thing you need to do to take care of your connective tissue is: drink water. CT is made up of ground substance (basically water + protein molecules) and a matrix of protein fiber strands.

Think of it like a pot of soup. When the body is dehydrated, the soup thickens and gets too sticky and we get fascial adhesions between our muscles; the same happens if the body gets too cold or if the body has been inactive for too long (cold, unstirred soup tends to clump and so does unmoved CT). That's why your body gets stiff when it's cold outside or if you've been sitting or lying in one position for a while. That's also why it’s so important to warm up before you stretch and to stretch before you work out: soup that has been warmed up and stirred is much easier to move than soup that has been cold and still.

Take care of your soup!

Of Energetic Exchange and Captain America

Before I became a massage therapist, I NEVER believed in woo-woo ~energy~ things. Crystals, auras, all of that--it all sounded pretty farfetched. Since I've started working in this field, though, I've had to revise that opinion based on simple empirical, first-hand experiences. I have gotten nausea, headaches, and anxiety from clients before. It’s a very weird and distinctive feeling when it happens: I can tell that it’s coming from outside of me, because I have experienced all of those sensations before myself…but the sensations I get from clients are slightly different. I have also GIVEN THOUGHTS TO MY CLIENTS. This one time when I was first starting out, I was massaging this guy who was very quiet, no talking. My mind wandered a bit and I found myself re-playing Captain America: The Winter Soldier, which I had just seen in theater.

Out of NOWHERE, after HALF AN HOUR of silence, this guy says, “You know, I bet Captain America has made it to the cheap theaters by now.”

O_O “Why do you say that?” I asked. O_O

“Well, I’ve been meaning to see it, and it just popped into my head.”

So, yeah. Our bodies run on energy, down to every cell. It only makes sense that somehow, that extends outside of ourselves and takes something of our own thoughts, feelings, and physical sensations with it. How, I don't know. I'm still not much of a crystal, aura-ish person. but I can't deny things that I myself have felt and seen and experienced.

Reader Response: Any suggestions on how to find a good massage therapist in a big city?

That depends on what your primary issue is. If you’re super-stressed out and need to relax, maybe go for a spa environment where everything is designed to be soothing and comforting–though watch out, they’ll probably try to sell you products while you’re there (usually they get paid by commission). If spa prices are too much for you, getting a standard Swedish relaxation massage (which most every massage therapist should be able to do) will help your nervous system settle down. If you’re looking for a more therapeutic massage, then things get more interesting. Any massage place should have a bio of the therapist on their website; if they don’t, then call the place up and ask them what techniques and modalities the therapist specializes in.

Got a history of surgery and joint replacements? Go with someone who mentions MFR (myofasical release) in their bio.

Got a bunch of muscles knots? TP (trigger point), Tui-Na, Shiatsu, Trager, and sports massage are all fitting choices.

Low back pain, muscles feeling bunched up? Thai‘s a good bet.

Terrible headaches or jaw issues? Craniosacral.

Swelling or lymphedema following cancer treatment? MLD (manual lymph drainage) or lymphatic massage.

Overall energetic imbalance, where you just feel blah? Tui-Na, Shiatsu, Reiki, tuning…there’s really a bunch of different types of energy work.

I’d suggest looking for a therapist with at least a year of experience. There’s a certain level of skill that you can really only achieve from having your hands on a lot of different bodies.

I hope that helps! If you have further questions about a specific ailment, please don’t hesitate to contact me. (And the same goes for everyone else.) And, if you’re in the Portland, OR area, I know a great massage therapist. *raises hand* :D

Reader Response: This is a bit of an odd question, but here goes: I have a gift certificate for a massage. Is it polite to tip the massage therapist, like you would a beautician or a manicurist? If so, is it the same going rate of like 20%?

Not an odd question at all, I’m glad you asked! Tipping massage therapists (and how much you tip) can vary depending on the situation. If you see a massage therapist at a chain–like Elements Therapeutic Massage, Massage Envy, or the like–then the therapist is actually getting very little of the price of the massage, so a tip is somewhat expected…and counted on. I used to work at a massage chain and there, tips were 1/3rd of my income. As for how much…15-20% is customary. I usually get a $10 tip for every hour of massage (so 1 hour = $10, 90 minutes = $15, 2 hours = $20).

No, I have a private practice. There, I do not expect or count on tips at all. If I get them, great; if not, no biggie, because I’m getting a MUCH bigger cut of the massage price (minus overhead). The same goes for therapists working at a chiropractic or acupuncturist office.

