The children are our future…So how about we pay attention now!

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I received a call the other day from a fellow Massage Therapist. He was
referring one of his clients, a 15 year old male athlete ( lacrosse
goalie and football linebacker) with severe pain in his right knee. The boy’s coach told his mother he needed an MRI and that he most likely tore
something. My friend did not agree and wanted to see what I
thought and if Integrated Therapeutic Stretching would help. He had tryouts in two days and they were concerned about injury.

According to the client he only felt the pain when he was crouching in goalie position. I had him do it for me. He had all of his wait on the outside of his feet which were not wide enough apart to support his weight properly.

I ran him through some quick range of motion & muscle tests as he lay on the table with no resulting pain but revealed very limited ROM throughout the boy’s lower body. As we started to stretch it was quickly discovered that his left glutes were locked up. Hip rotators on both sides were in as bad a shape. IT Band and hamstrings were at 60% ROM and his quadriceps were down to 45%. This is 15 years old folks!

It is terrifying to see the physical shape of children today. Either they are overweight and under exercised or they are over worked, participating in multiple sports where proper strength and flexibility training is nonexistent.

Sports injuries are on the rise in children and teenagers. Each year more than 3.5 million sports-related injuries requiring medical treatment occur in children under age 15. Today, as more and more children and adolescents participate in the same sport year-round, many young athletes are developing overuse injuries. In fact, overuse is responsible for about half of the sports injuries that happen to middle and high school aged students.

We worked together through each stretch, showing him how his body is supposed to move utilizing body proper form and mechanics. He was very eager to learn as was his mother. I assisted and guided him through the stretches focusing especially the ones which really opened his restrictions. Both he and his mother were surprised at how tight he was in the beginning and at speed with which he loosened up.

Now as we were working I observed a deep scar about 1inch in length on his left knee which he claimed was “no big deal” and said it was over a year old. His mother chimed in “the bad one was on his foot”. Three years prior he flayed his right foot open on a fence. There was a huge c shaped scar on the sole of his foot which upon palpation showed to have spread and attached into the arch.

I asked if he wanted to see something cool and then I proceeded to release the scar on his knee. When I asked him to bend his knee his eyes opened wide and said “That’s Sick!”. His knee flexion had increased by 20% . Next with his mother’s permission I went to work on his foot. When I was done I had him stand up. He laughed out loud and said “No Way! Thats Totally Sick! I can feel the bottom of my foot”. His mother , shocked at his reaction said ” I didn’t know you couldn’t feel your foot?!” “Neither did I” was his reply.

We followed this up with gait re-education and proper mechanics required for his respective sports positions (i.e. crouching and squatting). While he still had some minor pain he could see how adjusting his stance took the pressure off his knee. After having him go through the stretches once more I recommend to the mother that if the pain comes back or increases then she should indeed seek their doctor’s advice.

The mother was shocked at how much the scars were affecting her son. I explained to her that scars and adhesions are generally overlooked by health professionals because the extent of physiological affects they can have on the body have never really been acknowledged. The slightest restriction from falling off his bike at 4 could alter how he grows and have major repercussions from one end of his body to the other.

Four days later the duo returned, the tryouts went great and when asked about his knee he said “it still hurts every now and then but whenever I felt it start I shifted around until I felt right and the pain stopped.” I asked if had been stretching and he say before and after the games. (In the four days since I had seen him he had two lacrosse matches and two days of football tryouts). He was also very excited for more scar therapy “It was so weird but I could feel my foot moving better as I played!” His mother than asked if I had any extra time to look at her two scars that have been driving her crazy for years.

During the course of my career I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had. While not every scar presents a problem, very often they do. Doctors, along with basically everyone else, tend to ignore scar tissue from surgery and accidents especially in children.

Today children are playing more and more sports driven by the need of scholarships and future fame. It is time we start to pay attention to the adverse affects of training and playing so hard so young. We need to make sure that the fall off the bike or the cut from climbing over the fence does not lead to issues later on.

Do’s & Don’ts of Healing Scar Tissue-Tip #1

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Essential Oils or Vitamin E for Healing Scar Tissue

Whether it’s acne pockmarks, or the legacy of a burn, wound, or surgery, few of us like scars on our skin. And there’s no shortage of remedies that claim to make scars smaller, thinner, less noticeable and heal faster. From natural at-home remedies to mass-produced and mass-marketed products, we are flooded with options that claim to help with scars. In this series of blogs, I will shed some light on natural and medical scar treatments.

What Should You Do to Heal Scar Tissue?

Do:

download (5)Use Lavender essential oil to treat scars especially burns. Lavender is one of the best all-round essential oil, according to Shirley Price in her book “Aromatherapy for Women.” Lavender oil is gentle, inexpensive, and effective. Lavender essential oil can be used to treat acne, scars, and most skin conditions; it can be applied directly to the skin, in small quantities.

