“Neutral Balance Alignment Is Key To Becoming Pain Free!”™

I mentioned in previous posts how PNMT treats pain and dysfunction caused by muscular imbalances within the muscular-skeletal system. So, I thought I would include more detail regarding the distortions (misalignments) I look for⏤via the measurements I take⏤when treating clients, which ultimately has to do with the quote/slogan I coined 8+ years ago…

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

When we are out of alignment, our body tends to spread distortions (via compensation) over as many segments as possible, which in turn spreads negative effects over multiple areas. My experience is that this usually stems from the hips, so my ultimate goal  during the first session (depending on my clients needs) is to get the pelvis back into neutral balance alignment.

I believe this is of great importance. In fact, when I get people back into alignment, this is when the magic really happens. To get there though, I take measurements before every session. I believe they are crucial for long-term health and wellness⏤it is about getting to the root cause; not just “rubbing where it hurts.”

Because most of my sessions last only one hour, I typically start with a select few based on my experience of what has worked over the years. If need be, I go from there considering we are all different, and our bodies respond differently as well.

The first thing I look for is a shoulder height discrepancy, while my client is standing. I check to see if they are level; most times not. This misalignment in shoulder height usually presents itself as being superior and inferior; one shoulder high, the other low. This is not an ideal situation to be in, but unfortunately, it can be difficult to avoid based on the factors that cause misalignments to begin with (more detail on that subject in another post). The good news is that this high/low discrepancy is usually an easy fix⏤one that I find most are unaware of for one reason or another.

The next thing I look for, while my client is still standing, are distortions in the pelvis. Distortions may include obliquity (high/low), torsion (twisting), anterior/posterior rotation (rolling forward/backward), etc. It could be one distortion or a combination of two or more. I also look at the knees⏤for more reasons than one⏤but specifically for confirmation of torsion.

Next would be to have my client lie on the table⏤on their back. From here I check the pelvis again; looking for more confirmation of what I saw while they were standing. I then look at the leg length. More times than not, there is a “long” leg⏤or “short” if you prefer to look at it that way. This also is not an ideal situation, but usually an easy fix if it is a functional leg length difference as opposed to a structural leg length difference. (It is my understanding that an x-ray of both legs with actual measurements of bone length, for comparison, is the only way to determine 100% if it is structural. And, of the 700+ people I have seen, a handful of them possibly had a structural leg length difference based on additional measurements I took.)

There are many other measurements in PNMT that are important indicators as to why something may be happening, but this is where I start… And they are well worth the few minutes it takes before I actually treat the muscles.

As always, I hope you find this information informative!

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

The Sciatic Nerve

I’ve had many clients come to me over the years requesting help with sciatic-type pain; either after having been diagnosed with “sciatica” or from assuming that it could be such. Unfortunately, it’s been made very clear to me that many people—the healthcare industry included—aren’t aware that discrepancies in certain muscles could mimic sciatica. I’m not at all saying that true sciatica couldn’t be the case, but my goal is to provide you with additional information to consider when it comes to the sciatic nerve, the muscles around it, and how PNMT can help you to become pain-free. First I’ll start off with the anatomy and then I’ll go into other details.

The sciatic nerve, which is the longest nerve in the body, is actually comprised of two nerves—tibial and common fibular (a.k.a. common peroneal)—which splits into two divisions, usually at the knee. Per Tortora & Derrickson (11th Edition), the nerve root origin is as follows…

  • Sciatic: L4, L5, S1, S2, S3
  • Tibial: L4, L5, S1, S2, S3
  • Common Fibular: L4, L5, S1, S2
    * (Click here for a dermatome chart: dermatome meaning the area of skin that provides sensory input to the central nervous system.)

As the sciatic nerve descends down the thigh, it sends branches to the hamstring muscles and the adductor magnus. At the knee, the distribution to additional muscles is as follows…

  • Tibial: Gastrocnemius, plantaris, soleus, popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. It then divides into the medial plantar and lateral plantar branches:
    – Medial Plantar: Abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis.
    – Lateral Plantar: Quadratus plantae, abductor digiti minimi, flexor digiti minimi brevis, three lateral lumbricals, dorsal interossei, plantar interossei, and adductor hallicus.
  • Common Fibular: Divides into the superficial fibular and deep fibular branches:
    – Superficial Fibular: Fibularis longus and fibularis brevis.
    – Deep Fibular: Tibialis anterior, extensor halluscis longus, fibularis tertius, extensor digitorum longus, and extensor digitorum brevis.

What could happen when the sciatic nerve is affected? Well, here’s what Tortora & Derrickson stated in their 11th Edition book…

Sciatic nerve injury, the most common form of back pain, is caused by compression or irritation of the sciatic nerve. Pain may extend from the buttock down the posterior and lateral aspect of the leg and the lateral aspect of the foot. It may be injured because of a herniated (slipped) disc, dislocated hip, osteoarthritis of the lumbosacral spine, pressure from the uterus during pregnancy, inflammation, irritation, or an improperly administered gluteal intramuscular injection.

To take it a step further and per my Precision Neural Mobilization training manual, a normal response from the sciatic nerve during a deep stretch, for example, could result in a sensation down the posterior thigh which may extend into the calf and foot. On the other hand, there are indications and causative factors that could result in abnormal responses. They are as follows…

Now back to some muscles and PNMT….

The gluteus minimuspiriformis, and hamstrings are a few muscles that can mimic sciatica. Trigger points (click here and here for previous posts on TrP’s—and please note that the muscles below, in bold, link to webpages that show TrP referral patterns) in the gluteus minimus can refer pain all the way down the side of the leg; usually stemming from the anterior fibers. TrP’s in the piriformis can send pain from the buttocks down the back of the thigh; however, the pain doesn’t go past the knee—it is also well known for its ability to entrap the sciatic nerve, so any tightness will produce sciatic symptoms. TrP’s in the hamstrings can also send pain down the back of the thigh. Travell reports that there are “rare” cases where the sciatic nerve is entrapped between two heads of the hamstring attachments on the ischial tuberosity; however, this study by Kari Saikku, Jarkko Vasenius, and Pekka Saar from the University Central Hospital in Helsinki, Finland found that this sort of entrapment “is not extremely rare.”

At the end of the day, muscular discrepancies within the muscular-skeletal system can in fact mimic sciatic-type symptoms—and I want you to be aware of this, especially if you have tried every other option out there to no avail. There are more holistic and non-invasive approaches to treating pain and dysfunction, and PNMT is a prime example. By taking just a few measurements to see how a person’s body is aligned, a trained therapist can ascertain what muscles are pulling where, and treat the affected muscles to help the individual to become pain-free again.

Sounds awesome, doesn’t it?

As always, I hope you find this information informative… And more importantly, HAPPY NEW YEAR!

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

 

More On Myofascial Trigger Points (TrP’s)

Back in May of this year, I posted an article titled Trigger Points (TrP’s) In Detail and thought I would take it a step further by describing additional TrP’s that I learned about via the Precision Neural Mobilization seminar I attended. Before I list them however, please allow me to give you some other details.

1) TrP’s may be caused by several factors, including acute or chronic muscle overload, activation by other TrP’s, disease, psychological distress, homeostatic imbalances, direct trauma to the region, accident trauma, radiculopathy, and infections/health issues.

2) TrP’s form only in muscles—as a local contraction in a small number of muscle fibers located within in a larger muscle or muscle bundle. They can pull on tendons and ligaments associated with the muscle, which in turn, can cause pain deep within a joint where there are no muscles. They can also cause muscle weakness.

3) TrP referral patterns follow specific nerve pathways and have been readily mapped—thanks to Travell & Simons—to aid in the identification of pain. Many TrP’s have pain patterns that overlap, and some create reciprocal cyclic relationships.

4) A taut band in muscles containing TrP’s can feel like hard nodules. Upon palpation, a twitch response can often be felt; activateing the “all or nothing” response in a muscle that causes it to contract. Pressing on an affected muscle can often refer pain, and clusters of TrP’s are not uncommon in some in larger muscles (i.e. the gluteus group).

As promised, here is a list of TrP’s above and beyond what I gave you the last time; the first three being what was listed in my previous post…

  • Active – A TrP that causes a clinical pain complaint. It is always tender; prevents full lengthening of a muscle; weakens a muscle; activates a local twitch response when stimulated; direct compression refers patient-recognized pain that is generally in it’s pain reference zone. (Click here for a website that lists reference zones and pain referral patterns.)
  • Latent – A TrP that is clinically inactive with respect to spontaneous pain; painful only when palpated. It may have all other characteristics of an active TrP and always has a taut band that increases muscle tension and restricts range of motion (ROM).
  • Satellite – A TrP that is influenced neurogenically or mechanically by the activity of a key TrP.
  • Associated – A TrP in one muscle that develops in response to compensatory overload, a shortened position, or referred phenomena cause by TrP activity in another muscle. Satellite and secondary TrP’s are types of associated TrP’s.
  • Attachement – A TrP at the musculotendinous junction and/or at the osseous attachment of a muscle that identifies the enthesopathy caused by unrelieved tension, characteristic of the taut band that is produced by a central TrP.
  • Central – A TrP that is closely associated with dysfunctional end-plates and is located near the center of muscle fibers.
  • Key – A TrP responsible for activating one or more TrP’s.
  • Primary – A central TrP that is activated by acute or chronic overload, or repetitive overuse of a muscle in which it occurs, and was not activated as a result of TrP activity in another muscle.

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies, but physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.

The above quote comes from a workbook titled The Trigger Point Therapy Workbook. With this book, you will learn about TrP’s and how to treat them; however, it is important for you to keep in mind that if your muscular-skeletal system is misaligned, other muscles are affected, which in my opinion, makes it hard to self-treat in a way that is more than just temporary. Every little bit helps though!

As always, I hope you find this information informative!

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

The QL: Another Player In Back Pain

In a previous post, I went over the psoas major and how it is a major player in back pain, so today I thought I would go over the QL—the quadratus lumborum, which is a common source of low back pain. Before I go on though, let’s go over the anatomy…

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Iliac crest and iliolumbar ligament.
Insertion: Inferior border of 12th rib and first four lumbar vertebrae.
Action: Acting together, pull 12th ribs inferiorly during forced exhalation, fix 12th ribs to prevent their elevation during deep inhalation, and help extend lumbar portion of vertebral column; acting singly, laterally flex vertebral column, especially lumbar portion.
Innervation: Thoracic spinal nerve T12 and lumbar spinal nerves L1-L3 or L1-L4.

The QL is a very strong lateral flexor and lateral stabilizer of the trunk; working synergistically with the psoas—on the same side—in lateral stabilization. It also assists the multifidi, erector spinae, and serratus posterior inferior in extension.

So, how do you know when the QL could be influencing back pain? Well, here are a few indicators for treatment…

  • Persistent pain, even at rest
  • Back pain after a violent sneeze or cough
  • Great pain when turning from one side of the body to the other while in bed
  • Excruciating pain when laterally bending or during forward flexion
  • Pain when standing; however, putting bilateral pressure above both iliac crests lessens the pain
  • Hyperlordosis is present.

If you experience one or more of the aforementioned, there is a good chance the QL is a player in your back pain—low back, specifically.

As always, I hope you find this information to be informative!

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

Headaches And Pain… Oh, My!

For me, the pain associated with headaches could be debilitating at times. So much so, I would sometimes just want to crawl in bed and cry like a baby until I fell asleep; however, when I first experienced PNMT, I quickly realized that there were other options out there aside from mainstream treatments. More on that later!

Before I go over the different types of headaches though, I feel it’s important that I share some RED FLAGS that I learned through becoming certified in PNMT:

  • See a physician to have other possible causes ruled out if the headaches are a new occurrence—the number of serious problems that have headaches as a side-effect is numerous.
  • See if physician immediately if you have any other global health declines.
  • See a physician if you’ve had headaches in the past but they are different in frequency, intensity, and/or location.
  • See a physician if you’ve had headaches for a long time but now they are daily; accompanied by GI symptoms, restlessness, anxiety, irritability, memory problems, difficulty in intellectual concentration, and depression. This could be considered analgesic rebound; analgesic overuse being very common.

Now, onward with different types of headaches. I will include some bullet points and reference the clinical studies, which happens to be where I got most of my information from…

TENSION HEADACHES – In the U.S., these account for 1-4% of all emergency room visits and is the 9th most common reason for doctor visits; being the most common type of chronic recurring head pain. All ages are susceptible, but most are young adults. — Michelle Blanda, MD; Tension Headache Clinical Presentation

  • These are usually associated with a stressful event, poor posture, or depression; and are not aggravated by physical activity.
  • They are of moderate intensity but can have a throbbing quality, are bilateral, and usually present in the occipitofrontal region.
  • They typically last 30-minutes up to 7-days.
  • Muscular tightness or stiffness in the neck, occipital, and frontal regions is common.
  • Cervical muscles, when palpated, may be very tender.
  • Nausea or vomiting is not present.
  • Insomnia is present.
  • Often present upon rising or shortly thereafter.

MIGRAINE HEADACHES – This disorder is one of the most common complaints in medicine. In the U.S., more than 30 million people have one or more migraines per year. — Jasvinder Chawla, MD; Migraine Headache

  • They typically throb or pulsate.
  • The pain is initially unilateral (on one side) and localized to the Temporalis and Frontalis muscles, or over the eye, but can be felt anywhere around the head or neck.
  • The pain typically builds up over a 1- to 2-hour period and then slowly diffuses towards the back of the head.
  • They typically last 4-72 hours; usually subsiding gradually within a day, and after a period of sleep.
  • Intensity is moderate to severe and intensifies with movement or physical activity.
  • Light and sound sensitivity are very common.
  • Nausea occurs in about 80% of migraines; vomiting in about 50%.
  • Other interesting symptoms include:
    – About 60% of people reported prodrome (preheadache) symptoms hours to days prior to the migraine. Postdrome symptoms may persist for 24-hours after the headache.
    – Auras—which can be visual, sensory, motor, or any combination of these—usually develop over 5-20 minutes and lasts less than 60 minutes.

CLUSTER HEADACHES – In the U.S., it is estimated that 2-9% of migraine sufferers experience these, making it relatively uncommon compared to the classic migraine. This condition is more common in males than in females. — Lori K Sargeant, MD; Headache, Cluster

  • No aura exists like they do in migraines.
  • Sudden onset peaks in 10- to 15-minutes; duration lasts 10-minutes to 3-hours per episode; frequency may occur several times a day for 1- to 4-months.
  • Typically, 1-2 cluster periods are experienced per year; each lasting 2- to 3- months.
  • The pain associated with is described as severe; as if the eye is being pushed out.
  • They are often nocturnal—active at night.
  • Triggers in some patients include stress, allergens, and seasonal changes.
  • Alcohol and smoking induce attacks during a cluster but not during remission.
  • Risk factors include: male sex; older than 30-years; small amounts of alcohol; previous head trauma or surgery (occasionally).

CERVICOGENIC HEADACHES – The presence of these headaches in the general population is estimated to be between 0.4% and 2.5%; however, the prevalence is as high as 20% in pain management clinics. This condition is four times more common in women than in men. — David Biondi, DO; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

  • This condition is a relatively common cause of chronic headaches that is often misdiagnosed or unrecognized; clinical features may mimic those commonly associated with other headache disorders, making this headache hard to distinguish.
  • They involve head pain that is referred from bony structures or soft-tissues of the neck; TrP’s are usually found in the suboccipital, cervical, and shoulder musculature.
  • These often develop after a head or neck injury, but may also occur in the absence of trauma.
  • They are typically described as a deep—or dull—pain that radiates from the occipital to parietal, temporal, frontal, and periorbital regions.
  • Sufferers will often have restricted cervical range of motion and altered neck posture.
  • Head pain can be triggered or reproduced by active neck movement.
  • Paresthesia and numbness over the occipital scalp are usually present.
  • Many sufferers overuse or become dependent on analgesics; medication, when used alone, does not generally provide substantial pain relief.

As stated earlier in this post, I have suffered from headaches for many years, but not so much over the past five years due to the powerful effects of PNMT. In fact, many of my clients have suffered from them as well—that is until I got my hands on them. 🙂

Believe it or not, muscle involvement—which is stated in some of the above mentioned headache descriptions—can be a huge contributing factor that is definitely worth looking in to. In fact, the SCM, Longus Colli, Trapezius, and the Suboccipital muscles are just a few examples that can mimic or refer headache-related pain. Also note that muscular-skeletal alignment is a key factor as rubbing where it hurts won’t solve the problem.

If this post strikes a cord with you, consider looking for a massage therapist as an alternative option for headache related pain-relief!

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