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Ice or Heat. Which Should I Use?

You’ve probably been told by your physical therapist on different occasions to use ice or heat on your injury. Both have benefits, but first you need to know when and how to use them.

Ice is most commonly used for acute injuries. RICER; Rest, Ice, Compression, Elevation, Referral – is a basic first aid practice for soft tissue injuries and should  be applied for the first 48 to 72 hours. For example, if you were to sprain your ankle, stop what you’re doing, apply ice to the injury, wrap a compression bandage around the ankle and keep it elevated above the level of the heart (eg. lie down with the ankle on a couple pillows) until you can see an appropriate practitioner such as your GP or a physiotherapist.

Ice will help minimize swelling and inflammation in the area, and reduce bleeding into the tissues, muscle spasm and pain.

After the initial 72 hours of an injury, it is recommended that you use  either ice or heat, depending on your preference.

If you haven’t got any muscle tearing or visible swelling, it’s likely you don’t have inflammation and don’t necessarily need ice. Basically it boils down to whether you suffered a nasty enough accident to have actually damaged tissue. Here’s a checklist;

  • Did the pain hit you suddenly during strong stretching or a moment of athletic intensity? Were you lifting something way too darn heavy and/or awkward? In other words, did you have an “oh sh*t” moment?
  • Is there a spot in the muscle that’s extremely sensitive to poking? (It may even be little bit deformed — is there a bump or a depression?)
  • Is the skin flushed and hot? Does it look puffy? [1]

Generally heat is recommended to soften muscle tissue and help you relax.
In a standardised trial of applying heat and cold for low back pain, the results created little difference and the best results were based on the patients preference. [2]

How to apply ice?
Once the injury is elevated, wrap an ice pack in a cloth and apply for 20 minutes, remove for 20 minutes, reapply for 20 minutes.  Continue to ice and remove while the injury is inflamed. Ice should not be applied directly to the skin, as it can burn.

Instant ice pack

An ice pack could be anything from some ice cubes in a plastic bag to a single or reusable chemist bought gel pack. Sporting facility first aid packs often have instant disposable ice packs that do not need to be frozen and are activated by squeezing or shaking.

How to apply heat?
Heat therapy may be used on a muscle injury after 72 hours, or when there is no swelling and inflammation. A heat pad that has a consistent controllable temperature is best but most likely you will have access to a wheat bag or hot water bottle. Test the heat of the pack before applying and wrap in a towel before applying to the area, to reduce the risk of burns. A superficial or minor  injury may only need 15-20 minutes of heat at a time but deeper or more serious muscle tears may need longer heat.

moist heat pad

Moist or dry heat? 
Again it is personal preference. Many prefer dry heat, such as heat pad or sauna for muscle injuries but others like moist heat such as a warm bath, steam room or a moist heat pack for deeper pain like arthritis or more serious muscle tears.

Heat is not recommended if you have skin problems such as dermatitis, or if you have sensitisation problems such as with diabetes.

Do not apply ice or heat if you are in any way cognitively impaired.

At Malvern Massage we have microwavable wheat bags available. If you’re partial to a warm bath for your sore muscles, try this sore muscle bath soak;

Sore Muscle Soak

Ingredients:

  • 1 cup of Epsom salt
  • 1 cup of baking soda
  • 7-10 drops of peppermint oil
  • 7-10 drops of lavender oil

Directions:

  1. Begin by mixing your Epsom salt and baking soda in a bowl. Mix well.
  2. Add your oils at this time. Fresh herbs or rose petals can be added for extra aroma.
  3. Continue mixing well. The moisture from the herbs and oils may cause some clumping. This is not a big deal. Just use your spoon to break through the clumps.
  4. Store the mixture in a glass jar with lid or air tight container. I like to let it sit for a few hours before using.
  5. To use your homemade sore muscle soak, just pour it into a running bath. The lavender will help you relax and ease muscle tension, the mint will help revitalize, and the Epsom salt and baking soda will help with inflammation and pain.
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What is the difference between acupuncture and dry needling?

