January 12, 2014
Massage and mouth work may sound paradoxical, but when we are discussing car accidents and impacts to the head and jaw, we are talking about trauma. Trauma to the mouth often means tissue and bones become compressed and ‘loaded.’ Whether or not you have a visit to the emergency room, or walk it off, the body does not take kindly to this kind of rough housing. Assessment by a qualified physician is always prudent. Following this, get yourself assessed by a quality massage or physical therapist, someone who knows how to assess and feel for restricted or compressed tissue. Such injuries are usually untreated because few health care providers understand how impact energy can reside in the tissue or how compression can be released. Trauma to the body can have as much to do with how a body (nervous system and tissue) perceives an event as it does simply absorbing external kinetic energy.
A hit or impact to the nose, mouth, eye, forehead or jaw may result in compression to many bones of the face. These bones have direct relationship to the deep tissue that surrounds the brain and spinal cord, potentially causing internal tension and restriction on tissue or cranial nerves. Such compression to the bones, tissues and muscles can be assessed and fully treated by a skilled practitioner. Left unaddressed, these tensions and restrictions can lead to pain and dysfunction for us in the future. Sometimes such residing tension from a childhood or teenage fall, seemingly not much of an issue at the time, can become the source of headaches, head pain, neck or shoulder pain or even low back pain later in life.
When would I want to get mouth release done? If you answer yes to any of the below questions, you may benefit from mouth work. Issues of tightness and restriction can come from impacts and falls, but also from braces, dental surgery, and bruxism. I recently worked on a woman with whiplash and her reaction of her jaw slamming closed at the time of impact was enough to create notable compression in the fascial bones and head. This seemed to be contributing to her cognitive deficit, short term memory issue and speech impairment. Releasing these structures helped mitigate many of these symptoms in her head, and elsewhere in her body too. If you are in doubt about potential mouth tension, discuss this with a practitioner ‘in the know.’ Select MDs, chiropractors, physical therapists and massage therapists offer this form of release. In the state of Washington, massage therapists are required to take an ‘intraoral endorsement’ for them to legally work in your mouth, meaning they pursue additional training for it. The work is very specific, however, not at all what we usually consider massage.
A few years ago my daughter, about four and top heavy in the head, as kids are of this age, leaned over a series of concrete steps while playing. Gravity took over and her entire upper torso was behind the force that impacted the bridge of her nose on the edge of the step. She was not a happy camper and had a couple of nasty abrasions that lasted for a week or so. She would have nothing to do with me working on her, so we took her to see Dr. Steven Hall in Issaquah. He graciously squeezed us in late in the day and found no restrictions, to our relief. I leave no stone unturned when it comes to my daughter and I slept better knowing she would not potentially be scarred with a facial compression that would surface later in her life.
Impacts to the face are not unlike a multiple car pileup. Each car involved can accrue some damage, some cars more damaged than others and it takes work to repair both human injuries and car damage. Let’s take an example of a soft ball hitting the face. The ball hits the cheek bone and the mid nose. There will be damage to the nose cartilage (not shown). Using the multiple car pileup analogy, we move from behind the nose moving deeper into the head. That means the next bone will be the ethmoid bone and the vomer (from the Latin meaning ‘plow,’ cause it is shaped like one) and the maxillae. These bones connect with other bones, leading to the bone at the back of our head, called the occiput.
Any or all of these of these structures can get compressed with the right impact and can be assessed, accessed and treated. In fact, if we take our anatomy a step further, the occiput then shares an intimate and direct connection with the tailbone, or sacrum, via the tough fascial membrane surrounding our nervous system. Impacts to the face can affect the biodynamics of the sacrum and sacroiliac joint and into the hips.
If you have never had mouth work, or if this has raised your curiosity, consider a treatment. It can be very relaxing for these structures are intimately in relationship with our head and nervous system. You may be surprised at the results. If you have history of impact here, it might be contributing to your lack of clarity, tension or possibly pain somewhere in the body, often not in your head. Migraines, sinus issues, headaches, or recurring neck issues may be present. If you are a massage therapist reading this, consider studying this region of the body and getting your intraoral endorsement. It is an essential part of the body to both assess and treat. Massage Therapy in Issaquah offers treatment in mouth care for both acute injuries and chronic ones.
