New Directions

New Directions for my blog

After a long hiatus from my blog, and a five-month maternity leave from my practice I return to my work with new focus. My new blog focus is on babies through the lens of bodywork and the mind-body connection. For the time being, most posts will be explicitly and simply about babies, since I am deep in the midst of babyland as I mother my vivacious 5-month-old twins. I don’t have anything new to say, instead, I hope my viewpoint can reach people as nuggets of info on options, possibilities and reasons to consider how we treat and raise our babies, from prenatal and beyond.

What do babies and bodywork have to do with each other?
Bodywork Helps Babies Before they are Born
Babies benefit from bodywork before they’re even born. When women receive massage when pregnant, they have better relationships with their babies after birth, seen in how often they touch their babies. Babies thrive when frequently touched and held.

Bodywork and Better Pregnancies
Bodywork can help a woman be more comfortable throughout their pregnancy, can help not only with pregnancy symptoms, but help prepare the body for labor, deal with the great demands her rapidly changing body as it accommodates a growing baby, adjust and open the pelvic space so the baby can move into optimal positioning for birth.

Bodywork Helps Babies Thrive
Babies themselves benefit directly from bodywork, whether it’s a daily 15-minute massage from a parent, or receiving more specific, therapy-oriented bodywork such as craniosacral therapy from a practitioner.

Thriving continued: Bodywork and Breastfeeding
Babies need to eat. There is no better source of nourishment for babies than breastmilk. Everything should be done to help support a mother to accomplish breastfeeding her little one(s). Bodywork is a very helpful tool to the mother-baby pair with breastfeeding: if a baby is having difficulty latching, if nursing is painful for the mother, or if the baby can only nurse on one side, then bodywork is certainly indicated.

Bodywork helps babies beyond the treatment space: it also has to do with how we hold, care for, engage with and play with our babies. But more on that in future blogs.


sources:

Field, Tiffany phD. Touch. Massachussets Institute of Technology. 2001.
https://www6.miami.edu/touch-research/AdultMassage.html

Mentoring and workshops with Carol Gray. www.carolgraycst.com

Workshops with Leslie Stager. www.Touchforbirth.com

Gail Tully’s website Spinning Babies, www.spinningbabies.com

First trimester bodywork and massage

Bodywork & Massage during First Trimester Pregnancy

The first trimester of pregnancy can be the most intense phase of pregnancy for many women. We go from being our normal selves to quickly becoming someone we may not even recognize. As our bodies shift to the focus of growing a baby, there is a tremendous shift in hormones, including the hormones being made and circulated by the placenta. These hormones affect how we feel and think about things, changing how we respond to a given situation. A sappy story on the radio makes you cry, that annoying little thing your spouse did last weekend is suddenly the focus of an enraged outburst, you catch every little cold and bug that's going around, you can't eat, you can't sleep, you can't do your normal daily routine because you're exhausted. You want to vomit. You feel like a stranger in your own body, and yet no one around you recognizes what's going on unless you've informed them you're pregnant. Your growing baby is still so tiny, the changes in your body remain subtle to the outside world for weeks to come.
When I was pregnant I was in a constant state of nausea and fatigue. My rational mind took a backseat to surging, confused emotions. I was simultaneously full of happiness and fear. There were many dark thoughts: Was I ready to deal with pregnancy? Were my husband and I in a good place to support a child? What kind of mother would I be? Had I already harmed the embryo when I drank that extra glass of wine before I knew I was pregnant? What if the baby is born sick or malformed? What if I miscarry or have a stillbirth? On days when I did not feel so nauseous and fatigued I feared I was no longer pregnant - ironically feeling horrible indicated to me that everything was ok.

These are such dark intense worries to flounder in, on top of the physical misery of first trimester. But society expects us to be rejoicing and doesn't allow much space for processing a very big change. 

My experience with bodywork and massage during my first trimester

I had booked a session with a mentor practitioner of mine weeks in advance, and thus long before I knew I was pregnant. When I went to see her, instead of receiving any kind of bodywork that day, I spent the whole session talking, ranting and crying. Before going into the session I'd had no idea I could be so emotional, or that there was 'unfinished business' in my heart.b It all just suddenly came pouring out. But the bodywork-turned-talk session' was good for me, and because it was in a therapeutic setting, I could empty out my thoughts and worries without feeling judged.

Although I was used to receiving frequent and various kinds of bodywork, during my first trimester I suddenly had little or even no desire to receive touch. I also did not feel confident or trusting of very many therapists, I became very particular about from whom I got my bodywork. Craniosacral therapy was ok, and the work is inherently slow, works on myriad layers of the self, and at the very least helped me feel more emotionally balanced. 

Surprisingly gentle foot massage, which I received from friends and my husband, helped mediate my nausea. I would've loved to have it everyday. But otherwise I was not interested in relaxation or swedish massage, nor even my beloved myfascial therapy (MFT). This makes sense, since  MFT changes relationships within the body and my body was already undergoing changes; it didn't need any extra external input on how to change, at least during the early stages of pregnancy. In later weeks of pregnancy, MFT may be indicated to help the body more comfortably accommodate the growing baby (or in my case, babies).

