Massage Therapy. Multiple Sclerosis. Release and Restore.

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Another member of my health team, Endre Papp, massage therapist, Making the best use of an engineer and designer’s approach to bodywork. Good for what ails me.

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Credits

The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors or Methodology Committee.

Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger

Web and Social Media Coach Kayla Nelson @lifeoflesion

Photo by Kira auf der Heide on Unsplash

Inspiration from Laura Zucker, Valerie Smith, Aparna Raghuram, Darlene Harrier, Keith Puri, Dafna Gold Melchior, Amanda Blodgett, Cherie Binns

Links

Endre Papp on LinkedIn

Related podcasts and blogs

Family Practice – The Cornerstone of My Team

My Optometrist Saved My Life

Physical Therapy: Needed When Needed

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. We will listen and learn about what it takes to adjust to life’s realities in the awesome circus of healthcare. Let’s make some sense of all this.

To subscribe go to https://health-hats.com/

Creative Commons Licensing

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The Show

Proem

Sustainable best health depends on building a healthcare team responsive to your leadership. In early 2020 I began a series about people on my health team – my primary care doc, optometrist, physical therapist, acupuncturist, chiropractor, and massage therapist.  I wouldn’t function as well as I do without these skilled, supportive, and warm masters in their fields. While cleaning my virtual file cabinet, I found an unpublished interview with my massage therapist, Endre Papp. I thought I had published it. Listening to the sound file, luckily that conversation continues to reflect the value of this crucial relationship. Multiple Sclerosis causes me to feel out of balance almost all the time. Yes, my balance sucks, but that’s not what I mean here. MS causes damage to nerve pathways in the brain, spinal cord, or optic nerves. I’m blessed with some damage in all three, causing muscular weakness, cramping, fatigue, and chronic pain plus neuropathy – numbness, tingling, and other psychedelic sensations. I never feel at rest. Rather I’m constantly adjusting and adapting. Plus, I spend much of my day sitting at a computer and playing my big horn, the baritone saxophone. As you’ll hear in our conversation, Endre is a genius at working out the kinks and spasms, restoring temporary balance, and paying attention to my movement, stretching, balancing, and strengthening program. Endre, how could I have missed you?    

Introducing Endre Papp

Health Hats: Endre, good to be talking to you today. Thanks for taking the time to join me. I’m recording a series about people on my health team, and you are certainly a key member of my health team.  I wanted to introduce people to massage and just talk more about why it’s important to me and more about you as a massage therapist. So, tell me first, where were you when you first realized that health was fragile?

Endre Papp: I love that question. And I’ve thought about it a little bit, and believe it or not, it was early on. I think while the entire concept of health might not have been grasped, when I was very young, I noticed that my grandmother was ill. And when I was about five or so, she passed away. In that process of being with her, I enjoyed my time with her while seeing visible signs on her body that she’s becoming ill. She passed away from a relatively unknown thing called amyloidosis, a protein mutation that attacks the body in different ways. But I was young enough to notice that things were changing, and those visuals and that understanding has stuck with me when you asked me that question. That’s the very first thing I think of.

Health Hats: It is interesting how, as we grow up and we become aware of our surroundings and when this whole idea that you just can’t guarantee health. It’s an interesting one.

Massage therapist engineer

So how is it that you became a massage therapist?

Endre Papp: That’s a funny little story. I was first an engineer. I went to Wentworth University. I became an architectural engineer, got my Bachelor of Science there. And I worked in construction as an engineer and a safety officer and a man of many hats is often people are. And a few years into that, we had our economic downfall. I find myself doing many more different types of things, trying to experiment with things like Aikido, and just being more physical. One time I hurt my shoulder badly enough. I ended up having a couple of partial tears in my left rotator cuff without health insurance available at the time because the construction industry was hit hard. And I didn’t have a job at the time, but my Aikido instructor said, you need to get a massage, not just any massage. I want you to see this guy. He knows how to do the right stuff. So, I said, okay, I got his name. And the guy’s name was Randy Payne. And he still practices in Watertown.

