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Movement of the arm requires joint mobility and muscular stability. Moving the arm requires appropriate muscle facilitation and mobility in the shoulder joint, the scapulo-thoracic joint (which is not a "true" joint, more of a physiological joint), the acromioclavicular joint (AC) and the sternoclavicular joint (this is the only joint connecting the arm to the axial skeleton).
Take a look at the pics on the left. There are a lot of muscles that can affect the movement of the arm, the scapula, the shoulder, and the clavicle. So... basically what I am pointing out here is that optimal muscle function of the shoulder girdle is key to a healthy pain free shoulder joint, neck and arm.
Muscle, bone and connective tissue adapt to how we use them. And typically during a day our arms are positioned out in front of the body: computing, driving, pushing a stroller/walker/cart. This positioning, along with all of our other daily habits of grasping, clenching and tensing can lead to shortened muscles, winged shoulder blades and internal rotation of the shoulder joint which can lead to impingement and eventual rotator cuff tendonitis/tear.
Do you experience burning, stinging or rawness in your vulvar area? Maybe you feel itching, throbbing, or aching in the perineum and pelvis. You are not alone. These symptoms are typical of vulvodynia.
Vulvodynia is a pain condition of the female genitals: clitoris, vestibule (vaginal opening), labia, and perineum.
There are two main subtypes of vulvodynia:
Self Care Strategies
Self-care and treatments for vulvodynia can help bring relief and recovery. Unfortunately, there is not a "one size fits all" treatment. Working with a trained healthcare provider who understands vulvodynia is crucial to getting out of pain. Here are a few suggestions to alleviate symptoms:
Avoid Irritants to the vulvar tissue
Relieve pain and ease pressure
Make an appointment with your local Pelvic Health Physical Therapist
Weak gluteal muscles can be blamed for many low back, hip and knee pain/injuries. Without the muscular support, the back, hip and knee are subject to increased loads and excessive motion leading to friction and wear and tear. The 3 gluteal muscles: maximus, medius and minimus assist in controlling the trunk and the leg as it is loaded during foot contact to the ground as in walking, running, jumping, going up/down stairs, as well as moving from a sit to a stand or bending.
When the gluteal muscles are weak, you will notice increased movement of the trunk toward the side of weakness, and the knee will cave in toward the midline. Are your glutes weak or strong?
Start to observe what you do when you go up/down stairs: do you turn your foot out to give yourself more support, does your knee drift to the midline, do you shift your torso over to the planted leg to make it easier to step up? If yes, then your glutes are weak
What happens when you bend down to pick something off of the floor or transition to get in and out of a chair: do your knees come together? If yes, then your glutes are weak.
Gluteal assessment: Step down from a stool.
Strengthen your glutes: standing progression
Photo courtesy Wikipedia
In my practice I work with a lot of people who have low back pain, and sacroiliac (SI) pain. How we stand, how we sit, and how we move in our bodies over time, contributes to our dysfunctions and potential pain syndromes.
Being mindful of HOW we stand and sit are simple steps to begin to unravel the increased loading and compression on the spine and SI joints, as well as the tension and pull on corresponding ligaments and muscles.
Before going over standing and sitting, let’s look at the anatomy: The pelvic girdle is comprised of the 2 pelvic (inominate) bones and the sacrum. The inominate bones join in the front by a thick fibrocartilage disc similar to that of the vertebral discs. This area is called the pubis or pubic symphysis. In the back, the inominate bones attach to the sacrum, creating the sacroiliac joints.
The function of the pelvic girdle is to transfer the loads between the trunk and the lower extremities via the spine and hips (lumbopelvic-hip complex). There are 35 muscles that attach directly to the pelvic girdle. Therefore, the mobility and stability of the SI joints depends on the interaction of these muscles, ligaments, fascia and nerves that surround the pelvic girdle.
Photo courtesy: www.pt.ntu.edu.tw
In healthy movement, the sacrum moves relative to the inominate bones. When the sacral promontory moves forward into the pelvic bowl, the motion is called nutation; counternutation is the opposite motion. The optimal position for the sacrum in standing and sitting is slightly nutated between the inominates. This is the goldilocks position: not too tight and not too loose.
During sitting and standing, you can diminish stress on the SI joints by maintaining a neutral pelvis.
