Tuesday, July 6, 2010

Interlude

I've changed the name from "Massage Blog" to something a little more evocative of the way my writing seems to be developing.  Originally, my intention was to keep things strictly business, but the nature of massage therapy and my tendency to think laterally make it hard to keep my thoughts rigidly businesslike.

"Life, Massage and Everything..." as a title also gives meaning to the blog titles.  Douglas Adams (author of "Life, the Universe and Everything") was the writer for the Hitch Hiker's Guide to the Galaxy radio series on the BBC.  The episodes were names "Fit the First", "Fit the Second", etc.  Hopefully that helps to clarify my odd titling choice!

Sadly,  I'm not the most prolific blogger on the planet, but hopefully quality counts for more that quality and those of you reading this will continue to enjoy my posts as I manage to gather my thoughts into some semblance of coherency.

My thanks to Carrie Anne for putting up with my verbal ramblings on the days when my thoughts are more scattered.  Being able to talk out loud helps me bring sense to the chaos and organize things into a format that can be written down and followed by (hopefully!) anyone.

Saturday, July 3, 2010

blog the ninth: The Barefoot Experiment, part 2

This has been a long time coming, but I seem to be having a day of decent mental activity, so I think I'll use it to write!

I haven't been able to run yet, so I'm still doing a lot of walking, and as much as possible barefoot. After a few months, people are telling me I've lost weight, my posture's improved and that I look as if I've been working out again. The only accurate observation there is my posture, but I certainly don't mind giving the perception that I'm more active and stronger than I actually am!

The best compliment I've received so far was at a visit to the Hapkido club last week. For the first time in quite a while I worked out a little bit with one of the only students who's been there longer than I have, and is now one of our small number of black belts (I'm still a brown belt, though hopefully that'll change if I can keep taking those baby steps towards a proper level of performance!). At any rate, Mario and I have been training together for over 15 years. We kicked in rhythm for a few minutes and he told me I was lighter on my feet and moving better than he's ever seen me. Quite the compliment considering my lack of direct martial arts training the past few months. I can't help but attribute this to the biomechanical and energetic changes that have occurred since I started barefooting.

Several weeks ago, I tweeted that I'd rediscovered the value of an old martial arts lesson while walking barefoot. That lesson was given by the late GrandMaster Chong S. Kim.

Since 1999, I've been to Los Angeles three times with my instructor, Kieth Stewart, to visit martial arts masters residing there. I have to admit that of the Hapkido masters I've met, Master Kim best embodies the spirit of the lifetime martial artist. Friendly, genuine, dedicated, and above all, open with his teachings. On the last two visits we had with him, Master Kim shared some advanced knowledge from his Dan Ki Woon Gong system of meditation and breathing.

I have to admit that the first lesson he gave us was largely lost on me at the time. Master Kim gave us so much information in so short a time, that I lost track of individual techniques and when attempting to practice on my own, made quite a mess of it! The last time we visited was a few months before his death, and we were able to spend over two hours going over much of that same information. This time we made sure to make a record so we could revisit his lessons and make the most of them over time. As with all martial arts, but particularly with "internal" exercises, the experience of learning happens with time and practice. The techniques are a way of beginning a particular path of knowledge that reveals itself very gradually.

In the early weeks of walking barefoot, I began feeling quite energized. My legs, and even my forearms would feel quite tingly and alive. This recalled two lessons from Master Kim. The first came from our second visit (and first lesson), involving seated breathing. He told us to never cross our limbs, and to feel the ground with the balls of our feet, rather than the heel or the sole proper. His explanation was that we could connect to the ground better this way. Experimenting with different motions of my feet in those early walking sessions, I found myself naturally gravitating to a forefoot strike, and actually keeping my heel just a little of the ground while in motion (and often even while standing still, I tend to bounce a fraction of an inch without actually putting my heel fully down). I started to feel a steady flow of "chi" (More on this in a later blog... I have some fairly detailed ideas of what chi is and is not that differs from both "believers" and "skeptics", so stay tuned!), bringing to mind that early lesson. This led me to treat every walk as an energetic exercise as well as a physical one.

