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Neurocentric Approach to Massage Therapy

What I propose is an approach to these people’s painful conditions that puts the nervous system first. Specifically, I’m looking at pain that originates from a mechanical deformation of nerve tissue and that can change with position or movement.

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Our Aging Population: Mobility, Wellness and Independence

What a Great Weekend!

We are always looking at increasing our skills and knowledge to better serve our patients. On May 5th, Marcy and Mike attended the sold-out RMTBC symposium: Our Aging Population: Mobility, Wellness and Independence. 

  Registration at the beautiful Anvil Centre in New West

Registration at the beautiful Anvil Centre in New West

After a rousing First Nations welcome by Coastal Wolfpack, Isobel Mackenzie, B.C. Seniors Advocate started off the day with a fascinating, in depth look at the demographics and conditions of todays' seniors population. Her talk was a great start to the days theme that Massage Therapy can play a key role in keeping mobility and wellness in seniors thus helping you keep your independence as you age. 

The first keynote address was Dr. Lorimer Moseley, one of the most respected pain researchers in the study of pain. Dr. Moseley is a fantastic presenter. He has been a strong promoter in giving people with persistent pain more tools to manage their pain.  

 The second Keynote was with Dr. Karim Khan who is a MD at UBC as well as the editor of the British Journal of Sports Medicine. He gave a great talk on how diet and exercise is very strong medicine in preventing illness. The day ended with an esteemed panel of Andrew Nemeth, Yvonne Poulin and Dr. John Sloan who provided tremendous information on their work with seniors.

2018 speaker Kahn.jpg

simple lifestyle modulators: diet, exercise, avoidance of smoking and excess alcohol, together with moderate physical activity reduce colorectal cancer by 50%

 

- Karim Kahn

 From left: Gordon MacDonald, Peter Behr RMT, Yvonne Poulin RMT, Dr. John Sloan, Andrew Nemeth RMT.

From left: Gordon MacDonald, Peter Behr RMT, Yvonne Poulin RMT, Dr. John Sloan,
Andrew Nemeth RMT.

  Mike catching up with colleagues

Mike catching up with colleagues

We had a fun and informative Saturday! Thanks to the RMTBC who always put on a world class symposium every year. Also, I would like to thank them for some of the photos and content of this post. 

Simple Changes Can Help Shoulder Pain

By Marcy Wright Reoch, BSc, RMT

Since the beginning of 2014 I have seen more shoulder related patients than I can count. Some patients presenting with pain between their shoulder blades and others with pain over the Deltoid muscle (side or front aspect of shoulder) and sometimes the pain can travel down the arm. Whatever the aggravating case, the shoulder complex always seems to be in a compromised position.
The shoulder joint is actually made up of four joints that together are called the shoulder complex. These joints are the sternum (chest bone) and clavicle (collar bone), clavicle and scapula (shoulder blade), scapula on the ribs, and the humerus (upper arm) in the scapula.  Don’t get bogged down in the anatomy, just remember to try and keep your shoulder comfortable and open. Try keeping your chest open during your everyday life whether we are sitting at a desk, driving in our car, working out at the gym, or playing with our children. Think of what a confident persons posture looks like. By practicing to open through our chest we discourage the rounding through our shoulders and collapsing of our chest. By keeping our chest open we are pulling our scapulaes together and down our back, we are depressing our clavicles so they are horizontal when looking in the mirror, instead of being diagonal and we are positioning the head of the humerus (upper arm bone) in it’s neutral resting point in our arm pit.
When we practice poor postural habits, the alignment of our shoulder girdle is inefficient, unsupported and allows risk for injury. Muscles might be working too hard and symptoms of pain, inflammation, weakness, headache, and others may arise. Practicing good postural habits through our shoulders, chest and upper back we allow the soft tissue to rest comfortably when we ourselves are at rest. Then, when we choose to move, the musculature is in it’s most efficient, supported and strongest positioning through the range of motion.
A great way to set your shoulders into a good position is to stand up tall and engage through your abdomen. Now, squeeze the muscles between your scapula (shoulder blades), which will pull your scapula closer together and then pull them down your back. Once you have done this, acknowledge where your head is. Most peoples heads will be too far forward and will need to be pull back into proper alignment. So, think of a string pulling the top of your head upwards. This will elongate your neck and retract your chin from jutting forward.
It is important once you have an understanding of good shoulder positioning, to check in with yourself throughout the day. If you sit at a desk, you can put a red sticky dot on the monitor that will remind you to re-evaluate your posture every time you look at the dot. If you are driving in your car, place the seat in an upright position. The biofeedback from the seat on your shoulder blades and back of head will help you recognize poor posture and allow you to re-correct it. When at the gym, it is important to always set your shoulders into good alignment before entering a new set of your workout. This will help prevent injury by supporting the joint and allowing the muscles to work as efficiently in order to gain strength and endurance as quickly as possible.