How I work with women during first trimester of pregnancy

The most important part of my bodywork in early pregnancy is support for the new mother, as well as focusing a feeling of deep respect and deep sensitivity to the new mother and her growing baby. A pregnant woman needs our extra support in every aspect; emotional, physical, psychological, economic, social and spiritual. Also, every woman experiences pregnancy differently, and every woman will experience each pregnancy uniquely. Bodywork can help a woman connect with her body-self as it changes rapidly as much as it can help balance her emotions and spirit in a time of great and rapid change. A bodywork session may simply focus on relaxing touch or it may include more specific craniosacral and myofascial work depending on what the pregnant client is feeling at the time. 

Get Rid of a Stiff Neck, continued

This is step 5, plus two bonus suggestions

• 5) Unwinding and Relaxing (about 1 hour) - I went for a short hike with my husband at nearby Hoyt Arboretum. Being outside and walking through a forest was comfortable, relaxing and revitalizing. Whatever activities lend you a sense of happiness, relaxation and good health will be helpful. Massage, craniosacral therapy, shiatsu, qi gong, a short day hike can all help in calming your nervous system down. If you can calm down your nervous system, it will help support relaxation in your spasming neck muscles. 
• a) Bonus: Keep feet loose (2 mins) - Do self-massage, using a tennis or lacrosse ball to the bottoms of the feet for 2 minutes each side. I recommend a tennis ball or firm fingers, as opposed to other foot massage devices. Your feet, by way of fascia, are directly connected to your spine and neck. Use the cold pack on your neck while you massage your feet if you want to save time. Keeping your feet healthy in this way is an easy way to support your whole self.
• b) Bonus: Keep hips loose (6-12 minutes) - Tension in your hips (which often feels like low back pain) can translate to your jaw, neck, shoulders and head. Keeping your hips loose will support your upper spine. The tennis or lacrosse ball you used on your feet can also be used on your hips. Place the ball on the edge of your sacrum (the big flat bone at the base of your spine and between your hip bones) and rest it there for several seconds, relaxing and letting your whole body melt over the ball. After a few moments, nudge it a bit further and rest your whole body over the ball several more seconds until you've done your sacrum and hip area.

Getting Rid of a Stiff Neck

Getting Rid of a Stiff Neck

I woke up with a stiff neck this morning; ick. But after taking certain actions I am nearly pain-free less than 12 hours later. The following is how I relieved this uncomfortable, painful problem, and hopefully this information will be helpful to others. I am a massage therapist and help people everyday who are in pain. Today I was given the mixed blessing to work my professional know-how on myself. I've learned new things, and reinforced the efficacy of others. 

(Please note: I hope this information is helpful to you, but I cannot guarantee results, and please use your common sense in ensuring your own safety and well-being. (If you have other symptoms beyond just mild-moderate neck pain on one side and are concerned, check the National Institute of Health site.))

Stiff Neck Onset & Symptoms 

What a pain in the neck! says Lauren.

As in most cases, the onset of my stiff neck began  a couple days ago, but other than slightly reduced range of motion, and vague stiffness on one side, I felt no discomfort. But this morning the monster awoke and unleashed its wrath. Upon opening my eyes, I could feel the classic symptoms of a stiff neck: constant dull pain, focused on one side, and increasing to sudden, exquisite stabs of pain with certain movements. At its worst, a stiff neck hurts despite any movement, and the goal becomes to find the least painful position for your neck.

5 Steps to a Happier Neck
Luckily, there are some quick and easy steps you can take to work through and minimize a stiff neck. But keep in mind

• There is no silver bullet - you can recover from a stiff, painful neck sooner by taking action right away, but you will likely still feel mild discomfort or reduced range of motion for a couple days before full recovery, and  
• Different things work for different people - I am a licensed massage therapist and am presenting my viewpoint. You might find completely different resolutions to a stiff neck. Please feel free to comment with your methods.

Ok, you wake up with a painful and stiff neck, what to do? In general, think "Moderate Your Stress, Increase Your Circulation." Keep in mind, by moderating your (sense of) stress, your body will automatically increase circulation. The first four suggestions  should take 30-45 minutes to complete. The fifth suggestion is equally important and is dedicated to whatever you like to do to reduce stress, be it get bodywork, hike or go for a swim, etc. The last 2 'bonus' suggestions are quick and easy to incorporate, and will help your neck feel better, but less directly than the other 5 points.  

• 1) Therapeutic Exercises (8-12 minutes): move your neck in tiny, gentle, discreet contractions, using your hands to push against. Do the same for shoulders, scrunching them up and rolling them forwards and backwards, slowly and rhythmically. I recommend this video from Dr. Ben Benjamin. *** Note the model in the video does not have a stiff neck. Move slowly, cautiously and push very gently. But DO follow along, it is a very worthwhile eight minutes of your time. *** 
• 2) Cold pack (10-15 minutes): At first, it might seem more comforting to reach for the hot pack or take a hot shower, but instead use a cold pack. The cold will slow down the muscle spindle - the part of the muscle that causes contractions (and thus spasms). It doesn't have to be icy or numbing. A gel pack wrapped in a towel will feel comforting and provide relief. Please refer to my earlier blog on 'Hydrotherapy Part I' and Hydroptherapy Part II for more information, including on the use of both hot and cold therapy.
• 3) Conscious Breathing (8-12 minutes): Spend a few minutes focusing on your breath. Breathe into your ribcage and focus on mobilizing your ribs. Several neck and shoulder muscles are attached to your ribs and will benefit from this. Let your lungs gently fill and push your ribcage outward in all directions. Keep your belly soft and allow it to expand gently as well. Begin with expanding your ribcage to the front (4-5 breaths), then to the back (imagine breathing into your spine - 4-5 breaths). If it's hard to feel movement, place a hand where you want the movement to be. Also, imagine you can feel movement where you want it to be. Next, focus on your ribcage expanding sideways (4-5 times). Do not force your breathing, but rather let it grow and increase gently. (Your neck vertebrae are directly connected to your lungs via ligaments). Then relax your focus and breath normally, feeling for the change in your awareness and breathing.
• 4) Apply Topical analgesic (2-3 minutes) - I like Tiger Balm (available in many grocery stores), Sombra (available online or through practitioners, and Zheng Gu Shui (available online and through practitioners). If you don't like the smell or feel of camphor, Topricin, Traumeel and Arnica gels are also very effective. Give yourself some self-massage for a few minutes but don't overwork your muscles, you might just bruise the already irritated tissue. 

