Monthly Archives: August 2011

Is This the Best Stretch for Low Back Relief?

Lower back pain is a prevalent problem in today’s society. Doesn’t matter if you are a bodybuilder, desk-jockey, or an overweight blind man on a scooter—lower back pain happens to anyone. What most people don’t understand is where there is lower back pain,  their is some sort of hip complex dysfunction. Most therapist and low back suffers are quick to focus their sights on “stretching the lower back“–hence, performing countless Yoga Child Pose stretches:

Although this stretch and other drills will help, one must understand that relief comes from mobilizing the hip complex. Let’s take a closer look at how lower back comfort is directly related to the hip complex.
As a therapist actually working with patients, I find that most of my patients find relief with drills that mobilize the hips; and flexibility exercises that target the muscle groups that originate from the pelvis. Most of my patients sit for 8-10 hours a day. Sitting causes an enormous amount of cumulative stress on the hip complex, and in turn, on the lower back.  Coupled with inactivity and extra weight, the pelvis becomes a central point of dysfunction. Some of the important muscles that are effected by pelvic dysfunction are:

Tensor Fascia Latae (TFL) – This muscle helps stabilize and steady the hip and knee joints by putting tension on the iliotibial band of fascia

Pectineus – This muscle adducts the thigh and flexes the hip joint

Quadratus Femoris – This muscle rotates the hip laterally; also helps adduct the hip

Psoas – This muscles flexes the torso and thigh with respect to each other

External Oblique – This important muscles rotates the torso. Most people that sit all day, rotate very little–so this muscle stiffens up–feeling like a large velcro belt around the entire mid-torso.

Quadratus Lumborom  (QL) – This muscle alone helps to laterally flex the spine. Again, most people that sit all day do not laterally flex,  so this muscle stiffens up feeling like a gun holster is permanently attached to your waist.

Recently, I have been utilizing a stretch on myself and some of my clients that complain of low back pain. It’s probably nothing new, but it uses  a stability ball (which will take some practice and balance), and some strength. After a bout of mobility drills that focus on range of motion and activation, I perform this stretch on a stability a ball. Myself and my clients have been virtually exonerated of any low back pain or discomfort since performing this stretch daily:

Revisiting the Scap Clock Drill

The scapula is an area of importance for proper upper body mechanics. It is the circuit board that controls the mechanics of the shoulder. Unfortunately, it is grossly overlooked in many exercise programs or simply poorly addressed. Many trainers tend to add in some simple push up pluses or rows to “target” the scapular muscles (mainly the infraspinatus and teres minor); however, many exercisers mistaken the function of the scapula with other back muscles.

With conventional rowing, many novice exercisers miss the mark with scapular function. Actually getting the shoulder blades to move is challenging for people that are deconditioned or what I like to term “anterior chain dominant”.

 

Anterior Chain Dominance is characterized by people that are predominately seated for most of their day. They are slouched in chairs staring at computer screens and typically have excess weight causing anterior pelvic tilting; as well as tight /inactive hamstrings and glutes. To add insult to injury, many of this individuals feel the answer to their weight problems is performing countless ab crunches. Performing hundreds and hundreds of abdominal crunches weekly places much unneeded stress on the cervical discs, and posteriorly tilts the pelvis. With the hopes of gaining 6-pack abs, many exercisers simply develop overly tight anterior (front) muscles. These tight muscles may include:
Cervical flexors
Upper Trapezius
Pec Minor/Major
Psoas
Biceps
Rectus Abdominals
Hip Flexors
With poor posture being a hot topic among personal training, it is only fitting to address the scapula region. Many trainers think it is simply rectified by adding more rowing to the exercise program. Rowing is a key player in combating anterior chain dominance, but we have to begin with focusing our efforts on the scapula. This is the area that begins to ‘freeze up’ and cause lay persons to experience pain and discomfort.  Albeit,  the core is a major factor when addressing anterior chain dominance; for the sake of this post, I’m going to focus on the scapula.
The muscles of the scapula are responsible for dynamically stabilizing the shoulder blades, as well as being mobile enough to allow for proper joint function. When the scapula stablizes correctly, the humeral head that makes up the glenoid-humeral joint is able to move freely without restriction. This is aided by a strong rotator cuff group that acts as a braking mechanism. The rotator cuff “clenches” the head of the humerus and doesn’t allow it to run against the ‘roof’ of the acromium and clavicle.
The problem lies when someone comes in with shoulder pain and it is diagnosed as impingement. Impingement means that the rotator cuff muscles are actually rubbing against the ‘roof’ of the acromium and causing inflammation. In long term cases, it become a tendinosis problem that hinders daily activity. In most cases, a physcial therapist, trainer, or doctor always focuses on strengthening the rotator cuff muscles. However, many professionals lack looking to the scapula for proper stabilization during shoulder movment. The scapula acts as an achor for the rotator cuff muscles. Without optimal rigidity, the rotator cuff cannot properly do what it is designed to do: grasp the humeral head.
This is where the Scap Clock Drill comes into play. It is not a beginner drill. You should not present any pain or discomfort in the shoulders prior to performing this exercise. It is simple to perform and easy  to include within a program. All you need is a blank wall–without any obstructions (walls, picture frames, posters, etc, etc). Next, you will need clean hands. No gym owner will like dirty hand prints on a smooth wall. Also, this drill cannot be perfromed on a mirror. Its been tried and your hands will not glide as smoothly. As I said earlier, this is not a beginner exercise; but it is not an advanced exercise either. I like intermediate.
Begin with standing facing the wall (as close as you can). Your nose should be about an inch away. Then, take 2-3 steps back. Depending on your height and leg length,  your steps can be modified. At this time, you should be about 6-8 or so inches away from the wall. Place your hands on the wall, with arms staright. Keep your core strong and scapula tight. Slide your hands in various position along the wall mimicking a clock face. As you slide your hands further out [from your torso], your body should get closer to the wall. It is easy to lose the tightness in your shoulder blades and core, so pay attention to that throughout the drill. Perform numerous positions to really accentuate range of motion. Don’t stick with one motion because its the one you are best at. Try diferent angles. If you have pain with certain angles, modify your step and distance from the wall. The object is to place most of your weight into the walls through your arms/hands.

