Sciatica, Piriformis Syndrome, Gluteus Minimus, or…?

 

Pain in the low back, gluteus/buttock muscles, low limbs, even to the feet, possibly including pins and needles or numbing. Who’s the culprit for all this physical discomfort? Once it starts interrupting our ability to find a comfortable sleeping position, we all want to know. Lower lumbar vertebrae impinging on the sciatic nerve (sciatica), or the piriformis muscle under the glutes compressing that same nerve? First off, wise to get things assessed properly. A good physical therapist or orthopedic doctor are solid professionals for covering musculoskeletal pain and imbalances. Second, keep in mind sciatica and piriformis syndrome are very often composite problems, meaning there are several influences creating the issue. As I focus continually on in this blog, other soft tissue imbalances can be adding to the problem, sometimes even the sole cause. 

Segue to gluteus minimus, a key player in creating mid-lower body pain patterns (though not the only one, sorry ;). Find this muscle on a nice, basic anatomy drawing. Found in the posterior to lateral portion of the hip, it is the deepest of the three glute muscles, attaching in at the front and top of the femur/upper leg bone. If it’s hypertonic/too tight, a large referral pattern of pain, weakness, pins and needles, and/or numbing can present from the hips all the way to the feet. A tennis or lacrosse ball is a great tool to start easing the tissue out of excessive tension, breaking down adhesions and interrupting pain signals from the tissue. Best to stay off the tendon attachment to avoid irritating a bursa/”cushion” located there, or the tendon itself. Stay about an inch away from the head of the femur bone, keeping in the belly of the soft tissue encircling that greater trochanter/top of the femur. This will all make more sense after glancing at an anatomy drawing – maps of the body are interesting, just try!

The area can be surprisingly tender or sharp feeling. Using a sports ball and having massage done will reveal these sensations, often recreating familiar pain patterns. No need for torture! A dark laugh at how sore it may be will keep the breath going if needed, but if the breathing stops and the swearing escalates, best to lighten the pressure or address another time. Let the physical sensations be the guide. Follow the tension in the tissue – coax and ease it open, backtracking it out of dysfunction and discomfort. Trouble sleeping on that side? Try using the sports ball right before bed, follow with a couple of gentle stretches to the glutes. Getting good bodywork done to the area really feels so relieving. Sensing pain and imbalance being led out of an area leaves us all feeling so much lighter, in spirit as well as in form.

 

Copyright © by Lara Stillo 2018

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Life in the Face of Death

A difficult topic that we generally skirt around is ever present while living in a physical form – the death of that form. It’s a major driving force behind the anxiety any one of us can feel when bodies exhibit pain, dysfunction, or chronic problems. Questions of, will I ever feel better again, is this the new normal, am I breaking down, how do I resolve this, all arise. Death is not going away, so how do we take care of our bodies with this reality staring at us ongoing?

First off, stare back. Different from obsessing over, it is resolutely acknowledging, deeply feeling, and actually accepting. That can be very grounding right there. It also keeps the pendulum of our reactions from swinging too wide. Meaning, we don’t need to drop all health measure, stop moving, and refuse responsibility for health; nor need we become fanatical without focus. Instead, keep it steady and basic with good intention:  honor and love the physical body you came in with; know and accept that it requires more attentive care ongoing than anyone ever taught you; and stay responsible, aware, and genuinely interested in that care as able.

Easily said, right? People are complicated in their emotions and viewpoints which gets inextricably interwoven with physical self-care. So think on this – if we under-water a plant, it dies; if we over-water a plant, it dies. If we apply this simple example to our own bodies, it can be awakening and calming, with a more detached though caring perspective. How about, do what’s naturally indicated or more commonly understood: drink water, get enough sleep, eat for nutrition as well as enjoyment, keep moving, exercising, stretching. And so key, enjoy how that makes you feel better on many levels. Notice it, pay attention to it, respect it, apply it. There are many topics I could branch into here from the aforementioned; lack of resources and environmental pollution are truly grievous ones. Without any disrespect for these realities, I’m staying simple for now, suggesting being in your body, hearing its messages, knowing it’s not your vehicle forever, and loving, cherishing, and be interested in it as a part of who you are, with best intentions and as able. If we mind the messages the physical body sends, flowing on an even keel in responding to its well-being, there can be endless room to grow.

