Desk Knees, Theater Knees, Plane Knees, and Etc.

 

As human animals, we’re instinctive. If something on the physical body is sore, we reach to touch the area, lightly rub it to see if pain dissipates, or palpate it to see if we can discover anything. Yet while we’ll instinctively use touch to ease, resolve, and learn, human anatomy is still beautifully complex and addressing pain in our soft tissue (or working on a client’s) can be confusing; it varies per area, per context, and per individual.  Because certain areas tend to make us more nervous when they’re in pain, it’s worthwhile to have an ever-increasing understanding of how our bodies work, how soft tissue can be addressed, and how touch really can promote and be an important aspect of healing and feeling good ongoing.

Aching, painful knees are a great example of an area that once off-balance can take us from irritated to worried. “Have I worn my knees out already? Is there something truly wrong in the joint?  Will my activities be limited?” Think of sitting at a desk, in a theater, or on a plane, no comfortable way to extend the legs into a relieving stretch, and that 90-ish degree angle the legs are bent into begins to make for some “chat” in the joints. Automatically, we may reach to the area surrounding the patella/knee cap and rub the tissue. Actual joint pathologies aside, since generally more than half of knee pain is referred from dysfunction in the upper thigh muscles, rubbing the tissue controlling the movement of the knee-joint ultimately can help. Soft tissue dysfunction in the form of hypertonicity, trigger points, adhesions between muscle fibers, and scar tissue, along with imbalances in strength amongst the upper leg muscles can all refer pain to the knee, pull it off alignment, and create improper movement and wear patterns in the joint.

There are so many good ways to address thigh muscles leading into and controlling movement at the knees: using a foam roller on the muscles, general to focused massage work on the upper legs, strengthening exercises to rebalance how the upper leg muscles are working together, etc. Given that,  I’ll focus this time on the lateral aspect of the knee; an area that can be surprisingly sore, yet we don’t usually feel it until it’s palpated. Because of how the femur/upper leg bone angles from the hip socket to the knee-joint, it creates a stronger pull on the knee laterally/to the outside of the leg. Accumulated soreness from being overly tight can lie deeply in the tissues to the outer side of our knees. Trace your fingers from the outer patella/knee cap to where the upper leg and lower leg meet along the side of the knee, exploring this zone in a circumference of a few inches. It can feel bony with less tissue mass and even “gristly” because different muscle tissues here thin down as they transition into tendons; the quadriceps muscles (which make up the bulk of the anterior upper leg muscles: rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) actually share a tendon that passes over the knee cap and attaches on the tibia bone below. All this makes for a bony, gristly, lumpy feeling landscape which can feel awkward and daunting to massage. Going back to exploring that outer knee zone, there is often a sore to bruised feeling in a few spaces here. Get lost in this region, seeking these hidden spots. Do small circular or back and forth friction movements with clustered fingertips, a supported thumb, and/or the heel of the hand; changing up how we use our hands is good so as not to overwork them. Spending time feeling where it’s tender, being interested by it, trying to gently move it, following where it may lead us to another spot in this small zone, or even applying several seconds of sustained pressure on a sore spot and then rubbing it away, can all help clear open the tissue.

I would never dissuade a client from checking in with an orthopedist if they had serious symptoms or concerns about their knees (or any other problem area in the musculoskeletal system), but it is important to remember that even if a pathology exists there, the surrounding musculature will respond to this imbalance via bracing or tightening to help offset the problem and maintain some kind of workable biomechanics. Meaning, no matter whether a joint pathology exists or not, if the knees are sore the surrounding tissue will have some dysfunction to address either way, leaving massage as a healthy addition in supporting the knees. And honestly, it feels great to get bodywork from both a therapist and via our own exploration. Giving care to oneself, accepting that the body needs and relishes nurturing, attentive touch, is fulfilling. It’s an emotional kindness back to oneself and a centering back into the physical form; a grounding back into the tangible, into something both simple and miraculously complex, reassuring us of our own solidity, presence, and intrinsic value over and over again.

 

Copyright © by Lara Stillo 2017

 

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Do I Want a Golf Ball Pressed into My Muscles?

