My Favorite Links: Psoas, Dynamic Stretching, Vagus Nerve and Nutrients

Here is a list of my favorite links. This is not a prescription nor is it a substitute for medical care. These are subjects that personally and professionally interest me and contain great content. If nothing else the topics create some great discussion and debate.

-PSOAS muscle. A tight/strained/weak psoas can cause everything from back/leg/groin/hip/abdominal pain to difficulty taking a deep breathe. I strongly believe everyone should learn as much as they can about the psoas and try connecting and releasing it in a relaxed/mindful state:
http://www.positivehealth.com/article/bodywork/the-psoas-within


-DYNAMIC STRETCHING: I'm a fan of dynamic stretching particularly of the hamstrings and adductors (inner thigh). Consult a personal trainer
https://www.youtube.com/watch?v=AWU9MH7zdJA


-VAGUS NERVE. Like the psoas the vagus nerve a critical and often overlooked culprit for pain, inflammation, digestive problems, etc.
http://mentalfloss.com/article/65710/9-nervy-facts-about-vagus-nerve


-NUTRIENTS NEEDED FOR PROPER MUSCLE FUNCTIONING: Symptoms like cramping, feeling stiff and fatigued and chronic pain can be an indication that the body is missing a critical nutrient for proper muscle functioning. For example, magnesium levels drop at night which can cause anxiety, cramping, interrupted sleep, and brain fog just to name a few. NOTE: this is not a prescription to buy nutrients. That is not in my scope of service. Moreover, many supplements can contain too little or alarming amounts of a nutrient. The FDA's website as a list of running supplements that are contaminated with heavy metals, antidepressants, steroids and many other hidden ingredients (this list is just a sample and not all inclusive). Many people also do not realize that their nutrients listed could be synthetic forms which have a whole other host of problems. A highly reputable dietician or specialist will be able to tell you what brands have a good reputation and what form of the nutrient is best absorbed. Even then, I always do my own research and ask my pharmacist if it is safe to supplement with my prescription medication. It can be dangerous to supplement in the presence of certain conditions and intolerances. This is a very basic link on electrolytes and there are many factors to proper absorption of other nutrients needed to make your nervous system respond normally to stress and movement:
http://www.livestrong.com/article/344358-what-nutrients-does-the-muscular-system-need/

Costa Rica School of Massage Therapy: Samara, Guanacaste has Power

Every now and then I watch this video. It always gives me chills and brings me back into the pure joy I experienced for 4 months studying massage therapy. I hope it is still preserved and magical as it was in 2012.

If you are looking for a travel destination I highly recommend Samara. The Nicoya Peninsula is one of the Blue Zones in the world (look it up for more info). My allergies of 15 years cleared after spending time here and four years later still holding. I made some of the most special connections of my life with locals and ex-pats. It will take you out of the NOVA sleepwalking state and make you feel and realize what you've forgotten. Moreover, there are some very talented massage therapists, chiropractors and bodyworkers in the area that some people in the states specifically seek out. No research or visa needed-- a local or ex-pat is happy to tell you exactly who, what and where to go. It is a small place, but full of quality. Restaurants include Italian, French, Vegan, Asian, Brazilian, pizza galore, a farmer's market and more. The water out of the tap is so good that when you go to a restaurant and they ask you tap or bottled you better order the magical tap water. I swear it is one of the reasons people live so long there!

Please, though leave the rush of NOVA behind. Things are slow and in order to preserve this place respect the pace do not bring it down with your expectations. Most of the locals are very tolerant of tourists and here in NOVA we would not be. I found myself apologizing to locals for the rude, aloof behavior of tourists. Look people in the eye. They WILL smile back and who knows they may invite you into their home and take you on an adventure! Your confidence will soar and you will return bearing the gift of Samara. Being there and embracing the Pura Vida lifestyle is a continual baptism. It will take some adjusting--took me a full week. Give yourself a couple days and engage the population. They are educated and far more advanced socially and spiritually than we are. 

