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Myofascial Energetic Length Technique: Why You Should Try It?

Overview

Ms. Sue Hitzmann developed a self-treatment system to manipulate and rehydrate the connective tissue. (MELT stands for Myofascial Energetic Length Technique.) Once you learn the method, she said, just 10 minutes three times a week is all you need (Lawlor, 2021 )

“The MELT Method focuses on rehydrating your connective tissue and rebalancing the nervous system to eliminate stuck stress and improve whole body efficiency.”  

Sue Hitzman

MELT Method creator Sue Hitzmann defines it as a hands-off approach to dealing with pain and injury that increases your strength, balance, and flexibility by restoring the stability of your connective tissue.

WATCH: Paula Nutting with Sue Hitzmann, Myofascial Energetic Length Technique

3 Methods of the Myofascial Energetic Length Technique

Rebalance with a Soft Body Roller/Foam Rolling

Nervous System Myofascial Energetic Length Technique

According to Chertoff (2019) Foam rolling is a self-myofascial release (SMR) technique. It can help relieve muscle tightness, soreness, and inflammation, and increase your joint range of motion. Foam rolling can be an effective tool to add to your warm-up or cooldown, before and after exercise. 

Here are some benefits of using foam rolling (Chertoff, 2019);

  • Ease muscle pain
  • Increase range of motion
  • Temporarily reduce appearance of cellulite
  • Relieve back pain

Rehydrate with a Foot Treatment

Foot Myofascial Energetic Length Technique

For this foot treatment, try to keep your head up and not look at your feet.

Instead, use your body sense to feel if you have the ball in the right spot.

You can stand next to a wall or chair to help you balance, if necessary.

Keep the pressure tolerable, and if you feel pain, back off (Miller, 2017)

Rehydrate with a Hand Treatment

Hand Myofascial Energetic Length Technique

Sue recommends doing the self-treatment techniques three times a week — even better, every day — to get immediate relief by rehydrating this tissue and reacquiring space in your joints (YOM Staff, 2020) 

  1. Position-point pressing
  2. Gliding
  3. Shearing
  4. And friction on your hands and arms.

“The MELT hand and foot treatment are designed to rehydrate connective tissue which is a real missing link to pain and learning how to address connective tissue in a very efficient way is what this methodology all about. In rehydrating connective tissue you could actually rebalance your nervous system and get your body’s natural healing mechanisms back on track. . . . . so in just minutes you can self treat your hands and feet and improve whole body communication and balance”

Sue Hitzman

Rebalance with the Neck Release

Neck Foam Roller Myofascial Energetic Length Technique

According to Lindber (2021) The neck release is a gentle way to loosen tension in both your shoulders and neck.

Here’s how to do it for MELT Method;

  • Slowly turn your head from right to left
  • Next, go to a sideway position
  • Use foam roller and place it underneath your head
  • Then, start to create small circles using your head while in sideways position
  • Repeat on the other side.

Here are some possible benefits of Rebalance with the neck release MELT Method:

1. Improved posture and alignment

2. Decreased neck pain

3. Increased range of motion in the neck and shoulders

4. Reduced tension headaches and migraines 

5. Better sleep quality (reduced stress on your muscles)

The idea is that you don’t have to hurt yourself to get rid of the pain. The MELT method is a self-treatment technique that encourages your body’s innate ability to stay healthy by rehydrating the connective tissue system.

Did You Know?

Connective Tissue Fascia

Fascia connects all of our muscles and tendons into one cohesive system and plays a part in everything from our posture to balance to digestion.

When it becomes dehydrated by daily stress, poor diet, and lack of exercise, it works less efficiently, resulting in aches, pains, tension headaches, poor posture, and stiff joints and muscles.

Myofascial Energetic Length Technique is used to reduce inflammation in the fascia system by activating the myofascial meridians. The fascia system is made up of connective tissues throughout your body that help your organs function properly.

When these tissues become inflamed or injured due to repetitive movement patterns or prolonged bouts of stress, they can become painful and restrictive to movement.

Conclusion

Myofascial Energetic Length Technique has been shown to increase circulation and relieve pain in the muscles and joints by increasing the length of their meridians through self-massage therapy using pressure points along their length. This increases blood flow through these pathways which helps improve range of motion and reduces pain because there are fewer restrictions on how far you can move each joint (and therefore how much force it can bear).

The MELT technique can be done anywhere at any time as long as you have access to a chair or wall for support. You'll need some room in front of you so that you have enough space between your hands and feet during each movement.

