Orthopedic Massage....What are we doing.

So this post is inspired by my frustration at some of the myths that perpetrate the massage industry through poor education, misinformation, poor training and subsequently are passed on to the general public. Orthopedic Massage is a science based practice based largely on evidence. While our understanding of what exactly is happening during treatment sometimes is incomplete, we try very much to keep within the boundaries of plausible science. As new information comes out we adapt and keep moving. Here are some of the tenets my practice as an orthopedic therapist is based on.

1.    While we use physical assessment during our intake, that assessment is primarily concerned with postures that avoid pain and general notation of physical differences. Our treatment is not based on fixing, changing or improving posture.  Structure does not always follow function. People can have poor posture and no pain or poor posture and pain. Unless a posture has been adopted to avoid pain and gives information about the causality, then it has little bearing on treatment. It is merely something to note. On the same token, imaging also has little information to lend to this people without pain are riddled with so called dysfunction. This does not mean we ignore it, but it is not absolute. 

2.       Homeostasis happens whether you are there or not. Most conditions are self resolving, we cannot change the body, what we can do is set the ideal conditions for change, and interact with the nervous system in such a way that we try to communicate that the crisis is over. 

3.      Pain is neurogenic and an output of the brain.  Pain is one of the body's few ways of communications with you, but that communication does not always mean damage. Some of the few areas of research that have been confirmed tell us that touch does help with pain mediation. We touch with the understanding we are not 'fixing' but more likely influencing processing.

4.      Nothing in the body goes to waste, there are no toxins or buildups of lactic acid that need to be dealt with through manual therapy. Lactic acid is an important chemical necessary for long term metabolism, and even your earwax is an mild insecticide.

5.      Other than scar tissue, which is slightly less functional than regular tissue and produced by inflammation, there are no adhesions in the traditional sense that need to be broken down.  It does not make sense that our body would just ‘gum up’. The natural movement of the body resolves most issues. Areas that are shortened should be approached from a neural perspective. 

6.      The body heals itself through it’s natural movements and function. The heart alone is not responsible for pumping all of the blood through the body, muscle pumping also aids, which is why movement is so strongly tied to our health.

7.     The likely hood of benefit, is always greater if the body is in control rather than a passive operation.

8.   Techniques where you  ‘re-damage’ tissues in order to promote healing such as frictions are outdated. 

9.  Stretching is not actually lengthening muscles, but conditioning them to the feeling of length. In muscle tonicity there is relaxed and contracted. (please see pain in neurogenic)

10.   Ice is an analgesic…it is not for swelling. RICE is made for emergency care to help manage pain and fluid soon after injury. There has been some confusion about this lately, as new information has come out the effect of ice on capillary beds. However, if you just got hit in the head with a hockey puck, please follow your protocol of RICE until an emergency worker arrives, nothing about emergency protocol has changed. Inflammation in general is not bad for you, it is part of the natural process of healing. Ice is also contractile so if you are applying ice to something that hurts, think about why your applying it, because it is also contracting the muscles in the area. 

 And this I am throwing in on principle...you do not need water after a massage, but it is nice! 

Marketing based on poor scientific conclusion about manual therapy, that makes the patient think there is something wrong with them that may only be fixed though intervention, is far more damaging that the problems they seek help for. Absolutely patients need a care continuum in their health care that involves manual therapy, but if we are not treating posture, imbalance, adhesions or muscle length, it might be hard to understand what we are doing. And while the question remains open on a biological level as to what is happening step by step, I view my job as an orthopedic therapist as that of a facilitator. I move people in a relaxed state, through the use of skin/muscle stimulation and passive, active and resisted ranges of motions while giving a safe place to explore and educate about mild to medium level pain. For many people this increases their range of motion and decreases their pain on the table, as well as off, which allows them to get back to moving in ways that are normal for them. 

Because Orthopedics is mostly concerned with increased ROM, we are looking at measurable results, that bring us away from more CAM practices. 


Find out more about Orthopedic Massage in NYC

-- 

Running Hot and Cold before your Marathon. The power of a contrast bath.

I get asked a lot by athletes 'What can I do to recover faster' or 'What can I do before a race if I am sore'. I almost always bring up contrasts baths. And that almost always that leads them to say 'What is that?'

If I think back to the time of where I first knew of contrast baths, it really brings up images of 80's sports movies where athletes are dunked in big steel tubs of ice, or institutional baths. They are ugly steel contraptions set awkwardly in corners of locker rooms. In today's utterly perfect, slick, performance world I can't remember seeing them anywhere. Instead, we eat a vitamin-filled gummy, or wear cool colored tape for our recoveries; however, the contrast bath should not be over looked. It is a huge tool in recovery, and if you are running with an injury you should not be running with, it might be a game changer.

