The following is an article written by Linda Fehrs, LMT in 2010 on the subject of CRPS or complex regional pain syndrome.

Chronic pain is a complaint massage therapists hear from many clients. The causes vary from pain as a result of injury or accident to post-surgery pain. There may be times that the actual cause is unknown or elusive. Learn more about complex regional pain syndrome, a chronic and often debilitating form of pain that may be helped by the use of massage therapy.

Complex regional pain syndrome (CRPS) is a chronic and progressive collection of pain symptoms characterized by severe, burning pain, tissue damage, stiffness, changes in skin texture/color (thin, shiny, blotchy, blue, purple, or red), temperature and/or swelling and extreme sensitivity to touch (allodynia). Persons afflicted with this disorder say that sometimes the pain is so bad it is like being doused with gasoline and set on fire.

There are two similar forms of CRPS, CRPS-1 and CRPS-II both with the same symptoms and treatments. CRPS-1 (previously called reflex sympathetic dystrophy syndrome) is the term given for individuals without confirmed nerve injuries, while CRPS-II (previously called causalgia) is the term for those with confirmed nerve injuries.

What Causes CRPS?

Unlike some chronic pain disorders, the pain of CRPS is triggered by a misfiring of nerves within the nervous system that, in turn, send constant pain signals to the brain. In more than 90% of cases, the initial trigger was a trauma or a minor injury, such as a sprain/strain, fracture, soft tissue injury (burn, cuts, bruises), fall or other physically traumatic event, including certain medical procedures.

Because chronic pain lasts for a long time, it can cause changes in the brain, which can consequently be responsible for changes in how the body functions. For example, a person with chronic pain might have trouble figuring out right and left side discrimination. Another change, called tactile discrimination, makes it difficult, if not impossible, to figure out what is touching the body in the area of the chronic pain. The brain cannot interpret whether something touching the body is soft or hard, pointy or dull. This might lead to an inability to be aware of an object causing even further injury to the body.

How Can Massage Help?

Persons with CRPS tend to have more than just moderate aches and pains. It is less generalized than fibromyalgia. At times the pain is excruciating, mostly in the arms and/or legs. Even light touch, such as clothing touching the body, can be irritating.

So how can massage, which consists mainly of touch, be helpful? A person with CRPS may have periods of less intense pain. This would be the time to introduce therapeutic massage, perhaps beginning with less intrusive modalities such as cranial-sacral techniques or polarity massage. At the very least, these techniques help a person to relax and refocus away from the pain.

Massage therapists can also educate their clients on maintaining proper body alignment, which will help avoid postural guarding of the affected limb and promote a more balanced use of muscles. Instructing clients on the importance of exercise is also important in the fight against pain. Exercise, as well as massage therapy, can increase the body’s production of endorphins and serotonin, both of which contribute to not only elevating a person’s mood, but also act as natural pain killers helping to block pain signals to the brain. Exercise can also help to reeducate the body with regard to special awareness or proprioception. If a person cannot do strenuous exercise, suggest something like Tai Chi or Qigong, which can help to improve balance, flexibility and the flow of energy within the body.

In addition to exercise, receiving various forms of massage therapy can help with proprioception and the re-training of the mind-body connection. Techniques such as lymphatic drainage can reduce edema and thus reduce pain that might be triggered by the pressure of built up fluid in the extremities, while neuromuscular techniques can help inhibit the pain-spasm-pain cycle.

In all my years of treating clients with therapeutic massage, until recently I had never encountered someone suffering from trigeminal neuralgia. Client S (as she will be referred to) presented with debilitating pain in her scalp, forehead, temple region, and jaw. She told me she had been diagnosed with Trigeminal Neuralgia and was seeking help from therapeutic massage. Since this was something I had not dealt with in the past we attempted a very short therapeutic treatment for her first session. But I immediately did some research and learned a good deal about this terrible condition and wanted to post something for those of you who may be suffering and looking for an alternative means of relief.

I will be posting excerpts from two different articles I discovered online about Trigeminal Neuralgia and Massage Therapy below, crediting the authors accordingly.  Client S has already told me that she has had several days without any pain and is very thankful for the treatments we have begun.

The first article comes from Linda LePelley, RN, NMT , written May 1, 2016. She writes:

“TN usually occurs when the myelin sheath of the trigeminal nerve has been worn away, sometimes due to a blood vessel causing compression to the nerve, or if the patient has Multiple Sclerosis, a disease which attacks the myelin sheath. Sometimes TN can be brought on by an arteriovenous malformation or a tumor. Trauma, dental work, and strokes affecting the nerve can also trigger TN. The trigeminal nerve consists of three branches, which service the face and up into the scalp. Any branch, and more than one, can be affected. Occasionally, it can occur bilaterally. 

When diagnosed, TN is classified as one of two types, which The National Institute of Neurological Disorders and Stroke describes as follows: The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours. The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating. 

TN is serious in that the pain is debilitating. According to the NIH, the incidence of new cases is about 12 per 100,000 people a year, and is more frequently found in women. Current treatment for TN begins with anticonvulsant medications, and tricyclic antidepressants are prescribed for pain relief. TN is not believed to be related to depression or psychological factors, but analgesics are generally ineffective. 

TN is a progressive condition, and if medications lose their effect over time, there are more invasive treatments available for pain relief. These include injections and several different types of surgery, all which involve the risk of unpleasant side effects. The NIH handout for TN states, “Some individuals manage trigeminal neuralgia using complementary techniques, usually in combination with drug treatment.” Although they list low-impact exercise, yoga, and visualization among other approaches, there is no mention of massage therapy. In my limited experience, massage therapy for TN has relieved everyone who has attempted it. From what I understand of this condition, it progresses over time. As the tissues become more compressed, the pain becomes more intense. If heat and massage can soften, mobilize, and relieve pain elsewhere in the body as it does, it can certainly relieve at least some of those cases of TN. It only makes sense to try therapeutic massage before administering drugs or performing surgeries.”

The next article is from Michael Dixon on December 22, 2017. Mike Dixon has practiced massage therapy for more than 30 years. He is an educator, and an international presenter in massage therapy continuing education (Arthrokinetic Therapy).

“According to the Mayo Clinic, trigeminal neuralgia is one of the most painful afflictions known to medical practice. Trigeminal neuralgia (TN) is a disorder of the fifth cranial (trigeminal) nerve. Here I’d like to share my experience treating patients with TN. A few simple treatment procedures will be discussed, and I believe they are worth a try for therapists to see if they also have positive effects in treating this nerve pain. 

The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw and lower jaw. The pain episodes last from a few seconds to as long as two minutes. These attacks can occur in quick succession or in volleys lasting as long as two hours. 

The “atypical” form of the disorder (called TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than TN1. 

Both forms of pain may occur in the same person, sometimes at the same time. 

The treatment procedure I use to treat TN is very simple. It involves stretching the three branches of the trigeminal nerve on the patients’ face. This may have a positive effect by reducing the swelling caused by a build-up of edema in the nerve. 

Stretching nerves – whether it is the trigeminal nerve, or the greater or lesser occipital nerve – causes a reflex effect allowing edema to exit the problematic nerve. This reduction of edema decreases the swelling of the nerve and improves its blood flow – resulting in improved function and reduced nerve pain. Improving blood flow is the key to allowing the nerve to start to heal and normalize. 

In short, stretching procedures can and may result in less pain and/or a resolution of the dysfunction of the TN or any nerve that has a build-up of edema due to stress – whether mechanical, chemical or otherwise. This is the theory upon which I based the treatment procedure for patients with TN. 

 So, the question is: why do nerves swell with edema, become dysfunctional, and often generate nerve pain? 

