Videos of Orthopedic Massage

One can only absorb so much by reading...  Here you can see snippets of Orthopedic Massage at work - and see for yourself how much more technical and precise it is than just "massage".

"I am in Pain"

Skeletal muscle is the most abundant tissue in the body, making up 40-45% of total body weight.  With such a large amount of muscle tissue in the body, it's no wonder there are so many muscle-related pain complaints.

Breaking the Cycle of Chronic Pain

Chronic pain is exhausting.  It's stressful.  Massage helps to interrupt the patterns that make your pain worse.

You hurt, so your muscles tense up, which makes you hurt more, which makes you anxious, which makes you more tense, which makes you hurt more... 

Orthopedic Massage is a non-invasive therapy for persistent, painful problems. Using proven practices the therapist can help you release the affected muscle(s) which will increase blood flow and facilitate healing (reducing the tension and discomfort, breaking the cycle).

Soft Tissue Pain – how does it develop?

There is a way to treat both the cause of musculoskeletal pain & the resultant symptoms. It involves therapeutic assessment, manipulation, & movement of the locomotor soft tissues to reduce/ eliminate pain & dysfunction.   It all traces back to the body’s fascial adhesions and muscle imbalance.

The entire body is surrounded by progressively deeper layers of connective tissue called fascia. Fascial adhesions are “sticking points” which prevent normal movement. 

In some joints, repetitive movements cause certain muscle groups to become strong & short while opposing muscle groups become overstretched & weak.  This is a “muscle imbalance”.
Muscle groups shorten, due to prolonged poor posture, repetitive motion, or  injury & need to be released, lest they pull bones onto nerves & blood vessels & cause or contribute  to a wide variety of painful conditions.

Muscle tension & imbalance around the joints sets up a neuromuscular response that attempts to restore balance, but also creates tension in the joint. This leads to joint degeneration, cartilage thinning, and an increasingly limited range of painless motion – a limit which causes the formation of adhesions (sticking points) in the joint capsule itself.  The fascia that should be moving instead begins to act as superglue – gluing the bone to the socket. 

Attempting to force movement (Ouch!) to free up the glued joint only lays down more “glue” (fibroblasts) & progressively deeper adhesions until the once fluid joint becomes  unyielding and feels solid. 

So why does Orthopedic Massage work on Soft Tissue Pain?

These deep fascial adhesions can be melted like you would melt jello. Much like jello, fascia becomes more liquid and pliable when it is heated up (with techniques such as using the bone itself to melt the fascia inside the joint with very gentle movements).

Theory states that heat, pressure, & gentle stretch facilitate myofascial (deep) warming & release – however, muscles rebel by tightening around the joint if even mild discomfort develops during the technique.

Therefore orthopedic massage must do a delicate dance between muscle imbalances, joint capsule melting & the absolute need to keep all work pain free.


Consider medications containing the active ingredient,Ibuprofen. Ibuprofen is commonly referred to as the brand name Advil, Motrin,or Nuprin. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which relieves pain and swelling (inflammation). It is used to treat headaches, muscle aches, backaches, dental pain, menstrual cramps, arthritis, or athletic injuries. This medication is also used to reduce fever and to relieve minor aches and pain due to the common cold or flu.  Back to the top

Mode of action

NSAIDs produce a range of effects in the body by inhibiting the enzyme cyclo-oxygenase (COX). COX is the main enzyme which converts arachidonic acid to prostaglandins, thromboxane and prostacyclins. Decreasing prostaglandins helps to reduce pain, swelling, and fever. It is found in many central and peripheral tissues in the body, and this explains why NSAIDs have such a wide range of effects. The known effects of these drugs are:

  • analgesia - acting on peripheral tissues, the dorsal horn of the spinal cord, and the brain
  • anti-inflammatory - via the prostaglandin effect
  • anti-pyretic - temperature control in the brain
  • gastric ulceration - impaired gastric lining protection
  • anti-platelet - anti-thromboxane effect prevents platelets sticking together with increased bleeding tendency
  • renal impairment - altered kidney blood flow control worse with dehydration
  • increased wheezing in susceptible asthmatics increasing the muscle tone in the bronchi of the lungs   Back to the top

Side Effects:

Upset stomach, nausea, vomiting, heartburn, headache, diarrhea, constipation, drowsiness, and dizziness may occur. Side effects include increased bleeding risk due to an anti-platelet effect, poor asthma control in susceptible asthmatics, and potential drug interactions with other drugs.  Ibuprofen may infrequently cause serious (rarely fatal) bleeding from the stomach or intestines (increased risk with daily use of alcohol and tobacco), kidney impairment in the susceptible and elderly, also Ibuprofen may rarely cause serious (possibly fatal) liver disease.  Caution is advised when using this drug in the elderly because they may be more sensitive to the side effects of the drug, especially stomach bleeding and kidney effects.