Copyright © by Lara Stillo 2017

Healing Old Scars

 

It interests me endlessly how the body reflects so much of what we’ve undergone and undergo in life, mirroring many aspects of who we are or have become. The tissue itself is filled with stories from our lives and experiences. Some things are more apparent, and some are hidden from view, but the physical body is a walking novel in its own way. While we cannot rewrite the past our body speaks of, we can amend some of how it presents today. Looking at how scar tissue easily piles up in the body from injuries, surgeries, and just ongoing usage, I marvel at how scar tissue can always be worked on and lessened, even if it’s been in place many years. Formed from collagen to bind an area together like a band-aid, scar tissue shortens the tissues, restricting movement both locally and along a chain of movement spreading away from the original location. We get used to our scars, their restrictions, and the change in how we move and feel, adapting while often feeling nagging discomfort. When scar tissue is worked on, it can feel intensely relieving or very uncomfortable, but it generally always feels freeing, on more than one level.

My thoughts here are not about how to work scar tissue (which can be covered another time). Instead, I wanted to present how wonderful it is that clearing restrictions from the tissue often times coincides with moving restrictions we actually feel in the mind and/or emotions; in clearing up the tissue, the mind and emotions can usually follow more easily. Rereading the first paragraph above with this perspective, it could translate as doing either emotional work or physical work. Not a new concept, of course – all relates to the idea of body/mind/spirit being inextricably interwoven. Excluding congenital issues and viewpoints on physical aesthetics, this instead highlights how things we experience and react to throughout our lives have a strong residual impact on our minds, hearts, and bodies, each of the three reflecting the other two.  Viewed from a place free from judgement, this way of interpreting then paints a beautiful, sad, human, inspirational, organic-animal, fragile, hope-filled reality. Old scars can be healed, on many levels of who we are, and we can continue to flow towards and through that all our lives.

 

Copyright © by Lara Stillo 2017

The “Language” of Our Senses

I was recently approached to teach a workshop solely on soft tissue techniques, versus teaching touch while learning anatomy. Mulling over the idea brought up much of what I try to explore in this blog: what is the tactile feel as you explore an area of soft tissue; what is the intuition of touch as you work with any given individual; how years of experience gained compile and strengthen said intuitive feel; and how to describe in words what is felt, in giving and receiving through touch, when there doesn’t seem to be enough words in spoken language to define the feelings? 

Muscle tissue has many stories to share. A client of mine some years ago had their Achilles tendon surgically repaired, leaving scar tissue that thick, it creates a line of tensile pull all the way up to the sacrum on that same side. It’s subtle, but that pulling is visible in how she lies on the table and can be felt in observing it. We’re all roaming around living in a human body. Looking at any given story in a body, we can often feel it in our own; staying centered in our physical self and in touch with our physical sensory responses. Touching the scar tissue on the achilles and exploring its unique thickness, noticing the restriction and how it spills slightly out into surrounding areas and structures, having acceptance that the structure is different now yet still functional and can have some ease brought in though it’s already healed – perceptions and sensations so interesting to experience in communicating with the tissue.

Then always there is more – more stories, more to explore, more to experience, more to understand. Our bodies communicate to us constantly through many kinds of signals. We communicate with each other constantly through body language. The communications are real, often loud, and all without wordsI actually love language and the creative use of words, yet the array of communications a physical body can give astounds me. It’s a seemingly endless capacity, it is beautiful, and I remain lovingly in awe. 

 

Copyright © by Lara Stillo 2017

Sedentary Society With Gym Workouts?

Living in the human body is both wonderful and terrible. It gives pleasure and pain, it is miraculous and beautiful, it is mysterious and frightening. It’s a complicated, individual organism requiring care on many levels. Each person requires both basic body care and care that’s unique to their system, yet all bodies are designed to move. It’s our natural, foundational blueprint. With current society primarily placing us at a desk, before a computer, seated in the car, or collapsed on the couch after doing the desk, the computer, and the car (so understandable!), our bodies don’t get the movement and strength training we need for well-rounded maintenance of this organic machine. Gym classes and workout routines are great, but we’re still primarily sedentary when you add up how we use our bodies over the hours. 

A good example here, the gluteal muscles and the imbalance that usually happens between the upper gluteus medius and minimus muscles, and the larger gluteus maximus muscle just below. Whether working on yourself with a sports ball and foam roller, or working on a massage client, the upper glutes generally feel tighter than the glute max below because they are used more often. The larger glute max muscle gets overstretched and weakened from the endless hours we’re sitting per day, per week, leaving these upper gluteal muscles to do the overtime. Add a weakened core area to that (also common from all the aforementioned), and we end up moving using tight low back muscles, upper glutes, and hip flexors, with residually weak, unengaged core and glute max muscles. 

