Core3 Massage

I recently finished a book titled “Muscle Pain: Understanding It’s Nature, Diagnosis & Treatment”. It is a dense book, with more of a discussion of the nervous system then muscles.  But, pain is all about the nervous system, and the nerves let us know when things are amiss.

Reading it reminded me that there is much we don’t know about the human body, but also how cool it is. So much going on in there, without us ever knowing . Below are some tidbits I picked up from the book and thought were relevant to my clients. Remember that the information below is based on a body of knowledge is ever growing.

Muscle Soreness: Many of you have experienced post workout/race soreness. This sroeness is probably due to sensitization of muscle nerve endings. Mechanical overload (i.e. a race or a hard workout effort) can cause damage to muscle tissues. Substances are released from the damaged tissue during the repair process. These substances can cause the nerve endings to be sensitive. This sensitization of the muscle nerve endings is most likely what causes your pain - not build up of lactic acid.  And what to do about this muscle soreness? Studies have shown that anti-inflammatory drugs provide little relief. Stretching may temporarily reduce the soreness, or not. One study found that stretching had no effect at all on the overall course of muscle soreness.

Nocturnal Leg Cramps: These cramps occur primarily in the gastrocnemius, the largest and most superficial of the calf muscles. They may result from dehydration or electrolyte imbalance.  Stretching of the gastrocnemius muscle can provide relief.  But it has been found that muscles that are prone to cramping may have what are called trigger points. Trigger points (TPs) occur at the junction of the nerve and the muscle - the motor end plate. Dysfunction here is caused by overload of the muscle, and refers pain to areas other than the TP. When these TP are deactivated and suppressed by regular stretching (and/or massage) the cramps are less likely to recur.

Low Back Pain:  A common pattern with low back pain is weak gluteals and strong (tight) hip flexors.  Gentle stretching (and/or massage) can release the hip flexors, and improve the strength of the gluteals.  (This is due to something called inhibition: a strong/tight muscle - i.e.  hip flexor - can cause the antagonist muscle - the muscle the causes the opposite action to the hip flexor - in this case the gluteals,  to be weak). So,  releasing the hip flexors allow for stronger gluteals and hopefully reduce low back pain. Of course there are many other possible causes of low back pain, but I have found that most of my clients with low back pain have some hip flexor and gluteal issues as well.

More can be said on all of these subjects, and perhaps I will revisit them in future posts. But for now, just food for thought.

These past few weeks I have been reading through a book that was recently published - Running Injuries: Treatment and Prevention by Jeff Galloway and David Hannaford DPM. I found it quite thorough- possibly useful and accessible to the regular runner - once I got over Galloway’s stretching paranoia and his walk/run obsession. 

The sections are grouped by body part (Foot and Toes, The Ankle, The Knee….) and the descriptions of injuries include terminology that runners might use, such as: Outside of the Ankle Mostly - But Can Be on the Inside, Various Pains in the Calf Muscle, or Outside of the Thigh from the Bony Knob on the Outside of the Hip, Going Down…..and so on.

The book was given to me by a client who has been dealing with calf issues for a long time.  Her calf issues (perhaps defined as “Various Pains in the Calf Muscles “) had stopped her from running at all for long periods of time. So, they were frustrating for her.

She is now, thankfully, slowly getting back into running, with her calves feeling good. She saw a podiatrist (discovering that yes she does need to wear her orthotics), as well as came in for regular calf focused massages.  But she also started regularly to do calf raises (as the above book suggests, for those runners with persistent calf issues) to strengthen her calves.

The book, like the New York Times article that I mentioned in my last post http://well.blogs.nytimes.com/2009/12/01/phys-ed-how-to-prevent-stress-fractures/  suggested calf raises as treatment for calf problems. They have you start with working up to 25 regular calf raises, and then progress to doing calf raises with your toes pointed in, and then toes pointed out. The goal is 25 of each (toes in, toes out) to give you a total of 50 calf raises.

