Types of Acromial Shapes & Size of Rotator Cuff Tears

Pain & Injury on December 15th, 2010 No Comments

There are basically three distinct shape classifications identified through an MRI: Type I (Flat), Type II (Curved) and Type III (Hooked). Researchers and Orthopedic doctors have speculated that the more severe Type III Hooked acromion was responsibile for a greater number of Rotator Cuff Tears. More recent research suggests that the Type III (Hooked) acromion increases the size of the Rotator Cuff Tear and not necessarily the frequency of these tears (Hirano M., Ide J., Takagi K.).
J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):576-8

The important point here is that not every muscle injury is caused by misuse, overuse and or trauma. Structural abnormalities can contribute to the severity and frequency of certain soft tissue injuries. Would love to hear other thoughts on this topic.


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Rotator Cuff Injury

Pain & Injury on December 12th, 2010 No Comments

Injury to the Rotator Cuff is very common and the two muscles that are typically injured include the Supraspinatus and the Infraspinatus. The Supraspinatus plays a strong role in stabilizing the head of the humerus into the glenoid fossa and is most commonly the one in need of surgical repair. While the Infraspinatus eccentrically check rains the powerful circumduction movements associated with throwing activities. The glenohumeral joint lacks ligamentous and capsular support and therefore relies on the same small Rotator Cuff muscles that move the joint to also stabilize the joint. This paradox is one important component related to the increased vulnerability of the shoulder joint. In addition the glenohumeral joint is one of the most freely moveable joints with the greatest range of motion. There are some very large and strong muscles like the Pectoralis Major, Latissimus Dorsi, Teres Major that generate powerful and multidirectional movements that must be controlled by the smaller Rotator Cuff – Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. In the case of a compromised Supraspinatus check out the Latissimus Dorsi, Teres Major and Subscapularis for adaptive shortening and spasm, this tension can pull the head of the humerus out of normal anatomical alignment causing greater stress on the Supraspinatus and the articulating surfaces.

Client Education an Integral Component of Treatment Success

Client Educational Tool on December 5th, 2010 No Comments

The MyoFinder app has seven distinct anatomical regions with anterior and posterior views of each region, so a total of 14 anatomical images that highlight the specific musculature of that region. There are 78 individual muscle overlays and 14 HD videos demonstrating basic stretching activities to help the client take an active role in their care, recovery or desire to improve their health and fitness level. Creating a team approach to the care and treatment of each client is the ultimate goal and will ensure the best possible results. Educated clients are able to be involved in treatment plan design which will assist the therapist in reaching the clients primary goals.  Information is knowledge and knowledge translates into confidence, so teach your clients as much as you can about their bodies because everyone has a musculoskeletal system.

Would love to hear other ideas on how to use this Mobile Muscle Mentor.

Defining Mastery of Palpation

Palpation Tips on November 24th, 2010 No Comments

A common definition of Mastery is: The full command – great skillfulness and knowledge of some subject or activity and the definition of palpation is: To examine or explore by touching something to determine the state or condition of a specific tissue. So Mastery of Palpation is: The full command – great skillfulness and knowledge of examining and touching the human body as well as its specific tissues.

How do we define Mastery of Palpation in the educational setting and in professional practice?  How important is this skill set to massage and manual therapists and can it be taught ?? Look forward to some dialogue around this important topic.

MyoQuiz™

MyoQuiz™ on November 20th, 2010 No Comments

MyoQuiz™ is a fun, fast and interactive way to increase your ability to recognize and identify 78 individual muscles on the body. Half the battle in learning the details related to each muscle is knowing exactly where the muscle is located. Increase your confidence and break up your study routine with this visually rich & kinesthetic learning tool. Select the practice button and you can test your knowledge of one of the 7 regions – Head, Neck & Face, Shoulder & Arm, Forearm & Hand, Spine & Abdomen, Pelvis & Hip, Thigh & Knee, Leg & Foot. Successfully identify each muscle to move to the next rank, you can challenge your friends on facebook, post your score on the leader board or try to beat your own best time. MyoQuiz™ has 4 distinct levels that progressively become more difficult – Rookie, Novice, Master & Guru.

