In these difficult financial times, when stress levels are high and every dollar counts, massage is more necessary than ever. I am frequently asked if I can bill insurance for the services I provide. Many people don’t understand why it is not covered in most instances, considering other treatments like acupuncture and chiropractic often are. My best answer is to suggest they look into flexible spending accounts, or FSA’s, as a reasonable alternative.

FSA’s are available through many health plans, most large employers, and any company that offers benefits under a “cafeteria plan”. Once the account is set up, the employee determines a set amount to be set aside pre-tax from their regular paycheck. These accounts are typically used to cover qualified medical related costs not covered by insurance. The primary advantage of a FSA is that the money goes in before payroll taxes, which means roughly 30% more value on every dollar.

Because expenses covered have to be “qualified”, it means your doctor has to prescribe massage for a specific health issue. The commonly accepted definition of what is qualified is as follows:
Section 213(d) of the Federal tax code stipulates that a qualified expense must be “to alleviate or prevent a physical or mental defect or illness.”
Since therapeutic massage is frequently used for stress related issues, like high blood pressure and anxiety, as well as chronic pain and musculo-skeletal issues, a physician would most likely write a prescription for these types of conditions.

A recent study, published July 5, 2011 (article) has shown that massage is clearly effective in reducing low back pain. This is a huge step forward in establishing the therapeutic value of massage in a resistant medical culture. Citing studies of this nature can be helpful in persuading a doctor who might be hesitant to prescribe.

The two common methods of using the FSA account are with a debit card and with reimbursement. Many companies are using the debit card option, as it cuts down on processing and paperwork. Otherwise, the client pays for the session, gets a receipt from the therapist, and submits that receipt for reimbursement. Receipts need to include the medical reason for the visit in order for the FSA to process it. Not all therapists are able to accept debit cards, so the reimbursement method may be the only option.

One thing to be aware of with the Flexible Spending Account is that it is “use it or lose it”. These plans are annually renewed, typically at the beginning of the year, which means the full benefit is available January 1. However, anything left in the account after December 31 gets absorbed, leaving the employee with a loss.

Many therapists offer bulk purchase discounts, allowing additional savings. When purchasing these bulk plans early in the year, the employee can potentially get a discounted rate for the package prior to actually paying for it, on top of the 30% pre-tax savings! A little advance planning is a worthwhile thing.

While most people believe in the therapeutic benefit of massage, the financial concern is the most often sited reason for visiting less frequently. With the Flexible Spending Account, you can think of your massage visit as being automatically discounted 30%. A conversation with your HR person or health insurance provider is strongly recommended to find out the specifics about the plan you have access to.

I hope this information is helpful to those who are hesitant to visit their massage therapist because of the expense. I’d love to hear feedback from people who have used, or are currently using a FSA for massage. Have your experiences been positive, negative or neutral?

Yoga has been an important part of my life in the last five years. I practice regularly, and recommend it often to my massage clients. When I started working on this post, I wanted to discuss the mutual benefits of massage and yoga. I believe strongly that the two complement each other, as I have experienced the benefits of both in my own life. For me, there is no denying an energetic connection with my clients. It is a similar type of energy I feel within my own body when doing my yoga practice.

It has only been in the last couple of years that I began thinking of chakras as something beyond metaphysical hooey and pretty colors. I come from a background rooted in “show me”. If I couldn’t see it, feel it, taste it or in some way have tangible connection to it, it fell into that category that belonged to sorcerers and snake oil salesmen. Imagine my delight when, on first accepting that at least understanding what they are and what they represent wasn’t a threat to my concreteness, now I have actually found resources that indicate that there are very tangible connections to highly charged nerve centers, called plexii, and by extension, muscular and immune function and hormone production, correlating to their locations and the properties assigned them.

For those of us less familiar with chakras, I will give a brief description of what and where they are, and what aspects of the person they represent. From there, we will look at their connection to the physical body.

In Ayurvedic and Yogic tradition, energy, or Prana, is the main life force. It travels along vessels, called nadis, and gathers in centers where these nadis come together. These gathering points are called chakras, a sanskrit term which means “wheel”, describing the circular movement of prana at these merging points. The concept has some similarities to the meridian system used by the Chinese in their medical system, with distinctions, one particularly important to this discussion. Where the Asian meridian system follows unique lines in the body, the yogic view follows the nervous system fairly closely, with nadis traveling throughout the body similar to nerves, and chakras again located at observable nerve centers where there is significant, measurable electrical energy.

There are 7 main chakras, with hundreds of smaller ones throughout the body. The 7 main chakras are the ones most focused on, and they will be the ones described here. Similar to the nervous system, there is a central nadi, with numerous branches stemming from it. This central nadi follows the line of, and is located within the spinal cord. When you see charts of the chakras, it is hard to miss that they stack one on top of the other along the central line of the body. In yogic and vedic practice, the focus is on opening all the 7 main chakras, allowing energy to flow unobstructed through the central channel, a state called “Nirvana” or enlightenment.

The lower chakras are considered to be more earth-bound, while the upper ones are more connected to the ethereal. As we look at the properties of each, the logic of this becomes evident.

We’ll start with the Root chakra, Muladhara. It is located at the base of the spine and the perineum, and is our physical and energetic foundation. Due to its position and controlling aspects of the legs and seat, it is considered the grounding connection to earth. It is said to enable confidence and trust, vitality and security, when in good health. In yogic charts, it is associated with the color red, and is involved with excretion and sexual function. It is here at the root chakra that Kundalini energy rests, the instinctual, libidinal energy that is typically represented as a coiled snake.

