Muscles In Sync
Joyce Mills and I just finished attending a educational course instructed by Shirley Sahrmann PT PhD. The course was titled Movement System Impairment Syndromes: Lower Quarter Advanced Applicatiion. Two other PTs from Olympia went too. It was very refreshing and stimulating and gave us new information about treating such difficult problems such as hammer toe, hip pain and back pain.
What are Movement Impairments and why should I care? Movement Impairments mean you are moving with a bad habit… stretching out what is already too loose and keeping what is too tight still too tight. For example, in previous blog posts such as the one below:: http://comstockpt.com/2011/10/19/chronic-ankle-sprain-weak-hip-making-recovery-difficult-lacey-wa/
the young man with the ankle sprain was a medial femoral rotation impairment. That means his knee kept rotating in because his inner thigh muscles were too short and gluts were too long and weak. Which out extra weight down through his ankle and made his recovery poor.
What is new? One of the things we learned is that it turns out hammer toes are sometimes caused by over using the muscles that lift the toes instead of the ankle muscle that is supposed to lift the foot when you clear your foot. This is often caused stiffness in the movement of the foot up, like you are marching. How to fix? Walk with more push off and stretch your calf.
On Friday a patient 0f mine came back for a recheck. I hadn’t seen her in about a month. She had started treatment about 3 months ago and had received 6 treatments before her recheck.
At her recheck she was doing much better, in fact she was now able to lift rain soaked flower pots and could sleep through the night. When she first started treatment she was waking up many times per night due hip pain, and could not tolerate more than 20 minutes or so of light yardwork due to back pain. After receiving exercises for hip weakness based on Chris Powers PhD PT’s research at USC and exercises for multifidus/transverse abdominis/pelvic floor coordination and strength training (core) based upon Paul Hodges PhD PT’s research at the University of Queensland she followed through diligently and is much better.
As I was finishing up treatment with her I remembered back to her first day of treatment when she brought in a thick 3 ring binder notebook. This notebook was FULL of exercise sheets she had received from various gyms and physical clinics in another state, and she wanted to show them to me so I could get up to speed. Very few of the exercises were based on Hodges’ or Powers’ research, and I thought to myself, “how can that be?” How were these exercises missed? and more importantly, what could she have done to get a jump start on knowing what questions to ask about her specific condition and what treatment was best?
One suggestion for future patients as to advance your knowledge about what kinds of treatment are best for your condition is to log onto pubmed, http://www.ncbi.nlm.nih.gov/pubmed/ , a centralized database of up to date research and type in your condition are look through the research abstracts which can help you know what the latest findings and treatments are that are relevant for your condition.
For example: type in “low back pain treatment guidelines” and here is the link’s first page http://www.ncbi.nlm.nih.gov/pubmed/?term=low+back+pain+treatment+guidelines
Of if you want to know if a specific kind of treatment is helpful for your condition, such as “physical therapy” for hip arthritis, here is that link: http://www.ncbi.nlm.nih.gov/pubmed/?term=physical+therapy+for+hip+arthritis
This video is an extreme example of whiplash, and it gets you thinking, what is the science about whiplash?
Mr. Villar's large neck muscles will go into spasm to protect him. The two muscles which will spasm the most are the sternocleidomastoid and scalenes.
When sternocleidomastoid spasms you suffer from headaches. When scalenes spasm you suffer from arm tingling and numbness. Mr. Villars will have both. What should he do to relieve his pain?
1) get physical therapy for stretches for sternocleidomastoid and scalenes, and for myofascial release, and
If he does both of these, his neck will probably fully recover!
Does the Biceps muscle remind you of Popeye? If you eat enough spinach, it will get big:)
The long head of the biceps pulls on the shoulder and the short head pulls on the shoulder blade, and when it is tight it can pull the shoulder forward causing the shoulder bone to slip forward a little, out of alignment. This condition is called "anterior humeral glide syndrome: and can have the side effect of causing impingement and pain in the rotator cuff.
Tight biceps can also cause tennis elbow by straining and pulling the forearm into pronation if it is too tight.
So Stretch those biceps!
The peroneus muscles are on the outside of the lower leg and ankle and usually get strained when the ankle gets sprained. This makes sense to most people because the tendons run so close to the outside of the ankle.
But…..the peroneus longus tendon crosses UNDER the foot after running along side the ankle bone to help support the arch. It attaches in the middle of the arch on the bottom side.
Here is a picture of the bottom of the foot:
When the peroneus longus tendon insertion starts to pull and get irritated, it can feel like plantarfasciitis and be confusing. However, the fix is usually the same, stretch your Achilles and plantarfascia and strengthen the side to side muscles as well as get manual therapy. Sometimes orthotics help too. Your physical therapist is particularly well trained to fix this condition.