Soft Tissue Treatment for Thoracic Outlet Syndrome (TOS)

Brachial Plexus

Myofascial release on the upper trapezius and cervical area

Moving the fascia back toward the spine allowing for a more neutral cervical posture.

Thoracic outlet is the clinical designation. It is also referred to anatomically as the thoracic inlet,  essentially a hole surrounded by a bony ring, consisting of the first thoracic vertebra (posteriorly), the first pair of ribs (laterally), and the superior border of the sternum (anteriorly), through which several vital structures pass.

 Thoracic Outlet Syndrome (TOS) is a collective name for several variations of nerve or vascular compressions near the base of the neck and upper rib cage. It is easily misdiagnosed because of the difficulty distinguishing between a cervical rib problem, a cervical disc problem or carpal tunnel. My work focuses on TOS involving compression of the neurovascular bundle, (brachial plexus) passing between the anterior and middle scalenes (neck muscles), compressing the nerves and brachial artery of the brachial plexus.

The brachial plexus is a complex web of spinal nerves coming from the cervical spine through the axilla (armpit) and under the clavicle (collarbone), innervating (supplying motor and sensory nerve fibers) the upper extremities, chest, shoulder, and arms.  It emerges between the anterior and middle scalene muscles (neck) passes underneath the clavicle into the shoulder and arm. Impingement of the plexus in the scalenes, ribs, and clavicles is responsible for TOS.

 Main symptoms are numbness, tingling, and pain–almost always present, sharp, burning, or aching down the arms and hands, side of the neck, and the chest, just below the clavicle, the armpit area, and upper back. One hand colder than the other, and weakness  is common.

 The most common causes of TOS include physical trauma from car accidents, on-the- job repetitive strain injuries, sports-related activities, poor posture, and anatomical defects such as having an extra rib. During pregnancy joints loosen, making it easier to develop bad posture, and TOS symptoms can occur for the first time.

 TOS treatment is similar to the protocol for carpal tunnel syndrome and can usually be relieved by thorough balancing muscles in the neck, shoulder, and cervical areas. If the treatment does not eliminate the problem, I refer my clients out for diagnosis by an orthopedic physician, which may include x-rays and most likely an MRI.

Relief for Temporomandibular Joint Dysfunction (TMD)

Also called TMD Syndrome and Temporomandibular Joint (TMJ) Disorder, referring to pain and dysfunction of the muscles of mastication (muscles that move the jaw). The TMJ, located just  in front of the ears, connects the mandible (lower moveable jaw) to the stationary upper (skull). Sometimes distinction is made between acute TMD, where symptoms last less than three months, and chronic TMD, where symptoms last more than three months.

 TMD has been considered a type of a musculoskeletal, neuromuscular, and rheumatological disorder. Approximately 23-30% of the adult population is affected with some form of it, usually between 20-40 years old, and more common among females. Although there are several clinical treatments available for TMD, at the present time, no widely accepted protocol exists because of a general lack of evidence for a medical solution.

 The TMJs are sometimes described as one of the most used joints in the body, and over time with normal use, wear and degeneration or osteoarthritis can occur, leading to defects in the shape of the tissues of the joint, limitation of function, restricted jaw movements, and joint pain.

 The three classic symptoms of TMD are: Pain and tenderness on palpation in the mastication muscles or the joint,  limited range of jaw motion or locking jaw, and clicking, popping, or grating noises from the joint during jaw movement. Symptoms will usually involve more than one of the various components of the masticatory system, muscles, nerves, tendons, ligaments, bones, connective tissue, and /or the teeth.

·          In six months before the onset, 50-70% of people with TMD report experiencing stressful life events involving work, money, and health or relationship loss.

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Lengthening the masseter

Lengthening the masseter

SCM Release

Balancing neck muscles, major contributors of TMD

Causes: Exact etiology (cause or origin) is unknown.  There are factors which appear to predispose to TMD, genetic, hormonal, anatomical, which may precipitate it. Psychosocial factors such as emotional stress, anxiety, depression, anger may cause grinding of teeth and sustained muscular contraction in the face. This produces pain which causes further anxiety and in turn causes prolonged muscular spasm at trigger points (small hypersensitive areas in muscle or fascia).

Soft TissueTreatment:  To be thorough and effective as possible, I start correcting any imbalance in the lumbar and sacral region to assure a stabilized foundation—the pelvis. Next, I focus on balancing the major and minor muscle groups of the neck, major contributors to TMD, and where most of the tension seems to be held. Finally, if the problem hasn’t already resolved, lengthening the two primary muscles of mastication, the temporalis and the masseter, takes the pressure off the TMJ, relieves the pain and increases motion of the jaw. If symptoms persist, I will intra-orally release another mastication muscle, the pterygoid.

Home self-care techniques for relieving and eliminating symptoms of TMD are easily learned and very effective for maintain symptom free status. 

Non-Invasive Relief for Carpal Tunnel Syndrome (CTS)

The Carpal Tunnel

Sectional View of Carpal Tunnel

Lengthening the Fascia of the Palm

Myofascial Release and Compression Broadening

The carpal tunnel is an anatomical compartment located at the base of the palm, surrounded on three sides by the carpal bones of the wrist that form an arch, and the flexor retinaculum (fibrous bands of fascia) also called the transverse carpal ligament on the top of the tunnel. Nine flexor tendons and the median nerve, which provides feeling or sensation to the thumb, index finger, middle finger, and half of the ring finger, pass through the tunnel.

 CTS  is a median entrapment neuropathy (disorder affecting the nervous stystem), that causes paresthesia (a prickling, tingling, or creeping on the skin), numbness, weakness, and pain. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence (the fleshy mass at the base of the thumb), and weakness moving the fingers.

 Symptoms include numbness, burning and tingling of the thumb, index, middle, and half of the ring finger, which are innervated by the median nerve. Numbness often occurs at night. Weakness gripping a scissors, for example,  is another common symptom of CTS.

 Causes:  Most causes of CTS are idiopathic, or unknown.  A variety of factors can lead to CTS including heredity, size of the carpal tunnel, previous fractures of the wrist, local and systemic diseases, and certain habits. Repetitive use tasks and trauma causing pressure that irritates the median nerve at the wrist is considered a risk for CTS.  Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, rheumatoid arthritis, and diabetes.

Tight and shortened wrist flexors (on palm side of forearm) and pronator muscles (turns the palm down) from repetitive and forceful activities of the hand and wrist leads to irritation and over development of the nine tendons that pass through the tunnel, compressing the median nerve, causing inflammation, pain, weakness, tingling, and numbness.

 Biological factors such as genetic predisposition and anthropometrics (physical dimensions and properties of the body) had significantly stronger causal association with carpal tunnel syndrome than occupational / environmental factors such as repetitive hand use and stressful manual work, suggesting that carpal tunnel syndrome might not be preventable simply by avoiding certain activities or types of work.

Therapeutic Massage Treatment includes Myofascial Release, stretching deep fascial layers, compression, decompression, spreading the tissue of the palm, mitigating adhesions, and carpal bone mobilization. The forearm flexor (palm side) muscles are lengthened to reduce the wrist tension so the tendons can again move freely through the tunnel.

My clients are instructed how to stretch the tight flexors to keep the tension off the wrist. Exercising (strengthening) the flexors at this point would be counterproductive, only creating additional tension on the already tight muscles to overload the tendons of the wrist and exacerbate the problem. I focus on treating the causes, usually in the shoulder, neck, flexor muscles of the forearm, and elbow areas, instead of the symptoms.

Core and Balance Training for Preventing Falls

Maintaining Balance On A Unstable Surface

Maintaining Balance On An Unstable Surface

Taking a Break

Taking a Break

The following information is from my most recent certification study material, Senior Fitness Specialist (SFS), from the Academy of Sports Medicine, and the section dealing specifically with fall prevention training for older adults.

Sixty-six percent of adults over 65 accidentally fall every year, and it’s the leading cause of injury related deaths in elders. Approximately 25% of seniors die within a year of a hip injury from falls. Unfortunately, many older adults who do fall, develop a fear of falling again, greatly limiting their physical and social activities.

The physiological changes and degeneration that take place with age yield a loss in neuromuscular efficiency (nerve & musculoskeletal interaction) resulting in an inability to prevent falls and injury. A comprehensive training program that includes core, balance, and reactive training can target these physiologic changes and decrease risk of falling.