On the physiological side, the Coccygeal Plexus is located here, between the L4 vertebra and the coccyx. This nerve bundle supplies most of the legs, the pelvic floor and parts of the sexual organs. The sciatic nerve, emerging from L4 to S3, is the longest nerve in the body, along with its branches providing sensory information and motor control to the feet, legs and hips. This nerve is a primary source of information from the ground to the brain.

There is no commonly accepted endocrine structure in the area of the root chakra, although there are those who believe that the coccygeal body, a collection of blood vessels at the base of the spine, could be an endocrine gland. It physically resembles a gland, but as yet, there is no known hormone that it produces. Some claim the adrenals are associated with the root chakra, due to its connection with the “fight or flight” response to danger.

The second chakra is called Svadistana, or “Place of Joy”, shown in orange. Located directly in front of the sacrum, it is associated with sensuality, creativity and joy. In women, this chakra is at the physical location of the womb, the origin of new life. In men, it is in proximity to the prostate, where seminal fluid is produced and stored. The reproductive glands of both sexes are found in the sacral region. The egg and sperm are produced here, as are the hormones estrogen and progesterone in women, and testosterone in men, hormones critical for the process of renewed life.

This second chakra is found at the lumbar spine, between L1 and L4, the location of the lumbar nerve plexus. Muscles of the abdomen and hip flexors, the thighs and the sexual organs are innervated from the lumbar plexus, as is the large intestine. Much of this nerve bundle is embedded in or on the surface of the psoas muscle, which has a big impact on the health of the entire lumbar region, including the internal and sex organs (see previous blog post on psoas for more details).

Manipura, or “City of Jewels” is the third chakra, represented by the color yellow. It is commonly known as the solar plexus, due to its location, just below the ribcage.  It is the place of personal power, motivation and vulnerability. This chakra is considered the transition between the earthbound lower chakras and the more spiritual upper ones. The drive to “become something” is based here, a motivation unique to humans. It is also the source of personal opinion and “gut reactions”.

Physiologically, the celiac plexus, also known as the solar plexus, is at the same location as the third chakra, in front of the top of the lumbar spine. It is made up of a number of smaller plexii that innervate the digestive system. The digestive nerves are a mix of autonomic, and enteric (controlling the function of the intestines), both being outside the realm of conscious control; and somatic nerves from the lower thoracic region, supplying the abdominal muscles.

Breathing is an important, life sustaining function controlled by the diaphragm, located just above the solar plexus. It is unique in that it functions on both a conscious and unconscious level, bringing oxygen into the body and moving carbon dioxide out, at the same time massaging the organs of digestion. It can be strongly impacted by emotional stress and tensional forces on the ribcage and abdominal musculature, causing shortness of breath and restrictions to the metabolic process that supplies every cell of our bodies with energy.

The solar plexus innervates the pancreas and adrenals. The pancreas produces insulin and glucagon, the primary regulators of sugar levels in the blood stream, controlling the amount of energy available to the body.  The adrenal glands, found on top of the kidneys, produce cortisol, epinephrine and norepinephrine, stress hormones. These chemicals are released into the blood to produce a rapid increase in blood sugar, allowing the body to respond quickly to perceived threats.

The heart chakra is fourth on the list, shown in green, and located at the heart. In Sanskrit, it is called Anahata, or “Unstruck Sound”. As with many cultures, yogic tradition associates the heart with love, compassion, relationship and empathy. It is at the heart that we begin to consider the needs of others, and the impact of our actions outside ourselves. Hugging brings a loved one physically close to the heart. Conversely, loneliness, anger, sorrow and grief are felt here.

Protected inside the ribcage, the heart is relatively safe from outside physical threats. Being the place where our interactions with others are negotiated, however, it is easy to see how a person might feel the need to protect from emotional insecurities. This often plays out in the musculature around the ribcage. The intercostals, muscles between the ribs that assist in breathing, can become stuck in contraction, limiting the ability of the lungs to function fully. The pectorals, which lay over the front of this region, can become shortened, causing the shoulders to roll forward, giving the appearance of a hollowing of the chest.

The cardiac plexus supplies the heart with significant information about the physical as well as the emotional state of the body as a whole. Made up of sympathetic and parasympathetic fibers, the cardiac plexus provides information relating to unconscious feelings. Nerves of the upper thoracic spine are part of the plexus as well, innervating the intercostal muscles and skin over the ribcage. Recent studies using biofeedback have shown that the heartbeat responds instantaneously to thoughts, emotions and activities. The heart also has its own electrical generator, the sinoatrial node, which creates and maintains the heartbeat that we are all familiar with.

The thymus is the endocrine gland associated with the heart chakra. It is responsible for healthy development of the immune system in children. It shrinks as we mature, but still plays an important function in determining what are foreign elements within the body, whether they are harmful or not, and whether or not they need to be removed. When the heart chakra is closed, the immune system is likely compromised.

Next up in the series is the throat chakra, called Visuddha. Located at the base of the throat, it is shown as blue. It affects the throat, shoulders and arms and is said to be involved with expression, communication, purification and discernment. Here is where we express to the outside world what is going on internally. Through vocalization and physical contact, writing and other forms of communication, we are able to let others understand what we are feeling and thinking. It is also at the 5^th chakra where all signals and emotions arising from the lower chakras are filtered before being received by the conscious mind.

