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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

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)
thumb and index fingers pressing on a man's nape

Suboccipital Muscles Pain: Causes, Symptoms, and Treatments

Today let's learn more about the suboccipital muscles pains, causes, symptoms and treatments? Do you have clients and patients that come in to see you that have recurring tightness in those upper cervical muscles, especially the ones attached to the skull? We call them our suboccipital muscles and they're the ones that our patients will say; these are the muscles that are really, really tight.

What are the suboccipital muscles?

The suboccipital muscles are a set of four paired muscles in the back of the neck. The suboccipital muscles attach to the atlas (C1), axis (C2) and occipital bone, connecting the atlas to the axis and the two vertebrae to the base of the skull. They are deep to the trapezius, splenius and semispinalis muscles and superficial to the atlanto-occipital and atlanto-axial joints. The suboccipital muscles commonly become tense and tender due to factors such as eye strain, wearing new eyeglasses, poor ergonomics at your home office computer setup, grinding the teeth, slouching posture, and trauma (such as a whiplash injury).

Suboccipital muscle pains symptoms

However, when the suboccipital muscles become tight, any of these symptoms may occur. These could include:
  1. Stiff neck
  2. Neck pain
  3. Headaches with a band of pain on the side of the head that extends from the back of the head to the eye. This type of pain feels deeper in the head.
Messages sent to the brain may be affected; reason why some people who have headaches may also experience sensory symptoms, including dizziness and visual instabilities.

Suboccipital pains treatments

Most treat them with one or a combination of things like neuromuscular techniques, muscle energy techniques, glides, joint capsule mobilizing, but here’s something that's a little bit more global, and something that I've found in the clinic that has got a little bit more lasting results with my clients’ and patients’. In this video, I started with assessing my patients upper cervical range of motion.
  1. Pushing the chin forward to see the quality and quantity of range she had (this is the extension of the upper cervical spine)
  2. As she pulls the head back we are testing her flexion
  3. Neck we looked at the quality and range of seated forward flexion of the spine, we need to look at the bigger picture when we are treating focused on the large myofascial lines (this assesses your thoracic spine)
  4. Observing any stiffness within her lumbar region
  5. Next, we assess passive ranges of upper cervical flexion and extension. We rule out any joint or inert tissue with this. If the head moves further through range, I know it is mostly muscular/soft tissue, if it is still heavily restricted I am erring towards the joints of the cervical spine. Active assisted would be getting them to try to get a double chin into the head back maneuver.
  6. Then, bending her knees and putting her feet flat, we get her to do some bridging actions. Get those big power driver buttocks muscles to bring her hips and pelvis off the ground. Always ask to move up into the bridge slowly so that the gluteal muscles are the primary target, quick moves can push the pelvis into an anterior tilt and cause the hamstrings to contract. We want the glutes to be the driver in this technique.
  7. Applying the traction to the suboccipital ridge when she’s elevating and relaxing off your pressure to the skull as she lowers herself. We increase the drag along the whole paravertebral erector spinae group with every move. Getting up into that position requires squeezing those glutes.
  8. Rolling down bone by bone, starting with a thoracic and then going down to lumbar vertebra is great because it forces the buttocks to stay in control of the move.
  9. As you do this technique take the pressure off the skull traction but try to find more of a chin flexed position between each hold. We are focused on lengthening the full paravertebral muscles.
  10. Each hold is for the count of 5.
The video shows us retesting Kristen to see what her neck and lumbar ranges were like. The movements on upper cervical flexion and extension looked quite a bit better glide. The seated flexion was probably the greatest of postural changes but the subjective pain had reduced dramatically along the right lumbar erector spinae and the suboccipital ridge on the same side. Use this for any clients that present with suboccipital pain, chronic tightness up through those erector spinae, and those who have got low back problems that you might be able to do this to assist with low back by acknowledging that we can work on the skull as well. NB* The erector spinae is not just one muscle, but a group of muscles and tendons which run more or less the length of the spine on the left and the right, from the sacrum, or sacral region, and hips to the base of the skull. They are also known as the sacrospinalis group of muscles. Watch the full video instruction below:
closed eyes woman cupping her neck with both hands

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.
woman twisting her upper body to the right

Improve Your Breathing and Upper Back using these Stretches!

