Massage Matters

Mindful musings on massage, muscles, and moxie

The Knot Whisperer Rides!

The Knot Whisperer Rides!

Saturday, March 26, 2011

How'd I Get That Pain? Part 3, Limbs

As noted in part 1 of this article, there are times when there is little doubt about why you have a particular pain. But if you have a muscle pain that seems to come from nowhere, factors such as those listed in the article linked to below might be responsible—factors that could be avoided in the future. Of course, when you can’t dodge an ache, it’s time to see your massage therapist! Calf pain? An ache in your forearm? Hamstrings killing you? You might have gotten that soreness this way:



Stressors of That Muscle


Top (or hairy side) of the forearm, from the outer edge of the elbow to the base of each finger

Repetitive forceful hand gripping and repetitive extension; weeding with a trowel, extensive handshaking, or Frisbee throwing; faulty mechanics (e.g., typing playing musical instruments)


Inside (or nonhairy side) of the forearm, from the inner edge of the elbow to the base of each finger or the base of the palm

Prolonged gripping or grasping (e.g., working with hand tools, racquet sports); being in professions such as massage therapy, carpentry, weight lifting, waiting tables, chefs

Pronator teres

Around the inner side of the elbow

Gripping ski poles for long periods of time; holding small hand tools lightly


Above and around the outer part of the elbow to the nearest third of the radius from there

Repetitive or sustained supination (rotation in which palm faces upward) of hand, especially with elbow straight as in “flipping” a briefcase onto a table, wrestling with a stiff doorknob, mis-hitting a ball off-center, twisting a racquet with elbow completely extended, wringing clothes; opening jars, working with a screwdriver

Triceps brachii

From the top, back of the shoulder joint to the back of the elbow

Strain from sports (e.g., “mis-hit” tennis ball or improper golf swing); overuse of forearm crutches or a cane that’s too long; prolonged extension lacking elbow support (e.g., holding down a sheet of paper while writing or doing needlepoint work); push-ups or overhead and bench presses


Top of the outer edge of the upper arm to the far outer edge of the radius

Combining gripping and twisting motions as in sports (tennis and other racquet sports)


From about midway down the inside of the upper arm to the front side of the top of the ulna

Heavy overload from lifting (e.g., holding a power tool or meticulous ironing)

Biceps brachii

From the inner side of the scapula to the inside of the elbow

Unaccustomed vigorous repeated supination (e.g., using a screwdriver); lifting heavy objects with the hand supinated; sustained elbow flexion (e.g., playing a violin or guitar, using electric hedge clippers)


Upper outer edge of the fibula to behind the outer edge of the ankle

A fall with twisting and turning inward of the ankle; weakness from prolonged underuse (e.g., being in a cast or mostly sitting day and night); lower leg length inequality; poor arches; pronated feet

Flexor digitorum longus and flexor hallucis longus

Down the back surface of the tibia to the sole of the foot and the base of the big toe, respectively

Hyperpronation or an unstable foot; a badly worn shoe (esp. with runners) that creates an unstable gait; an inflexible shoe sole that prevents normal extension of the foot and toe joints during walking or running; walking and running on sand, especially barefoot

Tibialis posterior

Underneath the soleus and gastrocnemius muscles

Running on uneven surfaces or being new to running; excessive pronation; footwear that is badly worn or encourages turning the foot outward or rocking

Extensor digitorum longus and extensor hallucis longus

Along the shin bone to the start of the toe bones on the top of the foot

Steep accelerator pedal in a car; sitting for long periods with the feet back under a chair; nervous twitching of the foot

Tibialis anterior

From the top of the outer edge of the tibia to the top of the foot

Catching the toe on an obstruction; overuse, such as during running (leading to shin splints)


From the outer surface of the lower end of the femur to the top of the back of the tibia

Excessive pronation; playing soccer or football, running, twists or slides, especially when running or skiing downhill; tearing of the posterior cruciate ligament


Long flat muscle under gastrocnemius

Wearing high heels, slipping or losing balance; sitting in a chair that is too high; too tight and/or high stocking or elastic-band socks that may limit blood supply; ice skating, roller blading, or skiing without good ankle support; lower leg length inequalities


From the inner and outer surfaces of the bottom of the femur to the back of the heel

Physical overload and/or bad positioning of the foot (e.g., climbing steep slopes, riding a bicycle with the seat too low, wearing a cast on the leg); wearing high heels, prolonged driving in a car, certain sleep positions


From the base of the pubic bone to the top of the inner side of the femur

Lower limb length inequality; horseback riding, gymnastics, soccer (running and kicking at the same time); sitting cross-legged; sitting with the hips in a jackknifed position

Adductor brevis and longus

From the lower edge of the pubic bone to the upper inside edge of the femur

Strenuous horseback riding, in-line skating, cross-country skiing; sitting in a fixed position with hips acutely flexed and on thigh or leg crossed over the other knee

Adductor magnus

The large triangular muscle that starts at the lower inside edge of the pubis and attaches the base of the butt and the inside of the femur