One of the last techniques Master Kim showed us, was to breath deep into the dan jun (Anatomically, breathing with the pelvic diaphragm and inflating the space just below and behind the belly button. Also known as the tan tien or dan tien. In yoga, it is the navel chakra or manipura.) and walk with fists clenched and turned out, on the balls of our feet. His words on the benefits were "better than jogging!". After practicing it for a couple of months I can certainly understand why, though I suspect using this technique WHILE jogging will be even better...

I've been gradually incorporating lessons learned from barefooting into the remedial exercise I assign to patients. I'm gaining more and more insight into the nature of posture and the potential for rehabilitating poor posture simply by relearning how to walk. It's not necessary to be barefoot to benefit (though it certainly makes it easier!), but it does require some preparatory exercise for particularly difficult cases. The capacity to walk on the forefoot with knees unlocked is necessary before even beginning to consider barefoot technique.

That's enough for today I think. I'll post more insights as I have them. Send any questions my way if you have any!

Monday, May 31, 2010

blog the eigth: A personal interlude to the Barefoot Experiment...

I've been asked a lot about why I want to walk around barefoot. I've talked earlier about reasons why it's healthy, reasons why the health risks aren't as bad as people often think, but that doesn't really explain why I'm doing it...

The simple answer:

I want to!

The long answer:

Last year, after several years of denial, avoidance and misdiagnosis, I was hospitalized and diagnosed with ulcerative colitis (UC). In the ongoing battle to keep my colon and recover some semblance of health, I spent a little over a year on corticosteroids. When I was on high doses, I was exercising, eating tons, and generally driving my girlfriend a bit nuts with my level of manic energy (not to mention the mood swings!). As I've made the switch from prednisone to immunosuppressants, my energy level has significantly dropped and since December I've found myself unable to exercise, either because of a lack of energy, or fear of the massively increased recovery time that I have to suffer through(and work through! Massage therapists that read this will all attest to the amount of physical effort involved in even a moderately busy day of massage).

Doing a little research, I found that the most likely cause of my woes was withdrawal from prednisone, combined with common side effects of the immunosuppresant azathioprine (Imuran). If the literature is correct, it looks like I could be out of action athletically for anywere from two months to two years. Just three weeks ago, I talked to my family doctor about managing these symptoms. His response was that I needed to be patient and stick to walking. Well, as followers of my blog will know, I've been talking about barefoot walking/running for a while now, and since it looks like I won't be lifting weights or sparring anytime in the near future, I've been walking barefoot more and more because I need a project!

Let's face it, the best way to combat the apathy, lethargy and depression that come along with extended periods of illness (and the unpleasantness of fairly serious medication!) is to find something to do. That same lethargy makes my brain a little slow sometimes, and I can't always concentrate well enough to get my thoughts down, so I've been a bit frustrated with my other project: This blog! However I can always walk... Even in the hospital I walked around and around the circular corridor of St. Micheal's gastrointestinal ward. So I'm continuing to walk, and the process of learning to walk barefoot in an urban environment is providing some mitigation of the frustration I've been experiencing.

I've had some insights into the world of barefooting that I'll share in a separate entry.

For more details on just how unpleasant UC can get, see my friend Katy's blog (bathroombound) to read her account of her battle. She's quite bravely being very detailed and personal in her posts, but it really does show just how deeply this illness can affect one's life. My struggle hasn't been quite as agonizing to this point, but it's fairly likely that I'll go through the same things at some point in my battle. With a bit of luck (and a lot of work!) I'll be much much older, but at the same time, what happens happens, and I'll deal with it as it comes. I'm certainly very interested in seeing the improvements in her life as her story progresses. She's been a great source of information and support all through my battle, and I'm keeping every finger (and toe) crossed for her.

Saturday, April 10, 2010

blog the sixth: How often to get a massage...


