Identifying and Correcting Perpetuating Shoulder Pain

December 12, 2018 by Christopher Flaig

Identifying and Correcting Perpetuating Factors

Shoulder pain doesn’t just happen. There are numerous perpetuating factors that can set up a condition of muscular imbalance and overload. Some of these, such as dysfunctional breathing, may seem unrelated but are actually extremely important (and common). Identifying and correcting perpetuating factors is what makes the difference between fixing the same problem each week and setting your client on a new, pain-free direction.

Possible perpetuators are very numerous. Some of the most common include:

Postural Asymmetry

Muscles are made to collaborate in an environment of relative balance and stability in the body. Postural distortion may occur due to anatomical variations such as a leg length discrepancy. Actual leg length differences are estimated to occur in approximately 18% of the general population, so this situation is not uncommon. LLD may cause issues with the QL, spinal erectors, glutes and shoulders, and any persistent patter of unilateral pain could be due to this situation.

Hyperpronation

Individuals with hypermobile ankles may exhibit an extreme tendency to pronate. This causes the ankle to collapse medially and tends to cause anterior (head forward) posture in the upper body. This situation can be corrected with extra support in the midfoot and forefoot.

Dysfunctional Breathing

Chest breathers overuse small muscles such as the pectoralis minor and scalenes to assist in expanding the rib cage. This causes many problems, and can set up shoulder and head neck pain.

Other Factors

There are many other factors that must be considered in a person’s lifestyle. Workstation ergonomics, sleep position, nutrition, stress must be considered. Be observant and read the Apropos of All Muscles chapter in Travell & Simons for extensive coverage of these issues.

Medications can be a powerful and unsuspected perpetuator of pain in the body. Few people are aware of the extensive pain-related side effects from many drugs. Some of the most common, like the statin family of drugs, have extensive muscular side effects and patients are often unsuspecting. Take the time to look up side effects for drugs.

Serratus Anterior

October 15, 2018 by Christopher Flaig

Serratus Anterior

Serratus anterior is misunderstood and overlooked by most manual therapists, despite its central function of stabilizing the scapula during all arm movements. In CTB we have come to recognize it as the hidden key to scapular positioning and hence, shoulder pain and movement dysfunction.

When a client has rounded shoulder posture (a.k.a. upper crossed syndrome) the shoulders are protracted and the scapular stabilizers do not have normal resting length/tension. Serratus anterior is a primary scapular stabilizer and tends to adaptively shorten and defacilitate. This, along with pec minor adaptively shortening results in the chronic protraction of the scapula. This misalignment of the shoulder will alter the scapulohumeral rhythm and then also impact the glenohumeral motion.

However, unlike pec minor, serratus anterior is a broad muscle that has many digitations and the muscle fiber directions can span more than 120 degrees! Some fibers protract/abduct the scapula. The low fibers upwardly rotate the scapula. The lowest fibers attaching to the 12th rib can be very vertical and capable of depressing the scapula. In addition, the highest fibers attaching to the first rib can produce scapular elevation. There are a lot of different motions possible by this one muscle!

The serratus anterior attaches to the ribs and to the medial border of the scapula. Because of its wide span of fiber directions, it is antagonistic to many other scapular stabilizers including: low trapezius, mid trapezius, high trapezius, rhomboids, and levator scapula. It is in length/tension relationships with all these muscles. That’s why most therapists fail to get a release of taut fibers in these other scapular stabilizers, particularly in the interscapular area. They are not addressing the antagonist, serratus anterior, the hidden key.

If serratus anterior is locked into protracting the scapula, the interscapular muscles (mid/low trap, rhomboids) lock into a lengthened position. The neuromuscular system “locks down” the muscles by purposefully creating taut bands (trigger points) in the muscles to provide stability without having to expend energy. Trigger points are metabolically stagnant. No ATP is then required to keep the static posture. The body basically creates a “fake ligament” with the trigger points. It is a strategy that makes sense and has been pointed out by renowned osteopath and author, Leon Chaitow. Many massage therapists and bodyworkers endlessly strip this interscapular area with as much gusto as they can muster (and their clients can handle), to no avail. Taut bands in the antagonist muscle, serratus anterior, must be released for these interscapular muscles to change.

