SIMON JAMES - Registered Massage Therapist - Victoria, B.C.

I just returned from Vancouver where I took my level 2 course for Visceral Manipulation. As I’ve mentioned before in an earlier post, Visceral Manipulation is a therapy that is concerned with maintaining proper motility of the organs. Organs can become stuck to other organs, to surrounding structural tissue, to muscles to name a few. Motility is important with organs so that they are able to function properly. The organs I work with are the liver, the stomach, large intestine, gall bladder, bladder, uterus and also includes the lungs and diaphragm. In addition to these structures are some very important valves with the digestive system. These include the valves between the stomach and small intestine, small and large intestine, liver and pancreas to the small intestine. These are important as they control movement of food and digestive enzymes during digestion. The valve can be stuck open releasing too much through at once, or stuck in a closed position not letting adequate amounts through. Breathing and digestion is really important so it makes sense to make sure that all the hardware involved is free to move so they can do their thing.

Okay, so I’m using the “my voice has left me” analogy to physical rehab again. I went to the Music Conservatory to practice, feeling like I now have a singing voice 7 weeks after first coming down with a bout of Bronchitis. I like comparing this with having a physical injury in the sense that you need to back off during the time that your voice or muscles are healing themselves, and how difficult it is to do this.  As I mentioned before, I had my first good sing and during this time, I have been singing a little bit here and there, but as my teacher said, having 1/2 a voice really makes you really focus on technique. It’s almost like you are starting over, and with 1/2 a voice, if you don’t use perfect technique, it can really harm your voice. Now that the voice is pretty much back, it sounds better than it has for quite a while. I can thank that to my Bronchitis and how careful I had to be during that. That’s irony for you. This is similar to physical injury in that during the time of injury, it is a perfect time to 1) slowly return to injury and 2) to fine tune your activity and re-educate your body to do this correctly to avoid re-injury in the future. 

So the tail end of my bout with bronchitis seems to be carrying on and on. I guess the hardest part of getting back to singing is how much do I do? When I start out, I get really good resonance and volume but it’s still seems to be declining after 20 minutes or so. I have an appointment with a Ear/Nose/Throat guy on May 6, which seems to be an eternity away, to see if there is anything structurally that I need to be concerned about. My immediate guess is that there isn’t anything structurally wrong (like nodes on the vocal chords and such) as I get good clarity for at least the first 20 minutes of singing, but that there is still a little bit of swelling and irritation that will take a bit of time to go away. It would be great to have an idea as to when this will be over as I’ve had to cancel my recital in May and would love to reschedule for sometime soon. The waiting is making me crazy as singing is such an important part of my life and something that I really love to do. The vocal chords are such a delicate structure that I guess I should be on the side of caution. I’m doing lots of good stuff like Licorice Teas (really good for the throat), water, salt water gargles to reduce the swelling and Slippery Elm lozengers that are really good for the throat. 

My post heart surgery is at month 9 and I’m really picking up with activity again and everything seems to feel great and back to normal. There is nothing different that I’m doing that would be different from someone that hadn’t had the surgery so it’s almost like nothing happened. I’m glad that I got the tissue valve replacement as opposed to the mechanical valve. My surgeon was saying that there really is no proof that one lasts longer than another. Any history with tissue valve and it’s life seems to be always outdated as the improvements in tissue heart valves are continuous. The mechanical valve would have meant that I would have had to take blood thinners everyday and that would have dramatically reduced my ability to throw myself down a mountain with my bike. Blood thinners essentially make you a borderline hemopheliac so you have to be careful even with simple stuff like cutting yourself shaving, never mind falling and bruising. If you are having valve surgery in the near future, think about the tissue valve and get lots of opinions on both types of valves so you can do what is best for you.  

I’m a big fan of stretching every day and pre and post exercises. There are a couple of aspects to stretching that is important to remember. I believe that a stretch should be done over a period of minutes and do not need to be intense to be effective. Stretching to me is similar to stretching leather. If you stretch it intensely for a short period of time, the leather will bounce back to it’s original length. When you are stretching, you are of course mechanically stretching the tissue but there is another important thing that you are doing as well. In every muscle cell and joint, there are receptors that monitor stretch and position and send that information back to the brain. The more time that you stretch, the more information is sent to the brain relaying information that the muscle in that stretched position is actually okay and there is no need for any protective spasm if the muscle is put in that position again during activity. Spasm can be annoying and unnecessary spasm can be reduced with a good long stretch and is gentle and not painful. Half of the intensity for twice as long is a good rule of thumb that I like during training. 

Speaking of training, when you stretch after an intense workout, it is doubly important to keep the stretch long and gentle. A good warm up and cool down is very important as well. The muscles are, for lack of a better analogy, hung over. They are tired and dehydrated. It’s like partying with your friend and when he’s sleeping and hungover, grabbing him and yanking him out of bed. Do you think he might be a bit annoyed? You need to ease him out of bed just like you need to ease your muscles while stretching them after a workout. 

