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Author: Sam Visnic

Unique Benefits Of Neuromuscular Massage Therapy

Unique Benefits Of Neuromuscular Massage Therapy

Written by Sam Visnic on . Posted in Uncategorized.

Benefits of neuromuscular massage therapy

There are some very unique benefits of neuromuscular massage therapy that make it a good choice for some people.

First, let’s discover what it is.

What is neuromuscular massage therapy?

Neuromuscular therapy (NMT) is a branch of bodywork that shifts the brain’s perception of pain.  The therapist will find sore or sensitive areas in the soft tissues, in particular trigger points, then desensitize these areas with a combination of techniques, such as static compression.

How do you perform neuromuscular therapy?

Benefits-of-Neuromuscular-MassageNeuromuscular therapy is not so much a specific technique, but rather a philosophy that includes an assortment of techniques.  There are types of NMT, including the European and American versions, and there are important differences between them.

The european system is much broader and emphasizes many more aspects of the therapeutic process, including evaluation, hands on techniques, nutrition, psychological, movement, etc., while in contrast, the American version is much more focused on the massage therapist and trigger point release components specifically.

Trigger points are an interesting topic, and one of considerable debate.  At Release Muscle Therapy, I do not particularly focus on trigger points, as they tend to be very common and difficult to specifically correlate to an individual’s pain (for example mimicking the pain), but they do tend to desensitize throughout the natural course of therapy.

At Release Muscle Therapy, I follow the more European model of neuromuscular therapy, in particular because I’m not a more classical massage practice, but instead utilize a variety of techniques to promote optimal health and wellness.

All NMT programs start with a comprehensive evaluation to identify movement restrictions and soft tissue sensitivity.  This helps to create a more effective overall strategy, rather than just massaging the areas where the pain is located.

What is the difference between deep tissue massage and neuromuscular massage?

You are probably wondering what neuromuscular massage can do that other massage styles don’t. There are often overlapping elements between many modalities. 

Both styles employ massage techniques that can involve deep pressure applied to tissues, but the intention may be very different with other techniques applied. 

In neuromuscular massage, classically the focus is identifying the location of trigger points and using techniques such as static pressure and also contract/relax movements to relax muscles that contain active trigger points. Deep tissue massage doesn’t utilize these methods because the intention is different.

How often should you get a neuromuscular massage?

The frequency at which you can get neuromuscular massages depends greatly on the goal of the therapy. 

For routine soft-tissue therapy and prevention, it can be done at the same frequency as other types of massage, which is usually based on convenience and financial capability.  Once per month or as frequently as once per month is common.

If the outcome of of the therapy is pain relief, this can change the frequency recommendation greatly.  Since a comprehensive pain relief program can involve a full-body approach, the frequency of sessions could be 3x per week while focusing on a different area each therapy session. 

The intensity of the therapy influences the frequency as well.  If the same body region is to be treated, then light applications can be done more frequently, which more days between more intense sessions.

The true benefits of neuromuscular massage therapy are maximized when the work is truly customized to the needs of the individual.

Learn more about neuromuscular massage therapy Temecula.

Multifactorial Causes of Pain - Why it's Important to Address

Multifactorial Causes of Pain – Why it’s Important to Address

Written by Sam Visnic on . Posted in Pain.

Multifactorial-causes-pain-imageBefore we dive in the multifactorial causes of pain, it’s important to note that chronic pain is a complex topic that is filled with debate, and it’s even more challenging to build therapeutic programs for.  There are pain scales and standardized therapy programs, but sometimes they simply are not enough to get people relief and back to their lives.

Thus, many people are in the active search of new options to deal with their chronic issues.  Yes, indeed it is a sensory impulse, just like smell and taste, but with profound emotional implications.  In the long term, chronic pain affects the individual’s independence and quality of life.

If a healthy young person feels grateful after relieving short-term pain after trauma with a known recovery time, just image how important it is for people with a chronic condition who live in pain day after day for years!

In this article, we’re diving into the topic, exploring the leading causes of chronic pain and aspects you need to understand to fully appreciate the scope.  You will learn why it is thought to happen, and what the doctor may be trying to communicate in a different way.

If you don’t know much about some of the thought causes of chronic pain are and why a multidisciplinary approach is recommended, then you will find your answers after reading!

What causes pain?

One of the leading authorities in chronic pain is the International Association for the study of Pain, IASP.  They have recently updated the definition of pain, describing it as a sensory and emotional experience associated with tissue damage. (but of course pain doesn’t have to be associated to ANY tissue damage!)

It is inherently unpleasant and influenced by social, biological, and psychological factors.  In other words, your mental state and also environmental conditions could increase or decrease your perception of pain.  It usually depends on sensory impulses, but not all types of pain go through these neurons.  They may also result from a malfunction in the central nervous system (1).

Accordingly, here are many causes of chronic pain.  For example:

  • Chronic pain associated with cancer:  This type is caused by nerve compression of a growing tumor, nervous involvement, or a side effect of chemotherapy (2).
  • Chronic pain after surgery or trauma:  Most people have had a peculiar sensation in their surgical would during and after healing.  Nerves cut in surgery and tissue damaged by trauma could trigger or worsen pain experience.
  • Chronic musculoskeletal pain:  This is the type of pain reported by patients with arthritis or any mechanical alteration of the musculoskeletal system.  Joint pain is usually associated with inflammation, a common cause of chronic ailments (3).
  • Chronic visceral pain:  This pain shows up when our internal organs are inflamed for a long time or have mechanical or vascular alteration.  For example, chronic pain is common in inflammatory bowel disease (4).  In children, small intestinal bacterial overgrowth (SIBO) is probably one of the leading causes of chronic abdominal pain (5).
  • Chronic neuropathic pain:  This type of pain arises after an alteration in the nervous system.  There are many pain pathways.  It only takes a single lesion in one of these, and the person could end up with a relentless and very distressing type of pain.  This happens in people with diabetes, and it is called diabetic neuropathy (6).