A contrast bath is a simple rehab tool anyone can use that helps decrease inflammation, decrease pain, decrease swelling, and potentially increase mobility. The bather, moves from a tub of warm water, to a tub of cold water and back for a cycle of 30 minutes. The back and fourth temperature changes from warm to cold, cause your circulatory system to repeatedly vaso-constrict and vaso-dilate. That "squeeze - release" action moves the fluid through your body at an expedited rate....as IF you were exercising but without the actual risk of exercising. 

We all know our blood moves through our body by the hearts pumping mechanism, but it does not move the blood by its power alone. Your muscle movement provides a very strong secondary pump that facilitates fluid movement throughout your body. For example, some of you might have noticed that your legs swell up a bit from lack of  movement when you are on an airplane. 

Plunging your whole body from hot to cold, or part of your body, can mimic the normal muscle movement, and be a very effective way of moving things along, especially if you are too close to race time to risk a massage, or cannot access treatment. In most cities there are bathhouses that have alternating cold hot dips that athletes can utilize for full-body plunges. You can also put one together at home with the use of buckets and thermometers. The bucket version is best for ankles and arms, or you can do a hot/cold compress for harder to reach areas. 

Before we get to the nitty-gritty of the recipe, I should like to add that it‘s very important to check with your doctor if you have any questions about if this is right for you. Anyone with circulatory problems, Reynaud’s, decreased feelings in their limbs or compromised skin should not be doing a contrast bath because it puts you at risk.

Here is the recipe for your contrast bath (if you are at home you will need a thermometer)

30 minute cycle repeating hot/cold and always ending on the hot

3-4 min hot water (100F)

1 min cold water (60F)

Have fun running hot and cold! For more information http://www.bodymechanicsnyc.com/
by Beret Kirkeby

Running a marathon can be a pain in the Butt. What a strain.

So many of us in the athletic world are preparing for marathons 

right now or at least gearing up our runs. It is a good time to remember that many running problems can be insidious.  I hear from runners all the time that they NEVER had a knee, glute or hamstring problem before, and that this problem just showed up. It's really important from a rehab point of view and a running point of view to understand that injury is often cumulative. When you are doing something like running a marathon, where you are constantly stressing the SAME muscles over and over, that much like your training, small increments can lead to larger ones.  Take for instance a hamstring irritation.  Every day you run, and you are in your arc before your taper. Things are great! But you are running after work and you're pretty tired. Now you never had pain exactly--however, every day you did a longer run, you noticed your hamstrings were super tight and even tighter in the morning.  Like a good runner who is invested in their home care, you made sure to stretch them out.

Now--I would never tell someone not to stretch at all.  However, if the hamstring tightening is the result of micro-tearing from overuse, muscle imbalance,and fatigue, it is a signal that your hamstring is saying “hey, back off! I am trying to grow new hamstring here!!’. So when you stretch that site, you are pulling the fibers away. What happens is the micro trama from friction and repeated overloading causes inflammation at the site of the ishial tuberosity (usually just under the butt).  That inflammation is a direct chemical signal to your body to build new tissue in order to support the damaged ones.  So now each time you run, it gets tighter and tighter…Ouch! What a pain in the butt! Now its hard to run at all and you are nervous about a long run.

So what went wrong? Well, maybe nothing.  Or, maybe a little of everything.  Don’t take the injury personally. You can't predict the future and there are many races coming down the line. So much can go into a hamstring strain--fatigue, overuse, muscle imbalances, the wrong shoes….the list goes on. It could be you did not warm up properly. It could be that you tripped and pulled it without realizing. It could be that the evening runs were not ideal for your healing because your circulation slowed down at night. Or it could be that there was no reason whatsoever other than that your body reached a point where it could not recover. The problem is, there is a tipping point for all people and many small ignored problems can add up to a larger one.  You can help yourself by following a few guidelines.

Recovery is a pre-game event.  Stretching and foam rolling really help, but it's best to use them preventively before you are scrambling. You should also really understand RICE protocol. That’s Rest (which runners hate) Ice, Compress, and Elevate….and they all have to be done together.  You can’t just stick an ice cube in your sock and hope for the best.

