Core3 Massage

Muscle cramps are acute involuntary muscle contractions that generally last for several minutes.  As many of you know, they can be very uncomfortable.  It has been thought that muscle fatigue, dehydration and electrolyte imbalance are involved.  And to get rid of a cramp once it starts, it has been suggested that one stretch the cramping muscle.

A recent New York Times article http://well.blogs.nytimes.com/2010/06/09/phys-ed-can-pickle-juice-stop-muscle-cramps/?src=me&ref=homepage  reports on new research regarding muscle cramping. New studies have shown that muscle fatigue probably is the casue, and drinking pickle juice (or vinegar) can help to shortern thier duration (along with stretching).

The article states that certain mechanisms within muscles have been found to start misfiring when a muscle is extremely tired.  And pickle juice may help alleviate these cramps, says one of the scientists (Dr. Miller) cited in this article, “by countermanding the malfunction. Something in the acidic juice, … , may be lighting up specialized nervous-system receptors in the throat or stomach, he says, which, in turn, send out nerve signals that somehow disrupt the reflex melee in the muscles. Dr. Miller suspects that ultimately, it’s the vinegar in the pickle juice that activates the receptors.”

Although it is only speculation, it gives us an idea of how to reduce the chances of their occurrence, as well as what to do once they start, if they do occur. They concludes that if muscle fatigue is the cause, “then training properly, building up your mileage slowly and perhaps adding strength training that focuses specifically on muscles that have cramped in the past, may help. In the meantime, if your calf or other muscle suddenly, painfully catches, “try stretching it,” Dr. Miller says. Doing so has been found in laboratory studies to significantly shorten the duration of a muscle cramp, most likely by shaking up and resetting the misfiring muscle and nerve reflexes. And perhaps, if you can stomach the idea, pack a few ounces of pickle juice on your next training session.”

Food for thought as we start the summer – hopefully with no (or less) muscle cramping.

My last post was on ice baths, and I am still on the icing kick.   However this time I will address the icing of specific areas. This type of icing  is obviously a little  less “painful” than ice baths, but still a great injury prevention tool. We all have those times when we come back from a workout and something is bothering us. It could be your feet, your shins, or that pesky hamstring…..you name it.  Icing the area right away will increase your chances that the same area will not be as painful tomorrow.

Icing right after you workout is best.  But for those of you in a hurry, you might not get to it until you are at work and sitting at your desk. For others it might not be until the evening while watching TV.  It is all good.  Better to ice later than not at all. Time-wise, the goal is 10-15 minutes of ice, but if you only have time for 5 minutes – 5 minutes it is. 

There are a lot of ice packs out there, and it is worth it to invest in one. They come in different sizes and shapes, depending on the area of the body that it is used on.  To check out the variety of ice packs available, click here: http://www.massagewarehouse.com/Category/hot-and-cold-therapy/hot-cold-packs/104203303 . 

I have one of the elasto-gel wrist wraps (for after those long hard hours at the massage table) and really like it. It conforms to the area to be iced (my wrist) and has a velcro band to keep it in place (useful if you are trying to do something else, like work, while icing). They are also nice because you do not need a towel between the pack and your skin. For more info on the ice/heat packs they offer see http://www.elastogel.com/index.php . Note that these (and many other ice packs one can purchase) can also be used as heat packs.

In general, unless you have specific needs, an all purpose ice pack in the 10” x 15″ range is good.  However, one certainly can use a bag of frozen peas or just a plain old bag of ice instead.

In most cases (no need if using one of the elasto-gel packs) it is best to put a towel (not too thick a towel – or you won’t feel the cold) between your skin and the ice, to help you avoid frostbite or frost-nip.  My experience with this, is that an area will turn white and hard. So check in with your skin as you ice, especially if you are going for 15 minutes. You can overdo it.

Ice massage is also a great tool. Freeze a paper cup filled with water. When frozen, peel off the top inch or so of paper to reveal the ice. Hold the cup in your hand and use the exposed ice to massage the sore area. Ice massage is great on shins.

Then there is that bucket of ice water for your feet/lower legs. This is great when you have a general soreness in your feet/lower legs – and are not up for a full ice bath.

If you are having plantar fasciitis issues (pain in the arch of the foot and going into the heel) a plastic water bottle filled with water and then frozen, can be great. Use the frozen water bottle to roll under your arch.  A little ice massage to to reduce the inflammation and sooth the pain.