Lavender essential oil is a very effective antiseptic, antibacterial, and antimicrobial that reduces pain, itching and promotes rapid healing. In addition, lavender reduces scarring. When lavender oil is applied to a burn from the onset, the burn may heal with no scarring at all. (For larger burns, put lavender oil onto a gauze or cloth and apply to the burn every few hours.)

How to use it?
• Apply several drops (2-4) on location several times a day
• Directly inhale, diffuse, or
• May be used as a dietary supplement

Safety Considerations With Lavender Essential Oil

Lavender essential oil can sting a little when a wound is still fresh, but once it’s scabbed over and has started healing, lavender essential oil, applied topically, can help minimize scarring while it heals.

Lavender has a relaxation property, often used to fragrance products for bedtime, like lotions and satchels for bedrooms. WebMD warns that lavender essential oil can depress the central nervous system and cause drowsiness and sleepiness (especially good when used properly to treat insomnia and induce relaxation but dangerous when used for other properties and healing in which sleepiness is not the desired effect). You shouldn’t drive or do other dangerous things until you know how lavender will work for you.

rene-maurice-gattefosse
History fact: A French scientist, René Gattefossé, was severely burned in a laboratory accident and immersed his hand in a vat of Lavender for two weeks. Gattefossé found that Lavender oil promoted tissue regeneration quickly and healed the wound with no scarring!

Don’t:

One of the most popular treatments for scarring is vitamin E.
But will vitamin E really help to improve your scar?

can_vitamin_e_h_photoVitamin E, or tocopherol, is a fat-soluble antioxidant. It’s found in capsule or liquid form at drugstores, grocery stores, health food stores, and online. The so called effective remedy consists of opening vitamin E capsules and applying the content on the scar. But this topical use of vitamin E does not result in scar healing.

Vitamin E has been shown to penetrate layers of the skin and reduce the formation of free radicals which can interfere with healing. Vitamin E also influences the production of collagen, a structural protein partially responsible for the strength and elasticity of the skin. Although many people apply vitamin E oil to their skin to minimize scars and it’s sometimes recommended by physicians after skin surgery, there’s very little evidence that shows it helps.

Vitamin E Research :
Current research does not support vitamin E oil to reduce scar formation.

A study on the effects of topical vitamin E on the cosmetic appearance of scars at the University of Miami that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed contact dermatitis to the vitamin E. Therefore it was concluded that the use of topical vitamin E on surgical wounds should be discouraged.

Research by K.C. Wan and J.H. Evans at the Hong Kong Polytechnic University, published in 1999 issue of “Free Radical Biology & Medicine,” found higher amounts of free radicals in hypertrophic scars, which become thicker, redder, and more elevated than regular scars. Another study by T.L. Khoo at the Hospital Universiti Sains Malaysia, published in a 2010 issue of the “Journal of Plastic, Reconstructive & Aesthetic Surgery,” concluded that tocotrienols, a vitamin E subfamily, made no significant improvement in scar parameters. Also, a study conducted by Morganroth, Wilmot, and Miller in Philadelphia for a 2009 issue of the “Journal of the American Academy of Dermatology” determined that scar products containing vitamin E oil did not support usage for the reduction of postoperative scar formation.

Be on the lookout:

For specific ingredients found in commercial wound ointments and dressings.

Listed below are just a few ingredients present in store-bought wound products. Most of these products produce skin irritation, sensitization, and are linked to allergies, cancer, and/or immune suppression.

Here they are:
• Petrolatum
• Mineral Oil
• Propylene Glycol
• Butylated Hydroxytoluene (BHT)images (19)
• Benzalkonium Chloride
• Yellow #5; FD&C Blue #1
• DMDM Hydantoin

Even many of the natural ointments contain some of these ingredients. Make sure to read the labels and please, test the area for allergic reactions before applying anything to your skin!

Hope this helps with your scar healing.

Check out the second post of the series: Do’s and Don’t’s of Healing Scar Tissue – Tip #2

》A B O U T   M A R J O R I E   B R O O K

marjorie brook lmt author headshotMarjorie Brook, LMT is a massage therapist, author and international educator. For over 21 years, she has specialized in scar tissue release and massage therapy. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method™) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

Law of Averages

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images (17)Who’s goal is it to be average? Average looking, of average intelligence and so forth. When it comes to social acceptance and self image the last thing anyone wants is to be considered average. Except of course when it comes to our health. Being average is actually the goal. Health is often determined or judged according to averages.

Take blood pressure for example, the average range for blood pressure is 120/80 to 110/70. Mine happens to be 90/60, I work out and am in relatively in good shape. During an annual check-up, the nurse taking my blood pressure was alarmed and said that my pressure was low. I had to explain to the nurse that if she would take the time to read my chart she would see that 90/60 is in fact normal pressure for ME. download

What would have happened if I did not know what my personal norm for blood pressure was? I may have been prescribed medication to raise my pressure, which I would most likely have taken without question, because we always listen to the Doctor in the nice white coat, right?

