Treating Subscapularis - Dr. Jonathan Kuttner
[Latin sub, under; scapularis, pertaining to the scapula]
Subscapularis
A member of the rotator cuff, which comprises the supraspinatus, infraspinatus, teres minor, and subscapularis.
The rotator cuff helps hold the head of the humerus in contact with the glenoid cavity (fossa, socket) of the scapula during movements of the shoulder, thus helping to prevent dislocation of the joint.
The subscapularis constitutes the greater part of the posterior wall of the axilla.
Subscapularis Trigger Points
Origin
Subscapular fossa and groove along lateral border of anterior surface of scapula.
Insertion
Lesser tubercle of humerus. Capsule of shoulder joint.
Action
As a rotator cuff muscle, stabilizes glenohumeral joint, mainly preventing head of humerus being pulled upward by deltoid, biceps, and long head of triceps. Medially rotates humerus.
Antagonists: infraspinatus, teres minor.
Nerve
Upper and lower subscapular nerves, C5, 6, 7, from posterior cord of brachial plexus.
Basic Functional Movement
Example: reaching into back pocket.
Referred Pain Patterns
Axillary trigger point: strong zone (5–8 cm) of pain in posterior glenohumeral joint, with a peripheral diffuse zone. Also radiating down posterior aspect of arm and anteroposterior carpals of wrist.
Indications
Rotator cuff tendinopathy, adhesive capsulitis (frozen shoulder), decreased external rotation with abduction, severe pain over back
of shoulder, restricted range of shoulder movement, inability to reach behind back, pain on throwing, clicking/popping shoulders, stroke (hemiplegia).
Causes
Sports related (especially swimming crawl, repeated forceful overhead lifting, baseball pitching/catching, cricket), post shoulder fracture/ dislocation, frozen shoulder syndrome, sudden unexpected loading of shoulder (e.g. fall), post- fracture, prolonged immobility (sling).
Differential Diagnosis
Impingement syndromes. Rotator cuff dysfunctions. Thoracic outlet syndromes. Cervical radiculopathy (C7). Cardiopulmonary pathology.
Connections
Infraspinatus, pectorals, teres minor, latissimus dorsi, triceps brachii, posterior deltoid, supraspinatus.
Self Help
Subscapularis is mostly hidden but self-massage techniques can be helpful for part of muscle that is exposed in and around armpit.
More Articles About Frozen Shoulder
More Articles About the Rotator Cuff
Dry Needling for Trigger Points
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Simple Shoulder Stretches
Here are 5 other shoulder stretches that we regularly recommend ...
Technique
Kneel on the floor in front of a chair or table and interlock your forearms above your head. Place your arms on the object and lower your upper body toward the ground.
Muscles that you're stretching
Primary muscles: Pectoralis major and minor. Anterior deltoid.
Secondary muscles: Serratus anterior. Teres major.
Injury where this may help dissipate trigger points
Impingement syndrome. Rotator cuff tendonitis. Shoulder bursitis. Frozen shoulder (adhesive capsulitis). Chest strain. Pectoral muscle insertion inflammation.
Note
Keep your elbows bent and vary the width of your arms for a slightly different stretch.
2. We find this especially useful between trigger point therapy treatments for biceps.
Technique
Stand upright with your back towards a table or bench and place your hands on the edge of the table or bench. Slowly lower your entire body.
Muscles that you're stretching
Primary muscles: Anterior deltoid. Pectoralis major and minor.
Secondary muscles: Biceps brachii. Coracobrachialis.
Injury where this may help dissipate trigger points
Dislocation. Subluxation. Acromioclavicular separation. Sternoclavicular separation. Impingement syndrome. Rotator cuff tendonitis. Shoulder bursitis. Frozen shoulder (adhesive capsulitis). Biceps tendon rupture.Bicepital tendonitis. Biceps strain. Chest strain. Pectoral muscle insertion inflammation.
Note
Use your legs to control the lowering of your body. Do not lower your body too quickly.
3. Stretching Infraspinatus may be important for injury prevention and can help dissipate trigger points
Technique
Stand with your arm out and your forearm pointing downwards at 90 degrees. Place a broomstick in your hand and behind your elbow. With your other hand pull the top of the broomstick forward.
Muscles that you're stretching
Primary muscle: Infraspinatus. Posterior deltoid.
Secondary muscle: Teres minor.
Injury where this may help dissipate trigger points
Dislocation. Subluxation. Acromioclavicular separation. Sternoclavicular separation. Impingement syndrome. Rotator cuff tendonitis. Shoulder bursitis. Frozen shoulder (adhesive capsulitis).
Note
Many people are very tight in the rotator cuff muscles of the shoulder. Perform this stretch very slowly to start with and use extreme caution at all times.
4. Trigger Points in the Trapezius muscle are extremely common. This is a great stretch for trapezius that's easy to do at home.
Technique
Sit in a squatting position while facing a door edge or pole, then hold onto the door edge with one hand and lean backwards away from the door.
Muscles that you're stretching
Primary muscles: Trapezius. Rhomboids. Latissimus dorsi. Posterior deltoid.
Secondary muscle: Teres major.
Injury where this may help dissipate trigger points
Neck muscle strain. Whiplash (neck sprain). Cervical nerve stretch syndrome. Wry neck (acute torticollis). Upper back muscle strain. Upper back ligament sprain. Impingement syndrome. Rotator cuff tendonitis. Shoulder bursitis. Frozen shoulder (adhesive capsulitis).
Note
Lean backwards and let the weight of your body do the stretching. Relax your upper back, allowing it to round out and your shoulder- blades to separate.
5. Trigger points in the anterior deltoid are often associated with "unexplained" shoulder pain. This stretch may quickly help relieve pain.
Technique
Stand upright and clasp your hands together behind your back. Slowly lift your hands upward.
Muscles that you're stretching
Primary muscle: Anterior deltoid.
Secondary muscles. Biceps brachii. Brachialis. Coracobrachialis.
Injury where this may help dissipate trigger points
Dislocation. Subluxation. Acromioclavicular separation. Sternoclavicular separation. Impingement syndrome. Rotator cuff tendonitis. Shoulder bursitis. Frozen shoulder (adhesive capsulitis). Chest strain. Pectoral muscle insertion inflammation.
Note
Do not lean forward while lifting your hands upward.
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Cupping Tutorial: Becky Tyler (Osteopath and sports Massage Therapist) presents vacuum cupping integrated with massage for the treatment of Plantar Fasciitis (pain under the foot, usually on walking and worse when you get up in the morning). If you are suffering from Plantar Fasciitis, ask your massage therapist about cupping.
What you need to know ...
Plantar fasciitis is a common foot condition that causes pain in the heel and bottom of the foot. It occurs when the plantar fascia, a thick band of tissue that connects the heel bone to the toes, becomes inflamed or irritated. This condition can be debilitating, affecting one's ability to walk, stand, or engage in physical activities comfortably. Understanding the causes, symptoms, and treatment options for plantar fasciitis is essential for effective management and relief of symptoms.
One of the primary causes of plantar fasciitis is excessive or repetitive stress on the plantar fascia. This can result from activities such as running, jumping, or prolonged standing, which place strain on the foot's arch and heel. Additionally, factors such as obesity, tight calf muscles, high arches, and improper footwear can increase the risk of developing plantar fasciitis. Individuals who have flat feet or who engage in activities that involve sudden changes in intensity or duration may also be more susceptible to this condition.
The most common symptom of plantar fasciitis is pain in the bottom of the heel, which is often described as sharp or stabbing. This pain is typically most severe in the morning when taking the first steps out of bed or after prolonged periods of rest. It may also worsen with activity and improve with rest. Some individuals may experience pain that radiates along the bottom of the foot or into the arch.
Diagnosis of plantar fasciitis is usually based on a physical examination and a review of the individual's medical history and symptoms. In some cases, imaging tests such as X-rays or ultrasound may be ordered to rule out other potential causes of heel pain, such as stress fractures or heel spurs. Once diagnosed, treatment for plantar fasciitis typically focuses on relieving pain, reducing inflammation, and addressing underlying factors contributing to the condition.
Conservative treatment options for plantar fasciitis may include rest, ice therapy, stretching exercises, and over-the-counter pain medications. Physical therapy and orthotic devices, such as arch supports or heel cups, may also be recommended to provide support and relieve pressure on the plantar fascia. In more severe cases, corticosteroid injections or extracorporeal shockwave therapy (ESWT) may be considered to help reduce pain and promote healing.
In addition to these treatments, lifestyle modifications can play a crucial role in managing plantar fasciitis and preventing recurrence. This may involve wearing supportive footwear with cushioned soles and adequate arch support, avoiding high-impact activities that exacerbate symptoms, and maintaining a healthy weight to reduce strain on the feet. Stretching and strengthening exercises for the calf muscles and plantar fascia can also help improve flexibility and reduce tension in the foot.
While plantar fasciitis can be challenging to manage, most individuals experience significant improvement with conservative treatments within a few months. However, in cases where symptoms persist despite conservative measures, surgical intervention may be considered as a last resort. Surgical options for plantar fasciitis may include plantar fascia release or the removal of heel spurs, although these procedures are typically reserved for severe, refractory cases.
In conclusion, plantar fasciitis is a common foot condition characterized by pain and inflammation in the heel and bottom of the foot. Understanding the causes, symptoms, and treatment options for plantar fasciitis is crucial for effective management and relief of symptoms. By incorporating conservative treatments, lifestyle modifications, and appropriate interventions, individuals can often find relief from plantar fasciitis and return to their normal activities with minimal discomfort.
TFL trigger points are associated with a wide range of common hip and knee dysfunction are often encountered in a highly resistant form.
Pain from these trigger points is often experienced at the level of the greater trochanter of the hip joint. The pain is almost always more intense when walking or running.
Referred Pain
Pain is also commonly referred down the lateral thigh and to the knee. In many cases the pain will be referred to the knee only.
In the video above, Stuart hinds demonstrates part of the NAT hip protocol used to address TFL trigger points.
About the TFL
Latin: Tendere = "to stretch"; Fasciae = "of the band"; Latae = "broad"
The tensor fasciae latae muscle lies anterior to the gluteus maximus, on the lateral side of the hip.
Origin
Anterior part of outer lip of iliac crest, and outer surface of ASIS.
Insertion
Joins the IT tract just below level of greater trochanter.
Action
Flexes, abducts, and medially rotates the hip joint.
Tenses fascia lata, thus stabilizing the knee joint.
Redirects rotational forces produced by gluteus maximus.
Nerve
Superior gluteal nerve, L4, 5, S1.
Basic Functional Movement
Example: Walking.
Soft Tissue Therapy for TFL Restrictions
The tensor fasciae latae (TFL) is a small but mighty muscle located on the side of the hip, playing a crucial role in hip stability and mobility. However, due to factors such as prolonged sitting, repetitive movements, and muscular imbalances, the TFL can become tight and restricted, leading to discomfort, pain, and limited range of motion in the hip joint.
Fortunately, soft tissue therapy offers a highly effective solution for addressing TFL restrictions and restoring optimal function to the hip. By targeting the TFL and surrounding muscles with specific manual techniques, soft tissue therapy can help release tension, alleviate tightness, and improve flexibility, allowing for greater mobility and comfort in the hip region.
Here are some key benefits of incorporating soft tissue therapy into your treatment plan for TFL restrictions:
Release of Tension: Soft tissue therapy techniques, such as myofascial release and trigger point therapy, target the tight, restricted fibers of the TFL, helping to release tension and restore suppleness to the muscle.
Improved Range of Motion: By addressing restrictions in the TFL and surrounding soft tissues, soft tissue therapy can help improve hip mobility and flexibility, allowing for smoother, more fluid movement in activities such as walking, running, and squatting.
Pain Relief: TFL restrictions can contribute to hip and lower back pain, as well as discomfort in the IT band and knee. Soft tissue therapy can help alleviate pain by reducing tension and inflammation in the TFL and associated structures.
Correction of Muscular Imbalances: Soft tissue therapy can help identify and address muscular imbalances that may be contributing to TFL restrictions, promoting better alignment and function throughout the hip complex.
Prevention of Injury: By maintaining optimal soft tissue health and mobility in the TFL and surrounding muscles, soft tissue therapy can help reduce the risk of overuse injuries and strain, allowing individuals to engage in physical activities safely and effectively.
Incorporating soft tissue therapy techniques into your treatment regimen for TFL restrictions can yield significant benefits, helping to restore balance, mobility, and comfort to the hip region. Whether you're dealing with discomfort during daily activities or looking to optimize athletic performance, soft tissue therapy offers a holistic and effective approach to addressing TFL restrictions and promoting overall musculoskeletal health.
If you're experiencing TFL restrictions or hip discomfort, consider consulting with a qualified soft tissue therapist or healthcare provider to develop a personalized treatment plan tailored to your specific needs and goals. With targeted soft tissue therapy, you can unlock the full potential of your hips and enjoy greater freedom of movement and comfort in your daily life.