Sitting in chairs for long periods; chronic hamstring strain and fascial distortion; pelvic misalignment; lower leg length inequality


From the front of the outer edge of the hipbone to the upper inside part of the tibia

Prolonged sitting in a cross-legged “tailor’s” position; excessive pronation of the foot


From the lower part of the pubis to the inner side of the knee

Slipping and resisting spreading legs while trying to recover balance; overenthusiastic exercising; structural knee dysfunction; postural imbalance

Vastus muscles

From the top of the inner and outer edges of the femur to just below the knee cap

Pronated arch; structural misalignment in the pelvis; imbalance between vastus lateralis and vastus medialis

Rectus femoris

Top of the front of the thigh to top of the knee cap

Jumping, running downhill, skiing, weight lifting, deep knee bends; lordosis (when the spine curves outward at its base; a swaybacked posture)

Thursday, March 10, 2011

My Bread and Barter

Bartering—the exchange of goods or services between two parties for mutual advantage—predates the use of currency and has probably been around since the dawn of humankind. It has even been argued that if symbiotic relationships are construed as a form of bartering, plants and animals engage in bartering as well.

According to “The History of Money,” a PBS online article from NOVA (, “Cattle, which include anything from cows, to sheep, to camels are the first and oldest form of money”—though it’s hard to imagine the kind of purse you’d need to carry a cow or how you’d get change for a camel! But even when metal coins first appeared in China around 1000 bc and then elsewhere, such as Greece, Turkey (then known as Lydia), and Persia, around 500 bc, not everyone had access to coinage, and bartering continued to be a common way for people to get things they needed in exchange for things they had. We should all be glad, in any case, that tax misdeeds are punished, today, only with fines or jail time—unlike the Danes that lived in Ireland around ad 800–900 who, if they failed to pay the Danish poll tax, had their noses slit—hence the phrase “paying through the nose”!

The overlap of bartering and currency-based economies has never ceased entirely. However, despite former Nevada state GOP chair Sue Lowden’s recent suggestion that health care costs be lowered by having people barter with their doctors (which I’m sure would be ever-so-appealing to your HMO or PPO!), bartering has decidedly not been a primary means of obtaining goods and services for people in this country for quite some time. Our current economy, though, in which money can be as hard to come by as a pocketful of sheep, has caused a resurgence of bartering.

And given this climate, I have to say that having something like massage to trade has come in very handy. I am, I think I can safely say, the envy of all my friends in fields like academia, social work, and data processing. For the most part, I’ve traded massage for personal training sessions, but I have also traded for construction work on my home, design work for my business, and getting a handmade belt made for my kickass Monster Half-Marathon finisher’s belt buckle. Theoretically, I have editing and writing services to barter as well, but frankly, not only do people have much less need for those (or think they do!), but having your punctuation checked is far less alluring to most folks than getting your stress relieved.

There are limits, of course—it’s not like I can offer a massage to someone at AT&T in exchange for some phone service or at Jewel Foods for bread and milk. But small businesses of all manner, as well as individuals, seem open to the idea of doing trades. And for me it’s been a huge help with getting some of the things I need or want that I wouldn’t have been able otherwise to afford right now.

Making sure the trades are fair to both parties is potentially tricky, but so far, using my hourly massage rate as a gauge has made it relatively easy to ensure equity. It also bears considering whether something like massage can ethically be traded for certain kinds of services, especially when there is an ongoing relationship with those you hope to trade with. For instance, I think you’d have to question the professionalism of any psychotherapist who was willing to trade counseling for massage—boundary issues spring to mind. . . .

But in the main, having a spare massage in my wallet to use for “buying” certain goods and services has been great. It really is win-win. And right now I’ve got my eye on a birch sapling over at the local garden center. Not sure how many massages it would cost (or even if they’d be willing), but whatever the price, it would be worth it just to drive the sapling home in the box of my cargo bike!

Sunday, March 6, 2011

The Wheels Roll Both Ways

The other day, my friend Brian Schab ( was coming to my house for the first time for a massage so I told him I’d pick him up at the el stop—in the bakfiets. I have been trading massages with Brian for boxing and personal training sessions, all of which had taken place at Fitness Formula Club where we both worked, until recently when Brian left there to strike out on his own. (I’ll have more to say on bartering in a future blog.)

Now, not many grown men—especially men who are martial arts experts—would be willing to sit in a wooden box on the front of a bike and let a woman pedal them down a major city street. But that’s what I like about Brian: he’s very open, not at all obsessed with showing how macho he is, and in possession of a good sense of humor. He climbed right in, sat down on the bench, and laughed about the fun of it all as I pushed the bike down off the kickstand and got ready to chauffeur him to my house.

Brian did refuse to put on the pink bicycle helmet I’d brought along for his safety. But to give full disclosure, I don’t believe it was the color that bothered him. Nor was it the possibility of messing up his hair, since he shaves his head. Rather, he was having trouble getting it to fit his head over his hat. So throwing caution—and my usually unwavering safety principles—to the wind (literally, as it turned out), we set off.

