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Home > 2021

Year: 2021

hand over painful neck
neck muscles neck pain paula nutting your musculoskeletal specialist
November 24, 2021 Paula Nutting

Stiff Neck Causes and Remedial Self-Massage for Relief

The pain a stiff neck brings about can be very bothersome and serve as a hindrance when it comes to carrying out the tasks that we need to do everyday. But what exactly causes this tightness in our necks?I was thinking about just general ways that I can give you a little bit of help with some aches and pains. As you know, I've tried to specialize in musculoskeletal, hence the name. We also look at what's going on with the connective tissue as well. Things about joints, the fascia, the nervous system and ways to actually make you feel like you are feeling stable.Today, I'm going to focus on the neck and give you some tips on how you can relieve a ropy and bandy scalene if you’re on your own or cannot come into the clinic to see someone like me.

Causes of Stiff Neck:

  • Looking down for a long period while reading, writing, or using your phone;
  • Excessive or vigorous movement of the neck;
  • Sleeping in the wrong position, which exerts too much pressure on the neck
  • Clenching the jaw;
  • High stress levels;
  • Medical conditions such as osteoarthritis and spinal disorders
  • Trauma to the neck or back due to injuries, a hunched posture, or picking heavy weights; and
  • Sudden movement of the head due to whiplash, which can pull your neck muscles and also can give rise to other serious symptoms.
Source: Vaughan, J. (2021)

Treatment:

  • Feel along the suboccipital ridge all the way along, both sides, to see if they feel even.
  • The area that feels painful, is not the area of complaint.
  • Gently tuck your chin down and feel around the back of the lower part of your skull (the top 3 survival muscles) and feel around the lateral joints.
  • Feel with two fingers and do some cross-fiber work .
  • Keep your shoulders down so you do not activate the trapezius muscles.
  • Once you find the tight ridge, palpate and see if you can feel into the area where the ribs are.
  • Feel for the upper trapezius and duck anteriorly to it, then press your fingers down into that tight space.
  • Palpate around the other side to see if it’s the same or different.
  • Drop your ear down to give a little bit of softness to the tissue of the lateral neck which will allow you to really sink deeper into the muscle.
  • Press and depress onto that region of the lower neck, it is the area that feels like it would be accessing your first rib, by doing this movement we are also making small changes to the restrictions or tightness over the second rib.
  • Laterally flex away from the area and give yourself a little active stretch while sinking down a little deeper.
  • As you work along your neck, press towards it and then gently glide away.
  • Repeat the process one more time this time moving a little more medially. Come closer to the neck dropping down and in.
  • Start to pull away and take the chin away, then try to access those fibers for posterior scalene, dropping down and back then coming along and forward.
  • Palpate and see if that made a difference. The scalene should be feeling less taught and bandy, and you should feel better through the range.
I want you to think about the things that make a difference to the neck. Sometimes we have to look at other distal attachments. We can apply joint play on our first and second ribs if they are stiff, palpate along the clavicle where the subclavius is and work on those fibres. Focusing also on the pectoralis major and minor to improve functional movement of the clavicle and shoulder joints. Assess one side versus the other to see if the problems felt in the neck can be compared to and aligned with the tightness felt in the chest tissues.Watching the video attached to this blog will assist you greatly in some self-treatment options whenever you feel restricted in the neck.References:Source: Vaughan, J. (2021) How to Get Rid of a Stiff Neck. eMediHealth. Retrieved from https://www.emedihealth.com/bones-joints/manage-stiff-neck#some_causes_of_a_stiff_neck
stretching both hands at the back of an old client
lower back pain
November 12, 2021 Paula Nutting

