Calm Waters Massage Therapy

INJURIES OF THE ACROMIOCLAVICULAR JOINT + SHEAR TEST A fall onto the shoulder or outstretched arm frequently causes dislocation of the acromioclavicular joint... and damage to the acromioclavicular ligaments. Ligament injury allows the lateral end of the clavicle to move independently of the scapula, causing it to appear upwardly displaced. The clavicle can be pushed down (with significant pain), but will spring back up when pressure is released (piano-key sign). Three grades of acromioclavicular separation can be distinguished clinically based on the degree of ligament damage (Toss classification). TOSSY I The acromioclavicular and coracoclavicular ligaments are stretched but still intact. TOSSY II The acromioclavicular ligament is ruptured, with subluxation of the joint. TOSSY III Ligaments are all disrupted, with complete dislocation of the acromioclavicular joint. Radiographs in different planes will show widening of the space in the acromioclavicular joint. Comparative-stress radiographs with the patient holding approximately 10kg weights in each hand will reveal the extent of upward displacement of the lateral end of the clavicle on the affected side. SHEAR TEST Purpose To test for acromioclavicular joint pathology or injury Technique Patient: sitting or standing with the arm dependent or in a neutral position on the lap. Clinician: standing adjacent to the patient. The heel of one hand is placed posteriorly over the spine of the scapula with the fingers pointing upwards; the other hand is positioned in a similar fashion anteriorly over the mid section of the clavicle. The fingers of both hands are then interlocked over the upper trapezius area of the shoulder. Action The hands are gradually squeezed together, imparting a shear stress through the ACJ created by the approximation of the clavicle and scapula. Positive test Localized pain over the ACJ or increased joint excursion are considered to be positive findings and are indicative of ACJ pathology or injury.

A great picture that may help you remember forearm anatomy.

THE BRACHIAL PLEXUS - INNERVATION OF THE UPPER LIMB The brachial plexus (plexus brachialis) is a somatic nerve plexus formed by intercommunications among the ...ventral rami (roots) of the lower 4 cervical nerves (C5-C8) and the first thoracic nerve (T1). The plexus, depicted in the images below, is responsible for the motor innervation of all of the muscles of the upper extremity, with the exception of the trapezius and levator scapula. See more

UPPER BACK PAIN CAN BE A RESULT OF PEC PROBLEMS ANATOMY FACTS The pectoralis minor muscle is located toward the outside of the chest. It attaches the 3rd, 4th... and 5th ribs to the front of the shoulder blade (coracoid process of the scapula). It pulls the shoulder and shoulder blade down and aids with inspiration by lifting the upper ribs so you can breathe in. PAIN PATTERN Pain in the front of the shoulder and upper chest is the most common symptom of pectoralis minor dysfunction. Pain can be due to a muscle tear/strain, repetitive stress injury, and trigger points. Rounded shoulder posture is a common sign of a shortened pectoralis minor muscle too. The muscle tightens and becomes short pulling the shoulders forward. Also pain in the upper back between the shoulder blades is often experienced due to the pec minor pulling the shoulders forward causing the upper back muscles to remain in an extended stretch. A band of pain just under the shoulder blades is also common. The pectoralis minor along with the scalenes, are known as neurovascular entrappers. Tight shortened pec minor and scalene muscles can put pressure on the axillary artery as well as nerves in the neck / shoulder area restricting circulation to the arm and causing symptoms such as numbness and tingling. So, the pectoralis minor muscle is a small muscle that can cause big problems. WHO IS AT RISK? People working with their arms out in front of the body. Using computers/laptops can put enormous strain on the pec minor if the arms are not properly supported. Sitting in a chair and reaching to use the keyboard rolls the shoulders forward and shortens the pec minor putting pressure on blood vessels and nerves that run under the muscle. People who have jobs or hobbies that require holding the arms up and overhead for extended periods of time can develop problems in the pec minor. Women with large breasts often experience shortened pectoralis minor muscles as well as the upper back pain caused by the shortened muscle and trigger points in the muscle. Carrying a heavy purse, or backpack can put pressure on the muscle cutting off circulation causing thoracic outlet syndrome symptoms of aching, numbness, and tingling. HOW TO STRETCH PEC MINOR? Try Towel Chest Stretch For this stretch, you will need a towel that is at least 3 feet long. Start with your arms hanging down at your sides and grasp the ends of the towel with your hands. Raise your arms over your head while keeping the towel taut. Stretch your arms behind your head as far as you can reach and pull the ends of the towel away from one another. At this point, the towel should be directly behind your head and your arms should be stretched out at in a v position. Hold this position for 10 to 30 seconds and repeat three times. This stretch also targets the pectoralis major and subscapularis muscles.