There are two preferred tourists seasons: dry and rainy. Dry is Dec-March/Early April and rainy well just about any other time with it peaking with thunderstorms in Aug-early Nov. I prefer dry season because it is not as humid, the evenings are lovely and the pacific winds are rolling through especially in Dec/Jan. Dry season is more hopping and all businesses are open. It's not as lush. Rainy season can be a ghost town, and it rains for a brief period of time once a day or you might get trapped in rain for a full day or more. It was a little too humid for my taste, but it is really stunning come May.

There are two airports you can fly into to reach Samara: Liberia and San Jose. Liberia is more expensive, but much closer and easy to reach Samara on paved roads. I went back to visit and left at 7am Friday morning, arrived in Liberia and was on the beach by noon. I recommend the connecting flight in Atlanta or Miami. Texas felt long. Spend at least two weeks here and slow down and love life.

Pura Vida!!

To Tip or Not to Tip, That is the Question

Tipping is a very ambiguous issue across massage therapy. Massage therapists work in various capacities such as spas, chiropractic offices and freelance work (by the way freelance work is not really legal in Fairfax county and therefore my insurance does not cover me if you choose to sue me).  Small business owners are stuck between a rock and a hard place in over regulated society.

Unlike restaurants, tipping is neither expected or communicated in massage settings. Prices are steep and usually an establishment takes 50% of a therapists income. Doesn't sound too bad unless you realize that massage therapists do not work 8 hours a day and many of us to not receive benefits and are often taken advantage of by establishments.

I work in a chiropractic office, therefore I only get about 10-50% of my clients who tip and I give a stellar massage. Clients assume that I work under a "medical" profession that I'm somehow compensated more so. This is not the case. If a client doesn't show up, I do not get paid---this happens at least once per week and the most I can do in a day is 5 hours. How would you like to go to work and someone says...thanks for showing up but you don't get paid today. It would be national news.

However, spa massage therapists rack in the money. They do less work and earn more....hmmm why would someone ever choose to work in a chiro office then?  Good question. Many do not and if you call around you'll see medial offices either do not have a therapist or they go through them like Vogue goes through changing styles.

Massage therapists in medical settings work MUCH harder than the spa therapists, risk more and get paid less. Why would I do this? One, spa work is boring. Two, I want to help people. Do I ever get an easy case? No. Maybe once a month someone wants a light massage. We work back breaking hours to help people elevate their quality of life and it all stems from our altruistic drive to help others. The monetary payoff is not a motivating factor.

The point is--show up for your appointment on time. Second, no one can tell you to tip. However, I get a massage once a month and I ALWAYS tip generously and I'm willing to bet I make a lot less than most.  You can choose to spend it on food, drinks, internet shopping or whatever. That fancy handbag will last how long and cost you what shoulder pain? This is truly insanity. If I can afford it then by all means realize your therapist is breaking down their body to help yours. We work the hardest and get paid the least. We can feel things that PT specialists, doctors, and other professionals cannot. Unfortunately, society has not caught up with the value. But when you receive a life altering massage then pay it forward. The average massage therapist lasts three years in the business and they are left with arthritis and chronic pain. So, yes tipping is not expected, but if you have the resources then please do. If you argue that massage is not covered by insurance then thank God because insurance will dictate the massage itself! You pay one way or the other. $10,000-$100,000 for surgery or quality of life?

If you are still not convinced...I suggest doing the research over a year in anatomy, physiology, and biomechanics and make an informed decision about where you would like to invest your money.

I want to also mention that if you do not tip me, it will not effect the quality of massage, availability or resources spent. I would never want someone to not book a massage because they can't budget a tip. Just be consistent about tipping no matter what establishment you visit :) .

Massage, Physical Therapy and Being Your Own Advocate

There is a reason why I choose to work in a sports rehabilitation setting. It is because I firmly believe in coupling multiple disciplines to control pain cycles. Often, clients are in the middle of physical therapy and they receive a massage for the first time from me and they are so impressed by how much better they feel that they discontinue physical therapy and opt for a few sessions of massage. They think they've found the solution.

No, no, NO!

What a waste.

