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If you’ve ever gone for a deep tissue massage only to be let down by the amount of pressure used, then you’re not alone. A majority of people equate ‘deep tissue’ with ‘deep pressure.’ The opposite can also be said of a Swedish massage. If you’re someone who likes only light to moderate pressure, then chances are you’ll go with a Swedish massage. So why is it that people get less than what they expect from their massage? The reasons can be as varied and as simple as: your therapist’s individual style or strength; your therapist’s training and experience; the amount of communication between therapist and client; and not least of which, some common misconceptions.

Just about everyone expects a firm touch when they go for a deep tissue massage. The term ‘deep tissue’ though can be a misnomer. A deep tissue massage is designed to target the deeper layers of muscles in your body and not necessarily to deliver deep pressure uniformly. This is misconception number one. The amount of pressure used in a deep tissue massage can vary greatly, from a light, superficial stroke designed to warm up the muscle, to a deeper, more focused application of pressure used to release adhesions. This is such a common misconception that even some therapists fall into the trap of using more pressure than is needed. By contrast, a Swedish massage is designed to target the superficial layer of muscles, which in some cases may not require as much pressure. So how do you ensure you’ll get the best massage for your money? The key is communication.

Another common misconception is that it’s better to remain silent for the sake of propriety. “The therapist knows how much pressure to use, even if I’m silently screaming in agony.” You may be thinking…, not me! But you’d be surprised at how many people suffer in silence. Your therapist should establish those lines of communication by asking you your preferences and checking in with you periodically throughout the massage. Some areas may require more pressure than others, so it’s at these moments when communication is crucial. There may also be a disconnect between what your body is saying and what your expectations are. Some therapists may use your body’s reaction to guide them in the amount of pressure they use. If you tense up or your breathing becomes shallow and subdued, then chances are the amount of pressure you’re getting is at or beyond your threshold.

Since pain is such a subjective matter, one person may prefer that feeling and another may not. The question of how much pressure to use has now become more complicated. From a purely therapeutic standpoint, the body never lies. If your muscles are splinting and tensing up, it’s your body’s way of saying ‘enough!’ Of course, depending on the circumstances, that may change and often does. If for example, you’ve recently strained a muscle or are dealing with chronically tight muscles, your body may react to ‘too much pressure, too fast’ by tensing up. In cases such as these, it may be a matter of warming up the tissue sufficiently or using a different technique, which can then allow you to go deeper. But generally speaking, trying to push through this resistance with a ‘take no prisoners’ approach may actually do more harm than good.

Some therapists may have a system they use to help modulate the pressure to your liking. Some may not. The important thing to remember is that you speak up and let your therapist know what your preferences are. If you clearly communicate this and you still don’t get what you’re looking for, then it may be a matter of finding the right therapist. In light of all these variables, not everyone is a good match. Do your research and find the therapist that suits your needs.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

The following was a treatment plan submitted during our clinical training at the Swedish Institute in NYC. It provides detailed, step-by-step instruction on a western style, medical massage approach for clients dealing with severe rheumatoid arthritis. While it might be more on the technical side, it should underscore the amount of consideration taken in a clinical setting where massage is administered every week, for a 6-8 week period.

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Goals for treatment should include: increasing flexibility and range of motion (ROM); relieving aches and pains related to muscle stiffness; increasing circulation – especially in clients with cardiovascular issues; reducing inflammation and joint pain during chronic flare ups/remissions; reducing contractures and adhesions; reducing anxiety and depression related to RA.

Bolstering to the knees, hip/lower back, and cervical spine may aid in relieving undue stress at these joints. Staying within a client’s pain threshold and using care to not apply overpressure when performing ROM, should also be observed. Some clients may develop osteoporosis, so caution should be taken with the amount of pressure used during a session.

Starting in supine, so as to better perform ROM and stretching techniques, we would begin at the arms. Moving the shoulder joint through coronal abduction/adduction, flexion/extension, medial/lateral rotation several times in order to warm up the joints and increase ROM. Moving down to the elbow and performing flexion/extension, supination/pronation, and finally the wrist with flexion/extension, radial/ulnar deviation, and circumduction. Taking the client through these gentle movements is invaluable in breaking up any fibrotic changes that may have taken place.

Applying myofascial release with passive stretching to the wrist flexors, biceps at the forearm, and pectoralis major at the shoulder, is a great way to promote length along these potentially hypertonic muscles. Resisted isometric tests (RIT) to the clavicular and sternal fibers of pectoralis major, followed by circular friction, will help to open up the chest and promote deeper breathing in this restricted area. Trigger point work, especially to the flexors of the wrist, may help to break up adhesions and promote blood flow to the area. Passive extension of the digits of the hand along the MP & DIP joints will promote lengthening in flexor digitorum superficialis and flexor digitorum profundus, respectively. Care should be taken with any ROM techniques at the wrist and fingers, since arthritic flare-ups and local osteoporosis are very common in these areas.

At the knees and ankles, gentle ROM would be performed. Cross fiber friction along the patellar ligament and muscle stripping of the quadriceps would promote length in these muscles. Mobilization of the patella itself, if not too painful for the client, would help to break up any fibrotic adhesions related to joint degeneration. Muscle stripping the tendons of the plantar-flexors and peroneals, would promote length and increase ROM. Cross fiber friction to the tendons would help to realign any scar tissue that may be present. Deep effleurage and petrissage to the foot will help to relax the client and increase blood flow to the extrinsic muscles of the foot.

In prone, vibration up the paraspinal muscles, followed by some myofascial release, would promote a deep state of relaxation and provide a nice warm-up of the area. Circular friction along the attachments for levator scapulae and upper trapezius would help to separate and realign its fibers. Muscle stripping and cross fiber friction to the erector spinae would help to release any adhesions related to muscle imbalance. At the hip, deep petrissage and circular friction along the fibers of quadratus lumborum would help to increase circulation and alleviate any pain resulting from contracture of this hip hiker muscle. Finally, RIT to the Hamstrings followed by myofascial release along its fibers would increase inhibition and allow for a deeper stretch of the fascia and its fibers.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Rheumatoid arthritis (RA) is an autoimmune disease which causes chronic inflammation of the joints of the body. Systemic by nature, it can also affect surrounding structures such as muscles, tendons/ligaments, blood vessels, and organs. The most commonly affected sights, however, include the small joints of the hands and feet, elbows, ankles, and knees. Women are three times more likely to be affected and its onset commonly occurs between the ages of 40 and 60.

RA often impacts multiple joints in an insidious, bilateral fashion (that is, if the right wrist is affected, the left will be as well). Sufferers often experience episodic flare-ups followed by remissions, which can last weeks to years. During flare ups, symptoms can range from fever, chills, fatigue, muscle pain, loss of appetite, to joint inflammation (redness and heat) and joint stiffness – which in most cases gets progressively worse.

In extreme cases, the condition can lead to gnarled and distorted deformities of the joint, loss of range of motion (ROM), and chronic pain. Inflammation of organs such as the heart and lungs can cause serious cardiovascular disorders and invariably results in organ failure. It has also been known to cause a condition called Vasculitis (inflammation of the blood vessels), which if not treated properly, can lead to necrosis of tissue. Since RA is a degenerative joint disease, it is not uncommon for suffers to eventually develop some form of muscular atrophy and local osteoporosis surrounding the affected joints.

The causes of RA are unknown, although it is thought to be a genetically inherited condition. Triggers such as streptococcus infections, viral and other bacterial infections, as well as smoking in some cases, are all believed to play a part. For some unknown reason, the body’s immune system attacks the synovial membranes of the body. Antibodies (RA factor) and inflammatory mediators produced by lymphocytes and white blood cells are produced and proliferated throughout the joint spaces and synovial linings. An inflammation response ensues, causing the synovial lining to thicken and swell. A substance called “Pannus”, which is produced by the cells of the lining, slowly erodes away the joint capsule, the articular cartilage, and eventually the bone. As a result, scar tissue develops and forms an ankylosis. Whether it be a fibrotic ankylosis restricting the ROM of a joint, or a bony ankylosis which fuses the bones together, the results can be debilitating.

The emotional and psychological implications of the condition are commonly fraught with chronic pain and daily limitations. During flare-ups, sufferers often experience pain in the morning and after prolonged periods of inactivity. This fact makes getting up in the morning and facing the day a particularly daunting task. As a result, sufferers tend to group their errands and tasks into as few activities as possible – so planning and forethought is of major importance. Socially, people with RA tend to curtail their interactions and engagements with others out of sheer necessity. Dancing, playing sports, or even going for a stroll, take on a whole new meaning. Emotionally speaking, this decrease in contact with others can take its toll on some.

Common treatments for RA can include taking aspirin and cortisone to reduce inflammation to anti-biotics and physical therapy for long-term sufferers. Immunosuppressants such as methotrexate have become popular in preventing further joint degeneration. NSAIDS, gold salt injections, and various other anti-inflammatory drugs have been used to alleviate pain. And as we will see, a treatment plan during periods of remission to help increase circulation, ROM, and decrease stiffness and pain at the affected joints.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

There are certain aches and pains that arise over time due to repetitive movements that can occur on the job, at the gym, or even at home. And whether we realize it or not, these aches and pains can be the result of a multitude of micro-tears to muscle, fascia, or tendon. These soft tissue structures become comprised from over use and eventually lead to inflammation. Let’s take a look at some of the contributing factors involved in this syndrome.