There are two important nerve plexii associated with the 5^th chakra. They are within the region of the cervical spine, between C1 and T1.  The first is the cervical plexus, which innervates the muscles and skin of the neck. The second, the brachial plexus provides for the entire upper extremity, including shoulders, arms and hands. The nerves that provide the lungs and upper abdominals generate from here, as do some of the cranial nerves that control speech and motor abilities for the mouth and throat.

Cases where this chakra is restricted may be related to the person feeling the need to hold in their emotions. A muscular pattern, similar to the fear response where the head comes down and forward, chin out, and shoulders elevated and often rounded forward, can become a chronic postural issue, causing back and neck pain, issues with the shoulders and arms, and physically constricting the airway and voice.

The thyroid, located just below the Adams apple in front of the throat is the endocrine gland associated with the throat chakra. The thyroid gland is controlled by the pituitary, and produces hormones that strongly affect the body’s energy level. It also works in conjunction with the parathyroid to balance calcium levels throughout the body.

The third eye, Ajna, is located between the eyebrows in the center of the forehead. This 6^th chakra, represented by the color indigo, is considered the psychic center, involved with perception, imagination, insight and dreaming. A manifestation of the brain, it is the control center for the mind/ body. The main goal of yoga is to clear blockages of the lower 5 chakras, allowing awareness of mind-driven conscious and body-driven unconscious impulses to be fully realized in the third eye. In this way, the individual can become more consciously aware of the body, and is much better able to make effective decisions about how to proceed through life.

Imbalances of the 6^th chakra occur with either regular overstimulation of the 5 senses or overstimulation of the intellectual mind. In our present western society, where computers, gaming and other mind-based pursuits far exceed more physically balanced ones in their esteem and popularity, it is no surprise that we have increasing incidences of ADHD, insomnia and an inability to concentrate.

The nervous system component of the 6^th chakra is the brain, the most electrically charged region of the body. The brain is the traffic cop for the entire body, involved with thinking, memory, motor control, spatial perception, the five senses, as well as the unconscious systems like breathing, blood circulation, body temperature and so on. As the brain is to the physical body, so the 6^th chakra is to the energy body.

And as the brain is to the physical body, so the pituitary gland is to the endocrine system. Its primary function is to manufacture and distribute broad-reaching regulating hormones that affect the entire body. It produces growth hormone, essential for growth and repair of tissue; prolactin, the activator for milk production; oxytocin, an important hormone for maternal behaviors such as bonding, breast-feeding and birthing; endorphins, the happy drugs released during exercise, excitement and orgasm; a hormone that stimuates the adrenal cortex during times of stress; thyroid stimulating hormone, and several others.

The hypothalamus links the pituitary to the central nervous system, acting as orchestra master and gatekeeper. Receiving its signals directly from the brain, it sends nerve impulses to the pituitary signaling the need to produce the hormones the body needs.

Last, but certainly not least, the seventh chakra is known as the Crown chakra, or Sahasrara in Sanskrit, located at the crown of the head. It is represented by one of several different colors; either violet, gold or white, with the symbol of a multi-petaled lotus flower. The crown chakra extends beyond the physical body, a globe of colored light, transcending the material universe. Those who subscribe to the idea of a god see this as the connection to the divine. In yogic tradition, there is a concept called “Samadhi”, which is the union between the consciousness of the experiencer and that of the experienced. When the practitioner feels himself one with the universe, leaving his attachment to “self” behind, he has reached an enlightened state.

Being the connection to higher consciousness, this chakra does not have the same correlations to physical properties of the body. There is no muscular or nervous association, and there is disagreement about an endocrine connection, which has some very interesting points.

Depending on the source, the pineal gland is grouped with either the 6^th or 7^th chakra. This gland is commonly known as the Third Eye. It is about the size of a grain of rice, and is located near the center of the brain. It is the only structure of the brain that is one-sided, leading 17^th Century French scientist and philosopher Rene Descartes to consider it the “seat of the soul”, the place where the body and soul meet, and where signals from two eyes, two ears and two hemispheres of the brain become one. Ancient cultures in Egypt and elsewhere believed the third eye was the doorway to the subconscious, or unconscious mind, leading to paranormal powers, astral travel, etc.

The pineal gland in humans has photoreceptors and some of the structures of an eye, although it is deep within the skull. There are examples of animals, including some types of frogs, lamprey eels and certain reptiles that have a pineal foramen (opening in the skull) and what is known as a “parietal organ”, an actual third eye.

The primary known function of the pineal gland is the production of melatonin, a chemical that regulates circadian rhythms, particularly the 24-hour cycle of awake and sleep time. It is most active at night, as it is sensitive to light. Melatonin has also been associated with depression and low energy during long periods of overcast skies and short days of winter.

Those who associate this gland with the 6^th chakra consider the third eye to be between the eyebrows. The crown chakra believers see it as accessed through a vortex from above the head, leading down to a fulcrum at the pineal gland.

I hope that those of you who managed to read through this “brief” synopsis have come away with a better understanding about, and possibly more affinity for this interesting system of organization of bodily function. For me personally, I have learned so much that writing it was a worthwhile endeavor all on its own. I am confident that the link between the physical and energetic connection that I already experience regularly when doing massage, as well as yoga, will be greatly enhanced by a clearer idea of what I am affecting, or trying to affect.

