The Shoulder Guide

"Even small problems can quickly become debilitating if not taken care of immediately."               

Your shoulders are incredibly flexible joints that allow your arms to move through a large range of motion. They are used in almost every activity and they take a lot of punishment on a daily basis. As a result, they are prone to a wide range of injuries. It's important to take good care of your shoulders because even small problems can quickly become debilitating if not taken care of immediately.

shoulder problems

The shoulder is prone to a variety of problems that can give you pain and limit your range of motion. Many of these are simply caused by wear and tear. For example, a common injury is tendinitis of one of the rotator cuff muscles called the supraspinatus. Through poor posture or overuse, the tendon becomes inflamed and painful. When the bursa becomes inflamed you develop what is known as bursitis. This can be extremely painful.

Trigger points, hyperirratable spots in taut muscle bands, are very common around the shoulder and can refer pain and tenderness into the muscles or joints. The referred pain can mimic other shoulder problems like tendinitis and frozen shoulder.

Sprains and dislocations typically result from falls. It's natural to reach your arm out to catch yourself when falling, but the impact can strain or tear the shoulder ligaments. If the impact is severe enough, the humerus may be knocked right out of the socket and the shoulder becomes dislocated.

With a severe trauma, the bones may actually fracture or break. The collarbone is most likely to break although the humerus can sometimes break as well. When this happens the arm needs to be immobilized. Fractures can take up to three months to heal.

Whenever you have a shoulder problem, you tend to limit your movement to minimize the pain. This can lead to frozen shoulder. Your shoulder becomes stiff and you quickly lose mobility. It can soon become extremely painful to lift your arm. If you develop a frozen shoulder, it will take a long time and lots of therapy to regain your normal movement. Sometimes the only option is surgery. The best medicine in this case is prevention. As soon as you develop any pain or discomfort in your shoulder, see your massage therapist immediately for assessment and treatment. Don't risk getting this serious and debilitating shoulder condition.

a quick anatomy lesson

massage can help

Massage therapists can help when shoulder problems occur. More importantly, they can help prevent these kinds of problems from happening in the first place. 

Their first priority is to make you feel more comfortable by getting rid of your pain. They can do this with specialized massage techniques.

For example, massage therapists trained in neuromuscular therapy (NMT) treat trigger points. As mentioned previously, these hypersensitive spots mimic other common shoulder conditions and are often an overlooked source of pain. Your massage therapist will be able to tell you if trigger points may be playing a role in your shoulder problem.

If you've injured your shoulder, your massage therapist will likely prescribe some exercises to help you regain the strength, flexibility and range of motion in your shoulder.

One of the areas most likely to get tense is the shoulders. An important shoulder muscle notorious for trapping tension is the trapezius - often referred to as the "trap". You can help prevent tension from building up in this muscle.

If you are sitting or standing still for any significant period of time, be sure to move the muscle through a full range of motion once in awhile. We suggest the 20/20 Rule: For every twenty minutes that you are inactive, spend twenty seconds moving. This helps ensure that your muscles don't have the opportunity to lock into any particular position.

Use the following two simple exercises to bring your traps through a full range of motion and to keep your muscles relaxed and tension-free.






Do these Shoulder Rolls to release tension in your neck and shoulders. Lift your shoulders up toward your ears. Then slowly roll your shoulders in a big circle moving them back, down, forward and up. Repeat several times and then reverse directions.









Neck Rolls. Drop your head straight forward toward the floor and let it hang for a moment. Be sure to keep your back upright. You may feel a slight stretch in your neck or upper back. Then slowly roll your head to the right. Continue until your head is tilted to the right as illustrated above. Let your head roll back down to mid-line to the center of your chest (*do not roll your neck into extension to complete a full 360 degree rotation) and continue the movement around until your head is tilted to the left. Roll your head back and forth slowly like this several times.

While the Holidays are a great time to celebrate and reconnect with friends and family, there's no doubt that they can also be stressful and put our already hectic lives into overdrive. Unfortunately, the path of stress frequently leads down the tight muscle road.

Muscle tension is like a car that's idling too fast. The engine is revved up and working hard but nothing is happening with the exception of more wear and tear on the motor. Not only that, but the motor is burning more fuel and creating more pollution. It's the same with muscle tension - your muscles are working hard, but nothing particularly useful is coming from it. The tension doesn't help you move, and it certainly doesn't improve muscle strength.

