Four Hands Bodywork

Anatomy Mondays: The cruciate ligaments of the knee.

2010-03-15T06:00:00.000-07:00

Welcome to Anatomy Mondays! This is a new feature which will explain anatomical structures in terms that hopefully are accessible to all.

An recent news report points to a recent NFL study about the rate of knees and ankles injuries during games played on turf and games played on grass. The study shows that there is more incidence of ACL (anterior cruciate knee ligament) injuries is significantly higher (88%) on turf than on grass. While the study does not really draw any conclusions on the reasons why (could it be that players wear the wrong kind of shoes on turf for example) and is just as statistical tally, it is interesting to follow the potential developments from it. Specially considering that all the grass playfields in Seattle are being replaced by turf fields.

The main injurie tracked is a rupture, partial or total of the ACL. ACL injuries are al too common if you are a soccer player or an avid skier. But what exactly is the ACL?

Location:

ACL stands for anterior cruciate ligament. It is a ligament deep inside your knee. It at

taches to the front head of the tibia (to be more precise on the anterior intercondylar area of the t

ibia). It runs up and towards the back of the knee to attach to the femur (the large thigh bone).

To be more precise, it runs postero-(towards the back)-supero-(above)-laterally-(towards the outside of) and attaches to the medial (the interior) aspect of the lateral femoral condyle. A condyle is the round bump of a bone where it forms a joint with another bone. In the case of the femur, there are two condyles, one facing the center line of the body (the medial condyle), the other facing the outside of the body (the lateral condyle).

There is another cruciate ligament, the PCL or posterior cruciate ligament. As its name indicates, the PCL is the opposite ligament to the ACL running from the back of the knee towards the front (from the posterior intercondylar area of the tibia, runs anterisuperomedially and attaches to the lateral surface of the medial femoral condyle).

The two ligaments actually cross, forming an X 'inside' the knee.

Function:

The role of the cruciate ligaments is to resist the hold the tibia and the femur together. Without the ligaments, the tibia could move too much towards the front or the back depending on the movement. The reason why the ligaments actually cross is to allow the joint to flex.

The knee is primarily a hinge joint, allowing for flexion (bringing your heel towards your bottom) and extension (bringing your heel away from your bottom). However to allow for faster reaction and for a more even distribution of forces during movement, the knee also allow for a tiny bit of rotation. During a lateral rotation (your foot is turning out), the cruciate ligaments are slacken somewhat, however during a medial rotation (your foot is turning in), they press against each other and become more taut.

The risk for injury is typically greater to the ACL than the PCL. ACL tears are often the result of either:

Hyperextending the knee, that is if the knee is straighten more than 10 degrees past the normal fully straighten position. This injury occurs often during skiing, volleyball, basketball, soccer and football.
Pivoting of the lower leg, particularly inward rotation. This injury is often seen with football, basketball, tennis and soccer.

The treatment for ACL tears is often a long rehabilitation and strengthening program as well as possible reconstructive surgery.

Take care of your knees! It is a complex structure that takes a while to heal.

Illustration taken from the excellent Anatomy of Movement
by Blandine Calais Germain, published by Eastland Press, 1993

Music: Dimunito by Rolf Lislevand et al

2010-03-08T14:57:00.000-08:00

A small departure from my usual world beat playlist, I have discovered Dimunito by Rolf Lislevand. I love medieval and renaissance music and this is absolutely sublime.

Lislevand set out to re-actualize the renaissance practice of embellishing a melody with improvisation. Renaissance artists frequently improvised based on familiar tunes for their audience. This practice shines a very different light on the sound we are used to come from specific instruments. I have never heard a lute sound so modern, almost jazz like.

I highly recommend this album!

Enjoy.

Book Review: Pelvic Power by Eric Fanklin

2010-03-03T13:10:00.000-08:00

Eric Franklin is head of the Franklin Method Institute in Uster, Switzerland and a member of the International Association of Dance Medicine and Science. In short, he is a movement guy :)

The book: "Pelvic Power: mind/body exercises for strength, flexibility, posture and balance for men and women" is a fantastic resource for all interested in the relationship between core strength and health. The book is organized around a series of exercises designed to raise your awareness of core muscles and a discussion of the anatomy and physiology of those muscles.

Franklin uses his intensive knowledge of movement based therapies with a interesting insight on energy based anatomy (qi) to create a fascinating, highly useable manual on one of the most important part of our bodies. I recommend it!

Enjoy...

Would you like fries with that? A comment on prices and massage.

2010-02-22T06:00:00.000-08:00

Regularly I am being asked if the price for my session is for regular work or deep tissue. This is an interesting question. I like to answer it is the price for the session you want or need.

