By: James Waslaski
2008 Massage Therapy Hall of Fame / 2009 Key Note Speaker
In 1998 I had the opportunity to teach at the Olympic Training Center in Australia about the vital role of orthopedic massage for Olympic caliber athletes. I was delighted to find that the entire staff at the Olympic Training Center attended my workshop with open minds. We were surrounded by physiotherapists, orthopedic physicians, osteopaths, chiropractors, sports psychologists, nutritionists, and sports massage therapists. Much to my delight they all left their credentials out the door and came together with the best interest of the athlete in mind. The entire staff had frequently met to teach each other how to best integrate all the varying disciplines, in order to optimize athletic performance, and how to best prevent and rehabilitate sports injuries. This was quite unlike what I had experienced throughout the United States where it was not uncommon to experience “turf wars” between various medical experts as a result of egos, differences in training, and competition to work with world class athletes. This began my passionate journey to go back to other countries and try to blend as many disciplines as possible to build a large tool box and enhance everyone’s ability to treat complicated sports injury conditions.
In this desperate journey to build a large tool box, I was fortunate to have many mentors including chiropractors from Florida, osteopaths from Scotland, leading physiotherapists from Australia, top sports massage therapists from the United States, sports psychologists, orthopedic surgeons, and many other experts in the field of chronic pain and sports injuries. However, many of these experts had a major difference of opinion on how to best treat complicated sports injuries, which often allowed the athlete to slip through the cracks and stay injured in our traditional sports medicine system. Through my own frustration I have found a way to blend as many disciplines as possible and build a great referral team of open minded medical experts that have the client’s best interest in mind.
In this particular article I intend to talk about two of the pieces I was able to add to the tool box of all medical experts in order to treat conditions that often fall through the cracks in our current sports medicine system. After years of being challenged on my sometimes controversial opinions, my trademarks seem to be a unique technique to immediately release complicated frozen shoulders and hip capsules, and the highly controversial use of hot and cold therapies.
Through feedback from around the world, and an intense self study of anatomy and pathology, I was able to discover the missing link for immediate release of complicated frozen shoulders and this work was adapted to releasing frozen hip joints. After being challenged with many clients with difficult frozen shoulders, also termed adhesive capsulitis, I was viewing the human dissection tapes by Lippincot, Williams and Wilkens and observed that at the articulating cartilage of ball and socket joints was a thick layer of fascia. Due to repetitive movements in the shoulder and hip joints certain muscle groups become strong and short while opposing muscle groups become overstretched and weak. This tension and imbalance around the joints sets up a neuromuscular response attempting to restore balance, but also creates tension in the joint. This eventually leads not only to joint degeneration and resulting arthritis as the cartilage wears down, but also the resultant discomfort limits range of motion causing a formation of adhesions in the joint capsule itself. The articulating fascia acts as superglue and literally glues the humerus to the scapula or the head of the femur to the ilium. Repeated forceful movements to free up the glued joint lays down fibroblasts and progressively deeper adhesions until there is a bone on bone end feel to the ball and socket joint.
The deep fascial adhesions however can be melted much like you would melt jello. In almost a miraculous discovery I was able to use the head of the humerus in the shoulder to melt the fascia (or superglue) using very gentle movements. Theory has it that heat, pressure, and gentle stretch facilitates myofascial warming and myofascial release. But the muscles would rebel by tightening around the joint if even mild discomfort was created during the technique. Therefore we need to do a dance between muscle imbalances, joint capsule melting and pain free release of sprains and strains around the shoulder and hip joints. Over the past five years we have been able to release hundreds of complicated frozen shoulders in literally one session. Most of our clients have undergone intense physical therapy for at least one year with little benefit to the adhesion inside the capsule. Some clients were actually on a program to strengthen the already tight muscles further restricting movement in the joint. Other clients were actually scheduled for what I classify as a “barbaric” surgical release where they put you under anesthesia and actually rip the capsule free tearing all the surrounding supportive structures in the process. I have seen many of these patients post-surgically and their condition is actually worse following this procedure as a result of all the scar tissue from this overly aggressive technique.
I have also found that one of the leading causes of SI joint pain is because of adhesions in the ball and socket joint of the hip capsule. At about 10 degrees of hip extension the ilium is forced into flexion on the involved side because the femur is superglued into the socket. This puts stress on the SI joint and results in sprains and strains in that area. In this case adjustments will not have any type of lasting effect. Yet the simple addition by chiropractors and osteopaths in releasing the joint capsule will eliminate the underlying cause of the SI joint dysfunction immediately, and when the muscle groups around the hip are balanced back out the patient will remain pain free. In my practice, I have found joint capsule adhesions in over 50% of my patients with low back pain including young children.
Finally we need to address the difference between hot and cold therapies. Through my intense collaboration with Performance Health, we have discovered a way to treat both the cause of musculoskeletal pain, and the resultant symptom. This goes back to the fascial adhesions throughout the body. The entire body is surrounded by progressively deeper layers of connective tissue called fascia. We compare this to jello. As we heat up jello or fascia it becomes more liquid in state and more accessible. When I approached Performance Health about an all natural heating ointment to be used in conjunction with a cooling application like Biofreeze, they needed an in depth explanation.
Let me use the forearm and wrist as an example to differentiate the use of hot and cold therapy. Most of my clients with carpal tunnel or tendinitis of the elbow are people who use the wrist flexors over and over each day. Without proper daily stretching the flexors of the forearm get stronger and tighter over time putting increased stress on the attachments of the wrist and elbow. The symptoms mostly show up at the joints because there is more joint tension as the muscle groups feeding that joint get tighter over time. As tension builds the fascia shortens and thickens and trigger points form in opposing muscle groups. The tension in the wrist results in “symptoms” like inflammation and joint arthritis as the articulating bones begin to wear out cartilage. We told Perry Isenberg from Performance Health that we feel Biofreeze is indeed the best product in our industry for treating the “symptoms” of joint inflammation and resultant joint arthritis. However, we also suggested a tremendous growing need to have an all natural heating product to melt the connective tissue surrounding the tight muscle groups feeding each joint. This will result in deeper and faster pain free release of taut bands and trigger points feeding the tight tendons that cause joint degeneration. I am grateful that Performance Health did not see this as a conflict to Biofreeze. Instead they put the patient’s best interest first and decided to revolutionize our industry by finally having synergistic products to treat both the cause and the symptoms of musculoskeletal pain throughout the body. The new product is called Prossage Heat. After about two years of changing the all natural ingredients, based on feedback from practitioners in my seminars worldwide, we have the perfect heating ointment with the perfect glide for fast, deep, pain free soft tissue release.
The Center For Pain Management