There are other contributing causes of chronic pain, and sometimes the origin is near impossible to trace.  When that happens, it is often termed “primary chronic pain” and it is complicated to address.

Common ailments associated with chronic pain include:

  • Migraine, glaucoma, trigeminal neuralgia, and temporomandibular joint dysfunction, leading to chronic headaches
  • Carpal tunnel syndrome, muscle strains, rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis, leading to chronic musculoskeletal pain
  • Herpes zoster infection, multiple sclerosis, and polyneuropathies leading to chronic neurological pain
  • Peptic ulcers, angina, endometriosis, and interstitial cystitis, leading to chronic abdominal or pelvic pain

What are multifactorial causes of pain?

We have reviewed several causes of chronic pain, but these individuals usually have more than one.  It takes extra time to control their symptoms because it often has multiple (and often very many!) triggers.  It is indeed a multifactorial pain.

Multifactorial pain is caused by several triggers at the same time.  One of the best examples is low back pain.  Lower back pain can be triggered by a dozen problems simultaneously.  A muscle strain, chronic stress, osteoporosis, and degenerative disc disease could converge in the same person.  Muscle relaxants and anti-inflammatories could reduce pain perception, but they won’t address every trigger, and the sensation still lingers despite those pharmaceutical interventions.

Essential aspects to address in multifactorial pain

Now you learned what multifactorial pain is, it will be easier to understand why some therapies may not be enough to either relieve symptoms, or keep them alleviated.  In these cases, your health practitioners may explore additional options across different disciplines to get results.

Why is it important to understand pain?

As a part of chronic pain management, you’re likely to undergo a number of different evaluations to flesh out some underlying contributors to your pain.

Not fully exploring multifactorial pain could lead to either therapy failure, or a complication in the long run.  This is one major reason why its important to explore the various triggers, even if it takes a good deal of time and effort to do so.

It is also essential for you to understand your specific pain experience.  This way, you could find additional ways to control pain or prevent flare-ups.  For example:

  • Strong emotion could precipitate a flare-up in rheumatic arthritis.  Ideally learning to cope with stress and eat a healthy diet would be recommended.
  • Osteoporosis-related pain improves with adequate calcium consumption and exercises to strengthen back muscles and bones.
  • Caffeine and alcohol could be worsening an interstitial cystitis problem.
  • The main reason for joint pain could be excess bodyweight.
  • Simple dietary changes like reducing carbohydrate intake and eating certain types of fermented foods could help SIBO-based discomfort.

What is the intensity of the pain?

When evaluating multifactorial pain, one of the most useful aspects is the intensity of this sensation. It is valuable information and often reflects the magnitude of the problem. Thus practitioners will try to ask patients to evaluate their own pain sensation and describe how strong it is.

The easiest way to describe pain will be using an intensity scale from 0 to 10. Zero will be no pain at all, and 10 will be excruciating pain. This is a quick way to measure the intensity of pain.

In scientific literature, pain intensity is defined as the magnitude of pain experienced by the individual. It is easier to evaluate pain intensity in adults because they have previous experience and resources to describe their condition.

Conversely, assessing pain in children is much more challenging. Besides self-report, therapists may need to evaluate their behavior and physiologic indicators.

The downside is that such indicators are usually not accurate in mild and lingering pain. In such cases, they depend on the patient’s tolerance and threshold levels (7).

Physiologic indicators and behavioral cues are also useful in adults. In this case, they are known as pain interference. It measures how pain influences the person’s physical function, mental health, and sleep patterns. Higher pain interference in chronic ailments leads to a decrease in quality of life.

Interestingly, pain intensity does not always correlate with pain interference. In other words, you can experience mild pain, but having this symptom for a very long time causes significant pain interference.

Conversely, people with acute ailments could feel more intense pain without substantial or long-term consequences in their physical function. That’s why pain interference has its own measure through the Pain Interference Subscale, included in a section of a tool known as Brief Pain Inventory (8).

What are the two types of pain scales?

As noted above, scoring pain is a fundamental step in the diagnosis. It is not always accurate and depends on the patient’s perception. However, they provide helpful insight and support doctors in assessing the extent of the problem. With no other objective measure, clinicians often depend on this type of scale and the patient’s description based on pain intensity scales.

The Brief Pain Inventory is one such tool, and there are multiple pain scales available for doctors and patients. They are all useful, and each has advantages and disadvantages. But they are broken down into two categories or types. They are unidimensional and multidimensional pain scales (9).

  • Unidimensional pain scales: They are easier to use in an emergency and whenever doctors have a clearly defined and single question to ask about pain. They are easier to understand by individuals, and rating depends on their experience. Self-report is not compared with behavioral cues or the person’s physiologic response. They include the Visual Analog Scale (VAS), the Numeric Rating Scale (NRS), and the Verbal Rating/Descriptor Scale (VRS/VDS) (10).
  • Visual Analog Scale: It is one of the most easy-to-understand and universal pain scales. Healthcare workers would simply draw a line and ask the person to select a point between both ends to express the intensity of the pain. One end describes no pain at all, and the other is the worst imaginable pain for them.
  • Numeric Rating Scale: This scale goes one step further and divides the same line in a series of numbers from zero to ten. One of the benefits of the scale is that you can apply this tool verbally or visually. It is widely used in oral interviews with your therapist when they ask you to describe your pain on a scale from zero to ten.
  • Verbal Rating Scale and Descriptor Scale: This time, instead of drawing a line or assigning numbers, the therapist asks the person to choose the word that better describes their pain. It usually includes the items “no pain”, “mild”, “moderate”, and “severe”. Similar scales could use a visual representation of faces expressing different degrees of pain with or without a written description.
  • Multidimensional pain scales: We mentioned that multiple elements influence how you perceive pain. Multidimensional pain scales are created in an attempt to consider these factors. For example, they include the affective contribution, which worsens pain or helps the individual control the symptom. The person’s belief system and pain interference can also be evaluated. Multidimensional pain scales consider this symptom as the result of physiologic, psychologic, and behavioral elements. Thus, they all need to be assessed to understand pain perception. As such, they are handy in chronic conditions, especially when multiple causes of chronic pain converge in the same person.