I hope that answered your question, and that you enjoy your massage! If you have any further questions about massage therapy, or if anyone else out there does, please don’t hesitate to ask; just hit the "Contact" link on the top menu bar.

Drink Water

Seriously. Drink water. Right now. The most abundant tissue in the human body is this stuff called connective tissue; the main component of connective tissue is something called “ground substance,” which is mostly just water with some proteins floating in it. When we’re dehydrated the ground substance gets sticky and thick, much like soup with too little water. Because connective tissue (CT) is everywhere in the body, that impedes our movements (tendons and ligaments are CT), our organ function (the outer lining of our organs is CT), and even our mental cognition (the axons of each nerve are wrapped in a myelin sheath made out of–you guessed it–CT).

Keep a full water bottle near you at all times and take periodic sips; keep one in the car, at your workspace, beside your bed; set alarms for yourself if you must. Do whatever it takes, but drink more water. The Mayo Clinic says that female-sized people should be drinking 9 cups of water* and male-sized people should be drinking 13 cups a day.

(And no, coffee doesn’t count. Caffeine dehydrates us, so that cancels out the liquid portion of the coffee and gives us a zero sum. Alcohol is worse: for every alcoholic drink, you need to drink a glass of water in order to balance out.)

Keep your soup runny, my friends!

Heat vs. RICE

Gentle PSA from your friendly local neighborhood massage therapist: if you are in an accident of any kind and your neck/ankle/ribs/shoulder/whatever is feeling sore, do not put heat on it. Acute injuries often create inflammation as the body tries to deal with whatever has happened; heat brings blood to an area, which can drastically increase inflammation in acute injuries and actually make the injury much worse. (The reverse is true in chronic injuries, which often result in ischemia or a lack of blood in the injured area.) If you’re injured, RICE for the first 48 hours (Rest, Ice, Compress, Elevate). Even after the first 48, I’d consult a professional before switching to heat.

This message brought to you by a string of clients who all presented with some variation of, ‘Oh, I was in a car accident last week, but I’ve been putting a hot pack on my neck–that’s supposed to help, right?’

Noooooooooo.

Why Breathing Is Important (besides the obvious)

Lemme talk to you for a second about breathing, y'all. 1. Venal return pump: you know how the heart pumps blood away from the heart to the arteries? Well, when it’s time to make the return trip through the venioles to the veins back to the heart to get re-oxygenated, that no longer gets the job done. The blood slows down so much in the capillary beds in order for oxygen exchange to happen with body tissues that once it reaches the veins it can’t get the speed back up on its own. (Heart–>arteries–>capillary beds–>veins–>heart is how blood circulates.)

So the body relies on other pumps. In the limbs, muscle movements contribute to venal return–but that only gets it into the vena cava, a giant blood vessel in the torso. (It's the blue guy on the left below.)

From there, one of the main ways that de-oxygenated blood gets back to the heart is through what we call “belly breathing.” You see that thing in the top of the abdomen that looks kinda like a church ceiling? That’s the diaphragm muscle. When you breathe into your belly, you’re not actually breathing into your belly: you’re contracting your diaphragm, which a) allows the bottom portions of your lungs to expand and fill all the way, and b) presses down on your stomach, intestines, liver, and the rest of your guts, causing them to swell outwards.

This also presses on the inferior vena cava, which squishes blood towards the heart like toothpaste out of a tube.

tl;dr: breathing improves blood circulation.

2. Lymphatic pump: there’s this thing called the lymph system (also called the immune system). It’s kinda like the circulatory system in shape, except it functions to filter toxins out of our bodies. You know lymph nodes, right? Those little bumps in your neck, armpits, and groin that get swollen when you’re sick? Well, they’re swollen because they’re working to fight off whatever pathogen you’ve got in you. There’s a whole network of vessels that carry crap to the nodes in order to be filtered.

Lymph is a gooey mess of proteins and pathogens that are sorta hanging out in the body tissue and eventually gets picked up by the lymph vessels, a delicate network that acts as a kind of sewage system for the body, moving the lymph through various cleaning points (the lymph nodes) that are full of white blood cells that attack and kill the pathogens before it dumps the filtered and (hopefully) purified result back into our heart. Unfortunately the lymph system doesn’t have its own pump either, so it, too, relies heavily on breathing to return filtered and clean lymph fluid back to the circulatory system. This improves the lymph system’s ability to fight off pathogens.

tl;dr: breathing improves the function of your immune system and overall ability to fight diseases.