Not only do calf raises (and overall calf strength) help to prevent tibial stress fractures (as suggested in the NY Times article), but they also help with overall lower leg health.

And as you may remember, the article also suggested decreasing your stride length as well to help prevent tibial stress fractures.  Likewise, the authors of Running Injuries also suggest: “The most efficient and gentle running form is a “shuffle”: the feet stay close to the ground, touching lightly and with a relatively short stride. When running at the most relaxed range of the shuffling motion, the ankle mechanism does a great deal of the work, and little effort is required  from the calf muscle. But when the foot pushes harder and bounces more, and the stride increase, there are often more aches, pains and injuries.”

So, another plug for shorter stride length. And, as some of you may be out running in the snow and ice, shorter quicker strides help you negotiate the messy stuff - and minimizes your foot slipping.

In my many years of running, I have had 2 stress fractures. One in my tibia and one in my upper femur. Stress fractures are not uncommon in runners, and can be a real drag. Once diagnosed, one has to take 6-8 weeks off  from running to let it heal. Runners don’t like not running. It makes us grumpy and miserable.  (It is at this time that we usually discover the pool or the bike to get our exercise fix, and a few triathletes are born)

As dreaded as stress fractures are, at least once the 6-8 weeks is over, the injury is healed. Then you can gradually start running again, and happiness returns to the runner.

Tibial stress fractures were recently addressed in a NY Times article http://well.blogs.nytimes.com/2009/12/01/phys-ed-how-to-prevent-stress-fractures/  , which is what got me thinking about stress fractures again.  Although it has been over 10 years since my tibial stress fracture, I still fear them.  So any tips on decreasing my, or my client’s, possibility of a stress fracture, grabs my attention.

First of all, the tibia is one of the 2 lower leg bones (http://adam.about.com/encyclopedia/Leg-skeletal-anatomy.htm).  In the article, tibial stress fracture prevention was focused on 2 possibilities: 1) strengthening the calves ( primarily found to help women)  and 2) decreasing your stride length.

Strengthening the calves can be as easy as just adding some calf raises to your strength or stretching routine (I know you all have one). As the article states “…rising up on to your toes and sinking back to the floor 10 or 12 times every day, might be enough.”  So , if you are a female runner, this might be something that you want to add into your daily routine.

The other suggestion is to reduce your stride length.  Back when I was the Assistant XC and Track coach at Bowdoin, this was something that all the runners were taught.  Head Coach Peter Slovenski had all his runner count their strides on a regular basis (I will call 1 stride every time your right or left foot - pick a foot - strikes the ground).  The goal was 90 strikes or more per minute. ( You can also try for 30 or more strides per 20 sec - if you can’t focus for that full minute).

As Peter told me, he based this on work  Jack Daniels, a respected running coach, had done.  He noticed that in the Olympics the runners all had a stride rate of 90-110.  So, these are the fast guy/gals - and they all had a short fast stride.

As the article states “The researchers determined that reducing stride length by about 10 percent seemed to reduce the stress on the tibia enough to lower the risk of a stress fracture. “  So, I am guessing that by counting your foot strikes and trying to increase them, one is on their way to decreasing their stride length by 10%.

Certainly more can be said about stress fractures, but in general they are an injury to respect.  They are usually first identified as a very specific area of pain found when pushing down on the bone.  You will feel it when you run, and can be so painful that it alters your stride, or even so that you just can’t put any weight on the bone. Have it checked out ASAP.  And a reminder - the tibia is only one bone where you can get a stress fracture.  The femur, the bones of the foot, and the spine are other examples of areas where stress fractures can occur - and not only with runners.

With all this said, I hope none of you ever have to suffer from a stress fracture ever - or ever again.

Several weeks ago I went to a massage class that focused on the lower leg and foot called “Neuromuscular Therapy and The Dynamic Foot”. Seemed appropriate, since I recently have been working with several clients on calf  issues, and often am working on someone with foot/lower leg problems.