It does, however, cause a lot of wear and tear on your body. Tension:

* Strains the tendons that connect your muscles to your bones.
* Puts increased pressure on your joints.
* Limits your movement and range of motion.
* Interferes with your co-ordination and may even make you more accident-prone.

Tense muscles also burn up fuel in your muscles, making you feel tired and create the equivalent of car exhaust – toxic waste products (called metabolites) that fatigue your muscles and make them feel sore and achy.

You know from experience – tension is not good.

It's important that you get your tension under control. Not only will you feel more comfortable, but you'll also prevent a lot of problems from occurring, from pains in your neck to early arthritis. To manage your tension, it helps to know what causes it.

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The culprits
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Stress is one of the major sources of muscle tension. When under stress, you become like a turtle trying to pull its head into its shell. Your shoulders round forward and lift up as your head pulls back. If your stress level is high, you may actually notice your shoulders around your ears. More often than not, the stress isn't quite so significant and the shoulder muscles simply tighten up.

Just sitting or staying still for periods of time will also cause your muscles to tighten up. By remaining static, you are in a sense training your muscles to lock your back or neck in a certain posture. When you begin to move, your muscles remain tense in an effort to maintain your position. It takes some time for the muscles to realize that they can let go and relax. The longer you sit without moving, the more you train your muscles to lock into position and the longer it takes to release them.

Although tension can develop in any muscle in your body, your neck, shoulders and back are must vulnerable and are the areas that are most commonly affected.

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Tenderness and tension
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How do you know if your muscles are tense? One of the best indicators is tenderness in your muscles. Tenderness is the discomfort you feel when you press on the muscles.

When your muscles are healthy and relaxed, they won't be tender. You won't feel any discomfort even if your massage therapist is applying lots of pressure.

Blood vessels normally deliver oxygen and nutrients to a muscle and flush away waste products. When your muscles are tense, they essentially squeeze their own blood vessels. The muscles are working hard and creating excess waste that doesn't get washed out of the muscle. As these metabolites begin to accumulate, they start to irritate pain nerves. If the tension is significant, you'll actually start to feel achy. If the tension is less severe, the nerves become sensitive and any added stimulus, like a squeeze to the muscle causes discomfort.

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Massage to the rescue
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Massage plays an important role in helping you deal with your tension. Massage has a twofold action.

First, it helps induce a relaxation response. This reduces the common defensive reactions in your body, including that turtle-in-the-shell action of your neck muscles. Relaxation causes your brain and nervous system to slow down and this in turn lowers the tension level of all the muscles in your body.

Secondly, massage pulls and stretches your muscles, physically relasing them. In addition, the sensations that your muscles feel, both conscious and subconscious, give your brain information about the level of tension that exists in your muscles. This helps your nervous system to adjust your muscles to a normal level of tone.

The wonderful thing about massage is that its effect on tension is almost instantaneous. You feel the tension leaving your body immediately. You don't have to wait days or weeks to see results.

However, don't expect long-lasting results from just one massage. Although this may happen, factors like stress and a sedentary lifestyle are likely to perpetuate your tension. For this reason regular massage is important.

While many are convinced that various and sundry of life's annoyances are a pain in the neck, millions of Americans find that life quite literally is a pain in the back – the low back!



According to the National Center for Health Statistics Report: Health, United States, 2006, Special Feature on Pain, of four common types of pain experienced by survey respondents, low back pain was the most common (27%), followed by severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%). In fact, over 26 million Americans aged 20-64 report having frequent back pain. Women report more back pain than men (29% vs. 25%).

Not only is it prevalent, but it is expensive. Researchers in a 2004 study at Duke Medical Center found that patients with back pain racked up over $90 bil annually in health care expenses, with roughly $26 bil of that directly attributed to treating the back pain. There are also significant indirect costs, as low back pain is a leading contributor of missed work and reduced workplace productivity and the most common cause of job-related disability.

As anyone who has had acute or chronic pain can attest, pain - including low back pain – takes an emotional toll as well. Those with low back pain in the NCHS study were four times as likely to experience serious psychological distress as those without back pain.

What causes it?

There are a range of factors contributing to low back pain, including muscle strain; overexertion; organ dysfunction; stress; obesity; smoking; misaligned bone(s); poor posture; improper lifting; poor sleeping position. Specifically identifying the source of the pain, though, can be challenging, and medical experts often disagree on the most effective approach to treat the problem.

What exactly is my low back?



