"Consider the Preciousness of Others"

I came across the title phrase last night in one of the many baby books I am currently devouring while on lockdown (“On Becoming Babywise” by Robert Bucknam and Gary Ezzo). It was written in the context of balancing the needs of your child/family with those of the people around you. But the simple beauty of the phrase struck me and felt particularly pertinent in the present moment.

We have all seen a lot of pleas to, basically, not be a jerk during the current crisis. Such reminders usually go along with requests not to hoard all the toilet paper and hand sanitizer. But that is a very basic level of decency. We have the potential to do so much more.

The call to “consider the preciousness of others” asks us to find and honor the intrinsic value of every human being. During this time of panic and trepidation, we each have the ability to make choices about our own behavior. We can succumb to fear and allow ourselves to be ruled by our most base and selfish urges or we can choose to rise to the highest calling of our humanity.

Living through this global health crisis, sequestered in out homes, it is easy to feel helpless and spiritually cut off from the world. But to give of oneself is to take back the power that felt lost and to rebuild a sense of oneness with all human kind. It is still possible to adhere to health and safety guidelines while we give of our time, our talent, or our treasure. It is still possible to renounce the voices that call for a callous rejection of our humanity. The present moment requires that we not only see the light in each person we meet, but that we hold that light precious and refuse to let it be dampened.

Take only what you need. Give all that you can. Meet each stranger with the kindness you would show an old friend. Consider the preciousness of others.

Here are a few local charities worthy of your consideration:

Central Texas Food Bank (volunteers and food/monetary donations needed) https://www.centraltexasfoodbank.org/

We Are Blood (blood donations desperately needed) https://weareblood.org/

Meals on Wheels Central Texas (monetary donations needed) https://www.mealsonwheelscentraltexas.org/

Foundation Communities (monetary donations needed) https://foundcom.org/

Temporary Closure

Over the last few weeks, I have struggled with whether to continue working during the COVID-19 health crisis. I firmly believe that massage therapy is an important part of maintaining both physical and mental health, something that is more important now than ever before. I am also committed to serving the best interests and needs of my clients. I have made every effort to ensure that my office and equipment are thoroughly cleaned between each client and to welcome only healthy clients through my doors.

However, yesterday both of the major professional organizations that represent massage therapists (the American Massage Therapy Association and Associated Bodywork and Massage Professionals) announced that they are now recommending that all massage therapists close their doors for the time being. This announcement, in combination with the fact that I am about to enter the last trimester of my pregnancy and am therefore at elevated risk of medical complications, has forced me to the unfortunate but necessary decision that I must temporarily suspend my business. Effective immediately, I am blocking online booking and cancelling all appointments for the next two weeks. I will make decisions about further cancellations as events unfold.

Please know that I will remain available by phone or text if you have any questions about self-care during this time. Gift certificates for future appointments will continue to be available, but please bear in mind that I will be taking maternity leave during the summer months.

In this rapidly changing situation, please be sure to get your information about the crisis directly from reputable sources such as the CDC in order to keep yourself and your loved ones safe.

Take care of each other and be well.

7 Tips for a Healthy Holiday

The holiday season is the most wonderful time of the year, but it can also be challenging for your health. Between the diet-busting food, family tension, and end-of-year stress at work, it’s easy to feel completely depleted by the time January rolls around. However, with a few small changes to your habits, activity, and outlook, you can make this a joyful time of year for both body and mind. Here are 7 simple tips for a healthy, happy holiday season.

1. Wash your hands! The holiday season is also cold and flu season. You will probably spend a lot of time in close quarters with friends and family — the perfect opportunity to catch a virus. The single most effective way to keep yourself healthy is to wash your hands thoroughly and often!

2. Take a walk. A brisk walk every day for about 20-30 minutes helps to clear the mind and reduce stress while improving your overall health and working off a few of those holiday calories. American adults tend to gain one pound between Thanksgiving and New Year’s and are unlikely to lose it later. Keeping up your physical activity during the holidays can help maintain a healthy weight. It also gives you a great excuse to get out of the house if family tensions rise!

3. Don’t sweat the small stuff. The holidays don’t need to be perfect to be fun and memorable. The focus of the holiday season should be the time spent with friends and family, not making your house look like an Instagram fantasy! Remember that as families change and grow, traditions will change too — hold on to the traditions you really love and be open to letting the rest go.

4. Indulge in only your favorite holiday treats. There’s no need to deprive yourself of all the goodies this holiday season, but choose wisely. Maybe you decide to pass on the store-bought cookies at work so that you can really enjoy that home-made pie later.

5. Maintain a normal meal schedule. Fasting all day before a big holiday meal or a party means that you will be ravenous and thus more likely to overeat. Instead, plan on eating breakfast, lunch, and dinner, and serve yourself normal portion sizes during the big meal.

6. Take a real vacation. Even if you can only take a couple of days off, make sure that you commit to the break. Turn off your computer and enjoy your time with family and friends without checking in with the office. Just a few days of truly relaxing will help you return to work with a renewed sense of energy.

7. Set yourself up for happiness. Accepting every holiday party invitation can leave you overwhelmed and deplete your holiday spirit reserves! This year, only commit to events for which you have the time and which you know you will enjoy. Then show up expecting to have a good time!

Muscle of the Month: Pectoralis Minor

The pectoralis minor is a small muscle that lies underneath the large pectoralis major, right against the rib cage and just below the clavicle (collar bone). It originates on the third, fourth, and fifth ribs and inserts on the coracoid process of the scapula (a part of the shoulder blade). The pecoralis minor depresses the scapula (pulls it down), abducts the scapula (pulls it out to the side), and anteriorly tilts the scapula. When the scapula is fixed, the pec minor can also assist in forced inhalation by pulling up on the ribs

Postural positions that include rounded shoulders and forward head position are an indication that the pec minor may be in chronic contraction. Another sign may be difficulty or even pain with pulling the shoulder blades together. Pec minor can also be injured by trauma to the neck or arm or fall victim to repetitive strain injuries from sports or daily tasks. Pain from the pectoralis minor may be felt in the chest, shoulder, inner arm, palm, and even into the fingers.

The major artery and vein of the arm as well as the nerve bundle known as the brachial plexus which serves the arm, all pass underneath the pecoralis minor, creating the potential for this muscle to compress the nerve and blood vessels if it becomes too tight. This condition is called pectoralis minor syndrome and its symptoms are very similar to and often exist alongside thoracic outlet syndrome. Symptoms of pectoralis minor syndrome include pain, weakness, numbness, and tingling in the arm and hand as well as tenderness in the chest and armpit. Massage therapy and physical therapy are the first steps towards resolving this issue.

Here is a quick video explaining a simple pec minor stretch (with fun accent!). It is just a slight variation on the pec major stretch that you may have seen me demonstrate before

Myth vs. Fact: Lactic Acid and Massage

I recently went to one of Austin’s top spas to use a birthday gift certificate for a relaxing facial. While I was waiting, I decided to check out what kinds of massage they offered. I was interested to see that several of the massage services offered at this spa were described as having the ability to flush lactic acid from muscles. I hear people talk about lactic acid all the time and, just like this spa, they almost always get it wrong. So today let’s take a quick look at what lactic acid is and what effect massage has on it.

The normal process that the body uses to metabolize glucose into usable energy requires oxygen. During periods of extreme exertion, even heavy breathing is not able to supply enough oxygen to maintain the required level of energy. At this point, the body must switch to an anaerobic (without oxygen) method of energy production. Lactate (commonly known as lactic acid) is then temporarily produced to help break down glucose and provide the muscles with energy. As soon as the exertion slows and more oxygen is available, the production of lactate stops.

Lactate makes muscle tissue more acidic and is responsible for the burning feeling that accompanies strenuous exercise. It is not, however, responsible for the muscle soreness that follows a day or two after exercise. That soreness (delayed onset muscle soreness or DOMS) is not completely understood, but it is is most likely caused by minor damage to muscle tissue and the resultant inflammation response as the body repairs that damage. Studies have shown that there is no significant correlation between the amount of lactate in a muscle just after exercise and the amount of soreness that may be felt later.

There is a common myth that massage flushes toxins, including lactic acid, from the body. I will leave a discussion of the pseudo-scientific use of the word “toxin” for another day, but suffice it to say that, while massage does have an effect on the flow of blood and lymph, it does not remove anything from the body. The human body is exceptionally well suited to processing all naturally occurring products of its own metabolism, including lactate. In fact, one obvious reason why it is practically impossible for massage to have any impact on lactate levels is that the body naturally removes this substance from the muscles within an hour after exercise!

Massage has many benefits including reduced stress and anxiety, improved sleep, lower blood pressure, improved mobility and range of motion, reduced pain, improved posture, etc. Several studies have shown that sports massage can reduce the severity of DOMS and is beneficial in athletic recovery for many reasons. But massage does not have the magical ability to remove “toxins” from the body. Anyone who tells you something different needs to check their science!

Tendon vs. Ligament

When speaking about our bodies, we often use the words "tendon" and "ligament" interchangeably. We know that they both have something to do with muscles and joints but the difference between the two is somewhat murky. Let’s take a look at some of the differences between these two important types of tissue.

While tendons and ligaments are both types of connective tissue, they have very different functions in the body. The simple way to tell the difference between a tendon and a ligament is that tendons connect muscle to bone while ligaments connect bone to bone. In massage therapy, we regularly work directly on tendons as a means of affecting change in the muscle itself. While massage work directly on ligaments is less common, it is sometimes necessary and beneficial.

Tendons allow muscles to do their job. The function of a muscle is to move the other structures of the body, therefore they are always attached to a structure other than muscle (most often bone). Every muscle has at least two tendons: one at each end. The fibers of the muscle and the tendon weave together so that it is difficult to mark the exact point where one begins and the other ends. Tendons come in many different shapes and sizes depending on the purpose and location of their muscle. When the muscle contracts, it's tendons contract as well, pulling on the bone and thus causing the desired movement.

Ligaments are found in and around joints, connecting one bone to another. Their main job is usually to hold the joint together and keep it stable. Ligaments can also connect other structures in the body, such as organs, to surrounding bone. Ligaments have enough elasticity to allow movement within a joint, but they are not nearly as pliable as tendons.

An injury to a tendon is known as a strain and is often caused by repetitive movement or physical activity. Strains often occur in the back, neck, and legs. An injury to a ligament is called a sprain. These often occur with a sudden accident like a fall. Sprains are common in the ankle, wrist, and knee. Both kinds of injury can be slow to heal, but the process can be aided by careful massage work.

7 Ways to Improve Your Driving Posture

Now that kids are back to school, Austin’s notoriously terrible traffic is back to full force and many of us are spending more time in our cars than we would like.  With this in mind, I thought it might be a good time to remind everyone of a few basic steps we can all take to make our time in the car less of a strain on our bodies.  Please remember to use common sense when making any of these changes and never make adjustments that would impair your ability to see the road, your mirrors, or your car's instruments clearly and easily.

1. Adjust your steering wheel down and towards you, but make sure it is at least 10 inches from your sternum (breastbone). The less your arms have to reach forward and up, the less of a strain is put on your neck and upper back. Keep you hands near the 9 and 3 o’clock positions rather than 10 and 2 as this will help keep your shoulder muscles relaxed.

