Am I Strong Yet?

My Roots

We all have to start somewhere.  My earliest experiences with strength training had to do with high school and was often connected to my love of wrestling.  Strength was a key element of the training and we worked really hard.  I was on a team in one school where almost the entire team consisted of state champions – no,  I was not one of them.

What was evident to me was that people who were stronger seemed to do better.  They were no pinned as easily and could often break holds.  I could see it’s importance but it was not something I particularly worked at unless the coach was making me do something like push-ups or sit-ups.  I do have to admit a more than passing interest in Charles Atlas and his dynamic tension.  I just never made enough money to buy his product.  It still sells for about $50!

And Then Came the Army…

I joined the Army to study Physical Therapy.  In my mind it is still one of the most important things that I have done.  I learned a good deal about the body and specifically about how therapy is done.  I was expecting to learn massage and exercise.  

What I actually learned was about 3 hours of massage and exercises for particular issues that are regularly seen in a military setting.  It was a very good foundation but it only emphasized the shortening aspect of exercise.  We specifically focused on strengthening muscles for the purpose of returning a soldier to duty in the shortest amount of time.  We were considered miracle workers by many due to the way we were able to get people out of the hospital so quickly.

One of the things that is burned into my mind is the amount of pain often experienced with our approach.  Many people told me that they really dreaded coming in for their treatment.  PT was said to stand for Physical Torture.  No Pain – No Gain was our slogan.

What I Learned as a Trigger Point Therapist

 I went to school to study Trigger Point Therapy.  It was not like today where one goes and learns to incorporate treating trigger points into a massage session.  This was actually studying Trigger Point Therapy as an actual discipline.  There are not many who actually do that.

One of my favorite memories is of a teach asking us periodically in class – with no time to think about an answer – How we were similar to and different from other specific disciplines.  She asked me about Physical Therapy.  My reply – PT sees a person in pain and asks, “How can I teach that person to exercise and increase their strength to get out of pain.”  A Trigger Point Therapist would ask, “How can I lengthen that person’s muscles to get them out of pain.”

Those 2 perspectives differ greatly.  In my experience I saw more people respond positively to pressing “Trigger Points” than I did to “Strengthening” muscles.  In fact, the strengthening approach often increased the pain so much that people often quit therapy before it was over.  The other really interesting thing is that I found people had more strength after the lengthening process and that it was an instantaneous improvement.  The patient did not have to exercise for weeks or moths to see the improvement!

The strengthening approach has grown in recent years into a movement in PT  Athletic Training that is called Core Strengthening.  It seems to make sense that if we strengthen the muscles most responsible for maintaining posture that we should be able to help more people.  The story about posture is pretty well debunked in my post, “Confessions of a Recovering Posture King.” There are numerous studies that actually show that core strengthening is now really effective at all and was implemented by good marketing instead of by good science.

 I really liked, taught, and used the lengthening approach for many years.  Now I think differently.  It’s time for the rest of the story.

The Rest of the Story

When a person is experiencing pain they learn to avoid it by not using the area.  Our brain, for some reason, has decided that it is safer to shut down and avoid movement in order to protect itself.  In long term pain we learn to guard or hold ourselves long after the injured tissue has actually healed.

This lack of activating the muscle shows up as weakness and we assume – often incorrectly that the body’s defense is actually a defect. This defect must be corrected by strengthening or lengthening – depending on the view adopted by your therapist.  

But……What happens if we simply remove the sense of threat?  What if we could convince the brain that there is nothing wrong with the tissue and that nothing bad is going to happen when we move it?  This is what modern pain science is indicating that we should actually do.

The there are those pesky 95 lb. weaklings with zero pain. They don’t need strengthening to avoid pain.  They may need help opening a ketchup bottle though!

You Can’t Replace Something with Nothing!

If the brain is experiencing a sense of threat when there is no actual threat – What can we do?  There are a number of specific things that we can do.  Here we are simply going to mention a few of them.

