Roots

Women's Healing Through Therapeutic Touch

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Nerve Flossing 101

 

 

Nerve compression can cause a variety of discomforts, including tingling, numbness, a burning sensation or radiating pain.  The nerves can be entrapped by muscles, bones or fluid.  Clients with entrapped nerves can benefit greatly from massage therapy.  Active release techniques to alleviate tension in the muscles causing the nerve impingement can bring welcome relief for nerve discomfort.  If the nerve entrapment is caused by pressure from excess fluid rather than muscle tension, then Manual Lymphatic Drainage is the perfect thing.  However, in addition to our session time, I always try to give my clients something they can do at home to help themselves.  For basic nerve issues, I often suggest trying a nerve floss.

Sometimes called a nerve glide, this technique involves mobilizing the nerve.  By slowly and gently gliding the nerve, it is possible to restore stretch and allow the nerve to move freely.  This often decreases inflammation and painful sensations.  It is done with a back and forth movement of the nerve along its pathway, much like the movement of dental floss in between teeth.  The nerve is tensioned first in one direction and then the other.  Once this movement can be comfortably done, you can also stretch both “ends” of the nerve into maximum stretch by stretching into opposite directions at the same time – but it’s best to get comfortable with the flossing motion first.

Clients report very positive results, and I enjoy doing nerve glides on myself.  However, there should always be a word of caution with procedures done at home without the supervision of a therapist!  So here goes:

CAUTION: These movements should always be done GENTLY and SLOWLY – there should be no jerky or aggressive movements.  Once or twice a day, for 5-10 repetitions, is plenty.  It is always advisable to start with the technique for only 1-2 repetitions at a time, to make sure it doesn’t cause further flare-ups of the inflamed nerve.  There can be a slight feeling of discomfort associated with this technique, but it is normally just experienced as a mildly pleasurable pulling sensation.  It should not cause pain, so if there is pain involved, STOP immediately.  Nerve flossing should NOT be done with active inflammatory conditions, acute neurological conditions such as Complex Regional Pain Syndrome, or acute demyelinating diseases such as Multiple Sclerosis.  When in doubt, always consult with your health practitioner.

SCIATIC NERVE:

The most common nerve complaint in my practice is sciatic nerve pain.  There are two doctors, Dr. Brian Abelson and Dr. Evangelos Mylonas, who form “Kinetic Health”, who have some of my favorite nerve flossing videos available online.  Here are two I find very helpful for sciatic nerve impingement, as well as the peroneal nerve further down the leg.

Here is another I like from “The London Chiro” Owain Evans, which is quick and to the point for those who don’t need the full explanation or anatomy lesson.

 

MEDIAN, RADIAL, ULNAR NERVES:

Second most common complaints in my practice are upper extremity entrapments (if you like you can read my previous posts on Carpal Tunnel Syndrome and Thoracic Outlet Syndrome).

Dr. Jo is another Physical Therapist with informative, easy to follow videos online.  Here is her all-in-one video on the median, radial and ulnar nerves and how to floss them.  She has excellent individual ones, as well – you can visit her website for more.

If you like these guys from above, here are Kinetic Health’s videos on the radial and ulnar nerves.

 

I am always looking for ways to empower my clients to take charge of their own bodies and healing.  Barring serious conditions, nerve flossing can be an easy, inexpensive tool to use at home as a complement to other therapies.

 

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Prenatal Massage: Why It Needs To Be A Part Of Your Wellness Strategy

I find there is a misconception in the public sphere that prenatal massage is just a luxury, a nice treat for wealthy women who need to relax during pregnancy.  This actually couldn’t be further from the truth.  Of course, relaxing the nervous system has many benefits for mother and baby, but there is so much more a therapist can do.  A knowledgeable, nurturing prenatal massage therapist can really round out any pregnant woman’s wellness team, as we address the pains specific to pregnancy, provide a crucial increase in body awareness, balance the ligaments and muscles in the pelvis, provide postural alignment and comfort tips for everyday, and support a woman’s confidence in her inner wisdom – ALL of which make for an easier pregnancy AND, most of the time, an easier labor.  I love partnering with my pregnant clients, serving as a support for them throughout the duration of their pregnancy and beyond.  I deliberately keep my prices reasonable, so that women on almost any budget can afford to come for an hour once a month.  I also volunteer my services through a non-profit organization for those who otherwise really wouldn’t have access to massage.  I am passionate about this work because I see what a difference it can make. As I have said many times, “It’s not just rubbing oil!”

