Why are healthy psoas and piriformis muscles and their relationship to each other so important for good posture and pelvic stability? They have an antagonistic relationship across the SI joint, making their relationship the first to become imbalanced and the last to come back.  As a result the pelvis becomes imbalanced and the foundation of the house becomes tilted or twisted, throwing everything else out of whack.

Did you know they are the only muscles that connect the legs to the spine? (See picture).  These four muscles connect the legs to the pelvis and the legs to the spine; a kinetic alignment system if you may; a bridge between lower body and upper body.  The pelvis is the keystone of your foundation and the piriformis/psoas muscle pairs are guide wires that determine the keystones positioning in motion and stillness.

When I work with clients I start by checking which piriformis and psoas is shorter and release them.  Then I teach some good stretches for each muscle and (remember) to reboot hip flexion as described earlier with heel raises in a seated position.   You can also check which piriformis is weaker and do muscle spindle techniques to promote tone.  I would not recommend this for the psoas.

And be mindful that tight does not equate to strong.  Muscles can be locked long or locked short and either can be the weaker or stronger in a pair of muscles

If you do not know how to check for shortened and weakened muscles or do spindle techniques take my next workshop and I will show you how.  Or come in for a session yourself and get a private session muscle testing and evaluation mastery and spindle techniques.

In Summary you can begin to balance your client’s body by addressing the psoas / piriformis muscles and treating them appropriately to bring balance between the two sets of muscles, which results in greater pelvic stability and improving posture.

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Posted by: ensomabodyworks | June 30, 2011

Rebooting Hip Flexion to treat a Pathological Piriformis Muscle

Remember why we are rebooting hip flexion after doing trigger point therapy and stretching to treat the piriformis muscle?

A pathological piriformis is due to a psoas-piriformis imbalance or / and modern living. We sit around all day then ask our bodies to run or bike or do yoga with hip flexors that are not firing 100% while other muscles have kicked in to compensate.  The flexors need “rebooting.”

They can be tight, weak, strong, shortened or elongated but in all instances they are most likely not performing “hip flexion” as optimally as they should. You heard right… you can have a tight muscle that is weak or an elongated muscle that is strong and in both cases not functioning as it should be.  Its length has little to do with if it’s doing its job.

Here is an easy exercise to reboot hip flexion: As in photo sit on edge of chair with your hips rolled forward creating an arch in your back (do not use back muscles to arch back-roll your hips).  Place pillow, yoga block, or ball between knees (not too wide where knees are wider than hips). Visualize a string from your knee caps going up to the ceiling attached to a pulley.  On exhalation gently squeeze pillow and pull heels up and off the ground for two seconds then lower slowly.  You can place your fingers at the tops of your thighs near groin and perform the exercise. (If you feel contraction here and not in your calf muscles you are doing it correctly).

Another version is to place a yoga strap around your knees and press out rather than squeeze in. If you do both versions you will be stabilizing your hips by activating inner and outer hip stabilizing muscles.

 

Next blog will be the lynch pin for good and bad posture.  The Psoas – piriformis relationship.

Posted by: ensomabodyworks | June 27, 2011

How to Fix a Pesty Piriformis Protocol – Steps One and Two

1:  See a skilled neuromuscular therapist.  (If you are an athlete you do not need to see a sports chiropractor trained in ART).  A skilled Neuromuscular Therapist knows how to “pin and stretch,”  muscle, A.K.A.  ART, and knows many more effective soft-tissue techniques.

2: Whether or not you have a professional working with you doing self-treatment is a must.                                  
See the picture here; the piriformis (directly above yellow sciatic nerve) is surrounded by other muscles above and below it.
Work them all by:

A:  Lying on your back with knees bent and feet on the ground and place ball on your outer hip (below the big hip bone and above the hip pointer bone). Now let the leg fall sideways to the ground.  You may need to turn on your side completely to get enough pressure.  If the pressure is too much take a folded towel and place under your thigh or low back (this decreases ball depth in the muscle).