We can show the brain that it is safe.  This can be done in a number of ways.  I often do this by passively moving a joint to show the person that it is safe to do so.  I then explain that pain does not necessarily indicate damage to tissue.  If there is redness warmth and swelling – indicators of actual inflammation – there may well be a problem requiring actual medical intervention.  If it is an acute injury it is usually a good idea to have the injury checked out – just to be safe.

You can also move the area where you feel pain.  I encourage people to move the area to the edge of pain and to practice doing that.  With practice – the initial point of pain is passed and greater movement is accomplished.  This is illustrated here by a PT.  He calls it Edge Work.

I often touch the painful area and then stay there as I distract the skin from another location.  This actually fires of stretch receptors in the skin and tells the brain that it is sage.  You can do that with a medical tape such as kinesio tape that is sold in drug stores.

These things commonly lead to strength increases without exercise and without pain. They are things that you can do for yourself.  There is almost always something you can do to help pain.

Confessions of a Recovering Posture King

The Culture

I always enjoy a good parade.  The floats are often amazing and there is always a great display of talent.  I like to see the various people as they pass by.  What tends to strike me is the way the people in each of the groups all try to look the same.  The Military people stand erect with stomachs in and shoulders back and they stare straight ahead.  The dance school groups come by and have a very characteristic posture that just can’t be missed.  The people watching are often just as entertaining as the actual members of the parade!

We often see people or even look in the mirror and comment on how good or bad someone’s posture appears to us.  We seem to have an innate understanding of how each other is supposed to look - in our culture!  We often work hard to hold ourselves in uncomfortable positions just so people won’t look at our bearing and criticize.  We know they will because we do it ourselves.

I have to admit that as a therapist I was rather horrible at postural evaluation when I first started.  My wife worked as my receptionist and would often come beck and tell me what she saw in a person’s posture and movement.  This was invaluable to me because I just did not see it.

Then I Learned About Posture

Then I attended a workshop where a local DO taught us how to evaluate posture.  He mentioned during his demonstration that we could use this new tool to see if our clients were making progress.  I light went off in my mind – perhaps I could evaluate the posture and then create a treatment that would intentionally alter it!

I eagerly applied my knowledge of muscles and their areas of attachment and developed a plausible theory of what to treat and what order to do it in.  I made it all up as I went along.  The results were amazing.  I was helping people that I had not been able to help previously.  It was an exciting time.

I even wrote an article about how to do it and got it published in a medical journal.  I had people come up to me at professional meetings and thank me for my work in this area.  I was even asked to demonstrate it for my national association as a major contribution to our discipline.

Another doctor – this time a DC added a substantial missing piece to my puzzle.  I was especially thankful for his input and developed his material to suit my own needs.  I eventually taught this in the school where I worked for 18 years and in seminars to therapists all over the country and even internationally.

This section has contained a good deal of what I call “Blowing and Glowing.” There is a reason for the overrated build up.  I think that most of what I did is wrong.  This is my public retraction.  To set the record straight – I was a Posture King.  I was wrong.

Problems

I helped a lot of people utilizing the approach that I developed.  I now believe that those successes resulted from other factors that were not directly related to my postural understanding.  I see a number of problems with my previous approach. 

A lot of people with poor posture don’t hurt.  This is readily apparent.  Just look at the people who you know with less than stellar posture and ask them if they hurt.  Many of them do not.  If posture is directly a cause of pain we should find that everyone with poor posture also has a pain complaint associated with that particular postural fault.  It simply is not the case.

We are not simple machines – in fact scripture teaches that we are “fearfully and wonderfully made.”  If we were a simple machine it would make sense that a lift under a short leg would balance everything and our pain would just disappear.  I have put lifts in shoes and under heels for years and can confidently state that many people remained in pain.  They did so because we are a flesh and blood creation and have our very own nervous systems.  A machine would have been fixed.

Fixing the posture rarely works long term.  I could often make a posture look rather stellar but it was often a short lived thing.  I saw those who were helped long term but unless they followed through on a number of other things I had them doing - those were a minority. 