Icing can be a great way to reduce post workout/race soreness and pain, but unfortunately it is not a cure-all.  If the pain persists and causes you to stop working out, or negatively effects your ability to workout (for example, if you run, it effects your stride so that you run differently), you should have it checked out by your favorite health care professional. 

Note:  Got some feedback about ice baths. A  few personal tips I will pass on:

1) “I fill up the tub and dump in the ice right before I get in, but then I soak a medium-sized towel in warm water in the sink, and tuck it between my legs (kind of like a diaper) to protect certain parts of the anatomy that are most affected by and least in need of an ice bath.  It makes the entry SO much easier!!”

2)”I’ve actually been sitting in my ice bath for up to 20-minutes, doing Sudoku puzzles with a heavy fleece on my top!”

I (Julia) read and wear a long sleeve shirt that I don’t care about getting wet. I need something to cover my tender tummy area.  

Anything to get you through.

Enjoy!

Icing is one of the most underutilized training tools. It takes time and is zero fun. You have just finished the discomfort of a hard workout or race, and the idea of more discomfort is not appealing. However, I believe that it is a great tool in helping you recover from those hard workouts or races.

I break icing down into 2 types: 1) icing a specific area and 2) “large-scale” icing to help general muscle recovery. I’ll deal with the specific area icing, usually applied to deal with a specific injury concern, at a later date. This post will deal with the overall icing of ice baths.

When you push yourself  physically, you are stressing your muscles and causing micro-tears. In the long term this is a good thing, because when the muscles heal, they are stronger. However,  this muscle damage can cause soreness a day or 2 after the hard effort. 

The research that has been done on cold water immersion appears  to be inconclusive.  The theory is that the cold water helps to reduce the muscle  inflammation, relieving the post- race/workout soreness, and speeds up recovery.  However, enough people ( like me) have tried their own experiments of one and found the cold water to help, hence the reason so many athletes are willing to subject themselves to it.

If you are one of the lucky few who can end their hard workouts near a body of water, getting your legs into the cold ocean/lake/stream/pond is perfect. Wade in up to the tops of your legs and enjoy the cold for as long as you can stand it (5-15 minutes).  However, most of us don’t have that luxury. So to the bathroom we must go.

If you have ever attempted ice baths, you know how difficult it is to motivate to actually get in one. Kurt Perham, coach extraordinaire of Personal Best Multisport Coaching ( http://www.pbmcoaching.com/), suggests what I think is pretty reasonable, considering this difficulty:

Sit in the tub, with bucket of ice (I am thinking a few trays of ice) next to the tub and allow the cold water to slowly cover your legs. Once the water just covers your legs, turn it off and dump in the bucket of ice. Sit in it for 5 minutes, after which you can get out and drain the tub. However, if you are hard core enough, you will continue to sit in the tub as the water slowly drains out. Total time in ice bath: 10-15 minutes.

Kurt is not the only coach to suggest ice baths to his clients. I know many other coaches who do, as did mine back when I was running marathons. My coach, who lived in Boulder, CO, talked of runners wading into cold mountain streams. Sounded idyllic, but I had to settle with an ice bath in a tub. I should have succumbed to the tub more often. Sometimes in the summer (as lame as it sounds) I would just run the cold hose over my legs for a few minutes. If you can’t do the full 10 minutes in the tub – a few minutes of some sort of cold water is better than nothing, I think.

So, if you are looking for that extra edge that helps you recover quicker – try an ice bath, or ocean/lake soak.  If your legs feel better then next day, then  great! If not, then at least you can boast to your buddies about how hard core you are.

In a previous blog post (October 2008) I wrote about gluteal (butt) tightness. I did not go into the specific muscles involved, but this time I am going to discuss one specific butt muscle – gluteus minimus.

The gluteal muscles are comprised of 3 different muscles: gluteus maximus, gluteus medius, andgluteus minimus. http://www.pilatespatio.com/gluteus_medius_minimus.gif

Gluteus minimus  is the smallest and deepest of these muscles, and so harder to get at.  It is a strong abductor of the hip – which means that it lifts your leg off to the side, away from your body – as well as a internal rotator of the hip. 

My interest in this muscle was recently piqued, thanks to a massage therapist friend of mine with chronic hip tightness.  While massaging her over the past year, she has encouraged me to go deep into the lateral hip. She has also done a lot of deep lateral hip work on me, and I found that it really did help my hips feel looser on my runs.

