roots

women's healing through therapeutic touch

by

Your “Other” Glute Muscle

When most of us think about our rear ends, we automatically think of our gluteus maximus muscle.  This mighty muscle is large and extremely powerful, plus it is the most superficial and thus most visible muscle in that region of the posterior chain.  However, just because it steals the spotlight doesn’t mean this muscle acts alone.  The “glutes” consist of three muscles, each with a different yet important role to play in the activities of daily living.  In addition to gluteus maximus, this muscle group also contains gluteus medius and gluteus minimus.  In this post, I will highlight gluteus medius, because it is problematic for many of my clients (and for me, too!).

Anatomy:

Gluteus medius comprises the middle layer of the glute muscles.  It originates on the lateral posterior surface of the ilium, or hip bone, and attaches to the greater trochanter of the femur, or the bony protrusion at the outer top of the leg bone. (If you prefer a video, here is a video.)

 

Function:

Gluteus medius is a powerful abductor of the leg, meaning it is the muscle we use when raising our leg out to the side.  Since it has both anterior and posterior fibers, it is also responsible for both internal and external rotation at the hip.  However, this muscle’s most important role in the body is that of pelvic stabilizer.  It provides stability to the pelvis while standing on one leg, for example.  Considering that we stand on alternating legs every time we take a step to walk, it becomes clear how important this little muscle is!  During the gait cycle, each leg takes a turn holding up our entire body weight as the other leg leaves the ground and swings forward.

Pathology:

If gluteus medius is weak, when we lift and swing the opposite leg forward, we can not hold the pelvis up.  In that case, that opposite hip dips down rather than being maintained upright.

Normally in order to compensate for this weakness, we use our back muscles to shift the torso over the affected hip in order to create more stability through an altered center of gravity, which in time can lead to the dreaded low back pain.  (A recent study found that pregnant women with weak gluteus medius muscles were 6-8 times more likely to have back pain than their “non-weak” counterparts.)  This weight shift can also result in torsion forces in the knee, which can contribute to knee pain.  Other muscles, such as the tensor fasciae latae, which attaches to the iliotibial band, may compensate for the lack of hip stability, which can lead to painful inflammation of the IT band.

My mentor, Ed Buresh, underscores the importance of the gluteus medius by highlighting its relationship to the psoas, a muscle which has definitely reached celebrity status.  Just as the psoas provides stability to the spine, the gluteus medius provide stability to the hips.  The two must work together.  The psoas is often identified as a source of low back pain.  However, one of the things I learned from Ed early on is that if we ignore the role of the gluteus medius in that scenario, we are missing half of the equation.  In my experience, the psoas tends to be tight and the gluteus medius tends to be weak.

The best way to gently build up weak gluteus medius muscles is to start incorporating non-weight bearing exercises, like the clam shell (figure to the right),

and gradually move toward more advanced movements like pelvic lists.

 

 

Here is Katy Bowman explaining the pelvic list:

For some in between exercises, here is an excellent resource I found online:

gluteus medius strengthening

The gluteus medius is often overlooked, although it is commonly one of the weakest muscles in the hip and thus directly involved in various soft tissue dysfunctions.  Becoming aware of the health of this muscle is key to maintaining proper gait biomechanics.  In my clinical experience, most of us could benefit from incorporating some strengthening of the lateral hip into our weekly movement program.

RESOURCES:

Yoganatomy  (for my yoga people)

Physiotherapy Exercises (other good ideas from same resource in article)

