What’s Occipital Neuralgia?

Neck Physical Therapy

Recently, while checking my brackets for the NCAA basketball tournaments, my mind turned to the topic of headaches. Martha Torrey wrote a post on this site a couple of months ago about headaches related to the jaw (or TMJ). Since headaches can happen for a variety of reasons, I thought it might be helpful to share some details about headaches caused by occipital neuralgia, a condition that is often helped by physical therapy.

Is the back of your head tender to touch, feel tingly or numb? Do you have brief shooting pain over the top of your head or behind your eyes, pain turning your head from side to side, or a constant aching in the back of your head or neck?

Neuralgia refers to pain within the distribution of a nerve, and occipital neuralgia involves the “greater occipital” and “lesser occipital” nerves that exit the spine between the first two cervical vertebrae (upper part of the neck, just below the back of the skull). These nerves innervate the back of your head, the top of your head and the sides of your head behind your ears. Pain from this type of headache can also be felt behind the eyes.

Is the back of your head tender to touch, feel tingly or numb? Do you have brief shooting pain over the top of your head or behind your eyes (like hitting your “funny bone” in your elbow), pain turning your head from side to side, or a constant aching in the back of your head or neck? These symptoms can be related to occipital neuralgia making it painful to lay with the back of your head on a pillow, turn your head from side to side, or sit for long periods of time. Symptoms are often one sided.

The onset of symptoms may follow trauma such as whiplash or a blow to the back of the head. Poor postural alignment in sitting, or with texting, can cause adaptive shortening of the small muscles at the base of the skull, applying pressure to the greater and lesser occipital nerves (see above).

During a physical therapy evaluation, we will assess your posture, the mobility of the sub-occipital muscles and joints in the upper cervical spine and tenderness to palpation of the greater and lesser occipital nerves as well as other physical factors that may influence the upper neck area.

Physical therapy treatment to improve upper neck mobility and posture, and to normalize muscle tone will be used. These treatments can include soft tissue mobilization (specific massage), joint mobilization (to improve neck motion), postural cues to reduce compression of the structures at the base of the skull and upper neck and exercises to improve spinal stability. Dry needling (insertion of small filiform needles into the affected musculature) can also help to relieve pain and muscle tension.

…imagine that your head is a helium balloon, and would tend to float up toward the ceiling, elongating your neck and bringing your head over your shoulders.

A simple way to achieve improved posture in sitting is to imagine that your head is a helium balloon, and would tend to float up toward the ceiling, elongating your neck and bringing your head over your shoulders. It is also helpful to make sure you use a chair that supports your lower back (lumbar support) by holding it in with a small inward curve not allowing you to slouch.

Many other types of headaches can cause symptoms of headaches in the neck and head, and you should see your healthcare provider to determine if occipital neuralgia may be the cause of your symptoms.

Well, now that I have no teams left in the NCAA tournaments my stress headaches should be over until next year.

~ Jeffrey Clough, PT

Anatomical illustration courtesy of surgicalneurologyint.com.

All About Abby: When the Four-Legged Inspires the Two-Legged

It is barely dawn and we’re heading out for our morning walk. My travels may require an umbrella, boots and sometimes microspikes or snowshoes. Whatever the footwear, I will always have treats in my pocket. Not for me, but for my sweet canine companion, Abby.

Abby is our 16 year-old English setter who brings joy to our lives every day. She came to us from Illinois Birddog Rescue in Chicago. This very sweet girl spent most of her midwest life tied to a tree, isolated away from the other dogs. We found our way to each other a decade ago on Petfinder.com, and after we made a long drive to Columbus, Ohio to pick her up, she became part of our family.

The rewards of walking with Abby far outweigh the energy it takes to step outside on a dark, damp morning.