Being more aware of gluteus minimus, I now notice that many of my clients are tight  in this area.  Tightness in this muscle can reduce the looseness in one’s outer/lateral hip joint.  And if the tightness is left untreated, trigger points (TPs) could develop.  If  TPs form in the gluteus minimus, referred pain could possibly be felt in 1) the more fleshy part of the posterior butt,  2) down the outside of the leg  to the outer calf and ankle, or 3) the back of the hamstring into the upper calf.

I can, and will, get in there with my elbow and thumbs to release the tightness. However, another great way to deal with tightness in this area is by self massage with a tennis ball. Lie down on the floor on your side, with the top leg in front of you for stabilization and bottom leg relaxed on the floor. Place the tennis ball under your hip between the edge of your pelvic bone and the top of the femur (check the above link for specific location of this muscle). Release as much of your weight as possible onto the ball, and roll back and forth. If you find a tight spot, just hang out there and try to relax into it. 

This area is not as sensitive as the illiotibial band (ITB) below it. You might feel some discomfort, but usually it just  feels really good to get in there. The foam roller, used to massage the ITB, doesn’t really get into the gluteus minimus – it is not specific enough to go deep between the bones.

For general flexibility of the area, stretching is also good.  Regularly stretching the outer hip http://www.sportsinjuryclinic.net/cybertherapist/stretching/outer_hip_stretch.php     feels really good. I love doing this stretch after I run, every day.   Another hip stretch I like http://www.sportsinjuryclinic.net/cybertherapist/stretching/standing_outer_hip_stretch.php, is great if you are at work or someplace where you just can’t lie down……like in that coffee shop after your bike ride.

Anybody who is active is going to use gluteus minimus to some degree. I know with my longer runs on uneven ground, I am asking a lot of it. So, keep those hips loose not just because it feels good, but because it could prevent pain in the future.

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.

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.

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.

I just wrote of all the fun that can be had, as well as the challenges, of running outside in the winter. To continue on that theme……. 

With all that slipping on loose and uneven snow and ice, your leg and glut muscles are subjected to increased stress.  The Piriformis muscle is one of those muscles that can be vulnerable to that constant instability with each step, as I relearned again this winter.

The Piriformis (located under the large Gluteus maximus muscle of your butt) helps rotate your thigh laterally (out) as well as helps stabilize the hip joint.  The Sciatic nerve passes under, over or through the Piriformis.  Therefore, if the Piriformis is tight, not only can you feel pain in your butt, but the possible entrapment of the sciatic nerve may also cause pain down the back of the leg, following the path of the sciatic nerve. ( http://images.google.com/imgres?imgurl=http://www.neurography.com/Images/Piriformis/PyrAnatA108.jpg&imgrefurl=http://www.neurography.com/Images/Piriformis/Piriformis1.htm&usg=__qJqe3pBcHNBpzWS9HmDJ3h2r_wA=&h=460&w=344&sz=154&hl=en&start=1&sig2=KpI9GNzD7bZyeidRd1Lw_Q&um=1&tbnid=BBAHIo7C8EJ8sM:&tbnh=128&tbnw=96&ei=zU9uSd-AHNuImQeBpPmcCw&prev=/images%3Fq%3Dpiriformis%2Bmuscle%2Bphoto%26um%3D1%26hl%3Den%26rlz%3D1T4GGLR_enUS240US242%26sa%3DX - this link provides a great photo of it’s location, as well as other info)

I have off and on Piriformis tightness, that I am usually able to keep in check with massage, acupuncture, self-massage with a tennis ball, and stretching. However, with running in the snow of these recent storms, it has become irritated again.

I was lucky enough to have an acupuncture appointment yesterday, just as my Piriformis was really feeling sore. I have been going to my Acupuncturist, Mary Lello (207-761-7228), for over 2 years. I love her treatments, which have helped me tremendously with several injuries.  She has a specific treatment for treating Sciatica (a tight Piriformis can cause Sciatica = pain (caused by the compression of the Sciatic nerve) that radiates from the low back or glut region down the back of the leg to the calf, and foot). So this morning on my run, my Piriformis was feeling much better. 

Massage, of course, is also excellent for reducing Piriformis tightness. But probably the best thing you can do for Piriformis pain, is regular self-care at home. Massaging your gluts with a tennis ball is easy.  Lay with your back on the floor, knees bent with feet on the floor. Lift your butt and place the tennis ball under the area of pain – lower/mid glut.  Release some of your body weight onto the tennis ball and roll it under your glut using your own weight, hitting all those tight painful areas. A few minutesof rolling (as well as holding the ball on the really tight areas) is all it takes. It is best if done daily – or at least regularly.