Health Hats: Okay. Randy Payne.

Endre Papp: I like that. P A Y N E. He was trained as a St. John’s neuromuscular therapist, and he specialized in rehabilitative massage and pain management. Now I had no idea what I was going in for, but when I went in, I felt all the things that were hurting me reproduced and amplified as part of the treatment, but they went away. And I thought that was fascinating. And as an engineer and a designer, someone who’s always asking questions and wants to know how things work, my curiosity was instantly peaked. So, when this happened. I was still in the process of figuring out if I wanted to stay in engineering if I wanted to transition into architecture. And I thought that in the meantime, as I started to hear more and more stories of people having positive effects from this type of massage, I thought to myself, Hey, this is so different from architecture is what I felt at the time. Why don’t I do this on the side? Get my certification, I’ll know if I want to go to grad school, and I’ll be able to do something that gives me a little side cash.  So, I went to massage school, and I didn’t like it.

Health Hats: This is getting better and better.

Endre Papp: I didn’t. I thought that the beginning stuff they showed and talked about was not what I wanted. But I knew that if I stuck with it, that something interesting would happen. And I got a lot of other stuff out of it, right? Like I realized that formalized education might not be the way that I want to continue going forward. So, I realized right off the bat that maybe grad school was out of the picture. But I said, okay if grad school is out of the picture, let me focus on this and see what happens. And about two-thirds of the way through the program, I’m sitting there, looking at the visuals of the human body, how everything connects, studying the musculature and the bone structure. Suddenly, it was like somebody took a geometry transparency overlay that they use, and they just placed all my engineering knowledge neatly right on top of the human body. I saw expansion joints. I saw stairs. I saw cantilever beams. I saw the, you name it, sheer connections, all these things. And it was like a huge spark, not even a spark. It was like wildfire. I started to stay late. I came in early. I asked my physical therapist, who was working with me with my shoulder at the time, questions that the teachers couldn’t answer or maybe felt that wasn’t the right time for me to answer. I’m stubborn and just really took my education into my own hands at that time. And I haven’t looked back since.

Elevator speech that wasn’t

Health Hats:  So, I’m gathering from this and my own experience, there are lots of different kinds of massage therapy. So, say a little more about your type and other varieties.

Endre Papp:  I always think about this cause. You always want to have a ten-second elevator speech that if somebody says, Hey, what do you do? You could explain it quickly. And I don’t have one. I haven’t been able to put it well, but I think I could give it a shot.   My type of massage is a rehabilitative modality that focuses on trying to resolve pain and improve performance and help people throughout their lives in a very clinically oriented mindset. So, this differs from the standard massage degree that you get, which is a fantastic base but doesn’t go into the depth of the science or how the body works as someone who might have a neuromuscular type of education may present with. So, in other words, if you go to Elements or go to any type of massage studio, you’re going to find people of various modalities. But generally, people who go there are looking for a generic, deep tissue circulatory kind of tune-up type of massage that addresses generic problems. People who come to me tend to have more complicated issues that require problem-solving with the knowledge of deeper levels of anatomy and physiology without necessarily needing to feel that they need things that might fall into other domains, like energy work or sacral work or things of that nature.

Multiple Sclerosis changes the signals

Health Hats: So how do you apply that when you treat me.

Endre Papp: As I always try and find out if there’s something specific that you want to work on, if there’s a particular type of pain pattern or trouble you’ve had with something, right? Whether that might be a difficulty with a movement or fatigue or whatever else might be going on. I still take all that information and then compile it with what I know to try and figure out the best possible way to help you. As someone who has MS, it’s fascinating working with you because you respond differently than someone else may because of the underlying nature of MS.

Health Hats: Okay. Say more.