I am a dog lover and always have been. The pure joy dogs bring to my life is immeasurable. I will often share stories of Abby antics and her pathetic start in life with my patients. We chose this breed because we wanted an active dog to be part of our active lives. Flossy, our first setter, hiked, biked, skied and walked with us daily on mountain and woodland trails. This breed requires activity and companionship. (Just like us!) English setters have a very soft disposition and soulful eyes that burn right to the heart. My day always begins with a meditative walk with Abby, a practice that keeps me feeling grounded and grateful. The sunrise, songbird trills, smells and sights of the forest in every season are a lovely way to contemplate matters of the head and heart.

In our home, its all about Abby. Fortunately, I have been able to weave my work schedules around our senior dog’s needs. There are days that I would rather stay inside with my cup of tea, but Abby will have none of that. The rewards of walking with Abby far outweigh the energy it takes to step outside on a dark, damp morning. Even at age 95 in dog years, Abby’s excitement and joy while hunting in the woods is inspirational.

If you are looking for a way to increase your heart rate and daily steps on your fitbit, or just enjoy nature and companionship, look to your local shelter and consider adopting a dog. We are so lucky to have their unconditional love and company. It’s hard to be a lazy couch potato when you have a dog.

The big question is who is rescuing whom?

~ Donna Lannan, PT


What Does Your Jaw Have to Do with Headaches?


Did you know that clenching your teeth can give you a headache? That the muscles around your temples help to close your mouth when chewing, talking or clenching? That there is a soft disc (sort of like a knee meniscus) in the jaw joint?

That jaw joint is referred to as the Temporal (of the temples) Mandibular (the lower jaw bone) Joint or TMJ. It’s the very important joint that connects the lower jaw to the skull, right in front of the ears on each side of the head. Though TMJ is the term that refers to the joint itself, it’s also often used as shorthand for the group of TMJ disorders. The soft disc in the joint (on either sides of our jaw) moves forward a bit with normal chewing or talking, but can get pushed too far during clenching—that is, when the jaw is very tightly closed. That forward movement can sometimes cause the jaw to lock up, similar again to what can happen with the knee meniscus. It’s not only painful but it’s sort of hard to walk around with your jaw locked up! I know because it has happened to me.

Sometimes we aren’t aware that we clench; we may even we do it at night when sleeping. Whether we’re aware or unaware of clenching, it’s the repetition that creates muscle fatigue and temporal headaches. Part of the problem may be that our teeth don’t close evenly, so we may grind at night. But before we rush to our dentist, it’s worth trying a simple exercise to alleviate our headaches.

As a physical therapist with a special interest in TMJ disorders, I have seen simple strategies be successful in resolving not only headaches, but other issues as well. For example, some people hear ringing in their ears (tinnitus) or the sound of water. Others may have pain in their ears, even though they don’t have an ear infection. Others may feel a bothersome sense of pressure in the ear. All of these symptoms can result from TMJ problems.

As with changing any habit, the first step is observation of our behavior. So, here, the first step is to notice when and how often we clench. Focusing on this question sometimes leads people to very interesting information. Clenching often happens while people are driving, studying, participating in a meeting, feeling tense, thinking hard at the computer, enjoying an exciting sports game or even just feeling cold. If we clench or grind our teeth at night, we can notice our cheek muscles and temporal muscles feel tired and we may have a headache or some of the above symptoms upon awakening.

Put the tip of the tongue up gently onto the roof of the mouth (palate) as if saying “nuh.” Leave it gently at that spot, and breathe with your jaw relaxed. That can change EVERYTHING.

The next step is to replace one behavior with another—one that’s not harmful.
Put the tip of the tongue up gently onto the roof of the mouth (palate) as if saying “nuh.” Leave it gently at that spot, and breathe with your jaw relaxed. That can change EVERYTHING. It’s called the “rest position,” and is commonly used in Tai Chi, and eastern medicine to “balance the flow of chi.” In physical therapy, we do it to immediately stop clenching; it’s adding a new habit that interferes with our habit of clenching.

Can it be that easy? Ask one of my patients who was going crazy with the sound of water flowing in her ears and was then able to stop the sound in one week using this strategy. This new habit truly can decrease frequency and severity of headaches and a lot of the other ear symptoms mentioned above. Best of all, it’s an exercise that nobody will know you’re doing! It becomes the new normal position of the tongue.
When it works, people do it more and more, almost unconsciously, even as they fall asleep. But, speaking of sleep, sometimes we grind so hard that a night guard—a special device made by your dentist—is needed. Your physical therapist and dentist can evaluate that need with you.

Of course, there is often more to the story, such as a blow to the head in sports, a whiplash injury or a really complicated occlusion issue. All of these situations require a thorough physical therapy evaluation. We’ll often use manual therapy skills to assist in resolving TMJ issues, mobilizing the jaw to ease it open and allow it to move more freely.

So headaches beware! If you are a clencher, you may be well on your way to comfort by simply creating a new habit, as described above. It’s not often that such a small action can ease our symptoms of headaches and other pesky symptoms.

Keep that chi flowing!

~ Martha Torrey PT

P.S. An extra bonus for the anatomically curious: you might find this animation helpful to understand what normal TMJ function looks like:

How Does That Work? Understanding Ultrasound and Electrical Stimulation

Ultrasound Therapy

Physical therapists do their work through a variety of methods and modalities, some of which may seem more mysterious than others. Many of my patients ask questions like “What is ultrasound?” or “What is electrical stimulation?” They also want to know how each can help their particular ailment. I thought perhaps a little clarification would benefit folks.

The term “modality,” when used in a medical context, simply means a therapeutic approach. In the more specific context of physical therapy, it usually implies the use of other equipment, like the ultrasound or electrical stimulation machines, both of which are often useful. Modalities have been used in the physical therapy realm of treatment since “physiotherapy” was first introduced. In the 1800s, heat and ice were commonly used to treat all sorts of musculoskeletal maladies. Some original tools and traction devices appear to us today to be barbaric (and many believe some were). Our modern modalities and tools are far from barbaric, however.

Over the years, scientific research has introduced a vast number of new modalities to augment the work of manual therapy and exercises in physical therapy. These new tools provide physical therapists with many options to meet patients’ needs with the most effective treatments. Well chosen modalities can assist the therapist in providing the best possible care.

Ultrasound is a non-invasive technique involving vibrations—sound waves—at a frequency above the range of human hearing. The vibrations, applied using a smooth head and lubricating gel, provide deep heating of soft tissues in the body such as muscles, tendons, ligaments and joints. This increases circulation to those tissues which then helps the healing process and decreases pain. An ultrasound treatment will usually take ten minutes or less. During the treatment, the ultrasound head is kept in constant motion, and the treatment usually feels relaxing to the patient.

electrical-stimulationElectrical stimulation, another commonly used therapy, may initially seem a bit scary or unknown to patients. You may hear us refer to it as “e-stim.” More than 100 years ago, medical researchers realized that the human body and its muscles operate on electrical impulses from the brain and spinal cord. The technique of stimulating muscles and tissues with electricity has evolved over the years to be a painless and dependable tool for physical therapists, especially in reducing pain. Treatments take from 10 to 20 minutes. Electrical stimulation involves the placement of electrodes on the part of the body being treated and may be used in physical therapy for the following situations:

  • to assist in reducing pain, inflammation and swelling around a joint;
  • to decrease pain and spasm in muscles;
  • to assist a muscle in contracting to increase its strength; and
  • in wound healing to stimulate tissue repair.

I try to take full advantage of modalities in my work with patients, incorporating both e-stim and ultrasound wherever appropriate. I find I use my hands as my eyes to understand a patient and form an assessment. This is part of what makes our approach unique here at Foothills. I believe it’s important for each person to receive individualized care, looking at the whole person and remembering that one size absolutely does not fit all!