 

Seemingly contradictory: I am in a health care field – I am not 100% perfect with my health. Don’t misunderstand; I definitely look after my health daily, ongoing, and with awareness. I’m just more of an 80/20 rule person. 80% of the time covers eating well, exercising, getting enough sleep, and being responsible in general about self-care, even to enjoying the discipline around it. That leaves 20% to cover my love of strong, rich coffee and dark, deep chocolate; chewy chocolate chip cookies with walnuts and the occasional dense, sweet donut; saying yes to more joyous social activities than I can actually do; and inadvertently waxing sometimes too dark and deep, needing to then pull myself back out and up. Yet, as I’ve told students in my massage classes many times before, I’m not a “guru” with all the answers, nor am I seeking to be. I seek to walk my talk and live by example. 

Being in the midst of winter rains storms and subsequent flooding here in the Bay Area, with sharper temperature drops and less daylight, self-care can fall away more quickly. I love having all the tools I use for support near at hand and pulled together. Right beside my tv sits a basket with bands and tubes for muscle resistance and strengthening; two different foam rollers and three different exercise balls for working the muscle tissue open; and a yoga mat and yoga block to support stretching the muscles back out. The visual reminder of this basket of tools, along with all being in one place, makes it hard to ignore, easy to use.

In using any of the aforementioned tools, much can be found on the net, in books, or often in any brief manuals that come with some of these supplies. Because I’m licensed as a massage therapist and focus on opening up and/or resolving soft tissue dysfunction and pain, I focus on the use of the foam roller and sports balls (lacrosse ball, golf ball, tennis ball) when talking to clients about self-care at home and defer to the physical therapists I work with for strength rehabilitation and training. I would say the same here that I tell clients: Know your own musculoskeletal health before going deeply with any of these tools; injuries old or new, the integrity of the skeletal system, any imbalances that may exist, etc.  It’s always good to start small and gentle no matter, so each individual can experience how these things feel and where modifications need to happen either direction (i.e., using a harder tool or a softer tool, which muscles to focus more time on, and so forth). The more you get used to using them, the more information you receive from your body, and the more you learn about your body. Small steps continually taken bring us to our goals well, versus dramatic leaps done in fits and starts. Meaning, try to consistently use one or more of these tools daily. I use the foam roller daily for a broad opening of the muscles, followed by one of the small sports balls for specific work. Stretching afterwards is ideal because the muscles are more open post-use of these tools.

Working the anterior, lateral, and posterior muscles is important as most of us feel discomfort in the posterior muscles from postural over-stretching and will be drawn to focus there. But since life is all about being flexed too far forward, the anterior muscles are often the offenders in tightest-of-the-tight without actually feeling sore; they need addressing. And it can feel great: Easing pressure into a sore, tight muscle – letting it sink in slowly with static pressure, or rolling in small 1/2 inch increments into the tissue, a couple different directions – following where these paths of tightness lead you, exploring your musculature in various areas – breathing with measured stretching after, opening different muscles, feeling how much more room there can be, how much more movement and flexibility. 

Humans are organic, not robotic. We’re all each our own, ongoing process; a garden constantly needing weeding, tilling, watering, and nutrients. It does not stop, it is ever-changing, but it’s rewarding and interesting if you can see it this way. Bodies are also shockingly resilient. That doesn’t mean waste what you have and burn it out, of course, but it does mean keep tending to it. There are ways to feel better. Life has intense, often grievous challenges, yet it also offers gifts, always. Here’s to taking care of ourselves in growing gratitude, which still can, I believe, include some type of “cookies” in there.

 

Copyright © by Lara Stillo 2017

Our Overworking Backs – Our Half Asleep Abdominals..

 

The physical body is quite beautifully complex, working always to maintain a fine balance within its systems and these systems with one another. Analogous to so much in life, keeping the body’s structure and function optimal is crucial. When either are compromised, pain can be a result. Imbalances that develop over time also logically require time to backtrack. Fortunately, along this journey of seeking functional balance, there’s that wonderfully satisfying sensation of “letting go” in a tight muscle which we experience right away via bodywork. It’s a warm, freeing sensation, like hot shower water on sore muscles; as if the tension is flowing off you just as shower water does in streaming down your back. 

