One of my notable realizations is that the type of massage I do - therapeutic/medical massage, a combination of pain relief and relaxation - would have a great home in a hospital. Whatever the problem may be, working holistically (that is, not just focusing on the disease or disorder or broken bone, but taking the whole physical and mental state into consideration) has so many benefits, and massage plays a big part in this type of treatment. And where best to complement Western treatment but in a hospital? Even in school, I had the grand idea of one day giving massages in such a setting.

Many hospitals in Britain include massage services, and one article states that "more than 100 hospitals and 200 health services around Britain offer 'touch therapy' such as massage to patients alongside conventional medicine." [source]. There's even a growing number of hospitals in the US that offer massage [PDF].

And the research promotes this addition. Just pulling some titles from the abstracts located here, massage has been shown to reduce hospital stay for adults and preterm infants; increase relaxation and decrease anxiety in intensive care patients; cause women in labor to release more endorphins, which lowers the need for pain killers; decrease anxiety in pre- and post-op patients; and decrease pain and anxiety for cancer patients (as previously discussed). Another study that I recall reading in school showed the positive effects of short chair massages for nurses at a hospital. Just like giving massages to caregivers, being able to help and support those who help and support others is a true gift.

But massage employment is a tricky situation, especially in this city. When I first looked into it, the few massage posts I found for hospitals required two years of experience. Now that I have this experience, all of those job postings are gone. As a temporary solution, I decided to pursue some massage-related volunteer work at one of the hospitals nearby. I could get a taste for the hospital environment and maybe even network among departments and staff in hopes of future employment. And everyone loves volunteers, right?

Well, in theory. But I've contacted volunteer coordinators at the three largest hospitals in town and they've all turned me down (to be fair, though, only two turned me down outright; one just never responded to my email). I'm fully trained, fully licensed, fully insured, and willing to use my special skills for the benefit of others... for free! But they said no.

When I asked one of the coordinators about this refusal, she mumbled something about how being "hands-on" was a liability issue. Never mind that I have complete liability coverage through my professional organization, and never mind the fact that I'm trained and compliant in Oregon's health and safety standards. Because most volunteers don't have this education, the hospital probably has a blanket rule against hands-on work for its volunteers.

This just means that they need to have proper positions for massage therapists on the actual staff. But they don't. My dream job is at Providence Hospital's children center, where they utilize physical therapists, occupational therapists, speech-language pathologists, audiologists, and nutritionists for holistic wellness. But there are no massage therapists on staff. And if hospital directors can't see for themselves how useful massage would be because volunteers can't do hands-on work, then they won't ever create these positions.

And therein lies the problem.

I haven't given up hope, though. My next plan is to contact the hospitals' HR departments and market my chair massage as "employee wellness". And I have a few contacts who might help with my networking. Naturally, I'll keep you all posted if anything comes of it.

A prospective client called to ask about my services, specifically about trigger point massage. How long does treatment take? she asked me.

I explained that this really depended on several factors, such as the client's activity level and general stress level. Typically, I told her, within 5 treatments she'd feel a huge difference, and by 8 to 10 treatments the trigger points (and pain) would be gone.

Despite the fact that every session and every person and every treatment plan is different, I've learned to be more confident about the specific benefits of my massages. It's part marketing, part psychology, but mostly me realizing that people don't want to hear about caveats or limitations - they just want a straightforward answer.

So that's what I gave the woman on the phone, as clear of an answer as I could without knowing the specifics of why she hurt or where or for how long, and without actually palpating the muscles.

But she wasn't satisfied. After considering my response for a moment, she asked me if she would feel any better after just one session.

I knew what she was getting at. I come across this sort of mentality every once in a while in new clients. Impatience. Because if there's one thing that Western medicine has "taught" us, it's that we shouldn't have to wait for results. Pain medication works instantly, so any sort of natural healing should work just as fast. As a society, we've grown to expect quick fixes and immediate results.

But let me stress this, and I don't think I could say it enough: Pain medication only takes care of the symptoms. It does not take care of the underlying problems. If the problem is muscular (and indeed, lots and lots and lots of everyday pain is muscular), then the muscles need to go through the processes of loosening, relaxing, stretching, healing. That takes time.

