Neurogenic Tremors


Sometimes a client will be part way through receiving a massage treatment and they may experience a tremor. Spasms may occur due to:-

  • Magnesium deficiency
  • Nerve issue
  • Underlying medical condition/disability
  • Accumulation of lactic acid in the muscle
  • Overworking a tight muscle

But what about more noticeable tremors?


All mammals have the ability to release tension through shaking, as a primal response to stress, helping to maintain homeostasis. Unfortunately, social conditioning causes us to suppress and store stress, impacting on our physical and emotional health.

The central nervous system instinctively gets rid of excess tension through rapid muscle contraction and relaxation to calm the body during the stress response when the adrenal state is in overdrive. These tremors may come with sensations of heat or release spreading throughout the body. Due to social conditioning and culture we suppress tremors for fear of being seen as weak, which means that instead of the nervous system having a restorative effect on the body, it becomes dysfunctional and chronic pain patterns develop.


When we enter the fight or flight response the body feels under threat, and it may shake to release stress hormones such as adrenaline and cortisol. This is a natural response of the autonomic nervous system which to enables us to deal with the threat so that we don’t remain in survival mode. These shakes are called neurogenic tremors, and are a product of a very complex neuroendocrine system, overcoming an over-active hypothalamus-pituitary-adrenal axis in order to rebalance and release emotion.

Some of us lose this ability to re-calibrate our nervous system due to being taught to suppress our emotions from an early age, meaning that any emotional trauma is repressed within the muscles. These neurogenic tremors may then occur in the main area of tension. Each individual will have an individual tremor pattern determined by their past history and experiences, upbringing and patterns of tension. The location and type of tremor will be controlled by the brainstem. They may be large amplitude tremors with significant shaking, often due to a large amount of superficial tension being broken down, or they could be more of a vibration that moves through the body as it relaxes. This is why occasionally clients who do an extreme amount of exercise or who have massages that break down a lot of tension, may experience these tremors.



PTSD will also make us more prone to these neurogenic tremors because the body is stuck in an anticipatory stress response. Animals do not suffer with PTSD because they they shake to release  trauma from their bodies. Human often have no escape from the stressful event so become frozen and develop PTSD, which means that excess energy is trapped in our bodies, contributing to chronic emotional and physical pain. The repeated stress cycle leads to high blood pressure,  the formation of deposits in the arteries and changes in the brain leading to anxiety, depression, and addiction.

When activation of this tremor mechanism occurs in a safe and controlled environment, the body is able to rebalance itself as it releases patterns of deep tension, stressor trauma by tremoring. Consequently the nervous system calms.

Therapeutic neurogenic tremors move along the spine, releasing chronic tension and rejecting the fight or flight response. This instinctive response in the body doesn’t have to be suppressed in a therapeutic environment, and the brainstem will initiate a release of deep physical tension which pushes us into defensive postures.



During any release of trauma there may also be an intense emotional release, potentially with recollections of past trauma. If the person wants this to stop they can straighten the legs or roll onto their side.


The nervous system is constantly monitoring for threats and if the defense mechanisms in place to deal with these don’t work, we enter the freeze response, where our physiology overrides our psychology in order to survive. Once we feel safe healing can begin. In PTSD the warning signs become automated which can sometimes be beneficial but this makes it difficult to identify and treat the root causes of our stress, tension etc. Neurogenic tremors will address the trauma that we have not dealt with and release years worth of stored tension and stress.





The IT Band v Vastus Lateralis

vastuslateralisThe vastus lateralis, which is the most lateral quadriceps muscle, is possibly one of the most overlooked muscles in terms of runners and other athletes, as we tend to attribute lateral thigh pain to a tight IT band, due to the runner not stretching sufficiently. However, we must consider how often we see clients who appear to do everything right, they stretch the IT band as much as it can be stretched, they use a foam roller on the outer thigh and they have sports massages with a therapist who strips the IT band, which itself results in pain, yet the symptoms persist. If this is the case then the problem isn’t with the IT band, but with trigger points in the vastus lateralis muscle, which refer pain to the outer thigh in addition to the knee.

While it is natural to think that lateral knee pain would be due to the IT band, we must not assume that this is the case, because the IT band fascia is actually intertwined into the vastus lateralis fibres, hence the IT band may shorten due to overuse of the vastus lateralis, which then pulls on the muscle and tightens it further. Trigger points in the muscle then form, which cause further contraction and reduced blood flow. Waste products and toxins build up in the muscle tissue and then when demands are placed upon the muscle, the pain starts.


Melanoma and Skin Cancers


As a massage therapist, I have the opportunity to observe changes on clients skin, in areas that they may not be able to see themselves. Last summer I got extremely sunburnt and still have marks on my skin from that nearly a year later. Since I’ve spent the last week looking at the development of cancer cells and with summer coming up, I thought this would be the perfect time to give some information about melanoma.