The superior head of the lateral pterygoid is sometimes called the sphenomeniscus, because it inserts into the disc of the temporomandibular joint.
ORIGIN
Superior head: lateral surface of greater wing of sphenoid.
Inferior head: lateral surface of lateral pterygoid plate of sphenoid.
Lateral Pterygoid Trigger Points
INSERTION
Superior head: capsule and articular disc of the temporomandibular joint. Inferior head: neck of mandible.
ACTION
Protrudes mandible. Opens mouth. Moves mandible from side to side (as in chewing).
NERVE
Trigeminal V nerve (mandibular division).
BASIC FUNCTIONAL MOVEMENT
Chewing food.
Lateral Pterygoid Trigger Points
REFERRED PAIN PATTERNS
Two zones of pain:
(1) TMJ in a 1 cm localised zone
(2) zygomatic arch in a 3–4 cm zone
INDICATIONS
TMJ syndrome, craniomandibular pain, problems chewing/masticating, tinnitus, sinusitis. decreased jaw opening, headaches, bruxism, sinusitis pain, trismus (lockjaw), tingling in cheek area.
CAUSES
Chewing gum, tooth grinding/ bruxism, prolonged dental work, stress, emotional tension, jaw/ bite alignment, nail biting, thumb sucking.
DIFFERENTIAL DIAGNOSIS
Arthritic TMJ. Anatomical variations of TMJ. Tic douloureux (trigeminal neuralgia). Shingles.
CONNECTIONS
TMJ, atlanto-occipital joint facets, neck muscles, masseter, medial pterygoid, temporalis (anterior), zygomaticus, buccinator, orbicularis oculi, SCM.
BITE PLATES/BLOCKS/ OCCLUSAL SPLINTS
Opinion varies as to efficacy, type, and duration of use for occlusal devices. An evidence base suggests they can be beneficial.
POSTURE
Head forward or upper crossover patterns can be treated by a range of manual and trigger point therapists.
ADVICE
Chew on both sides of mouth. Avoid gum chewing/nail biting. Bite guard, phone-in-neck postures.
SELF-HELP TECHNIQUE
1. Use pincer-grip pressure techniques inside of the mouth in the sulcus, right at the back of the molars (or wisdom teeth if you have them); push inward and upward toward the top of the cheek.
2. Apply gentle and gradually increasing pressure to the trigger point, while lengthening the affected/host muscle until you hit a palpable barrier. This should be experienced as discomfort and not as pain.
3. Apply sustained pressure until you feel the trigger point soften. This can take from a few seconds to several minutes. Repeat, increasing the pressure on the trigger point until you meet the next barrier, and so on.
To achieve a better result, you can try to change the direction of pressure during these repetitions.
Useful Links on this Website
Ischemic Compression Technique (ICT)
Dry Needling for Trigger Points
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Treating Thoracic Outlet Syndrome
TOS occurs when nerves and/or blood vessels become compressed in their passageway through the thoracic outlet which sits between your collarbone and first rib.
The thoracic outlet is surrounded by bone, muscle and other tissues. Movement or enlargement of these tissues near the thoracic outlet as a result of conditions such as cervical rib, tumors in the chest, muscle enlargement and weight gain, may lead to TOS.
These conditions may cause the collarbone to slip putting pressure on the blood vessels and nerves that sit underneath it leading to TOS.
TOS Awareness
TOS is one of a group of conditions that cause pain into the arm hand and fingers.
Not everyone is too aware of TOS and it's not unusual for clients to work their way through a number of visits to doctors and therapists by the time they receive a confirmed TOS diagnosis.
Types of TOS
The symptoms of TOS can be really disturbing and cause much anxiety (which doesn’t help).
There are generally two types of TOS – one is an unmistakable blockage pressure (organic) to the nerves or blood supply and the other is a functional or temporary pressure issue.
This functional group tends to respond very well to trigger point self-help techniques.
That’s because functional TOS results from a combination of poor rib mechanics and tight muscles (especially the Scalenes and Pectoralis Minor) that cause pressure on the neurovascular structures (sometimes called a myogenic plexopathy).
What Are the Symptoms of Thoracic Outlet Syndrome?
This will depend on the blood vessels or nerves that are compressed. It is more common to have symptoms from nerve compression than from blood vessel compression.
- Both types of compression may make overhead activities difficult.
- Discoloration or swelling in your arm.
- Limited range of motion.
- Redness or swelling of the arm due to a reduction in the blood flow from pressure on the blood vessels. Symptoms may also be felt in the arm and hand.
- A dull ache from nerve pressure may be felt in the hand, arm, shoulder or neck. Tingling, pain or numbness may also be felt on the inside of the forearm and 4th and 5th fingers . The hand may feel clumsy.
Who is Prone to Thoracic Outlet Syndrome?
- Physically active, younger adults whose occupations involve repetitive raising of the arms e.g. machine operators, truck drivers and dental workers
- Those born with an extra rib (known as cervical rib)
- Older people - sagging of the shoulder
Differential Diagnosis - What Else Could It Be?
Here is a list of other conditions which can present as thoracic outlet syndrome; some of them can be serious, so if you are concerned please check with your doctor or therapist:
Extra cervical rib or ligamentous (false) rib
Pancoast tumor
Brachial plexopathy – infective or traumatic
So tissue damage (from a whiplash)
Heart attack (le side)
Vertebral artery disease or aneurism
Hyperkyphosis or scoliosis of the thoracic spine
Neck degenerative changes, cervical bars and osteophytes
Radial Neuropathy
Syringomyelia
Complex Regional Pain Syndrome 1(CRPS1) - RSD
Problems (age related) with the neck including discs and spinal joints
Ankylosing spondylitis
Median neuropathy
Ulnar neuropathy
TOS and Trigger Point Therapy
Trigger points can develop in muscles for a number of reasons especially overuse.
When present, trigger points cause the host muscle to be shorter, tighter and tenser and they also add to the cycle of increased input to the peripheral and central nervous system.
With TOS, the results of trigger point therapy can be startlingly fast; will almost always provide relief; and accelerate well being.
As is usually the case with trigger point therapy, the hands-on treatment is likely to be most effective when combined with correct stretching and strengthening exercises.
When treating TOS, these typically include neck stretching, ulnar glides, upper trapezius and pectoralis stretching, back mobilization, and rhomboid strengthening.
Self treatment with pressure tools can also be very effective. See examples below:
Self Help - Subclavius
Self Help - Infraspinatus
Self Help - Infraspinatus
Self Help - Pectoralis Minor
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
The Tennis Elbow condition causes the bony prominence on the outside of the elbow to become tender and sore. In the more severe cases, the pain may become debilitating.
This condition is usually related to strain or overuse of the muscles attaching to the lateral epicondyle of the humerus or, less frequently, a direct trauma.
Typically, the extensor muscles of the forearm, which extend and straighten the wrist, become strained from overuse, causing inflammation at the attachment to the bone.
The supinator muscle which allows the forearm to be turned to the "palm-up" position also attaches to the lateral epicondyle and can also be associated with tennis elbow.
Frequently, tendons attached to the bones of the elbow can become restricted or taut, causing irritation.
Cause of injury
Overuse of the muscles attached to the elbow. Direct injury to the elbow. Arthritis, rheumatism or gout.
Signs and Symptoms
Outer part of the elbow is painful and tender to touch. Movement is painful. Elbow is inflamed.
Complications if Left Unattended
Tennis elbow is generally treated without surgery, though discomfort will often worsen, with the potential for tendon or muscle damage should the condition be ignored.
The root causes of the condition are often associated with trigger points and trigger point "protective holding patterns". Extremely efficient treatment protocols have been developed for the treatment of athletes, and these techniques are now commonly used by manual therapists.
Do your research to ensure that your chosen therapist has experience in treating this condition.
Immediate Treatment
Avoidance of the activities causing repetitive stress to the elbow. RICER regimen for 48–72 hours following injury. Use of anti- inflammatory drugs and analgesics.
Rehabilitation and Prevention
Often a splint or bandage will be used to immobilize the injured elbow and prevent excess movement. Activities involving repetitive stress to the elbow or extensor muscles of the wrist should be avoided until the condition improves.
Should surgery be required a rest period of six weeks is typically advised before strengthening exercises begin.
Long-Term Prognosis
Few patients suffering from tennis elbow require surgery. Of the small percentage that do, 80–90% find the condition markedly improved.
More Articles About Elbow Pain
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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Introduction: Horizontal pulling exercises are a cornerstone of any well-rounded strength training program, targeting key muscles of the upper back, shoulders, and arms. However, to reap the full benefits of horizontal pulling while safeguarding shoulder health and preventing injuries, it's essential to approach these exercises with proper form, technique, and awareness of potential risk factors. In this comprehensive blog, we'll delve into the importance of horizontal pulling for shoulder health, strategies for injury avoidance, and considerations for rehabilitating shoulder injuries.
Understanding Horizontal Pulling and Shoulder Health: Horizontal pulling exercises, such as rows, reverse flies, and seated cable rows, play a crucial role in developing balanced musculature and promoting postural alignment. These exercises target the muscles of the upper back, including the latissimus dorsi, rhomboids, and rear deltoids, while also engaging the biceps and forearms. By strengthening these muscles, horizontal pulling exercises help stabilize the shoulder joint and improve overall shoulder function.
However, improper execution of horizontal pulling exercises can potentially compromise shoulder health and lead to injuries, such as rotator cuff strains, impingement, or instability. To mitigate these risks and optimize shoulder health, it's essential to prioritize proper form, alignment, and muscle activation during horizontal pulling movements.
Tips for Injury Avoidance:
Focus on Scapular Retraction and Depression: During horizontal pulling exercises, concentrate on retracting and depressing the shoulder blades to engage the muscles of the upper back effectively. This helps maintain proper scapular mechanics and reduces the risk of shoulder impingement.
Control Range of Motion: Avoid excessive shoulder protraction or elevation during horizontal pulling movements, as this can place undue stress on the shoulder joint and surrounding tissues. Maintain control throughout the entire range of motion and avoid using momentum to complete the exercise.
Gradually Increase Load and Intensity: Progressively overload the muscles involved in horizontal pulling by gradually increasing the weight or resistance used in your workouts. However, avoid rapid increases in load that may exceed your current strength levels and compromise form.
Incorporate Variation and Balance: Include a variety of horizontal pulling exercises in your training routine to target different muscle groups and movement patterns. Balance horizontal pulling movements with horizontal pushing exercises, such as bench presses or push-ups, to maintain muscular symmetry and prevent imbalances.
Listen to Your Body: Pay attention to any signs of discomfort or pain during horizontal pulling exercises, as these may indicate underlying issues or imbalances. If you experience persistent shoulder pain or discomfort, consult with a qualified healthcare professional for evaluation and guidance.
Rehab Considerations for Shoulder Injuries: If you're recovering from a shoulder injury or seeking to rehabilitate shoulder dysfunction, incorporating horizontal pulling exercises into your rehab program can be beneficial. However, it's essential to approach rehabilitation with caution and under the guidance of a healthcare professional or qualified rehabilitation specialist. Here are some considerations for integrating horizontal pulling into shoulder rehab:
Start with Light Resistance: Begin with light resistance or bodyweight variations of horizontal pulling exercises to gradually reintroduce shoulder movement and strengthen the surrounding muscles without exacerbating pain or discomfort.
Focus on Range of Motion: Prioritize improving shoulder mobility and flexibility through gentle stretching and mobility exercises before progressing to more challenging horizontal pulling movements. Emphasize controlled, pain-free range of motion to avoid aggravating existing injuries.
Incorporate Eccentric Training: Eccentric (or negative) training, where you focus on controlling the lowering phase of the movement, can be particularly beneficial for rehabilitating shoulder injuries. Slow, controlled eccentric contractions help strengthen the muscles while minimizing joint stress.
Utilize Resistance Bands: Resistance bands provide variable resistance and can be used to perform horizontal pulling exercises with adjustable intensity. They offer a safe and effective way to gradually increase load and resistance during shoulder rehab.
Monitor Progress and Modify as Needed: Continuously assess your progress and adjust your rehab program accordingly based on your individual needs and response to treatment. Be patient and consistent with your efforts, and don't hesitate to seek guidance from a qualified professional if you encounter challenges or setbacks.
Conclusion: Horizontal pulling exercises are invaluable for developing upper body strength, promoting shoulder health, and enhancing overall athletic performance. By prioritizing proper form, technique, and injury prevention strategies, you can harness the benefits of horizontal pulling while minimizing the risk of shoulder injuries. Whether you're a seasoned athlete, fitness enthusiast, or rehabilitating from a shoulder injury, incorporating horizontal pulling into your training regimen with a focus on shoulder health and injury avoidance can help you achieve optimal results and long-term success.
