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:
Finger-to-wrist stretching, rotation of the hand, joint and finger rotation
When doing shiatsu, use the pad of the thumb of the finger, not the tip.
Extend the thumb when using it; don't flex it.
Apply gradual pressure to the area between the thumb and the point of the finger.
There are three pressure points that must be applied to each in between the fingers of the hand.
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:
Hi team, I thought we might talk about some stuff that you may NEVER have thought of before. It’s the links that the body has in our myofascial and neural lines of the body, and this is all about the jaw and jaw clenching and its effects on the strength of your gluteus maximus. Being a part of the face, the jaw and the jawline are often perceived as a marker of beauty, but this facial feature is more than just a mere accessory. Our jaw is part of the alimentary system, as well as our defense system when we go into what is termed our VENTRAL-VAGAL social engagement which is part of Porges Polyvagal Theory.Clenching the jaw is a primal act and if you think about it, survival of having it traumatically removed is part of keeping our species alive. The same primal move it probably accessing our FREEZE reaction, one that comes from DORSAL VAGAL SHUTDOWN which generates from about 500 million years ago and can be linked to immobilizing emotionally also.When the FREEZE component occurs it reaches along the spinal nerves and dampens the full chain of muscles that will propel us forward, gluteus maximus being the greatest in this action, the hamstrings involved as well but to a lesser degree.
Our Jaws in the Modern Day
Moving forward 500 million years where we live in a world of ongoing stress, increased hyper-vigilance, high acid systems we see more and more people you clench or grind their teeth. These habits may have varying reasons, like stress, anxiety, or different types of arthritis. Too much jaw clenching may result in cracking of teeth, TMJ dysfunctions, headaches, tension and pain in the neck and head, and farther afield including the paraspinal muscles and muscles of the lower back. It is surprising how stress and/or chronic jaw clenching can have such a significant impact on our glutes, but that is the truth of it. There is an easy way to test this, but you must first have someone else around to help you.
Lie down completely relaxed, and bend your right knee up, with your foot planted firmly on the floor.
Have your friend attempt to lift up your right foot, while you use your glutes to resist.
Now, clench your jaw, and have your friend attempt to lift your foot once again. Try to resist.
You will notice that your glute strength has been reduced significantly while your jaw is clenched. Jaw clenching not only affects the muscles near the face, it tends to reproduce right down to our lower bodies. People must be mindful of their jaws, as a bad jaw can lead to a multitude of pain and tension all over the body.You could also watch the full demo of this exercise in the YouTube video below.
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:
tension/hypertonicity
tight left lateral neck and shoulder
some altered sensation
numbness over the region of the lateral humerus. Her description of the region included "feels like a block" and
"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:
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.
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.
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.
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.
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
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.
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]
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
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.
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.
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.
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
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.
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.
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
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.
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.
The Major Problem About Having Lower Back Pain. Have you ever wondered why your body feels older and achier than you’d like? Recurring lower back pain? Neck pain, headaches or migraines?You think about the things that you have been doing recently and realize that you’re not really doing anything particularly wrong. You’ve been stretching at your desk in the office, getting up from the chair and moving around if sitting for too long in front of the computer but you just don’t know why you feel like you do.But you know what!
The "Secret Culprit"
There is a “secret” culprit that can be responsible for a majority of the pain your experiencing in your pelvis and all the way to your spine and neck.Want to know what it is?It’s actually your wallet or iPhone that you put on your back pocket while sitting in your car or just sitting all day in front of your computer.
Don't Get Surprised!
Surprised?Well, a lot of people are SHOCKED when I tell them that this little culprit continuously in your back pocket can be the main reason why you’re having so many pain issues, especially your lower back.A lot of people don’t realize the damage caused by consistently sitting on your phone or wallet for lengthy periods of time. Especially when it’s full of credit cards, ID’s, coupons, and receipts that you don’t even need.Imagine doing this every single day! You’re unknowingly causing yourself back and neck pain because the wallet causes you to elevate one part of your hip, distort your posture, and put continuous pressure on your spine, causing misalignment.Try this now, put your wallet, purse or phone in your pocket and sit down, one hip is now elevated and your hip or sacro-iliac joint is higher than what it ought to be. You have created a scoliotic curve in your lower or lumbar spine. This scoliotic curve is the start of small changes all the way up through your spine.I see clients presenting to my clinic complaining of pain in the lower back pain, pelvic pain, and spinal pain anywhere along the mid back all the way to the shoulders and the neck. Not only that but migraines and headaches too. We treat to balance the muscles that have been tightened, shortened, lengthened and stressed in my clinic and your homecare plan is take that NASTY object out of your back pocket when sitting. Again, that major problem about having lower back pain strikes!
Important Note
*If you're long driving and sitting with a bag under one of your hips, especially in the case of cab drivers and those who do regional driving as well, you’ll realize that one of your legs is sitting longer (or shorter) when driving. Having overstuffed purse or wallet can put pressure on you piriformis muscle that seriously affects your sciatic nerve, causing you to have sciatica-- a pain that radiates along the sciatic nerve and into the buttocks, hips, and the lower back all the way down to each leg.So always be mindful of the way you're sitting in the office or in your car.
So the answer to that Major Problem About Having Lower Back Pain...
Make sure that you create the HABIT of removing things from your back pocket before you sit down, the outcome is even and balanced pelvis. You’ll definitely see and feel the difference of having to sit without anything on your hips.Let’s reduce the incidence of back and neck pain, migraines or headaches, and even scoliotic spine because of that single culprit: your stuffed wallet.There you have it! I hope you learned about the great tips I shared with you so you can avoid having a lot of pain issues on your hip, back, and neck.
