About focusbodywork

I am a massage therapist specializing in bodywork for athletes. My clients are athletes ranging from weekend warriors to professionals in a wide variety of athletic pursuits. I help athletes stay healthy through their training, treat a variety of acute sports injuries such as strained hamstrings, and work with my clients medical team to ensure a speedy and through recovery from serious sports related injuries such as ACL repairs. I rely heavily on Neuromuscular Therapy, Myofascial Release and Myoskeletal Alignment techniques for specific soft tissue repair and am regularly participating in advanced trainings to further my education.



Carli Lloyd nails the penalty kick!

It’s a joy thing to watch people at the top of their craft. And that’s just what the experience of Tuesday’s Women’s World Cup quarterfinal match between the USA and Germany delivered. The USA squad played the best they had all tournament and made it nearly impossible for the (usually) excellent German players to gather momentum. The Americans first goal came from some luck (a foul that drew a penalty instead of direct kick) and focus (Carli Lloyd’s excellent execution).


Kelley O’Hara’s super-skill to get a foot on that ball (before the defender) and place it in the net!

On the other hand, their second goal … well, their second goal was pure beauty – a sequence of passes from Megan Rapinoe on the side that was dropped back to Tobin Heath who sent it direct to Carli Lloyd, with her perfect set-up, to Kelley O’Hara’s brilliant completion (watch it here).

The play exemplified skill, patience, practice, awareness, and teamwork – that is what soccer is all about.

And that is exactly what we have going for us at Focus Bodywork with the addition of Brenna Gardner, LMT, to our team! With our own stroke of luck, we’ve nabbed Brenna from one of the high-end spas in Park City. With her nearly 15 years of experience and extensive additional training, Brenna has a host of skills that complements the injury and training needs that face our clients. Just when I was looking for a way to make sure our clients get seen in a timely fashion, Brenna was looking for a venue where she could build on-going relationships with folks navigating the pre- and post-surgery world of injuries. Score!

photo full

I’ve known Brenna for almost three years (we both worked at Prana Yoga) – she has been one of my go-to people when my body starts complaining. I’d often wished I could send on clients needing her special skill but, for most of us, the fancy spa setting is out of our reach. But now, wish granted! She is ready to pick-up some orthopedic assessment and treatment techniques and Shannon and I are lucky to learn more from her about manual lymphatic drainage (in which Brenna is a certified therapist), muscle attachment therapy, and hydrotherapy (to name a few!).

As the US women re-group for Sunday’s final match (with whomever wins today’s line-up between Japan and England), please join me in welcoming Brenna. Over the next few months, she will be building up her hours at Focus Bodywork, starting now with Tuesday and Thursday afternoons. You can book with her online or give us a call at 801-359-5149.

– Margaret Madsen

Hello, Goodbye!

Or is that goodbye, hello again?

Emma to BendMy news is bittersweet; I am relocating to Bend, OR. I am so excited for this new adventure, but it is very hard to leave the community here. When I started Focus Bodywork thirteen years ago, my dream felt like a pie-in-the-sky fantasy. I am in awe today that Focus Bodywork has exceeded my vision and provided the medium for me to develop into the therapist I am proud to be. I cannot thank each of you enough for trusting me, it has been a privilege. I leave you in the best hands I know, Margaret. – Emma

Hi! I’m Margaret Madsen – perhaps we’ve met in passing when you’ve come in for a treatment with Emma or Shannon in the past year and a half? Or when we’ve worked together directly? Maybe it was getting that rotator cuff functioning so you could do downward dog, or keeping your elbows happy so you could keep sending those hard routes, or was it sleuthing out the crazy-cool rotation of your torso that was leading to back pain? Whatever soft tissue restrictions have been keeping you from fully doing the activities you love, I am still here to help!

Mentoring with Emma has been a truly amazing professional opportunity. Being a part of Focus Bodywork has fostered my innate skills and knowledge while providing countless examples of how to push the envelope in providing the best care possible. Thus it is a great honor to announce I am taking on the role of owner of Focus Bodywork. I am sorry to see Emma go (I haven’t finished picking her brain yet!) but I am comfortable and ready to carry on the same high level care and customer service for which the business is known.

Shannon will continue providing her excellent care on her new-Mom based schedule. A few changes you can expect to see in April are a new location (a smaller treatment space) and, to reflect my professional growth, my rate will be $70/hr. Scheduling will stay the same, with the same phone number and online service – only now I’ll be the one answering the phone and responding to emails!

Goodbye for now, looking forward to our next hello (again)!

Bike Without Wrist Pain

By Emma Maaranen

Perfect fall weather along the Wasatch Front has the masses on their bikes commuting to work, getting a last hit of the Crest Trail or bike-touring the Nebo Scenic Loop to gawk at the colors. In the clinic we are seeing a lot of disgruntled cyclists who are not getting to pedal as much as they want due to wrist pain. A few simple adjustments to your bike may be all you need to get back in the saddle.

