Photo courtesy of ABMP
It was a cool and rainy day last spring. A woman sat in my office describing her neck pain that had been occurring almost daily for months. Her doctor told her it was probably from a pinched nerve in her back, and some arthritis to boot. She asked if she could continue receiving massage therapy and her doctor agreed that it might be helpful. Besides, the October edition of Consumer Reports listed massage therapy as one helpful treatment for osteoarthritis.
She pointed to a spot on the side of her neck, where her neck meets the top of her shoulders and said that sometimes she feels the pain up the side of her neck, into her jaw, and occasionally a headache that she can feel in her eye.
I placed my flattened fingers over the spot that my client had indicated she felt the pain. Upper trapezius, platysma, scalenes… I would address all three, but figured that most of the pain was coming from the upper traps. There are myofascial trigger points in the upper traps that refer pain to the head and eyes and sometimes into the jaw but one has to be conscientious when treating them since the area may already be exquisitely painful.
The traps’ action on the neck is lateral flexion, side bending, and her son had been telling me about how she naps—sitting upright in her easy chair, with her chin nearly on her chest, sometimes with her right ear toward her right shoulder. I have known administrative professionals with a similar kind of pain from holding a phone in a similar way. So, I decided to treat the upper trapezius first.
Paying careful attention to the “V” of the shoulder, the area in between the clavicle and the top of the shoulder blade, the muscle was treated. When I heard “Oooh that’s it,” I hung out on that spot until she said the pain was going away. Then I dug in a little more, but she quickly said that pain was subsiding, too. We repeated the releases one more time.
The upper traps also attach on the head at the superior nuchal line of the occipital bone at the back of the skull. After bringing fresh blood, oxygen and nutrients to the part of the upper traps at the V, the attachment on the occiput was treated. Having the head cradled and fascia manually rubbed and stretched is an experience that most people like. A lot. I found that to be true once again.
The traps are a big muscle, and when I was satisfied that I had left no stone unturned with her upper traps, I sifted through some of the muscles on the front of her neck that could be contributing. We did a myofascial release on the platysma, creating a little space between the chin and the shoulders. I scooted her sternocleidomastoid muscle (the scm) over a little bit to treat the scalenes all the way down to the connection on the first and second ribs. When we finished she sat up, moved her head all around, and said “THAT feels really good.”
If you suspect that your neck pain is from spending a lot of time with your ear toward your shoulder, you might enjoy some myofascial pinning and stretching, too. Try bending your ear toward your shoulder and using your firmly planted palm to pin the muscles alongside the neck. Then slowly unbend your neck and enjoy the stretch of the fascia under your palm. Feels great!
Of bird dogs and back pain
Most of the literature on the subject suggests that 80% of people will suffer from at least one episode of back pain sometime in their life. No matter what the underlying reason is that causes the pain, one of the muscles that is often involved is the multifidus or plural, multifidi.
The multifidi can be found running along the right and left sides of the spine. From the axis, or the neck vertebrae C-2, all the way down to the sacrum, each multifidus section spans three vertebral segments and helps to stabilize the spine. Because of the placement of the muscle attachments, when both sides contract the multifidi help with spinal extension and fine-tuning of movements. When only one side contracts, you rotate to the opposite side. For example if your thoracic multifidi contract on the right, your torso will rotate (or be stabilized rotating and/or fine-tuning) to the left. As we all know, that is called contralateral rotation and a knot in a contralateral rotator can inhibit the ability to rotate to the same side.
Since it is hunting season, I’ve been observing my dog’s movement patterns. She’s a natural athlete. When she points I observe her nose, spine and tail in perfect alignment as her multifidi and spinal muscles contract. Her strong core allows balance as her front leg is raised. And she can get into position immediately, without a second thought, with excellent balance, over all kinds of terrain, for hours. Amazing!