A lot of overuse injuries occur on the job. They can affect just about anyone from a manual laborer to an office worker. Whenever we perform repetitive actions such as in typing at the keyboard, lifting heavy objects, standing or sitting for prolonged periods, we run risk of overtaxing the soft tissue structures involved in those actions. Carpal tunnel syndrome for example can be the result of faulty mechanics, such as in prolonged extension of the wrist and hands while at the keyboard. It can also occur from micro-trauma due to repetitive movements done over time, such as in those who use power tools, paint, play an instrument or racquet sports — the list can be extensive. The median nerve which passes through the carpal tunnel of the wrist becomes compressed and inflamed, which can then lead to tingling, numbness, weakness and pain in the finger and wrists.

Another place where over use injuries can occur is at the gym or while playing sports. Athletes are notorious for developing tendonitis and stress fractures due to repetitive movements and over use. Runners for example are prone to developing conditions such as Achilles tendonitis, plantar fasciitis, and shin splints, especially in those who are poorly conditioned. People who play racquet sports or golf are susceptible to developing shoulder tendonitis in any of the rotator cuff muscles, golfer’s elbow (which is tendonitis of the forearm flexors attaching on the inner part of the elbow), or tennis elbow (which is tendonitis of the forearm extensors attaching on the outer part of the elbow). People who play soccer, basketball, volleyball, or any sport that requires starting and stopping, cutting movements, sprinting, or jumping can see overuse injuries ranging from patellar tendonitis (i.e. jumper’s knee, runner’s knee), to ITB friction syndrome which is caused by a tight iliotibial band frictioning the outer part of the knee. Chondromalacia Patella or Patellofemoral Syndrome occurs when the patella does not track properly in the patellar groove when the knee is extended under load. Think of doing squats or climbing stairs. The articular cartilage eventually gets worn away, resulting in pain and inflammation along the inner part of the knee.

These types of repetitive use injuries are not limited to the job or the gym. Most of us have hobbies that involve repetitive movements. Playing an instrument is a good example. Think of the muscles involved in playing the piano or the violin. Hours and hours of practice can eventually lead to pain and inflammation of the fingers, wrists, elbows and shoulders. How about gardening? Pulling up weeds or potting flowers can require us to maintain certain positions which can stress our knees, hips and low back. There’s even a condition known as blackberry thumb or gamer’s thumb. De Quervain’s syndrome, its clinical nomenclature, is a tenosynovitis (a tendon sheath inflammation) and repetitive use injury (RSI) of two key tendons attaching on the thumb. It usually results from an over use of the thumb and wrist while texting or playing video games.

Now that we’re familiar with some of the most common manifestations of repetitive use injuries, here are some of things we should consider as part of a preventative care plan:

  • Most over use injuries stem from muscle imbalances. Are we pushing ourselves too far, too fast in our training before we’re properly conditioned? Are we using good form when performing certain movements?
  • Certain jobs may require us to perform repetitive movements at work. If this is the case, are we taking periodic breaks? Can we switch sides so we’re not using the same hand, arm, or shoulder? Are we using faulty equipment to perform these tasks? Developing an awareness of these mitigating factors can go a long way in preventing an injury.
  • Warm ups and stretches. Whether we’re going out for a run or getting ready to play an instrument, a little warming up goes a long way. Gentle range of motion of the joints and targeted stretching of key muscles will help reduce the likelihood of a strain by increasing blood flow and oxygen to the area.

Signs and Symptoms:

If you think you may be dealing with a repetitive use injury, here are some common signs and symptoms:

Localized pain: Whether its Achilles pain, knee pain or shoulder pain, you’ll feel it acutely at the site of inflammation. The pain may be brought on from use of the inflamed muscle or tendon, as in an isometric contraction. It can result from stretching the inflamed tissue. And in advanced cases, the pain may be constant even while at rest.

Tenderness: Minimal pressure to the area can often induce pain. In cases of acute tendonitis, the whole muscle may feel sore to the touch.

Limited ROM: Your mobility of the affected area may be limited and painful. Lifting your arm above your head for example may be hard to do in certain cases of shoulder tendonitis.

Swelling: Inflammation can lead to swelling and heat in the affected area.

Crepitus: Clicking or creaking sounds may be heard during certain movements of the affected area.

Treating over use injuries can require several approaches, not least of which is time to heal.

Treatments:

R.I.C.E.: If you’re not familiar with this acronym, then it maybe one of the only things you should remember when dealing with acute injuries.

  • Rest: In some cases as much two weeks may be indicated. The body needs time to mend the damaged tissue.
  • Ice: applying ice is a great way to reduce inflammation.
  • Compression: wrapping the injured area with and ACE bandage or brace will provide added support and help keep you mobilized.
  • Elevation: In cases of acute trauma and inflammation, elevating the area will help to reduce the swelling.

Proximal massage: Massaging the area directly above the injured site, for example the calf muscles in cases of Achilles tendonitis, will help to increase circulation and drainage to the injured site.

Range of motion exercises: Moving the affect area in a pain free and gentle way after the acute phase has passed, will prevent muscles and tendons from tightening up from under use.

Ice massage/Contrast bathing: Depending on where you are in the healing process, ice massage to the affected area will help reduce pain by decreasing inflammation. Later on in the healing process, heat can be introduced in conjunction with cold applications to create a pumping affect. This is excellent for removing waste byproduct trapped in the affected area.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In this 5th and final post on the major muscle groups of the body, we’ll discuss muscles of the lower leg, the back of the thigh, and hip.

The lower leg can be divided into three compartments, the anterior (front), lateral (side), and posterior (back). There are a total of eleven muscles in the lower leg, all of which operate the foot. These muscles are referred to as extrinsic muscles, while the muscle located on the foot itself are referred to as intrinsic muscles. There are three in the front, three on the side, and five in the back. We’ll focus on two of theses muscles, which form the superficial layers of the calf.

Gastrocnemius: Located just below the back of the knee, the two bellies of the Gastrocnemius are what give the calf muscles their contoured shape. They descend about half way down the lower leg and are easily the most superficial and accessible muscle of the lower leg. Due to the fact that Gastrocnemius crosses both the knee and ankle joint, it can just as effectively flex the knee as it can plantarflex the foot. The lower portion of the muscle blends with another lower leg muscle known as Soleus to form the Achilles tendon. The Gastrocnemius is a powerful muscle capable of lifting your entire body weight, making it most active when running or jumping.

Gastrocnemius Soleus

Soleus: Sometimes referred to as the body’s “second heart”, the Soleus muscle plays a very prominent role in pumping blood back to heart. The upper portion of the muscle is buried beneath the superficial bellies of the Gastrocnemius, but its lower half is easily accessible and palpable. Although Soleus does not cross the knee joint, it does blend with Gastrocnemius to form the Achilles tendon. The main function of this muscle is to plantarflex the foot. Unlike the Gastrocnemius, which is known for its short bursts of power, the Soleus is a workhorse muscle, essentially working anytime you’re on your feet.

Hamstrings: The hamstrings as they’re commonly referred to, are the major muscle group found in the back of the upper leg and thigh. There are three distinct and individually named muscles, which surprisingly occupy less space at the back of the leg than one would imagine. The lateral portion of the Quadriceps and the medial Adductors fill in a big portion of the posterior thigh. Yet these three slender muscles are capable of performing several actions that affect the hip and knee in variety of ways.

Hamstrings

  1. Biceps Femoris: The most lateral of the hamstrings, Biceps Femoris has two distinct bellies. One belly originates at the sitz bones and the other shorter head, starts half way down the femur. Both heads then blend together to form a common tendon, which crosses the knee joint to attach on the fibula. This portion of the hamstrings can: flex the knee, laterally rotate the knee (when flexed), extend the hip, laterally rotate the hip, and tilt the pelvis posteriorly.
  1. Semitendinosus & Semimembranosus: The only major difference between these two muscles, which happen to form the medial hamstrings, are their insertion points. They both originate on the sitz bone and they both perform the exact same functions. Semitendinosus overlies the deeper Semimembranosus, but they both cross the knee joint. Instead of blending together to form on common tendon and one insertion point, they each maintain their tendon and attach at slightly different points on the tibia. The Semis can: flex the knee, medially rotate the knee (when flexed), extend the hip, medially rotate the hip, and tilt the pelvis posteriorly.

Moving up the leg and into the hip, we come to an area with many layers of muscle collectively referred to as the ‘glutes’. There is of course Gluteus maximus, which is the most superficial layer of the glutes and one that we’re all familiar with. Beneath this muscle however, lie two other muscles named “gluteus”: Gluteus medius and Gluteus minimus. Both these muscles are key players in moving as well as stabilizing the hip. Then we have the deep six’ lateral rotators – a grouping of six slender muscles that fan out around the head of the femur in the hip socket. As the name implies, they laterally rotate or roll the leg and hip out. One of these lateral rotators is called Piriformis.

