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Mitsko's Sciatica Course Notes
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Mitsko
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January 29, 2014 - 12:13 pm
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I was going to work on the sciatica course a bit later so I could apply it for the next round of CES, but due to it's excellent introduction, I am completely drawn in. I see how much effort Shama gas put in this!  The research, the setting up the platform, the images, the graphics and editing, his vast amount of first hand experience .... I am so looking forward to learning from Shama.

As a newly starting out therapist, i also particularly enjoyed his reminder that we are not there to perform miracles and complete cure for all.  Sometimes we just cannot solve the pain issue and that is what it is.  

I am very much looking forward to the upcoming modules....can't wait to receive the nest one.

Mitsko

Sokssage & Bodywork | MitsukoIto.com

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January 29, 2014 - 9:50 pm
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Hi Mitsko, good to see you in the forum! You are right, I put a huge amount of effort into this course in many ways as you noticed. I really enjoy coming up with first class information and training.

I am looking forward to hearing more from you as you go through the course! Smile

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Mitsko
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January 31, 2014 - 9:27 am
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Module 2.

Topics (that stood out to me)include:

1.High Tech vs. Low Tech diagnostic tools;

2.How we could test where the main problem area is;

3.How we as MTs are to provide a Holistic treatment rather than pinpoint diagnosis....

 

On #1: High Tech Diagnostic Tools

I really enjoyed having a big picture provided.  You have done the research and put them all together for us in a concise manner so when I'm talking to a client, I'll have much better understanding of where s/he's at.  For example if he says Dr. recommended CT, I know that that was one of the three major diagnostic tools MDs offer.  I like that rather than not knowing what all the options there are out there.

 

On #2: MTs Testing we could do

1. Straight Leg Test with Quick Dorsiflexion of the foot ... is it a test to have the muscles/fascias pull along with the nerve and see how an inflamed piriformis muscle catches it or has friction with it, (sort of?)

2. Flexed, Adducted, Internally Rotated Leg Test ... stretching out the Piriformis, then trying to have it contract while we resist to check how strong/week the muscle is.

Great to be able to do this, not just so we know where to work on, but I'm sure the client will also feel the pain (or lack of it), the pull, or the weakness and recognize it, therefore appreciate we're on the right track as we work on the area.

 

On #3:

I am interested in learning more about the energy flow aspect of it.  In my service offering, I have General Relaxation Sessions and more Issue Specific/Focused Sessions.  Which I believe are the same as macrocosm vs. microcosm.  It's good to hear to hear confirmation that those two approaches are equally valid.  And I am reminded that even as we provide microcosm bodywork, we do want to also spread the effect, like a ripple effect, and not forget that we are working on the whole - not just a specific small area and muscle.  They surely are all linked together.

 

I look forward to learning more ....

 

Mitsko

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January 31, 2014 - 10:16 pm
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On #1: My thought was that if we as massage therapists only know some sciatica techniques, we don't look very professional and we cannot have a meaningful conversation with the client about sciatica. That's why in this course I decided to go with the bigger picture. If we want to be known as a sciatica expert, we should know more than just the techniques. This is also a huge confidence builder for massage therapists.

On #2-1: The purpose of the test is to activate and/or aggravate the sciatic pain so that we get an indication if a) we are actually dealing with sciatic pain and b) if the probable cause is piriformis syndrome. However it is not the piriformis muscle which is inflamed, as you wrote, but it is the sciatic nerve which is compressed by one or two muscles depending on where the nerve is running.

On #2-2: This is not a strength test, but again a test which aggravates the nerve pain in order to tell us if the likely culprit is a sciatic nerve which is compressed by the piriformis muscle.

On #3: Energy flow always plays an important role in any physical condition since it is the underlying cause. It is like hand in glove. The physical body is the glove which takes on the shape of the hand which is the energy body. Dealing with energy is a whole big subject. Actually I have produced an entire course which deals with this more in depth: 

Magic Touch Secrets

If you ever feel inspired to get deeper into the energetic aspects, that's where you would find a lot more information on it. It is a huge subject which has no limit really. 