Endre Papp: So, what I mean by that is that typically the neuromuscular massage that works with trigger points with contractures and fascia and problem-solving those types of things, they have a very visceral and strong reaction neurologically to what’s going on. So current trigger point hypothesis still says that when people have referred pain or people have specific pain patterns, there’s a connection between a lot of nociception sensation that can turn into pain but isn’t necessarily pain and dysfunction. As an example, if somebody’s walking around and they’re limping a lot, and they’re putting a lot, they’re favoring one side, maybe that side is overworked, and it hurts. And there might be specific areas in that muscle tissue that when I press might refer somewhere else, so I could press in their hip, their gluteus medius maybe. And they might feel it in their lower back. Now that can be a fascial response or a neurological response. With you, the only times you think referrals are when there’s a very strong fascial response, but not so much a linear correlation between your vertebrae, your nerve root and the ways that they’re innervated, where they connect, and how the pain patterns might flow, the way that the nociception works.

Health Hats: And that’s because of the MS?

Endre Papp: Yeah, because of how the myelin sheathing and how the signaling is interrupted. My hypothesis is purely my speculation. My speculation is that because there’s an interruption and things are slightly slowed in many ways. There’s a delayed response. And so, your fascial system compensates for it. And the only times you feel those referrals are when there’s a fascial connection, not when there’s a neurological connection.

Health Hats: Wow. I know that the constellation of different things that I come in with can range from the weakness on one side or that I use two canes or play a baritone saxophone. There seems like there are different kinds of causes or triggers or whatever.

Endre Papp: You have different types of patterns. And those patterns are something that you’re not straight-up asking me. Still, as part of when you come in or when someone comes in with some sort of pain, they’re asking me to figure out the combination code of that pattern to unlock it for them so that they can continue doing what they want to do with as little or no pain as possible.

Recruiting a massage therapist that fits

Health Hats: Wow. It’s true.  It’s beneficial. So, let’s move a little bit from me.  How does somebody either first choose somebody and then evaluate if it’s the right fit?

Endre Papp: You need to have a goal in mind. Okay. What do you want to achieve? Do you want to relax? Do you want to feel like you have a deeper, energetic thing that needs to be fixed? Do you have a pain that has been bothering you? Are you post-surgery, or are you pre-surgery? There are some qualifying questions once you know what your objective is, or you think you might know what your goal is, then you can start looking for a specific type of massage therapist. I always recommend that once you have an idea of what you might like or your goal, then give a call to a few people. Find out what’s going on, send them an email, a text, call them however you want to communicate, and then ask them how they’d go about it. If it resonates with you, then go for it.  It’s not only massage is interesting. It’s not only the modality or the style of massage, but it’s also the person’s philosophy around their work. Okay. So, there might be 10 20, maybe 50 people with the qualifications that I have in a 10-mile square radius in greater Boston right now, how I look at it. And how I might approach releasing tissue or resolving your issue might be completely different from somebody else’s philosophy. People like cross-fit guys or high-intensity athletes, they like to come in, and they’re like, just go for it, man. Just beat the snot out of me, do what you have to do. I want this pain gone.  I need to be able to play a match tomorrow. And maybe somebody who is recovering from a hip replacement might say it hurts when I sleep on this side, my PT said I could sleep on the side, but he thinks there’s a soft tissue dysfunction. What can we do? I want that pain gone, but I’m so tired of being in pain, and I’m very sensitive. So how can we still be productive in our work without me having to be in a lot of pain during the session? So that communication and those types of questions are important to have some concept of so you can talk that through, and a good massage therapist will happily talk you through their philosophy and tell you how they work and why they think that’s good. And if it works for you, then go for it. If it’s not quite what you want them, give a call to a couple of other people.

Now a word about our sponsor, ABRIDGE.

Use Abridge during your telehealth visit with your primary care or family doc. Put the app next to your phone or computer, push the big pink button, and record the conversation. Read the transcript or listen to clips when you get home. Check out the app at abridge.com or download it on the Apple App Store or Google Play Store. Record your health care conversations.