Most trained prenatal massage therapists are proficient in deep tissue techniques to ease the specific complaints of pregnancy.  Most of my clients experience low back pain and hip pain as their pregnancy progresses.  Many also have tightness in the outer calf, discomfort in the neck and shoulders, and occasionally in the head and jaw.  Regular massage can help alleviate all of these aches.  For the uncomfortable swelling in the legs and feet, manual lymphatic drainage massage helps to bring some welcome relief.  The increase in body awareness is a wonderful collateral benefit to touch, as many women are not aware of how much tension they hold and where exactly in the body they hold it.  Labor becomes much more comfortable if a woman is already practiced in recognizing where she is holding tension unnecessarily and has learned how to let it go.

She needs a belly prop but this is a great stretch.

Besides the hands-on time we have together, I love to show clients little things to make them more comfortable at home and during daily living.  The right pillow propping so that the belly and legs are properly supported can make all the difference in a night’s sleep. Learning how to fill the lungs with air when there is a baby pushing up against them makes it easier to avoid shallow breathing.  Postural education can be so helpful as the center of gravity starts to shift forward.  Doula training has given me some excellent tools to teach my clients and their partners, and many of them can be used during labor to give baby a little more wiggle room if there is a stall.  Some of my favorites involve the use of the rebozo, a brilliant contribution to birth learned from Mexican midwives.  Partners can use the rebozo in a “sifting” motion, to give mama temporary relief from the baby weight and allow the abdominal muscles to relax.  The rebozo also takes the strain off of the uterine ligaments.  With repetition, this can serve to decrease imbalances in the body which can cause hiccups in labor.  It also just feels great!

Midwife Gail Tully, of Spinningbabies.com, showing one use of the rebozo (shared by Midwife Ximena Rojas Garcia)

Pregnant women need support – LOTS of it.  (Postpartum women need even more, but that is for another post.)  Along with a great doctor or midwife, birth education provider and doula, a caring prenatal massage therapist adds much benefit to a woman’s pregnancy team.

 

 

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Kindred Spirits: Learning From The Medicine Women

Dhyani Ywahoo, Priestcraft Holder of the Ani Gadoah Clan, Tsalagi (Cherokee) Nation
Annie Kahn, The Flower That Speaks in a Pollen Way, Navajo Medicine Woman of the Water Clan

 

 

 

 

 

 

 

 

 

I find a kernel of wisdom in just about everything I read, but every once in a while I stumble upon some piece of writing that makes my entire being light up.  I recently read “Medicine Women, Curanderas, and Women Doctors”*, looking to get some insights into the curandera way of seeing the world.  I wasn’t looking to publish anything on my website or to declare anything about myself; I was really just looking for resonance with other women who find themselves in a healing capacity and maybe shed some light on another facet of my identity for myself.  The book itself is good, but there were many parts that didn’t speak to me personally.  As a Latina, I picked it up thinking I would vibe most with the stories of the curanderas, as I have good personal experience with this type of healing from my years spent in Venezuela.  Instead, it was the eloquent and vibrant description of the Native American vision of illness and healing that made my heart sing.  I am Panamanian; I am not Native American.  I do not wish to appropriate the Cherokee, Navajo or Apache ideology or be disrespectful in any way.  I just want to share the wise words of the two women in the photos above in case they might resonate with you as much as they did with me.  I think most of us have read books about the Native American way of thinking (and I know there are more famous ones out there), but sometimes we need to remember how powerful this mindset is.  I use remember to mean “re-member”, as in piecing together parts of ourselves that have perhaps been cut off or long ago lost (“dis-membered”).

Dhyani Ywahoo said to the authors of the book: “May this book you are writing bring many women again to the certainty of their gifts, and may the men who read it realize the mother within, and may we all realize ourselves in the circle of light.”  In my very small way, I want to keep this going.  (Ywahoo was understandably adamant in the book that her own words be used, so I use direct quotes whenever referring to her.)

The theme that emerged from all three Native American medicine women is that disease is about being off balance, in disharmony.  It is not just about biochemistry or about being out of equilibrium in our own bodies, as in the Western medical thought, but on a larger scale.  For Ywahoo, “the concept of illness is anchored in the idea of discord:  discord in human consciousness, discord in our vibratory frequencies.”  To them, consciousness-raising is the first step in healing, and the connection with the earth, sky, plants, the universe is a vital part to this.  Annie Kahn explained that prior to her client’s arrival, she engages her connection to earth and sky, setting the intention for the client and preparing the space and the energy to flow.  She is basically a conduit to reconnect the person to their own connection to Spirit.  In her words, “Two people coming together make medicine.”  This applies not only to massage therapy and healing practices, but to anyone, regardless of the nature of our contribution to the world.