Working the soft tissue right under that bony ridge of our posterior upper hip bone (the iliac crest), you’ll find the tightness set deeply there. For this post, I’m focusing on medius, since minimus sits deepest of all three gluteal muscles and can often be too sore to work on at first with clients (or in self-work). Zeroing in on that glute medius, you can start near the sacrum and do purposeful, slow circular friction moving out laterally along that iliac crest/upper hip bone line.  You can sense the overwork strain of the muscle tissue here in comparison to how the glute max tissue feels. It has the feel of a clenched fist, or a tiny army of fibers not dense enough to be doing the tasks at hand. Pushing and opening that tissue out and down, coaxing it from where it attaches along that bony ridge, can ease open the low back area and allow some space to open up. In both receiving and giving, it feels great once the whole hip area begins to open slightly away and decrease excess low back curvature; you can see the hips drop down slightly and often even out between L to R sides, once both sides have been addressed; a sensation of deeper breathing and ease of movement is felt in the area from the work. 

We know we need to move more. Consider all the different devices and apps that count our steps, or ring alarms if we’ve been still for too long. But if we do a slight shift in perspective from thinking “I NEED to move” to innately feeling “I’m DESIGNED to move,” our motivation can also shift. It’s subtle, but runs deeply thus: moving from intellectually accepting a truth and being disciplined about it, to physically, intuitively feeling that we MUST move to live, and that continuing to move throughout our life in body and consequently in mind and spirit, we live well. 

 

Copyright © by Lara Stillo 2017

Are Elbows Ever Relaxed?

 

Consider how much we use the elbow joints; constantly in flexion, use, and motion. Our arms are not limp by our sides even when we’re relaxed or asleep. Discomfort in the elbows can often be alleviated simply by opening the well-used muscles above and below the joint. Focusing on the upper arms in this example, so much hypertonicity can sit here, muscles can harden until all tissue pliability seems gone. With all the tension in people’s necks into shoulders, it’s common for that tension to just march down the chain into the upper arms. affecting function and movement of the elbows. 

Applying broad, sweeping strokes along those upper arm muscles down towards the elbows feels great to receive. A surface level opening usually begins right away. As the movement pushing open the tissues flows down into the elbows, you can feel the joint seemingly lighten and expand, both in doing and receiving this work. The mechanics beginning to free up, the joints can feel almost renewed, like years have been shaved off. The massage strokes can start from lighter and move to deeper and slower as the client’s tolerance permits. It’s nice to do this work when the client is face up and down, accessing different angles and planes of the arm without having to put too much demand on moving the shoulder joint into awkward positions. It allows the therapist to gently, thoroughly explore this region, all the way around. Since the upper arms are a smaller area, nerves and blood vessels can be more easily accessed, so being aware of working to your client’s tolerance and remembering sensitive and more exposed spots is important (example: the medial side of the upper arm into the elbow region where so many nerves structurally sit). Opening this area up can create a sense of warmth, as blood moves more freely from the tissue expanding and the muscles regaining a wider movement range. In doing the work, it’s interesting to balance pressure and movement from our own bodies into these small, compact zones. Asking the area to open as we flow forward in our mechanics, applying that movement onto and into the tissue.

Looking at the body as the whole unit that it is, a complete system where all aspects of it affect the economy of the entire environment, we end up with a better understanding of how to support it. Pain or imbalance in any given area of the musculoskeletal system can be both a local issue and a part of a chain of dominos. Thinking about all the muscles that lead into any given joint in the body, if any of these muscles controlling the joint’s movement are too tight, it will create difficulty for the joint.  An example of applying basic and logical concepts of self-care to our bodies with happy, effective results. Wonderful to enjoy the feelings of expansion, warmth, and freedom that come from muscle tissue being restored!

 

Copyright © by Lara Stillo 2017

 

Holding a Space for the Nervous System

Sometimes the kind of bodywork any of us may need is actually a simple light touch, more like holding a space for the client’s own nervous system versus working the soft tissue open to effect changes. This sort of approach can seem dubious in our more allopathic western system of medicine, the focus being on pharmaceuticals, surgeries, and pathologies. Yet there’s room and need for all the aforementioned, human health being that complex to address. So in this range from surgery to doing the most basic touch within bodywork, I’d like to briefly look at cradling a client’s head, fingers at the occipital ridge of the skull, the client’s head resting easily in the palms of the therapist’s hands.

