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Fix Wrist & Elbow Pain with This Simple Trick!

Overview

Elbow and wrist pain are common problems caused by various factors such as overuse, injury, or arthritis. The simplest way to address elbow and wrist pain is to stretch the muscles in the arm and hand through range. Stretching will help reduce muscle tension, which will help with much of the pain you may be experiencing at any of these joints. Manual therapy is another option for people with chronic elbow or wrist pain.

Hence, a certified Musculoskeletal Therapist like Paula Nutting, Your Musculoskeletal Specialist, can teach you numerous exercises that will lengthen and strengthen the muscles around that are problematic in your body. This will usually help alleviate pain in the area.

Myotherapy is another treatment option for people with chronic elbow or wrist pain. Myotherapy is a form of physical therapy that focuses on the muscles and soft tissues of the body (Healthline, 2016). It is a hands-on treatment that uses massage, stretching, and joint mobilisation techniques to relieve pain and improve mobility.

According to the Myotherapy Association of Australia, Myotherapy is a trusted medical specialty that uses evidence-informed assessment, treatment, and rehabilitation for musculoskeletal pain, dysfunction, and injuries. In simple terms, “It helps people in pain to move better and lead their best lives.”

What can Myotherapy treat?

Physical Therapy Vs. Myotherapy

You may have seen physiotherapy and Myotherapy mentioned online or on TV, but what do these treatments entail? Are they the same thing? Do they offer the same benefits?

In this post, we'll explore the differences between physiotherapy and Myotherapy. We'll outline what each treatment involves, its benefits, and who they're typically recommended for.

Physiotherapy uses physical interventions and education to promote, maintain and restore physical function and health. Physiotherapists work with people of all ages who have a range of health conditions, including musculoskeletal conditions (like arthritis, back pain, carpal tunnel syndrome, or sports injuries), neurological conditions (like stroke, Parkinson's disease, or cerebral palsy), respiratory conditions (like asthma, chronic obstructive pulmonary disease or cystic fibrosis), cardiovascular conditions (like coronary artery disease, heart failure or hypertension), metabolic conditions (like diabetes or obesity), and cancer.

A study concluded that physiotherapy provides substantial benefits to Australians at all stages of life and in response to many different life events. Benefits include better quality of life such as reduced pain, increased mobility, reduced burden of disease and longer life expectancy, and  avoided costs of healthcare (Australian Physiotherapy Association, 2020).

Physiotherapy is a great option for anyone suffering from injury or illness who wants to regain mobility and quality of life. It can help people of all ages and abilities, from newborns with birth injuries to athletes who have suffered a sports injury to the elderly who are struggling with arthritis.

If you're looking for treatment for a specific condition or want to improve your overall health and wellbeing, physiotherapy could be the right choice for you.

On the other hand, Myotherapy is a type of massage that uses targeted pressure and stretches to release muscle tension. It can treat various issues, including muscle pain, tension headaches, neck pain, and jaw pain. Therefore, Physiotherapy is a holistic treatment that uses various exercises, remedial massage, and body manipulation to help patients recover from injury or illness, while Myotherapy is a more specific approach as it focuses on determining the underlying causes of muscular pain and dysfunction and rehabilitating musculoskeletal injuries.

Both physiotherapy and Myotherapy offer a range of benefits that can help improve your quality of life. If you're experiencing pain or discomfort, either of these treatments is worth considering.

Simple Lifestyle Changes to Prevent Elbow and Wrist Pain

If you're experiencing pain in your elbows or wrists, you're not alone. In fact, it's one of the most common musculoskeletal complaints.

There are a number of things you can do to help reduce or prevent elbow and wrist pain. In this blog, we'll share some tips that have been proven effective.

Use Proper Form When Exercising

One of the most common causes of elbow and wrist pain is using the improper form when exercising. Think about the last time you did bicep curls at the gym. If you didn't use proper form, you might have experienced pain in your elbows and wrists. This is because when you curl your arms, you're putting a lot of stress on these joints.

To avoid this pain, make sure to use proper form when exercising. This includes using the correct weight, keeping your back straight, and not locking your elbows.

Take Regular Breaks

When you're stuck in the same position for hours on end, your muscles can start to ache. Not only that, but if you don't take regular breaks, you risk developing musculoskeletal problems like carpal tunnel syndrome and cubital tunnel syndrome.

These problems are caused by compression of the nerves and blood vessels in your elbow and wrist. The symptoms can range from mild discomfort to pain and tingling sensations and, in some cases, can lead to permanent nerve damage.

To avoid these problems, take regular breaks from your workstation. Get up, walk around for a few minutes, or do some stretches. If you can, try to vary your tasks throughout the day so that you're not doing the same thing for hours on end.