  • remains the UK’s most common cancer with 130,000 cases of non-melanoma skin cancer diagnosed in the UK each year and over 2,400 deaths from melanoma every year
  • the rates of melanoma (1 in 54 people) are rapidly increasing due to ignorance regarding the early signs
  • this is one of the biggest cancers causing death in those aged 15-34
  • 86% of melanoma cases are preventable - with early diagnosis you can avoid disfigurement through surgery and improve prognosis and even prevent death
  • can appear anywhere on the body
  • all skin types can be damaged by UVR



  • fairer skin that burns more easily
  • sunbed users and active tan seekers due to intense and cumulative damage
  • anyone with a history of sunburn, particularly in childhood and/or adolescence
  • outdoor workers that spend regular, prolonged periods of time outdoors
  • sports enthusiasts who enjoy extended, regular time outdoors without protection
  • mature skin which has accumulated UV damage over longer periods of time
  • those with more than 100 moles over the entire body
  • family history of skin cancer or melanoma



The sun emits three types of UV rays, which are carcinogenic:-

  • UVA - UVA rays penetrate the middle layer of the skin, contribute to skin burning and skin cancer, and are responsible for premature ageing
  • UVB - UVB rays reach the outer layer of the skin and are the primary cause of sunburn and skin cancer
  • UVC - UVC rays are blocked by the ozone layer


Sunburn, reddening, blistering, peeling and even tanning of the skin are clear signs of sun damage, causing the superficial layers of the skin to release chemicals which cause the blood vessels to expand and leak fluid. This is why sunburn is painful. When UV radiation penetrates into the deeper layers of skin, the cells become damaged, and while the tan fades the damage remains.

However, some exposure to UVB (15- 20 minutes day) is beneficial, as it is the main source of vitamin D, so it is important to get the balance right.

Vitamin D can also be found in egg yolks, fatty fish eg. trout, mackerel, salmon or tuna, cod liver oil, fortified milk, juices and cereals.



Sunbeds have been proven to emit around 10-15 times the amount of UV rays as the sun at midday, and is thought to be a leading cause of skin cancer in younger people. Even using a sunbed once a month can double the risk of skin cancer, in addition to causing premature ageing, sagging, wrinkling and blotching.

Even the UV light used when having gel nails done can be damaging to the hands and feet as well as the nail beds themselves.



Approximately 86% of skin cancer is preventable by:-

1) keeping shoulders covered as they can easily burn

2) using an SPF 30+ broad-spectrum sunscreen to exposed skin

3) wearing a wide brimmed hat to shade the face, neck and ears

4) wearing good quality sunglasses to protect the eyes

5) staying in shaded areas when possible, during peak UV hours (11am-3pm)



Recognising changes in the skin is crucial as skin cancer rarely hurts.

There are 2 types of skin cancer:-

  • Non-melanoma skin cancer
  • Basal Cell carcinoma
  • Squamous cell carcinoma
  • Melanoma


Whilst non-melanoma skin cancers are more common,  melanoma is more deadly and can quickly spread to form new cancers around the body.



  • the most common type of skin cancer, usually occurring on areas that are exposed to the sun eg. head, face, neck, ears
  • slow growing and rarely spread elsewhere
  • can be different shapes and sizes
  • if a basal cell carcinoma is ignored it can grow large and be disfiguring
  • Symptoms include (see comments):-
  • A persistent non healing sore
  • A pearly, shiny bump or nodule
  • A pink growth with a rolled, slightly elevated border
  • A patch of reddish irritated skin
  • A white, yellow or waxy scar like area



  • the second most common form of skin cancer
  • usually occurs on areas exposed to the sun eg. face, neck, ears, forearms
  • can be different sizes and shapes
  • grow at variable rates
  • rarely spread unless ignored
  • can cause discomfort and become disfiguring
  • can be life threatening if left untreated
  • Symptoms may include (see comments):-
  • Persistent, thick, scaly patches that may bleed – may look like warts with a crusty surface
  • Small hard, white or skin coloured lumps
  • Persistent scaly red patch with irregular borders
  • An elevated growth with a central depression
  • Open crusty sore that bleeds





  • the most deadly form of skin cancer
  • can occur anywhere on the body
  • the appearance of melanomas can vary considerably
  • usually appears as a new mole or an existing mole that changes in appearance
  • if not treated early melanoma can spread to other areas in the body
  • is difficult to treat
  • can be fatal
  • use the ABCDE rule :-
  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolving




  • most aggressive form of melanoma
  • accounts for approximately 20% of cases
  • does not follow the ABCDE melanoma rule and tend to be more even in shape and colour
  • is usually invasive by the time it is diagnosed (when it becomes a bump)
  • commonly occurs on areas exposed to the sun eg. head, neck, the torso in men and legs in women - but can appear in other areas of the body
  • grow fast, downward and become invasive within months
  • usually black, but occasionally are blue, grey, white, brown, tan, red or skin tone
  • Use the EFG rule (see comments):-
  • Elevated?
  • Firm?
  • Growing?



Take action if:-

  • a mole changes shape, particularly gaining an irregular outline
  • a mole changes colour, becoming darker, patchy or multicoloured
  • a mole is getting larger or growing quickly
  • a mole starts to itch, bleed or become painful, crusty or inflamed
  • any lesion on the skin, lips, genitalia or nails behave differently to moles/lesions elsewhere



  • located on the palms of the hands or soles of the feet
  • the only type of melanoma which occurs equally across all skin types
  • can quickly become invasive compared to other forms of melanoma
  • often appear as black discolouration but may present as grey or light brown
  • ABCDE rules of melanoma apply
  • A flat patch of discoloured skin that gradually enlarges is an early sign


  • Begins in the nail matrix as opposed to the skin
  • Symptoms may include:-
  • a dark band, usually vertical, on the nail that slowly expands
  • dark nail pigmentation that spreads to the surrounding skin
  • a nodule underneath the nail
  • usually occurs on just one nail
  • brittle and cracked nails with pigmentation and possibly bleeding



Not all GP’s are sufficiently trained in the detection of skin cancers and it is not uncommon for these to be misdiagnosed, so you should ask for a dermatology referral. You can also access MASCED online for information, sun safety tips, early detection advice, a self examination body mapping chart, a mole ruler and other educational resources.


Effective Palpation

Picture1.jpgDespite having done Swedish and deep tissue massages for years, it wasn’t really until I became a sports therapist that I discovered the art of palpation. I had, of course, palpated abdomens regularly as a midwife, but that was to feel for uterine contractions or to assess foetal position, rather than muscle tension.

The muscle tissue of athletes feels very different to that of more inactive clients, so techniques that are used in swedish or deep tissue massage are often ineffective to athletes. As massage therapists we rely on the instant feedback we get via our hands regarding the texture of the tissues. Healthy tissue tends to feel consistently smooth whereas injured or dysfunctional tissue often feels either stringy or hypertonic, across the whole muscle or across a section of the muscle fibres. If there is inflammation within the muscle it will feel spongy. Different techniques will be necessary to resolve each of these muscle textures. Becoming “literate” in palpation, involves practice on a wide variety of clients and intense focus on what the tissue feels like, but is a priority in providing an effective treatment.

The Diaphragm

 diaphragm1I have previously talked about how addressing the cause of a problem, rather than just treating the symptoms with soft tissue work is important in really making a difference. This doesn’t always happen, however, and one of the most overlooked areas is the diaphragm. For the last week I have suffered increased bloating due to my IBS and for the first time ever was also experiencing shortness of breath just from a few minutes of walking. My whole abdomen right up to the rib cage felt tight and it dawned on me that since the breathing problems were most likely due to the diaphragm being pulled tight, maybe the diaphragm could be involved in other issues that I commonly treat clients with, for example:-

Empathy and Energy Exchange

During any massage there will be an energy exchange between client and therapist which will determine the experience as a whole. It is not merely the therapists skill, knowledge and technique that makes a massage but also the intent of the massage. This is where empathy in the therapist is important, because the intent can change the whole experience for the client.
As a nurse and a midwife I am no stranger to taking an empathetic approach with patients, experiencing an emotional resonance with them. When you understand a clients emotions to the point of feeling them as if they were your own, you are able, as a therapist, to intuitively understand what your client needs. This is particularly important, for example, in a massage for grief. When this compassionate exchange of emotions is present, the intent of the massage will be experienced differently, even if it looks from the outside to be the same. If the therapist is in tune with the client they will instinctively find areas of tension and recognise signals from the body, which will lead to a more healing experience. For example, if a therapist has just gone through a messy divorce and is full of anger, her energy will not be particularly healing. Just as we can pick up on negative atmosphere in a room, the client will pick up on the therapists energy, even if not on a conscious level. Due to the close nature of a massage the energy exchange is much more likely.

The Importance of Understanding Medical Conditions

When I commenced my journey into massage therapy back in 1997, it all seemed very straight forward, the biggest thing to remember being the list of contraindications that were included in the training. As massage therapists we treat clients with a whole array of medical conditions, which means that we are required to not only recognise contraindications, but be competent in working around them to offer our clients a safe service, and there lies the problem.

caduceus medical symbol 3d print model by doubleagent2005 ddkhoh1 fullview

Very few massage therapists are fortunate enough to have the medical and surgical background that I myself dedicated many years to, and so they are often uncomfortable, and dare I say, incompetent when it comes to assessing a client for contraindications. This is not necessarily their fault, as they enter training programmes in the belief that they will be given all the knowledge they need, but there is a very large hole in current training, that being on how to deal with medical conditions safely and effectively. Massage students can come away with an example of a contraindication form but if they don’t know how to use it or how to act on the answers, what good is it? I am a firm believer that every massage therapist, like nurses, midwives and other healthcare professionals, must be accountable for their own practice and work within their competency level, and continuing professional development is so important, so if a therapist recognises that they are struggling with how to manage medical conditions, then it is their responsibility to pursue further training and access research so that they may better serve their clients.

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