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References

Lawlor (2015). Rolling and Flexing to Massage Away Pain and Stress. https://www.nytimes.com/2015/01/02/arts/a-class-in-the-melt-method-of-body-work.html#:~:text=the%20same%20effect.-,Ms.,week%20is%20all%20you%20need

Chaudhry et.al (2017). Effect of MELT method on thoracolumbar connective tissue: The full study. https://pubmed.ncbi.nlm.nih.gov/28167175/

Ruback (2020). Validation of a Mindful Practice: The MELT Method. https://search.proquest.com/openview/f1f710c2f2ff7f9edd3eb7be92187ac4/1?pq-origsite=gscholar&cbl=18750&diss=y

Chertoff (2019). What Are The Benefits Of Foam Rolling? https://www.healthline.com/health/foam-roller-benefits#back-pain

Miller (2017). Do This Foot Treatment Tonight Before You Go To Sleep. https://www.womensrunning.com/health/do-foot-treatment-before-sleep/

YOM Staff (2020). Improve Your Hand Strength with MELT. https://www.yomreporting.com/blog/blog/post/improve-your-hand-strength-with-melt

Mansour (2019).How to use a foam roller to relieve neck, back and knee pain. https://www.nbcnews.com/select/lifestyle/how-use-foam-roller-relieve-neck-back-knee-pain-ncna978301

Painful wrist remedies and treatment banner

Know How to Treat Painful Wrist: Simple Remedies

Overview

If you’re suffering from a painful wrist, don’t worry! It’s completely treatable. Undoubtedly, for those with painful wrist due to some fell down, accidents while doing household chores, or while performing your skateboard stunts.

There are treatments and remedies for that pain, mobility with rotations, medial, and lateral rotation may be just what you need to treat your condition.

Besides, these treatments will help you 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.

What is Wrist Pain?

A wrist joint is a joint that connects the hand to the forearm. A wrist fracture takes place when a person broke one of the small (carpal) bones in this joint or commonly, the distal radius, which is twice the size of the two bones that make up the forearm. In addition, this bone often breaks on the lower end part, which is near to where it connects the bones of the hand and thumb.

An image of a hand with fingers over it showing pains on a person's wrist

Injuries

Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. Thus, a scaphoid fracture involves a bone on the thumb side of the wrist, and this type of fracture may not show up on X-rays immediately after the injury.

Repetitive stress. Any activity do involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — these can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain's disease is a repetitive stress injury that causes pain at the base of the thumb.

Prevention

It's impossible to prevent the unforeseen events that often cause wrist injuries. Even so, these basic tips may offer some protection:

Build bone strength. Getting adequate amounts of calcium — 1,000 milligrams a day for most adults and at least 1,200 milligrams a day for women over age 50, — can help prevent fractures.

Prevent falls. Falling forward onto an outstretched hand is the main cause of most wrist injuries. To help prevent falls, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.

Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as football, snowboarding and rollerblading.

Pay attention to ergonomics. If you spend long periods at a keyboard, take regular breaks. When you type, keep your wrist in a relaxed, neutral position. An ergonomic keyboard and foam or gel wrist support may help.

Steps for Treatment and Remedies:

Sometimes we may encounter events where we do disruption to the joints, which results in fractures. Or could be an interosseous membrane, (a thick dense fibrous sheet of connective tissue that spans the space between two bones forming a type of syndesmosis joint), which is the membrane between the owner and the radius that contracts and be caught in that kind of position.

Addressing mobility with rotations, medial, and lateral rotation

  • Loosen through the interosseous membrane by pouring the right amount of oil on the hands; make them move through the soft tissue well.
A remedial massage therapist gliding down a finger over the wrist of the patient
  • Glide down with your thumb between the radius and the owner.
A remedial massage therapist pressing down a finger on the arm of the patient
  • Roll a thumb over that taut band.
  • Move all the way to the wrist joint.
A remedial massage therapist rolling a thumb on the arm of the patient
  • Next maneuver is to take fingers to the back of the wrist.
A remedial massage therapist maneuvering fingers on the wrist of the patient
  • Gently glide it on a round motion with a thumb
A remedial massage therapist gliding down a thumb on the arm of the patient in a round motion

The gentle rolling motions in this exercise will help loosen the wrist joint. Roll up and down the length of the arm, finishing above and below the wrist joint.

If you have pain in your wrist, this exercise will be good for you. It’s easy to do and can be done anywhere: at the office, while watching TV or eating dinner with friends. You can even do it with your eyes closed if that’s what floats your boat!

Do this a few times each day to ease pain quickly and strengthen your wrist for future strong use.

The exercises that you do for your wrist can be done a few times a day to ease pain quickly. You should do them every day so that they become part of your routine and strengthen your wrist for future strong use. The exercises will help you to feel better, get stronger, and get better!

Lie on your back on a flat padded surface with your arms at your sides, palms facing down.

Lie on your back on a flat padded surface with your arms at your sides, palms facing down.