Often when looking at the different options offered by spas, prices differ based on modalities. This is a typical up-selling technique. If you want more than oil spread on you and for the practitioner to really start working with you, you need to pay extra. While this make some sense when selling cars, it is harder to quantify when it comes to services, specially when the service cannot be standardized. And I consider massage to be one of those services. Everybody coming to my office is unique. Each body is different. Each pain pattern, stress pattern, life pattern is unique to every one of us. So it is therefore impossible, in my opinion, to standardize a massage.

Sometime you hear some 'enlightened' spa owner talking about how much harder a deep tissue massage is for the practitioner. While this might be accurate, it is also harder to work with someone who doesn't hydrate enough or is particularly tall or small. And really, how do you quantify what a deep massage is? Depth is one of those interesting metric that everybody talks about but no one can really measure, partly because it is unique to each of us.

Maybe a better metric than duration and depth should be the intent of the session. If you want the great, overall relaxation session, we would use particular payment scale. If you come for help with your back/neck/ankle or other (more treatment oriented session), we would use a different scale. And if you come with a post/pre event related goal (running a marathon or training for the curling event in the olympics) we could use a different scale all together.

Food for thoughts I guess... Any opinions?

Jamie Oliver's talk at TED

2010-02-17T06:00:00.000-08:00

Nutrition as medicine is a concept I believe very strongly in. I am convinced that the best medicine is a combination of diet and movement (to paraphrase Thomas Edison). Alas, it seems we are losing the battle on the diet front.

The need to reform our eating habits is a topic discussed by many people from the scientific community or journalists. This is the first time I hear it coming from a "food" personality.

Jamie Oliver is a British chef better known for his books and TV shows. During his talk at T.E.D. he introduced himself as someone who is trying to save lives. With his typical fast pace and emotional delivery, he is really talking plainly about the need for food education for our kids.

Absolutely a must... Go watch it (it is only 19 minutes)...

Running without shoes? Good or bad for you?

2010-02-15T06:00:00.000-08:00

The latest trend in the running world is to run without shoes. New designs for minimal footwear are coming out from all the major athletic shoe brands along with a plethora of opinions in the media and blogosphere about the benefits or problems with them.

From all the reading I've done on the subject, it seems like the current athletic shoe design and our current way of life shapes the way we have been running lately. The cushioning of the shoe seems to have lull the runner into a false sense of comfort, allowing for a heavier heel strike while running. While running barefoot, the whole foot is used to cushion the impact of the stride, not just the heel. This really how the foot is "designed" to function. In the long run, it seems that running with minimal footwear would minimize the opportunity for injury. There is also a need to learn how to run barefeet. This sounds a little counter intuitive but since we spend most of our lives in shoes (leather coffins as Tom Meyers likes to call them) and we certainly have invested quite some time running with athletic shoes on, it is important to re-learn the proper techniques to absorb the stride with the whole foot. Otherwise, injuries will occur running barefoot or with shoes.

For more information, the Skeletal Biology Lab at Harvard University as devoted a great web site on the topic. Another interesting resource is the web site Running Barefoot which has some good tips and resources.

Keep moving!

A conversation with Dr. Abraham Verghese

2010-02-10T09:52:00.000-08:00

Dr Abraham Verghese, author of "Cutting for Stone" and "My Own Country" is talking to KUOW's Steve Scher about life and the practice of medicine.

This is probably one of the most moving and thoughtful discussion about the practice of medicine I have heard in a very long time. From the need to go beyond the iPatient and the need for hands-on, bedside medicine to the need for reform of the medical education, this talk is an absolute must. One of those moments where radio is not a background noise and makes you stop and listen.

Treat yourself. Listen to it.

Book Review: Overcoming Headaches, a natural approach by Pat Thomas

2010-02-08T12:58:00.000-08:00

Once in a while, a book set on the display tables at my local library catches the corner of my eye. That is where I came across Pat Thomas' book: Overcoming Headaches, a natural approach.

The author lays out some pretty interesting facts about headaches and how to take care of them. She emphasizes the fact that headaches are only the symptoms of an imbalance in one or more body systems (for example in the muscular system or the endocrine system). She also outlines some pretty interesting short term relief ideas as well as the need to keep a log of when headaches happen and in what circumstances (the headache diary concept).

Overall a nice, straightforward treaty of probably one of the most widespread ailment plaguing us. Check it out...

From the Seattle Public Library system.

or from Amazon.com

When to use ice?

2010-02-01T13:07:00.000-08:00

A recent article in Training and Conditioning brought my attention to the use of ice by hands-on therapist. The article in question compares the benefits of Biofreeze, a common ice substitution product manufactured by Performance Health, Inc. (the manufacturers of Thera-band) and actual ice. If you want to read it, check it here (but keep in mind of who actually paid for the research).

A question clients often ask is: "should I ice it?".

The answer is: it depends.

