Starting July 15 we will be raising our massage therapy prices.
30 min- $65.00
45 min- $90.00
60 min- $110.00
75 min- $130.00
90 min- $155.00
120 min- $230.00
Jeff Gabert is a graduate of the inaugural massage therapy program at Langara College. Throughout the program he was fortunate to work with diverse populations and benefited from the knowledge shared by fantastic teachers and fellow RMT’s. Jeff has a special interest in treating chronic pain and fatigue, particularly those dealing with arthritis. He regularly leads talks and workshops for the Arthritis Society dealing with coping skills and tips for pain management. Another area of interest for Jeff is sports massage and injury rehabilitation. He will be spending a week this summer traveling and working on the competitors of the BC Bike race, keeping them in riding shape. Jeff seeks to aid the body in its natural healing process and help clients implement a homecare program that will facilitate their recovery. By employing a variety of massage techniques including: Swedish, deep tissue, myofascial release, joint mobilizations and muscle energy; Jeff creates a unique and client centred massage treatment.
Outside of massage, Jeff enjoys cycling the seawall, weight training, playing music and a weekly trivia night. “I look forward to meeting you and working together.”
By David Kent, LMT, NCTMB
When clients schedule a treatment session, they expect results and regardless of which massage modality or technique you’ve mastered, you want to deliver.
Back pain is a common complaint among massage clients, and symptoms such as pain across the mid-back or low-back pain over the sacrum below the iliac crest in the gluteal region could be the result of myofascial trigger points in the rectus abdominis. (Figure 1) According to Simons and Travell, “An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level.”1 The authors also state that “In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.”1 (Figure 1).
Although many trigger points have been identified in the rectus abdominis muscle, this article will cover two primary trigger-point patterns that cause back pain in these regions, as well as tips about how to treat them and how to educate your clients about the nature of their pain.
Trigger points can form in the rectus abdominis muscle due to visceral disease, direct trauma, emotional stress, poor posture and over-exercise, to name a few. Examples of trauma include surgery in the area or injury to the muscle during a motor vehicle accident. These muscles can also become overstressed by everyday activities, including certain exercises or rigorous housework.
Before treating the rectus abdominis, however, it is important to rule out other muscular possibilities. Referred pain from myofascial trigger points into the lower thoracic region can also be produced by muscles in the back, such as the latissimus dorsi, serratus posterior inferior, illiostalis thoracis, multifidi, intercoastals and insterspinales.
Lower lumbar, sacral and gluteal pain often includes trigger points from the quadratus lumborum, gluteul muscles, piriformis and the hamstrings. In addition to the rectus abdominis, the iliopsoas is another muscle that refers pain into both of these regions.
Encourage clients to reveal important clues about their pain by having them complete a thorough health history and intake form. This useful tool also enables you to ask intelligent questions relevant to the possible causes of the client’s pain.
In addition to the health history and intake forms, have your clients complete a visual-pain chart to specify and document the regions of their discomfort; this tool will help you easily spot the trigger-point patterns and treat them accordingly. (Figure 2)
And before getting started, remember to communicate with the client to rule out potential contraindications, such as recent surgery, abdominal aortic aneurysms, or pregnancy, for example. This information should also be documented on the intake form.
Using analogies can help your client understand the cause and effect of trigger points and their pain. For example, some trigger points are similar to a gun and bullet. When pressure is applied to the “trigger” of a gun, it shoots a bullet, which produces an effect at the point of impact. Likewise, when a therapist applies pressure to a “trigger point” in myofascial tissue, it produces referred phenomena (shoots a bullet) to another area of the body; that effect is usually described as pain, numbness, tingling, weakness or other like complaints.
Therapists and clients must communicate with each other to determine the presence of trigger points. Instruct your client to let you know if you reproduce the pain when you palpate a myofascial trigger point. Only the client can tell you if the region being palpated is tender and referring pain elsewhere. Once you have identified the culprit, you can treat the appropriate muscle.
Place the client in the supine position with support under the knees and the arms at the side to avoid tightening the skin over the abdomen. (Note: These same techniques can also be used with the client in a side-lying position).
Determine the borders of the rectus abdominis by asking the client to tense the muscle; he can do this by moving into a semi sit-up position as you palpate the region. Make sure that the client relaxes the muscle before you start treatment. Check for muscle sensitivity by palpating with your fingers using static compression.
