Steering clear of pain
It was a dark and stormy night, one of those nights when the wind threatened to lift the roof off the house and send us spinning into Oz. I heard the phone ringing and went to answer, knowing that these storms often blow in the most interesting conversations.
“Is this the anatomy nerd?” asked the voice on the end of the line.
“Yes,” I replied, hoping this was a call about muscles, bones and posture. “What’s going on?”
“Well,” said he, “I drive a lot for work and I think its wreaking havoc with my body. Every time I go for a long drive I get a pain in my low back or sometimes my cheek. Sometimes it feels like it travels up my back and locks into a painful spot under my shoulder blade. I want to understand why.”
“Well,” said I, “Tell me what you think happens to your body while we’re driving.”
This is what he said. “My car is an automatic transmission, not a stick, so when I drive my right leg is outstretched and my left leg is bent. In other words, my left leg’s hamstrings are passively contracted while my right leg quads are passively contracted. That probably puts an uneven torque on my pelvis.
Moving up my spine, that torqued pelvis probably makes my shoulder height different. With my arms outstretched to reach the steering wheel, one scapula probably rotates more than the other, putting a strain on the scapular muscles giving me a pain right under the shoulder blade. That’s what I visualize is happening when I drive.”
“So what you’re saying,” I began to reiterate, “is that when you drive, one leg is outstretch and one is bent so the muscles adapt respectively. Maybe that position, over time, puts torque on your pelvis, which causes the muscles up the spine to contract more on one side than the other. When your arms are reached around the steering wheel, maybe one scapula rotates upward or downward more than the other side and you think that perhaps that contributes to the pain under your shoulder blade. Did I understand your theory correctly?”
“Yes, precisely.” He said. “I’ve been using my foam roller to roll on and also stretch out after work. I try to take stretching breaks to get myself into a different position than I’m in all day. I noticed that the bird dog pose both strengthens and stretches the muscles that are weak from driving, so I do that too. Do you have any other ideas?”
I thought for a moment. It sounded to me like he had a good handle on things. I suggested maybe meeting with a physical therapist or a personal trainer to learn some corrective exercises. I also told him that some kinds of therapeutic massage could help realign his muscular-skeletal system especially when used in combination with core exercises. Another suggestion was to consider the purchase of a trigger point bar, like the Theracane variety they sell at health food stores or some doctor’s offices.
We were just about to disconnect when the wild winds whipped once again, completing the task for us. I often look back on this call and hope that more people take proactive steps such as hydration and exercise to prevent certain kinds of musculoskeletal pain.
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.