How Can Massage Treat Patellofemoral Syndrome Knee Pain?

Patellofemoral syndrome is a term used to describe knee pain caused by improper movement, or tracking, of the kneecap over the femur. This condition often results from muscle imbalance in the quadriceps, or thighs. Massage therapy is useful in addressing this muscular imbalance, resulting in decreased pain and increased function of the patellofemoral (knee) joint.

The patellofemoral joint specifically refers to the articulation of the femur and the patella. The patella, or knee cap, is a sesamoid bone and is located within the quadriceps tendon. The patella glides over the boney prominences of the femur, or the femoral condyles, as the quadriceps contract or tighten during extension of the knee.

The quadriceps (aka, quads or thigh muscles) is really a group of four muscles, consisting of the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis. The muscular imbalance which may be one cause of patellofemoral syndrome occurs when the vastus lateralis is stronger than the vastus medialis, and pulls the kneecap to the outside of the thigh during movement. This imbalance is often seen in athletes such as runners, though it is not limited to athletes, and may be caused by posture.

Pain occurs when the quadriceps tendon tightens during movement and pulls the kneecap “off track” – meaning that the underside of the kneecap articulates improperly with the femur. If left untreated, this misalignment can cause inflammation and degeneration of the bony surfaces, eventually leading to arthritic changes.

The treatment

Massage therapy is very useful in reducing the tone and myofascial trigger points of the quadriceps, specifically that of the vastus lateralis. Trigger points in this muscle, which refer pain to the lateral thigh along the iliotibial band area, as well as the lateral knee, may contribute to altered gait. During a massage therapy treatment, the therapist will address the involved and compensating muscle groups, as well as stretching and using hydrotherapy during treatment (heat) and post treatment (ice or cold). The application of cold post treatment will assist in the reduction of inflammation in the patellofemoral joint and surrounding muscle tissue.

Another important aspect of rehabilitation is the strengthening of the vastus medialis, specifically the lower, oblique fibres medial to the patella, known as the vastus medialis oblique (VMO). By strengthening this muscle, the normal position of the patella is regained and it will interact correctly with the femur.

The duration and frequency of the treatment will depend on the presentation of the condition, and how long it has been present.

© Copyright 2010
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Low Back Pain and Disc Herniation

The discs located between vertebrae are vulnerable to injury, and can cause debilitating pain when injured.  Disc herniation most commonly affects the lumbar spine, but it can also occur in the cervical spine, and rarely, in the thoracic spine.

What is disc herniation?

Disc herniation is a term that refers to displacement of the nucleus pulposus of the intervertebral disc, due to injury or weakening of the external portion of the disc (annulus fibrosis).  The term “slipped disc” often refers to this type of injury, as does bulging disc.

There are four stages of disc herniation, with various degrees of displacement of the nucleus pulposus. The final stage occurs when the annulus fibrosis is completely ruptured and there is a complete loss of integrity of the external structure.

Pain occurs due to increased pressure on the nerves exiting the spinal cord. Symptoms such as pain, numbness and tingling will occur in the area that is supplied by the affected nerves.

How does disc herniation occur

Disc herniation most often occurs due to injury, sometimes from a seemingly innocent action such as bending over or twisting to pick something up. These actions of sudden flexion or rotation often cause an increase in pressure which forces the nucleus pulposus in a posterior (toward the back) direction.

Signs & Symptoms of Disc Herniation

If you’ve ever had an issue with a disc, it is an unforgettable experience.

1. Sudden, excruciating pain – into the legs and buttocks if the herniation occurs in the lumbar spine; into the arms and hands if the herniation occurs in the cervical spine.
2. Muscle spasm will occur in the injured area – this is the body’s protective mechanism to prevent further injury by immobilizing the area.
3. certain actions will increase pain and symptoms, such as bending forward from the hips, side bending, or twisting. As the action causes the pain, a therapist can tell where the bulge is happening by the pain distribution.

How is disc herniation treated?

Disc herniation is a condition that must be managed in the initial stages, with a focus on removing pressure from the affected nerves and pain control.  As the condition progresses, the focus turns to strengthening the supporting structures – if the herniation has occurred in the lumbar spine, core muscle strengthening will be incorporated into a rehabilitation program.