Use the Right Equipment

One of the best ways to prevent elbow and wrist pain is to use the right equipment. This includes choosing the right keyboard and mouse and adjusting the height of your chair and computer screen.

When it comes to keyboards, it's important to find one that's comfortable for your hands. The keys should be easy to reach, and the keyboard should be positioned so that your wrists are in a neutral position. You may also want to consider a keyboard with a split design, which can help reduce tension in your wrists. The mouse is also important, as it can strain your wrists if it isn't comfortable to use. Try to find a mouse that fits comfortably in your hand and has buttons that are easy to reach. You may also want to consider a mouse with a scroll wheel, as this can help to reduce movement.

If you're having trouble finding the right equipment or are unsure how to adjust your current setup, talk to a Remedial Massage Therapist for help. They can recommend products and advise on making your workstation more ergonomic.

Don't Overdo It

We get it. You're eager to make a change and start feeling better. But sometimes, less is more. Don't overdo it in the beginning and risk aggravating your injury. Start small and work your way up.

If you're unsure what's causing your pain, consult a therapist or doctor who can help you diagnose the issue. They may prescribe a few simple exercises to help stretch and strengthen the muscles around your elbow and wrist.

Stay patient and be mindful of how your body is feeling. You'll start to see progress if you're consistent with your treatment plan.

Strengthen Your Muscles

Strengthening your muscles is a great way to help prevent elbow and wrist pain. This can be done in several ways, including through exercise, massage, and a brace or splint.

One of the best exercises to help prevent pain is the wrist curl. To do this, you'll need a weight (or canister of water), which you'll hold in your hand with your palm facing down. Next, slowly curl your hand towards your body, keeping your elbow stationary. Hold for a second before lowering the weight back to the starting position. Be sure to repeat on the opposite arm.

If you're looking for a more targeted exercise, try the plank. This exercise works your entire core, as well as your forearm muscles. Start in a push-up position, with your forearms resting on the ground. Hold for 30-60 seconds before repeating.

Stretch Your Muscles

One way to help reduce pain is to stretch your muscles. This can be done before and after you do any activity that might cause pain.

Before you start any activity, stretch the muscles in your arms and hands for a few minutes. You can do this by sitting or standing and reaching your arms as high as possible above your head. You can also clasp your hands behind your back and stretch your shoulders.

After you've finished any activity, take a few minutes to stretch the muscles in your arms and hands again. This time, focus on the muscles in your elbows and wrists. You can do this by gently rotating your wrists in both directions, bending and straightening your fingers, and gently pulling on each finger.

Use Heat or Cold Therapy

You can use heat or cold therapy to help reduce elbow and wrist pain.

Heat therapy can help to increase blood flow and reduce inflammation. You can use a heating pad, hot water bottle, or heating gel pack.

Cold therapy can help to reduce swelling and pain. You can use a cold pack, ice pack, or even a bag of frozen vegetables.

Take Over-the-Counter Pain Relievers

If the pain is manageable, you can try over-the-counter pain relievers to help reduce inflammation and discomfort. Ibuprofen and aspirin are two of the most common types of pain relievers, and they can be purchased at any local pharmacy.

However, it's important to consult your doctor before taking any medication, as they may not be suitable for everyone. If you're pregnant or have a pre-existing medical condition, you should speak to a health professional before taking any medication.

Get a Massage

Massage is a great way to help relieve muscle tension and stress, which can often lead to pain. If you're experiencing elbow or wrist pain, booking a massage with a remedial massage therapist is a good idea.

Not only will they be able to help relieve the pain, but they can also give you some tips on how to prevent it from happening again.

Try Acupuncture

Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body. Acupuncture is an effective treatment for reducing pain and inflammation and has been used for centuries to treat all sorts of conditions.

If you're experiencing elbow or wrist pain, you may consider trying acupuncture. Acupuncture is a relatively safe treatment and can be done in a therapist's office, so it's a great option if you're not comfortable with needles.

Use Trigger Point Injections

One of the most common musculoskeletal pain treatments is trigger point injections. This is a treatment where a small amount of local anaesthetic is injected into the taut muscle fibres causing pain.

The anaesthetic will help release the muscle's tension and stop it from sending pain signals to the brain. This treatment often stops pain straight away and can prevent the need for more invasive treatments further down the track.

Conclusion

Pain in the elbow and wrist can significantly reduce your quality of life. Luckily, there are many things you can do to reduce and prevent this pain. From making small lifestyle changes to seeing a therapist, these tips will help you get on the path to relief. Want to know an easy stretching and massage technique for elbow and wrist pain in just 1 minute?

