St. Lukes Elks Rehab Blog » Massage Therapy

My Favorite Strech-Piriformis.

St. Luke's-Elks Rehab — Mon, 08 Sep 2008 20:28:33 +0000

We see so many patients presenting with lower back pain, and usually from chronic or repetitive use, combined with inner core instability. We administer the standard inner core exercises focusing on the pelvic floor, the transversus abdominus, and the transversospinales, or multifidus muscles. These exercises are wonderful for beginning the stabilization process.

Also, if indicated, we facilitate stretches; of the Piriformis, or external hip rotators, the lower thoracic spine, the hamstrings, and the quadriceps. These work well to release the lower back, but my personal favorite would have to be stretching the piriformis.

And my favorite way of stretching the piriformis is by crossing one leg on top of the knee of the other, and bending over in a seated position, keeping the “down” leg in a solid 90 degree bend. I think what is most appealing is the relative level of ease in this stretch. It is good for people who have trouble doing the same motions while on their back, and it allows for more of the whole body to relax into the stretch, using gravity instead of lifting the crossed legs up and working against gravity. Almost every patient I’ve coached in this stretch says “oh yeah, I feel that.”

One important tip: try and imagine that while you are bending forward in the chair that your only fulcrum is at your hips, keeping your chin up as you lean forward. Imagine your hips are a hinge and this is where you are bending. Also, if the person can not totally cross their legs (elderly or more stiff folks) then they can cross them as far their comfort level, then lean forward.

This stretch, combined with thorough deep tissue massage when indicated, in the lower Lumbar region including the Quadratus Lumborum , Gluteus Maximus/Medius, and Piriformis without major contraindicated spinal pathology, are most certainly highly beneficial therapeutic protocols.

Paul Greear NCTMB

Nampa North

Quick fix for Neck Pain

St. Luke's-Elks Rehab — Tue, 15 Jul 2008 14:30:02 +0000

Ok, here’s the latest quick self-fix i’ve discovered for sore and aching erector spinae muscles(not to rival self trigger point work with the Thera- cane…): Take two tennis balls, tape them together but leave some of the crease between (duct tape works really well).
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You now have a little wall massager. Place it against a wall, move your back against the taped tennis balls so that the crease fits your spinous processes, and do wall squats, working and varying the pressure of the tennis balls to your desired intensity. Feels really good if you can get some pressure inbetween the rhomboids, and if you’re good you can even work around the superior edges of the scap.
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Then reposition lower and work into a lower squat (yep, watch your knees) and work some of the lower lumbar, multifidus muscle (this takes skill!).
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Wha Lha! you have now discovered another effective self massage technique. Don’t be suprised if your coworkers look at you funny as you piston up and down, making goofy, feel good faces.

Paul Greear NCTMB
Nampa North

What's Your Scope: What Massage Therapists Offer

St. Luke's-Elks Rehab — Wed, 21 May 2008 17:26:54 +0000

Respect What We Offer:

-Massage therapists are and will be increasingly necessary in the health care field:

-We manually manipulate soft tissue in trained ways to increase circulation

-We stimulate metabolism and the production of endorphins in response to “good pain”

-We can help prepare athletes for competition

-We move and direct Lymph

-We can manipulate deeper level connective tissue

-We can help stretch broad level connective tissue

-We can facilitate positive diaphragmatic breathing (Neuromuscular Release techniques)

-We can guide and direct healing imagery to enhance pain thresholds

-We can use our developed skills to assess a body from a torsion perspective,

-Although bodywork often “feels good” its not just about the feel good; it should be about the efficacy of goal achievement in relationship to the stated plan of care. -Qualified and skilled personal touch in these areas cannot be overrated!

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility

What's Your Scope 5: Refer to Other Professionals

St. Luke's-Elks Rehab — Mon, 12 May 2008 15:23:47 +0000

Refer immediately to the local PT, OT, or ATC any signals from your patient that are caution flags. If operating independently, be confident with and know the health care provider you will refer this patient to. Sometimes because we get such positive feedback from those with whom we’ve worked, we can have an “exaggerated idea of our skills.” It is crucial to exercise caution when your higher senses flag danger, and move the patient towards the proper level of care.

