In this blog post (click on the blue link above) are some very kind words from Jay Aldos, a gifted ultra runner and Focus Bodywork client about how sports massage has become an essential part of his training. Thank you Jay!

PS – Jay went on to win the Zion 100 last weekend.

Poster in a Medical Clinic in Beijing

While in China for the better part of March, I experienced as much and as varied bodywork as I could. I wanted to see how Eastern philosophies of medicine worked in practice, experience Chinese modalities and get some work done on my post-op ankle that has hit a healing plateau. Armed with a translation app on my iPhone, an open mind and a sense of humor, I tried a new modality daily.

In China bodywork is a part of the medical system.  Therapists are typically based in medical clinics, but in tourist areas I occasionally saw practices with “massage” translated under the Chinese characters on their signs.  I had sessions of reflexology, shiatsu (pressure point massage to balance your energy), cupping, ear candling, abdominal massage (for my organs), and even a massage by a blind therapist.  Each treatment was unique, but the compassion and thorough care I received left the biggest impression.

Me, after a Shiatsu session. Apparently the energy left my head as if I had stuck my finger in an electrical socket.

On my first full day in China I walked into a medical clinic and realized that no one spoke English and that my tiny rehearsed mandarin phrases were not understood. Finally I pointed to my ankle and was promptly ushered to a large room where a practitioner wearing a lab coat looked at my ankle.  He examined my swollen ankle and healing scars to which he made a cutting gesture acknowledging my post-op state.  I nodded, and he quickly left.  The practitioner returned with a bucket of very hot water steeping with herbs. As he soaked my feet (a practice I later learned that almost every clinic performs), I had to resist all urges of jumping out of the almost scalding broth.  While soaking my feet he started massaging my shoulders.  Although I wondered if my ankle would get more attention than scalding water, I was relieved to have my shoulders addressed because they did not weather the flight to Asia well.  My therapist quickly located the culprit muscles, released them through massage and in a simple fashion adjusted my neck.  This was a feat.  I will not let Chiropractors adjust my cervical spine (a future blog post), but this therapist simply moved my neck in a strange position and put the smallest pressure on my head, and I was adjusted.  It was so simple and effective that, given the opportunity, I would let him do it again!

Now that my shoulders were back on track, he went to work on my foot.  I must stress the point that we could not exchange a single word, and my ankle injury (a subtalar dislocation) is a rare one to which every physician/therapist I have seen in the US has mentioned that they have read about this before but never seen it.  My Chinese therapist felt my ankle, gently took it through a range of motion, tested the strength of the healing ligaments, then performed the most precise and effective manual therapy treatment I have had to date.  I completely trusted this therapist to manipulate my ankle because he took the time to explore what was swollen, tight and atrophied.  He understood where my injury was in the healing process and what the next step was to further my recovery.

The most profound part of this therapy session was how I was approached as a client/patient.  In the US, my orthopedists take x-rays, MRI’s and CT scans to see how my healing is progressing, and my therapists look at the diagnosis in my chart and evaluate my healing by the time elapsed since injury. Images reveal structural repair (if the ligament completely knit back together), and comparing the functionality of a patient against research subjects gives good measures of normal or abnormal healing.  My Chinese therapist, on the other hand, used only touch to assess my injury and its healing progress.  Hands-on evaluations like this show how tissue responds in dynamic situations (like if a ligament is too tight to allow motion).  I feel a combination of all of these evaluations will provide practitioners with the most insight to guide their patients care.

Clinician after clinician in the states has told me that my recovery will take time.  I have been reassured that the structural damage is well repaired, but have not been given much insight as to what to do to improve the functionality of my ankle or what to expect down the road. My Chinese therapist did not seem daunted by an unusual and slowly healing injury.  He devised a treatment and revised what he was doing by what was working and what was not.  I appreciated my Chinese therapist being creative, and I think he was even having fun trying to understand how to help an atypical injury on a patient with whom he couldn’t verbally communicate with.  In the West, it is easy to rely on research and standard protocols, but I don’t think this honors the intelligence of the clinician and the practice of medicine nor is this complete care for the patient.

Going to a clinic and seeing a doctor/therapist is scary.  My experiences with Chinese medicine showed me that treating the whole person, not just the injury creates a wellness environment that alleviates a lot of fear. I am going to make sure I have this at the forefront of my practice.  No matter what type of medicine is practiced or the flavor of therapy provided, I believe compassion for the person in the room will guide the best outcome.

