Children in a chronic pain clinic respond significantly to massage. The laying on of the hands also has a significant effect on distress. This is an under-utilized resource that needs to be taught to parents.
Paediatr Anaesth. 2008 Sep;18(9):884-7.
Massage therapy in outpatient pediatric chronic pain patients: do they facilitate
significant reductions in levels of distress, pain, tension, discomfort, and mood
Suresh S, Wang S, Porfyris S, Kamasinski-Sol R, Steinhorn DM. Department of Pediatric Anesthesiology, Children’s Memorial Hospital, and Feinberg School of Medicine, Northwestern University, Chicago, IL
- ages 9-19
- Problems included
– peripheral neuropathy
– abdominal pain
– back pain
– ear pain
– CRPS type 1
– ilioinguinal neuralgia
– joint arthralgia
– sickle cell disease related
- Results are mouth watering:
Some of the tehcniques I use include positional release, stretching, massage, and myofascial release. Case in point: child investigated for possilbe appendicitis with nothing found. Still moderately severe pain RLQ abdomen. I dug in fingers, nearly horizontal, laterally and pushed abdominal muscles medially. You could feel the tightness. It was perceived as uncomfortable and confirmed abdominal wall was part of the problem. This is held (while pushing medially) at a tolerable level for 5+ minutes until softens some. The area stressed is now transversely(across) rubbed until lets go. This process may need to be done several times – weaken bands by side-stretch, then massage out. This eventually relieved the abdominal wall pain but the patient still felt pain. This was felt coming more from the posterior abdominal wall in the psoas muscle. This was released by positional release – if you get a msucle in its most shortened position- it will relax for up to 8 hours (and then process can be repeated):
The patient is supine (on back)
1) knees are bend up 90+ degrees
2) ankles crossed
3) ankles supported on one of my shoulders.
4) Knees are separated a bit.
5) Abdomen palpated with one hand
6) Legs are moved up and postioned any which way will cause the psoas to relax and become painfree.
7) This position is held 90 seconds while checking for tenderness once in a while with palpating hand.
8) Other side (or indeed other abdominal levels) are inspected for tenderness and procedure repeated.
I did that to this young fellow and the psoas relaxed and his abdominal pain remitted. Parent was instructed on how to repeat this at home. Child was quite amazed – of course bowel spasms can re-knot muscles though.
Back pain at the Thoracolumbar junction(where ribs end) is common with a tight psoas and ridiculously easy to temporarily remit – lie so on abdomen, feel the band in back (at level ribs end), lift up ipsilateral iliac crest. (pull up with hand or put something under it). Pain should come out (occasionally you have to prop patient up some) – hold for 90 seconds and presto. Repeat every 8 hours or whenever returns.
Myofascial release in part works on the principle that nerves in the tissues are under a lot of tension – if you cut a radial nerve at the wrist you may have to go up 1-2 inches to find it as it snaps back like an elastic band. Now visualize this – if you stretch skin tissues even further – you can temporarily shut down the skin nerves and reflexively relax muscles. Case in point:
Elderly lady with moderately severe unremitting pain above right ankle – told was “arthritis”. Skin was quite hyperesthetic over a small area of varicosities. It appeared a perforating vein probably irritated the nerve that perforated with the vein. Grasping above and below the level with hands and doing an “Indian rope burn” while distracting hands apart lead to gradual relaxation of tissues (called a release). The was done several times with varying distractions. Patient got up with amazement with relief of her pain – daughter and her instructed on rope burn technique. I will see again this week to see how faired. I did this to one elderly lady once that used to bring me cookies – after in graditude.
Mid lower back pain can be myofascial released as well:
Putting hands on back at lower rib level with thumbs parellel to spine, engage tissues and push towards armpits is another pleasant way to relieve lower midback pain that I have taught parents to do.
For low back try putting hand on sacrum (pelvic end of back) and another hand higher up and distract the two apart.
For headaches, having child lay on back and stand facing head from above. Bend fingers at proximal joints 90 degress and lift back of head by putting fingers at level where skull ends – the tops of your fingers should be off the skull but the pads touching skull. Hold your fingers there and feel the tissues gradually soften – most patients love this release.
If you have got someone during an acute headache, refer to the blog I wrote on migraines – pressure on both temporal and occipital arteries for 6 minutes will soften the tissues and remit most headaches (unless unilateral when only works 50% of time).
A scar neuralgia site – if one puts thumbs on either side of area and stretch apart (straight on, sideways etc.) pain may shut down there as well (for a while in which case is repeated..)
These techniques have been delineated for most areas. For the shoulder, however, I find putting fingers in armpit and rubbing the subscapularis on inside side of scapula hel,ps considerably. I have never been able to get it to relax under 120 rubs.
I wish I had pictures – maybe will take some…
Would be interested in any experience dealing with pain in children by manual techniques. I have asked the author of above article for clarification of their techiques as well.
Addendum – came across a book on pediatric massage:
Pediatric Massage Therapy
Lippincott Williams & Wilkins; 2 edition (Mar 1 2004)