B:  Feel for tightness or and pain.  Apply direct and sustained pressure, with deep breathing, that elicits pain of a 3-4 (on a scale of 1-10). Most people go too deep and agitate the muscle tissue. Remember by nature  trigger points are hyper irritable so
why make them angrier.

C: Hold pressure with deep breathing until pain or tightness begins to go down to a 1-2

D: Increase pressure so pain or tightness is back to a 4 – breathe deep-let muscle relax more.

E: Do this 2-5 times then move to another spot.  You will find many.  Then go back to previously worked spots.
(Treatment should take 5-10 minutes).

NOTE: you may also do “micro moving” over spots.  Move very slowly over a tiny area back and forth – this coaxes the tightened tissue to release.

3: Stretch as show here for 1-2 minutes X 2 and use 50-75%
of maximum stretch no more!                 

4: rebooting of hip flexion will be explored next blog. ”
Stay tuned and email me with questions or ah ha! Moments J

marty

Posted by: ensomabodyworks | June 23, 2011

The Pesty Piroformis muscle: AKA The Pain in my Butt Muscle!

From Runners to yogis to soccer Moms, many know the obnoxious and chronic tightness, tenderness or even  debilitating pain due to the “piriformis” muscle.   A pernicious piriformis has a litany of symptoms when tight and dysfunctional due to trigger points (noxious knots in the muscle belly).

Symptoms include:

  • Piriformis Trigger points (TP’s) keep the muscle rock hard.
  • A trigger pint laden piriformis can press on the sciatic nerve and be misdiagnosed as sciatica due to low back problems.
  •  Piriformis pain on the outer hip and butt is sharp, almost electric, and can even be felt in the low back and the hamstring area.
  • A Piriformis muscle that is shortened and swollen by trigger points can  compress numerous other nerves and blood vessels coming out of the pelvis, resulting in a sense of swelling in the buttocks, leg, calf, and foot.
  • A tight piriformis muscle can impinge upon the pudendal nerve, causing impotence in males and pain in the groin, genitals, or rectal area of either gender.

    Holy cow!  That’s a lot of weirdness and pain due to one muscle!  I wonder how many people get misdiagnosed with other conditions and improper treatment? A tight piriformis will compress the sciatic neve in the hip and  is often mistaken for sciatica in the back.



What causes the piriformis to misbehave?

Two Things:

  • Lack of hip flexion due to modern living:  When we sit all day at work then ask our hip flexors to fire and raise the knee when walking (or running) the foot and toes do not have enough clearance to pull through without scraping the ground. The body is pretty smart and adjusts by laterally rotating the leg allowing the foot to pass the ground at a higher and slightly sideways angle.  (Just watch people walk or run-many will have one foot that flops out sideways-just do nor stare!My last date accused me of ogling a pair of legs but confessed I was looking at “the biomechanical imbalance of…….” She did not by it…..   So if you are an expert or laymen do not use my excuse…it does not work.
  • The piriformis / psoas balance: The balance of these two pair of muscles determines optimum posture and alignment. (To be covered next time).

How to Fix? 

  1. First release the trigger points and tight muscle tissue with massage or self – massage with a tennis ball followed by a good stretch.
  2.  Second: reboot hip flexion.
  3. Balance the piriformis/psoas relationship

Tune in to the next blog. Just days away……….to explore this protocol together.

Posted by: ensomabodyworks | June 17, 2011

Pesty Piriformis!

Get ready for easy solutions  to Butt, hip and Back  pai: Next week we will start with the piriformis muscle: A BIG culprit causing major back, hip and BUTT pain.  Stay tuned.

Posted by: ensomabodyworks | April 25, 2011

Pain Free Living Workshop Saturday April 30th!