Place your head on a pillow and relax.

Slowly lift the affected arm straight up over your head until you feel a stretch through the affected side of your body.

  • Slowly lift the affected arm straight up over your head until you feel a stretch through the affected side of your body.
  • Don't force it, and don't hold your breath. Don’t arch your back or bounce when lifting it; just move gently in a natural way.
  • After holding the stretch for several seconds, release and allow the muscle to relax again before repeating this process on the other side (if applicable).

Hold for 10 seconds, then slowly lower arm back to the floor and repeat 10 times.

Hold for 10 seconds, then slowly lower arm back to the floor and repeat 10 times.

You should do this a few times each day. It will relieve pain quickly and strengthen your wrist for future strong use.

Give these exercises a try today to see what you need to do.

  • Use the following exercises to get rid of pain in your wrist:
  • Grab a bottle of water and hold it on your hand with both hands, palms facing up.
  • Then stand up straight, raise one leg so that it is just above hip height and then bend at the waist as far forward as possible until you feel a stretch in your lower back (make sure not to move too far). Hold this position for 30 seconds before switching over to the other side.
  • Sit down on a chair with both feet flat on ground and place hands behind head supporting weight of neck/head through shoulders/chin area; keep chest out lifted up slightly off seat cushion but don't let chest sink too low- make sure not push against table edge!

All content provided on this site is for informational purposes only and should not be used to diagnose or treat a health problem or disease without the advice of a healthcare professional.

Watch this Video

Here's a video brought to you by Paula Nutting, Your Musculoskeletal Specialist, where you can see how to do this treatment and remedies effectively. 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. Click here

https://youtu.be/7awXHWjYxbY

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References

Yale Medicine (2022). Wrist Fracture: Causes, Diagnosis & Treatment. Retrieved June 07, 2022, from https://www.yalemedicine.org/conditions/wrist-fracture

Mayo Clinic (2022). Wrist Pain. Retrieved June 06, 2022, from https://www.mayoclinic.org/diseases-conditions/wrist-pain/symptoms-causes/syc-20366213#:~:text=Overview,arthritis%20and%20carpal%20tunnel%20syndrome.

elbow pain tips and hacks for effective treatment

Free from Elbow Pain: Useful Tips & Remedies

Overview

If you’re suffering from elbow pain, which is caused by Arthritis. There are treatments and remedies for that, with maneuvers and skin pulling for mobilizing the nerves,  which may be just what you need to treat your condition.

Besides, these Tips and Hacks will help you 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.

Elbow Pain Causes

According to Penn Medicine (2022) Elbow arthritis takes place whenever the cartilage in the elbow is embellished , worn or damaged.

Here are some of the most common causes:

  • Overuse due to age
  • Stress and tension
  • Fracture or dislocation.
  • Trauma (such as a fall) or incorrect use of your arm/hand/fingers
  • Degenerative conditions such as osteoarthritis, rheumatoid arthritis or carpal tunnel syndrome

In  addition, Elbow arthritis can be extremely painful and can interfere with daily tasks that involve bending your arm.

Know more about Elbow Pain

If you have elbow pain, and  maybe one of the various disorders listed below  could be the reason behind that pain. Meanwhile, worn out, sports, or household related injuries cause many elbow conditions. Golfers, baseball pitchers, tennis players, and boxers often have elbow disorders, (Briggs, 2020)

Elbow pain may involve any of the following

  • Arm Muscles
Arm showing musculoskeletal anatomy
  • Elbow Ligaments
image showing elbow ligaments
  • Tendons
image showing a hand with a ben pointing at a model of tendons
  • Bones in the Arms
woman wearing white shirt with elbow pain
  • Bursae

Elbow Pain Treatment

Elbow pain is a common injury that can affect people at any stage of their lives. It's also one of the most painful types of injuries, which means that doctors and physical therapists often recommend treatment options for elbow pain. While there are many ways to treat and prevent elbow pain, some methods work better than others. Elbow pain treatments vary depending on the scale of pain and symptoms you are  experiencing. Nevertheless, most elbow pain requires conservative treatment. Surgery is a last resort if your symptoms don’t improve.

Your treatment options include:

Ice

  • Ice the elbow for 15 minutes. A bag of frozen vegetables works well, or you can use a cold compress on your elbow.
  • Rest the elbow in an elevated position for 20 minutes to 30 minutes each day, such as by putting one leg up on a stool and resting the other on the floor below it or even leaning against something (such as a wall). This will help reduce swelling and inflammation around your joint while allowing blood flow through it easier so that it doesn't get clogged up with dead cells and other unwanted material like bone spurs or calcification which can cause further damage over time.