How life has changed since 2019!! We see lack of movement caused by so many different things now. The usual sedentary lifestyle from poor motivation, restrictions in where and how to get exercise  AS WELL AS the increase in working from home. This has all amassed to increases in sitting, both on the computer and then in front of the television. The outcome is restriction and stiffness in the full spine and specifically poor thoracic spine mobility. We also need to consider those people who have recently experienced violent trauma as which includes motor vehicle accidents, bad falls, sporting injuries etc. These insults also induce pain and immobility on our thoracic vertebrae. Other precursors to a stiff and painful thoracic spine include people suffering from Osteoporosis in jobs requiring strenuous lifting, patients with a history of cancer, drug abuse, HIV, or partial or complete suppression of the immune response/prolonged use of corticosteroids. These are just a few of those I see in my clinic complaining of “a bad upper back”.

Muscles Involved

The muscles involved in Thoracic Rotations are: “During rotation, the external oblique (EO), rectus abdominis (RA) and lumbar multifidus (MF) muscles act contralaterally, whereas the latissimus dorsi (LD), internal oblique (IO), and transversus abdominis (TrA) muscle act ipsilaterally3,4,5,6). Trunk rotation is a motion involving both thoracic and lumbar vertebrae.1” Some of the most commonly known treatments for pain in the thoracic region include stretching, massage, and some other counter (OTC) medicines.  Others, also try heat and/or cold therapy which helps lessen the muscle pain and stiffness in the short term but have little evidence around the long-term benefits. So what can YOU do to help if you have a stiff, painful back? If you struggle to get up in the morning, find it difficult to twist to look over your shoulder when driving or simply turning in seated or standing positions. Here is a quick exercise you can do just about anywhere to help relieve this tension and limited thoracic rotations. Stretch twists of the torso can help improve rib mobility, muscle restrictions, and ultimately diaphragm integrity which is probably the biggest benefit when we consider the need for blood enriched with oxygen.

Twist and Stretch Exercise

I want to offer you the feeling of length/balance of the spinal segments, feeling taller or straighter, and the overall state of postural strength of the core.  This is also a very good practice to strengthen your Diaphragm & Upper Torso.
  1. In the first sequence, put one hand underneath your leg locking your sit bones securely onto the table or chair, while your other hand is across your body and grabbing the chair to be able to start you on your way to twisting your spine.
 
  1. Twist as far as you can go and then try to return to the midline using the muscles of your trunk but use that second hand to hold on and resist.
 
  1. Hold that position for about 10 seconds and return back to the centre position so your back is in neutral.
 
  1. Take a deep cleansing breath in/out and then relax.
 
  1. In the second sequence, repeat the twist to as far as you can turn the spine. Then include a head/neck turn in the same direction to apply a small amount of overpressure to the stretch.
 
  1. Hold this position for 10 seconds, return to centre and take another full breath in and out.
 
  1. The third and the most important of the three sequences are including ocular or eye movement. This encourages the motor cortex to add more rotation via the descending pathways and usually assists in further changes in the nervous system along with the muscles and fascia.
 
  1. Rotate both the head and body as far as possible and hold again for 10 seconds.
 
  1. Now, make your eyes look as far around as you can possibly can and add a bit more stretch.
Watch this 2-minute video for a more visual presentation of this Twisting Exercise.

    1 Source: National Center for Biotechnology Information, U.S. National Library of Medicine [Relationship between the spinal range of motion and trunk muscle activity during trunk rotation]
woman stretching her leg and hamstrings

DIY Myofascial Release techniques for ITB and Adductors

How long do you sit in front of your monitor every day?

Whether you're in a work-from-home or office setup, we can't deny the fact that sitting for a long time is a struggle for us. And I know how hard it is to find a comfortable position for your hips, butts, and legs. Here’s a DIY for your clients during Lockdown - the Myofascial Release and Stretching Technique for ITB Region and Adductors. Can’t access your regular massage therapist or can't afford one? No problem.  Grab a tennis ball and get a cheap foam roller (simply bind two pool noodles together) and let's hit that trigger point one more time!

Myofascial Release

We talked about Myofascial Release in my previous blog, but for those who are new, let me describe it for you. Also called the trigger point release or active release technique. Myofascial Release is a technique used for treating skeletal muscle immobility. It involves applying continuous slow and deep pressure to the network of muscle/s that are stiff, restricted, or showing referral pain patterns.

Self-Myofascial Release

The fitness industry, businesses, and experts have embraced this technique because it's effective. Moreover, aside from being effective, this technique is easy-to-do and accessible. Why? Because you will do it yourself. And yes, we will be using trigger balls and foam rollers for that. Who would have thought of that, right? But first, let's know what trigger points that we will be hitting.