2. Don’t lean to one side.  The reality is that many of us use only one hand to drive while leaning the elbow of the opposite arm against an arm rest or the center console.  This position can create pain in the low back, upper back, shoulders, or neck.  Rather than leaning, allow the inactive hand to rest gently in your lap while you drive.

3. Keep your seat back reclined slightly as sitting up too straight will put undue pressure on your back.  Your hips and upper back should come into contact with the back of the car seat.  

4. Adjust the position of your seat so that you can comfortably depress the pedals without your back leaving the seat.

5. Make an effort to rest your head against the head support while driving so that you are not holding your head forward.  Position your head support so that your head rests directly in the middle of the support.  This step has the added bonus of significantly decreasing the severity of whiplash in the case of an accident.

6. Keep your legs parallel to each other.  While driving a car with an automatic transmission, many people allow their left leg to splay out to the side and lean against the car door.  This position can cause low back, hip, and leg pain. Keep your left foot flat on the floor and engage your inner thigh to hold your left leg parallel to your right.

7. Keep integrity in your core muscles while driving.  The abdominal muscles help to support the low back and entire spine, but are not usually engaged while driving.  These muscles may be activated by imagining a string pulling the belly button towards the spine.  Aim to hold this tension in the core muscles with only about 10% of your strength.  Maintaining this integrity in the core will help to keep your entire spine in proper alignment while you are driving.

While we can all take steps to improve our driving posture, the truth is that there is nothing we can do to make driving good for our bodies!  Even with perfect posture, driving is still incredibly fatiguing for the muscles of the low back and pelvis because the seats in cars simply create an unnatural position for the human body.  If you have a long commute, make sure to take a few minutes to walk around and stretch when you arrive at your destination. Remember, every body that is spending a lot of time sitting in Austin traffic needs some attention and Peacock Bodyworks is happy to help!

Muscle of the Month: Sternocleidomastoid

The Sternocleidomastoid or SCM is one of the most important muscles of the anterior neck.  It has two heads, one of which attaches to the top of the sternum (breast bone) while the other attaches on the clavicle (collar bone).  These two heads join into one muscle and insert on the mastoid process of the temporal bone which is behind the ear.  There is one SCM on each side of the neck and they can work either together (bilaterally) or individually (unilaterally).  Working unilaterally, the SCM rotates the head and neck to the opposite side and bends the neck to the same side.  Working bilaterally, the SCMs bend the neck forward, bringing the chin towards the chest.

This is another muscle that is often ignored by massage therapists because it is awkward to massage and can be very tender. Most people that I see have never had this muscle worked on before visiting my office!  While it is not common to experience pain in the front of the neck, trigger points in the SCM can send pain to the head, eyes, ears, and jaw.  A tight SCM can also severely limit range of motion in the neck.  The SCM may be stressed by keeping the head in a position of looking up or to the side for an extended period of time or by sleeping with too many pillows.  It may even be strained by holding the head too far forward (such as while looking at a computer or mobile phone) which requires the SCM to support much of the weight of the head.

The SCM is almost always injured in acceleration/ deceleration incidents such as whiplash.  Because it contributes significantly to three out of the four major motions of the neck, it is very important to seek care after any whiplash-like incident, even minor car accidents and falls. I recommend seeing a chiropractor immediately after any such injury for a thorough evaluation and then quickly beginning a series of massage sessions to address any injury to the SCM.

The SCM is one of the easiest muscles to massage yourself.  This video will give you a good idea of how to massage your SCM.  I recommend that you try this while lying down with the head supported so that the SCM is relaxed. It is not possible to pick up arteries, veins, or nerves while massaging the SCM so don’t worry about causing injury to those structures.  If, however, you find that you can feel your pulse in a certain area, move you fingers away to ensure that you are not pressing on an artery. When you finish your self-massage, give this stretch a try - you might be surprised how much better you feel after stretching the front of your neck!

If you are experiencing headaches, jaw pain, or a limited range of motion in your neck, it’s time to schedule your next massage!

Backpack Basics

As adults, many of us experience pain due to the way that we have learned to carry our bodies through space.  These postural habits are the result of a lifetime of experiences.  Busy parents and caregivers often overlook the small physical habits that children develop, unaware that they may be leading to a postural behavior that could cause the child dysfunction and even pain as an adult.

As kids begin their new school year, my thoughts return again and again to one of the most common problems that I see in my young clients: improper use of backpacks!  Backpacks are, of course, a necessary part of the school day, but many adults are unaware of the damage that a heavy, ill-fitting, improperly carried backpack may be inflicting on children.  Poor backpack use can slowly shift a child’s posture, causing imbalances that may go unnoticed until adulthood.  Fortunately, backpacks can also be a wonderful tool for properly distributing the weight that needs to be carried without putting undue pressure on any one part of the child’s body.  Here are seven tips to help adults guide the children we love towards better backpack use:  

1. Pay attention to backpack design.  Look for a lightweight backpack with two wide, padded straps.  It should have a few compartments to help distribute weight.  A hip belt is a very useful backpack feature, but only if your child will actually use it!

2. Always wear both straps.  It is important to explain to your child that wearing her backpack over just one shoulder will inevitably cause her to shift her weight to one side in order to balance and this small action can, over time, become an unconscious habit.  If that habit is not broken, it will become part of her posture and that postural imbalance may eventually surface as pain in adulthood or even adolescence.