Torn Rotator Cuff

Rotator cuff tear surgical repair procedure

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In an adult population, a torn rotator cuff is the most common cause of debilitating shoulder pain and disability, with approximately 300,000 rotator cuff surgeries performed annually in the United States. The diagnosis and management of rotator cuff disease places a significant financial burden on the U.S. economy, amounting to an annual cost of $3 billion.

What is the anatomy and function of the rotator cuff?

The rotator cuff consists of four muscles (namely the supraspinatus, infraspinatus, teres minor, and subscapularis) that act in concert to both stabilize and move the shoulder joint. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, serving in tennis, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.

 

These muscles arise from the shoulder blade and insert on the humeral head to create a continuous cuff around the shoulder joint, and provide a link from the trunk to the arm. The ball (humeral head) and its socket (glenoid) have relatively little inherent stability, and have often been compared to a golf ball resting on a golf tee. In this capacity, an intact rotator cuff is essential to provide stability to the joint by a compressing the humeral head into the concave glenoid. A large torn rotator cuff , particularly of the subscapularis, can render the joint at risk for instability and dislocation.

The deltoid and rotator cuff muscles work synergistically to maintain a balance of forces around the shoulder joint in every direction. The deltoid and infraspinatus/teres minor maintain a balance in the vertical plane, while the subscapularis and infraspinatus balance each other in the horizontal plane. With lifting of the arm, the deltoid generates an upward force that is resisted by the downward force produced by the rotator cuff muscles, preventing a loss of reduction of the humeral head on the glenoid. A torn rotator cuff can disrupt this balance of forces and compromise normal shoulder joint motion. In fact, a high riding humeral head that shifts superiorly off the glenoid with raising of the arm can be seen in the setting of a massive torn rotator cuff.

What is a torn rotator cuff?

A torn rotator cuff is a disruption in the integrity of the tendon at the insertion into the humeral head. Tendons connect the rotator cuff muscle belly to bone. Most commonly, tears involve the supraspinatus tendon but can involve any combination or all four of the rotator cuff tendons. The mechanism of injury can be highly variable. A torn rotator cuff can result from trauma such as a fall on the shoulder or after a shoulder dislocation. More commonly, however, athletes suffer a torn rotator cuff from repetitive wear and tear activities that strain and chronically fail the tendon. Such tears are particularly prevalent in overhead athletes and are often seen in tennis players, baseball pitches, javelin throwers, swimmers, and football quarterbacks. Sometimes, a narrow space for passage of tendon underneath the acromion can result in direct mechanical abrasion of the tendon. This has been termed outlet impingement and is commonly referred to as impingement syndrome. A prominent acromial spur and thickened bursal tissue in the subacromial space can abrade the tendon running underneath.

How does a torn rotator cuff occur in athletes?

Damage and ultimately tearing of the rotator cuff tendons has been attributed to either static or dynamic causes. Static changes refer to impingement and mechanical abrasion of the tendons from narrowing of the subacromial space, most commonly due to roughness or “spurring” on the underside of the acromion or thickening of the coracoacromial ligament. On the other hand, a torn rotator cuff can result from abnormal dynamic motion of the humeral head and cuff relative to scapula, leading to abnormal strain on the tendon and tearing on either the joint or bursal side. For example, muscle weakness can allow the humeral head to rise higher towards the acromion and is considered to be one of the most common dynamic causes of a torn rotator cuff in athletes.

A torn rotator cuff result when the muscles and tendons of the rotator cuff become frayed under the acromion bone of the shoulder. This occurs both with aging as well as in younger people who perform repetitive overhead activities.

How is a torn rotator cuff classified?

Unfortunately, there is no universal classification system for a torn rotator cuff. They can be classified based on various characteristics, including thickness, size, pattern or degree of retraction. Commonly used terms to descriptively categorize rotator cuff tears include:

Partial vs. Full thickness Tears
L-shaped vs. U-shaped Tears
Small, Large, or Massive Tears (retracted <3cm, 3-5cm, or >5cm respectively

What is the natural history of rotator cuff tears in athletes?

Many patients with rotator cuff tears are asymptomatic. As many as 50% of people over the age of 60 years may have rotator cuff tears. Correspondingly, however, many patients with shoulder pain may not have a cuff tear. In addition, the presence of a rotator cuff tear in a patient with shoulder pain does not necessarily mean that the tear is the primary cause of pain. It is clear, however, that patients with asymptomatic tears are at a high risk for symptom progression over time.

Unfortunately, rotator cuff tears do not heal spontaneously. In addition, tear size progresses over time and can unfortunately lead to irreversible changes in the tendon and muscle. Retraction of the tendon, scar formation, and atrophy of the muscle with infiltration of fat are all predictable changes that occur with greater chronicity of tears. These changes not only produce a weak shoulder with abnormal mechanics, but also compromise the ability to perform a surgical repair of the tendon to bone. The condition can progress to the point where the relationship between the humeral head and glenoid is permanently altered, with significant upward migration of the head. Arthritis secondary to a massive rotator cuff tear can develop as the humeral head erodes the superior glenoid and undersurface of the acromion. For throwing athletes, fixing a rotator cuff tear is important for them to retain their velocity and control of the ball. Pedro Martinez was able to return to the major league level of baseball competition after a repair of his full-thickness tear.

Symptoms of Rotator cuff tears.
What Does a Torn Rotator Cuff Feel Like?

While rotator cuff tears may be asymptomatic, they will frequently manifest as shoulder pain, particularly at night and during activities of daily living. Patients may complain of varying degrees of shoulder weakness and variable losses of range of motion. Crepitus and swelling can occur as well. On physical exam, patients with longstanding tears may have visible atrophy of muscles around the scapula. Functional deficits often correlate with the location of the tear. Overhead activities are often the most difficult and painful.

Overhead athletes with rotator cuff tears may complain of stiffness and pain during warm-up exercises. Pain is often most prominent during the acceleration phase of throwing or serving. Pitchers will often complain of a loss of velocity or ability to “control their pitch” at the mound.

Rotator cuff tears and MRI. Are imaging studies useful?