Self-Shiatsu for Physical and Mental Healing

 These days, self-care is as important as total healthcare [1] for a person to be able to survive this pandemic, physically and mentally. Self-care is basically taking care of oneself for the purpose of achieving physical, mental, spiritual, and financial well-being. One important aspect of self-care is the physical care which eventually covers the other aspects of self-care. Musculoskeletal specialist Paula Nutting interviewed her guest,  Leisa Belmore, a shiatsu specialist from Toronto, Canada. She has been a shiatsu specialist for twenty years already. Her approach is more western than its origin in the east. She is working in an integrative clinic in a hospital with other biomedical and complementary practitioners. The clinic especially focuses on creative artists who suffer physical injuries, chronic conditions, and mental issues. Shiatsu points on specific body issues for physiological reactions. She also has written and collaborated on research papers with medical practitioners, including a behavioral therapist, nurse practitioner, physiotherapist, chiropractor, registered dietician, massage therapist, social worker, psychiatrist, and soon, a language pathologist.According to Belmore, not taking care of oneself is detrimental to the career of an artist. While in lockdown, she opted to run her workshops virtually, teaching self-shiatsu as well. She addresses the neck and shoulders as well as the hands and arms. According to her, the most prone to injury is the hands, not just for the shiatsu therapist but also for chiropractors, other manual therapists, massage therapists, and physical therapists. As for the shiatsu therapists, their thumbs are usually the most commonly injured joint due to the treatment style of the Shiatsu, thumbs are the tool to compress on the relevant chi points of the body.  Leisa gave some tips on Self-Shiatsu: 
  1. Finger-to-wrist stretching, rotation of the hand, joint and finger rotation
 
  1. When doing shiatsu, use the pad of the thumb of the finger, not the tip.
 
  1. Extend the thumb when using it; don't flex it.
 
  1. Apply gradual pressure to the area between the thumb and the point of the finger.
 
  1. There are three pressure points that must be applied to each in between the fingers of the hand.
 
  1. After applying pressure on the points in between the fingers, the phalanges are addressed next. Every joint of the fingers has points that need to be pressured on by pressing them from front to back and on the sides too.
 These tips can help a person calm down. She has her website where there are several videos they can watch to learn how to do self-shiatsu to assist with anxiety and sleep disturbances [2] as well as the app for shiatsu, too. These videos and apps were able to help with sleeping patterns for some patients as well as concentration problems. Leisa demonstrated how to do it gently for the flexibility of the muscles and the nervous system. She specified that the neck and shoulder muscle areas are good places to work on. She demonstrated how to do the sub occipital area of the neck by putting both hands just above the occipital area and holding the area longer. If it feels tight or tender, then move to the right side, the next point, and do the same, then on both sides of the spineous processes. Repetition is good to achieve better results. Posture has been adversely affected because of the increased usage on the computer while working at home and being busier than working on site. To improve postural positions we can address various points in the sternum and the chest area remembering that stretching is also very important to include in self care. The incidence of anxiety has increased since COVID and we need to be mindful that some treatment may not be applicable to people with specific medical conditions or who are reticent about it. It is better to start small with little things to do and if they are doing anything positive, encourage that. Some have self-esteem issues. Since spending time in solitude can be boring, she suggested trying small goals such as meditating for ten minutes twice a week. She also added self-care tips for everyone, such as stress management to help sleep. Have a little time for ourselves to do something that we enjoy, such as walking, reading a book, or simply hanging out with friends.She also created a variety of PDF's for some specific health conditions. Leisa created them so that they are easy to understand and do not contain medical terms for easier understanding. Self-care sessions such as self-shiatsu, stretching points, are self-care for specific needs. She shows them how it is done, talks to them, and lets them demonstrate it to her. When asked about lower back pain, Leisa started in the lumbar region, pressing on the erector spinae along the lateral edges of the lumbar vertebra; this is good for sciatic pain she said. Then next is the part of the pelvis near the spine, which is good for people who stand or sit for prolonged periods of time. It is comfortable to apply Shiatsu on the massage table, but keep it at a low height for best biomechanics i.e. using your body weight for pressure. For the hands, there are several stretches made to remove tightness in the soft tissue. For the face, the pad of the point finger is used to press on the points below the eyes and the brow bone above the eye area. If the patients’ learn Shiatsu, they will have more control over their conditions, especially in areas concerning their mental health.Leisa’s latest study was on care-partners with patients with dementia and shiatsu therapy. She had first hand experience being able to work with her father, who had dementia, and realized that they could have interaction without the need for words. Further study needs to go towards the mental wellness of both carer and the patient using this style of therapy. This simply shows that Shiatsu is not just for physical relaxation but also for the appeasement of the troubled mind. Together with other medical and complementary practitioners, it can support the goal of well-being for everybody. 