These first four suggestions can be accomplished in about a half hour or forty-five minutes. They should be helpful, if anything hurts, then stop. And though you may be busy, it's better to take action sooner than later. Repeat at end of day and the following morning. The last suggestion is also important, but may not be as easy to squeeze into a full schedule. But if that is the case, then it may be an indication that it is exactly what is most needed. 

Step 5 warrants a post all its own. Check it out here. 

Event Weekend!

Event Weekend!

This weekend is the annual Gulch-O-Rama, where the residents of Sullivan's Gulch gather to show off their craftsmanship, artistry and talent. There will be music, artwork, jewelry, pottery, photography, and at least one massage therapist! I will be in attendance, massage chair at hand, to demonstrate my own expertise at the art and craft of event massage and promote the opening of my new office location at 2430 NE Broadway St in NE Portland. The block party is from 4p to 9p this Saturday, Sept. 8, 2012 at NE Clackamas St, between 24th and 26th Avenue blocks. It is a potluck event, so come see some neighborhood art and eat some good grub! My husband will also be there with savory treats from Esparza's Traditional Texmex Restaurant. Come check it out!

Runners - (Graham Shofied, at flickr)

For the runners and spaghetti-eaters among us, meet me at the Old Spaghetti Factory this Sunday morning, Sept 9, 2012 for some volunteer table massage in celebration of the Pints to Pasta 10k footrace. I've volunteered my massage services at several of the Run With Paula events and they are always a lot of fun and well-attended. For post-race or workout people, specific sports massage can help relieve cramps, reduce aches in over-used muscles and improve the body's transition after an adrenaline-filled six-mile run. For those just there for beer and pasta, massage promotes your body's parasympathetic response. What does that mean? It increases your digestion (among many other functions), thus helps make room for all that good eating you'll be doing.

 

Hydrotherapy Part II

HYDROTHERAPY PART II

(Here's the link to Hydrotherapy Part I)

This is a continuation of an earlier post, wherein I described the use of warm and cold packs or a combination of the two to help alleviate pain and speed healing. Here are some further thoughts, in Q & A form, on using hydrotherapy:

Q: Why should I use Hydrotherapy?
A: No doubt about it, hydrotherapy takes a little time and effort. So why bother? Pain is a great motivator, and hydrotherapy is an excellent, easy, non-invasive, cheap and readily available way to quickly reduce pain (and perhaps get a good night's sleep). Just using hot and cold packs to address a specific area for a few moments, or soaking in a warm tub and rinsing off with a 30-second cold shower for a full-body treatment can bring comfort and relief.

Q: How often should I use hot/cold packs?
A: It is typically recommended to administer hydrotherapy for 15-20 minutes every hour for three hours per day. I personally recommend do just do what you can, as far as you're motivated, and don't beat yourself up if you only do a little bit. If all you can manage is to slap on a frozen bag of peas to your shoulder while you catch the evening news or read an article, that's great.

Q: How long should a hydrotherapeutic session last?
A: Hydrotherapy sessions should not extend past 20 minutes per treatment. If you're taking hot bath, don't over do it. If you have a cold pack applied, do not fall asleep with it on, if you're using a heating pad, do not forget about it or fall asleep with it. Too much of either hot or cold therapy can cause unnecessary inflammation, and thus cause pain and inhibit the healing process.

Q: How do I know which to use, Hot? Cold? Both?
A: Go with what works best for you. Be fair to yourself and give each a try. I am a big advocated of contrast hydrotherapy (using both hot and cold), but more than anything, I recommend using what works best for you. Remember, contrast therapy uses a 3:1 ratio, with warm being applied for 3 minutes and cold for 1 minute. You can play around with the timing, just stick to the ratio of 3:1 and always end on cold.

Share Shiatsu

I just can't get enough of the Eastern modalities this summer:

I went for a Shiatsu session today from one of my favorite practitioners, Susan Hare. The session was absolutely lovely. Shiatsu is a traditional form of hands-on therapy from Japan, by way of China. I studied Zen Shiatsu briefly under the patient tutelage of the lovely Sande Mullany and remain curious and fond of it, but I do not use it per se in my own practice (though the three months I spent studying have proven to be instrumental in my work)

In Shiatsu, like in Thai Massage, the client remains clothed and the work is done on a traditional futon mat on the floor. At the beginning of the session, the practitioner reads the 'Hara', or abdomen to assess what work might best benefit the receiver. This is usually just gently placing a hand on the abdomen and 'listening' and observing. Shiatsu systematically works the 12 meridians, or energy pathways (pretty much the same meridians as in acupuncture), and the Hara represents all 12 meridians in a specific arrangement.

