The Jiffy Lube of Neck Fixing

The other night, I was hanging at home watching Al Madrigal’s comedy special, and he mentioned hurting his neck while sleeping.

“As a man,” he said, “You have very few massage options.”

I braced myself. Massage comes up in comedy from time to time, frequently in borderline offensive ways. I tend not to get riled up over these things, but I do raise my eyebrows at whomever is watching with me and huff a little or cluck disapprovingly if it is actually offensive. I thought Madrigal was pretty funny. I was watching with my husband, who knows the comedian tangentially, just enough to follow his career and root for his success, so I lowered my eyebrows a little from the get-go, and his jokes were novel — he outlined the bad deal that is trading massage with his wife, the downsides to mall chair massage, the excessive time commitment involved in a “real” spa, and the perils of strip mall massage. Here’s the clip if you’re interested.

I think jokes are funniest when they resonate with your experience or beliefs; the bit about limited massage options most likely caught laughs because lots of people share the feeling that a good massage is not always an option. As such, here’s what I want people to know after watching: Whatever your gender, wherever you are, you have more massage options than you think. 

The trading with the wife thing was funny and relatable and a story I hear all the time. The other options are all pretty viable. I don’t practice much chair massage,  but people I know who use chairs keep their “doughnuts” clean by changing cradle covers for each client just as you would with a table and by wiping down the chair. Not as germy as you might think. As far as strip malls go, we don’t really have them where I live, but I’ve had lots of interactions with massage therapists around the country, some of whom practice in strip malls. Some of these are franchise locations, some are private practice (The Times posted a little peek into strip mall healing fairly recently). There are lots of great professionals working in all kinds of buildings. Some don’t have a brick and mortar location at all, choosing instead to practice out of their homes or to travel to yours. There are many tools available to point you toward quality and legitimacy; location alone is pretty flimsy. You can figure out who’s legit by checking directories — AMTA or AMBP, for example — or looking up massage therapists online just as you would any other business.

As for the “real spa” experience described in the bit, I have to say that four hours in a cucumber-water Utopian environment sounds pretty good to me, but I recognize that not everyone has the time. I giggled when Madrigal pointed to his neck and declared, “I want the Jiffy Lube of neck fixing!”

Here, perhaps, is the biggest secret of all: A really great massage therapist, whether using a massage chair or table, working in a strip mall office or a fancy spa, in the span of four hours or a mere 30 minutes, will listen to you and work on what you want to work on.

I tend not to use the word “fix” very much (for reasons that warrant a whole other post), but this totally resonated with me. Sometimes you just want to work out that one thing. I am not a large-scale operation, a chain of franchises, or a speedy mechanic, but I’m a good listener and a skilled massage therapist, and I can be your Jiffy Lube of Neck Fixing. If you’ve only got 45 minutes and you slept funny and woke up with your head cocked to one side, unable to move it back to where it belongs, we can spend every one of your precious minutes warming and softening that neck of yours, easing your head back toward its upright position. We’ll do that whether you come to my yoga studio room on its industrial little block or to the spa where I work part-time in the land of magazines and snacks and herbal tea. I can focus on the issue at hand, zoom in on the neck (or shoulder or feet) and get you in and out in the amount of time you have with attentiveness and care, regardless of locale. You have a lot of massage options.

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Obsession of the Week: Breath

In all lines of work, we can form obsessions. I’m not talking big, unhealthy obsessions, but little ones, tasks or concepts we relish because we believe they are the key to so much more. In my previous career as a fundraiser, the database was my baby — I developed an actual passion for getting data squeaky clean.  I love these little passions — they give us a point of focus, keep us ticking.