August 26, 2013
This article discusses the potential repercussions of impacts to our heads from a bodyworker’s perspective. I’m guessing that most of us are not aware that tension in the head can accrue as a result of falls, hits and sports injuries. Forces to the head, of course, can have an immediate impact in the form of concussions with symptoms like vertigo, imbalance, hearing issues, memory loss and headaches. Sometimes we walk away from injuries that seemingly should have left us marred in some way. However, it is possible that over time, either months or years, the tension from a prior impact that went unresolved can present symptoms later in life. In my line of work, I see many people who have an onset of headaches, or other symptoms of the head or neck or elsewhere, perhaps in mid-life, without an apparent cause. This might be attributed to stress. It also may have its origin in a fall or injury from long ago. A skilled therapist can feel these restrictions in the head and treat them, bringing relief that would have benefited the client following the initial injury.
How many of us have seriously banged our head against something, been impacted by something heavy or have fallen and hit our heads on the ground? The body has amazing compensatory abilities. ‘Tension’ as I will call it, or ‘energetic trauma’, can be absorbed by bone or tissues through the cranial or skull (or anywhere in the body for that matter). Bones such as the occiput, temporals, parietals and frontal are all in line for potential impact for they are the bones that make up the back, sides and front of our head. There is more to it than this though. Each of these bones is connected to fascia in the head and other bones. Tension forces can travel along fascial lines in the head, ‘residing’ at another point in the cranium. Alternatively, tension forces can transmit between bones. For example, the occiput, the bone at the back of our head, is connected to the bone that sits behind our eyes, called the sphenoid. When we hit the back of our head, as when our head forcefully impacts the head rest during a car accident, the kinistetic force can impact and compress the joint between these bones. This bone behind our eyes, the sphenoid, in turn, connects to many bones of the face and mouth. Where these bones connect with each other are potential areas of compression. Bones can acutally get ‘jammed’, becoming, to a certain degree, ‘dysfunctional’. Also, within the sphenoid bone sits the pituitary gland that plays a role in hormone production. Might hormonal function be influenced by trauma to this bone to some extent?
To understand this concept of energetic ‘tension’ better, here is another example. What is the difference between two people falling on outstretched arms, where one person succumbs to an arm fracture, but the other person doesn’t? Let’s say they are both young, in their 20s, in excellent health and relatively athletic. The event is unfortunate for the person with the fractured arm. Many of us are familiar with the process of fracture healing and it’s not fun. What about the person who didn’t get the fracture? Are they lucky? Maybe. It depends. It depends on whether the kinestetic force from the fall was deflected out of the body or not. If it was, the story ends here. If, however, some of that force that was almost enough to fracture the arm (but didn’t) got stuck in the tissue, then there might be issues of discomfort and pain or joint restriction in the future. This could happen right after the injury, or, as strange as it sounds, potentially months or years later. There are many variables to this.
One of the challenges of blows or falls to the head is assessment. Who is going to tell you that you have accrued such tension? Who is going to refer you to get such tension released? Unfortunately, the only way of identifying this is through palpation, meaning that someone feels this when they hold your head. You might get lucky and find a physician, physiatrist, osteopath, physical therapist, or massage therapist with just such skills. X-rays certainly don’t show the kind of ‘tension’ I am referring to, neither do MRIs which are expensive and sometimes inconclusive.
There is growing documentation of the process of ‘trauma in the body’. The long time stand by on this subject has been Peter Levine’s book Waking the Tiger. Robert Scar, PhD., in his book The Body Bears the Burden directs much of his focus on why it is challenging for so many of us to fully recover from car accidents. Other authors speaking to this subject are Babette Rothschild with The Body Remembers, Michael Kern’s book titled Wisdom in the Body, and Dr. John Upledger and Michael Shea’s books on Craniosacral Therapy.