Plain x-rays can be useful to examine the relationship between the humeral head and glenoid. Also, they can demonstrate a narrow outlet or downsloping acromion that may put the rotator cuff at increased risk for mechanical abrasion. Magnetic resonance imaging (MRI) and ultrasound are the most common imaging modalities used to diagnose rotator cuff pathology. Ultrasound (US) certainly has a role in the diagnostic evaluation of cuff pathology. While the specificity and sensitivity of US is highly operator dependent, the test is dynamic and permits evaluation of the shoulder with during provocative maneuvers that reproduce symptoms. MRI is more than 95% sensitive in diagnosing rotator cuff tears and can accurately be used to estimate tear size, retraction, and fatty infiltration. This has important clinical implications, as the amount of fatty infiltration can help to prognosticate the success of a surgical repair.

What are my treatment options?

Treatment options for rotator cuff tears can be broadly categorized as nonsurgical or surgical interventions.

Nonsurgical options offer the advantage of avoiding the complications of surgery, and focus on pain relief and improving function by increasing the compensatory role of surrounding muscles. On the other hand, nonsurgical treatment will not result in healing of the torn tendon. Correspondingly, the risk of recurrent symptoms as well as tear progression with irreversible, chronic changes is substantial.

Surgical repair offers the potential benefit of expeditious pain relief and cessates tear progression and secondary chronic changes. Improvements in surgical techniques allow the vast majority of rotator cuff tears to be addressed arthroscopically through minimally invasive techniques. Nonetheless, small risk of infection and stiffness after surgery exist.

What are the nonsurgical modalities available for a torn rotator cuff? 

Initially, sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation can be applied to a torn rotator cuff.

Rotator cuff exercises for rehabilitation:

Exercise is the most important and useful intervention in the nonoperative management of a torn rotator cuff. Initially, athletes should rest and avoid any provocative maneuvers that elicit discomfort. When the pain has resolved, stretching can begin. The initial focus is on obtaining full and painless range-of-motion.

When full and painless range-of-motion have been gradually achieved, strengthening of the intact rotator cuff muscles and associated peri-scapular musculature can ensue. Strengthening of the rhomboids, levator scapulae, trapezius, and deltoid is of tantamount importance to provide a stable platform to maximize the efficiency and function of the remaining, intact cuff tissue. Some useful rotator cuff exercises to focus on these muscles include:

Seated rows
Latissimus pull downs

Corticosteroid Injection:

Local steroid injections in the subacromial space can function as potent anti-inflammatory agents in the subacromial bursa. They are very effective in relieving night pain and can also be used as an augment to rehabilitation exercises in patients that otherwise cannot comply secondary to discomfort. Steroids can have adverse effects on the quality of tendon tissue and healing, however, and for this reason should not be performed more than 3 times in the same shoulder and no more frequently than at least 3 months apart.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS):

NSAIDs help to both control inflammation and relieve pain, and can be very useful as an adjunct to rehabilitation exercises in the management of a torn rotator cuff. These medications can have significant gastrointestinal and renal side effects, however, and should be carefully monitored by a medical physician.

Iontophoresis and Phonophoresis:

These are both techniques used to delivery medications locally through the skin, and can be useful to provide shoulder analgesia as an augment to rehabilitation exercises. Iontophoresis uses electrical current delivery, while phonophoresis uses ultrasound.

What does surgery involve for a torn rotator cuff?

Several factors influence the decision to pursue surgical treatment, including tear size and pattern, patient expectations, medical comorbidities, and occupational demands. Surgery for rotator cuff tears may be performed as an open, mini-open, or entirely arthroscopic procedure.

Partial-thickness tears:

Partial-thickness tears usually involve the supraspinatus and/or infraspinatus and can be located on the articular or bursal surfaces of the tendon. Articular-sided tears on the side of the joint are about twice as common as bursal-sided tears. There is increasing evidence to suggest that partial-thickness tears, particularly those that are ignored or left untreated, progress to larger, full-thickness tears.

Partial-thickness tears are common in overhead athletes who perform repetitive activities, such as tennis, baseball, swilling, or cricket. Athletes will have pain and stiffness with warm-up exercises, and are often uncomfortable during the acceleration phase of throwing. They may demonstrate mild weakness with resisted elevation and/or external rotation of the arm, and will complain of a loss of velocity and control with pitching.

Currently, most surgeons decide of the treatment strategy for partial-thickness tears based on the depth of the lesions. If the tendon tear is less than 50% its thickness, the tear is typically debrided. If the tear is high-grade and involves greater than 50% of the tendon thickness, the tear is often completed and repaired down to bone. If the tear is on the bursal-side, a subacromial decompression and acromioplasty (shaving of the acromion) is also important to increase space for the tendon and avoid future injury.

Full-thickness tears:

Symptomatic full-thickness tears can be approached with arthroscopic or open surgical techniques to repair the tendon back to bone.

Regardless of which technique is performed, the first step of the procedure involves carefully exposing and visualizing the tear to determine its pattern and configuration. This involves performing a thorough resection of the overlying subacromial bursa until the bursal side of the cuff tissue is clearly visualized. The bursa can often be thick and inflamed, and may provide indication of mechanical impingement. An acromial spur or downsloping anterolateral acromion can certainly compromise visualization and contribute to mechanical injury of the tendon. In this setting, an acromioplasty (shaving of the acromion) to increase the clearance for the cuff and improve visualization should be performed. Bony prominences (or osteophytes) related to osteoarthritis of the acromioclavicular joint may also be encountered, and these should be resected as well to improve clearance for the rotator cuff tendons.

After careful inspection of the tear, a repair strategy should be developed to approximate the tendon to bone. If the tear is chronic, mobilization of the tendons may be necessary by releasing adhesions and scar tissue. Without this step, the retracted tendon may not be repairable to bone.

The tendons are typically repaired to bone using suture anchors that are placed in the humeral head at the site of detachment. These are metallic or biocompatible composite screws loaded with on or two sutures. The sutures are passed through the tendon, pulled down, and tied to the bone. The number and position of anchors required depends on the size and configuration of the tear. Sometimes side-to-side sutures can be placed between tendon edges if a tear within the tendon is present as well.

After the tear is anatomically repaired to bone, the surgeon must also evaluate all other lesions within and around the shoulder that may be a source of pain as well. This will include an inspection of structures within the joint such as the glenoid labrum and long head of the biceps tendon. In addition, the acromioclavicular joint and distal clavicle can be a source of pain and may require a resection as well.

What are the advantages of arthroscopic surgery over a conventional open procedure?

Arthroscopic surgery has become the technique of choice for rotator cuff surgery. It offers several advantages, including:

1- Small skin incisions
2- The ability to visualize and inspect the inside of the shoulder (glenohumeral joint) at the time of surgery, and treat other potential pain-generating lesions. This is not possible with conventional open procedures.
3- Avoid splitting and potential detachment of the deltoid muscle.
4- Ability to visualize and treat partial-thickness tears on the articular (joint) side.
5- Less soft tissue dissection.
6- Less postoperative pain.
7- Expeditious rehabilitation program.

Subacromial decompression, acromioplasty, debridement of partial-thickness tears, and repair of full-thickness tears can all be performed using arthroscopic techniques. Tears of the subscapularis tendon, however, can be challenging using the arthroscopic technique and may require an open procedure to fully visualize and repair.

What is involved in postoperative rehabilitation?

In the postoperative period, the arm must be protected. The forces related to daily activities with the shoulder exceed the strength of the repair and can disrupt it until some healing has occurred. A postoperative brace maintains the arm in approximately 15 degrees of abduction and prevents any overhead activity. Ice packs or custom devices that circulate cooled fluid are very useful to control pain and swelling in the immediate postoperative period.

As pain resolves, early passive range-of-motion is initiated within the first week of surgery. A physical therapist can be a very useful adjunct to this process in order to maintain a safe, supervised program. Gentle pendulum exercises in the sling, as well as passive motions in forward flexion and external rotation are continued for the first six weeks.

Rotator Cuff Exercises: Stretching & Strengthening Strengthening exercises are typically delayed until 8 to 12 weeks when healing has progressed and full range-of-motion has been achieved. Start strengthening exercises only after you have your health professional’s approval. Muscle strengthening with rubber tubing can be very effective and often safer than weight machines. Strengthening of the scapular stabilizers (deltoid, trapezius, rhomboids, levator scapulae, etc) is paramount to the strengthening of the rotator cuff to maintain a stable platform and favorable posture for cuff mechanics. Patients continue strengthening for up to a year or longer until satisfactory strength and function are achieved. The degree of strength achieved often relates with the severity and chronicity of the initial tear.

Rehab after rotator cuff surgery can vary widely, but there are some general principles that are true for most patient having surgery for treatment of a torn rotator cuff. Usually these rotator cuff exercises are started gradually as soon as you can do the exercise routine without pain.

How long will it take for me to get back to my sport?

Just like all tears are not created equal, neither is the rehabilitation and recovery. Unfortunately, these timelines need to be individualized based on the severity of the tear and demands of your sport. Tennis, baseball, and other overhand sports can be very demanding, particularly at high-levels of competition. With these sports, a gradual return to activity is planned with your doctor. After healing has occurred, this is usually initiated through a graduated and supervised throwing program in which distance and velocity is slowly increased as tolerated over 2 to 3 months. Small or partial thickness tears will generally permit an accelerated recovery compared to large tears, but the ultimate plan to get you back on the field or court must be determined by your doctor and should reflect a balance of moving forward expeditiously without placing the repair at undue risk.

Can I prevent a torn rotator cuff? Rotator cuff Exercises.

The etiology of rotator cuff tears is multifactorial, and it is unclear with current evidence if tears can be completely prevented. Maintaining the health of the rotator cuff muscles and peri-scapular musculature, however, can certainly help to prevent injury and optimize the kinematics of the shoulder joint. These strategies are employed by elite pitchers and overhead athletes who place remarkable demands on their shoulder and rotator cuff daily. The internal rotators are inherently stronger than the external rotator cuff muscles, and maintain a balance of these forces is important. Rotator cuff exercises to consider include:

Seated rows
Latissimus pull downs
Resisted tubing exercises
Side-lying external rotator
Propped external rotator
Shoulder roll
Shoulder blade squeeze
Wall push-ups

If you suspect that you have a torn rotator cuff, it is critical to seek the urgent consultation of a local osteopath for appropriate care. To locate a top osteopath or therapist in your area, please visit our Osteopathic Pain Relief Centre.

Understanding Your Fascia

Cover of "Anatomy Trains: Myofascial Meri...

Cover via Amazon

You’ve got this injury you just can’t shake. You take time off. You ice and stretch and do all the right things but you’re still limping home. You spend too much time trying to articulate your particular brand of hurt to those loved ones who still put up with you. You follow referrals to physical therapists and massage therapists and you’d go to an aromatherapist if it’d help you run again, but nothing does. You diagnose yourself on WebMD: You’re a structurally flawed human being for whom recovery is impossible.DON’T GIVE UP YET

The answer may be right under your fingertips. About 2mm under your fingertips, to be precise. Under your skin, encasing your body and webbing its way through your insides like spider webs, is fascia. Fascia is made up primarily of densely packed collagen fibers that create a full body system of sheets, chords and bags that wrap, divide and permeate every one of your muscles, bones, nerves, blood vessels and organs. Every bit of you is encased in it. You’re protected by fascia, connected by fascia and kept in taut human shape by fascia.

Why didn’t anyone mention fascia earlier? Because not many people know that much about it. Fascia’s messy stuff. It’s hard to study. It’s so expansive and intertwined it resists the medical standard of being cut up and named for textbook illustrations. Besides that, its function is tricky, more subtle than that of the other systems. For the majority of medical history it’s been assumed that bones were our frame, muscles the motor, and fascia just packaging.

In fact, the convention in med-school dissections has been to remove as much of the fascia as possible in order to see what was underneath, the important stuff. That framed Illustration hanging in your doctor’s office of the red-muscled, wide-eyed human body is a body with its fascia cut away; it’s not what you look like inside, but it’s a lot neater and easier to study and it’s the way doctors have long been taught to look at you. Until recently, that is.