Lots of massage therapists are prone to this kind of focus. Absorbed in the work of a good massage, the bigger release that comes from unlocking a particular muscle, say, or the discovery of a new way to use forearms, can seem downright critical. I’ve seen a number of people develop a bit of a psoas obsession (you know who you are). There are times when releasing the scalenes seems like the most important work in the world. Muscles I’ve highlighted on this very blog — pecs and quadratus lumborum come to mind — illustrate some obsessions of my own. This is not to say that we then only use that new forearm stroke or declare that the psoas is the key to all lower back pain to the exclusion of what’s going on with your unique self or spend the whole massage digging into your pecs and QL. But these are things we think about when we are not actively practicing massage, picturing the slant of the psoas connecting lumbar spine to thigh, spinning out from that the whole world of the hip and lower back, viewing posture through that lens. I may have a week when I think about the role of the lung in eastern medicine, how it can impact posture, breath, emotion. I may think about the role of sub-occipitals in alert response as well as headaches.

And through it all, I think about breath.

Is there anything more vital to life? I think not. I could write a hundred posts about breathing — the way we hold breath when afraid or anxious, how muscles of inhalation and exhalation get stuck over time when breath is chronically shallow, how focusing on deeper breathing slows heart rate and improves, well, everything. I stumbled upon an article in the Huffington Post this week about breathing as a healing exercise, and it felt particularly timely as I am taking a class this week on myofascial release of the ribcage, abdomen, and pelvis. We will undoubtedly discuss intercostal muscles and diaphragm. I have wanted to take this class for years, to better understand restrictions that keep us from breathing deeply, to learn more about release and better breathing.

I am very much looking forward to getting back into the classroom, and I will report back soon on new tools to improve breath and healing. In the meantime, on this here spring equinox, I wish you deep breaths and much oxygen as we move into a new and brighter season.

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How to Get a Massage

Yesterday, I wrote a note to people who have a hard time relaxing. Sometimes the transition from mile-a-minute NYC life to lying still for an hour or more can be a little bumpy. Massage tends to smooth it out on its own; daily stresses melt away over the course of an hour or so. As a massage therapist, it is my job to ease you into a state of relaxation. It’s the best job in the world. But there are some things you can do to facilitate your own de-stressing session and make the most of your massage.

Culled from years of experience getting massages (hard work, but someone’s got to do it), I give you this handy guide to getting a great massage.

Give Yourself Time

Running late is stressful. Rushing gets your heart rate up. You can set the stage for a more relaxing massage by giving yourself lots of time to get to your appointment. One of the greatest gifts of massage is the opportunity to slow down. If you’re able, budget a little extra travel time into your day to kickstart that process. If this isn’t possible — if “train traffic ahead” holds you hostage for a few extra minutes underground or if something else goes awry — call me. Being on time is ideal, but you can still get a great massage if you’re running 5 minutes behind.

Get Comfortable

Many of us have precious few opportunities in life to simply lie down, fully supported and aligned. When you get on the massage table, make the most of that opportunity! If you’re not totally comfortable with the way pillows are set up or with the angle of the face cradle, please let me know so we can troubleshoot and get you cushy comfy. Setting yourself up to feel physically supported sets the mind at ease so you can get to relaxing!

Practice Relaxation

Have you had times when you feel like you can’t turn off your brain? Or maybe you’ve experienced that moment in a massage where the massage therapist is moving your arm and tells you that you’re helping and to let it go, and you find that you don’t really know how? I’ve seen it a hundred times. I’ve also done it. It can be challenging to let go of your thoughts, your day, or the weight of your arm. Most of the time, we’re not allowed to — we have to be alert, respond to emails, hold our heads up — and sometimes it’s hard to believe that there’s a time and a place where the exact opposite is expected of us. This is your time to do nothing.

Relaxation is an art, and perfecting it takes practice. Taking a page from meditation’s book and focusing on breath can be a great way to shift your focus inward.  Just as you would with a yoga class, taking a moment to focus on breath and set an intention before getting a massage can set a positive tone. I recommend something simple and relaxing — to breathe, to let go, to rest, to be easy.

