Overview 

Education

Learn important ways to help keep your body healthy, free of pain and more responsive to treatment.

THE “ORGANIC FOOD” MYTH

Myth: If the food label claim says “organic” then the product must be “100% organic”

Not true! The only time a product is 100% organic is if the product claim actually says 100% organic on the front of the package! This means the product has 100% organic ingredients by weight. An organic sticker on fresh fruit and vegetables will also mean 100% organic. Label claims can be tricky to understand, so here is a little more information: If the label displays the USDA logo, that means at least 95% of the product is organic by weight. If the label lists one or more organic ingredient on the front of the package; for example, “Contains organic tomatoes,” this means at least 70% of the product is organic ingredients by weight. Last, if organic ingredients are listed on the side or back of a package, this means that less than 70% of the ingredients by weight are organic, but it will still contain those listed organic ingredients. So next time you are looking for a product that is 100% organic, make sure the label claim actually says "100% organic" on the front of the package.

Myth: Brown Eggs are Better for you than White Eggs

Brown eggs are not considered better for you than white eggs; they just come from a different breed of chickens. Both brown eggs and white eggs are a great source of protein and are low in calories. They contain about the same amount of fat, vitamins and minerals. Brown eggs do not offer any health benefits over white eggs. If you are concerned with antibiotics, growth hormones or animal welfare you may want to buy certified organic, free-range eggs. You can even find eggs that are fortified with heart healthy omega-3s.

QUANTITY AND QUALITY OF EXERCISE

ACSM Recommendations on Quantity and Quality of Exercise

These recommendations reflect current scientific evidence on physical activity and including recommendations on aerobic exercise, strength training and flexibility. Consistent with the 2008 Physical Activity Guidelines for Americans, *ACSM’s overall recommendation is for most adults to engage in at least 150 minutes of moderate-intensity exercise each week.


The scientific evidence we reviewed is indisputable. When it comes to exercise, the benefits far outweigh the risks. A program of regular exercise – beyond activities of daily living – is essential for most adults.

The basic recommendations – categorized by cardiorespiratory, resistance, flexibility and neuromotor exercise – are as follows:

Cardiorespiratory exercise

  • Adults should get at least 150 minutes of moderate-intensity exercise per week.
  • Exercise recommendations can be met through 30-60 minutes of moderate-intensity (five days per week) or 20-60 minutes of vigorous-intensity exercise (three days per week).
  • One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise.
  • Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.
  • People unable to meet these minimums can still benefit from some activity.

Resistance exercise

  • Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.
  • Very light or light intensity is best for older persons or previously sedentary adults starting exercise.
  • Two to four sets of each exercise will help adults improve strength and power.
  • For each exercise, 8-12 repetitions improve strength and power, 10-15 repetitions improve strength in middle-age and older persons starting exercise, and 15-20 repetitions improve muscular endurance.
  • Adults should wait at least 48 hours between resistance training sessions.

Flexibility exercise

  • Adults should do flexibility exercises at least two or three days each week to improve range of motion.Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort.
  • Repeat each stretch two to four times, accumulating 60 seconds per stretch.
  • Static, dynamic, ballistic and PNF stretches are all effective.
  • Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.

Neuromotor exercise

  • Neuromotor exercise (sometimes called functional fitness training) is recommended for two or three days per week.
  • Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive training and multifaceted activities (tai chi and yoga) to improve physical function and prevent falls in older adults.
  • 20-30 minutes per day is appropriate for neuromotor exercise.

    In addition to outlining basic recommendations and their scientific reasoning, the position stand also clarifies these new points:

    • Pedometers, step-counting devices used to measure physical activity, are not an accurate measure of exercise quality and should not be used as the sole measure of physical activity.
    • Though exercise protects against heart disease, it is still possible for active adults to develop heart problems. All adults must be able to recognize the warning signs of heart disease, and all health care providers should ask patients about these symptoms.
    •  Sedentary behavior – sitting for long periods of time – is distinct from physical activity and has been shown to be a health risk in itself. Meeting the guidelines for physical activity does not make up for a sedentary lifestyle.

    It is no longer enough to consider whether an individual engages in adequate amounts of weekly exercise. We also need to determine how much time a person spends in sedentary pursuits, like watching television or working on a computer. Health-and-fitness professionals must be concerned with these activities as well.

    The position stand’s purpose is to offer health-and-fitness professionals scientific, evidence-based recommendations that help them customize exercise prescriptions for healthy adults. The position stand is published in the July 2011 issue of Medicine & Science in Sports & Exercise®, the official journal of ACSM.

    *”The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 45,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.”

    Neck Pain

    Neck pain is a common complaint and can be due to a variety of causes.  The cause of neck pain is not always clear because it can be associated with many other symptoms ranging from arm and shoulder pain to headaches.  The best way to determine the cause of neck pain and formulate an effective treatment plan is to start with a careful and through physical assessment from a musculoskeletal trained physician

    Neck muscles can be strained from poor posture — whether it’s leaning into your computer at work or hunching over your workbench at home. Wear-and-tear caused by arthritis also is a common cause of neck pain. Rarely, chronic neck pain can be a symptom of a more serious problem and is normally a result of a more serious disease. Seek medical care if your neck pain is accompanied by numbness or loss of strength in your arms or hands or if you’re experiencing shooting pain into your shoulder or down your arm.

    Causes of Neck Pain

    Causes of neck pain can be caused by many different factors.  Three factors that frequently are associated with neck pain are the muscles of the neck and shoulder, the skeletal system and the nervous system.

    Muscular neck pain is the most common type of neck pain and often results when a person performs an activity that requires more strength or more endurance than the muscles of the neck can provide.  Everyday activities including using a computer, driving or reading in bed can cause strain on the neck and neck pain.  Sometimes more acute injuries are to blame for the pain like in the case of car accidents and whiplash injuries.

    When muscles are forced to contract harder or longer than they are able, then muscle spasms and inflammation can result.  One should not underestimate how much pain muscles can cause. Treating neck pain that is due to muscle first involves a careful physical exam that includes the neck, shoulders, arms and upper back as all of these areas can be effected.  Initial treatment of many neck pain conditions includes pain control with non-narcotic medications and then treatment of the cause of the muscle pain.  This frequently involves a combination of massage therapy and physical therapy to improve postural muscles and movement patterns that create pain.  On occasion, small trigger point injections are used to reduce pain and spasm so that a person can sleep more effectively.  Trigger point injections actually have lower risks then giving narcotic pain medications.

    Bone and joint problems are a common cause of chronic neck pain.  Unfortunately, disorders of the bones and joints can be difficult to diagnose.  The first step in determining bone or joint related back pain is a careful physical examination. The causes of pain can range from trauma or arthritis of the small joints called facets, tears in the discs of the spine or fractures of the bones of the spine.  Frequently, x-rays or MRIs are used to assist in diagnosing the exact cause of pain.  Occasionally, carefully performed injections using x-ray guidance may be used to clarify the cause of pain if a physical exam and imaging are not enough.  These injections are frequently helpful in decreasing pain and allow other treatments to be more effective.  The mainstay of long term treatment and prevention of reoccurrence is to restore proper posture and strength to the neck and shoulder.  Sometimes injections or medications are required to reduce that pain so person move and sleep so they can participate in physical therapy.

    Pinched nerves of the neck are often the most painful source of neck pain and require the more urgent attention. Pinched nerves can cause pain into the arm, numbness, weakness or all the above.   Very rarely, pinched nerves can cause bowel or bladder incontinence and this requires immediate evaluation by a medical provider.  It is a common belief that all pinched nerves require surgery.  However, the majority of pinched nerves can be treated without surgery.  If a pinched nerve only involves pain and numbness, physical therapy to reduce compression on the nerves combined with either steroid pills or steroid injections can be used to effectively manage a pinched nerve and support the body while it heals.  If there is weakness then this needed to be closely evaluated with repeat physical exams and potentially a study to evaluate the heath of the nerves called an EMG.  One can follow a pinched nerve with mild weakness for 2 to 3 months before a discussion about surgery is needed. A pinched nerve that causes weakness that is functionally impairing that does not improve with steroid injections, physical therapy or medications often require surgical consultation. Generally nerves can be compressed mildly for 2 to 3 months without permanent damage. After this time,  increased risk of permanent damage results.  It is often valuable to see a rehabilitation physician such as those at  Musculoskeletal Medicine first, to help diagnose and provide supportive treatments for a pinched nerve prior to referral to a surgeon. Most surgeons require at least some conservative management, that is, massage therapy, medication management, injections and physical therapy before even considering surgery for pinched nerve in the neck.