In general I think that I know a lot about the legs, but there is always more to learn (I learned that the Plantaris muscle  - in the calf - has the longest tendon in the body. See  http://www.criticalbench.com/calve-muscles.htm - the muscle is red and the tendon is white) , or to be reminded of.  This class reminded me of the deep calf muscles that are so hard to palpate. The Soleus is one of these, as is the Tibialis Posterior.

One can palpate the Soleus a bit at the lateral and medial sides (around the larger and more superficial Gastrocnemius).   (You can check this pic to see some of the muscles I am refering too - and in this instance, how the Soleus sort of peaks out at the edges of the Gastrocnemius and the Achilles Tendon  http://www.best-leg-exercises.com/calfmuscle.html )   Also, when one massages deep into the Gastrocnemius, one is indirectly working on the Soleus below it. Sort of like a 2 for 1 massage.

The Tibialis Posterior is even more difficult to access. It can really only be worked on by working on the muscles that lay on top it - the Gastrocnemius and the Soleus.

 The calf, as with other areas of the body, has many layers of muscles. Some muscles are superficial, some deep, and some even deeper.  When I am massaging I am usually working on several different muscles, and not just one.

During a massage I think about all the individual muscles I am working on. I actuallysort of imagine what they look like in my head (I really needed to take a cadaver class - where one dissects a cadaver - so I can get a better idea of what all the muscles really look like). I think about the superficial muscles immediately beneath my hands, as well as the muscles that are even deeper below. Toss in the tendons (which attach muscle to bone) that I palate and the overlying fascia that surround all muscles, and there is a lot to think about.

So when I am massaging you, it is never just one muscle that I am working on. And it is usually not just one muscle that is the problem when you have pain. There is lots going on, and hence lots for me to think about when I am giving you your massage.

In my many years as a runner, I have used Ibuprofen to help me deal with occasional pain and soreness. I have been known to pop a pill after a long run to prevent that post “long run soreness”. I’ve even downed a few before a workout when dealing with some persistent discomfort.

 Of course, I have regular massages to help prevent and reduce any of the soreness and pain from hard training…..but you know how it goes - there are just those days when you want to get out there and you don’t want that stubborn soreness to stop you.

I just read an article that leads me to think that I wasn’t doing myself any favors. http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/  According to the article, researchers found more inflammation in athletes that used Ibuprofen before/during activity….. actually inhibiting recovery. And, compared to athletes not taking Ibuprofen, their legs were just as sore post-activity.

Something to think about, and more reason to not use pills to mask your pain.  Keeping those muscles loose and healthy with massage, stretching and proper hydration and nutrition is best in the “long run” anyway.

Back in the 80’s, when I was runner @ Northfield Mount Hermon, I learned something that has stayed with me since. Relaxing your jaw helps relax your whole body.

It is hard to tense up your shoulders and other muscles, if  your jaw is relaxed. This works with cycling as well as running….and I am guessing with other activities as well as work situations.

Try it: if your jaw is relaxed, it is hard to tense up your shoulders. And tense shoulders can make you tight all over. Shoulder tightness, if left untreated, can spread up (into the jaw) and/or down (to the low back and pelvis) the body. (This is not based on scientific studies, but on my own massage experience and knowledge of how the body is connected…this said just to cover my butt.)

So, instead of wasting your energy clenching your jaw (and hence tightening your shoulders….etc), you could spend it actually running or riding  faster. All this in the spirit of relaxing all those tight shoulders out there.

The illiotibial band (ITB) is a fibrous band of fascia that runs down the outside of your upper leg.  More specifically, it goes from the junction of the tensor fasciae latae (TFL-otherwise know as the hip flexor) and gluteus maximus (the big butt muscle), down the outside of your leg and attaches just below the knee to the lateral condyle of the tibia (that bump just below the outside of the knee).

(FYI - As mentioned above, the ITB is fascia  not muscle.  Fascia is a type of connective tissue that also takes the form of ligaments (attaches bone to bone) and tendons (attaches muscle to bone).  And like other types of connective tissue, fascia binds structures together, provides pathways for blood vessels and such, and serves as a framework.  Perhaps more on fascia in a later post. But together with the TFL, the ITB helps with hip flexion, abduction and medial rotation.)