As a rule of thumb when an muscular injury occurs, we need to control the swelling that occurs with tissue damage. The swelling (or edema to be technical) is a natural reaction stemming from the release of serous fluid and blood from the damaged structure. It is important to contain the fluids to prevent adjacent area to be damaged as well by the increase in pressure. To do this, the traditional response to a sprain or a strain in the acute stage (24 to 48 hours after the injury) is R.I.C.E. or Rest, Ice, Compression and Elevation.

The ice constricts blood vessels and lymphatic vessels, helping to slow the release of fluids in the area.

Beyond the acute stage of the injury, ice can help numb the pain but it doesn't really help speeding the healing process. If the area is re-injured (if the rest part of the treatment hasn't been followed :)), icing can help control secondary swelling.

Some precautions need to be applied when working with ice:

do not apply ice to the skin directly: to prevent potential frost damage to the superficial layers of the skin, it is better to wrap the ice in a towel.
do not apply the ice for more than 20 minutes to the same area: this again to prevent frost damage to the skin and superficial tissue.
frozen peas or corn bags make great ice bags than can be reused again and again. Don't eat the vegetables if they have been thawed and refrozen.
Biofreeze or other ice substitution product can also be applied. Carefully wash your hands after application.

I will cover the treatment options for sprains in the February newsletter.

Keep moving!

A passing... Lhasa de Sela

2010-01-27T20:15:00.000-08:00

Music is an important part of my sessions. I truly enjoy sharing my love of world music with my clients during our work together.

Lately, I have been playing the music of a very special artist, Lhasa de Sela. In her own words:

Lhasa's unusual childhood was marked by long periods of nomadic wandering through Mexico and the U.S., with her parents and sisters in the school bus which was their home. During this period the children improvised, both theatrically and musically, performing for their parents on a nightly basis. Lhasa grew up in a world imbued with artistic discovery, far from conventional culture.

This unique background gave her music an unique, bewitching quality. Juggling between French, Spanish and English, her songs have a way to weave themselves around your heart and never let go. I have been playing her first two albums: La Llorna and The Living Road.

Lhasa died after a long battle with breast cancer earlier this year. She will be missed.

To learn more about her visit her web site at http://lhasadesela.com

Enjoy...

The efficiency of 'fitness' video games.

2010-01-20T14:50:00.000-08:00

This morning while indulging in my strongest addiction (listening to NPR), I heard this small segment about the efficiency of fitness oriented video games (such as Wii Fit). To summarize, it is a great way to start moving but it is not enough.

To view the transcript for the story, click here...

Keep moving!

Music: Strings Tradition

2009-12-01T14:59:00.000-08:00

Music plays a big role in my life. The music selection that I play during a massage is not your typical spa music. I like music to be a companion during the session, not solely something to drown out the external noises.

A big part of my music education has been shaped by Western Africa. Sounds and melodies from Senegal, Mali and Mauritania amongst many. I love Farka Toure, Toumani Diabate, Rokia Traore and have shared much of their music with you at one time or another.

Once in a while, music melt into something absolutely phenomenal. When the deep musical tradition of Mali meets the deep musical of South Asia (India and Pakistan), you get a magical, hypnotizing mix.

The album String Traditions combines the Malian Kora from Mamadou Diabate with Sitar, Tabla, Violin and Ghatam to make a most amazing musical journey. I highly, highly recommend it and can't wait to share it with you.

Enjoy!

Book Review: How to Use Herbs, Nutrients & Yoga in Mental Health Care

2009-11-23T10:34:00.000-08:00

Let me start by stating that I am not a mental health specialist. I just love integrative health care solutions. I firmly believe that medicine should first be a combination of diet and exercise but that's another matter.

This book, written by three medical doctors (Richard P. Brown, Patricia L. Gerbard, Philip R. Muskin) is NOT a self-help or self-treatment book. It is a rather technical look on how exercise and a combination of herbal and nutritional changes can dramatically affect the outcome of common health care ailments such as depression, learning disabilities, substance abuses, etc. The authors review the application and potential side effects of complementary and alternative approach through pretty extensive case studies presentation and analysis.

While this book is definitely not for everybody, it is a wonderful addition to the bookshelf of mental health practitioners.

Enjoy.

Anna Deavere Smith on Bill Moyers Journal

2009-11-17T10:25:00.000-08:00

In my list of podcasts subscriptions is the audio version of Bill Moyers Journal which airs first on PBS. The show is a fascinating look at current events from a somewhat different point of view.

Last night I stumbled on a rare gem. Playwright and actress Anna Deavere Smith was the guest of the show. She was invited to talked about her last one-woman show "Let me down easy".