What a winter! I don’t remember the last time I’ve seen this much snow! For those of us with snow blowers, it’s enough of a challenge  just figuring out where to put it all. Without one, it becomes important to be aware of what we are doing out there. There are several things we can do to make shoveling safer for our bodies.

First, we need to understand that shoveling, while it may not be everyone’s first choice for a workout, is a challenging physical activity. A shovel full of snow can weigh anywhere from 12 to 20 pounds, depending on how wet it is. The movement necessary to get that 12 pounds from the driveway to the top of that ridge involves the use of pretty much every muscle in the body. There is a combination of pushing, lifting, twisting and throwing activities, never mind scraping and chipping at the icy layers. The higher the banks, the more exaggerated the movement. Add to this that in half an hour, one might fill the shovel 30 to 50 times, each time going through that complex pattern of movement.

When we go to the gym, if we are being intelligent about our workout, we incorporate a warm-up, breaks and changes in our activity. Hopefully, we wouldn’t jump right in and do a bunch of biceps curls on one side to exhaustion, without counterbalancing on the other side. We might start with a little bit of cardio to get the blood flowing, maybe some stretching to limber up, and then get into a balanced routine that works both sides, and mixes work on different muscles and muscle groups.

So in an ideal situation, would we not apply the same logic to shoveling? A few minutes of stretching, simple aerobic activities like jumping jacks or treadmill before, during and maybe after, can be an excellent approach to keeping the body loose and well supplied with necessary blood, reducing the possibility of injury. Resting breaks every so often can be enough to stay aware of where we are feeling it, and whether it might be a good idea to change our approach.

Changing hands with the shovel is the equivalent of doing those biceps curls on the opposite side. The workload is distributed across both sides of the body, avoiding overloading one shoulder, and uneven tension patterns in the back from constantly rotating to the same side. Mixing tossing with pushing is another great way to assure we are not overdoing any one thing. Keeping the shovel close to the body reduces the amount of work the muscles must do to get the job done.

Legs, Yes Legs! Need to be incorporated in the process. If we plant our feet, and do all the work with the shoulders, arms and back, our arms become exhausted quickly, and you can be almost guaranteed to feel it in the back the next day. Bending at the knees and using the legs to lift as much as possible alleviates much of the stress on the upper body. Creating the twist needed to get the snow from the ground to its final resting place with the feet, legs and hips means the low back and core have stable support and don’t have to work nearly as hard. Walking to the place where the load needs to be dropped rather than throwing it long distances is another great way to use the strongest muscles most efficiently.

If the back is already a little unstable, support braces are a great way to protect the back, and are readily available at many of the larger building supply centers and hardware stores.

Most of all, maintaining a level of awareness about how tired we are, and listening to that, is huge! It’s when we are tired that we are most likely to hurt ourselves. And when the job is done, massage is a fantastic way to relieve those aches and pains of a hard workout!

Please leave comments about your snow experiences this winter, and additional suggestions for self care!

It’s amazing what a motivator pain can be, and how hard it can be to pin down sometimes. For years, I have had low-grade pain in my right side. At different times, it has affected my shoulder, ribcage, outer hip, groin and knee; sometimes one area by itself, and other times in different combinations. There are any number of events in my life which could have been contributing causes. Between bicycle accidents, falls, the amount of heavy lifting I’ve done over the years and just day-to-day living, it would be hard to say any one thing was behind it. My focus lately has been on trying to determine what is happening in my body, and what I can do to improve it.

I’m convinced that there is a connection between the areas of pain; all are right sided, and seem to play off of each other. I went to a chiropractor, who told me I had a subluxation (when a rib slips out of alignment at the attachment to the spine). He adjusted me many times, and it felt great for a few hours but came right back. A physical therapist gave me a great set of exercises for my shoulder, which have helped, but haven’t resolved the tension I get there, and didn’t even come close to addressing any of the other issues.

My general doctor recently checked for hernia, appendicitis, kidney and liver issues, with no satisfaction (if you can call a positive result for any of those things satisfying). Yoga has been the most constant source of relief, although the relief seems to last just about as long as it takes me to overdo something and spark a new wave of symptoms.

Through all this, I’ve had it in mind that the hips must be playing an important role. An imbalance there can create issues throughout the body. I see it in my practice regularly, and have been working with clients there for some time. In particular, there is a muscle located directly in the path of much of my pain. It is known as psoas, one of the deepest muscles in the core of the body. In my schooling, I learned that it, along with its best buddy iliacus, is a hip flexor. They bring the knee toward the chest, or the chest toward the knee, depending on which body part needs to move at a given moment. Simple, right? Wellllll….maybe not.

As I began doing research for this post, I found many interesting articles about the psoas. One such article mentioned a book by a woman named Liz Koch, the title of which is “The Psoas Book”. Ms. Koch, a sufferer of scoliosis, has dedicated much of her life to understanding and teaching about the significance of this muscle in healthy movement, as a fundamental support muscle, and its impact on many levels when there is imbalance there. The book is a short read; actually it is a student manual that goes with workshops she offers on the subject, primarily for yoga and dance instructors. It is also a prime example of great things coming in small packages. She discusses many interesting points, quoting Ida Rolf, author and founder of The Rolfing Institute, Moshe Feldenkrais, innovator of the Feldenkrais Method of Somatic Education, Judith Aston of Aston Patterning and others. This book, along with articles by Tom Myers, Leon Chaitow, Gil Hedley and others, has opened my eyes to a whole new level of understanding.

