Referring to...

As a massage therapist I am constantly explaining that just because someone feels the pain in one area of their body doesn't mean that the pain is originating there. A chiropractor I once worked with would break it down like this: a ceiling light comes on in the middle of the room but it's coming from a switch on the wall. This is what pain can be like in the body. Yes, it can be confusing when a therapist is pressing into your gluteus after complaining that your lower back hurts, but there is a good reason for it. 

There are light switches all over the body called trigger points. They are infamous for collecting the trauma, inflammation and strain in our muscles and eventually when that all converts to pain they radiate out into the muscle, and at times into other muscles. There are a handful of muscles that are mysterious in their dealings often referring pain to seemingly random places and making it difficult to track down the root cause of the issue. In addition to this challenge these tricky muscles are rarely stretched and usually not worked on during general massage sessions. There are more muscles than the three I mention that share these characteristics but they are the most common areas I encounter in my practice so we will just start there.

Let's begin with the infraspinatus, the muscle that lays on top of the scapula or the shoulder blade. My client will come in complaining of tingly and/or numb sensations that run down the back of their arms and into the pinkie and ring fingers. It's usually worse at night and if it progresses the condition could turn into frozen shoulder. We'll refer to the infraspinatus as I.S., or izzy if we happen to be in a cute mood this evening. Izzy is difficult, if not impossible, to stretch on ones own and yet it gets tighter the more we utilize our arms out in the front of our body. Most people feel the ramifications of a too-tight I.S. radiating into the upper thoracic rib set, the cervical rib set, down the arm and into the hand. Translated that is referring to the upper mid-back and the base of the neck where it intercepts the top of the shoulder. I can't tell you how often I've had someone wanting me to work on their hand because it's been tingly and achy, and I throw them off entirely by working on the shoulder, base of the neck and pec muscles. Just like the light switch! 

The second popular choice in our line up is a slight antagonist to the infraspinatus, pectoralis minor. There is a major and although it plays a major part in the referral game it is nothing compared to what I've seen of pec minor. Pec minor moves the shoulder blade forward when we use it to push or pull something. Extended computer work or paperwork begins to exhaust the body forcing it into a lazy and therefore strained posture. One of the victims of a slouched form is pec minor who is trying to beat the odds and keep your arms up and moving. Think of it this way, the top of your shoulder to the tips of your extended fingers should be like a slide, sloping on a slight curve away from your raised sternum and underneath your chin which is delicately held parallel to the floor. The wrists should be resting in front of the keyboard or paperwork at waist level and the monitor of the computer should be just a hair under your eye level. When we slump because we have "hit the zone and just want to get through this" all of that energy the arms are spending is being generated by pec minor, and coincidentally, the infraspinatus. Additionally both create numb, tingly sensations down the arms and reduce range of motion. Similarly to the consequences of a tight infraspinatus pec minor produces numb and tingly sensations to occur most commonly down the arm and into the thumb and first two fingers. Left untreated it can progress into thoracic outlet syndrome. It is also common to feel both muscles agitation right in the shoulder joint itself, especially if one is a side sleeper. This occurrence comes about because both muscles attach at the shoulder joint and pull on it when they're tense. In my self-care I use tennis balls, Miracle Balls and self-massage to get into these areas since it can be a difficult treatment to take when done correctly.

Last one for the night, the psoas muscle! This is where the "dun dun dun" music chimes in and lightning and thunder crash through the window because anyone who has had their psoas worked on remembers for life. It is a deep strong muscle that originates on the spine in the front of the lower thoracic vertebrae, runs parallel with the spine on either side and attaches to the lower pubic bone on the inside of the hip joint. This muscle makes it so we don't simply fold in half and crack our head on the sidewalk; it keeps us erect. And I know you're all aware of the emphasis out there on core strengthening in exercise. Well here's the secret, you need to know the difference between when the abs are engaged and when the psoas is engaged, because it is always be one or the other thats working. Too many people do not know the difference between the two. The most common area of pain due to a spasmed psoas is the lower back. Ever had that pain that made it so you could either stand completely straight or have to be practically fetal but nothing in between would do? Psoas. Lower back ever been so bad you have to keep your knees bent when you're laying down? Psoas. Constant dull pain in the lower back that you can't stretch out and it seems to be bad when you first wake up but gets a little better as the day goes on? Psoas. When the psoas tightens it pulls the spine together and creates compression. When it's that tight inflammation isn't far behind creating radiating pain down the legs and across the lower back. I would venture a guess and say that 80% of the lower back pain cases we see in the clinic are caused by the psoas muscle. And we have found the most effective way of releasing this muscle to allow it some rest is to work on it through the stomach. What i mean is we manipulate the muscle as we would do any other but we have to work around the layers of organs and tissue that makes it a less than comfortable process. This should not be preformed by anyone without a valid degree and license to do so, such as a chiropractor or massage therapist. It isn't the most pleasant experience but it is very effective. Educating oneself on stretching the psoas and how to recognize the difference between using the abs and using the psoas in exercise, lifting or in daily routines is highly recommended if you want to avoid that embarrassing moment when you mysteriously throw out your back reaching for a pencil one day. 

Well, I think that's enough stodgy information to process for one sitting. My point, beloved, is to be open to another possibility. Perhaps the pain in your wrists is coming from your shoulder which is coming from your persistence at work which is coming from... Possibly your body just wants one on one time with its provider. Is that really so bad?