If you have ever had a blow or fall to the head, you may have walked away unscathed. You may, on the other hand, have accrued some trauma in your system. Keep this in mind as you manage your health care throughout your life. It may provide you or your family the relief you’ve been looking for.
Acute Injury Care in Issaquah offers skilled massage therapy that helps address such issues as tissue trauma. Both the Seattle and Issaquah regions have skilled health care providers that offer similar techniques to address such trauma.
March 28, 2013
To every person that I pose this question to, there is often a reply of a memorable incident around sledding, slipping on black ice, falling down stairs or some kind of sports related event. In some cases the resultant fall onto the tailbone caused significant pain for up to a week or longer with difficulty sitting for perhaps weeks. Certain activities can almost guarantee some amount of trauma to the tailbone, like gymnastics, horseback riding (the quick eject), ice skating, and snowboarding on hard packed snow. Regardless of the mechanism, we recover, the pain resolves (hopefully) and we move on, end of story, right? Perhaps.
Here the plot can thicken. It depends on many variables, but it is possible a tailbone injury may not fully resolve following a fall. Part of the ‘impact force’, if not fully dissipated at the time, can be held in the tissue indefinitely. The body has a remarkable ability to ‘absorb’ excess energy from a host of different situations, from falls, overuse, surgeries, verbal and emotional abuse to dental surgery, even birth trauma. This excess energy or ‘trauma’ draws upon our bodies’ resources to contain it. Life goes on as usual until such a time as our resources grow limited. Like when we are dealing with an extra number of external stresses, for example, like a new job or work assignment or managing a financial challenge or going to ‘the Prom’. We may wake up one morning with a pain somewhere in our body. Even though our initial trauma might have been the tailbone, this may not be where we the pain show up. It may be our low back or tailbone, or symptoms might show up elsewhere like in the hip or through headaches or knee pain or our shoulders. This pain or ache can escalate with time until this traumatic energy is identified and released.
Why might you get headaches from a fall on the tailbone? It has partly to do with energy transfer and energy following the path of least resistance. A fall on the tailbone can transmit energy directly up the tailbone to the neck, head and brain. You can imagine how the neck and head muscles might respond to such an incident. Such an impact can lock up the muscles holding your head on your upper spine, or result in tension through the fascia and structures of the head and brain. Such response may happen relatively quickly like that day in a form of a concussion or in the following days or weeks with headaches, or the presentation may be more subtle, taking years to actually manifest as discomfort and pain. Variables of force vectors, angles of impact, health of tissue, emotional state all enter into the equation.
Fortunately, there are ways of identifying such trauma and releasing it. Peter Levine has written extensively about this subject. Other books related to trauma have been written by Dr. Michael Kern, DO., Dr. John Upledger, DO., Dr. Robert Scaer and Babette Rothschild, to name a few. An advanced craniosacral therapist can identify and release such trauma in the body. Traditional massage therapy does not usually address this. Both Seattle and Issaquah, Washington have very good practitioners to help facilitate such release both on adults and children and babies.
How do you know if you are carrying some kind of trauma? Everyone is managing trauma to different degrees. It is part of the human condition and experience. One potential sign is if you have been managing a chronic condition somewhere in your body or a tight muscle like the piriformis, for example, that, despite all your efforts of stretching, using a foam roll, attending physical therapy, massage, and a good diet, will not let go and give up the ghost, then a reasonable next step is to see if there is an underlying trauma somewhere in the body. It may be that the tight muscle needs to stay tight to help ‘contain’ that ‘trauma energy.’
A fall on a tailbone may just be a simple, albeit painful incident. Or it can lead to pain down the road. There is always an answer and wisdom for everything we experience. The challenge is in identifying and understanding it.
January 31, 2013
It sounds like a simple question. Wouldn’t an injured neck feel puffy and, well, … swollen? It depends. It will, if you have a superficial injury or condition. If, however, you have been in a recent auto collision or sports injury or fall that involved your head being rapidly impacted, pulled or pushed, accelerated or decelerated, then no. It may not feel ‘feel’ swollen at all, rather, it will feel very, very tight. But the swelling is there!