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Mitsko
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February 1, 2014 - 12:25 am
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My re-response to your original response is in -->bold and italics below.

Shama said
On #1: My thought was that if we as massage therapists only know some sciatica techniques, we don't look very professional and we cannot have a meaningful conversation with the client about sciatica. That's why in this course I decided to go with the bigger picture. If we want to be known as a sciatica expert, we should know more than just the techniques. This is also a huge confidence builder for massage therapists.  

--> Certainly agreed and appreciated!!!

On #2-1: The purpose of the test is to activate and/or aggravate the sciatic pain so that we get an indication if a) we are actually dealing with sciatic pain and b) if the probable cause is piriformis syndrome. However it is not the piriformis muscle which is inflamed, as you wrote, but it is the sciatic nerve which is compressed by one or two muscles depending on where the nerve is running.

--> Ah, thanks for the correction.  Not an inflamed piriformis, but perhaps a hypertonic muscle??  And you mention "one or two muscles" - do you mean other muscles like those in the leg and glutes?

On #2-2: This is not a strength test, but again a test which aggravates the nerve pain in order to tell us if the likely culprit is a sciatic nerve which is compressed by the piriformis muscle.

On #3: Energy flow always plays an important role in any physical condition since it is the underlying cause. It is like hand in glove. The physical body is the glove which takes on the shape of the hand which is the energy body. Dealing with energy is a whole big subject. Actually I have produced an entire course which deals with this more in depth: 

Magic Touch Secrets

If you ever feel inspired to get deeper into the energetic aspects, that's where you would find a lot more information on it. It is a huge subject which has no limit really. 

--> This is surely on my wish list along with your abdominal massage!

--------------------------------------------------

On Module 3

It was very nice to see the rocking by feet was endorsed in your course.  That's what I do for my clients - just like you say, me being 110lb, working on people for the most part larger than me, it's a body-saver.  

I thought I would mention that having a simple stick or cane would help a lot, even if you have your balances, it'd be a nice safety feature especially when starting out.  

Got to enjoy taking a glimpse of the rocking massage - I hear you say that by rocking, you are providing not just comfort for the client as we approach to the target area, but it will also have the diffused / spill-over / holistic aspect reaching to larger and connected areas.  I love that.  As a trigger point therapist, I have tended to just dig in.  Which is fun and sometimes clients enjoy the "hurts good" sensation too and can literally tell as the tension melts.  But this is a big alternative tool as a "(w)holistic practitioner in the healing arts business".   Something I respect of the Eastern culture. 

Looking forward to the next one coming in!

 

Mitsko

Sokssage & Bodywork | MitsukoIto.com

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Mitsko
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February 1, 2014 - 12:32 am
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Hm... I don't know how all those blocks and background colors appeared. 

Hope it's helpful rather than harmful, but if not, please excuse me!

I also sent a note re: payment for CE test.  Thanks!

Mitsko

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Shama
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February 1, 2014 - 12:54 am
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"Not an inflamed piriformis, but perhaps a hypertonic muscle??  And you mention "one or two muscles" – do you mean other muscles like those in the leg and glutes?"

The reason why I mentioned one or two muscles is this: In most people the sciatic nerve runs below the piriformis muscle. So in this case the compression occurs between two muscles, namely the piriformis and the muscle below it (or pressing it against the sacrospinous ligament). However in some cases the sciatic nerve runs right through the piriformis muscle, and that's why in this case we are dealing primarily with one muscle. (The piriformis has two heads, an inferior one and a superior one, and that's why the sciatic nerve can run right through it)

It's a bit more complex than that. If the balance of the various hip muscles is out of whack, the result can be sciatica. Why? Let's say someone has weak hip abductors and tight hip adductors, this can shorten and tighten up the piriformis muscle. This in turn will greatly increase the likelyhood of pressing on the sciatic nerve since now instead of having a nice soft and pliable muscle, you now have an uptight, hardened and enlarged little monster on the loose in your butt. 