Although a massage session can make a profound impact on the body, discontinuing physical therapy can unravel the process in a matter of days or weeks. There is no single solution. Finding the source and attacking it with one modality is an old paradigm. I studied an unnecessary amount of English literature/linguistics coupled with cultural attitudes in college and the way we problem solve and handle conflict stems from a polarizing approach in our language and communication. It's either "this" or "that," "us" or "them," "start" and "finish." Being able to compartmentalize and organize our thoughts and judgments reduces our anxieties and gives us a sense of completion. Good luck doing that with the human body which is one of the most complex pieces of engineering.

I will resist floating into the ethers on this post. I may have already lost you on some points. Back to physical therapy. Eight weeks of physical therapy is a drop in the bucket in your decades of habits run by a brain that is more powerful than the sum of all the computer processes in the world. I have enough experience with clients who complete the process from start to finish (ha! what finish line?) to confidently say they become the true masters of their bodies. Physical therapy isn't always about building muscle or stretching. It's about RE-EDUCATING muscles. Muscles are like people in a workplace: some are the work horses, some are lazy, some are angry, others are depressed or overly enthusiastic. I believe physical therapy helps distribute responsibility more evenly. I love analogies. Here's another one. Muscles are like petulant children. You cannot possibly control them by yourself. You need super nanny, a drill sergeant, psychologist and a master of diplomacy to whip them into productive members of society. Embarking upon treating your own musculoskeletal pain means going to school for many years and having an advanced level of self-awareness before you even begin to understand what you are doing. So yes, this is why massage therapy--one of the most passive and easy ways to address pain-- is often not the main solution. If there was a quick fix then everyone would know about it and I'd be rich.

Some things learned in physical therapy must be done long term. We are never finished maintaining the body any more than we're finished brushing our teeth. If there was an embarrassing social consequence to not doing PT you better believe most everyone would do it.


Being Your Own Advocate

First and foremost, you are your own advocate. If you sense something is not working SPEAK UP. We are taught that doctors and authority figures in health and wellness have all the answers and then we act passive aggressive (or aggressive) when we think it's not working. Only you know how you feel. No apologies necessary when challenging authority. (S)He who asks receives.

Questions to Ask a PT or Chiropractor:

• Is it normal to feel like I'm not making progress week to week?
• Should I be doing my physical therapy at home? What should I purchase to do this at home (theraband, foam rollers, balance ball)?
• Do I continue doing my own exercises and stretches after I'm discharged? Which ones?
• What activities should I avoid during and after physical therapy?
• Should I ice or heat an area? Which areas and for how long? (heat should NOT be applied to inflammation)
• Is there any other cause for my pain which wouldn't be musculoskeletal at the source? Should I consult a specialist to have it checked out?
• Do you have any online resources that show me how to do these exercises in case I forget?
• Do you have any affiliated partners like nutritionists, massage therapists, personal trainers who work with complex medical cases, etc that you think I'll benefit from?
• Should I be taking any supplements that might help me?

Keep a Journal

Keep a daily journal. What you ate, what you did, pain on a scale of 1-10, your stress levels & triggers, how much water you consumed, notation/revelations about postures, flare-ups like heartburn/sinus pain/allergies, etc. Be honest. When you go to PT you will at least have a coherent train of thought and a journal as reference. We cannot watch what you do outside of PT. There are things YOU will have to correct yourself or bring up at your next visit. If you are checked out of the process then it probably won't work or at best will stunt progress. Please note that a more anxious mind can go a bit overboard drawing conclusions that have very little correlation with their own issues. Patterns are good to bring up to a health care provider. If they brush you off then go to someone who will listen.


Best of luck! I believe in you regardless of age, medical issues and other challenges. You are the result of millions of years of evolution and you are the best of the best. And if you don't believe in evolution then you come from a long line of badass warriors and ancestors who survived things luckily we'll never see. Be proud and rock on.