This technique generally sounds pleasant and relaxing, yet it might seem inconsequential in describing. However, this simple hold can prompt relaxation within the central nervous system through activating our parasympathetic NS, the system that supports healthy functioning of unconscious body actions while the body is at rest (digestion, for example). The technique comes from a modality known as craniosacral therapy, which dates as far back as the 1830s. While I’m not a practitioner of the aforementioned, I do like many of its principles and practice this one hold on clients occasionally. The effect is generally increased relaxation and often deeper release in the upper shoulder and neck muscles. While it may not work for all people, it’s worth trying! A nice way to end a session after already having done manual therapy on the neck muscles.

Some things to keep in mind…explain to your client the basics of the technique and that you’ll try just for two minutes. Do right before the session ends, making sure your client is fully awake before you send them out the door to drive! Get your chair height with the table correct to sustain this hold easily while you clock it over the two minutes; longer time can be applied another time if you and the client agree to do so. Keep your hands, arms, and shoulders relaxed and allow your client’s head to merely fill your palms, like water someone poured into them. This is truly “holding a space” for your clients. It allows their muscles time to ease out of holding patterns while they breathe and expand into the table. 

Reading further about the purported effects and benefits of craniosacral work is recommended for anyone who has the interest, since I’ve touched very briefly here on one hold and the most basic application of it. The point of looking at this one hold in this most simple approach is to remind that sometimes the best we can do is to present a peaceful space, the room and time (even if two minutes 😉 for any given individual to breathe and expand out of constriction, and the acknowledgement that our systems naturally want to be in balance, but time with appropriate ongoing tending is needed for any garden to sprout and grow the right direction. 

 

 

Copyright © by Lara Stillo 2017

 

Stress Response and Animal Posturing

 

 

We are animals – human animals – yet we disregard this in very subtle ways, remaining almost condescending about the physical in favor of our intellects and our wills. Taking care of our bodies by noticing and feeling what they tell us, listening to its demands and responding is what we need to do, but this ball is usually dropped, if it is even picked up at all. How stress plays out in the body is a great example for this disconnect. One muscle that reacts quickly to stress with a  primal postural result is the levator scapulae. When hypertonic and overly engaged or “on,” it gives us a posture mimicking an animal protecting the vulnerable neck vessels from attack; a visual reminder of how we are a part of the animal world, despite our desire to control or reject it.

Spanning from the sides of our upper cervical/neck vertebrae to the superior border of the scapula/shoulder blade, the levator scapulae helps us to elevate the shoulder blade towards the neck, shortening the distance between the two attachment areas. When we think of stress affecting muscles in the body, the neck and shoulders are one of the primary areas people feel it; shoulders hunching high towards our necks. Levator scapulae helps create this posture, making it a good muscle to address in many bodywork sessions. A great place to start is to find the lip of the upper trapezius muscle at top of the shoulder, then work to get your fingers moderately under it, seeking to hit the edge of the levator scap. Depending on the person’s musculature, you may only hit the very edge of the levator, but that’s enough. A steady, gentle pressure with friction against and along the tightness felt there can begin the process of coaxing the tissue out of its rigidity, moving some of the adhesions that come along with hypertonicity. Remembering its path from the lateral/side neck to the upper part of the shoulder blade, it feels good to do the friction strokes slow, with a purposeful yet easy pull away from the neck towards the scapula blade; asking the muscle to come out of the hunching posture it’s frozen in.

Even after all these years of working on clients and myself, I’m taken aback at the rock-like feel the levator scapulae can hold. It has a distinct. sharp hardness to it once it’s become too tight, almost as if the tissue itself is gone and hardware has taken its place. Part of this is because levator is a small, thin muscle generally overloaded by taking over the work load of larger muscles that have become weak. But in musing on this stress response and the animal-like protective posture that levator can move into, it seems possible to me that the very quality of the tissue becomes defined by this primal, wordless protection of self and of life:  hunching up our shoulders to protect the jugular veins of our neck. An interesting reminder that’s both visual and palpable. Our bodies know what to do and give us messages all the time. Listening to them with respect and responding with care can bring balance back into our physical selves that then blossoms over into all other aspects of who we are as individuals.

Copyright © by Lara Stillo 2017