3. Adjust the fit.  The backpack should fit close to the child’s body.  The bottom of the pack should rest just above his waist while the top sits between the base of his skull and top of his shoulders.  Consider the photo above: the child on the right has a pack that fits her body nicely and it is sitting on her back as it should, while the child on the left has been overburdened with an improperly fitting backpack.  The bag that the younger child is carrying is too big for his body.  It also has not been adjusted properly so he is wearing it far too low.  The bottom of his backpack should rest against his low back so that the weight can be transferred to his hips.  Wearing the pack this low is simply asking the body to do something for which it is not built.

4. Pack well.  The heaviest objects (usually textbooks) should be packed first so that they are carried lower and closer to the body.  Distribute the weight of other objects throughout the compartments of the pack so that the weight is well balanced.

5. Check the weight.  Put your child’s full backpack on the bathroom scale to see just how heavy it really is.  Medical science suggests that the weight of the pack should be no more than 15% of the child’s own body weight.  Most kids are carrying much more than this and need help cutting it down.

6. Discuss options for limiting weight.  Children may need help sorting out the logistics of what to carry in their pack at what time and what may be left in their locker, desk, or at home.  They may also need help remembering to clean out their backpack (and binders) every few days so that they are not carrying around unnecessary weight.  Explain to your child that it is important that she carry the least amount of weight possible while her body is growing.

7. Know the warning signs.  If your child must lean forward while wearing his backpack, this is a sure sign that the pack is too heavy.  If your child begins to complain of back pain, take any steps necessary to lighten his load.  It is very safe for children to receive chiropractic, massage therapy, and physical therapy to help relieve pain.  The good news is that they usually respond to these treatments very quickly

Travel Self-Care

As we come to the end of summer, many of us are preparing for last minute vacations. While we all look forward to these late summer getaways, they often mean returning home with new aches and pains. Fortunately, with a bit of thought and planning, we can care for our bodies while we enjoy our travels and return home ready to conquer the Autumn! Here are 7 simple self-care tips to keep you healthy while on vacation:

1. Pack light and carry your luggage properly. Bringing the minimum amount of clothing and other possessions on your trip will mean less weight for you to carry. Rather than using a single-strap shoulder bag, opt for a backpack and wear both shoulder straps to distribute the weight evenly. Take the smallest suitcase possible, preferably one with wheels, and roll it as often as you can rather than carrying it.

2. Consider a lumbar support pillow. If you tend to get low back pain and you know that a long plane or car ride will be a part of upcoming travel plans, you may want to purchase a lumbar pillow to provide the support you need. If you find yourself already in the midst of such a trip, a rolled up sweater (or something similar) placed in the curve of your low back can work in a pinch to provide some relief during prolonged periods of sitting.

3. Wear good shoes. Travel often involves a lot of time spent walking so be sure to plan your footwear according to your activity. Flip flops are fine for the beach, but if you wear them for a day exploring a new city, you will end up with sore feet and open yourself up to hip and back pain.

4. Pack a small foam roller or tennis ball. These take up little space and can be very welcome at the end of a busy travel day. Use them to do a little self massage for tired shoulders, hips, or low back.

5. Move and stretch. Whether it’s a layover at a busy airport or a small town pit stop on a long road trip, take any opportunity you can to move your body while traveling. Just a quick walk around the terminal or gas station will help you be much more comfortable. And no matter what your travel plans, you can always find a place to take ten minutes at the end of the day for yoga or simple stretching.

6. Eat and drink mindfully. Vacation is a time for great food and drink, but too much of either will take a toll on every system of your body, including your muscles. Try not to overeat and be sure to make some healthy choices. When you drink alcohol, drink at least an equal amount of water and be sure to have water handy all day so that you never get dehydrated.

7. Take time to rest. Vacations are supposed to be about rejuvenating, but if you are busy every minute of the day you will come home exhausted not only mentally, but physically as well. Be sure your trip has some scheduled time for rest and relaxation!

Muscle of the Month: Gluteus Medius

The gluteus medius is a fan shaped muscle found on the outside of the hip, partially covered by the larger gluteus maximus. Gluteus medius has a broad origin on the gluteal surface of the ilium (hip bone) between the anterior and posterior gluteal lines, and inserts on the greater trochanter of the femur (top of the leg bone). Gluteus medius is sometimes called the “deltoid of the hip” due to the similarity of its shape and actions to the powerful shoulder muscle. Gluteus medius is a strong abductor of the hip, meaning that it lifts the leg out to the side. The posterior fibers extend the hip out behind the body and outwardly rotate the hip, while the anterior fibers assist in flexing the leg up in front of the body and in internally rotating the hip.

While most anatomy books will list the main action of the gluteus medius as abduction, its most important function is really as a stabilizer of the pelvis. When one leg is lifted during walking or running, the pelvis is inclined to tilt toward the side of the lifted leg. During this motion, the gluteus medius on the opposite side contracts to stabilize the pelvis and keep it level throughout the gait. If the muscle is either short and inflexible or long and weak, problems with pelvic stabilization can occur, often leading to low back pain on the opposite side.

You may have heard that sitting for long periods of time is bad for the muscles of the pelvis and the gluteus medius is a great example of why.  We have already discussed the fact that the front and back of this muscle have different actions. With that in mind, we can see that the sitting posture (which flexes the hip in relation to the pelvis) puts the anterior fibers of the gluteus medius into a shortened position and the posterior fibers into a stretched position. Thus, sitting for an extended period of time clearly has a detrimental impact on this muscle, to say nothing of the surrounding tissues.

Most people who would consider themselves to be active during their free time are still spending long periods of time sitting each day and are at risk for developing tightness and/or weakness in the gluteus medius. Going from the sitting position most of the day to a 5 mile jog after work has the potential to cause serious problems for the gluteus medius which is often unprepared to handle the sudden stress of pelvic stabilization. If you have a sedentary job and home life but wish to engage in a sport or activity that involves running a few times a week, it is best to also make time for some cross training to stretch and strengthen not just the gluteus medius, but all of the muscles of the pelvis. It is also beneficial to take as many breaks as possible during the workday to walk around and, if the option is available, to switch between sitting and standing throughout the day. 