PAIN FREE LIVING

Uncommon Solutions for Common Muscle Pain and Dysfunction, Joint Problems and Chronic Pain

Saturday, April 30, 2011  YWCA Central Carolinas

·  Get rid of chronic back, hip, and shoulder pain.
·  Enhance your active lifestyle with a more functional body.
·  Restore ease of movement.
·  Reduce or eliminate arthritis, tendonitis, and more.

Join Marty Kestin, neuromuscular consultant and somatic educator, and Debi Hawkins-McLendon, E-RYT®, in a dynamic
workshop to learn how to self-treat many of the problems that would typically send you to the doctor or physical therapist.

You do not need a shot, pill, or extensive physical therapy to resolve pain or get rid of that chronic issue for good.  Marty will teach powerful, simple but not widely known therapeutic techniques including trigger point therapy, functional exercises and unique postures.

Debi will weave a simple yoga practice throughout the day, providing an integrative experience on how
the therapy affects your body.

Session Information
10:00 – 1:00 Shoulders and Back 2:30 – 5:30 Hips and Lower Back

Investment General Public
Morning Only $60 Full Day $110 (* Early Bird $100) Massage Professionals (for CEU’s)
Morning Only (3 CEU’s) $65  Full Day (6 CEU’s) $125 (* Early Bird $115) Half day participation is limited to morning only

Registration: To pay by credit card, please call the YWCA at 704.525.5770.
What to Bring A tennis or racket ball and a yoga mat if you have one.

Call Marty for more info: 704.335.8115

Unique solutions to two common, major maladies plaguing runners

Rationale for different self-treatment

Traditional treatments for Achilles Tendinitis (AT) and Plantar Fasciitis (PF) from the doctor do not workand Physical Therapy (PT) protocols can be hit or miss and take months or a year to fully resolve.1 The Lancet, in November 2010, reported that in 41 high quality studies involving 2672 patients with “tendinopathies” (diseased or damaged tendons), patients received only short-term relief with the traditional cortisone injection.  The second traditional treatment (rest) only limits the injured tendon from getting worse.  Jane Broody of the New York Times broke this news February 28th 2011. She added that tendinitis is a misnomer, as the tendon is often not inflamed and why the tendon does not respond to steroid injections. Also the tendon is often  “gnarly” and mis-shapen.  She  noted that counterintuitive remedies may work better than the two traditional cures (cortisone injections and rest).  One involves strengthening the muscles around the joint of the affected tendon, to stabilize it, then exercising the muscle more than you would think, which brings more blood and nutrients to the injury, promoting faster healing.

If experts have a hard time, why not try something else?  My self-treatment method is similar to the counterintuitive remedy above but goes further in treatment, using specific soft tissue techniques, not widely known, that are easily learned with reproducible results.    How many runners do you know with PF or Achilles Tendinitis and it plagues them for months or even a year?

So just what is and what causes plantar fasciitis (PR) and Achilles Tendinitis.

Tendonitis and Plantar Fasciitis are “tendinopathies” or diseases of the tendon.  Often, but not always, the tendon is over taxed due to long term strain.   At some point the tissue micro-tears (injury response with pain, swelling and weakness) and then the healing response begins.  The healing response involves remodeling or “knitting” new tissue onto the damaged tendon.  The athlete typically ices, stretches, and continues running. However, the strain is still there, and the tendon is constantly being micro-torn and re-knitted but in an unhealthy fashion, resulting in the gnarly tendon described above. What occurs now is a tendonosis or condition (bad), not an inflammatory response.  Usually combinations of the following, not in any order of importance, are causing the development of the unsmooth tendon.

1. The wrong footwear creates muscle imbalances leading to strain on the tendon.

2. Knots in muscles, called Trigger Points, which are a normal occurrence if you are living and breathing, in shape or not.  These knots are actually tiny spots of contracted muscle tissue harboring metabolic waste products that irritate pain receptors causing pain. These knots also cause improper muscle firing, discrepancies in muscle length, and muscle group imbalances.

Muscle imbalances, modern living (sitting in one position too long, performing the same movements all day, etc.), and poor posture are a few causes of Trigger points.

Trigger Points tax the tendon immensely, straining it perpetually, causing it to becoming tender and inflamed. Trigger Points are possibly the most over looked source of pain and muscle dysfunction as doctors focus on joints and nerves as chief sources of pain and dysfunction.2 In fact “tennis  elbow” is nothing more than Trigger Points in the forearm muscles.3 New research shows that once the tension is released in key muscle bellies of the forearm by treating the Trigger Points, the tendon, which anchors the muscle to the bone, will relax.

Key Concept:

Trigger points, muscle imbalances, and improper foot wear alter the optimum “line of pull” in the muscle and tendon that is trying to heal. The new tissue is laid down in a messy manner.

One typical scenario:  Your heavily into training and your heel starts to hurt.  Months later it’s so bad you go to the doctor and get a diagnosis of “plantar fasciitis” and maybe a shot of cortisone, or maybe “the boot.”  You also do your physical therapy as instructed.  But, it’s still there, to some degree, months later.

Each time you irritate (run on) the injured tendon, it micro tears.  Then the knitting process begins again.  The problem arises when you have trigger points, muscle imbalances and / or bad footwear the body lays down more type III collagen and not enough type I collagen. Type I is smooth, looking similar to your three middle fingers held straight up in the air. Type III collagen looks like those three fingers intertwined.  The solution is to break up the gnarled tissue, provide positive tension for healthy remodeling, and do all the other things you have been taught already.

Another Solution:

Remember traditional treatments do not remodel the tendon nor deactivate Trigger Points in the muscles around the tendon.  Your coach or Physical therapists are experts at muscle imbalances and footwear but in order to heal the tendon and prevent future problems one must:

·          Treat trigger points and massage the muscles going into tendon

·          Remodel the tendon manually

·          Place positive stress on the tendon

·

Key Point:

Why massage and muscle focus?  Massage loosens the entire muscle, the fascia surrounding it, and releases strain on the tendon.  To release the tension on the tendon, you must treat the entire soft-tissue unit of muscle, the fascia, and the muscle/fascia anchor, the tendon.

Self-treatment protocol for Plantar Fasciitis  and Achilles Tendonitis .

Treatment of any tendinopathy uses the same protocol except in the case of a new injury. Brand new ones, as in it started hurting last week, does not have the gnarled tendon.  In this case no remodeling is needed.  This protocol is in addition to what your coach or physical therapist has given you. You still need to stretch and strengthen.  Let’s treat AT and PF!

Massage and Trigger Point therapy. The method I use goes by different namesNMT, Trigger Point Therapy (TPT), deep stroking massage.  Here is what to do.

Muscle massage: Using your thumbs, form a ‘V,” and apply mild to moderate pressure. Sink into the tissue half an inch from your heel and slowly glide up to the base of the big toe.  Repeat from base to all four toes.  Repeat this 5 more times. Do not forget to treat the flexor muscle of the big toe on the medial arch of the foot. You can substitute any massage tool that fits the into the muscle group, like the foam roller or a tennis ball instead of your thumbs.

What’s mild tomoderate pressure? On a pain scale of 1-10, mile to moderate pressure is a 2-4. If you wince or are not completely relaxed, it’s too much and the tissue tightens in response.

Treating Trigger Points: During the massage you probably found spots that hurt, felt hard, like little nodules, or just “weird.”  These are trigger points.  Next: In no particular order, do these two techniques, with pressure that elicits a pain of 4-5.

1. Rub the trigger point with your fingertips, thumb or with your tool of choice.  Make tiny movements back and forth over the spot for 10-20 seconds.  Rest a minute then repeat.

2. Hold static compression with thumb, finger or tool on the spot with a pain level of 4-5 and deep breathe. You will soon find the pain decreasing.  Increase pressure into spot as pain goes down, it will come back up, keep repeating (less pain more pressure) for 1-2 minutes.    If it’s getting worse than your pain of 5 is actually a 7 or 8….ease up…Trigger points do not like to be irritated. We are not using the same pressure as with a foam roller on your IT band adhesions.

After doing either or both techniques, go find more spots.  Then come back and treat again (up to 3 times each spot).  Trigger points are by definition, hyperirritable.  If you go too deep they will get angry and get worse, not better.

Remodeling the Tendon: Deep cross fiber frictioning

Find the gnarly spot.  Holding tight, rub and rub back and forth between thumb and forefinger (Achilles tendon) or pressing deep then rubbing with a thumb or hard tool into the base of the plantar fascia near the heel.  Do this for 20-30 seconds.  This should hurt, not a 10, but more than a 5.  Rest a minute then repeat 2-3 more times.  Then ice for 3 minutes and repeat 1 more time treating and icing.

By “frictioning” the tendon, the tissue micro-tears, causing the injury then healing response, resulting in new collagen being laid down (just like injuring and reinjuring the tendon).

To finish, ice the entire tendon for 5-7 minutes, not the muscle (which prefers heat).  Icing immediately after frictioning limits the injury response (pain, swelling, secondary cell death) and provides a pain free stretch to begin the healthy remodeling process. Do this technique every 2-3 days for 2-4 weeks or until tendon feels smooth.

Place positive stress on the tendon:

Positive stress means putting healthy strain on the tendon followed by ice.   For example, if a runner has Achilles tendonitis, they should bike or do the elliptical or life cycle (mild intensity the first two weeks then moderate intensity) and not run until the tendon is healed.  I also recommend isometric strengthening exercises to ensure positive strain and a smooth tendon. Note: Time of return to intense activity or even light running is determined by how bad the injury is.  It maybe 2 weeks or 2 months.  Please be reasonable.

In summary, treatments that focus on “allowing the tendon to heal while strengthening the joint” miss the mark.  Left alone or with common techniques, tendinopathies only sometimes heal themselves over the course of a year or so.  Treatment that includes manual soft tissue care shortens healing time to a matter of  a few months or even weeks.   Empower yourself with this non-invasive treatment and get back to your sport or activity in no time!

1 Traditional Tendon Remedies Fall Flat in Trials – NYTimes.com, Personal Health  For Tendon Pain, Think Beyond the Needle By JANE E. BRODY Published: February 28, 2011   A review of 41 “high-quality” studies involving 2,672 patients, published in November in The Lancet, revealed only short-lived benefit from corticosteroid injections.  Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials, The Lancet, Volume 376, Issue 9754, Pages 1751 – 1767, 20 November 2010

2 Simons DG. New views of myofascial Trigger Points: etiology and diagnosis. Archives of  Physical  Medicine and  Rehabilitation 2008;89:157-9.

3 Fernández-Carnero, Josué PT, et. Al.  Prevalence of and Referred Pain From Myofascial Trigger Points in the Forearm Muscles in Patients With Lateral Epicondylalgia. The Clinical Journal of Pain: May 2007 – Volume 23 – Issue 4 –  353-360).

When you pull a back or leg muscle in yoga class or doing yard work you are micro – tearing muscle fibers. As a result the area becomes inflamed.  You should always ice inflammation.  How do you know if there is still inflammation two or three days after the injury?  There are 5 cardinal sings:

  1. Swelling – fluid rushes to the injury.
  2. Pain – from chemicals released by the body.
  3. Heat – Increased blood flow to area.
  4. Redness – enlarged blood vessels.
  5. Loss of function – from  pain and swelling.
  • Ice any acute injury for 48-72 hours for 10-15 minutes. Envelope the entire area plus a little more with ice – do not just put an ice pack on most of the injury.  Why? Secondary cell death. The body has cells, like little Pac men, that clean and eat up the torn tissue and a little healthy tissue around the injury site – just like a surgeon who removes a tumor then also a healthy tissue around the tumor to ensure all the cancer is removed.  Ice 3 times a day  for 2-3 days and you will be amazed at how much faster your recover.
  • So when do I use  heat?  About 2-3 days after a mild to moderate muscle pull.   Can you ice and heat an injury together?  Yes.  Just be sure there is no swelling as heat will perpetuate it.  I.E. If, on the 2nd or 3rd day after I strain my back, I wake up and my back is achy but not painful to the touch or swollen I will use heat. That night I will ice to reduce swelling that accumulated from the day’s activities.

