Inoperable Sports Injury Testimonial from Paula P.

“Nicole Ftacnik is simply the best medical massage therapist. Her magic fingers keep me painless and mobile. I have an inoperable sports injury in my neck/shoulder area. Nicole just knows exactly how to treat that. I do not need to give her any advice. She knows her thing. I recommend her to anyone needing medical massage. Also, she is funny, easy to talk with, and caring.”

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

What Exactly Is PNMT?

Precision Neuromuscular Therapy (PNMT) is a soft-tissue manipulation technique used to treat pain and dysfunction caused by misalignment of the body by the muscular-skeletal system. Misalignment—or distortions—of the body trigger muscle imbalances, which are caused by an accident or trauma, poor posture, repetitive movement patterns, and/or nerve influence. Restoring weight bearing equality and symmetry is essential for good health, which is why it is SO important to bring people into neutral balance alignment!

PNMT specifically addresses several arenas of pain that can cause a mild ache to extreme discomfort in our bodies. These arenas include… Structural imbalances, which can impact the muscles, connective tissue, and joint function; functional imbalances, which can effect muscle strength/weakness and range of motion, etc.; trigger points (TrP’s), which can disturb muscle function, refer pain, and reduce muscle length; neural influences, which involve nerves and their ability to affect muscular function including entrapment/nerve compression; and ischemia, which is a lack of blood flow to tissues (i.e. connective, muscular, nervous, and epithelial).

So, as you can see, there are several factors that can play a role in pain and dysfunction when it comes to muscular imbalances. I’m going to go out-on-a-limb here and assume that you are now curious what it is I do in a treatment session that relieves a person of said pain and dysfunction…

As far as my clients go, the first thing I do is take measurements. (This I learned through becoming certified in PNMT.) Measurements include looking for shoulder discrepancies (i.e. height, rotation, etc.), distortions of the hips (i.e. obliquity, torsion, increased inclination, etc.), and discrepancies in leg length; among others if necessary. It is through these measurements that I am able to ascertain what muscles are influencing what muscular imbalances. From that point, I treat the affected muscles, paying special attention to TrP’s (active, latent, satellite)—Communication is key as far as I’m concerned, so don’t expect this to be a typical massage session where you get some zzz’s. 🙂

As stated in my very first post on this blog, PNMT is the “real deal”. And I know this from personal experience; after having suffered from low back pain myself for so many years.

If interested, stay tuned for my next post… It has to do with conditions that PNMT can improve, if not, get rid of.

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