About My Massage Practice
I’ve been a massage therapist since 1991 and have worked at some of the top spas in the country; The Chopra Center, Cal-a-Vie, The Greenhouse, Bodywork Emporium and Equinox to name a few. Although my practice now focuses on somatic education, rehabilitation and Chinese medicine, many clients still see me for their weekly feel-good massage appointments.
Because my background extends far beyond traditional massage therapy, it's important that clients clarify their goals when scheduling their appointment.
When most people think of massage, what comes to mind is understandably, Swedish massage. Swedish massage is by far, the most common type of massage in the US. But Swedish massage is only one type of massage and although it feels wonderful while being performed, is arguably the least effective for addressing musculo-skeletal and other issues.
To this end, it's important that clients be open to other approaches than what they may be familiar with or accustomed to.
For a detailed explanation of what to expect during a bodywork session with me, please see the section on Somatic Integration.
Massage Therapy, Manual Therapy, Manipulative Therapy and Bodywork
Massage Therapy, Manual Therapy, Manipulative Therapy and Bodywork are largely interchangeable terms. While there are certainly some clear distinctions between them, each involve various forms of hands-on work that can vary from barely perceptible to extraordinarily aggressive.
Manual Therapy and Manipulative Therapy are generally used to describe medically based hands-on work. The techniques are often highly technical and intended to address a specific problem – think chiropractic adjustments and stroke rehabilitation. Modalities in this category that I have studied include various Joint Mobilization Techniques, Cranio-Sacral Therapy, Visceral Manipulation, Lymphatic Drainage, Myofascial Release, Muscle Energy Technique, Functional Technique, Autonomic Regulatory Technique, Positional Release Technique, Neuromuscular Therapy and Movement Education.
Post surgical massage or Lymphatic Drainage Massage is a very gentle form of hands-on work that many people find subtly pleasurable and deeply relaxing.
There are a few different approaches to lymphatic drainage but they all emphasize the same principle of gently mobilizing and reducing fluid congestion with slow, rhythmic tissue compressions.
The amount of pressure is usually comparable to the pressure you might use to delicately massage your eyelid over your eye ball. However, you can also use significantly more pressure to move your eyeball in certain directions, which is less about massage than about moving tissue. The same principle applies to working on the superficial and deep lymphatic flows of the body.
It may be helpful to imagine a puddle of water on your kitchen counter with a piece of saran wrap placed over it. Lymphatic Drainage Massage attempts to influence the movement of the puddle without compressing the saran wrap against the counter and obstructing the flow of water underneath.
While the available research data remains inconclusive as to the precise benefits of post-surgical massage, most plastic surgeons agree that it's extremely beneficial for post-surgical recovery. In my own experience of working on literally hundreds of post-surgical patients and post-liposuction cases in particular, lymphatic drainage can have nearly miraculous results in reducing pain and fibrosis while normalizing tissue appearance.
Trigger Point Therapy
The term "trigger point" was first coined by Dr. Janet Travell in 1942 to describe what she recognized as a common cause of musculo-skeletal pain. Dr. Travell's biggest claim to fame was being President John Kennedy's personal physician.
Trigger points can occur in any connective tissue of the body but are most common in skeletal muscles. Muscular or myo-fascial trigger points are distinguished from trigger points in other tissues like skin, ligament and bone by a variety of factors. When trigger points are palpated or pressed, they feel like a hard, gummy nodule within the muscle and often cause the muscle to quickly contract. When the contraction occurs locally in the muscle being palpated, it's called a twitch response. When the twitch response occurs across multiple muscles, it makes the entire body appear to jump and is hence called a jump sign. Another phenomena of palpating trigger points is that pressing them largely reproduces a persons pain pattern, which is often located quite far from the actual trigger point.
Trigger points are positively diagnosed as the source of pain when they elicit a twitch response or jump sign, and most notably, reproduce the pain pattern.
These images show the pain distribution from trigger points in two different muscles. Note how the pain may appear quite far from the actual trigger point.
The X's represent the Trigger Points. There's no difference between the black and white X’s. The red shaded area is the referred pain caused by the Trigger Point and the darker red means more people experience pain in that area.
Levator Scapulae Scalenes
Trigger Point Treatment Strategies
The most common treatment strategy for trigger points uses heavy pressure directly on the trigger point for anywhere between 20-120 seconds. This type of ischemic pressure works by breaking up the intra-muscular adhesions that keep the muscle in spasm. Once the adhesions are broken up, the muscle can begin to behave normally again - but not necessarily optimally, which requires a different kind of intervention, namely Movement Education or Neuromuscular Re-education. Trigger point work can be physically demanding on a therapist's hands, requiring them to use their fingers, elbows, feet or various tools to avoid overusing their hands.