What is dry needling?

Dry needling, also known as myofasical dry needling or myofascial trigger point needling, is a technique used by myotherapists and other physical therapists to ease muscle tension and pain.

The term ‘dry needling’ was coined by Janet Travell, in her book, Myofascial Pain and Dysfunction: Trigger Point Manual, and it refers to the solid filiform needled used by practitioners, as opposed to a hypodermic needles used for injections. Travell experimented with dry and wet needling techniques, based on traditional and Western acupuncture techniques.

Dry Needling is predominantly comprised of acupuncture techniques; primarily from the Ming dynasty. Trigger points and painful areas are needled with acupuncture needles; in Traditional Chinese Medicine this is termed “ahshi” needling.

The placement of needles in dry needling relies on the theory of trigger points, developed by Travell. A trigger point is a point of contraction in the muscle, where a ‘knot’ has formed, and often results in referral or myofascial pain.

Dry needling practitioners believe that proper technique will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibres in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point and improves the outcome.

No study to date has reported the reliability of trigger point diagnosis and physical diagnosis cannot be recommended as a reliable test for the diagnosis of trigger points. But that said, it is the foundation of most remedial and myotherapy massage treatment, and is widely recognised by other physical therapists.

What is acupuncture?

Simply put, acupuncture works by using needles to stimulate a point on the body that sends a message through pathways in the body called meridians, which connect to our internal organs. In order to have a healthy body and mind, TCM believes Qi needs to be in abundance and circulating freely. Balance is also required. This is the traditional theory which has been around for thousands of years.

Acupuncture has a long history of use in the treatment of a wide range of conditions and used to treat a lot more than just muscular pain. Acupuncturists regularly treat conditions affecting the respiratory, digestive, cardio-vascular, reproductive, urinary and nervous systems.

The placement of needles in acupuncture is very specific and uses protocols of placement for specific stimulation.

Studies into the efficacy of acupuncture have been widely inconsistent with each other, showing that for reducing pain, real acupuncture was no better than ‘sham’ acupuncture (where the skin isn’t penetrated), and concluded that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. The same review found that neck pain was one of only four types of pain for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias. 

The risks of needling

The risks of acupuncture or dry needling are low if you have a competent, certified practitioner using sterile needles. Common side effects include, localised tenderness, minor bleeding or bruising where the needles were inserted.  Single-use, disposable needles are now the practice standard, so the risk of infection is minimal.

Contraindications to acupuncture or dry needling (conditions that should not be treated) include coagulopathy disorders (e.g. hemophilia and advanced liver disease), use of blood thinning medications, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns). Further, electroacupuncture should be avoided on patients with implanted electrical devices (such as pacemakers). The most frequent adverse events include pneumothorax (puncturing of the lung field), and bacterial and viral infections.

Ensure your practitioner is qualified, certified, insured and always follow safe infection control procedures.

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The 8 best stretches and exercises for Triceps

The triceps brachii, or more commonly known just as the triceps, are located at the back of the arm and is the major muscle in the extension of the elbow, or straightening the arm. Triceps brachii muscle means “three-headed arm” muscle as it originates in three places, attaching at the scapula (shoulder blade) and at two places at the top of the humerus (arm bone). The three heads act in varying movements of the upper arm and elbow, but with its origin on the scapula, the long head also acts on the shoulder joint and is also involved in backward rotation and adduction of the arm. The muscle inserts in just below the elbow at the olecranon of ulnar.

Injury to the triceps can cause a range of symptoms including;

Pain patterns for tricep trigger points

Commonly;
Back of Arm Pain
Back of Shoulder Pain
Dorsal Forearm Pain
Upper Thoracic Back Pain
Volar Finger Pain

Less commonly;
Front of Arm Pain
Lateral Epicondylar Pain
Medial Epicondylar Pain
Olecranon Pain [1]

Your massage therapist will likely work the triceps in conjunction with other muscles in the area such as the biceps, muscles of the forearm and muscles of the rotator cuff, depending on where your pain is.