Next time you find yourself shifting abruptly from a whirlwind day of craziness to a candlelit room where you have a set amount of time to relax, try the following when you get on the table, before your massage therapist even enters the room:

  • Take a few deep breaths. If you are lying on your back, let your belly and ribs expand. If you are face-down, think about the back of your ribs expanding up and outward. I have been known to practice a little Ujjayi breathing when I first get on the table. It slows me down right away.
  • Notice your positioning. If you’re in a cool room with a table warmer on, focus on the places where the warmth radiates and meets your skin. Think about dropping your weight into the table, what it feels like to be fully supported there. If anything falls short of comfort, mention it when your massage therapist comes back so he or she can help make an adjustment
  • Notice the places in your body that do not feel relaxed, and visualize those places becoming soft and dropping into the table, also fully supported.
  • Set a simple intention. If you’re one of those people who finds yourself “helping” during massages, it can be useful to remind yourself in those moments that you are there to breathe. No more, no less.

There are many ways to get a great massage, of course. This simple routine is what helps me unwind right away. If you find relaxation challenging, I encourage you to try it for yourself when you come in for your next massage.

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Taking it Easy isn’t Always Easy

I have a confession to make. I haven’t always been good at getting a massage. I don’t mean booking a massage and putting it on my calendar — this is not a post about scheduling (though that is also important). This is a post about what to do when you get through the door, because it doesn’t always come naturally.

I’ve always been pretty good with massage-getting etiquette: showing up on time, being clean and cordial, that sort of thing. It’s the bit about dropping everything when I get on the table that used to really trip me up. I recently read a blog post from a fellow massage therapist in which she implored her clients not to help with range of motion or stretches, instructing them to “just go limp” and pointing out that not doing so is annoying. While I’ve been on her side of things, jostling clients’ limbs in hopes of that loose limpness setting in, her reprimand to people who aren’t loosey goosey enough struck a nerve. Being floppy and relaxed is great, but sometimes that state doesn’t feel within reach. Even in the midst of an amazing massage, going limp may not be available to you. If you are one of those people who melts right into the massage table the second you lie down, clean sheets and table warmer enough of a comfort to limpen limbs and get you breathing evenly and deep, I applaud you sincerely and wholeheartedly. This might not be the post for you, though I do want to take a moment to tell you that the ability to drop into that state, whether by natural talent or finely honed skill, is not something that everyone has. It really is a skill, and I really do marvel at those of you who do it with such apparent ease and grace. You are awesome.

The rest of you, the ones who fiddle with the face cradle and who aren’t sure where your arms are supposed to go? Those of you who don’t practice being still all that much and aren’t entirely comfortable doing it? You are also awesome. You are awesome in your humanness, weight of your day not yet sloughed off your shoulders. You are awesome for showing up, putting forth the effort to feel good, and seriously, if it takes three whole minutes to finagle the face cradle into an angle that works for you or to adjust the pillow under your legs so your ankles don’t feel weird, I really don’t mind. Comfort is underrated.

In my next post, I’ll share some suggestions for how to get closer to relaxation right off the bet and to get more out of your massage.  I’m aware that some people might find all of this silly, the idea that one might have to make an effort to feel effortless, but sometimes that’s just how it is. Sometimes taking it easy isn’t easy at all. Lucky for you, I’ve spent years practicing the art of getting massage, and I look forward to sharing the tips I’ve picked up along the way.

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Muscle Spotlight: Quadratus Lumborum

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What is the Quadratus Lumborum?

A) The muscle that connects the hip to the ribs, earning it the nickname “hip hiker”
B) A deep muscle of the lower back and frequent culprit in back and hip pain
C) Part of the posterior wall of the abdominal cavity
D) A boring old square (quadratus lumBORum)

Did you think it was all of the above? Nope! It’s A through C. There’s nothing boring about the QL. Lumborum refers, of course, to the lumbar spine (and not to boredom). Quadratus refers to the shape of the muscle. Though it is made up of bands of fibers overlaid at slightly different angles as depicted above, it appears on the whole to be quadrilateral, a squat, square muscle that helps form the posterior wall of the abdominal cavity and that connects hips to ribs, assisting with lumbar extension and lateral flexion, hip hiking, stabilizing the lower back and twelfth rib.

Why Should You Care?

The Quadratus Lumborum is a common culprit in non-specific low back pain. Low back pain is one of the top reasons people come for massage (and one of the top reasons people miss work), and there’s some research out there that suggests that massage therapy can be an effective way to treat lower back pain. Working the QL can help your back feel better and get you back to work. Good stuff!

What Makes the QL Exciting?

Like a compelling love interest, the QL is deep, but accessible. Though it is located beneath several layers of paraspinal muscles, it is lateral at its outer edge, coyly peeking out from under more superficial muscles. I’m anthropomorphizing a little, but there is something cool about deep muscles that can be accessed directly during massage. As with sliding under the scapula to address subscapularis or dipping under pec major to reach pec minor, working on the quadratus lumborum reminds me how easily we can reach what doesn’t, at a glance, seem readily palpable. My favorite approach to quadratus lumborum is to find the lateral border, its edge dropping off into softer tissues, and to sink in from the side. Sidelying position is excellent for accessing this muscle and leaning in, but prone works, too, a slow drag of fingertips easing into the layers of the back, finding what’s deep, and releasing.

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Songs to Soothe You

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I’ve got music on my mind today. There’s a music only yoga class at Sacred on Sunday evenings, instruction at a minimum. It’s a standard Bikram-style sequence, so it works for anyone who’s taken a similar class before, and it is beautiful, a room full of people breathing together and moving silently and in sequence, adjustments to poses coming from within rather than from a teacher. Teachers are wonderful and insightful and irreplaceable, of course, but there’s a special kind of focus that comes from tapping into yourself for guidance, and the music can feel like magic.

Songs for the Sunday night class are usually based around a theme, singing along encouraged when the songs are familiar and call for such a thing. Tonight’s class was lovely, but there weren’t many opportunities to hum or mumble along, and I kind of missed it.

When I practice massage, I tend to keep the music pretty tame. No evocative sing-along songs, usually no lyrics at all, just relaxing songs to serve as part of the backdrop for your session. A fellow massage therapist had a great post about music the other day, in which she mentioned specifically avoiding “super-familiar, easily identifiable songs.” I tend to agree with this — unintentionally stirring up memories, whether good or bad, is not my goal. It can be distracting and can shift the mood, and I like to keep things nice and calm.

That said, sometimes you just want to hear your tunes. While I wouldn’t necessarily recommend a sing-along massage (singing through the face cradle sounds crazy awkward), you may have a particular song or album that puts you at ease. You may be soothed by Beck or Pink Floyd or Nina Simone; music from a particular era might make your heart feel glad. We all have our comforts. If there’s something you’d like to hear during your massage, you are welcome to bring it. I use an iPod dock, nice and simple, and you are welcome to replace my music with yours during your session if you’ve got tunes you want to hear and a compatible device. If that’s not your thing, I’ve got a nice ambient mix at the ready.

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Running Piglet

The other day, I mentioned my terrific acupuncturist, how one of the things that I like about her is that she talks through treatment strategies with me. Acupuncture is based on the same philosophy as shiatsu, so there is some overlap in our knowledge. I understand where the primary meridians are, and I know what it means when she says we need to bring up my kidneys. The difference is that she knows much, much more than I do. When I don’t understand why she’s needling a certain point, or when I can’t tell from the sensation what point it is, I ask, and she explains, and it’s interesting to me. It’s not uncommon for her to remark “this will help with your headache,” or “this will get you sleeping well.”

I frequently learn a little something. I usually take it pretty seriously. As much as I love acupuncture, I actually dislike the needles part. Not a big fan of pain, it turns out, so I steel myself and put on my serious face.

During a recent treatment, instead of “this will help you with your digestion,” she said, “this will really help with your running piglet.”

WHAT?

