“I keep getting that deeeeeep pain in the rear!” my client says. “I can’t seem to stretch where it hurts.”
Can you relate? But what is it?
Your butt? Sciatica? Or something else?
The most common culprit is piriformis syndrome.
The piriformis is a small, pizza-slice-shaped muscle that lies deep under the gluteus maximus and controls external rotation of the hip and stabilization of the pelvis.
It can be a real pain in the butt.
It can cause symptoms like pain, numbness, burning, and tingling (which could extend all the way from the hip to the toes).
Many of the people I see with this pain, have been told by their doctor (or Dr. Google) that they have sciatica, when it's often piriformis syndrome.
Both the pinching of the sciatic nerve by vertebrae in the spine (sciatica) or the compression of the sciatic nerve by a tight piriformis muscle in the butt (piriformis syndrome) can cause pain to radiate up into the back or down the leg. As a result, most people--even doctors--associate it with sciatica. Symptoms can overlap, and medically it may be kind of a ‘same difference’ situation, but it does matter in regard to massage treatment.
The major difference between sciatica or piriformis syndrome is where the compression occurs.
Sciatica is pain resulting from compression of the nerve at the lumbar vertebrae in the spine. This can be caused by spinal rotation, vertebral disc compression or asymmetrical pelvic rotation and usually, but not always, sends pain, tingling and numbness down the entire length of the leg. In many cases of sciatica, there will also be pain in the buttocks.
Piriformis syndrome is caused when the piriformis muscle, which lies on top of the sciatic nerve, gets too tight and spasms, causing it to compress the sciatic nerve, like a kink in a garden hose. Pain is often centered in the middle of the butt (glutes) and can be tender to the touch and/or painful when sitting. In some cases, the spasm will occur in the glute.
What causes the piriformis to tighten up?
Excessive amounts of sitting - This can cause the piriformis to stretch and compress the sciatic nerve. Also, it can cause pelvic instability because the glutes, piriformis and other muscles become underactive. This can lead to the muscle going into spasm when asked to suddenly perform a strenuous activity such as running. You're asking it to perform under stress (running) when it's not prepared to. Kind of like a pop-quiz.
Excessive internal rotation of the femur - When your foot turns in like a pigeon this is internal rotation, and it causes the piriformis to lengthen. The piriformis is an EX-ternal hip rotator, so excessive internal rotation will cause it to lengthen too much and over time become overactive trying to hold that lengthened position. This often leads to trigger points and overly tight (hypertonic) muscle fibers.
Poor pelvic floor/core control - Having a strong pelvic floor and core stability is not necessarily having 6-pack abs. If you're a runner or dancer, core stability is a must to reduce the risk of many types of athletic injuries. A weak core causes other muscle groups to pick up the slack, which causes them to work harder and will eventually lead to fatigue and overactivity.
Additionally, piriformis dysfunction also often results in tight inner thigh muscles (adductors).
Your physician or physical therapist should be able to assess and differentiate between true sciatica and piriformis syndrome and give you an official diagnosis. As a massage therapist, I can’t diagnose, but we can work together to solve the issue regardless of an official diagnosis.
Treating Piriformis Syndrome - Luckily, piriformis syndrome is relatively easy to treat, in most cases. Here are 4 simple and effective ways you can get rid of piriformis syndrome.
Ice - sitting on a bag of frozen peas can help to reduce inflammation and swelling, which in turn can take some pressure off the nerve. Just remember not to overdo it. Inflammation is your body's way of healing, so a little inflammation is a good thing.
Stretching - One of my favorite yoga stretches for the piriformis is pigeon pose (modify to suit your body's ability; don't try to go any deeper than you can tolerate). This effective pose will target not only the piriformis, but the glutes and deep hip rotators. However, if your piriformis is tight because of too much internal rotation, it’s far better to stretch the inner thigh (adductors) to take some stress off the piriformis.
Foam rolling - Using a foam roller, ball, or other tools to target trigger points of the muscle or relieve stress on the attachment points at the sacrum or the top of the thigh bone (greater trochanter of the femur) can help relieve pressure on the nerve as well.
Be sure to use the correct tool for rolling. I often have clients use lacrosse balls, which is a very hard tool. However, more pressure is not always better. "No pain, no gain" is the wrong motto here. A tennis ball might be more appropriate, especially at first.
Like massage, you need to work within your body's pain tolerance level and work with your nervous system. You also only need 30-60 seconds of sustained pressure to get relief. More or longer pressure can make an already irritated muscle worse and can cause issues up to and including nerve damage. Meet your body where it's at.
One more thing: you also want to be careful not to accidentally compress the nerve yourself.
If you're unsure of how to use a tool, just ask, I'll be more than happy to give you a demonstration.
Massage - If stretching and foam rolling isn’t enough or you just don't want to do the DIY method, it might be time to see a professional. A licensed or certified massage therapist has the dexterity and training to get into areas a foam roller cannot or help stretch you in ways you may not be able to do alone.
If you're ready to take that step, you can book your next appointment here.
Once the soft tissue dysfunction is removed, strengthening the glutes, core, and hip flexors is recommended for lasting results. A corrective exercise specialist, personal trainer, or physical therapist may be able to help with specific exercises to strengthen weak muscles to keep the problem from returning.
Have you ever experienced numbness and tingling in the arm or even into the hand, and your doctor has ruled out carpal tunnel? Believe it or not, the issue might not actually be in your hand or wrist; it could be Thoracic Outlet Syndrome (TOS).
The thoracic outlet is a narrow space between your collarbone and the top of your first rib. Muscles, nerves, and blood vessels run through that opening or “tunnel.”
When the tunnel becomes blocked, it can cause dysfunction in the nerves and other structures that run through it.
There are 3 types of thoracic outlet syndrome: neurogenic, venous, and arterial. The latter two are sometimes grouped together and referred to as vascular TOS. Although vascular TOS is rare, it can be very serious. It can be caused by a blood clot or aneurysm in the veins or arteries beneath the collarbone. It’s generally safest to get a diagnosis from a physician or physical therapist to rule out vascular TOS before seeking massage as treatment, as massage could cause more harm.
If you experience any of the following symptoms, consult your primary care doctor immediately:
Okay, disclaimers over. You still with me? :P
The third type (neurogenic TOS) can be treated with massage, is the most common, and will be what we are actually discussing.
Neurogenic TOS affects the bundle of nerves called the brachial plexus (see images). These are nerves that come from your spinal cord at the cervical (neck) spine and lead from the neck down to the arm. When muscles in the neck and shoulder become too tight and impinge (clamp down) on the brachial plexus, this can cause pain in the neck, shoulder, and/or arm. It also can often cause tingling, numbness, and even weakness. This is why it’s quite commonly misdiagnosed as carpal tunnel syndrome. Symptoms can be consistent or they can come and go. They are usually worse when arms are raised above the head, raised in an upward position for too long, or when sleeping on the shoulder of the affected arm.
What causes TOS?
The causes of TOS often vary. It can be a result of a traumatic injury like whiplash, or from overdeveloped muscles from something like bodybuilding. It can also very commonly be from repetitive movements or a certain posture from a job or hobby. This would be especially so if the activity causes a person’s head to come forward excessively, causes their shoulder to roll forward, or requires them to have their arms over their head a lot. And weirdly and frustratingly to some, TOS can also have no known cause or origin at all.
Hairdressers, auto mechanics, carpenters, plumbers, and health care workers are some of the many professions more likely to develop TOS than others, simply due to the body mechanics required to perform their job. Individuals who work on computers for long periods, housekeepers, and people who enjoy hobbies like swimming or painting can also develop TOS. Even carrying a heavy shoulder bag, purse or briefcase over a long period can result in someone developing TOS.
A structural anomaly like an extra rib can also be a contributing factor.
So, can massage help?
Yes, maybe, probably. (I know, super helpful.)
In all honestly, it really depends on if the TOS is caused by a structural or functional anomaly.