What do multidimensional pain scales measure?

Anyone could draw a line and ask you to describe how intense your pain is. However, that won’t be enough in multifactorial pain and chronic health conditions. In these cases, multidimensional pain scales are better to assess the magnitude of the problem. They help therapists identify triggers and pain modulators, which then become potential therapeutic targets.

Scientists have developed plenty of multidimensional pain scales. Each one has its applications and benefits for a given type of chronic health condition. The best-known example is known as McGill Pain Questionnaire. This scale measures several aspects of pain using many words to describe the symptom. The person would read each word and assign a rank value. They would also assign a rank value for present pain intensity. The numbers are counted down, and the Pain Rating Index (PRI) is obtained. This tool also evaluates the exact location of the pain and how it is felt throughout time.

Other multidimensional pain scales measure additional aspects of pain. For example, the Minnesota Multiphasic Personality Inventory takes into consideration the individual’s psychology and how it affects the perception of pain. Another scale that measures a similar aspect of pain is the Pain Beliefs Questionnaire. Similarly, the Checklist for Interpersonal Pain Behavior evaluates what the person does and social considerations that modulate pain perception (9).

One of the most comprehensive multidimensional pain scales is known as the West Haven-Yale Multidimensional Pain Inventory. This scale was developed to make a complete assessment of pain in clear words and quickly. Still, it includes 12 scales, and it is divided into three parts, examining the symptom and the impact on the person’s life (11).

Most multidimensional scales are long and can be tedious to administer. Thus, abbreviated versions are made available sometimes to simplify the task. For example, there’s a short version of the McGill Pain Questionnaire. The Minnesota Multiphasic Personality Inventory also has a short version, and we have tools such as the Memorial Pain Assessment Card, a cancer-specific assessment tool that evaluates pain intensity, pain relief after therapy, and the person’s mood. It only takes a few seconds to take the test, so repeating the measure is not a burden for cancer follow-up (9,12).

Why is chronic pain management important?

Acute and chronic pain are different from each other, and pain management works differently in each case. Temporary relief with pharmaceuticals, but a comprehensive therapeutic program should also include additional considerations. Otherwise, the person may experience the adverse effects of anti-inflammatories and meds and still not get back to full functioning.

Chronic pain management is a multi-step process with many guidelines and opposing opinions. Recent research highlights the role of cognitive-behavioral therapy, exercise, and biopsychosocial rehabilitation as promising options with lower risks than opioids. Massage therapy could also offer an alternative solution, especially for chronic back pain and other musculoskeletal conditions.

Sometimes the solution requires surgical treatment, and other invasive procedures. In all cases, decisions should be made after evaluating the risks against the benefits. As opposed to acute pain relief, chronic pain management considers the multidimensional aspects of pain, standardized or coadjutant treatment, and the risks and benefits of each therapeutic option (13).

It may seem too much, and the process could be exhausting for individuals and their relatives. However, it is essential to go through this process for several reasons:

  • Pain relief will improve the quality of life
  • Controlling their symptoms will help them regain confidence, mobility, and independence, relieving the burden of their relatives as caregivers
  • In the long-term, successful pain management may reduce costs in opioids and expensive drugs
  • People are adequately educated about their condition and start contributing actively to their therapeutic program
  • Newe therapeutic targets are revealed, and more options are made available
  • Proper chronic pain management has a lower risk of side effects and complications

For all of the above, addressing the multiple causes of chronic pain is essential for these individuals.  It is also essential to understand the basics of pain scales and other tools.

Conclusion

You can prevent annoying symptoms if you know what causes pain, but chronic conditions are much more complex. These individuals often have multifactorial causes of pain, and multiple factors contribute to their symptoms.

Something as simple as back pain could respond to osteoporosis, muscle strains, degenerative disc disease, and stress, all at the same time. If you fail to address one of these factors, you might not experience complete pain relief.

Five Landmine Row Variations

5 Landmine Row Variations – How To Perform Them Perfectly

Written by Sam Visnic on . Posted in Movement and Exercise.

If you’re looking for some variety in your shoulder training and keep them healthy for the long-run, then look no further than the Landmine Row.

The landmine is a special tool that anchors one end of a barbell so that you can use it for a variety of exercises that wouldn’t be possible otherwise.

The landmine creates a bar path that occurs in an arc, which, depending on the exercise, can provide a more natural feeling movement to back and shoulders exercises.

Below you’ll find some of my favorite variations of landmine rows.

1. Chest Supported Single Arm Landmine Row

The chest supported landmine row is a great option not only for better isolation of the scapular retractor musculature, but also for those dealing with lower back issues.

One of my pet peeves is watching people do rows and using a shortened range of motion, never completing the full scapular retraction.  This chest supported version anchors the torso in place and there is less emphasis on rotation.

Low-Incline-Landmine-Row-1

Low-Incline-Landmine-Row-2

  • Lay face down on a low incline bench next to the landmine set up.
  • Make sure when your arm hangs down with the bar your foot is clear of the bar path.
  • Slightly lift your chest up to activate your spinal extensors.
  • Row the bar up and emphasize a shoulder blade squeeze at the top.
  • If you feel it in your lower back, squeeze your glutes.

 

2. Chest Supported Pronated Single Arm Landmine Row

The chest supported row with the arm abducted (out to side) will place more emphasis on the rear deltoids and rhomboids.

You certainly won’t be able to use much weight on this one, so focus on quality.

Landmine-Row-Pronated-Low-Incline-1

Landmine-Row-Pronated-Low-Incline-2

  • Lay face down on a low incline bench next to the landmine set up as shown.
  • Brace by grabbing the bottom of the bench with your opposite hand.
  • Its common to over-extend the neck on this version, so be sure to elongate your neck by keeping it slightly retracted.
  • Row the bar up with your elbow out to the side and emphasize the shoulder blade squeeze.