Your cockpit (shifters, brake levers and handlebars) and saddle are the most typical culprit for bike-fit related wrist pain. If either or both of these are just a millimeter or two adjusted in an unfavorable position for you, too much weight is transferred onto the tiny bones that make up your wrist (the carpal bones).

Elbow - wrist -  index finger position on a road bike

Elbow – wrist – index finger position on a road bike

Elbow - wrist - index finger position on a mt. bike

Elbow – wrist – index finger position on a mt. bike

Ideal cockpit position for both a road or mountain bike style handlebars creates a straight line from your elbow through your wrists to your outstretched index finger on the brake levers. If this alignment is strait, the carpal bones are stacked on top of each other to perfectly bear weight. If there is a bend in your wrist the bones are not stacked.  Unstacked carpals cause the muscles, tendons and ligaments at your wrist overwork and can lead to injury.

Adjusting angle of road-style handlebars

Adjusting angle of road-style handlebars

Adjusting shifters and levers on mt. bike

Adjusting shifters and levers on mt. bike

You can loosen the shifters and levers on a mountain bike style handlebar and adjust the angle of the shifters/levers to achieve a straight line from elbow through index finger. On a road bike handlebar type you can loosen the screws at the bike stem to adjust the angle of the handlebars to accommodate a straight line from elbows through index finger.

Too wide mt. bike handle bars with a lever angled too far down put excessive weight on the thumb side of the wrist.

Too wide mt. bike handlebars with the lever angled too far down and too wide on the bars.

The ease of using your shifters and brake levers also effects your wrists. On a mountain bike style handlebar you can move the shifters and levers in or out on the bar. You want the end of the brake lever (most mechanical advantage so you don’t have to squeeze very hard to brake) in-line with your index finger. Your hands should rest on the handlebar grips so your index finger is as wide as your armpit. (For some disciplines of mountain bike riding you may want your hands wider, but this is a good biomechanical place to start from.) Here is a link to walk you easily through doing these mechanical tweaks yourself.

Too wide road-style handlebars causing the wrists to bow outward.

Too wide road-style handlebars causing the wrists to bow outward.

The width of the bars is really important for a road bike set-up. They should be as wide as the rider’s armpits. Too narrow and the wrists will bow inward causing pain on the pinkie side of your wrist. Too wide and excessive weight is placed on the thumb side of the wrist. The only fix for too narrow or wide road bike handlebars is a new set, but they can be inexpensive at your bike shop, you may be able to just trade them out if your bike is a relatively new purchase, or you may be able to swap them out at a bike collective. Added bonus – you can put new fun handlebar tape on your bike while you are at it!

Speaking of re-wrapping your road handlebars; a thick, squishy foam or cork tape will provide some padding for your hands. There are also adhesive gel strips you put on the handlebars where you hold them before you wrap the bars with tape adding even more personalized padding. Your bike shop can help you with this.

Mountain bikes have grips you hold onto. All too often these are a compacted, torn mess on the end of the handlebars. These are cheap and a new set will not only be kind on your hands but may make your bike look fresh too. There are ergonomic grips made by Ergon that create a platform for your hands to rest on. Several of our dedicated bike commuting clients swear by these.

Padded Bike Gloves

Padded Bike Gloves

Adding a little padding where your hands contact the handlebars can ease pressure spots and absorb some of the vibrations. Invest in a good pair of bike gloves with padding on the palms.

Level Bike Saddle

Level Bike Saddle

If your saddle is tipped forward (and just a millimeter can cause a huge shift in your weight distribution on the bike) more of your weight will be placed on your hands instead of in the saddle. I recommend using a level to check your saddle angle.

Finally, how you hold the handlebars can exacerbate wrist pain. No Death Gripping! You should be able to wiggle your fingers, chicken-wing your elbows, roll your shoulders and bobble head your neck at all times. It sounds silly, but smiling will relaxes you into a loose position on the bike where you are securely contacting the bike so you don’t let go if you hit a blind pot-hole.

If all these simple customizations to your bike do not alleviate your wrist pain while biking, you may need help from a professional. Most bike shops have a professional bike fitter on staff who can pinpoint an error in your fit that is compromising your wrists.

And, this should be obvious, any wrist pain that is debilitating, lasts for weeks, is the result of trauma, causes numbness that does not go away shortly after you get off the bike, or simply feels like it is an injury should be evaluated by a physician.

Our business plug: At Focus Bodywork we can treat the wrists through massage therapy if there is some irritation and inflammation created from your old bike set-up, do an evaluation of your bike position and help you train to support better biomechanics through movement therapy, and diagnose wrist injuries through physical therapy. We love addressing specific problems such as bike induced wrist pain by treating your pain source AND your contributing factors to come up with a complete solution.

You Don’t Have to be Training for Wimbledon to Get Tennis Elbow!

