Costochondritis- Massage vs. Medical Massage

Reading through my blog, you'll see that I'm a fan of medical massage therapy. Many people have asked me, "what's the difference between the 2?" Well, I have no clue. =) But I came across this article that went into great detail about the difference between regular massage therapy and medical massage therapy for Costochondritis. My goal is never to steer anyone to do what I'm doing, but to simply put as much information out there about Costo and the different ways that sufferers handle and heal from this Gag Gag Gag condition. =)

"Simply put, Medical Massage Therapy is the focused use of advanced massage techniques to treat a specific condition and achieve a specific outcome. In some cases the condition treated is first diagnosed by the patient’s physician. In other cases the medical massage therapist simply treats the patient based on the patient’s subjective description of his symptoms following a thorough assessment of the patient’s muscles, posture, etc.

Techniques used during a medical massage often include neuromuscular therapy, myofascial release, and lymphatic drainage massage among many others; however, they can also include more common techniques such as Swedish massage. The major difference between a medical massage and a regular massage is that it is performed by therapists with advanced training and the treatment is structured to obtain a specific outcome.

All massage therapists in Arizona must be licensed by the state to legally practice, however, there is no separate license that recognizes “Medical Massage Therapists” over any other licensed massage therapist (LMT). Any LMT can legally perform any type of massage, including medical massage.

Despite this, it is very helpful to seek out a Medical Massage Therapist if you require massage therapy to treat a specific symptom. Any therapist using this term to describe himself or his practice is clearly advertising that he focuses on medical massage. This will narrow down your search for the proper massage therapist for your needs from among the thousands of therapists who mainly focus on relaxation or general therapeutic massage techniques. You can think of the term Medical Massage Therapist as a specialty among massage therapy. It is similar to a family practice Medical Doctor advertising that she specializes in “medical care for women”. The MD is still just an MD like any other, however, knowing her focus is a great help to the patient when seeking a doctor.

Costochondritis is an inflammation of the cartilage that connects the ribs to the sternum. It causes sharp and often severe pain in the costosternal joint (where the ribs connect to the sternum), sometimes mimicking a heart attack. While the cause of this condition is not know, medical massage therapy focused on the breathing muscles and other muscles that attached to the thoracic cage (rib cage) has been shown to be an effective treatment for the pain associated with costochondritis.

Humans normally have 12 rib bones on each side, ten of which attach to the sternum via costal cartilage. Cartilage is softer and more pliable than bone allowing the ribs to expand during inhalation. Dozens of individual muscles attach to the ribs and many of those muscles are used during inhalation. When these muscles are tight (hypertonic) additional stress is place on the costal cartilage contributing to the painful condition.

Additionally, the pain from the cartilage inflammation sometimes causes patients to breathe more shallowly contributing to muscle tightness that can cause continued pain long after the cartilage inflammation has dissipated.

By assessing the condition of the breathing muscles and other muscles connected to the rib cage, your medical massage therapist can formulate a treatment plan to effectively alleviate your symptoms completely in many circumstances. Your therapist will stretch and release hypertonic muscles in the intercostals (muscles between each rib), diaphragm (your main breathing muscle) as well as the other muscles he or she finds are exerting an abnormal amount of pressure on the costosternal joints.

For the massage therapist:
Be sure to assess all muscles of inhalation as well as any other muscles which attach to the thoracic cage or thoracic spine. While all muscles are important to assess and treat if needed, specific muscles which should not be overlooked are; the sternocleidomastoids, scalenes, obliques, rectus abdominis, internal and external intercostals, pectoral major and minor, diaphragm, serratus anterior, latissimus dorsi, and trapezius. Muscles on the posterior of the body must be addresses even though symptoms may only present themselves at the costosternal joints because of the pressure these muscles exert on the thoracic cage. You may experience difficulty in palpating and releasing deeper muscles until the more superficial muscles are released. According to the Mayo Clinic other treatments for costochondritis include muscle relaxers, NSAIDS, antidepressants, physical therapy, and heat." - written by Steve Ibach with help from the mayo clinic website.

Costochondritis- Trigger Point Ther,

Trigger Point Therapy was brought to my attention by my sister -n-law. Thanks Katy! It's something I'm looking into....

The following is cited from the Trigger Point Therapy Workbook.