Massage therapy itself is not a standalone therapy for disc herniation – it can help with pain control and removing some of the excess muscle spasm. It must be noted that removing all of the hypertonicity (excess muscle tone) in the muscles surrounding the injured area is not wise – the excess tone in this case is used to stabilize the area, and if it is completely removed, the area can become very unstable and make the injury worse.

If the injury to the intervertebral disc is severe, the condition can become chronic and progress to degenerative disc disease.

For more information, please see The Anatomy of Low Back Pain.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

How Often Should I Get a Massage – Frequency Guideline

Following my initial blog post on this subject How Often Should I Get a Massage, here is my treatment frequency guideline, for massage therapists and their clients.

Remember, this is just a very generic guide, and will have to be adapted for individual situations.

Here are my general guidelines for treatment frequency:

Relaxation – once a month for an hour, unless you want to come more often.

Acute injury – more frequent treatments of shorter duration should help – for example, 2 times a week for 30 – 45 minutes. This should help relieve pain and congestion in the area, then after a few weeks, switch to deeper, muscular work for longer periods of time. At this point your injury may have moved into a subacute or chronic stage of healing, depending on the severity of the injury, 1-2 times a week for an hour, over a period of 3-4 weeks should get you on the road to recovery.

Treatment for chronic conditions (i.e. headaches or back pain) – one hour twice a week for 4 treatments, then try once a week for 3 or 4 weeks, and try to decrease to 1x in 14 days for 2 treatments. You will then go into maintenance mode. Once again, very individual, and the longer the condition has been an issue for the client, the more treatments will usually be needed to make consistent gains.

Some more general guidelines:

Follow remedial exercise and homecare advice – passive treatments such as massage therapy can only take you so far, it is YOUR responsibility to be proactive in your own health care. This means follow exercise, stress management, nutrition and lifestyle advice. Record what you do and how you feel, try to make a correlation between various factors. If you have a team of health care providers who are willing to work together, use them!

Don’t go too long between treatments! Progress made during a treatment is building on the progress made in a prior treatment. This means that if I’ve treated a client for chronic back pain for a month and we’re seeing some results, if he stretches out the length of time between appointments to 8 weeks instead of my recommended 2 – 4 weeks, it may be like starting all over again. What a waste of money for the client!

Remember, though, that if you start to feel consistently better (and consistent is key), you have the right to say “I’d like to stretch out the time between treatments a few more days, can we try that?” Your therapist can only give you advice and guidance, you have to figure things out what works for your situation.

If the treatment is not helping – find another therapist! Sometimes people feel awkward about ditching their therapist, especially if you have a good relationship with him or her. BUT, it’s your time and money, and you should see results. Sometimes massage therapy is not the be-all-end-all of treatments, I personally find a combination of therapies to be the most effective.

Knowing your rights as a client will prevent you from getting expensive, unnecessary or ineffective treatments, and will enable you to receive treatment that suits your needs.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Can Massage Therapy Treat Fracture Injuries?

Massage therapy treatment can help maintain and improve tissue health in a fracture injury, enabling a person to regain his or her full function sooner.

Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.

Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.

Considerations for treatment

It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.

In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.

Before your massage therapist begins to treat you, he or she will want to verify the following information:

• your physician has approved massage therapy
• are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
• what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
• are there any open wounds which must be addressed? (i.e. with a compound fracture)
• Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
• is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
• do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
• the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
• have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
• muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
• tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue

As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.

Types of fractures

There are several basic types of fractures:

1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.

Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.

Finding the best massage therapist for you

It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.

© Copyright 2009

www.whymassagetherapy.com

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Thoracic Outlet Syndrome Types, Causes and Symptoms

What is thoracic outlet syndrome, what causes it, and what are the symptoms?

Thoracic Outlet Syndrome, also known as TOS, is a compression of the brachial plexus and subclavian artery and vein. The brachial plexus supplies the upper limb with both sensory and motor nerve fibres, and the subclavian artery supplies the blood supply. There are four areas where the plexus and artery may be compressed and in each instance, the symptoms will present differently.

The part of the brachial plexus most likely to be affected is the medial cord, which orginates from nerve roots C8 to T1.

Symptoms of Thoracic Outlet Syndrome:

Due to involvement of the medial cord of the brachial plexus, the ulnar nerve is most impacted by this compression syndrome. Muscles affected will be the Flexor Carpi Ulnaris, the ulnar aspect of the Flexor Digitorum Profundus, as well as most intrinsic (small) muscles of the hand. As a result, there will be some weakness or altered sensation on the ulnar aspect of the forearm, the hand and little finger. Signs and symptoms will vary, however, depending on the location of the compression and the structure involved.