Iliotibial Band Track Region

The Iliotibial band tract (ITB) is also sometimes known as Maissiat's band. ITB Region is a dense group of fibers that extends from the outside of your hips and knees to the tip of your shin. The ITB serves as an important structure involved in lower extremity stability and in some instances motion.

Hip Adductors

In addition to ITB, we will be targeting your hip adductors as well. The adductors are a group of muscles that function to adduct the femur at the hip joint. Most of them are thin muscles. This group of muscles assists the equilibrium and coordination in your inner thighs.

Let's Begin! Below are the step-by-step procedures that you should follow:

Trigger Ball for Gluteal Muscles:

  1. On your yoga mat or soft flooring, lie sideways. Make sure you are in a comfortable position. See to it that you are taking most of your weight on your elbows rather than having the ball leaving bruises on your buttocks.
  2. Place the trigger ball onto the belly of your buttock muscle and locate the points that are probably exquisitely tender. Focus on the parts that cause a referral pain. When you feel that there is a referring pain down to your legs, that's when you know that you are in the right spot.
  3. Inhale and exhale slowly and deeply and wait for the tightness in the muscle to start to soften off. You will feel like you are starting to have the tennis ball sink deeper into your buttock muscle.
  4. Repeat the process until you feel that the pain is relieving bit-by-bit. You can find up to 4 or 5 areas that may be tender.

Foam Rollers for lateral thighs/ITB:

  1. In the same sideways positions, find your lateral thigh right in the ITB Region and vastus lateralis.
  2. Do the same thing, Slide the roller up and down. Apply an amount of pressure that equals your own pain scale. I usually suggest 7/10 as a maximum because we want to be firm enough to relax and loosen the area but not too hard as to create unwanted inflammatory responses.
  3. Run the full length of those muscles and band until you feel like you are releasing some tensions on your lateral thighs.

Stretching Techniques for Adductors and Lower Back:

  1. Since your inner thighs affect your lower back, let's do some stretching of the adductors and lateral trunk. Start by sitting on the ground and widening your legs till you feel a good stretch along the inner thigh.
  2. Reach your arm overhead and then out to the side of the trunk to reach down to the ankle or lower limb. You will feel the right arm glide down the left leg and vice versa. This will improve cross patterning stretches and locking the “sit bones” down to keep the pelvis stabilized. 
  3. Hold each side-bend for a minimum of 10 seconds.
  4. Go as downward as possible. In that way, we open up the hip and the pelvis.
  5. Repeat 3 times on both sides.
These are the few techniques that you can use to treat yourself without the help of anyone. If you have aches and pains and want some easy to watch advice, then flick over and subscribe to my YouTube channel. Stay happy and safe folks! 😉
woman holding her left shoulder pain

Shoulder Injury, Neurolymphatic Point Stimulation Case Study

Clinical features

This is a shoulder injury and neurolymphatic point stimulation case study.  A 44-year-old healthy female came to me presenting a 5 ½ months-post fall that caused a fracture to her greater tubercle and dislocated the humerus posteriorly.

Intervention and Outcomes Before using Chapmans Reflexes

A variety of interventions were performed by her physiotherapist before commencing treatment with me and the application of Chapmans reflexes. Non-surgical relocation of the humerus was performed by her surgeon followed up with weekly rehabilitation therapy with physiotherapy using closed chain small exercises. To date, she has a humeral elevation close to 80 degrees. She was also seeing her regular chiropractor, Dr. Sandy [10 years +]. She has included acupuncture to try for more movement in the shoulder complex. Dr. Sandy referred her to me to address the still limited range of motion.

Interventions using Chapmans Reflexes and Various NMT

For the interventions using Chapmans reflexes, one treatment was applied per week for three weeks. Then one more 14 days later with follow-up in so that she could return to full ROM and strength. This also enables her to perform push-ups from a toe stance. The pain was significantly reduced to VAS less than 1/10. I also addressed her underlying chronic lower back pain complaint.

METHODS

INITIAL PRESENTATION

Mrs. W showed:
  1. tension/hypertonicity
  2. tight left lateral neck and shoulder
  3. some altered sensation
  4. numbness over the region of the lateral humerus. Her description of the region included "feels like a block" and
  5. "has a heaviness when trying to reach overhead".
Over the last 10 weeks, she stated that the medial and anterior deltoid muscle "now finally getting the tone and feels like it is activating". She had actively been doing her home care as instructed by the physiotherapist assigned to her. The home care included the use of heat packs to alleviate the tight and tense soft tissue.