Stretching Triceps

Tricep stretch

The best way to stretch triceps is to reach up with you the arm you want to stretch, bend at the elbow, and reach over with your other hand and grasp your elbow on the top, so your palm faces down towards the mid-back.

If your flexibility is not good enough to be able to reach your elbow with the opposite hand, have a towel in the hand of the affected side, and reach the bottom of the towel with the other hand at the back of the body. Gently tug the towel down while gripping.

A cross body stretch will also stretch the long head of the triceps. Reach your straight arm across the body and use the other arm to create tension and support the elbow.

Strengthening Triceps

Exercising the triceps directly will achieve the best results, with compound movements.

 

Close Grip Bench Press

  1. Lie on a flat bench with your feet flat on the floor. Make sure your back is completely flat on the bench, with no “arching” of your spine.
  2. Grip the barbell with an overhand grip, shoulder width or slightly less than shoulder width apart. (Do not make your grip too narrow as it limits stability of the barbell which can lead to injury)
  3. Push up using your chest and shoulders to lift the barbell above your body, then lower it slowly ( a count of 2) towards the centre of your chest. Hold for a count of one.
  4. Without “bouncing” the weight, force the barbell back up over the middle of your chest, straightening your arms and locking your elbows once your arms are fully straight. Hold for a count of one.
  5. Repeat.

Tricep Dips

  1. To get into the starting position, hold your body at arm’s length with your arms nearly locked above the bars.
  2. Now, inhale and slowly lower yourself downward. Your torso should remain upright and your elbows should stay close to your body. This helps to better focus on tricep involvement. Lower yourself until there is a 90 degree angle formed between the upper arm and forearm.
  3. Then, exhale and push your torso back up using your triceps to bring your body back to the starting position.
  4. Repeat the movement for the prescribed amount of repetitions.

Overhead Extensions

  1. Sit on a bench with back support.
  2. Grip a dumbbell at one end using both hands. Your palms should be facing inward.
  3. Hold the dumbbell overhead with your arms fully extended.  This is the the start position.
  4. Keep your upper arms close to your head (biceps roughly level with your temples) and near to 90degrees to the floor.
  5. Moving only your forearms, lower the dumbbell in a smooth arc behind your head until your forearms and biceps touch. Hold for a count of one.
  6. Return to the start position by using the triceps to extend your arm and raise the dumbbell. Exhale as you do this.
  7. Repeat.

Lying Chest Overhead Extensions

  1. Lie on a flat bench, holding a barbell on your chest with an overhand grip. (Your hands should be shoulder width apart)
  2. Get into starting position, raising the bar above your chest by extending your arms, but do NOT lock your elbows.
  3. Keeping your arms slightly bent, slower lower the weight in a smooth arc to a position behind your head by rotating your shoulders. (as if putting your hands in the air)
  4. Keep moving the barbell behind your head until you feel a slight stretch in your chest. Hold for a count of one.
  5. Return to the start position in a smooth revers arc.
  6. Continue holding the weight above your chest, then repeat.

Tricep Cable Rope Push /Pull Downs

  1. Set up a cable station with a straight bar on attached to the top pulley.
  2. Grip the bar with an overhand grip,with your hands slightly less than shoulder width apart.
  3. Position your feet shoulder width apart,with knees slightly bent for stability.
  4. Pull the bar down until your forearms are parallel to the floor with your elbows close to your body and your wrists locked in a straight position. This is your staring point.
  5. Moving only your forearms, push the bar down towards the floor until your arms are fully extended and you feel a stretch in your triceps. Hold for a count of one and squeeze your triceps.
  6. Return to the start position moving your forearms only. Hold for a count of one then repeat. [2]
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Four easy exercises to ease Achilles tendonitis

What is Achilles tendonitis?
Achilles tendonitis (also known as Achilles tendonitis, Achilles tendinitis, Achilles tendon pain, Achilles tendinosis, Achilles tendinopathy) is inflammation of the Achilles tendon. The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon is also called the calcaneal tendon. The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. [1]

Anatomy of the heel

How do you get Achilles tendonitis?