There are various other scenarios which can cause this, like sitting all day long or certain types of sports activities. That's why it is not always sufficient to do massage work. In most cases the client needs to do some life style adjustments and some exercises as well. As you will see towards the end of this course, I have this covered in this training. 

At the risk of making it sound even more complicated, both hypertonia and hypertrophy can play a role in piriformis syndrome. Example: hip flexors are shortened due to too much sitting, resulting in weakened gluteal muscles which in turn puts more stress on the piriformis (and other muscles) which take up the slack, resulting in pressure on the sciatic nerve.

However you really don't have to get that much into the theoretical aspects as this will not really change or improve your treatment protocol. The main thing is to have a comprehensive treatment approach which includes the elements which I mention in the training, including a client interview, client education, the hands on massage work, suggestions for life style changes and do-it-yourself home work assignments.

Regarding the blocks and colors, I thought they look nice. I was wondering what special techniques you used to get them there. I don't know how to do that! Laugh

I responded to your email about the CE test.

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Mitsko
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February 1, 2014 - 2:46 am
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I LOVE the explanation!  I am probably getting 80% of what you say but it really helps me have a more comprehensive knowledge as my clients seem to appreciate having some explanation and figuring out together what's going on.  This also helps me be better prepared for you upcoming modules.  Thank you so very much for taking the time to write down and explain to me.  

And am I correct to assume a lot of this overlaps with lower back problems that lead to herniated disk etc?  With the short amount of time I have been working professionally, the number of clients with hernia-like, or post-surgery (at least a couple years back, coming back with pain) have been very very high.  

This course reminds me of massage school - once I'm out of it, it's harder to ask questions and get feedback that's practical and to the point.  

Thanks so much Shama.

Mitsko

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February 1, 2014 - 2:31 pm
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(I cleaned up your previous posts a bit Smile)

"I LOVE the explanation!  I am probably getting 80% of what you say."

80% is more than enough. Actually at some point anatomical knowledge can become an intellectual exercise which does not contribute to the actual work we are doing. The problem is that at some level anatomy can become so intricate and involved that there are all kinds of experts who don't agree with each other how exactly it all works. My previous post probably entered the realm of 'too much information' already. I try to provide simple and useful anatomical education without getting involved in all kinds of hair splitting intellectual exercises.

Some anatomical understanding for a condition like sciatica is definitely essential, otherwise we'd just end up randomly pressing and rubbing somewhere in the vicinity of the pain, and that's not good enough of an approach. However an anatomy expert could write volumes about all the various possibilities that can cause or contribute to the sciatica problem, and it can get plain overwhelming, and the language used can sound like Chinese to many practitioners.

So we have to stay grounded and focus on what's really essential for us. After all we are not doing exploratory surgery, but we are holistic practitioners working with a modality (Thai Massage) which is more based on energy concepts than on strictly scientific and clinical methods. But I am happy to provide some information even if it ventures into the not so essential realm as far as our work is concerned. Smile

Q: "And am I correct to assume a lot of this overlaps with lower back problems that lead to herniated disk etc?"

A: You are totally correct. Lower back problems can be caused by herniated disks, and those can cause sciatica. The overlap can be, for example, that a herniated disk can cause a lower back problem in general. Then one unlucky day you make a certain movement which shifts the sciatic nerve just enough to end up in a position where it gets compressed by the herniated disk. Now it gets irritated and hurts. Then that can subside after a while, but the herniated disk is still there and acts like a ticking time bomb until the next trigger sets off another episode of sciatica.

"This course reminds me of massage school – once I'm out of it, it's harder to ask questions and get feedback that's practical and to the point." 

The big difference between this course and massage school is that with my training you will always have access to me and can always ask questions long after the course has ended. My support is not limited to the duration of the actual course.

 

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Mitsko
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February 3, 2014 - 10:25 pm
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1.  Got the online testing worked out - you're right - I tried from a different browser (instead of Safari, with Mozilla) and it went as smoothly as it could.  

