Shoulder Pain

I see a lot of clients with shoulder pain in my practice. I’ve had shoulder issues myself and some of them could be avoided. If you go by the motto, if it ain’t broke - don’t fix it, then don’t worry. But if you are one of those people who regularly takes a car in for preventative maintenance, has your teeth cleaned twice a year and/or changes the filter on your furnace as recommended, then you may want to read the rest of this article. An ounce of prevention is worth a pound of cure.

If you are seeing and using a personal trainer then you probably don’t have to worry too much about if you are exercising correctly. They are probably giving you well balanced exercises to keep your body well developed on all sides. I see so many people with forward head posture - it is the normal posture these days - but it is not good for your body. It’s hard to avoid forward head when so many of us are looking down at our phones, computers, video games, etc. But with forward head usually comes forward rounded shoulders. If you can, take a break right now and roll your shoulders back and down. Go ahead, do it a few times. Feels good,  doesn’t it? 

The picture above illustrates an exaggerated forward head and rounded shoulders. Usually when this happens, the chest and accompanying muscles are tight and contracted. The muscles in the upper back are stretched out and weak. The shoulder blades have moved toward the front of the body, too and this causes problems with impingement. If your hands start getting numb and tingly it could be a nerve getting impinged at the AC joint.  

The picture above illustrates the difference between a normal shoulder and one with an impingement. The acromion is part of the shoulder blade and when that rotates forward it is more likely to be putting pressure on the shoulder bursa, fraying the rotator cuff muscle and pinching the nerve that runs through the shoulder and down the arm. So it’s important to keep your shoulders back. It also helps keep your head in the correct place, too.

So, hold your head up and keep your shoulders back. Your body will thank you.

Posterior Pelvic Tilt - Do You Have It?

     In the picture above there are 4 of the many types of postures you can have.  A is what we all should strive for, although no one has perfect posture.  B is getting to be the norm in our looking-down-to-text society.  C and D could both be described as a posterior pelvic tilt which is a less than normal curve in the lower back. (D also has too much curve in the shoulder blade area which could be caused by too much texting as well.)  Why do we need some curve in our lower back?  We need it to absorb some of the impact from walking and running.  If your lower back is in constant pain you may not have enough curve in your lower back.  (You could also have too much.)

     Posterior pelvic tilt could be caused by a number of reasons including too much sitting (especially if you slouch while you sit), walking improperly, sitting improperly, weak psoas (that muscle on the front of your spine that attaches the spine to the inside of the legs) and/or weak gluteal muscles, tight hamstrings and/or erectors of the lower back.  Or a combination of these.  How can you tell if your lower back problems are caused by posterior pelvic tilt?  If you can lie on your back on the floor without bending your legs and you cannot slide a hand between your lower back and the floor.  If there is not space there then you should consider changing some things.  The first if probably the way you walk.  I suggest two books on posture that I recommend for every problem including and especially back pain:

           Pain Free by Pete Egoscue and 

           8 Steps to a Pain-Free Back by Esther Gokhale

     In Esther Gokale's book, she discusses how most of us in this country walk incorrectly and how we can fix it.  I found a video which also explains the same concept fairly well.  If you walk correctly you also won't end up with a flat butt which is very unattractive.  You should push yourself forward with your legs.  Click on the link below to watch the youtube video.

How to walk correctly

     There are also exercises you can do to help also, but mostly it depends on why you are having your particular problems.  In general doing exercises to strengthen your gluteals and psoas, and stretch your hamstrings and lower back.  Both recommended books have exercises and stretches in them.  Or you can make an appointment to see your massage therapist.  I am sure he or she will have some suggestions if you ask.

Forward Head Posture

Forward head posture or the newer term, called "text neck" is a problem that is steadily getting worse in our culture.  There are so many reasons that we have to look down that our heads are continually creeping forward.  If we are not texting on our cell phones, we are looking down at our tablets or kindles, washing dishes, doing laundry, etc.  It's hard to think of some activity that gives our necks a break.

Eric Dalton, PhD (originator of the Myoskeletal Alignment Techniques and founder of the Freedom From Pain Institute) said this picture could be one of the most plagiarized photos on the internet.  He says that for every inch your head is forward on your shoulders (your ears should be directly above your shoulders) it increases the force on your cervical spine by 10 pounds.  Your head doesn't actually increase in weight, but the force on your spine tricks your brain into thinking that it has.  So your mother was right, "sit up straight".  