By Emma Maaranen

We see a lot of tennis elbow cases at Focus Bodywork, and so far none of these cases have been in individuals who play racquet sports.  Mostly our tennis elbow clients are desk jockeys who moonlight as climbers, but athletes who uses their arms are suspect!

Lateral Elbow LandmarksTennis elbow is the common name for lateral epicondylitis.  This tendonitis (acute or trauma causes) or tendonopathy (chronic degradation of the tissue from repeat assaults) refers to inflammation of the tendon on the outside elbow.  Most of the muscles in the forearm that extend the wrist and open the fingers merge to form a common extensor tendon that inserts on the outside of the elbow.  Tendonitis develops from a simple motion that is repeated ad nauseaum such as flicking a gear lever on a road bike, or a short duration but intense effort that is abnormal such as repeating an odd bouldering move twenty times one afternoon.  Seldom does an injury occur at a notable instant.  Usually the lateral elbow is tender the day after use. It is easy to be seduced into thinking a few days of rest has healed the injury.  Often it feels okay, but on returning to use it is tight or mildly painful for the first few minutes of use.  The elbow may feel like it “warms-up” after a bit of use, and continuing activity may lead one to believe they are not making the injury worse.  However, a few hours after the athlete has cooled down, the elbow is tender and painful again!  Rest alone rarely allows a tendonitis to heal.

Elbow extensor mm groupYou have pain on the bony outside of your elbow and you think its lateral epicondylitis, but you are confused – you can only cite repeated gripping activities as the culprit motion, not repeatedly opening your hand and extending your wrist.  What is going on here?

Palpating forearm extensors while making a fist

Palpating forearm extensors while making a fist

Actions of the hands are quite complex, requiring a symphony of muscle firing orders, varying muscle tensions and speeds of muscle contractions in order to do even the simplest of tasks such as holding a fork.  Just imagine what has to happen in order to leverage a body in motion upwards when you are pinching a quartzite crystal on a rock face!  Forearm muscle synchronization requires the wrist and hand flexors (the muscles on the pale part of your arm that insert on the medial/inside elbow and allow you to grip) to work in tandem with the extensors.  If a flexor is contracting to grip, its antagonist extensor is resisting being lengthened (eccentric contraction) to provide a fine-tuned squeeze on the object instead of crushing it.  Eccentric muscle contraction is more demanding on muscles, which causes the extensors to work harder than the flexors.  You can experience this for yourself by feeling your forearm.  The extensors (on the tan  part of your forearm) are bigger than the flexors (on the pale part of your arm).  Now gently grip your forearm around the thickest part (where the bulk of the muscles are) and squeeze the hand of the arm you are gripping.  You should feel more muscles contracting and to a greater extent in the extensor group (on top/tan) than in the flexors (below/pale).  The extensors do more work than the flexors when gripping.  This is why forearm extensors can be injured when you perform primarily flexion activities.

Once your lateral epicondylitis has been diagnosed, treatment usually involves targeted eccentric strengthening of the forearm extensors, range of motion exercises, rest from strenuous use, and ice treatments.  Most of the time this is all that is required to completely heal.  If the injury is recent, healing should take about six weeks.  If you have been aggravating the injury by pushing through the pain for a while, healing may take up to six months.  More serious or chronic cases may be treated with ultrasound, e-stim or a cortisone injection.

However, we see a lot of these injuries that are NOT healing with the standard medical interventions!  In these incidences there are often other causes complicating or contributing to the tendonitis.  We love to help you identify these factors; either after standard treatment is not resolving the injury or, better yet, congruently with standard care!

The usual suspects:

  • Over training can cause excessive damage to fascia (think nori wrap for muscles) in excess of what the body can repair between training sessions.  Damaged fascia becomes tacky and can stick muscles together so that when you need to only use one, both muscles have to fire.  Muscles are overworked, tighten, and yank the tendon into a lengthened position.  Tendons do not like to be lengthened for a long period of time and will become inflamed.  If the forearm fascia is sticky, it is difficult to resolve tendonitis until the fascia has been mobilized.
  • When the muscles in the forearm have been tight for a while, they can compress the joints that they cross: the elbow, wrist and finger joints.  When joints are compressed they can become inflamed and range of motion is lost.  The muscles of the forearm will compensate and overwork through the reduced range of motion.  This is not an ideal situation for healing a tendon, so we release the hypertonic (too tight) muscles thus allowing full range of motion to the joints and eliminating compensatory muscle firing.