It’s our goal to provide patients with lots of information about their physical therapy program, and to involve them as we go along in refining the plan. Patient understanding and involvement is actually critical to the success of our work together. If something we’re doing seems mysterious or confusing, it’s even more important that we talk it through. Ask plenty of questions!

~ Marion C. Howell, MS PT

Creating a Daily Exercise Practice


I used to imagine that as I grew older I would find more time to do my daily practices. My current practice may be yoga, quiet sitting, reading a text that lends me insight, or pursuing another creative endeavor to slow down and reflect. Yet, as I age and accumulate responsibilities, I find that it is extremely difficult to continue to engage in the mindful practices that I know I need. Whereas I assumed the choice for mindfulness would become easier over time, I have experienced the opposite. The choice becomes more and more intentional every time I make the conscious and active decision not to do another activity, in order to focus on active growth and intentional change.

Over the years, at any given time, the physical practice I found most meaningful has depended on which part of my body was loudest in its request for immediate attention. I have met a variety of physical challenges, none of which (I assume) I am alone in experiencing. Sometimes the backs of my legs might feel extremely tight for several days, or my back might be stiff and sore when I am bending, or maybe my shoulder is bothering me with reaching. I tell myself that I will practice some strengthening activities to protect against injury when I get some extra time. Inevitably, this extra time never arrives. But it occurs to me more strongly each day, I will be extremely unlikely to “find” any extra time. I must actively create the opportunity to mindfully explore my movement patterns and ensure that I am able to move with ease. I want to be able to enjoy movement for as long as I can!

And that brings me to this challenge that I see every day in myself and with my patients: how do we make the time to practice our exercises? Instead of providing a step-by-step list of how to do it, I am going to offer a few thoughts that may help to inspire us when we are faced with not wanting to do our intended daily practice.

First of all, I will try to answer the question, “If physical therapists have several tools in their kit, why do they so often use exercises to treat their patients?” The exercises we prescribe are designed for the patient in order to strengthen a muscle; to stretch a muscle or tissue; or to improve neuromuscular coordination (that is, proper sequencing for muscle action to occur appropriately). Therapeutic exercise is one of the tools most consistently used because it gets the patient involved in their own rehabilitation process on a regular basis. We see patients perhaps one to two times a week for a half hour, but the body is continuing along in all its activities 24 hours a day. The exercises are a way to guide the body on the correct path: a little nudge here, a little nudge there, each time we practice. Remember the maxim, “Give a man a fish and he eats for a day. Teach him to fish and he eats for a lifetime.” We want your body to return to all activities with ease of movement.

We have to guide the body to do something, but then we have to listen with our sense perceptions about how we respond to this new activity. And as a matter of fact, your physical therapist will often ask you how the exercises went. This is a good time to share any insights you may have gained during your exploration.

Secondly, think of your exercises as an exploration. Do you remember what it is like to do something for the first time? Whether that is to taste a new food, travel to a new place, or go to an event you may not have considered previously, when you do something for the first time, you are actively receiving information without interference from your previous experience. All of the exercises will have the same nature of give and take. We have to guide the body to do something, but then we have to listen with our sense perceptions about how we respond to this new activity. And as a matter of fact, your physical therapist will often ask you how the exercises went. This is a good time to share any insights you may have gained during your exploration.

And finally, allow the practice to be mindful. Pay attention while you do your exercises. As a matter of fact, some studies have shown that simply performing rehabilitative exercises in one’s mind can assist in the healing process. Conversely, performing the exercises while distracted may not make for as effective treatment. If we are trying to do something else while practicing the exercise, then we will probably have to do it many more times or for an extended period, and will most likely still not have the desired effect. Performing the exercise with quality in mind may actually reduce the amount of time you need to spend doing it in the long run. This practice of concentrating on one thing at a time may perhaps also help you to develop your ability to focus on other aspects of your life as they are presented. A few minutes of mindful exercise is more than none!