In Zen Shiatsu, the treatment, after the Hara assessment, begins on the front of the right leg and then the left, moving down from the upper thigh to the feet, with the intent to 'ground' the receiver (by working the Earth meridians of Stomach and Spleen) The practitioner uses her fingers, thumbs, and palms to press and sink down into the meridians. Then the right arm, followed by the left arm are worked (the Fire - Heart and Sm. Intestine - and Metal meridians of Lung and Lg. Intestine). Finally, the client turns over onto her stomach for work down the back, hips and legs (the Water meridians of Kidney and Bladder). Finally, the client turns over for some work on the neck and head. Mmmmm! Maybe that's the best part. When working the neck and head, a silk cloth is used for the finger-pressing up and down the neck, along the scalp and face. The scarf or towel can even be used for adding a little traction to the head. Ahhh, great stuff!

I highly encourage everyone to experience Shiatsu - sooner than later!

Standing West, Looking East

It's true I've referred numerous times lately to Traditional Chinese Medicine, with references like Fire Element, Qi Gong and Traditional Chinese Medicine. But really, i know only very little about such things. After all, what's my brief study to a philosophy that was 4000 years in the making? And it's fun and satisfying to learn and involve myself in a completely different (and yet not alien) paradigm. As well, the (traditional) Eastern-based paradigm is rooted in finding harmony with the world around us. This segues nicely with the work I do, which is also rooted in creating and supporting balance for our selves and the world we must engage in. 

Beyond some personal dabbling, my practice and the bulk of my pursuits is based on Western-developed concepts of bodywork therapy. Though I studied Swedish massage techniques for my basic training, I've since moved on to more in-depth techniques, including craniosacral therapy, myofascial therapy, and deep tissue. These forms, known as modalities in health-jargon, provide me with techniques that I use with skilled and experienced discretion. I combine and use them as a painter uses her paints on a pallet - deemed appropriate to a given setting, or to achieve a desired outcome. I seek to open up possibilities and invite change in the soft tissues - nothing forceful or dominant. Just making suggestions, in a non-verbal sort of way, my fingertips, to your muscles, tendons, ligaments and fascia. The results are often profound.

Fire and Laughter

No, this isn't about walking over fiery coals, but it is about a challenge, of sorts.

In honor and recognition of the Fire Element, which in Traditional Chinese Medicine is represented by the hot and sunny months of summer, I am emphasizing laughter in my daily routine. Laughter and joy are the sound and emotion associated with the Fire element.

I need at least a giggle a day to get my minimum need of vital joy and well-being. Who knew I'd have to make an effort to ensure this 'kleinigkeit' in my day? Shouldn't laughter, at least a chuckle, be easy enough to come by? It's not like I need to hoard it and save it for a rainy day. But I've found I have to make a conscious effort to make it happen. But practice makes habit and good habits lead to success. Laughs away!

So where to start?

Words:
The Funny Times (www.funnytimes.com)
Calvin and Hobbes
Puns
Dr. Know of the weekly Willamette Week (http://www.wweek.com/portland/articles.sec-121-1-dr-know.html)

Performace:
Mel Brooks (Blazing Saddles, Space Balls, Young Frankenstein, to start)
Kids in the Hall ('Buddy Cole and the Dinosaur', Chicken Lady sketch, etc.)
Colbert Report
Ministry of Silly Walks (Well, really all of Monty Python)
The 3 Stooges
Jim Carroll's ("A Day at the Races," etc. from Praying Mantis)

Links:
http://www.snorgtees.com/
www.fark.com (esp. the photoshop contest)

Other:
Getting an unsolicited piggy-back ride from my husband
Talking with my oldest, bestest pals

Maybe you have some dependable sources of giggles and laughter? Nothing violent, political, gross or sarcastic (though these things can elicit laughter too sometimes), just good, healthy fun?

Me and Qigong

After two years of saying 'shoulda, coulda, woulda' about learning some qigong for self-care, I finally jumped in to the summer session taught at Oregon College of Oriental Medicine (OCOM) in late July. The specific form we learned was Hui Gong (pronounced "way gong"), which means "Heart Wisdom" qigong and focuses on the energy of the Heart. This form is taught in the summer as the 'Heart' is a part of the Fire element, which corresponds to the hot, bright month's of the year's cycle, summer.

Qigong from afar looks kind of like a person pretending to swim very slowly underwater, or perhaps dancing among the clouds with some flourishes of the hands thrown in for poetic dazzlement. Really, it is a beautiful form of combined mindful exercise, breath and meditation. Each movement and repetition has a very specific wisdom, purpose, meaning and execution.  I find it helpful, and very interesting, to know the story behind each motion, but it is not necessary to understand the background in order to get the benefits of the exercise.

I was finally prompted learn and practice qigong because of a worsening overuse injury to my shoulder. Indeed, the exercise worked wonders and I am amazed how quickly I began to heal and feel less pain immediately after the first class. Ideally, I would practice the Hui Gong routine daily (it takes anywhere from 20-40 minutes for a sesssion), but I usually manage 4-5 times per week.

Also, in the Traditional Chinese Medicine (TCM) paradigm, the physical is not separate from the mental, emotional and spiritual health of a person - all of these things combined is well-being. So while my qigong exercise helps with my shoulders, arms and neck, it also helps me to deal with stress, be more communicative, and especially, achieve a deep sense of self-security and calm, as I've noticed over the past several weeks.