It is not recommended for use during the last 3 months of pregnancy due to the potential for fetal harm and interference with normal labor/delivery.  Back to the top

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Medication for Pain

Just because you can buy many medicines without a prescription doesn't mean they're entirely safe, either. Over-the-counter drugs can kill you. It is very important that you always read the labels of over-the-counter medications and take into consideration combined doses when combining drugs.

Over-the-counter medications come in two main types, which are discussed in detail below: 

  • Analgesics/antipyretics 
  • Nonsteroidal Antiinflammatory Drugs (NSAIDs)  

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

What are NSAIDs and how do they work?

Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation, pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.

Prostaglandins are produced within the body's cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal antiinflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding. Although NSAIDs have a similar mechanism of action, individuals who do not respond to one NSAID may respond to another.  Back to the top

For what conditions are NSAIDs used?

NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever. NSAIDs also are included in many cold and allergy preparations. Specific uses include the treatment of headaches, arthritis, sports injuries, and menstrual cramps. Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk. Aspirin is a unique NSAID, not only because of its many uses, but because it is the only NSAID that inhibits the clotting of blood for a prolonged period (4 to 7 days). Most NSAIDs inhibit the clotting of blood for only a few hours. This prolonged effect of aspirin makes it an ideal drug for preventing blood clots that cause heart attacks and strokes.  Back to the top

What are the side effects of NSAIDs?

NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs. The most common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. NSAIDs may also cause fluid retention, leading to edema. The most serious side effects are kidney failure, liver failure, gastric ulceration and bleeding, kidney impairment in the susceptible and elderly, increased bleeding risk due to an anti-platelet effect, poor asthma control in susceptible asthmatics, and potential drug interactions with other drugs.

Nonsteroidal antiinflammatory drugs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.  Back to the top

What NSAIDS are approved in the United States?

The complete list of approved NSAIDs is very long. The following list contains only NSAIDs that are commonly used:

  • aspirin
  • celecoxib (Celebrex)
  • diclofenac (Voltaren)
  • diflunisal (Dolobid)
  • etodolac (Lodine)
  • ibuprofen (Motrin) - see below for more information
  • indomethacin (Indocin)
  • ketoprofen (Orudis)
  • ketorolac (Toradol)
  • nabumetone (Relafen)
  • naproxen (Aleve, Naprosyn) - see below for more information
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • salsalate (Amigesic)
  • sulindac (Clinoril)
  • tolmetin (Tolectin)

Soft Tissue Pain Clinic


Side Effects

Aleve is the brand name of the generic drug naproxen that is manufactured by Bayer. First sold by prescription in 1976, Aleve was later approved for over-the-counter sales in 1994. Since then, there has been no knowledge of significant Aleve side effects, but on December 20, 2004, the National Institutes of Health (NIH) announced it was suspending the use of Aleve from its study after finding patients taking the drug when compared to those taking a placebo have about a 50 percent greater chance of suffering strokes or heart attacks.

The Aleve side effects were considered great enough by the investigators that they could not continue to administer the drug until resolving questions. Aleve was the only medication used in the study, but the FDA says the warning pertains to all drugs that contain naproxen as the active ingredient. While some doctors are skeptical that significant Aleve side effects exist considering the drug has been on the market for decades, Dr. Gregg C. Fonarow, professor of cardiovascular medicine at UCLA noted these medicines were originally studied in the short term for treatment of pain, and their cardiovascular effects were never really well scrutinizedNow theyre being used in higher doses longer term, and were seeing they indeed can increase the risk for myocardial infarction and strokes.