One often first becomes aware of their ITB when they feel pain on the outside of their knee.  This pain could be from the increased friction of the ITB rubbing over the bony lateral condyle of the tibia, with every running stride or pedal stroke. If left untreated, the ITB gets tighter and tighter with use, and movement at the knee becomes more painful, eventually causing so much pain that one has to stop running/cycling because it is so painful to do.

But it doesn’t have to be this way!!! All it takes are some preventative measures — and some time.  Believe me, severe ITB pain is not something you want to have, unless you are looking for an excuse not to exercise.

I have worked on so many endurance athletes with ITB tightness/pain,  that I  almost assume that it will be a problem area on all endurance athletes that I work on.  I actually work on the ITBs of every single client I have, since ITB tightness/pain is so prevalent overall. 

Therefore, as you might have guessed, I strongly believe that one should use preventative measures regarding the ITB. If caught and dealt with early enough, it doesn’t have to be an area of concern.

Regular massage is a great preventative measure, since most massage therapist will massage the ITB to help keep it loose. However, even better is to do self-massage on a regular basis by using the foam roller.

Foam rollers can be purchased online (www.performbetter.com) or locally @Peak Performance (www.mypeakmultisport.com). I suggest the black ones (3′ long 6″round). They are firmer and last longer than the white ones. There are other foam roller options, but regardless you can’t go wrong.

If you are totally new to these rollers, you might have someone at the store show you how to use them.  Basically you lie down on the floor on your side. Support your upper body with your arms, place the foam roller under the outside of the leg lowest to the floor.  Using your arms and top leg, release as much of your body weight as you can handle (pain-wise) onto the roller and roll from your hip down to your knee and back. Roll up and down for a few minutes, pausing and focusing on the most painful/tight areas.

This is great to do daily after your run, ride, walk. Lots of people use the time at the end of the day while they are watching TV to roll. You can roll not only your ITBs, but also calves, hamstrings, adductors, glutes, and quads.  You can be pretty creative with it. You may not “have fun”, but if it is painful, you need it. It is a lot better than having me use my forearm or elbow  on your ITBs.

I am finally settled into my new space @ Health Coaches on Free St. Still in the Old Port, but best of all, across the street from Arabia Coffee. It’s sort of like my second office. So, here I sit thinking of all the things I have wanted to write about, but have been too busy to do so.

Thinking about hip flexors lately. There is rarely a person that I work on that does not have tight hip flexors (or Tensor Fasciae Latae - TFL - in muscle speak). These muscles assist in hip flexion (such as when you lift your thigh up when you are biking, walking or running).

They also tend to get tight on people who sit a lot.  While sitting, the hip flexors are in a shortened position.  If one sits for long periods, the hip flexors get used to this shortened/tight position.

When hip flexors are really tight, they can limit leg lift. One might not notice this reduced range of motion at first. However, you will notice the tightness when you feel the discomfort/pain when they get massaged.

There are a few things you can do to keep these important muscles from getting too tight. One is to stretch them regularly. The best stretch that I have found, is one that I learned from Erica Napuli of Evolution Fitness (efitness08@yahoo.com).

Start by standing facing steps or a bench/chair. Bend your right knee and place your right foot onto the bench (or a higher or lower object depending on your flexibility). Angle inwards the toes of your left foot, that is still on the floor.  Then raise your arms above your head and arch back, pushing your hips forward to give your left hip flexor a stretch.  Repeat on other side. If you don’t feel a stretch doing this try a higher step, or maybe they just aren’t that tight on you. Lucky you.

Another great way to reduce tightness in your hip flexors is to do self massage with a tennis ball. Find your hip flexors. They are located on the outer front of your “hip”.  Between where you might feel your hip bone and where you might imagine that your quads start.