I had to try this out. My therapist was indeed blind and performed a thorough full body massage to rival any I have had at a spa.

Bike Friendly: We bike to work as often as possible (even with a mound of sheet laundry strapped to a pannier rack), we worked with our landlord to get bike racks installed at the plaza so that our clients may be enticed to bike to the studio, and we are a member of Bicycle Benefits.

Reusables: The health department requires us to have disposable hand towels, but we also provide cloth hand towels. It is important to stay hydrated, especially after bodywork.  For this reason we have filtered water (from a refillable pitcher) available to consume in glassware, not disposable cups.  We also reduce waste by buying massage lotion by the gallon and refill small dispensers to use in the treatment room.  (The gallon jugs are also great for storing flour or sugar; let us know if you would like one!)

Green Products: We do a lot of laundry.  Not only do we only run full loads, but we use an environmentally friendly detergent.  Our office is cleaned with green products as well.

Local Sources: We use and sell local or regional products whenever possible. Among our favorites are Beyond Coastal sunscreen (Salt Lake City), JTree embrocations (CA), Big Dipper Waxworks candles (WA) and Peaceful Mountain arnica gel (CO).

Less Waste: In business there is a lot of paper waste.  For this reason we do our bookkeeping and scheduling electronically as well as we e-mail receipts/invoices if they are requested.

Energy Efficient: To reduce energy use we set our thermostat to 80 in the summer and 60 in the winter using blankets to keep our clients comfy while reducing energy demands. And, we use LED light bulbs if natural light will not do.

We are always looking for other ways to support the health of our community and would appreciate any ideas you may have. Happy Earth Day!

At various times each of us has been told to ice an injury.  Maybe a soccer coach sent you to the locker room to ice a sprained ankle, or a co-worker recommended it to treat a stiff neck.  Usually the ice treatment helped.  Why?  When you experience a soft tissue injury (muscle strain, joint sprain, bruise, muscle spasm, etc.) cells are damaged and leak their contents into the surrounding tissue.  These bits of cellular debris and chemicals irritate healthy cells and stimulate nerve receptors to illicit a pain response, as well as to call in your immune system to start cleaning up the mess.  When you ice an injury, making sure you do not frostbite the area and create a bigger problem, the tissue cools to a point where the blood vessels constrict, preventing blood to perfuse the injured area.  Then, after the ice is removed and the tissue rewarms, there is a moment where the blood vessels dilate and flood the injury site with blood.  This flood not only pushes out the bits of damaged cells and chemicals that are causing pain and slowing healing, but bathe the area with fresh white blood cells and nutrients to repair the damage and decrease the pain.  Although the brief numbing may be relief in itself, note that the most important part of this process is not cooling the area for a long period of time, but the rewarming phase.  I recommend applying ice (direct ice massage, insulated chemical ice pack or bag of frozen carrots) as long as it takes to make the area numb.

Heat on the other hand acts more like a swamp at the injury site rather than a flood.  Heat will increase circulation to the injured tissue bringing in white blood cells and nutrients to heal tissue, but does not pack the punch of a flood to push out irritants.  However, in the middle of winter after a long day of skiing in a snowstorm, heat really does feel nice on that aching low back.

So what should you do?  During the first 72 hours of an injury damage may still be taking place from the assault.  Swelling, if excessive, will hinder circulation to the injured area, and ice will do a better job or reducing swelling.  Heat causes fluids to expand.  If cells are delicate, the increased pressure on their walls may cause them to rupture.  For this reason, ice is almost universally recommended for the first three days of an injury to prevent further damage.  After this phase, there is little empirical data to support greater benefit of ice over heat.  I personally believe ice does a better job, but if you simply won’t do an ice treatment, heat is a great alternative.  Another option is to use heat to amplify the flood event of icing by applying heat after the tissue is numb, and go back and forth between ice and heat.  I typically ice an injury in the evening, hop into a hot shower then go to bed and dream of speedy tissue repair!

Hopefully this makes the choice to flood or swamp for an injury more clear.

This is a great discussion of the benefits of post-workout massage, including the physiology of muscle repair and a little plug about why taking NSAIDS (like ibuprofen) for muscle pain may not be such a good idea.

Skiers Thumb is a strain or rupture of the ulnar collateral ligament of the thumb.  It causes pain and swelling in the web of the hand between the base of the thumb and index finger, and it makes it difficult to grip or fully extend the thumb.  The injury usually occurs when a skier falls on an open palm with the ski pole still in the hand.  The pole, on impact, forces the thumb to the dorsum of the hand (non-palm side), overstretching or tearing the ligament.  Most skiers know this discomfort. A mild strain of the ligament is quite common and can plague a skier all winter if left untreated.