From the show's website:

In the 90 minutes of LET ME DOWN EASY, Anna Deavere Smith becomes 20 people on stage, from a rodeo bullrider to a Buddhist monk, cyclist Lance Armstrong and the late governor of Texas, Ann Richards, each talking about life, illnesses, mortality and the human body. The project began when a doctor asked Smith to lend her talents as an interpreter of real voices and characters to the study of modern health care.

It is truly amazing! I highly recommend it. If you happen to be in NYC for Thanksgiving (the show plays through December 6 at the Second Stage Theatre) or if Anna Deavere Smith takes the show on the road to a city near you do not miss it.

Second Stage Theatre web site: http://www.2st.com/
Bill Moyers Journal: Episode of November 13, 2009

Enjoy!

Contrast Hydrotherapy

2009-11-12T17:17:00.001-08:00

Often enough you will hear me advising using Contrast Hydrotherapy to help decrease inflammation, such as plantar fasciitis or tennis elbow.

Contrast Hydrotherapy is the process of assisting the vascular pump by alternating period of dilation and constriction on an injury using alternating heat and cold.

Let me translate:

When you apply heat to an injured area, you dilate the tissue and draw circulation to it. Apply cold on the same area you constrict the tissue and flush fluids out of it. The greater the difference in temperature between the heat and cold, the greater the effect on local circulation.

How do you do it?

It is best to affect as much of the injured area as possible. For example, in the case of a tennis elbow, it is best to treat the whole forearm.

You can alternate placing the injured tissue in warm and cold water directly, using buckets for example or use hot and cold packs on the area. Hot towels work pretty well for applying heat (soak a hand towel in warm water, wring it then microwave it for a minute. Be careful, the center of the towel will be warmer than the edges.). Bags of frozen peas or corn work well as an ice pack.

The rule of thumb I follow is to use a 2:1 ratio of time for each application. For example, I apply heat for 6 minutes than ice the area for 3 minutes. Pay attention to not burn yourself or freeze the skin.

Repeat the process as much as you have time for. I like to do 3 of 4 applications in one sitting.
Gently stretching during the heating can help.
ALWAYS finish by applying cold, encouraging vasoconstriction instead of congestion.

When to do it?
Do not use Contrast Hydrotherapy on a freshest injury (acute). Use ice at first to contain the swelling. As a rule of thumb, you can start Contrast three days after the initial onset, when the injury is in the subacute phase (when in doubt, consult your primary care physician or bodyworker).
Try using Contrast Hydrotherapy at least once a day.

Try it! It is really powerful.

North End Arts Tour

2009-11-09T16:47:00.001-08:00

Four Hands is proud to support the North End Arts Tour. Dec 4th to 6th, 2009.

This free, self-guided tour showcases the work of 32 local artists at seven north Seattle locations just minutes apart.

A perfect place to look for the perfect gift.

For more information and links to artists' websites, visit www.neatseattle.com

Healthcare, a history.

2009-11-06T11:31:00.000-08:00

The healthcare system of the United States is unique, complex and in need of some reforms. Alas, the debate about what those reforms need to be has been taken over by shouting matches, blame games and scare tactics.

Thankfully Chicago Public Radio's This American Life has created a wonderfully clear and concise explanation of the healthcare system in two episodes.

In my opinion, this is probably the most understandable explanation of the origins of the system, its evolution and its problems. Truly a must!

Episode 1: More is Less: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320
Episode 2: Someone Else's Money: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321

Enjoy!

Blink!

2009-11-05T18:38:00.000-08:00

Mmmm... Looks like I haven't paid much attention to the blog lately... Let's change that...

Not exactly bodywork or massage related but I thought I would share this with you. One of my favorite radio shows is WNYC Radiolab. In their own words:

"Radiolab believes your ears are a portal to another world. Where sound illuminates ideas, and the boundaries blur between science, philosophy, and human experience. Big questions are investigated, tinkered with, and encouraged to grow. Bring your curiosity, and we'll feed it with possibility."

The episode I would like to share with you is called "Blink". It asks a simple question: "Why do we blink?". The answer might surprise you...

Enjoy!

http://blogs.wnyc.org/radiolab/2009/10/05/blink/

Four Hands now accepts credit and debit cards.

2009-02-03T17:18:00.000-08:00

You have been asking for it. So starting February 1st, you can now pay for your session or gift certificates using Visa/Mastercard or Discover. The equipment I have allows the use of your debit card as well. This also means that you can now earn miles (or any other rewards associated with your card) every time you come for a massage!

This Summer, I will update the web site to allow purchase of gift certificates online.

We, of course, continue to accept cash and checks. The updated version of the Payment Policy Document is available on the web site.

Celebrate your Valentine with a little help from Four Hands

2009-02-03T16:00:00.000-08:00

Celebrate that special someone!
Show them that you care!
Offer them a waste free gift!
Give them an opportunity to take care of themselves
Give them a massage!