    Treatment

    Our Clinic provides comprehensive diagnostic and treatment options for neck pain.  These include physicians to evaluate the cause of pain with physical exams, imaging review, EMG’s and injections.  Additionally,  Musculoskeletal Medicine has skilled providers from physical therapy, massage, and athletic training that work as a team to address your specific needs to improve your pain and restore your health and function.

    Our Clinic provides an integrated approach to resolve your neck pain. We first confer with our specialist and then create a unique program specific to each patient for their neck pain. Contact us for an appointment to start you on a path to a pain free and healthier life.

    MIGRAINE HEADACHES

    What are Migraine Headaches?

    Migraine headaches often affect one half of the head; they are pulsating in nature and last from 2 to 72 hours.  Associated symptoms can, but do not always include nausea, vomiting, increased sensitivity to light, increased sensitivity to sound and the pain is generally made worse by physical activity.  Up to one-third of people with migraine headaches have an aura which is a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally an aura can occur with little or no headache following it.

    Migraines are believed to be due to a mixture of environmental, genetic factors and complications from some neurological diseases.  Two-thirds of cases run in families.  Hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty, but about two to three times more women than men.  Migraines decrease during pregnancy.  The exact cause of migraines are not known.  It is  believed to be a neurovascular disorder. The primary theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

    Migraine ranks in the top 20 of the world’s most disabling medical illnesses. Amazingly, over 10% of the population, including children, suffers from migraine. Nearly 1 in 4 U.S. households includes someone with a migraine disorder. For some, they and not disabling, but for many, headaches and migraines are extremely disabling and interfere with the ability to carry out day-to-day life.

    Migraines also have triggers and these may include foods we eat, different types of stresses including emotional stress, lack of sleep and physical stress.  Migraines are also triggered by pain in close by places, such as mechanical factors in the neck and spine, neck joint injury or arthritic disease, jaw pain such as TMJ, stresses on the eyes caused by straining vision and sinus pain.

    Our Clinic Provides Migraine Headache Therapy

    The most effective treatment results when there is an effective partnership with the patient.  An effective partnership allows the treating doctor to address all causes and possible treatment of a patient’s migraine headache.  Therapy can be optimized through a management program that encompasses education, behavioral treatments, physical therapy, diet modification, treatment of sleep and anxiety as well as medication management. Controlling migraine headaches involves two types of treatment, treating the pain of the migraines when they happen, and stopping the triggers or factors that lead to migraines.  Treating the pain when it happens allows you to live a normal life, but, preventative treatment the causes allows us to develop a life-long strategy to keep migraines from coming back, and, is the approach we prefer to take at  Musculoskeletal Medicine, through our coordinated team approach.  We do this through education and correction of all triggers

    Acute Treatment

    Acute treatment most commonly involves the use of medications and reduction of factors that will aggravate the symptoms when a migraine occurs.  Sometimes we need to use an abortive drug to stop a migraine when it happens.  Numerous abortive medications are used for migraine. The choice for an individual patient depends on the severity of the attacks, associated symptoms such as nausea and vomiting, comorbid problems, and treatment response.

    Simple analgesics alone or in combination with other compounds have provided relief for mild to moderately severe headaches and sometimes even for severe headaches.[84] Acute treatment is most effective when given within 15 minutes of pain onset and when pain is mild.[85]

    Simple pain relievers Tylenol, NSAIDs, and narcotic analgesics (eg, oxycodone, morphine sulfate).   For more severe pain, a class of drug known as triptans and/or opioid analgesics are used, either alone or in combination with drugs such as Compazine.  The use of abortive medications must be limited to 2-3 days a week to prevent development of a rebound headache phenomenon.   Toradol is also an effective alternative agent for the relief of acute migraine headache in an urgent situation.   Triptans include drugs such as Sumatriptan, Rizatriptan, Frovatriptan etc and can be used orally, through nasal inhaler, injected under the skin or into muscle.   Triptans are most effective when taken early during a migraine.  There are novel combination drugs such as a triptan and an NSAID, Treximet.