Another important but overlooked issue with the serratus anterior concerns its referral pain. It projects referral along the lateral border of the scapula, down the posterior arm to the last 2 fingers, but most importantly right into the belly of the low trapezius near the inferior angle of the scapula. Low trapezius referral projects upwards into the mid trap, rhomboids and upper trap. So referral pain generated by the serratus anterior reaches all its antagonists via satellite referral! This is a phenomenon (an agonist referring pain over its antagonist) Chuck Duff has termed “reciprocal referral”. Muscle dysfunction in reciprocal referral situations can quickly spiral into severity, but can be addressed effectively if one understands this relationship. Referral pain originating in the serratus anterior can also cause posterior neck pain and even migraine headaches via satellite referral through the low trapezius.

As if all that wasn’t enough, the serratus anterior is also an accessory breathing muscle. Because of its rib attachments it is recruited to assist in expanding the rib cage on inhalation. Thus dysfunction in the serratus anterior can be caused by dysfunctional breathing. If a person doesn’t adequately use their diaphragm to breathe, the serratus anterior is recruited to do more work than which it was designed. This overload causes trigger points to develop and cascades into shoulder pain and dysfunction.

Serratus anterior has so many fiber directions and relationships; to antagonist scapular stabilizers, shoulder posture, reciprocal referral and breathing. Through many years of clinical experience, we have come to see it as the hidden key to shoulder pain and dysfunction. Some of the fibers are deep to other muscles and structures and inaccessible via palpation. Even these fibers can be influenced by the penetrating vibration of the Muscle Liberator making it the perfect tool to treat serratus anterior.

Word of The day is Pressure

September 18, 2018 by Christopher Flaig

The Word of the Day: Pressure

Pressure, as you know, does some pretty amazing things. It turns peat into coal and coal into diamonds. In the human body, it actually has the reverse effect. It takes little diamonds called trigger points and teaches them to relax, and it takes muscle that is stuck together and helps it glide once again. I tell people time after time that you can always tell how healthy a muscle is by applying pressure. Applying pressure to a muscle should really only refer a pressure sensation back to your brain. If you apply pressure to a muscle and get a pain response back, we now know that muscle is irritated, and has some unhealthy characteristics to it. The by-products of muscle energy production are acidic to the nerves. When musculature becomes tight, it is harder for the circulatory system to get healthy blood into the muscle, and export waste out of the muscle. This creates a toxic environment that can cause atrophy, (decrease in size of the muscle) tightness, and ultimately pain. It is worth noting again to keep at the forefront of our mind that pain is a lagging indicator. It really is the last piece to the puzzle. Most people think pain is just the beginning but it is far from it. Pain is telling you something is breaking or already broken. It’s not telling you you have time yet to push yourself. Even though I recommend training through your recovery or recommend using strength movements to garner yourself back to health. If we’re in pain, we need to slow down. When we are applying pressure to our muscles we want to make sure we stay in between a pain scale of 6-8, never wandering above that mark. Discomfort is a result of returning our body and its structures to health, but it should never be the purpose. More pressure and more pain do not yield better results. We want to be comfortably uncomfortable. We are not applying pressure to our muscles to achieve a pain scale of 8, working in the 4-6, or 2-4 range is completely acceptable. The reason for this is because when we reach a significant pain threshold, our body fires our sympathetic nervous system, which tells our body to fight against what we are doing. The alarm bells tell our brain to lock up the muscle and since the strength of our muscles is easily greater than any amount of pressure we can apply, by continuing to do so we are wasting our time and energy. You could be using a hammer and chisel and you still will not be able to make a change to the muscle.

One of the key aspects that makes my approach unique is making sure we always move when applying pressure to our muscles. The human body heals through movement, not through stabilization, or immobilization. Even something like going for a relaxing walk can calm the central nervous system, ground ourselves to the magnetism of the Earth, and promote healing. Lying in bed or on the couch for days should be archaic and a thing of the past, but there are still some people that believe rest is the answer.