Brachial plexus posture

  • Shoulder posture can also impede elbow range of motion.  If your shoulders are rounded forward and/or elevated, your elbows will stay bent when relaxed instead of hanging strait down from the shoulder.  This causes the forearm muscles to shorten, work poorly and excessively tension the tendons.  This posture issue can often be addressed by balancing the muscle tension of the shoulder girdle and upper thorasic spine.  Often this requires a combination of massage, targeted exercises to strengthen, lengthen or restore range of motion, and changing habits such as slumping at your desk all day.
  • Brachial Plexis EntrapmentEntrapment of the brachial plexis (nerve line down the arm) may be occurring.  Nerves that tell the muscles of the forearm what to do can be squished or rubbed on constantly at some spot as the nerve traverses from the spinal column at the lower neck and upper back to the elbow.  When a nerve is stimulated constantly it will send a dull message to the muscle tissue it acts upon telling it to contract just a little bit all the time.  This is exhausting to the muscle; it will shorten and the tendon will be overstretched.  There are three common spots this nerve line is compressed at: below the scalenes (front of neck muscles used to inspire), under the clavicle (the collar bone) and upper rib cage can be too close to each other due to biomechanical factors and/or muscle tension), or under the pec minor muscle which becomes tight and short with slumped shoulder posture.  Again, massage and targeted training will relieve the pressure on the nerve.
  • Occasionally there is pressure on the nerve as it exits the spinal column at the lower neck or upper back.  This can be from disk or bony changes of the spine.  If we suspect that this is the issue that may be complicating your tennis elbow, we refer you to a specialist to be evaluated and can then aid your medical team in addressing these problems.

Whenever we work with a client with lateral epicoldylitis we treat not only the tendonitis but address any and all other factors that may be complicating or causing the injury.  This ensures a speedy recovery and reduces the likelihood of a repeat injury.  Your elbow may feel so fantastic once we have helped it heal that you pick up tennis!


Focus Bodywork is again on the move.  Not far though, just across the parking lot into #2C starting Monday, March 31, 2014.  This is a larger suite where we will have more treatment rooms and an exercise/movement therapy area to accommodate our clients’ needs more fully.

We are also so excited to announce that Focus Bodywork now has a resident physical therapist, Esther Smith, DPT, Cert. MDT.  Esther is an amazing manual physical therapist who specializes in treating athletes.  The collaboration of massage and physical therapy will allow us to treat soft tissue injuries, address structural and joint limitations, and create comprehensive rehabilitation plans.  We will work together as a team of experts providing a seamless plan to get clients back to doing what they love.

A bit more about Esther:

Esther Smith

Esther Smith

Esther received her doctorate of physical therapy degree from the University of Utah.  Since graduation, she has worked in the orthopedic setting with a particular focus on the management of musculoskeletal problems and sport performance.

Her goal is to offer clients education and treatment that addresses the cause of their symptoms and aids in the prevention of future injury, so that clients can get back to living life faster and pain-free.

Time with Esther means one-on-one, hands-on sessions that focus on client self-treatment education, tailored exercise and manual therapy including spine and joint mobilization. Esther is also certified in the McKenzie Method of Mechanical Diagnosis and Therapy™ and is a Restorative Exercise Specialist™. This additional training provides her with an assessment process that allows her to reach a mechanical diagnosis and produce an appropriate treatment plan for complaints such as:

  • Spine pain and referred pain into the limbs
  • Spinal disc pathologies
  • Joint stiffness and pain
  • Muscle problems including spasms and tendonitis/tendonosis
  • Intermittent numbness in hands or feet

In her free time, Esther enjoys cooking up good food gathered from local producers, testing her movement theory rock climbing in Utah’s wild places and generally playing outside with friends and family.

And Focus Bodywork’s growth does not end there!

Shannon is pregnant with her first (a girl), and will be on maternity leave for the month of July.  We are already discussing how to continue support for Shannon’s clients while she is out of the office to ensure there are no gaps in care.

Thank you so much for fueling our growth.  It is a dream of ours to create a team of sports minded therapists working together to meet the needs of the athletic community along the Wasatch Front.  It is so exciting to see this dream move into reality!

By Emma Maaranen

Sherlock Holmes and the Painful Low Back

Sherlock Holmes Cartoon

By Emma Maaranen

We see many athletes each week with back pain. Some of these clients have disk, joint or nerve injuries that cause their pain, but more times than not, back pain does not come from a diagnosed injury or pathology. However, just because there isn’t a diagnosed problem does not mean that this pain is not real, debilitating or needing to be solved. Although we feel for your pain, we love these cases! It allows us to practice our detective work and help to solve the mystery of back pain!

It is a rare person who gets through life without experiencing a bout of back pain at some point. You may experience constant soreness, a biting pain that prevents you from standing, or momentary stabbing pain when you twist. The pain may last for a period of a few weeks to a few months, and it may be a one-time ordeal or a recurring theme. After serious injury has been ruled out as the cause of pain, we at Focus Bodywork put on our detective hats and get to work.