So now what? Your hurt, but you want to run. My first suggestion is to see a physical therapist and find out what they say. Strains are categorized by severity and you really need to see if you're doing permanent damage to yourself. If they give you the all-clear, there are some things you can do for yourself after you run it past them.

 Injury treatments that are not acute often include contrast baths. You submerge the offending limb in warm water and then cold, and then repeat. The ongoing cycle causes vasodilatation and contraction, which aids in recovery and flushes out the area.  This technique can also be used for general recovery. This is old school, serious recovery.

No one advises running on an injury, but if you do, you might use a compression sleeve to limit the inflammation.  Runners often use this sort of device for injuries that are older and come back with a vengeance.  You can also use KT tape or Rock Tape to help support and  increase circulation to the area. These two treatments are slightly different in approach, as KT tape lifts the skin a bit to increase lymph and blood flow to the area, while compression does the exact opposite.  So how do you choose? With compression, you are saying, “I know this is going to swell up, I am going to minimize this."  When you choose tape, you are saying,  "This might swell a little but not too much and I am am taping preventatively". The tape can also be used in places no compression garment can go.

Above all, listen to your body and bear in mind that the number one thing you can do for yourself is rest. No runner likes to hear it. Even if you make it through your big race on your injury, afterwards you will still have to take that break (and by then you will really deserve it).  Boy, what a pain in the butt. For more information on recovery please see For more information see our sports massage program in NYC

or http://www.bodymechanicsnyc.com/#!athletes-corner-strains/c1541

What is Orthopedic Massage?

What is orthopedic Massage exactly? Well, to be honest, that is a hard question. I have heard it described multiple ways, such as it is a combination of medical and sports massage, or a way of treating soft tissue injury which is its own style. 

Truthfully, the answer is an issue I also struggle with because my training is different from anyone trained in NY who is doing ortho work, and at first I did not realize that my training was any different because, in Ontario, where I went to school, everyone works the same way. I  was aware that I had gone to school nearly twice as long as the  New York program , but I never thought that what I  was being taught was entirely different that what was being taught here.

Lake Ontario- Toronto, Ontario

I suppose I should go back a bit and explain that in Ontario massage is covered by the National Health System.  Canadian massage therapists operate in a very different capacity than in New York. Massage is not seen as a luxury but as affordable basic health care for physical problems that do not require a prescription.  Canadian therapists might work in conjunction with a doctor or physical therapist, or entirely alone. The entire attitude towards the profession is different.

Here is what I learned about the difference:  In the first year of school in Canada we learn the basic concepts of Swedish massage, which is essentially the same as the training here in New York. It is the second year in Canada--where we only treat dysfunction,  go through an internships plus the continuing education-- is where things take a turn. The second year of massage in Canada is solely ortho. The therapists learn every single thing that could possibly go wrong physically (within reason, ie we are not studying super-rare subsets of infections and disease)  in each part of the body, including those things that we are NOT able or licensed to treat, and you are drilled on it...over and over. We are run through literally thousands of scenarios, good, bad and ugly, and graded on them. The drills are run like real live client interactions where we assess, interview, decide to treat or refer out to higher care, and then provide home care.  When the school thinks we have done enough ground work we are sent to practice on real assessments for real conditions. It is essentially our residency.  I was sent to a Parkinson's clinic, and an AIDs hospice for 3 month stints. By that time, organizing a treatment for someone with a physical problem is not really a challenge, however, reading about someone who is dealing with the possibility of death or disease is entirely different than caring for someone who is dealing with it. This part of the program gives us essential real life clinical experience, and it‘s pretty tough. Incidentally, they also make us intern in an office as a lesson in how not to ruin a business. 

From what I have understood from therapists here, they touch on ortho. The class might visit a Parkinson clinic here, and they might learn the techniques from a book just as we did, but they don't have the time to work in those environments.  In essence, the program here is a tasting platter and the Canadian is a full 6 course dinner. There is nothing wrong with the program here, it is just different. It is designed to give a great relaxation massage and show the therapists IF they wanted to learn more that there is more out there. Many, of course, have learned more, and are working in hospitals, teaching throughout NY and generally doing great work. Many therapists never move beyond working in a spa however. But why the difference? Why educate all therapists to work in a way only a handful do in NYC?

Massage Therapy in Canada is covered by the NHS, and since the insurance  is paying, they are invested in the product. The massage therapy program in Ontario fills the gap between physical therapy and your doctor. We handle the manual therapy components that often pt's are uninterested in, pain management, and the physical components of stress-related problems,  while keeping the doctors’ offices clear of minor bumps, sprains and strains. My days were filled with never ending streams of very normal problems ranging from headaches, surgery recovery, car accidents, over training, back pain and fibromyalgia. The end result is less people in the doctor’s office, less prescriptions for pain relief, and more problems caught before they become serious. 