In short ice any acute injury for 2-3 days then it becomes a continuum of heat or ice until the injury  is healed.

Posted by: ensomabodyworks | September 1, 2010

Commitment – Why changing habits can be hard.

In my last blog, I talked about Grief and Chronic Pain and the four emotions one needs to go through in order to be happy and well -adjusted with a chronic illness or a life changing injury.

One of those energies is “bargaining.” It’s the one I see most with clients who continually struggle to change their habits in order to undo the bodily damage their current habits have created.

Some of us have committed to changing for the better but continually do something  counterproductive to the change we want. One reason why we fail is an underlying energetic block, deficiency or imbalance in the chakra system.  Yes me, Mr. Muscle and Dr. Trigger point sees the body as more than just soft tissue.

Anodea Judith, in her workbook “Eastern Body Western Mind,” beautifully lays out the Chakra system. She presents each chakra’s purpose, symptoms of deficiency, excess and blockages and offers healing exercises to bring balance to the entire chakra system. She clearly compares psychological problems with the correlating chakra issue.

I have used this book in my own life with success and I recommend Anodea’s teachings for clients who are having trouble with commitment. Those that do the chakra healing work slowly become more resilient in their commitments.

Anodea uses the example of a woman who desperately wants to lose weight but always fails in her commitments of new eating and exercising habits. Why? Unknowingly there is an unconscious emotion and specific chakra deficiency that sabotages her.

I think this explains why people “bargain” with lifestyle and habit changes.  Rationalizing why fast food is easier than prepping breakfast and not having enough time to get on the yoga mat 4 times a week may just be a chakra issue.

If you’re having trouble making some positive changes in your life, check out Anodea’s  website, explore the chakra system, buy a product and do some chakra work.  Self – defeating talk, negative patterns, lack of motivation and other roadblocks to success will begin to transform into positive self – talk with motivated, positive and constructive behavior.

Marty has been integrating chakra work into his bodywork practice successfully for the past 2 years.
mkestin@ensomabodyworks.com
• 704.335.8115 • www.EnsomaBodyWorks.com

Posted by: ensomabodyworks | July 30, 2010

The connection between Grief – Chronic Pain – And Healing

As a rehab specialist I have had many clients struggle to make the necessary changes in their lives to address underlying causes of pain. For example – John has a bulging disc in his lower back and he agrees that it was caused by poor posture at work and not exercising enough.

John starts off great with weekly treatments and is doing postural exercises every morning for the long day ahead. After a month he begins telling himself he has no time for the am routine every day. Soon his back begins to hurt more and he questions the effectiveness of our work.

Why?  John began to rationalize (excuse) why he could not continue his daily postural care. What John does not realize is that this rationalizing is actually “bargaining,” a step in the grieving process.  He is not acknowledging the loss (his healthy back) in his life and is subsequently sabotaging his progress unconsciously.

I was a social worker and worked with people grieving and realized a few years ago that many of my massage clients with chronic pain or a life changing injury would benefit from consciously looking at their situation from a grief perspective.

The most well known grief model is by Elizabeth Kubler Ross.  Her model involved the person working through 4 emotions / energies:

  • Anger
  • Denial
  • Depression
  • Bargaining

Once having done so, they come to the 5th emotion / energy of acceptance. The first 4 steps need to be dealt with if there is to be acceptance and the ceasing of unconscious sabotage.

If you or someone you know has had a serious loss or injury and are not well adjusted years later maybe doing some grief work is in order?

Call or email Marty today to get more information about grief work   mkestin@ensomabodyworks.com 704.335.8115

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