Of course, it wasn’t just the dog’s multifidi that were contracted, but her other spinal muscles, and glutes too. I noticed that the dog was lengthened through the hip flexors –very important to have length here to avoid too much swaying of the low back. Anatomically, there was a lot going on. It got me thinking that perhaps muscles are only named and defined to ease our ability to describe sensation or one specific action. The thing is, I can’t think of any real-life action in which only one muscle moves. It makes more sense to think in terms of a kinetic chain. The hip bone is connected to the back bone, the back bone is connected to the neck bone…
If you have performed any bodyweight exercises you may have done an exercise called bird-dog, in which you performed a movement similar to the pointer. Bird-dog can be a great exercise to strengthen the multifidi and other muscles that run along the spine, but there is more to it. Our muscles are connected to each other and organs by fascia, a strong, fibrous connective tissue. Our muscles and fascia work together to provide smooth movement along a kinetic chain. In a position like bird-dog, the lats on the arm-up side must be able to stretch, which requires the arm rotating muscles of the shoulder to have an acceptable range-of-motion. The (usually weak) glutes must be strong enough to extend the hip. Activation of the glutes can happen almost immediately, however, when the hip flexors are stretched.
A good massage can help improve your back pain and help your muscles function better. Additionally, your bird dog might recover faster and enjoy improved endurance if you spend a little time treating his or her muscles to massage.
photo courtesy of ABMP
The headache king’s royal pain
It was a dark and stormy night. I had just finished writing my notes for the day when I heard a knock on the door. I went to open it and I saw a man standing there, squeezing his neck at the base of his skull. “Are you the Anatomy Nerd?” he asked, wincing a little. “Yes, and you are…?” “The Headache King,” he replied. I nodded, dimmed the lights and led him to a comfortable chair in my office. “Do you get headaches very often?” I asked. “Yes. I’ve been in a few car accidents over the years, fallen off horses, fallen skiing, and now I sit at a desk all the time.” He grimaced. “The pain starts in the back of my head and wrap all the way around to the front. It’s worse if I get a draft on my neck. My wife gets them too, but they’re much better since she found out she’s allergic to corn.”
I had him show me exactly where he feels the headaches and perform some basic range-of-motion to help me understand his headaches more.
Determined to dethrone the “headache king” part of all this, I started in on the suboccipital muscles. I decided to start on the one called Rectus Capitis Posterior Minor, because that’s usually a biggie for people with headaches when… “Thaaat’s the spot.” he said. Like most people when their massage therapist gets THE spot, he acknowledged that I was in a very good place to work.
The sub-occipitals are a group of muscles that allow you to turn your head and look up. Turning the head we’ll call rotation, and looking up we’ll call extension. If these muscles are locked long or short you may have difficulty rotating your head as well as flexing or extending. If he is sitting at a desk all day, his head probably comes forward, and his suboccipitals have to work to tilt his head back and keep his eyes level with the horizon so he’s not looking down.
I thought about how our brains control our muscle length and realized that if his head was forward of his center of gravity, his sub-occipitals would stay contracted until we changed something further down the kinetic chain. The Sternocleidomastoid, the SCM for short, came to mind. If you are familiar with this muscle then you know that its main action, when both the right and left contract, will bring the back of the ears (mastoid) toward the breastbone (sternum). Try that on yourself. Try to bring your mastoid process, the bump behind your ear, toward your sternum. Now, keep your eyes level with the horizon. Because of neurological laws, your body will adapt to that position in a very short time. Did the back of your head move toward your spine? Even though for most of us that movement was an exaggeration, that is how your occipitals contract and they’ll do that every time. If your head is forward, your suboccipitals may stay contracted, causing painful headaches and limited flexion.
After releasing the suboccipitals, he begged me to wrench on his SCMs. “He’s a jester now,“ I thought happily obliging. I soon wrapped up, saying goodbye to the tissue.
He made another appointment, bought his wife a gift certificate for Mother’s Day, then left doing neck rolls, stretching and whistling a happy tune as he walked back out into the dark and stormy night.