Gift Certificates for sessions at Four Hands are
only $85 for 90 minutes
or only $72 for a 60 minutes session
(when ordered between Feb. 1 and Feb. 15, 2009)

Yes, you can gift them to yourself :).
Regular prices are $80 for a 60 minutes session and $95 for a 90 minutes session.
For additional volume discounts, please contact me!
Gift certificates do not expire, however, the price per session is only guaranteed for a year. If the price of the session has increased after a year, the certificate bearer might be asked to pay the difference.
Cannot be used with other discounts.

Give the Gift of Massage!

2008-12-08T17:17:00.000-08:00

This Holiday Season, Give a Massage!
with a little help from Four Hands Bodywork & Massage.

This year, how about offering a massage to someone you care about.
Give them a waste-free present.
Give them an opportunity to take care of themselves.
Give them some relief from chronic pain or stress.
Give them some support for that New Year's resolution.

Tell them that you care!

Gift Certificates for sessions at Four Hands
are only $85 for a 90 minutes gift certificate,
or only $72 for a 60 minutes gift certificate!
(when ordered between Dec 1st and Dec 31st, 2008)
(spread the word!)

Happy Thanksgiving!

2008-11-26T12:49:00.000-08:00

Giving Thanks
to my friends and clients for all their support

It is that time of the year. The time to remember and express what you are thankful for. I am very grateful for your continuing support. It has been a fabulous journey so far and I look forward to the path ahead.

A very Happy Thanksgiving to you
and all whom you care for.

Advanced Orthopedic Massage

2008-11-12T17:25:00.000-08:00

In an effort to further my training in more medical-oriented bodywork modalities, I have been pursuing my certification in Advanced Orthopedic Massage with James Waslaski. Now, after almost 6 months of hard work, I am happy to announce that I have achieved this certification.

So what is Advanced Orthopedic Massage?

Advanced Orthopedic Massage (AOM) is a multidisciplinary approach to chronic pain conditions outlined by world-renowned bodyworker James Waslaski. This approach uses a combination of structural integration techniques, deep myofascial techniques and the latest scar management techniques to address complicated conditions such as carpal tunnel syndrome or frozen shoulders (adhesive capsulitis) in a pain free manner. The techniques have been developed using the latest medical research in musculo-skeletal related conditions and fascia.
The techniques used in AOM are many of the myofascial techniques I have used for years. The difference lies in how we approach the injury. You probably have heard me say that I imagine you have one muscle and 600 or so compartments of that muscle. It is referred to as structural bodyworking. AOM adds a balancing element to that equation. When using AOM, we work to balance out the different compartments. For example, if you suffer from carpal tunnel syndrome (CTS), it is likely that the flexor muscles in your arm, the muscles that you use to flex your fingers and your wrist, are more developed than the extensor muscles. The extensor muscles are called the antagonist muscles (or more accurately muscle group) to the flexors. Restoring balance between the flexors and extensors would be the first step needed before we can efficiently address the tenosynovitis, adhesions and the other causes of CTS.
AOM is a more active or engaged style of bodywork. During the session, I use many joint movements and gentle muscle loading to help with scar tissue treatment. While this is always performed in a pain-free manner, it requires a greater participation on your part in the session than the traditional relaxation massage.

AOM results are truly impressive. It is particularly effective in treating frozen shoulders, thoracic outlet syndrome, carpal tunnel syndrome, piriformis (also known as ‘false sciatica’) syndrome, knee problems and plantar fasciitis. Typically, you should see significant results after a couple of sessions. Combined with some gentle stretching exercises, you will be amazed by the results we will get using AOM techniques.

You probably have noticed that I have been using some of these techniques in your session. I am creating a new session format for the more medical-oriented treatments. This will help me better understand your expectations for the session, prepare the self-care exercises for you and give you some additional information about your session that you can share with your other medical providers (ie: primary care provider, physical therapist, or chiropractor).

If you are wondering if Advanced Orthopedic Massage would work for you, feel free to call me or send me an email with your questions.

4 Hands Now on Twitter

2008-11-07T12:05:00.000-08:00

I am excited to announce that you can now follow me at Twitter.

If you don't know Twitter, it is a service that allow you to post short messages about what your status or mood is.

I will use Twitter to publish the availability I have for that particular day as well reminder of current promotions.

Check it out!

Vote!!

2008-11-03T08:49:00.001-08:00

It is time! If you haven't voted yet, tomorrow is your last chance! Rain or shine!

To find the polling station closer to your home, click here.

After having voted, you can get a free cup of coffee at any Starbucks store.

Go Vote!

* the image I use here is from one of my favorite artist, Nikki McClure from Olympia. You can learn more about her work here.

Happy Halloween!