    Prevention Medications

    Our prevention or approach of the treatment for migraines is to not only treat the symptoms using medications and common household interventions, such as reducing too much stimulation, including noise and light. Other investigations for the catalysts are to focus on identifying the triggers neurological disease or emotional stress if these are prevalent in an individual.   Medications to prevent migraines are generally divided into a class of beta blockers, calcium channel blockers, tricyclic antidepressants, standard SSRI antidepressants and seizure medications.   Botulinum toxin injections into the muscles that spasm with migraines are also an extremely effective technique to prevent migraines. Unfortunately, Botox is required every 3 to 4 months to be injected into the muscles of the skull in order to continue to prevent migraines. For those who respond to Botox, 70 to 100% relief is commonly reported after the successful Botox injection. These injections are performed routinely at  Musculoskeletal Medicine.  At  Musculoskeletal Medicine, however, we do not believe in lifetime use of Botox rather, it is a tool to reduce headache intensity while a more effective preventative strategy is developed as below.

    Understanding and Treating Triggers

    Perhaps one of the most effective and satisfying approaches to treating migraine headaches is to understand the factors that either bring them on or make the body more sensitive to developing migraine headaches.   This is an area where  Musculoskeletal Medicine excels managing migraines as we feel that the best way to treat migraine is to keep it from ever happening again.

    Following is a typical screening approach that the team at  Musculoskeletal Medicine uses to assess and treat any triggering or predisposing factors that might make a person develop a migraine in the first place.  Many of these factors are closely connected to each other, so is most effective if we start treatment of all of these factors together. In this way, when a person is treated correctly, they can graduate from our clinic with the tools needed to manage their migraines independently.

    Sleep

    Sleep problems have been shown to both increase a person’s sensitivity to developing a migraine to studies that show that a bad night’s sleep can actually trigger a migraine.  The same has been shown with the treatment of chronic pain. One of the first steps in treating migraine headaches is to improve not just sleep duration but sleep quality.   One reason for waking with migraines is that REM sleep is most powerful just before awakening.  Sleep problems can then trigger migraines by causing instability of serotonin and a lowering of dopamine levels.  Antidepressants, specifically the selective serotonin reuptake inhibitors (SSRIs), may help stabilize serotonin membranes and block migraines. These medications are sometimes used as migraine treatment.

    Sleep can be treated through a number of methods, medications, reducing stress, specialized sleep evaluations looking for sleep apnea and other causes for poor sleep

    Neck Problems

    There is a significant connection between those who have upper neck pain and those who suffer from headaches. Those who suffer from migraines will generally experience greater migraines when their neck pain flares. Successful treatment of migraine headaches requires a careful assessment of upper cervical neck pain. This often involves special physical therapy exercises to stabilize the posture, looking at work and home ergonomics and sitting methods as well as improving how a person sleeps.   Sometimes injections in the neck can provide valuable diagnostic information as to the causes of migraine headache pain. This will also allow the medical team to understand the types of therapies that will be most effective.   Many people sit with poor posture particularly given more jobs at require long hours and computer and many workplaces often do not automatically assess ergonomics.  Chronic poor posture can lead to stresses in the upper cervical neck joints as well as chronic muscular strain and both of these are either a cause of headaches or a trigger for person already has a migraine problem

    Anxiety and Behavioral Treatment

    When we are anxious, we tense our muscles and when we tense our muscles then they become tight and stiff and the ends of these muscles, the tendons, will often become inflamed. Many people carry their stress and anxiety in their neck musculature and many of these muscles start under the skull and the upper cervical neck joints. When these muscles get inflamed, they radiate pain into the skull.  This pain can cause or trigger a migraine headache. Anxiety also interferes with sleep.  Some people that already have anxiety suffer from a problem known as hypersensitivity, which is when they are overly aware of every sensation in their body to such a degree that when they feel any change they experience a rush of anxiety and possibly a panic attack. Not all migraines cause headaches, and many may have other symptoms as well. That sensitivity may lead to severe anxiety, as the person is overly aware of the sensations and possibly experiences fear as a result.  Other behavioral strategies include more regular sleep patterns, improvement in diet, and the addition of an exercise program.  Patients should be encouraged to participate in behavioral modification programs that have been proven to be successful. These include cognitive-behavioral therapy, stress management, relaxation training, and biofeedback therapy.

    Diet and Nutrition

    It is well known that some foods may trigger migraines. There are a few different hypotheses on why such as different foods affect the release of certain brain chemicals which could lead to migraines, different types of foods cause different amounts of blood-vessel constriction or dilation which could lead to headaches and last certain foods directly stimulate specific areas of the brain leading to migraines.

    Although studies are inconclusive, it is possible that some amino acids (the building blocks of protein) are linked to migraine frequency. Other compounds in food, both natural and artificial, can contribute to migraines including Tannins (found in tea and coffee), Sulfites (added to dried fruits and canned vegetables) and Nitrites (used as a preservative in processed meats like hotdogs).

    There is a long list of possible food triggers including some common ones like chocolate, caffeine, sugar and Monosodium Glutamate (MSG). The variability of food triggers is huge and depending on the individual can range from different fruits and vegetables to dairy and alcohol. Keep in mind each person is unique and what may be a trigger for some won’t cause migraines in others.

    A first step in discovering your food triggers is keeping a detailed food dairy including food, beverages, physical symptoms and meal timing. Once you discover a pattern between diet and migraines you may try eliminating the food from your diet to see if you have a reduction in symptoms.

    Introducing calming, anti-inflammatory foods into your diet is also a good idea. Temporary inflammation is part of the healing process while long-term inflammation eventually harms the body and can cause health problems.  When a migraine comes on, various physiological processes start to happen which only adds to the overall inflammation in the body.  Fortunately, incorporating anti-inflammatory foods may help in the recovery process by reducing inflammation.  Eating foods known to decrease inflammation also promotes a calmer, less stressful state of being.  Since stress can trigger migraines, anti-inflammatory foods may help to prevent migraines.

    Exercise

    Healthy exercise is a key to managing migraines.

    The finding could help explain the links between sleep problems and migraines. It also should make it easier to find new drugs to treat migraines, researchers say.

    Contact us to put you on the road to a healthy pain free life.

    MASSAGE THERAPY

    For many years now, massage has been gaining in popularity as a way of reducing stress, and treating numerous conditions. Massage use is widespread in the US, and is increasingly viewed as part of integrative health care. This is due to a rapidly expanding evidence base (Moyer & Dryden 2012, Moyer et al. 2009) and massage therapy’s popularity for treating common health complaints. Form of massage have been utilized in the treatment of illness and injury for thousands of years by health care practitioners.  Chinese writings dating back to 2500 BC describe the use of this modality for a variety of medical purposes.  Massage has been promoted as a treatment of choice for numerous conditions including musculoskeletal injuries, cancer, fibromyalgia, stress, relaxation, pregnancy and post-operative rehabilitation.

    Lifestyle factors, such as long work hours or physically demanding and repetitive tasks, can cause muscle soreness and tightness and adversely effect ligaments.  Many report significant improvement working with skilled medical massage therapists.   A seemingly minor injury can have a profound impact on a person’s ability to stay physically active, participate fully in life, or even make a living if it becomes chronic. Massage therapy is one way of preventing that kind of outcome and can be part of a coordinated treatment approach to treating injuries from minor to severe.

    Some massage therapy techniques are specifically recommended to address sore muscle and sore tissue, these are discussed below.  An overly sore or irritated muscle cannot function properly so by alleviating or preventing pain through massage therapy, dysfunction can be eliminated or reduced.

    Many people don’t realize how much a tight muscle can impact the body such as its posture. A tense muscle can throw off your body’s natural balance and before long, muscles that were not initially tight begin to tense as they try to compensate. Unfortunately, this becomes a chain reaction that can spread far from the initial problem spot. A talented massage therapist can identify the source of the problem and start working to alleviate the problems true origin.

    We’re all becoming more aware of the role stress plays in health. People who are stressed are less healthy than people who are relaxed. Stress has been shown to increase the risk of heart disease, stroke and many other serious health conditions. Massage therapy is an effective and enjoyable way to reduce stress. The effect of massage therapy on anxiety has been researched more than any other outcome.  It has been shown to reduce both “State Anxiety” (current level of anxiety) and “Trait Anxiety” (the tendency to become anxious) in both adults and children  (Moyer et al 2004, Dryden & Moyer 2012).