Anatomical variation is hugely apparent in people – often in the same people from side to side!  In a recent study the pelvis was compared for symmetry from side to side in the same person.  The sides were clearly different.  There is great variability in studies when therapist attempt to describe what they see posturally in the same person.  This is in the literature and I have seen it numerous times myself in settings where I have tried to teach postural assessment.

Freeze, Fight or Flight is something we have all heard of.  Simply stated – When we have a sense of threat we tend to curl up in a ball to protect our “tender vittles.” In our homes and work places we tend to live in this constant curled up little ball.  No amount of bodywork is going to correct our posture if we live under a constant state of threat and stay curled up in a tight little ball.

Why Did It Work?

To hear me tell the story above about how I learned of the importance of posture and how to treat it successfully you are probably wondering why I have come to believe my approach was wrong.  I did give those reasons in the last section but of course the question remains – Why did it work in the first place? You can bet I asked that question myself.  It’s the stuff insomnia is made of.  I have a few thoughts on that subject.

I not only started dealing with posture – I also began doing a number of other things at about the same time.  One of the biggest things was that I really lightened the amount of pressure I was using.  I really thought that in order to be effective that I had to cause a good deal of pain during the treatment session.  Once I lightened my pressure it really helped the process.

I also began to look into the ergonomics of my clients at home and at work.  I showed them how to vary their routine and encouraged them to move frequently.  This had the effect of allowing the blood to be supplied to the nerves and to lower the threat level experienced by the brain.  More blood to the nerves is generally a good idea.

I also started talking more with my clients about things that tend to perpetuate pain.  I recommended books and began to give a good deal of movement for them to do between sessions.  Those who did these things  seemed to improve more quickly.  I believe these are a few of the things that made people feel better and I credit them rather than my attempts to correct posture – with helping their posture!

Another Way

I now have an entirely different focus when I treat people.  I generally look for signs that a person is in sympathetic mode (that’s a fancy way of saying Freeze, Fight, or Flight).  There are a few indicators that are especially helpful.  

• ·       Upper Chest Breathing
• ·       Feet that point to the ceiling
• ·       Cold hands and feet

I see these as indicators that their nervous system is on overload and I work to calm them down using a variety of massage techniques.  These are often performed on the neck.  It is very common to see a pelvis untwist and the shoulder drop after a few minutes of this.  I am trying to calm down the nervous system and as the person begins to relax they begin to uncurl from that tight little ball and the posture does actually change.  The difference – and this is a BIG DIFFERENCE – is that I am not forcing my will on the person and trying the change their posture. Instead, I am supplying novel input to their nervous system and it is adapting itself to the new information gleaned by its receptors in the skin that I am touching. 

There are a number of other ways of getting our nervous system out of this condition of sustained irritation.  Believers can be seen doing these things all throughout the scriptures.  Here a few of them.

Theologians in the Presbyterian tradition often speak of what they call the “Means of Grace.” These are enumerated as:

• ·       The Word of God
• ·       The Sacraments
• ·       Prayer

Let’s look at these and see how they apply to our subject.

The Word of God is identified as the Scriptures contained in the Old and New Testament.  When we hear it preached, taught, or when we read it the Holy Spirit often uses it in our lives.  We deepen in our love for our Triune God as we see his plan of redemption, Christ’s death and resurrection for our sin, and as the Holy Spirit applies it to our lives.  This happens in many ways.  We begin to think about him and the focus and meditation of our heart is on him and his person and work.  We rise above this world and adore him.  It is not uncommon for our cares to roll away.  I have seen shoulders drop and people rise changed.  It’s hard to be in Fight or Flight when adoration of our God is occurring.

The sacraments of the church are identified as Baptism and the Lord’s Supper.  These are done in community.  People in pain often tend to live in isolation that increases stress.  In worship we not only adore God but we pray for each other and try to meet each other’s needs.  This often gets the focus off of us and our problems and can be incredibly effective in lightening our cares.