There are things you can do improve this condition to look and feel better, and maybe even prevent pain from creeping into your neck.  The first thing you should do is check in on your posture regularly to make sure you are not hunched forward.  If you are doing something that keeps your head looking down and it cannot be avoided, make sure you are taking frequent breaks to give your cervical spine (your neck) a break.  Also, when you are driving, make sure your sit upright and your head is against the headrest.  It also helps if your rearview mirror is adjusted so that you have to sit upright to use it properly.  While you are at your computer, figure out a way to keep your monitor at eye level.  It is also a benefit to have your feet flat on the floor, as well.  Don't slouch when you are watching television as this also encourages your head to move forward, even if you aren't looking down.

If you have forward head, you have lots of company.  There are exercises and stretches you can do to improve this condition.  It does not have to be permanent.  First you will want to contract the muscles in the front of your neck because they are in a lengthened position.  Doing chin tucks shortens and strengthens at the same time.  One way to do chin tucks is to lay on your back on the bed with your head over the edge of the bed.  Hold your head in a position parallel to the floor and tuck your chin to your neck as if you are trying to get at least one double chin.  You can use your hands to help support your head if necessary.  Try to hold this position for about a minute.  It feels great!

While your neck is straining to keep your head up, your rhomboids (those muscles between your shoulder blades) are over stretched and weak.  A good way to strengthen them is to pinch your shoulder blades together and hold.  Make sure your shoulders are back and down and pinch the shoulder blades for 10 seconds and release.  Repeat 5 times.  

There is a wealth of information on the internet.  Google "forward head posture" and you will see what I mean.  So admit that your mother was right and good luck improving your posture.

Flat Butt Syndrome

I thought I was making up the name of this condition, but it turns out that  if you google it, you will get hits.  It seems to be a common condition these days, for both men and women.  It can be caused from sitting too much.  While I was a massage therapist in New Jersey, I thought it was a caused by tight hamstrings.  When I moved to New York and had to go back to massage school to get my NY massage license, my Myology teacher cleared up that misconception.  He explained that it was from under developed gluteal muscles.  Chances are that tight hamstrings are also present with Flat Butt Syndrome, but they are not the cause.  So as a massage therapist, loosening up the hamstrings will not save someone's butt. That was disappointing news for me because I like the idea of making someone look better in pants.

In Esther Gokhale's book, 8 Steps to a Pain-Free Back, she says that walking incorrectly causes under-developed gluteal muscles, in particular, the gluteus medius muscles.  She goes into great detail about how to walk correctly.  As she explains it, "Walking should be a series of controlled forward propulsions.  The buttock and leg muscles contract strongly to propel the body forward, thus getting the exercise they need while the back is spared unnecessary wear and tear."  So walking correctly not only makes our backsides more appealing it also reduces back pain.  In her book she has many pictures of people walking correctly and some walking incorrectly.  The difference in body physique is amazing.

Yesterday I was out and about and noticed a woman with a concave butt.  I didn't even know that was possible.  If I didn't have laryngitis I would have given her my card, because it looked like her lower back must be in constant pain.  Maybe I will run into her again on a day when I can talk.

I did see a lot of interesting stuff when I did my google search, including some great youtube videos from personal trainers who know much more about building glutes than I do.  Here is a link I particularly like: 4 exercises to get rid of Flat Butt Syndrome
The quality isn't great, but the content is very good.  I started doing these myself, because who doesn't want a better looking backside?  Esther Gokhale also has an exercise in her book to help develop the gluteus medius which looks very similar to one of the exercises on the video except that it doesn't use weights.

So if you have Flat Butt Syndrome, there is hope.  But it does require some effort on your part.  Why not get started today?

The Benefits of Correct Posture

Ever since I went to massage school back in 2005 and learned about posture, I have enjoyed watching people walk and tried to predict where they might feel pain.  My sister teases me that most people don't look at others to see how they walk - most people notice what others are wearing.  Maybe I am weird, but I enjoy my hobby.  I remember one time waiting in a long line that went out onto the street in front of a popular restaurant.  I had at least 30 minutes of watching people of various ages walking down the street and one thing was very evident - the younger the person, the better their posture.  We have all seen the geriatric person who has the body shape of an "L" who can barely see in front of them as they walk.  Not everyone ends up this way, thank goodness.

