breathing pattern

Shoulder pain...which one?

Shoulder pain is one of the most Image-1common musculoskeletal issues that I see in my practice from week to week. Its easily as common as neck, lower back, hip and knee pain. So why is shoulder joint dysfunction so common? Well from the lay view, most people intepret shoulder pain as a rotator cuff issue, usually stemming from increased medial rotation. Common thoughts are that the use of the computer mouse, impact on this postural problem.

Too much bench press, throwing, ipad playing, racket or club, bat sports or anything that contibutes to excessive internal, external rotation, protraction, retraction, elevation or depressing of the shoulder joint and girdle and other actions will contibute to shoulder pain. Impingement syndrome is probably one of the most common shoulder problems.

Often external rotation exercises are utilised to combat these problems, often ineffectively. Determining whether the issue is one of mobility or stability and motor control should dictate which modality of therapy should be used together and the type of movement should be dictated by the dysfunction of each of the four joints of the shoulder.

Paul CHEK used the term slave joint to decribe any articulation below C2 (2nd cervical vertebrae) as a term to describe the vulnerability afforded to any joint that could be affected by heirachical factors such as breathing, atlas ( 1st cervical), vision, jaw and others that could influence lower joints such as the shoulder. Whilst this is a particularly useful model to bear in mind, both local and global dysfunction often effect the shoulder joint in isolation or together, from the head down or the foot up.

More often than not dysfunction in the opposite ankle can increase the facilitation of shoulder muscles. A lack of dorsi flexion or movement of the ankle which raises the whole foot off the ground whilst keeping the heel on the floor, can be a common feature in shoulder dysfunction. treating the shoulder may be the last thing that needs to be acheived in restoring shoulder function and decreasing pain.

Restoring shoulder mechanics need not be lengthy periods of shoulder rehab. Identify the cullprits involved in over working, rewire the ones that don't work enough, and create a stimulus that holds that pattern.

If you have shoulder pain and all people ever do is look at your shoulder, ask them to take a look at your ankle, breathing pattern, neck just in case they need a nudge in the right direction.



5 reasons why you get back pain.

image There are many reasons why we get back pain. In fact the points raised above are merely what occurs when the musculo-skeletal system is out of alignment, I repeat, what occurs when the musculo-skeletal system is out of alignment. What does that mean? Well if you work on balancing structures then all of the above points can be managed and in many cases eradicated. When we breathe, sit, think and complete exercise inefficiently we start to compensate with a variety of muscles. So getting movement and structure analysed can help to determine mobility and motor control issues that need to be addressed.

If you are ever diagnosed with any of the factors above and are told that you should avoid exercise then ignore that specialists advice. One of the most important things in anything spine related that you can do is to exercise but you need to exercise correctly, understand what has caused these conditions and use a variety of therapy and exercise to rectify the faults. Here is a brief summmary of the points suggested above.

1. Sacro-iliac joint dysfunction- is one of the most common forms of back pain and one of the most commonly mis-diagnosed conditions, often mistaken for a disc herniation. Females are often more exposed to SIJ dysfunction and can often be resolved with mobilisation and exercise to support the extra width of the pelvic basin.

2. Facet (zygapophysial) Joint- is the main articulation of the vertebra and can often become dysfunctional due to the position of the spine as most of these conditions can. Mobilisation and improving recruitment of spinal muscles can help to improve the movement of the facet joints.

3. Disc Herniation- a common problem in those over 30 mostly in the lumbar spine (can occur in cervical/neck too) with pain often felt either locally or referring commonly along the distribution of the sciatic nerve into the back, glute, legs and feet. The nucleus of the disc, the hardened jelly like material between the disc can rupture causing compression of the spinal nerves and pain ensues. Flatter back people are more predisposed to herniations but rotational and lateral movements also contribute to herniations. Strengthening of the core muscles, particularly the multifidus muscles can help alleviate and remove pain. Sometimes restoring the natural lumbo-pelvic rythm can be effective in this condition too.

4. Stenosis- the hole created by the lateral structures of the spine, is the space where the spinal nerves exit. Often when there is instability, osteophytes, small growths of bone can occur to stabilise segments of the spine. A side flexion of the trunk can close down the space of the nerves exiting that vertebral segment too. This can cause irritation of that particular nerve. Once again understanding what structures are over and underworking can provide relief to this problem.

5. Spondylolisthesis- is a fracture of the pars articularis a part of the vertebra which causes a rotation (if one sided) and forward slippage of the vetebral body, which can create torsion of the disc, also placing pressure on the spinal cord itself. Some people are born with this fracture but rotational sports such as golf contribute to this condition. Rotation and flexion at high speeds can create the sheer responsible for this fracture but can easily be avoided with the right stretch, mobilisation and exercise program,.

There are many other causes of back pain all of which can be rectified or avoided with the right program. One thing to take away from this blog is that if you are experiencing pain then you need to change what you are doing. Don't worry pain is a communication from your body to change but find someone who can deal with structural issues decribed above. You may often find that the solution is with doing less but more intelligently.

1. Bogduk, N. Clinical Anatomy of the Lumbar Spine. Churchill Livingstone. 2003

2. Porterfield, J.A., DeRosa, C. Mechanical Lower Back Pain. W.B. Saunders Company 1991.