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View Full Version : Is the Problem Where the Pain Is??


James Boelter
02-18-2004, 02:24 AM
Having seemingly strained the "Flexor Pollici Longus" tendon (which powers the thumb/thenar muscles) in my right volar forearm recently during a clinical massage, I've been feeling the chilly breath of mortality and facing the abrupt end of my dream career as a massage therapist after only 7 months of school. (That particular tendon has been a weak point for several years, and tends to flare up whenever I work Clubbells too hard, too soon, so it's not a big surprise).

I've read enough and trained enough to know that 'he who treats the pain where it hurts is lost'. So I performed seeking massage on the area, including the thenar pad, and behold, found trigger points and referred pain in both the thenar pad AND just under the distal base of the first metatarsal (index finger to non-anatomy geeks).

And tonight in class, we saw our first Neuromuscular Therapy video (by Sean Riehl) on the extremities, and there it was...it turns out that it's a BAD mistake to perform 'rotary' motions with the thumb under a load, and that the FPL tendon is the one most frequently injured in massage therapists. (Talk about good timing! :D ). So the real problem with my forearm lays in the way I use my thumb. And the most effective treatment seems to be in the thumb/thenar pad trigger points, and a certain anchor/stretch protocol where the sore spot in the forearms gets the anchor (stationary pressure ) from the other hand or knuckle, while the thumb flexes back and forth to essentially iron out the strained fibers in the tendon under the pressure. This is very cool.

But what scares me is that if I had gone to a GP, there is a VERY good chance that I simply would have gotten a prescription for NSAIDs and been told to 'take it easy' for a couple weeks (not an option at this point if I want to graduate or to start a career afterwards). I could have fumbled around for weeks, MONTHS, before I managed to argue my way into a referral to a PT, who could probably have diagnosed the real problem in 30 seconds.

Friggin Health Care system...I already know more than 95% of the public and lay people out there, and yet I managed to hurt myself. And if I hadn't had some previous clues from reading people like Pete Egoscue and Coach Sonnon, I could easily have spent the rest of my life in pain, waiting for the next flareup and loss of income. And if I hadn't been lucky enough to KNOW there had to be a non-surgical, non-drug related approach, I might not have been lucky enough to see this particular video.

And what kills me is: the NMT approach, if you know a little anatomy, is completely straight forward and easy to apply. There are only about five techniques - the rest is all knowing where to apply it (avoiding getting fooled by referred pain and some muscle testing) and how to rotate/adduct etc body parts so you can get directly at the muscles with the problem. Once I completely absorb the material in this one 2 hour video, I will be able to help a whole bunch of people (not everyone, but most people) get past seemingly intractable pain and debility, or at least give them major improvements, in only 2-3 short sessions.

(Riehl also includes a simple, straight-forward 'self care' regime based on this techniques for anyone who works a lot with his hands and is at risk for RIS type injuries).

So why did I have to become a professional massage therapist to hear about this stuff? Why isn't it common public knowledge? I'm no bodywork prodigy...this is SIMPLE STUFF!!! Why don't even most doctors and nurse-practitioners seem to know about it? This info is simple enough that it could be in 'picture format' pamphlets in your first aid kit, along with the aspirin! Why are so many people limping along with shots and pills and splints and similar bandaids when help is so simple and so close at hand?

What the heck happened to us???

bob_stra
02-18-2004, 03:43 AM
> Having seemingly strained the "Flexor Pollici Longus" tendon (which
> powers the thumb/thenar muscles) in my right volar forearm recently
> during a clinical massage

*stares sternly at James*

Put your hand out!

*raps James on knuckles*

Bad Therapist! No biscuit!

:lol:

> And the most effective treatment seems to be in the thumb/thenar pad > trigger points, and a certain anchor/stretch protocol where the sore

Out of curiosity, are they making you buy the Travel And Simons' trigger point manuals? They're pricey, but worth their weight in gold.

> But what scares me is that if I had gone to a GP, there is a VERY good > chance that I simply would have gotten a prescription for NSAIDs

99.9%

Ironically, Massage Today magazine (USA), had an article on a MD who, after getting her MD, decided to study for her LMT license.

I thought that was cute story. She was very humble and not in the slightest bit snooty about being a MD. (BTW, a law professor of mine calls em "Medical Divinity". :-)

> before I managed to argue my way into a referral to a PT, who could
> probably have diagnosed the real problem in 30 seconds.

You have to be referred to a PT in the US? Dayum.
That must make the PT's antsy.

> And what kills me is: the NMT approach, if you know a little anatomy, is > completely straight forward and easy to apply.

How sweet it is..... ;-)

> So why did I have to become a professional massage therapist to hear > about this stuff? Why isn't it common public knowledge? I'm no
> bodywork prodigy...this is SIMPLE STUFF!!!

Now, multiply that by all the 'simple stuff' re: nutrition, exercise, stretching, breath work .... why, you could create an entire profession out of that :-)

> What the heck happened to us?

"A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects" - Heinlein

Sorry James, I gotta stop honing in on your threads ;-)

Vbrown
02-18-2004, 09:06 AM
Bob,

I think the world would be a better place if more people quoted Admiral Heinlein more often....

And didn't you say something earlier like "No thumbs!"? :?

Thanks James for summing up nicely why I've chosen my career path in acupunture. NSAIDS and hope aren't really my idea of "treatment".

Though you're hurt your thumb (argueably the thing that makes you human) it sounds like you've caught it before it can ruin your life. So like the man says: "There is no coming to conciousness without pain." You'll never hurt that thumb again!

Regards,

Vince

James Boelter
02-18-2004, 01:23 PM
Bob, I was hoping you'd chime in on this...I don't want to tax your patience and go whining to you for free advice whenver I get a setback or a boo-boo. I didn't know about the manuals you mentioned, but I will check them out.

Vince: yes, it is embarassing to get a thumb related injury less than two weeks after I wrote about 'Just say No to Thumbs', but I thought I was taking it easy and being conservative with 'em. That tendon has been giving me trouble off and on for years (probably thanks to my Playstation/Doom/Final Fantasy habit in my late 30's), and I will just have to be more mindful and attentive.

The original 'ping' happened during a seemingly un-thumb related move where I slipped fingers medial side first between the scapulae and the table for a neck traction; I've changed the angle of insertion of the fingers in a way that seems to take the stress off the area. The new way seems to require considerably less 'oomph', and is just part of the evolution of my 'stroke table mechanics', I guess.

We grow old too soon and too late smart...

bob_stra
02-19-2004, 01:58 AM
James my friend, the entire policy of this forum is "ask and ye shall receive".

Anything I know is yours for the asking.

> I didn't know about the manuals you mentioned, but I will check them > out.

They are quite expensive. Amazon lists them @ $190 US.

http://tinyurl.com/346c3

(say, who's face / "featured book" is that down there on the left hand side? :lol: )

As such, smaller private collages (I'm assuming your in one of those?) don't usually have a copy.

Do you happen to be anywhere near a university campus that teaches health science (physio, chiro, etc)? Usually you can find a copy there.

Failing that, if you PM me a postal address, I will send you a few photocopied sample pages, so you can decide whether you want to buy the whole thing or not.