Hydotherapy, Part I

"Hey Kate, What is hydrotherapy and how should I use it?" you might ask. "Hydrotherapy," I would answer, "Is the use of water for therapeutic reasons"

The term can refer to drinking extra water to help flush toxins from your system, released during a bodywork session. But more often hydrotherapy is used to describe using heat or cold to encourage the body's healing process.

Hot (Thermo) Hydrotherapy
Using heat can be very comforting to tense muscles, though I would not encourage it on injured muscles alone. Contrast hydotherapy (the use of both hot and cold) is ok, but I am getting ahead of myself. The idea with using heat is that it increases blood flow and thus nutrients, hydration, white blood cells and other good stuff to an area that needs it. Hot hydrotherapy can come from an electric heating pad, a hot water bottle, hot tub, sauna, steam room, hot shower, etc. As with all forms of hydrotherapy, it is key to not overdue it; do not use heat for more than about 15-20 minutes, or else it will increase inflammation in the area and be counterproductive to healing and relaxation. 

Cold (Cryo) Hydrotherapy
Using cold packs is great! I highly encourage using more cold packs - this coming from someone who used to hate even the thought of ice packs. But I've learned, you don't have to use ice - just using cool is even beneficial. Cold therapy slows down muscle spasm, calms down the inflammation response, and actually can increase circulation, just like hot hydrotherapy. Cryotherapy can come from ice cubes in a plastic bag, a cold pack, a frozen bag of peas, or even submersion in a bathtub of cold water, augmented with several trays worth of ice cubes. Again, do not overuse any form of cold hydrotherapy - use cold for max 15-20 minutes, otherwise it becomes counterproductive, just like in hot hydrotherapy.

Contrast (Hot-and-Cold) Hydrotherapy
Contrast therapy is a really great way to get the benefits and comforts of both hot and cold hydrotherapies. The cold calms down spasming muslces, while the heat keeps from the area from  up too much. Contrast hydrotherapy is invigorating and the routine ensures that you don't get bored or distracted and leave a cold or hot pack on for too long. It can be seen as more work, but if you use a shower to switch from cold to hot and back again, it can be a pretty convenient and effective way to get the maximum benefits from both hot and cold. There are two 'rules' to keep in mind with contrast therapy. 1) Use the ratio of 1:3 for cold and hot therapies. Use a cold pack for 1 minute, followed by a hot pack for 3 minutes, and so on. Or use cold for 3 minutes and warm for 9 minutes, etc. And 2) Always end on cold, to discourage inflammation.

Handedness

In my last post I talked about overuse injuries. On a somewhat related topic, I wanted to discuss briefly handedness. Most of us are right-handed. By most of us, I mean all mammals (if not also even the larger animal kingdom including birds, lizards, amphibians, insects, etc.) are right-handed. Researchers have observed animals, such as hunters, having a dominant paw/hand with which to grab hold of prey, be it a cheetah or a chimp. Even killer whales have been observed to have handedness, but instead of hands, or even fins, most killer whales will attack their prey with the right side of their jaws. This fact has been deduced by examining the bodies of orcas that have washed up on shore - the majority have dominant scarring on the right side of their mouths, presumably from their prey fighting back.

Why handedness? Why not use both hands equally? One common explanation is straight out of a modern economics text: a dominant hand is a physiological expression of specialization. Extending the theory to our hands, if you have two hands and do all tasks equally with either hand, then your accomplishment of tasks will be mediocre, or average. But if you allow one hand to dominate, to become specialized, then it can excel at tasks that require either extra dexterity (dexter coming from the latin for 'right') or strength, or both. 

In the uniquely upright human body, our handedness goes beyond just a dominant arm and hand - it usually amounts to a full-body spiraling affect, usually starting in the hips, if not even in the legs and feet, and just to make things fun, the body will throw in some counter-rotation, often masking the underlying primary rotations. In a word, we are all a bit lopsided, one way or another. But with this lopsidedness comes heightened skill, and thus, more likelihood of success, be it catching a fish in your mouth if you're a porpoise or sticking a forkful of food in your mouth or writing a birthday card to your grandma if you're a homo sapien.

Homework: Just for kicks, try walking 'left-legged'. Walking seems like it would be a pretty even-footed endeavor, but actually if you are right-handed, you likely walk with a dominant right step. Try walking for a block with your left leg being the dominant limb. When I do this exercise, it takes a bit of concentration, even just the minute it takes to traverse a block. I also feel like my hips straighten out, comparatively, though I don't notice them being crooked when I walk normally. And I can feel my torso lengthen as my deep core muscles (in this case, the psoas) become more evenly engaged. Even better, when I think and run left-legged, my poky jogger's pace actually increases, without any extra effort, other than the mental concentration on my left leg. That, I think, is pretty darn cool.  

Overuse Injuries

A while back I overworked my shoulder to injury. It took about 6 weeks of overuse. We tend to think of injuries as being a traumatic one-time event, like stepping off a curb funny and twisting an ankle, or slipping and landing on your wrist with a bang. But our bodies can suffer injury from overuse, or what is also called 'wear and tear,' as well. Overuse injuries can be just as painful and debilitating as a sudden traumatic injury. Overuse injuries occur when we perform an action over and over again, and don't provide the conditions for the soft tissues to heal. Often poor body mechanics can be a major contributor to wear and tear injuries.  Also, it is common to develop compensation patterns, such as using other muscles that are not as strong or designed for the task, further complicating the matter.