Trajectory of Touch

When most people think of massage they think about a therapist pushing down on the body, squishing the muscles. The back alone along the spinal column has five layers of muscles. Some need to be coaxed out in order for a therapist to fully address them. Pushing directly down on muscles is only one of infinite (?) trajectories a therapist can utilize. I've talked about the importance of pressure in previous blogs and now I'm speaking of direction AND pressure. In order to "catch" some of these muscles and adhesions I have to be attentive to pressure and direction of muscle fibers. Typically, I start pushing down gently and slowly and then I feel where the tissue wants to go--it is resistant in certain directions and compliant in others. The ease of direction is typically what I follow initially. This is the direction that the muscle "wants" to go. For example, if I push on a spot between the shoulder blades, the tissue may be cooperative as I move slightly caudal (towards the head). I work in that direction a centimeter at a time and then change direction to let's say moving slightly to the left to move the muscle away from the spinal column to "release" or soften the muscle. As I get to the next layer to the deeper muscles my trajectory gets more dynamic and the centimeter I'm working with is halved. You can see why this work takes so much time. I can spend an hour on the back alone and feel as though I've only gone 2-3 layers. I think that concentrating the work in this way can have dramatic effects on the tissue and overall deep relaxation benefits which we see in Shiatsu and myofascial release.

I like this analogy (over simplified, but you'll get the idea). Let's imagine you are given the task of making a bed. The comforter is laying flat and affixed to the box spring with some give and there are sheets under the comforter that are bunched up and uneven. The rule is that you cannot take the comforter off to make the bed. You have to apply pressure to spread out the sheets and reduce bunching. You have to apply different amounts of pressure and "catch" the sheets under the bed. Under the skin there is a matrix of tissue in tension and being creative with trajectory until you feel the muscle soften is key to creating an unforgettable impression .

Neglected Abdominals

By Liz Schneider 2014

Look at all the connective tissue (white) attached to the abs--can you imagine what kind of restrictions and tension those are vulnerable to and the postural implications? We forget to stretch our abs--stretch baby stretch! (Disclaimer: please consult a physical therapist or trained professional when trying any new stretches/exercises).

Very few people have experienced an abdominal massage for a number of reasons.  It is one of the most vulnerable areas of the body (neck is the another), because it is not protected by bones and A LOT happens here. The area is a place of constant breaking down of food, assimilating nutrients and producing energy. It is a place of destruction, birth, and rebirth. An estimated 300-1000 types of bacteria that help us assimilate nutrients and drive our immune systems call this place home (please consult reliable sources for more information/verification). Additionally, social and cultural attitudes and values influence how we feel about this part of our bodies. Many people carry stress in the stomach and belly making them slouch, unaware they are "protecting" the area with defensive postures.

Personally, I love receiving abdominal massage. I know that massage therapists have a different view of the human body and I'm around this work all the time. Second, it's very soothing and healing to have this area treated. If we look at dogs for example, they roll on their backs and adore a belly rub. Assuming I know anything of what goes on in a dogs mind--when they trust and submit to authority, they are able to experience the relaxation effect of letting go of control and calming an active area. Our organs are encased in connective tissue which is also attached to more connective tissue that wraps our muscles as well. My clients who receive the work report less tension in their backs and an overall relaxation affect. HOWEVER, comfort is of utmost importance and I will only address this area when I have explicit consent from a client. It's not something I typically mention directly unless it's vital to the client's goals or I've worked multiple times with the client and a higher level of trust is achieved. If I sense a client is adventurous then I may simply explain how it may help.

Meditation and Mindfulness

WILLPOWER CAN BE CULTIVATED
I've been meditating consistently for approximately 9 years, multiple times a day in some cases. Meditation for me came from a desperate need to ease widespread pain, spasm, and sensitivity to stimuli. I had very little control over the external environment and so I was forced to harness my own internal reactions and processes. In my case, the motivation came from the sheer need to survive. The wild horse let loose within needed to be run hard every day. I got kicked in the head and trampled many times before I gained the trust of an overactive nervous system that did not respond well to being controlled.

Dr. Daniel G. Amen in Making a Good Brain Great describes two types of brains: one of willpower and the other running wild. By the way, Dr. Amen's brain scan clinic is here in Reston, VA and I find his books interesting and practical. They are not without fault and he overreaches at times, but he makes some profound points. Dr. Amen says that even if you have a brain running wild you can change it with enough focus, consistency and effort.