A tight gluteus medius may also cause discomfort for side sleepers. When sleeping on the affected side, the muscle is compressed, and sleeping on the opposite side causes the affected muscle to be in a stretched position. Because both options can cause pain if the muscle is too tight, hip pain while sleeping is a good indicator of possible gluteus medius problems.

Pain from the gluteus medius may be felt in the low back, sacrum, buttocks, hips, and leg. It is vulnerable to overuse injury while hiking, walking on sand, in sports that involve running, or in weight training. Because the gluteus medius acts as a stabilizer for the pelvis, people who tend to stand with all of their weight on one leg often have problems with this muscle as well. Ignoring pain from the gluteus medius and continuing the triggering activity can lead to tendinitis or bursitis.

Massage therapy is an important tool for unwinding gluteus medius dysfunction and relieving the associated pain. 

Check out this video for exercises to activate and strengthen the gluteus medius. Bear in mind that these exercises get progressively harder. If you think you may be dealing with a weak gluteus medius, especially if you are experiencing lower back pain, I recommend doing only the first three exercises until you have developed enough strength to proceed through the rest of the video. 

For gluteus medius stretches we have two yoga poses. The first is the reclined pigeon, probably my most recommended stretch! If that feels easy for you, try doing full pigeon pose with this slow and thoughtful tutorial.

Stay Hydrated This Summer!

The weather in Austin over this past week has been downright pleasant, but as summer starts to heat back up, it is more important than ever to stay well hydrated. Dehydration can set in quickly on a hot summer day here in Texas and it affects every system of your body, including your muscles, tendons, and fascia. Water makes up about 60% of your body and it is essential for every process that keeps your body working.

Researchers recommend that men drink about 13 cups of water a day and that women have about 9 cups, but your ideal intake really depends on many factors including your health and lifestyle. Generally speaking, thirst should never be ignored, especially during these hotter months, and water is the best fluid to drink. Be sure to hydrate an hour or two before exercising or spending time outside and take water breaks during physical activities. It is much easier to maintain ideal hydration than to try to play catch up. Remember that if you are adequately hydrated, your urine should be clear or light yellow. Make sure you keep a reusable water bottle with you at all times this summer and don’t forget to use it!

What is a Pinched Nerve?

Radiculopathy, commonly known as a “pinched nerve,” is caused by compression on the nerve root. All nerves originate in the brain and spinal cord and branch out through small spaces in the spinal column. The place where the nerve exits the spine is called the nerve root. The most common kind of nerve compression is caused by a herniated disc. The disc acts as a cushion between each vertebrae, but when damaged it can bulge out and put pressure on nearby nerves as they branch off from the spinal cord. As we age, our discs naturally shrink, bringing the vertebrae closer together and often resulting in the development of small bone spurs that can also compress nerves. Another common type of nerve compression is caused by the wrist bones and is known as carpal tunnel syndrome.

Clients often come to my office complaining of what they have self-diagnosed as a “pinched nerve,” but that is rarely the problem they are experiencing. There is a common misconception that radiating pain must be caused by nerve compression, but this is not so. It is, for example, very common for trigger points to cause radiating pain.

I believe that, for many people, the idea of what constitutes nerve pain comes from their experiences at the dentist’s office. Because of this, when they experience something like sharp pain in the neck that travels down the arm, they assume it must be nerve compression. But there is a big difference between a dental tool hitting an exposed nerve and an intervertebral disc pushing on a nerve root. 

While there are many possible issues that could cause pain, nerve compression is best characterized by numbness or a feeling of pins and needles. Think of sitting or laying on an arm or leg in such a way that it goes numb. That is nerve compression. This is not to say that a “pinched nerve” can’t cause pain, it can, but that pain will be accompanied by numbness. 

It is important to note that, even when nerve roots are compressed, they rarely cause symptoms. Nerves are pliable structures and the holes through which they exit the spine are actually quite generously sized so that, even if the space is compressed, the nerve is often not compromised. Most middle aged or older people have at least one area of nerve compression caused by normal aging and do not experience pain because of it.

It is also possible for soft tissues such as muscles and tendons to compress nerves and there are a few areas of the body where this is of special concern such as the sciatic nerve which runs under (or sometimes through) the piriformis muscle, or the brachial plexus nerve bundle which runs between the scalene muscles at the base of the neck. In these instances, however, we would still expect nerve compression to result in numbness.

When clients come to me complaining of a “pinched nerve,” they are almost always actually suffering from some form of myofascial dysfunction. Myofascial tension and adhesion, trigger points, and postural imbalances are substantially more common than pinched nerves, but don’t get nearly as much attention. It is very common for myofascial dysfunction to present as intense, sometimes sharp pain, that radiates and can even cause tingling or weakness.

Because myofascial pain is very poorly understood by the medical community, this pain is often misdiagnosed as nerve compression. When this kind of pain is felt, it is best to start with conservative treatment methods. The pain will often resolve with rest and ice at home. If the pain persists more then a few days, massage therapy and chiropractic care are the next options that should be pursued and these will often resolve the pain relatively quickly. Physical therapy may be needed to strengthen weak muscles and prevent the pain from recurring. Surgery should always be the option of last resort after conservative measures have failed. 