Photo courtesy of ABMP
Beans about neck pain
I woke up the other morning with a terrible crick in my neck. I know, I know, these small, annoying but generally harmless pains happen to almost everyone at some point. It hurt to turn this way, it hurt to turn that way, and the discomfort was making me feel a little crabby-- like I woke up on the wrong side of the bed.
I suppose I could have taken some ibuprofen, but I'm always playing a game with myself where I say "Let's try this first." I don't like to take over the counter medication so I make it a priority not to. I try to keep healthy by doing all the preventative things like hand washing, getting enough sleep, managing stress, eating right, exercising, and keeping my internal organs warm. But sometimes I do feel things creeping up on me and I don't want them to become a problem. If I don't have time for sickness or pain now, then I certainly won't have time for the side-effects of ibuprofen, should such side-effects develop.
I wondered about the cause of the neck pain. A cold draft? Not likely. An injury? Nothing came to mind. It was probably a simple case of sleeping wrong. After all, I noticed it right away in the morning. It didn't hurt too much either, maybe 2-3 on a 10 scale. Mostly it was annoying.
I hadn't even had my coffee yet, so as I stumbled around grasping for my portkey to wakefulness (French roast in a local pottery cup), I thought about my next steps. I tried to pinpoint the spot from where the pain was coming. I put my fingertips on the back of my neck, near my spine, and pressed in. When I felt a spot that reproduced my symptoms, I hung out there. I pushed on the spot while turning my head this way and that. "Find the spot, then add movement," is what my mentor always said. Pin and stretch.
That felt pretty good, so between sips I massaged my neck from the sub-occipital region at the base of my skull all the way down to the bump on my spine and over to my shoulders. I carefully felt around each vertebrae, paying attention to the point where muscles attach on the spinous processes and the transverse processes. Wherever it felt important and related to this bout of pain I did some point holding, adding movement as needed. A little pin and stretch always feels great and seems to help the muscles return to a point where they can glide along like they should.
When I was ready for a refill, I also grabbed my microwaveable rice pack and an ice pack to put in my bag for work. I know there is a lot of current research suggesting maybe the conventional RICE-rest, ice, compression, elevation treatment is outdated. It suggests that ice isn't the best thing to heal the tissue. I didn't think my current pain was from an injury so I wasn't too worried about it. I only sought to have less pain, to have a good toolbox handy so I wouldn't have to deal with the pain yet could avoid the ibuprofen.
I filled my thermos and headed to work. Throughout the day I continued to rub my neck for 2-3 minutes at a time, every hour. I don't know when it happened exactly, but at some point my neck stopped hurting. Cool beans!
Leverage. It's a word we hear often enough, but what does it mean to you? We often think of leverage as having the upper hand in a situation, an advantage. Today, let’s see how our bodies use leverage to allow us smooth, strong movement as we do our stuff.
First, let’s make sure we are all on the same page with what leverage is. Tortora and Grabowski, 2003, describe leverage as an advantage when a smaller effort can move a heavier load. A lever can be a bone. Effort would be your muscle contraction, and the fulcrum would be the joint that hinges bringing the bones closer together. A load, or resistance, opposes the movement. Movement occurs at the joint, or fulcrum, when the effort is greater than the load.
There are three different types of levers and they categorized by the positions of the fulcrum (F), the effort (E) and the load (L). We'll call them first-class levers, second-class levers, and you guessed it, third-class levers.
Here is our first scenario: You are sitting at your desk, muddling through your taxes or the Obamacare website, and you notice a pain in your neck as you nod off, again. In this case, the weight of your head is the load (L), is in front of the fulcrum (F) which is your atlanto-occipital joint. The effort (E) comes from the muscles that attach the back of your head to your spine. They are working very hard to keep your head up. No wonder we all get massage and stretch to relieve the tension in our necks! This EFL arrangement is a great example of a first-class lever. As an aside, a pair of scissors works the same way. Your thumb and fingers contribute the Effort, the Fulcrum is the hinge and the Load is the paper. EFL.