How can we heal from an overuse injury?

First things first: get extra sleep and extra water. Treat your body like it's sick, cuz it is. Instead of your white blood cells attacking foreign invaders, they are attacking the damaged and destroyed cells at the site of your injury. And of course, limit, reduce or stop doing whatever action led to the overuse injury - which is easier said than done. But however you can creatively avoid or limiting further damage to the area, the better. This does not mean to not use or move the injured area. Far from it. If you stop moving the joint or limb, you will only encourage adding insult to injury by inducing long term joint immobility. Frozen shoulder, anyone? I don't think so. Keep moving! Go for a walk, swing your arms, roll your wrists, rotate your neck and  head, any kind of slow, gentle movement that explores the range of motion of a given joint is vital - and do it at least daily. Better yet, find a Qi Gong class. Qi Gong is a slow, methodical exercise, developed from thousands of years of experience and wisdom in Traditional Chinese Medicine (TCM). Use Hydrotherapy, meaning use cold and hot packs to increase circulation to the area. And get some good bodywork. I went for a energetic-form of Shiatsu for my shoulder injury - it worked beautifully. But any kind of therapeutic massage will help balance the soft tissues, boost endorphins and encourage healing by promoting the parasympathetic response. And finally, find out, either from a massage therapist, a trainer, a physical therapist, or any licensed professional who works with and understands the musculoskeletal body how to balance the muscles around the injured area. 

Not Knots

I get asked all the time what a muscle knot is. Believe it or not, there is no scientific definition of a knot. It is an everyday term we use to describe that hardened lump of soft tissue we find often in our necks, backs and shoulders, though a knot can occur just about anywhere. My non-massage therapist husband explains it as good as anyone: "a knot is when my muscles are being stupid and they won't relax."
  
In massage school, you never find out what a knot really is; 'knot' is not a term to be found in the glossaries of any massage textbook, much less Anatomy & Physiology, nor Pathology books. Nonetheless, as a massage practitioner, I can palpate the knots that my clients feel and expect me to rid them of. And it is my professional obligation to record these so-called knots on my chart notes. But there is no medical terminology equivalent to 'knot,' I cannot report finding a "moderate-to-severe knot in the lateral aspect of the right rhomboid major."

Knots exist, yes, but what is a knot if it is not a knot? A knot can actually be a few different things, and it is my job to differentiate and treat the lesion, or abnormal tissue, accordingly. Here is a non-exclusive list of what a knot can actually be:

Knot I - When muscles "are being stupid and they won't relax," is otherwise known as Hypertonic muscles. Hyper (Over) and Tonic (the tone of a muscle) is when a muscle is contracting too much and is staying in a shortened state.

Knot II - The opposite of a Hypertonic muscle is a hypotonic muscle, hypo meaning 'under'. It would seem a contradiction that an underly toned muscle would feel 'tight' and 'knotted', but often it is the hypotonic muscles that cause us the most pain. Hypotonic muscles are overly lengthened, stretching beyond comfort in order to compensate for the hypertonic, or overly-toned muscle that lay opposite of them.

Knot III - Adhesions, as the name implies, are glued bits of soft tissue, specifically the connective tissue called fascia. Adhesions of the fascia can occur within a muscle, between two or more muscles, and even between muscle and viscera. Ideally, all the tissues of our body, despite whatever names and distinctions we've created for them, should slide and glide past each other, like wet spaghetti noodles. But when our bodies become dehydrated or suffer trauma, or have reduced circulation because of lack of movement, the 'spaghetti noodles' of our tissues dry out and get glued, or adhesed together. These adhesions are palpable and lead to reduced range of motion in our joints and less power in our muscles.  

Knot IV - Trigger Points are special knots. They really do feel like tiny, tight knots deep in the muscle belly, and sometimes like a taut band, like a fishing line. Trigger points occur specifically in the muscle tissue, unlike adhesions, which can occur in the connective tissue, but like adhesions, are also caused by dehydration, trauma, and/or lack of mobilization of the tissues. Trigger points are unique in that they send referral pain to other area of the body when palpated.
  
Each of these 'Knots' is different and should be approached and treated as is appropriate.

Some Fun Features

Some (new) features offered at PDX Massage Therapy to help things run smoothly and happily, for both me and my clients:

• Accept Credit Card and Debit Payments: For over a year I have been using the Square device to accept credit and debit cards. Square, which is now on the verge of becoming ubiquitous, is a tiny chunk of white plastic that fits into the headphone jack of your smart phone or tablet and reads the magnetic stripe credit cards when you slide them through. Payment is immediate and secure and you can receive your receipt via email or text message. This little device runs smooth and true and has proven entirely reliable.

• Schedule your Appointments Anytime - Online -  I have integrated online scheduling on my website, using as service called Full Slate. I tried out a few other online schedulers, such as Schedulicity and Simplify This, but Full Slate won out because it does not require you to set up an account in order to book. You do have to supply either a phone or email, but you don't have to create yet another online account. The web app is also very easy to use, intuitive and fairly customizable. The smart phone app is not great, but it looks like there have been some recent improvements made.

• Increased Availability - I am now available 5 full days per week, up from just 2 days week. I made the jump and signed a lease to an office in a new location and can now determine my own schedule and focus my time and energy on my own practice and business fully 100 percent.