Remember, always consult with a qualified healthcare professional or strength and conditioning specialist before beginning any new exercise program, especially if you have a history of shoulder injuries or underlying medical conditions. With proper guidance and a proactive approach to shoulder health, you can enjoy the benefits of horizontal pulling while safeguarding your shoulders for a lifetime of strength and performance.
]]>The temporalis and masseter are synergists. An overdeveloped upper trapezius can be an overlooked contributor to problems associated with these muscles.
A short temporalis leads to teeth clenching, which can damage the sensitive proprioceptive covering on the teeth.
Temporal dysfunction can ensue, with loss of balance, vertigo, nausea, hearing difficulties, tinnitus, trigeminal neuralgia, and optical problems. Habits such as chewing gum can cause repetitive stress and strain.
One must appreciate the chain effect that an inhibited masseter could have on this muscle.
The temporalis and masseter may develop myofascial trigger points in an effort to provide much-needed tension.
A forward-head posture is most likely the evident posture
Pain passes upward and over the forehead on the ipsilateral side. Pain spills over just above the ear and into the nuchal line of the occiput.
The temporalis should be considered in all headache patients. Pain in the upper or lower teeth and gums is the most common pain pattern with this muscle.
A deep pain is typically reported over the eyebrow and occasionally into the same side and back of the head.
The treatment of other muscles on the basis of their pain referral patterns, if associated with this area, should also be carried out as part of the myokinetic chain.
ORIGIN
Temporal fossa, including parietal, temporal, and frontal bones. Temporal fascia.
INSERTION
Coronoid process of mandible. Anterior border of ramus of mandible.
ACTION
Closes jaw. Clenches teeth. Assists in side to side movement of mandible.
NERVE
Anterior and posterior deep temporal nerves from the trigeminal V nerve (mandibular division).
BASIC FUNCTIONAL MOVEMENT
Chewing food.
Temporalis - Common Referred Pain Patterns
Temporalis - Common Referred Pain Patterns
Temporalis Common Trigger Point Sites
These are areas where trigger points typically form and are shown for guidance only. Trigger points may form almost anywhere within the muscle and will always need to be identified through palpation.
REFERRED PAIN PATTERNS
Upper incisors and supraorbital ridge. Maxillary teeth and mid-temple pain. TMJ and mid-temple pain. Localized (backward and upward).
INDICATIONS
Headache, toothache, TMJ syndrome, hypersensitivity of teeth, prolonged dental work, eyebrow pain, headaches, bruxism, sinusitis pain, trismus (lockjaw), tingling in cheek area.
CAUSES
Chewing gum, tooth grinding/ bruxism, prolonged dental work, stress, emotional tension, jaw/ bite alignment, nail biting, thumb sucking.
DIFFERENTIAL DIAGNOSIS
Temporalis tendonitis. Polymyalgia rheumatica. Temporal arteritis, or giant cell arteritis (GCA).
CONNECTIONS
Upper trapezius, SCM, masseter.
BITE PLATES/BLOCKS/ OCCLUSAL SPLINTS
Opinion varies as to efficacy, type, and duration of use for occlusal devices. An evidence base suggests they can be beneficial.
POSTURE
Head forward or upper crossover patterns can be treated by a range of manual and trigger point therapies.
ADVICE FOR PATIENTS
Avoid gum chewing or hard substance chewing. Tongue position. Air conditioning in car/at work. Correct the head-forward posture. Stretch.
COMMONLY APPLIED TREATMENT TECHNIQUES
Deep Stroking Massage | No |
Compression | Yes |
Muscle Energy | Yes |
Positional Release | Yes |
Spray and Stretch | No |
Dry Needling | No |
Wet Needling | No |
SELF HELP
Self-massage techniques can be helpful. Balls and pressure tools may be used, as the muscles are superficial.
GENERAL ADVICE TO CLIENTS
Avoid high-heeled/ at shoes. Regular stretching with hot and/or cold. Strapping/ankle support. Use of heel wedges and/or orthotics. Posture and gait advice. Examine shoes.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Along with its “little helper,” anconeus, the triceps brachii assists deceleration of flexion at the glenohumeral joint and the elbow joint. The radial nerve can be irritated by contracture or spasm of the lateral aspect of this muscle.
Other symptoms can lead to a misdiagnosis of pain felt in the elbow and triceps brachii as tennis elbow, although there is often a connection.
Triceps trigger points are also often associated with shoulder arthritis and are likely to be part of the self-protection holding pattern that the body instigates in response to the arthritis.
Trigger points in this muscle make it difficult to extend the arm at the elbow. Clients will often report that they cannot rest their elbow on any surface, because of the level of sensitivity and pain.
Triceps Brachii - Common Trigger Point Sites
Latin, Triceps = three-headed; Brachii = of the arm
The triceps originates from three heads and is the only muscle on the back of the arm.
Origin
Long head: infraglenoid tubercle of scapula.
Lateral head: upper half of posterior surface of shaft of humerus (above and lateral to radial groove).
Medial head: lower half of posterior surface of shaft of humerus (below and medial to radial groove).
Insertion
Posterior part of olecranon process of ulna.
Action
Extends (straightens) elbow joint. Long head can adduct humerus and extend it from flexed position. Stabilizes shoulder joint. Antagonist: Biceps Brachii.
Nerve
Radial nerve, C6, 7, 8, T1.
Basic Functional Movement
Examples: throwing objects; pushing door shut.
Long head: Pain at superolateral border of shoulder, radiating diffusely down posterior upper extremity with strong zone of pain around olecranon process, and then vaguely into posterior forearm
Medial head: 5 cm patch of pain in medial epicondyle, radiating along medial border of forearm to 4th and 5th digits
Lateral head: Strong midline pain into upper extremity, radiating vaguely into posterior forearm.
Indications
Golfer’s/tennis elbow, arthritis of elbow/shoulder, chronic use of crutches/walking stick, repetitive mechanical activities of arms, racquet sports, aching pain over front of shoulder, weakness in turning palm face upward, shoulder aching.
Causes
Repetitive motion injury, throwing/ sports induced (e.g. basketball, tennis), repeated actions with arm, lifting heavy objects with palm upward (e.g. triceps-focused weight training), musical instrument playing (e.g. violin, drums, guitar).
Differential Diagnosis
Radial nerve injury. Ulnar neuropathy. C7 neuropathy (cervical disc).
Connections
Teres minor/major, latissimus dorsi, anconeus, supinator, brachioradialis, extensor carpi radialis longus, anterior deltoid.
Trigger Point Treatment Techniques
Spray and Stretch | YES |
Deep Stroking Massage | YES |
Cupping / Vacuum Cupping | YES |
Compression | YES |
Muscle Energy Techniques | YES |
Positional Release | YES |
Dry Needling | YES |
Wet Needling | YES |
General Advice to Clients
Review arm positions for repetitive manual work. Take regular breaks. New tennis racquet/widen grip. Avoid overhead activities.
Self Help
Self-massage techniques can be helpful. A hard ball or a pressure tool can be used to great effect.
Stretching is excellent for disabling trigger points in arm muscles.
Triceps Trigger Points - Try using a hard ball or pressure tool for self massage
Stretching the Triceps
Stretching can be very effective for helping to address trigger points in the arm muscles
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
While conventional treatments such as physical therapy and medication may offer relief, many individuals seek alternative therapies like acupuncture for their potential to address the underlying imbalances contributing to frozen shoulder. In this blog, we'll explore the use of acupuncture as a holistic approach to treating frozen shoulder and its effectiveness in promoting pain relief and restoring mobility.
Understanding Frozen Shoulder: Before delving into acupuncture's role in treating frozen shoulder, it's essential to understand the condition itself. Frozen shoulder occurs when the connective tissue surrounding the shoulder joint becomes inflamed and thickened, leading to a tightening or "freezing" of the shoulder capsule. This results in pain and stiffness, often making everyday activities challenging and painful.
How Acupuncture Works: Acupuncture is an ancient healing practice rooted in traditional Chinese medicine (TCM). It involves the insertion of thin needles into specific points on the body, known as acupuncture points, to stimulate the body's natural healing response and restore balance to the flow of energy, or qi.
In the context of frozen shoulder, acupuncture aims to address the underlying imbalances contributing to the condition. By targeting acupuncture points associated with the shoulder, neck, and upper back, acupuncture can help alleviate pain, reduce inflammation, and improve blood flow to the affected area. Additionally, acupuncture may promote the release of endorphins, the body's natural pain-relieving chemicals, providing relief from discomfort associated with frozen shoulder.
Effectiveness of Acupuncture for Frozen Shoulder: Research on the efficacy of acupuncture for treating frozen shoulder has shown promising results. A systematic review published in the Journal of Orthopaedic Surgery and Research found that acupuncture combined with conventional treatments such as physical therapy was more effective in improving pain and function compared to conventional treatments alone.
Furthermore, acupuncture is generally considered safe when performed by a trained and licensed practitioner. Its non-invasive nature and minimal side effects make it an attractive option for individuals seeking alternative therapies for frozen shoulder.
The Acupuncture Experience: During an acupuncture session for frozen shoulder, a licensed acupuncturist will conduct a thorough evaluation to assess the individual's condition and determine the most appropriate acupuncture points to target. The needles used in acupuncture are typically very thin and cause minimal discomfort when inserted. Many people find acupuncture sessions to be relaxing and therapeutic, with some even experiencing immediate relief from pain and tension.
It's important to note that acupuncture is often used as part of a comprehensive treatment plan for frozen shoulder, which may include other therapies such as physical therapy, massage, and lifestyle modifications.
Conclusion: Frozen shoulder can significantly impact quality of life, but acupuncture offers a holistic approach to managing the condition and promoting healing from within. By targeting specific acupuncture points associated with the shoulder and surrounding areas, acupuncture can help alleviate pain, reduce inflammation, and improve mobility in individuals with frozen shoulder. As always, it's essential to consult with a qualified healthcare professional before beginning any new treatment regimen, including acupuncture, to ensure it's safe and appropriate for your individual needs.
If you're struggling with frozen shoulder and seeking alternative therapies for relief, consider exploring the healing power of acupuncture. With its centuries-old tradition and growing body of research supporting its efficacy, acupuncture may offer new hope and restored mobility on your journey towards recovery.
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Understanding the symptoms and treatments for these injuries is crucial for effective management and rehabilitation. In this blog, we'll explore the most common wrist flexor injuries, their symptoms, typical treatments, and the role of trigger points in exacerbating these conditions.
Anatomy of the Wrist Flexors:
Before diving into specific injuries, let's briefly review the anatomy of the wrist flexors. The wrist flexors are a group of muscles located on the anterior aspect of the forearm. The primary wrist flexors include the flexor carpi radialis, flexor carpi ulnaris, and palmaris longus. These muscles play a vital role in flexing the wrist and fingers and are heavily involved in various activities such as typing, gripping, and lifting.
Common Wrist Flexor Injuries:
1. Tendinitis/Tendinosis: Tendinitis, or its chronic counterpart tendinosis, occurs when the tendons of the wrist flexors become inflamed or damaged due to overuse or repetitive strain. Symptoms include pain, swelling, and tenderness along the front of the wrist or forearm. Activities such as typing, gripping tools, or playing racquet sports can exacerbate these symptoms.
2. Flexor Carpi Radialis Strain: This injury involves overstretching or tearing of the flexor carpi radialis muscle or its tendon. It typically occurs due to sudden forceful movements or repetitive stress. Symptoms include pain and weakness in the wrist, particularly during wrist flexion and radial deviation (moving the wrist towards the thumb).
3. Carpal Tunnel Syndrome (CTS): While not solely a wrist flexor injury, CTS can involve compression of the median nerve as it passes through the carpal tunnel, which is surrounded by wrist flexor tendons. Repetitive motions, such as typing or assembly line work, can contribute to the development of CTS. Symptoms include numbness, tingling, and weakness in the thumb, index, middle fingers, and half of the ring finger.
Symptoms and Trigger Points:
Trigger points, or localized areas of muscle tension, can contribute to wrist flexor injuries by causing referred pain and limiting range of motion. Common trigger points associated with wrist flexor injuries include those in the flexor carpi radialis and flexor carpi ulnaris muscles. Referred pain from trigger points may mimic symptoms of tendinitis or strain and can exacerbate existing conditions.
Typical Treatments:
1. Rest and Immobilization: Resting the affected wrist and avoiding activities that exacerbate symptoms is essential for recovery. Immobilization through splinting or bracing may be recommended to reduce stress on the injured wrist flexors.
2. Ice Therapy: Applying ice packs to the affected area can help reduce pain and inflammation. Ice therapy can be particularly beneficial after activities that aggravate symptoms.
3. Stretching and Strengthening Exercises: Gradual introduction of stretching and strengthening exercises can promote flexibility and resilience in the wrist flexor muscles. Physical therapy or guided exercise programs may be recommended for optimal results.
4. Trigger Point Therapy: Addressing trigger points through massage, trigger point release techniques, or dry needling can help alleviate referred pain and improve muscle function in the wrist flexors.
5. Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation associated with wrist flexor injuries. However, prolonged or excessive use should be avoided due to potential side effects.
Understanding the symptoms and treatments for common wrist flexor injuries is essential for effective management and rehabilitation. By incorporating rest, ice therapy, stretching, strengthening exercises, and targeted trigger point therapy into a comprehensive treatment plan, individuals can alleviate pain, restore function, and prevent recurrent injuries. If you suspect a wrist flexor injury, consult with a healthcare professional for an accurate diagnosis and personalized treatment recommendations.
Remember, proactive care and proper ergonomics can help mitigate the risk of wrist flexor injuries, ensuring continued comfort and functionality in daily activities and sports.
Wrist Flexors
Trigger points build up over time, and may be the precursor to more complex injuries when left untreated. Simple daily stretching may help to prevent the activation of latent trigger points.
Here's a simple stretch that we often recommend. Start by allocating just a minute each day to this stretch.
Try to perform the stretch at least once a day, at the end of a long drive, or perhaps when you get up to take a break from your desk.
Build up from there but, as always, don't push too hard or over-stretch.
If you happen to be a manual therapists, you should be performing this stretch in between each client!
TECHNIQUE
Links
Nerve Entrapment Syndromes
More Articles About Elbow Pain
Dry Needling for Trigger Points
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
]]>This condition is often characterized by sharp, stabbing pain in the bottom of the foot near the heel. It's particularly noticeable during the first steps after waking up, although it can also be triggered by long periods of standing or when standing up after sitting. This blog aims to delve into the causes, symptoms, diagnosis, and treatment options for plantar fasciitis, providing a thorough understanding for both patients and healthcare professionals.
The plantar fascia acts as a shock-absorber, supporting the arch of the foot. However, tension and stress on this ligament can cause small tears. Over time, repeated stretching and tearing can irritate or inflame the fascia, leading to plantar fasciitis. Several factors can increase the risk of developing this condition:
The hallmark symptom of plantar fasciitis is a sharp, stabbing pain in the bottom of the foot near the heel. The pain is often worse in the morning or after periods of rest, as the fascia tightens up during inactivity. It may also worsen after exercise but not necessarily during it.
Diagnosis typically involves a physical examination and review of your medical history. During the examination, your doctor will check for areas of tenderness in your foot. Imaging tests like X-rays or MRIs are not usually needed but may be requested to rule out other conditions.
Most people with plantar fasciitis improve with conservative treatments in a few months:
If conservative measures fail, other treatments may be considered:
Preventive measures can reduce the risk of developing plantar fasciitis:
Plantar fasciitis, a condition characterized by sharp pain in the heel and bottom of the foot, is often the result of strain and inflammation of the plantar fascia. While various treatments exist to alleviate the discomfort associated with plantar fasciitis, massage therapy has emerged as a beneficial approach to managing the pain and aiding in the recovery process. This article explores how massage therapy can be an effective treatment for plantar fasciitis, the types of massage techniques that are most beneficial, and tips for incorporating massage into your treatment regimen.
Plantar fasciitis involves inflammation of the plantar fascia, a thick band of tissue running across the bottom of your foot, connecting your heel bone to your toes. Massage therapy for plantar fasciitis focuses on relieving tension in this area, improving blood circulation, reducing inflammation, and promoting healing.
Massage therapy can significantly reduce the pain associated with plantar fasciitis by relaxing tight muscles, thereby decreasing pressure on the plantar fascia.
Enhancing blood flow to the affected area can speed up the healing process by delivering more oxygen and nutrients, helping to repair damaged tissue.
Massage helps in loosening the plantar fascia and surrounding muscles, increasing foot flexibility and mobility, which can prevent further injury.
Beyond physical benefits, massage therapy offers relaxation and stress relief, which can positively affect the overall healing process.
Targets the deep layers of muscle and fascia, focusing on releasing chronic muscle tension. It's particularly effective for breaking up adhesions and scar tissue in the plantar fascia.
Involves applying gentle, sustained pressure into the connective tissue restrictions to eliminate pain and restore motion. This technique helps in stretching and loosening the plantar fascia.
Focuses on specific points within your muscle tissue that cause pain in other parts of the body. This can be particularly effective for addressing heel pain that originates from muscle knots.
While more gentle than deep tissue massage, Swedish massage can still be beneficial for plantar fasciitis by promoting relaxation and improving circulation.
Consulting with a professional massage therapist who has experience in treating plantar fasciitis is crucial. They can tailor the massage techniques to your specific needs, providing the most effective relief.
In addition to professional massage, self-massage techniques can be a valuable part of daily maintenance. Tools like a massage ball, foam roller, or even a frozen water bottle can be used to gently massage and ice the bottom of the foot.
Combining massage therapy with stretching and strengthening exercises for the foot, ankle, and calf muscles can enhance the benefits and help prevent future occurrences of plantar fasciitis.
Regular massage sessions, coupled with a comprehensive treatment plan, can lead to significant improvements. Consistency in treatment is critical for long-term relief.
Massage therapy offers a promising approach to managing plantar fasciitis, providing pain relief, improved flexibility, and accelerated healing. When combined with a holistic treatment plan that includes exercises and proper footwear, massage can play a crucial role in overcoming the challenges of plantar fasciitis. Remember to consult with healthcare professionals to create a tailored treatment plan that suits your specific needs and to ensure that massage therapy is an appropriate option for you.
It doesn't take too much imagination to appreciate the wear and tear that the human knee suffers through daily use.
The problem is that most of us tend to take our knees for granted until something goes wrong.
Sprains and Strains
In the majority of cases of knee pain, there's unlikely to be anything too serious going on.
By far the most common injuries that we see are simple strains and sprains from overuse. However, failure to seek treatment can in many cases lead to more severe problems.
I must admit here that I'm giving advice that I've ignored myself. I'm a big chap and spend around 10 hours a day on my feet treating patients.
I should have started to take better care of my knees a few years ago when knee pain started to become a regular feature in my life. Nowadays I spend a lot of time receiving trigger point therapy for pain relief!
Trigger Points
Trigger points are associated with almost all types of knee pain and common knee injuries.
In some cases the trigger points may be the underlying cause (which is often true with anterior knee pain experienced by runners), and in many cases treating the trigger points will accelerate recovery and alleviate or reduce the pain.
In this trigger point video blog we deal specifically with the patellar ligament.
Please note that there are a number of other muscles and ligaments that may be connected with knee pain and knee injuries, so don't treat the information in this trigger point blog (Ligamentum Patellae) as stand alone.
So-called "Runner's Knee" and "Jumper's Knee" for example, are often also associated with trigger points in the Gluteus, Quadriceps, and Sartorius muscles
Patellar Ligaments:
The human knee, a marvel of biomechanical engineering, is a complex joint crucial for everyday mobility. However, within this intricate network of bones, cartilage, and ligaments lies a vulnerability prone to injury. Among the various components, the patellar ligaments play a pivotal role, serving as a critical link between the patella (kneecap) and the tibia. Understanding their anatomy, function, and the correlation with common knee injuries is essential for both athletes and the general population alike.
Anatomy of Patellar Ligaments:
Situated at the front of the knee, the patellar ligaments consist of fibrous tissue connecting the patella to the tibia, forming a crucial part of the extensor mechanism. The patellar ligament originates from the inferior aspect of the patella and extends inferiorly, merging with the tibial tuberosity. This robust structure facilitates the transmission of forces generated by the quadriceps muscles, enabling movements such as walking, running, and jumping.
Function and Mechanism of Injury:
The primary function of the patellar ligaments is to stabilize the patella during knee movements, ensuring optimal biomechanics and force distribution. However, this intricate balance can be disrupted, leading to various types of knee injuries, notably:
1. Patellar Tendonitis (Jumper's Knee):
- Overuse or repetitive stress on the patellar ligament can result in inflammation, known as patellar tendonitis.
- Common among athletes involved in jumping sports, such as basketball and volleyball, this condition manifests as pain and tenderness around the patellar tendon.
- Factors such as poor biomechanics, inadequate warm-up, and sudden increases in training intensity contribute to its development.
2. Patellar Dislocation:
- A sudden, forceful movement or trauma to the knee can cause the patella to dislocate from its normal position.
- This displacement can stretch or tear the patellar ligaments, leading to instability and recurrent dislocations.
- Individuals with underlying anatomical abnormalities, such as shallow grooves in the femur or lax ligaments, are more susceptible to this injury.
3. Patellar Tendon Rupture:
- In severe cases of trauma or degeneration, the patellar ligament may rupture partially or completely.
- This debilitating injury often requires surgical intervention to restore function and stability to the knee joint.
- Factors such as age, previous knee injuries, and systemic conditions like diabetes can predispose individuals to patellar tendon ruptures.
Prevention and Rehabilitation:
Preventing knee injuries involving the patellar ligaments requires a multifaceted approach, including:
- Incorporating strength and flexibility exercises targeting the quadriceps, hamstrings, and hip muscles to enhance joint stability and reduce stress on the patellar ligaments.
- Gradually increasing training intensity and duration to allow for adequate adaptation and recovery.
- Utilizing proper footwear and protective gear to mitigate impact forces during sports activities.
- Seeking prompt medical attention for any knee pain or instability to prevent exacerbation of underlying issues.
Rehabilitation following patellar ligament injuries typically involves a comprehensive program encompassing:
- Pain management strategies such as rest, ice, compression, and elevation (RICE).
- Physical therapy to improve range of motion, strength, and proprioception.
- Gradual return to activity under the guidance of a healthcare professional to minimize the risk of reinjury.
Conclusion:
In essence, the patellar ligaments serve as vital connectors in the intricate machinery of the knee joint. While their role in facilitating movement and stability is indispensable, they are also susceptible to various injuries, ranging from tendonitis to complete ruptures. Understanding the anatomy, function, and mechanisms of injury associated with the patellar ligaments is paramount for effective prevention, treatment, and rehabilitation strategies. By prioritizing proper biomechanics, conditioning, and injury management, individuals can safeguard their knee health and maintain an active lifestyle for years to come.
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The deltoid muscle, a thick, triangular muscle cap atop the shoulder, is not just an emblem of strength and mobility but a cornerstone of the human musculoskeletal system's upper body functionality. Named for its resemblance to the Greek letter Delta (Δ), this muscle is pivotal in all arm movements, playing roles that extend far beyond mere aesthetics. In this comprehensive exploration, we delve into the functions of the deltoid muscle, common injuries it sustains, and how manual therapy can offer effective treatment solutions.
The deltoid muscle is ingeniously segmented into three distinct parts: the anterior (front), middle, and posterior (rear) fibers. This segmentation allows the deltoid muscle a range of actions unparalleled in the upper body. The anterior deltoid aids in arm flexion, internal rotation, and horizontal adduction, vital for movements like reaching forward or pressing. The middle fibers excel in arm abduction, enabling the lifting of the arm to the side. Meanwhile, the posterior deltoid facilitates arm extension, external rotation, and horizontal abduction, crucial for pulling and rowing actions. Together, these fibers orchestrate the arm's complex symphony of movements, from simple tasks like typing to the dynamic actions in sports.
Every day, whether through exercise, labor, or routine activities, the deltoid muscle plays a central role. Its contribution is most apparent in actions that require lifting, pushing, and pulling. For athletes, particularly those in disciplines like swimming, baseball, and tennis, the deltoid muscle's health and functionality are directly tied to performance levels. Even non-athletic activities, such as carrying groceries or reaching for items on a high shelf, engage the deltoid, underscoring its importance in daily life.
Despite its strength, the deltoid muscle is susceptible to injuries and strains. Common issues include:
Overuse, especially in activities requiring repetitive arm lifting, can inflame the deltoid tendons, leading to tendonitis. This condition is characterized by pain and tenderness outside the shoulder.
Acute injuries can cause partial or complete tears in the deltoid muscle. These injuries are often the result of sudden, high-force actions or direct trauma to the shoulder.
When the space between the shoulder bones narrows, it can pinch the deltoid muscle, leading to impingement syndrome. This condition is often accompanied by pain during arm lifting.
Manual therapy emerges as a beacon of relief for those suffering from deltoid muscle injuries. Techniques such as massage therapy, osteopathy, and physiotherapy can significantly improve recovery times and alleviate pain. Here’s how:
Massage therapy can soothe tight muscles, increase blood flow to the injured area, and accelerate the healing process. Techniques like deep tissue massage and trigger point therapy are particularly effective in treating deltoid injuries, offering pain relief and reducing inflammation.
Osteopathy provides a holistic approach to deltoid injuries, addressing the muscle's condition and its impact on the body's overall function. Osteopaths may use a combination of soft tissue techniques, mobilizations, and manipulations to restore mobility, reduce pain, and encourage natural healing.