Make the most of your therapist

Health Hats: What makes me think about is that how do people make the best use of their massage therapists? So what I mean is that I can envision that people lay on the table and they’re passive, just do whatever you do. One of the things I like about working with you is it’s I feel like, I don’t know. I come out of there with. I feel different. Maybe something got released. Perhaps it doesn’t tell tomorrow or the next day, but something changes. But I feel like there’s one thing that we talk about somewhere during the session is like tomorrow, do you know? It isn’t just. You’re working on me.  What can people think about when they’re trying to make the best use of their massage therapist? You already said when you’re looking, go in with what your goal is, but it does that go for the visit as well? How do you mean? I’m just trying to think, how to me when I think about using somebody on my team, I think about that, there’s like my preparation, and then there’s my follow through.  So, what do you recommend in terms of preparation and follow through when somebody’s working with you?

Endre Papp: For preparation, I think you don’t really have to think too hard about it. Usually, muscle tissue responds best, or even fascial tissue responds best when somebody can have a good night’s sleep; they’re well-hydrated—some of the things that seem to be common in most people’s vernacular these days. Try and eat smartly.  Don’t eat all sorts of junk food. Maybe don’t go out, have 10 beers with your friends, eat a bunch of nachos, get two hours of sleep, and then come in for that good session. Yeah. If you’re reasonable about it, if you’ve been trying to do a good job with making sure that you get a little sleep, you’re well-hydrated, you eat sensibly? You’re well-rested. Whatever it might be. Those are some of the markers that help the body be able to respond expeditiously. Let’s say you come in and have shoulder pain or neck pain and you have had a good night’s sleep, and you’re well-hydrated and stuff. We’re working through the areas that we find that might have pain or discomfort and were working in those areas. If you meet those few little simple goals, it might respond twice as fast as somebody who decided to have six beers and is dehydrated and got two hours of sleep. Unfortunately, I haven’t figured out a better way, but since it is a duration-based service, if you want to get the most money out of your session with a massage therapist, then making sure that you do those few little prep things will expedite the potential for more work to be done during the session. Okay. So, value wise, right? Just by doing a couple of those things, you’re going to be able to, in many cases, get more done because the body will respond more quickly than if you didn’t.

Health Hats: Oh, so that’s where when you’re working on me that you work in an area and you’ll say, Oh, did you feel that release there? And so you’re saying that if it takes longer to work something than in the hour, there’s fewer things you can do. As opposed to if it releases more quickly and those releases can depend on general health, hydration and rest. 

Endre Papp: It is a factor. Okay. Okay. There’s a lot of other factors, whether something’s just happened. Is it acute? Is it chronic, right? Did you just pull your hamstring yesterday? Maybe it’s going to be inflamed and we really can’t work it because we need to wait for the inflammatory response to get to a point where it’s going to be willing to have, to change, right? If your body’s in full production mode, nothing’s going to happen no matter what you try and do. But if you follow those general health things, then yes, if let’s say we found a spot in your hip that’s tight, we start working it. I feel a change in the muscle tissue. Maybe you feel a change in what you might think is me changing my pressure or the amount of pain that’s elicited there. The better health, general guidelines of health you have that gives us the potential to cut the window of time we are working that area from, I don’t know, say 40 seconds to 20 seconds. And throughout a session that adds up to maybe 10 minutes, 15 minutes, something like that.

Integrative massage therapy

Health Hats: Let me ask you a different question, different area. So how do you integrate with other treatment modalities?

Endre Papp: Very well. I think so.

Health Hats:  What I mean is, so I have a team of people, right? So, I go to acupuncture, have a primary care physician. I have a physical therapist, people meditate, others, maybe that’s not calling them treatment modalities, but whatever. But how do you, how do massage therapy, how do you think about the different modalities that a person might be using when working with somebody?