Be nice to your muscles. After a work out simply squeezing your muscles repeated is good as well as it sends lots of blood there to pick up metabolic waste to be eliminated from your body which will help to reduce pain and fatigue and also help to repair any muscle tissue that may be damaged during the workout.

As a singer, the job is to get as much air into your lungs with as little rigidity as possible. The more rigid you are, the less the sound can resonate, the harder you have to try to make more sound. What you want to try to do is to breath at the bottom of your abdomen, allowing your abdomen to expand to the front, side and back. What you try not to do is to expand your upper chest and more importantly not to allow your shoulders to rise. Having the shoulders rise causes tightness in the neck and around the throat. So, here I am, trying to breath in the correct manner. I’m getting lots of expansion out front and side but just not getting much expansion in the back. I discovered that my posture was very much contributing to this. I have been a victim of the “swayback” posture, and this compresses your lower back making it very difficult to expand. As soon as I tried a bit of a pelvic tilt and was able to expand my lower back much easier. 

The irony is singing is that the less “intense” you are physically, the better, more resonant sound you will get. 

I picked up a little bug that was going around that included a lovely flu symptom for a couple of days and now what seems to be a continuous cough that seems to just goes on and on. I’m taking classical voice at the Music Conservatory and just discussing this with my teacher. She has told me that I shouldn’t sing and it could be a while before I can let it rip again. All this has made me acutely aware of what it is like when I tell a client that they need to back off for a while when they have an injury. Many times, the client responds with “I was hoping you wouldn’t say that”. But I think it is like any goal that you are working towards. You need to keep visualizing where it is that you want to be and the transition steps that you need to make to get there.  For me, I need to do lots of things like drinking lots of fluids and really listen to my voice and make sure that I’m not overdoing it. Patience is the biggie though.When  a runner, for example,  has a moderate injury that may allow them to remain active (but not running), I will advise them to walk for the same amount of time that they normally run. Do not walk through the pain. During the transition, they re-integrate running. So maybe walk for 1 hour, then walk 55 minutes with 5 minutes run, then slow transition until they are back to running. This allows the person to remain active but also allows the body to heal itself properly and avoids re-injuring the area (making their return to activity even more lengthly).  This is true with any activity and injury that can occur.  

From my own personal experience, when doing a strenuous bike ride, I have made it a habit to spend at least 10 minutes post activity to spend cooling down. I think that 5 minutes cool down per 1 hour activity is a good baseline. When I am biking, I will go into a much easier gear and do high rep’s for that amount of time. A runner may find it beneficial to walk for 5 minutes or so after an hour of running. This is beneficial in helping the body to rid itself of any metabolic waste from the muscles, therefore helping to reduce or eliminate DOMS (or delay onset muscle soreness). I would prefer doing this over stretching after an activity. This is especially important when starting or working towards a goal with an activity.  So, if you are experiencing discomfort or muscle pain post activity, give this a try. Remember to stay hydrated as well up to 6 hours post activity. 

Very often I have clients that come in complaining of neck muscle strain and very often they are in a job or have a hobby that involves sitting in front of a computer. As part of my home care, I help the client to re-establish a good position for the shoulders an proper balancing of the head on the neck. Once you properly position the shoulders and the head, if you work with a computer, then you need to adjust the position of the monitor and the keyboard so that you can maintain your shoulder/head position. A good rule of thumb is to have the keyboard pretty much near your belly button (so that your shoulders are back and in a good position) and have the monitor usually about 1 or 1 1/2 feet away from you with the bottom of the screen at eye level. This is easier if you have a flat screen. The reason that the screen is so close to you is that often the resolution is so high, it makes the print very small, leading you to lean forward to read the font (another option is to make the print bigger on the screen). Using a glare protector is helpful to reduce eye strain. Also the screen is so high because when your head is balanced, you are actually looking up about 10 degrees from the horizon. This is because the front of the head is heavier than the back, so it needs to be tilted back a touch to be properly balanced. So there are some thoughts about keyboard and monitor position. It is always good to adapt your environment to you so you don’t have to adapt yourself to your environment (which will cause chronic muscles strain, pain and headaches. 

