Sleeping Positions

The cute looking kitten shown above looks pretty comfy, huh? Now imagine yourself sleeping in that position. Some of us might be thinking how cozy that position would be - but a lot more of us are thinking about how when we wake up how our whole right side aching, how much our lower back would kill, and so on.


Your sleeping position is a cause and effect of your body's state of being. This is derived from the fact that your body is constantly compensating for proper support. If you have stomach cramps going to bed, you are going to sleep in a position that lessens the pain you feel in your stomach. When you wake up, your sleeping position from last night is going to affect the way your body feels in the morning, resulting in another compensation, which may carry on til the next time you go to bed...you get the picture. It's a cycle, a cycle that is probably intended to keep us balanced and healthy. But unfortunately, if your body gets out of synch, your sleeping position could be compensating in a way that is over-stressing another area of the body, creating an indeterminable number of problems.

Good sleep is about good support. There is no "best way" to sleep, since everyone's body is different, but there are definitely good ways to support your body when you are sleeping. Support can be provided by a good, firm mattress and putting pillows in the right places.

Although I can't assess anyone individually via the world-wide web, I can give some general tips that should help with some very common sleeping position pains. These are what I would say are the top three sleeping issues I have heard people complain of (bonus sleeping issue #4 is thrown in for my friend that has this problem). If my possible cause is most certainly not the cause of your sleeping position pain, read on. These are very general tips, and more likely than not, something here will improve your sleep experience.

Sleeping Position Issues and Tips

When I wake up...

1) my neck usually hurts.

This could be due to the way you position your pillow when you sleep. Pillows are supposed to prevent strain, but if used incorrectly they can cause strain instead. The neck is part of the spine, and when you fall asleep you should try to keep your spine in a neutral position. This means no neck tilts up or down. So if you sleep with your pillow propped under your chest and neck, or fold the pillow in half so your head is propped up, you are putting unnecessary strain on your neck. If you feel like your pillow is not giving you proper support, get a new one! Pillows are an external support system, and support systems sometimes lose their effectiveness Try sleeping with the pillow all the way under your head.

2) my lower back usually hurts.

If it is not a neck pillow problem, it is very likely you can alleviate some of the stress on your lower back with an extra pillow between/under the knees. If you sleep face up, trying putting a pillow underneath your knees. This will help to support your lower body and allows the back to maintain a neutral position. It works the same way if you sleep sideways; try putting a pillow between your knees so the pillow supports the area from your feet to your knees.

3) I snore so loudly I wake my partner/myself up.

There are a lot of reasons for snoring that I won't go into*, but your sleeping position can contribute to the severity of your snores. As the daughter of a human foghorn (I can actually hear him "signaling the ships" as I write this), I understand the pain and frustration that comes with snoring. Snoring is caused by the vibrations of the tongue or the palate, so if you sleep on your back, this could be causing your snoring, or at least making it worse. Sleep with the head in as neutral of a position as possible (meaning not tilted forward/backward/sideways) and this should help. There are also nasal strips and other devices you can use, and there is nothing wrong with those. SPECIAL TIP FOR FRIENDS/PARTNERS OF SNORERS: if you catch him/her snoring, try gently (so as not to wake them) tilting their chin up a couple inches. This can help open up the airway passages.

4) my arms drift above my head and I wake up with pins and needles.

I really wish I could help you, but unfortunately this is out of my scope of knowledge. For what it's worth, I can give you my opinion - drifting appendages may be your body trying to find a comfortable position. If the same body parts keep drifting, it is possible that you have tight upper back muscles that need attention. But sleep disorders are very complex, and it is likely to be a combination of things that are leading to your uncomfortable sleeping patterns. Go to a doctor if this is bothering you!

Though we don't really understand why, we know sleep is important. And sleeping in a good position is very much a part of getting a good night's sleep. So please, make sure you are getting proper rest. It makes for less grumpy people, and therefore a much happier world.


While researching this post, I stumbled upon a site about the different ways couples sleep together. This was my favorite:



*if you want more information on snoring, this site is well organized and as to-the-point as it gets.

The Psoas

(photo taken from freemyself.net)

The psoas muscle, more commonly known as the "filet mignon muscle" on cows, is one that gives most of us humans lots of trouble. Lower back pain is almost ALWAYS linked to the psoas since it is one of the main muscles that connects the hips to the spine (your lower body is connected to your spine by ligaments and muscles - no bones!). This muscle originates on the bodies of the transverse processes of the lumbar vertebrae (the little lateral pointies on your lower spine) and inserts on the lesser trocanter, which is that big leg bone that juts out just below your hips (and causes a great deal of swearing when banged against the kitchen table).

But how do you know if your lower back pain is partly due to the psoas, or if you just have five herniated disks that are preventing you from running that extra thirteen miles a day?* Try this simple muscle test to see:

The Psoas Test

Lie down on a flat surface above the floor (a sturdy table, a firm bed) with your legs dangling off the edge of the surface, feet not touching the ground. Pull your knees into your chest, and then slowly drop one leg towards the edge of the table/bed once again. Repeat with the other leg.