The low back is roughly six inches long, and consists of the five lumbar vertebrae (L1, L2, L3, L4, L5) which begin at the lower end of the rib cage. Between each vertebra is a cushion called an intervertebral disk. The 5th lumbar vertebra joins at the top of the triangle-shaped bone called the sacrum; functionally, the lumbar vertebrae and the sacrum work together.

Massage to the rescue!

While most occurrences of low back pain go away in a few days, others can persist for much longer and if left untreated, can develop into more serious conditions. Traditional treatments for low back pain include pain medications, cortisone injections and surgery. While frequently necessary, they generally treat only the symptoms and not the cause of the pain.

Over the years, use of complementary and alternative medicine (CAM) has risen significantly. While people suffering from any acute or chronic pain problems are advised to consult with their physician, research is proving that massage therapy not only alleviates back pain, but may reduce the costs of care.

In a study published in the June 2003 Annals of Internal Medicine ("A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain," Cherkin, et al.), researchers evaluated the effectiveness, safety and costs of three popular CAM therapies for the treatment of back pain. Although the conclusions were preliminary, initial studies found massage to be effective for the relief of persistent back pain. Moreover, preliminary evidence suggested that "massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy" (approximately 8 sessions). The initial costs of a course of massage therapy may be justified "by the substantial improvements in functional outcomes and reduced use of health care services for back pain during the year after treatment."

More recently, research published in the May-June 2010 Journal of the American Board of Family Medicine ("Perceived Benefit of Complementary and Alternative Medicine (CAM) for Back Pain," Kanodia, et al.) shows that 60% of those surveyed who received at least one CAM therapy in the preceding 12 months found significant relief using the top six CAM modalities (chiropractic; massage; yoga, tai chi and chi gong; acupuncture; herbal therapies; and relaxation techniques). Chiropractic and massage were the two most common CAM modalities used to treat back pain.

References:

Annals of Internal Medicine 6/03. Cherkin, Daniel C., et al. "A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain."

Duke University News Release 1/12/04. "Back Pain Carries Significant Economic Costs." http://www.dukenews.duke.edu/2004/01/backpain_0104.html

Institute for Integrative Healthcare Studies 3/30/10. Cutler, Nicole. "Four Tips to Help Prevent Back Injury Reoccurrence." http://www.integrative-healthcare.org/mt/archives/2010/03/four_tips_to_he.html

Journal of the American Board of Family Medicine May-June 2010. Kanodia, Anup K., et al. "Perceived Benefit of Complementary and Alternative Medicine (CAM) for Back Pain." http://www.jabfm.org/cgi/reprint/23/3/354?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=massage&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Massage & Bodywork Dec./Jan. 2006. Benjamin, Ben E. "The Mystery of Low Back Pain: Part I." http://www.massagetherapy.com/articles/index.php/article_id/1024/The-Mystery-of-Low-Back-Pain%3A-Part-I

Massage Today 9/01. Crownfield, Peter W. "Massage for Back Pain: Let's Look at the Research." http://www.massagetoday.com/mpacms/mt/article.php?id=10312

National Center for Health Statistics. "Health, United States, 2006, With Chartbook on Trends in the Health of Americans." http://www.cdc.gov/nchs/data/hus/hus06.pdf

National Institute of Neurological Disorders and Stroke. "Low Back Pain Fact Sheet." http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

Often called runner's knee, Iliotibial Band Friction Syndrome (ITBFS) is a relatively common over-use injury seen frequently with runners, although it can be experienced by other athletes, such as cyclists, soccer players, weight lifters (especially during squats) and skiers. ITBFS is caused by inflammation of the Iliotibial Band, the connective tissue that begins at the hip, providing the attachment site for the Gluteus Maximus and Tensor Fascia Latae (TFL) muscles, and extends down the lateral side of the leg to the outside of the knee, attaching on the lateral tubercle of the tibia, the head of the fibula and the patellar retinaculum.



Affecting beginners and seasoned runners alike, symptoms of ITBFS include pain on the lateral aspect of the knee and may also radiate up the thigh towards the hip. Pain results when a tight ITB rubs across the lateral epicondyle of the femur (the end of the thigh bone).

