Conditions Treated
I've been amazed at the things that improve from structural integration/structural bodywork. It can dramatically help or eliminate many different conditions (though it can not help everything). Here is just a short list of some conditions that benefit:
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Bad Posture, Postural Distortions, & Functional Scoliosis
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Aches & Pains
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Arm, Wrist, and Hand Pain
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Upper & Mid Back Pain
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Hip Pain
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Leg and Knee Pain
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Foot Pain
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Hammer Toes, Claw Toes, Mallet Toes
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Golfer's Elbow, Tennis Elbow, Medial Epicondylitis, Lateral Epicondylitis
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Trigger Finger and Dupuytren's Contracture
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Chronic Pain, Fibromyalgia, and Chronic Fatigue Syndrome
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Headaches, Migraine headaches, and Tension Headaches
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TemporoMandibular Joint Dysfunction (TMD) (a.k.a. Jaw Soreness, TMJ)
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Thoracic Outlet Syndrome
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Frozen Shoulder
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Whiplash
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Sciatica & False Sciatica
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Strains & Sprains
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Tendonitis
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Asthma
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Constipation
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Sleeping Disorders
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Shin splints
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Achilles Tendonitis
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and more!
MORE DETAILS
Here are the basics. Our fascia (a.k.a. one type of connective tissue) condenses in three dimensional space and gets stuck that way. I refer to it as "pattern," while other may say things like muscle knots, adhesions, etc. Pattern in the fascia can cause all sorts of issues. We call it something different depending on where it is happening in the body. If it happens in the head it can cause headaches, tinnitus, and jaw pain (TMJD). If it happens in the neck (cervical spine), it can cause a stiff neck, kink in the neck, neck pain, torticolis, and also possibly thoracic outlet syndrome. If it happens in the shoulder it can cause thoracic outlet syndrome, stiff or frozen shoulder, rotator cuff issues. If it happens in the forearm it can cause carpal tunnel syndrome, wrist pain, hand/palm pain, even finger pain. If it happens in the rib cage (aka thoracic spine)... you are starting to get the idea, aren't you? Pattern happens everywhere in the body.
Pattern in the fascia limits our movement, including the internal movement that happens within our bodies as well. Your arm is made up of lots of tissue and fibers. All of that has to be able to stretch, such that it can extend and expand outward as you reach your arm out to grasp for something with your hand. If pattern is present in the arm, the arm's function or ability to move is limited compared to when the tissue is free of pattern.
To learn more about fascia, read the Structural Integration page.
A few of the conditions, I explain in further detail. Continue reading below if you want to learn more about any of these specific conditions:
Temporo-Mandibular Joint Dysfunction
Temporo-Mandibular Joint Dysfunction (a.k.a. TMJ, TMD, TMJD, jaw soreness/pain) is a condition in which the mandible (i.e. the jaw bone) becomes painful to move, open, and close.
The joint (which most people refer to only as the jaw) is an interesting one.
Let's start with some basic anatomy to give you some context. The mandible is shaped like the letter "U" when looked at from above. Looking at it from the side it looks more like a capital letter "L". The mandible has a horizontal piece (with your teeth) known as the body, and another portion that moves up (for it to connect with the skull) which is called the ramus. The ramus (the portion that extends up to meet the bottom of the skull) has a saddle-like shape at its top when viewed from the side. At the front of the ramus (the side nearest the teeth) is a process (or extension of bone) that points upward called the coronoid process. The coronoid process acts at an anchoring point for muscles (especially the temporalis muscle which is a large flat mucles located on the side of your head). Heading back from the coronoid process, the bone dips down into a valley called the mandibular notch. Continuing back further, we move upward again to the back of the saddle, and find another process called the condylar process. This condylar process is the part of the mandible which makes contact with the base of the skull. In the world of anatomy, anytime two bones come together at a joint, the surfaces where they meet are called articular surfaces. Usually articular surfaces are smooth to allow easy motion, and that area of the bone is extra dense to withstand the forces placed upon them. Between the articular surfaces of the mandible and the skull sits a small cushioning disk whose job it is to make the movement even more smooth.