If the TOS is caused by a structural anomaly such as subluxations (that's when a joint is slightly out of alignment) in the cervical spine, or from an extra rib, it’s best to consult a physical therapist, chiropractor, or osteopath to free up a cervical spine impingement first. Addressing both structural and functional causes of TOS can provide much better and longer term relief.
If the TOS is caused by a functional anomaly such as tight neck muscles, overuse, or positional and postural issues, massage techniques that target trigger points can help relieve muscle tension (like trigger point therapy and myofascial release), and reduce or eliminate muscle-related nerve impingement. Other techniques that can be used are gentle stretching and passive range-of-motion movements, and can help restore full movement to the area. These are all techniques I can provide as a massage therapist.
How do you keep TOS from coming back?
Unfortunately, short of a career change or new hobby, those with TOS may experience recurring symptoms if causes remain unaddressed, such as tight muscles, repetitive movement, or poor posture between sessions.
Self massage with myofascial trigger point release, followed by gentle stretching, are great exercises to help manage TOS between sessions. I can teach you how to do this if you'd like.
I highly recommend using a tool like a Theracane or a tennis or lacrosse ball against the wall or lying on the floor can help release tension by targeting specific tender spots in the muscle tissue. Your massage therapist (it's me, hi!) can help identify which muscles you should focus on and show you how to do the exercise correctly. There's a lot going on in this part of the body, and you don’t want to risk further nerve damage or damage to veins and arteries.
Remember, just because it feels good doesn’t mean you need to dig in deeper; you might actually be doing more damage this way.
Consulting a physical therapist for strengthening exercises to improve your posture will also help.
Thoracic Outlet Syndrome doesn’t have to stop you from doing things you enjoy!
If you would like to see if massage can help relieve your TOS-related pain, you can book an appointment with me by clicking here.
An estimated 45 million Americans complain of headaches annually, which makes it the most common complaint or symptom in medicine today. The pain can range from mild annoyance to a debilitating migraine that feels like someone stuck an ice pick through your brain. Additionally, headaches can interfere with productivity, concentration, and overall quality of life.
When you have a headache, it can be hard to function normally until you find relief. But treatments vary from myths and anecdotes to medical facts, and it's difficult to know which techniques are actually helpful. Not every remedy works on every type of headache. Let's look at the different types of headaches and treatments available, including massage. Before we take a look at the most common types of headaches including tension, sinus, migraine, dehydration, cluster, injury and medication-induced headaches, I want to highlight the fact that is some cases headaches can be the result of a more serious issue (such as an aneurysm, stroke or high, uncontrolled blood pressure).
Tension Headaches - As the name suggests, tension headaches are the result of holding tension in your body. Holding stress in your shoulders, clenching your jaw or grinding your teeth, and spending too much time staring at a computer screen or a smart phone can all lead to tension headaches. Tension headaches mainly occur in the temples or the forehead and often feel like a vice grip around your head. They range from mild to severe and are most commonly treated with over-the-counter medication, such as ibuprofen or acetaminophen.
Sinus Headaches - Nasal congestion and inflammation from allergies or sinusitis can cause your nasal passages to swell. This blocks the nasal cavity and prevents mucus from being able to drain. Sinus headaches are generally located in the front of the face, between your eyes and/or cheekbones. Taking an antihistamine or other allergy medication for allergy induced sinus headaches can help prevent them from occurring. Mild sinus headaches that result from a sinus infection can sometimes be cleared up by rinsing your nasal passage using a neti-pot or saline rinse. More severe sinus infections will require antibiotics and possibly OTC pain medication.
Migraines - Typically occurring on one side of the head, migraines affect approximately 35 million people in the US. Symptoms include pulsing, and can be accompanied by nausea, dizziness, sensitivity to light and/or sound, and hallucinations (like auras or halos). Some people experience migraines only rarely, while other people experience them on an near daily basis. These types of headaches can be debilitating and most likely to interfere with quality of life. Mild migraine headaches can sometimes be managed with NSAIDS (Non-steroidal Anti-inflammatory Drugs) while more moderate and severe migraines might require prescription medication. Botox is another treatment option that has been proven effective in clinical trials. However, it is best to consult your doctor before deciding if this is the best treatment option for you.
Cluster - As the name suggests, these headaches usually happen in clusters or cyclical periods ranging from weeks to months, followed by long periods of remission. Cluster headaches usually present as pain around or behind the eye that can often wake you up in the middle of the night. During an episode, cluster headaches will occur daily or sometimes multiple times a day and can last from 15 minutes to 3 hours. Due to the rapid and intense onset of this type of headache, you may feel exhausted once the headache has disappeared. Treatment options for cluster headaches include prescription medication, injectables such as Botox and oxygen therapy.
Secondary Headaches - These are not conditions themselves, but symptoms of other conditions. Secondary headaches can be the result of dehydration, medication or caffeine misuse/overuse, head injury, or illness such as pink-eye (conjunctivitis) and meningitis. Pain from secondary headaches can successfully be managed with NSAIDs. However it's important to focus on getting the appropriate medical treatment for any underlying condition.
Can Massage Help?
Tension headaches, the type of headaches people are most likely to experience, seem to respond well to massage therapy. Not only does massage often seem to reduce pain in the moment, but consistent massage therapy also appears to increase the amount of time between headaches for those who experience them on a chronic basis. This may be a result of helping to manage stress. Or it may be that it helps resolve the underlying mechanical issues resulting in headaches. There's no solid science yet on precisely why massage helps; only that it does.
More good news! It probably doesn't surprise anyone that people who experience regular headaches are also more likely to experience high levels of stress, depression, and anxiety. Studies have found that massage can help with these issues, not just for the general population, but also specifically for people who live with chronic headaches.
Some people with secondary headaches can also benefit from massage. Those with fibromyalgia, for example, who often experience headaches as part of their condition, can experience both pain and stress relief with regular massage therapy. While massage during a flare-up of symptoms may need to be modified to be more gentle, some people find that it can provide relief for headaches, as well as for pain throughout the body.
Massage therapy is wonderful and often helpful, but it's not a cure for headaches. While some people just need a bit of rest or a drink of water (dehydration is a surprisingly common cause of headaches), other people continue to experience headaches their whole lives. While people who experience headaches caused by stress or muscular tension can and will absolutely benefit from massage, migraines triggered by things like foods or hormonal changes probably won't notice any effect.
There are some times when getting a massage for headaches is more than just unhelpful, it's actually dangerous. Most often, this will be related to secondary headaches. Fevers, for example, often cause headaches as well as achy joints. While this could lead someone to want to receive massage, it not only risks overly stressing a body that's already fighting off an infection, but it also has the possibility of spreading the illness to the massage therapist and anyone else they come into contact with. Another example, such as headaches resulting from a recent head, neck, or back injury could also be made worse by a well-meaning massage therapist.
When there is the possibility of pain being caused by an illness or injury, it's best to seek out a physician's opinion first. They can provide or recommend appropriate care for the issue causing the headache in the first place, and at that point you can ask them about whether it would be okay to receive a massage. It's always better to be safe than sorry!
While we massage therapists are still exploring the use and efficacy of techniques like trigger point therapy and myofascial work for tension headaches, many people find the results are worth paying a professional. And even if massage does not help your headaches, you might find that the soothing experience of a massage is a nice tradeoff while you seek other headache relief.
If you are ready to schedule a session with me, click here.
Below is a video of me demonstrating a qigong neck stretch that may help with some tension headaches.
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
I have been practicing massage therapy for 11 years now. I’ve been reflecting on what initially drew me to this practice and why I love doing it. The profoundness I find in this work is both humbling and empowering. In hopes of connecting with you a bit more, I want to share some of these insights.
So why do I do this work?
It gives me purpose
I know what it's like to struggle with chronic pain and discomfort. It depletes your energy and gets in the way of daily living and as a massage therapist, I want to help my clients in alleviating their pain. This process of helping my clients with pain management and stress relief gives me great purpose.
I like to use my hands
I always knew that I was a tactile person that enjoyed using my hands. As an active person drawn to movement and touch, I find massage incredibly grounding and centering. I also enjoy using the power of touch to calm the nervous system and help my clients feel grounded as well.
There is a touch deficiency in the world
I can feel around me that our society is touch deprived and I believe that massage can offer a safe and therapeutic space to address that. Through massage I am able to process my own touch deficiency and hopefully help others that deal with this in a professional setting.
I like puzzles and mysteries
When I work with a client, it's a bit like solving a puzzle as I learn what their body needs to feel its best. This intuitive problem solving aspect of massage is stimulating and exciting to me. Massage at its best, is a collaborative process where I help my clients find solutions to recurring issues in the body.
I do well in small group settings, and best in one on one
As someone with ADHD, I’ve always preferred one on one connections over being in large groups. Massage allows me to focus on a single client and purpose: helping them feel better in their body. This is another reason why I love massage, it provides me with focused work and allows me to build impactful relationships with my clients.
I am a muscle geek
As a kid, I was fascinated by anatomy and science. To this day, I am constantly seeking to learn more about the human body and how to best tend to it. Learning new massage techniques is something I take great pleasure in and I’ve studied trigger point, myofascial release, sport massage and prenatal massage. I am in the process of learning more about oncology massage and lymphatic massage.
I am really good at it
Developing my massage skills over the past 11 years has allowed me to help numerous people. Every time someone leaves a session feeling relieved and more comfortable in their body, it gives me added motivation to continue my work.
I know that I’m a talented massage therapist and using my skills to help others brings me incredible joy and happiness. I look forward to sharing my skills and passion with you.
For most people, money is the biggest obstacle to getting regular massage. We don’t like to talk about money, it’s supposed to be a private issue. But I’m going to address it head on. Regular massage is a considerable budget item, and it’s important to acknowledge that.
If I expect you to jiggle the numbers and budget $130 for a massage every week, month, or quarter, it’s my job to tell you what you’re buying. So here it is, what you get from a 1 hour, $130 massage.
Clarity in Pricing
What I charge is clearly listed here.
Gratuity is accepted and appreciated, but not required.
A Full Hour
1 hour = 60 minutes. The clock doesn’t start until I walk in the room and lay my hands.
That’s not the case for every business. Massage Envy’s hour is 50 minutes. Elements gives you 55 minutes.
Even some spas and chiropractic centers operate on a 50-minute hour. But in my office, 30, 60, 90, and 120 minute treatments last exactly as long as indicated. (Unless you’re late, then I may have to adjust accordingly.)
Ease of Scheduling
Scheduling tends to be the second biggest obstacle to getting regular massage. We never think of scheduling massage at a time that is actually convenient to call. I take all that out of the equation to make it easier for both of us. No phone tag. No waiting for a message reply.
You can schedule with me online right here.
You get my full and undivided attention. For a whole hour, you are center of the universe - the star! You are the reason we’re in the room.
Need silence? You got it!
Want me to spend the full hour on your feet? Absolutely!
Music request? Sure!
Extra pillow? No problem!
You get your own full attention. No phone. No demands. Just you.
I’ve had 10 years of practice and hours of continuing education. They were all just prep for your massage.
I know how to work with fascia in the traps, scalenes, and occipitals to relieve tension headaches. I know how to release a hypertonic subscapularis muscle that is causing arm and shoulder pain and tingling in the fingers. I have trigger point techniques for back pain caused by tight hips muscles. I could go on, but you get the picture.
I won’t practice any techniques that are unsafe for you and your health condition.
I will not use joint movements if you have Ehlers-Danlos Syndrome. I will use safe pressure around your spine if you have degerative disc disease. I will not use deep pressure in any particularly swollen area, because I do not want to cause damage to your lymph system. And if I see any signs of deep vein thrombosis, I will avoid that area and inform you immediately and encourage you to get it checked it asap.