Click here for : Body Awareness - Shoulder Positioning Video

Get a Grip on Osteoarthritis

By: Michael Reoch, RMT

The online medical dictionary defines Osteoarthritis (OA) or degenerative joint disease (DJD), as a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name osteoarthritis comes from three Greek words meaning bone, joint, and inflammation(1)

The common perception is that OA is caused by wear and tear of the cartilage in the joint. Eventually this cartilage is worn down and we get a “bone on bone” situation that we are told is very painful (2). Now, there are new ideas emerging on what helps to cause OA and what its relationship is to painful experiences (3).
Instead of looking at OA as your cause of chronic pain, it may be that it is the chronic pain that comes first(4)(3). Lets say you get a RSI (repetitive strain injury) from doing a task without rest, such as using a mouse too often (5)(6). This injury will cause long-term inflammation chemicals such as a group called cytokines to hang out in the area where pain is felt. Over time these inflammation chemicals may cause the tissues in the area to degenerate or break down(7)(8). This is first felt as
achiness accompanied with stiffness in movement, usually after waking up in the morning(2). Over time the OA has a central nervous system component(3). What that means is the brain and spinal chord play a major role in the pain you feel. There is an increase in cytokines in the spinal chord, which start to inhibit our natural pain dampening ability(7)(9). Also, some brain regions may have glitches in processing the signals between it and the painful joint(10). Studies show people with OA are more likely to feel pain with less provocation not just in the involved joint(s) but in areas away from the joint(s)(11)(3). There are also studies coming out that are showing that joint surgery for knee arthritis is no better than placebo surgery(12)!

The take home message is that joint damage is a poor indicator for how much pain you actually feel.

If you feel pain in an area from doing repetitive tasks you should make an effort to permanently decrease that pain: Ask your RMT for help. If you already have bony changes from OA seeing a RMT should be part of your pain management program. This program should involve tweaks to make you activities easier, exercises and massage therapy as well as any medications your doctor may prescribe. To better understand this new way of viewing OA you can watch this video or this interesting one that uses mirrors and video tricks to decrease OA pain!

 

Bibliography:

1.             osteoarthritis - definition of osteoarthritis in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia. [Internet]. [cited 2014 Mar 4]. Available from: http://medical-dictionary.thefreedictionary.com/osteoarthritis

 

2.             Osteoarthritis Symptoms and Causes | Information about Osteoarthritis Diagnosis [Internet]. [cited 2014 Mar 4]. Available from: http://www.arthritis.com/osteoarthritis_symptoms

 

3.             Lee AS, Ellman MB, Yan D, Kroin JS, Cole BJ, van Wijnen AJ, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene [Internet]. 2013 Sep 25 [cited 2014 Jan 21];527(2):440–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23830938

 

4.             Brandt KD, Radin EL, Dieppe PA, van de Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Ann Rheum Dis [Internet]. 2006 Oct 1 [cited 2014 Jan 21];65(10):1261–4. Available from: http://ard.bmj.com/content/65/10/1261.full

 

5.             Van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet [Internet]. 2007 May 26 [cited 2014 Mar 4];369(9575):1815–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17531890

 

6.             Ratzlaff CR, Gillies JH, Koehoorn MW. Work-related repetitive strain injury and leisure-time physical activity. Arthritis Rheum [Internet]. 2007 Apr 15 [cited 2014 Feb 27];57(3):495–500. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17394178

 

7.             Fernandes JC, Martel-Pelletier J, Pelletier J-P. The role of cytokines in osteoarthritis pathophysiology. Biorheology [Internet]. 2002 Jan [cited 2014 Feb 22];39(1-2):237–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12082286

 

8.             Al-Shatti T, Barr AE, Safadi FF, Amin M, Barbe MF. Increase in inflammatory cytokines in median nerves in a rat model of repetitive motion injury. J Neuroimmunol [Internet]. 2005 Oct [cited 2014 Mar 4];167(1-2):13–22. Available from: http://www.sciencedirect.com/science/article/pii/S0165572805002365

 

9.             Elliott MB, Barr AE, Kietrys DM, Al-Shatti T, Amin M, Barbe MF. Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure. Brain Res [Internet]. 2008;1218:103–13. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2553006&tool=pmcentrez&rendertype=abstract

 

10.             Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Man Ther [Internet]. 2009 Feb [cited 2012 Aug 3];14(1):3–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18511329

 

11. <span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Full Text: Recent Approaches to Understanding Osteoarthritis Pain [Internet]. [cited 2014 Mar 4]. Available from: https://jrheum.com/subscribers/04/70/54.html

 

12.            Moseley JB, Wray NP, Kuykendall D, Willis K, Landon G. Arthroscopic Treatment of Osteoarthritis of the Knee: A Prospective, Randomized, Placebo-Controlled Trial: Results of a Pilot Study. Am J Sports Med [Internet]. 1996 Jan 1 [cited 2014 Mar 4];24(1):28–34. Available from: http://ajs.sagepub.com/content/24/1/28.short

 

 

 

 