Our second-class lever is the strongest. With our days getting longer and hopefully warmer, I've been thinking about the garden which makes me think of moving heavy loads in the wheelbarrow. In this example, the Fulcrum is the wheel, Load is all the dirt or weeds we have to move and Effort is applied to the handles. Because the load is close to the fulcrum, we use less effort to lift such a heavy load. It is the strongest because E is further from the pivot. FLE. Most anatomists believe that we don't have any second-class levers in the body. Some people contend that the action of the calves attaching to and lifting the heel produces a similar wheelbarrow effect.
The third-class and most common kind of lever is when the effort is situated between the fulcrum and the load. FEL. Here's the vignette: Imagine you're at the gym doing bicep curls. The weight is in your hand (load), and your biceps brachii muscle (effort) contracts which bends your arm at the elbow (fulcrum). This set-up isn't as strong as a second-class lever because here the effort is closer to the fulcrum.
Sometimes our levers are unable to function smoothly and efficiently due to muscles that are too tight or not aligned. Take a load off. Improve your leverage by seeking regular soft-tissue self-care such as a stretching routine combined with therapeutic massage. A combination of the two can help your joints move more smoothly and efficiently through a greater range of motion.
Many years ago I had a friend in the Nursing school at St. Scholastica. I remember going up to visit her and going to her cadaver lab. Horrible smells aside, I thought it was interesting to see what lies beneath our skin. Sure, in high school, we did our share of dissections in biology, but I don't remember ever looking at the muscular anatomy until visiting my friend.
I grew up in a city with a family — like many, if not most urban families — disconnected from our food and our bodies. It is uncomfortable to think about and admit that sometimes I still buy chemical-laden meat from animals that grew up in a warehouse far away, eating genetically modified (and perhaps rancid) grain. At the right time, it's processed and wrapped in foam and plastic which ultimately ends up in the landfill, and is trucked here. But don’t get me started on petroleum consumption. In the end, we know our food is good and safe, because it bears the USDA Inspected sticker. Right? Comforted, we consume.
But forgive my tangent. I'm writing about anatomy. Like most people around me it was, and still sometimes is, hard to imagine what the package means when it’s labeled "shoulder" or "neck roast." The thing in the package certainly doesn't look like my shoulder. Or does it?
Fortunately, I had the opportunity to help cut up some venison. I recalled my trip to the cadaver lab, but this somehow seemed more real. No preservatives had been added. After the skin was removed there was a layer of "insulation" and then the connective tissue and fascia that surrounds the muscles. My friend started to cut. I found the shoulder and could feel the familiar bony landmarks under the meat. I grabbed the portion just above the spine of the scapula and asked, "Do you think this is supraspinatus or upper trapezius?" It was hard to differentiate.
I palpated for trigger points and tried to see areas of thickened fascia. While I cut, I wondered about muscle pain in wild animals. Do they, too, ever have poor posture? Do they, too, get overuse injuries? I wondered if any scientist or naturalist has observed a behavior that would suggest the deer is rubbing his or her sore muscles. This deer was pretty young. I'll bet a bigger, older buck would have much thicker fascia and tighter shoulders.
I wanted to dissect the entire animal muscle by muscle, but pressures like time and needing to get the deer in the freezer prevented me from doing so. Once I finally did get all the meat off, I was struck by the scapula and how the deer shoulder blade is so similar to ours-- triangular in shape, with a vertebral border, a spine, a superior and inferior angle. The shoulder joint and the hip joint are similar too.
By this time, we were all starting to feel the muscle strain in our own backs and shoulders from skinning, cutting, grinding and wrapping all day. If I were the scientist or naturalist, I would have observed our stretching and shoulder rolling behavior and wondered about our pain too. My friend held up the back strap for us to inspect. We all agreed that our own back straps were tired and could use some attention. If we had four legs instead of two, our back straps wouldn't feel so weak from trying to hold us up. I wrapped it up and stuck my own label on it, thankful to be filling our freezer with local, organic, free range venison.