A little wobbly at first—Brian being my heaviest “cargo” to date—I gradually picked up speed as I gathered confidence. “This is awesome!” Brian shouted over the wind. “Hey,” said, “I not only pedal massage to you, I pedal you to massage.”

I only wish we'd gotten a picture. . . .

Saturday, March 5, 2011

"Beyond That Which Is Known to Man"

Along with how amazing a massage feels, the thing that may surprise massage newbies the most is how science-based this practice is. Even after putting to rest any misconceptions about “happy endings,” far too many people seem to think that a massage is only a lot of rubbing and kneading. Though that may in fact be the case with a relaxation or stress-relieving sort of massage, every legitimate massage therapist who works in a state that requires massage practitioners to be licensed will have had to complete coursework that not only teaches them how to do basic massage techniques but also gives a fairly thorough understanding of the human body. At its most basic, this knowledge allows the therapist to make informed choices about what techniques might work best for which muscles or muscle conditions and to avoid endangerment sites: areas where nerves, arteries, or veins lie close to the surface, theoretically exposing them to possible damage during, say, deep tissue work. (The actual danger involved in massaging these so-called endangerment sites have recently been called into question, however; I plan to investigate further and post my findings here.)

Especially for therapists doing any kind of therapeutic work, though, such knowledge of the human body is particularly critical. There are probably innumerable examples of why this is so, but as an example, let me address the concept of referred pain. It is a fairly well established fact that, while you may perceive a pain to originate in a particular muscle, the source of the pain can actually be in another muscle entirely. Experience and/or advanced studies teach, for example, that a client pointing to pain in his or her neck might actually have tight muscles in the upper back that need to be treated as well. There are charts that can be consulted (and committed to memory) that show common referral patterns so that a therapist will know immediately that when heel pain is the issue, the soleus muscle should also be examined. But even if such charts have not been committed to memory, just the fact that a licensed therapist knows that where the pain seems to be isn’t necessarily where it comes from gives him or her the foresight to address more than a single muscle for any given complaint.

Some massage therapists rely especially heavily on the training they received and “go by the book” when working with a client. That is, continuing with the example of referred pain, they know where the sore spots in a muscle should be and where they should refer, and they simply go to those spots. And for the most part, this should work. It certainly makes sense for a therapist new to the field to take this approach.

But the longer I practice, the more I find that my own experience as a massage therapist along with a newly discovered sense of intuition have lead me beyond the guidance of my teachers and the textbooks. The word “intuition” doesn’t quite get at what I mean to convey, though, since intuition often originates, at least in healthcare fields, in a deep understanding of the human body. I have no doubt that intuition bears on the work I do, too, leading me to a knot in a muscle, say, without me even thinking about it.

There are times, though, when the process seems nearly mystical, as though I have been led to a muscle by some power or knowledge outside myself. Perhaps it is only intuition that guides me or only past experience. That would certainly seem reasonable. Or perhaps it is a sort of telepathy between myself and the client that evolves as I put my hands on him or her, maybe even subtle cues of some sort that I pick up from the client. But I can’t tell you how many times clients have commented on the fact that my hands go directly to a knot like metal to a magnet—ergo, the Knot Whisperer! It isn’t even only that, though.

It is also the way that when I am applying pressure to a knot with my elbow I feel a vibration as the knot begins to release. At first, I thought I must be imagining this vibration or confusing a shaking in my own body with what I took to be the client’s muscle loosening. There are a couple of pieces of evidence, however, that led me to conclude that I was neither imagining the pulsing nor confusing it with some tremor in my own body. To begin with, I noted that, before I applied pressure, the muscle had a distinct area of tightness—maybe a tight strand like a piano wire running through it or a flat piece of rock—whereas afterward, the muscle felt pliable, with no hard spot in the area where I had been working. In addition, when I would return to a muscle that I felt had released a little but not entirely, clients would often report that the pain was less than when I had pressed the first time, indicating that the muscle was indeed less tight. And finally, clients who are particularly in tune with their bodies will sometimes comment that they feel the muscle releasing simultaneous with the vibration I feel.

This might raise the question: What the heck are these vibrations? Am I feeling the actual movement of the muscle fibers as they let go of each other? Is it the energy created by the fibers being set in motion that I feel? Perhaps it’s some sort of transcendental force that I am sensing? In short, it is a very good question—for which I have no answer.

If this all sounds a little Twilight Zone to you, you’re not alone—it feels that way to me, too. Since it seems to be working, though, whatever it is, I have learned just to go with the flow. Of course, after my magical mystery tour of knots and adhesions and sore spots, I can talk science with the best of them, explaining, for instance, how Epsom salts help remove muscle-tightening chemicals produced by the body through osmosis or how a knot might have formed. But during the massage itself, there is not only science at work but also something deeper, more spiritual that connects me to clients in that moment. If this is true, that would explain why the client isn’t the only one who feels physically and mentally revived by the massage, why I, too, feel a sense of peace and improved health.