Now here is the interesting point... Since the mandible only has small bony connections at the condylar processes (one on either side), how is it held in place? The mandible is slung underneath the skull by a bunch of muscles, most of which attach to the ramus and along the body. Because the mandible is in a sling of muscles, the muscles have great influence... not only on its movement, but also its resting position. Muscles move it side to side (for chewing like a cow), front to back, up and down. The muscles are also responsible for the movement of the little cushioning disk inside the joint, so that as the jaw moves forward the disk travels with it to continually provide cushioning. This is an amazing piece of anatomical engineering!
So, where can (and does) this wonderful joint go wrong? Why does it cause pain or not open easily? Usually the problem comes from either the cushioning disk not moving correctly, or the muscles of the mandibular sling become unbalanced. So effective treatment must address most of the muscles that sling and control the mandible. As we have already discussed, some of these muscles are on the outside of your skull, along your jaw, and under your jaw. But other muscles that need to be addressed are inside your mouth. Yes, you read that correctly... INSIDE your mouth. These must also be addressed for successful resolution of your jaw pain.
As the muscles that restrict your mandibular movement become soft and lengthen, losing their restrictions, your mandible will move much easier and will also be able to reposition itself properly. Your pain will decrease and the movement of your jaw will become more smooth. Any wiggle (or wobble) of the jaw (where your jaw moves to a side while opening, or one side releases down before the other) will be addressed during therapy too. The goal is to get your mandible moving freely as quickly as possible.
Note: In the state of Washington, intra-oral massage (inner mouth massage) is regulated by the Washington State Department of Health. So any massage therapist that works inside your mouth must be legally endorsed to do so while working in the state of Washington.
Neck Pain
There is nothing worse than a pain in the neck. We depend on our necks so much during regular activities that when they are painful and not moving freely, our lives become more limited very quickly.
So where does neck pain come from? And how do we get rid of it?...
Neck pain usually comes from:
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Nerve compression- Nerve compression occurs when bones apply direct pressure to a nerve, trapping it and squeezing it. The spinal nerves come out of the spine through openings called foramen. Usually the foramen provides enough space to allow free movement of the vertebrae and the nerve independent of each other. If the vertebra change there relationship to one another in space, the shape or size of the foramen alters. Usually this happens in one of a few situations:
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Spinal misalignment - If the vertebra move significantly (due to injury, soft tissue restrictions, etc.), then the foramen's shape can effectively be made smaller such that the nerve is pinched by the bone where it leaves the spine. To determine the best course of treatment, one needs to know the specific cause for the spinal misalignment. If the misalignment was caused by an injury and the soft tissue is not involved, then a chiropractic visit is likely to be in order. If soft tissue is involved, then some manual therapy (massage or structural work) is also needed. There are also other situations where no injury has happened, and the spinal misalignment has occurred over a period of time. In these cases, the soft tissue has tightened and pulled the bones out of alignment. As such, manual therapy to release the restricted tissue provides the best results.
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Ruptured disc - Each vertebral disc acts as a spacer between two consecutive vertebra. If the disc is ruptured then the space between the two vertebra becomes smaller, and again the foramen that the nerve runs through also gets smaller causing the bones to pinch the nerve. Usually if a disc is ruptured, it typically calls for surgery. There are artificial replacement discs, but these currently don't seem to be highly successful, and fusion of the vertebra is the usual procedure.