Our health care uses averages as it’s guidelines. Now, do not get me wrong, we need guidelines but that is all they are a guide – not the ultimate answer

images (16)I have a client, 49 year old female, who is very flexible – almost hyper-mobile. During rehab for a knee replacement the PT tested her range of motion (ROM) and noted that she had 90 degrees of hip flexion and told her “wow you have healed really well” and was satisfied with her recovery. For the average person 90 degrees of ROM is considered, sadly, as acceptable and in some cases the goal. Unfortunately for my client, her normal hip flexion ROM prior to surgery was 120 degrees. Trusting that the PT knew what he was talking about she accepted the diagnosis. Meanwhile she did not feel like “she was good to go”, again quoting the PT, and was still experiencing pain and restriction. After increasing her limited ROM and eliminating her back pain she said “I had no idea my pain was related to the knee as they said I was healed. I just thought, well this is what getting old was like”. Again she is only 49 years old. Her ROM prior to surgery should have been documented somewhere. Rehab goals should not be to achieve the average. While a surgery such as a knee replacement will present new limitations it should not be assumed that she is only ever going to be average from here on out.

images (13)Let’s look at this from another perspective. What Doctor should a female go to when the symptoms of Menopause begin? The standard answer is the Gynecologist. But why? – a Gynecologist, for all intense purposes is a plumber. Menopause is not a plumbing issue it is a hormonal one- women should be turning to an Endocrinologist for assistance with the change.
A gynecologist will most likely prescribe estrogen for all of the women who come to him/her. Here is another important time when a woman needs to know what is normal for her. All women should get a full hormonal blood work up every ten years starting when they turn 20 and put the information away until the time occurs. Then she will have a complete history of her hormones. This would be a more appropriate guide for what she personally needs as a supplement, if any, at this point in life.

It is so important that we pay attention to our bodies as well as our instincts when it comes to our health care. We need to when know something is not right for us personally. We should not blindly accept recommendations for surgery, or reasons for continuing/ending treatment. We rarely follow our instincts because we are unsure and uninformed about our own body. The more connected one is with their own body, the better prepared one is to figure out which health options are best suited for us, indidivually. Knowledge is power, combine it with understanding and confidence the result is a uniquely healthier, you. And there is nothing average about that.

Wholistic Toolbox: The Rotator Cuff and injuries related to it

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Jenns 6 InjuriesThe shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade. The arm is kept in the shoulder socket by the rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate the arm.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when the move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object. The fraying is caused by too much tension or an imbalance in the muscles which needs to be corrected.

Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a baseball or placing items on overhead shelves. Repetitive use and/or improper body mechanics can also lead to injury. As we age and become less active we tend to lose strength and tendons begin to breakdown. Rotator Cuff Injuires are most common in people over 40 years old. There is a very good chance that a rotator cuff injury provided it is not severely torn, can heal with self-care measures or exercise therapy

Rotator cuff injury signs and symptoms may include:

Pain and tenderness in the shoulder, especially when reaching overhead, reaching behind the back, lifting, pulling or sleeping on the affected side

Shoulder weakness

Loss of shoulder range of motion

Inclination to keep the shoulder inactive

The most common symptom is pain. It may occur when reaching up to comb hair, bending the arm back to put on a jacket or carry something heavy. Lying on the affected shoulder also can be painful. If a severe injury, such as a large tear, has occurred there can be continuous pain and muscle weakness.

So our primary goal is to release scar tissue that has formed following injury, restore ranges of motion and regain stability. Torn muscles, most commonly the supraspinatus (on the top of the shoulder blade), create general instability in the shoulder joint. Once range of motion has been restored, strength will be required to fully resolve the injury and prevent the problem from becoming chronic (i.e. frozen shoulder).

The manner in which the treatment is tailored depends on which muscle is torn. Make sure to determine the exact injury and tailor the treatment accordingly. If your client is very apprehensive about stretching the shoulder, begin with strength training (i.e, manual resistance and ROM movements) to establish confidence and stability. Once initial gains in stability have been attained you will have greater success doing the stretching protocols. This is especially true for dislocations.

Make sure to pay attention to the client’s reactions both emotional and physical. Work with the client and address their issues as you go.

So how would I work with A Rotator Cuff Injury:

I would use the following Stretching protocol

Shoulder Horizontal Abduction

Shoulder Extension

Shoulder Internal Rotation

Shoulder External Rotation

Shoulder Horizontal Adduction

Shoulder Abduction

Posterior Hand Clasp

I would then proceed to opening up the cervical area with another series of stretches. Once I have the client out of pain and confident that they can in fact use their shoulder I would introduce strengthening exercises. Starting with a light manual resistance and gradually moving up to weights. I am also massaging (in between stretches – gives the client a break and brings their awareness to the changes in the soft tissue) and treating trigger points as they arise. Finally I would review the client’s body mechanics and try to correct improper use that is contributing to the problem. The client would be given a protocol do follow at home with daily shoulder stretches and a shoulder-strengthening to help prevent a recurrence. Especially important is a program of strength exercise to promote balanced strength about the shoulder.

So now you know my approach I would love to hear yours! Please share how you view and treat the Rotator Cuff.