Back in Cincinnati I had a mentor who, when speaking about pain relief, often spoke of balanced alignment. I know, it sounds like we’re talking about wheels and it’s easy to visualize the uneven wear and tear on the tires, but roll with me for a minute. Let’s look at the role that balanced alignment, or posture, plays in pain and pain relief.
Ever since we were children, our parents have told us to stand or sit up straight. I can hear my mom’s voice in my mind’s ear reminding me not to slouch. That’s a great tip to take seriously, but it doesn’t stop there. You see, muscles (which cross joints and allow us to move) all have an optimal resting length. When our muscles are in neutral/balanced alignment, meaning at their optimal resting length, we usually have a pain-free lifestyle, a “normal” range-of-motion and normal grip strength. Yep. When our muscles are at their optimal resting length, we usually have a pain-free lifestyle, normal range-of-motion, and normal grip strength.
Let’s look at the chronic shoulder tension of the computer muscles as they’re so often called. Many times people grasp one side of the shoulder, sometimes saying something like “It’s always on my right.” Or what have you. A person with a trained eye can make all sorts of observations and assessments. In this case, if the client were to stand in front of a posture grid, a professional might be able to observe (objectively) a shoulder height discrepancy, or a forward head, or as my mentor used to say “When one side of the pelvis shifts, the shoulder often follows.” It was in this way that we were trained to look at the musculo-skeletal system as a whole and dynamic system instead of just isolated muscles that simply perform a single job.
Professional bodyworkers may be trained to make assessments which measure range-of-motion. Additionally, the use of a posture grid will allow a therapist to see discrepancies and torsion in his or her clients. A person simply stands in front of the grid and the therapist takes a picture and/or marks position on the grid. You and your bodyworker will be able to clearly see if you have any shoulder or hip height discrepancies or rotational considerations. As we all know, muscles attach to bones and therefore can cause misalignments and imbalances at joints (where two bones come together) if the muscles are too tight. Assessments help the therapist determine which muscle groups need attention and what kind of modality would be most effective to make more space for the muscle fibers to glide and communicate as well as restore them to a more optimal resting length for pain relief and improved range of motion.
Overuse, sports injuries, poor ergonomics and an inability to resist gravity are a few reasons for changes in muscle length and the fascial fibers that surround everything inside of us. Therapeutic massage combined with corrective exercise can be a great non-invasive treatment option to restore your muscles and fascia to a more normal resting length. Or, as my mentor would have said, get closer to balanced alignment.
It was a moonlit and snowy night high on the Bayfield Peninsula. The wind was blowing the snow into dunes and my shoulders and core were all warmed up from their shoveling workout and I was looking forward to a break when the phone rang. It was a colleague returning a call to talk shop. We like to share stories and anecdotes about things we’ve been working on.
She said she had a new idea for teaching people how to do soft-tissue work on their own muscles and fascia. She was teaching people massage. I was curious.
“What do you mean,” I asked her.
She told me that she gives her participants a bit of hard beeswax at the beginning of her class. The hard beeswax is a bit like our muscles when they’re not getting proper fluid and circulation. If we immediately try to push on or pull the beeswax it resists pressure. You have probably tried it with clay and had it SNAP from being pulled too fast. But if we move slowly and give it gentle pressure, warming it up in our hands first, it becomes softer and more pliable. Soft-tissue is much the same way. To avoid pain and bruising, we try not to work too deeply until the muscles and fascia have been warmed up.
I thought the beeswax was a great analogy and wonderful teaching tool. What a gift. My mind’s eye could see it getting softer as it warmed up and relaxing just like one’s tight muscles do when they are feeling the effect of improved circulation during a massage. I thought about how long of a worm one can roll, or how thin a pancake one can make when the beeswax is completely relaxed. The massage made the beeswax less stiff. As my muscles were cooling off, the impact of my snow shoveling was starting to be felt in my stiffening shoulder muscles and I made a mental note to schedule a massage as soon as possible.