“How often should I get a massage?”


This is a surprisingly complex question to answer. It would be nice if there was some kind of standardized treatment schedule that works for everyone, but outside of insurance claims, it's impractical to try to impose a set schedule on every person. There are, however, some broad rules of thumb that I like to use to help my patients decide what is best for them.

Usually when someone first comes to see me, it's for an acute injury (sports injuries, sprains, strains and repetitive motion injuries all fit into this general category, assuming the onset is recent). In these cases, the first massage is primarily assessment and symptom management. I recommend at least one follow up for mild injuries. For repetitive strain disorders and for more severe injuries, I recommend an additional two to three treatments to facilitate the formation of functional scar tissue at the site of injury, and the prevention of postural dysfunctions caused by compensatory changes in gait, posture, and hand/arm use. Additional treatments may be necessary, but I find that if I haven't achieved at least an estimated 70% recovery after the 3rd or 4th treatment, then I need to reassess and possibly refer the patient to their doctor.

For chronic musculoskeletal problems (arthritis, tmj, tension headaches, epichondilitis and carpal tunnel are all examples) a longer treatment schedule is most likely necessary, based on the clients response to treatment, financial considerations, and their activity level (patients that can't or won't exercise tend to need more frequent massage treatments). Depending on the condition, this can potentially continue for as long as the patient chooses to come and see me. When the prognosis is for full recovery, I haven't seen many cases where the ongoing treatment plan of the condition continued for more than 3 months.

For both acute and chronic issues, the treatment plan depends on my ability to measure recovery in an objective manner. This involves observing posture, range of motion, inflammation, muscle strength/weakness, and sensory changes (numbness or tingling primarily).

Sensory change does involve a certain subjective experience on the part of the patient, but I think it's sensible to consider it in this category of observation. Once these issues have been resolved, we move more into the subjective experience of the patient.

Subjective experience can involve pain, changes to activities of daily living, stress and mood.

Once we're dealing primarily with these problems (and if it's what they have come in for in the first place), it's fully up to the patient to define their needs. I recommend weekly treatments until subjective changes are significant, and then gradually extending the distance between treatments until a maintenance schedule has been established. By this I refer to the length of time at which symptoms recur. Settling into a treatment schedule of once every 3-6 weeks seems to be the most common.

For management of both pain and stress specifically, I suggest that weekly treatments are optimal. Patients with chronic pain conditions and those living and working in high stress environments seem to benefit from more frequent treatment. Anxiety and risk of depression seem to be reduced (This is one of the areas where massage therapy is well researched. Check here for a good abstract with additional links.).

These guidelines do tend to differ slightly from therapist to therapist, but a quick investigation on Google shows that I'm not out of sync with other therapists. The "Why Massage Therapy" blog is quite interesting to show the similarities and differences between our perspectives.

One last note:

Beware any therapist who tells you that it will take more than 10 sessions to make significant progress! Excepting certain long term conditions where the goal is relief rather than rehabilitation (see above!), you should begin to feel better fairly early on in the treatment process. Even if the improvements are only small, they suggest we are on the right track and can proceed. Anyone insisting you continue treatment when no change is evident could be leading you on, and is almost certainly wasting your money.

Please feel free to add to this or ask questions! As I said above, everyone has a different perspective on this issue and I'm always interested in people's thoughts and opinions.

blog the seventh - The Barefoot Experiment


The Barefoot Experiment – Part I

(This blog was written a couple of weeks ago while helping my friend's out at the new location of their chocolate store. See www.delight.ca for info! Seriously! It's good stuff!)

Today was my second barefoot walk and my first of any length. It felt pretty good.
Now why would I want to go around barefoot in Toronto, you may ask? Well, I've been researching all winter, and hanging out a bit with Barefoot Moe uptown (Check out his website here). Barefoot walking and running is becoming increasingly popular as people try to find new ways to prevent chronic joint dysfunction. If you talk to barefooters (as they collectively call themselves), you'll find that they all believe there's little valid evidence to justify our tendency to wear overpriced, over-supported footwear. I did my own searching on Google Scholar and found several papers on the relationship of chronic ankle and knee injury and footwear (for more info try Thieme eJournals, Medicine and Science in Sports and Exercise, and a particularly good one in which the full text is available: SportScience ).