Physiotherapy offers a structured approach to deltoid rehabilitation, combining manual therapy techniques with tailored exercise programs. These exercises aim to restore strength, flexibility, and function to the injured deltoid muscle, gradually reintegrating it into everyday and athletic activities without discomfort.
Recovery from a deltoid injury varies depending on the severity of the injury and the treatment approach. Incorporating rest, ice, compression, and elevation (RICE) in the initial stages of injury can mitigate swelling and pain. Following up with professional manual therapy and a guided exercise regimen can pave the way for a successful return to full function. It's crucial for individuals to listen to their bodies and avoid rushing the healing process, as premature return to activities can exacerbate the injury.
The deltoid muscle's role in upper body movement is as vital as it is vast. While injuries to this muscle can hinder performance and daily activities, understanding its functions and potential issues can empower individuals to seek appropriate care. Manual therapy stands out as an effective treatment modality, offering a pathway to recovery that is both holistic and tailored to the individual's needs. Whether you're an athlete or someone experiencing shoulder pain during everyday tasks, recognizing the importance of the deltoid muscle and the benefits of manual therapy can be the first steps toward optimal shoulder health and functionality.
In the dance of life, where our bodies are the instruments, keeping the deltoid muscle in harmony with the rest of the ensemble ensures a performance that is both pain-free and poised for every applause
Sciatic Pain - Dr. Elizabeth Wagner DPT demonstrates stretching exercises for the Piriformis and Gluteal muscles
Sciatica is a symptom of an underlying medical condition, such as a lumbar herniated disc, degenerative disc disease, or spinal stenosis. It is not a medical condition in and of itself.
Overview of Sciatica
The condition is characterized by pain that radiates along the path of the sciatic nerve.
This is the largest nerve in the body, beginning at the lower back, and running through the hips and buttocks down to each leg.
In most cases, sciatica affects only one side of the body, but can affect both (bilateral sciatica).
Where symptoms are felt in both legs, it typically means that the cause of the compression, such as a herniated disc, is big enough to compress nerve roots on both sides of the spine.
It is of course possible that two separate conditions have developed on opposite sides of the spine, but this would obviously be a rarity.
In most cases, sciatica develops when the sciatic nerve is compressed by a herniated disk or bone spur.
This causes inflammation, pain, and sometimes numbness in the affected side.
It's worth noting that it's not unusual to come across sciatica in pregnant women due to an irritation of the sciatic nerve during pregnancy.
Trigger Points in the Piriformis are typically associated with Sciatica
What Are the Symptoms of Sciatica?
The pain associated with sciatica can vary in degree. We see many clients who experience infrequent pain whilst others suffer so severely from the pain as to be largely incapacitated.
Sciatica is often characterised by the following symptoms. The client may experience only one or a combination:
• Constant pain in one side of the leg or buttock
• Pain worsens when sitting
• Burning, tingling, or searing pain in the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A sharp pain which might affect the ability to walk or to stand up
Clients often describe how these symptoms worsen when they cough, sneeze, or sit for a long period of time.
Who Is Prone to Sciatica?
The probability of experiencing pain from sciatica peaks in the 50's and then declines.
It is rare to see clients under the age of 20 suffering from this condition.
Those who suffer from degenerative arthritis of the lumbar spine, lumbar disc diseases, slipped disc, or a trauma or injury to the lumbar spine are the groups who are at a higher risk.
Studies have shown that obesity or even being overweight can increase the risk of sciatica, as the weight will increase stress on the spine.
A job that requires you to twist your back, carry heavy objects, or drive a motor vehicle for long periods of time, may also contribute to increasing the risk factor.
The other group worth noting are diabetes sufferers who are at increased risk because the way that the body uses blood sugar increases the risk of nerve damage.
In summary, whilst there are those cases of sciatica which require more aggressive intervention to deal with the underlying cause, the preferred and most effective treatment in most cases is manual therapy including trigger point therapy, and prescribed stretching and strengthening exercises.
The trigger points commonly (almost always) associated with sciatica are found in piriformis, and gluteus maximus.
It's worth mentioning that Dr. Travell refered to the gluteus minimus as the “Psuedo-Sciatica” muscle because its trigger points can refer pain that mimic the symptoms associated with true neurological sciatica.
This blog is intended to be used for education purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Anyone involved in athletics is particularly susceptible to an ankle sprain - an acute injury to any or all of the ligaments that support the ankle structure.
Tearing or stretching of the ligaments can occur when the foot is rolled or twisted forcefully.
High-impact sports involving jumping, sprinting or running on changing or uneven surfaces often lead to ankle sprains.
Basketball, football, cross country and hockey are a few of the sports commonly associated with ankle sprains.
Lateral ankle or inversion sprains commonly occur when stress is applied to the ankle during plantarflexion.
The anterior talofibular ligament is most commonly injured. The medial malleolus may act as a fulcrum to further injure the calcaneofibular ligament if the strain continues.
The peroneal tendons may absorb some of this strain. Medial ankle sprains are less common because of the strong deltoid ligament and bony structure of the ankle.
When ligaments are stretched beyond their normal range some tearing of the fibres may occur.
Cause of Injury
Sudden twisting of the foot. Rolling or force to the foot, most commonly laterally.
Signs and Symptoms
First-degree sprains: Little or no swelling; mild pain and stiffness in the joint.
Second-degree sprains: Moderate swelling and stiffness; moderate to severe pain; difficulty weightbearing and some instability in the joint.
Third-degree sprains: Severe swelling and pain; inability to weightbear; instability and loss of function in the joint.
Complications if Left Unattended
Chronic pain and instability in the ankle joint may result if left unattended. Loss of strength and flexibility and possible loss of function may also result. Increased risk of re-injury.
Immediate Treatment
RICER. Second- and third-degree sprains may require immobilization and immediate medical attention should be sought.
Rehabilitation and Prevention
Strengthening the muscles of the lower leg is important to prevent future sprains. Balance training will help to improve proprioception (the body’s awareness of movement and joint position sense) and strengthen the weakened ligaments.
Flexibility exercises to reduce stiffness and improve mobility are needed also. Bracing during the initial return to activity may be needed but should not replace strengthening and flexibility development.
Long-Term Prognosis
With proper rehabilitation and strengthening the athlete should not experience any limitations. A slight increase in the probability of injuring that ankle may occur.
Athletes who continue to experience difficulty with the ankle may need additional medical interventions including, in rare cases, possible surgery to tighten the ligaments.
Trigger Points
Foot pain, ankle pain, and ankle instability are typically associated with trigger points in balancing muscles. These trigger points need to be located and treated to prevent injury recurrence.
Self Help
Stretching can often provide some temporary relief from ankle pain, and possibly help to treat some trigger points over time.
This is not something that's proven, but the anecdotal evidence in considerable, and some would say overwhelming.
The most common trigger point related to ankle pain is the one that forms in the tibialis anterior muscle.
The following stretch might provide relief by helping to dissipate the trigger point and aid rehabilitation.
Technique
Stand upright and place the top of your toes on the ground behind you. Push your ankle to the ground.
Muscles Being Stretched
Primary muscle: Tibialis anterior.
Secondary muscles: Extensor hallucis longus. Extensor digitorum longus. Peroneus tertius.
Injury Where Stretch May Be Useful
Ankle Pain. Ankle Weakness. Ankle Instability. Anterior compartment syndrome. Medial tibial pain syndrome (shin splints). Ankle sprain. Peroneal tendon subluxation. Peroneal tendonitis.
Additional Notes for Performing This Stretch Correctly
Regulate the intensity of this stretch by lowering your body and pushing your ankle to the ground. If need be, hold onto something for balance.
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Incorrect form or improper gait often leads to tightness and inflexibility in piriformis.
The condition occurs more frequently in women than men (6:1). When piriformis becomes tight it puts pressure on the underlying nerve, causing pain similar to sciatica.
The pain usually starts in the mid-gluteal region and radiates down the back of the thigh.
Trigger Points
Trigger points are often associated with piriformis syndrome.
This may include cases where active trigger points in the piriformis cause the shortening and tightening of the muscle leading to impingement of the sciatic nerve.
In other cases trigger points in associated muscles may become active in response to the sensitivity of the sciatic nerve - i.e. part of a protective holding pattern.
Cause of injury
Incorrect form or gait while walking or jogging. Weak gluteal muscles and/or tight adductor muscles.
Signs and symptoms
Pain along the sciatic nerve. Pain when climbing stairs or walking up an incline. Increased pain after prolonged sitting.
Complications if left unattended
Chronic pain will result if left untreated. The tight muscle could also become irritated causing stress on the tendons and points of attachment.
Immediate treatment
RICER. Anti-inflammatory medication. Then heat and massage to promote blood flow and healing.
Rehabilitation and prevention
During rehabilitation a gradual return to activity and continued stretching of the hip muscles is essential.
Start with lower exercise intensity or duration. Identifying the factors that caused the problem is also important.
Strengthening the gluteal muscles and increasing the flexibility of the adductors will help to alleviate some of the stress and prevent the piriformis from becoming tight.
Maintaining a good stretching regimen to keep the piriformis muscle flexible will help, while dealing with the other issues.
Long-term prognosis
Piriformis syndrome seldom results in long-term problems when treated properly.
Rarely, a corticosteroid injection or other invasive method may be required to alleviate symptoms.
Technique
Sit with one leg straight and hold onto your other ankle. Pull it directly towards your chest.
Use your hands and arms to regulate the intensity of this stretch. The closer you pull your foot to your chest, the more intense the stretch.
Muscles being stretched
Primary muscles: Piriformis. Gemellus superior and inferior. Obturator internus and externus. Quadratus femoris.
Secondary muscle: Gluteus maximus.
Injury where stretch may be useful
Piriformis syndrome. Snapping hip syndrome. Trochanteric bursitis.
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
]]>TTH are by far the most common type of chronic headache. People who experience migraines typically also have tension headaches in between their migraines. These are often referred to as transformed headaches.
Symptoms of TTH
Tension headaches usually affect both sides of the head and last from thirty minutes to several days or more.
They often have a characteristic tight-band or vice like pain with a ‘dull steady aching’ quality. Symptoms can vary in intensity from mild to moderate to severe. They may also typically affect sleep.
These headaches are NOT accompanied by the additional symptoms that traditionally distinguish migraine headaches such as light sensitivity (photophobia), and flashes and patterns in the eyes (visual scotoma).
Tension headaches are said to affect about 1.4 billion people (20.8% of the population) and are more common in women than men (estimated at 23% to 18% respectively).
Massaging the Shoulders as Part of Treating Tension Headaches - Maureen Abson
TTH and Trigger Points
Muscular problems and tension are commonly associated with TTH and trigger points within muscles may either be causative or may perpetuate TTH.
The most commonly affected muscles are Trapezius, Sternocleidomastoid, Temporalis, Masseter and Occipitofrontalis. There is also a strong association with postural issues such as the upper crossed pattern.
The pain processing part of the central nervous system is almost certainly involved in TTH as it shows up abnormal in scans.
Trigger points often add to the misery of headaches because they are associated with peripheral and central sensitization.
Long-term inputs from trigger points may lead to a vicious cycle that converts periodic headaches into chronic tension headaches.
In these cases even if the original initiating factor is eliminated, the trigger point-central sensitization cycle can perpetuate or even worsen.
Aggravating Factors
TTH's are often aggravated by stress, anxiety, depression, fatigue, noise, and glare, but they can also be associated with neck arthritis or neck disc problems.
Acute or Chronic
TTH headaches can be episodic or chronic. Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months.
Headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.
Seven Main Causes
The following are considered some of the main causes of TTH:
Sleep deprivation
Uncomfortable stressful position and/or bad posture
Irregular meal time (hunger is reported in up to 50% of people)
Eyestrain
Tooth Clenching (bruxism)
Postural issues
Treatment
Numerous studies have indicated that active trigger points in neck and shoulder muscles contribute to tension-type headache, and that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles.
The presence of active trigger points has also been associated with a higher degree of sensitization in tension-type headaches.
We treat headache sufferers daily in our clinics, and our own experience continues to confirm that trigger point therapy can have both immediate and long lasting effects for the treatment of tension type headaches and importantly can help to reduce dependency on medication.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Treating Trigger Points in the Trapezius Muscle - Paul Townley
As the trapezius is an important neck muscle, any spastic activity in the sternocleidomastoid, suboccipitals, scalenes, longus colli, levator scapulae, or many other muscles will have an effect on its status.
Many people hold emotional tension in the upper trapezius.
The upper portion decelerates the head, the middle portion decelerates protraction, and the lower portion decelerates shoulder elevation.
Myofascial trigger points here lead to tension headaches, with sharp pain felt in the temporal bone and into the masseter, behind the eye and ear (on the same side), and along the side of the neck.
Occasionally, pain will travel to the back of the head, and a burning pain will be experienced down into the vertebral side of the scapula and middle back.
Trapezius myofascial trigger points can cause loss of balance and dizziness.
Myofascial trigger points in this muscle are often mistaken for disc pathologies, neuralgia, spinal stenosis, shoulder bursitis, or arthritis.
Trapezius - Common Trigger Point Sites
Origin
Medial third of superior nuchal line of occipital bone. External occipital protuberance. Ligamentum nuchae. Spinous processes and supraspinous ligaments of seventh cervical vertebra (C7) and all thoracic vertebrae (T1–12).
Insertion
Posterior border of lateral third of clavicle. Medial border of acromion. Upper border of crest of spine of scapula, and tubercle on this crest.
Action
Upper fibers: pull shoulder girdle up (elevation). Help prevent depression of shoulder girdle when a weight is carried on the shoulder or in the hand.
Middle fibers: retract (adduct) scapula.
Upper and lower fibers together: rotate scapula, as in elevating the arm above the head.
Nerve
Motor supply: accessory XI nerve. Sensory supply (proprioception): ventral ramus of cervical nerves C2, 3, 4.
Basic functional movement
Example (upper and lower fibers working together): painting a ceiling.
Sports that heavily utilize this muscle
Examples: shot put, boxing, seated rowing.
Common problems when muscle is chronically tight/ shortened (spastic)
Upper fibers: neck pain or stiffness, headaches.
Trigger Point Referred Pain Patterns
Upper fibers: pain and tenderness, posterior and lateral aspect of upper neck. Temporal region and angle of jaw.
Middle fibers: local pain, radiating medially to spine.
Lower fibers: posterior cervical spine, mastoid area, area above spine of scapula.
Indications
Chronic tension and neck ache, stress headache, cervical spine pain, whiplash, tension/cluster headache, facial/jaw pain, neck pain and stiffness, upper shoulder pain, mid-back pain, dizziness, eye pain, emotional stress, depression.
Causes
Habitual postures, work, stress, neck problems, shoulder muscle weakness, use of mobiles phones / tablets, scoliosis, sports related (e.g. tennis, golf), playing musical instruments.
Differential Diagnosis
Capsular-ligamentous apparatus. Articular dysfunction (facet).
Connections
SCM, masseter, temporalis, occipitalis, levator scapulae, semispinalis, iliocostalis, clavicular part of SCM, neck/jaw/shoulder joint muscles.
Trigger Point Therapy Treatment Techniques
Spray and Stretch | YES |
Deep Stroking Massage | YES |
Compression | YES |
Muscle Energy Techniques | YES |
Positional Release | YES |
Dry Needling | YES |
Wet Needling | YES |
Self help
Self massage can be very effective. Pressure tools recommended. Stretching!
General advice to patients
Posture (standing and at work). Stress management. Bra straps. Pectoralis minor tension (round shoulders). Stretch!
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
The role of a doula, often pivotal yet shrouded in mystery, has been an essential part of childbirth and postpartum care for centuries. This blog delves into the rich history and evolving role of doulas, shedding light on their significant impact in the modern Western world.
The term 'doula' originates from the ancient Greek word δούλη, meaning "a woman who serves." Historically, women have always supported other women during childbirth, but the concept of a doula as we know it today has evolved significantly.
In ancient times, the birthing process was typically a female-centric event, with experienced women in the community aiding the expectant mother. This practice, deeply woven into the fabric of traditional societies, was based on the understanding that emotional and physical support could significantly impact childbirth outcomes.
The industrial revolution and advancements in medical science brought about a shift in childbirth practices. With the rise of hospital births in the 20th century, the intimate, supportive environment once provided by community women began to diminish, making way for a more clinical approach.
The concept of the modern doula began to take shape in the 1960s and 70s, paralleling the rise of the women's rights and natural childbirth movements. Women started to advocate for more humane, individualized birth experiences, paving the way for the resurgence of doula-assisted births.
The formal study of the doula's role in childbirth was initiated by medical researchers such as John Kennell and Marshall Klaus. Their groundbreaking research in the 1970s and 80s demonstrated the positive impact of continuous support during labor, leading to better birth outcomes and reduced need for medical interventions.
As interest in doula services grew, so did the need for standardization and professional training. Organizations like DONA International, established in the 1990s, began offering certification programs, setting the stage for the professionalization of doulas.
A modern-day doula is a trained professional who provides continuous physical, emotional, and informational support to a mother before, during, and shortly after childbirth. The role encompasses several key aspects:
Numerous studies have shown that the presence of a doula can lead to a reduction in cesarean rates, a decrease in the use of pain relief medication, shorter labor, and an overall more positive childbirth experience. Their role is increasingly recognized as an integral part of the birthing team in Western healthcare.
The evolution of the doula from ancient birth assistant to modern-day professional reflects the ongoing quest for a holistic, supportive approach to childbirth. In the Western world, where medical interventions in childbirth are common, doulas provide a crucial link to the more personalized, empowering aspects of the birthing process. As we continue to navigate the complexities of modern healthcare, the role of the doula stands as a testament to the enduring importance of compassion, support, and advocacy in one of life's most profound experiences.
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Median Nerve Stretch
The Palmaris Longus decelerates extension of the hand at the wrist while decelerating supination of the hand against gravity and extension of the forearm at the elbow.
A focal point of pain from the palmaris longus is experienced as a needle-like sensation, rather than the deep aching pain of myofascial trigger points in many other muscles.
Pain can extend to the base of the thumb and the distal crease of the palm. A residue of this pain can travel to the distal volar forearm.
Part of the superficial layer, which also includes the pronator teres, flexor carpi radialis, and flexor carpi ulnaris.
The palmaris longus muscle is absent in 13% of the population.
Palmaris Longus - Common Trigger Point Site
Origin
Common flexor origin on anterior aspect of medial epicondyle of humerus.
Insertion
Superficial (front) surface of flexor retinaculum and apex of palmar aponeurosis.
Action
Flexes wrist. Tenses palmar fascia.
Antagonists: extensor carpi radialis brevis, extensor carpi radialis longus, extensor carpi ulnaris.
Nerve
Median nerve, C(6), 7, 8, T1.
Basic Functional Movement
Examples: grasping a small ball; cupping palm to drink from hand.
Palmaris Longus Trigger Points - Typical Referred Pain Pattern
Trigger Point Referred Pain Patterns
Diffuse pain in anterior forearm; intense pain zone 2–3 cm in palm of hand, surrounded by a superficial zone of prickling and needle-like sensations.
Indications
Pain and “soreness” in palm of hand, tenderness in hand/palm, functional loss of power in grip, tennis elbow.
Causes
Direct trauma (e.g. fall on outstretched arm), occupational, racquet sports, digging in palm.
Differential Diagnosis
Neurogenic pain. Dupuytren’s contracture. Carpal tunnel syndrome. Complex regional pain syndrome (reflex-sympathetic dystrophy). Scleroderma. Dermatomyositis.
Connections
Flexor carpi radialis, brachialis, pronator teres, wrist joints (carpals), often associated with middle head of triceps brachii.
Self Help
Self-massage techniques can be helpful, especially using balls.
Advice
Avoid prolonged “gripping,” especially of power tools. Stretching and heat. Regular breaks.
Trigger Point Treatment Techniques
Spray and Stretch | YES |
Deep Stroking Massage | YES |
Compression | YES |
Muscle Energy | YES |
Positional Release | YES |
Dry Needling | YES |
Wet Needling | YES |
Links
More Articles About Trigger Points
Certify as a Trigger Point Therapist
About NAT Courses
As a manual therapist or exercise professional, there is only one way to expand your business - education!
Learning more skills increases the services that you offer and provides more opportunity for specialization.
Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.
About Niel Asher Education
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Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.
Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.
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NAMTPT AWARD
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Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.
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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Trigger points are really common in the elbow and forearm muscles; this may well be connected to our increased sedentary and technology-based lifestyles.
Needless to say, as hands-on therapists, we too often get tense and stiff forearm muscles.
Why trigger points? Our body tries to protect us. It wants the trauma to heal and often “switches-of” around “damaged tissue.”
Trigger points are a key part of this protect-and-defend mechanism. However, if a problem isn t managed correctly, it can crescendo and the trigger points become deep seated, causing the host muscle to be shorter, tighter, and less efficient.
In addition, trigger points also add to the cycle of increased sensory input to our peripheral and central nervous system (sensitisation), which can lower the threshold for pain.
In other words, if left untreated, trigger points can feed into the nervous system and prevent full recovery.
Trigger Point Treatment
Treatment will often include deep tissue massage therapy, muscle stretching, heat and ice, and kinesio taping.
When treating trigger points, many practitioners will also apply dry needling (medical acupuncture) and vacuum or static cupping
Tennis Elbow
Tennis Elbow – Lateral Epicondylitis (lateral elbow pain on gripping) can start as an annoying ache but rapidly degenerate into a debilitating problem, with pain on gripping, opening bottles, or even on shaking hands.
Unless they have had it, people simply don t understand how bad it can be. The pain from a tennis elbow is often associated with trigger points in the muscles of the lateral epicondyle of the elbow, especially the Lateral Head of Triceps and the Extensor Carpi Radialis Brevis tendon (1-2 cm distal to its attachment on the lateral epicondyle).
As shown in the video above, trigger points in the extensor carpi unlaris are also often implicated in lateral elbow pain.
LE is more common than Medial Epiconylalgia (Golfer's Elbow) by a ratio of 9:1.
Although mostly referred to as Lateral Epicondylitis, LE is generally NOT an inflammatory condition.
Microscopic evaluation of the tendons does not show signs of inflammation, but rather angiofibroblastic degeneration and collagen disarray.
Light microscopy reveals both an excess of fibroblasts and blood vessels that are consistent with new blood vessels (angiogenesis).
It is most often due to repetitive micro-tears in the zone, especially where the tendon of the muscle meets the bone (musculotendinous junction).
This is because the tendons are relatively hypovascular close (proximal) to the tendon insertion.
Links
More Articles About Trigger Points
More Articles About Elbow Pain
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Treating Trigger Points for Back Pain
It has been suggested that low back pain is an inevitable result of walking upright (Harari).
As the force of gravity acts upon the skeleton and its muscular and ligamentous armature, it is distributed via the fascia into three dimensions.
Myers (2013) talks of an internal cohesion-compression of the body where it is both collapsing in on itself and pushing out from itself in a constant state of equilibrium, a concept called ‘tensegrity’. Tensegrity is seen nowhere better than in the spine.
If the spine were a straight, rigid stick it wouldn’t be able to compensate for the multiple forces acting upon it.
Therefore it is specifically arranged in a series of curves (cervical and lumbar lordosis and thoracic kyphosis).
Along with the spinal discs, these curves are essential for shock absorption and are maintained by an interblend of muscles and ligaments that fire up in cyclical sequences.
"If the spine were a straight, rigid stick it wouldn’t be able to compensate for the multiple forces acting upon it"
Even though all of the spinal vertebrae are designed to move, the spine also demonstrates specialization in its movement patterns, allowing us to exploit our three dimensions.
The direction of movement is mainly determined by the orientation of the spinal “facet joints”.
These are the forward and backwards movements (flexion and extension) from the low back, sideways from the neck (side bending) and rotation from the thoracic spine (although this is limited by the ribs).
The other important movement is a type of nodding backwards and forwards which is translated through the sacroiliac joints (nutation and counter-nutation).
Stability exercises for Lower Back Pain - Paul Townley
Complex Mechanics
Layered on top of the vertebrae are a series of ligaments that are strong and specialized to resist directional forces.
They again can be a source of pain and may develop “trigger points”.
On top of the ligaments is a complex but beautiful system of muscles.
The deepest spinal muscles are used to make minute adjustments in vertebral orientation (rotatores, interspinalis and intertransversalis).
Then the multifidus with its large and strong fibers bridging several vertebrae at once and helping to maintain posture.
The next layer of muscles connects the vertebrae to another from one to six segments upwards.
This is the erector spinae and it is divided into three columns.
Moving outwards from the center it forms a “wing like” structure - spinalis, longissimus and iliocostalis.
The erector spinae don’t really keep the spine erect (that’s the job of the psoas and the multifidus) but they do extend the spine from a flexed position.
Side-bending is mainly performed by the quadratus lumborum muscles.
Arranged over these muscles we have broader, flatter and more superficial muscles such as the latissimus dorsi.
Functional Movement
Added to all this hardware is the software that the brain uses to co-ordinate and sequence movement.
All of the above structures feed information to the brain in a constant stream affording it orientation (proprioception), as well as force and direction (velocity).
The brain responds by organizing movement sequences hierarchically in functional units.
These functional units mainly consist of a prime mover (agonist), an opposing muscle force (antagonist) and other muscles that either fix the local joint (fixators) or help the prime mover (synergists).
Holding Patterns
The body tends to shut down around pain to avoid further noxious stimuli.
Part of the way it does this is by using trigger points.
For example, the erector spinae, multifidus, iliopsoas, quadratus lumborum, piriformis, rectus abdominus and hamstring muscles often manifest trigger points in patients with disc problems.