Achilles tendonitis is an overuse injury that can occur with over training or poor biomechanics due to anatomy or poor footwear.

Common causes of Achilles tendonitis include;

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface, such as grass to bitumen
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poor footwear
  • Hill running
  • Poor eccentric strength [2]
Excessive high heel wearing can lead to Achilles tendonitis

What are the signs and symptoms of Achilles tendonitis?
The main signs and symptoms of Achilles tendonitis are pain in the Achilles area, particularly on walking/running and swelling around the back of the heel and Achilles tendon. Other symptoms include tight calf muscles, poor range of motion in the calf and ankle and the feeling of heat or burning in the heel.

Who gets Achilles tendonitis?
Achilles tendonitis is a very common runner injury . It can however, also affect athletes, basketballers, dancers, or people who put a lot of repeated stress on their feet.

Those with an over-pronating gait due to high foot arches can often be inflicted with chronic Achilles tendonitis and have to manage the injury for life.

How is Achilles tendonitis treated?
Most cases of Achilles tendonitis can be treated at home before it gets too severe.

Use the RICER formula:

  • Rest: Don’t exercise for a few days, or try an exercise that doesn’t stress your feet, such as swimming.
  • Ice: Apply an ice pack wrapped in a towel or a cold compress to your tendon for 10 minutes or more after you exercise or if you feel pain in the tendon.
  • Compress: Use tape or an athletic wrap to keep swelling down and help support and immobilise the tendon.
  • Elevate: Lie down and raise your foot above the level of your heart, and if possible, try to sleep with your foot elevated. This will help keep the swelling to a minimum.
  • Refer: See a physical therapist, such as a podiatrist and a massage therapist for treatment
  • Take anti-inflammatory medications. Pain relievers like ibuprofen can help ease pain and reduce swelling in the short term.
  • Stretch and exercise your ankles and calf muscles while you recover. Keeping your muscles, tendons, and ligaments strong and flexible will aid in your recovery and help you keep from re-injuring your Achilles tendon. A physical therapist can help you come up with a good exercise program.
  • Prescription orthotics. Orthotics can be helpful if you have poor biomechanics. Talk to your GP or a podiatrist to find out if they might work for you.
  • Massage. Remedial massage can help manage the muscle tension in the hamstrings and calves and help reduce swelling around the Achilles tendon [3]

What stretches should I do for Achilles tendonitis?

Calf Stretch: Place your hands on a wall with one leg straight and the heel to the ground. Place the other leg, with the knee bent, in front of the straight leg and push your hips toward the wall. Stretch your calf to the point where you feel a strong pull but no pain. Do not let your heels come off the ground. Hold the position for 20-30 seconds, and then relax. Repeat 3 times on each foot in a slow controlled manner.

The same stretch can be repeated, with both front and back knees bent.

Straight Leg Calf Stretch

Seated Heel Raises: Sit on a chair and raise your toes up as high as you can without pain. Slowly lower your heels. Do 5 repetitions, 4 times a day. You can gradually increase the intensity, as you get stronger by holding a weight on your thighs.

Seated Calf Raise

Following are some other exercises you can do, but they should be done under the supervision of a physical therapist, at least initially, because they could damage the Achilles tendon if they’re not done correctly:

Bilateral Heel Drop:  Stand at the edge of a stair or a raised platform that is stable. Put the front part of each foot on the stair. This position allows your heel to move up and down without hitting the stair. Hold on to a railing or support to help your balance.