Watch This Video and Subscribe to Learn More!

Here's a video by Paula Nutting, Your Musculoskeletal Specialist, teaching you how to fix elbow and wrist pain in just 1 minute! Click here

https://www.youtube.com/watch?v=3urx1FCw39E

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References

Australian Physiotherapy Association. (2020, October 1). Value of physiotherapy in australia. https://australian.physio/sites/default/files/Report_FA_WEB.pdf

Bernstein, S. (2021, July 31). What’s physical therapy? How to feel and function better. WebMD. https://www.webmd.com/pain-management/what-is-physical-therapy

Myotherapy - better health channel. (n.d.). Better Health Channel Australia. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/myotherapy

What is myotherapy? (n.d.). Myotherapy Association Australia. https://www.myotherapy.org.au/About/Myotherapy

Muscle Energy-Technique-for-Shoulder Rotator Cuff Pain Chapmans Reflexes

Muscle Energy Technique (MET) for Shoulder Rotator Cuff Pain

Overview 

Learn Muscle Energy Technique Shoulder Rotator Cuff Pain today. If you’re suffering from rotator cuff pain, don’t worry! It’s completely treatable. For those with shoulder pain due to rotator cuff tendonitis, inflammation, or impingement, applying a Muscle Energy Technique (MET) may be just what you need to treat your condition and get back to your daily activities without pain interfering with your quality of life. In fact, our recommended treatment is one of the most effective non-surgical solutions available today.

Muscle Energy Technique for Shoulder Rotator Cuff Pain- Chapmans Reflexes Blog Image

Related Article: Neck and Shoulder Office Exercise

Why do we need rotator cuff muscles?

According to Athwal (2017), the rotator cuff is a set of four muscles that form a "cuff" over the head of the humerus via tendons. The scapula leads to the four muscles that make up the following muscles:

Rotator Cuff Muscles and four parts- Chapmans Reflexes Blog Image

Photo courtesy of A.D.A.M., INC.

The larger and lesser tuberosities are where the rotator cuff tendons join to the humeral head. These muscles altogether allow the rotator cuff to perform its important role of arm lifting and rotation as well as the stabilization of the shoulder's ball within the joint (Maruvada et al., 2021)

What is a Muscle Energy Technique (MET)?

Muscle Energy Technique (MET) is a type of soft tissue manipulation used to treat muscle imbalances and other issues. This was developed by Fred Mitchell, Sr. and Fred Mitchell, Jr. In MET, small contractions are used to stretch a tight muscle while they’re in their shortened state. The purpose of MET is to gain control over trigger points and improve mobility in muscles with limited range of motion. MET is an active approach in which the patient acts as in active participation, as opposed to static stretching, which is a passive technique in which the therapist does all of the work.

MET can be beneficial for improving stability in both shoulders. Athletes who perform overhead movements, like baseball pitchers or swimmers, tend to experience shoulder pain due to injuries like rotator cuff tears or labral problems. While steroids injections can help reduce shoulder pain and inflammation caused by these conditions. They only treat symptoms—not underlying causes of shoulder pain. In addition, it may have negative side effects if not administered correctly by professionals.

Related Article: Muscle Energy Technique Your Therapist Does For You

When should you use muscle energy technique (MET)?

Muscle Energy Techniques can be utilized for any issue where the goal is to relax and lengthen muscles while also improving joint range of motion (ROM). Almost any joint in the body can be safely treated with METs. A lot of athletes employ MET as a prophylactic treatment to avoid muscle and joint injury in the future. It is mostly utilized by those who have limited range of motion in their neck and back owing to facet joint dysfunction. Likewise, for larger issues including shoulder discomfort, scoliosis, sciatica, asymmetrical legs, hips, arms. It could also treat persistent muscular pain, stiffness, or injury.

Muscle Energy Technique (MET) for Shoulder Rotator Cuff Pain

How do you perform Muscle Energy Technique (MET)?

Muscle energy technique is effective for shoulder pain relief and it's easy to learn which is why its use in recent years have increased. Here's how you can do it for your patients. 

Physical Examination (Muscle Energy Technique Shoulder)

You will have to look at the natural range or passive range of movement of the patient. Have your client lie supine and you move their arm into abduction to a 90° angle.

External rotation of the shoulder, natural range or passive range of motion ROM should be between 80 and 90° degrees-Chapsman Reflexes Blog Image

Bend the elbow and passively check for external rotation of the shoulder as seen in the photo below. You are assessing their current ROM or the limits to their range of motion, normal range should be between 80 and 90°. If the range of external rotation is less than these numbers it can indicate that either the pectoralis major, the latissimus dorsi, and/or the teres major may be inhibited and shortened, which decreases this range performed within the upper extremity.