This was not something I’d heard of. This was not something to steel myself against. Running piglet sounded downright silly, though I understood the (not very funny) concept right away. Much of what I’ve found online when looking into running piglet pertains to running piglet syndrome or disorder, essentially meaning panic disorder, but I found this description of the qi itself on the Pacific College website: “A sensation of qi rushing upwards from the lower abdomen to the chest, epigastrium, and throat.” Even though I was not experiencing full-blown running piglet syndrome, the imagery resonated with how I think of anxiety: the fluttery feeling in the abdomen, the scampering sensation of worry.

I won’t pretend to have an in-depth understanding of running piglet as a full syndrome in eastern medicine; I don’t totally understand the channels or the appropriate treatment, and I am not an expert in panic disorder. But I do know a little something about anxiety, and I think I understand running piglet in its mildest form, anxious heartbeat like tiny hoofs, sense of control slipping just the littlest bit out of grasp, piglet wriggling free. These are the symptoms I understand, and where I know massage can help.

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When NOT to Get a Massage

Today, I bring you an important message: getting a massage isn’t always a good idea. As much as I love massage therapy and enjoy extolling its benefits, it’s not actually the answer to all the world’s ills or to all of your bodily ailments. When you are sick, sometimes it’s better for you to stay home.

It might seem like a good idea, when you’re under the weather, to lie down on the warm massage table and get yourself some care and deeper rest. Sometimes it’s just the thing. I’ve written here about how great massage is for the immune system (and touched on it here), but the context was prevention rather than curing current illness. If you’re feeling vaguely run-down but not actually sick, massage can be a great way to rejuvenate and steel yourself against the germfest that is deep winter. And sometimes, massage can help you feel better. I wrote just last week about self-massage for sinuses, and I do a top-notch face massage to assist with drainage for the stuffy-headed among you to get you breathing better. But let’s be clear about this: assisting with drainage is pure symptom relief. If you’ve got a crazy sinus infection, please go to a doctor. Massage is not going to fix it.

If you have any kind of acute infection or if you are running a fever, please stay home. These are systemic contraindications here in New York (it’s believed that boosting your circulation can speed the spread of infection throughout the body), which means I’m not even allowed to give you a full-body circulatory massage. You’re not going to want to put your face in the cradle anyway, and it’s frankly not very nice to go sharing infectious illnesses with your massage therapist and fellow clients. Occasionally, caring means not sharing.

If you’re feeling sick and are not sure whether or not to keep your massage appointment, err on the side of caution and reschedule. If you’re sick enough that the thought of going to the doctor has crossed your mind, please do that instead. Still not sure? Give your massage therapist a call. We are an understanding lot, and we can help you decide if staying in bed will be a better option for you.

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Finding Your Match

I love acupuncture, and I’m lucky to have a great acupuncturist. She first treated me in the clinic when I was in massage school and she was finishing up her acupuncture studies, and somehow she just “got” me. When she graduated, we lost touch.

I’d seen other acupuncturists before, and I saw some after Sue graduated and moved on, students as well as licensed professionals, but it wasn’t the same. Sometimes I felt judged. I’m a vegetarian, and some acupuncturists said that eating meat was the only way for me to be truly healthy and shrugged shoulders when I said I was not going to change this lifelong facet of myself, mouths turned down as if to suggest that they’d done all they could for me. Sometimes I didn’t know what was happening. I am fascinated by acupuncture and love to know what’s going on, and some acupuncturists are more willing than others to explain treatment strategy and to discuss points. Other times, in the quest to find a good acupuncturist, I didn’t feel heard. One unfortunate student told me lots about what he believed, but asked little about my health. Other times, I felt like treatment strategies were created around things I’d mentioned as asides, but not on the things that felt most pressing to me. Listening is a biggie.