Trigger points in a muscle can be the culprit in many pain disorders. In this post, I provide a self care technique to assist with these potentially troublesome trigger points. The muscles that can refer pain into the hip area are the tensor fascia lata, iliacus, psoas and sartorious. If you are interested in learning more about what causes trigger points and how to treat them, I have listed some websites dedicated to trigger points and myofascial pain syndromes at the end of the blog. Click on the pictures below to enlarge the picture and to link you to triggerpoints.net, an amazing resource for trigger points and referred pain.
If you are experiencing any of these pain patterns , try this:
Release tension in the psoas, and the surrounding hip musculature by performing a constructive rest position with a bolster. Allow yourself to breathe and relax for 5 minutes. For instructions on how to do this click here.
Perform a release technique utilizing myofascial release balls such as Yoga Tune Up Therapy Balls for Self Massage (that's what I have and I love them), Melt Method Products, or good old tennis balls. There are a lot of different ways to get into the muscles. For this technique you will take two balls held together in a sock or bag. My finger is pointing to my ASIS on the iliac crest. Place the balls horizontally just below the ASIS.
You will be working near a tender area due to the superficial exposure of the femoral vein, artery and nerve at the femoral triangle. If you start to feel tingling and nerve sensations, move to a different area. Just underneath the vessels and nerve lies the iliopsoas. The next muscle laterally (to the right in this pic) is the sartorious, and the muscle in red is the tensor fascia lata. Sandwiched in between the two is one of the quadricep muscles, the rectus femoris. This will get released as well.
The balls are placed as above on the left side here. With the right leg you can adjust how much body weight you put down into the balls. If it is more comfortable, you can prop up onto your elbows. If you are not able to get down onto the floor, you can place the balls at your hip, and lean into the wall or a door jam. Try to allow your muscles to relax and mold over the balls. If you find that the balls are too intense to start with, place a folded hand towel over them to disperse the pressure. If you are holding your breath and tensing your muscles to deal with the pain, this defeats the purpose. You should be able to feel the sensation and breathe into the area as the muscles release. Once you feel that the muscle has let go, move the balls into a new area. Spend 5 minutes on each side. Enjoy how you feel when you get up to walk. Feel the freedom in your hips!
In my practice, I see many people with back and neck pain. When I assess the spine, I often find that the thoracic spine and ribs are frozen stiff. When the thoracic spine is not mobile, the low back and neck may compensate for this lack of motion, which can lead to overuse, tension and dysfunction.
Last weekend I purchased a lecture on the Thoracic Spine by Sue Falsone, PT, ATC from the website Movement Lectures. I was impressed with the material, and was inspired to include some of the exercises that she recommended to regain thoracic mobility into my Restorative Exercise™ class last week.
I have also been loving my new Yoga Tune Up® self massage therapy balls, so I added some myofascial release into the class as well.
Below I share with you 3 movements to free your thoracic spine.
Thoracic rotation assessment
Breathing Exercise: Enhance Rib mobility, improve rotation
Reassess thoracic rotation: More motion
thoracic extension and myofascial release with ball
I would love to know how great you feel after practicing this for one week!
Not quite a month ago I wrote a post about raking leaves and waking up the next day with pain at my shoulder blade. I was able to relieve it after a few minutes of exercise. Well.... it came back after a weekend of hovering over my computer.
This time I had a different strategy: address the tension in my neck and pectoralis minor.
Due to the attachment on the coracoid process of the scapula, tension in the pec can pull the scapula forward lifting the bottom edge away from the body, potentially creating dysfunction for the entire shoulder girdle.
I was inspired by Jill Miller's YogaTune Up® Blog on the pec minor. So I share with you pics from my 2 minutes of myofascial work with a tennis ball, and "bam" no more pain! I used a tennis ball for this, but I recommend the high grip rubber of the Yoga Tune Up massage balls.
I felt good all day! Until I woke up the next morning and there it was again: pain in my left shoulder blade! This time I released my pec minor AND added the ball release to the muscles at my neck just above my clavicle. Five minutes later, no pain! Check out how I did it by watching this video:
Recently I had the opportunity to work with a woman 7 weeks postpartum. She had been experiencing heaviness and pressure in her vaginal area with walking, lifting, and prolonged standing. At her 6 week check in with her midwife, the midwife said she had a mild prolapse. Concerned about the discomfort and the inability to perform daily activities: lifting her 5 yr old and newborn, walking, standing...etc., and the potential further descent of her organs, she made an appointment with me (smart woman).
My evaluation confirmed her midwife's diagnosis of prolapse: a mild rectocele and urethrocele (see pic above).