2008-10-30T16:11:00.000-07:00

Well... It is that time of the year again. Every Halloween for the past few years I have been the Gate Keeper at the Stoker Farm's Field of Screams corn maze. It is great fun! If you happen to be around Snohomish around Halloween, come experience the maze. You won't regret it!

Enjoy!

Stress help from 4 Hands...

2008-10-22T16:40:00.000-07:00

Breathe!

Between the plummeting economy, the darkening days of Fall and the constant barrage of election related ‘advertisements, stress is running high.

As our way to bail you out of this gloomy climate, we would like to offer you an opportunity to relax.

All sessions at Four Hands are just
$72 per session
from October 17 to November 17, 2008
(this includes 60 minutes sessions, 90 minutes sessions and one gift certificate per client)

Schedule Now!
and spread the word!

Speaking of sport injuries and women athletes

2008-09-04T17:34:00.000-07:00

This morning NPR Morning Edition ran a piece on the higher rate of injuries in women athletes and the efforts of University of Cincinnati to look for a conclusive prevention training program.

The piece is a nice introduction to Sokolove's book I reviewed a couple of weeks ago. It is nice to see the issue gaining some traction with the media.

You can read or listen to the story at NPR.org.

Keep moving!

Book: Warrior Girls by Michael Sokolove

2008-08-25T17:00:00.000-07:00

While I was lending half an ear to the controversy about the age of the Chinese Olympic female gymnastic team, I discovered a very interesting book about sports injury rates sustained by women athletes.

Michael Sokolove presents a fascinating piece of investigating journalism about an under-reported epidemic; why do women athletes seem to get injured more often than their male counterpart. The numbers are impressive. According to his investigation, young women playing soccer at a competitive level are eight times more likely to rupture their ACL (a stabilizing ligament in the front of the knee) than their male counterparts. The numbers are as high for concussions and other injuries in a wide variety of other sports. The question he asks is why?
Naturally the answer is far from obvious. Sokolove explores the several leads such as the lack of cross-training for young athletes (kids are being pushed to specialized in a single sport as early as grade school), the gruesome schedule they submit themselves to (year-long seasons, playing for school and club teams) and of course the incredible amount of money at stake (from Ivy League college admission selection process to specialized tournament sponsored by the usual suspects).

A good portion of the book is also dedicated on understanding the state of research around female athletes' injuries, particularly when it comes to ruptures of the ACL.

Sokolove never questions if women are capable of the same athletic performances as men, nor does he question the benefits of sports for anybody. His thoughtful and rather thought provoking book challenges the rather obsessive culture we have created about children sport. Reminding us that exercise and sports are not the same thing, the author raises the hypothesis that competitive sports can be detrimental to a healthy body. He relates the story of young soccer players who have their 4th or 5th knee surgery before the age of 20, forced to 'retire' before they leave college with debilitating knee pains.

The book also reminded me of a few injuries I have sustained as a competitive fencer but also of a few injuries I see regularly in my practice. Over-training is definitely a big issue in a society where nuance and moderation are secondary values. I cannot emphasize enough the need for anybody to factor rest time as part of their program whether training for a triathlon or to be a massage therapist.

This book is fascinating and written in a page turning style. I highly recommend it to anybody with children involved in sports (boy or girls) or anyone interested in the socio-economical role sport is playing in our society.

Keep moving!

_________________________
Warrior Girls by Michael Sokolove
Simon & Schuster (June 3, 2008)
ISBN: 978-0743297554

Eco-Centric Practice

2008-08-18T15:12:00.000-07:00

It has been a while since my last entry. It took me longer than I thought to get settled in my new office. But with new beginnings come new opportunities.

Green seems to have become the new black. There is not a day that goes by in the media without talk of carbon footprint, climate change, energy consumption, etc. And it seems that everybody has an opinion about what to do about it.

Living in harmony with my surroundings, my environment has always been high on my priorities list. I constantly try to find the proper balance between my well-being and my impact on the well-being of others; people, animals, plants or minerals.

I am committing to turn Four Hands into a more eco-centric* practice. My vision is to improve the well-being of my clients (that would be you) and to a larger extend the well-being of our planet by reviewing Four Hands operational and business procedures twice a year to assess their environmental impact. With that information, I will improve the procedures to bring them progressively in line with the eco-centric vision. If you have any suggestions or tips, I would love to hear them.
The first priority in this endeavor is to identify how to improve products and processes that ‘touch’ my clients directly. As such I have changed the creams and oils I use in my practice to now only use organic and free of known harmful chemicals (parabens, etc) products. I have chosen the massage crème from Sacred Earth Botanicals (a company based in Eugene, OR) and organic Jojoba oil. I will continue to use Castor oil and to some extend Traumeel Homeapthic Ointment in my practice due to their incredible efficacy.
The biggest environmental impact of a massage practice is without doubt the laundry. I typically wash a load of laundry every day. For sanitary reasons, I do the wash with hot water and dry the sheets, towels and face cradle covers at high temperature. I am fortunate to have a modern, high efficiency commercial washer/dryer set on premise and do use a soy based detergent (Ecos from Earth Friendly Products). While it is difficult to truly evaluate the environmental impact of the laundry, I am signing up with the Seattle Light Green Up! program to offset some of my energy consumption. The Green Up! program offers business and residential City Light customers to purchase a fraction or the entirety of their electricity from green power sources.