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Herniated disc - When a vertebral disc herniates, part of the inside of the disc pushes out of the more tough and fibrous outside "shell" of the disc. Sometimes the herniated tissue pushes out and it isn't a big deal... most people don't know they have a herniated disc. In other cases however, the herniated tissue pushes directly into a spinal nerve, and that means pain. Though a herniated disc might technically be nerve entrapment instead of nerve compression, I'm including it here along with the other "bony/spine" issues. Herniated discs are treated with a variety of injections, and various surgeries. People also find inversion tables and massage therapy helpful to lengthen out the spine and help relieve some of the pressure in the injured area. For many people, these methods allow them to manage their symptoms and avoid surgery and drugs.
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Nerve compression can also occur in other areas of the body, such as the elbow or shoulder, though it is most common in the spine.
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Nerve entrapment - Nerve entrapment occurs when soft tissue (muscle, fascia, ligament, etc.) applies direct pressure to a nerve, trapping it and squeezing it. Usually this occurs when muscles and fascia become thickened or tight. In the case of neck pain, the tight or thick tissue will usually be in the neck although the condition causing it often comes from lower down in the body. Nerve entrapment is most successfully treated with massage/manual therapy to release the tissue and correct the source of the problem.
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Soft tissue restrictions- In addition to the possibility of nerve entrapment by soft tissue, the soft tissue itself can be very painful if there was:
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local tissue damage
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increased tissue thickness
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adhesions (i.e. tissue sticking together)
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inflammation
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constantly contracted muscle
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tissue that is over stretched
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etc.
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The many ways in which these situations can come about are too numerous to list, but many times it is from an overuse type of injury. Sometimes the overuse injury is very apparent (e.g. "I lifted a heavy weight and now my shoulder and neck hurt"), while other times it is not apparent at all (e.g. "I didn't do anything out of the ordinary, and all of a sudden my neck hurts like crazy!"). In the latter case, usually the trouble slowly builds over a long period of time until it is beyond a certain threshold, at which time you become aware of it. Soft tissue restrictions are most successfully treated with massage/manual therapy directed and dealing with the specific issue at the source, and correcting any imbalances in the body that support the problem.
Usually all three of these problems (nerve compression, nerve entrapment, and soft tissue restrictions) have a soft tissue imbalance as either the source or a component of the issue. For long term success, the imbalances in the soft tissue must be addressed with manual therapy of some kind. The manual therapy must focus on correcting the imbalance, creating space and softness in the tissue, and bringing the body back to neutral position.
Shoulder Pain
Shoulder pain can be very debilitating, especially if it occurs on your dominant side. Not only do you have more restrictions in how much you can move your arm, but you have pain too. Talk about adding insult to injury!
Shoulder pain can come from many different sources, such as:
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an acute injury
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a pinched nerve
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strain
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tension
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adhesions or thickened tissue
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torn tissue
In many of these situations (excepting muscle or cartilage tears), the tissue become short or thick and the bones can become displaced from their normal resting neutral position. The shoulder is a unique joint since the shoulder blade (a.k.a. the scapula) only has one bony attachment to the skeleton, which is the collar bone (a.k.a. the clavicle). Since there is only one bony joint, the shoulder blade is very mobile and its movement and position is mostly controlled by the muscles of the shoulder girdle and upper arm. Imbalance in the muscles responsible for the position of the shoulder blade tend to cause pain in the chest, rib cage, or neck. Imbalances in the muscles responsible for the movement and position of the upper arm (i.e. humerus) will often cause pain along the shoulder blade, the shoulder joint (the arm to shoulder joint), or in the upper arm.
The treatment goals are to not only eliminate the pain, but to balance the shoulder and reposition it into its neutral location. Strategically softening and lengthening both the tissue that position the shoulder relative to the ribcage, and the tissue that position the upper arm to the shoulder, helps achieve both results. In addition, making sure that you have as much range of motion possible from the arm and shoulder, allows you to resume all your normal activities in a pain free manner.
Carpal Tunnel Syndrome
Most of us have heard the name of carpal tunnel syndrome, but not many know what it is. I'll give you an explanation, and then tell you about the current treatments usually prescribed. After all, the more information you have, the better a decision you can make as to how you want to go about eliminating it.