The answer is: stress to the nerve. When a nerve is stressed, it produces macromolecules known as proteoglycans. These long chain proteins can absorb up to 50 times their weight in water molecules thus causing a physical swelling of the nerve. The proteoglycans are like tiny sponges inside the nerve. 

Why do the nerves produce proteoglycans? 

The physiological response to a nerve being injured or stressed is to swell with these water molecules that attach themselves to the proteoglycans. By stretching the affected nerve, we can reduce the swelling by allowing some of the water molecules to exit through the elastic properties of the nerves. 

Healing Hands would like to add another experienced therapeutic massage therapist to their team. The position would be that of a full time, independent contractor. Pay is commiserate with experience and repeat clientele. If you, or someone you know, are interested or are looking for a room to rent, please contact us. Energy workers need not apply.

We look forward to meeting you.

And specifically Michelle Prud’homme Stanlee, for her generous article about our business.

The following is an excerpt taken from the November 2016 Massage Therapy Journal written by Christian Bond.

Whether you pull a muscle, have an overuse injury or strain, or are dealing with any number of issues, one thing typically remains true: You never really understand how much you use your shoulder, hip or knee until you’re dealing with chronic pain or injury.

Shoulder injuries and strains are common for many people, and according to George Russell, a massage therapist and chiropractor in New York City, massage therapy can be ideal for helping those who suffer from shoulder dysfunction.

Anatomy and Structure

The rotator cuff consists of four muscles— supraspinatus, infraspinatus, teres minor and subscapularis—whose fibers emerge directly from all over the shoulder blade and converge on the humeral head. These muscles are called a cuff because they attach like a cuff to the very outer top of the humerus. “Picture an epaulet on a military jacket,” Russell suggests. When contracted, these same muscles rotate the humerus, which is why the group of muscles is called the “rotator cuff.”

But that’s not all they do, and “rotator” may not even describe their primary function. “It’s true they move the humerus in various ways, especially rotation,” Russell says. “But kinesiology reveals the rotator cuff’s real function—to snug the humeral head into the middle of its shallow socket on the outside of the shoulder blade, no matter where the arm moves in space.”

Like a mortar and pestle, the shoulder joint (like any ball-and-socket joint) functions through roll and glide. When you lift your elbow over your head, the humeral head rolls up in the socket and would roll out and hit the acromion if there weren’t an equal and opposite glide down in the socket. The opposing glide is what keeps the joint from harm, and that glide is the job of the rotator cuff. “The rotator cuff muscles come off almost every surface of the scapula— front, back and top,” explains Russell. “That pattern of attachment suggests that the scapula is the stable end of the muscles and the ‘cuff’ all around the outer top of the humerus is what is moved—in whatever way glides the humeral head to the center of the glenoid fossa.” Think, for example, of a professional baseball player pitching a fastball: The rotator cuff is what keeps his arm from flying over home plate with the baseball. “When Masahiro Tanaka throws his fastball, the rotator cuff pulls the humeral head backward and toward his scapula, gliding the humeral head back into the center of the socket where it belongs,” Russell says.

Common Injuries

Instead of starting by releasing spasm and tightness in the rotator cuff, consider the shoulder joint itself as a whole. “In my opinion, all of the common injuries of the shoulder result from shoulder joint misalignment,” Russell says. “The rotator cuff becomes damaged when it tries its hardest—but fails—to glide the humeral head to the center of the socket.” Following are some of the most common shoulder injuries.

A SLAP tear (superior labral tear from anterior to posterior) is a tear of the superior labrum and, often, the long head of the biceps. The labrum is a ring of cartilage that deepens the socket for more controlled movement. In a SLAP tear, the bone rolls up to move the whole arm up in space, but for some reason, the rotator cuff fails to counter the force of that movement so there’s equal glide back into the socket. The labrum is the next line of defense, and it should act like a guardrail on a highway, bouncing the ball back into the socket. “But you can only drive so long against a guardrail before it gives,” Russell explains. Sooner or later, the humeral head will breach the labrum, and it almost always starts at the top and front of the joint, where the ligamentous and joint capsule protection is the least and where the human arm tends to go.