Meditation is one tool that is proven to reduce stress/cortisol, increase focus and this writer believes it can create an environment fertile for creativity, problem solving, reflection, growth and balanced brain chemistry.

WHERE MY MIND IS DURING A SESSION
So what does this have to do with massage? I'm getting there, I promise. During a session I'm practicing mindfulness. This is where I am actively engaging all the senses in to a session--NOT just touch. I'm paying attention to differences in skin temperature, watching breathing patterns and seeing where skin and fascia gather abnormally, feeling my own body mechanics, checking the tone of my voice, paying attention to room temperature, taking note when a client shifts, and making sure I'm not distracted by dehydration/thirst. I'm also dismissing external noise, being mindful of pressure, following direction of muscle fibers and noting resistance or weakness in muscles/connective tissues. It irks me to think of a therapist whose mind wanders. There's no room for that and I often think I could been MORE attentive every day I do this work. One of my goals is to be in the highest state of attention possible during a session. If I am clear and engaged, the client's nervous system will welcome me even further into the body-mind. Lastly, I do believe in energy work, but because it's so mysterious I'd rather not address "energy work" in this blog.


WHERE YOUR MIND IS DURING A SESSION
Clients can also "participate" in my and their own mindfulness while still fully relaxing. They do this by really feeling what I'm touching. Actively relaxing and breathing into tender areas can, I think, aid in cooperation. I must emphasize that forcing and willing are two very different things. Some people try VERY hard to relax and this only backfires. Being in control, but not controlling is a very tricky line to walk. During a session is a fantastic opportunity to practice mindfulness and meditation. Since a client is being touched their mind is less likely to wander and they can concentrate on being in the moment. Some may argue that meditation is simply being in the moment without judgment. Simply put, graciously receiving the world or handing over control to someone else is a freeing experience. Being free allows the rest and repair function to do some of its best work.

DOING IT "RIGHT" VS. CONSISTENCY: CONSISTENCY WINS
Employing my imagination and using visualizations are very powerful in my personal growth. In the beginning I'd have varied results. Sometimes I'd have very clear moments and then I'd try to cling to it and it would dissolve. Consistency instead of results was key in the beginning of my meditation practice. "Trying too hard" is normal and a phase in learning (or unlearning) how to quiet the mind. Don't take my word for it--do your own research and consult the experts.

FALLING ASLEEP DURING MEDITATION
Many people complain about falling asleep during meditation. It is normal to fall asleep. It still happens to me from time to time. It means I need sleep first before I can do anything else. I try to stay awake and present, but no need to complain about getting rest!!

SITTING UP VS. LYING DOWN
Some meditation practices will encourage you to sit cross legged or maintain some kind of challenging position. I say get comfortable. Many people cannot sit in these positions without becoming distracted by discomfort. I like to lay flat on my back, palms up, heart open. I want to give everything the opportunity to relax. Sitting has its benefits, but I make sure I do it in a chair, legs at a right angle, imagining my feet have deep roots into the ground.

VIDEOS: WHERE TO GET GUIDED MEDITATIONS
There are thousands of guided meditations on Youtube. Not all are created equal and certain visualizations resonate more strongly than others. If I don't like the tone of the narrator's voice or the content then I move on. I opt for 10-20 minute meditations and I use keywords like "guided meditation", "meditation letting go," "heart opening meditation," "body scan meditation," "meditation forgiveness," "meditation gratitude," "meditation for stress," "diaphragmatic breathing," and so forth.

BODY SCAN MEDITATION
Body Scan Meditations: get in touch with specific areas of the body through concentration and start becoming aware of where and how you hold stress:
https://www.youtube.com/watch?v=i7xGF8F28zo

CHAKRAS OR...GLANDS
What are chakras? Even if you do not believe in chakras, I think they are poetic descriptions of major glands and organs where there are high activity levels in the body. This is a fun, easy description regarding self-examination and where some people believe we hold blockages in the body. If nothing else it gets you thinking about why you hold tension in particular areas and taking some personal inventory. Who knew Nickelodeon had come so far!
https://www.youtube.com/watch?v=02FkMr21xOA