Next, check the internal range of the arm. Move the arm passively into internal rotation. The normal range is 70° to 90° with any limitations perhaps coming from dysfunctions in either or both the subscapularis or teres minor muscles. We also note for any ‘hard end feel’ which may indicate bony issues which means we would do further joint assessments.

internal rotation, internal range of the arm should be between 70 and 90° degrees- Chapsman Reflexes Blog Image

Performing Muscle Energy Treatment (MET) Shoulder

Move their forearm into an external rotation to perform MET. It is important that you stop at the first point where you feel restriction of the tissues. This is called Point of Bind and is at this length of the tissues that we get optimum results. They contract back towards internal rotation at 40% of the effort and no more; it is an isometric contraction where you are stabilizing the wrist and elbow to keep the joints motionless. This contraction is held for approximately 7 to 10 seconds. Ask your patient to take a deep cleansing breath and as they exhale they stop applying pressure of the muscle contraction. Keep in mind that it's important that their arm doesn't move. You will still be holding the wrist and elbow through the entire procedure and finding a new point of bind after each of the post-contraction relaxation phases.

Post-contraction Relaxation Phase

This time called Post-contraction Relaxation is when the tissues that had been contracting relax even further. We stay in limb ‘stiffness’ for up to 90 seconds and in this time the muscles relax even further so that we find the new passive end range or apply our new point of bind. Ask the patient to apply the contraction into internal rotation, still at 30% to 40% of their effort. This contraction again should be a minimum of 7 - 10 seconds. We get them to take cleansing breaths on each exhalation to improve the parasympathetic effect on the tissues; they can relax their muscle contraction as they breathe out.

Important Notes

Do the technique 3 times to see the most effective changes. Tell them to take a deep cleansing breath and that they relax the muscle contractions as they exhale. We reassess the ROM of external rotation after the third contraction and relaxation phase and we should see greater evidence of improved length through that range of motion.

This is a gentle technique for patients that feel pain and/or for those with issues in their range of motion. You might not want to use this treatment when there's a bony block when you test out the ranges. Be aware that if there's a joint restriction, we'd apply a mobilization technique or we'll adjust something deeper into that joint capsule.

Related Article: Best Pain-Free Subscapularis Massage for Shoulder Pain

Watch this Video

Here's the most effective video where you can see how to do this Muscle Energy Technique. It's a simple yet effective way to address the restrictions created by hypertonic internal rotators and gives more balance to their external rotator counterparts! Watch to go through these steps so you can practice from your clinic and also what homecare you can offer your patients when they are not in your practice.

References

Athwal, G. S. (2017, March). Rotator Cuff Tears. American Academy of Orthopaedic Surgeons. Retrieved February 20, 2022, from https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears-frequently-asked-questions/

Maruvada, S., Madrazo-Ibarra, A., & Varacallo, M. (2021, May 8). Anatomy, Rotator Cuff - StatPearls. NCBI. Retrieved February 20, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK441844/

Blog-Banner-Glenohumeral-Treatment-Techniques-for-Shoulder-Pain-and-Problems

Myotherapy: Glenohumeral Joint Pain Treatment

Patients can come in with pain and stiffness from the neck that can refer to and causes elbow wrist and shoulder pain- acromioclavicular (AC) joint and the glenohumeral (GH) joint. Typically, it impedes movements such as lifting of the arms, brushing the teeth, or holding a golf club. It may be described as a moderate pain or a chronic pain that could affect sleep especially if it’s the shoulder you sleep on.

Shoulder Anatomy

You can help them by applying a variety of techniques to relieve uncomfortable pain or sensations in and around that area. But first, let's understand the shoulder anatomy. Since it is one of the most unstable joints in the body with the most movement, it can be complex to understand its structure and functionality.

Shoulder Structure and the three kind of bones, glenohumeral joint- Chapmans Reflexes Blog Image

The two shoulder joints that are prone to injury are the acromioclavicular (AC) joint and the glenohumeral (GH) joint. 

  • The acromioclavicular joint is situated where the clavicle is in contact with the acromion and the scapula. 
  • The glenohumeral joint is where the socket of the scapula connects with the rounded head of the humerus. It is responsible for the wide range of motion of the shoulder including flexion, extension, internal and external rotation, adduction and abduction and circumduction. 

There are  eight muscles attached to the bones of the shoulder. They are responsible for the form we see of the shoulder and underarm, they aid in its range of movement, and help protect the GH joint which is the main primary joint involved in function.