There is nothing quite like prayer to get out thoughts off of us and onto God.  We pray to him as Christ taught us.  We pray acknowledging who he is and what he has done.  We bring our requests to him and we trust him with our needs.  Talk about stress relief.  The Creator of the universe loves us and asks us to ask him.  Burdens are lifted.

There are other things that can also help in dealing the stresses that curl us into little balls.  Learning certain breathing techniques is a great way to bring us into a calmer state.  The way I like to have people train their breath is to have them breath in to a count of 4.  Hold for a count of 1. Exhale to a count of 6.  The longer exhale puts us into a more relaxed or parasympathetic state.  It should be done for about 3 minutes.

Nutrition is a big thing also.  Studies seem to indicate that stress uses up our B vitamins and that supplementing with a good B complex can keep our nervous system from being as irritated.

Regular massage therapy is also an ideal way to keep our nervous system happy.  As a massage therapist I recommend it highly.  Exercise is another great way to help your nervous system.  These are a number of ways to keep out of that tiny stressed out little ball – and maybe even improve your posture as a side effect!

Entering the Matrix – the Neuromatrix!

I really enjoyed reading Elyse Fitzpatrick’s, “Idols of the Heart: Learning toLong for God Alone.”  In it she does a really good job of explaining, in very understandable language, what the Bible means when it uses the word “heart.”  That is a word that we tend to use a good deal and you may have even heard people teach about it at church.

The idea is that the word heart in the Bible has an incredibly rich meaning that I can only touch on here.  Please see the book for a more in depth treatment.  Basically the heart refers to our non material self and is loosely described as having:

         

·       Intellect

·       Affections

·       Will

The intellect refers to what we think – and we are always thinking.  We are constantly told in scripture that thinking is very important.  Look at these well known verses:

(Rom 12:2)  Do not be conformed to this world, but be transformed by the renewal of     your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

(Php 4:8)  Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things

As you can see – the Bible teaches that what we think is incredibly important.  What we think tends to show up in our speech and life.  It is not only biblical – it makes sense as well.

Not only do we have thoughts – we have Affections as well.  The term does not refer to nice thoughts as much as it does to our deeply seated emotions and emotional attachments to things and ideas.  We can love the world the flesh and the devil (Eph 2:1-3) in the sense that we have a deep attachment to them.  We can also love the LORD our God with all our heart, mind, and strength (Dt 6:5).

There is always the ever present will.  We always make a decision to do or not to do.  This is perhaps most famously demonstrated in the decision of Adam and Eve in the garden when they partook of the “fruit.”  We see a radically different one made by Jesus when he was tempted by the Devil in Luke 4.  Joshua commanded the people to “Choose this day.”

Compare this with the following picture of the Neuromatrix.  It is the attempt of psychology and pain science to explain the phenomena of pain.  On the left side it shows the input to the neuromatrix.  They use this word to describe the brain.  On the right side they show the output of the brain which is based on the input on the left side.

The left side of the diagram show input from our:

·       Cognitive-related brain areas

·       Sensory Signaling Systems

·       “Emotion-related brain areas.” 

The way this works is that each of these 3 types of input go into the brain/neuromatrix.  Let’s see how this works from this perspective.

The first input mentioned comes from our thoughts.  What we think has a huge effect on what we are going to experience in the realm of pain.  If we are told that a particular tissue is responsible for what we are feeling we get that idea firmly planted in our thinking.  If we saw horrible things happen to someone having a pain like ours we are likely to link that idea in our mind to our own situation.  This goes into the neuromatrix mixing bowl.

The second area on the left input to the neuromatrix is the actual sensory input carried by nerves from our tissues.  There may be inflammation or lack of blood and oxygen to a particular area.  The nerves transmit this information to our brain/neuromatrix – the mixing bowl.

The third input to the neuromatrix comes from our Emotion-related brain areas.  They call this the Limbic System.  Let’s say you saw aunt Sally fall from a ladder and hurt her back. 