Slowly lift your heels off the ground and slowly lower your heels to the lowest point possible. Be sure to do this in a controlled manner 20 times. You can also do this starting on the floor rather than the stair.

Unilateral (Single Leg) Heel Drop: This is similar to the bilateral heel drop except it’s done on one leg while the other leg is bent. Raise your heel off the ground and slowly lower it down. Do it in a slow controlled manner. Then switch to the other leg. [4]

Unilateral Heel Drop

 

 

 

 

 

 

 

 

 

 

 

 

 

[1] https://www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1

[2] http://physioworks.com.au/injuries-conditions-1/achilles-tendonitis-tendinitis

[3] http://m.kidshealth.org/en/teens/achilles.html#kha_11

[4] https://www.webmd.com/fitness-exercise/stretch-achilles-tendon

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Magnesium: what is it & what does it do for you?

I regularly recommend my clients use magnesium, either in the form of a supplement, topical cream or oil, or as salts dissolved in a warm bath.

But what is magnesium, and what does it do for our body?

The Science

Magnesium

Magnesium is a chemical element. It is the fourth most common element on Earth, and the third most common dissolved in seawater. Magnesium is the eleventh most abundant element by mass in the human body and is essential to all cells and some 300 enzymes.

The important interaction between phosphate and magnesium ions makes magnesium essential to the basic nucleic acid chemistry of all cells of all known living organisms. More than 300 enzymes require magnesium ions for their catalytic action, including all enzymes using or synthesizing adenosine triphosphate (ATP).

Now I don’t want this to turn into a boring chemistry lecture, but ATP is a complex organic chemical that participates in many processes, including providing energy for nearly all of the body’s metabolic processes and muscular contraction. 20% of the body’s magnesium is for skeletal muscle function.[1]

Magnesium is also an imperative part in;

  • Nerve conduction
  • The production of energy from carbohydrates and fats
  • The production and maintenance of healthy bones, including the synthesis of bone matrix, bone mineral metabolism and the maintenance of bone density
  • Maintenance of healthy heart function and normal heart rhythm.[2]

Where can we source magnesium?

The Source

Nuts, Greens, Cocoa & Spices

Spices, nuts & seeds, cereals, cocoa (W00T!) and leafy green vegetables are rich sources of magnesium. [3]

Thankfully, if we are not getting enough magnesium in our diet, or are experiencing symptoms of magnesium deficiency alternative methods for magnesium intake is readily available.

Bath salts

Magnesium chloride

Magnesium chloride is extracted from seawater and is more readily absorbed through the skin than other forms of magnesium, so it’s perfect for bath salts. It is not for ingestion.

Magnesium sulfate

Magnesium sulfate is more commonly known as Epsom salts. A great source of magnesium and available in most supermarkets and chemists, Epsom salts have been popular since it was discovered in the British town it was named after, in the 17th century. [4]

Topical creams and oils

As both magnesium chloride and sulfate are absorbed through the skin, they make great topical applications and are available in creams and oils that can be rubbed directly on the sore or cramping muscle. Great for carrying in your sports or travel bag and cant get to a bath.

Topical spray, supplements, bath salts

Supplements

Magnesium itself cannot be absorbed and needs to be bonded to another molecule to be absorbed. The most common bonding agents are oxide, citrate, glycinate, sulphate or amino acid chelate.

This is the least absorbed form, but also has one of the highest percentages of elemental magnesium per dose so it still may be the  highest absorbed dose per mg. This is a great general purpose magnesium if really Mg is all you need.  It makes a simple muscle relaxer, nerve tonic and laxative if you take a high dose.

This is one of the most common forms of Mg on the commercial market. This is Mg bonded to citric acid, which increases the rate of absorption. Citrate is a larger molecule than the simple oxygen of oxide, so there is less magnesium by weight than in the oxide form. This is the most commonly used form in laxative preparations.