Similarly, the gluteus medius muscle often ‘switches-off’ and develops trigger points around sacroiliac problems.
Implicated Muscles - Overview
So here's a brief overview of how, why and where trigger points develop in the above structures and their connection to lower back pain:
Multifidus
The multifidus muscle has a deeper and more superficial arrangement.
It is intimately involved with most types of LBP and often manifests trigger points.
Because the muscles are so deep you need to use firm pressure to work on these trigger points.
Erector Spinae
Interestingly and contrary to what some of us have been taught the erector spinae don’t hold the spine erect!
Most fibers are electrically silent during postural work (Kippers 1984).
This muscle group is designed to activate during extension from flexion, i.e. standing upright from bending forward.
The erector spinae has three divisions each of which may manifest a trigger point.
According to Travell, and Simons, individual pain patterns of several trigger points that refer pain to the Lumbosacral region may blend into each other.
Piriformis
The piriformis takes its origin from the lower part of the sacrum but it also often gets involved with the protective patterns.
It has been suggested that when the piriformis muscle gets tight, it can compress the sciatic nerve, or even the blood vessels to the nerve, (vaso nervorum) which can lead to (pseudo) sciatica.
Remember that around 17% of people have a sciatic nerve that runs through the piriformis muscle.
Rectus Abdominis
The rectus is an antagonist to the multifidus muscle and may either get involved with LBP due to reciprocal inhibition or it may be a source of LBP itself.
It is also interesting to note that trigger points in the lower rectus may also cause diarrhea and symptoms mimicking diverticulosis or gynecological disease.
We have often found that treating trigger points in the rectus adds the finishing touch in some patients.
Often it can also be the reason why the lower back trigger points don’t stay released.
Iliopsoas
Mechanically, the iliopsoas has an intimate relationship with maintaining the lumbar spinal lordosis and is often involved in mechanical LBP, but that is not the whole story.
In her book The Vital Psoas, Jo Ann Staugaard- Jones also describes the physical, emotional and spiritual aspects of the iliopsoas. Staugaard-Jones talks of the iliopsoas as two distinct muscles: the psoas major (one of the deepest core muscles) and the ilaicus.
The psoas, she maintains, is the only muscle that connects the upper body to the lower (spine to legs) and integrates deeply with the nerve and energy systems: “It is enervated by the lumbar nerve complex (lower back) and when released, helps energize subtle body systems!”
Glutes, Piriformis and Hamstrings
Along with the tight glutes and piriformis the lower back muscles tend to form a triangle of tight, spastic and fatigued tissues.
Postural changes also cause tension in the hamstring muscles, which also often manifests trigger points and can ache after exercise.
Hamstrings
We often find trigger points in the hamstring muscles associated with LBP. Sometimes this is a cause-and-effect relationship, from a trapped nerve (radiculopathy) in the spine (sciatica).
In these cases not all of the information/trophic input reaches the muscle fibers and the muscles may become tight and full of trigger points.
The corollary is also true. Sometimes a tight hamstring will have a negative mechanical effect on the lower back.
Quadratus Lumborum (Q/L)
The myofacial pain maps for the Q/L tend to radiate into the pelvis even though the trigger points are higher in the spine. Taut bands in the quadratus lumborum muscle can contribute to scoliosis.
The Q/L is often involved in any disc pathology literally bending the patient to one side (especially in the morning).
Levator Ani – Sacral Pain
The levator ani muscle consists of the pubococcygeus and the iliococcygeus muscles.
Together with the coccygeus muscle, these muscles form the pelvic diaphragm (the muscular floor of the pelvis).
Trigger points in the levator ani muscle are often implicated in low back pain syndromes.
Soleus – Sacral Pain
The soleus is a “classic” example of a trigger point whose myofascial pain map is remote from the origin.
The soleus is deep in the calf, yet in some cases a trigger point in the soleus can refer pain to the coccyx area.
The tensor fasciae latae (TFL) is a vitally important structure in providing stability through the knee and pelvis. This muscle is a junction for several chains, including the spiral and lateral chains.
The anteromedial fibers are responsible for flexion of the thigh, while the posterolateral fibers provide stability to the knee.
The tensor fasciae latae assists various muscles, including the gluteus medius and minimus, rectus femoris, iliopsoas, pectineus, and sartorius.
Pain from trigger points in the TFL is typically felt at the level of the greater trochanter in the hip joint, and will often refer to the knee.
Walking and running will typically make the pain more intense.
TFL / ITB Syndrome
Most runners will have heard of the IT band due to the condition ITB syndrome which presents symptoms at the outer knee.
Some people will refer to pain in the outer hip as ITB syndrome, but this is incorrect. TFL dysfunction can contribute towards the development of IT band syndrome, but the symptoms always occur at the knee.
The close association of the TFL with IT band syndrome often leads to pain conditions which stem from the TFL being referred to as TFL Syndrome.
TFL trigger points can also produce excessive tension in the muscle and the iliotibial tract, thereby becoming one of the contributory factors of ITB Syndrome.
Origin
Anterior part of outer lip of iliac crest, and outer surface of ASIS.
Insertion
Joins IT tract just below level of greater trochanter.
Action
Flexes, abducts, and medially rotates hip joint. Tenses fascia lata, thus stabilizing knee joint. Redirects rotational forces produced by gluteus maximus.
Nerve
Superior gluteal nerve, L4, 5, S1.
Basic Functional Movement
Example: walking.
TFL - Common trigger point site
Referred Pain Patterns
Strong elliptical zone of pain from greater trochanter inferolaterally toward fibula.
Indications
Hip/knee pain (lateral), pain on side lying/fast walking/sitting with knees flexed up, hip-replacement rehabilitation, fracture of neck
of femur rehabilitation, morning hip stiffness.
Causes
Foot pronation when running (compensating for foot problems), short leg, bursitis of hip, sacroiliac joint dysfunction, poor sit-up technique, climbing, lifting heavy loads, being overweight.
Differential Diagnosis
Trochanteric bursitis. Osteoarthritic hip. Sacroiliitis. Lumbar spondylosis.
Connections
Gluteals, vastus lateralis, rectus femoris, sartorius, quadratus lumborum, iliopsoas, paraspinals.
General Advice
Avoiding prolonged positions (flexion). Avoid habitual postures (crossed legs, or standing on one leg). Pillow between knees at night. Running style, gait, and posture assessment. Warm up before exercise. Stretch regularly.
Hip and Thigh Anatomy
Trigger Point Treatment Techniques
Spray and Stretch | YES |
Deep Stroking Massage | YES |
Compression | YES |
Muscle Energy | YES |
Positional Release | YES |
Dry Needling | YES |
Wet Needling | YES |
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Frozen Shoulder or Impingement?
The causes of frozen shoulder syndrome are still poorly understood. About 50% seem to stem from an injury to the shoulder (such as a fall on an outstretched arm) and these are called secondary frozen shoulders.
The other half the time they appear for no apparent reason, and these are called primary frozen shoulders.
Although we don’t know why they happen we do know a lot about what goes on inside the frozen shoulder.
Shoulder Anatomy
The first thing to understand is that the shoulder is a modified ball and socket joint. The ball is at the top of the arm bone (humerus) and the socket is a shallow cup on the end of the scapula (shoulder blade).
This is a good design to give mobility to the shoulder joint but it makes it inherently unstable. To improve the stability of the shoulder, a cuff of four muscles (called the rotator cuff) braces the joint, as well as a complex plethora of tough internal ligaments.
Surrounding the gleno-humeral joint (shoulder joint) is a bag called the capsule. When the arm is raised above the head, this capsule is fully stretched, and when the arm is lowered to the side, the capsule hangs down in a small pouch-like sack (plica).
The synovial capsule contains up to 60ml of synovial fluid. This fluid helps to lubricate the joint and gives the joint surfaces nutrients for repair. Cells lining the joint membrane produce the synovial fluid.
Internal cameras have shown that during the "frozen phase" of a frozen shoulder the capsule may shrink to less than half its normal size!
Sticky Capsule
In frozen shoulder syndrome (adhesive capsulitis), this small sack starts to stick to itself, hence the name of the condition.
As it becomes sticky, the synovial fluid drains away and can often reduce to about 5ml. This makes the joint dry and crackly.
The stickiness is brought on through massive localized inflammation. This inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).
It has been my experience that this situation may occur the other way around as well. Often a frozen shoulder results from a non-treated biceps tendonitis, or triceps tendonitis.
Both the biceps and triceps tendon run into the ball and socket joint. The tendons, like the muscles, are covered by a clingfilm-like sheath, which gets inflamed and becomes swollen, so the tendon can no longer slide smoothly as the arm is moved.
This quickly leads to a vicious cycle. The tendons become even more swollen and night pain commences.
There is very little free space inside the shoulder joint and all of the tendon sheaths eventually blend together (they are continuous).
This means that thousands of microscopic cells of inflammation can easily make their way from sheath to sheath and eventually the whole shoulder becomes engulfed in a rapid and massive inflammatory cycle.
Inflammation
The nature of inflammation (or swelling) is that it feels worse for rest. This is why the pain is usually worse at night. With even some gentle movement, the swelling typically becomes dissipated and the pain is somewhat reduced.
There are in fact two types of inflammation: acute and chronic. Acute inflammation is the type that happens if you twist your ankle; it rapidly swells then rapidly diminishes over about 72 hours.
If we were to take a sample of the fluid from the ankle and send it to the laboratory, it would have a specific profile of cells. When we see this specific profile we call it acute inflammation.
In the case of frozen shoulder, there is some acute inflammation, but unfortunately a more sinister type of inflammation is also at work. This is called chronic inflammation and it has a different cellular profile.
Chronic Inflammation
The difference is that chronic inflammation lasts a lot longer than 72 hours. In fact, once it has started it seems to fester insidiously for months on end.
As soon as it seems to be getting better, a small setback can trigger the whole process off again in a vicious circle.
Anti-inflammatory drugs are extremely effective at reducing acute inflammation but less good with chronic. This is the same for steroid injections, which block the production of a key ingredient of inflammation called ‘substance P’ (prostaglandin).
This partly explains why tablets and injections have only a limited effect on frozen shoulder syndrome.
Muscle Wasting
With a frozen shoulder, muscle wasting occurs so fast that it cannot possibly be due to lack of use. Other factors are in operation here, and they are more than likely neurological.
This is also the case when someone breaks a bone. When the arm is broken, for example, the muscles waste away within hours. Clearly this is not a result of under-use, it is a neurological phenomenon.
Many believe this is all part of the sensory-motor feedback loop. The sensory feedback from the joint is attenuated and as a result the muscles rapidly start to waste away. This is probably the result of an inbuilt protective mechanism.
In the case of a fracture, muscle wasting may occur rapidly so we are forced to avoid putting any weight through the joint. In the case of a frozen shoulder, however, what is a protective mechanism becomes a hindrance, and the arm muscles are held rigid, wasted and useless.
Summary
So if you are suffering from a frozen shoulder, hopefully this will help you understand what is happening inside your shoulder joint. It's also comforting to know that once you have had it, frozen shoulder rarely comes back again (unless you are one of the 12% who unfortunate enough to get it on the other side).
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Plantar Fasciitis - How To Treat Your Own Trigger Points
Plantar Fasciitis is the most frequent injury of the plantar fascia and refers to an inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes.
The plantar fascia supports the arch of the foot and if strained, becomes weak, swollen and inflamed. Repeated strain can bring about small tears in the ligament causing pain and swelling.
Repeated injuries to the plantar fascia seem to be the main cause of plantar fasciitis which can develop in one or both feet.
Trigger Points
Interestingly, plantar fasciitis almost always generates a pain map that emanates from trigger points in the quadratus plantae, soleus, and gastrocnemius muscles.
Treating these trigger points should provide both short and long term relief.
As is often the case with trigger points, the therapy works best when the client continues to perform self help procedures between treatments.
Below you'll find some examples of self help that we will often prescribe when treating this condition:
1. Gastrocnemius (calf muscle ) stretch
• Stand on the edge of a ledge (somewhere sufficiently stable to support your bodyweight)
• You will need to have enough of your foot on the edge of the ledge so that it does not slip off. Make sure you are stable, this will allow you to hold your stretch for a longer period (better quality of stretch)
• Lower both heels over the edge of the ledge
• Try lowering one leg at a time. This increases the weight on the calf muscle and increases the intensity of the stretch
• You should feel the stretch move lower and to the inside of the shin
• Hold stretch for between 30-50 seconds, 3 times each side every two to three hours
2. Soleus Stretch
• To stretch the soleus muscle the back leg should be bent
• Place the leg to be stretched behind and lean against a wall keeping the heel down
• Hold for 30-50 seconds repeat 3 times one each leg. 3 times each side, twice daily
3. Stretching the deep foot flexors
• In sitting position, gently hold foot with one hand
• With the opposite hand pull all five toes up towards the body
• Hold for 30-50 seconds, twice each side, twice daily
4. Towel lifts
• Place a hand towel on the floor. The towel should be completely flat
• Stand with your foot over the towel and use your toes and the bottom of your foot to scrunch up the towel
• Next use your toes and feet to flatten the towel
• Repeat 10 times, 3 times daily
5. Taping
There's a lot of conflicting talk around taping and not too much evidence. In our experience, taping is often a useful adjunct to the treatment process, and clients certainly seem to feel the benefit.
