Earlier this year I found myself with a severely injured wrist that caused me to halt life as I know it. My wrist that was in so much pain that I had nearly lost all functionality. It interferred with my morning coffee. It was awful.
As someone who has had joint pain since the age of 8, I've learned a substantial amount about pain and the management there of. Pain is an ugly, multifaceted beast. There is no one route to pain management. Pain must be approached from every possible angle: lifestyle factors, medicinal, nutritional, holistic, etc.
I approached owner of Om on the Range, massage therapist and yoga instructor Alaina Binfet to discuss her take on how both massage and yoga can each help a person with their pain. I dropped her name and one of her best pain relief gems in the 2nd blog of this pain series last week. Alaina has a very unique and helpful perspective.
DISCLAIMER: None of the information in this blog series is meant to take the place of your healthcare provider’s advice. Continue with your existing pain management plan and seek medical care as needed. Inform your healthcare provider of any changes, alternative treatments and self-care techniques you decide to implement.
Sheila Amir: The pain is primarily in my wrists, but when I'm massaged, the actually places that hurt are my neck, shoulders and elbows. Can you explain that?
Alaina Binfet: Trigger Points! A Trigger Point is a small area of contracted tissue within a muscle that can cause referred pain to other parts of the body. Trigger Points have common patterns of pain referral and have been well documented and diagrammed. These are called “referral patterns”.
Most of the time trigger points are not located on the area where you are feeling pain or discomfort and working on the areas that are bothering you most likely will not give you long term relief.
Example, you come in because your wrist is hurting – but when I massage your subscapularis muscle (the muscle that lays on the UNDERSIDE of your scapula or shoulder blade) you will feel tenderness in that direct spot as well as feel a tingling/shooting pain down into the wrist.
Below is a picture indicating the area of the trigger point and where the pain is referring to.
Photo credit: http://www.triggerpoints.net/muscle/subscapularis
SA: How often would you recommend massage for this type of injury/pain situation and is there a certain type of massage that you would recommend?
AB: In a perfect world, I would recommend the individual receive massage for this type of pain at least once a week until symptoms subside, but for many of us, that’s just not feasible. That’s where the beauty of self-care comes in. I like to show my clients treatments that they can do at home to help themselves when they are unable to receive treatment when they need it.
SA: What would be important to tell my massage therapist to get the best outcome?
AB: First off, be honest. When they ask you how many hours you sit in a day - tell them. If they ask how often you exercise or if you do stretches, it’s because it’s important for them to know what they’re dealing with and how to approach the massage session – they’re not going to judge you for it.
Tell them what kind of pain you are having, when you started experiencing it and if there is anything that seems to help it or make it worse.
Let us know what kind of pressure you prefer vs what kind of pressure you can handle. Be sure to speak up during your session if it gets unbearable. Working on trigger points often means using a lot of pressure and it can be painful; we don’t want you to be in such severe pain during the treatment that you never come back again!
SA: There is stretching and then there is practicing yoga. While both are great for this type of injury and overall health, what daily stretches would you recommend?
AB: Aww, stretches – I love them so much. I tell every one of my clients to do them, yet it’s one of the most overlooked forms of pain relief and preventative health for us.
As you have said, you have wrist pain due to crocheting, but you do not have Carpal Tunnel Syndrome – that being said, I think you should still be stretching your hands, wrists, and forearms daily! You may not have Carpal Tunnel Syndrome now, but you don’t want to develop it later on down the road either.
Hand & Wrist Stretches
Your hands will want to scrunch up; don't let them! Be sure not to roll your wrists or forearms while performing this stretch. Repeat on the second side. Roll out the wrists a few times in each direction to complete the stretch.
Extend one arm in front of you at shoulder height. Keep your palm down, facing the floor. Release your wrist so that your fingers point downward. With your free hand, gently grasp your fingers and pull them back toward your body. Hold for 10 to 30 seconds.
To stretch in the opposite direction: Extend your arm with your palm facing toward the ceiling. With your free hand, gently press your fingers down toward the floor. Gently pull your fingers back toward your body. Hold for 10 to 30 seconds. Repeat both stretches with the other arm. Cycle through stretches two or three times with each arm.
There is also a GREAT stretch that can be done up against a wall, but rather than even attempting to explain it, HERE is a YouTube video of it. It gets a little weird around 4:20 mark when the gentleman starts self-massaging his subscapularis muscle... but the beginning is very informative.
SA: Not being able to put weight on my wrist rules out a lot of poses. What are some poses that you recommend to not only stretch out the issue, but strengthen the supporting areas to prevent injury from occurring down the road?
AB: While practicing yoga and you find yourself in a pose that requires a lot pressure on the wrists, try to focus on spreading your fingers wide and pressing down through your fingertips, and the 4 corners of your palm. Make sure that your middle finger is straight forward, parallel with the length of the mat.
Also, if you have the option to do so, you can lower down to your forearms rather than using your hands. Ex: Plank or Downward Dog can be done on the forearms versus the hands.
Gorilla Pose (Padahastasana)
Upward Bound Fingers Pose (Urdhva Baddhanguliyasana)
SA: A contributing factor to this is my lower back muscles are weak. My upper back ends up compensating for lower back and it perpetuates the cycle. For someone who isn't versed in pain or the body, that may sound weird. Can you explain this in human terms?
AB: When most people think of their lower back muscles, they are thinking of them as single muscles that only sit at the lower back. The muscles that support the lower spine are actually along the whole length of the spine; they run all the way from the neck to the sacrum.
When you think of your lower back muscles being weak, it usually means that your entire core is weak. Your core is made up of the muscles along the spine, your hip flexors, glutes and the deep muscles that lay inside your abdomen called your psoas, illiacus and quadratus lumborum (see image below).
When you have a weak core, your posture will be compensated, which can lead to pain, inflammation and general discomfort throughout your entire back.
Photo credit: http://www.runforwealth.com/an-analysis-of-why-your-core-is-a-vital-component-of-your-running/
SA: What are some simple home techniques that a person can do to support healing?
AB: Self-care is the most valuable tool a person has!
We all want a quick fix. It sure would be amazing to walk into a treatment office and have someone completely cure you with a few pokes and prods. Unfortunately, it’s not that easy. You need to be diligent about exercise, stretching, strengthening and of course mental health!
If you live in a life that is full of stress, not only are you going to be exhausted and high strung, but your body will begin to break down from all the stress.
It also makes your (massage) therapist’s life a lot easier if you are taking care of yourself outside of your appointments. I can’t tell you how many times I’ve had clients come to me with chronic low back pain. Every time they come back and tell me how great they felt after their last massage, but the pain is back. When I ask them if they’ve been doing anything like yoga or stretches at home, they say no.
I recommend doing some form of yoga or meditation daily. It doesn’t have to be an hour long yoga session.
Even if you wake up and do 3 sets of Sun Salutations, you’ll feel so much better! You’ll start your morning off by waking up your muscles, and taking deep relaxing breaths to help set the pace for your day.
Grab your dog’s tennis ball (hopefully one that’s not too slobbery) and lay down on the ground. Place the tennis ball directly under the painful area, and slowly lower yourself down and allow yourself to relax (as much as you can. I know, it can be hard to do). Once here, concentrate your breath and see if you can feel the muscle twitching and releasing underneath you.
Another great option – Epsom Salt BATHS! Baths sure are a lot more appealing than they were when we were little kids. When I was 6 if you’d have told me to take a bath, I would have run screaming and locked myself in my closet along with all my dirty socks – but now that I’m an adult, I run to the bathroom shedding my clothes along the way with excitement when I hear the word.
Epsom Salt is primarily made up of magnesium, a mineral that the body needs, and can actually be absorbed through the skin! Magnesium helps relax skeletal muscles by flushing lactic acid buildup in the muscles, which can occur from physical exertion.
Magnesium also helps regulate nerve function and plays a role in helping the body’s absorption of vitamins - a good nutritionist friend of mine told me this. All of these effects significantly influence muscle soreness, which also affects muscle stiffness.
Also, foam rollers are great for do-it-yourself massaging and trigger point release. These are exactly what they sound like – foam cylinders that you place on the ground and roll over with your body weight on the specific area.
SA: If I walked into your studio and explained what was going on, what would you tell me? Get your life together? Ha! For example recommended massage schedule, stretching suggestions, yoga suggestions, self-care, etc.
AB: All of the above. I would first recommend an initial massage appointment so I can see what kind of shape your body and muscles are in. From there, I would provide information on self-care so that you can get started on a good regimen.
I would recommend you come in for a massage at least once a week for the first 3 weeks, then we can re-evaluate where you are. Yoga, and stretching are a must. Many people have this misconception that yoga has to be some intense form of crazy intertwined stretches, but it can be done quite gently and can be very effective.
SA: Do you feel nutrition affects overall pain, how well a person responds to massage, and/or how a person progresses in their yoga practices?
AB: Yes! I absolutely feel that nutrition affects overall pain, but I’m not the expert in that department ;) As I mentioned above, your muscles need specific vitamins and minerals in order to be healthy and functional – if you’re not feeding your muscles these vitamins and minerals, how can they do their best for you?
Also, if you are eating healthy, you are more likely to feel better and have more energy; therefore you’re more likely to engage in healthy activities.
Another important thing to remember is water. When you’re hydrated, your skin and muscles will be more supple and elastic – affecting your overall muscle function. Drinking adequate amounts of water before yoga practice, and massage will definitely help! Your muscles won’t be as sore afterward and your body won’t absorb as much oil during your massage, which your (massage) therapist will be grateful for.
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