A broad canvas of muscles, soreness can be found a variety of places in the back. The spinal muscles near the base of the ribs is an especially great area for over-taxed muscles. Commonly, there are weak abdominal muscles and a postural collapsing of the anterior rib cage to go along with this, since the anterior torso muscles  interplay with and directly affect the back muscles. Postural fatigue, some muscles too tight and some too stretched out, and even just gravity all play a role here. In this curved forward position, back muscles get over-stretched, especially around that posterior bottom rib zone; a recipe for soreness. In gently asking a bound muscle here to open, I really love that sensation of select pressure applied and sustained to a pinpointed area. Sometimes it’s a trigger point, creating a radiating referral pattern from that spot; sometimes it’s simply one of many bullseyes in the hypertonicity asking to be dispersed. Palpating the muscles that are right along the spine near the inferior rib cage, then moving away from the spine, there will be many spots to pinpoint within a trio of spinal muscles:  spinalis, longissimus, and iliocostalis. Also known as the erector spinae muscles, this group extends along the length of the spine either side and is generally sore on us from helping to maintain erect posture day after day.

It feels good to use the lower aspect of the forearm, supported fingers, and supported thumbs with sustained pinpoint pressure in this aforementioned junction. Alternating these approaches changes what we feel within the tissue while also making it easier on the massage therapist. Focused palpation can help highlight the tightest area within the tight muscle; like seeking the center of a bullseye. It’s good to include massage strokes to the sides of the torso as the abdominals wrap around here and can be addressed to balance out the back. Since a lot of people don’t like their abdomen worked on, sweeping along the sides of the torso while working on the back, then doing some stretching open of the anterior torso once the client is turned, will keep the massage balanced and in alignment with addressing structure and function. 

The weight of gravity, of our thoughts, and of all we carry in life can pull down on us. This is normal for humans; we have to forgive it. But to keep sweeping it off of our frames, lightening the burdens and the soreness, can be a sweet feeling, a warm relief, and fresh start to another new day and a new vision.

 

Copyright © by Lara Stillo 2017

Neck to Shoulder, Shoulder to Neck

 

Sitting at a jazz show Saturday night, one of the best I’ve seen in some time, I found myself reaching my hands back to the base of my neck into shoulders, trying to comfort the area; that C7/T1 zone, where the cervical vertebrae transition into thoracic vertebrae.  If a stellar jazz performance can’t distract me from muscular tension, I know I’ll be working on the spot later, just like I do so often with clients. What a great area to give focus to! The trick is not to over-do the work and make the area weaker compared to its anterior counterpart, since most of us are posturally flexed forward more with over-lengthened, weaker back muscles trying to counter-balance.

I like to address the tighter side first, sinking fingers gently into the tissue of the C7/T1 vertebrae area. Staying focused on this small zone, feeling what the tissue quality is like, exploring it from its start alongside the vertebrae to just about an inch or less out laterally, and in a superior/inferior direction. Moving fingers up, down, and out from the spine, it challenges the tissues to open up in different directions, breaking down adhesions, warming hypertonicity out of the area.The focus feels wonderful to receive and to give. Just in being attentive and patient, relaxation and movement can happen. So often in life, we don’t feel like we get the attention we desire, whether it’s in being heard, recognized, or understood. Receiving this honed in attention on a troubled area is a wonderful balm to the physical body and to other layers of who we are as people.

Taking a moment to look up some anatomical charts and apps, it’s fun to explore the layers of muscles attaching in and around the lower cervicals and upper thoracic vertebrae. Trapezius, splenius capitus and cervicis, rhomboid minor and major, semispinalis cervicis and thoracis, multifidus, spinalis cervicis and thoracis, all layering over each other and inserting into the area. Given this amount of pull from so many head, neck, and upper back muscles, that junction is usually crying out for relief. In ending, it’s good to do broader, lighter sweeps away from the area, carrying it through the surrounding musculature. The last complement to this work would be to do some work opening the anterior upper torso. As in life, balance is often everything. To over-do in one area while disregarding another can create other problems; again, analogous to life. Go in with a plan, see what you find, adjust the plan as needed, and keep the intention clear: supporting a harmonious system, in body and in spirit of life.