Assessment

Her levels of stress were reported were extremely high. She stated that she felt like she was holding everything internally. She was unable to take full diaphragmatic breaths and her thoracic range of movement was limited in all ranges. Strength testing was performed and showed moderate weakness on the diaphragm-supraspinatus isometric test. There is also a moderate weakness to the latissimus dorsi, the thoracic extensors, posterior deltoid/shoulder complex, and the external humeral rotators.

Treatments

Treatments for Mrs. W included the following:
  1. Chapmans Reflexes – Commenced by stimulation of the neurolymphatic points feeding the diaphragm and then teaching her diaphragmatic breathing to elicit the “relaxation response” and trigger the parasympathetic nervous system. Chapmans Reflexes were applied to the neurolymphatic points for the latissimus dorsi anterior and posterior points and the Tx and shoulder extensors, where I followed the protocol of vigorous but not deep rubbing for 30 seconds in each region. Once these areas were stimulated her strength had improved to very strong isometric holds of the shoulder muscles and increased ROM of humeral extension and internal adduction.
  2. Muscle Energy Technique - Following the neurolymphatic stimulation, I added a muscle energy technique to the humeral internal rotators. This will allow greater resting length in these muscles and increase mobility and ROM of humeral external rotation. During the post isometric relaxation phase, the resting length of the muscle will be greater. This technique has been found to effectively reduce capsular restrictions noted at the glenohumeral joint through ROM.
  3. Low load muscle activation - She then performed a low load muscle activation of the subscapularis in its closed position. The action of the subscapularis is internal humeral rotation as well as adduction of the humerus. This allows the target muscle to contract independently from the other muscles used in the action of the primary muscle.
  4. Neuromuscular techniques - Various neuromuscular techniques including glides and gentle cross fiber movements to the biceps, pec minor, posterior deltoid, and the fascial line between the triceps in supine were applied. Seated active movements of the head and neck in rotation to the left upper and mid trapezius and thoracic erector spinae, prone to the left latissimus dorsi, around the scapula, rotator cuff, and levator scapula were also applied. Mobilization of the bilateral Cx joints to address the left-sided stiffness. Both sides were painful but became less painful after 3 applications on each side.
  5. Homecare - This included activating the neurolymphatic points of the diaphragm, 10 diaphragmatic breathing, and breathing full breaths often through the day.
Mrs. W had plenty of resentment issues over the fall and the lack of support with those around her during the incident. So, we also discussed ways for her to do self-anger management and let anger become less of an impediment to her treatment progress.

2ND TREATMENT

Mrs. W did her homework using the breathing exercises to manage her stress and chest restrictions. She also wrote her resentment issues down on butcher paper and stated that she was “feeling like moving forward a bit more”. Her shoulder’s range had improved but still with pain and some mild swelling for a few days post-treatment. She attempted to do toe push-ups (did 3 this morning) which she had been unable to do.

Assessment

There were still some weaknesses with thoracic and humeral extensors and latissimus dorsi. Also, there was still weakness in recruiting the neck muscles to assist in the strength testing with a note to actively retracting the jaw in every movement. Strength testing also included weakness in neck flexion so the neurolymphatic point for the region was included. Assessment of supine rotations of the lower limbs to assess the balance of the soft tissues of the trunk lateral flexors, obliques, and deep lumbar rotatores, multifidi, and intertraversii muscles were done. Looking at the Anatomy trains and links to the functional backline, lateral line and spiral line with the connections from the shoulder and pelvis have led me to include lumbar muscle energy techniques to address rotations or torsions of the sacrum and/or ilia.

Treatments

  1. Chapmans Reflexes - These were applied to the left latissimus dorsi, thoracic flexors/humeral extensors, and sternocleidomastoid/deep neck flexors. Re-assessment of strength was markedly improved with almost complete full range of shoulder abduction.
 