View the entire Ask-Me-Anything event with Leisa below:

  1 - Self-care | Public Health | Royal College of Nursing (rcn.org.uk) 2 - Effectiveness of Hand Self-Shiatsu to Promote Sleep in Young People with Chronic Pain: a Case Series Design (nih.gov)
inner leg tightness exercise
paula nutting your musculoskeletal specialist
October 22, 2021 Paula Nutting

Treat Inner Leg Tightness Fast With This Simple Trick!

Long and Short Adductor Muscles

What are the adductor muscles how can we treat them?The adductor muscles are called adductor muscles because they add or adduct in. Anatomically, when we think of them, they are going to be attached to the pubic bone, and attach to either the femur or the pes anserine. The latter being our two longer joint adductors.Our adductor muscles assist us when it comes to moving the leg inwards. When the leg moves toward the body, it uses the longer adductors as the primary movers, and when the knee is in flexion, it uses mostly the shorter ones including brevis, and etcetera.The adductor muscles play a huge role in hip stability and pelvic control. They need to be treated if we see pain or instability of the ilia, the knee, in general tightness with sitting wide legged or cross legged. Moreover, it is also an indication for treatment if there has been sporting injuries where the pubic bone or soft tissue of the hip, thigh or pelvis is present.

Treating the Adductor Muscles

If you are going to treat someone who has any of the symptoms listed above the best way to do so is by having them lay sideways.To begin, we should first asses the ability to list the affected leg in both straight and knee bent movements. Why do we do this? It is so we can get an understanding of whether the short or longer adductors (or both) need to be treated. In the video demonstration below we can see that there is more weakness and incorrect lifting when the knee is bent and the longer adductors removed from the assessment. This meant my focus of treatment would be closer to the upper leg (proximal) rather than if she was weak and felt pain with a straight knee.

Steps to Follow

  1. Start to feel around the inner leg and gently palpate for muscle hypertonicity (muscle feels tight).
  2. With some lotion or lubricant, place your hands at around a 45 degree angle towards the upper inner thigh and slowly glide along the tissue—starting from just above the knee, towards the pubic bone.
  3. If you come across any taught bands, you can cross fiber across the belly of the muscle/s using a gentle action. There are loads of nerves housed along the inner thighs so this can be painful if too deep or too quickly frictioned.
  4. We can also work into the muscle groups palpating for long bands of firm or tight muscles. These normally run along the line of the femur and not across it. To address these restrictions, let us apply a positional release technique. The bands can start anywhere above the knee and soften midway along the femur or in nasty restricted cases all the way up to the pubic attachments.
  5. Now, making use of both your hands, place each thumb on the area where the tautness begins and  push your thumbs towards each other. This is called the positional release technique, which is an excellent way to change the tension between two ends of the muscle fiber. We actually shorten the muscle belly by physically bunching it into the middle. Think about an uncooked sausage and if you apply pressure at each end and direct towards the middle, then that area has less tension.
  6. Hold the positional release until you can feel a sensation at the tendons where it feels like it’s softening. For about 90 seconds or until you feel that the muscles start to give. It should feel slightly uncomfortable but not dreadful.
  7. Start to feel around the inner leg once again, and gently palpate for any further restrictions of the muscle. If there is still some tightness, repeat the process.
The video below shows me treating Kristen’s adductor muscles. We can see that in the start of the video she is experiencing hip flexion as well as difficulty when lifting her lower leg. Then after completing all these steps, we can see that she is feeling less tenderness in her adductor muscles and can actually lift her leg more easily in a better range.Watch the full video instruction below:Sources:Hank Grebehttps://www.istockphoto.com/photo/male-hip-adductor-complex-muscles-anterior-view-isolated-on-human-skeleton-gm1271838675-374300620?utm_source=unsplash&utm_medium=affiliate&utm_campaign=srp_photos_top&utm_content=https%3A%2F%2Funsplash.com%2Fs%2Fphotos%2Fadductor-muscles&utm_term=adductor%20muscles%3A%3Asearch-aggressive-affiliates-v1%3AaAdductor Magnus. (2012). Physiopedia. https://www.physio pedia.com/Adductor_Magnus
closed eyes woman cupping her neck with both hands
neck pains reduce neck pains
June 22, 2021 Paula Nutting

Neck and Shoulder Pain At Work? Try this!