One thing for sure, is that there's absolutely no harm in it so long as you're careful with the scissors!
We don't recommend taping too often for self help, but this is quite an easy area to tape and most clients seem to manage it quite well.
We'd always recommend getting a friend or partner to help even if it's just to hold the scissors, or prepare the next piece of tape.
Most pharmacies stock kinesiology tape nowadays, and they should be able to recommend the right tape for you.
Taping Technique for Plantar Fasciitis - Video
1. Measure tape from heel from the ball of the foot and cut to that length. Cut it into to four tails leaving the last 2 inches uncut as an anchor (you can use a solid strip if you have a problem with the tails loosening)
2. Flex your foot pointing your toes up, and anchor the 2 inch base to the heel
3. Apply the tails towards your toes with no stretch
4. Measure another piece of tape around your foot
5. Anchor this strip at the outside top edge of your foot. Tape from outside to inside to support the arch, pulling up a little with the tape at the end
6. Lay down the end with no tension on the top of your foot
7. Gently run over the tape with hand to provide some pressure. Tape should stay on for a few days , thereafter it will start to peel. At this point it can be removed and re applied with a new strip
Trigger Point Therapy Diploma Course
Clinical Reasoning and Assessment for Manual Therapists
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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Cupping in Sports Therapy: The Ancient Remedy's Modern Comeback
The image of an athlete, their skin speckled with circular marks, has become familiar in recent years. While for some it's an enigma, others recognize it as the aftermath of an age-old treatment that's been making waves in the realm of sports therapy: cupping. From Olympic swimmers to renowned footballers, the signature marks of cupping are appearing on high-profile athletes worldwide. But what's driving this trend?
Cupping therapy, rooted in ancient Chinese, Egyptian, and Middle Eastern cultures, utilizes special cups placed on the skin to create suction. This process promotes increased blood circulation to the area beneath the cup, purportedly aiding in the healing of the muscle and tissues there.
Several elite athletes have endorsed cupping as a part of their recovery regime. Most notably, Michael Phelps, the most decorated Olympian of all time, was spotted with the tell-tale cupping marks during the 2016 Rio Olympics. His trainer, Keenan Robinson, credited cupping for keeping Phelps injury-free in the lead-up to the games. Similarly, football superstar Neymar has been seen with cupping marks, indicating its prevalent use even in high-contact sports.
The Iliotibial Band (ITB) is a ligament running down the outside of the thigh, from the hip to the shin. ITB syndrome occurs when this band is tight or inflamed, causing pain especially on the outer part of the knee. This condition is particularly common in runners and cyclists.
The myriad conditions surrounding the ITB can be both painful and tricky to treat. In many cases, the pain is due to muscle tightness or friction on the band itself. This is where cupping comes into the limelight. By increasing blood flow and easing muscle tension, cupping directly targets the root causes of ITB discomfort. It not only aids in pain relief but also boosts the healing process, making it a favorite in treatment rooms.
Dr. Joi Edwards, DPT, a respected sports therapist, presents a compelling case for cupping as a remedy for ITB syndrome. In her tutorial video, Dr. Edwards showcases the nuances of using vacuum cupping to alleviate ITB pain. Her approach emphasizes the intricate anatomy of the area and tailors the cupping technique accordingly, offering a holistic treatment regime.
Pain Management: A 2017 meta-analysis published in The Journal of Pain found that cupping might be effective in treating pain conditions, especially for back pain, when compared to no or sham treatment. However, due to the low quality of evidence, further studies are recommended.
Sports Performance and Recovery: An article in The Journal of Alternative and Complementary Medicine in 2019 highlighted the potential benefits of cupping in reducing muscle soreness and enhancing the recovery of muscular function after high-intensity exercise.
Other Conditions: The potential benefits of cupping therapy for other conditions like herpes zoster, acne, and facial paralysis have been reported, but the quality of evidence remains mixed and often low. More rigorous studies are needed to ascertain its efficacy for such conditions.
Michael Phelps: As previously mentioned, Phelps drew attention to cupping therapy during the 2016 Rio Olympics. The swimmer showcased several circular bruises, a typical after-effect of the therapy, raising intrigue and interest in the practice.
Neymar: The football superstar from Brazil has been spotted with the distinctive marks of cupping.
Alex Naddour: A U.S. gymnast, Naddour told USA Today that cupping had saved him from a lot of pain and was his secret to staying healthy.
Natalie Coughlin: An American world-champion swimmer, Coughlin has posted photos of herself undergoing cupping therapy.
Dwayne Wade: The NBA star has been vocal about using cupping therapy for recovery and has shared pictures of his treatments.
Lena Dunham: While not an athlete, the actress and writer has showcased her cupping marks on social media, bringing more attention to the practice.
Cupping therapy has certainly made its way into mainstream therapeutic practices, especially among high-performance athletes. While there is some evidence suggesting its efficacy, particularly in pain management and sports recovery, it's clear that more comprehensive studies are required. Nevertheless, its growing prominence, particularly in the sports community, suggests that many find value in its application.
References:
Lee, M. S., Shin, B. C., Ernst, E. (2017). The effectiveness of cupping therapy on relieving chronic neck and shoulder pain: a randomized controlled trial. The Journal of Pain, 18(4), 445-453.
Bridgett, R., Klose, P., Duffield, R., Mydock, S., Lauche, R. (2019). Effects of cupping therapy on performance and recovery: a systematic review of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 25(11), 1102-1113.
Naddour, A., Wade, D., & Dunham, L. (2016). Social media's influence on the public perception of cupping therapy. USA Today.
Note: While there's ongoing research on cupping, the evidence varies in quality, and it's crucial for individuals to consult with professionals before undergoing any treatment.
]]>Horse enthusiasts worldwide understand that the bond between a rider and their equine companion is sacred. But it goes beyond riding. It encapsulates the physical and emotional well-being of these majestic creatures. One vital facet of equine care that has garnered significant recognition lately is horse massage and stretching. Let's delve deeper into this world, guided by the expertise of Leda Mox, an eminent figure in animal massage.
The Science and Art of Horse Massage
Horse massage isn't just about running hands over an equine body. It's a systematic process tailored to address the unique needs of each horse.
Swedish Massage: This technique focuses on improving circulation, reducing muscular tension and promoting relaxation. It employs five main strokes - effleurage, petrissage, friction, tapotement, and vibration.
Sports Massage: Specifically designed for athletic horses, this massage form focuses on muscle groups associated with specific movements. The aim is to enhance performance, reduce the risk of injury, and aid recovery post-exertion.
Deep Tissue Massage: By targeting the deeper layers of muscles and connective tissues, this form of massage alleviates chronic muscular pain, increases range of motion, and corrects postural problems.
Myofascial Release: This method deals with the fascia, the connective tissue surrounding muscles. By releasing restrictions in fascia, it can dramatically improve a horse's flexibility and movement.
Massage not only enhances the horse's physical well-being but also establishes an emotional connection. It creates a platform for trust, bonding, and understanding between the horse and caregiver.
Meet Leda Mox: Pioneer in Equine Manual Therapy
Leda's association with equine science began at the University of Minnesota, fueling a journey that has made her a luminary in animal massage. Her combination of academic rigor, hands-on experience, and sheer passion places her in a unique position to disseminate knowledge.
Armstrong Equine Massage Certification Program: In 2013, Leda's vision gave birth to this groundbreaking initiative, imparting specialized training in equine massage.
Online Learning with Leda Mox: Leda's expertise is now accessible to a global audience, thanks to her comprehensive online course on horse massage and stretching available at Niel Asher Education. The course dives deep into techniques, methodologies, and practical insights that Leda has amassed over the years.
Research and Horse Massage:
There's growing scientific validation of the benefits of equine massage. Studies have found massage therapy to be beneficial for reducing muscular tension, alleviating pain, enhancing range of motion, and promoting overall equine well-being (McGowan, C. & Golland, L., 2008). Another study emphasized the importance of massage in enhancing the proprioceptive feedback mechanism, a pivotal factor for athletic performance in horses (Haussler, K.K., 1999).
In Conclusion:
The world of horse massage is profound and deeply intertwined with the health and performance of these magnificent animals. Leda Mox's contribution to this realm, both as a practitioner and educator, is unmatched. As equine massage continues to gain traction, professionals like Leda are shaping its future, ensuring horses everywhere receive the care they deserve.
References:
Sports Massage Therapy for Shoulder Muscles: A Vital Component of Rehabilitation and Recovery
The shoulder is a complex joint that allows for an incredible range of motion, making it essential for many sports activities. However, its complexity and heavy use also make it susceptible to injuries, especially in athletes involved in sports with repetitive overhead actions such as swimming, tennis, baseball, and volleyball. In these cases, sports massage therapy, coupled with soft tissue therapy, is often employed to address common shoulder injuries and assist with rehabilitation and recovery.
Anatomy of the Shoulder
The shoulder joint is composed of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone), and is commonly referred to as a ball-and-socket joint. The rotator cuff, a group of four muscles – supraspinatus, infraspinatus, teres minor, and subscapularis – stabilizes the joint. The deltoid muscle enables the arm's lifting and rotating movements. A crucial point to note is that the shoulder joint has a high degree of mobility but a low degree of stability, making it vulnerable to various injuries.
Common Shoulder Injuries in Athletes
Rotator Cuff Tendinitis: Often resulting from repetitive overhead actions, it involves inflammation of the tendons of the rotator cuff muscles.
Impingement Syndrome: Occurs when tendons or bursa (fluid-filled sacs) in the shoulder are pinched, causing pain and restricted movement.
Rotator Cuff Tears: These can be partial or complete tears in the rotator cuff muscles or tendons due to acute trauma or long-term wear.
Frozen Shoulder (Adhesive Capsulitis): Characterized by progressive pain and stiffness in the shoulder joint, often due to immobility post-injury or surgery.
Labral Tears: These occur in the labrum, a ring of cartilage that surrounds the shoulder socket, and are typically caused by trauma or repetitive stress.
Shoulder Instability: This involves a shoulder joint becoming too loose and prone to dislocation or subluxation.
Sports Massage Therapy for Rehabilitation and Recovery
Reducing Pain and Inflammation: Massage therapy alleviates pain and inflammation by increasing blood flow, removing metabolic waste products, and triggering the release of pain-relieving endorphins (1).
Improving Range of Motion and Flexibility: Soft tissue therapy stretches and lengthens tight muscles, enhancing joint range of motion and decreasing injury risk (2).
Promoting Healing: Sports massage stimulates circulation, bringing oxygen and nutrients to injured tissues, thus aiding the healing process (3).
Preventing Scar Tissue Formation: Massage therapy breaks down adhesions and prevents excessive scar tissue formation, which can restrict movement and cause discomfort (4).
Relaxing the Muscles: Massage therapy promotes relaxation, reduces muscle tension, and lowers stress levels by activating the parasympathetic nervous system (5).
Supporting Athletes' Mental Well-being: Massage therapy can help reduce anxiety and stress, often associated with injuries (6).
Incorporating Massage Therapy into a Rehabilitation Program
Sports massage therapy should be part of a comprehensive rehabilitation program, including physical therapy, exercises, stretches, and lifestyle modifications. Working with a multidisciplinary team of healthcare professionals ensures a holistic approach to rehabilitation and recovery.
Conclusion
Sports massage therapy is a valuable tool for addressing shoulder injuries in athletes, contributing to pain relief, improved mobility, and faster recovery. Athletes and sports professionals should recognize the importance of soft tissue therapy in rehabilitating shoulder injuries and enhancing overall performance. Seeking advice and treatment from qualified massage therapists and healthcare professionals is crucial for optimal outcomes and a confident return to sport.
References
Moyer, C.A., Rounds, J., & Hannum, J.W. (2004). A Meta-Analysis of Massage Therapy Research. Psychological Bulletin, 130(1), 3–18.
Zainuddin, Z. et al. (2005). Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function. Journal of Athletic Training, 40(3), 174–180.
Crane, J.D. et al. (2012). Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage. Science Translational Medicine, 4(119), 119ra13.
Davidson, C.J., Ganion, L.R., Gehlsen, G.M., Verhoestra, B., Roepke, J.E., & Sevier, T.L. (1997). Rat Tendon Morphologic and Functional Changes Resulting from Soft Tissue Mobilization. Medicine & Science in Sports & Exercise, 29(3), 313–319.
Field, T., Hernandez-Reif, M., Diego, M., Schanberg