In serious cases where after a fall the thumb swells, becomes painful to move, may bruise, and/or becomes more painful over the next few days, it is best to have a sports medicine doctor or orthopedist evaluate the injury.  Typical treatment involves immobilization of the thumb for 4-6 weeks, but you can usually sweet talk your doctor into a cast where a ski pole can fit so you can still ski.  However, surgery is occasionally required to repair the ligament.

In mild cases where the thumb is merely sore and quickly improves, self-care can help heal the injury so it does not hurt all ski season.  For the first few days after any mild strain you should ice the area several times a day, reduce motion with an ace bandage or over the counter splint, and protect it from a repeat blow, meaning that skiing is not a good idea.  After 3-5 days of gently care for your thumb, you can start performing exercises to help heal the ligament.

Exercises

• Thumb active range of motion: With your palm flat on a smooth surface, move your thumb away from your hand as far you can. Hold this position for 5 seconds and bring it back to the starting position. Next, rest your hand on the table in a handshake position. Move your thumb out to the side away from your palm as far as possible. Hold for 5 seconds. Return to the starting position. Next, bring your thumb across your palm toward your little finger. Hold this position for 5 seconds. Return to the starting position. Three pain free sets of ten are recommended.  Pain is a sign that you are re-tearing tissue!
• Wrist Range of Motion (do three sets of 10 of each)
  1. Flexion: Gently bend your wrist forward with an open hand then curl the fingers into a fist. Hold for 5 seconds.
  2. Extension: Gently bend your wrist backward, straitening the fingers as you extend the hand. Hold this position 5 seconds.
  3. Side to side: Gently move your wrist from side to side in a beauty queen wave motion. Hold for 5 seconds at each end.

  After a few days of performing these range-of-motion exercises, normal motion should be restored.  If not, see a doctor.  Otherwise, you are ready to start strength training.

• Thumb strengthening: Pick up small objects such as pennies between your thumb and each of your other fingers. Practice this exercise for about 5 minutes.
• Finger spring: Place a large rubber band around the outside of your thumb and the fingers. Open your fingers to stretch the rubber band. Do three sets of 10.
• Grip strengthening: Squeeze a tennis ball and hold for 5 seconds. Do three sets of 10.
• Wrist flexion: Hold a light weight or soup can in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Do three sets of 10. Gradually increase the weight.

If your Skiers Thumb injury is mild and you take care of the injury you should be back to skiing pain-free in about two weeks.  Within this time frame you should also be able to fully extend your thumb and catch a friendly ride up the canyon.  Happy Skiing!

As I plan out my 2012 calendar, I also page through the recent edition of my favorite journal, The Physician and Sports Medicine, which has several articles on osteoarthritis (OA). Several research studies note a fact I hate to dwell on: women athletes (especially those with a history of knee injuries) have a higher risk of developing OA than men and their sedentary counterparts. The usual excuses are noted in each article: women have a greater angle of the femur (thigh bone) from the hip to knee due to a wide pelvis; women are small and therefore have small knees unable to absorb as much force as larger ones; and women have lower bone mineral density (BMD), which is currently believed to be the greatest indicator of OA likelihood.

I cannot change my womanly curves, nor can I double the size of my knees, but I can address my BMD. Glazed over and tip-toed around in literature regarding women athletes is a dirty word: anorexia. In the culture of athletes, being too thin is an obsession praised as a mark of perfect training, discipline and sacrifice for sport. But at what cost? Eating disorders are common among women athletes (and becoming more common in men). A malnourished woman will often experience amenorrhea (a pause in her fertility cycle) as the body’s way of conserving nutrients. This pause changes hormone secretion, including a decrease in estrogen levels. This decrease is a major factor in bone density loss; a low BMD means higher risk of OA.

As an aging woman athlete with a history of knee injuries, I am going to be proactive in reducing my risk of OA in my knees; I am going to accept those two extra pounds on my goal weight.  I am going to do this by not changing my eating plan (crafted by a wise nutritionist), but I am going to occasionally splurge and eat that second cookie. And, instead of feeling guilty, I’m going to tap my crumb coated fingers to my knees and say it is for them.  Here’s to a few more cookies in 2012 and healthy knees that will keep me skiing well into my 80’s!