Compression of a nerve will result in pain, loss of sensation and in chronic cases, muscle wasting or weakness. (this is known as denervation atrophy) Compression of blood vessels (subclavian or axillary arteries, depending on site of compression), will result in pain, paleness of the skin supplied by the artery, possible cyanosis (blue coloring) and decreased skin temperature. Prolonged decrease of blood supply can result in trophic skin changes, emboli (blood clots) and gangrene. Compression of a vein will result in edema, and the blood is unable to be carried back to the heart and lungs.

There are 4 main areas where compression may occur

1) The anterior and middle scalene, a.k.a. the interscalene triangle. The brachial plexus and subclavian artery pass through here, but it is the medial cord of the plexus, arising from the C8-T1 nerve roots, which is most likely to be affected. (*note: the scalenes are classified as secondary muscles of respiration because they attach to the ribs and contract during respiration)

2) Pectoralis minor – compression will occur between the pectoralis minor and its insertion on the coracoid process of the scapula. A person who presents with hyperkyphosis (rounded, slumped shoulders) may be more inclined to have compression here, especially when the muscle is stretched (for example, when they straighten up). The pectoralis minor, by attaching on ribs 1-8, may be affected by any respiratory disorder, leading to hypertonicity of the muscle and subsequent compression of the subclavian artery as it becomes the axillary artery when it passes deep to the clavicle.

3) Costoclavicular – compression occurs between the 1st rib and the clavicle. This is most likely to be a result of injury to the clavicle, such as a break or dislocation, and is prone to affect the vasculature (as the axillary vein becomes the subclavian vein)

4) Presence of a cervical rib - the presence of an extra rib is determined by an x-ray, and it interferes with the size of the interscalene triangle, therefore allowing less room for the plexus and vasculature.

The borders of the thoracic outlet are:

posteriorly (the back) the body of vertebrae T1 laterally the 1st rib bilaterally
anteriorly – manubrium of the sternum

Structures passing through the Thoracic Outlet
The brachial plexus, subclavian arteries and veins.The muscles involved in this syndrome are the anterior and middle scalenes, pectoralis minor and the subclavius.

Who is at risk for Thoracic Outlet Syndrome?

Thoracic Outlet Sydrome usually affects people whose posture tends to be very forward and slumping. Think of a person who sits at a desk all day, or who does a lot of work moving forward (or a massage therapist!). Others at risk may also have “military posture”, extreme retraction of the shoulders which pulls the pectorialis minor tight over the plexus and artery, thus compressing it. Also at risk are people who have had a broken or dislocated clavicle, especially those with a more complicated or compounded break. Due to the attachment of the scalenes and pectoralis minor on the ribs, people who have a respiratory disorder and difficulty breathing often recruit these muscles, thus increasing the incidence of hypertonicity, and the presence of myofascial trigger points.

Thoracic Outlet Syndrome or Raynaud’s Disease?

The therapist, during the course of performing orthopedic tests for TOS, will look for a positive test of a decreased or absent pulse, as well as numbness and tingling or fatigue in the ulnar distribution of the forearm and hand. Raynaud’s Disease presents similarly, but is a peripheral vascular disorder which occurs due to vasospasm and results in decreased circulation. For Raynaud’s disease to be diagnosed, it must be followed closely by a physician for 2 years and manifest as decreased circulation and increased sensitivity of the arms and hands.

How can massage therapy be used to treat Thoracic Outlet Syndrome?

Massage therapy can provide valuable assistance to someone suffering from TOS, either as a stand-alone treatment, or in conjunction with other modalities (i.e. physiotherapy or chiropractic).
Wherever the location of compression, the therapist will attempt to decrease hypertonicity and myofascial trigger points of the involved muscles as well as stretching. Manual lymph drainage can assist in the reduction of fluid build up post treatment. It will also be necessary to retrain the client concerning proper posture.After the treatment plan concludes, it would be wise to encourage the client to continue stretching, and also to schedule maintenance appointments to prevent a relapse.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy, Fitness and Optimal Performance

Massage therapy is often used as an adjunct to a fitness routine to assist in achieving peak athletic performance. There are a variety of ways in which massage therapy is used to promote optimal fitness – massage therapy is not all just about spas and “fluff”. Massage can be used to increase the suppleness of muscle, aid in recovery after exertion, assist in fluid removal in the presence of injury or inflammation (from non-infectious origins) or control pain through the release of endorphins.

Massage therapy affects muscles in 2 ways: mechanically and chemically. Mechanically, it is the kneading, stretching and compression of the tissue which stimulates the smooth muscle of the blood vessels and increases blood flow to and from the area. (due to an increase in histamine – see below). Manual manipulation of the tissue will also literally break adhesions and scar tissue, regardless of whether techniques are applied with or against the muscle fibre. This decrease in inelastic scar tissue will allow muscles to contract and elongate as they should, and will increase muscle performance.

At a chemical level, massage therapy can cause the release of “endorphins”, neurotransmitters that reduce the perception of pain, and increase a feeling of wellbeing. Increased permeability of the blood vessels is caused by release of histamine in response to mechanical stimulation – this increase in blood flow leads to “hyperemia”, redness which is often visible after a massage.

The application of therapeutic massage plays a role in event preparation as well as recovery and maintenance, though the goals and application will be different depending on the timing of the treatment in relation to the activity.

Pre-event, the purpose of massage is to “wake-up” and warm-up the muscles, ensuring that they are ready for physical demands to be placed on them. During a pre-event treatment, the movements of the therapist are quick, stimulating the nerves in the area and increasing the ability of a muscle to react to stimuli. Circulation to the muscle is also increased and with it oxygen delivery to the muscle cells, causing a subsequent increase in cellular metabolism and improved functionality. Increased blood flow also warms up the muscle, allowing for greater pre-event stretching, imperative to optimizing performance and reducing injury due to muscle strain.

Post-event massage is much slower, encouraging the body to relax after exertion. Massage therapy at this stage is utilized to assist the body in removing metabolic waste, relaxing and stretching the fatigued muscle. This is done by increasing the circulation and pliability of the muscle tissue. The increased removal of metabolic waste such as lactic acid will decrease recovery time and soreness in the days following an event.

Massage therapy used as a maintenance tool will assist an athlete in maintaining optimal muscle health. During maintenance treatments, the therapist will assess the condition of tissue and establish a treatment plan in conjunction with the goals and condition of the client. It is during these treatments that muscle imbalances are often identified; adhesions and scar tissue are broken down (thus increasing muscle functionality) via manipulation, stretching and breaking down of tissue. Circulation is increased, assisting in oxygen delivery and metabolic waste removal.

Regardless of fitness level, massage therapy can help a fitness enthusiast or athlete achieve his or her performance goals by promoting and maintaining muscle health.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Carpal Tunnel Syndrome, Massage Therapy and Surgery Prevention

Carpal tunnel syndrome is a compression of the median nerve as it passes through the carpal tunnel of the wrist. Caught early enough, carpal tunnel syndrome, or CTS, doesn’t have to progress to the point where it is debilitating or affects activities of daily living. The incidence of surgery, which involves cutting the carpal tunnel ligament (aka flexor retinaculum) could very well be reduced if massage therapy was used more frequently as an early intervention.

Symptoms of Carpal Tunnel Syndrome:

The median nerve is not the only structure that passes through the carpal tunnel – the muscles of the anterior forearm (the forearm and wrist flexors) also figure prominently in CTS. In early stages there is often numbness, tingling or “pins and needles” in the lateral 31/2 digits of the hand (thumb through to 1/2 of the ring finger). There could also be pain and local inflammation or swelling over the wrist on the palmar surface of the heel of the hand. In later or more chronic stages, there could be atrophy of the thenar emminence (muscles which move the thumb), or trophic skin changes in the same area, such as redness, dry or scaly skin. At this stage, there may also be altered sensation in the forearm and axilla (armpit).

In conjunction with the muscle wasting, there may also be difficulty in activities which require fine motor control (i.e. picking up car keys, buttoning a shirt). It is not unusual for people with more severe or chronic cases of CTS to wake at night from pain, which is relieved by moving or elevating the limb.

Who is at risk for Carpal Tunnel Syndrome?

CTS often affects people whose activities of daily living (either work or hobbies) involve repetitive motion of the fingers and hands. (Think of a data entry clerk, a musician, a massage therapist or someone who knits a lot). Repetitive motion causes “hypertonicity” of the muscles of the forearm, and as they pass through the carpal tunnel, the larger size of the tendons impinge the nerve. Left long term, the muscles are unable to function as they should and they become weak.

Injuries to the wrist, with displacement of the carpal bones, may also compress the median nerve or cause swelling of the tendons that pass through the carpal tunnel; edema during late stages of pregnancy or during illness may also narrow the tunnel, compressing the median nerve.

How can massage therapy help prevent and treat carpal tunnel syndrome?

Massage therapy can provide valuable assistance to someone suffering from CTS, either as a stand-alone treatment, or in conjunction with other modalities. Massage can also assist in prevention of the syndrome; when treatment is started early enough, muscle hypertonicity is decreased, and edema can be reduced.

Treatment will depend on the actual cause and stage of presentation of the condition. For example, in a case where repetitive stress is the cause, the therapist will attempt to decrease hypertonicity and myofascial trigger points of the brachium, ante-brachium, all of which are proximal to the site of compression. This can be achieved by doing deep work to the muscles of the arm and forearm, as well as stretching of the forearm flexors.

If the structures in the carpal tunnel are impinged due to thickening or scarring of the flexor retinaculum, friction therapy to break down the tissue can be invaluable, if painful, to reduce compression.

Manual lymph drainage can assist in the reduction of fluid build up post treatment.

The therapist may also stretch the carpal ligament and palmar tissue & fascia, reducing compression of the structures, and finish with a cold hydrotherapy application on the site to reduce any inflammation.

Outside of surgery, there is no “cure” for carpal tunnel syndrome which results from hypertonicity of the forearm flexors. If CTS is caused by a repetitive stress injury (RSI), then maintenance will be necessary. Maintenance in this case will involve a program of stretching, hydrotherapy, massage therapy and possibly a wrist brace. The use of ergonomically correct keyboards for those whose work involves a lot of typing can also be useful.

Depending on the severity of the condition, a treatment plan may involve a few weeks of treatments 2 times per week, in addition to a homecare plan to reinforce the effects of the treatment. As hypertonicity of the forearm flexors is reduced, the frequency of the treatment is reduced to once a week for several weeks.If you have questions concerning the treatment plan, your massage therapist should be more than willing to discuss it with you.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and the Power of Touch – Relieving Depression Naturally

Humans are tactile beings. From the moment of our birth and throughout our lives until death, touch plays an important role in our health. For massage therapists, it is very easy to see how the skin, as the largest organ of the body, reflects physical and emotional health. Looking back, we can all remember a time when hurt or distress has been relieved by touch, such as Mom kissing a banged up knee, or when we’ve received a comforting hug from a family member or friend. Touch can also express joy and love, as well as the opposite end of the emotional spectrum, where touch can trigger fear and pain.

What role should touch play in our daily lives? It has been well researched and documented that positive touch, that being touch from someone you trust done with your consent, can affect us at a cellular and hormonal level. The release of endorphins makes us feel good, and actually contributes to not only our physical health, but also our emotional health as well. Much to our detriment, however, the inclusion of touch in our daily lives has taken a back seat to other priorities.

We live in a society where touching on a social level has become taboo. In a nutshell, we are touch deprived. A world-wide study done in the 1960’s noted the number of times pairs of people touched each other when out at a cafe. Peurto Rico was at the top of the list, with 180 times an hour; at the bottom of the list was Britain, at 0 times per hour (yes, that’s right, ZERO). This would seem to indicate that a normal, healthy social gesture seems to have become degraded to something which is not appropriate and needs to be avoided. In our own culture we seem to be becoming more touched deprived; in an article ‘The Touch Deficit’ by Patti Wood, 15% of Canadians go for 3 or more days without touching another human being. Could this be a contributing factor to our soaring levels of depression in our society?

How might we change this unfortunate trend? In addition to changing other lifestyle factors, the inclusion of regular, consensual, non-sexual touch may very well help turn the tide on our cultural downfall. Massage therapy has been extremely well researched, and we all know it can assist our function at a physical level, by relieving headaches, back pain and other common complaints. But did you realize that massage therapy also improves our function at an emotional level, contributing to decreased depression and anxiety, improved sense of well-being, and improved sleep?

I would suggest that if you are feeling even a little (or a lot) anxious that massage therapy may be able to
help you. If you feel great, I would hazard a guess that you may feel even better by taking an hour out of your day and taking care of yourself. Think of it as a preventive therapy, and enjoy the power of touch.