3. Improved sleep and relaxation: deep breathing has been shown to trigger the parasympathetic nervous system.

The parasympathetic nervous system is part of the autonomic nervous system, which controls all the automatic or involuntary things that happen in our body like organ movements, hormone releases, etc. The parasympathetic side controls things like rest, relaxation, digestion, and sleep; the sympathetic side controls fight-or-flight response. We tend to live our lives on the sympathetic side, with lots of stress and work. Unfortunately that leads to the release of tons of a vicious little hormone called cortisol that SCREWS. UP. EVERYTHING. Like, if you’re running from a tiger it’s great, it does all sorts of things to the body to make it more efficient at fight-or-flight, but it also does awful things to pretty much every body system in the process. This is why stressed-out people get sick, can’t sleep, develop heart problems, have higher rates of neurological and mental disorders, get cancer, get diabetes…Google practically any disease + “cortisol” and there’s a link. I’m serious.

Breathing can change that. The way and amount that we breathe has been shone to drop us out of fight-or-flight and into rest-and-relax. This is why deep breathing helps with anxiety: when you’re anxious you’re locked in the sympathetic nervous system response, but deep breathing drops you into parasympathetic response and tells your body, hey, it’s all cool, man.

tl;dr: breathing improves everything.

Reader answer: Would you mind if I asked what has surprised you about massage or the human body, or say what are some interesting things you have learned/wish people knew?

The thing I wish people knew is that massage does not have to hurt in order to be deep tissue/therapeutic massage. Seriously. “Deep tissue” refers to the fact that there are tons of muscles layers in pretty much every part of the body, overlaid on top of one another like rings in an onion; sometimes the issue that’s causing pain is in the top layer but more often it’s a few layers down or even at the bottom. In order to reach that layer, a massage therapist has to find ways to work through the upper layer(s). Now, a lot of therapists are trying to rush b/c their clients want a full body massage in an hour plus focus work in the area that’s bugging them most. So they press really, really hard. That’s one way of getting to the bottom layers, but it causes some bruising and pain to the upper layers.

A far gentler and more effective method is to relax the top layers of muscle then work your way down. Think of is in terms of an archaeologist’s slow, meticulous, careful excavation versus the jackhammer of a construction crew. The former is far less painful, more beneficial, but takes longer. You can’t do the archaeologist method if you’ve got one hour to massage a client’s whole body.

Add to that, people who have had deep tissue massage before think that it has to hurt in order to be effective, because they’re so accustomed to the jackhammer method. Thus, I’ve encountered clients who won’t tell me that I’m causing them pain because they think that’s what I have to do in order to be effective and actually treat their issues, and a lot of the time I don’t. I’ve had clients outright lie and say that the pressure level/technique that I’m using doesn’t hurt, and then when I go to turn them over I realize that they’ve soaked through the sheets with sweat.

So please: don’t let your massage therapist cause you pain. If you’ve got a major physical issue that you need work on, tell them you want “focus work” in that specific area, and tell them which body parts they can skip (i.e. you don’t care about having your hands worked on, or your legs feel pretty good today, etc.). A lot of the time things are connected, and an issue in the back may actually be caused by something in the abdomen or hips; but it’s virtually impossible to do a deep tissue massage on the whole body without causing a lot of pain and bruising. Focus work lets us strategically and carefully hit the areas that are causing the issue instead of whipping out a jackhammer.

Also, don’t go to Massage Envy, they have a history of hiring sexual predators. There’s a reason they’re so cheap: I know plenty of good people who work there, folks I went to school with, but overall the company does not have quality control for who they hire and they apparently don’t even communicate in between franchises. This one time in Texas, a male therapist sexually assaulted a female client at one Massage Envy, got fired, and six months later was re-hired at a different Massage Envy a few miles away where he sexually assaulted another female client. So. There’s that.

The 5 Things A Massage Therapist Will Probably Tell You To Do In Order To Stop Hurting

1. “Shoulderblade kisses” aka scapula retraction exercise. You know that spot between your shoulderblades that gets tense all the time? Well, it’s not actually tense: it’s stretched. Those are your rhomboids and the pain they experience is the price we pay for using a computer, studying, driving a car, texting, and any other activity that involves our arms being out in front of us. That position brings our shoulders and our shoulderblades forward into protraction. That stretches out the rhomboids and causes them to tense up in an effort to counteract our slump.