I’ll say it again. I won’t practice any techniques that are unsafe for you and your health condition.
There are plenty of massage therapists offering discounted massage, operating under the radar.
If a therapist is operating without all the proper licenses, their insurance will be voided in the event of a claim. That can be super scary.
You can check my certification anytime with California Massage Therapy Council (CAMTC).
I have and keep liability insurance coverage through ABMP (Associated Bodywork & Massage Professionals) with Allied Professionals.
High-quality massage oil
I only use the best products on your skin. I use first-pressed jojoba, and it’s not exactly an oil. It’s an ester that is very similar to our naturally produced sebum. It is non-comedogenic, so it will not clog your pores. And it is hypoallergenic, so no worries if you have any topical allergies.
You get to support a small local business
It’s just me! No conglomerate. No fancy management structure or corporate set up. Just a little business owner, paying her taxes, making a living, and participating in the same communities she serves. When you pay $130 for a massage with me, you know that money is staying in the local economy.
All that, from a $130 massage. :)
A massage is generally intended to be a calm and relaxing experience. However, if it’s your first massage, you may feel a little apprehensive.
Let me help with that uncertainty by sharing some information about what to expect. You’ll be able to walk into your first massage feeling confident!
When you book your appointment, you’ll fill out an intake form including information about yourself, your health history, and what your body may experience on a daily basis. Your clear and honest answers will help me perform the best massage possible for you.
Expect several questions at your first massage appointment. I may need to know a little bit more about your health history.
We’ll also talk about why you’re coming in for a massage and what your goals are for the session. Are you having pain? Do you need to relax?
I’ll show you the massage room and walk you through the process. We’ll decide what to prioritize and how you should lay on the table (face up or face down, or on your side) before the massage.
Expect to Dress or Undress to Your Level of Comfort
What does that mean exactly? Many people worry about having to be undressed for their massage. Most massage techniques are traditionally performed with the client unclothed; however, what you wear is entirely up to you. Simply put: you can leave your underwear on or take them off.
I’ll leave the room so you can undress, get on the massage table (it’s super cozy), and get comfortable under the sheet & blanket.
Movies and TV shows often show massage clients naked on a table with just a tiny towel for draping, and that is rarely what real massage draping looks like. I use sheets that cover your whole body. You’ll stay covered throughout the massage, I’ll only undrape the part of your body that I am massaging right then.
Expect More Communication
When I come back into the room, I’ll help you get comfortable by adjusting or adding pillows or bolsters. I will ask about the temperature of the table and ask if you’d like the warmer turned up or down. Don’t be afraid to adjust and fidget as needed during the massage to stay comfy.
It’s awesome if you can let your body relax and sink into the table. If I need to move your arms or legs, etc, I prefer to do the work! This takes practice, and you’ll probably try to help me. And I’ll try to remind you. ;)
It’s really important for you to tell me if any massage techniques I use cause pain. Pain is not okay.
There is likely to be a certain level of discomfort and ‘hurts-so-good’ sensation if we’re working on a problem area. And it’s important that you tell me about that, too, so we can tailor the massage to be most effective without causing injury.
I’ll check in with you as we go, but please speak up if you get too warm or too cold, if the face cradle needs adjusting, if you are not comfortable on the table, if you need another pillow, or if you just hate the music! (I do take music requests)
I’ll let you know when the massage is over and then leave the room so you can slowly get up and dressed.
Expect Some Final Instructions
Depending of the kind of work we did, you should generally expect to feel mellow and relaxed after your massage. You may also feel like you can move a little easier. We’ll talk about how you feel and I may show you some self care stretches or share some tips to keep you feeling great between appointments. If you’d like, we can also talk about how frequently you may want to get massage to keep on feeling great.
If we addressed pain issues, you may immediately feel a decrease in pain, or it might take a day or two before you feel that relief.
You’ve already made the first step in making the most of your first massage by learning what to expect. Next, when you come in, you can ask all the questions you like! That way we can make sure you feel comfortable before, during, and after the session.
See you at your first massage! :)