So, when you feel overwhelmed by the thought of your exercises as just another thing on your to-do list, return to the basics. You are getting involved with your own rehabilitative journey. You may learn something about yourself. You strengthen the effect each time you intentionally practice. Sometimes I have to tell myself how satisfied I will be when I know I completed my exercises. Sometimes I tell myself how good I will feel physically. Sometimes I tell myself I will sleep better. But no matter what the reason, I never regret having made the choice to practice.

~ Courtney Germano PT, DPT

Keep Moving, Keep Your Balance


Woman Balancing on Rocks

While I was hiking recently in the beautiful White Mountains along a path covered in colorful fall leaves, I found myself teetering from rock to rock, carefully planning my every step so I would not twist my ankle or step into the river. Quite often I found myself hesitating and misstepping. Then a young 20-something bounded by me, gracefully going from rock to rock without hesitation or fear. So I asked myself, “When did my balance get so bad?”

We get balance by using three different systems: our eyes, ears, muscles and joints.

To define balance, we can simply say it is the ability to stay upright and not fall to the ground. A more precise explanation is that balance is keeping our center of gravity, which is an imaginary spot just behind our belly button, over our base of support, which is our two feet. That is why, when we were kids, it was so hard to pick up the rock in hopscotch when we were standing on only one foot! We were, in essence, making our base of support very small. But let’s break it down even further, because we get balance by using three different systems: our eyes, ears, muscles and joints.

Our eyes not only let us see our surroundings, but they judge distance and determine depth as well as whether something is getting closer or moving away from us. That visual system signal goes directly to our brain and sends out an immediate muscular response that allows us to place our foot ever so gracefully on the rocks in our path. A good example of failure of this system is when we think we are at the bottom step, but we are not, and we jam the floor hard with our foot. Another example is skiing when the light is “flat” and you cannot see the bumps on the trail, which then make you lose your balance.

The inner ear sits deep in the bone on the side our head, just behind the external ear. The inner ear is made up of three fluid-filled canals that detect head motion from side to side and up and down. There are also calcium crystals embedded in the inner ear that detect the pull of gravity. The canals function to keep our vision clear by stabilizing our eyes as our head moves and the crystals tell us our body position in relation to gravity. The inner ear also talks to our muscles constantly allowing us to move smoothly through space. A good example of this system at work is when a person unexpectedly trips and their arm goes out to protect them before they even know they’ve tripped.

Finally, the system that makes the other two systems look good is the muscles and joints. We need strong muscles and flexible joints in order to maintain good balance. We need strong core muscles like our abdominals (aka belly muscles) and gluteals (aka butt muscles). They start the process of holding that center of gravity still so it can be stabilized over your feet. Then your foot and ankle muscles need to be strong enough to keep the your body above them, and if the center of gravity moves outside of your feet you need to be able to take a step to prevent a complete fall to the ground.

Now, back to the hike. It takes a lot of coordination among those three systems to gracefully step from rock to rock. Therefore, any decrease in function in any of these systems can make balance difficult. So, as we age and our vision starts to change, and our joints get stiffer and muscles get weaker, our balance will suffer.

The good news is that these systems can all improve with exercise. This is why yoga and tai chi are such great activities. They focus on strength, flexibility and MOVEMENT. Anything that keeps us moving challenges our balance and, if we add mental tasks like talking, that is even better.

To quote Albert Einstein, “Life is like riding a bicycle. To keep your balance you must keep moving.” So, keep moving, talk while you move and look around while you move to improve your balance.

~ Brigitte Cook, PT

Growth, Adventure and Change: A Journey of the Heart


Thank you for sharing this adventure with me. ~ Carol Wong PT

A few days ago, I boarded a plane to leave behind one amazing and rich adventure, heading toward the next. While an array of feelings arise during this major transition, though I’m struck time and time again with the feeling of gratitude.