2.  Thanks for cleaning up my post - yes it was a bit too much.

3.  Module 4:

I'm starting to witness the breathing aspect of your work.  It's likely one of your massage secrets?  Awareness is the first step and I hope I'll be able to monitor and improve with more practice.  Your wave like movements, rolling in-&-out with the forearm, the finger wiggle technique with leaning in-&-out, etc.  Along with relaxed breathing....  how I wish I'm able to naturally incorporate that.

You mentioned in reply to my earlier post that being grounded and staying focused as one of the most important aspect.  Emptying my mind from all the academic exercise is, I believe, one privilege of us as somatic healers living in the modern world - it is so hard to do (for me at least).

 

On a side note, I am very impressed at how you're able to maintain your level of English... may sound like a silly comment.  Do you speak Thai or any other language as well?  I grew up in Japan, but the more years I live in the US, the less able I am to retain words that are not used in daily lives.  Also since I often perform work in silence, I feel like my "verbal" communication skills are needing attention.  I do think my hands/feet sensitivity, so communication skill in that sense where I'm able to read from people's bodies, are receiving upward education - which is so cool and I love it.  Yet at the same time, if we are to educate other people, I feel a strong need to hone my verbal communication skills - perhaps it's a much more valued/heavily emphasized thing in the US, more than it needs to be....

Looking forward to the next module.  Thanks Shama.

Mitsko

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February 4, 2014 - 12:50 am
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I speak fluent German, English and Spanish, and some Thai. My English needs to be pretty good since I am doing lots of writing. I grew up speaking German, but that was 40 years ago. Since that time I have primarily spoken English. Out of all my languages English is my best one since this is what I use most of the time, including here in Thailand, although it is not my mother tongue, but it feels like it to me.

Breathing, awareness, fluid in and out motions, flow, connection... - I guess you could call it a secret since there are many therapists who don't pay much attention to those things. And yet this is what makes Thai Massage a healing art versus a mechanical repetition of techniques.

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February 13, 2014 - 4:56 am
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OK, I clearly know that I am one of those who does best with reading, at least at this time in my life (and probably even if I'm out of this stage, where my kids interrupt me all the time or tries to take over my computer when I'm watching the video instructions).

I have a couple of modules that I need to watch.  But let me jump to the last bonus module, because that one I spotted "Download the Transcript" in addition to the video and audio, and I loved reading through it.  (I think I take in information so much faster reading through).

I loved reading about the energetic aspects, the success stories, the honest voice of Shama's (i.e. it may not work all the time, but it has worked for me in many cases - not quote-to-quote but the basic message).

You even provided some exercises we could incorporate, and I do believe too, that taking in these steps increases our awareness and connection, to our own as well as the client's mind-body-spirit aspect, and can only do good (at least in most cases), as long as we have good intentions.

I think this bonus module would serve as such an asset to any therapist, and Thank you Shama for sending that to me too!

Now I'll get back to my other missed modules soon so I can actually complete the whole course this time!!Laugh

Mitsko

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Mitsko
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February 13, 2014 - 5:01 am
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Missed to mention - thanks for your reply and sharing your personal situation - wow that's SO COOL you can speak so many language!!  So do a lot of Thai people speak in English too, is that why it's the most?  Or is it the most because you communicate with your students all over the world via web?  Do your Thai community folks speak in Thai with you or in English?  Excuse me for being nosy-ee if I am...

I enjoy hearing people's story - and each one is so unique:)

Take care!  

(From a sleet covered Atlanta - thus the whole city is quiet and kids get to dominated the street!)

Mitsko

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Mitsko
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February 13, 2014 - 10:02 pm
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Sciatica Course Module 5:

Some (might be silly) questions that came to my mind as I progressed through the video.

1. How often does the sheets gets changed?  Do you change the sheets the clients lie on after each client?    

2. Rocking - especially the hip area.  In massage school an instructor or two have mentioned to be careful providing too long a rocking to male clients as it might encourage/stimulate some internal movement (not necessarily bowel).  What would you say as a male, if I might ask?
I love providing rocking movements as I find it relaxing myself and indeed is helpful in loosening up clients too, and I do find myself doing it longer on female clients without hesitation, but having a bit sense of caution with male clients.  Am I overly concerned?  Or is it valid?  Is having the client clothed or draped under the sheet without clothing something that makes the difference?