3. Landmine Bent Single Arm Row

The bent single arm landmine row is a good alternative to the standard 2 arm row with dumbbells or barbell.

The offset aspect of the lift forces you to stabilize to great degree with your whole body.  Needless to say, this can significantly reduce the amount of weight you can use during this exercise, but it doesn’t make it any less effective.

Landmine Bent Single Arm Row 1

Landmine Bent Single Arm Row 2

  • Stand with your feet hip width apart next to the landmine setup.
  • Bend forward by tipping from your hips and maintaining a slightly arched lower spine.
  • When you row, you’ll feel your weight shift toward the side that is working. (this is correct)
  • Perform the row by thinking about lifting from your elbow, and not from your bicep. This will help you feel it in your lats.

 

4. Landmine Bent Meadows Row

This bent over landmine row is a modification from what is commonly called the “Meadows Row” in some circles as developed by John Meadows.

Landmine Bent Meadows Row 1

Landmine Bent Meadows Row 2

  • Instructions for set up are the same as the single arm bent version.
  • Use an overhand grip with your elbow out to the side for this row variation.
  • Since everyone has different body proportions, you will need to test your set up to get the most natural feel for the row, so start light!

5. Landmine Supported Row

The landmine supported row is a great version for loading up the weight.  The split feet stance and holding onto a support gives you a lot stability.

Landmine Supported Row 1

Landmine Supported Row 2

  • Stand facing a bench or equivalent and split your stance so that the leg is back on the rowing arm side.
  • Tip forward from your hips while maintaining a slight arch in the lower back.
  • On this version, you can use more of your legs for a more full body rowing exercise.

Special thanks to my colleague and Landmine Row model Brittany Kohnke.

Beat Pain with Mobility Podcast

New Podcast: Beat Pain With Mobility

Written by Sam Visnic on . Posted in Mobility.

Timestamps:

0:00​ – Intro

7:05​ – What are your thoughts on mobility work?

12:47​ – What is your approach and how do you find a balance between gaining muscle and attaining mobility?

38:29​ – What are some of the exercises that tend to create the most common problems?

41:38​ – How can someone determine their ankle mobility?

45:21​ – How about the bench press and its relation to shoulder pain?

47:41​ – What are your thoughts on rotator cuff exercises?

56:22​ – What are your thoughts on massage guns and foam rollers?

1:09:44​ – Where can people find you and your work?

Pec Minor Release Techniques

Best 4 Pec Minor Release Techniques – Pain Free And Safe Movements

Written by Sam Visnic on . Posted in Massage Therapy, Muscles, Pectorals, Stretching.

Best 4 Pec Minor Release Techniques

Most people are quite familiar with the larger, more superficial chest muscles, called the pectoralis major, however, underneath this muscle is another, called the pec minor.  The pec minor release techniques later in this article will be specific to this muscle.

This muscle is very important to address, since it’s responsible for pulling the shoulder blade forward and down onto the ribs. (contributing to the rounded shoulders appearance).

If during an evaluation there is an upper cross syndrome with rounded shoulders and excessive forward head positioning, this muscle should be addressed.

For the most part, in any upper body impairment the pec minor is likely to be strongly involved.

Pec-Minor-Release

How to know if you may need to address the Pec Minor Muscle:

  • Hunched or slouched forward shoulders
  • Rotator cuff or other shoulder injuries
  • Neck pain
  • Thoracic outlet syndrome
  • Breathing imbalances

Pec Minor Release w Tennis Ball

The pectoralis minor can be addressed with a tennis ball.  This is one of my favorite self pec minor releases.  Now, one thing to mention here is that you will NOT be making contact directly with the muscle.

Since the pectoralis major lays over the top, you’ll be influencing the pec minor indirectly with this technique.  You will need to play with ball positioning to find the most tender spots.

Pec Minor Release Massage

Addressing the pec minor with massage release techniques can be very powerful and useful.  My favorite position for this is side lying, as it allows for gravity assistance in moving the pec major out of the way.

However, some therapists prefer to do this supine (client laying on their back).  The preference will ultimately depend on the anatomy of the individual, and the therapist’s ability to feel the muscle.

Pec Minor Stretch
The pec minor can be challenging to stretch due to how deep the muscle is and it’s function.

It’s not uncommon to feel either a stretch OR some discomfort on the front of the shoulder when attempting to stretch the pec minor. Therefore, take your time when setting up this stretch and avoid being too aggressive.

Pec Minor Release – Post Isometric Relaxation
Post-isometric relaxation is very effective for the pec minor muscles, in particular for resolving pec minor trigger points.

A therapist is needed for this technique.

Lay on your back with arms down at sides. The therapist will guide the shoulder slightly up away from the nipple as well as down toward the table. You do NOT need to go far with this stretch.

Hold for 8-10 seconds, take a deep breathe in, and exhale as you attempt to relax further into the stretch. Next, while maintaining a light stretch, gently push the shoulder into the hand of the therapist with about a 10-15% percent effort.

Hold for 10 seconds, then take a deep breath and relax fully, allowing the therapist to take up the slack and see if the stretch can be taken a bit further. Repeat 2-3 more times or until no additional range of motion is achieved.

Thanks for checking out my recommended best pec minor release techniques.

As always, no muscle should be seen as the sole contributor to any given problem.  No muscle works in isolation.

It’s always best to approach muscular imbalances with a systemic approach to get the best results.  That is why I developed my Posture Hacking System.

How To Sit with SI Joint Pain

How To Sit With SI Joint Pain

Written by Sam Visnic on . Posted in Mobility, Pain, SI Joint.

How-to-Sit-With-SI-Joint-Pain

Sitting with SI joint pain for any length of time can make you miserable.  Unfortunately there isn’t just “one fix” that will work for everyone all the time.

Instead, there are a number of things that can help reduce SI joint discomfort.  They need to be tested to find out which works best.

However, the key reason why most people feel pain when sitting is because of a lack of movement.  Tissues, and especially nerves, need blood flow and oxygen to reduce increased sensitivity.