Even before Covid, people have been prone to spending hours in front of a computer, either for work, school, or even just for entertainment. This is what we are going to fix here by doing some simple neck and shoulder exercises for office workers.  And when we’re in front of computers, we tend to disregard our posture. Most people who sit in front of their computers all day tend to lean their necks forward. Long periods in this position are bound to give referral pain patterns. It is important to do short exercises that will get them into neck extension.Before we even begin with exercises, there is an important thing to consider. The chairs that you or your patients use must be of the right height for the legs and back. It must have back support and elbow rests. This is important because often, an uncomfortable chair can affect our posture when we sit, which is one of the leading causes of neck and shoulder pain.

Step-by-Step Guide for the Neck and Shoulder Office Exercise

In this article, I will share with you a few easy exercises to check your range. It is important to see how comfortable you are when you go into flexion, extension, and rotation. These exercises (neck and shoulder office exercises) will help determine whether you feel any restrictions in your movement whatsoever.

For the neck:

  1. Sit up straight, slowly tilt your head forward, bringing your chin to the chest.
  2. From this position, slowly tilt your head upward, until you are looking at the ceiling.
  3. Return to the starting position, looking straight ahead.
  4. Turn your head gently to the left, then to the right. Return to the starting position.
  5. Lastly, slowly lower your head to your right shoulder. You should be able to do this at a 45-degree angle without any restrictions. The shoulders should not hitch up, and instead, remain still.
  6. Return to the starting position, and repeat, slowly tilting towards the left shoulder.

Arm ranges to check with adductions, abductions, and flexions:

  1. For the starting position, hold your arms out on both sides.
  2. Raise both hands up overhead. Repeat 5 times. this is to check elevation.
  3. Return to starting position. Then slowly swing your arms forward to check horizontal flexion. Repeat 5 times.
  4. Return to starting position, then stretch them backward to check extension. Pull your shoulders back as far you can. Repeat 5 times.
  5. Lastly, do figure of 8 movements.

For the elbows:

  1. Hold out your arms in front of you, palms up.
  2. Bend your elbows up towards you. Repeat this 5 times, then return to the starting position.
  3. Twist your arms outward gently. This is to test internal and external rotation.
  4. Lastly, try to do the figure of 8s movement with your elbows.

For the wrists and hands:

  1. You will start with the same starting position as the one from elbows. Bend your wrists upward five times.
  2. Then, move them from side to side.
  3. Lastly, do figure of 8 movements.
  4. Go back to starting position, then flip your hand over so that your palms are facing down.
  5. Bend your fingers 5 times.
  6. Then stretch them out, holding them apart from each other. Repeat this five times
  7. Lastly, try making piano movements with your fingers.

Another tip for your neck and shoulder office exercises

After these neck and shoulder office exercises, make them go through the neck ranges again, to see if they get any changes. Another tip I have today is to tuck the chin back into your neck. I always use the analogy of pretending that someone you really don’t like is coming up to you and is trying to give you a great big kiss on the chin. Naturally, you would be recoiling your head back.
  1. Tuck the chin in. This is the starting position.
  2. Hold your arms out to your sides, and then pull your shoulders back, like step 4 for the arm movements. hold for 10 seconds.
  3. Relax.
  4. Repeat it 5 more times.
I recommend doing these 2 to 3 times every day, as doing so will give you a lot more flexibility as well as reduce the pain in your neck and shoulders. For a demonstration of the movements, please watch the video.
both hands massaging man's neck
benefits of stretching in our body chapmans reflexes chiropractor neck pains
June 18, 2021 Paula Nutting

Target Platysma or Neck Pain Easily using this Method!

This is one of my 3 favourite muscle names in the body – it’s in your neck and it’s called the platysma!First of all, what is the platysma? It is a muscle that begins at the jawline, right at the mandible, and runs down in a fan shape to the superior portion of the clavicle. It is responsible for helping the mouth and lips to move. Specifically, it is the muscle that we use when we react with fear or fright – when our mouth is drawn down or to the side.

Image from Wikipedia

Many therapists miss out on getting the best outcomes because they overlook this little muscle. In fact, did you know that a lot of neck-related pain can be traced to the platysma? As therapists, 75% of people entering our clinic complain of either neck or lower back pain! If you are focusing your techniques at the back, which is quite often joint-related or soft tissue around the traps, splenius, etc, then can I ask you to try this simple technique on your next neck pain client?