In the same vein, I would like to thank you for helping me in this effort. As of today, the 18th of August 2008, I am offering a 10% discount on your session if you have come to the appointment under your own power. That includes walking, running, biking or using public transportation to come my office. Please check my updated Payment Policy document for details.

Keep moving!

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* The term Eco-Centric was first coined by my friend, the fabulous ceramic artist, Randolph Sill. You can check his work at www.madpotter.com

Four Hands is moving... just around the corner

2008-06-05T18:22:00.001-07:00

Dear Friends,

I am thrilled to announce that I have moved my treatment space to a new facility. This bigger space offers plenty of opportunities to continue our work together in a more comfortable setting.

The new space is just around the corner, on 1403 NW 85th. It is in the same building as before. The entrance to the building however is located on 14th Avenue, just around the corner from the pharmacy.

I look forward to seeing you soon.

Olivier;

Pain as a teacher.

2008-05-14T18:24:00.000-07:00

After writing the blog entry about the Spinal disorder seminar, I would like to share some personal experience about back pain.

About 3 months ago, I helped a friend move his fridge down a couple flight of stairs. He was (actually still is) remodeling his house and needed the fridge to be moved to the garage. We carried the fridge on an oversized hand truck down the stairs, him at the top, and me at the bottom. In retrospect, that may not have been the smartest thing in the world to do. Ah well.

On the last step (why does it always have to be the last step?), the fridge fell on my knuckles. In a reflex, I lifted the fridge to free my hands, alas not exactly using proper lifting techniques (and swearing quite a bit as well). The reaction of my back was immediate. I felt a sharp, unbearable pain in my low back. I couldn’t straighten my back. I was bent over, trying to catch my breath and not panic. The latter was easier said than done. Images of slipped discs and debilitating pain flashed before my eyes. I didn’t know if would be able to work again and if yes, how soon. It is pretty much impossible to perform any kind of massage with a back seized up. I cursed myself for being so stupid and for knowing better than to try to lift a whole fridge with my arms.

After I managed to quiet my initial panic reaction (when in doubt, just breathe…), I tried to assess the situation. Movement and heat seemed to help. That is good news. I didn’t feel any shooting pain in my legs, and no numbness or tingling. Another good news. That’s when I remembered that I see many people every week with all sorts of back problems. It is easy to let such intense pain take over your emotional being (at least for me). I have been privileged to witness many amazing recoveries and the amazing healing abilities of the human body. So I calmed down and remembered: I will be alright. I will recover. It might take weeks, months or (shudder) years but I will recover. I will not let the pain take over me, define me, rule over me.
This affirmation changed my outlook on the situation. The pain, the injury became an opportunity, a teacher.

Let me clarify a few things. I do not pretend to a higher ground because of this decision, nor do I think it would work for everybody. I have seen the relentless erosion work that chronic pain can have. I completely understand the feeling of hopelessness that it sometime creates and I don’t think I am actually immune from it. But this pain, although probably the worst I’ve ever felt with the exception of some raging toothaches, was different.

I have been lucky to manage to go through life without ever experiencing serious back injuries. Because of my work, I need to understand the structures and mechanisms involved in a lot of back injuries but until now could not really understand the emotional and psychological ramifications of the pain. I now understand better how profound a back injury can be. Almost all major movements initiate in our core muscles, our low back and lower abdominal muscles, from our lower Dan Tien as referred to by Tai Chi practitioners. When your back hurts, almost every movements of daily life hurt. This can really be distressing. Also, the back is perceived as the strong side of our bodies, our shell. Don’t we turn our back to protect ourselves from a potential blow? The implication of our armor, the strong side of our bodies, our shell to be injured definitely feeds a sense of insecurity, of vulnerability.

This revelation allows me to be a better bodyworker, understanding not only the mechanics of back pain but also its emotional impact on the whole person. After all, it is all connected!
As for my back injury, after about 3 weeks of intensive care by massage, yoga and contrast therapy, it is healed, as expected :).

If you are interested to learn more about the concept of pain as a teacher, I recommend you read “The Gift of Pain” by Paul Brand and Philip Yancey. Check the booklist on my web site for more information.

Surgical and Nonsurgical treatment options for Spine disorders.