3. I love the name "Spiderman Move" !  Making it seamless, great ideas and tips - thanks.
Something I would want to be a bit more considerate about. 

4. I see a lot of forward leaning in with arms in front.  Even though you're leaning in with your body, which is better than just pushing with your arms, I am still thinking that there's got to be much stretching or self care done afterwards.  Might you briefly explain your self-care routine?  I've learned you do QiGong.  Do you do yoga poses or stretches or self massaging pecs or....?
I struggle with my C2 sliding out chronically - one of the reason I'm trying to work on clients with my feet rather than hands because after 2-3 clients, I already feel like I'd need to receive a session myself! Would appreciate your sharing any information there.

5. In the US, I hear a lot of - "have the client's face in the face-cradle - just having them face sideways is way too much stretching for the neck" .... to which, I'm not sure I completely agree.  But then I do have C2 issue so maybe they are right.  I love sleeping on my stomach with my one cheek down and one up, just like your client in the video.  Any thoughts and insights there?

6. Knee power technique - you mentioned it might be good for smaller therapists to do this on larger client.  I cannot quite see how I can comfortably reach over and grab his/her larger hip and bring it up without causing lots of stress on my body - but surely seems like it's going to feel good if I'm on the receiving end!!  Not to disagree, but just wanted to share my internal conflict.

 

All the kneading seemed just so good ... I need to look for some thai massage therapists in my area.  I don't think there are many table practitioners that can incorporate such moves.  Looking forward to the next ones!

Mitsko

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February 15, 2014 - 12:44 am
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In regards to Thais speaking English - actually Thais are not good at all with their English in general. However in those areas where there is a lot of tourism you can get by with English just fine. You won't have any profound conversations, but you can make yourself understood.

The Thais have to get their act together with their English since within a year many southeast Asian countries will be connected in a similar way like the EU (European Union). It's called ASEAN. And the only way that they will all be able to communicate with each other is via English.

Regarding changing sheets - I don't use sheets in the western sense. I have a primary cover on my mat, and I put one of those thin Thai towels on top of that. They are big enough for someone to lie on, and they are so thin and light that they can be easily changed and washed.

In general regular Thai Massage shops don't change their sheets for every client. This is really not necessary since the clients are fully dressed. However what many of them do is give each client a set of thin pants and shirt to wear during the session, and those get washed after each client. This is not a messy oily scene like with Swedish massage where you really have to change sheets. Thai Massage however does not use oil and hardly any skin comes in contact with the sheet since clients are fully dressed.

Regarding rocking and potential male erections - let's call a spade a spade - rocking does not have such an effect. However it is just part of the male physiology that erections, or partial erections, can and do happen during any kind of massage. 

In most cases this has nothing to do with sexual stimulation and it is something that most men are rather embarrassed about, but it is something that is somewhat out of their control. 

It is a fact that certain moves and stretches in Thai Massage can put pressure on the penis, or can stretch the pants over the penis, which then results in increased blood flow into it. But rocking is generally not one of the culprits. 

I think most female massage therapists have seen this phenomenon and they realize that it is nothing to worry about unless it is accompanied by an intentional come-on. So they just disregard some movement in the male genitals which is the best policy.

Regarding self care: I have learned to work in ways which don't stress my body much. I don't use my hands that much. Whenever possible I use other body parts. And I use lots of rocking movements which are much easier on my body as well. I maintain a fairly regular routine of walking, swimming, bicycling, trampoline jumping and yoga to keep my body in shape.

Regarding the face cradle issue: If someone has a flexible neck, then turning the head sideways is not a problem. If the neck is not so flexible, then I simulate the face cradle with pillows. You can watch a demonstration of this in the video here:
Thai Massage Tips And Tricks Part 1

Regarding knee power technique: If you are small and the client is twice your size, then you would not do this technique. Small therapists will always have some limitations in regards to which techniques they are able to do, and they will have to skip some on heavy clients. That's why I always stress that the techniques which I present in all my courses are not mandatory sequences but options to choose from.

 

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