I could go as far as to say unless we address the tightness in the platysma. We won't get full neck movement.

Your First Moves

First, you must assess your client’s neck range. From a relaxed, sitting position, have your client lookup or go into full neck extension. Watch and be vigilant on the lift to note any tightness of the anterior neck esp the flat band of the platysma. Have your clients return to neutral or as neutral as they can. This video will show you step by step how I teach the muscle and surrounding soft tissue via way of an active glide. This way both of you are working together. Plus, they are increasing their afferent and efferent nervous system. They will also increase their agonists and antagonists, and myofascial trains.

Active Glide

For therapists out there, when we do active movements, it means that both you and your client or patients are actually actively involved in the process.

1. Stand on the treating side, in this case, stand on the right and have the client turn their head to the right, as far as they can go comfortably. 2. Place two fingers or knuckles. If you have OA issues just above their right clavicle at the midline closest to the supraclavicular notch and sink into the tissues. The fingers will be facing out towards the AC joint on the superior line of the clavicle so that you can take up the tissue along with its attachments. 3. Have your client slowly rotate their head back towards the left as far as they can go comfortably. 4. As they move their head allow your fingers to glide along with their muscle. Work with a pace that mimics the speed of the rotation and at the tension of the hypertonic muscle/fascia. 5. I always apply any technique three times before I re-assess. NB* make sure you DO re-assess! 6. Repeat the same process on the other side.

The Results

As you’re doing this, it should feel “tight” and “stretchy” or “burny” to your clients – all signs of fascia, muscle, and/or tendon. Have your clients test their range again, by moving their heads up, down, and side to side. The results can be astronomical in pain management, posture, and range. You should be able to see the tissues are not as taut as this time around.

The beauty of this work is that you can offer it to clients as homecare.  This is an attempt to release any ongoing restrictions felt in the neck. This is another cool technique that adds value along with the other ways to assist in neck pain that we've discussed in earlier videos.

Have fun and hope this helps you and your clients in the future! 
pressing a man's jaw and cheeck
glutes lower back pain
May 27, 2021 Paula Nutting

This is How Jaw Clenching Destroys your Glutes!

Hi team, I thought we might talk about some stuff that you may NEVER have thought of before. It’s the links that the body has in our myofascial and neural lines of the body, and this is all about the jaw and jaw clenching and its effects on the strength of your gluteus maximus. Being a part of the face, the jaw and the jawline are often perceived as a marker of beauty, but this facial feature is more than just a mere accessory. Our jaw is part of the alimentary system, as well as our defense system when we go into what is termed our VENTRAL-VAGAL social engagement which is part of Porges Polyvagal Theory.Clenching the jaw is a primal act and if you think about it, survival of having it traumatically removed is part of keeping our species alive. The same primal move it probably accessing our FREEZE reaction, one that comes from DORSAL VAGAL SHUTDOWN which generates from about 500 million years ago and can be linked to immobilizing emotionally also.When the FREEZE component occurs it reaches along the spinal nerves and dampens the full chain of muscles that will propel us forward, gluteus maximus being the greatest in this action, the hamstrings involved as well but to a lesser degree.

Our Jaws in the Modern Day

Moving forward 500 million years where we live in a world of ongoing stress, increased hyper-vigilance, high acid systems we see more and more people you clench or grind their teeth. These habits may have varying reasons, like stress, anxiety, or different types of arthritis. Too much jaw clenching may result in cracking of teeth, TMJ dysfunctions, headaches, tension and pain in the neck and head, and farther afield including the paraspinal muscles and muscles of the lower back. It is surprising how stress and/or chronic jaw clenching can have such a significant impact on our glutes, but that is the truth of it. There is an easy way to test this, but you must first have someone else around to help you.
  1. Lie down completely relaxed, and bend your right knee up, with your foot planted firmly on the floor.
  2. Have your friend attempt to lift up your right foot, while you use your glutes to resist.
  3. Now, clench your jaw, and have your friend attempt to lift your foot once again. Try to resist.
You will notice that your glute strength has been reduced significantly while your jaw is clenched. Jaw clenching not only affects the muscles near the face, it tends to reproduce right down to our lower bodies. People must be mindful of their jaws, as a bad jaw can lead to a multitude of pain and tension all over the body.You could also watch the full demo of this exercise in the YouTube video below.

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