I have been studying the concept since then and have had some books recommended to me.  And what I have learned is that posture does not have to deteriorate as we get older.  I, for one, do not want to be one of those "L" configured seniors I sometimes see.  And I would like to live without the pain that comes from having gravity take over.  One of the books that was recommended to me was Pain Free, A Revolutionary Method for Stopping Chronic Pain by Pete Egoscue.  I call this book directions on how to give Myofascial Release to yourself.  I took some courses in Myofascial Release as continuing education requirements for massage therapy.  We learned how the fascia that surrounds the muscles can lose its fluidity and become contracted or constricted.  We also learned as manual therapists things we could do to improve the problems.  In Pete Egoscue's books, he gives exercises to help alleviate pain in different parts of the body.  These are not your usual exercises, they focus on stretching the areas that need it and strengthening others.  i.e., Myofascial Release you can do yourself, plus exercises to strengthen the body and keep it in an erect position. The whole point is to correct posture "mistakes", either from chronically bad posture habits or previous injuries or surgeries.

The other book that was recommended to me was 8 Steps to a Pain-Free Back, by Esther Gokhale, L.Ac.  In Esther's book she, also, points out that chronically bad posture is causing our chronic pain and gives ways to correct the problems.  She discusses and demonstrates through pictures how we can sit, walk, sleep and drive with out spines in a decompressed position.  She has great illustrations in her book, plus exercises in the back of the book for stretching on strengthening.

So if you have chronic pain, don't give up.  There is hope.  It may take some effort on your part, but it will be worth the effort.

What is a muscle "knot"?

Before I went to massage school, I really didn't know what those bumps were in your muscles that hurt when you touched them.  I had been taught a technique in aikido (called kiatsu) that could help them diminish or get rid of them completely, but I never really knew what they were. Now I can explain.

Muscles in your body are actually bundles of thin muscles strands surrounded by fascia.  (It's really more complicated than that but this is a good visual.)  Fascia is connective tissue all over your body that has different jobs depending on where it is.  The fascia that surrounds the muscle strands keeps them  lubricated so that they move freely when contracted and relaxed.  If you are dehydrated or tense or injured the fascia doesn't work as well.  The muscle strands adhere to one another and don't contract and relax as they should. So those "knots" that you feel that hurt are really just your muscle strands bunching together and not allowing free movement as they should.  So when you or another person presses on them in the right way it helps break up the fascia and separate the muscle strands. Fresh blood gets into the area and promotes healing.  

So how do you prevent those muscle knots in the first place?  Well, of course drink lots of water.  It's also important to warm up before you exercise and to stretch when you are done as you are cooling down.  It's actually not a good idea to stretch BEFORE you work out because you have not warmed up the muscles yet, so you could actually do more harm than good if you stretch too soon.  It's also very good to drink water as you are exercising to keep that fascia lubricated.

Fascia has memory.  It can get "stuck" in a shortened length preventing the muscles from stretching as they should.  It also has more pain receptors than your muscle.  So when you have that nagging tightness, it is probably your fascia.  Sitting at a desk, leaning over you cell phone, bent over your work, are all ways that fascia gets shortened.  So drink lots of water, get up and move around frequently, and, of course, get a regular massage.

Massage is Good

More and more research is being done on the benefits of massage.  Maybe that's why places like Massage Envy and Hand and Stone are doing so well.  It's true that any nurturing touch is beneficial to the body.  It promotes blood circulation and reduces stress.

I recently taught a class to care givers of cancer patients.  In doing research for the event I found out that scientific studies have found that massage reduces anxiety significantly in patients going through chemotherapy.  These benefits last longer than expected also - at least 24 hours.  Just massaging a cancer patients hands or feet for 10 minutes a day can do so much.

Here's an article that contains some interesting information on benefits of massage:

http://www.oprah.com/health/The-Health-Benefits-of-Massage

I'm lucky.  As a massage therapist I have human contact through my "work" for hours a day.  The benefits for me are not the same as for my clients, but they are there.  Have you ever heard of a massage therapist committing suicide?  They are generally very happy people.  There are times I think about giving up this profession to go to some more stable, predictable profession, but then I'm pulled back to reality by some grateful client who tells me how great they feel after a massage.