"Chest pain diagnosed as angina, heart pain, pleurisy, and costochondritis (inflammation of the ribs) may actually be referred pain from myofascial trigger points (tiny contraction knots) in strained or overworked pectoral muscles of the chest. Pain from these trigger points can also lead to the supposition that you have a separated rib, an ulcer, or gallbladder trouble.

These are some of the surprising discoveries by Doctors Janet Travell and David Simons, revealed in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual. The trigger points shown here in the pectoralis major muscle can cause pain that feels like angina from the heart.

Breathing Difficulties

Trigger points in chest muscles can cause distortions of your posture that promote shallow breathing and shortness of breath. Tenderness, pain and breathing difficulties caused by these trigger points are often mistaken for symptoms of emphysema, hiatal hernia, or lung disease.

Pain Referral

Travell and Simons also found that pectoral trigger points can refer pain to your upper back. In middle-aged women, trigger points in chest muscles can contribute significantly to development of a dowager’s hump by keeping the shoulders and head pulled forward. A complicating factor in finding the source of chest wall or rib cage pain is the fact that it doesn't always come from trigger points in chest muscles. It can be referred just as often from back muscles or from the scalene muscles in the neck. The following three drawings show scalene trigger points and the patterns of pain they send to the chest and back.

Misdiagnosis

It goes without saying that your chest symptoms can be signs of a true medical problem. Nevertheless, Doctors Travell and Simons believe that trigger points are the primary cause of pain and that the public suffers needlessly because too many doctors are still uninformed about them. Physicians are often mistaken diagnoses and misdirected in their diagnoses and treatment, including needless surgery. For more on what Costochondiritis can be mistaken for, click PLEASE CLICK HERE.

Imaginary Pain?

When pain comes from trigger points, it's not unusual for diagnosis to entirely elude the physician, who then is apt to write the problem off as minor or imaginary and categorize it as untreatable. Trigger points should be at the top of the list during any examination for pain in the chest, sides, or upper back.

Self-Treatment

When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself quite effectively.

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies simplifies Travell and Simons' extensive research into myofascial pain and makes it accessible to the layman. When trigger points are the cause of your angina, false heart pain, chest pain, or costochondritis, you can gain significant relief using his safe, precise methods of self-applied trigger point massage."

To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.

Costochondritis- Gastron Technique

There's a technique called the Gastron Technique. I have read in a case study that this technique helped a volleyball player with Costochondritis. So I did a lot of research and think it has a valid point of view. I've chosen to use a medical message therapist instead of the Gastron Technique. But it's something to look into.

The following is cited from The Natural Standard, The Authority on Integral Medicine:

Graston Technique® is a patented form of non-surgical instrument-assisted soft tissue mobilization that is used to break down scar tissue and restrictions in fascia (connective tissue present throughout the body, surrounding blood vessels, nerves, muscles, bones, and organs).

The Graston Technique® uses a unique set of stainless steel instruments designed to break up scar tissue buildup in body areas such as the shoulder or wrist, which are often associated with acute or chronic soft tissue injuries. Soft tissues include skin, muscle, nervous (neurological), and connective tissues. Examples of soft tissue injuries include strains, sprains, subluxations (partial dislocation of joints), carpal tunnel syndrome, and repetitive stress injury. Treatment using the Graston Technique® involves sliding a stainless steel instrument designed for a particular body part over the surface of the skin in a back and forth motion. Generally, advocates suggest several Graston Technique® sessions for treatment of soft tissue injuries.

Scar tissue is a type of fibrous connective tissue that may occur in any area of the body. This tissue generally receives a smaller blood supply than normal tissue and doesn't expand easily. Scar tissue also tends to be thicker than the tissue it replaces after an injury. Scar tissue may build up around muscles, tendons, and ligaments as the body heals from an injury. As a result, the movement of the surrounding body tissues may be impaired, or the patient may experience pain when they try to move. Clinically, the buildup of tissue after an injury is called soft tissue fibrosis, but most practitioners refer to these areas as adhesions.

An athlete invented the Graston Technique® after experiencing an incomplete recovery from a knee injury. Surgery and other forms of conventional therapy did not return the athlete to full functionality. In order to find a way to fully recover from the soft tissue injury, the athlete used his background in machining to create the first templates of the stainless steel instruments used in the Graston Technique®. The parent company of the Graston Technique® is TherapyCare Resources. The first clinic using the Graston Technique® opened in 1994. Since then, several major sporting organizations use the Graston Technique® for professional athletes. Several bodywork therapy schools have integrated this modality into their curriculum.