Then again, my GP is not that great a listener, and I love him. I’ve always sought out doctors who ask lots of questions, stick to appointment times, and take a more holistic view. It’s surprising to me that I am as happy as I am with my neighborhood doctor, who has only walk-in hours, who drinks coca cola and eats snack cakes in the office and occasionally smells vaguely of cigarettes, who talks more than he listens and doesn’t dig deep when he doesn’t deem it necessary. When I injured my thumb in massage school (not by massaging, incidentally, but by lifting a pan from the oven in a supremely awkward manner — body mechanics apparently matter all the time), he diagnosed me with “some kind of sprain.” Obsessed as I was, at that particular time, with learning and remembering muscles and ligaments, it was kind of funny that I was OK with his vague diagnosis. But it was enough for me. In part because I trust him. In larger part because he told me that his thumb sometimes gets funky when he writes too much, and wearing a brace for a little while helps. He asked his assistant if they had any braces lying around to loan out, and, when they did not, he opened up his desk drawer and loaned me his personal brace and told me to bring it back in two weeks. Who does that in New York? That guy.

I am very fortunate to have these healthcare professionals in my life. One whose office is around the corner from my apartment, found entirely by happenstance, the other the aforementioned student acupuncturist (now a professional) with whom I reconnected when we took the same class last year, reunited through common interest. Even though they take different approaches and are very different people, there’s something about them each of them that makes me feel like I’m getting good care. It’s personal and amorphous, and it’s incredibly important.

So it goes with massage. At brunch with friends the other day, I said something to a fellow massage therapist friend about her massage not being particularly relaxing. My husband thought I was was being weirdly rude until my friend agreed. Relaxation massage is not her passion. That woman will hurt you (in a deep pressure kind of way, never in a doing-something-wrong way). She will also completely obliterate your trigger points and separate adhesions like nobody’s business, and I would recommend her in a heartbeat to any and all who want that kind of work. While I’d love to say, especially here on my very own blog, that I am the most amazing, perfect massage therapist for you and everyone else on the whole entire planet, there are many kinds of massage therapy, and you might be looking for something or someone else. And, as much as I love my acupuncturist, there are many different ways to approach acupuncture, and I might suggest someone with a different style — trigger point acupuncture over classical, for example — it that would be your preference. There are many approaches, and sometimes it’s about finding what’s best for you.

In this city, with so many people informed by so many philosophies, employing so many different techniques, finding your match can be a real game of trial and error. Whether you are looking for a doctor, a therapist, or a great massage, you may find yourself in a vulnerable spot while you look for the right fit. I can help with the massage part by pledging here to be nice to you, to be honest, and to tell you, whenever possible, who might be a better fit for you if I am not a good match.

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Spontaneous Adjustments May Occur

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We massage therapists are not allowed to do spinal manipulations, and rightly so! We are not chiropractors or osteopaths, and even though we get to know the spine pretty well in our training, we don’t get into it the way these doctors do. Occasionally, a client will ask for a little back cracking, and I always explain this and politely decline.

We were taught, however, that “spontaneous adjustments“ may occur, and indeed they do! It makes sense. There are lots of little muscles that attach to your vertebrae, weaving together to keep you upright and moveable. When these wee muscles shorten, they tug on your vertebrae and may pull your spine a little out of whack. Releasing these muscles allows the bones to slide back into place. It’s not uncommon to hear pops and cracks when working the back as muscles release the spine from their overzealous clutches. By working on the muscles, we allow the spine to return to its natural state, which is not the same at all as forcing it or manipulating bones directly (I have nothing against that when done by a trained professional, but it’s tricky business if you don’t have the training).

I love the phrase “spontaneous adjustment;” it tickles me every time I hear it. Going for a massage? Look out! Spontaneous adjustments may occur! Your spine may click back into place! But it doesn’t end there. Your may also experience a spontaneous attitude adjustment, the grumbles of your week giving way to calm. You may experience spontaneous acceptance of your body, spontaneous compassion for yourself and others.

Every massage is different. These things may or may not happen in your session. As massage therapists, we are not there to force bones or attitudes back into place. We are there to release the muscles and whatever else wants to go with them. But there is always the possibility, when you get on the table: spontaneous adjustments may occur.

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