Among the points I found most interesting are:

• The location of psoas positions it to be central to interaction between the visceral body, the diaphragm, the blood, and the nervous system.
• The Lumbar nerve plexus, a grouping of autonomic nerve ganglia responsible for innervating the viscera below the diaphragm, is actually embedded in this muscle. In a state of surprise/ threat, the instinctual response of psoas is to contract, bringing the knees toward the chest, protecting this vital and exposed area of the body. Continual tension in psoas can have a huge impact on the health and function of these vital organs
• The solar plexus, sometimes referred to as the “abdominal brain”, is located directly in front of the thoraco-lumbar junction, where psoas attaches at its top-most point. The solar plexus is commonly associated with emotion and “gut feelings”.
• The thoraco-lumbar junction, located at the lowest thoracic vertebra and the first lumbar vertebra, is a significant anchor for, and place of interactivity between the psoas, quadratus lumborum, diaphragm, and trapezius, supporting proprioceptive and nervous system information up and down the spinal column
  1. Psoas’ upper most attachment is at the sides (transverse processes) of T12 and each of the lumbar vertebrae, and is a significant player in controlling the lordotic curve of the lumbar spine
  2. Quadratus Lumborum attaches at the 12^th rib and the transverse processes of all the lumbar vertebrae but the lowest, and the crest of the hipbone. It functions as a lateral stabilizer for the trunk
  3. Trapezius, a large muscle on the back of the body, is significant in maintaining the kyphotic curve of the thoracic spine, as well as controlling a large amount of shoulder and neck movement. It’s lowest attachment is at the backmost outcropping (spinous process) of the same T12 vertebra, and at each of the spinous processes of the thoracic and cervical vertebrae up to the back of the head
  4. The diaphragm attaches at the front of the lumbar vertebrae and the inner surfaces of the lower 6 ribs. Its tendinous crurae merge with the fascia of the psoas. In addition to being the primary muscle of breathing, this muscle creates a shelf of support for the heart and a “roof” over the liver, stomach and spleen, and is a contributor of support for the lordotic curve of the lumbar spine
• Fascial connections between the psoas, diaphragm above and pelvic floor below, put it in an ideal position to control compression of the lumbar spine, aiding stability of the low back
• Contraction and release of this muscle, along with the diaphragm and abdominals, actually massages the internal organs, helping support blood flow and the general healthy function of the organs
• The positioning of psoas allows it to assist the pelvic floor, creating a shelf of support for the internal organs, and for the fetus during pregnancy
• The fascial layers of the kidney are so closely integrated with those of psoas as to be one and the same; one can not surgically separate the two without negatively impacting the connective tissue of one or both
• Psoas follows a significant parallel path with the descending aorta through the lumbar and hip region, having an impact on, and being impacted by, blood flow to the lower body
• Psoas is an important muscle for maintaining the lordotic curvature and rotational balance of the lumbar spine. From its’ 6 attachments at the transverse processes of the lowest thoracic vertebra (T12), and each of the lumbar vertebrae, it extends downward and forward around the fronts of the hip joints. Each segment of this muscle can contract or lengthen more or less independent of the others, allowing it a great deal of control over the entire low back and by extension, the entire body
• It also has an impact on pelvic tilt of the hips and stability of the pelvic floor, functioning in opposition to the deep lateral rotators on the outer hip
• As a hip flexor, one of its most important roles is to support the free swinging movement and weight transfer into the legs during walking and running

The fear response is one that happens beyond our conscious control. When there is a loud noise or an event that catches us off guard, particularly one that threatens physical harm, the body goes into a protective mode. The head retracts in toward the shoulders, shoulders ride up toward the ears, the abdominal muscles and hip flexors contract, and the muscles of the back become rigid. In normal conditions, the threat subsides, and the contractions relax.

But as life becomes increasingly hectic, and stress is engrained as part of our daily routine even at a young age, the fear response also becomes part of that routine. Patterns of contraction become imbedded in our posture, creating numerous issues posturally, in the circulation and in the nervous system, all of which contribute to a negative impact on our sense of wellbeing. Specifically relating to psoas, we can see all of these elements. Too much tension compresses the lumbar spine, contributing to low back pain, disc problems, and compression of the vital organs within the core. Breathing becomes restricted as psoas pulls on the fascia and tendinous tissues of the diaphragm. Free movement of the hips and femurs, so important to healthy motility, become restricted, causing limitations of range, injurious wear patterns and pain in the hips, knees and feet. The descending aorta, which follows the path of psoas, can become constricted, limiting blood supply to the lower extremities, the sex organs and other viscera. With the lumbar plexus embedded within psoas, constant stress of the muscle sends signals out through the nerve endings, causing a negative feedback loop and dysfunction in the nervous system.

Whether as a response to anxiety, injury or just the way we have learned to carry ourselves from the time we were infants, imbalances in this muscle result in patterns of rotational pull on the spine, hips and by extension, the entire structure. In severe cases, scoliosis, a potentially debilitating condition results, causing the spine to curve dramatically to one side, forcing the ribcage to compress against the lungs and organs within.

There are several perspectives on the best way to address tension in the psoas. While many sports activities popular these days value muscle strength and endurance over maintenance of a limber body, there are those that do consider a balance between strength and suppleness to be of the utmost importance. Martial arts and yoga tend to be more focused in this way, although even in these activities, the understanding and approach of the teacher are fundamental to keeping this healthy balance.

Bodywork is primarily focused on maintaining healthy flexibility, although there are many approaches to and perspectives regarding maintaining that healthy balance between flexibility and stability. Manual therapists, and Rolfers/ Structural Integrationists in particular, believe that direct manipulation of psoas is the best approach. Due to its location, with so many sensitive organs, blood supply, nerve structures and easily damaged tissues nearby, proper training is a must when working manually. Others, like Feldenkrais practitioners, believe that body awareness is the key, while Judith Aston and others use a combination of the two.

Ms. Koch states in her book that direct manipulation of psoas is counterproductive due to its instinctual contraction response. She proposes a simple relaxation technique which she calls “Constructive Rest Position”, in which the person lies on their back, knees up and feet on the floor and just lets the body relax for 10 to 20 minutes. Following this is a series of slow movement exercises at the hip joint, focusing on movement of the legs independent of the pelvis. While I have done these exercises (in fact they are pretty much what my most recent physical therapist recommended) and find them to be very helpful, I also believe that direct manipulation of psoas, done slowly and carefully, is equally rewarding.

I find myself in that common position of knowing just enough to know that I don’t know much. I’m sure that as I continue the search for answers to my own issues, more will be revealed, and then more again. And as I learn more about myself, I hope to be able to apply it to clients with similar concerns.

Please feel free to comment on personal experiences and insights.

References:

The Psoas Book 2^nd Edition, Liz Koch; Guinea Pig Publications

Anatomy Trains 2^nd Edition, Tom Myers; Elsevier Publications

The Trigger Point Therapy Workbook 2^nd Edition, Claire Davies, Amber Davies, David Simons; New Harbinger Publications

The Opinionated Psoas, Tom Myers; Massage Therapy Magazine, 2001

One of the things I love about this field is the unending potential to learn and grow. From simple things, like learning to use a tool I have been using in a new way, to more complex concepts, and in some cases a complete revamp of the understanding of the functioning of the body, there is always more to absorb, something new that brings it all to life.

When hot stones were introduced into the western scope of bodywork, they were looked at as a tool for activating energy flow through the body. My training, based on LaStone, the oldest technique in this country, was a protocol, which included a combination of applying the stones to energy centers, and gently massaging with them, using the heat as a means to relax the nervous system and relieve muscle tension. This has been an effective approach for achieving deep relaxation, leaving the client feeling refreshed and balanced.

Recently however, I have discovered that there is another world of options for the use of hot stones. The notion of using heat as a way to calm the nervous system, and cause muscle tension to dissipate, can be applied to deeper, more therapeutic approaches as well.

When someone has low back pain associated with leg and hip tension, for example, stones can be incorporated along with the hands, in myofascial stretching and deep compression techniques to work the tissue, achieving a quicker release, less work for the therapist and faster relief for the client. Used as a preparation for really stuck tissue, the static application of hot stones allows for access to areas that might otherwise be too sensitive or resistant to be worked effectively. Once these areas have been softened, the muscle/ fascial tissue and associated joint(s) can be freed from restriction, allowing easier movement, increased strength and reduced or eliminated pain for the client.

This new way of using stones has opened up different avenues in my therapeutic work. Where before I would be inclined to use an elbow to really get deep into someone’s back, I might consider the softer edge of a large stone. Or tracing the edge of a muscle that is resistant to move, applying heat along with pressure for a more complete release. So many options present themselves that I can’t wait to incorporate them all!

They’re nothing new. Heels have been found in depictions as far back as ancient Egypt, Rome and Greece. Primarily used by males for their practical benefits, by warriors on horseback in particular, elevated heels kept the boot from sliding out of the stirrup. In the seventeenth century, both men and women in the upper classes adopted the high heel as a statement of status and style. Through the centuries, styles and associations have branched out, and the heel appears to be firmly ensconced in modern culture, in all its varieties. In the majority of our shoes today, even in some better quality athletic shoes, there is some form of elevation at the back of the shoe.

While there is evidence of heels in shoes going back to ancient times, our understanding of their impact on us physically has only begun to grow in the last few decades. The more we understand about how the body functions, the clearer it becomes that what we put on our tootsies affects us right to the top of our heads.

Arguably, our bodies were designed to function with bare feet against the ground. When we stand with no shoes on, our contact and weight bearing is evenly distributed between the heel and across the ball of the foot. With the advent of shoes with heels, it has become necessary for us to accommodate the change in our base from flat to pitched. As the heel is elevated, more weight is shifted to the front, pushing the center of gravity forward. If a person were to stand without compensating, they would constantly fall forward, even with a fairly low heel. The higher the heel, the more forward the center of gravity, and the more compensation is necessary.

This change plays out in all the major joints of the body, causing adjustments that become ingrained in our every day posture. In order to maintain an upright position, it becomes necessary for the feet to angle down toward the toe, and the knees to shift forward. The muscles in the back of the calves become very short and tight, accommodating the new angle of the foot, and the muscles in the fronts of the legs are required to work constantly, as they now support the weight of the upper body more, where the bones cannot.

The hips shift back, tightening the muscles in the fronts of the hips (known as hip flexors), and causing an increased arch in the low back, which translates up the spine. The torso shifts forward, forcing the head to roll back seeking its balance. The arch of the neck becomes pinched, causing tension at the base of the skull, a significant factor in headache.

The toes, those poor little digits that play such an important role in balance and forward propulsion, become weight bearing. In the case of women’s high heels particularly, they get squished and mashed, with the majority of our entire body weight constantly pressing and squeezing them down into a tapered toe box.

Just standing still in high heels becomes a feat of endurance and balance, never mind moving. In a normal, healthy stride, the heel plays an important part in walking and running, bearing much of the impact when the foot comes into contact with the ground, and taking a significant amount of the weight, allowing the toe to better push off. With an elevation of 2 inches or more in the heel, this role is effectively negated, leaving the ball of the foot as the primary mechanism for weight bearing and forward movement in the foot, a mighty task for such a concentrated area. Bunions, hammertoes and neuromas have all been linked, in some cases, to the regular use of high heels.

Another concern is that walking in high heels is like walking on a balance beam. There is no support for the arch, causing the foot to roll outward (supinate). With the ankle already in a compromised position, this lack of support hugely increases the risk of falling and/ or spraining the ankle.

As popular culture continues to embrace the high heel, even making it mandatory in some work environments, they will likely be around for some time. Educating ourselves about the issues involved can help us better prepare to counteract at least some of their impact. If, in providing this information, some readers are convinced to keep a pair of walking shoes handy to replace those wedges, pumps or stilettos when on their way to and from the office, and consider a routine of muscle maintenance through massage, stretching and exercise, our mission is accomplished.

This simple stretching exercise can help alleviate many back and neck pain symptoms and free up the shoulders. It was shown to me by a physical therapist, and I use it frequently for myself. I call it “Floor Angels”, a variation on the snow angels we used to do as kids. There is a version of this same exercise that is done against a wall, which is a bit more challenging, since it doesn’t use gravity as a helper, but is well worth the effort.

To begin, lie on the floor, face up, with feet flat on the floor and knees elevated. Arms are straight at the sides with hands facing the ceiling, shoulder blades gently pulled under the ribcage toward the spine and down out of the ears, causing the shoulders to open out. Notice if your elbows are touching the floor. If not, gently push them back and rest. Just lying like this on a firm surface like the floor can feel really good for the back.

Next, think about the curves in your spine that occur naturally. Typically, the tailbone, mid back and back of head will be in contact with the floor, while the low back and neck are elevated. With a gentle effort tightening the abdominals (stomach muscles), bring the low back as close to the floor as you comfortably can.

The neck is next; tuck the chin into the chest, lengthening the neck, and draw the head away from the shoulders as much as is comfortable. This will be the starting position for the movement. Relax like this for a few moments, allowing your body to become comfortable.

The movement is a simple one in theory, but depending on the tension in your body, it can be quite challenging. While maintaining as much contact with the floor as you can with the whole spine, shoulders, elbows and backs of hands, SLOWLY move your hands away from the body, arcing out and up toward an overhead position.

Most likely, there will be points where the shoulders feel stuck and don’t want to move through. Also likely, the elbows will want to come up off the ground as you go. If either of these occurs, back up to a place where you can lie comfortably with the low back, neck, shoulders, elbows and backs of hands contacting the floor. DO NOT push through pain.

Once you have found that place, rest into it for a minute or so, then try moving ahead, arcing the arms toward the overhead position. Ideally, resting in the new start position without pain conditions the muscles, tendons and fascia (and nervous system) to move further into the stretch. If it doesn’t, go back and rest again, trying again in another minute or so.

As you move through the full range of motion SLOWLY, there will probably be more than one place where a rest is necessary. And depending on your level and depth of tension, you may only be able to get to half way or less. This is Not Failure, it’s just as much as the body can handle at that time. Trying the exercise again later in the day, after exercise, or the next day will likely yield a different result. The intent in the end is more extensive, fluid range of motion in the shoulders. In the meantime, beginning a process of caring for ourselves is a worthy endeavor, no matter where we start.

Happy Stretching!

A client recently came in complaining of pain and tension in his head, neck and shoulders. At our initial conversation, he mentioned that he spends long hours on the computer. As with many who work with computers, he had the classic signs of Forward Head Posture (FHP). These include a rounding of the upper back, forward rotation of the shoulders, head pulled down and forward, and chin jutting out. Our main goal for the session was to relieve these issues.

We started the session with him lying face down on the table. As he relaxed, he began to doze off. His breathing became heavier, then turned to snoring. Within minutes, the snoring became sporadic, interrupted by a few seconds of choking, then starting up again. During those seconds, while the air wasn’t getting to his lungs, it was clear that his whole upper torso began working hard, trying to get that needed air. Although I had heard of sleep apnea before, this was the first time I had witnessed it first hand. Watching how difficult it was for him to breathe, it was easy to understand how this challenging symptom could make it very difficult to get a good nights sleep, which might account for the speed at which he was out during the session. It also occurred to me while watching his body tense up and struggle for its needed sustenance, that the apnea might well contribute to some of his postural issues.