She was bed ridden for some time and could only get around in a wheel chair.  When you now fall you remember that feeling – in fact now feel the same way after your fall.  This is a potent addition to the neuromatrix mixing bowl. 

This is all mixed and baked in the brain and the individual ingredients now serve in this mixture to give an output from your brain’s oven of a pain experience.  You may also have an output of movement and stress related chemical soup.

I have read a good deal about the neuromatrix theory from some real sharp atheists.  I don’t know what the developers of the concept thought about the existence of our common Creator.  What I do know is that we all live in the same created universe and that as we look at the same material we are bound to get a few things right.  I believe that the concept of the neuromatrix is in essential agreement with scripture and can be adapted easily to our purposes for pain relief.

The Cognitive concept certainly fits well with the intellectual information that the biblical concept has.  The actual input from our tissue via nerves is in no way disagreed with in scripture.  It is certainly clear from scripture that we have deeply rooted affections.  Jonathan Edwards actually wrote a great book entitled Religious Affections.  It is available at the time of this writing for .99 in a kindle edition and is well worth the read.

The purpose of this post is to give you an understanding of what leads to pain.  In other articles we will discuss what can actually be done for it. We will utilize this information in those posts.  I hope you will seek out the books mentioned here and look forward to the more that is to come!

Scientific Skepticism and the Christian Massage Therapist

It is a very interesting time to be a Christian Massage Therapist.  There are very few resources for a Christian who is also a Massage Therapist to utilize that are specific to my discipline.  The only one I am aware of is a small Christian Massage Therapists group on Facebook that I am a part of.  Aside from that we have to depend on resources that are not specifically dealing with the issues we face. 

One of the newer things we are facing is the emergence of science based massage therapists who consider themselves to be Scientific Skeptics.  They even have their own group on Facebook but a number of them are active in other groups as well.  Many of them are very articulate and appear well educated. 

I often appreciate the contributions they make in threads.  They frequently deal with massage related issues using the tools of logic and the scientific method.  They frequently post or at least mention specific articles and research.  I think we need more of that in our profession.

As Christians, we too appreciate logic and science – or at least we should.  The problem is that we place a different value on these tools and we use them differently.  Let me explain.

A Christian worldview entails that we believe what the scriptures teach.  We accept that on the authority of God’s word revealed in the Bible.  It gives us an interpretive grid.  Our goal is to, in the words of the Apostle Paul, “Take every thought captive to the obedience of Christ.” Let me try to explain.

If you were to enter my house from any of its 3 doors you would see certain indications of where you are at.  If you come through my basement door immediately on your left would be an old VCR tape of my wedding.  A little farther is a case with medals I earned in my time in the Army Reserve.  Surrounding  you would be bookcases on 3 of the walls with my name on the inside of many of those books.  If you entered by the garage door you would find a number of filing cabinets with my files inside and yes…another couple of bookcases.  Coming through the front door you will pass a mailbox with my name on the mail.  Immediately coming through the door you would find my computer with my documents and a few more bookcases – again- with my name on the inside covers. 

You could try coming in by landing on the roof and rappelling in through the windows.  If you come in through the bathroom window my name is on my toothbrush and on the prescriptions in the medicine cabinet.  It would be similar coming in by the other windows.  There are marks of my ownership everywhere from the name on my diplomas and my recently earned degree to the message on my phone.

It would be incredibly difficult to come into my home and to think it was anything other than my home.  You could not pretend otherwise and be believable.  It simply is not sensible to think anything else.  It is that way with the world we live in and how we know of God.  Psalm 19:1-6 tells us:

The heavens declare the glory of  God; And the firmament shows His handiwork.

Day unto day utters speech, And night unto night reveals knowledge.

There is no speech nor language Where their voice is not heard.

Their line has gone out through all the earth, And their words to the end of the world. In them He has set a tabernacle for the sun,

Which is like a bridegroom coming out of his chamber, And rejoices like a strong man to run its race.