“The relationship of human consciousness is always very real to the native people.  No, it is not a metaphor. … You have a relationship with the spirit of every tree, and with the spirit of the sea, and with every creature that walks, crawls, swims, flies, walks on two legs, four legs, a hundred legs.  Each one of us has a relationship.  Somehow being out of phase with that cycle of relationships, either with ourselves, our family, is going to have an effect on the individual’s health and, ultimately, on the whole planet. … Acknowledging the sacred flow within is a key to evolving consciousness,” explains Ywahoo.  Maybe most of us already know this, but I think at this point we could all stand to live it a little more.  Many people these days practice mindfulness and gratitude, but there appears to be a nuance in this culture in that it only relates to Self, always trying to heal Self as a singular contained being.  I can easily slip back into this way of thinking myself.  From what I see, the generalized concept of wholeness needs not be only of Self as whole, but also of Self as inextricably connected to a larger sense of a Whole.  One layer of the medicine, then, is our connection:  connection to plants, animals, music, each other, Spirit.

For Ywahoo, “medicine is … a holy power that makes things well, one who can bring someone again to their remembrance of their true nature.  The gift of the female healer is to comfort, to nurture the person, so that they can recognize the whole being within.  To help someone heal is to allow them to recognize their holiness: through resonating, a song, so that one can feel themselves coming again to the right note of their true expression.”  One of her many gifts is song, and these holy songs are a part of various indigenous and shamanic healing practices.  Resonance is key.  Sound healing is a powerful way to access resonance (I find biofield tuning with tuning forks to be profound), but I think this can be expanded to include other gifts.  Everyone reading this has a gift to share;  mine is touch.  Through allowing me to share this, each client brings both of us closer to our connection to our higher selves.  Therein lies one layer of the medicine.

Again, Ywahoo:  “the ‘why’ to become a medicine person is to realize that one has the gift to share and has an inherently great capacity for carrying energy and that energy may be positive for the benefit of the people, one chooses to walk the medicine way. And it chooses you.”

This is not to say that anatomy and technique are unimportant.  I will still blog about muscles, the nervous system and tips for more comfortable alignment.  I am continually studying and learning.  The body consists of multiple complex systems, and as massage therapists we have a responsibility to understand them as much as possible.  However, as much as I rely on this knowledge and on evidence-based studies and pain science, I have never claimed that these explain everything. You are all probably tired of hearing me say that regardless of all of our “scientific advancements”, the body is still not well understood.  There is a part of illness and healing that remains a bit of a mystery, and in trying to formulate an explanation, that explanation can sound quite mystical.  I am ready to admit that I am OK with that.

I will leave you with a final quote from Ywahoo (PS – this book was written in 1989):  “it is only now that some people are being stirred, and also through the recognition that the prevailing mindset of industrial man is only going to lead to death of the planet and everyone, that has brought people again to consider and look with curiosity (and some respect) to the native practice.”

 

*”Medicine Women, Curanderas, and Women Doctors,” Bobette Perrone, H. Henrietta Stockel, Victoria Krueger

 

 

 

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Pain Science Reframe: Your Body Is NOT “All Messed Up”

 

At some point during the first intake, almost every new client declares that her body is a “complete disaster”, pointing out everything from tight traps to herniated disks to bad knees.  While it is important for us to discuss and address any areas of injury, I am always careful to gently steer the narrative away from “I’m a mess.”  We are all in desperate need of a reframe in the way we view our bodies, myself included.  I genuinely want to listen to everything a client has going on, and I always want my client to know that she is heard.  However, I want to make sure we are also reworking the pathology paradigm, together.  Bodies deserve more credit, and as scary or counter-intuitive as it may seem at times, we need to have confidence that our bodies “work”.  For the most part, bodies are capable of functioning and healing very well, despite the presence of one or more conditions we consider pathologies, and even despite the presence of pain.  Part of the tunnel vision in seeing only what’s “wrong” and the ensuing feeling of helplessness is ingrained in our system of allopathic medicine.  I have already written a blog post explaining my philosophy around this here.  Unpacking the fear of movement associated with pain and injury is another critical piece in healing.  Perhaps the most important piece in this shift, however, is to look at how we conceptualize pain and attempt to better understand its mechanisms.

Thinking of our bodies as being “all messed up” breeds fear of movement, which is counterproductive to healing.  We need to make some adjustments when dealing with an acute injury, but smart movement is not only possible but necessary.  Strengthening the muscles that support an area of injury as well as any weakened muscles that cause compensation in other areas has been shown to improve overall function.