Piriformis: If you’ve ever had sciatica or experienced sciatica-like pain, then you’ve probably heard of the Piriformis. The reason for this is that, out of the deep six lateral rotators, the Piriformis is the only one the runs directly over the sciatic nerve. The other five lie beneath it. If for some reason the Piriformis becomes strained or inflamed from overuse or trauma, that extra bit tension could compress the sciatic nerve causing an entrapment.

The Piriformis muscle originates on the sacrum and attaches to a part of the femur called the greater trochanter. As mentioned, it’s a strong lateral rotator of the hip and leg. When the leg is stationary, it can also rotate the body to the opposite side. For that reason, an activity or sport that involves quick cutting or twisting movements could potentially cause trouble for the Piriformis.

Piriformis

Iliotibial Band: Although technically not a muscle, this thick band of fascia covers the outer part of the hip and thigh and serves as central tendon for two muscles: Gluteus maximus and a muscle called Tensor Fascia Lata (TFL). The vertical fibers of the IT band originate and are an extension of both these hip muscles. This thick tendon like structure runs the length of the outer leg and inserts just below the knee on the tibia. The IT band essentially transmits the power of the Gluteus maximus and TFL to help move the hip and leg. More importantly, the IT band helps to stabilize the hip and knee when standing, walking, and running.

IT Band


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

This month we’ll continue on with another set of important muscles located in the front of the body.

Abdominals: Nowadays so much focus is placed on strengthening our core and sculpting those “washboard abs”. The advantage of having a well toned midsection however goes much deeper than that sought after look. Stronger abdominals will mean better support for the spine and back, which can in turn lead to a better overall posture.

The abdominals are comprised of four individual pairs of layered muscle. They work together to help flex, twist, and side bend the torso.

  1. Rectus Abdominis: The most central and superficial layer of the abdominals. Rectus Admoninis runs vertically down the mid section. Its segmented muscle fibers are what give you the washboard look. It originates on the pubic bone and attaches below the sternum to the 5th-7th ribs.
  1. External Oblique: The next layer beneath Rectus Abdominis is the External Oblique. Originating along the side of the torso and the lower eight ribs, it runs down at an angle to attach to the front the pelvic bone. The External Oblique, unlike Rectus Abdominis, is a broad and flat segment of the abdominals.
  1. Internal Oblique: This thin segment lies deep and perpendicular to the External Oblique. It originates along the front of the pelvic bone and attaches to the lower three ribs and its surrounding fascia.
  1. Transverse Abdominis: As the deepest layer of the abdominals, the Transverse Abdominis runs horizontally across the midsection. It originates along part of the hip bone, the lower six ribs, and surrounding fascia to attach along the midsection line known as the Linea Alba.

Rectus Abdominis        External Oblique    Internal Oblique      Transverse Abdominis

Rectus AbdominisExternal ObliqueInternal ObliqueTransverse Abdominis

This unique criss-crossing configuration provides plenty of support for the spine and the organs of the abdominal cavity. The abdominals are instrumental in both normal and forced exhalation and provide plenty of exerting power in actions such as vomiting, defecation, and urination.

Quadratus Lumborum: Often referred to as the Q.L., this muscle is considered by many to be a low back muscle when in reality it’s one of the deepest muscles in the abdomen. The muscle originates along the back of the hip bone and attaches itself to four of the five lumbar vertebrae and the 12th rib. Q.L. is also known as a “hip hiker” muscle for its ability to lift or tilt the pelvis side to side. Its other actions include extension of the spine, and aiding in forced exhalation.

Psoas & QL

Psoas: This deep hip flexor muscle is often referred to as the Iliopsoas. The reason for this, is that part of its muscle fibers blend with another muscle that lines the inner side of the pelvic bone called Iliacus. Since both perform virtually the same function, they’re often referred to together.

The Psoas lies deep to the viscera of the abdomen. It originates along the lumbar spine and travels down to the pelvis where it blends with Iliacus. From there the two muscles descend past the groin to attach on the inner part of the femur.

The main actions of the Psoas are to flex the hip, laterally rotate the hip (turn leg outward), and adduct the hip (bring leg in, closer to the body). It also helps to raise the upper body into a seated position when lying down. The Psoas is a major player in stabilizing the hips and the low back and is an often an overlooked cause of low back pain when trigger points are involved. If you have pain or difficulty standing up straight, the Psoas may be to blame.

Quadriceps: As the name implies, the Quadriceps are made up of four individual heads which cover the front, outer, and part of the inside of the upper leg. They’re the biggest and most powerful muscle in the human body. Their main function is knee extension. The bulgy part of the muscle that runs down the front of the thigh is known as Rectus Femoris. The other three heads are named for their position in relation to the femur. Vastus Lateralis covers the lateral or outer part of the thigh. Vastus Medialis covers the medial or inner part of the thigh. And Vastus Intermedius, the deepest layer of the Quads, lies beneath the other three heads.

QuadsVastus Intermedius

The Quad, namely Rectus Femoris, is also capable of hip flexion. Anatomically however, Rectus Femoris is the only head of the Qaud to cross the hip joint. The other three heads originate on the femur but do not actually cross the hip joint. All four heads however converge into one tendon to cross over the knee joint.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Let’s move on to some of the major muscle groups found in the front of the body. In this post we’ll discuss the location and action of four muscles: Pectoralis Major, Pectoralis Minor, Biceps Brachii, and Serratus Anterior.

Pectoralis Major: The “Pecs” as they’re collectively known are the large, broad muscle of the chest. Its muscle fibers are divided into three segments: upper (clavicular), middle (sternal), and lower (costal). All three segments help to: adduct the shoulder, medially rotate the shoulder, and aid in forced inhalation by lifting up the ribcage. Its upper and lower segments however are capable of performing opposing actions. The upper fibers can flex and horizontally adduct the shoulder, while the lower fibers can extend the shoulder.

When the Pecs are tight they can create a whole host of undesirable side effects. Tight Pec muscles can pull the shoulders forward putting the muscles of the upper back on a perpetual stretch. This can lead to a rounded shoulder posture and can force the head and neck to pitch forward, creating a further postural imbalance. This upper crossed posture has been known to compress nerves, constrict blood vessels, restrict breathing, and lead to chronic head, neck and jaw pain.

Pectoralis Minor: Underneath Pec Major lies the smaller Pec Minor muscle. This muscle originates along ribs 3-5 and converges upward to attach on a part of the scapula known as the coracoid process. As a result Pec Minor acts predominantly on the scapula. It serves to: depress the scapula – moving downward along the ribcage, abduct the scapula – moving it away from the spine, and tilt the scapula anteriorly – shifting the scapula forward. Pec Minor also assists Pec Major in forced inhalation.

A tight Pec Minor can also contribute to a rounded shoulder posture. More importantly it can constrict the major blood vessels and nerves that supply the arm due to its direct placement over them. This type of neurovascular compression can lead to shooting nerve pain, numbness and tingling, and weakness of the arm and hand.

Front of Body

Biceps Brachii: Just about everyone knows where their Biceps are. From an early age when we’re taught to “make a muscle”, we automatically flex our Biceps. And as the name implies, the Biceps consist of two muscle bellies – the long head, which is the outermost belly and the short head, which lies closest to the chest.

Both heads of the Biceps help to: flex the elbow, flex the shoulder, and supinate the forearm – that is, turn the forearm so the hand is face up. The Biceps also play a big part in stabilizing the shoulder joint. Without the biceps, the shoulder joint would not be able to maintain any significant weight without being pulled apart.

We rarely feeling pain along the Biceps themselves, but when they’re in trouble, fully extending the elbow with hand face down can be difficult and painful. Trigger points in this muscle will most often refer pain to the front of the shoulder joint and along the elbow crease.

Serratus Anterior: Although not as well known as the Biceps, Serratus Anterior is often very well developed in superheroes. Yes, superheroes! Located just below the armpit along the side of the ribs, its serrated ends are distinctly outlined in some of our most beloved action heroes. One end of the muscle attaches to the underside of the scapula, while the other end attaches to the upper nine ribs. It’s this small portion of the muscle which is actually visible, most of it lies hidden beneath the scapula, the Lats, and Pec Major.

Serratus

Despite its placement, Serratus Anterior is a shoulder muscle. It serves to abduct and depress the scapula. It also helps to stabilize the scapula and aid in forced inhalation. Runners may be familiar with the all too common “side stitch” pain, which can result from a spasming of this muscle.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In the last post we covered four key, well-known, yet superficial muscles of the back and arms. In this post, we’ll delve a little deeper into the musculature to discuss four other key muscle/muscle groups which lie deeper to these muscles.

Erector Spinae: You may not know them by name, yet they are one of the most distinguishable muscle groups of the back. Located on either side of the spine, the Erectors are a densely layered group of muscles that run from the hip bone to the back of the head. Their mound shape appearance creates a natural trough between the spine and the closest of their muscle fibers. You can see a segment of them on the right side of the back where the superficial muscles have been reflected in the image below. Although they are partially hidden beneath the Trapezius and the Lats, they are still considered a superficial muscle group because there is yet another layer of spinal muscles beneath them!

There are three layers to the Erector Spinae (not distinguishable in the image below):

Spinalis, Longissimus and Iliocostalis — the former being closest to the spine and the latter being farthest away. As a whole, the Erectors are a postural muscle group helping to keep your spine erect and providing balance for the upper body. Their main function is to laterally flex the spine to either side and extend the back bilaterally. They’re also involved to some extent in actions involving forced exhalation, such as coughing and sneezing.