The trial is suspended until more information is gathered since no one knows for sure why the Aleve side effects developed, or if the Aleve side effects are an indicator that all NSAIDs carry cardiovascular risks. NSAIDs, or nonsteroidal anti-inflammatory drugs, are the class of drug Aleve and other naproxen drugs belong to. Because heart attacks normally develop from a blood clot that forms in the blood vessels that supply these organs, the NSAIDs may increase the likelihood of developing such a blood clot, which researchers are trying to better understand the link.   Back to the top

In addition to the evidence that increased cardiovascular Aleve side effects were present, research investigators also suspended the use ofCelebrex from the study after a separate federal study on cancer prevention found a strong indicator of heart risk among high dose Celebrex patients.

Celebrex belongs to the same class of NSAID drugs as Aleve, but more specifically to a subset of NSAIDs called Cox-2 inhibitors. The FDA warning that Aleve side effects may include increased heart risks has been made at an especially controversial time for both the drug industry and the federal drug agency regulating it. At the close of September 2004, Vioxx, another Cox-2 inhibitor, was recalled from the market in the largest prescription drug recall of all time.

The focus after the Vioxx recall soon expanded to questioning the safety of all Cox-2 drugs when shortly after, the FDA warned increased drug warnings were being placed on Bextra labels, a Cox-2 inhibitor as well. The Celebrex announcement made December 17, 2004 put further scrutiny and criticism on drug safety. If cardiovascular Aleve side effects do exist, the heart attack and stroke risks seen in Cox-2 drugs could possibly include all drugs in the NSAID class of drugs.

The FDA advised doctors at the time of the Celebrex warning to seek alternative treatment methods for patients, but the agency stopped short of issuing a similar warning about the possible Aleve side effects. Officials did warn patients to consult with their doctors and to carefully follow drug instructions and avoid taking Aleve for more than 10 days.

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Call Us:  906-792-0494

Uncommon Questions

This is a very detail-oriented page that explains all about what we do and how we approach your pain issues.  It is placed here for the researcher-at-heart who thrives on details and facts, and it is most certainly not required reading for those seeking to come to us.

At the Soft Tissue Pain Clinic, we use orthopedic massage as a modality for addressing issues of pain associated with soft tissue.

If you are unfamiliar with exactly what orthopedic massage is or what is so special and amazing about the therapy, I encourage you to spend some time here checking out our website.  Inside you will find answers to your questions.

Sections on this page:   

"I am in Pain!"

What is Orthopedic Massage?

Videos of Orthopedic Massage

A discussion of medications

What is Orthopedic Massage?

Orthopedic massage is a type of massage therapy that is focused on treating painful conditions which affect the soft tissues of the body.  

Why the name Orthopedic?  

Although It stems from "ortho" (straight) and "pedic' (child), in conventional medicine the term "orthopedic" is used to refer to the locomotor system, as it describes a conceptual approach to medical practice more than just one particular treatment method.  Orthopedic massage in turn is also concerned with the locomotor system (specifically the soft tissue), and a broad spectrum of techniques and approaches to treat soft tissue dysfunction - allowing it to be a more comprehensive and effective approach.

Simply put, orthopedic massage is a hands-on, pain free, multi-disciplinary approach utilizing deep tissue, connective tissue, & stretching techniques - providing a comprehensive system of expertise for the most effective treatment of soft tissue pain and injury, to find a more lasting relief of chronic/continuing pain & restricted range of motion.  

Who is Orthopedic Massge for?

Orthopedic massage may be recommended for anyone with previous injuries or chronic/continuing pain.

Orthopedic massage may be recommended by a physician who wants a patient to pursue multiple treatment modalities, or people can see an orthopedic massage therapist independently. In addition, many athletes and dancers receive orthopedic massage regularly to enhance and optimize performance, which reduces injuries and restores balance to the entire body for pain-free movement and optimal performance.

The Path to Pain Relief

With chronic pain conditions, many people start with the standard drugs orsurgery.  In my opinion, a better place to start would involve less side effects and be a less invasive route. Orthopedic massage is a much more appropriate place to start when we are treating musculoskeletal pain conditions or sports injuries. I also believe that conditions like joint pain/arthritis are symptoms that can result from tight muscles around a joint; thus, thoracic outlet and carpal tunnel syndrome are actually conditions that can be treated with orthopedic massage.

How Does Orthopedic Massage work?