6 Tips for a Safe Summer Workout

As the temperatures here in Central Texas continue to climb, it may be necessary to adjust your exercise habits to keep your workout safe and effective. The most obvious solution is to move your workout indoors, whether at the gym, exercise classes, or your own living room. But since many people dislike working out indoors, it is worth discussing ways to make outdoor exercise safe for summer. It is important to remember that heat will have a huge impact on how well your body handles the same exercise routine. Simply put, the hotter the environment, the more you are asking of your body as it struggles to fuel your muscles while keeping you cool. As you shift you expectations and plans for your summer workouts, keep these tips in mind:

1. Get in the water! The best outdoor exercise for summer is swimming. Swimming gives an incredible full body workout while naturally keeping you cool. Just be sure to protect your skin from the sun and remember to stay hydrated.

2. Respect the sun. Outdoor exercise should take place in the morning or evening to avoid the sun’s most powerful rays. Wear sunscreen with an SPF of at least 30 and plan to reapply it according to the package directions (sunscreen is not sweat proof). Wear lightweight, light colored, loose fitting clothing and a wide-brimmed hat.

3. Check the temperature. Before heading out to exercise, check the temperature and humidity levels to be sure they are within your comfort range. Do not exercise outdoors on days when there is a heat advisory or excessive heat warning.

4. Stay hydrated. Drink one or two glasses of water before heading out to exercise in the heat and carry water with you. Plan to stop every 15 minutes for a water break, whether you are thirsty or not. Dehydration can creep up very quickly on hot, humid days. Drink one or two glasses of water after your workout as well.

5. Snack after your workout. The hotter the day, the more you will sweat which means not just the loss of water, but also salt and minerals. Sports drinks and gels are designed for elite athletes and are completely unnecessary for the average person. It is better to avoid the dyes, sugars, and high levels of sodium in such products in favor of a small, healthy snack. Combined with regular meals throughout the day, this is all you need to replenish lost salts and minerals.

6. Listen to your body. This is important with any kind of exercise, but becomes especially vital when exercising in extreme heat. You simply will not be able to run as fast in July as you can in January. If you start to get cramps while exercising in the heat, you need to stop your workout for the day. Absolutely do not push through.

Know the Signs and Symptoms of Heat Exhaustion and Heat Stroke

While exercising outside this summer, you will often be surrounded by other people working out. Be on the lookout for signs of heat exhaustion or heatstroke not only in yourself, but in those around you as well.

Symptoms of Heat Exhaustion: cool, moist skin with goose bumps when in the heat, heavy sweating, extreme fatigue, faintness, dizziness, nausea or vomiting, weak but rapid pulse, muscle cramps, headache. If you experience any of these symptoms, stop exercising immediately, get into a cool environment and drink cool fluids. Seek medical attention if symptoms worsen or last more than one hour.

Symptoms of Heat Stroke: temperature over 104, disorientation, confusion, slurred speech, seizure, nausea and vomiting, rapid pulse and breathing, flushed skin. This is a medical emergency that requires immediate attention. If you suspect that you or someone around you is experiencing heat stroke, call 911 and use any means available to cool the person down.

Muscle of the Month: Levator Scapula

The levator scapula is a small, thin muscle of the neck and upper back. It originates on the transverse processes of the first four cervical (neck) vertebrae and inserts at the superior angle and medial border of the scapula (upper corner of the shoulder blade). As it’s name would suggest, the primary job of the levator scapula is to elevate the scapula (shrug). It also laterally flexes the head and neck (bends to the side), rotates the head and neck, and extends the head and neck (to look up). The way in which the fibers of this muscle twist around themselves between attachment points, allows for the scapula to downwardly rotate as well.

There are multiple factors of modern life that put undue stress on this muscle. The levator scapula is one of the main muscles that braces to allow a bag to be carried over the shoulder and it is easily injured by whiplash, holding a phone between the ear and shoulder, or sleeping on one’s stomach with the head turned to the side. It is commonly put under stress by the forward head position which is chronic in our society and which the levator scapula tries to work against. Emotional stress can also create dysfunction in this muscle because it often causes us to hold our shoulders up for extended periods of time which tenses the levator scapula.

The levator scapula is often involved in neck and upper back pain. Pain from this little muscle may be felt in the base of the skull, neck, top of the shoulder, and down the inside of the shoulder blade. The most common symptom is a stiff neck that is painful to turn or bend to the side. People with levator scapula pain often have to turn their entire upper body to check their blind spot while driving.

Luckily, pain from the levator scapula can be released with deep tissue massage. The pain is usually significantly better with just one session, though it may take several sessions (and some lifestyle modifications) to really unravel the tension patterns impacting this important muscle.

Here is a simple stretch for the levator scapula. Remember to only use about the weight of your hand when pulling your head since too much pressure can cause injury.

Strengthening this muscle is not really necessary for most people, but a nice compliment to the stretch above is a simple roll through the shoulders by drawing the shoulders up into a shrug, then pressing them back and down. Hold the shoulders down for a few seconds and then repeat the move. Do this as many times as you like.

Are Teens Growing “Horns”?

You may have seen the recent viral news article about a study claiming that teens are growing “horns” on the backs of their heads due to excessive use of mobile devices. In this post, I am going to break down exactly what the study is alleging and give you my take on it. 

The claim is that young people are developing enlargements of their external occipital protuberances as a result of chronic forward head posture while looking at their devices. The external occipital protuberance (EOP) is the attachment point for the ligamentum nuchae, a ligament that runs along the back of the cervical spine. The ligamentum nuchae helps to stabilize the head and neck and serves as an attachment site for several muscles of the neck and upper back such as the trapezius. The study in question claims that forward head posture is causing calcification of the ligamentum nuchae at the EOP, creating what is essentially a bone spur at the back of the head. A bone spur is a small outgrowth of bone that occurs in an area of soft tissue inflammation around a joint or a tendon/ligament attachment.  The inflammation stimulates the cells that create bone to start depositing calcium in the soft tissue as a protective measure. Some bone spurs can cause pain, numbness, or tingling, but others are asymptomatic and may never be detected. 