Release the attachments around the xyphoid process (Figure 3) and costal margin (Figure 4) with your fingers or thumbs. The pubic attachments can be easily located by asking the client to place their thumb over their belly button and extend their middle finger down until they palpate the pubic symphysis. Use static pressure initially. If the area is not too sensitive, add a combination of friction movements in the direction of the muscle fiber (superior and inferior) and across the muscle fiber (medial and lateral). It will be more comfortable for the client if the intention of your pressure is more dominant in one direction.
Lubricate the muscle belly; then stabilize the skin with the non-treating hand. With the other hand, treat with the muscle fiber using a scooping movement with the fingers (Figure 5), followed by cross fiber (Figure 6).
Make sure to check in with the client frequently about the level of pressure. The body is reflexive, and it responds automatically to stimulation. For example, when you touch a hot surface with your hand, you automatically, or “reflexively,” pull away to avoid burning the skin.
This concept is also true in massage therapy. If the client is reflexively protecting him or herself by pulling away, tightening the muscle, holding his breath, squinting his eyes or clinching his teeth, then you are applying too much pressure. Additionally, if the tenderness in the area and/or the intensity of the referred pain does not ease up within 8 to 12 seconds of holding static pressure on the trigger point, again too much palpation pressure is being applied, leave the area and return later; and then use considerably less pressure.
Emotions and Sensitivity: The abdominal region can be a sensitive area for clients. Use good judgment and educate your clients to ensure that they are comfortable with having the abdomen treated.
Positioning and Draping: The client must be positioned comfortably on the treatment table in order for the muscle to fully relax. Additionally, your client’s privacy must always be protected and respected. There are a host of factors that determine the draping technique that you use. If the client is not comfortable with his/her abdomen exposed during treatment, you can still effectively treat the area through the draping itself.
Ice or Heat: If the injury or trauma is acute and/or swelling is present, avoid the injured area, and use ice when appropriate. Otherwise, a moist heat pack can be placed over the muscle prior to therapy.
Topicals: Topicals can help relieve the client’s pain between treatment sessions. You can earn additional income without being in the treatment room. One topical company offers free samples and will even print your contact information on the accompanying promotional materials.
Staying informed by reading articles, textbooks, watching DVDs and taking hands-on seminars to keep your knowledge and skills sharp while helping you perform at your best in the treatment room to meet your personal goals and your clients’ expectations. A percentage of the back pain you treat will be from myofascial trigger points in the rectus abdominis. Watch for the clues and patterns, educate your clients, and use all of the tools at your disposal. Wishing you much success.
Massage is a proven method for stress/tension relief but recent research suggests that massage can enhance the immune function in preterm infants, decrease blood pressure and improve stability in older persons. People of all ages are beginning to understand the many benefits of massage therapy, including the role it can play in overall health and well-being.
Below are summaries of recent medical research about massage compiled by the American Massage Therapy Association, which suggest that massage therapy can be an effective tool for a variety of health and medical conditions.
Research published in Pediatrics, the official journal of the American Academy of Pediatrics (AAP), showed that for stable, preterm infants, daily massage therapy is positively associated with higher natural killer (NK) cell cytotoxicity and weight gain. American Massage Therapy Association President, Cynthia Ribeiro, says of the study, “This research demonstrates that massage therapy can benefit preterm infants by enhancing immunity and stimulating growth. Parents of preterm infants are encouraged to speak with a certified massage therapist to learn more about certain techniques designed to aid in their child’s development.”
Ang J, Lua J, Mathur A, et al. A Randomized Placebo-Controlled Trial of Massage Therapy on the Immune System of Preterm Infants. Pediatrics. 2012; 130(6):e1549-58.
Research published in the International Journal of Therapeutic Massage and Bodywork (IJTMB) found that older adults who receive massage therapy for up to six weeks could benefit from decreased blood pressure and improved stability. “This study suggests that regular massage therapy can produce several advantages for the older generation, including a relaxation effect for the entire body, lowering blood pressure, decreasing stress and improving balance, amongst other things,” says American Massage Therapy Association President, Cynthia Ribeiro.
Sefton JM, Yarar C, Berry JW, et al. Six weeks of massage therapy produces changes in balance, neurological and cardiovascular measures in older persons. International Journal of Therapeutic Massage & Bodywork.2012; 5(3):28-40.
Research published in BMJ Supportive and Palliative Care indicates that massage therapy can have a positive influence on the quality of life of people suffering serious illnesses such as brain cancer. The American Massage Therapy Association acknowledges these study results, which suggest that massage therapy can improve physical as well as emotional well-being in patients with late stage disease and when used in combination with standard care, massage can help reduce stress, anxiety, pain and fatigue.
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678 Leg In Boot Square
Vancouver, BC V5Z 4B4 Canada