• Enhanced skills and knowledge - Since the new year, I've taken workshops in myofascial techniques to specifically treat Headaches, TMJ pain, and issues involving the Shoulder, Arm and Wrist, which is in addition to some of the other workshops I've taken to address issues in the Neck and Head, Back, Hips, Legs, Knees and Feet. And there's so much more to learn! I am a bonafide massage nerd. I can't get enough of the stuff. Thus the workshops are supplemented by time spent studying articles, books, research, webinars and with other practitioners.

New Things

This year has been one to embrace the new: in February I exchanged vows with the love of my life beneath the vaulted timbers of the Redwood Forest in Hoyt Arboretum. We were treated to a rare dusting of snow, while golden sunlight simultaneously shone through a veil of low clouds and tall trees. Drops accumulating on the pine needles high above fell on our heads, but otherwise we stayed dry, if not very warm. And so I am newly a wife, and even have a new name. And with this new name, I have new articles of daily living, like a driver's license, check books and an address: I am Mrs. Dennington now, it still sounds so formal. As well, I am learning a new signature and opting to change my name on Facebook, Gmail, my website, and all my other online affiliations. The process can be slow, but perhaps after a few decades of holding one name, trying to change it won't happen all at once.

Another exciting new change is the expansion of my practice. In June, I signed a lease for a charming office in historic Dahl Building in the Irvington neighborhood of NE Portland. I spent much of June and July painting, furnishing and setting up shop there. And with this new space for my practice, I now also have much more time. Before, I only had 2 days a week with which to practice, now I am able to practice and offer bodywork services full time. This is a tremendous step forward along my path as an independent practitioner. My goal is to have a fully-self sufficient practice by the end of this year. I am well on my way to attaining it, so long as I keep my eyes and my heart open.

On the Surface

Used by permission, ABMP.com

As a massage therapist, I am proud to provide wellness services and promote health in my community. Part of how I do this is by the choice of products I use, or rather, do not use. Many people associate massage with having oil, lotion or cream slathered up and down their backs. This can feel wonderful and serves to help promote relaxation, release endorphins and spur the body's self-healing capabilities.

The kind of massage I typically practice, what I refer to as bodywork, does not employ the use of lubricants, or at least, seldomly so. Using myofascial, deep tissue and craniosacral techniques, the intent is to change the relationship of the tissues within the body for better balance and a healthier dynamic. This kind of change is impossible to accomplish when lotion or oil is used; my hands merely slide over the surface remaining in the superficial layers.

When I do use lubricant, I make every effort to ensure it is safe for the client, and for me as well. I strongly encourage all massage therapists to research and consider the kinds of lubricants they use, again for the safety of their clients, but also for their own occupational safety. After all, those that do use lubricant have direct contact with it for hours at a time, day after day after day.

A great place to research the safety of your lubricant ingredients is the Cosmetic Database, located on the Skin Deep page of the think tank and advocacy group Environmental Working Group (EWG). There one can search many thousands of personal care products and find out about the safety of the chemicals used in a given product. Each product is given a rating between 0 and 10, 10 being the most hazardous. If a specific product you're interested in is not listed, you can search by the individual ingredients listed on the packaging.

Used by permission, ABMP.com

It is important to note that personal care products are not regulated the same way our grocery items or drugs are. In fact, there is very little regulation of the products we put on our skin, hair, lips, teeth, nails, eyelashes, underarms, etc every day. It is also important to note that our skin is in fact permeable, thus what we put on our skin can wind up in our bodies and affect our system (that's how nicotine or birth control patches work).

I like the Cosmetic Database for its robustness and usability, and for the effort EWG puts into explaining its methodology in researching and reporting and for its disclosure of what is known (or not known) about these chemicals. Information available on a given chemical is a large factor in how it scores on the database.

It is my professional obligation to ensure the safety and quality of care for my clients (as required to hold a license in the State of Oregon) . Part of this is taking the time to research and know the products I use.


Thanks for reading!

All content authored by Kate Barkume, Licensed Massage Therapist, Portland, Oregon

Bodywork or Massage?

A few weeks back, I was sitting with a dear friend of mine in one of our favorite haunts in NE Portland. Following a late afternoon romp in Laurelhurst Park, avoiding duck poop as we tossed a nerf ball back and forth, we were enjoying a brew and a plate of nachos. Perhaps we were discussing possible ideas for a logo for her new business, or our endeavor to train for and run a 1/2 marathon, when out of the blue Lauren, my friend, said, "I think I'm starting to know what you mean when you say 'bodywork'."

Ah, yes bodywork. After going to school for 'massage therapy' and becoming a 'licensed massage therapist', my friends and family don't quite follow when I describe what I do as bodywork, not massage.

The term bodywork can be understood in two ways: it is an umbrella term, encompassing all forms of manual therapy, including massage. It is also the term I use to distinguish and differentiate myself from the word massage. A contradiction this would seem? Allow me to elaborate.
 
In broad terms, bodywork is an umbrella term for all kinds of manual therapies. Manual therapy is the use of skillful touch to deliver treatment, describes Deane Juhan, in Job's Body: A Handbook for Bodywork. Thus, as different as these practices are from one another, Swedish (relaxation) massage, Shiatsu, Feldenkrais, Rolfing & Structural Integration, Visceral Manipulation, Trager, Craniosacral and Aston Technique can all be labeled under the umbrella term of bodywork (and these are just a few of the many hundreds of manual therapies and modalities that may fall under bodywork). I even consider private instruction in Pilates and Yoga as forms of therapeutic bodywork.