Rotator Cuff Muscles: There are four individually named muscles that comprise the rotator cuff muscles. Each one originates and covers an area of the scapula and attaches to the very top of the Humerus in the shoulder joint. Each muscle performs its own action, which helps to mobilize the shoulder and arm. The three visible rotators in the image below are: Supraspinatus, Infraspinatus and Teres Minor. The fourth rotator cuff, Subscapularis, is located on the front side of the scapula and is therefore not visible.

1. Supraspinatus: Hidden beneath the upper fibers of the Trapezius, Supraspinatus helps to abduct the shoulder and stabilize the shoulder joint.

2. Infraspinatus: Below Supraspinatus and partially hidden beneath the lower fibers of the Trapezius, is Infraspinatus. This muscle is capable of performing several actions.

  • Lateral rotation of the shoulder
  • Adduction of the shoulder
  • Extension of the shoulder
  • Horizontal adduction of the shoulder
  • Stabilizer of the shoulder joint

That’s quite a workload for one muscle. Its key action however is lateral or outward rotation of the shoulder. Without this action, you would not be able to raise your arm above your head!

3. Teres Minor: Although similar in name and in close proximity to Teres Major, Teres Minor is a complete synergist to Infraspinatus. That is, it basically assists Infraspinatus in all its actions.

4. Subscapularis: This last rotator cuff muscle covers the front side of the scapula. Due to its placement, only a small portion of the muscle is truly accessible and palpable along its lateral border. This muscle is an antagonist to Infraspinatus. It medially rotates the shoulder and stabilizes the shoulder joint.

Back Muscles

Rhomboids: Located between the medial border of the scapula and the upper thoracic vertebrae are the Rhomboids. Named for their geometric shape, they are segmented into major and minor fibers but perform the same actions.

  • Adduction of the scapula (moving it closer to the spine)
  • Elevation of the scapula
  • Downward rotation of the scapula
  • Stabilizer of the scapula

Actions that require moving the shoulder and arm back behind the body, such as throwing a ball or rowing a boat, can easily over tax these muscles. The military stance with the spine erect, chest forward, and the shoulders back, require the Rhomboids to fully engage.

Levator Scapula: This next key muscle originates on the side of the cervical spine and twists its way down to attach itself on the upper portion of the scapula. Levator Scapula is mostly hidden under other muscles but is easily palpable and accessible. You may not have heard of this muscle by name, but when it spasms it will prevent you from turning your head to the side. This is another muscle which is capable of performing several actions.

  • Elevation of the scapula
  • Downward rotation of the scapula
  • Lateral flexion of the head/neck
  • Rotation of the head/neck to the same side

 As a pair they help to extend the head and neck back. This is one of those muscles that can be easily over taxed and cause a lot of issues for many people. It’s most vulnerable action is elevation of the scapula. People who are prone to anxiety, emotional distress, or high levels of stress may find their shoulders held up high, forcing this muscle to be in a perpetual state of contraction. Other factors such as poor postural habits, side sleeping without proper support, craning the head and neck, or even heavy backpacks can all cause trouble for this muscle.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

We have close to 320 pairs of muscles in the human body. That means we have a staggering 640 named muscles in total throughout the body! Up until the 18th century however, muscles were not given a nomenclature but assigned a number as a way of identifying them. Two anatomists by the name of William Cowper and James Douglas are credited for changing this.

Some muscles are better known within the context of a group, such as: the rotator cuff muscles, the hamstrings, and the quadriceps. But in fact, each of these muscle groups contain four individually named muscles. While it’s not important to know every named muscle in the body, there are key muscles and muscle groups that everyone should be familiar with. The first part of this article will focus on four of the key muscles depicted in the diagram. We’ll cover these superficial and easily accessible muscles first before delving into the slightly deeper layers of muscle beneath them in part two.

Back Muscles

Trapezius: One of the most superficial of the upper back muscles. The “traps” as they’re often referred to are a flat, shawl-like muscle that cover the back of the neck, tops of the shoulders, and middle of the back. When you place your hands on top of someone’s shoulders to give them your best shoulder rub, you’re predominantly grasping the upper fibers of the trapezius. The word “trapezius” is Greek for “small table,” which reflects its four-cornered shape (the right trapezius in the diagram has been removed to show the deeper layers). The muscle is segmented into upper, middle and lower fibers, each capable of performing several actions. All segments of the muscle perform retraction of the shoulders as their main function.

The upper fibers perform:

  1. extension of the head and neck
  2. lateral flexion of the head to the same side
  3. rotation of the head and neck to the opposite side
  4. elevation of the scapula
  5. upward rotation of the scapula/arms

The middle fibers perform:

  1. stabilization of the scapula

The lower fibers perform:

  1. depression of the scapula
  2. upward rotation of the scapula/arms

The upper traps play a big role in supporting the weight of the head and neck during all its movements. So poor postural habits that keep the head and neck pitched forward can greatly over-tax these muscles. The middle traps are strong stabilizers of the scapula when we have our arms out in front of us.

Deltoid: Much like the trapezius, the deltoids are also a segmented muscle which cover the outer shoulder like a cap. The name comes from the Greek letter “delta” which resembles the shape of a triangle. The deltoids have an anterior, lateral, and posterior set of fibers. It’s for this reason that they’re usually referred to in the plural form, “deltoids.” Also like the traps, each segment is capable of several actions. All fibers, especially the lateral fibers, perform abduction (moving the arm up and away from the body) as their main function.

The anterior fibers perform:

  1. flexion of the shoulder
  2. medial rotation of the shoulder (moving the arm into the “handcuff” position)
  3. horizontal adduction of the shoulder (with the arm out in front, moving the arm across the front of the body to the opposite side)

The posterior fibers perform:

  1. extension of the shoulder
  2. lateral rotation of the shoulder (with the elbow bent, moving the arm into a “stop sign” position)
  3. horizontal abduction of the shoulder (with arm out in front, moving the arm away from the body)

Triceps Brachii: As the name implies, the triceps have three individual heads: long, medial & lateral. Each of these heads originate on a different part of the arm but ultimately converge into a thick tendon at the elbow. Since they’re the only muscle found at the back of the upper arm, they’re the muscle solely responsible for straightening out the elbow (extension). The head closest to the body, the long head, is also capable of extending the arm back and moving it in close to the body (adduction).

Latissimus Dorsi: The “Lats” as they’re commonly referred to are the broadest of the back muscles. Their name translates into “broad back muscle.” In bodybuilders, well-developed Lats will give the trunk a “V” shaped appearance. Considered a superficial and easily accessible muscle, the Lats originate along the low back, then fan upwards along the sides of the trunk where they insert into the upper arm. Surprisingly, the Lats do more to move the arm than they do the back. Their main functions include:

  1. extension of the arm/shoulder
  2. adduction of the arm/shoulder
  3. medial rotation of the arm/shoulder

Another muscle worth noting along with the Lats is muscle called Teres Major. The muscle originates along the outside of the scapula and then blends in with the Lats to attach at the same point. Teres Major which translates into “big, round muscle” is often referred to as “Lat’s little helper,” as it’s a complete synergist with the Lats — that is, it performs the exact same movements. Although the Lats do perform one vital function, which Teres Major does not: forced exhalation. Due to its placement, its broad muscle fibers can compress the trunk to aide in quick respiration. The best way to remember their collective actions however is to think of them as the “handcuff muscles.” In order to get your arms behind your back as if to be arrested, both the Lats and Teres Major must contract.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

What is considered good posture? According to the Physical Therapy Dictionary, good posture is defined as “the state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which the structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded the thoracic and abdominal organs.” By contrast, the American Academy of Orthopedic Surgeons defines poor posture as “a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.”

To better understand the implications of this, let us consider how the position of the head can have an effect on the muscles of the neck and shoulders. The average human head is said to weigh approximately 10-11lbs. When it rests squarely upon the neck and shoulders, the weight is translated down the spine placing little to no strain on the muscles of the head and neck. According to physiatrist Rene Cailliet, MD, the weight of the head is effectively increased by a factor of ten for every inch of displacement. If your head pitches forward by 2 inches for example, you’re essentially adding an extra 20lbs of pressure to the surrounding structures! Doing so places the muscles of the neck and shoulders under tremendous strain. Research has shown that faulty postures can lead to bone and soft tissue changes, which in turn can create a whole host of other issues — such as chronic neck & shoulder tension and headaches.

The spine is made up of 33 individual vertebrae. Nine of these vertebrae fuse together through a process known as ossification by the time we reach adulthood – 5 in the Sacrum (S1-S5), and 4 (sometimes 3-5) in the Coccyx or tailbone. That leaves 24 moveable vertebrae: 5 – cervical, 12 – thoracic, and 5 –lumbar. The spine has what is known as primary and secondary curves. Primary curves are the curves in the spine that we’re born with; namely the thoracic and sacral curves. These curves are formed in the developing fetus and are structural in nature. Secondary curves on the other hand are formed in response to muscle strengthening and develop a little bit later. The cervical curve for example takes shape as the newborn learns to lift his/her head. The lumbar curve develops after this as the child begins to sit up. Because of the nature of secondary curves, they are more susceptible to being over and underdeveloped, and as a result can lead to faulty postures. Let’s take a look at some examples.