This is especially important to remember because at the end of the day, you need to MOVE as a human being, and not doing so simply cannot be worked around by using an expensive ergonomic chair, creams, pills, etc.

The sacroiliac joints and surrounding joints need to be addressed not only with positional changes, but also with specific exercise protocols, which can be found in my other posts.

That said, let’s get to our how to sit with SI joint pain list.

How To Sit With SI Joint Pain – Seated Hip Shift Mobilization w Ball

Since we are all asymmetrical (not balanced front/back/left/right), we tend to have favorite sides to sit on, muscles to use more, etc.

These asymmetries can be exacerbated in our daily activities, so we need to be conscious of using both sides of our body.  This movement in particular will help accomplish this task while sitting.

SI joint dysfunction is often associated to relative anterior/posterior tilting of the iliac crest on the sacrum. While this is hard to validate, especially visually on a standing movement or posture test, we can replicate this alternating shifting movement with this mobilization.

Here is how to do it:

  1.  Sit upright with your feet flat on the floor and with your hips slightly higher than knee level.
  2. Place a small ball or yoga block between your knees. (even a rolled up towel or pillow will work)
  3. While keeping your feet flat on the the ground, shift your weight to one side and pull your hip back while simultaneously pushing the opposite hip forward.
  4. Hold this position for 1-2 seconds, then repeat on the other side.
  5. Shift from side to side until you start to feel some fatigue, you start to lose good form, or feel any discomfort.

When you perform this hip shifting maneuver, it’s essentially “pumping” the hips and lower back.  You need to make sure this movement is done with low intensity.  It’s not about forcing the range of motion or building strength or anything else.

Just introducing movement, getting blood flowing, and relaxing overly sensitive nerves.

How To Sit With SI Joint Pain – Seated Hip Shift Mobilization w Band

This option is almost identical to the previous one, but in this version you will place a light mini-band around your knees.

The first version emphasizes the groin muscles to pull the hip back, and this version emphasizes the glutes to slide the opposite knee forward, but also to decelerate the same side hip as it goes back.

Yeah, that can sound a bit confusing, but the point is those muscles need to do both. In addition, adding a bit of resistance to the glutes further helps you to feel them and also get a bit of a muscle pump for blood flow.

Here is how to do it:

  1.  Sit upright with your feet flat on the floor and with your hips slightly higher than knee level.
  2. Place a light-moderate mini-band above your knees. (don’t go too heavy on this as it will distort the movement!)
  3. While keeping your feet flat on the the ground, shift your weight to one side and pull your hip back while simultaneously pushing the opposite hip forward.  Maintain the tension outward against the band with your knees.
  4. Hold this position for 1-2 seconds, then repeat on the other side.
  5. Shift from side to side until you start to feel some fatigue, you start to lose good form, or feel any discomfort.

You may find that one of these versions appears to help reduce discomfort better, OR doing both of them provides the best effect.

The one that works better for pain relief is the one you should repeat often throughout the day.

That said, IF you are going to do an exercise movement frequently, my rule is to make sure it’s done with LOW intensity.  Getting excess muscle soreness or fatigue is not the goal, and in fact it may slow down progress because you have to wait until it goes away to proceed.

 Should You Use A Standing Desk?

A standing desk is always a good option to rotate with sitting, especially if you’re dealing with sacroiliac joint pain. The loading on the SI joints is different in the standing position due to differences in muscle activity.

The standing desk is a great option to allow you to take frequent breaks from sitting and reduce the pressure on your spine .

Seat Cushions For SI Joint Pain

Seat cushions can often be helpful for low back pain and SI joint relief. The surface of many office chairs aren’t comfortable and may generate a source of noxious input into the lower back.

There are many different seat cushion options, but I have frequently recommended the Auvon version, which you can check out here.

Sometimes just adding a novel source of stimulation from a new sitting surface is enough to reduce sacroiliac joint pain.

 

Related Blog Posts:

5 Special Tests To Uncover SI Joint Dysfunction

How To Know If Your SI Joints Are Causing Your Pain

Sacroiliac Joint Belts – Do They Work?

Is Cycling Good For SI Joint Pain?

Best Mattresses For SI Joint Pain

Is Walking Good For SI Joint Pain

Yoga For SI Joint Pain – Here Are The Best Poses

Best Chair For SI Joint Pain

How To Release Voodoo Floss Elbow

Voodoo Floss Elbow: How To Release

Written by Sam Visnic on . Posted in Mobility, Muscles.

Mobility wrap (also known as “Voodoo Floss”) techniques can be extremely helpful as “catch all” therapy to address various issues. I find it extremely helpful for nagging issues such as elbow tweaks and also tendinitis relief.

In this article I’ll show you how to apply the voodoo floss to the elbow. This technique is different from how to wrap an elbow with traditional athletic tape or kinesiotape, and the results are different, so be sure to ask your healthcare provider if it is appropriate for you before trying it!

Step 1: How to start the wrap

Getting the wrap started is often the toughest part. You want to make sure the first wrap around is tight so that it doesn’t unravel as you get it going.

Place the wrap around your upper forearm, then pin your arm to your stomach to hold it in place as you pull tension in the wrap to cover the loose end.

Step 2: Hold the wrap on your knee to reposition

Hold the wrap down on your knee by pressing down with your elbow. Then, you can reposition your hand without the wrap unravelling. (You will do this every time you perform a wrap around in order to maintain the tension).

The goal tension of the tape should be around a 5-6 on a 10 scale in terms of max tension. You should easily be able to keep it on for 90 seconds to 2 minutes max with very little discomfort.

WARNING: Do NOT put too much tension on the band! This does not in any way make it more effective, and may cause injury!

Step 3: Continue wrapping with 50% overlap

Continue wrapping the tape around the arm moving toward the elbow and over the top with approximately a 50% overlap every round.

Avoid bending the elbow too much when wrapping directly over the elbow, or you’ll lose the quality of the placement.

When you reach the end of the tape, tuck the end into the last 1-3 layers of tape so that it stays put.