Its rising is from one end of heaven, And its circuit to the other end; And there is nothing hidden from its heat.

The very heavens declare God’s glory – they testify of him.  The passage tells us that this information is inescapable.  It is everywhere we turn to look.  A similar passage appears in Romans 1:18-32 (I won’t quote the entire passage):

For the wrath of God is revealed from heaven against all ungodliness and unrighteousness of men, who suppress the truth in unrighteousness, because what may be known of God is manifest in them, for God has shown it to them. For since the creation of the world His invisible attributes are clearly seen, being understood by the things that are made, even His eternal power and Godhead, so that they are without excuse, because, although they knew God, they did not glorify Him as God, nor were thankful, but became futile in their thoughts, and their foolish hearts were darkened…..(there is a long list of sins here)…who, knowing the righteous judgment of God, that those who practice such things are deserving of death, not only do the same but also approve of those who practice them.

This passage goes even farther and tells us that all men everywhere know 4 things:

         

o   God exists

o   He is powerful

o   He has a law

o   They deserve to be punished for breaking that law

This knowledge is a guilty knowledge because they hold down or suppress this truth – in unrighteousness.  Verse 28 is particularly telling, “they did not like to retain God in their knowledge.” I mention this in regard to scientific skepticism because the Bible teaches that they are deliberately holding down the truth in unrighteousness and denying the first principles that should inform life in this world.  Yet they are walking around in God’s world with all of the evidences of his ownership and creation and they pretend that He does not exist.

The tenants of scientific skepticism include atheism and a belief that only the material world actually exists.  This is no worldview for a Christian – and it is a worldview.  People accept a worldview at face value.  It is a foundation that all of their thought rests upon so they do not question it. 

This is where we must part company.  We know from scripture as well as from creation that The God of the Bible created all things and that all 3 members of the Trinity were active in it.  Rather than holding down the truth in unrighteousness – we acknowledge that “The fear of the LORD is the beginning of knowledge…(Prov. 1:7)” The entirety of our worldview arises from God’s revelation of himself to us.

This God has created a world that makes sense.  It is a cause and effect place.  It is a reflection of him and as such it manifests order and we can make sense of it by applying the laws of logic that arise from his character and apply the scientific method to understand his creation.  Creation is his house and the facts are not there for just any interpretation.  Much like you can’t come into my house and deny it belongs to me and give a history of my possessions that has no basis in reality – so the Skeptic has no business falsely interpreting God’s creation.

The Skeptic believes that they can use the scientific method to understand reality.  As Christians we would agree because we ground this understanding in the fact that God has created a cause and effect world and it is understandable.  The Skeptic can’t justify his use of the scientific method.  The method requires that we live in a cause and effect world.  They have nothing to base this on – it is an assumption.  They do not know if they will run into a new fact that will disprove what they are saying. 

If reality is only physical we have no grounding or foundation for the laws of logic.  The law of contradiction – A is not non A - is the foundation of logic.  It is only possible to ground this concept in the character of God himself.  It is not physical and can not be subject to the scientific method.  It simply has no reason for existence.

We know from God’s revelation of Himself in his creation and in his word that there is non-physical existence.  The laws that govern our thought are revelatory of his character.  We use them regularly as he expects us to.

What does this have to do with massage therapy?  It has a good deal to do with what we think about the person on our treatment table.  I can look at them as a unique creation of God that I have an opportunity to help.  I believe that my actions during that time have significance and will have predictable results.  If the Skeptic is right that person has no more significance beyond any other thing that happens to exist.  They are just there and meaning is an illusion. 

At the end of the day we have to ask ourselves – can I live according to what I believe?  As a believer that is an easy answer.  God has created me and I have a purpose.  Skeptics can only deal with physical existence.  At the end of the day they want to believe they have meaning and purpose.  Their worldview does not allow that.  Jesus does.  He died for sinners and paid the price for unbelief.