In this form, Mg is bonded to the amino acid glycine. Glycine itself is a relaxing neurotransmitter and so enhances magnesium’s natural relaxation properties. This could be the best form if you’re using it for mental calm and relaxation.

Magnesium amino acid chelate is usually bonded to a variety of amino acids. In this form there is less magnesium by weight but the individual amino acids could all be beneficial for different things. Every formula is different so if you need both Mg and a particular amino acid, then this could be the way to go. [5]

Recommended daily intake of magnesium is;

  • 400 mg/day for men aged 19-30 years, increasing to 420 mg/day for those aged 31 and above,
  • For women aged 19-30 years, the RDI is 310 mg/day, increasing to 320 mg over the age of 30,
  • Depending on their age, the RDI for adult women who are pregnant is 350-360 mg/day.
  • The RDI for breastfeeding for those who are breastfeeding is 310-320 mg of magnesium each day. [6]

What happens if I don’t have enough magnesium?

The Symptoms

If you’re not getting enough magnesium in your diet then you may be experiencing symptoms such as;

  • Muscular cramp

    Muscular problems such as cramps, twitches, slow to recover from injury, aches and pains,

  • Fibromyalgia is sometimes linked to magnesium deficiency,
  • Migraines and headaches, including tension headaches,
  • Period pain and symptoms of premenstrual syndrome, including mood swings , fluid retention, premenstrual migraines,
  • Stress, irritability, insomnia and anxiety,
  • Fatigue, which may be a symptom of magnesium deficiency.

It may also play a role in helping to maintain cardiovascular health and healthy bone density.

What could be causing my magnesium deficiency?

The Seed

  • Stress (especially when prolonged or severe),
  • Inadequate sleep,
  • Profuse perspiration,
  • Excessive consumption of caffeine, salt, sugar and alcohol,
  • Heavy menstrual periods,
  • Eating large quantities of processed and refined foods,
  • The use of some multiple pharmaceutical medications,
  • Gastrointestinal disorders such as short-term diarrhoea or vomiting and conditions that affect your absorption of nutrients,
  • Getting older. [7]

Can I have too much magnesium?

Doses less than 350 mg daily are safe for most adults. When taken in very large amounts, magnesium is possibly unsafe.

Symptoms of magnesium overdose include;

  • diarrhea
  • nausea and vomiting
  • lethargy
  • muscle weakness
  • irregular heartbeat
  • low blood pressure
  • urine retention
  • respiratory distress
  • cardiac arrest. [8]

 

The best way to ensure you’re getting enough magnesium is to maintain a healthy diet of whole foods and steer clear of processed and refined foods. If you are getting regular cramps or muscular pain it might be a good idea to get some advice from your physical therapist.

Maintaining muscular health can be as easy as regular gentle exercise and stretching, fresh air and water each day, a 20 minute magnesium bath a week, some leafy greens and nuts in your diet and regular massage.

If you think you have a serious magnesium deficiency you should consult your doctor.

 

Have you ever used magnesium? How did it work for you?

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Why Am I Sore After a Deep Tissue Massage?

Deep tissue massage is a style of massage that is usually practised with oil on skin, with a firmer pressure than relaxation massage. It’s aim is to reach the deeper layers of muscle and connective tissue than those underlying the skin.

How does it work?

iStock_000010728710XSmallOur muscles are made of tiny fibres call myofibrils. When our muscles are overused or misused the fibres can adhere together or tear. It’s not really known why this happens but we know that heat and compression helps to break down the adhesions, attracting blow-flow to the area and help heal the tears. This is where deep tissue massage can help.

Deep tissue massage promotes blood flow to the injured area and creates micro-tears in the muscle tissue, to speed up the healing process. Because of this, the area becomes bruised, and this is what causes the pain after the massage. Usually this is only felt when you touch the area that was treated, and normally wont be visible on the skin.

The pain you experience after a massage should only be likened to how you feel after a heavy exercise session, and not a worsening of the pain of your injury that was treated. If your injury feels worse then the massage may have been too firm, or that your condition cannot be remedied with massage.