Recovering from an injury

Orthopedic massage helps people recover from soft tissue injuries in several ways.  Massage can decrease excess neurological activity, decreasing spasm and restoring proper muscle tone and length in the area of injury.  Reducing muscle spasm will increase the flow of blood and nutrients to the area, which supports healing. 

"...but I never had an injury."

Muscle groups shorten, due to prolonged poor posture or repetitive motions, and shortened muscle groups need to be stretched out or they will pull bones onto nerves and blood vessels, and cause or contribute to all sorts of chronic/ continuing painful orthopedic conditions. Orthopedic Massage can address compensations in posture and movement, as well as treat myofascial trigger points that may be contributing to pain and movement limitations.
"So what's the point?"

The objectives are to restore structural balance (normal resting length of muscles and tissue) throughout the body, dissolve adhesions, normalize the position of the soft tissue and release its torsion, lengthen the connective tissue, hydrate the joints, facilitate normal neurological function, release entrapment of the peripheral nerves, and decompress arthritic or painful joints. 

This is done by addressing issues of hypertonis (most commonly, it is an increased state of contraction stimulus to the entire muscle causing it to hold a higher degree of resting tonus than it normally would - muscle memory), scar tissue (disfunctional soft tissue) and the compensitory issues that occur with both of the previous.

This allows a focus on the preventing & rehabilitating of soft tissue dysfunctions & chronic pain.  In short, to provide an extremely efficient and effective method of therapy.
The Break-down

The work involves thorough functional assessment, myofascial release, structural integration, neuromuscular therapy, positional release, neuromuscular re-education, scar tissue mobilization techniques, joint capsule work, myoskeletal alignment techniques, active isolated stretching, and p.n.f. stretching.

We use active isolated stretching techniques to increase range of motion.
We use myofascial, trigger point, pin and stretch, post-isometic relaxation, reciprocal inhibition, and neuro-muscular techniques to reset normal muscle-resting length. 

By the very nature of the work, all of these techniques are done pain-free.

The Difference:


If you have ever looked for a massage therapist in the phone book, you would note page after page of listings, but only a very few have certification in orthopedic massage therapy as it requires considerably more training and what may seem like a radically diferrent approach.


The orthopedic massage practitioner is knowledgeable and skilled in their understanding of the body and its mechanics, the musculoskeletal system, of pain and injury conditions, and of many different massage therapy treatment techniques.  


They also must be skillful critical thinkers to understand the condition present, discern which anatomical structures are involved, and what protocols are required to create functional and measurable improvements.  In orthopedic massage, we strive to find not just relief of a symptom, but also using different assessment to determine the exact underlying cause of the symptom.  

This combination of expertise provides for the most effective treatment of soft tissue pain and injury conditions using massage therapy.

Understanding that everyone is different:

  • Muscle/soft tissue testing determines the source of pain patterns and takes into account your overall health history.
  • Treatment should be according to your needs, indications, and contra-indications.  The orthopedic massage therapist integrates a wide range of techniques to treat a single situation, ideally adapting his/her style for each client, as every person's body is slightly different. 
  • Treatment will not be the same for each client, nor will each session for the same client be the same.  As the body responds, so the techniques, protocols, and treatments will adapt. 
  • Your treatment plan will be designed to suit your unique needs, but the goal for everyone is the same:  to return the individual to a permanent state without discomfort and with full pain-free range of movement.

Four elements are used regardless of the injury or medical treatment involved:

  1. Assessing the injury/discomfort
  2. Matching the treatment to the issue
  3. Adapting the treatment as needed for best results
  4. Educating you (the client) in ways to prevent future discomfort.

These four points are very important in orthopedic massage, because unlike other forms of massage therapy, the most emphasis is placed on understanding the injury as well as what it will take to address/treat it and create a permanency of pain relief.