I have the belief based on years of clinical practice that identifying a swollen neck is difficult. It has little to do with the practitioners’ or patients’ ability to detect what most of us perceive as a ‘swollen’ area on the body and everything to do with the anatomy of the neck.
The cervical anatomy is relatively complicated and intricate. It is downright astounding! There are a multitude of muscles that play a host of roles for us: help hold our head up, allow us to nod, look up, turn and flex from side to side. There are postural muscles, there are some that play a role in eye movement, proprioception and balance (subocciptals). Two connect to the tough dura mater tissue surrounding our spinal cord (RCPMi). Many muscles on the front side of our neck support our chewing, swallowing and speech (hyoids). Some assist with breathing (SCM, Scalenes), and others help us in the functions of talking, coughing, and sneezing (prevertebral group). One study done in 2009 looks at the significance of the deep muscles at the base of our skull (suboccipitals) in playing a role in effecting hamstring tension!
As fascinating as the multitude of neck muscle functions are, it is the connective tissue, or fascia that covers all these muscles that is more significant in our conversation of swelling in the neck. One definition of fascia is a ‘sheet or band of fibrous connective tissue enveloping, separating, or binding together muscles, organs, and other soft structures of the body.’ If we were to remove all our organs, muscles, tendons, blood vessels and nerves, we would be left with a detailed framework for all those missing structures. It’s everywhere. It can be very strong. It helps separate, compartmentalize and support many functions of the body. In the neck, there are many layers of fascia running superficial and deep to support the vast array of cervical musculature and structure.
When the neck is introduced to some form of trauma by getting tossed about, muscles or ligaments, for example, can get torn. Swelling will develop and progressively push against the closest layer of fascia. The greater the injury, the greater the swelling and so more pressure is exerted against these fascia layers. It is common for a recently ‘whiplashed’ neck to feel very ‘tight’ upon feel. It is a ‘special’ kind of tightness, however. Usually in a muscularly tight neck one can readily discern the multiple layers of tight muscles. With an edematous neck, and by this I mean a swollen one, that tightness disallows clear discernment of the muscle layers. The neck almost feels pressurized from the inside. Symptoms that go along with this tend to be pain, lack of movement, and ‘guarding,’ often with a head pressure or headache.
My working theory seems to be supported by the application of lymphatic techniques to such cervical calamity. The application of these specific techniques by a skilled practitioner helps improve the natural flow of the lymphatic system. Considerably. By the end of a session, that guarding has decreased. It is easier to feel and identify individual muscles, especially the deeper ones. Range of motion improves as well as ease of movement. Pain decreases, sometimes to a surprising degree for the patient. Once this fluid draining system of the body has been elevated to a higher flow rate, it takes hours for it to return to a resting rate, all the time continuing to support the injured area by moving out excess swelling that promotes the next stage of the recovery process. It is important to note that the few hours following a session is an important time of recovery. Go easy with the neck and don’t over tax it! The splinting has been removed for a short time to be replaced with healthier tissue.
If you have the misfortune to be the recipient of a neck injury followed with noticeable tightness, you may be an excellent candidate for ‘acute injury care’. Issaquah, Washington offers a tremendous network of health care providers that can support your recovery, from primary care physicians to quality acupuncturists, massage therapists and more. I invite you to ‘optimize your early care’, manage your swelling early on and progress so you can return to your full potential ASAP.
December 18, 2012
It is widespread practice in the sporting community to use compression bandages to help manage swelling in injuries. The intent is to minimize additional fluid developing at the site of injury, especially in the early stages of injury. It makes sense that the less swelling that accrues in the tissue, the less swelling is needed to manage during rehabilitation. Compression bandaging is one of four standard elements of care currently used as part of a R.I.C.E. strategy: Rice, Ice, Elevation, and Compression.