The carpal tunnel is essentially an archway made of bone. When your palm is face-up to the ceiling, then the bony arch is upside down, with the "top" of the arch toward the back of your wrist. Across the "bottom" open end of the arch, a thickened band of connective tissue (called the flexor retinaculum) crosses to close off the arch and create a "tunnel." This tunnel is the pathway for many of the tendons of the forearm flexor muscles (which control hand movement and grip) as they descend from their respective muscles in the forearm down into the fingers and palm. Along with the tendons, the median nerve crosses the wrist through the carpal tunnel. The median nerve innervates (or supplies nerve function to) some of the muscle at the base of the thumb (area of the thenar eminence) as well as some small muscles that are used for movement of the first two fingers. It also innervates the skin on the palm side of the thumb, index, middle, and ring fingers.
So now that you know what structures are involved, what happens? In carpal tunnel syndrome, the soft tissue that are within the carpal tunnel get inflamed and thickened. Usually this occurs due to trauma or overuse, such as typing on a computer at work for years. The muscles of the forearm continue to shorten and thicken the more they are overused, which causes them to get inflamed. As this cycle continues (more shortening, thickening, and inflammation), it propagates further down the muscles and causes their tendons to get inflamed. As the tendons get inflamed, they use up more room within the carpal tunnel (which is limited on space anyhow). As more room is used up by the inflamed tendons, more friction is created and thus there is more inflammation. As this process continues, the median nerve starts to get compressed and irritated. As the nerve gets trapped and inflamed, you experience numbness or pain or both.
Conventional treatment for carpal tunnel syndrome tends to be one of the following:
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Wrist splints - Immobilization at the wrist does ease some pressure on the tendons by preventing the tendons from becoming either over stretched or over contracted. Typically this is the "wait and see" approach to see if the swelling/inflammation will go down on its own (or with the assistance of drugs). This is ineffective since it does not do anything to soften up and lengthen the irritated muscles and tendons which are the source of the problem.
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Surgery - Usually the flexor retinaculum (the connective tissue thickening that keeps the tendons and the median nerve in the carpal tunnel) is either cut completely, or cut such that it expands like an accordion. The idea here is to create some additional space so that pressure is taken off the nerve, and general inflammation can decrease. Carpal tunnel surgery has mixed results, often with recurrence of symptoms in a reasonably short period of time. Again, the source of the problem (the thickened inflamed muscles and tendons) have not been addressed. This may account for the recurrence of symptoms, but it is also a strong possibility that the whole situation has been misdiagnosed... read on!
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Manual therapy - Proper massage therapy or manual therapy will address the issue at the source by softening and lengthening from the shoulder (and possibly neck) to the wrist and hand. As these structures soften and lengthen, the inflammation is able to recede, and with it the pain and numbness go away. This is by far the most effective, cost-efficient, and non-invasive way to deal with carpal tunnel syndrome.
Unfortunately, many people are misdiagnosed with carpal tunnel syndrome when they actually have thoracic outlet syndrome! Thoracic outlet syndrome is a similar case of nerve entrapment with symptoms of numbness, tingling, or pain in the forearm, wrist, or hand, but the nerve is (usually) trapped higher up in the system (at the neck and/or shoulder). Make sure that whoever you seek treatment from is aware of both conditions and has the ability to diagnose and treat both.
In addition to which ever treatment protocol you choose, you should also be aware that the majority of cases in both carpal tunnel syndrome and thoracic outlet syndrome are caused by:
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Overuse
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Poor posture or positioning
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A combination of both of the above.
Because our behavior, posture, and positioning of our bodies are usually the cause of both carpal tunnel syndrome and thoracic outlet syndrome, it only makes sense to modify our behaviors to prevent future issues. Your therapist or doctor should be able to give you some helpful suggestions in this regard.
Low Back Pain
Low back pain can be annoying and debilitating. So understanding your back and the causes for the pain is the first step to proceeding down the road to recovery.
Unless you have had serious trauma where bones break or grind together, and discs rupture, then soft tissue restrictions and inflammation are usually the primary causes of pain. Even if you have had serious trauma, after the acute phase of your recovery has passed, soft tissue restrictions will play a large roll in your overall recovery. The following are some of the items to take into consideration when determining where to work to correct low back pain:
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Body alignment - Is the body lined up to efficiently oppose gravity? Is the pelvis in the right position to properly support the upper body?
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Condition of the Tissue - Are the tissues that support the lumbar spine restricted, injured, or inflamed? Is there pull into the tissue of the lumbar spine from above or below the region? Is the tissue getting overworked by its current use?
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How many structures are involved - It could be one little nagging area, or a whole group of tissues causing you pain.
The lumbar spine sits between the spine of the ribcage and the pelvis. Those two adjacent areas have a lot of bony support (the rib cage stiffens up the thoracic spine, and the pelvis is a fairly rigid structure when compared to the lumbar spine). So when there is extra stress either above or below, the forces usually end up being directed into the low back/lumbar region since more movement (and thus compensation) is available there. This is one reason why low back pain is a common complaint.
The lumbar spine is supported not only on the back side by muscles and soft tissue, but on every side... front, sides, and back. These various tissues act as a support doughnut around the lumbar spine. You can think of it as a tire's inner tube, with the lumbar spine in the center opening. As we move, various parts of the doughnut act to support or provide strength for our activities. When the lumbar support tissues become injured, it is less flexible and less able to do work. Sometimes in circumstances like this, the tissue will "lock down" to prevent movement and further injury.
There are also situations where the low back is being pulled on from either above or below. To complicate things further, the pain may be caused by the framework of the body (the skeleton) being out of alignment. Many cases of low back pain are actually caused by a torsion (a rotation of one side) of the pelvis. Often people experiencing pelvic torsion are diagnosed with a "long leg." In reality, the femur (thigh bone) connects in front of the rotational center of the pelvis, while the spine is located behind the rotational center. When the pelvis rotates forward, the legs and feet travel (down) while the spine travels up, each moving "further away" from each other. If this rotation only occurs on one side of the pelvis (i.e. pelvic torsion), then that leg appears to grow longer, while the low back on that side compresses (causing low back pain).
So as you can see, there are many different possible sources of back pain. You individual circumstance needs to be evaluated to determine the contributing factors involved.
I approach the problem of back pain by viewing how the body aligns itself, and by examining the low back area itself. This allows me to see what larger body issues might be affecting the issue of your low back pain, as well as any issues that reside locally in the low back causing direct pain. Using this comprehensive tactic, we are able to address all the areas contributing to the low back pain and eliminate them.
Plantar Fasciitis
Plantar Fasciitis is a term we have heard around, but we may not know what it is, what causes it, or how to get rid of it. Are you ready to find out?
What is plantar fasciitis? Plantar fasciitis is simply the inflammation of the plantar fascia. What!?? Let's break it down to simpler terms... Fascia is connective tissue in the body. It surrounds muscle tissue, thickens to create ligaments and tendons, and generally does a lot of support and structuring/organizing of the body. (If you are interested in learning more about fascia, you might want to read the article on the structure of the body.) The plantar fascia is the connective tissue located on the bottom of the foot (the plantar surface, or the sole of the foot if you prefer). The plantar fascia, along with the muscles that control positioning of the foot and the toes, is responsible for creating the arch of the foot (which is actually more like a dome or multiple arches) along with the springy nature of the foot (during activities like running, walking, and jumping). When there are too many restrictions in the tissue, it gets irritated and inflamed (too much blood supply), and painful. Many times the foot pain will be experienced either early in the morning (as one gets out of bed), or late at night (after work). Sometimes waiting out the discomfort works, but usually not... and plantar fasciitis can become a chronic condition that plagues people for years.