2008-05-08T15:38:00.000-07:00

I love Seattle! I really feel blessed to live in an area of the country where we have access to so many resources about healthcare and well-being. One of the resources I recently discovered is the collection of community education seminars put together by the Swedish Medical Center. These seminars are open to the public and almost always free. Check Swedish’s web site for details (http://www.swedish.org/).

Last week, I attended a seminar put together by the Orthopedic Institute about surgical and non-surgical treatment options for Spine disorders. I see a lot of clients complaining about back pain in my practice. I thought it would be quite interesting to hear what orthopedic surgeons' take on the problem was.

The presentation was delivered by Dr. Alexis Falicov, an orthopedic surgeon for Proliance Surgeons. Dr Falicov went through a set of slides describing the basic anatomical structures making up the spine. He then covered some of the traditional symptoms associated with spinal problems and the most common spinals disorders encountered. He then reviewed non operative treatment and prevention options before explaining in detail the different surgical procedures available.

Far from being an advertising for surgery, Dr Falicov really emphasized that surgery should be your last recourse and should not be considered lightly. He mentioned that the United States performs 3 times as many surgeries as other ‘industrialized’ countries, primarily because it is a very lucrative industry (this is probably a good topic for another entry). His message was clear: surgery is a traumatic event for the body and should really be avoided if possible. This is definitely a message I agree with.

The section about nonoperative treatment options and prevention methods was particularly interesting to me.
The prevention message was clear: exercise is the fountain of youth when it comes to your spine. Flexibility and conditioning training such as yoga and Pilates are amongst the best thing you can do to maintain a healthy back. Also critically important is the use proper lifting techniques.
One statistic worth repeating was that 90 to 95% of all back problems can be treated without surgery. The secret: patience! It may take months and sometime years for the symptoms to completely disappear. Also, most back pains are a result of muscular problems along the spine which surgery will not help. Massage therefore can help a lot!

Dr Falicov’s approach to spine problems is rather simple: plenty of prevention, 48 to 72 hours of rest after a flair, use of heat and ice to calm to muscle spasms (or what I call contrast therapy), patience, the use of over the counter medications (if it cannot be avoided) and talking to your primary care physician.

It was also interesting to hear him talk about the use of corticosteroids injections. He said that the injection’s primary role is to hide the pain, not to accelerate the healing. The healing speed is the same with or without the injection. What changes is the patient’s comfort level.
When surgery is the only option, Dr Falicov outlined some general principles to remember:
· Arm and leg pain are more often relieved than neck and back pain
· Pain and weakness respond better to treatment than numbness
· Surgery is a physical stress and trauma to the body
· Psychosocial stressors dramatically modify pain and do not respond well to surgery (ie: if you are under a lot of stress at the moment, chances are it is the cause of your pain).
· It is difficult to restore motion. You more than likely sacrifice motion in the back to regain function in the limbs.

Another interesting fact I learned during the seminar is nerves actually can regrow. The process is extremely slow (about 1mm per day) and the recovery is rarely complete.

I highly recommend those seminars. They are truly a wonderful resource to help us take ownership of our health!

Thoughts about treadmills and TVs.

2008-04-15T23:00:00.000-07:00

With spring upon us, some of us are looking forward to trade the monotony of indoor training sessions for the feeling of the wind on our faces and the joy of running on pavement again.
I work with a few runners in my practice. Some of them enjoy running as a way to keep their fitness level while others enjoy the challenge of endurance running. I can usually tell if a client is a runner. Tight IT bands, tibialis anteriors and glutes are some of the tell-tale signs betraying their addiction.

This winter I have worked with a few of runners complaining about some different pain patterns. The pain was generally unilateral (only on one side of their body), located on the side of the hip, low-back or knee. The other interesting variable was that the pain was only present while using a treadmill. During the massage, I did notice some tension around the external rotators of the hip and the Lats. This is a rather unusual pattern for a runner, at least in my experience. The tension seemed to indicate torsion in the hips and the upper body while running.
The common environmental factor to all these cases was the position of the TV monitors. While trying to break the monotony of the run, a lot of people watch TV while on a treadmill. Interestingly, if the TV is not directly in front of the machine, we naturally turn our heads and to some extend our shoulders and torso towards the screen. Our hips however continue to face forward to allow us to run on the belt. This is the torsion I noticed during the massage. In my opinion, that torsion creates a slight stress on the hip rotators which could explain the pain pattern. During a run outdoors, we never maintain our upper body in a rotation for very long. And since we tend to be creatures of habit, it is not unusual to always use the same treadmill at the gym. This could explain why the pain is always on one side.

So, when running (or walking) on a treadmill while watching TV, try to have the screen straight in front of you. And if that’s not possible, try to alternate which machine you use or which screen you’re looking at.

Have fun!