Just A Couple Shoulder Pathologies

There are so many things I want to write about, but since I mentioned a muscle related to the shoulder joint in a previous post (The Infraspinatus), I figured I might as well continue with the same theme.

To start, pathology is the precise study and diagnosis of disease, which I obviously do not specialize in. Pathologies can cause individuals a lot of distress and here are just a couple linked to the shoulder that I have come across with clients in my own practice…

Impingement Syndrome – Also known as rotator cuff tendonitis. This syndrome is one of the most common causes of shoulder pain and dysfunction. Repetitive movements of the arm in over-the-head positions (i.e. baseball, tennis, lifting weights, swimming, painting, carpentry work, etc.)—or holding the arm in the same position for a long period of time or a direct blow or stretch injury—can cause continuous pinching of the rotator cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor). This can then cause inflammation and result in pain. If movement is continued despite the pain, a tendon may degenerate near the attachment and ultimately tear away from the bone resulting in a not-so-welcome rotator cuff tear.

Torn Rotator Cuff – This injury is pretty self-explanatory, but nevertheless, is diagnosed when one or more of the rotator cuff tendons tear away from the head of the humerus. OUCH, not so funny if you ask me—pun intended! Most tears of this nature occur in the supraspinatus muscle and tendon, but other muscles and tendons can be involved as well.

Do you have shoulder problems? Have you been diagnosed with one of the above mentioned ailments? If so, PNMT can help! It won’t mend an actual tear, but it will lengthen shortened muscles, thus relieving tension on the tendons and increasing range of motion.

All in all, before taking the surgery route followed by lots and lots of post-op rehabilitation—unless of course it’s absolutely 100% without-a-doubt necessary per a medical professional—I highly recommend giving this non-invasive option a whirl.

NOTE: Due to a much anticipated upcoming vacation, I may not be posting on here for 2-3 weeks.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Muscle Contractions

In this rather lengthy post, I’d like to go over muscle contractions and their types; isotonic (concentric and eccentric) and isometric. However, before I delve into each contraction specifically, I’m going to start off by providing a very watered-down version of an anatomy and physiology lesson in regards to our muscular system from a cellular level. For the record, I am not an A&P professional… Just thought I would use this opportunity to brush-up on some facts that I learned back in ’06. In fact, I probably learned this sometime between ’90 and ’93, but who remembers such detail from almost 20-years ago and while in high school. Hahaha! 🙂

Skeletal muscle tissue—which produce body movements, stabilize body positions, store and move substances within the body, and generate heat—is made up of hundreds to thousands of cells, also called muscle fibers. Muscle fibers consist of sarcomeres, which are made up of thick filaments, thin filaments, and Z discs; among other things. In order for muscle fibers to contract, certain proteins must be present; two of those being actin and myosin. Check out this link for visual aids and here is where you can read more about this in detail.

Okay, enough A&P for now! I’m a layman so onward with layman terms regarding the functions of skeletal muscles, that being muscle contractions. While the muscle is under tension, it may shorten, lengthen, or remain the same…

Muscle contractions are classified as being either isotonic or isometric. An isotonic contraction (iso- = equal; -tonic = tension) happens when tension developed by the muscle remains almost constant while the muscle changes its length. These contractions are used for body movements and for moving objects. The two types are known as concentric and eccentric.

Concentric isotonic contractions happen when two ends of a muscle are brought closer together during the contraction. The muscle shortens and pulls on another structure, such as a tendon, to produce movement and to reduce the angle at the joint. An example of a concentric isotonic contraction is when one does a bicep curl. As the dumbbell is lifted up, visualize how the two ends of the bicep move closer together during the contraction. This is the simplest form of contraction and is usually the least problematic.

Now imagine one lowering the dumbbell after the bicep curl. It is with this movement that the previously shortened bicep now lengthens during the contraction, which is known as an eccentric isotonic contraction. The bicep in this example contracts so it can control the speed at which the dumbbell is lowered. Per Tortora & Derrickson, 11th edition, repeated eccentric isotonic contractions produce more muscle damage and more DOMS (delayed-onset muscle soreness) than concentric isotonic contractions.

Isometric contractions happen when a muscle contracts but the ends do not move at all, and even though they do not result in body movement, energy is still expended. Isometric contractions are vital because they stabilize some joints as others are being moved. They maintain posture and support objects in fixed positions. The perfect example would be me sitting at the computer typing this right now. I’m sitting erect trying to use good posture and my mid-back is starting to hurt… Ugh! My lower trapezius is sustaining a contraction—to hold me upright—and it is becoming too much. At no time have the ends of the muscle come closer together. Make sense? I bet all of you have experienced this at one time or another.

There is one more category that should be mentioned, that of approximation; the length-tension relationship. If two ends of a muscle are brought closer together, over time, the muscle will adjust its length to keep the same tension. While not a true contraction, it acts like one. This is the concept of Davis’ LawWhen two ends of a muscle are brought together, the pull of tonus is increased. When two ends of a muscle are separated, tonus is lessened or lost, thereby weakening the muscle.

The first part of Davis’ Law has to do with adaptive-shortening. Unless something acts upon the shortened muscle, it will remain in the shortened position and adapt that position as the new “normal”. It will then resist attempts to return to the old “normal” as it has forgotten what that position was.

The second part of Davis’ Law has to do with stretch-weakeness. Muscles are affected by either duration or magnitude. Stretch-weakness is definitely a factor of duration, not magnitude. Having a shoulder much lower than the other for a short period of time is not as powerful as having a small difference for a long period of time.

It is through this length-tension relationship that PNMT comes in handy. These discrepancies within the muscles can cause pain and dysfunction. That being said, proper measurement from a Certified Precision Neuromuscular Therapist can help verify whether your pain and/or dysfunction is caused by misalignment within the muscular-skeletal system.

I hope this information has been informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

The Infraspinatus Muscle

In my last post, Trigger Points (TrP’s) In Detail, I briefly mentioned a TrP in the infraspinatus and thought I would go ahead and write about this muscle more thoroughly since it is a big player with shoulder issues.

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Infraspinous fossa of scapula.
Insertion: Greater tubercle of humerus.
Action: Laterally rotates and adducts arm at shoulder joint.
Innervation: Suprascapular nerve.

The infraspinatus is one of the four deep muscles that join the scapula to the humerus. The four tendons merge together to form the rotator cuff. The rotator cuff strengthens and stabilizes the shoulder joint and is comprised of the supraspinatus, infraspinatus, teres minor, and subscapularis; think S-I-t-S (small “t” representing the teres minor–not major).

The prime function of the infraspinatus is to decelerate forward motion of the humerus. Repetitive movements with the arm in over-the-head positions—such as in throwing a baseball, a tennis serve, spiking a volleyball, and swimming—can result in injuries. This happens because much of the work of the infraspinatus is done in eccentric contraction. Eccentric contraction is when the muscle fibers lengthen during contraction… More on muscle contractions in my next post.

Great info, Nicole, but how does one know if the infraspinatus needs some TLC from a CPNMT (Certified Precision Neuromuscular Therapist)?

LOL! That last sentence is so ridiculous. 🙂

Well, some general indicators for treatment could include, but are not limited to:
1) Difficulty brushing or combing your hair;
2) Inability to sleep on your side at night;
3) Inability to reach behind your back and touch the opposite shoulder blade.

There are other—more medical—indicators for treatment, which is why I recommend contacting myself or another CPNMT for an evaluation if you are experiencing problems within the shoulder girdle.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Trigger Points (TrP’s) In Detail

You’ve heard the term “trigger point” or “knot”, but do you really know what it is? I find in my practice that many people do not have a full know-how, which is why I feel it’s important to go into detail with it here.

First and foremost, the term “myofascial trigger point” was coined by Dr. Janet Travell in 1942. If it wasn’t for her hard-work and dedication on the subject—followed by others as well (here is a brief history)—we may not have the awareness today regarding how TrP’s can cause referred musculoskeletal pain. Kudos to her and those who followed!

TrP’s are those highly sensitive areas within our muscles that hurt when touched; giving rise to specific sensations or symptoms. Technically speaking, they are hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. At a cellular level, the individual “knot” is made up of sarcomeres that are extremely contracted, which produces heat and a local energy crisis for the tissue. Symptoms of this crisis can include referred sensations (i.e. pain, numbness, tingling, pins-and-needles, hot/cold, etc.), a local twitch response, decreased range of motion (ROM), pain on contraction against resistance, and weakness.

There are three types of TrP’s; active, latent, and satellite. How do we know which is which though? When a TrP is compressed, or pressure is applied to, certain characteristics will follow…

Active TrP’s actively refer pain locally or to another location in the body along nerve pathways. At rest, they are commonly known to radiate pain that is familiar to the original pain complaint.

Latent TrP’s may be tender when pressure is applied, but they do not cause pain at rest, and do not yet refer pain actively. They produce shortening of length and increased muscle tension.

Satellite TrP’s are active TrP’s that rely on another “key” TrP for their existence. Treating the “key” TrP will often resolve the satellite TrP by either changing it from active to latent, or get rid of it all together.

I find TrP’s to be fascinating and I wish more people were aware of them and how their referral patterns can be related to—or actually be the direct cause of—pain and dysfunction within our muscular-skeletal system. Because I have found that so many people are unaware of TrP referral patterns, I decided to include one example of more than 620 potential possibilities in human muscles. And considering so many people suffer from pain in and around the shoulder girdle, I thought I would show just one of the four TrP’s found in the Infraspinatus.


Infraspinatus - Thorax & Arm
Image copyright of Primal Pictures

NOTE: I personally added the TrP and referral pattern to this image. It is just an approximation. The “X” is where the actual TrP is and the black area is where it could hurt when pressed upon.

If you are interested in the image you see in this post, please visit Primal Pictures to check out their Award Winning software. I own the 3D Human Anatomy: Regional Version and it is awesome.

If you are interested in learning about TrP and their referral patterns, I highly recommend that you check out this flip-chart. I also own this and refer to it quite frequently in my practice.

In closing, the number of people that get misdiagnosed and/or undergo unnecessary, invasive, and expensive treatments and procedures for pain-relief—with less than stellar results—honestly amazes me. I’m not disregarding other medical professionals and treatment options out there by any means, just hoping that some day in the near future, certified Precision Neuromuscular Therapists will be one of the first lines of defense when it comes to pain and dysfunction caused by muscular-imbalances; TrP’s do play a huge role and that’s what we treat.

UPDATE as of 9/20/12: Here is another post with additional information related to TrP’s.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

What Conditions Can PNMT Treat?

So many of us, myself included, have struggled with—or are currently struggling with—some form of pain and/or dysfunction. Sadly, a plethora of conventional treatments are sought out, and in some instances, provide no relief. Frustration soon arises. Some clients have even, initially, walked into my office stating that they have succumbed to it; feeling like they might as well accept it as the norm since there has been no relief thus far.

This fact upsets me, which is one of the reasons why I decided to start this blog. Although PNMT can’t fix everything under the sun, it can help with many conditions—oftentimes quickly and in a non-invasive way. My former mentor expressed to me from the very get-go that, “We do not have a revolving door…” What that means, is by using the knowledge I gained through becoming certified and also by utilizing precision techniques, I am able to treat ailments caused by muscular-imbalances in a reasonable time frame; give or take depending on the ailment and the amount of time a person has been dealing with it.

Without further ado, here are some of the conditions that PNMT treatments can be beneficial for…
Headaches and migraines; low back pain; neck and shoulder pain; frozen shoulder; whiplash injuries; rotator cuff issues; TMJ dysfunction; tennis/golfer’s elbow; tendonitis; thoracic outlet syndrome; carpal tunnel syndrome; shin splints; plantar fasciitis; fibromyalgia; muscle spasms, cramps, and strains; postural distortions; and many more.

Well, does any of this hit close to home? If so, I highly recommend that you look into this as another option for pain-relief. Whomever you go to, just make sure that you ask for credentials, as there is such a thing in this business.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me