 

Copyright © by Lara Stillo 2016

Breathing a Little More Deeply…

 

Working the soft tissue open along a line under the clavicle – often sensitive because the pectoralis major is generally tight on people, sometimes awkward since there’s less tissue mass here, and usually it’s not an area one thinks of as “relieving” to have worked. But that said, it’s interesting to see that most people do respond positively to the work here. Understanding anatomical function and common postural imbalances, it is an important area to address, yet the way people respond with such surprise and relief themselves always interests me; I learn from it, every time. Watching these same reactions over and over helps me to refine my work and supports the style and intention of it:  to accomplish the most I can, as effectively and efficiently as possible, promoting some positive and acceptable change for the client, while keeping the touch itself great to receive. And we can work this area a little on ourselves, too, which is always a plus.

Apply it to yourself first. Bring the four fingers of each hand together, placing them under the most medial portion of the clavicle, staying in soft tissue, off the sternum and above the first rib. Sink in a little bit first, anchoring your fingers into the tissue, noticing how just the pressure can feel good. Let the fingers slide simply by applying more pressure (a little lotion may be needed here, so the skin isn’t dry, but also isn’t overly lubricated). Sensations can vary: the head and neck can feel less restricted from the anterior pulling of flexion; the upper thorax feels more open, allowing the ribs to expand more in breathing; the shoulders also feel less of that anterior pulling from postural flexion. And even if the client (or you) can’t put words to all the above, there is a lightness felt, like a weight has been removed from around the upper body. Another simple, effective technique here is to apply gentle, rapid, continuous pulses from your fingertips; like a faster rocking to the area. With this approach, the fingertips do better sitting lightly atop the first ribs, anchored in enough to allow the jogging movement against the solidity of bone, while not applying so much pressure that the client feels like you’re trying to do chiropractic adjustment. It creates almost a small wave moving through the client’s body as they lie on the table, or a shorter wave through the upper torso if you’re applying to yourself. Keep the focus on the pectorals major, the primary muscle being addressed here, as it attaches along the anterior and more medial surface of the clavicle and drapes down along the upper anterior torso.

Anything that feels less restrictive in our bodies, anything that feels freeing, is generally well-received and gratefully acknowledged. We don’t always notice the feelings of heaviness we carry around until they are removed. The result can feel like our mood lightens, or we’ve more energy, or sometimes even that years have been dusted off. The responsiveness of the body to touch is amazing, affecting us on so many levels, and so often difficult to describe fully. How does it feel if you apply it to yourself? Grounding, relaxing, opening, comforting, revitalizing, or? See what you notice, see what your client’s non-verbal responses tell you, and hopefully breathing can go more deeply because of it.

 

Copyright © by Lara Stillo 2016

 

 

The Tactile Comfort of Massage Linens

 

Musing on how much we look forward to receiving bodywork, to receiving therapeutic touch, receiving kindness through this touch. Soreness in our muscles yanks at us, the tension in our bodies piles up and pulls us off course, and the energy drain of these imbalances weighs us down; so whatever the cause or reason for how we feel off kilter, massage is generally always something we feel uplifted about. What I find really lovely, interesting, and pertinent to why I started this blog, is how many clients over the years have expressed their liking of simply having the linens arranged over them; continuously shifted and re-draped during the massage session, like origami respectfully and carefully done.

I confess that while I love pleasant, tactile sensations and certainly delight in receiving massage, I have not payed as much attention to how nice the linens feel around you during a session. Yet I’ve always been very aware of how it might feel to the recipient as I work, so as I drape, I’m conscious of the different folds and layers of the linens and blankets, both in how they look and how they look like they feel. How are they laying across the client? Are they pulling too much, or feeling too tight, too heavy, or too loose? Is there ease in how these materials rest on the person, covering them with respect, warming them just enough, enfolding them in a way that matches the caring, professional, goal oriented intention of the work? Details matter. All our actions and intentions speak more loudly than our words.

A client of mine recently mentioned how the linens being moved around made her more aware of her own body, of areas that might be more tense than she realized, of imbalances that were spot specific that she was unaware of until she felt the drapes shift. I loved hearing her insight and experience; very unique to her and a reminder to me as well. Now I expand my own awareness from doing the draping and being attentive to how it could feel, to myself receiving it when I get bodywork done. Any reminder to be in the moment, enjoying simple sensations in a meditative kind of way, is lovely, mindful gift.