CALCIFIC TENDONITIS OF THE SHOULDER INTRODUCTION Calcific tendonitis of the shoulder happens when calcium deposits form on the tendons of your shoulder. The... tissues around the deposit can become inflamed, causing a great deal of shoulder pain. This condition is fairly common. It most often affects people over the age of 40. ANATOMY Calcific tendonitis occurs in the tendons (tendons attach muscles to bones) of the rotator cuff. The rotator cuff is actually made up of several tendons that connect the muscles around your shoulder to the humerus (the larger bone of the upper arm). Calcium deposits usually form on the tendon in the rotator cuff called the supraspinatus tendon. There are two different types of calcific tendonitis of the shoulder: degenerative calcification and reactive calcification. The wear and tear of aging is the primary cause of degenerative calcification. As we age, blood flow to the tendons of the rotator cuff decreases. This makes the tendon weaker. Due to the wear and tear as we use our shoulder, the fibers of the tendons begin to fray and tear, just like a worn-out rope. Calcium deposits form in the damaged tendons as a part of the healing process. Reactive calcification is different. Why it occurs is not clear. It doesn't seem to be related to degeneration, though it is more likely to cause shoulder pain than degenerative calcification. No one knows what triggers the body to reabsorb the deposits. But once this occurs and the tissue begins to be remodeled, the pain usually decreases or goes away altogether. SYMPTOMS While the calcium is being deposited, you may feel only mild to moderate pain, or even no pain at all. For some unknown reason, calcific tendonitis becomes very painful when the deposits are being reabsorbed. The pain and stiffness of calcific tendonitis can cause you to lose motion in your shoulder. Lifting your arm may become painful. At its most severe, the pain may interfere with your sleep. REHABILITATION Even if you don't need surgery, you may need to follow a program of rehabilitation exercises. It is recommend that you work with a physical or occupational therapist for four to six weeks. Your therapist can create an individualized program of strengthening and stretching for your shoulder. It is very important to strengthen the muscles of the rotator cuff, as these muscles help control the stability of the shoulder joint. Strengthening these muscles can actually decrease the pressure on the calcium deposits in the tendon. Your therapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes. Simple changes in the way you sit or stand can ease pain and help you avoid further problems.

SPIRAL LINE (SPL) The Spiral Line (SPL) loops around the body in a double helix, joining each side of the skull across the upper back to the opposite shoulder, ...and then around the ribs to cross in the front at the level of the navel to the same hip. From the hip, the Spiral Line passes like a 'jump rope' along the anterolateral thigh and shin to the medial longitudinal arch, passing under the foot and running up the back and outside of the leg to the ischium and across the midline to the long dorsal sacroiliac ligament, and from there to the erectors, so that we end up on the opposite side of the skull from where we started. This line stabilizes the body in all planes through its double enclosing loop. It connects the foot with the pelvis and is important in the regulation of the knee position when we walk. Credit: muscleandmotion

