Monthly Archives: March 2017

Double Crush Phenomenon 

Pain resulting from compromise of neural structures (neuropathic pain) is common in various regions of the body and is often thought to be associated with excessive tension or compression on a nerve leading to ischemia (loss of blood flow). One of the most familiar syndromes associated with neuropathic pain is carpal tunnel syndrome (CTS). In this case, the median nerve is thought to be compromised at the carpal tunnel of the wrist.
What many people are not told is that there is a concept referred to a the double crush phenomenon where it is believed that when a nerve is compromised in one area along it’s path, then it is more likely to demonstrate symptoms somewhere else. In the example of CTS and the median nerve there are numerous areas where the median nerve could run into problems including the neck, inter-scalene triangle, near the first rib, under pectoralis minor, under the pronator trees muscle and at the carpal tunnel. When these areas are addressed, through conservative care, the carpal tunnel symptoms (usually found in the hand) often clear up. So, before rushing into surgery or allowing someone else to do so for neuropathic pain, make sure they are examined by a practitioner who can check the entire nerve’s path. All too often we see patients who have surgeries like a carpal tunnel release and are found to be no different than individuals who only underwent conservative care at long-term follow-ups.


Muscle- Tendon Unit


The muscle-tendon unit can be broken down into three components which include the muscle itself (contractile element), muscle membranes (parallel element) and tendon (series element). Both the muscle membranes and tendons are connective tissue structures and can be collectively group as the ‘elastic elements’ of the muscle-tendon unit.


When developing force, the contractile element is often the only component that is considered, but the elastic elements are also important. The muscle membranes and, even more so, tendons can store energy and contribute to total force production. Connective tissue structures also undergo physiological adaptations (hypertrophy, stiffness, etc) associated with training just like the muscle tissue.


Each of these components are susceptible to injury and/or pain too. Muscles can be strained and tendons can undergo reactive changes leading to tendinopathy when load surpasses capacity. When it comes to the muscle-tendon unit and injury prevention, the most useful concept to keep in mind is the relationship between load and capacity. Load that surpasses capacity, that is appropriately dosed, can be positive for adaptation. However, if load magnitude extends far beyond tissue capacity or volume is too high, then injury may result. Many problems can be prevented if one puts a little thought into how they will manage the load-capacity relationship.



This muscle, if cramped 😖😫 will compress on the sciatic nerve and cause you to have pain that may radiate down your leg ⚡️


This condition is called piriformis syndrome


If you have this condition, odds are you will have a shortened and tight piriformis!! This tightness will rotate your pelvis to one side and change your hip biomechanics. This will also causes the thoracic spine to counter-rotate which will create 🔀torsion throughout your back 😑



1️⃣ It’s cause is unknown

2️⃣ Can be a cause of acute and chronic low back pain

3️⃣ It usually starts from the buttocks and can spread down to the hamstring or as far as the calves

4️⃣Typically pain occurs during the stance part of running, or during extended sitting periods

5️⃣Stretching too aggressively will irritate the problem more and is not recommended

6️⃣ 15% of people have the sciatic nerve traveling through the piriformis, which make these people more likely to experience this problem


🕵🏼If you have this problem what do you do? Usually people recommend strengthening/stretching exercises, ice, and rest. These work to a certain degree, but there are better ways to go about it!


 Reciprocal inhibition in simple terms is when one muscle contracts, the other relaxes. For example when you flex 💪 your bicep the triceps will lengthen and relax, and the opposite is true.
For this release we will find the muscle, sink in and use reciprocal inhibition to relax the supraspinatus and then contract again. This release is best done if you have a partner to sink into the muscle due to the awkward position of bringing your opposite arm over your shoulder. If you don’t have a partner, below is a self release method: 

1️⃣ Find a chair/table sit up straight, bring your opposite arm over your right shoulder(if you are treating the right supraspinatus). Let right arm hang roughly 10-15 degree away from the chair/table and let the palm of the hand touch the side of the chair/table.

2️⃣ Palpate for the spine of scapula by running your fingers up and down

3️⃣ Once you have located the spine of scapula roll on top of it sink into the muscles on top(supraspinatus).

4️⃣ Begin at the medial end of the spine of scapula and work along till the lateral end for 1-2 mins while doing step 5 below⬇️

5️⃣ Press your palm towards the chair(adduction) to relax the supraspinatus and sink in deeper, then relax and contract again.
Tips – You may need to release your upper traps before you can reach the supraspinatus – This may not work for everyone due to other compensation patterns that needs to be resolved before targeting the supraspinatus – Seek out a professional if you need to 

Give this a shot hope this helps with your neck and tennis elbow!!! 


People always ask me, my [insert body part] hurts here, what can I do!? The reason why I can never give anyone a direct answer is because it really doesn’t matter where the pain is


To figure out the source of your pain, I need to look at the relationship between different areas of your body, and then based on how they interact with each other I can come up with a plan of action


To reinforce my point, let’s look at the upward + downward rotators of the shoulder


Let’s say you have shoulder problems with a lat-pull down (or any movement for that matter)


It could be that

🔹your downward rotators are unable to coordinate together to do the ⬇️motion smoothly

🔹your upward rotators are overactive and won’t allow smooth motion


🔹or maybe 2/3 of your downward rotators are sleeping on the job and 1/3 is overactive!

🔹etc. the combinations are endless…😑


Basically it’s all about relationships, how do the upward and downward rotators relate to each other? And within each group, how do the 3 muscles interact with each other to produce ⬆️ or ⬇️ rotation?!


Knowing your anatomy is one thing, but understanding how each body part relate to each other is what separates the noobs from the rehab gods 🙏🏼



About CLICKING or SNAPPING you feel in the hips?😫


As highlighted in the picture, a snapping feeling in the front area of the hip/groin region could be from the tendons of the illiacus/psoas muscles that are rolling over something called the ILIOPECTINEAL EMINENCE (say that one 5 times fast 😐) as the ILIOPOAS BURSA may be inflammed.


This issue is called INTERNAL IMPINGEMENT of the hip. There are others which I will discuss later on.😜


So imagine this issue occuring during your squat, stairs, or even simply walking throughout your day – not too fun is it? In hip flexion (deep squat) the tendon is lateral to this “eminence” and then going into flexion causes it to go medial. This produces a feeling of snapping or sometimes even an audible sound.👂🏼


To help with this, you can try the stretches . In addition, try out this quick hip distraction drill/stretch to see if it helps! .


1️⃣Wrap the band around something steady and then around your leg as in the picture

2️⃣Slide it all the way up as high as it can go

3️⃣Go into a PIGEON POSE (yoga) by folding your leg under your body so that your shin is running perpendicular to your spine

4️⃣Slowly lower your hips backwards as if you’re going further into the stretch

5️⃣Posteriorly tilt your pelvis as we’ve discussed previously

6️⃣Move around slightly to find the position that works best for you! 

7️⃣Breathe, and relax 👌🏼💆🏻‍♂️💆🏽


⚠️DISCLAIMER: A less prevalent but more serious issue may be something within the hip joint itself (ie – issue with the labrum or potentially the overall structure of your hip joint). .


The role of the hip flexors and how they impact overall alignment. The hip flexors are quite complex due to the number of muscles that actually contribute to hip flexion.


What’s interesting is that these can be an issue across a wide range of people from the very athletic to the traditional desk worker.


Typically discussed are the following muscles:

👉🏼Psoas major



But in addition to these there are a number of other muscles from other muscle groups which also play a role in flexion the hip:

👉🏼Tensor Fascia Lata (TFL) of the gluteal muscle group

👉🏼Rectus femoris of the quadriceps


👉🏼Pectineus (adductor group)

👉🏼Adductor Longus (adductor group)

👉🏼Adductor Brevis (adductor group)

👉🏼Gracilis (adductor group)


Furthermore, the adductor muscle groups can even be divided into two parts based on their action. Believe it or not, they can actually FLEX AND EXTEND the hip. I know, right?😅


From this list we can see how important it is to understand various aspects of someones activity patterns that may point us in the proper direction when dealing with issues around the hip. These muscles will work in different amounts depending on the specific tasks and position of the leg itself.


As these muscles are “HIP FLEXORS” the corresponding action on the pelvis is a an anterior tilt of the pelvis (APT).



I’ve seen a lot of guys carrying around 🎒 big gym bags all day slung over one shoulder. And no doubt, quite a few of them felt it at the end of the day in their low back.
Your spine is built as a very mobile structure, with support and stability provided by a 🌐 guy wire system of muscles. Optimal stability is achieved when you have equal tension and strength built on all sides.
Most of you have a preferred side to carry things, whether it be a gym bag, a purse, or when you 😠 try to get all the groceries in in one trip (you know you do). And over time, all that weight loaded on one side can create a strength and tension imbalance from side to side.
The Quadratus Lumborum is one of the ↔ lateral stability muscles of your core, keeping you from toppling over to one side or the other. One of the best ways to train the QL is through ⛃ heavy carries. Holding a weight on one side, works the opposite QL as it keeps you upright.
This is basically what you do when you carry your bag on one side. You are training your QL. But if you carry it only on one side, you can create an imbalance as well as overwork and fatigue the one you constantly stress.
So practical applications:

🔹Switch up which side you carry your bag on.

🔹Incorporate suitcase carries into your training to balance out both sides and build a core as solid as @therock’s.


The thoracic spine naturally curves forward, known as a kyphosis. Day to day 📱 habits and 💻 lifestyles typically have us curled forwards, increasing this kyphotic curve. And because we tend to spend hours in that position, we begin to lock our bodies down into that posture.
Then one day you wake up, look at yourself in the mirror 😲, and see that hunchback you’ve formed. You’ve locked yourself into that increased kyphotic curve, now having a HYPERKYPHOSIS.
Getting yourself 🔓 unlocked again takes just as much time as it took to get you stuck there. But it can often be done. You just have to make daily habits changes and put in work to make the change.
Check the pic here. The Shortened muscles often need some TLC in the form of ↔ mobility work. The Stretched muscles need improvements in end range 💪 strength and endurance to hold you up again.



Today let’s take a 👀 at a commonly seen word : Kyphosis


Derived from the Greek word kyphos which means “a hump”🐪, the word kyphosis refers to the normal convex curvature of the spine as it occurs in the thoracic and sacral regions


You often see this posture with office workers or people who generally sit a lot for work. ✏️📌 Consistent slouching exacerbates the forward curve of the spine over time


🤔Is kyphosis reversible❓❓❓

It depends


In life, experience with motion becomes gesture which repeated over time becomes habit. 🚶Movement habits slowly become posture, and IF NOT taken care of, prolonged posture BECOMES permanent structure


👴🏻👵🏼 Experience ➡️ Gesture ➡️Habit ➡️Posture ➡️ Structure


So how do you reverse kyphosis?! With SPECIFIC manual therapy techniques, it is possible to give the patient a window of body awareness in which they have an easier time retraining proper movement patterns. (ie. Sit properly and walk around upright) .

Once that window is open, it’s a matter of working on retaining the fascialgainz as best we can with proper movement awareness exercises.

%d bloggers like this: