"What causes that?" [client question]

[wuffer]

I usually feel a little stumped by this question. Almost every client who is new to massage asks it, and many who are massage veterans. I am working on a "knot" or a trigger point, or just a plain old sore muscle. Usually the shoulders, but it can be anywhere. The question varies. It could be "What IS that?" when I'm working on a knot, or a thickened or hardened area. But mainly they ask "What causes that?" or "Why is it like that?" or some variation on that.

Now, I feel like I know the answer. For one the answer varies from person to person. Frequently, almost always it has to do with stress. That feels like too short or simple an answer. I think the main answer is that it has to do with our emotions, our fight or flight response, and what area of the body it is stored in is highly dependent on the person and their personal history. I have done Hakomi and Psycho-Somatic Awareness type stuff, so I am totally into the emotions are stored in the body idea. I think this is too far out for many of my clients. I also think that these theories take too much explanation to be understandable. If I tell a client the short version, they may scoff. If I take the time it takes to really explain it all, they may get it. But I might as well refer them to take a Somatic Psychology course or something.

In your answers I'm interested in a couple things:

1. How do you answer this question?
2. How can I give the "emotions are stored in the body" schpeel in an introductory way that would be palatable for "mainstream" folks. And in a way that helps explain their knots in some way.
3. Is there a good passage in a book that explains the physical aspect in a short, simple form good for clients? I mostly subscribe to the emotional theory myself [even though I know the physical is valid/true], and so knowing the physical causes have sort of dropped away in my mind. Why do we have trigger points? Remind me.

 

[jessnluna]

wow, it's not just me! (again, i ask: where's the "whew!" icon?)

the best way i've been able to put it is by explaining the stress-tension-pain cycle. you said it yourself: you're stressed, you protect yourself, you hold your body tense and the muscles get shortened and voila! it's the same thing with depression, frustration... something as simple as someone cutting us off in traffic or the computer not working correctly (darn that hacker!) can make us - make our bodies - very tense. the longer we stay in that state, the longer we stay in that state.

you'll be surprised what the mainstream people can accept. i just had an in-depth conversation with one of mine about animal symbolism and the beauty of the predator-prey relationship.

 

[furball123]

i come at this from an opposite approach than you. i just finished school for the second time, and this school is very clinic/protocol based. i had a few brief moments while going through school that i felt i lost the "art" of doing massage. i am actually interested in learning more about how emotions are being stored in the body.

anyway, as far as your questions, i'll answer what i can... i cannot answer to explaining the emotional theory (am interested to see what everyone has to say on that). i can however answer about triggerpoints and what causes them. you are absolutely correct that it varies from person to person AND it usually has to do with stress. the body is out of balance.

these noxious nodules (knots, tight bands, tenderpoints, triggerpoints) can be broadly attributed to factors of negative influences in three general categories:

biomechanical (overuse, misuse, trauma, disuse, congenital, etc.)
biochemical (nutritional deficiency, ischemia, inflammation, toxicity, endocrine imbalance, etc.)
psychosocial (unresolved emotional states, somatization, anxiety, depression, etc.)

also, it is important to remember that as we are whole beings, all of these factors play a part in myofascial dysfunction in varying degrees for each individual. and these factors are incredibly interdependent on each other. (inflammation may lead to disuse. depression may be linked to endocrine imbalances.) the client should consider treating as many factors leading to dysfunction while staying within therapeutic limits.

 

[Kyeraa]

these noxious nodules (knots, tight bands, tenderpoints, triggerpoints) can be broadly attributed to factors of negative influences in three general categories:

biomechanical (overuse, misuse, trauma, disuse, congenital, etc.)
biochemical (nutritional deficiency, ischemia, inflammation, toxicity, endocrine imbalance, etc.)
psychosocial (unresolved emotional states, somatization, anxiety, depression, etc.)

also, it is important to remember that as we are whole beings, all of these factors play a part in myofascial dysfunction in varying degrees for each individual. and these factors are incredibly interdependent on each other. (inflammation may lead to disuse. depression may be linked to endocrine imbalances.) the client should consider treating as many factors leading to dysfunction while staying within therapeutic limits.

My gosh. I sooooo want to steal what you said/how you worded it for a faq on my website!
I'm going to read it and absorb it and try to word it my own way

 

[Sammzie]

My gosh. I sooooo want to steal what you said/how you worded it for a faq on my website!
I'm going to read it and absorb it and try to word it my own way

well, the examples of each category came straight out of my nmt manual. you could word it something like this:

Q: Why do I get "knots" in my muscles?

A: Everybody generally has one or more of three factors that can cause muscle fibers to form "knots". One is biomechanical. This can include poor posture, repetitive use strains, injury, or being born with one leg shorter than the other. Another factor is biochemical which can be affected by nutrition, inflammatory disorder, and many other things including hormonal changes or imbalances. The third factor to take into consideration is the psychosocial connection we have with our own bodies; if we are anxious or nervous, or depressed, or have unresolved emotional states this dysfunction is communicated through our nervous system to our muscles.

i sometimes have a hard time speaking with clients about the physiology of massage without getting too technical, but i think the above breaks it down in a way easy to understand. i learned the term noxious nodule the second time through school, and i just love to use that word instead of knots or crunchies.
well, i am just curious to know what wording you do come up with, but i wouldn't mind if you "steal" some of my words. it's common knowledge, so i don't really think it is stealing, you know?

 

[Taken nme :)]

ccMarie, What is your NMT manual???