I hate to break it to you, but your lower back is not perfect. Each low back has a slight deviation from anatomical perfection: a small tilt in the pelvis, too much (or too little) curve, micro-scoliosis, tiny bone spurs, thin discs, extra-fat nerve sheath, etc. These deviations may not cause any grief and, if “fixed”, may actually cause a lot of new pain! In fact, when MRI’s are taken on people with no back pain and no history of back pain, the MRI’s often reveal bulged discs, arthritis or degeneration. (Click here for a nice NPR story about this.) Currently the spinal orthopedic world is revisiting commonplace spinal surgeries, such as fusions and micro-discectomies, and finding that for some patients these surgeries are not alleviating their pain and may in fact be making it worse. It could be that for these individuals, the pathology seen on an MRI was not the cause of the pain. Back pain is frustrating!

We love to search for clues to back pain. We start by watching you move (sitting down, standing up, walking, squatting, lunging, twisting, balancing on one foot, etc.) to spot odd patterns of motion. For example, we may notice that one hip does not rock back when you sit down. Or perhaps your low back is very stiff, and we notice it causing your mid-back to overcompensate by doing too much of the motion. Or maybe your gluteus muscles are too weak to stabilize your hip when you balance on one leg, which forces excess load onto your spine.

Clues to back pain can also be found in your story. An athlete’s training plan, if too strenuous, may not to allow tissue to heal. For others, a new diet plan to get to race weight may not provide sufficient nutrients to support tissue repair. Often insufficient (or absent) warm-up and cool-down procedures are suspect.

In addition to our eyes and ears, our hands are our top-secret tool for solving these mysteries! Through palpation (feeling your low back and surrounding tissues) we often detect adhesive scar tissue, taut fascia bands and trigger points in muscles that are contributing to low back pain. Now we know enough to set a trap to catch the culprit!

Focus Bodywork therapists are able to address problems in soft tissue that are contributing to low back pain, but often we need to call in experts from other fields to put away the problem for good. Depending on what we have uncovered in movement patterns, your story and palpation, we may recommend a manual physical therapist to manipulate joints, a movement practitioner to retrain faulty posture, a sports nutritionist ensure you meet your diet goals without compromising your health, or an acupuncturist to reduce nerve pain.

Just as Sherlock Holmes leaves no stone unturned, we are determined to guide you in solving the mystery of your low back pain.

Smart Supplementation

Dr. Shannon O'Grady

Dr. Shannon O’Grady

By Emma Maaranen

As we are making our New Year’s resolutions, many of us make some type of commitment to better our health.  These commitments usually include dietary changes such as reducing sugar intake, eating more dark leafy greens  or making sure we are getting the minerals we need.  Often these choices about diet supplementation are based on assumptions about what is good for us and what may be lacking.  Recently I had the opportunity to chat with Dr. Shannon O’Grady, an expert on human physiology and nutrition, who shared/debunked a few myths about supplements.

“I’ve heard nutritional supplements are not regulated by the FDA.  Therefore, how do I know if the amount of a nutrient on a label is really what I am getting?”

Shannon has been spending the past year working with a major supplement manufacturer ensuring they would meet the requirements of a scheduled FDA audit.  Per FDA regulation, all dietary supplement must meet any listed label claim for ingredient source and potency at the time of manufacture as well as through the listed expiration date (beware of supplements that do not list an expiration date). These label claims must be accurate after normal shipping and storage by the manufacturer and retailer. It is true that supplements are not as rigorously tested as pharmaceuticals.  This is because supplements “may help digestive health,” not “prevent acid reflux of the stomach.” Both supplements and pharmaceuticals may cause side effects and may even interact, and it’s extremely important to consult a healthcare professional if you have any major health issues and you’re thinking of starting a supplement program.

“Probiotics are in the news a lot lately, touting better immunity from communicable diseases to reducing belly fat.  I want to take this super supplement!  Is eating yogurt every day enough?”

vitamin picResearch on the exact benefits of probiotic and how they work is still being worked out, but all evidence suggests that a diverse and thriving flora in our guts enhances health in many facets.  However, when you take a probiotic, most of the bacterium are killed in the stomach before they are able to have a beneficial effect. The higher the per strain dose (measured in colony forming units of CFUs) you take the more likely it is that some of those microbes will get to their destination and have a beneficial impact on gut health.  In a nutshell, it’s better to take a probiotic containing 2 strain than a supplement with the same dose, but spread among 10 strains.  Also – stick with a higher CFUs count, at least twenty billion.   Unfortunately your yogurt has too few CFUs to be a therapeutic dose.

“I’ve heard you should take probiotics when you are on antibiotics; why is this important?”

Taking antibiotics as prescribed by your physician is very important.  However, the antibiotics will kill much of your beneficial bacteria as well.  If you are taking a probiotic while taking an antibiotic, the organisms your are ingesting will be killed off as well.  Most people will have their guts repopulated with flora a few days after the course of antibiotics is complete, but taking a probiotic concurrent with your course of antibiotics will help the process out.  There is probiotic yeast, sacchromyces boulardii, that has been found to aid in digestive function and is not venerable to antibiotics (antibiotics target bacterium, not yeast).  A significant body of scientific literature has shown that taking this yeast while on your antibiotic regimen will reduce antibiotic caused diarrhea and reduce the likelihood of developing a C. difficile infection (a life threatening bacterial infection of the digestive tract that can occur after antibiotic treatment). This can be taken while on antibiotics and may be compounded with antibiotics in the future!