The Effects of Orthopedic Massage: 

Orthopedic massage has many benefits to offer patients, including the following:

  • Increased blood circulation—this can help to heal an injury.
  • Decreased pain—the massage itself, as well as the side effects caused by the massage, can help to relieve pain. In many cases the pain relief is just a side effect of restoring normal muscle resting length or creating functional scar tissue from dysfunctional scar tissue.
  • Relaxation—not only can this reduce pain in the injured area, but it can also help to promote healing by relaxing the muscles near the injured area.
  • Reduces tension—this is a great benefit whether it is preventative or used as a pain relief (such as for sprains, etc.).
  • Enhanced performance - orthopedic massage is used by many athletes regularly to enhance their performance (the relaxation, tension relief, and realignment help to accomplish this).
  • Realigns tissues - Orthopedic massage can take dysfunctional, uncomfortable scar tissues and realign it.  This can help relieve pain, promote healing in injuries, as well as prevent injuries.
  • Managing scar tissue - massage therapy is very effective in managing the development of scar tissue.  In fact, doctors often instruct patients to massage their scar tissue after surgery.  There are specific techniques that help your body create the most functional scar tissue possible (tissue that offers both mobility and flexibility in the injured area). Scar tissue (collagen fibers) is very rigid, and will never have the elasticity of normal tissue. but, if you can realign the collagen fibers to the point that they allign with the muscle tissue, you are in essense creating fuctional scar tissue. The body is very good at protecting itself by putting down scar tissue, but it does a very poor job of getting rid of it when you are done healing.  These fibers can remain and hinder normal functioning.  It's like a lazy contractor.  He puts up the scaffolding to fix a building, but leaves the scaffolding up long after he's finished.  Scar tissue is the scaffolding that your body puts up to hold everything together as it is healing.  The severity of scar tissue is never constant - it can change given a number of different factors, including severity of the injury, and activity levels before and after the injury.​
    • A low-level amount of scar tissue leaves one somewhat functional, but still restricted.
    • Moderate to severe amounts of scar tissue leaves one very disfunctional, creating adhesions in the surrounding tissue, which in turn creates more compensation, pain, and less mobility
  • Dissolve adhesions—Adhesions and excess scarring after injury can limit movement and functioning.  This can cause muscle tightness and compensations that, in turn, cause further pain and dysfunction. This scar tissue glues itself to nearby muscles, tendons,  ligaments, and other tissues - greatly limiting one's range of motion.  Once these adhesions are released, the range of motion returns to a healthy normal, and movement becomes much more natural and free.  The process is rather surprisingly pain-free, and the effectiveness often catches clients by surprise! 
  • Strengthening—this can be helpful with enhancing performance, but it is most helpful to patients who have had an injury and have been unable to use certain muscles in their body due to the injury. When this happens, the muscle will begin to deteriorate over time and orthopedic massage can help strengthen those muscles again. As you can see, there are many benefits to receiving an orthopedic massage. Whether you are looking for enhanced performance or are seeking to recover from a soft-tissue injury, you can achieve this with orthopedic massage. Start enjoying these benefits by finding an orthopedic massage therapist near you and scheduling an appointment today!  If you are not within driving distance of our office, you can find a certified orthopedic massage therapist here.


Tylenol (Acetaminophen)

Consider medications containing the active ingredient, paracetomol (also known as acetaminophen).  Acetaminophen, commonly referred to as the brand name Tylenol (used by more than 200 million Americans a year), is not as safe as we all might think.  Acetaminophen can be highly toxic. The use of Tylenol instead of aspirin to treat fevers in infants has greatly reduced the occurrence of Reye's syndrome, an often fatal form of liver failure.  Ironically, however, taking too much Tylenol (an overdose) can also cause liver failure.  At Parkland Memorial Hospital (where President Kennedy died) in Dallas, acetaminophen is for example the #1 cause of acute liver failure.  The drug accounts for 100,000 calls to poison control centers, 56,000 emergency room visits, 26,000 hospitalizations, and 450 deaths annually.  Back to the top

Unsafe At Any Dose?

The FDA approved acetaminophen in 1951. The fact that an accidental overdose of acetaminophen can result in liver toxicity, liver failure, and even death has been known for some time.

Consumers may not be aware that acetaminophen is an ingredient in nearly 200 medications both over-the-counter (such as Excedrin, Midol, NyQuil, and Sudafed) and prescription (such as Vicodin), as well as many over-the-counter combination products, so they may unknowingly exceed the recommended maximum dose if they take more than one acetaminophen product without knowing that both contain acetaminophen. Most cases of liver damage occur in people who have taken at least 10-15 grams—more than twice the recommended dose. Many of the emergency room visits and deaths linked to acetaminophen poisoning are due to accidental or intentional overdoses (for example, suicide attempts). People who use over-the-counter medications should read labels carefully and look for the ingredient acetaminophen in analgesics, preparations for headaches, cold and allergy medications, sleep aids, preparations for osteoarthritis, and other products.