 

[A-choo!]

neuromuscular therapy american version by judith delaney

it is basically the nmt routine manual that gets handed out at the beginning of the course, and there is a section at the beginning which they call applications of nmt. it is a brief (imo) overview of the theories behind nmt.

a lot of my instructors referred to clinical applications of neuromuscular therapy by chaitow & delaney. volumes one and two. here's a link:
http://www.leonchaitow.com/neuromuscular.htm#n2

i have not purchased these books yet, as my tuition included travell & simons myofascial pain & dysfunction: the trigger point manual. this is a very useful set of books, but i believe the clinical apps. book is more for therapists, while the travell book seems to be intended for doctors and PTs. i will definitely be buying the clinical apps. books next year.

 

[Orlaigh]

My gosh. I sooooo want to steal what you said/how you worded it for a faq on my website!
I'm going to read it and absorb it and try to word it my own way

well, the examples of each category came straight out of my nmt manual. you could word it something like this:

Q: Why do I get "knots" in my muscles?

A: Everybody generally has one or more of three factors that can cause muscle fibers to form "knots". One is biomechanical. This can include poor posture, repetitive use strains, injury, or being born with one leg shorter than the other. Another factor is biochemical which can be affected by nutrition, inflammatory disorder, and many other things including hormonal changes or imbalances. The third factor to take into consideration is the psychosocial connection we have with our own bodies; if we are anxious or nervous, or depressed, or have unresolved emotional states this dysfunction is communicated through our nervous system to our muscles.

i sometimes have a hard time speaking with clients about the physiology of massage without getting too technical, but i think the above breaks it down in a way easy to understand. i learned the term noxious nodule the second time through school, and i just love to use that word instead of knots or crunchies.
well, i am just curious to know what wording you do come up with, but i wouldn't mind if you "steal" some of my words. it's common knowledge, so i don't really think it is stealing, you know?

Well, I took what you first posted and copied it into word, then went to dictionary.com and copied and pasted the definitons of the words I thought a layperson/client wouldn't really know.
So that's what I'm working with now
Noxious Nodule sounds like a band name, hahha Great term!

 

[Micky C]

Depending on the client and the mood of the session, I either give an explanation simialar to what ccMarie gives, or:

1. Life......chuckle ha, ha.
2. I dunno, I haven't been following you around with a video camera. What do YOU think it's from?

#1 is basically a true answer, short and sweet, for someone that you know isn't going to follow the longer explanation.

I acutally use #2 a lot, and can manage to say it without sounding like a smart-ass. It's a way I use to remind the client that it's theirs, their problem, and help them put some thought and some responsibility into preventing it in the first place as opposed to me fixing it.

Noel

 

[PokerFace.]

My answer is usually that it can be caused by stress, overuse of the muscle or trauma/injury. I don't go into detail since most people want a quick answer to satisfy their curiosity.

 

[mcnally]

I tend to give the client a range of Possible causes which they can consider so that I am not saying for example " your pain is caused by emotional trauma" to someone who is not ready to accept that.

 

[robbinhood]

When it comes to addressing the issue of emotional/stress
related issues, (& how it shows up in the body) I usually address it by relating how I've noticed people, and animals as well, show what is going in with them through their body language.

Anyone who has ever seen an abused animal and reached out to it has seen it shrink away from touch. Anyone who was ever physically injured, (or abused), tends to pull back from someone touching the site of an injury. Sometimes those "injuries" were not all physical, and left behind deep emotional scars. The emotional and mental impact of trauma often get buried so deep that people disassociate from the events & people they don't wish to deal with. Both people & animals have responses which can be involuntary, this is instinctual to us as living beings. It is the survivial instinct which allows for this to occur.

The clients I've worked with are generally in tune enough with their bodies to "get it" when I mention how stress, sadness & grieving, etc. affects the ability to sleep, or to be able to focus on day to day things, as well as how they can't seem to take a deep breath or even that they are breathing shallowly, holding the breath, etc. That said I have one client who has been in a grieving process for years, and yet she has never verbally acknowledged this to me, (and probably not to herself either) But I can see how it affects everything in the way her body is constantly tense & armoured. Sometimes, there is a crack in the armour, but she is quick to cover it, because it is just so painful for her to handle. She will not allow others to know & understand her pain, and I know from what she has shared that she is incredibly private about her thoughts & feelings. She's touched my heart, but she makes it difficult for others to touch hers. There's only so much you can do when it comes to clients like this, and of course it is their process, which we must honor and give them the space in which they will hopefully find their way.

 

[Snowy Betty]

t081 Love your #2 answer seeking equanimity!!!!!!! I use a remark similar to that one myself!!!

When I do give an answer to "what is causing that" I mention the a&p relationship to the work, stress, etc that the client generally undergoes in everyday life. Also, mention the possibility [to them it may be a new concept -- I already understand it] that there may be an emotional component to the problem area as well. If there is a need for more information by the client, we proceed to discuss..... if not, we don't.

It has been my blessing to come to understand from those lovely folks in my practice, that sometimes they just need to ask "a stupid question" [their words, not mine] because they just don't have a way to link cause and effect efficiently within their own frame of reference.

 

[carmenH2-ali]

Sometimes I demonstrate with my hand and I'll explain how "when our muscles hold excess tension it's like when my hand is clenched in a fist. Even if I'm "relaxing" or "asleep" this fist is still shut tight and not useable. Sometimes emotional stress, sometimes poor posture and chronic issues and sometimes an accident or injury. What we want to do is reset this muscle so it will relax, and be flexible again and work properly."

And when I say that part I press on my knucles and uncurl my fingers and slowly open my palm up and the clients all go "ooohhh...." and it's like little lightbulbs that go off in their heads. I've even had clients tell me later when we were working particular difficult or chronic areas that they visual that muscle releasing like my clenched fist relaxed and released and opened up.

Angela

 

[Daniel I]

It's also important to remember to remind a client that they didnt develop these triggerpoints, knots, nodules, etc etc overnight.... that they can't expect them to disappear overnight.