3 Simple Core Exercises To Eliminate Lower Back Pain

August 24, 2018 by Christopher Flaig

TVA Activation (Core Function) – Planking
Lung/Diaphragm Activation – Breathing Techniques
Finding Neutral Spine

The Transverse Abdominus (TVA) is a layer of abdominal muscle, which is the most important muscle within the ‘core’. A strong TVA is critical to a healthy back and pelvis, and is necessary for efficient human movement and function. People that suffer from Lower Back Pain and other Back Pain pathologies often have significant weakness within this muscle. Lack of movement, sedentary lifestyle, and prolonged sitting can lead to a de-activated TVA, which leads to poor posture, which leads to pain. The TVA is also directly to the diaphragm, lung function and breathing. Co-ordination of these structures is paramount when correcting posture and eliminating all kinds of Back Pain. ultrasound.scanner8

Correct implementation of core strengthening exercises can have immediate effect in eliminating back pain. Completing perfect Transversus_abdominis isometric holds can neurologically up-regulate core function and calm pain receptors within the Back (think introducing the brain to the core once again – making them friends again!). The following series of planks are sourced from Functional Patterns, and are aimed at activating the TVA, within 3 differing contexts of hip flexion (think sitting to standing). Depending on what type of back pain you are suffering from or whether you have more pain whilst seated or standing, it is important to attempt and master all 3 of these planks in order to increase your core function and improve your posture. Following on from this series of planking, it is important to understand how to activate the TVA and diaphragm whilst going about your daily life. Creating intra-abdominal pressure whilst increasing rib cage expansion is paramount to finding neutral spine whilst standing and moving. Planking will increase your ability to create intra abdominal pressure, which will aid in the elimination of your lower back pain.
NAUDI PLANK NAUDI WALL RETRACTION

PLANK 1 – QuadPad Plank – Replicating Sitting

PLANK 2 – Half Plank (Knees 45 degrees) – Replicating Sitting to Standing

PLA NK 3 – Full Plank – Replicating Standing

Pain Management through Movement Therapy

August 21, 2018 by Christopher Flaig

A lot of people who are experiencing chronic pain, especially those who are suffering from certain conditions including Plantar Fasciitis, Thoracic Outlet Syndrome, Carpal Tunnel Syndrome, and several others do their best to find the best pain management solution.

As such, some have resolved to move as minimum as possible, believing that the less action they make, the less pain they will face. Well, the opposite may actually be true. In fact, there is a recently introduced discipline these days, in the form of movement therapy. Movement Therapy is a whole lot like physical therapy. However, it involves several other aspects, such as introducing functional strength and corrective exercise, with a focus on manual therapy. Treatment through touch.

The Advantages:

This type of therapy will work towards strengthening muscles, which in turn, improves muscle support provided towards the rest of the body. As you simply allow the muscles in your stomach to lose their strength, you might end up suffering more injuries, including back pain, neck pain, as well as migraines. This is because the muscles in your stomach also help in supporting your back.

Movement therapy also works in increasing endurance so that people who are suffering from these types of pain can still continue working on their everyday activities. As such, it is also proven to increase the stability of the joints, thus decreasing the events of falls, as well as the pain that is linked with swelling of joints.

It also increases flexibility in the joints and muscles of the body. Exercise also fosters the release of natural hormones in the body, the endorphins, which are the ones responsible in relieving pain. The exercise involved also makes an individual feel even better regarding them, thus helping to alleviate instances of depression that most people who are dealing with chronic pain usually deal with. As an added feature, it also helps individuals to maintain the recommended body weight. This factor also reduces pain.

There are a lot of conditions that can benefit from a movement therapy rehabilitation session. For example, those who are dealing with frozen shoulder, whiplash, sprains/strains, and others, are helped accordingly. In fact, almost all conditions that can cause pain can certainly be given treatment by simply implementing the right combination of techniques involved in movement therapy.

There are a lot of methods used in movement therapy. You definitely need to explore all of these methods, including their different combinations until you are able to select the best ones for your specific condition. However, it is highly recommended to take advantage of the assistance of a professional who can help you out. A movement therapist can help you in this regard, giving you the right solution for your specific need.