“Vitamin D was the darling of the health industry last year, and I have added it to my regime of supplements.  Is it still believed to be important?”

Yes, vitamin D is important.  It is needed for our bodies to absorb calcium to strengthen bones, regulates the immune system and reduces the severity of asthma (including exercise-induced asthma).  We get vitamin D from the sun, but wearing sunscreen and living with air pollution reduces what we get naturally, so supplementation may be useful.  However, we don’t absorb those 600 IU/day we are taking unless we are pairing it with magnesium.  You could eat a spinach salad with avocados and pumpkin seeds to get a hefty dose of magnesium with your vitamin D!

These are some on the insights Dr. Shannon O’Grady shared with me that I thought were especially useful for athletes.  As you turn your New Year’s Resolutions into lifelong healthy habits, I hope these tid-bits about nutrition supplements help you navigate the confusing world of nutrition.

Jelly Filled Doughnuts


By Emma Maaranen

This slushy morning my dog and I braved the elements and found a beacon of Sunday morning warmth and ritual on our walk – the doughnut shop.  With powdered sugar on my lips, I bit into the pastry and caused the jelly filling to shoot out the back, leaving me with a gooey mess.  Being me, a therapist who sees anatomy everywhere she looks, this reminded me of a disc injury in the back.

The jelly filled doughnut is a great analogy for a spinal disc.  Spinal discs are puck-shaped shock absorbers sandwiched between every vertebrae of the spine.  The vertebrae protect the spinal column and allow spine motion between each segment.  Each vertebra has a pair of nerves that exit the spinal column next to the disc to innervate a specific region of the body.  Discs are made of tough rings of cartilage, called the annulus fibrosus, which look like a cross-section of a tree.  Their layered circular fibers resist compression in all directions.  Discs have a squishy middle, called the nucleus pulposus, which absorbs forces put on the spine.  This is the jelly center of the doughnut.  If too big a force or a constant force is applied, the nucleus pulposus can push into the annulus fibrosus and damage it, much like a big bite into a doughnut causes the filling to escape.

disc anatomy illustrationCommon Disc Injuries

Disc Herniation – This is where the nucleus pulposus tears through the annulus fibrosus and escapes the disc; the jelly filling has exploded out of the pastry.  Pain and numbness are caused by the torn disc or extruded nucleus pulposus pressing on the nerve nearby as it exits the vertebrae.  The body will absorb the nucleus and the torn disc often will mend over time.   If the disc continues to irritate the neighboring nerve, surgical intervention may be required.  However, the nucleus is gone and can never return to the middle of the disc.  This disc will not be able to resist compression in the same fashion in the future, and care (a strong core and good biomechanics) will be needed to keep the disc healthy in the future.

Bulging DiscIn this case, the nucleus pulposus is being squished on one side and is pressing on the opposite side of the rings; the jelly is oozing into the pastry and with a little more force may burst out.  The nucleus pulposus is tearing the inner rings and expanding the disc.  This disc bulge can put pressure on the nerve causing pain and numbness.  By removing the pressure on the disc the nucleus can reabsorb into the middle of the disc and the tears in the disc can repair.  A bulged disc is quite delicate and too much force on the injured disc can cause it to herniate.

Degenerated Disc – Long-term pressure or a history of trauma to the disc can cause the nucleus pulposus to disintegrate and/or the annulus fibrosus may flatten; your doughnut is drying out and the jelly filling is turning to a dense paste.  The disc is no longer able to cushion compression in the spine as it used to.  Pain will generally come from the muscles trying to protect the spine in that location or from the spinal joints (facets) smashing together now that the flattened disk has reduced the space between the affected vertebrae.  Disc degeneration is often accompanied with arthritis of the spine in that area.

You may hear people referring to their disc injury as slipped, ruptured, compressed or prolapsed.  These terms loosely refer to a bulged or herniated disc.

If you have injured your back, there are several things to consider on how to proceed.  It the pain is sudden and is accompanied with numbness down the arm or leg, especially if numbness is present in both limbs, you need to go to the ER!  If pain comes on gradually and is accompanied by numbness down the arm or leg you should see a physician.  If any pain in your back continues or worsens over three days you should see a physician.  Once your doctor has diagnosed your disc injury a plan to heal it can be made.  Surgery is rarely performed on new disc injuries unless there is damage to the vertebrae above and below the disc (such as a displaced fracture) or the spinal column is compromised and paralysis is a concern.  Disc injuries typically heal with therapy, anti-inflammatory medication and time (six months to two years).

Therapy for disc injuries involves changing postural habits such as sitting at a desk and lifting mechanics.  Muscle imbalances will be addressed and joints will be mobilized to restore normal range of motion.  A physical therapist that specializes in spine injuries (we know a few fantastic ones we can recommend) is critical to healing a disc.  Massage therapy will address muscle tension at the injury site and can help with nerve generated pain down limbs.  Acupuncture reduces nerve pain in many people.  Healing from disc injuries is a slow process.  As an athlete it is important to have a team of professionals guiding you in return-to-play parameters and to be creative and open to new activities (like swimming or Pilates) to keep you active while supporting the healing process.

When a disc has healed it is important to continue thoughtful training and biomechanics forever!  Honestly, anyone who would like to reduce their chances of disc injuries should do this.  Discs are the most vulnerable when the spine is in flexion (forward folding) and a twisting action is done; such as sitting in a slouched position and twisting the legs to the side to get up from a workstation.  This is made more tenuous by adding a heavy object into the equation; such as bending over at the waist to pick up a backpack and twisting while straightening the spine.  It has been said over and over, but it is true – a strong core will support the spine and make it more resilient!  There are many methods to do this: Pilates, specific weight training programs, personal training, home videos, kettle bell, etc.  I’ve even seen a “spin your core strong” class advertised!  Find something you enjoy and add it to your weekly routine.  Even two minutes of targeted dynamic core strengthen exercises as part of a warm-up routine will yield excellent results.  With a strong core, you may even indulge in a doughnut now and then.

And Then There Were Three!

Margaret2We are excited to announce that Focus Bodywork has added another amazing therapist to its team!  Welcome Margaret Madsen.

Margarets childhood fascination of the natural world led her to earn a graduate degree in vertebrate paleontology.  After ten plus years working with fossils, Margaret looked to work with bones in motion and eagerly completed her national certification as a massage therapist in 2011.

Applying her unique understanding of anatomy to the quirks of the human body is one of Margaret’s strengths.  She incorporates orthopedic massage and deep tissue techniques to her sports massage therapy session, and recommends exercises based on her experience as a yoga instructor.  She also practices cranial sacral therapy, and when appropriate, incorporates this light tough modality into her work.

Margaret loves to hike in the Wasatch Mountains and keeping up with the real athlete of the family – her dog.  She can talk for hours about all aspects of food and freely admits her favorite hobby is puttering about the house and yard.

With the addition of Margaret, we will be better able to meet the needs of our clients.  We will have:

* Last minute sessions available weekly for those unforeseen massage emergencies such as the inevitable hamstring tension that develops the week before a big race

*Friday appointments

*Referral networks between several sports medicine doctors and physical therapists

*Community classes on self-massage, sports injury physiology and “anatomy for athletes”

We invite you to experience the excellent clinical work Margaret has to share.  As she grows her clientele we are offering a $55 introductory rate for a sixty minute massage therapy session with Margaret.  Call or text us to set up your appointment (801) 359-5149

By Emma Maaranen

Photo Diary of Injury Care

My dirt face after my bike crash

Post bike wreck grimace

By Emma Maaranen

Often I’m asked by clients, “What do you do when you get hurt?”  Unfortunately I did get hurt a few weeks ago, so I have a fresh example of what professional care I seek and what home care I perform to treat my injuries.

My Accident/Injury About a quarter mile from the finish of a mountain bike race, I took a high speed crash onto my right leg.  On impact I experienced sharp pain in my lower leg/ankle region, heard a snap and had a wave of nausea wash over me.  I rolled out of the way of chasing bikers to avoid further injury and quickly assessed my leg before the adrenaline wore off and pain set in.  Visually I was okay; there was no serious bleeding or visible

Care from the medic tent

Care from the medic tent

deformity to the injury area.  I was tender to the touch on the lateral maleoleus (the bony bump on the outside of the ankle) and along the bottom third of the fibula (outside lower leg bone).  I could put weight on my leg, but it was painful.  I performed a few orthopedic assessments to rule out ankle ligament ruptures or Achilles tendon tears (I know most readers won’t know how to do this, but if you have some special skills, you should use em’).  I knew I did not need immediate medical attention because of the lack of bleeding, or deformity, and because of my ability to move my leg and bear some weight.  I carefully got back on my bike, rolled through the finish line and into the medical tent.  The medical team repeated my assessment, decided I was just banged up, and sent me on my way with an ace bandage, ice and ibuprofen.

Icing my ankle

Icing my ankle

Immediate Self Care for my Trauma Injury I strictly follow the RICE (Rest, Ice, Compress and Elevate) protocol after any trauma.  Once home from my race I applied arnica, an herbal preparation that aids in inflammation reduction, and continued the RICE-ing through the evening.  I was confident that the injury I sustained could wait until the morning for medical attention.  It was possible that is was just really sore from impact, but I suspected that I had fractured my fibula.

Day 2 Before I got out of bed I assessed my ankle and leg again.  The swelling had increased, and bruising was apparent around my ankle and through my toes.  My ankle was stiff, but I could almost move it through a full range of motion.  Weight-bearing elicited the same level of pain as the day before.  I begin RICE-ing again and called a sports medicine clinic to schedule some x-rays this morning.

Walking boot

Walking boot

Diagnosis I had a stable distal right spiral fibula fracture.  This means: I broke the bottom third of my right lower leg. It is stable, meaning that only one structure (bone or ligament) in the ankle complex is severed, and the other structures will maintain ankle alignment so that surgical stabilization (pins and plates) are not needed to allow the bones to heal.  Because the fibula only bears about 20% of the body’s weight,  a walking boot was all I needed for added stability.  We decide to x-ray my injury again in two weeks to make sure the fracture is healing well and the ankle is still stable.

Throwing Everything Into Healing I am a believer that to heal an injury best, you need to provide it all the nutrients and support it could possibly need.  Now that I know what I’m dealing with for an injury, I can be active in my healing.

Some of my nutrition products to aid bone healing

Some of my nutrition products to aid bone healing

Nutrition Healing takes a lot of energy (calories!), this is the worst time ever to think about losing a few pounds.  I often struggle to keep weight on when I am injured because so much fuel is needed to repair tissue.

Muscle is mostly protein so I increase my protein intake to provide my body the building blocks needed to repair soft tissue.  My nutritionist recommended I increase my protein intake from 40g/day to 100g/day.  This is a lot, so I incorporate a protein shake in my daily diet to fill this need. (My favorite protein smoothie is a scoop of Vega vanilla chai protein powder blended with 1c. almond milk, 1T peanut butter, 1T cocoa powder, 1t. vanilla extract, a pinch of salt and a frozen banana.)

Bone requires minerals to rebuild.  I take a bone-specific formula that has calcium, magnesium and potassium along with other minerals needed for bone remodeling.  I also take vitamin D, which is necessary for the body to actually process calcium.  Otherwise most of the minerals you are taking pass right through you!  Just in case I’m missing some nutrient, I also take a multivitamin and fish oil.  Fish oil is high in omega fatty acids, which work as an anti-inflammatory.  In addition I take a homeopathic remedy for bone fractures (available at any holistic grocer).

Spiral compression wrap

Spiral compression wrap

Swelling When you first injure yourself, swelling runs rampant to act as a cast and stabilize the injury site.  Swelling is great at protecting the injury from movement, but the swelling actually impedes healing.  Wanting to heal fast, I put myself to the task of reducing the swelling.  RICE is the first step to swelling management.  (A  note on compression: you do not want to wrap an injury so tight that you restrict circulation.  For acute swelling I apply an ace bandage starting at my toes and spiraling the bandage up to my knee.) I also performed MLD (manual lymphatic

Kinesiotape application for swelling

Kinesiotape application for swelling

draining) therapy to my leg twice daily.  MLD is a gentle massage technique that assists the lymphatic system to vacuum up the inflammation (bits of torn cells, blood leaked from capillaries, fluid, etc.).  I applied kinesiotape in a web fashion to aid the lymphatic system and continue using arnica.

Exercise No, I wasn’t about to get a cleat fitted for my boot so I could get back on my bike, but I did need to get my heart rate up!  Yes, I was antsy to be active, but getting circulation cruising through an injury also helps push out inflammation and deliver the nutrients to where they are needed.  I headed to the pool and put a buoy between my legs so I could swim with my arms and went to my favorite Pilates class where I modified any activity that might have compromised my injury.  I also took my ankle through all its pain-free ranges of motion before I iced (which I did as often as I could).

Acupuncture to aid healing

Acupuncture to aid healing

Day 4 At this point I was out of the acute injury phase, so I could start doing some real massage therapy on it.  Daily I spent 30 minutes self-massaging all the soft tissue in my foot, ankle and lower leg.  I was able to move inflammation out, gently move the joints my foot, treat sprained ankle ligaments, address trigger points in the muscles, and drive more circulation to the healing area.  I also set up an appointment with my acupuncturist to help in pain management and aid in healing.

Day 11 I had another visit with my sports medicine doctor to make sure we did not miss any serious soft tissue injuries (torn ligaments, tendons or muscles), to x-ray my leg again to make sure the fracture is healing in alignment and to check that the ankle is in fact stable.  My doctor found that everything is looking great!  Over the next two weeks I can start adding in some stationary biking, and two weeks after that I can start weaning off my boot.  I should be back on my mountain bike in four more weeks, and my fracture will continue healing for 6 months before it is completely healed.  I will keep up my regiment of home therapy and have scheduled physical therapy and massage therapy appointments to begin in two weeks.

Every injury is different and has specific needs to heal.  I hope this “diary” entry gives you a few ideas of what you can do to heal proactively rather than just waiting for your injury to heal.  Being active in your healing process will improve your recovery and help you stay sane while you are side-lined!