My east coast and Foothills adventures began 19 years ago, when my family moved from the west coast to Concord, New Hampshire. My husband and I would raise our kids here, see them off to college, fine tune our professional skills and form countless friendships and connections. It’s easy to do that in Concord. I found it to be a tight, interconnected community where I was likely to bump into patients and other colleagues at the farmer’s market or when out for an evening neighborhood walk. I’ve learned and am grateful to feel what it means to be a part of the fabric of a community.

As a founding partner at Foothills, I experienced the deep satisfaction of working in a partnership that puts values first, every day. Five of us came together in 2000 to create a practice that would make decisions by consensus and never let “business” make us lose sight of what was important to us. A leap of faith, really. What followed was 16 years of learning, growth, change and friendship, along with a heck of a lot of humor.

As Brigitte stated so well: “We never really knew 16 years ago what we were going to create. We were a handful of people trying to create a work environment that was warm, nurturing, healing and fun—a place where we could continue to grow as therapists, friends and families. We did create that, plus much, much more.”

I am in awe of what we have created at Foothills. We have kept moving forward with mutual trust, passion, a belief in good work and goodness of people, and endless communication. It has been an amazing life lesson in the value and fruits of a steady and mindful process. It’s a gift, indeed, to know the power of this kind of synergy and that allows Foothills physical therapists to do work that makes a difference in people’s lives.

Of course, it was hard to say goodbye, not just to friends, partners and the Foothills staff, but to my patients. I’ve known many of my patients for 16 years or more, sharing life stories and wisdom, along with health challenges and health triumphs. They’ve taught me the art of partnering, of meeting people exactly where they are and seeing them completely. The giving and receiving has truly been a two-way street.

That plane that I boarded a few days ago brought me back to a place of deep roots, family and long-standing connections. It marks a new life chapter. Deciding to return to the Bay Area felt like a decision of the heart, one of reconnecting and deepening roots that I never really left behind. In the spirit of a true adventure, I’ll be honoring the process itself as details fall into place. I know that the days of enjoying a seven-minute commute are behind me. I know that my new commute will likely involve my new folding bicycle, which will allow me to navigate and “embrace” the longer and congested commute in an area I call Home. I’ll be practicing PT, of course, stretching and learning as I go, holding the warmth of the Foothills community in my heart.

As a dear friend and colleague said in one of so many touching goodbye messages that I received regarding the sentiments about Foothills Physical Therapy: “We are who we are because of the uniqueness of each one of us.” That includes you—the Foothills family and community. Thank you for sharing this adventure with me.

In gratitude and health,
Carol Wong PT

Recovering from Rotator Cuff Surgery: Lessons of a Stubbornly Independent Doer

IMG_0561 (1)

June 25 It’s a gorgeous summer afternoon and the strawberries call. I talk a friend of mine into driving me to the local pick-your-own patch, a spectacular spot with a great view of Mount Kearsarge and Okemo off in the distance. I am feeling pretty good. I am nine days out from a large rotator cuff repair on my dominant arm. I’m in my sling with a bulky bolster and I’m using a hiking stick to walk on even ground. I got off of my pain medications after three days, so my mind is clear. I’m pretty cocky.

We spent a good hour and a half picking strawberries that fine day. I used only my left hand, of course. I consciously worked hard to hold my right shoulder back in a good position, being careful not to move it. We loaded our quarts into the car and headed back home.

That night, my shoulder was very achy and painful. I iced it a lot and still woke up the next morning feeling very sore. I found myself feeling quite scared. What if I screw this up? What if it is doesn’t heal and I can’t get back to doing the things I love to do? I talked myself down eventually and diligently resumed my efforts to rest my shoulder. The pain finally calmed down.

I’m a physical therapist and I know the protocol: six weeks in a sling with a bolster, with no moving that shoulder! After six weeks, it’s a gradual process of starting to reuse the arm, slowly regaining motion and strength. I know this is a process that takes three to six months. I’ve seen it time and time again in my patients. The Boston Shoulder Institute tells me specifically that at four weeks the strength of the repair is just 20 percent. At eight weeks, it’s 40 percent. At 12 weeks, it’s 60 percent. And, sometime between six and eight months, it is finally at 80 percent. Patience is key.

In my head, I know this is about tendon healing. But I am a doer and I am stubbornly independent. Aren’t these good qualities? During those first couple of weeks, I kept testing and pushing. Can I hold the jar while I’m unscrewing the cover? Can I hold vegetables while I cut them with my left hand? Can I figure out a way to water my garden one-handed? It is amazing how it’s possible to overuse a shoulder without actively moving it. Simply writing too much, keeping the shoulder tense or not supporting it enough while I sit can make it cranky. Even if I’m careful to not to use my arm when I’m getting in and out of my sling or getting dressed, I can see clearly now that I’m using it more than I think.

I get that my job now is allowing my shoulder to heal and that rest itself is productive.

So, this process of learning “radical self care” has not been a smooth and easy one! Slowly, I am learning. I’m now at week five and I know that, if I do not do my part, I am wasting the time and effort of all those who are helping me, and will be shortchanging myself in the end. I’m finally practicing what I regularly preach to post-surgical rotator cuff patients—not doing any new activity for more than 20 minutes. That way, I can see how my shoulder tolerates that activity without abusing it in the process. I ask myself more frequently these days, “Is this a helpful choice right now?”

I am not perfect by any means! At five weeks, I continue to redefine what being productive means to me. I continue to deepen my appreciation for what it means to rest, and what self care is really all about. I get that my job now is allowing my shoulder to heal and that rest itself is productive. My new mantra is, “As I relax and am still, I heal.”

I’ll be allowed to start using my shoulder and arm soon enough, and will be starting physical therapy soon. But, for right now, I need to stay where I am. As my surgeon says, “It’s all about biology.” I would add that there’s a fair amount of psychology in it, too. It’s amazing how we keep learning all the time!

~ Julie Dewdney, PT

Why Would A Yankee Get A Massage?


It’s been 26 years since I first got involved with massage. My family goes back five generations, living in both this town and the town next door, and all were tended toward yankee sensibility. My community was conservative. People were very careful with their resources—perhaps a hangover from the Great Depression as well as the thrift of country living. So when I found myself drawn to the field of massage therapy, I was fairly surprised—actually, I remain surprised for a number of years. I am not from a community of people that do things just because they feel good or who even practice leisure on a regular basis, so who on earth would ever come to me for a massage?

As in launching into any new endeavor, I learned those reasons over the years.


Pain seems to be the first thing that gets people through my door for massage to their neck, back, shoulders, knees, hips—some part of them that won’t let them sleep, get to work, move comfortably or play with their kids or grandkids. It’s wonderful to see how massage loosens up tight muscles, decreases pain, increases circulation and helps people move with more ease.

Mood and Stress Relief

Stress, anxiety and depression also bring people in for massage therapy. Massage in no way replaces physical therapy or psychotherapy, but there is real therapeutic value in creating time for one’s self to relax and receive skilled, professional, nurturing touch. Muscles relax and the busy brain quiets. In our society, we are most often thinking ahead or about what has already happened, rather than being in the moment. During massage there is nothing to do but be there; it is a time to feel where our muscles hold tension and witness how, with gentle manipulation, we can let that tension go. When we are tense, anxious or depressed, our muscles often tense up as a protective response. Massage not only helps release this tension but brings us into greater awareness of our patterns of tension. We then know that we can develop strategies to deal with this in the future.

This is a profoundly relaxing and calming experience. Many people sleep more soundly after having a massage. It doesn’t cure the problem, but it makes coping easier.