Who can benefit from deep tissue massage?

Hip painAnyone suffering from chronic or acute muscle tension. This can be caused by overuse or misuse, a pre-existing condition or recent injury.

Deep tissue massage can break down old scar tissue left from injury or surgery. It can help alleviate tension built up from conditions like arthritis or inflammation in the joints. It can help manage pain from poor posture or repetitive motion like sitting at a desk all day, using tools or long hours exercising.

What to expect in a massage?

Your massage therapist will start with a kneading style of massage, generating some heat in the tissue to start to warm up the muscle and help you relax. They then might perform firm stripping motions in the direction of the muscle they are treating. A good massage therapist will normally (but not always) be able to feel the change in tissue tension and know where you are tight, where you have trigger points and taught bands.

shutterstock_412363579Unfortunately this can often be uncomfortable. Your massage therapist should always work within your pain threshold and ask you if the pressure is okay. They may even ask you to grade the pain out of ten. Don’t be afraid to speak up if the pressure is too much for you. In this case, pain is not gain. Too much pressure may be doing further damage to the muscle and cause your injury to flare up further.

The massage therapist will just their palms, knuckles, fist, forearm and even their elbow. The speed of the strokes will most likely be slow and even stop and hold at points with more tension until it eases.

Don’t forget to breathe

Be sure to breathe throughout the treatment, this may sound obvious, but you’d be surprised how many people hold their breathe to cope with the pain. If you need to hold your breath, then the pressure is too much. Deep breathing can help you tolerate more pressure and the oxygen will help the muscles release. Your massage therapist may even ask you to take a deep breath ‘into the muscle’ that they are treating.

What to do after a massage?

shutterstock_252553801Your massage therapist should give you after care advise. It is recommended you rest after your massage, drink plenty of water to replenish fluids that have been flushed out during the massage and apply heat to the area you had treated. This will help your muscles recover from the massage and recover from your injury. Another great way to ease muscle soreness after a massage is to have an Epsom salt bath.

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Muscle in Review: Psoas Major

Psoas major (pronounced ‘so-az’), is located in the deep abdominals. It originates at the at the lower vertebrae (T12-L5) and attaches to the front of the femur. Its main function is to flex the hip when the spine is in a fixed position, but it also aids in curving the lower spine.

Psoas is the often forgotten hip flexor that can cause pain in the front of the leg, abdominals, groin and lower back.

Iliopsoas
Psoas Major trigger points

Pain from trigger points in psoas can cause pain down into the groin and scrotal areas, mimic appendicitis or period pain, and cause a ‘band’ of pain across the lower back.

When treating psoas I generally use deep tissue and manual myofascial release. It is very difficult muscle to dry needle due to it’s deep location and proximity to other major organs. Some cupping to the insertion point on the upper femur can help but massage to the abdominals is often the best method.

Other techniques like pin and shift, where the therapist puts pressure on the muscle and has the client activate their hip can work, simple compression to the muscle, or counter strain technique where the muscle is passively held in position for up to 90 seconds is also effective if the client is relaxed enough.

Taking care of psoas can mean a lot of relief from groin and lower back pain.

What can cause tension in psoas? Long periods with the hip flexors active, such as long drives with the foot on the accelerator. Cycling can cause a lot of tension in the hip flexors, psoas in particular, as the back is often in the the foreshortened position.

Bridge Pose

Stretches to psoas can be effective if done correctly. A deep lunge position, dipping into the groin, and sometimes stretching the arm of the same side up and laterally over the head can help.

Warrior I
One-Legged King Pigeon Pose

Yoga poses effective for psoas and hip flexors include warrior poses, either kneeling or on toes, pigeon pose and bridge pose.

 

 

Be sure to counter balance any prolonged hip flexor foreshortening, like fixed seated positions with stretches in the opposite position.