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

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

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?

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

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

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?

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!