    What is the difference is between a ‘regular’ massage and a ‘clinical’ or ‘rehab’ massage?   If you are getting a massage because you enjoy receiving them but don’t necessarily have a chronic injury or problem area, then this is considered a regular or relaxation massage. Whether relaxation or clinical, there are great benefits in seeing the same practitioner. A licensed massage therapist who sees you regularly will get to know your body and could help you identify potential issues.

    A clinical or rehabilitative massage has a specific focus or outcome in mind. Clinical massage therapy (or rehabilitation massage therapy) means that the massage is a site-specific treatment (or multiple site-specific) with a precise goal. Curiously, this often means working in an area of your body that does not have pain. A pain area is not necessarily the source of the issue.  So, similar to receiving physical therapy for a specific need or issue, you would go to a clinical massage therapist with a specific complaint that you would like treated.

    Rehabilitative Massage

    At Overlake Medical Clinics Musculoskeletal Medicine, most patients arrive for various levels of rehabilitation and pain management. With rehabilitative massage, we use techniques to address your particular rehab needs. While it may include a full body Swedish massage, or some deep tissue techniques, treatment is usually more specific and specialized. Other modalities are often more appropriate. Lymphatic drainage, for example, will be used if you have swelling, craniosacral therapy to treat an overstimulated nervous system and trauma, fascial and neuromuscular release for bound tissue and muscular imbalances. If you have a history of overtraining or repetitive work activities, focused ligament therapy may be optimal for you. We pride ourselves in offering you the right techniques to help facilitate your return to health and we work as a team to do so.

    Our massage therapists are Pete Connolly, Kiley Roesch, Mandy Tapp and Leah Goldberg

    Massage for Fitness

    If you are resolving a sports injury, massage is an ideal way to help your body perform its best. Sports-specific massage focuses on the muscles used most frequently during exercise as well as draws attention to other muscles that can contribute to muscle soreness or injury. Massage can effectively improve range of motion, decrease muscle and tissue tension, aid in muscle recovery, prevent and treat injuries. By stretching and broadening shortened muscles as well as increasing attention to the joints, both muscles and joints are able to move more freely. Specific massage mobilizes scar tissue and can release adhesions that play a role in muscle tightness and soreness. In addition, massage can release tight muscles and painful trigger points in the muscle. Our therapists use a variety of techniques to improve body function, including myofascial, deep tissue, neuromuscular  and ligament release.

    What to Expect During a Medical Massage Session

    The therapist will discuss your levels of pain, tightness and what areas you seek relief in. They will perform some assessment to help foster the best results. The therapist will also have your physician’s referral and treatment plan. We encourage good communication during the session. If you are feeling pain at any time, please share this with your practitioner. The concept of ‘no pain, no gain’ does not fit well into medical massage, where deep tissue can be helpful in certain areas, yet often counterproductive on the whole. We want to enhance your health, not challenge it. Our massage therapists should be able to work within your comfort level and achieve therapeutic results. Do not be afraid to talk with your therapist about any concerns you might have.

    You will be taken into a private massage room where you have the option of undressing to your level of comfort. We say option, because not all treatment types require undressing. Depending on your needs you can receive very effective work clothed. If disrobing is the preference you and your therapist decide between you, you will be guided how to lay on the table and you will be draped with a sheet and blanket to ensure privacy and comfort. Depending on the areas that are to be worked in a massage, you may start face up or face down on the table. Sidelying is also an excellent option too. They will leave the room while you undress and get on the table.

    Massage Therapy, the Bigger Picture

    This is an exciting time for the massage therapy profession. It is growing in many ways. Research is finally beginning to make inroads in this area, with a tremendous surge in the last decade. The first International Fascial Congress took place at the Harvard Medical School in 2003 where scientists gathered from points on the globe to share and learn about latest research. Since then two additional Congresses have met, the latest in Vancouver Canada. The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, is currently spending $2.7 million on massage research, up from $1.5 million in 2002. The Massage Therapy Foundation, a nonprofit organization that funds massage research, held its first scientific conference in 2005.

    New areas in the profession are being explored such as the treatment of nerves, ligaments and fascia. The National Institute of Health recently awarded a sizeable grant to a scientist to study the effects of Visceral Manipulation, specialized massage to the abdomen, organs and thoracic rib cage. An increasing number of conditions are showing benefit from massage including osteoarthritis, fibromyalgia and Alzheimer’s.