I knew what the woman on the phone wanted to hear, but I had to be honest with her. I told her that immediately following the first appointment, she'd feel great. In all likelihood, she'd be nearly pain-free for a number of days. But then the pain would return, and it would return for a very simple reason: The problem wasn't yet solved. That, as I had said before, would probably take 8 to 10 sessions.

She thanked me for my answer, told me she'd think about coming to see me, and hung up. I knew immediately that I had lost a potential client. But her expectations were out of sync with what the reality of the treatment would be, and it didn't sound like there was anything I could do about that.

Thinking through this situation, I wondered what this reluctance meant for the woman (and for the various clients who stop coming to see me because their muscles haven't been "fixed" fast enough). Would she just continue to live with the pain? Maybe she would take medication to help, and over time the pain would become just another ignorable factor of life. On the flip side, working with me for two months would force her to focus on the pain. It would also make her more aware of the difference between being pain free and living in pain, which might be more than she could handle.

It takes the right mindset to heal, I suppose. You can't just be a passive player when it comes to non-Western medicine, but some people would rather have a quick, temporary fix than gradual, although much more permanent, relief. It's an unfortunate thing when someone considers physical wellness not worth the effort, but there are enough people who do realize the benefits of massage to make my job more than worthwhile.

I've heard a little bit about fibromyalgia, especially in recent years. Occasionally I'll have a client come in with the disorder, and although we never learned specific techniques for fibromyalgia in massage school, I've been able to work effectively with these clients. It is, after all, a pain condition, and managing these conditions happens to be my specialty.

But you might not know anything about the disorder, besides the name. So let's start from the beginning. What is fibromyalgia?

Fibromyalgia is a widespread, chronic pain disorder. It has an unknown cause, and there are no objective tests to diagnose it. Rather, a patient is diagnosed with fibromyalgia if they have pain in 11 out of the 18 predetermined sites (see diagram below). These areas need to be in all 4 quadrants - left and right side, above and below the waist.



Oh dear, that's a lot of pain.

But take a look at the diagram again. Don't those areas look... familiar? No? Well they do to me, anyway. I regularly find trigger points at all of those sites.

The painful areas in fibromyalgia patients are known as "tender points". How similar are these to trigger points? According to one study, there's a huge overlap in the two points' pain patterns, and the researchers conclude that "most of the tender point sites in FMS (fibromyalgia syndrome) are trigger points."

That's certainly good news, in my opinion. This conclusion points to the theory that it isn't the pain itself that's unique to fibromyalgia. Indeed, plenty of people have trigger points without having fibromyalgia. Rather, it's how the brain translates and experiences this pain that defines the disorder. This hypothesis is known as "central sensitization", which refers to a hypersensitivity to pain, light, temperature, and other stimuli in the central nervous system (brain and spinal cord).

Fibromyalgia isn't the only disorder with its roots in central sensitization - researchers and doctors believe that migraines, chronic fatigue syndrome, and irritable bowel syndrome (among other disorders) may stem from this as well. And conveniently enough, fibromyalgia has a high comorbidity rate with these disorders. Depression and anxiety are also common in FMS patients.

But back to the tender points. If these really are trigger points, then there's an easy fix for them, right? Well, ideally. But as I've written about before, trigger point massages are not always the most pleasant to endure. And if the patient is already hypersensitive to pain and pressure, a trigger point massage certainly won't be like an afternoon at the spa.

But the answer, as usual, is communication. The massage therapist needs to work very closely with her fibromyalgia clients in order to stay within an acceptable range of pressure. Communication will also help to keep the client focused on the goals of treatment and the positive, though gradual, progress. Overtime, the frequent massages will release the trigger points, thereby making the tender points disappear.

Just in time for the holidays!

Starting today and going until the end of the year, I'm offering a special discount on gift certificates. So if going to the mall and dealing with the crowds gives you a headache, or if you just want to make your loved ones feel good for the holidays, this is the perfect gift for anyone on your list.

Seriously, who doesn't like getting a free massage?

Discount details:

- One 60-minute massage gift certificate: $50

- Buy three, get the fourth for half price: 4 for $175

Want to give an even more awesome gift? How about a 90-minute massage?