Enhanced Movement

Many people come in because they’re tight and stiff, either from activity or inactivity. I see weekend warriors and weeders and others who just can’t manage to get out and move on a daily basis. In addition to the traditional oil on muscles massage, they might choose to receive stretching and range of motion to loosen things up. Those who try the Traditional Massage of Thailand say that is like getting a WD-40 treatment for their joints.
Meet some clients who have touched my heart over the years. So many people have opened their hearts while touching mine over the years, many of whom I might never have guessed would try massage.

The 89-year-old woman who was recently widowed but wanted to stay as “creak and groan free” as possible. She loved her massage and allowed me to work on her for several years until a few days before her death. Even when she couldn’t speak anymore the massage brought a smile to her face.

A big bearded Harley-riding mechanic, who believes massage keeps him able to work hard and long hours without having to take time off for soreness and injuries.

Ministers and priests, since my days as a massage student I have worked on more religious leaders than I ever imagined. It’s not an easy business leading a flock.

The young high school girl whose periods were so painful she would miss school and lie on the bathroom floor in misery. After one session of massage and after being taught to do self abdominal massage she felt ever so much better.

The guy who was a warehouse worker. He was a big, solid guy and could barely bend to get his socks on. He came in once after he had had a Thai Massage and then gone “huntin'” with his brothers. He said “Well, I leaned up against that “berch”(birch) tree, crossed my ankles and slid down into sittin’ injin (Indian) position.. I ain’t been able to do that since I was in grammar school.”

I love the people who are wary of massage, but come to see me because their doctor or therapist has insisted that they try it. They have courage to show up, we discuss their needs and expectations and I give them a safe experience that leaves them feeling great. Their faces are transformed with the joy they feel.

~ Tamara Krenn, LMT

Tamara Krenn shares space here at Foothills, providing massage therapy to her grateful clients. She has been an important part of the Foothills family since the beginning, and is well-known to folks in the waiting room as the woman who calls her clients in with the resonant sound of a large gong.

Walking for Heart Health


Having received a fitness tracker for a holiday gift I decided to do a self-test on how walking might improve my cardiac fitness. Most of us are aware of some of the benefits of walking on a regular basis, and I just wanted to have some numbers that would back up the fact that improvement was occurring. To be simple about it, I decided to track my resting heart rate and the YMCA Bench Step Test for Cardiovascular Fitness.

If you can walk, you can improve your cardiac fitness; and it’s good for the heart AND soul.

The Bench Test tracks the time it takes for your heart rate to return to normal following a period of exercise. You would check your heart rate prior to stepping up and down from a twelve-inch bench at a specific pace for one minute, then rechecking your pulse rate after one minute of sitting. My initial resting heart rate was 66 beats per minute and an age adjusted score on the Bench Test (108 beats per minute) was in the “above average” range.

I initially began my walking routine in January (New Year’s Resolution?), starting with a time of 45 minutes, that gave me a distance of one and one-half miles walking at a rate of two miles per hour.  At that time, I was also in the Cardio Target Heart Rate Zone for 35 minutes of the walk, reaching a peak heart rate of 156 beats per minute. As the effort became easier, I continued to walk for about 45 minutes, but my distance has increased to two miles, at a rate of three miles per hour. I am fortunate to live in an area where my walks are through fields and wooded trails and are quite enjoyable. The mild winter also helped. My new routine became a positive part of my day, something to look forward to.

So, did anything improve? My resting heart rate has decreased to 54 beats per minute. During the walk, now my peak heart rate is 143 beats per minute. Results for the YMCA Bench Step Test now put me in the “excellent range” (74 beats per minute).

There are many factors in cardiac health, but it is nice to have some objective data that positive changes are occurring. Also, I have lost 10 pounds and my most recent cholesterol level has dropped more than 20 points, with absolutely no dietary changes.

Of course, these are just two simple tests and cardiac fitness involves many factors. You should always check with your primary care provider before beginning any exercise.

If you can walk, you can improve your cardiac fitness; and it’s good for the heart AND soul.

~ Jeff Clough, PT