What causes plantar fasciitis? It can be caused by many different things, but usually it comes from either over working the foot (by too much activity), or from the foot being too bound up and not being able to move properly. Let's tackle these, each in turn...
If you stand on your feet all day long, the muscles of the lower leg and foot as well as the fascia of the foot are active that whole time. They are all working hard to not only move you around, but to provide a shock absorbing foundation on which to support the weight of the entire body. They can do this for a period of time (days, weeks, months, or even years) without much rest, but eventually the fascia will take more work on as the muscles get overloaded. If the fascia is over worked, it will get irritated and inflammation will occur. Usually the fascia thickens as it takes on more of the work (to provide more structural support), and blood flow through thick fascia is even worse in regard to alleviating inflammation.
Along with being overworked, plantar fasciitis can also come from the foot being too bound. The foot itself is comprised of many bones; finger-like ones for the toes, smaller rectangular ones nearer the ankle, and then larger ones in the ankle area and heel. The foot is constructed this way to allow for many different movement and adjustments of the foot in our daily activities (including standing and walking). In the modern world, most everyone wears shoes. Shoes are good from the standpoint of preventing injury to our feet (such as stepping on sharp glass or a nail), but they are bad for your feet from the standpoint of what the foot is trying to do for you. I can hear some of you saying "that's crazy talk", but just read on for my reasoning... Most shoes (even sneakers) are not really very flexible. Sure some flex at the toe a bit, but that is nothing compared to what a healthy foot can do on its own. In that regard, every time you wear a shoe you are restricting the motions that occur within your feet. The longer you wear shoes, the more this (restricted movement) becomes your pattern, and the more the fascia will thicken to prevent the motions you are no longer using. The thicker your feet become, the easier it is to irritate the tissue and experience the associated inflammation. There are a few exceptions to this shoe issue: If one has always worn REALLY flexible shoes (such as moccasins), or stretches their feet out on a regular basis.
How do we get rid of plantar fasciitis? The goal here is to soften, spread, and lengthen the tissues on the bottom of the foot, and the associated muscles that move the foot and toes. There are many ways to do this, and treatment massage therapy is one of these ways. Once the foot is soft and flexible again, it will be pain free. The goal then is to keep it soft and flexible so that you never experience that pain again.
Making the transition to truly flexible shoes... Shoes do play a part in our normal lives, and we can't really escape them, but we do have choices as a consumer... and it is worth making a choice that is better for your feet and body. If you wear high heel shoes, slowly transition yourself into flats over time (and a few pairs of shoes). If you wear stiff shoes (even sneakers qualify as stiff due to their thick soles which don't allow for flexing sideways), slowly transition from the thick stiff soles you have to shoes that have soles which are thinner. Gradually over time you can work your feet into shoes that are as soft and flexible as moccasins, and your feet will thank you for it. NOTE: Do take time to make the transition slowly. If you go from thick soled shoes to thin soled shoes, your feet will hurt as the foot will not be soft or strong enough to handle the quick change. Taken in steps, slowly moving to more flexible shoes than the last pair will get you there without any major foot discomfort. My own journey from sneakers to moccasins took about a year and a half and three pairs of shoes (sneakers, boat shoes, and the moccasins). People ask me about walking on hard surfaces such as pavement, and doesn't that hurt my feet in the moccasins? Surprisingly, pavement feels softer now than it ever did in sneakers... my foot has adapted to being able to transmit the forces more easily, and so pavement is not an issue at all. Others ask about how walking on pavement is all flat, and how can our feet really adapt on flat surfaces? In reality, even flat surfaces are not very flat. My feet constantly adjust to cracks in the sidewalk, bumps in the road, etc. which other shoes would not allow for. Should you undertake this journey yourself, you will be amazed at how varied the terrain actually is. But be warned... the more you allow your feet to do their natural job, the less you will find "normal" shoes comfortable.
So, soften up your feet and keep them soft to stay pain free.