WIN: Both your legs drop down to the table like a rock and you don't feel a thing. Congratulations, you have no psoas problems!

FAIL: You feel a stretching sensation before one or both of your legs touches the surface of your table/bed. What a bummer; you have a tight psoas.


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If you failed, no biggie. You are one of the many, many people that has a tight psoas. Having a tight psoas impacts the way your hips move, and therefore affects the way you walk. You may not feel any pain when you walk, but abnormal walking patterns have a way of adding up to bite you later. Though muscles stretches will not necessarily "fix" your walk, they may be a component in helping your body move more efficiently. These are some easy stretches I personally like to use.

Some Psoas Stretches
translated from Active Isolated Stretching: The Mattes Method by Aaron L Mattes

Method #1: rest upper body and pelvis on table with no weight on the nonactive leg against the table. Maintain exercising leg 95 - 100 degree angle at the knee so that you won't stretch other muscles that may interfere with this stretch.

Kick your leg up into the air, keeping the knee bent. Try to stretch it back as far as you can without bending the knee. Doing this repeatedly, about 10 times, will help stretch those tight psoas muscles out.


Method #2: from a kneeling position, begin with weight on the knee of the leg that is to be stretched. The weight bearing foot should be 12 inches in front of the weight bearing leg.

Drag your body so that your front knee finishes directly over the top of the front ankle. When moving forward onto the flexed front leg, keep the top of the pelvis tilted backward by contracting your stomach muscles. As you move forward, keep the pelvis parallel and the body as vertical as possible. Do this stretch as many as 15 times for both psoas.


For tight psoas muscles, do one of these exercises twice a day and then repeat the psoas test. After a couple days you should see improvement in your range of motion.
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For any questions on these stretches, do not hesitate to contact me! Leave comments or feel free to e-mail me (emily.nine@gmail.com).


* if you "just have five herniated disks", you would most likely feel areas of stabbing, nerve-cringing pain in your back. You probably do not have five herniated disks, especially if you are running thirteen miles a day or more.

Clinical Evaluation of Client C, #1.1

Client C
6'1, male, 49
Diagnosis: no problems, no medications.

Subjective:
- piano player, music school teacher (elementary level)
- requested work on lower back, inner thighs, ankles, and calves

Observation:
- very stiff SCM
- relatively tight in both traps, but greater tightness in R trapezius
- tight levators
- tenderness in L inner thigh area (semimembranosous + gracilis, is that you guys?)

Assessment:
- focused on therapeutic techniques, some relaxation.
- relaxation: deep tissue on arms, lower back and hips (noticed some glut tightness afterwards). hearty hand massage for his piano hands.
- therapy: trigger point on SCM near mastoid process and trigger points in R trapezius. cross-fiber friction for levators, passive arm movement for pecs major/minor. passive rib cage movement, timed compressions to PSIS/sacrum. moved client to side-lying positions for tenderness in inner thigh area.

Plan:
- get up and stretch after piano lessons!
- do this stretch: sit on the ground and stretch legs apart as far as they can go without strain. drag knuckles along tender inner thigh areas in the direction towards/away from the pubic area. then try to touch toes in this position. *should help inner thigh muscles relax & activate lower back muscles*

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One of my funnest clients to date. He actually let me do abdominal work on him, which is unusual for a first time client. He asked lots of great questions about what I was doing and what he could do to help. Next time I'd love to do more abdominal work on him and maybe some active stretches for his psoas musles.

For men it is especially important that I do side-lying massage when working the inner thighs. Not only is it important to get all that anatomy facing away from me, it's also a lot easier to reach the thighs, and clients feel less threatened when their top leg is in the way of all that "stuff". I really need to work on more men so I can get used to the anatomical differences, of which there are many!

Dance Blog

Courtesy of my ever-lovely friend Marianna, here is a beautiful dance photography blog that you should check out: http://www.ideasrojasphotography.blogspot.com/

I don't know how often it's updated, but gosh, just take a gander -










I have great respect for any and all athlete's heightened proprioception, but I find dancers especially captivating. In full awareness of movement, the dancer seeks an expression of beauty...just makes you breathe that heavy goosefleshed sigh, doesn't it?

Clinical Evaluation of Client B, #1.1

Client B
6'1, male, 69
Diagnosis: arthritis in wrists, ankles, and knees. Mild psoriasis. Medications: Tozarozene, NSAIDs (was not specific)

Subjective:
- retired attorney
- complains of lower back pain and stiffness in lower back (L5-S3 region) due to bulging disks
- discomfort in arthritic areas, but today only wrists feel inflamed
- requested special attention to traps, lower back, and knees

Observation:
- Elevated R trapezius
- swollen L and R ankles, more severe on R ankle
- swollen wrists
- signs of carpometacarpal thumb arthritis
- signs of hammertoe
- psoriasis most prominent on appendages (lower arms, hands, lower legs, feet)

Assessment:
- combination relaxation/therapeutic techniques
- relaxation: started in prone position to work out knots in the upper back/lower back. careful attention to wrists and fingers - light hand effleurage on fingers and moderate pressure on the palms. applied herbal adjustment/peppermint oil to wrists and thumb carpometacarpals. effleurage on the SCMs.
- therapy: moved Client B into supine position and rotated arms while compressing pectoralis insertion area. between moderate/firm pressure to the gastrocnemii + iliotibial tracts. special focus to the R ankle area to reduce swelling. ended with passive leg pulls, followed by passive hip rotation.

Plan:
- homework: consider lymph drainage work + continue recieving massages, especially passive stretch work for arthritic joints. continue taking medication/applying peppermint oils to wrists/ankles.
- drink water after each massage


Public Notes:
Client B is the oldest client I've had so far, and a great learning experience. His hand arthritis was pretty severe but that day it wasn't feeling too bad, so I was able to get a good look at (and even did some light work on) the irritation in his thumb and finger joints. Very interesting. I also saw some immediate results when I did the ankle work; the swelling went down considerably, foot temperature went up (a basic sign of increased circulation), and I noticed an increase in mobility during the stretching exercises. And most importantly, he left happy with the results.

If I could do it over again, I wish I had done a little bit of lymph drainage on his lower body. I think it would have helped with his psoriasis. Next time I'd also like to work on his abdominals, which I always hesitate to do when I've never worked with someone before. Working his psoas muscles should help with his hip/lower back pain.

Clinical Evaluation of Client A, #1.1

Client A
5'3, female, 20
Diagnosis: scoliosis of the spine diagnosed in her early teens. No medication.


Subjective:
- complains of cracking joints and hip pain
- enjoys dance, but cannot continue (doctor's orders)
- first massage
- wants increased mobility & stretching tips

Observation:
- elevated left shoulder
- elevated right hip
- medially rotated arms
- medially pronated feet (more severe on right foot)
- knots in L5/S1 area

Assessment:
- mainly relaxation massage with some therapeutic techniques (promotes comfort + not overly intrusive for a beginner massage)
- therapy: rotated scapula (R, L was too tight), compression work on quads w/random rotation technique, trigger points on traps
- relaxation: arms, fingers, feet, gastocs, deep petrissage for lower back

Plan:
- homework: get up after using the computer for more than 1 hour, get a cervical pillow/replace old bed pillow (pillows should be discarded after 1 yr of use), don't wear the same shoes all the time & retire worn shoes after 6 months or get them re-soled
- drink plenty of water after a massage



Public Notes:

New clients are usually a bit nervous, so I've found it's better to just proceed with a run-of-the-mill Swedish massage before bombarding them with all their problems and how to fix them. I also rarely turn over clients on their first time, which was the case here, even though she definitely could have used the pec/abdominal work. Turning over clients interrupts flow and can be disorienting, and it's also a matter of exposure and comfort level.

That said, I love first timers. Most of them don't know what to expect and end up falling asleep, giving me time to slow down and play around with techniques. It's also a great compliment; it tells me the client is comfortable and completely relaxed.

Brief Explanation of Clinical Evaluations

Part of my massage therapy training is spending a minimum of 54 hours in the school's local clinic, offering massages at a student discounted rate. Due to my other college schedule and the considerable commute it would be to drive from Southfield to Ann Arbor on a school night, I've decided that I'm going to do my clinical hours during Thanksgiving and Christmas. At clinical orientation all of us were given a nice packet of information that included all the common medical abbreviations, the types of notes they use, evaluation sheets, and pretty much everything else that I'd need to prepare before I start my clinicals.

The clinic's notes are based on S.O.A.P (Subject information, Objective information, Assessment, and Plan) notes. For the extra-curious reader, here is the breakdown of what SOAP notes really are.

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Subject information is the client's needs and goals for the massage. This is a list of symptoms and analysis of the symptoms (onset, location, intensity, duration, frequency).

Objective information is the treatment goals. This can include the visual data from the client (posture, breathing, gait patterns, bruises, swelling, muscle guarding, tension) and observation after gathering some basic information from palpation (spasm, trigger points, tight muscles, scars, adhesions, joint ROM, muscle testing, tissue temperature, cranial rhythm, etc).

Assessment is the changes observed in a clients symptoms, function, musculature, mobility, and posture after massage treatment. This is also where I will indicate the therapeutic techniques used.

Plan refers to the future work needed. This may involve client "homework", which will vary greatly depending on the client; recommendations could range from lumbar stretches, applying heat/cold to indicated areas, or seeking medical advice from a doctor.
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I realize clinical evaluations will not be so readily accessible/interesting to the general public. But, in case anyone is interested, I will make all of the evaluations public and remove any and all confidential information that the client does not want to share. Important Note: if you receive a massage from me it does not automatically mean you will be featured on this blog. I will always ask permission before I post anything about anyone on this type of public forum.


If you've read this far, tune in later this week too! I plan to do the following:

- scan a reference list of abbreviated language
- report my first tentative practice clinical evaluation
- write an informative and (hopefully) interesting post on muscle stretches for cyclists!

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EDIT: I prefer calling the SOAP notes by Subjective, Observation, Assessment, and Plan. Better wording, imo.