Why are some elders at higher risk of falling than others? An older adult’s functional ability and overall risk of falls can be determined by simple physiological and movement assessments. Research studies conducted in adult communities and nursing homes found that exercise can reduce fall risk by improving physical functioning, and seniors, who are physically active, with a strong core stability and strength, are less likely to fall.

A weak core is a fundamental problem that causes inefficient movement and leads to predictable patterns of injury. Exercise programs specifically designed for an individual’s needs improve core stability, balance capabilities, and reaction time.  Core exercise is also important to assist in the management of chronic pain.

·     Balance training makes it possible to reduce force at the right joint at the right time, and in the right plane of motion to prevent falls, ankle sprains and other lower extremity injuries, and is an effective intervention for fall prevention. When placed in unstable environments, the body must contract the right muscles at the right time to maintain balance.

Reactive training will help to prevent falls by providing seniors with the balance and neuromuscular efficiency required to respond automatically in the event of a sudden perturbation, like slipping on the ice, for example.

More detailed information on fall prevention for seniors can be found at www.mnfallsprevention.org.

Treating Headaches

Acupressure Points for Treating Headach and Stiff Neck

Releasing attachments of key muscles contributing to headaches

Gently relaxing frontalis muscle in forehead

Lateral stretch of forehead to relieve headache

 

There are over 200 types of headaches ranging from harmless to life-threatening, various types of tension, migraine, and cluster headaches, some of which could be symptomatic of a serious condition, and why I will occasionally ask a client to get their doctor’s permission prior to working with them to make sure the headache is not indicative of a more critical health condition. When I’m not sure, I refer.

 There are also signs and symptoms that signal a session in progress should end immediately and call 911 quickly; they include sudden numbness or weakness especially on one side of the body, drooping face and eyelid, slurred speech or difficulty, fainting or severe dizziness, sudden blurred or double vision, and loss of consciousness.

 Fortunately, the tension headache, the most common type, represents ninety per cent of headaches. Pain is frequently bilateral (both sides of head), typically mild to moderate and may be severe, often radiates from the lower back of the head, the neck, eyes, or upper shoulders. Common causes of tension-type headaches are stress, muscle tension, clenching teeth, poor posture, and eyestrain.

 Migraines are a chronic neurovascular disorder characterized by recurrent moderate to severe headaches, tend to be pulsating, affecting one side of the head and can be disabling in severity, lasting from 2-72 hours.  Approximately 66% of cases run in families.

 Research: Although evidence-based studies about the benefits of massage for migraine sufferers are limited, they do exist. One such study, titled A Randomized, Controlled Trial of Massage as a Treatment for Migraine, conducted by S.P. Lawler and L.D. Cameron through the University of Auckland, provided one of the first evidence-based conclusions that massage can be an effective treatment for migraine sufferers—both during the acute phase of migraine attack and as a preventive treatment. Ann Behav Med. 2006-PubMed

 Clinical massage therapy helps combat stress, one of the triggers for migraines, and in turn helps reduce migraine frequency, severity and duration. Reduced stress levels can decrease anxiety, enhance sleep quality, increase energy levels, improve concentration, increase circulation, and reduce fatigue. Some additional triggers besides stress include: certain foods, strong perfumes, flickering lights, and weather changes.

 Cluster headache pain is excruciating, almost always on only one side of the head, and can last from 15 minutes to three hours or more. Doctors and scientists have described the pain from cluster headaches as the most intense pain a human can endure. Fortunately they only affect approximately 0.1% of the population; More men are affected than women.

 Treatment: I have successfully treated tension headaches and migraines, some are easy to treat and some are difficult. The easy ones are most often due to stress and tension.  Releasing the tightened fibers directly under the ridge of the occiput (base of the cranium), gently working the soft tissue that encapsulates the entire cranium, frontalis (cranial forehead muscle) and the temporalis (muscle over the temporal bones), are basic techniques that usually resolve even the most severe tension headaches.

The more difficult cases are structural imbalances, trauma—injuries, car accidents, etc. Muscle contractions involved with headaches are the back of the neck, occiput, and tops of the shoulders. Postural structural imbalance is oftentimes the culprit; Ninety per cent of clients presenting with headache have a forward protruding head, neck, and shoulders. Orthopedic massage techniques corrects the dysfunctional posture, brings it back into structural alignment, which relieves the muscular tension in the neck, upper back, and shoulders—major contributors to headaches.