In our session we worked on making her aware of habits that increase downward pressures which can contribute to prolapse, with the ultimate goal of reducing or eliminating such patterns.
Automatic habits addressed in the first session:
My client stood as most of us do, with her pelvis out in front of her. She also lifted her ribcage to bring her shoulders back. Ideally we should stand with our pelvis stacked over our ankles and our ribcage stacked over our pelvis; think about our functional core connection here: diaphragm, transversus abdominis, pelvic floor and deep back muscles. (For an educational read, get the book, The Pelvic Girdle by Diane Lee.) When the pelvis is out in front, we no longer have a neutral pelvis, which is important for the position of the pelvic organs (bladder, uterus) to have support of the pelvic ring below (notice in the pic above on the left, the bladder and uterus rest on the pubic bone). This means more grativational load on the fascia and ligaments leading to tissue failure (and descent of the organs). So my client learned how to stand.
Sucking in the stomach
Pulling in the gut to “look” slimmer freezes and shuts down the diaphragm, not to mention increases pressure in the cavities above and below. Read more about sucking in here: So my client learned how to breathe.
Tension in the pelvic floor
All muscles need to be able to contract and relax optimally. When the pelvis is out in front, the muscles in the pelvic floor are held in a shortened position. When there is increased pressure in the abdomen and pelvic cavities from sucking in, the pelvic floor muscles try to create balance by increasing contraction to maintain continence. Chronic tension means decreased blood flow, decreased oxygen, decreased waste removal = potential for pain signals. So, my client learned how to relax her pelvic floor.
Very shortly my client returned to the clinic with noticeable improvements:
Within a week she felt less heaviness and pressure in her vaginal area. She felt pressure only with heavy lifting. She possessed the education to continue her home program from the initial visit and we added gluteal strengthening to her program.
Two weeks later she returned to clinic reporting continued improvement. She was able to walk and perform yard work without any discomfort! She had a follow up visit with her midwife who reported upon exam significant reduction of prolapse! She was given additional functional movement reeducation for her home program. I will follow up with her in a month and more than likely discharge treatment.
Moral of the story is this: if you feel pressure or heaviness in your vaginal area postpartum (or at any time), get it taken care of, go see a pelvic health physical therapist. Or contact me for more information!
If you are in the Salt Lake City area, I am offering a Postpartum Workshop March 1, 2014, where we will address these issues and much more. The workshop will be held at my office: 231 E 2100 S, ste 100 | Salt Lake City from 9:30 to noon.
We had a good storm this week to blow off all of the leaves of the frontyard tree.
I spent two hours raking and bagging. The next morning I woke up with pain and pulling at my left shoulder blade.
I am sure that many of you can relate.
So, instead of waiting it out and griping about it all day, I took 15 minutes to work with the muscles and set freedom to my scapular sling muscles. Post session, no pain!
Below I have pics and video of the simple movements and stretches I went through to decrease the pain in my shoulder girdle.
These are also great exercises to perform daily to combat shoulder blade, arm, and neck tension from computing, driving, hair styling, pushing strollers, carrying babies, etc.
The first movement is called the Rhomboid Pushup. Complete 5-10 repetitions. Make sure that your fingers and elbow creases face forward, and keep your elbows straight.
After the rhomboid pushup, perform a shoulder stretch as shown here.
Repeat the rhomboid pushup 10 more times and then go into this next stretch, Quadruped Rib Twist.
Complete another cycle through of each, the rhomboid pushup, the shoulder stretch and the rib twist. Finish up with some wrist stretches shown below.
Hip mobility is key to the health of the spine. When we lack the motion at our hip joints, the spine will take up the slack by moving into flexion or extension. Here I am trying to lift my leg backward. Compare the two pictures. You can see the increase of the lumbar curve on the left, this is called extension. This creates compression and degeneration of the tissues and tension in the back muscles. This picture on the right shows my true hip motion without compensating by getting more motion through my spine.
Now, here I am lying on my back with my knees bent. On the pic on the top, the dots demonstrate having a level pelvis. As I bring my knee toward my chest, I moved past my actual motion at my hip joint and my pelvis tilts posterior or toward the floor. This action creates flexion at my spine and places more stress on the lumbar discs making me more susceptible to a disc herniation or degeneration.
Restore mobility to your hips, and save your spine from wear and tear from all that extra motion! Below are 10 of my favorite Restorative Exercises™ to free up the hips and the spine! Unless stated otherwise, hold the stretch for one minute each side.