Find a tennis ball. This might involve wrestling one from the jaws of your fun loving dog.  Wipe off the doggie slobber and place it between your hip flexor and the wall or floor. It might take some trial and error to find the exact tight spot, but when you do find it, keep the pressure on the tennis ball and move it back and forth gently over the tight hip flexor.

The duration of this “massage’ depends on your tightness, but shouldn’t be longer than a few minutes. Doing this regularly will keep those pesky hip flexor from ever causing you a problem.

If left untreated, tightness in your hip flexors not only limit range of motion at the hip - but the tightness can move down into your Illiotibial Band (ITB) of the outer thigh, down to your outer knee (the ITB attaches to the TFL)….causing pain and discomfort. But I’ll save the discussion of the dangers of tight ITBs for another day.

As I have mentioned to a number of you already - I am moving, and I am excited about it.  My move is due to Tri-Me’s  office consolidation. (BTW - they put on really great races right here in Maine - triathlons and well as running races.  Check them out at http://www.tri-maine.com/  .) 

I share my current space with Will (epic leader of the Tri-Me gang) - who is consolidating all his offices to 164 Middle St, Suite 3 (instead of being in Suite 1 (with me) and Suite 4). Just in case you want to be blown away - check out Will’s successful journey to become an EpicMan (kayak from Peak’s Island to Portland/bike from Portland to Boston/run the Boston Marathon - all in under 24 hours!!), along with his fearless friend Seth the Red Bull Guy http://theepicmancometh.blogspot.com/.

I will really miss my yellow office here on Market St., and being right next to Tri-Me.  Although they are a busy group, I like to bug them now and then. Friendly guys and gals, who share Red Bull and chocolate treats.  I have a feeling that I will continue to bug them, always remembering the day they had brownies.

So where am I going?  To another wonderful place - Health Coaches @ 17 Free St in Portland,  not far at all from my current office. The parking situation should be better (a parking garage next door and parking lot across the street help), and I hope to be able to validate parking.

Health Coaches (http://www.health-coaches.com/ ) is a cool place. Especially because my friend Erica works there. It is primarily a facility for personal training.  However, they also providing massage and corporate health programs.  The Pres. of Health Coaches, Mark Holmes, has graciously offered me use (@ a good price) of one of their massage rooms to continue my Core3 Massage work.

Looking forward to it all very much.

Now that Spring is almost here (perhaps?) no more musings on winter running for me.  Enough of the snow! I am thinking ahead to long bike rides along the ocean, trail running in the woods and lots more light!

The approaching season of Spring also leads me to reflect on Springboard Pilates, the place where I take my Pilates classes. Pilates is a set movements based on exercises developed by Joseph Pilates. These exercises “…strengthen your core (torso)  muscles and work out from there to stretch and strengthen every muscle in your body.” , as is written on their website (www.springboardpilates.com). 

One can start with Mat classes, where most of the exercises are done lying down or while sitting. You learn a set of exercises and build on them each week.  In private sessions, one works on equipment instead.  With springs and leather straps, these machines look sort of scary, but they are actually pretty cool. They help add resistance to the movements, as well as support you (if needed) as you become stronger.

I love Pilates for what it does to my body. Having a strong core during movement (running, massaging….) makes me feel more effient . And working from a strong core makes me feel stronger overall.

I enjoy the structure of the workouts (Meredith telling me what to do) and the fact that the exercises progress as one gets stronger. The Springboard Pilates studio is also a very beautiful space. It is in an old townhouse (on Spring St.) with high ceilings, wood floors and great art work on the walls.

I encourage you to contact them (the lovely Meredith or Momma To Be Bethany) if you are at all interested in Pilates.  15 min consultations are free.  Right now they are having a New Client Special: 30 min Private session for $10 or a 50 min Private session for $20 - great deals!

If Pilates is not your thing at the moment, check out the Tri-Maine (www.tri-maine.com) races for the year. Along with perhaps giving you a reason to work-out this spring/summer, these races are always fun events. One might even say they are “epic”.