And yet, bodywork is also a very specific term, more specific and very different from what massage, unfortunately, has come to imply.

Going back to Juhan's description of bodywork, he writes that it conveys the 'idea of the body being touched in a deliberate fashion for specific results,' meaning there is a process of intention for both the the client and the therapist. The client is not passive, like a slab of meat on table, the therapist is not impassive, like a lump of stone. A session of bodywork is the meeting point between the needs of the client and the methods and the discretion of the therapist. 

Bodywork is a practice that one builds upon over time. Meanwhile, massage is what is innate to our human selves and we use it on ourselves or to comfort others when we hurt physically, emotionally, spiritually. A person benefits enormously when they receive respectful, safe touch from any other human being. But bodywork is not innate to us, it is a combination of knowledge, skill and study that are developed over time and practice. Bodywork is about intention.

An example of what I mean is that a person may come in with a knee that becomes painful during running. I could massage the area around the knee, the quads, the IT band, the hamstrings and perhaps the sensory input will assuage the pain for a while and relieve muscle spasm. But the knee will more than likely continue to cause pain when that person runs again.   

In contrast, with bodywork I assess the factors that may be causing the knee pain, often which are not at the knee, but come from the hip and/or the foot, and use methods to recreate balance there. When the foot and the hip are in balance, the knee will naturally and quite happily come into balance. And is more likely to stay in balance, as the factors causing it to be imbalanced have been addressed.



Thanks for reading!

All content authored by Kate Barkume, Licensed Massage Therapist, Portland, Oregon

Adding Assetts: Advanced Hip and Pelvis

Last week I learned some new powerful and refined techniques for assessing and treating troublesome hips. Advanced Rolfing instructor and head of the certification program Advanced Myofascial Techniques, Til Luchau, demonstrated techniques to release tension in the soft tissue around the hips, as well as releasing the joints within the hip and pelvis.

Along with adding a couple dozen techniques to my repertoire, I also learned how to quickly assess and find restrictions in the hips and pelvis, allowing for more focused work where it is needed most. Even in the short time since implementing this new know-how into my work, I've enjoyed seeing my clients walk out of sessions feeling better and moving more freely.

The hip bone, also called the innominate, meaning 'nameless' in Latin, is actually 3 bones that fuse embryologically: the iliam, ischium and pubis. The two innominates join at the pubic symphsysis joint in the front and the sacrum in the back.

Some brief Anatomy:

The hip/pelvis system is marvelous and complex. It is where our upper body meets our lower body and its unique wide, bowl shape allows for our distinctly human upright nature. The hip socket is shallow and dish-shaped, allowing the femur that articulates with it great flexibility to move freely in many directions. Freedom of motion is important and a key aspect of the hips, but also has an inverse relationship to stability. Therefore strength in the soft tissues, the ligaments, tendons, muscles and enveloping fascia, is required to create stability in this vital structure, which must negotiate the functions of mobility for our legs to carry us where we want to go while also giving support to our heavy upper body. Altogether, about 20 muscles work in a harmonized symphony to create or prevent movement in our hips as we move and stabilize ourselves throughout the day, according to J. Earls and T. Myers in Fascial Release for Structural Balance (2010).

Where the hips are in space, whether we are standing, sitting or in motion, also determines the alignment of the spine and upper body. The base of the spine, the sacrum, articulates with the two hip bones creating the sacroiliac joint (SI joint). The sacrum is also the platform for the first lumbar vertebra (L5). If the hips are tilted to one side, often due to tightness around the hip socket, then the sacrum is also tilted and the spine must compensate for it by curving and counter-curving. The pelvis also tilts front to back. A little tilt is good, and creates relaxed curvature of the spine. But too much (sway back) or not enough will put tension on the body as it tries to maintain an upright posture. It's good to keep your hips relaxed, mobile and balanced, because their condition affects your whole body!



Techniques and Applications:

While at this Hip/Pelvis workshop, one of my favorite techniques I learned is actually a ligamentous release (ligaments are the dense connective tissue the link bone to bone). The sacrotuberous ligament attaches the bottom half of the sacrum, which is the fused base of the spine, to the back and bottom of the hip bone. This ligament anchors the sacrum. Working to release this ligament can help relieve tension further up in the low back, along with tension in the musculature of the hips, such as the gluteus maximus.

This technique, along with the others I learned last week, are helpful in balancing and mobilizing the hips, including in treating sciatic pain, which is a common condition, causing pain, usually on one side, starting in the glutes and down the back or side of the leg, and sometimes into the low back area.



Thanks for reading!

All content authored by Kate Barkume, Licensed Massage Therapist, Portland, Oregon

Square Power

The Square swipes debit and credit cards.

I am really excited to be able to now accept debit and credit cards (Visa, Mastercard, AmEx, Discover) at PDX Massage Therapy! I've been using "Square" for a couple months now, having learned about it from a client. The card reader, which attaches directly into my droid phone, is small and works via a simple, free app. I've been happy with the utter simplicity: all I need is my phone, the Square device and with a swipe of the payers card, I can accept their payment in less than 30 seconds. I spent so much time researching Paypal, Google Checkout and other companies offering credit card processing, and was dismayed by what an unwieldy process it is. But for my simple transactions, I've finally found a simple device and service. I can recommend square to any other massage therapist, or small business owner who needs to process simple payments in person. Here's a recent review from PC Magazine.




Thanks for reading!

All content authored by Kate Barkume, Licensed Massage Therapist, Portland, Oregon