What do? Take your arms out to the sides, Jesus-style. Now bend your elbows and try to bring them behind your back. Your forearms should still be out to the sides. You’ll kind of look like you’re trying to pick a fight with someone. Do 25 of these and you should be able to feel those rhomboids getting stronger, pulling your shoulders back where they should be.

2. “Write the alphabet with your nose” aka neck exercises.

Stiff neck? Tension headaches? You might be tempted to stretch. Don’t. Necks are super-prone to adhesions and trigger points, both of which can actually get worse if you stretch without warming up the muscles first. Next time you wake up with neck pain, try exercising it instead of stretching.

What do? My favorite is the alphabet exercise, in which you pretend the tip of your nose is a pencil and write the alphabet with it. Start off small with A and get bigger until the Z is huge. That takes your neck through a lot of different motions.

3. “Play superman” aka back extension exercises.

Hand-in-hand with the shoulder slump is the back curve. This usually presents as pain in the mid-back on either or both sides of the spine, in what’s called the erector spinae group (or ESGs in massage lingo). True to their Latin, the ESGs hold us upright–but when we’re slumping forward all the time they, like the rhomboids, get stretched out and weakened. Then when we go to lift something too heavy and bend over instead of using our legs, we get that eeeeeeak feeling in our back that is the ESGs informing us that this shit is not on.

What do? Lie on your front with your arms out to the sides. The picture above is kind of advanced: feel free to not have your arms out so far above your head, I only have my arms at a ninety-degree angle with my shoulders, frankly. Start off with maybe 20 reps of that motion and work your way up to 50 and arms straight out. Don’t overwork the muscles, but get them going.

4. “Cobra pose” aka psoas stretch.

You ever get that pain in your low back from sitting in a chair for a long time? That’s your psoas being a jerk. This stretch is a natural transition from the superman exercises. Really, it stretches a whole lot of things that need it, but especially the psoas muscles. The psoas attaches to the fronts of the vertebrae in the small of your back and run down through the pelvis to end up on the insides of your legs. It’s a waist flexor, which means that all that time you spend sitting down is teaching it to be short. Then when you go to stand up, it wants to STAY short instead of stretching, and the result is a sharp, powerful tug on your lumbar vertebrae and a helluva lot of low back pain.

What do? Lie on your front and lift your torso until you are propped up on your elbows. You should feel a stretch in your abdomen. If you don’t, go up onto your hands like the figure to the right.

If you still don't feel a stretch, try doing this. Then get the hell away from me. What's wrong with you, do you not have a freaking spine??

5. “Foam rolling your IT band” aka WHY GOD WHY DOES IT HURT??

I don’t know who made that picture but it is 100% accurate. See, there’s this swath of connective tissue (think tendons and ligaments) that runs down the sides of both your thighs from your hips to your knees, called the Iliotibial Band, or IT band or ITB for short. The ITB, being sticky-wicky connective tissue, loves to get tangled up in everything around it, which is primarily the hamstrings and the quads. The adhesions that form along the whole length of the ITB prevent both these muscles groups from relaxing, and leads to all sorts of painful things, from torn hamstrings to kneecaps getting out of alignment and wearing down cartilage (thus necessitating knee replacements) to hip issues (gluteus maximus aka “the butt” feeds into the ITB and tugs on the sacro-iliac joints). Basically the ITBs want to fuck up your entire lower body.

What do? Well, if you’ve got a high pain threshold like the lady with the rictus grin in the picture, you can buy a foam roller and plop down on it like she is, then roll back and forth to your heart’s screaming, agonized content. If, however, your IT band is as sensitive as most people’s, I recommend a) taking a hot shower/bath before rolling, as it makes the ITB more pliable, or b) getting a hard plastic water bottle (one that won’t crack and has a tight lid!!), filling it up with warm water, and using that instead. You can  simply sit in a chair and rub it up and down your legs from hip to knee. Do it for about five minutes each day and that will relax the IT band as well as loosen the adhesions to the hamstrings and quadricep muscles. Stretch both those muscle groups afterwards for maximum benefit!

Again, these are just the things that I’ve found to be most helpful for my clients. I take no responsibility if you injure yourselves actually doing these things, and especially no responsibility if you actually decide to foam roll your IT band. Seriously, that shit hurts.