Once swelling has established itself at an injury or surgery, what now? We might give some thought to the system that naturally moves excess fluid out of the tissue on a daily basis. According to Dr. Bruno Chikly, the French Osteopath that wrote his doctoral thesis on the Lymphatic System, 70% of the lymphatic system functions peripherally in the body, just under the skin. These tiny but significant vessels are found at the dermal-subdermal layer of the skin. Interestingly, the rate of flow of this system can be increased up to 10x its resting rate. Stimulating the lymphatic system can happen a few ways, including manual therapy, but also with specialized compression wraps.
There is a company here in the Seattle Area of Kent has developed specialized compression wraps that will help move swelling out of an injury by stimulating these peripheral lymphatic vessels. JoAnn Rovik, the owner of JoviPak, expanded the technology of imbedded ‘chipped foam shapes’ to create user friendly wraps and sleeves for any location on the body. The highly resilient shredded foam is encapsulated in a soft cotton-lycra wrap and held firmly against the area of swelling by an overlying short stretch wrap. As we move our limbs, the muscles push against the differing foam particles creating high and low pressure points in the skin and underlying tissue. The net effect is a stimulation of the lymphatic system. This means less swelling to your injury area.
In many ways, this is a dream team’s solution to early injury care for swelling. It supports an injury site by furnishing some of the benefits of a standard compression wrap while maximizing the body’s natural ability to reabsorb the excess swelling (lymphatic system). What’s more, it can be worn and works at night, and because of its particular design and sizing, it will not leave you with that ‘throbbing’ sensation due an overly tight ace bandage.
JoviPak’s primary focus is in creating comfortable, adjustable, reuseable products to help people manage excess swelling. They offer both customized and ready-made products. If you are dealing with a recent surgery or injury, look into their orthopedic line, both for upper and lower body. The rest of their products are designed for lymphedema patients.
For Upper body rehabilitative product line, go to http://www.jovipak.com/upper_rehab.html
For Lower body rehabilitative product line, see http://www.jovipak.com/lower_rehab.html
September 21, 2012
I recently typed in two phrases into the Google search engine. One was ‘decreasing swelling’, the other was ‘reducing swelling’. I was both intrigued by the results and disheartened. In the first 40 results, only two sites obviously mentioned the lymphatic system. Only two! One did so cursorily and the second authoritatively.
By far, the predominant advice offered were variations around R.I.C.E. therapies, ‘R.I.C.E.’ being the common acronym referring to the treatment strategies of rest, ice, compression and elevation as the standard care for recent injuries and post surgical care. E-how’s website was the second search result found (encouraging!) and the only site in the first 39 that obviously mentioned ‘lymphatic’ work, though not convincingly or fully. Lymphatic treatment was #8 of its list. Here was their ordering:
I will not comment in this blog on #1-#7 here, but I would move # 8 to #2 or #3, and change the description to ‘The lymphatic system is the primary system in the body for removing excess swelling from the tissue. A skilled therapist can increase the resting rate flow by 10x, effectively helping to direct excess fluid out of the injured area. Treatment is effective, quick and lightweight and non-invasive. #1 Rest is often critical and ice can moderate the volume of swelling that can potentially gravitate to the injury, especially in the first few days of the event.
There was one site I found with both searches that spoke authoritatively on the lymphatic system, albeit briefly, and this was a San Francisco Plastic Surgeon, Dr. Stephen H. Williams. This result came up #40 and #55 respectively. For me, the disheartening aspect of this search is that many people on the web are querying where and how to get relief from swelling associated with injuries and post-op care, and unless ‘you are in the know’ about the lymphatic system, you may not find it. Long standing swelling in the tissue can delay and in some cases, complicate the rehabilitation process. As many people noted, rest, ice, compression and elevation were not very effective for removing swelling. I found inquiries for how to reduce swelling for ankle sprains, tendinopathies of golfers and tennis elbow and a host of plastic surgeries. Rhinoplasty was a hot topic. Numerous references were made that it can commonly take more than a year for the swelling to abate, sometimes a year or more beyond that! Utilization of lymphatic drainage can have a significant impact on reducing edema, even directly following the event, when the swelling is due to an injury or post op condition.