I am a huge advocate of the importance of having the shoulders in a neutral position to reduce things like joint impingement, nerve impingement, muscle fatigue and pain, reduced range of motion to name a few. I wanted to talk about muscle fatigue today. Like other joints in the body, the shoulder joint (or Glenohumeral Joint) has a capsule that surrounds it. The very top of the capsule is thickened and supports the arm bone as it hangs down. If the shoulder is rolled forward at all, the stress of the arm pulling downward is then transferred to the rotator cuff muscles. As rolling forward the shoulder also stretches and weakens these muscles, they will go become fatigued over long term and go into chronic spasm.  The rotator cuff muscles are responsible to control joint movement while the arms moves around, so arm movement will also be affected.So to make a long story short, neutral shoulder positioning is important to take the strain off the rotator cuff muscles that have their own job to do during the movement of the shoulder joint. Don’t let your shoulders fall forward   

I have clients that have low back issues and very often, they are sitting for long periods of time during the day. Personally, I’m not a huge fan of sitting on stationary surface for long periods of time. I recommend using the big exercise balls (which I use in my clinic room as much as possible), but sometimes that isn’t possible as they are very bulky and sometimes not very appealing in a business atmosphere. So what does a guy or girl do in this situation? You can use the balance disc to sit on. It’s a flat disc that is often used for standing on to improve balance in rehab. Anyhoo, you can sit on it too. The best thing about the disc is that you can sit on it and continuously keep your back moving. It also helps to reduce the compression forces around your low back and pelvis. This is a really good thing. Locally, in Victoria, you can pick up this product from Sports Traders or Aloyd Fitness. If you get a disc, make sure that there isn’t too much air in the disc. Keep it fairly deflated, but not so much that you feel the surface of what you are sitting on. Clients have mentioned that they use this product in all sorts of different places like at the movies, theaters, sports events, meetings. So pick one up, try it out. They’re really portable, inexpensive and good for the old back. 

I have had a number of patients come in with complaints of chronic muscle tightness. The tightness may have come from an auto accident in the past, over use or physical work that involves a lot of lifting, someone that has a heavy workout schedule or perhaps a person with poor posture that has been overworking their back muscles. The common denominator is that the muscles are in a chronically shortened position. The way that a muscle brings in oxygen and gets rid of the off-product, Carbon Dioxide, is through shortening and lengthening. When a muscle is chronically shortened, it loses it’s ability to bring in Oxygen and get rid of the CO2, this can cause pain, that causes continued tightness and the cycle continues. Epsom Salts are beneficial in helping to remove by-products of muscle function and increasing oxygen delivery to muscle tissue. Epsom Salts are Magnesium Sulfate. Here is some information regarding additional benefits of Epsoms Salts Your handy Thesaurus might not list it, but the scientific name for Epsom Salt is magnesium sulfate. And while most people know little about these low-profile elements, numerous studies have demonstrated the wide-ranging benefits of magnesium and sulfate for areas such as beauty, health and gardening.It makes sense. Magnesium, a major component of Epsom Salt, is the second-most abundant element in human cells and the fourth-most important positively charged ion in the body. Magnesium also helps to regulate the activity of more than 325 enzymes and performs a vital role in orchestrating many bodily functions, from muscle control and electrical impulses to energy production and the elimination of harmful toxins.The National Academy of Sciences, however, reports that most Americans are magnesium deficient, helping to account for our society’s high rate of heart disease, stroke, osteoporosis, arthritis and joint pain, digestive maladies and stress-related illnesses, chronic fatigue and a host of other ailments. The Academy estimates the average American male gets just 80% of the magnesium required for good health, while females get only 70% of their recommended levels. Nutritionists say Americans’ magnesium levels have dropped more than 50% in the past century.Researchers and physicians report that raising magnesium levels may:

• Improve heart and circulatory health, reducing irregular heartbeats, preventing hardening of the arteries, reducing blood clots and lowering blood pressure.
• Improve the body’s ability to use insulin, reducing the incidence or severity of diabetes.
• Flush toxins and heavy metals from the cells, easing muscle pain and helping the body to eliminate harmful substances.
• Improve nerve function by regulating electrolytes. Also, calcium is the main conductor for electrical current in the body, and magnesium is necessary to maintain proper calcium levels in the blood.
• Relieve stress. Excess adrenaline and stress are believed to drain magnesium, a natural stress reliever, from the body. Magnesium is necessary for the body to bind adequate amounts of serotonin, a mood-elevating chemical within the brain that creates a feeling of well being and relaxation.

 While increasing magnesium levels, Epsom Salt also delivers sulfates, which are extremely difficult to get through food but which readily absorb through the skin. Sulfates, which are minerals, serve a wide variety of functions in the body, playing a vital role in the formation of brain tissue, joint proteins and the mucin proteins that line the walls of the digestive tract. Sulfates also stimulate the pancreas to generate digestive enzymes and are believed to help detoxify the body’s residue of medicines and environmental contaminants. The most important thing to remember is that you should use 1 - 2 cups of salts in a bath and drink up to 2 litres over the next 24 hours to rehydrate as the salts draw fluid out of your tissue.  The next thing is always check with your doctor to make sure that the baths are safe. This is quite a powerful detox and can be harmful if you have a condition that can be aggravated by the process. Your doctor may not agree that it is beneficial, but always make sure that it isn’t harmful to use.  

Have a listen to this link…

http://www.youtube.com/watch?v=PgvJg7D6Qck&feature=related

Now excuse me while I go have a good cry now.