by

Shoulder Mobility in Baby Steps

In a perfect world, the shoulder would be one of the most mobile regions in our bodies.  It is comprised of the shoulder (or glenohumeral) joint, the space where the arm connects to the body, and the shoulder (or pectoral) girdle, which includes the collarbone, the shoulder blade and their surrounding muscles.  In both of these areas, there is great opportunity for movements in all planes of motion.  However, despite the possibilities available in the anatomical “best case scenario”, the majority of us suffer from a general lack of flexibility in this region.  Of course, each person has individual reasons for this and they are often multifactorial.  However, one of the most common factors contributing to this decreased range of motion is too much time spent in static postures or a narrow range of repetitive movements.  Being hunched over isn’t necessarily “the problem” – it’s being constantly hunched over for hours and hours without switching it up.  Studies have shown that what is generally considered “good posture” has very little correlation with a lack of pain in the shoulder region (or anywhere, actually).  Just as standing 100% of the time is not the fix for the discomfort caused by continual sitting, throwing your shoulders back and sticking your chest out 100% of the time is not the solution for hunching.  Variety, as they say, is the spice of life.  My clients who work at computers will inevitably spend a large part of their day with their arms in front of them, rotated inwardly, just as I will inevitably spend much of my day with my arm rotated so that I can put my forearm on a client’s body in front of me.  We need to accept that SOME of these postures are unavoidable consequences of our biomechanical environment, but we have agency over how much movement we can sneak in even within limitations.  If we are mindful of performing a variety of opposing movements, we can avoid some of the discomforts and range of motion issues experienced by our modern lifestyles.  One simple way to focus on this is to periodically lengthen the muscles that become continually contracted through daily living.  Stretching a muscle will not necessarily produce any permanent changes in muscle length, but introducing motion in a different direction can ultimately increase the range of motion.  From my clinical experience, two of the main muscles that could benefit from this temporary lengthening on almost everyone are pectoralis minor and subscapularis, both in the shoulder region.

 

Pectoralis minor:

Pec minor is a small but very important muscle in the chest region.  It originates on the surfaces of the third, fourth and fifth ribs and attaches to the coracoid process of the scapula, which is the little hook-like structure of the shoulder blade which sticks out on the front of the body.  It pulls the shoulder blade medially, forward and down.  In other words, when it contracts we end up in the “hunch” position. Click here for a 30-second video of pectoralis minor in action.  Since many of us end up in this position chronically, it’s helpful to alternate our computer work / driving / massaging with short bouts of lengthening.  The doorway stretch is excellent for accomplishing this and can be done any time we pass through doorway, or, for example, every time we get up to get water or on our way back from the restroom.  Here is Brent Brookbush demonstrating proper form for this stretch:

Subscapularis:

Subscapularis is another muscle which can easily become chronically contracted.  It is the internal muscle of the rotator cuff, originating on the interior surface of the shoulder blade (the part against the ribcage that we can’t normally touch) and attaching to the humerus of the arm.  Other than the stabilizing function of the rotator cuff muscles as a group, subscapularis is responsible mainly for rotating the arm medially, or inward.  Video here.  Hunch posture starting to sound familiar?  Performing a broomstick stretch once in a while to lengthen this muscle is an easy way to counteract that habit.  I like Dr. Mandell’s version:

We may not be able to incorporate constant gentle movement into every moment of our days.  If we have desk jobs, we are going to sit a lot and perhaps hunch a lot.  The important thing is to try to switch it up when we can.  These are but two easy ways to do that.  Of course, you could also get your massage therapist to help you release these muscles too 🙂

by

Befriending The Body

 

My last post focused on the physiological feedback loops occurring in the body as a result of traumatic situations, as explained in Bessel Van Der Kolk, M.D.’s “The Body Keeps the Score.”  Essentially, he shows that the world is experienced through a different nervous system after a traumatic event (and this can be any event with lasting consequences; I would bet that every one of us has experienced at least one traumatic event in our lifetime).  We are often triggered into sympathetic nervous system activity, or “fight or flight”, by seemingly benign situations, unable to put what is happening into a historical context of past versus present.  Trauma sufferers never quite feel safe in the body, as the brain’s “alarm system” is always signaling danger through chronic stress hormone activity.  Van Der Kolk puts it best: “Trauma is much more than a story about something that happened long ago.  The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present.”   If every time we experience an emotional trigger, we get upset, our hearts race, our breathing becomes shallow and we can’t articulate our fears, it makes it very difficult to make good choices and behave in our own best interests.  The question then becomes: how can we pull ourselves out of this disruptive state and realize that we are safe in the present moment?