Step 4: Move elbow and arm in a variety of positions for 90 seconds

Once the tape is firmly in place, begin moving the elbow and arm around in various positions (remember your biceps and triceps attach to your shoulder so move everything!).

Perform this varied movements for roughly 90 seconds to up to 2 minutes max (depending on how much tension you have on the tape) or if you feel discomfort, take it off sooner.

Step 5: After 90 seconds to 2 minutes, unravel the band and test

After 90 seconds to 2 minutes, unravel the band and move your arm around. Test any previously restricted movements and/or painful ranges of motion.

You should notice improvement ranging from minor to often dramatic!

Voodoo Floss Elbow: How To Release – Demonstration Video

 

Back Extensor Release Techniques

Back Extensor Release Techniques

Written by Sam Visnic on . Posted in Massage Therapy, Muscles, Stretching.

The back extensor muscle group contains the Longissimus, Iliocostalis, and Spinalis.

If during an assessment excessive anterior pelvic tilt, excessive lumbar spine lordosis, back or sacroiliac joint pain is found, these muscles should be addressed.

Back Extensors Release

How to know if you need to address the Back Extensor Muscles:

Back Extensors – Massage Therapy

The back extensor muscles are easily accessed because they are superficial muscles.  They run from the sacrum all the way up to the back of the skull.

Due to the length of the muscles, its easiest to treat them in smaller chunks.  Elbow glides are most commonly used by massage therapists, but after the warm up, thumb-based techniques can address the spinal extensor muscles with more precision.

VIDEO

Back Extensors Release – Knees to Chest Stretch

Since most people do not feel a stretch in thoracic region of the extensors (due to excess rounding of the back called kyphosis), we focus on lengthening the erectors of the lumbar spine.

The knees to chest stretch is a simple way to accomplish this goal, but don’t worry if you do not feel a stretch.  Not everyone does!

VIDEO

Back Extensor Release – Cat Stretch

The Cat stretch works very well for lengthening the spinal extensors, but the emphasis needs to be on pelvic tilting to affect the lower aspect of the muscles.

Its important to note that the lumbar spine doesn’t flex very far, so only a little pelvic tilting is necessary.  Its not uncommon for some people to feel slight discomfort at the L-5/S-1 level, so only go as far as comfortable.

VIDEO

Back Extensor Release – Post Isometric Relaxation

Post-isometric relaxation works very well for the back extensor muscles.

Correct positioning over the end of the table is essential during this one, and if any discomfort is felt in the lower lumbar spine, reduce intensity and/or consult with your physician for guidance.

Be sure to contract at a low intensity for 8-10 seconds prior to relaxing fully into the new stretch position for another 8-10 seconds.

VIDEO

 

Back Extensor Release – Side Bend Stretch Over Ball

The side bend stretch over a swiss ball, when correctly positioned, is a great way to lengthen the spinal extensors.

VIDEO

Back Extensor Strengthening

Prone Extension

  • Start lying face down with your arms at your sids, palms facing the floor, and feet together.
  • Squeeze glutes, lift your chest up as high as comfortable while keeping your chin tucked and head retracted.
  • Lift and externally rotate your arms for a full shoulder blade squeeze.
  • Hold for the desired amount of time, then lower back to the starting position.
Prone-Extension-Back-Extensor-Strengthening

Opposite Arm – Leg Raise

  • Start on your hands and knees.  Wrists under shoulders and knees under hips.
  • Find neutral pelvic position, lift chest, and tuck chin.
  • Lift your hand and opposite knee just high enough to slide a magazine under while maintaining your alignment.
  • Maintain normal breathing.
  • Hold for the desired amount of time, then return to the starting position.
Opposite-Arm-Leg-Raise-Back-Extensor-Strengthening

Kneeling Hip Extension

  • Start in a kneeling position on a soft pad or mat.
  • Place your hands across your chest and arch your lower back slightly.
  • Shift your weight back as you tip from your hips until you reach a comfortable depth or until you start to lose ability to hold your lower back arch.
  • Pause for the recommended duration, then reverse the motion back to the starting position.
  • Repeat for the desired number of repetitions.
Kneeling-Back-Extension-Strengthening
Hypnosis and Chronic Pain The Future of Relief

Hypnosis And Chronic Pain: The Future Of Relief?

Written by Sam Visnic on . Posted in Lifestyle, Pain.

Hypnosis and chronic pain is a controversial topic to talk about, and some people immediately dismiss it because of the commonly seen exaggerated or ridiculous claims normally associated with the practice.

However, hypnotherapy, mindful meditation, and similar techniques have been tested in various settings with excellent results.

Unlike the pharmaceutical approach, hypnosis has few or no side effects, and versions such as self-hypnosis can be assigned via personal instruction, or audio recordings, thus making this an inexpensive technique to implement for the chronic pain sufferer.

Even as hypnosis is surrounded by skepticism mostly due to its reputation in the entertainment industry, recent research has identified some significant effects in the human brain after its use.

So, is hypnosis really effective?

Can we just categorize the results as being related to the placebo effect?

Lets take a deeper look at this.

Chronic pain and mindfulness

Addressing chronic pain with mind-body interventions is an interesting approach, especially in chronic disease conditions such as cancer.  These interventions are non-invasive, are inexpensive, and do not have side effects, so they can often times be easily implemented with minimal hassle.

The majority of these interventions have something in common: They promote mindfulness and help pain sufferers to manage their emotions, thoughts, and behaviors.

There are some pretty impressive studies that show how mindfulness and practicing meditation is associated with a higher pain threshold, and lower activation of areas in the brain that assign an emotional response to pain.

There is definitely a link between emotions and perception of pain, and chronic pain sufferers found in these techniques a way to use the connection between mind and body to relieve symptoms.

Even if 5-10 minutes of practice can start reducing pain, longer interventions (up to 8 weeks) are required for more effective pain management. Clearly the more you practice the better the result.

Application of hypnosis for different pain scenarios

The extent to which hypnosis has been tested in the medical field is pretty impressive.  For example, it has been used as the sole form of anesthesia for delivering babies, and it has been documented to manage normally painful dental procedures.