In theory, the idea that chronic forward head posture as the result of cell phone use could stress the soft tissue at the base of the skull so much that it could cause bony growth in the ligamentum nuchae does make some intuitive sense. Unfortunately, the authors of this particular study have failed to convincingly prove that this is happening. One glaring issue is that enlargement of the EOP is not a new phenomenon, nor has it been shown to necessarily be problematic when it occurs. The study also has serious problems with how the subject pool was selected and is completely lacking in data that would connect the subjects’ cell phone use to the development of the bone spurs. Overall, the study appears to be riddled with holes. PBS Newshour did a fairly good job of breaking down the problems with the study.

This case is a wonderful reminder that, until a study has been replicated and validated by other scientists, it cannot be taken as fact, even if it is published in a peer reviewed journal. I am interested to learn about future research on this subject, but at the moment I do not believe that this particular problem is something we need to be worried about.

That being said, there are many other musculoskeletal conditions related to the rise in mobile device use that, while not nearly as sensational as the idea of “growing horns”, are setting up young people for serious problems down the road. Looking down and directly in front of the body for prolonged periods of time is bad for everyone, but is especially concerning for teens because their bones and muscles are still growing and they are developing postural habits that they may carry with them for life. Forward head posture creates muscular imbalances that can cause pain in the neck, shoulders, back, arms, and head. It can also lead to spinal issues such as kyphosis (an exaggeration of the upper back curve), loss of the cervical curve, disc degeneration, and more. Postural education, regular exercise, and massage and chiropractic care can all help in the correction and prevention of this postural issue.

The idea that technology is causing our young people to grow new bone masses went viral so quickly precisely because it plays into our fears about a rapidly changing world. But, while we are distracted by headline-grabbing stories of bone mutation, the very real health issues that technology is already creating for both young and old alike are flying under the radar. It is important to remember the value of thinking about health from a holistic point of view and teaching our children to do the same.

Protect Your Precious Skin

Summer is here! Although school has been out for awhile and the weather has been seriously heating up here in Central Texas, today is actually the first official day of summer. And in my massage practice, there is one health problem that I see more than any other every time summer rolls around: sunburn! The skin is the body’s largest organ and the only organ of the body that I, as a massage therapist, directly touch. Since I have such a close relationship with skin, I hate seeing it damaged by something so easily preventable. Unprotected sun exposure causes a myriad of skin problems, including of course, cancer. You already know that you should wear sunscreen, but here are a few specific facts about sun protection that you should also know for a safe and happy summer:

1. There is no such thing as waterproof sunscreen. If you are swimming or sweating you need to reapply sunscreen regularly. Make sure to read the product label for information on how long your sunscreen holds up in water. To be on the safe side, reapply every 45 minutes.

2. Sunscreen does not completely block UV radiation. Other sun protection measures are also required to protect yourself from sun damage. Be sure to avoid sun exposure between 10:00 am and 4:00 pm when the sun’s rays are strongest. Long sleeves and pants are recommended, but are often unbearable in the Texas heat so opt for a seat in the shade rather than the sun and wear a wide brimmed hat and sunglasses.

3. Only broad spectrum sunscreen protects against skin cancer. UVB rays are the primary cause of sunburn and all sunscreens protect against them, but both UVB and UVA rays contribute to skin cancer. Only a sunscreen labeled “broad spectrum” with an SPF of 15 or higher will offer protection from both kinds of harmful sun rays.

4. Sunscreen does not last all day. Sunscreen must be reapplied at least every two hours to remain effective. Don’t apply before you leave the house and assume that you are covered for the entire day. Bring sunscreen with you and be that annoying person who forces everyone to take a sunscreen break (they’ll thank you when they’re older).

5. Sunscreen takes time to activate. Most sunscreens are chemical barriers that need to be applied at least 15 minutes before sun exposure in order to be effective. If you are using a natural sunscreen with a physical barrier (zinc oxide or titanium dioxide), it will be effective immediately. And yes, experts still agree that you should use a shot glass full of sunscreen to adequately cover your entire body!

6. All exposed skin needs sunscreen. Some of the most common areas for skin cancer to develop are the eyelids, scalp, and ears — areas that receive direct sun on a daily basis, but rarely get protected with sunscreen. It is important to wear a moisturizer with an SPF of at least 15 every day and be sure to cover your entire face, ears, and neck. The easiest way to protect your scalp is with a hat although men who are balding should apply sunscreen directly to their heads.

7. Sunglasses should offer UV protection. Sunglasses not only protect your eyes and help reduce incidences of cataracts, but they also help prevent crows feet! Look for sunglasses that offer a UV rating of 100% and remember that darker lenses do not indicate a higher UV rating. Make sure that children’s sunglasses also have a UV rating (many do not). Remember that sunglasses are most effective when worn with a wide brim hat.

Please be aware that a severe sunburn is a contraindication for massage, meaning that I cannot work over that area until the skin has healed. If you find yourself sunburned this summer, drink plenty of water, take a cool oatmeal bath, and apply aloe gel.

Stay Healthy for Father's Day

Father’s Day is the perfect time to remind your dad that you love him and that you want him to be around for a long time. This year, take inspiration from the following ideas and find a healthy gift for dad. Maybe you could take him for a hike, cook him a healthy meal, or get him a massage! No matter what, make sure he knows how important his health is to you and encourage him to take steps to improve and maintain it. Here are a few health tips for all the dads, grandpas, uncles, husbands, and friends out there:

1. Get enough sleep. Adults need 7-9 hours of sleep each night. Simply put, chronic lack of sleep leads to depression and disease. Make whatever changes are necessary to allow yourself enough time for sleep.