Daily Piriformis stretching also helps to loosen the muscle.  As I was reminded by my trainer Erica Napuli (207-329-7528 efitness08@yahoo.com) the Pigeon Pose , from yoga, is an excellent way to get a deep stretch. (Check out http://yoga.about.com/od/yogaposes/a/pigeon.htm and http://www.fitsugar.com/121200  to see the pose). Make sure you do both sides, or at least the side where the Piriformis is tight.  I like to bend forward over the knee and relax into the pose.

Remember, that the longer you have had the pain, the longer it will take to go away.  So don’t expect all the pain to disappear with one massage, if you have had glut pain for years. However, the self-care options can be a great way to keep a tight Piriformis muscle from becoming an injury. Enjoy!!!

I am all about taking care of one’s body to reduce pain, tightness and injury.  One of the tools I have used (and recommended to others), that I recently rediscovered, is The Stick (www.thestick.com)  The Stick is a bar with hand grips on either end, that has a slightly flexible core with revolving spindles between the grips.  The middle section of The Stick bends to mold to various body parts….like calves and hamstrings.

The purpose of its use is to promote circulation of blood in the muscles, so as to warm them up, or to help disperse lactic acid after a workout.  It also helps to eliminate trigger points – areas of knotted up muscle (muscle adhesions), that can be caused by any repetitve activity,  like running or sitting at the computer all day.

I used to use mine religiously before and after every run.  I really noticed the warm-up effect it had on my muscles, as I started off on my morning run, the day after a really hard workout.  My muscles felt looser than if I had just started out for a run cold, and those “tight spots” ( areas of muscles adhesions) felt better than they had the day before. I took that thing with me everywhere.

I recently did a 4 mile trail race (the wicked fun Mountain Epic) at Sunday River. The result being extremely sore quads the following day, from screeching down those steep ski slopes.  The Stick really helped to loosen my adductors and quads, as I attempted to do some easy runs in the days following the race. As a result, I have now returned to regular use, and worship, of The Stick.

You can buy The Stick at any running store, online, as well as at Peak Performance (www.mypeakmultisport.com) here in Portland.  The Stick comes in a variety of lengths and types.  I have the Travel Stick since it is easy to take along with me, is shorter than most sticks, and seems to mold best to my leg and glut muscles.  There are ones that are longer for those with bigger muscles and bodies, as well as ones for your feet, and even ones for you the computer geek (Alex).

Check them out online (www.thestick.com) if you want.  They describe the different types, as well as how to use them.  Best is to go to any running store or to Peak Performance, where the staff can help you find the Stick right for you.  Just hoping to keep everyone as healthy as possible.

I was reading the Fall issue of Massage Therapy Journal (www.amtamassage.org/mtj) recently when I came upon an article discussing the most common injuries that massage therapist see in athletes.  Eagerly reading away, I was surprised by the naming of an injury which I too find in some of my clients, many of them being cyclists.  It is called Tight Ass Syndrome (TAS), which describes the injury perfectly.

The massage therapists interviewed for this article say that they found TSA in many of their cyclist clients. One saying of the cause “….follows an exceptionally hard effort, as in a time trial, where one pushes big gears at close in maximum for an extended period.”  Basically I’ve found, that if you are gong to push yourself on your bike, your glutes are going to get tight.

Stretching your glutes on a regular basis is key to avoid excessive tightness of the glutes.  One great stretch invloves: lying on your back, bring one knee up and across your chest to opposite shoulder.  Massage is also great for loosening up those tight glutes. Self-massage can be done with a Myo-Release Ball - they have these at Peak Performance (www.mypeakmultisport.com) or a tennis ball, to get deeper.

I have found that tight glutes over time can lead to a tight low back.  People tend to come in  for a massage only when their back starts to bother them.  But if caught before the low back is involved, the tight glutes are much easier to release. So best to come in before you are in severe pain.

Obviously, cyclist are not the only ones with the tendency to get “tight asses”.  So pay attention to your glutes even if you don’t cycle.  Stretching and self-massage of the glutes can go a long way to preventing TSA or a painful low back.

If you have any questions regarding the use of the tennis ball (or Myo-release ball) or other stretches that help to loosen your glutes, feel free to contact me. 

And for those of you who ride – enjoy getting out there on your bike.  Falling cycling can be a great way to get out and see the fall colors….as long as the wind and rain are not too relentless