Of course, we all know that our muscles have an optimal resting length which allows us sufficient strength and efficient movement with which to perform our daily activities without weakness or pain. Being a results-oriented gal, if the pain isn’t just general muscle soreness, I like to find out what muscles or muscle groups are too tight or not tracking correctly and work on restoring the muscles to a more normal resting length. My snow shoveling pain was that of a good workout, not necessarily a bad thing.
I started rubbing my ever-stiffening traps, deltoids and biceps. I was going to circulate my delayed onset muscle soreness right outta there. I started to work a little deeper when my muscles warmed up. Lifting, twisting, sifting and separating the muscle fibers like one might card wool.
I got into my low back, finding the trigger points near each the lumbar vertebrae and digging in. “Fresh blood and oxygen to the tissues,” became like a mantra. But I was still on the phone so I didn’t say it out loud. My colleague and I agreed to pick up our conversation in a month. I wished her a fabulous year and went to look for some beeswax to have for my next workshop.
Click he Four actions of the lower leg
I’ve been working on a lot of legs lately, and it’s no wonder why with all of the outdoor-oriented careers and endurance activities that we Chequamegonites participate in. When we are running, hunting, or checking out a timber stand, our muscles are contracting and relaxing thousands of times and we usually don’t notice it until something is amiss. Walking and running over sometimes quite rugged terrain requires special muscular strength and endurance as well as balance and coordination. I thought it would be timely to write about the unconscious actions we perform to maintain our footing while doing what we love to do.
Have you ever heard anyone talk about pronation? Sometimes runners talk about pronating or overpronating, and what they mean is that when they walk or run their ankles roll in. On the outside of the lower leg from the tibia/fibula to the outside of the foot is a group of three muscles, called peroneals, and when contracted they turn the sole of the foot toward the outside which makes the medial ankle roll inward. Sometimes we call this lower leg motion “eversion” meaning that the sole of the foot is everted (turning toward the outside) of the body.
Inversion is an action in which the bottom of the foot turns inward. This action is performed primarily by two muscles in the lower leg, the tibialis anterior and the tibialis posterior. The tibialis posterior tendon ru+ns behind the inner (medial) ankle bone through a tunnel then inserts onto a couple of foot and toe bones so that when it contracts, the sole of the foot turns inward. The tibialis anterior has a similar route and action. Inversion and eversion together are necessary so we can move with agility and safety.
Dorsiflexion is performed when the tibialis anterior and the long extensor muscles of the toes contract making the space between the toes and the knee smaller. When you are running, during the strike phase of your gait, your lower leg comes over your foot into dorsiflexion. If your calf muscles are too short, you won’t be able to get this range-of-motion and it could cause too much load on other structures leading to pain and injury.
When your toes are pointed toward the ground, or you are standing on your tip-toes, or doing standing calf-raises, your muscles are performing plantar flexion. The calf muscles gastrocnemius, soleus and plantaris merge together to form the calcaneal (Achilles) tendon and attach onto the heel via the tendon. When the muscles contract your toes point downward. Many people find that massage therapy helps to restore the calf muscles to a more normal resting length and improves the painful symptoms of plantar fasciitis.
No matter what your activity, your lower leg muscles help provide stability and the finely-tuned movements of your feet. Eversion, inversion, dorsiflexion and plantar flexion are movements that are repeated over and over while we walk and run over rocky, root-laden forests and fields. If you have muscular discomfort or seek a greater range-of-motion, check in with your massage therapist and/or PT to see if it helps you feel better, go further, and run faster.
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Gina McCafferty is a licensed massage therapist, and heath coach who works with women in their peri and menopausal years who have Autonomic...stuff... Persistent Pain, Excessive menopausal weight gain, Type 2 diabetes, Hypertension, Osteoarthritis and Stressors.