  1. Local cross-fiber friction and neuromuscular techniques - These were applied to the upper anterior humerus/anterior deltoid tendon, subclavius, 2nd/3rd ribs at the sternalis region - using forced inspiration and expiration; myofascial ringing of my hands across the lateral humerus/ interosseous membrane just inferior to the deltoids with active humeral rotation, compression/stripping into the thenar muscle. These techniques were chosen to include the fascial arm lines of the Anatomy Trains. Studies show that restrictions along these superficial and/or deep arm lines will alter the biomechanical efficiency of the shoulder complex and cervical ROM. Lumbar muscle energy technique and gluteal stretches were included in this treatment. [Shoulder Injury & Neurolymphatic Point Stimulation - A Case Study]
 
  1. Homecare – A 30-second stimulation of the neurolymphatic points of the latissimus dorsi, thoracic flexors/humeral extensors, deep neck flexors/SCM, and diaphragm were prescribed including 2 minutes of diaphragmatic breathing. I started Mrs. W on the functional stabilizing activity of wall springing push-ups x 20 daily. This reduces the load of the shoulder complex and still offers eccentric and concentric contractions to any of the muscles with attachments to the scapula, humerus, or ribs.
 

3RD TREATMENT

Mrs. W had been doing the Chapmans activations each day. She has full pain free range of the humerus in all ranges, has been doing wall springing push-ups and today performed 15 toes push-ups for her physician. He has commented that her post-non-surgical relocation recovery has accelerated far greater than usual progressions. He is very happy with her outcomes.

Assessment

The latissimus attachment pain is finally settled and latissimus strength is 100%. Shoulder ROM was considered to be full range in all planes, though a painful taut band was noted on the left teres major. We are now focusing on an ongoing episodic complaint of lower back pain which is 6-7/10 on the VAS scale and can flare up with long hours standing at work. Strength testing showed the weakness of the left lateral sling including lateral trunk flexors, gluteus medius/minimus; weak right gluteus maximus, right hip flexor iliopsoas, right superficial front and back fascial lines with weakness in strength testing of the quadriceps, gastrocnemius, and tibialis anterior.

Treatments

  1. Neurolymphatic points stimulation  - This was applied to the weakened muscles tested listed above. Neurolymphatic points relevant to musculoskeletal dysfunction are found primarily on the anterior of the body, when there is chronic weakness/stress we also need to treat the associated posterior Chapmans Reflex points housed near the erector spinae of the relevant spinal nerves.
  2. Low load activation - I added low load muscle activation to the left rhomboid to increase the stability of the left rotator cuff of the scapula which affects the spiral line of the anatomy trains.
  3. Prone various neuromuscular techniques - These techniques were applied to the gluteus maximus, minimus, and medius, adding compressive mobilizing techniques to the sacral ILA, sacrotuberous and iliolumbar ligaments, complimenting with myofascial release/passive internal rotations of the deep hip rotators, also applied XFF to the tendon of the right quadriceps in supine with Mrs. W adding active femoral rotations.
  4. Homecare – Mrs. W continued to apply her 30 seconds of vigorous but not hard rubbing to the neurolymphatic points associated with the latissimus dorsi, thoracic flexors/humeral extensors, deep neck flexors/SCM, diaphragm and continue her diaphragmatic breathing each morning and if she felt she was going into a stress state. She will also include the low load muscle activation of the rhomboid muscle to address any dysfunction of the spiral line of the anatomy train.
 

4TH TREATMENT

Mrs. W booked in 2 weeks later – she had increased her University assignment load and she works full time as a registered nurse which added more stress to the shoulder and back. One episode of neuralgia from the right side of the neck resulted in a silent migraine occurred with excessive hours in front of the computer. Her shoulders were still maintaining full range of motion but last week, a feeling like a band or pressure developed across the posterior deltoid and over the shoulder which is still present today. No complaints of lower back pain since the last treatment.

Assessment

Full strength when testing the shoulder muscles which was encouraging. There was also a full range of movement though a feeling of the band over the deltoid still present. The taut band and pain commonly referred to as a "Trigger Point" was no longer present on palpation of the teres major. Lumbar rotations in supine were equal and full range. Sacral hypertonicity and painful areas were no longer a concern.

Treatments

  1. Local neuromuscular treatment - This was applied to the left shoulder commencing with positional release techniques to the external rotators of the humerus, glides to the pectoralis minor and major.
  2. Prone neuromuscular techniques - These techniques were also applied to the full-back, latissimus dorsi, lumbosacral and thoracolumbar fascia, shoulder rotator cuff, upper trapezius, and levator scapulae.
  3. Homecare - Activation of the Chapmans Reflexes three times a week and increase to daily if the range reduced in any of the humeral movements were advised. She would continue with the low load muscle activation of the rhomboid before stronger shoulder exercises. She would have to find strategies to add small breaks into the assignment writing tasks so that long hours working at the computer are broken up.