    The American College of Physicians and the American Pain Society now include massage as one of their recommendations for treating low back pain, according to guidelines published in 2007. Recently the massage profession in this State of Washington was asked to respond to the government’s recent challenge of providing documentation towards the efficacy of massage for the Affordable Care Act . The response, by a particularly savvy group of practitioners was a document compiling almost 1000 research sources. The findings are revealing. Research is helping to move massage therapy out of the alternative category and more into mainstream healthcare. We here at  Musculoskeletal Medicine are following such research and are integrating appropriate findings into our treatment plans. 

    Massage Techniques Offered at  Musculoskeletal Medicine

    Myofascial is a term that describes working both the muscle and and the fascia, the binding connective tissue that runs through and covers all our muscles. Layers of tissue that are designed to move and slide along each other can get stuck and adhesed. These techniques help mobilize tissue, increase function, movement and decrease pain. There can be much cross over between this and deep tissue massage and it is applied both superficially and deep depending on where the restrictions are.

    Deep Tissue is a technique that releases chronic patterns of tension in the body through slow strokes and deep pressure on contracted areas, either following or going across the grains of muscles, tendons and fascia.

    Swedish – this is a technique that can be applied for either relaxation to treatment. It usually involves an emollient of either oil or lotion. This is what many people think of when they hear massage, with long sliding strokes of effleurage, the lifting with the petrissage and friction strokes deeper in the muscles.

    Ligament Therapy – Research is showing that ligaments may play a significantly greater role in governing and regulating muscle tension than generally believed. There are new techniques that address ligament dysfunction that result from joint overuse, repetitive activity, inactivity and injury. L.I.F.T., or ligament influenced fascial techniques are used to release muscles that are limited and tight from this.

    Craniosacral therapy:  is a light-weight, non-invasive form of touch that focuses on the health of your craniosacral and nervous system. Our craniosacral systems are comprised of the deep membranes and cerebral spinal fluid that surround our brain and spinal cord. As with any connective tissue in the body, this deep fascia is susceptible to tensions, strains and adhesions. The craniosacral system also irrigates and chemically balances our nervous system. Stress, injuries, posture can all affect this system. For those who cultivate their palpation skills, it is possible to feel the internal rhythms of movement that manifest as cerebrospinal fluid bathes and irrigates the tissues of the head down through the spine. Therapists can listen in and feel these rhythms to find areas of restriction and holding in the body.

    Restrictions located in these deep regions of the body can create pain, anxiety and dysfunction. A skilled therapist can help identify and release these restrictions, providing release, often where other modalities do not. Craniosacral Therapy can be a powerful technique for head trauma, headaches, sinus conditions, low back pain, and post-surgical rehabilitation.

    Lymphatic facilitation reduces swelling in the body’s tissue (interstitial space). If you are managing swelling due to a traumatic injury or a chronic orthopedic condition or surgery, this may speed your recovery, possibly dramatically.

    This work is light and non-invasive. The amount of pressure it uses is comparable to the pressure it takes to slide your eyelid over your eyeball. As such, and contrary to most forms of bodywork, it can be used immediately following an injury and will support the body’s physiology in what is called the acute stage of healing.

    For almost every injury the body encounters, swelling is part of the body’s normal recovery process. There are two kinds of swelling involved in traumatic edema. The first is ‘primary’ edema which is the swelling that is the direct result of the initial injury. The ‘secondary’ edema is the swelling that gravitates to an injury site as a result of the primary edema. It can take up to 24 – 48 hours for secondary edema to fully manifest following an injury, as many of us who have had significant sprains/ strains can attest. Lymphatic facilitation can stimulate the drainage and removal of this secondary edema, in essence creating more ‘breathing’ room around the primary edema, thus expediting recovery of the tissue.

    This technique has many applications. If you are an athlete in training, this can support your body’s preparation for its next big training or competition event by removing micro swelling associated with training and workouts. It simply accelerates what your body would do on its own. If you are dealing with an annoying chronic condition that won’t seem to go away, part of this might be excess fluid in your tissue, inhibiting your body’s normal recovery process, (stuck in sub acute healing phase). Fibromyalgia patients whose tissue is tender to the touch have benefited significantly from a session or two of this work.