In cases of acute pain, hypnosis has been applied in chemotherapy, to manage burn wounds, and as anesthetic to take needle biopsies and certain forms of plastic surgery.  In fact, some of these individuals have been shown to have an 89% improvement in their medical and psychological condition compared to those who did not receive hypnosis.

Additionally, in individuals suffering from chronic pain, there are many randomized-controlled studies for issues like chronic back pain, fibromyalgia, cancer-related pain, and gut directed hypnotherapy for irritable bowel syndrome (IBS) and even small intestine bacterial overgrowth (SIBO).

In the majority of cases, hypnosis was found to be similar to standard care, which includes things like medication, group support, relaxation, and other techniques.

It has been found to be useful not only to improve pain, but also to promote self-sufficiency in individuals with those chronic ailments.

Meta-analysis of hypnosis for pain relief

There are a ton of studies of hypnosis, but they do not always have the best quality of evidence.  For this reason, there are reviews and meta-analyses, which is a special type of research that analyzes the evidence after gathering ALL of the studies available to date.

Meta-analyses not only include data from many different sources but also they investigate the possibility of bias and methodologic problems and how they would potentially affect the results.

In the most recent review and meta-analysis about hypnosis for pain relief, the authors included data of a total of 3632 participants from 85 controlled experimental trials.  After carefully assessing the data, they concluded that hypnosis produces a moderate to large analgesia in all types of pain.

Another key finding is that hypnotic suggestibility (the ability of a person to induced into a hypnotic state, which varies from person to person is important in determining whether or not the intervention will be effective.

Individuals with a higher susceptibility to hypnosis had 42% reduction in pain intensity while those with a medium hypnotic susceptibility reduced their pain symptoms by 29%.

Since the majority of people (close to 90% of us) fit in the medium to high susceptibility to hypnosis profile, these findings suggest that hypnosis is much more useful than placebo, and we can have a real and measurable improvement in pain perception after just a single visit.

What we know about hypnosis and chronic pain

Many things about hypnosis are currently unknown, including the exact mechanisms for how it works.  However, there are imaging studies about the brain in hypnosis.

Hypnotic suggestions for analgesia cause an altered activity in the prefrontal area of the brain, the insular, and the anterior cingulate cortex.  These brain areas are associated with the state of relaxation and awareness of external stimuli, and are important in pain modulation, which is essential to achieve hypnotic analgesia.

Studies have also found that people with lower hypnotic suggestibility have a different response in their anterior cingulate cortex and prefrontal region, and this is probably one of the reason why they won’t experience any meaningful change in their symptoms post-hypnosis.

There’s also a psychological explanation that may contribute to our understanding of the role of hypnosis in pain relief.

Models suggest that hypnotic suggestion creates an attentional shift from pain sensation that is responsible for reducing the monitoring and perception of pain.  This would also explain why patients with lower suggestibility have less pronounced effects after hypnosis.  They are just less responsive or willing to engage in the intervention.  Clearly this would reduce its therapeutic effect.

To sum it up, hypnosis for chronic pain is ultimately a fairly effective therapeutic intervention that is safe and economical.  It can be added to most if not all types of standard therapeutic protocols to assist with pain relief and empowerment of the individual to be able to modulate their own pain perceptions, emotions, and behaviors.

 

References:

Eaton, L. H., & Hulett, J. M. (2019, April). Mind-Body Interventions in the Management of Chronic Cancer Pain. In Seminars in oncology nursing. WB Saunders.

Thompson, T., Terhune, D. B., Oram, C., Sharangparni, J., Rouf, R., Solmi, M., … & Stubbs, B. (2019). The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials. Neuroscience & Biobehavioral Reviews.

Moss, D., & Willmarth, E. (2019). Hypnosis, anesthesia, pain management, and preparation for medical procedures. Annals of palliative medicine.

Rizzo, R. R., Medeiros, F. C., Pires, L. G., Pimenta, R. M., McAuley, J. H., Jensen, M. P., & Costa, L. O. (2018). Hypnosis enhances the effects of pain education in patients with chronic nonspecific low back pain: a randomized controlled trial. The Journal of Pain, 19(10), 1103-e1.

Dillworth, T., Mendoza, M. E., & Jensen, M. P. (2011). Neurophysiology of pain and hypnosis for chronic pain. Translational behavioral medicine, 2(1), 65-72.

Jensen, M. P., & Patterson, D. R. (2014). Hypnotic approaches for chronic pain management: Clinical implications of recent research findings. American psychologist, 69(2), 167.

Rizzo, R. R., Medeiros, F. C., Pires, L. G., Pimenta, R. M., McAuley, J. H., Jensen, M. P., & Costa, L. O. (2018). Hypnosis enhances the effects of pain education in patients with chronic nonspecific low back pain: a randomized controlled trial. The Journal of Pain, 19(10), 1103-e1.

Sensitization In Chronic Pain: Knowing This Changes Everything

Sensitization In Chronic Pain: Knowing This Changes Everything

Written by Sam Visnic on . Posted in Pain.

Over the past decade, more scientific data has been made available to explain challenging cases of chronic pain that appear resistant to any generally accepted and appropriate therapeutic approach.

A new theory that is gaining acceptance is central and peripheral sensitization.  It’s a process that contributes to various types of pain syndromes, including things like fibromyalgia and osteoarthritis.

As you will see in this article, central and peripheral sensitization has been found to be responsible for unexplained changes in pain caused by both biomechanical and other triggers.

Knowing about these phenomena can be an absolute game-changer for people with chronic pain that no one can seem to figure out or help them with.

The role of central and peripheral sensitization

Different from many other organs, the brain undergoes continuous changes, known as neuroplasticity.  These changes are responsible for learning, but they also modulate excitability and neuronal activity.

Central sensitization is a modulatory process in the brain that results in a persistent state of high reactivity.  In this state, the pain threshold is lower, and individuals may still feel pain after an injury has already healed.