Palpatory Anatomy As A Stand Alone Component of Curriculum

Palpation Tips on November 18th, 2010 No Comments

How important is the skill of palpation in basic training programs for manual and massage therapy?? I believe that skilled palpation is the foundation and cornerstone for effective technique application and treatment outcomes. Knowledge of the musculoskeletal system is imperative when trying to accurately assess and work with common orthopedic and sports injuries. Interestingly enough, our educational institutions say that palpation is an important aspect of their training, yet very few programs have Stand Alone Courses dedicated to Palpation.  Most basic training programs blend palpation with various modalities or they have lecture classes dedicated to musculoskeletal anatomy with no hands on component. The continued overemphasis on assessment, technique and speciality modalities shadows the real importance of knowing your musculoskeletal anatomy. Everyone including instructors are looking for some cool new trick, the trick is knowing the condition/state of the tissue that you are trying to effect and how best to treat this condition. The most powerful assessment tool that hands-on practitioners have is palpation. We need to go back to the basics of knowing the human body through skilled and knowledgable touch. I sure wish that educational institutions would place more emphasis on Palpatory Anatomy skills, their graduates would be more successful in their respective disciplines if they did.

Internal Organ Trauma and Somatic Complaint

Pain & Injury on November 16th, 2010 No Comments

My 18 year old nephew was in a bad dirt bike accident a little over 2 weeks ago which resulted in broken ribs, punctured lung, liver laceration, numerous abrasions, stitches in his lip because he bit through it and an unwanted case of pancreatitis. We have all been worried sick over this kid and it seemed like every time he turned around there was another problem and another painful procedure to endure. I wont comment on the medical care here, but just know that if you have a loved one hospitalized someone should be there to advocate and monitor best care practices if you want to avoid the worst case scenario from happening.
Organs have pain referral patterns just like trigger points, my nephew consistently complained of shoulder pain. Interestingly enough the liver, lung and pancreas all refer into the shoulder region.  I provided gentle massage therapy to him for 3 days in a row, although the massage felt good it did not decrease his pain as much as one would think. The soft tissues of his neck and back did change from extremely hypertonic, fibrotic and tender to less tender, soft and mobile.
The point here is, don’t be disappointed if the somatic complaint which you may think is all about the musculoskeletal system does not go away with massage if the person has internal organ damage. I believe that knowing the various organ pain referral patterns is as important as knowing the musculoskeletal system if the individual has suffered organ trauma or has a disease entity in their organs. My experience tells me that the shoulder pain will probably subside when the organs have regained balance and have healed completely.

Rounded Shoulders

Postural Dysfunction on November 10th, 2010 No Comments

Rounded shoulder posture usually accompanies Forward Head Posture (FHP). In this posture the scapula’s are abducting and the glenohumeral joints are medially rotating. The result is adaptively shortened pectoralis major, lats, teres major, subscapularis, anterior deltoid, corcobrachialis, serratus anterior and stretch weakened infraspinatus, teres minor, posterior deltoid, rhomboids, middle and lower trapezius. There may also be evident restriction in lateral rotation of glenohumeral joint and adduction of the scapula. Treatment focus should be directed towards lengthening the adaptively shortened (AS) muscles first and then work on strengthening the stretch weakened (SW) muscles. Sometimes the muscles are not weakened they are just neurologically inhibited by the adaptively shortened muscles and once you normalize the (AS) muscles normal strength often returns. That is why it is really important to know if the muscle is truly (SW) or neurologically inhibited, ongoing muscle testing can confirm the basic need for the integration of specific strengthening exercises.

Anterior Pelvic Tilt

Postural Dysfunction, Uncategorized on November 6th, 2010 No Comments

Anterior Pelvic Tilt (APT) is commonly associated with Low Back Pain (LBP), this postural dysfunction can be a unilateral or bilateral problem. (APT) increases the lumbar lordotic curve which shifts the weight distribution off the intervertebral disc and places it onto the facet joints, which are not weight bearing joints. This structural shift can close down the transverse foramen causing nerve compression at the nerve root and increases the potential for degenerative changes in the facet joints. The (APT) creates a flexed posture where the lumbar musculature and the hip flexors become adaptively shortened and the abdominals are lengthened and consequently weakened. Learning to access the Iliacus and Psoas require a different level of sensitivity and skill set, understanding the exact location of these muscles is imperative. I suggest using the skeleton as a way to visually understand the attachment sites for these critical muscles that are associated with Low Back Pain from a functional and referral stand point.

Muscle Tension and Joint Subluxation

Pain & Injury, Uncategorized on November 4th, 2010 No Comments

Muscle tension can cause joint subluxation which in turn can lead to nerve compression and resultant neurological symptoms such as numbness, tingling and paraesthesia. It is so great when massage and chiropractic can work together to resolve these common and painful situations. Neuromuscular Therapy can reduce  muscular tension and make chiropractic adjustments easier to apply, more effective and easier to tolerate. A skillful assessment that includes postural assessment, range of motion and health history can help guide the treatment plan and direct the selection of treatment techniques. Specificity is key to getting positive results and knowing the role that each muscle plays in the restriction of range of motion is critical for success. That is why it is imperative that massage therapists know their anatomy. I would love to hear other reasons why manual therapists need to know their anatomy inside and out.