Gentle, fluid movement increases lymphatic flow, helps the muscles rid themselves of cellular waste, improves joint function and generally decreases pain.  The more we are afraid to move, the less our bodies will ultimately BE ABLE to move.  If instead of thinking of our bodies as “broken”, we think of them as awe-inspiringly capable, with a few caveats, we have a much better paradigm.  This doesn’t mean we have to push through acute pain, continuing to run with an injured achilles tendon, for example.  That would be detrimental to the body (and stupid – I’ve done it).  This means we can’t be afraid of ALL movement, because there is inevitably some beneficial movement that can be done.  These days, even Western surgeons have their patients up and moving just hours after surgery!

 

Of course the other piece to the fear of movement is the avoidance of pain, which is the tricky and complicated part – especially when we get into the realm of prolonged chronic pain. Chronic pain is still not fully understood.  However, recent developments in pain science can help us decipher the multiple causes for pain and what it might actually be signaling.  Here is a great article by Lorimer Moseley on pain.  I will summarize his four key points:

  1. Pain does not provide a measure of the state of the tissues.   In human pain experiments, researchers were able to deliver a non-harmful noxious stimulus to the subjects’ nociceptors (pain receptors) and elicit a pain response, in the absence of actual tissue damage.  In this case, the assessment is inaccurate: there is pain without tissue damage.  In the reverse, there can be tissue damage without pain.  In the now famous MRI study testing the correlation between herniated disks and back pain, asymptomatic herniated disks were found in 52% of the subjects who reported NO back pain.  This experiment has been replicated multiple times, leading to the conclusion that a herniated disk does not necessarily cause back pain.  Again, the relationship between tissue damage and pain is not always correlative nor causative – it’s not that simple.
  2. Pain is modulated by many factors from across somatic, psychological and social domains.  Pain is governed by the central nervous system and has been shown to be affected by emotional states, anxiety and stress.  In my clinical experience, chronic back pain is often affected more by stress and anxiety than it is by anything at the tissue level in the back muscles themselves.  Moseley mentions inflammatory mediators, as well, and through understanding the genomics work that my boyfriend does, I have come to see how chronic inflammation in the body can affect the nervous system and amplify pain.  Our own attention to and expectation surrounding pain is yet another factor in pain modulation.  Anecdotally, we have probably all had the experience of being engaged in a sport or other physical activity, and looking down to find ourselves lightly bleeding from a cut somewhere that we didn’t notice. Once we pay attention to the cut, it starts to hurt.  Studies have shown that if we expect something to hurt, we report the pain as being more intense than if we don’t – and it is postulated that this phenomenon is related to anxiety and stress. Perhaps the most interesting related finding of the studies Moseley cited … believing pain to be an accurate indicator of the state of the tissues is associated with higher pain ratings, whereas believing that the nervous system amplifies noxious input in chronic pain states decreases the perception of pain.  In other words, fear around the belief that pain means our bodies are damaged increases pain levels.  This is not to say the pain is “all in our heads” – the pain is real, and the fear increases the actual pain.
  3. The relationship between pain and the state of the tissues becomes less predictable as pain persists.  As pain becomes chronic, changes occur in the neural pathways and they become sensitized, causing us to experience increased pain even when the painful stimulus no longer exists.  Whitney Lowe, one of my favorite massage educators, explains sensitization very eloquently here and here. Essentially, the nervous system can become more sensitive to certain stimuli once exposed to pain over time.  This is common in the case of trauma survivors, and once the sensitization exists, even a mild stimulus can elicit an extreme pain response.  The two most common clinical manifestations of the changes in the sensitized nervous system are hyperalgesia (formerly painful stimuli become more painful) and allodynia (formerly non-painful stimuli become painful).
  4. Pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger.  In other words, when our brains perceive that we are under threat, pain results as one of the outputs of the central nervous system.  Pain is real and can feel debilitating.  His point is that the pain output occurs as a result of the perception of threat, not because of the state of the actual tissue.

 

The good news is that our bodies are not all messed up!

 

 

Adopting more proactive beliefs about the body’s potential for good health can help us release some of our fears around movement.  Understanding the effects of anxiety and trauma may empower us to seek out somatic therapy.  Grasping the importance of proper methylation and controlling inflammation may lead us to seek out the guidance of a holistic practitioner.  There is still room for massage therapy in this paradigm, too!  Massage addresses the nervous system, and regular massages may help to alleviate some of the symptoms of central nervous sensitization.  Additionally, massage encourages body awareness, which is key to understanding pain.  It has been shown that even reproducing pain or eliciting a new sensation in a non-threatening environment can begin to rewire neural pathways. As massage therapists, we have the capacity to support agency in our clients by interpreting feedback and learning together how their pain works – we become their partners in shedding some light.  For those of us on tighter budgets, simply educating ourselves on the role of the nervous system in pain management is incredibly impactful, as is finding a buddy who will support and encourage smart movement.