2. Exercise more. Aim for at least 30 minutes of moderate exercise, five days a week. Walking, hiking, swimming, even mowing the lawn all count toward this goal. Just don’t forget to stretch afterwards!

3. Eat a healthy diet. Forget the fad diets. The truth about a healthy diet is simple: lots of fresh veggies, fruits, and whole grains; some lean protein and healthy fats; very little salt, sugar, or processed foods. Stick to those rules and you’ll reduce your risk of heart disease, diabetes, and even some cancers.

4. Protect your skin. It is summertime once again and time to protect yourself from the sun with hats, sunglasses, and sunscreen. There seems to be an attitude among many men that sunscreen is somehow not masculine. Well, it’s time to get over that ridiculous idea! Sunscreen is simply a way to protect your largest organ from radiation that can cause cancer. Look for an SPF of at least 30 and reapply as directed on the package.

5. Go to the doctor! Men are statistically less likely to seek medical care than women are, putting them at greater risk for many preventable diseases. It is important to get regular checkups, screenings, and dental exams because it is very possible to feel perfectly fine even when you have conditions such as high blood pressure, high cholesterol, or the early stages of diabetes. Regular medical care helps to catch the first signs of health issues before they interfere with your life.

6. Reduce stress. Excessive stress is detrimental to your mental, emotional, and physical health. Meditation, hobbies, exercise, and regular social time can all help to mitigate stress. Another great option is massage therapy which can help to calm your mind as well as reduce physical manifestations of stress such as muscle tension and high blood pressure.

Muscle of the Month: Tibialis Anterior

Tibialis anterior is a long, narrow muscle on the front of the lower leg. It is one of the major muscles of a group that sits just to the outside of the tibia (shin bone), known as the anterior compartment. The tibialis anterior originates on the upper part of the tibia and the interosseous membrane (connective tissue between the two bones of the lower leg). It’s tendon crosses over the front of the ankle and inserts on the medial cuneiform and the base of the first metatarsal (bones in the arch of the foot).

Anatomy books will tell you that the actions of the tibialis anterior are to dorsiflex the foot (lift the toes up toward the knee) and to invert the foot (cause the foot to roll onto it’s outer edge), and that it also helps to maintain the arch of the foot and prevent the foot from everting (rolling inward) too much. Functionally however, in addition to those actions, the tibialis anterior is also involved in lowering the foot back to the ground during walking or running, requiring an eccentric contraction.

Because both the concentric and eccentric movements of tibialis anterior are necessary for walking and running, we can see that this little muscle is engaged during each phase of the stride and is therefore easily overworked and prone to developing trigger points. Tibialis anterior pain is usually felt during or after activities that are stressful for the muscle such as excessive walking, running, or hiking (especially up and down hills or on hard surfaces), kicking with pointed toes (soccer), or wearing tight shoes. Pain may be felt in the ankle, foot, or shin. Pain from tibialis anterior tension or trigger points is one of several conditions often called “shin splints” (see previous blog post).

Because the tibialis anterior tendon crosses the front of the ankle, it is susceptible to aggravation from tight footwear. Athletes experiencing ankle or shin pain should try loosening the laces of their shoes and see if the problem resolves itself.

Shin pain is usually easily treatable at home with rest and ice. If pain persists, there may be a more complicated issue that needs to be addressed. Massage therapy can be a very effective tool to help calm the soft tissues involved and ease the associated pain.

Check out this video for a simple strengthening technique for the tibialis anterior (the actual exercise starts at 1:20). Click here for a good example of a tibialis anterior stretch - just ignore how awkward the poor instructor is!

What are Shin Splints?

“Shin splints” is a blanket term used to describe overuse or repetitive stress injuries that result in pain along the shin bone in the lower leg (the tibia). There are many conditions that fall under this term, including medial tibial stress syndrome, tibial stress fractures, anterior compartment syndrome, and micro tears in the muscle and/or fascia around the tibia. The common issue shared by the various shin splint conditions is some degree of inflammation in areas where muscle tendons connect to the layers of connective tissue that surround the bone.

Shin splints usually cause a dull, aching pain at the front or along either side of the tibia. The area may feel hot, swollen, and tender to the touch. In the early stages, the pain may improve with exercise, but return later. As the condition progresses, pain may become constant and increase with exercise. Small, hard bumps may also become palpable along the bone.

Shin splints are common among runners and dancers and are usually the result of progressing too quickly in a new sport or suddenly changing a workout routine without allowing time fore the body to adjust. They can also be caused by poor biomechanics, insufficient rest, and using improper or worn out footwear. When starting or changing an exercise routine, shin splints can be avoided by focusing first on proper form and by increasing the intensity level slowly over time.

The best self care for shin splints is ice and rest. Ice should be wrapped in a thin towel and applied for 15-20 minutes. Allow at least 1 hour for tissues to warm up before reapplying. Depending on circumstances, rest may mean anything from continuing light exercise (such as walking) to completely avoiding weight bearing activities. If rest and ice do not lead to an improvement in symptoms, please seek medical advice.

Massage therapy can be a helpful tool in the recovery from shin splints. Tibial pain can be caused by tension, restriction, and trigger points in the muscle and fascia of the lower leg which massage can help to relieve. Massage can also help to maintain the health of the muscle and fascia which will reduce the chance of further injury and keep any scar tissue mobile and pliable. If the shin splints occurred due to a biomechanical problem, massage can be useful as part of a program to correct postural imbalance and develop proper form.