The first image in the diagram below depicts what is considered “good posture.” The plum line suspended along side the lateral view of the body serves a reference point for the head, shoulders, hips and feet. As you can see in the first image, the head sits squarely on the shoulders so that the ear is in front of the line. The shoulders are then evenly aligned with the plum line so that they don’t round too far back or too far forward. Make note of the gentle curves in the spine in relation to the faulty postures. When we get down to the hips, we see a natural tilt that is approximately 30 degrees. This is considered normal. An anterior pelvic tilt will show an increase of more than 30 degrees and posterior pelvic tilt will show a decrease of less than 30 degrees. As the line continues down to the feet, we can see that the anklebone sits just behind the plum line.

Faulty Postures

As we move on to the various types of faulty postures, we must first consider the degrees to which these deformities take shape. There are three classifications of postural deformities.

1st degree deformities: Also known as postural or functional deformities. These variations in posture are a result of muscle imbalances. There are no structural or boney changes and the person can self correct.

2nd degree deformities: Also known as transitional deformities. These are also due to muscle imbalances formed from soft tissue contractures. There are no structural or boney changes, but because these have become so entrenched, the person cannot self correct.

3rd degree deformities: These deformities are structural in nature. There are definite boney changes, which are congenital in nature or born out of degenerative changes. A person cannot self correct.

Faulty Postures

A) Here we see a relaxed faulty posture. Notice the increased angle of the pelvis. This is considered a 1st degree deformity and through strengthening of key muscle groups and postural re-education, this type of posture can be corrected.

B) A kyphosis is the result of an exaggerated, posterior curve of the thoracic spine. There are two different types:

  1. Kyphosis Arcuata: This considered a 1st degree deformity. Both the shoulders and the upper back are rounded forward. The front of the shoulders are rolled inward and the head and neck pitched forward. Poor postural habits as well as psychogenic causes (i.e. emotional and psychological) can lead to this muscle imbalance of the upper body.
  2. Kyphosis Angularis: This is considered a 3rd degree deformity. Also known as a “hunchback” deformity. This exaggerated posterior curve of the thoracic spine is often caused by osteoporosis or Pott’s disease – a tuberculosis of the spine.

The counterpart to a kyphosis is a lordosis. A lordosis is an increased or exaggerated anterior curve of the lumbar spine. This means that the forward tilt of the pelvis is greater than 30 degrees. This is considered in most cases a 1st degree deformity. Some common causes could include obesity, pregnancy, or some form of muscle imbalance due to poor postural habits.

C) A sway back posture occurs when the angle of the pelvis is greater than 30 degrees and there is a forward shift of the pelvis, forcing the hip joint into hyperextension. As a result, a long kyphosis of the thoracic and upper lumbar spine develops. Considered a 1st degree deformity, this posture is usually the result of a muscle imbalance due to poor postural habits.

D) A flat back is the result of a posterior pelvic tilt (less than 30 degrees) which flattens out the normal curve of the lumbar spine. If not addressed properly this first-degree deformity, caused by a muscle imbalance and poor postural habits, can lead to a flattening of the thoracic spine.

E) A round back posture can either be a result of a kyphosis arcuata or a kyphosis angularis. In this representation, a flat back in the lumbar spine accompanies a kyphosis of the upper back. The angle of the pelvis is less than 30 degrees creating a roundness to the back. Notice the angle of the upper back in relation to the kyphosis represented in B. Notice also how the knees and lower legs are hyper extended.

Scoliosis: Another deformity of the spine not represented in the diagram is what’s known as a side bending or lateral curve of the spine – a scoliosis. A scoliosis can develop in the cervical, thoracic and lumbar segments of the spines. If the scoliosis occurs in only one part of the spine, it’s referred to as a “simple curve” or “C curve.” On occasion it can develop in several parts of the spine creating a “double/compound curve” or “S curve.”

There are two primary types of scoliosis. A postural scoliosis is considered a 1st degree deformity and is often the result of a muscle imbalance. An idiopathic scoliosis has no known cause, is considered a 3rd degree structural deformity, and is the most common form.

Developing good posture

For most of us, developing good postural habits can be a bit of a challenge. Some habits have become so entrenched and so much a part of who we are, that changing them will require some work. But the benefits are well worth the price.

Tight, contracted muscles have a way of restricting oxygen and nutrient rich blood flow to our cells. As a result, metabolic waste can accumulate in the tissue creating pain and imbalance. Chronically contracted muscles also burn up more energy and place an undue strain on the joints of the body. Over time these conditions can lead to illness, fatigue, and arthritis. Let’s not forget the psychological effects our posture plays in our lives. Walking around with our shoulders and our heads hanging low may initially be a way of coping with social anxiety or poor self esteem, but over time these postural habits can actually influence our state of mind. On the other hand, walking with our shoulders back and our heads held high has a way of creating and conveying confidence.

It all starts with awareness. Developing a certain amount of body awareness is crucial for any kind of change to occur. How many of us walk around stiff as a board and completely tense…without realizing it?! Check in with yourself a couple of times a day. Doing so will train your mind to catch moments of tension and contraction in the body before they set in below the level of awareness. Taking a break from the computer or office desk to get up and move around is a great way of doing this.

Exercise is the great equalizer. Whether it’s a full blown work out at the gym or a 20min walk in the park, getting your heart rate up and your body moving is a great way of breaking up stagnant energy and increasing blow flow to your muscles. And the powerful practices of yoga, tai chi, and Pilates can all help strengthen and stretch key muscle groups and create balance in our bodies.

Here are a few other tips to keep in mind.

When standing:

  • Make sure your feet are shoulder width apart
  • Keep the weight of your body on the soles of your feet
  • Keep your shoulders square with your body
  • Pull your head back and tuck in your chin
  • Stand so that your spine is erect, your head rests comfortably on your shoulders and your arms hang loosely by your side

When sitting:

  • Sit up straight with small of your back pressed up against the back of your chair (doing so will help prevent slouching)
  • Adjust the armrests on your chair so that your arms rest comfortably at an angle of 75-90 degrees
  • Both feet should rest on the floor so that your knees are bent at approx a 90 degree angle
  • If you’re in front of a computer, make sure the monitor is placed at comfortable viewing distance to prevent eye fatigue and neck strain. Avoid angles that force your head to pitch up or down or crane to the side. Using ergonomically designed keyboards and chairs are a great way to start.

With the advent of social media and mobile devices, we now have a tendency to constantly be looking down at our phones and tablets to check emails, update our facebook page, send texts and tweets, etc… This is creating unprecedented amounts of head, neck, and shoulder issues. To avoid making this potentially harmful and rudimentary mistake, always make sure to hold your device UP so that it’s at eye level. And don’t forget to breathe….


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In this article we’ll consider the various manifestations of hip pain and what could be at the root of some of these aches and pains. But first we’ll need an understanding of the anatomical structure of the hip itself.

Each hip bone is comprised of three smaller bones: the ilium, the ischium, and the pubis. At birth these three bones are joined together by cartilage. By the time we reach our mid-twenties, they fuse together through a process known as ossification. The two hip bones are joined together by the sacrum and coccyx to form the pelvis.

The sacrum is also formed by unfused bones, namely five vertebrae, which begin to ossify by our late teens. The tail end of the sacrum, or what’s known as the tailbone or coccyx, is formed by 3-5 boney segments. Together these two bones join the two hip bones into what’s known as the sacro-iliac joint (SI joint).

Hip

All the bones of the pelvic girdle are held together by strong fibrous ligaments. The weight of the upper body rests on top of the pelvis and is then transferred diagonally into the hip sockets and down the legs. Although the SI joints are limited in movement, the two hip bones are designed to rock forward and backward independently of one another as we walk. On occasion the SI joint can get locked in place, whether due to injury or constant tension in the hip muscles, and prevent the natural movement to transfer up the spine. Since each hip bone can move independently of one another, it’s also possible for them to get locked into an anterior or posterior tilt, creating a leg length discrepancy.

The hip is capable of six different movements: flexion, extension, abduction, adduction, medial and lateral rotation. The hip joint is considered a ball and socket joint, which affords it the unique ability to move on so many planes. As mentioned in a previous post, there is what’s considered a normal degree of movement or “range of motion” for each plane.

Flexion:           80-90 deg w/extended knee — 110-120 deg w/flexed knee

Extension:      10-15 deg

Abduction:      30-50 deg

Adduction:      30 deg

M. Rotation:   30-40 deg

L. Rotation:    40-60 deg

Each movement in turn is performed by a series of muscles. Some of these muscles are known as primary movers, while others are known as synergists – that is, they assist the primary movers in their function. Flexion is done with a total of 10 muscles, extension – 6 muscles, abduction – 5 muscles, adduction – 6 muscles, medial rotation – 6 muscles, and lateral rotation – 8 muscles. When the hip is functionally optimally, all these muscles and joints work free of pain and with a normal range of motion. But as we’ll see, age, injury, and normal wear and tear are just some of the factors which can contribute to hip pain.                                  