In 2007 the first international Fascia Research Congress, held at Harvard Medical School, brought about a new demand for attention to the fascial system. Since then fascia has been repeatedly referred to as the “Cinderella Story” of the anatomy world, speaking both to its intrigue and the geekiness of those who study it. While you may not share the medical and bodywork communities’ excitement over mechanotransduction and the contractile properties of myofibroblasts, think of it this way: Fascia is a major player in every movement you make and every injury you’ve ever had, but until five years ago nobody paid it any attention. And now they’re making up for lost time.

FASCIA FUNDAMENTALS

What exactly does it do? It wraps around each of your individual internal parts, keeping them separate and allowing them to slide easily with your movements. It’s strong, slippery and wet. It creates a sheath around each muscle; because it’s stiffer, it resists over-stretching and acts like an anatomical emergency break. It connects your organs to your ribs to your muscles and all your bones to each other. It structures your insides in a feat of engineering, balancing stressors and counter-stressors to create a mobile, flexible and resilient body unit. It generally keeps you from being a big, bone-filled blob.

“Fascia is the missing element in the movement/stability equation,” says Tom Myers, author of the acclaimed book Anatomy Trains. Myers was among the first medical professionals to challenge the field’s ignorance of fascia in the human body. He has long argued for a more holistic treatment, with a focus on the fascia as an unappreciated overseer. “While every anatomy lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing. The ‘illusion’ of separate muscles is created by the anatomist’s scalpel, dividing tissues along the planes of fascia. This reductive process should not blind us to the reality of the unifying whole.”

BUT, THAT’S THE OLD NEWSWhat rocked the medical community‘s world was this: Fascia isn’t just plastic wrap. Fascia can contract and feel and impact the way you move. It’s our richest sense organ, it possess the ability to contract independently of the muscles it surrounds and it responds to stress without your conscious command. That’s a big deal. It means that fascia is impacting your movements, for better or worse. It means that this stuff massage therapists and physical therapists and orthopedists have right at their fingertips is the missing variable, the one they’ve been looking for.

WHAT DOES THIS HAVE TO DO WITH YOU?

Grab hold of the collar of your shirt and give it a little tug. Your whole shirt responds, right? Your collar pulls into the back of your neck. The tail of your shirt inches up the small of your back. Your sleeves move up your forearms. Then it falls back into place. That’s a bit like fascia. It fits like a giant, body-hugging T-shirt over your whole body, from the top of your head to the tips of your toes and crisscrossing back and forth and through and back again. You can’t move just one piece of it, and you can’t make a move without bringing it along.

Now, pull the collar of your shirt again, only this time, hold onto it for eight hours. That’s about the time you spend leaning forward over a desk or computer or steering wheel, right? Now, pull it 2,500 times. That’s about how many steps you’d take on a half-hour run. Your shirt probably isn’t looking too good at this point.

Fortunately, your fascia is tougher than your shirt is, and it has infinitely more self-healing properties. In its healthy state it’s smooth and supple and slides easily, allowing you to move and stretch to your full length in any direction, always returning back to its normal state. Unfortunately, it’s very unlikely that your fascia maintains its optimal flexibility, shape or texture. Lack of activity will cement the once-supple fibers into place. Chronic stress causes the fibers to thicken in an attempt to protect the underlying muscle. Poor posture and lack of flexibility and repetitive movements pull the fascia into ingrained patterns. Adhesions form within the stuck and damaged fibers like snags in a sweater, and once they’ve formed they’re hard to get rid of.

And, remember, it’s everywhere. This webbing is so continuous that If your doctor’s office were to add a poster of your true human anatomy, including its fascia, fascia is all you’d see. Thick and white in places like your IT band and plantar fascia, less than 1mm and nearly transparent on your eyelids. And within all that fascia you have adhesions and areas of rigidity. You likely have lots of them.

But, this isn’t bad news. Every bit of the damage you’ve caused your fascia is reversible, and every one of the problems it’s caused you were avoidable. You take care of your muscles with stretching and foam rolling and massage. You take care of your bones with diet and restraint. You never knew that you needed to take care of your fascia, but now you do. You may just shake that nagging injury after all.

How to Care for Your FasciaMOVE IT OR LOSE IT: Sticky adhesions form between fascial surfaces that aren’t regularly moved, and over time these adhesions get strong enough to inhibit range of motion. Take a few minutes first thing in the morning to roll around in bed and really stretch out, head to toe, just like a cat after a nap.

STAY LUBRICATED: Just like every other tissue in your body, your fascia is made of water. It works better, moves better and feels better when it’s wet. So, drink!

STRETCH YOUR MUSCLES: When your muscles are chronically tight the surrounding fascia tightens along with them. Over time the fascia becomes rigid, compressing the muscles and the nerves.

STRETCH YOUR FASCIA: Once your fascia has tightened up, it doesn’t want to let go. Because the fascia can withstand up to 2,000 pounds of pressure per square inch, you’re not going to force your way through, so stretch gently. Fascia also works in slower cycles than muscles do, both contracting and stretching more slowly. To stretch the fascia, hold gentle stretches for three to five minutes, relaxing into a hold.

RELAX! If you spend all day tense and tight at a desk, ice baths may not be the best thing for you. Fifteen to 20 minutes in a warm Epsom salt bath can coax tight fascia to loosen up, releasing your muscles from their stranglehold. Make sure to follow it up with 10 minutes of light activity to keep blood from pooling in your muscles.

USE A FOAM ROLLER: Like stretching, using a foam roller on your fascia is different than on your muscles. Be gentle and slow in your movements, and when you find an area of tension hold sustained pressure for three to five minutes. You may practice self-massage with the same rules.

RESPECT YOUR BODY: If you’re attempting to run through an injury, or returning from one with a limp, beware: Your fascia will respond to your new mechanics and, eventually, even after your injury is gone, you may maintain that same movement pattern. That’s a recipe for an injury cycle. It’s better to take some extra time than to set yourself up for long-term trouble.

SEE A FASCIAL SPECIALIST: If you have a nagging injury, or just don’t feel right lately, see if your area has a fascial or myofascial therapy specialist. There are different philosophies and methods, ranging from Rolfing, which is very aggressive, to fascial unwinding, which is very gentle. Some methods are similar to massage, while others concentrate on long assisted stretches. Talk to the therapist to see what you need and want. Some osteopaths, chiropractors, physical therapists and massage therapists are beginning to embrace fascial therapies, so ask around.

SEE A MOVEMENT EDUCATION THERAPIST: The Alexander Technique and the Feldenkrais Method are the two best known of this sort of therapy, long embraced by dancers and gymnasts. They use verbal cues, light touch and simple exercises to lessen unconscious destructive movement patterns that may be irritating your fascia.

Copyright © 2011 Running Times Magazine – All Rights Reserved.

Massage Benefits Not Many People Understand

Most people believe that getting a massage is a luxury. There are those who think their main purpose is to provide an avenue for flirting. It’s true that some folks affirm that getting a regular massage has many benefits but, mostly, the major benefits of massage are still being discovered. Have you been trying to work out if you should spend your hard-earned money on getting regular massages? The following are a few benefits for doing exactly that.

Know that massage makes your brain’s chemical makeup change. These chemical changes bring down your pain and stress throughout your whole body. This is important as it means that you do not have to physically massage the right part that is in pain. This means that if you don’t wish another person touching, for instance, your lower back, you should ask them to massage somewhere you do feel comfortable instead. The pressure applied on those areas signals your brain to change its chemical makeup. After some time, the other muscles will destress and decompress too.

There are several experts who think that getting a regular massage can help you remain in a healthy state. Studies have been conducted that indicate massage offers a boost to your immune system and that makes it more effortless to ward off diseases. This happens because your body creates more de-stressors when it is massaged. For example, studies have shown that massage lowers the levels of cortisol in the body. Cortisol is caused by stress and it assaults your body’s immune system so decreasing your stress levels can only help you continue to be healthy.

Are you aware that massage can help lower your blood pressure? Additionally, regular massage can bring down high blood pressure. This occurs because massage sets off the vagus nerve which is responsible for helping the brain regulate the levels of your blood pressure and other crucial bodily functions. A 2005 study found that individuals hypertension showed a marked improvement in their levels after having just ten ten-minute massages over the course of several weeks.

It’s possible to massage yourself as well. A lot of people believe that they must be massaged by another person but this isn’t true. You don’t have to be able to reach the exact proactol plus area that is hurting, you just have to be able to reach a point that is close to it. For example, individuals who suffer from carpal tunnel syndrome can feel a perceptible improvement by massaging their arms for fifteen minutes several times each week.

There are many health benefits to getting a massage on a regular basis. Many folks realize that getting a massage can be a relaxing experience but they don’t know that it can treat a number of medical conditions also. Moreover, be aware that there is no one form of massage that is better than the other. As long as you apply adequate pressure to make indentations on the skin you are massaging then you are giving (or getting) a relaxing massage. So why not give it a try and see a few of benefits yourself?

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The Most Annoying Part of Exercising

The Most Annoying Part of Exercising.

Activating the Lower Traps

Muscles connecting the upper extremity to the ...

Image via Wikipedia

Image via Wikipedia

What are the lower traps and what do I mean by activate?  This is by no means an exhaustive, comprehensive post, but this should give you a general idea.

There are three parts of the trapezius muscle: the upper fibers (used to bring your shoulders to your ears), the middle fibers that bring your shoulders up and also inward, just like the rhomboids, and the lower fibers (that pull your shoulder blades downward.)  If you will, try a little exercise with me for a minute: pull your shoulder blades down.  Kind of an odd feeling, isn’t it?  When was the last time you remembered performing this kind of action?  Probably not very recently, as we don’t spend a good deal of time with our shoulder blades back and down….unless we’re doing a good stretch because we’ve been sitting at the computer for too long.

Now, lift your shoulders towards your ears – fairly easy?  This action is performed readily when the “fight or flight” syndrome is engaged; pulling our shoulders towards our ears is a protective mechanism.  What else feels tight when you hold your shoulders there?  Well, if you hold your shoulders there long enough, you might feel several things

  • tightness at the base of your neck
  • a pain or pulling in your rhomboids or that vague area somewhere “in between my shoulder blades”
  • your chest feels sore from contracting
  • you begin to feel a pulling soreness along your rib cage

and several other things.  What happens all too often is that the “shrug mechanism” is seen in a lot of people’s posture today.  Our more sedentary lifestyles coupled with movements that encourage a protruding head and neck and arms forward posture have led to an epidemic of sorts of “bad posture”.  I say “bad” because really, what we get is altered posture due to muscle compensation.

This is one of the reasons I do not advocate anyone (except bodybuilders who are training for size and symmetry) include shrugging movements in their weight training regimens.  Most of us, who train for function and stability (and even those of us training for size) need to be focused on the middle and lower fibers of the trapezius.

When the upper traps are chronically activated, this can lead to dysfunction in the form of the lower (and possibly middle) traps becoming weakened to the point of “sleeping”.  This term is used not in a literal sense but to describe the problem of muscle imbalances caused by the upper traps being chronically activated, which causes the lower trapezius muscle fibers to not fire properly.

What to do: Activation Exercises

First off, as stated in several previous posts, you must first stretch what is tight.  In this case, that can be several muscles: the pectoralis major and minor muscles (chest), levator scapulae and scalenes (muscles in the neck) are the ones I would stretch first.  These can be accomplished with a doorway stretch (at 90 degrees to hit the pec major and with the arm extended to hit serratus and pec minor) and the specific stretches for levators as seen in the previous post: The Flutist’s Pain Points

Once the tight muscles have been stretched (also called autogenic inhibition – or static stretching) one can move into activation exercises: which could also be called active-isolated stretching.  This is done by a process called Reciprocal Inhibition which uses agonistic and synergistic muscles to dynamically move the joint into a range of motion.  These stretches are done for 1-2 sets of each exercise and hold each stretch for 1-2 seconds for 5-10 repetitions.

Activation Exercises

The lower and middle traps are vital for shoulder stability, so doing exercises to ensure they are doing their job is vitally important.  The first rule of strength training form is to retract and depress the shoulder blades.  This not only ensures that the middle and lower traps (as well as the rhomboids) are active and functional, it inhibits upper trap, levator and other compensatory muscles from taking over.  Use this motion any time during the day as an exercise on its own, and then use it during strength training sessions to make sure your shoulder girdle is stable and lower traps are activated.

Some excellent exercises for activating the lower traps (and rhomboids – as by now you can see they can be synergists) are wall slides, soup can pours, Face Pulls, Prone lower trap raises and LYTP’s.  The primary movements, as discussed before, are Adduction (retraction) and depression.   This website lists some excellent exercises, shows their movements and gives more anatomical descriptions.

This is by no means an exhaustive list, but a few suggestions on some exercises you can do to “wake up” those lower traps.  For a warm-up, I might do something like this:

  • Active Pectoral Chest Stretch (major and minor – 90 degrees and extended) 1-2 setsx5-10 reps each. Hold 1-2 sec.
  • Wall slides 1-2 sets of 5-10 reps
  • Arm circles 1-2 sets of 5-10 reps
  • Scapular pushups or dip shrugs 1-2 sets of 5-10 reps
  • LYTP’s on stability ball or bench
  • Prone lower trap raises on incline bench

By now, your lower traps should feel a pleasant “burning” or tingling sensation, letting you know that the muscles are beginning to fire.  After this, I would probably follow up with a few rotator cuff exercises to help with shoulder stability.  In fact, Diesel Crew has put out an excellent circuit for “shoulder rehab” that you might want to check out.  You can sub it in for the circuit above. (Always check with your doctor or a qualified medical professional if you have any shoulder injuries, issues or concerns before attempting any of these exercises.)

(By the way, I LOVE the pull up retractions!)  And flutists (and other musicians) you should pay special attention to this video!  These are great exercises to perform before practicing, or any other time of day you want to counter balance the effects of playing your instrument.

From there, with whatever workout I was doing, I would make sure to include exercises that engage the lower traps and throw in one or two exercises to help strengthen the shoulder girdles, my favorite exercise being face pulls.  These are very easy to do incorrectly if the shoulder blades are not depressed and retracted.


The list goes on…

There are lots and lots of exercises to increase shoulder stability and when you make a regular habit of incorporating these activation exercises into your programs, you will not only see increased stability, but an increased range of motion, a possible decrease in pain and a possible improvement in upper thoracic posture.

Make sure to include lower trap activation exercises in every warm-up if not each workout!  Please let me know how these exercises worked for you and your own experiences!

You can read more about Angela McCuistonon her website: http://www.linkedin.com/pub/angela-mccuiston/25/666/976

UNDERSTANDING YOUR PAIN

The majority of injuries (that I see in my practice) are a result of “micro-trauma*” of the soft-tissue  due to long-term overload of the muscles, ligaments, joint capsules and intervertibral discs.  These are most often caused by the postural demands of bending/lifting, made worse by the individual by “overworking” (repetition/fatique), improper body mechanics, and moving too quickly.  The next two types of individuals come to be in pain because of incidents such as falls and vehicular accidents.  The final group comes to me because, and I quote, “I’m hurting, but I don’t know why.” 

Hopefully in this article & others I write on Pain/Pain Management, you will come to a better understanding of why you are hurting and what options are available to you.


Pain vs. Discomfort

This is not to be patronizing in any way, but what may be pain to one person, can easily be deemed “discomfort” to someone else.  Either way, after giving the problematic area a few days (even a week) of rest/recovery and the problem still persists, it would be best to see a professional.  Pain is marker, a sign from body to brain instructing you to “do something about it.”  Nobody knows your body better than you!  Learn to describe (in detail) your pain/discomfort.  When did it start? What were you doing?  Can it best be described as dull or sharp, local or traveling (to give you an idea).  Make a journal.  The more educated you become about your body, the more information you can give to your doctor, therapist, chiropractor, or acupuncturist, the better understanding they will have.

Bodies In Motion

The human body is made for movement.  However, it completely surprised me when I read that one-third of US adults have no leisure-time activity… at all!  In order to maintain peak health, our body (spine and supporting muscles, joints & ligaments) require regular “loading” from activities such as walking and stretching.

Do Not Neglect Your Feet

My “mantra” when providing manual therapy to someone is “Function precedes structure.” My mentor Erik Dalton, Ph.D., states that “Any kink in the kinetic chain (the moving human body), whether it’s in the spinal column or in the fascial network (structure covering the muscles) is going to show up as a kink somewhere else.  It will show up as a compensation somewhere else.” His concern (as should be a concern to all) is that we should aim to “restore proper function during gait.”

A major “spring” that always seems to get neglected and certainly takes a pounding are the feet. ….

 

Nothing Tastes Better than Health Feels

One of the hardest things for many (myself included) is eating properly.  Not only will eating right consistently begin to shed the extra pounds,

The Muscle Pain and Spasm Cycle

Your muscle pain is the build-up of metabolic toxic wastes and oxygen starved muscle tissues.

And no this is not always caused by an injury. You can develop muscle pain and spasms without an actual injury. There are many internal circumstances that can lead to pain and dysfunction; poor or habitual posture, long periods of sitting, habitual emotional stress that causes chronic muscle contractions can all function like an injury internally.

And if these habits are kept up for any prolonged period of time, more serious complications may arise resulting in weakening of your entire system.

What is happening in the pain/spasm cycle?

This vicious cycle is a result of a reflex reaction to even the smallest amount of tissue damage; pain sensory signals are transferred to the motor neurons in the spinal cord that are associated with the muscle cells in the injured area. This reflex reaction from the spinal cord stimulates muscle tissues surrounding the injury to contract in order to protect or offer support to the injured tissue. What starts out as a good thing can turn bad when sustained for a long period of time. This reflex reaction can cause more damage to the surrounding muscle tissues than the original injury.

This complex situation can become widespread and cause even more pain to the original injury while creating a new pain to the surrounding muscle tissues. Ischemia is a sustained muscle contraction that reduces blood flow through the capillaries in the constricted area. This restriction and the lack of oxygenated blood getting into the muscle tissues can be very painful. And again this can happen not only to the original injury but also the surrounding muscle tissues.

Now you have two sources of pain:

  1. The original injury that is causing muscular contractions,
  2. The secondary ischemia that has been started up and accelerated by the sustained muscular contractions.

The more serious problem with muscle pain

Chronic emotional anxiety may be develop if this injury is situated in a critical area (i.e. near the spine, ribs or diaphragm). These areas complicate both the pain symptoms and the healing process. These same areas when inflicted with pain symptoms can make every motion and every breath painful which causes bracing reactions and emotional anxiety especially if your tolerance to pain is low.

The increased anxiety and emotional stress from sustained muscle contractions will lead to oxygen starved muscle tissues and prevent toxic metabolic wastes from properly circulating out of the muscle tissues. This buildup of toxic metabolic wastes can be poisonous to the muscle cells and cause a weakening of the entire system leaving you open to serious problems. Your resistance to all sorts of pathological developments are more acute leading you to any number of diseases, inflections and viruses which can be  the only the first step.

Toxic wastes may eventually start to eat up muscle cells killing them outright which now your body begins to form as scar tissue and fibrosis. Fibrosis can permanently limit the ability for connective tissues to lengthen and stretch preventing movement.  These toxins (lactic acids) can buildup to the point where they will periodically start depositing small amounts into the bloodstream affecting not only your local muscle tissues and cells but also your nervous system.

All this can be happening right now to your body without you even knowing it.Why? Because your lifestyle has you running in a “fight or flight” mode constantly from processed foods, on-the-go hectic work schedules, stress, sugar and caffeinated drinks that are numbing you to your body’s alert system.Solution? Slow this system down, break the cycle, stop this vicious cycle of oxygen starved muscles and metabolic waste buildup with a massage.

Resource: “A Handbook For Bodywork” Job’s Body by Deane Juhan.

Can Poor Posture Kill You?

Are you suffering from “Silicon Valley Syndrome?”

Are you suffering from neck, shoulder or wrist pain from poor postureThis term relates to computer engineers back in the late 80’s and early 90’s but now in the year 2011 it relates to anyone who uses the computer for work or play; from our kids to your parents due to sitting at computers for prolonged periods of time.

This puts a lot of strain on the neck from looking at the monitor, the wrist and shoulder from using a mouse and a keyboard. And the lower back which is in the most stressful position of sitting for long periods of time is really affected.

But Can A Forward Head Posture Dysfunction Kill You?

I am not going to sit here and tell you, “yes it will” but what, I will do is share with you some information that, I found about the decline of your health as you get older and the tendency become less functional and physically active. And if you stop moving all together, you would die.

chronic pain syndromes caused by prolonged periods of immobilizationWe all know that a forward head posture can cause headaches, neck/shoulder pain, TMJ, Depression and dysfunctional breathing patterns. But do we ever pay attention to our breathing habits?

No, not really not when your is head pounding from a migraine headache or when you have a sharp pain in your back. But truth be told the dysfunctional breathing patterns will affect, your health much deeper.

In a 2004 study done right here in California by the Journal of the American Geriatrics Society they measured the effects of a hyperkyphotic posture and rate of mortality in adults, I believe between 45-55. They discovered persons with hyperkyphotic posture had a 1.44 greater rate of mortality. Why? Because a hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis. Now of course this does not happen overnight, it is a slow progressive and cumulative process. According to the American Heart Association 81 million American suffer from some sort of Cardiovascular disease.

Dysfunctional Breathing:

Are you suffering from Silicon Valley SyndromeNow don’t get me wrong, I know that when these research companies dump enough money into a study and twist the findings, they can link anything. But as a massage therapist, I know how poor posture can limit your oxygen intake.

Your rib cage is not just mode of bones its surrounded by connective tissues and muscles that need to expand and relax in-order to get maximum circulation to your vital organs. And what do you think happens when, you sit for hours in this forward head posture? These supporting structures become chronically tight and restrictive.

I could not say this any better so, I am sharing this excerpt from, The Posture Clinic. Check out the rest of this article on their website.

Studies have shown a 30% reduction in oxygen intake in people with FHP. There are two reasons. First, when the head comes forward at a sharp angle, you use the scalene muscles in the neck exclusively to draw in air. This shallow type of breathing doesn’t make use of the diaphragm, and results in a lower volume of oxygen in the body.

You can try it for yourself. Push your head out as far forward as you can, then try to draw in a deep breath. You’ll notice how little air you’re capable of inhaling.

The second reason is the collapsing of the chest wall. When the head comes forward and shoulders round, the chest cavity hollows and compresses. When the ribcage presses down on lungs, the diaphragm can’t work optimally, and air capacity is significantly reduced. The Posture Clinic

Repetitive Strain Injuries (RSI).

For repetitive stress injuries and inflammation use contrast bathAs more and more work, education and recreation involves computers, everyone needs to be aware of the hazard of Repetitive Strain Injury to the hands and arms resulting from the use of computer keyboards and mice.

This can be a serious and very painful condition that is far easier to prevent than to cure once contracted, and can occur even in young physically fit individuals. It is not uncommon for people to have to leave computer-dependent careers as a result, or even to be disabled and unable to perform tasks such as driving or dressing themselves.

Beyond the Physical Pain

Psychological distress (depression and anxiety) make pain seem worse as this creates a vicious loophole as feeling emotionally depressed decreases physical activity and increase poor sleep and eating habits. Chronic pain, regardless of its source, leads to a cycle of increasing depression and reduced physical activity. Reduced physical activity reduces pain in the short term but increases it in the long term

What You Can Do…

  1. Deep Tissue corrective massage work – is necessary to loosen up the contracted muscles that support the rib cage and allow it to expand.
  2. Strengthening & Stretching exercise programs –  is necessary to stay active not staying active will limit mobility.
  3. A Good Nutrition Plan – is necessary to reduce inflammation and cholesterol

Correcting a forward head position when, you have been this position for years is not an easy fix but you can definitely choose to slow down the process from getting any worse because it will. Not only will your pain symptoms decrease from better posture but your health and vitality will also improve. And for athletes getting that extra oxygen rich blood into, your lungs and muscles when you are doing your event or activity will only improve performance and efficiency.

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