Endre Papp: There’s always I think that any very professional massage therapist is very in tune with what their scope of work allows them to do. Okay. But that doesn’t mean that you don’t have additional knowledge that is useful in some way. So, for a great, as a great example, I’ll just use myself. I worked at marathon physical therapy up in Newton for four years, three and a half, four years. I got to work hands-on with PTs all the time. I saw all sorts of stuff. We worked closely together. We triaged things, they’d asked me what I would do, or they’d asked me to see something or work on something because they might not have the time. They taught me a lot about joints. They showed me therapeutic exercises. Now can’t do a lot of that stuff because it’s outside of my scope of work, but it’s good knowledge to have because it helps me identify when someone might benefit from seeing a PT, just like I like to know as much as I can about diseases. Auto-immune things, anything like that. So, I know that if something’s happening where I’m feeling something, or someone gives me certain clues that maybe that’s an indicator that they should talk to their PCP about something.

Health Hats: Okay. Okay. So, in terms of referral and support.

Endre Papp: Yeah. But it’s a team effort, right? I always advocate for people to let me know who their healthcare providers are. I always ask them; would you like me to reach out to your healthcare provider? Do you want me to write anything down to give to somebody? Because I do believe that the best possible way to take care of your health is by teamwork with many different people. I think that’s important. I don’t believe that there is such a thing anymore, if there ever was, as a one-stop-shop.

After the session

Health Hats: What should I be asking you that I’m not?

Endre Papp: I did want to quickly jump back and say that there are things that you could do after the massage as well, not just during or before. There’s a lot of self-maintenance that people can do. There are many things that they could ask about, whether it’s soft tissue, were stretching. At this point, most massage therapists are well-versed and understand how strength, stability, and flexibility play into a comprehensive recovery from something. And while not everyone is a PT or has a strength and conditioning certification, making a client or a patient aware of that so that they can follow up will help them expedite their overall recovery. So I would much rather see 120 people a month and only see them once apiece as maintenance to keep them able to do what they want to do in a preventative way, than to only see 30 people, four times a month or 40 people through whatever, some people multiple times because they don’t have the tools to be able to continue working on things on their own to help promote the work and the healing that we did when we were in session together. And I think that I think that’s great. I think everybody should do that or should try to have some examples of that. In their lives because that’s how you get the whole experience. You prep a little bit, you make sure you get a good night’s sleep well eat, you hydrate, you come, we do some work. We figure out what’s going on. We get you a little bit better. I show you a few things you could do to work on things yourself or tell you to talk to one of your other healthcare providers about how something I noticed. Maybe I say, oh man, you know this release, but this isn’t. We looked at all the things soft tissue-wise, perhaps it’s a strength efficiency, or perhaps it’s a stability deficiency. Why don’t you talk to your provider and see if they can help you figure out what that is so that I don’t see you here in two weeks where you say that man, it lasted two days, and that was it. Why don’t we see if we could figure out together how to make it so that your pain-free or pain-free for way longer. And I think that should be the goal of somebody who gets rehabilitative types of massages. It’s what can I do together with my entire team to get me to feel pain-free or as good as I possibly can. But I guess I just want to elaborate a little bit on that. Yeah. Great.

Health Hats: Thank you. Thanks for taking the time. I appreciate it.

Endre Papp: Yeah, you’re very welcome. Thank you for giving me a moment to sit down and talk. Yeah, that’s great.

Health Hats: I’ll see you soon.

Reflection

This series offers voice to my physical/medical team – licensed professionals. These past few weeks my spiritual and mental challenges eclipse my baseline physical challenges. Perhaps fatigue grows, so much COVID, who knows? I can tell because I find it harder to get started in the morning with a fog of fatigue. I want to cry about nothing like I did when six. I vent virtually, which I try to never do. My usual solutions include drink more water, stay active, network – anything that opens the sluices of endorphins. I rely instead on different teams, not licensed, not medical.  The team members of family (including our dog, JoJo), music, and collaborators at PCORI, podcasting, Forward Link, Safe Living, etc. I’m grateful for these riches. They work. Who’s on your team? Whose team are you on?