WINGED SCAPULA DUE TO WEAKNESS OF THE SHOULDER STABILIZERS The scapula is the largest bone present in the shoulder. Several muscles are attached to it. The sc...apula slides along the rib cage and allows smooth movement of the arm in all directions. The muscles attached to the scapula prevent dislocation and over sliding of the scapula and assist movements of the arm at the shoulder joint. These muscles act at all times together as a single unit for smooth movement of the arms. WINGED SCAPULA FACTS: A winged scapula is mostly observed during movement of the arm and shoulder joint. The angulation of scapula is observed when one group of muscle is paralyzed or weakened and contraction of normal muscles pulls the scapula away from chest wall. In normal individual the contraction and relaxation of different group of muscles maintains the normal position of the scapula. A winged scapula usually arises due to weakness of the shoulder stabilizers, most notably the Serratus Anterior. CAUSES The weakness or paralysis of the Serratus Anterior muscle causes the floating or uncoordinated movement of scapula resulting in scapula protruding out like a wing. Maintaining poor posture for prolonged period of time. The weakness results from damage or irritation of the Serratus Anterior muscle nerve. Damage to the long thoracic nerve SYMPTOMS Clear protrusion of the shoulder blade in an outward direction Mild to severe pain at rest and during upper arm movements Pain is spread over the shoulder blade and becomes worse when pressure is applied over the scapula Pain is also observed during change of position from lying down to sitting or sitting to standing when upper arm is used to support the movement TREATMENT 1. Physical Therapy and Rehabilitation - Strengthening of weak muscle and retraining of normal predominant muscle can reduce the deformity and pain. 2. Scapular Protraction Exercise - To do this exercise, start with end of a band in one hand placed at shoulder height and the elbow bent. Now, try and push the hands forward in the process straightening the elbow entirely as far as possible. Gradually return to the starting position. 3. Serratus Press Exercise - To do this exercise, start in lying down position with a medicine ball in both hands and keeping the elbows straight. You need to ensure the elbow is kept straight throughout the exercise. Now, push the ball up by using only the shoulder girdle. Bring the shoulders down and repeat the same.

FROZEN SHOULDER - CAN MASSAGE AND EXERCISE HELP? Frozen shoulder is a condition where an individual will experience pain and stiffness in the shoulder and is ...not able to lift the arm over the head. Frozen shoulder causes stiffness and restricted range of movement in the shoulder. This condition is medically known as "adhesive capsulitis." However, the adhesive capsulitis is a specific condition where there is a slow onset of stiffness and pain in one shoulder due to inflammation and tightening of the joint capsule. Usually the terms frozen shoulder and adhesive capsulitis are used alternately. PHASES Clinical presentation is typically in three overlapping phases: Phase 1 lasting 2 months to 9 months. Painful phase, with progressive and increasing pain on movement. Pain tends to be constant and diagnosis in the early stages before movement is lost can be difficult. Phase 2 lasting 4 months to 12 months. Stiffening or freezing, where there is gradual reduction of pain but stiffness persists with considerable restriction in range of motion. Pain pattern changes from constant to end range pain of reduced intensity. Phase 3 lasting 12 months to 42 months. Resolution or thawing phase, where there is improvement in range of motion with resolution of stiffness. End range pain may persist until full resolution. TREATMENT In most of the cases adhesive capsulitis resolves on its own over a period of a year to year-and-a-half. Treatment for adhesive capsulitis basically focuses on alleviating pain and trying to preserve as much range of motion as possible in the affected shoulder. EXERCISE Stretching exercises are usually the cornerstone of treating frozen shoulder. Here are just a few. 1. Cross-body arm stretch 2. Pendulum stretch 3. Arm circles 4. Towel stretch MASSAGE Massage therapy is very beneficial in treating frozen shoulder as it increases the blood circulation to the injured region and also reduces the formation of scar tissue. Regular massage should be done to reduce the muscle stiffness. The pain and stiffness usually gets relieved after several massage treatments. There are various combinations of techniques done by a professional massage therapist, which provide relief from shoulder pain and help in the recovery stage. DEEP TISSUE MASSAGE One of the common techniques used to treat frozen shoulder is deep-tissue massage. In this technique, the massage therapist applies constant pressure to the muscles in order to release the scar tissue or adhesions, which may be causing the shoulder pain. Shiatsu is a Japanese form of deep-tissue massage, which involves deep pressure on certain regions of the body. These are called acupressure points and helps in controlling the energy flow ("Ki" in Japanese) across the body and thus results in decrease in pain. Deep-tissue massage techniques should not be done in case of acute shoulder pain, swelling or inflammation, as it may aggravate the condition. TRIGGER POINT THERAPY Trigger point therapy is another massage technique, which benefits the frozen shoulder. In this technique, a steady pressure is applied on certain targeted points within the muscles. This helps in relieving the muscle spasms. HEAT THERAPY Heat therapy is also very helpful in treating the frozen shoulder. It can be applied before or after a massage. Heat therapy can be also done for trigger point massage for frozen shoulder. It helps in relaxing the muscles and decreasing pain. Mild heat can be applied for multiple times daily using pads, which are heated an hour before application. source: Harvard Medical School, British Orthopaedic Association.