The deltoid muscle, which you may also know as the deltoideus muscle, is the shoulder muscle considered to be the largest and responsible for stabilization of the shoulder joint for the prevention of dislocations. 

The other muscles which work with the deltoid for shoulder movement and its functions include:

  • Infraspinatus - for arm raise and lowering
  • Triceps brachii - arm straightening
  • Pectoralis major - connects to the sternum
  • Pectoralis minor - stabilizes the scapula
  • Teres major - arm rotation 
  • Biceps brachii - rotates the forearm; flexes the elbow
  • Latissimus dorsi - helps with arm rotation and movement away from and close to the body
  • Subscapularis - aids to rotate the humerus 
  • Supraspinatus - help to raise arm away from the body

Shoulder Pains and Problems

Muscle Energy Technique

When any of the aforementioned muscles become dysfunctional, inhibited and reduced in their passive resting length, they tend to pull the humerus forward. According to OrthoInfo, shoulder problems that patients can experience fall into these categories:

  • Tendon inflammation - can be bursitis or tendinitis
  • Shoulder Instability - stretched lining of the shoulder joint, labrum, or ligaments 
  • Arthritis - joint tenderness and swelling
  • Fracture - can be caused by trauma or injury from a fall, sports activities, vehicular accident, or a direct hit to the shoulder

Other causes for shoulder pain that are less common include infections, tumors, and nerve related problems.

See Related Video: Shoulder Pathologies: Different Causes and Cool Tubing Treatments

In this article, we are going to focus on glenohumeral joint pain and an amazing muscle energy technique that could improve the humerus’s resting position. This will improve the quality and range of motion and reduce the notable pain felt by your patient. 

Almost any joint in the body can be safely treated with these techniques. Many sportsmen utilize them to avoid future muscle and joint injuries. It's primarily used by people who have restricted range of motion in their neck and back due to facet joint dysfunction found in the neck and back, for those who have broader issues like shoulder pain, sciatica, scoliosis, unsymmetrical legs, hips, or arms, and to treat chronic muscle pain, stiffness, or injury.

See Related Video: BEST exercises for the majority of shoulder problems using the water

Conducting the Assessment

You can clearly see how  far forward the humerus of the patient is. To conduct the test, ask them to be seated comfortably. Stand behind the patient and place your hand over their shoulder. Press your thumb into the tissue, as is in the picture below, until you can palpate the humerus. Note how far forward the humerus is, you can apply a second finger along with your thumb for a more clearer view.

Conducting the assessment for shoulder pain, glenohumeral joint and problems-Chapmans Reflexes Blog Image

Upon confirming that the humerus is anteriorized and checking if any symptoms of pain locally, and/or radiating up in the neck down to the elbow and wrists are present, you can go ahead with this simple muscle energy technique that will improve length of restricted tissue and bring the humerus back into the glenohumeral joint.

Related article: Shoulder Pathologies: Different Causes and Cool Tubing Treatments

Treatment

Let’s begin with the treatment steps. Here’s what you can do:

  1. Have your patient lie on their back (supine).
  2. Put your four fingers behind the humerus while your thumb and wrist sits on top of the humerus.
  3. Slide your thumb down until you get into a firm position.
  4. Push the top end of the humerus down, letting it press onto the table. At the same time, let your other hand elevate the elbow. Continue to do this seesaw-like motion that gently moves the humerus in the capsule a couple of times. Since it can be quite tender, remember not to apply too much force. 
  5. Apply gentle pressure until you can feel the bony end range and ask the patient to push their elbow to the floor and hold it for about 10 seconds. 
  6. Let the patient take a deep breath and when they release their breath you reduce the pressure applied to the limb whilst ensuring that the joint remains in an isometric position. 
  7. Repeat steps four to seven: You apply a rhythmic rocking back and forth motion of the humerus within the joint space for approximately 30 - 45 seconds or until it has a softer feel on the movement, it will start to have a smoother end feel. Continue with the gentle push while the patient takes a deep breath. When they breathe out, stop applying pressure as a counterforce on their humerus. When you apply the muscle energy technique, here are several tips to remember. When pushing down gently, hold it for about 10 seconds and ask the patient to exert 30% to 40% of their effort. Let them take a deep cleansing breath in and when they breathe out, that's when they stop contracting. You can do this three times before reassessing the joint position again. This should make headway into better movement patterns and reduced myofascial pain of the shoulder and surrounding compromised structures.

Watch This Video

Here's a short video where you can see how the steps are carried out. Watch to learn more how to follow through with the muscle energy technique. Try it from your clinic and you will see positive changes in your patients pain and function.

hand over painful neck

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

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

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
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