 

Copyright © by Lara Stillo 2016

The Base of the Thumb – A Large Small World

 

Seriously, who doesn’t enjoy having their hands massaged? Let’s do a simple one for the thumbs (talk about an overworked area). Think of this as a very small road trip, a tiny but effective exploration. – Take the thumb tip of one hand, place it on the medial  or inner side of the thumb joint on the opposite hand. Stroke it down along that inner edge of the thumb’s metacarpal bone, following it along to where the bone ends. Then turn a right angle to trace inward along the palm’s base, moving toward the center of the hand, still staying low along the base of the hand. It’s simply two short, firmly pressed lines, tracing the outer edge of the thenar eminence, yet these two brief strokes do help to move tension out from the area – and it feels really good! A lot of tension can sit around that edge, in our usually over-used thumbs. Notice spots that are tender, tighter, or even gritty in muscle texture; the left and right hand will probably feel different from one another. Grouping the forefinger, middle, and ring fingers together is a nice alternative to using the thumbs here. With this broader point of contact, you can use these three finger tips to apply strokes from the thumb joint down across the thenar eminence, to the base of the hand right above the carpal/wrist bones. A nice break from the computer, allowing a space for “zoning out,” exploring this small area with simple, focused strokes. 

What are we feeling in there, besides tension or soreness? Applying the above simple strokes explores along the abductor pollicis brevis, the flexor pollicis brevis, and the opponens pollicis muscles. Along with the soft tissue, there’s also the carpometacarpal joint at the thumb, the first metacarpal bone, and a little of the trapezium in the wrist –  all the aforementioned in this small space, receiving needed touch, and working hard and ongoing for us as we move through the world. The complexity of human anatomy seems never-ending, and still our learning about it continues. The power of simple but focused touch seems even more of a universe; constantly new, every time, and so often without words to explain how it feels. You don’t need to know the anatomy of the area to appreciate massage here, though it does help to grow our appreciation of what we are and what we have. The more over-worked or stressed any given region of the body is, the more we seem to expand and let go once these areas are addressed with care and attention. So work on your own hands, or offer this gift to another. Allow yourself to notice in receiving this touch, how a stillness can rise above the noise, and a quiet can grow deeper within.

 

Copyright © by Lara Stillo 2016

 

 

 

 

A Furrowed Supraorbital Ridge Impedes the View

Tightness in the brow ridge above the eyes, the supraorbital ridge, is another one of those small, delicate spots where addressing it can be wonderfully helpful, yet it’s an often overlooked area, especially when limited time is usually a part of any bodywork session.  Relaxing this zone can ease eye tension, affecting our eyesight; it can release pressure on the sinuses located right behind the brow ridges; and it can reduce tension being held throughout the facial muscles, felt both within the tissue and the emotions. 

Some people love having their complexion touched while others do not. It’s always best to ask your client first about receiving facial massage, making sure no medium (oil or excess lotion) is on your hands, as it can make people break out, alter their makeup, and so on. Working close to the seat of someone’s sensory organs (eyes, nose, mouth, ears), creates that much more of a need for awareness and sensitivity in approach. The forefinger tips are usually easiest to use here, placing one at a time lightly but with assurance, so the recipient can relax into having digit tips that close to their eyes. Try starting at the medial edge of the brows, doing a gentle pull with the forefingers in a superior direction, away from the eyes. The client can often immediately feel sinus passages opening and tension dissipating out of furrowed expressions, away from the center of the face. Noticing how the therapist gives the eyes plenty of space usually generates even more relaxation within the client. For the massage therapist, it feels good to let the finger tips sink into that bony curve at the top sides of the nose, right between the brows. There is a happy sense of evaporating tension within a few seconds; a sense of positive, focused effect being created quickly and easily.

Working within small, delicate areas can sometimes create more hand tension for the therapist, so it’s good to change how the hands are used. Try thumbs for a few seconds instead of forefinger tips, or all four fingertips on the length of the brows sweeping medial to lateral while also pulling in a slightly cranial direction. Alternating with fluid, slow deliberation amongst the aforementioned approaches can feel good to both the therapist and the client. It creates a subtle wave of changes in address, contact, pressure, and direction, keeping the therapist and client very present, focused yet relaxed, and more interested in what’s occurring. A meditative moment shared by both people, in a tiny space with a big effect.

 

Copyright © by Lara Stillo 2016