Over the last thirty years, psychiatry has relied more and more on medication to regulate the post-trauma brain’s activity.  Medication can greatly improve our quality of life, but the problem is that we have to keep taking it.  The symptoms reappear when we stop taking the medication; it does not actually solve the problem.  Talk therapy is another option. This treatment encourages us to name what happened to us, to trust another person enough to be vulnerable in front of them and to have our experiences and feelings recognized, all of which can be very powerful.  However, talk therapy alone won’t solve the problem, either, because, after trauma, the rational brain is always hijacked by the nervous system.  Nervous system activation ultimately trumps intellectual insight.  In order to fully heal from trauma, we need to incorporate our bodies, too.  We can befriend our bodies again and use them as a way into the nervous system.  We can accomplish this through mindful awareness of our subtle body sensations.  When we see that we can make little shifts to these sensations, we can remap our brains to better respond to the present moment.  Therapies such as EMDR (Eye Movement Desensitization and Reprocessing), Neurofeedback, Somatic Experiencing and TRE (Tension & Trauma Release Exercises) have consistently produced profound healing with lasting results.  My “personal” opinion is that these types of therapies are the best at resolving trauma (see below for resources).  Yoga is another excellent way to recalibrate the nervous system, as it encourages the development of interoception and the ability to approach the body with curiosity and acceptance rather than fear.  Studies have shown a permanent decrease of PTSD symptoms after only 10 yoga sessions.  I have an irrational and inexplicable resistance to doing yoga myself, but I DO recommend it to my clients, as it truly has so many benefits.  Ok, so now for my “professional” opinion: let’s talk about massage!

Massage alone will rarely heal trauma, but massage is a wonderful adjunctive therapy for it.  One of the most natural ways humans can calm distress is through touch.  There are definitely people who enjoy touch less than others, but a significant majority of us find comfort in a rhythmic back rub or in being gently rocked.  Skilled touch can affect us on an even deeper level.  A stressed person is on constant sensory overload, and one of the most well-documented benefits of massage is its calming effect on the nervous system.  Massage puts us into parasympathetic nervous system activity, or “rest and digest”.  Brainwave studies using electroencephalograph (EEG) technology show that massage decreases beta activity in the brain (the highest frequency and the most alert state) and increases theta and alpha activity (associated with states of peace and calm).  Another benefit of massage is that through nurturing touch, we establish a connection with another person, ameliorating the isolation that can accompany trauma.  A massage therapist can impart empathy and a sense of safety through touch, safety being one of the fundamental requirements of trauma healing.  As clients, we are in control, and we determine the boundaries of where, how and in which way we are touched.  Further, as we allow ourselves to receive touch, we bring awareness to the parts of the body being massaged.  In so doing, we are grounding ourselves in our bodies as well as in the present moment, another fundamental tenet of trauma healing.  An added benefit of this increase in body awareness is that it invites us to notice where we are holding tension and release it.  When emotions are bound up inside of us, the body is tense.  As we relax, it becomes more difficult to hold on to negative emotions.  In this way, too, we are recalibrating our nervous system.

Finally, to return to the two pathways for perceptive input from my prior post, massage addresses both options for trauma recovery.  According to Van Der Kolk, treatment can be based on recalibrating the nervous system or strengthening our mindfulness surrounding body awareness.  Massage can provide a powerful support to primary therapies utilizing either treatment protocol, as I have illustrated above.  Even if we are not in trauma therapy, many of us have emotional triggers from a past experience and the basics of trauma healing can apply to us:  reestablishing ownership of body and mind, having experiences that restore a sense of physical safety and calming physical tensions in the body.  These are all benefits of massage therapy!

 

RESOURCES:

EMDR:  Leslie Larson, LPC  leslielarsontherapist.com

Somatic Experiencing:  Miranda Jane, mirandajanecounseling.com

 

 

 

by

Trauma: Your Issues Really ARE In Your Tissues

My last few blog posts have focused on the relationship between body and mind.  Most massage therapists are very interested in how one informs the other.  In keeping with that theme, I recently read a fascinating book about Post Traumatic Stress Disorder, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel Van Der Kolk, M.D.  In it, Van Der Kolk explores the physiological changes in the body and minds of people who have experienced traumatic situations, essentially providing a more scientific explanation for the visceral and very physical reactions to emotional triggers exhibited by sufferers of trauma.  These reactions in the body can keep us trapped in a feedback loop of defensive or non-productive behavior, hindering our capacity to heal emotionally.  Van Der Kolk convincingly argues that since the nervous system after trauma is altered, we can utilize the nervous system in order to remap the brain and heal from past experience.  In very simplified terms, we can use the body to reprogram our minds.

Van Der Kolk bases much of his book on his work with war veterans and survivors of childhood abuse.  These extreme definitions of trauma provide very vivid examples of how the body and mind can react to shocking and stressful situations.  However, for my purposes I would like to expand the breadth of how we talk about trauma.  Fear or hurt in reaction to almost anything can leave dramatic marks on our psyches, resulting in traumatic effects. A “traumatic incident” can encompass a wide spectrum, from a car accident to a teacher’s harsh reprimand.  Shame around sexual desire or sexual rejection can cause trauma.  Even a tired father absentmindedly refusing a hug during childhood can leave a scar.  A situation that appears benign to one participant can leave a painful impression for a lifetime on another participant, if not dealt with.

Multiple studies show that trauma produces physiological changes in the brain (please refer to the aforementioned book for specifics – it is dense and full of research articles and case studies).  Trauma activates the right-brain, which is responsible for emotion and creativity, and deactivates the left-brain, which governs rational thought, language and historical sequencing.  This shutting down of the left-brain activity explains why when faced with an emotional trigger, we may not be able to put into words what we are feeling or experiencing.  Rational thought escapes us, the lines between past and present become blurred and we are incapable of understanding that we are not in actual danger in the present moment, as we were back when we initially suffered the traumatic event.  There is an accompanying increase in stress hormone activity, or a recalibration of the brain’s “alarm system”, which becomes chronic, keeping us in a constant state of sympathetic nervous system activity, or “fight or flight”.  Here is a basic idea of how this works:  the thalamus in the brain combines our perceptive input into a coherent picture of what is actually happening.  This can take two pathways in the brain.  The first is what neuroscientist Joseph LeDoux calls “the low road”, down to the amygdala in the limbic brain.  Van Der Kolk refers to the amygdala as our smoke detector, as one of its main functions is to determine whether input is relevant for our survival or not.  This function is quick and automatic, and if danger is sensed, the amygdala can instantly trigger the release of the stress hormones cortisol and adrenaline and recruit the nervous system to produce a whole-body response.  The second pathway, “the high road”, is much slower than the first.  The input here is directed up to the frontal cortex, for a conscious interpretation of the situation.  We can then judge whether the threat is real through conscious assessment: we observe what is happening, predict what might happen in various scenarios and then make a choice to act.  The problem is that the low road gets first dibs on interpreting the incoming information, so we can ostensibly get into nervous system activation before we can consciously assess whether there is real danger or not.  Trauma increases the risk of misinterpreting the signals and thalamus processing can break down, so those with PTSD have a much harder time making sense of the input, often over-reacting to innocuous comments or facial expressions.  In addition, the medial prefrontal cortex of trauma victims is often shut down.  This affects our sense of being fully alive and the sense of who we are.  For this reason, trauma sufferers often feel “dead inside” or feel like they “are not themselves” after the trauma.

The topic of trauma is incredibly complex and I have obviously simplified things for the purposes of this blog.  The vagus nerve plays an important role, and that will be the subject of another post.  However, I hope I have begun to make clear that trauma sufferers often repeat behaviors not out of a lack of willpower but due to actual changes in the brain.  This is why talk therapy alone is often not enough to resolve the problem.  If the emotional brain is wreaking havoc on the nervous system, no amount of insight and understanding will silence our “danger signals”.  Naming a trauma and connecting with another person can be an important part of healing the sense of isolation often felt by victims. However, adjunctive therapies are almost always necessary.  Trauma involves constant sensory overload and makes us feel chronically unsafe in our own bodies.  In order to recover we need to become familiar with and befriend our bodily sensations again; we need to feel IN our bodies and in the present moment.  Developing our sense of interoception, the awareness of our subtle body-based feelings, can help us change our relationship to our bodily sensations and learn to identify past versus present.  Van Der Kolk suggests going about this in two ways:  recalibrating both the low and high roads.  We can regulate the nervous system activation through breath, movement and touch.  We can also strengthen the capacity of the frontal lobes to monitor body sensations through mindfulness meditation or yoga.  Our perceptual and emotional map is nurtured and shaped by our experiences.  In other words, “neurons that fire together, wire together”; this is the neuroplasticity of the brain.  We can use the concept of neuroplasticity to remap our brains and regain our agency after traumatic experiences.

In summary, after trauma we experience the world through a different nervous system.  However, we can rewire our brains in order to regain a sense of normalcy.  In the next post, I will elaborate on some effective ways to accomplish this, including how massage therapy comes into play.  Massage therapy by itself will not resolve trauma, nor is it the most effective adjunctive therapy for all conditions.  However, it can be an incredibly powerful tool to develop body awareness, ground us in the present moment and reestablish boundaries and a sense of safety in touch.