Acromial impingement, shoulder bursitis, and supraspinatus or other rotator cuff muscle tendonitis/tear.  All of these injuries have to do with the failure of downward/backward glide, which is also a failure of all the rotator cuff muscles. “Powered by the deltoid, the humerus rolls up to bring the arm overhead,” Russell explains. “If the rotator cuff cannot or does not glide the ball down into the glenoid fossa, the bone eventually hits the acromion, which sits above the humeral head like a carport above a car.” Damage to any structure from the humeral
head to the acromion can result. Eventually, one can expect arthritis as well, since a poorly seated joint doesn’t allow the cartilage surfaces to stay against one another and to be nourished by the joint fluid.

Who Gets Rotator Cuff Injuries

As might be expected, Russell explains, anyone whose work requires that they have their hands above their heads for long periods of time are prone to rotator cuff injuries. “The rotator cuff is ‘white meat’ muscle. It has no myoglobin, so it can’t burn glucose for energy. It’s like it’s on battery power (glycogen),” he says. “When the battery runs out, the liver needs a half hour to recharge the battery, so if you’re going past that deadline again and again, you’ll get overuse syndromes and fascial adhesions.”

Athletes who throw, too, are more likely to have rotator cuff problems because the rotator cuff is the structure that decelerates the arm once you’ve let go of what you’re throwing. “To throw with any power, you usually rotate your body,” Russell adds. “This means that the rotator cuff often has to work around a corner or at some odd angle because the shoulder blade is very protracted and the ribcage is rotated as well.”

Russell also notes that swimmers are at risk for shoulder problems because of the big range of motion they take their arms through against the resistance of the water, while also rotating their neck and ribcage. “It’s a complex task,” Russell says, “and can lead to rotator cuff strain, especially in the subscapularis, which stabilizes while it also assists internal rotation of the arm as you push the water back with the arm.”

The following is an article by Dr. Jordan Metzl  published November 5, 2015 on the Triathlete-Europe website. The article is targeting individuals who lead a very active, even aggressively athletic lifestyle. However, Piriformis Syndrome can affect anyone, at any time. I hope you find the information helpful. If, after reading this short article, you think you may be suffering from Piriformis Syndrome, it is important to know that massage therapy has proven highly effective as a form of treatment for this painful condition. Please click here for an appointment so we can begin a program to bring you relief today.

Piriformis Syndrome Treatment, Prevention

• By Dr. Jordan Metzl
• Published November 5, 2015

The Symptoms

Pain in the lower back and/or buttocks, sometimes feeling as if it’s deep inside the buttock muscles. It may be too painful to sit on the affected buttock. The pain and/or tingling can radiate down the backs of the legs as well.

What’s Going On In There?

The piriformis muscle runs behind the hip joint and aids in external hip rotation, or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many working people can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.

The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, like a compressed lumbar disc. Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause.

Runners, cyclists and rowers are the athletes most at risk for piriformis syndrome. They engage in pure forward movement, which can weaken hip adductors and abductors, the muscles that allow us to open and close our legs. Throw in some weak glutes, and all those poorly conditioned muscles put extra strain on the piriformis. And you’ve got a painful problem.

Another risk for runners: Overpronating (when your foot turns inward) can cause the knee to rotate on impact. The piriformis fires to help prevent the knee from rotating too much, which can lead to overuse and tightening of the muscle.

Do you have frequent headaches? Think you’re stuck with them? Well, the  links below will take you to a number of resources that indicate that massage therapy is very helpful in alleviating and even, possibly, preventing headaches.

If you experience constant headache pain or suffer from occasional tension headaches, I would encourage you to make an appointment by clicking here and I will do my best to bring you relief. But definitely check out the links below.

Holding Headaches at Bay

Massage Can Be Effective for Tension Headaches

Massage Brings Relief  to People Suffering from Headaches