    Our clinic offers massage therapy for stress relief and other disorders. We confer with our specialists within the clinic to develop a unique program of massage therapy to help relieve the patient of their stress and pain. Contact us to start you on a pain- and stress-free life.

    BACK PAIN

    Lower back pain is second only to the common cold for why people seek medical care. Back pain may be mild or extreme and cause lost job time, lost personal time and can significantly decrease quality of life.

    Causes of Back Pain

    Causes of lower back pain can be caused by many different factors. Three factors that frequently are associated with lower back pain are the muscles of the lower back, the skeletal system and the nervous system.

    Muscular low back pain is the most common type of back pain and often results when a person performs an activity that requires more strength or more endurance than the muscles of the lower back can provide. When muscles are forced to contract harder than they are able, then microscopic tears result causing significant inflammation. This is commonly called a back spasm or back strain.  One should not underestimate how much pain muscles can cause. Treating muscular low back pain first involves reducing the pain and inflammation so that one can move more freely.  Initial treatment is typically in the form of medications that decreased pain and inflammation.  The goal of this treatment is to encourage comfort and normal activity.  In some cases muscle spasm may be severe enough to require more aggressive treatment.  On occasion, small trigger point injections are used to reduce pain and spasm so that a person can sleep more effectively.  Trigger point injections actually have lower risks then giving narcotic pain medications. Once pain is manageable then a combination of massage therapy, then physical therapy combined with either acupuncture or medication management, can allow person to return to normal activity.  Once the pain level has decreased to a low enough level the treatment should be centered on strengthening the core muscles to prevent reoccurrence of the muscle pain.

    Bone and joint problems are a common cause of chronic back pain. Unfortunately, disorders of the bones and joints can be difficult to diagnose.  The first step in determining bone or joint related back pain is a careful physical examination. The causes of pain can range from trauma or arthritis of the small joints called facets, tears in the discs of the spine or fractures of the bones of the spine.  Frequently, x-rays or MRIs are used to assist in diagnosing the exact cause of pain.  Rarely, carefully performed injections using x-ray guidance may be used to clarify the cause of pain if a physical exam and imaging are not enough.  These injections are frequently helpful in decreasing pain and allow other treatments to be more effective.  The mainstay of long term treatment and prevention of reoccurrence is to restore proper posture and strength to the spine and hip.  Sometimes injections or medications are required to reduce that pain so person move and sleep so they can participate in physical therapy.

    Pinched nerves of the low back are often the most painful source of lower back pain and require the more urgent attention. Pinched nerves can cause pain into the leg, numbness, weakness or all the above.   Very rarely, pinched nerves can cause bowel or bladder incontinence and this requires immediate evaluation by a medical provider.  It is a common belief that all pinched nerves require surgery.  However, the majority of pinched nerves can be treated without surgery.  If a pinched nerve only involves pain and numbness, physical therapy to reduce compression on the nerves combined with either steroid pills or steroid injections can be used to effectively manage a pinched nerve and support the body while it heals.  If there is weakness then this needed to be closely evaluated with repeat physical exams and potentially a study to evaluate the heath of the nerves called an EMG.  One can follow a pinched nerve with mild weakness for 2 to 3 months before a discussion about surgery is needed. A pinched nerve that causes weakness that is functionally impairing that does not improve with steroid injection, physical therapy or medications, often require surgical consultation. Generally nerves can be compressed mildly for 2 to 3 months without permanent damage. After this time, increasing risk of permanent damage results.   Is often valuable to see a rehabilitation physician such as those at Musculoskeletal Medicine first, to help diagnose and provide supportive treatments for a pinched nerve prior to referral to a surgeon. Most surgeons require at least some conservative management, that is, massage therapy, medication management, injections and physical therapy before even considering surgery for pinched nerve in the back.

    Treatment

    Our clinic provides comprehensive diagnostic and treatment options for back pain. These include physicians to evaluate the cause of pain with physical exams, imaging review, EMGs and injections. Additionally, Musculoskeletal Medicine has skilled providers from physical therapy, massage, and athletic training that work as a team to address your specific needs to improve your pain and restore your health. Our clinic provides an integrated approach to resolve your back pain. We first confer with our specialist and then create a unique program specific to each patient for their back pain.

    Contact us for an appointment to start you on a path to a pain free and healthier life.

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