Hip Injuries and Conditions

Of the many muscles that cover the hip and allow it to function, there are a number of them that also cross over into the low back and down into the legs — any of which can become strained. There are also a number of ligaments and bursa (fluid fill sacs) in and around the hip which can become lax or inflamed due to overuse. The exact placement of the pain therefore becomes an important factor in determining what the source of the pain could be. Here are several of the most common forms of hip pain. (For nerve pain that affects the hip, see a previous post on sciatica).

Anterior/Medial (Front & Inside) Hip Pain:

Adductor Strain (aka: Groin or Rider’s Strain)

The adductors are a group of five individual muscles located on the inner part of the thigh that move the hip and leg towards the midline of the body. Pain associated with an adductor strain will present itself as a sharp, stabbing pain in the groin area. An injury to any of the muscles that originate on the pubis is the most common cause. Irritation of these muscles can also lead to inflammation. On occasion, bruising and swelling may occur several days after the injury. If not addressed properly, an injury to any of these muscles can lead to chronic pain. Abduction of the hip (swinging the leg away from the midline of the body), will stretch adductors and elicit the pain.

Quadricep Strain (aka: Rectus Femoris Strain)

The quadriceps muscles are found along the front, inner and outer parts of the upper leg. They are considered primary movers in knee extension. The quadriceps get their name from the fact that there are four individual heads. Only one of these heads however crosses both the knee joint and the hip joint – that muscle is called rectus femoris. It is the most central head of the quadriceps and by far the most commonly injured. This is due in part to the fact that it contracts both concentrically and eccentrically, and is the only head of the quadriceps which assists in hip flexion. As a result it can become easily fatigued and overused in sports involving kicking, cutting (side to side), and start & stop movements.

Pain is usually felt in the front and inner parts of the thigh where the muscle originates on the hip. With first degree or mild strains, your gait will not be affected – but it will be with more severe strains. Stretching the muscle by flexing the knee and extending the hip will elicit the pain, as will contraction of the muscle through hip flexion and knee extension.

Iliopsoas Strain

The iliopsoas is considered a strong hip flexor and primary mover in hip flexion. In reality, the iliopsoas muscle is actually two muscles — the psoas and the iliacus. The psoas originates along the lumbar spine and the iliacus along the front of the pelvic bone. They blend together to cross the hip joint and attach on the femur. Pain from an iliopsoas strain will be felt in the groin area – that is, the front and inner part of the thigh. In severe strains it may be difficult to stand up straight without causing pain. The iliopsoas is most commonly injured when the hip is forced into extension from a maximally flexed position.

Since the muscle attaches itself along the inner part of the femur, abducting the hip (swinging the leg out), extending the hip or internally rotating the leg will stretch the muscle and cause pain. Contracting the muscle through hip flexion will also be painful.

* Pain associated with any pathology of the hip joint itself is typically felt in the groin and antero-medial aspect of the thigh.

Posterior (Back) Hip Pain:

Hamstring Strain

The hamstrings consist of 4 individual heads located along the back of the thigh. Three of these heads cross both the hip and knee joints – two along the medial aspect of the thigh and one along the lateral aspect of the thigh. The 4th head is found along the lateral aspect of the thigh but does not cross the hip joint. The lateral head that does cross both joints is known as biceps femoris. It is this part of the hamstrings that’s most commonly injured.

Since three of the hamstrings including the biceps femoris originate on the ischial tuberocities (aka: your sitz bones), the pain associated with a hamstring strain is usually felt at this insertion point. The hamstrings can also be injured at their insertion points on the inner and outer aspects of the knee, but more often than not the pain will start at the sitz bones and radiate down the leg. If not treated properly, a hamstring injury can become a chronic problem.

The hamstrings are primarily involved in hip extension and knee flexion. They’re also involved in medial and lateral rotation of the leg. They’re most commonly injured in sports involving running, kicking, or any activity that suddenly over stretches them. The pain can be exacerbated by sitting, fast running or stretching.

Ischial Bursitis

Located between the sitz bone and the gluteus maximus is a small fluid filled sac known as a bursa. Bursa are found around the joints of the body. They provide cushioning and reduce the amount of friction muscles and tendons exert as they glide over the boney prominences of a joint. The ischio-gluteal bursa as it’s known can become irritated from prolonged bouts of sitting – although this is not usually the cause of inflammation. This inflammation can on occasion irritate the sciatic nerve and cause pain down the leg.

The pain resulting from ischial bursitis however is pin point and con-scribed to the area around the sitz bones. It can come on suddenly and make sitting or sleeping on the affected side rather painful. Coughing, sneezing or any bearing down can exert pressure on the bursa and cause pain. People with ischial bursitis will often shorten their stride as they walk or lean away from the affected side while sitting to help alleviate the pain.

Lateral (Side) Hip Pain:

Abductor Strain

The most commonly strained muscle in an abductor strain is the gluteus medius muscle. Located on the outside of the hip, the gluteus medius is partly buried beneath its bigger brother — gluteus maximus. The other half of the muscle is superficial and easily felt along the pelvic bone toward the lateral and anterior aspect of the hip. The gluteus medius does a little of everything. Its primary function is hip abduction (swinging the leg out), but segments of this muscle are also involved in  flexion, extension, and medial and lateral rotation.

One of the most important functions of this muscle is stabilization of the hip. As the weight of the body shifts onto each leg as we walk or run, the gluteus medius must contract and exert enough force equal to twice our body weight! If this key muscle becomes weakened or strained from overuse, it will loose its ability to stabilize the hip and allow it to buckle while weight bearing.

There are several factors which could strain this muscle. Being overweight can exert more pressure over this muscle than it can bear. A cross-over gait or running on banked surfaces can also overload this muscle. Over time the weakened side will force the opposite hip to drop and adaptively shorten, causing a functional shortened leg.

Pain from an abductor strain is felt along the lateral, outside aspect of the thigh. The pain can be particularly acute while running and often mimics the pain of trochanteric bursitis. Stretching the abductors by swinging the leg inward will cause pain, as will contraction of the abductors (swinging the leg out).

Trochanteric Bursitis

An inflammation of the three bursa found around the hip socket is known as trochanteric bursitis. The bursa can become inflamed due to arthritis, obesity, or a strain of any of the hip or lower back muscles. This in turn can lead to faulty postures and abnormal gaits. Shortening of these strained muscles can contribute to chronic tension along the hip socket and eventually irritate the bursa.

The pain from trochanteric bursitis can be a deep, dull pain or a sharp ache along the outside of the hip that extends down the lateral part of the leg. The pain is usually worse at night and can make it difficult to sleep on the affected side. A cross-over gait while running can lead to irritation of the bursa, as well as a leg length discrepancy or a pronated foot.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Myofascial release is a form of bodywork that helps to relieve soft tissue restrictions by engaging the layers of fascia within the body. The work usually involves slow, broad, deep strokes, with the use of little to no oil. The purpose of this is to create a certain amount of “drag” and resistance within the tissue, which can then be used to slowly release trigger points and other fascial adhesions. Some people find myofascial release very relaxing and highly effective. But in order to understand why, there are a few things we need to know about fascia.

The term “myofascial,” was first used by Dr. Janet Travell in the 1940’s in her work with trigger points. If we break down the word, myo means muscle and fascia means elastic band. In actuality, fascia is a thin layer of connective tissue that covers all the organs and muscles in the body. Think of it as a continuous web of tissue that connects all your muscles, organs, bones, blood vessels and nerves together. There are three layers of fascia within the body. The first layer is called “superficial fascia.” This topmost layer lies directly below the skin and subcutaneous tissue. The second layer, known as “deep fascia,” surrounds and is interwoven into the muscles, bones, blood vessels and nerves. The third and final layer is called “deepest fascia.” This layer is found within the dura of the cranium. If we stop to consider the fact that all three layers are connected to one another, then it’s easier to see how a myofascial stretch applied in one area of the body (i.e. the foot) has the potential to affect a very different area of the body (i.e the head).  In reality, releasing fascial adhesions in one area will affect tension within the whole fascial system.

Fascia is made up of collagen fibers suspended in a ground substance. Normal, healthy tissue will have a certain amount of extensibility and elasticity due to something known as “critical interfiber distance.” Collagen fibers must maintain a certain distance from one another or they begin to stick together and eventually form fascial adhesions. The ground substance, which holds these collagen fibers apart, does this by retaining water. Therefore the more hydrated it is, the better it is at maintaining this distance.

Another element of fascia, and the one that makes myofascial release effective, is something known as thixotropy. Thixotropy is a property of fluids and gels that allows them to become less viscous (less stiff) and more fluid when stress is applied. In the context of a massage, the depth and direction of the stroke is the stress which melts the fascial adhesion and makes the surrounding fascia more fluid. There are many factors which can affect the thixotropic nature of fascia. Injury, stress, and inactivity are just a few of the most common. Damage to the ground substance can lead to fluid depletion and a build up of metabolic waste, which can eventually lead to soft tissue restrictions.

Another important aspect of fascia is that, within this continuous system of connective tissue, are meridians or “trains” of fascia than run in very specific directions. In his book “Anatomy Trains,” Thomas Myers describes several meridians that run at various lengths throughout body, stopping at boney landmarks along the way. Myers lists 11 distinct meridians that criss-cross the body from different angles. But for the sake of this article, we’ll take a look at two.