To better understand ITBFS, is important to understand the mechanics of the ITB. The ITB provides a stabilizing function to the hip and outside of the knee. When standing, the ITB is fairly relaxed; it really starts to engage when the knee is flexed (bent) to about 20 degrees. Studies have shown that the ITB passes over the lateral epicondyle – the ITBFS "hot spot" – at around 30 degrees of knee flexion. The repeated force of impact during running and the continuous knee flexion required for cycling puts significantly increased demands on the ITB. If the ITB is unusually tight, the rubbing on the femoral epicondyle can eventually lead to microtrauma and inflammation – and resulting pain.

Factors contributing to ITBFS include old / improper running shoes; too much activity (too many miles) too soon; excessive running downhill; other biomechanical factors (e.g., weak hip abductors, anterior hip tightness, uneven leg length, over pronation of the foot, etc.)

Treatment strategies may include:

* Rest – Decreasing your mileage or taking time off from running or other activities perpetuating the pain.

* Ice – Ice over the lateral epicondyle of the femur to reduce inflammation.

* Massage – Slow, myofascial release will help loosen the ITB, which in turn decreases the rubbing and friction on the lateral epicondyle.

* Figuring out the cause – You may need to consult with a physical therapist or other biomechanical expert to help solve the problem.

When your body's hurting it feels comforting to put a hot water bottle or a heating pad on the sore areas. But it may not always be a great idea. Heat can aggravate your injuries and prolong your pain. When should you use heat and when should you use ice? If you're ever in doubt use ice, but here are some guidelines.

use ice if:

• your injury (e.g., muscle pull, strain, sports injury) is recent
(within 48 hours following the injury)

• your muscles are in spasm

why ice?
Ice will reduce inflammation and decrease the time it takes for your injury to heal. It also has an anesthetic effect that will lessen your pain and relax muscle spasms.

use heat if:

• your injury is chronic
(more than 48 hours old)

• your muscles are tense

• you have pain that's the result of trigger points or muscle knots

why heat?
In either of these cases, there is no danger of aggravating the inflammation. The heat will relax your muscles and help improve your circulation.

It's easy to pull a muscle or sprain a joint, whether from a sports injury, an accident such as a fall, or from simply overdoing everyday activities like gardening or shoveling snow. Use the RICE formula immediately after hurting yourself. You'll dramatically reduce the time it takes for your injury to heal and get back to your normal routine as quickly as possible.

RICE is an acronym for rest, ice, compression and elevation.

Rest

The simplest and most effective thing you can do is rest. Many try to "work through" the injury in the hopes that it will go away or work itself out. Injuries don't spontaneously disappear. In fact, excessive movement will damage the tissue further, increasing the amount of inflammation and pain.

Unless the injury is severe, absolute rest should not exceed 48 hours. Otherwise, your muscles will become stiff and weak, and scar tissue around the injury will tighten up. So as soon as the initial pain and swelling subside, you should begin to gently exercise the injured area.

Ice

Apply ice immediately. The importance of icing your injury cannot be emphasized enough. Ice is a natural pain reliever and anti-inflammatory. It slows down blood flow to the area and reduces internal bleeding and swelling. Depending on the type of injury, your healing time may be cut in half.

Simply place ice cubes in a plastic bag. You can also use commercial gel packs that you keep in your freezer or a bag of frozen vegetables (peas seem to work well). You may find that these mold better to your body. Wrap whatever you're using in a towel or cloth and apply it to the injured area. Leave it on for 10 to 20 minutes and then allow your skin to warm up. As a general rule, don't leave the ice on for more than 20 minutes because you may cause frostbite. Ice the injury as frequently as possible, preferably every 3-4 hours, or as advised by your physician.

Compression and elevation

Compression and elevation help reduce swelling. You can apply compression to the area with an elastic type bandage. Be careful not to tie the bandage so tightly that you cut off your circulation. If one of your arms or legs is injured, you can elevate the extremity above the heart level.

See your Massage Therapist

Follow the RICE formula for the first 48 hours following an injury and then see your massage therapist. It's not wise to massage the injured area within the first two days because this may aggravate the injury. After that time, however, massage becomes an important part of the rehabilitation process.

Massage therapy can help drain the fluid out of the swollen tissues. It can also get rid of muscle spasms that develop as a result of the pain.

As your injury continues to heal, massage will help restore or increase your range of motion, as well as aid in the removal of scar tissue, which, if left untreated, can set the stage for re-injury and chronic soft tissue pain problems. Massage enables you to get back to your sports and other daily activities as quickly as possible.
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To help prevent excessive pain and swelling try not to use the injured part. Put an ice pack on the area, use a tensor bandage to provide some compression and elevate the limb.