The general idea is that wearing shoes inhibits the foot's ability to actively absorb shock as we step or stride. The muscles and joints of the foot are thought to work best when allowed the freedom to operate individually and freely (think independent suspension). This is particularly true on hard surfaces like asphalt and concrete. By walking barefoot we allow the small support muscles to strength, and retain full proprioceptive sensation (proprioceptors are the nerve endings in our joints that communicate the position of the joint to our brains, giving us a more complete mental image of our position in space. The more active our proprioceptors are, the more detailed and accurate is our sense of position in our environment.). The larger and more movement oriented muscles don't have to do as much work maintaining our balance and can be left to their main job of propelling us forward. At the same time, shock is absorbed through many more joints rather than just the ankle and knee, diffusing the impact and reducing overall wear on the joints (Think arthritis prevention!).

The reaction most people have to the idea of going barefoot in the city is “Ewwwwww!”. Sanitation is a primary concern. The answer to that is quite simple if you really think about it: We don't tend to lick our feet, or eat with them, or touch any surface that our food is likely to come in contact with. The risk of infection through the skin is limited as pathogens have difficulty passing through the thickened sole of the foot.

The next reaction is “But aren't you afraid of cutting your foot?”. Well, I don't particularly like cutting myself no matter where it is, but for the most part, glass and sharp stones can be avoided. I don't know about anyone else, but I don't like walking through glass even in my shoes! (That also applies to feces, spit, vomit, gum, discarded food and any other noxious substance one might encounter on the sidewalks of Toronto.). Watching one barefoot jogger explain himself in a youtube video, I had to agree with his reasoning (and I'm paraphrasing here.): Which is worse? A small cut that heals in a couple of days, or arthritis that's with you forever?
I know which one I'd take!

Now as for the risk of infection through that little cut, for that reason, barefoot runners in particular carry along with their normal running gear, a pair of tweezers, some antiseptic, and dermabond/crazy glue. I'd also like to point out that we bleed out, not in, so unless a cut is allowed to become septic, the risk of internal infection is very low. Ask your Doctor for more qualified advice on that side of the issue. (Barefoot Moe asked his, and I'm again paraphrasing the response.)

Both times I've been out for a barefoot walk, I've been pleasantly surprised by how good I felt during and after. My legs and feet were actively tingling after this one! And the sore back I had (from carrying a duffel bag of sheets home... Massage therapists share my pain!) felt much better.. It's really quite difficult to walk barefoot without erect, dynamic posture. It does get quite tiring towards the end as I'm not quite used to walking for long periods with my forefoot. It feels a bit slower than heel striking, but ultimately more satisfying (and it hurts less).

Some things to consider if you decide to give this a try:

Pick a warm day. It'll put you off walking in the rain, or the cold.

Don't walk for too long. Depending on your skin type, it may take some time before you can do more than get the mail. You don't want to get blisters.

If you're testing your limits, take a pair of sandals or thongs with you. Also handy if you're going shopping, or out to eat. Most commercial establishments are going to either treat you like you're crazy, no matter how good you are at explaining yourself, or they're going to be worried about the potential liability of injury.

If you're really grossed out by walking on urban sidewalks, try Vibram Fivefingers. I haven't tried a pair yet, but they certainly look ideal for wet weather and skin protection on long outings. Plus they'd be a conversation starter I'm sure!

Keep a towel by the door. That way you don't dirty your floors (or get nasty looks from your girlfriend! And on that note NEVER get into bed without cleaning your feet first...).

Check back here for more. I'm going to try running soon. Once I've done a few of those, I'm sure I'll have some thoughts for part II...