The image below is depicts the “superficial back line” or SBL. The “tracks” run from the plantar surface of the feet, up the back of the legs, into the glutes, along the spinal muscles, and around the top of the head to your forehead. The “stations” are the boney prominences the fascia runs over. In this case it’s the heel bone, sitzs bones, sacrum, skull, and brow ridge.

SBL_0001

This second image shows the “superficial front line” or SFL. See how it runs from the tops of the feet to the backs of the ears.

SFL_0001

These meridians clearly illustrate how a muscle strain or adhesion in one area of the body can create tension all along that fascial line. Myofascial release endeavors to meet that restriction and stretch it past its barrier to create a release. It’s normal for certain areas to be more tender or sore than others depending on how bound the tissue is. This can also be a sign of a trigger point, which can at times relay it pain signals along this fascial network. Freeing up trigger points and adhesions along these meridians can have a dramatic affect on the whole “train.”

One final note on this fascial network should help to underscore the continuity of the body as a whole. From a classical anatomy perspective, muscles and bones are given separate names and functions. Bones act as the struts and levers, and the muscles, tendons and ligaments as pulleys and stabilizers. However, due to the presence of this fascial network, the body act more like a “tensegrity” structure than anything else. The word tensegrity is a combination of the words “tension” and “integrity.” It describes a structural unit whereby its integrity is created by an even distribution of tensional forces throughout the system. So your skeletal bones are no longer viewed as the framework your whole body rests upon, but rather, as “spacers” “floating” within the body. This radical perspective is more in line with how the body truly acts than the conventional machine-like paradigm we’ve grown accustomed to. So this means that tension (whether traumatic or therapeutic) applied to an area of the body will be absorbed and distributed throughout the whole body. It kind of makes you wonder what’s really causing that headache or pain in your foot…


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Chances are we’ve all experienced the painful effects of a muscle cramp. Some can be mild and annoying and others can stop us dead in our tracks. Whether we’re out for a jog in the morning, sitting at our desks at work, or sound asleep in the middle of the night, muscle cramps can strike suddenly and without warning. So what exactly causes a muscle cramp? What are some of the risk factors that predispose us to cramps? And what can be done to break a cramp when it occurs?

A cramp is an involuntary and sustained muscle contraction that can last anywhere from a few seconds to a couple of minutes. Commonly referred to as a “Charley Horse,” these sudden and painful spasms cause a noticeable hardening and bulging of the affected muscle(s), and can at times leave some residual soreness once they’ve passed. It’s not uncommon for a cramp to strike multiple times before it’s completely resolved. Let’s take a look at the different types of cramps and what’s behind them.

Types and Causes

Muscle cramps can occur anywhere in the body. True cramps, as differentiated from tetany, dystonic cramps, or even smooth muscle cramps (i.e. menstrual cramps), are cramps that affect voluntary skeletal muscles. Some commonly affected areas include the hands, ribcage, abdomen, thighs, calves, and foot muscles.

Cramping that occurs during or after exercise or physical activity is considered a fairly normal occurrence. Muscle fatigue and over-exertion, such as in writer’s cramp or long distance running, are the likely culprits in cases such as these. But more often than not, the exact cause may be hard to identify since there are so many contributing factors. Here are some other leading causes:

  • Chronic muscle tension
  • Poor circulation
  • Dehydration
  • Overuse
  • Injury
  • Vitamin deficiencies
  • Drug side effects
  • An overly facilitated nervous system
  • Myofascial trigger points
  • Restless Leg Syndrome
  • Insufficient stretching before or after exercise
  • Increased levels of lactic acids and metabolites
  • Medical conditions such as: diabetes, cirrhosis of the liver, thyroid disorders, kidney disease, MS

A muscle spasm can develop in any of the voluntary muscle groups as a protective mechanism against further injury.

Repetitive use of certain muscles can lead to muscle fatigue, which in turn can cause cramping.

Resting cramps, such as those that occur while we’re sitting or lying down in awkward positions, are more likely to occur as we age.

Dehydration, either from a lack of proper hydration or excessive perspiration, can increase the chances of cramping due to sodium depletion; so can diuretics, which are medications that promote urination.

Severe vitamin deficiencies have also been associated with muscle cramping. B1, B5, B6, magnesium, potassium, and calcium are all important for proper muscle functioning.

Leg Cramps

Leg cramps, such those that affect the front and back of the thigh, as well as the calf and foot muscles, are usually at the top of the list of afflicted areas. Cramps that occur while walking or running can be the result of poor circulation caused by muscle tension in the lower leg. The gastroc/soleus complex, the two prominent muscles of the lower leg, is an integral part of the venous return to the heart. The soleus muscle in particular has the unique distinction of being called the “body’s second heart.” The reason for this is that the soleus contracts both while shortening and lengthening, making it very efficient at pumping blood back to the heart. If the muscle is chronically tight and shortened due to trigger points or poor conditioning, it can impede blood flow and therefore be an indirect cause of calf cramps.

Muscle tension on the top of the foot, whether due to tight footwear or trigger points in the interosseus muscles, can cause numbness, swelling and cramps on the top of the foot. The poor circulation resulting from this is likely to promote trigger points in the area.

Nocturnal leg cramps can also be the result of trigger points in the lower leg muscles. Vitamin deficiencies, such as magnesium and potassium, can be a significant factor in such cases. Calf cramps that occur in the later stages of pregnancy may be considered normal to some, but can often be the result of a calcium deficiency.

Poor circulation can lead to decreased levels of oxygen to the muscles. In some cases a condition known as claudication, which causes pain and/or cramping in the lower leg or thigh, is a result of inadequate blood flow to the leg. The pain is typically felt while walking or running, when oxygen is needed the most. It subsides while at rest and is sometimes referred to as “intermittent claudication” for that reason. Claudication can be a symptom of a more serious condition known as peripheral artery disease (PAD). Atherosclerosis, which is hardening of the arteries due to high cholesterol and an accumulation of plaque in the arteries, often begins in the arteries furthest from the heart. The pain associated with claudication however does not necessarily come from a muscle cramp, but from an accumulation of lactic acid and other chemical byproducts held in the tissue.

Cramp Relief

There are a few things that can be done when we’re in the throes of a cramp. Most of us will gently massage and/or stretch the affected muscle until the cramp subsides. This is an instinctual reaction to an acute attack of pain. And for most of us, is all that it takes. Here are some alternate ways of breaking a cramp.

Sustained compression: Hold the cramped muscle with steady pressure until it subsides. This is an especially good technique when dealing with multiple cramps.

Ice/Heat Application: The numbness caused by icing a cramped muscle will inhibit nerve impulses and help to break the cramp. Although it may take longer, it will aid in reducing post cramp soreness and may be a good option when a muscle cramps multiple times. Heat is also a great way of soothing and relaxing cramped muscles. A twenty-minute soak in a warm bath with Epsom salt or applying moist heat compresses should suffice.

Reciprocal Inhibition: Muscles work in opposition to each other. In order for one muscle group to contract, the opposing muscle group must relax. For example, in order for the calf muscles to flex, the shin muscles must relax and give to a certain degreee. This neuromuscular technique uses the inhibition naturally created in the opposing muscle group to stop the cramp. If the cramp occurs in the calf muscles, place the opposite (non-cramping) foot on top of the cramping foot to provide resistance, and try to lift your toes against the resistance. Flexing the shin muscles of the cramping leg against resistance will create reciprocal inhibition in the calf muscles. Although this technique is a bit more involved and requires some forethought, the relief it provides is often immediate and well worth the practice.

Muscle Spindle Approximation: This other neuromuscular technique uses a set of proprioceptive cells found in the belly of a muscle to provide relief. This technique is ideally suited for large, graspable muscles such as the quadriceps, hamstrings, and abdominals. Grasp either end of the cramping muscle and squeeze the ends together. If the quadriceps are cramping, grasp just above the knee with one hand and just below the pelvis with the other hand and bring the ends together.

Stretching: Although stretching is one of the most common ways of breaking a cramp, caution should be used as stretching during a severe cramp can make it worse. For lower leg/calf cramps, gently point the toes up and down until the cramp subsides. Stretching before and after exercise is an excellent way of reducing your chances of getting a cramp. For those who suffer from nighttime cramps, some gentle stretches before going to bed should be part of your routine.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Sciatica is commonly referred to as pain that affects the low back, hips, buttocks, and backs of the legs due to compression and irritation of the sciatic nerve. An injury or impingement of the sciatic nerve can lead to a neuritis (inflammation of the nerve), neuralgia (pain along the course of the nerve), or a radiculopathy (nerve root involvement). Although sciatica can sometimes be the result of a herniated disc, there are other causes and contributing factors that can cause or mimic symptoms of sciatica. Such factors may include postural deviations, piriformis entrapment, and trigger points in the gluteal muscles, all of which are fairly common causes of sciatic pain.