- One 90-minute massage gift certificate: $70

- Buy three, get the fourth for half price: 4 for $245

Massage gift certificates are the perfect gift! Call or visit my clinic to order some today!

Clinic phone: 503-445-8114
Clinic address: Grain Integrative Health, 4246 SE Belmont St.

I used to roll my ankles all the time. Sometimes I'd underestimate distance or sometimes it was just a simple misstep, but it always resulting in my ankle twisting and buckling. I blamed this painful occurrence on figure skating (my sport of choice for 11 years), since the sturdy skates I wore supported my ankles so well that they never had to strengthen on their own. I didn't know if this was actually true, but it was a satisfying excuse.

The fact remained, however - and no amount of excuses would fix it - that I had an unfortunate habit of twisting my ankle. Ouch.

And I know I'm not alone. People twist their ankles all the time. After all, we depend on our ankles quite a bit. They support all of our weight, and on top of that they're expected to be agile and flexible. That's asking a lot from a joint.

Especially a joint that doesn't move too freely. The ankle joint is a hinge joint, which means that it's technically only built to move along one plane (backwards and forwards). The unique structure of the ankle allows for limited rotation and side-to-side movement, but again, the main function of the ankle is for flexing and pointing. Flexing, pointing, and holding you up.

These are all important actions, used for basic things like walking, running, and standing. Since ankles are expected to do so much, we need to keep them strong. And did you know that there's an easy way to do that?

Here's what you do:

• Stand up.
• Lift up one foot.
• Stand there for as long as you can.

Yep. That's it. Just stand on one foot.

--
Why does this work?

Most of the time when we stand or walk or run, our weight is being distributed between both ankles. By putting all of your weight on one foot for a significant amount of time, you're demanding that the muscles around this one ankle work extra hard to keep you stabilized. Remember - your body doesn't actually have to be doing anything active in order for your muscles to be working. That's why your muscles can ache so much just because of posture problems. Holding your bones in place is a full time job!

Naturally, you can do this little exercise all the time. Give it a try whenever you have a free moment and happen to be standing around (or at least, whenever you don't have to be sitting). Personally, it's my favorite "waiting for the bus" activity. Standing around never felt so productive!

People often tell me about their shoulder pain. They'll use words to describe the pain - sharp, dull, achey, shooting, etc - and they'll also use their hands to point out exactly where the pain is.

Shoulders are oddly complicated. There are two groups of muscles that make up your shoulders: the ones that connect at your rotator cuff, which are involved with arm movement; and the ones that connect at your scapula (the "shoulder blade"), involved more with your upper back. Muscles in both of these regions are commonly known as the shoulder muscles, even though they're in different places and perform different actions.

But let's talk about the muscles near your shoulder blade. What muscles are here? Most notably, the rhomboids (see diagram below) and your mid-trapezius. They're involved in pulling your shoulders back (imagine touching your shoulder blades together), and shrugging your shoulders (rhomboids help bring the shoulder up, trapezius helps bring it down).


The problem area. Look familiar?

Why does this area hurt? It can hurt for a variety of reasons, usually due to overuse or posture (or both!). Personally, I find that these muscles bother me after a lot of physical activity. And the best course of action for making these muscles feel better is - would you believe it? - massage.

But unless you're extra flexible, you can't really reach that area yourself. And even if you could, the muscles you'd be using when massaging are the ones that you'd simultaneously be trying to relax, so it would all be a bit counterproductive. Solution? Tennis ball!

What to do:
Lie on the floor. Put a tennis ball under your back, between your spine and shoulder blade. Roll up and down on the tennis ball and vary the amount of weight you put on it. I would hold any uncomfortable spot for at least a few minutes - sometimes I'll even take out a book and read for a bit while in this position.

Don't have a tennis ball on hand? Try standing in a door frame with the edge digging directly into the muscles. Feels better than it sounds, I promise.

And that's it! Applying ice to that region afterwards wouldn't hurt either.

Naturally, if the pain keeps creeping back, a visit to a massage therapist would be the best long-term solution. But using a tennis ball for self-massage is great to ease muscle tension in between sessions.