On the other hand, peripheral sensitization is often a cause of central sensitization, and it is modulation or change in the peripheral nervous system that disrupts pain perception, and is perceived by the brain as a constant source of pain.

This is a common finding in cases of nerve injury, both mechanical and chemical.  Thus, central and peripheral sensitization may be responsible for various forms of pain that cannot be explained by a biomechanical model, as in ghost limb pain and fibromyalgia.

The type of pain triggered by central and peripheral sensitization has two main characteristics, known as hyperalgesia and allodynia.

Hyperalgesia is an exaggerated perception of pain after a stimulus that is mildly painful, such as slight pinpricks.

Allodynia refers to experiencing pain with stimulus that is not normally painful, as in simple touch or gentle pressure.

Individuals experiencing unexpected or random shifts in pain sensation are not crazy or making up their symptoms.  That same goes for those who sometimes experience improvements after taking medications, doing movement, or getting a massage, but at other times are extremely irritable as a result of these same things.

Still, we cannot generalize and say that ALL types of pain come from central and peripheral sensitization.  In most cases, they are no more than pain modulators that contribute to noxious stimuli and sometimes explain the maintenance of pain symptoms in otherwise healthy people.

Mechanisms of central sensitization in chronic pain

The changes and modulation of pain pathways in cases of central and peripheral sensitization are very subtle and difficult to detect.  In most cases, they will be changes in the receptors at the molecular level inside whats called neuronal cells.

These changes occur after repetitive activation of pain receptors.  These changes in brain connectivity are coupled with changes in neurochemistry, in particular an increase in the release of chemicals that are associated with pain perception.

Thus, we will have abnormal levels of GABA, choline, and glutamate, which have been correlated with a bad mood and increased perception of  pain.

There are a few potential causes of central sensitization:

  • Stroke:  It causes chemical and structural modifications in brain tissue, leading to altered pain perception in some individuals.
  • Spinal cord injuries:  This leads to structural modulation of pain pathways, and it is responsible for unexplained causes of pain after trauma.
  • Genetic factors:  There appears to be a genetic prevalence as a predisposing factor for central sensitization.  None has been found yet, but it appears to be the case according to the scientific data.
  • Stress and anxiety:  Negative emotions have a profound effect on the neurochemistry of the brain, and can promote a state of alert that triggers excitability and favors the perception of pain.
  • Prior history of psychologic or psychiatric ailments:  Anxiety, traumatic memories, depression, psychosis, and similar ailments maintained for long enough can create dysregulation in the neurochemistry of the central nervous system that may trigger central sensitization.
  • Poor sleep:  It is a cause and consequence of pain, and acts as a vicious cycle, increasing sensitivity to pain at the same time.

As noted, pain perception is much more than biomechanical impulses.  It has a strong biopsychosocial aspect that we should be aware of.

The most logical approach to dealing with chronic pain

Even though the understanding of central and peripheral sensitization is available for everyone, and has a pretty solid foundation, many healthcare practitioners don’t appear to be well-informed of these mechanisms and may not take them into consideration when working with an individual suffering from chronic pain.

The focus is often almost exclusively on biomechanical causes of pain, rather than realizing the value of the biopsychosocial aspects of health as they relate to the PERSON that has the pain.

Several therapeutic recommendations have been synthesized to improve chronic pain in individuals with central and peripheral sensitization.

  • Exercise:  Aerobic based physical activity, such as walking, light strength training, swimming, and even yoga can be helpful.  They improve psychological symptoms such as depression and anxiety, and contribute to strengthening muscles.  This is important for addressing any potential biomechanical sources of stress in the body.  Interestingly, even individuals with irritable bowel syndrome can improve their symptoms and quality of life after following a 12-week exercise intervention!
  • Cognitive-behavioral therapy:  It is extremely important to educate people about pain (pain science education!), and techniques to cope with it.  Cognitive-behavioral therapy can help relieve emotional responses to pain episodes, and help control the severity and frequency of symptoms.  Even individuals with biologic causes of chronic pain, such as pelvic pain due to endometriosis, have reported improvements in quality of life after using cognitive-behavioral therapy in combination with alternative health therapies.
  • Massage:  Relaxation massage and/or bodywork which emphasizes reducing excess muscle tension can have profound effects on the chronic pain sufferer, even if only for the short-term.  Research shows the effectiveness of massage therapy on symptoms such as anxiety and depression.
  • Nutrition:  The value of anti-inflammatory nutritional guidelines, eating for optimal blood sugar regulation, and attaining recommended daily intakes of certain vitamins and minerals is often under-emphasized.  Food allergies, sensitivities, and nutritional deficiencies should be evaluated and addressed in the chronic pain sufferer in order to reduce overall physiological stress load.

So, in conclusion, recognizing central and peripheral sensitization in the chronic pain sufferer can immensely change the focus of the therapeutic approach health practitioners take to help the individual improve not only pain levels, but also quality of life.  It’s clear that focusing purely on the biomechanical model is insufficient and will fail to address the primary underlying issues involved.  As always, a multi-disciplinary, biopsychosocial-based, TEAM-approach is best when it comes to working with chronic pain!

 

References:

Eller-Smith, O. C., Nicol, A. L., & Christianson, J. A. (2018). Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Frontiers in cellular neuroscience, 12, 35.

Fleming, K. C., & Volcheck, M. M. (2015). Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides medical journal, 6(2).

M Adams, L., & C Turk, D. (2015). Psychosocial factors and central sensitivity syndromes. Current rheumatology reviews, 11(2), 96-108.

Ji, R. R., Nackley, A., Huh, Y., Terrando, N., & Maixner, W. (2018). Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology: The Journal of the American Society of Anesthesiologists, 129(2), 343-366.

Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S., … & Keefe, F. J. (2011). Pain and emotion: a biopsychosocial review of recent research. Journal of clinical psychology, 67(9), 942-968.

Nijs, J., Van Wilgen, C. P., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with ‘unexplained’chronic musculoskeletal pain: practice guidelines. Manual therapy, 16(5), 413-418.

Woolf, C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.