I proceeded to work on his spine, rib cage, shoulders and neck, then had him roll onto his back. As he settled, I mentioned the breathing pattern. He informed me that he had been diagnosed with Obstructive Sleep Apnea (OSA), and had been using a ventilator at night for some time. After a minute or two of work on his chest, he was back to the snoring and choking pattern. But I noticed that as the musculature in his pectorals and rib cage released, his breathing became more even, and the choking lessened. Moving to the neck, again the muscle tension released, and there was a noticeable change in the breathing for the better. At one point I was working the occipital ridge at the base of his skull, with his head lifted off the table, and felt the neck muscles completely let go. The snoring and choking went away, and he breathed normally for several minutes.

This experience prompted me to do a bit of research on the relationship between Forward Head Posture and Obstructive Sleep Apnea. Logic indicated that this type of posture must adversely affect the airway, since the neck is in such a compromised position. Studies have proven this out.

One such study, sited here, clearly indicates that within a group of 252 male participants (this condition is typically found in males), a definite connection is shown between Forward Head Posture and Obstructive Sleep Apnea in all levels of severity. Other factors, such as size and shape of the airway and tongue, and Body Mass Index (weight compared to height) are significant as well. Carrying extra weight is a challenge to the body on several levels.

While the contours of the airway passage and tongue may well be affected by the other factors, there is a fair amount of genetics that determine their size and shape, rendering them beyond our control. The postural and weight concerns, however, are well within our means to influence positively. A regular program of massage, stretching and awareness can without doubt improve posture, and a consciousness about diet and exercise are the best, most enduring approaches in controlling body weight.

Unfortunately, the handful of sessions we had together did not provide enough opportunity to see whether these changes would hold over an extended period of time. None the less, the glimpse of positive change was inspiring.

Study sited:

Natural Head Posture, Upper Airway Morphology and
Obstructive Sleep Apnoea Severity in Adults
M. Murat Özbek*, Keisuke Miyamoto*, Alan A. Lowe* and
John A. Fleetham**
*Department of Oral Health Sciences, University of British Columbia and **Department of
Medicine, Division of Respiratory Medicine, Vancouver Hospital and Health Sciences Centre,
University of British Columbia,

When it’s a trigger point! *ba dump-bump*
(Thankfully, I Love my day job!)

So anyway, tennis elbow, or lateral epicondylitis, is a common injury in those of us over the age of 35. It is typically brought on by repetitive activities, particularly those that involve an impact, like tennis, hammering or chopping wood. The tendonous attachment of Extensor Carpi Radialis Brevis, the muscle that brings the whole hand back into extension, (as if shooing a fly away) at the outside of the elbow tears slightly, causing pain, an inflammatory reaction and poor healing. Depending on the severity, treatment options range from ice and stretching all the way to surgery.

Here’s the kicker: the pain you feel in your elbow could be stemming from issues as far away as the shoulder! Or the triceps, or a number of muscles in the forearm. And there is a high likelihood that trigger points are the primary culprit, or at least a major factor.

Trigger points are minute bits of muscle tissue that have become locked in contraction due to trauma, overuse or constant irritation. Decades of research by Drs. Janet Travell and David Simons have mapped and repeatedly shown what they dubbed “referral patterns”, sensations caused by trigger points in a muscle that are felt remote from the origin. While many of the trigger points that refer to the elbow are located in the forearm, there is one well-known point in a rotator cuff muscle at the top of the shoulder, and one in the triceps, which when pressed, cause sensation in the elbow, and when released, can alleviate the elbow pain.

Neuromuscular Therapy is a manual massage technique that focuses on finding and releasing trigger points, allowing the musculature to retain its original length, strength and flexibility. I have found it to be a very effective approach to alleviating pain in my clients, and use it regularly. It is non-invasive, relatively painless, and much less disruptive to life in general than some of the more drastic approaches.

Before considering surgery or even cortisone shots for treatment of chronic pain, I strongly recommend looking into this approach as an alternative or adjunct. While it doesn’t rebuild torn tissue, and does not replace surgery where surgery is indicated, it can be beneficial in muscle conditioning, and may release tension enough that the muscle can heal

A pillow is a pillow is a pillow, right? Actually, you might be surprised to find out how many different types of pillows there are! There are foam filled, cotton filled, down, memory foam, buckwheat hull, flat, rolled, contoured, hypoallergenic, water, and the list goes on.

Why so many types? And are there real differences? Simply stated, yes. Each has its unique properties, and many claim to be the ultimate solution for a healthy night’s sleep. The bottom line is that it is quite important to find a pillow that matches the needs of the individual. Every person has their own body shape, sleeping habits and general health, all factors that play into the decision whether to go with softer versus firmer, thicker versus thinner, shaped versus flat.

If we consider that we spend approximately one third of our existence sleeping, it makes sense that what we sleep on (bedding as well as pillows) is incredibly important. Can you imagine walking around for 8 hours tipping your head to one side? Or pulled forward? Just thinking about it gives me a neck ache. When we do that to ourselves night after night, the patterns can get stuck in the musculature, creating soreness, headaches and imbalances which may well show up in other parts of the body.

Ideally, the head wants to be supported in a neutral position, not too much to one side or the other, and not too much forward or back. A person who sleeps on their back, for instance, might use a flatter, softer pillow, which allows the head to remain even with the shoulders. A side sleeper would probably benefit from one that is thicker and denser, which keeps the head from tipping too far to the side, and maintains that position through the night.

The best way to determine what works best for you is to look into options and try them first hand, in the position(s) you are most likely to use them. Many places, retailers and online, allow a trial period of up to 30 days to assure a comfortable fit. It’s worth the effort to sleep better and live healthier. Happy sleeping!