ILIOPSOAS TIGHTNESS CAUSED BY INGUINAL LIGAMENT DISFUNCTION ANATOMY & FUNCTION The Inguinal Ligament is a constricted band of thick fibrous connective tissu...es which are present in the pelvic region of the body. These tissues arise from the external oblique and course through across the groin and attaches to the front part of the iliac spine. The inguinal ligament forms the floor of the inguinal canal and provides support to the passage of structures through the canal. The inguinal ligament supports the muscles which course inferiorly to the fibers of the ligament, including the iliopsoas muscles. It also supports the femoral vein, artery, and nerve along with other blood vessels and nerves of the lower extremities as they course through the pelvic area. This support is important to maintain the flexibility of the hip and supply nutrients and blood supply to the lower extremities. PAIN SYMPTOMS AND DIAGNOSIS According to a peer-reviewed report published in the Ochsner Journal and the National Institutes of Health, inguinal ligament pain has several possible diagnoses: Direct hernia where a bulge is able to be seen Indirect hernia where a bulge is not able to be seen (sports hernia or athletic pubalgia) Ligament and muscle strains affecting the adductors, lower abdominals, or ilipsoas muscles Nerve entrapment (one of the possible complications of a sports hernia) Hip joint issue INGUINAL LIGAMENT PAIN TREATMENT The ligament also helps to supports the iliopsoas muscles which includes the psoas major muscle that runs from your upper femur, through your pelvis, to your lower spine. Because of its positioning, the ligament is responsible for helping to support the lower abdominal wall and prevent the groin from tearing. When looking at muscle and ligament issues, there are two causes of the pain, and the first is much less serious. Groin Strain Sports Hernia A groin strain is a more common type of injury where the muscles of the groin become overstretched or tear slightly as a result of sudden movement, such as sprinting or a quick shift during a game of soccer or basketball. Groin strain treatment is relatively straightforward and follows the 3-point physical therapy approach: Stretching Mobility Strengthening With just stretching and no mobility work or strengthening exercises, you will not see lasting flexibility and pain relief - it will be only transient and short-term right after you get done. With just physical therapy exercises and no mobility, you will be unable to get into the proper positioning. This leads to poor form and incorrect movement patterns - which is how you got injured in the first place. Bottom line, make sure you do all three. GROIN STRAIN EXERCISES You can begin stretching your groin muscles right away. Stretch gently and avoid any pain. If you have pain while doing these exercises, you should not do them. Hip adductor stretch: Lie on your back. Bend your knees and put your feet flat on the floor. Gently spread your knees apart, stretching the muscles on the inside of your thighs. Hold the stretch for 15 to 30 seconds. Repeat 3 times. Side plank: Lie on your side with your legs, hips, and shoulders in a straight line. Prop yourself up onto your forearm with your elbow directly under your shoulder. Lift your hips off the floor and balance on your forearm and the outside of your foot. Try to hold this position for 15 seconds and then slowly lower your hip to the ground. Switch sides and repeat. Work up to holding for 1 minute. This exercise can be made easier by starting with your knees and hips flexed toward your chest. Resisted hip flexion: Stand facing away from a door. Tie a loop in one end of a piece of elastic tubing and put it around the ankle on your injured side. Tie a knot in the other end of the tubing and shut the knot in the door near the floor. Tighten the front of your thigh muscle and bring the leg with the tubing forward, keeping your leg straight. Return to the starting position. Do 2 sets of 15.

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Despite the pain and frustration so many experience with fibromyalgia, some have found significant relief under the hands of a massage therapist or bodyworker.