What is DNM? By: Michael Reoch, RMT


The term DNM Stands for Dermo (skin) Neuro (nervous system) Modulation (a change from one state to another). It is a method of manual therapy/massage therapy used to change the state of the nervous system from a painful hyperactive state to a less painful and reactive one through the skin receptors. Diane Jacobs, a Canadian PT with 40 years experience developed DNM as a way to better treat people with chronic and persistent pain. I have had the lucky pleasure to directly learn from and work with Diane over the last four years.
She explains the background of the method:

     

    The nervous system is comprised of 72 km of nerves, a brain 5 times bigger than it needs to be to run a critter our size. Even with all this length, even with the huge brain, it's tiny, only 2% of the whole body, but because it's busy 24/7, even when we're asleep, and because it runs all operations, it sucks up an amazing 20% (!) of all available oxygen and glucose, all the time, at speeds of about 270 miles per hour, so it's a big energy suck. You are part of it. It's not part of 'you' the way we usually think of our body parts. You are part of it. 'You' are the human bit in there, but most of it we have in common with all the other critters out there that have vertebrate nervous systems. It runs 'you'. It looks after 'you'. It keeps 'you' alive. It puts 'you' to sleep at night so it can do other things, but it keeps your heart beating and your lungs working, right? It's your survival machine and your threat detector. It wakes 'you' up in the morning because it needs you to get it something to eat. It never shuts off! It's your operating system. It's an old evolved thing and some parts are really old while other parts are quite new and they're all hooked together and sometimes it can get itself into a glitch. Usually that's all that's the matter. So, we do a systems check and help it fix itself. 
This amazing nervous system goes all the way from the brain to the skin and back. There are Billions of sensors in our skin. On average sensors are one to two cells apart. These sensors tell our brain what is happening in the world around us, what is happening within us and what is happening to us. There are many different sensors and each have specific rolls. There are sensors for just heat others for just cold, there are sensors for just heavy pressure others for light pressure, ones for quick stretch others for slow stretch and so on...

 

DNM is a method of manual care that puts the patient and their needs first. Instead of operating a recipe treatment the treatment is an interaction between the patient and the therapist. We work together to find the areas that need attention and remove the tenderness and pain felt in that area. The focus is on changing the signaling within the nervous system to decrease your pain. Pain does not happen in the muscles and other tissue but in the nervous system itself; therefore, weather or not the area of pain is damaged we can reduce that pain with DNM.
 
The manual part of DNM is to change the input signaling from some of these receptors to help the brain get a better picture of what is happening to/in the body. What we want to do is show the Brain that the area where you feel pain is not under the threat that the brain perceives it to be in. 


Some effects of an effective DNM treatment:

You will get sleepy
You will have less swelling/inflammation after
You will feel warming, an ease of movement, and a softening of hardened muscles
Your pain relief will continue throughout the day of the treatment and will usually peak 72 hours after the treatment.

See it in action

How does stress make pain worse?

Do you ever have neck or back pain after a stressful day? Maybe a headache?
Why do you get tight muscles when something stresses you out?

There are nerve receptors that are involved in pain generation. There job is to send a signal to the brain that they have been stimulated. The brain knows that a signal from these receptors in the body is usually a sign of danger and will usually then decide that the body is in pain, specifically to that area. In his talks, David Butler often brings up adrenaline sensitive peripheral nerves and the amazing ion channel turnover. Specifically, this means that these nerve receptors can become extra sensitive to the chemical adrenaline, also called epinephrine. With this sensitivity, less stimulation is needed to send a danger signal to the brain. Think of a car alarm that is set to go off when someone breaks the window. When the alarm is hypersensitive the alarm may go off if a loud truck drives by. No damage happened to the car but the alarm still went off. When we are stressed out our body produces more adrenaline. This can be a good thing because it helps us to prepare for action. Unfortunately, if a nerve is damaged, stretched, or pressed on for too long it will create "baskets" of adrenaline sensitive fibers. As David says here:
"If a person has a highly adrenoreactive area of peripheral nerve and if they are in a state of persistent elevated stress then repeated firing into the CNS will occur. And if the person is stressed, central inhibitory controls will probably be lifted anyway and a persistent neuropathic pain state may ensue."

What this means is that if someone has a nerve that is sensitive to adrenaline and if they are always stressed out then the danger signal to the brain will be almost constant. If that is the case then the Drug Cabinet in the brain will be lifted away and persistent pain will likely develop. Not fun.

Fortunately, you have some control over this. The first line of defense is to reduce your stress level  thus reducing your adrenaline. Also, just knowing that your pain is not from a damaged muscle but stress chemicals, your brain will then be less likely to think of the signal as pain. Third, if you get out and move your body in a way that reduces any specific nerve perturbations you will have less chance of a future sensitivity. Most good Manual Therapists (RMT, Chiro, PT, etc) will know how to help you do this.

Most forms of massage therapy have good evidence behind them on their ability to reduce stress. Two of the modalities Michael implements, DNM and Simple Contact, work on a model that directly addresses pain and adrenal sensitive nerves.
If you have any questions about this feel free to contact us at well+able and we would love to help you out if we can. It would also be of benefit to watch the previous stress video, the Drug cabinet video and the What is pain video.

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