You might pose the question of litigation. Here in NY we worry about litigation a lot. Therapists here are trained to explain that their care is not a substitute for medical care, which is really confusing as we are listed as medical professionals. You might think that, because we more frequently work with injured in Canada that the risk would be higher, however it is the opposite. Canadian therapists are far more likely to stay out of trouble by being able to accurately identify problems before they start. We have the extra training to understand when a problem is too big for us, and our training prepares us to work in emotionally difficult scenarios. 

So what is Orthopedic Massage? For me it’s being a trained professional, knowing what I can provide, and understanding my limits so I can make available the best care possible to the people seeking me out. Good care comes from understanding and pulling in the right resources, not from being the only stop in health care. Orthopedic treatment means I can pull from lots of sources and work in conjunction with trainers, and other health care providers to get the best.

For more information on Orthopedic massage in NYC please visit our website a

The key to less injuries is prevention. Information for athletes and Sports Masssage

 We all know the primary work of the circulatory system is to push your blood around your body.   But the other job of the circulatory system is to deliver essential nutrients to your body tissues and to work in conjunction with your lymph system to remove waste products.  So how does that all work?  Your blood is pumped by your heart;  it moves through your body, and when your heart rate goes up due to stress, activity, or receiving a massage, it moves at an even faster rate, with more pressure.  Your lymph system, on the other hand, is completely independent of your heart and works on muscle pumping  to move fluid and broken cells through the tiny collection vessels in your body.  When you move your body more, and your body is warmer, the rate of movement and collection goes up.  But that is in a perfect world.  What happens when you are trying to push blood through the blood vessels and lymph through the collection vessels when you have been in heavy training?  When you are tight and sore?  Essentially you have a bottle neck--there are too many cars on the highway, and not enough space to get through.  No matter how hard you push, which nutrients you eat,  how hard you train, or  how much you move--unless there is enough space within the tissue to get that stuff there, you will  be more prone to injury and fatigue. To compound matters, when you are injured, it is going to take longer to heal.

Tissue often changes by means of inflammation.  In some cases this is not a problem, but too much inflammation is bad.  Inflammation is a generalized first response to injury, and signals the body to lay down non-functional layers of tissue in order to support the body structure. Your body’s response to any kind of unknown stress is to stabilize. It is very important to understand that  your body sees training as a form of stress and your body’s response to that stress is to lay down thicker tracts of tissue through  an inflammatory process.  Those tracts are less functional than the original ones and will thicken along the fascia trains already in existence, reducing fluid flow, which robs your body of the things it needs to make you a top performer.  Thicker trains means more compression, more inflammation, and  less movement of fluid, and that means more injury, slower healing and less performance. 

By icing any areas  where unusual heat or soreness are present (thus limiting the amount of inflammation you endure while exercising), you can help your body defend against excessive inflammatory processes.  Some people are also more prone to inflammation than others and might also benefit from a low inflammation diet, which is a way of eating that limits or reduces your reaction to inflammation.  Compression socks, and KT/or Rock tape can also be helpful by limiting swelling and/or encouraging lymph flow in order to minimize damage in an event.  Any area that is prone to shock, friction, load bearing or overuse is at risk. Take steps to give yourself the best chance to heal by learning to stretch and realign these areas appropriately prior to exercising. The best medicine is prevention. It is far easier and far cheaper to limit inflammation than to require extensive treatment to correct a problem in full flair…and perhaps even risk missing the big event entirely.

For More information  on Sports Massage and how you can prevent your own injury's you can visit me at www.bodymechnaicsnyc.com or book a treatment. If you are interested in learning more on the topic of how your body works, how to prevent injury, increase your recovery times and get relief for FREE,  I am speaking at Jack Rabbit sports this month at Self-Massage Clinic here is the info:

Jack rabbit sports 14th st. Sept. 18, 2013 -7pm  Curious how to expedite recovery, increase performance, and decrease risk of injury? Body Mechanics NYC joins us to host a self-massage clinic at Jack Rabbit Sports 42 west 14th st. (between 5th and 6th). You'll learn which recovery tools work best for certain aggravations and how to use each properly. And by addressing discomfort immediately and effectively, you'll increase your chances of crossing the finish line injury-free.
 for more info on sports massage in NYC please check out our website