The sciatic nerve is considered the largest nerve in the human body. Segments of the nerve are formed between L4 & S3 in the sacral plexus. The nerve, which is actually comprised of two divisions — the peroneal and tibial, travels through the greater sciatic foramen of the pelvis, under the piriformis muscle, and down the back of the leg to the foot. The peroneal branch and the tibial branch travel down the back of the thigh together until they reach the back of the knee. At this point, the peroneal branch splits from the tibial branch and travels down the back of the lower leg, around the inner ankle to the bottom of the foot. The tibial branch, once at the back of the knee, will wrap around the fibula bone and bifurcate once again into two other branches – the deep peroneal nerve (DPN) and the superficial peroneal nerve (SPN). The DPN travels down the front of the lower leg between the shin muscles and the tibia to the top of the foot. The SPN will travel down the lateral or outside part of the lower leg.

Piriformis

With the exception of the front and inner parts of the thigh, the sciatic nerve innervates all the other muscles of the leg. This includes the hamstrings and all the lower leg and foot muscles. The femoral nerve operates the hip flexors, namely the quadriceps, and the obturator nerve controls the adductor muscles. Due to the sciatic nerve’s origin and wide distribution, it can cause pain and discomfort in the low back, sacro-iliac joint, buttock, hip, back of the leg, and foot.

Signs & Symptoms:

  • Symptoms may be insidious or have a sudden onset
  • Unilateral in presentation
  • Radiating pain that can extend from the low back and buttock area, down the back of the leg, and into the foot
  • Paresthesias (i.e. burning, pins and needles, numbness), weakness, and muscle spasms anywhere along the course of the nerve
  • Pain can be a constant, dull ache or a shooting pain down the back of the leg
  • Pain may increase while sitting and diminish while standing or lying down
  • Coughing or laughing may exacerbate the pain
  • Standing in antalgic position: Depending on the site of the irritation, a person suffering from sciatic pain may hunch over and to the side to help alleviate pressure on the nerve

Causes:

  • A disk lesion, such as a protrusion or herniation at L4-L5 or L5-S1. The disk pushes into the nerve root and sacral plexus causing a radiculopathy
  • Stenosis: a narrowing of the vertebral canal in which the nerve passes through
  • Postural deviations: An anterior pelvic tilt, such as one that occurs during pregnancy, can decrease the space in the sciatic notch through which the nerve passes through. A posterior pelvic tilt can shorten the muscles the sciatic nerve must travel under
  • Piriformis syndrome: When this hip muscle shortens and begins to spasm, it can put direct pressure over the nerve
  • Sitting for extended periods of time with an object in your rear pocket, such as a wallet, can put direct pressure on the nerve. This is known as “back pocket sciatica”
  • Trigger points in one of the gluteal muscles can mimic sciatic pain
  • Joint dysfunction of the lumbo-sacral area
  • Inflammation of the nerve due to an infection or tumor

Another predisposing factor in the development of sciatica is the course the nerve takes once it exits out of the greater sciatic foramen in the pelvis. This congenital variance may explain why some people are more susceptible to developing sciatica than others.

In a majority of the population, the two branches of the sciatic nerve will exit out of the pelvis, through the greater sciatic foramen, and under the piriformis. This is true in about 85% of people. In approximately 10% of the population, one branch of the nerve passes through the piriformis, and the other underneath. In yet another small percentage, approximately 3%, one branch passes over the piriformis, and the other underneath. And finally, in less than 1% of people, both branches pass through the piriformis.

If the sciatica is a result of piriformis involvement or trigger points in the gluteal muscles, the pain may be more conscribed and only reach as far down as the knee. In a vertebral impingement the pain may be more widespread, radiating into the back and all the way down to the foot in severe cases.

Glute Medius TP

Diagnosis:

A history of unilateral low back pain that extends down the back of the leg is usually the defining symptom. A CT scan or MRI may show a disc herniation in the lumbar spine if one is present. The straight leg raise test, also known as Lasegue’s Sign, can be performed to determine the origin of the pain. On occasion, the pain may be due to a glute or hamstring strain. Other times, the pain may be due to some pathology of the lumbar spine or sacroiliac joint. While lying flat on your back, one leg is passively raised until the pain is elicited. Sciatic pain usually presents itself between 35 – 70 degrees of hip flexion.

Treatments:

If the sciatica is a result of a disk herniation, infection, or tumor, you should consult a doctor as to the appropriate form of treatment.

Mild cases of sciatica will often resolve themselves over time. Ice and heat applications are a great way of addressing the inflammation and muscle spasms associated with sciatica.

Anti-inflammatories and muscle relaxants may be prescribed by your doctor to help manage the pain. And if the pain is particularly acute, steroid injections may provide relief for a period of time.

Women who develop sciatica during pregnancy as a result of an excessive anterior pelvic tilt, will find that their symptoms abate once they deliver and the pelvis returns to normal.

Those suffering from sciatica resulting from obesity or faulty postures, will find that losing the extra weight and strengthening key muscle groups in the low back and abdominals will help correct pelvic imbalances.

Sciatica caused from prolonged periods of sitting and/or back pocket sciatica is easily addressed and typically of short duration.

Those with piriformis syndrome and/or trigger points in the glute muscles can greatly benefit from direct massage to the muscles of the low back and hips. Trigger points in the piriformis can shorten and irritate this key muscle. These changes can cause the piriformis to place direct pressure over the sciatica nerve, which runs underneath it. Trigger points found in other gluteal muscles can often mimic sciatic pain. And although these muscles may not be directly over the sciatic nerve, their pain pattern is very similar to that of an entrapment – such as the one created by the piriformis. Targeted stretches in combination with massage will help to restore extensibility and length to these muscles and help alleviate the pressure over the nerve.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Frozen shoulder (FS) or adhesive capsulitis is a clinically diagnosed syndrome which affects the shoulder joint (glenohumeral joint), causing pain and a progressive loss of movement. Tissue changes and a low-grade inflammatory response can lead to a shrinking of the joint capsule, joint stiffness and immobility. The condition is self-limiting and in a majority of cases will resolve over a period of time.

Causes:

There are two primary forms of FS:

Primary FS: The most common type. This form of FS is idiopathic (of unknown origin) and is often caused by some unidentified stimulus.

Secondary FS: Often the result of some previous injury affecting the shoulder joint. Some common examples could include: direct trauma, fractures, surgery, arthritis, or infection. The disuse of the shoulder predisposes it to the pathological changes associated with the condition.

Incidence:

FS has been known to affect a certain demographic of the population:

  •  It primarily occurs between 40-70 years of age
  •  It usually affects the non-dominant arm
  •  Women are affected more often than men at a 2:1 ratio
  •  It’s most prevalent in insulin dependent diabetics

Pathological Changes:

1) With the disuse of the shoulder, the shoulder capsule shrinks; the synovial lining and surrounding tendons shorten and become inflamed.

2) Adhesions form in the capsule and in the surrounding rotator cuff muscles.

3) Eventually the humerus is drawn tightly into the thickened joint capsule and becomes attached to the bone.

4) The surrounding muscles become stiff and inelastic, preventing normal range of motion.

Signs & Symptoms:

  •  The onset is usually gradual
  •  Joint stiffness and immobility
  •  Pain is dull, constant, and aching
  •  Pain with movement of the shoulder (active or passive), most acute in midrange
  •  Pain is usually worse at night, especially if sleeping on the affected side
  •  Limited range of motion of the shoulder, especially external rotation. Activities such as brushing your teeth, combing your hair, or getting dressed become painful and     difficult
  •  Shoulder is usually held in a fixed position (internally rotated & adducted, w/ the elbow flexed)

Progression of the condition:

There are three stages to FS, each lasting approximately 6 months.

Freezing Stage: A painful, inflammatory stage characterized by constant shoulder pain and muscle spasms. During this stage the fibrosis of the joint is just forming. Limited ROM is mostly due to inflammation and spasms.

Frozen Stage: Pain is no longer constant at this stage. Resting pain begins to decrease and a dull ache is present during movement. There is however an increase in joint stiffness and a progressive loss of shoulder movement.

Thawing Stage: There is a gradual restoration of movement and a decrease in pain and discomfort during this stage. Functional activities return. ROM increases but some residual restrictions could remain.

Treatment:

During the freezing stage:

  • NSAIDS and analgesics are often used to manage the pain. In some cases, corticosteroids are used when pain is unmanageable
  • Pendulum exercises may be used to help traction the joint and aid in continued movement of the shoulder
  • Passive and active ROM exercises are used to help with the pain and prevention of adhesion formation
  • Massage around the joint capsule and rotator cuff muscles to help decrease muscle stiffness and pain

During the frozen & thawing stages:

  • Moist heat applications
  • Massage to hypertonic muscles and friction to adhesions in rotator cuff muscles
  • Gentle tractioning of the joint along with ice massage to rotator cuff tendons
  • Trigger point work and myofascial release to cervical, thoracic, and shoulder girdle muscles
  • Passive ROM along with gentle stretches

Due to the pathological changes in and around the joint capsule, it’s important to keep the shoulder muscles – especially the rotator cuff muscles – as flexible as possible. This includes doing passive and active ROM exercises, gentle stretches, ice & heat applications, and trigger point work to the surrounding muscles. Doing so can have a significant impact on pain management, mobility, and ultimately the expediency of  the condition. Towards the end of the thawing stage, physical therapy along with isometrics and other muscle strengthening exercises may be helpful in restoring the shoulder to full capacity.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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