Other treatment methods include various stretching techniques, the injection of a pain killer or saline water into the trigger point, or inserting acupuncture needles directing into the trigger point. The various techniques that address trigger points are collectively called Neuromuscular Therapy.
All the above listed approaches to trigger points are helpful to varying degrees. Unfortunately, none of them address the underlying mechanical imbalances that cause trigger points to form in the first place and then maintain their existence through chronic mechanical stress on the muscles.
It's fairly easy to find and eliminate a trigger point but unless the underlying mechanical imbalances are resolved, the trigger point simply returns at a later date.
Because of this, for many people, trigger points remain a long-term problem with frequent flare-ups after prolonged bouts of mechanical stress on their muscles.
My Approach to Trigger Points
To successfully and permanently resolve trigger points, we need to not only focus on breaking them up, but we also need to address the underlying mechanical imbalances that both cause and maintain trigger points. This second part of the treatment equation is accomplished through Movement Education or Neuromuscular re-education.
For further information on my approach to Movement Education, please see the Movement Education page
Sports Massage and Rehabilitation
I work with athletes of all ages and skill levels in my practice, from youth sports, through professional and masters level athletes. Athletes are some of my favorite clients to work on. They're not merely healthy, but their bodys are very resilient and receptive to change.
When I work with an athlete, I tailor each session to their specific needs. I don't do "one-size-fits-all" sports massage sessions. By understanding the specific demands of their athletic activity, I can create uniquely individualized therapy sessions to address their personal musculo-skeletal issues.
However, musculo-skeletal issues are only one part of the athletic equation. Many sports related issues are actually the result of inefficient or dysfunctional biomechanics. When the problem is rooted in how an athlete uses themselves during a given action, muscular problems, although painfully problematic, are of secondary concern. The main concern is to change the firing sequence of the muscles or their pattern of use. This is where Movement Education comes into play.
For further information on my approach to Movement Education, please see the Movement Education page
Cranio-Sacral Therapy & Visceral Manipulation
Cranio-Sacral Therapy and Visceral Manipulation are both osteopathic techniques that utilize gentle hands-on work to facilitate changes within the cranial and visceral systems of the body.
The term Craniosacral Therapy or CST was first coined by the American osteopath John Upledger in the 1980's. However, CST is actually a derivative of Cranial Osteopathy, a much older osteopathic sub-specialty that was developed by William Garner Sutherland in the 1930's. At its core, cranial work is really just an extension of Osteopathy as originally envisioned by its founder, Andrew Taylor Still.
The basic premise of cranial and visceral work is that the body possesses subtly inherent undulations or rhythms that can be felt with sensitive palpation. The cranial and visceral rhythms are very much like the respiratory rhythm that occurs when we breathe. During inhalation, our lungs fill with air and our rib cage moves outward to accommodate that expansion. Then during exhalation, air flows out of our lungs and our rib cage returns to its original starting position.
The cranial rhythm is thought to work along this same principle.
The Historical and Contextual Development of Cranial Work
To better appreciate how cranial work fits into the broader picture of osteopathy, we need to understand osteopathy as the manipulative paradigm that it started out as.
There are various stories about how Andrew Taylor Still, the founder of osteopathy used to give spinal adjustments to people sitting in rocking chairs. As it was described to me, he would use the combined leverage of the chair moving in relationship to himself, to allow the persons body to self-adjust or self-correct any skeletal restrictions. We see a similar concept in the distraction tables used by modern chiropractors and osteopaths. Likewise, most modern joint mobilization techniques also use a variation of this concept; by fixating or stabilizing one side of the joint and actively moving the other side in a certain direction, the joint is allowed to achieve a more mechanically neutral and balanced position. This philosophy of guiding the body to move in such a way that it self-corrects a skeletal restriction, is quite different than the typical "high-velocity" chiropractic type of adjustment that forces bones to go where the practitioner wants them to go.
This principle of using bodily movement to facilitate self-correction, was eventually developed into many other osteopathic techniques. In one technique, the practitioner uses a persons breathing to facilitate self-correction. As we breathe in and our rib cage expands to accommodate increased air volume in our lungs, significant force is transmitted throughout our skeleton (pelvis, spine, ribcage, collarbone, shoulder blade and skull). By either promoting or inhibiting movement of the skeleton during breathing, micro-adjustments occur with minimal possibility of harm. This same principle is used in cranial work, except that the cranial rhythm is used instead of the respiratory or rhythm.
Peter Jones Acupuncture