LAST TREATMENT

Two weeks further to follow up and all ranges are full, pain-free, and feel easy throughout the entire range. I added a bike exercise to help with stress management. She would continue with the low load muscle activation and Chapmans Reflexes point stimulation.

Treatments

  1. Therapeutic management - She asked to have a more relaxed treatment so I removed any neurolymphatic point stimulation or exercises to the treatment protocol and gave a general treatment including glides, effleurage, petrissage, myofascial release techniques, positional release techniques, some active and passive stretches.
  2. Homecare - She would continue with the physiotherapist's exercise routine adding the low load and neurolymphatic point stimulation before these rehabilitation activities.
I followed up 6 and 12 months later and Mrs. W had no further need to intervene on her shoulder.    
stretching woman's hip and thighs

Hip and Back Pains? Your Body Badly Needs These Stretches!

For today’s article, "Hips and Backs NEED these TWO Stretches to Resolve Hip and Back Pains", we talk about all things hips. Particularly interesting are the two stretches that help resolve the common hip and back pains.  This is especially advantageous to those who constantly sit for long periods of hours who may occasionally experience lower back and hip pain. And this is quite true also for people with occupations that require them to stay in a variety of uncomfortable positions for any length of time. Plumbers are a PERFECT example of having an occupation that leaves them flexed, rotated, side bent, back bent, crouching, and all manner of odd positions. When I see these clients, they almost ALL present with lower back pain especially in the morning.

Which Occupations Mostly Suffer from Hip and Back Pains?

So if you think about your clientele who you treat for back and hip pain, how many fit this demographic?? Occupations that put them in tight and awkward body positions will undoubtedly increase the risks of having them experience lower back and hip pain. These include plumbers, carpenters, electricians, mechanics not to mention those who sit for hours each day. The mechanism of injury is extended periods of forwarding flexion which loads the posterior chain of the body – excessive glute contraction, and also hamstring and the erector spinae fatigue. Our contralateral muscles often co-contract leading to tight hip flexors, tight adductors, and a restricted capsular hip joint.

The Two Powerful and Effective Stretch Techniques

Let’s address both lower back and hip pain using two powerful and effective stretch techniques.
  • Let’s start with the client supine.
  • Take the affected leg into hip flexion.
  • Now externally rotate their leg until you get the end feel of the tissues in the gluteal region. This can include glute Maximus, minimus and minimus, deep rotators, and/or piriformis. You may also feel the end of the range in the actual joint. Depending on the flexibility of your client, you should be able to externally rotate their leg till the ankle nears their opposite hip.
  • Then you apply a little bit of pressure using your body weight by leaning forward into the client’s raised leg while holding the adjacent hip using your other hand. Fixating the hip stops the pelvis from moving into counternutation or rotation.
  • While in this position, try to flex, externally rotate. Abduct the leg as far as they can manage while stabilizing yourself using your client’s opposite hip. Make sure that the stretch is deep but comfortable. They should be able to breathe through it.
  • You should ask your client for feedback, where they feel the stretch. Any pain felt is usually in the socket and the deeper hip rotators i.e. obturators and Gemelli.
  • Now reposition yourself into a position where you can grasp the full thigh with both your arms. Take the femur into a supportive hug and keep the external rotation and abduction.
  • From there, lean backward away from the table, distract the thigh putting the abductors under stretch. You hold each of these positions for 20 – 30 seconds to allow for some soft tissue ‘creep’.
  • Repeat these two manoeuvers twice more each time going much deeper into the stretches and distractions and leaning more of your body weight.

Watch out for Compressive Groin Pain

  • Now, this stretch is not applicable if your client complains of compressive groin pain. This can be a multitude of reasons including:
    • arthritis,
    • bony spurs,
    • bursitis in the lessor trochanter trochanteric tendonitis, etc.
  • We can address this by getting a pillow slip or hand towel, put it at the proximal medial region of the thigh i.e. the groin or crotch area. Further, distract the femur with the material. You are creating a wedge to encourage the head of the femur further into the posterior lateral region within the acetabulum. This should reduce pain when the client's leg is taken into flexion/adduction/external rotation.
  • Repeat the steps with the other leg and see the difference in the range in motion as you rotate the legs forward and backward.
Now that’s a stretch!!! It focuses on abduction and adduction restrictions, gluteal hypertonicity, tight hip flexors. It can give your clients great relief for both lower back and hip pain. That’s just about it for now with "Hips and Backs NEED these TWO Stretches to Resolve Hip and Back Pains". See you in the next article!
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