Rest

Rest the elbow in an elevated position for 20 minutes to 30 minutes each day, such as by putting one leg up on a stool and resting the other on the floor below it or even leaning against something (such as a wall). This will help reduce swelling and inflammation around your joint while allowing blood flow through it easier so that it doesn't get clogged up with dead cells and other unwanted material like bone spurs or calcification which can cause further damage over time.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

If you’re experiencing elbow pain, there are many different options for treatment. One of the most common methods used in treating elbow problems is medication. Medications can be helpful in reducing pain and inflammation, but they may not help with the underlying cause of your injury. Nonsteroidal inflammatory drugs such as ibuprofen may be prescribed by doctors in severe cases but these medications come with side effects such as nausea, should only be taken if prescribed by medical professionals.

Physical therapy

Physical therapy is another option many people choose when they're experiencing chronic pain due to injuries sustained while playing sports such as basketball or football where there could have been injury sustained during playtime.

Other Ways to Prevent Elbow Pain

Most elbow pain is the result of overuse and injury.

You can prevent them by:

  • correcting improper sport techniques
  • using a proper-sized grip on sports equipment
  • using correct tension on racquets
  • warming up and stretching properly
  • using elbow padding

It’s also important to take breaks from repetitive tasks. Practice exercises that can help strengthen the muscles around your elbow joint.

Exercises for Elbow Pain Relief

  • Stretching
  • Strengthening exercises for the biceps, triceps and forearms:
  • Biceps curls: With a dumbbell in each hand, hold it at shoulder height with palms facing forward. Lower until your arms are at 90 degrees and then raise up again. Repeat 10 times in total before resting for one minute. Then repeat on other arm. Do this two times per day if you have elbow pain in both elbows or just once if it's only one elbow that hurts (or maybe even three times).
  • Tricep kickbacks: Stand on an exercise ball (or similar) with feet hip-width apart so that you are balanced on the balls of your feet; bend knees slightly while keeping hips square; lift hips slightly as if sitting back into a chair (but don't let them go down); slowly lower back down until thighs come off floor; repeat 15 times then rest 30 seconds before repeating again!

Professional Help with Elbow Pain

If you're suffering from elbow pain and can't seem to find a solution, seeing a doctor is the best way to get treatment. The first step is getting an x-ray or CT scan of your elbow. This will help determine what's wrong with your joint and whether there are any other problems involved in its development. You may also need blood tests done as well as an exam by a physical therapist who can evaluate how well your muscles function at rest (which could indicate muscle weakness) or during movement (which could indicate muscle tightness).

When it comes time for diagnosis and treatment, talk with your doctor about the potential causes of elbow problems. Some people might benefit from nonsurgical options like pain relievers such as ibuprofen while others may require surgery if they have advanced arthritis in their joint cartilage—though this decision should be made after careful consideration based on recent findings about how much arthritis affects different parts of our body differently depending on where they sit within them overall structure."

If you have arm pain that persists, see a doctor.

If you have arm pain that persists, see a doctor. If the pain is severe or lasts more than a few days, see your doctor right away.

  • Pain accompanied by swelling: If you feel the pain in only one part of your elbow and it's accompanied by swelling around that area (inflammation), then this could be an indication that there is something wrong with either tendons or ligaments in your arm bones. In this case, it could be helpful to speak with an expert who can help determine whether or not surgery is needed; however, sometimes just rest will do the trick on its own!
  • Pain accompanied by weakness/numbness: Weakness or numbness from arthritis can cause problems throughout the body—especially when combined with fatigue due to poor circulation—so it’s important for anyone experiencing such symptoms not just focus on themselves alone but also seek medical attention right away if possible so they don't wind up doing anything harmful like cutting off circulation even more than normal because we all know how bad having severed limbs would feel!

All content provided on this site is for informational purposes only and should not be used to diagnose or treat a health problem or disease without the advice of a healthcare professional.

Watch this Video

Here's the most effective video where you can see how to do this treatment and remedies effectively. 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. Click here

https://youtu.be/uY5wxoWA6JA

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References

Penn Medicine (2022). How to Treat Elbow Arthritis. Retrieved June 14, 2022, from https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/elbow-pain/elbow-arthritis#:~:text=Elbow%20arthritis%20occurs%20when%20the,that%20 involve%20 bending%20your%20arm.
Spriggs, B. (2020). Elbow Pain Types of Disorder. Retrieved June 15, 2022, from https://www.healthline.com/health/elbow-pain#types-of-disorders

Myotherapy: Shoulder Pain Muscle Energy Technique (MET)

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

Overview 

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 (MET)

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.

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

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.

Performing Muscle Energy Treatment (MET)

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
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%3Aa Adductor Magnus. (2012). Physiopedia. https://www.physio pedia.com/Adductor_Magnus
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