In addition some people are more susceptible to acetaminophen toxicity and can experience liver damage even at the recommended dose. A study by the U.S. Food and Drug Administration (FDA) showed that about 20% of people with acetaminophen-related liver toxicity had taken less than the recommended daily amount.

For other people, a dangerous dose is not much higher than the recommended dose—that is, the “window” between a therapeutic dose and a toxic dose is smaller for acetaminophen than it is for many other drugs.

Some experts also believe that taking acetaminophen for several days in a row may cause a dangerous build-up of the drug in the body. In 2006, the American Liver Foundation stated that acetaminophen should not be taken for more than 3 consecutive days, and then only sporadically.  Back to the top

Drug Class & Mechanism:

Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known.

Mode of action is not completely understood, but is thought to act in the brain. It has very weak effects on the COX-1 and COX-2 systems (see NSAIDs below), and therefore it has minimal peripheral anti-inflammatory actions, and does not cause gastric ulceration. Recent research suggests that it may work through a newly discovered COX-3 enzyme system.

Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated.   Back to the top

How Acetaminophen Harms the Liver ( i.e. the technical explaination )

Like many drugs, acetaminophen is metabolized by the liver. If the normal processing pathway is overwhelmed by a high dose, a different pathway known as the cytochrome P450 enzyme system kicks in. When this happens, a toxic metabolic byproduct called NAPQI is produced that can kill liver cells. Alcohol and many other drugs also use the cytochrome P450 processing system, and the risk of a “bottleneck” is greater if the liver has to deal with both acetaminophen and these other substances at the same time. Acetaminophen poisoning has three stages. During the first 12- 24 hours after taking the drug, a person may experience nausea and vomiting. During the second phase, from 24-48 hours, the person usually feels better. After 48-72 hours, however, liver enzyme (ALT and AST) levels start to rise, indicating liver injury.  Back to the top

Potential Problems

Taking acetaminophen on an empty stomach causes a condition called acetaminophen toxicity. That alone kills 100 people every year. Toxicity occurs when your body cannot process the drug quickly enough. Acetaminophen, in itself, is a deadly poison to the human body. However, a healthy liver produces enzymes to counteract the poison. This is what gives us the analgesic effect that we all know and love from the drug. When someone is not receiving proper nutrition, the liver slows down on how quickly it can produce those enzymes. In turn, that leaves us with the poison in our systems.

Alcohol consumption is another key factor in potential liver damage from the drug. Individuals regularly consuming excess amounts of alcohol can develop liver toxicity at lower levels of acetaminophen intake. This, too, has been known for some time. It is not recommended that you take any NSAID (non steroid anti inflammatory drug) like acetaminophen if you consume more than three alcoholic drinks per day. Aspirin, ibuprofen, and naproxen sodium (Aleve) are all counted in that category, That means no more popping a handful of Tylenol to alleviate that hangover.Patients with liver and kidney disease should also exercise caution in taking acetaminophen.

Patients with overdoses of acetaminophen should seek emergency care immediately. Early treatment can prevent liver damage or death. The signs and symptoms of liver toxicity may not become apparent for 2-3 days after a toxic overdose.  Back to the top

The following tips can help prevent acetaminophen related liver toxicity:

  • Do not take more than the recommended dose of 4 grams within a 24-hour period (for example, 12 regular strength or 8 extra strength Tylenol tablets)
  • Do not take the full day’s dose at one time; space it out over the course of the day
  • Do not take acetaminophen for more than 10 days in a row
  • Avoid drinking alcohol; this is important for people with hepatitis whether or not they use acetaminophen 
  • People who do consume 2-3 alcoholic drinks per day should not take more than half the usual recommended dose of acetaminophen (2 grams within 24 hours) 
  • People with advanced liver fibrosis or cirrhosis should avoid acetaminophen 
  • Write down how much acetaminophen you take, and when, if you have trouble remembering
  • Check the labels of all medications; small doses of acetaminophen in combination remedies can add up to big trouble.

 Web Reference:  Tylenol Toxicity