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility

What's Your Scope?:Don’t Interfere w/ or Contradict a Physician's Recommendations or Prescriptions, and Don’t Support a Client (Patient) Who Wishes to Do So

St. Luke's-Elks Rehab — Fri, 02 May 2008 16:40:51 +0000

I have had patients try to get me to badmouth doctors, or other physical therapists. NOT GOOD. Good medicine and effective therapy is self evident. So even if I might have inclinations towards different folks, or prescriptions, not only is it my job to point to them, but it is good practice to be silent on such dilemmas, and address the issues if they are significant with said therapist, or Doctor, if at all possible. After all, the liability for such Prescriptions should lie where it falls.

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility

What's Your Scope?: Avoid Presenting Yourself As Having Expertise That You Don’t

St. Luke's-Elks Rehab — Wed, 30 Apr 2008 17:26:16 +0000

-In working sports massage with the Boise Burn, I am fascinated how a team can work together to achieve a goal, each team member having just the right job. In just the opposite way it would be catastrophic if I jumped out and tried to play referee for the game (although some of you fans would disagree based on the performance of the refs during the home game opener against the Tri-Cities Fever!).

-Use your developed professional judgment to determine whether or not the issue being brought to your attention during treatment is for some other more qualified therapist (and then make sure you at least try to glean what their recommendation becomes, in order to enhance your global understanding!).

-Not all physical assessments need be brought to a patient’s attention; be aware and courteous of sensitivity to their own health deficiencies.

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility

What's Your Scope?: Tip 2

St. Luke's-Elks Rehab — Tue, 29 Apr 2008 20:52:01 +0000

Massage therapists don’t diagnose, and officially, we don’t do “evaluations.” But Massage Therapists MUST be able to assess and critically think through the relative condition of each patient/client that they see. We make observations that facilitate our treatments, and sometimes these observations help illuminate the overall condition. Communicate with the health care provider who referred the patient.

What's Your Scope?

St. Luke's-Elks Rehab — Mon, 28 Apr 2008 15:04:02 +0000

Recently I grazed across an article in Massage and Bodywork concerning how to best define what a body worker’s scope of practice is. As a Massage Therapy provider with a relatively new role in the Health Care Field, it is crucial that I understand and effectively define what my scope of practice is. After One year and almost Six months of service with SLIERS Nampa North outpatient facility, and as a team Massage Therapist with the local Arena2 football team the Boise Burn www.boiseburn.com , I have learned how to better operate as a Massage Therapist within the realm of Physical Therapists, Athletic Trainers, Chiropractors, and Occupational Therapists, each with their own unique scope. And through these experiences I am more comfortable operating independently as a Massage Therapist while maintaining the integrity of my own scope of practice, and the scope of my colleagues.

First I had to operationally define my scope of practice. Over the next few days I will Post suggestions for other Massage Therapists working alongside an assortment of Health Care Professionals. [Some of these concepts are paraphrased from McIntosh, Nina. “What’s your scope of Practice?” Massage and Bodywork, p.130 May/June 2008.]

First off:

Know Local and State Regulations:

-In Idaho there are no state Licensure requirements for Massage therapists.

-A Massage therapist (should) obtain a city business license if in sole proprietary business work.

-Although not regulated by our state municipality, It is a requirement that any Massage Therapist working with SLIERS have a certificate of completion in Massage therapy from an accredited school.

-It is highly recommended to obtain further credentialing through a National agency such as National Certification Board for Therapeutic Massage and Bodywork (NCTMB), Medical Massage National Certification Board, or to have legitimate training in any area of extensive bodywork modalities such as Rolfing, Myofascial Release, Lymphedema, or Cranio-Sacral work, not to mention many other valid modalities. KNOW YOUR ETHICAL BOUNDARIES, as stated in your credentialing agency’s code of ethics, and demonstrate caution with multidimensional relationships.

-If working in a state that requires licensure (such as Oregon), a Massage Therapist must obtain Licensure from the appropriate municipal board (sometimes this could be county, or city depending on the area of the country).

-Extend your credentialing leverage through liability insurance with an accredited agency (such as AMTA or ABMP) –if working as a sole proprietor this is a must!

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility