Referred pain: the infraspinatus and shoulder pain

My new client came in for a session, reporting shoulder pain, primarily in the front of his deltoid (the muscle at the top of the arm).   The pain had started while lifting weights one day and had not gone away, worsening after time spent working on the computer.

He said he suspected it was a rotator cuff issue. After an intake and discussion of other possible causes, we got to work.

We began with treating the pectoral muscles, which were extremely tight (as is common). We also worked the attaching neck muscles, and deep release of the scalenes brought a bit of release to the shoulder joint.

Next, we went to work on the infraspinatus. The infraspinatus is one of the four rotator cuff muscles, and it lies directly on the back of the scapula. A tight, spasming infraspinatus tends to refer pain into the front deltoid, and the front of the shoulder joint (right where the shoulder meets the arm), and I suspected this was the cause of the pain he had complained about.

After releasing the other primary muscles involved, including the supraspinatus, subscapularis, trees minor, and lattisimus dorsi, we moved on to the other large back muscles: mainly, the erector spinae group, which run up and down the back and support the spine; and the quadrates lomborum, which is the large muscle of the low back.

After the session was finished, the client happily reported that the pain was “almost completely gone.” I asked where he still felt pain, and he moved his arm around, noting, “It’s almost hard to find!” He found, however, that there was still a bit of pain in the original spot.

I had him lie on the floor on his back, and I placed a therapy ball (a tennis ball will do) under his scapula, so that his shoulder blade lay right on top of the ball, applying pressure directly to the belly of the infraspinatus. His eyes widened. “That’s exactly the spot!”

His homework, I told him, was using a ball to release that muscle, exactly as we were doing. In many cases, a spasming muscle will refer pain elsewhere.  But, once the “culprit” is found, releasing the problem muscle and preventing further pain becomes much easier.

The rotator cuff muscles are not unique in referring pain in this way, but they do seem to do it frequently. Habits such as long work hours at a computer can cause tightness in the rotator cuff muscles that can often be relieved by pressure with a therapy ball/ tennis ball.   Stretching can be of value with many muscles, but in the case of the infraspinatus, which lies directly on the scapula, direct pressure is needed.

To release this muscle, lie flat on your back and position a tennis ball or therapy ball directly under the shoulder blade.  (This is tricky because it’s a bit of a balancing act).  Sink directly into the ball.  Most people are tight/ sensitive in this muscle, and you should feel it!  If you don’t feel anything, adjust around a bit until you do.  (Be sure to stay on the shoulder blade).  Once you find “the spot,”  sink in as best you can and hold steady pressure for 2-3 minutes.  Following this, come off of the ball carefully, sit up and stretch your arms and shoulders.  If you’ve gotten into the infraspinatus muscle, you will likely feel a bit more range of motion just from doing this exercise.

Questions about this muscle and related pain?  Email me at rachel@bodyworkbyrachel.com, or book a session here  if you’d like do some work on releasing the muscles in the shoulder area.

Take care of yourself and your muscles!  They’re working hard for you.

Piriformis Syndrome and Sciatica

Many people are unclear about the difference between piriformis syndrome and sciatica:  “which one do I have?”  To answer this, it’s important to break down the terms and understand what we’re referring to.

Sciatica is a term that refers to pain that is caused by irritation of the sciatic nerve.   It is most often felt in the low back and radiating down the back of the leg.

“Radiculopathy” is the term for when the nerve is affected by spinal issues such as disc degeneration, a herniated disc, or a bone spur that compresses the nerve.  So, radiculopathy is a condition that causes sciatic pain.

“Piriformis Syndrome” is a condition in which the sciatic nerve is compressed or irritated by a tight piriformis muscle.   Piriformis syndrome is generally very responsive to treatment such as massage therapy or myofascial release.  In some cases, even a single session can greatly relieve pain from piriformis syndrome.

In contrast, sciatica caused by a bone spur or disc degeneration is a more complex issue generally requiring long term treatment.  Always check with your doctor or primary health care provider about what treatment options are best for your condition.

The diagram below shows the piriformis muscle’s location.  Tightness or spasming of this muscle can be caused by activities such as running, driving, or long hours sitting at a desk.

pririformis muscle

Hip stretches such as “pigeon pose” can help relieve a tight piriformis muscle.   You can help prevent piriformis syndrome by performing adequate stretching before and after activities such as running, and by taking breaks to stretch throughout a long work day.

A regular yoga practice is also an excellent step to maintaining healthy hips that function at their best.  For some of the many benefits of a yoga practice, check out this article here: https://www.jenreviews.com/yoga

 

Rachel Hardy, CMT is a massage therapist specializing in myofascial release and deep tissue massage. She runs a private practice located in the Silverlake area of Los Angeles, CA. For more info, click here.

10 tips for an overloaded nervous system

In my practice, I tend to attract clients who, like myself, are extremely sensitive.  Hypersensitive, perhaps.  Often both physically and emotionally.

I believe this extreme sensitivity is a gift, but it comes wrapped in a challenging package.  It is not easy to manage.

One of the challenges of living with deep sensitivity, particularly in a busy city like Los Angeles, is the propensity to overload.  It is so easy to allow our nervous systems to become overloaded with stimuli.  And when that happens, we tend to shut down (or deal with it in unhealthy ways, such as addictions).

After a recent conversation with a client, I felt compelled to create a list of tools that I use to manage what I experience as “system overload.”

my top ten tips for an overloaded nervous system:

1). Breathe.  It’s deceptively simple, and so powerful.  Breathing deeply and slowly will encourage the parasympathetic nervous system to take over.  The parasympathetic system is the “rest and digest” system.  It’s the opposite of “fight or flight”.  And we can encourage it to turn on by simply deepening and lengthening the breath.

2).  Find your feet.   This was a technique that my energy work teacher taught me, and I use it almost daily.  Bringing your attention to your feet is an instant grounding technique.  Simply bring your awareness into your feet, becoming aware of them and feeling them on the ground, supporting you.

3).  Donna Eden’s energy balancing work:  this deserves a post of its own, but suffice it to say that Donna Eden is one of the most masterful and visionary energy work teachers of our time.  Her pose titled “wayne cook posture” is a seated pose that brings instant calm to the nervous system.  It is practiced as follows:  sit in a chair with the right ankle resting on the left knee.  Place the left hand on the right ankle, and with the right hand reach over and clasp the bottom of the right foot.  (I know, it sounds a bit like twister, but bear with me because it works).  Holding this position breathe steadily in and out.  Repeat on the opposite side.

Photo on 5-14-15 at 10.06 PM

4).  Water.   Epsom salt baths are fantastic for grounding, releasing excess energy, and relaxing the whole system.  If it’s practical to be in or near the ocean, even better.

5).  Protein!   Keep your blood sugar stable with sufficient protein- your body will thank you for it, and your system will respond in healthier ways to stressful stimuli.

6).  Meditation.  An always powerful tool, relaxing the mind and bringing the focus to the breath will center you and help release the excess energy.

7).  Journaling & gratitude lists- I keep notebooks full of them.  Being hypersensitive means being sensitive to positive stimuli as well, and taking 5 minutes to journal about the positive things, people, events, and sensory input in my life has effects for miles.

8).  Be in nature.  Connect to the grass, feel a tree bark beneath your hands, breathe the fresh air, look into the night sky.  remind yourself of your place in the universe.  Let it bring you back home into your body.

9).  Let your senses rest on whatever makes you happy.  colors, music, fabrics, whatever sensory input brings your system moments of joy- find those, and keep a list of them.

10).  And lastly, be present.  Be in the moment, as difficult as it may be.  Know that your sensitivity is overwhelming, and it is also wonderful.  Be present with it. Be alive.

 

namaste.

 

 

plantar fascitis

I was back in class recently, for the first time in awhile. Myofascial Techniques for Plantar Fascitis.

Working with myofascial release is endlessly interesting. It’s simultaneously both simple and complex. The fascia (connective tissue) weaves throughout the body, providing both structure and fluidity; motion and stability. Understanding the fascial system brings insight into a vast array of conditions and ailments, often linking seemingly unrelated body parts through this complex web of connective tissue.

For example, in treating plantar fascitis, (a thickening of the connective tissue on the soles of the feet that causes pain when walking), from a perspective of myofascial release we want to work not only on the plantar fascia itself, but the fascia on the ankles, legs, even the hips.

Lying on the treatment table in class, I breathed deeply as another student worked on my calf muscles. My calves are so sensitive. It’s not an area I enjoy having released. But my class partner was good, very good; and he easily and gently released the connective tissue, stretching the soleis muscle, the thin flat muscle that connects to the achilles tendon.

This was a technique called “deep mobilization”. It’s one of the deeper, more intense techniques of myofascial release (many forms of which are very gentle). This one was not so easy, not so gentle; but it was okay. I breathed. I could breathe through it.

Driving home that night through the Franklin Hills of Los Feliz, admiring the city lights, I felt a strange sense of lightness. Happiness. Ease. And I felt it distinctly connected to the muscles in my calves that had been released.

Emotional release through massage and myofascial work is extremely common. The body holds memories, emotion, stored in it’s cells (reference). When deep, chronic tension patterns are released, emotional holding patterns can be released as well.

Commonly, this comes in the form of painful memories surfacing. And yet that night, I experienced something different. It was as if a sense of the easiness, the lightness, the freedom of life had somehow been locked away. Protected? And releasing old muscle restrictions allowed me to tap in to a feeling I had not felt in some time. A feeling of ease. It’s all going to be okay.

Hiking, the day after class, I hit my usual trails up the steep hills of Griffith Park. I’m conscious of allowing my foot to pronate, rolling gently and easily inward. It feels easy. What’s more, it feels like there is more spring in my step. Like my foot automatically launches me forward.

I can feel the difference all the way up to the connections at my hips. There is less strain on the outer hip; more of a balance all the way across to my adductors & inner thighs.

And there is a lightness. A beauty. And an ease.

meet your scalenes

I tend to have a “favorite” muscle. One at a time. That muscle, or muscle group that I’m fascinated with. Like I have a crush on it, it haunts my thoughts. I observe it in everyone I see, on the street, on my treatment table. Watching its behavior.

Right now, my muscle of the moment is the scalenes. Those muscles that run down the side of the neck, splitting in three, attaching to the first two ribs.your scalene muscles

(Those first ribs are pretty high. Sometimes we tend to think of our ribs around our chest and sternum, but those first ribs are way up there).

First Ribs

And the scalenes attach to them. They attache to those first ribs.

Why is this so important?

Because when the scalenes tighten and shorten, they pull the head forward and rotate the shoulders internally. And this forms the classic “hunched over” posture that is so common in our modern world. A world that requires us, so often, to be at a desk; at a computer; driving in a car. All actions that tend to cause this hunched over shape, and the resulting tension in the muscles in the neck and back.

What’s interesting in treating people with shoulder and neck tension (read: everyone) is that sometimes, you can release the tense shoulder and neck muscles and it will feel really great. But it doesn’t necessarily lead to long term change.

In contrast, releasing the scalenes doesn’t feel so good. In fact, for the majority of people it’s downright uncomfortable. But to a person, when I release the scalenes, there is a noticeable and lasting difference in the neck and shoulder tension. When we release the long held tension that is pulling the head and neck forward and the shoulders in, all of those muscles on the back of the body can suddenly relax- sometimes, for the first time in years.

Massage Therapist Peggy Lamb, MA, LMT, describes the difference with this image: “Are you a bulldog or a great dane?”

The Bulldog’s head is pulled forward, between it’s shoulders, creating undue pressure on the rotator cuff muscles and eventually leading to chronic neck and shoulder tension and pain. The Great Dane, in contrast, has a long neck that is released and lengthened throughout the front muscles.

Now, as a dog lover, I happen to be a big fan of both bulldogs AND great danes. But for the purposes of this analogy… we want you, of course, to be a great dane.

Pit BullGreat Dane

But let’s go back for a moment to those interesting scalene muscles.

There is another nearly universal reaction whenever I treat the scalene muscles (besides general discomfort!)… and that reaction is surprise. “Why have I never felt them before? Why have I never felt that tension there?!”

One of the more fascinating aspects of practicing bodywork is observing which tension clients feel- and which areas of tension they do not feel. Ask a person on the street where they feel tension in their body, and chances are you’ll hear something about the neck, back, shoulders. These large muscles on the back body, as a general rule, tend to be where we are aware of tension in our bodies.

And yet those scalenes- those incredibly important muscles that are nearly always so very tight… have likely never been “felt” before. The client will say something to the effect of “I’ve never felt that and I can’t believe there’s so much tension!”

I believe there are many reasons for the phenomenon of why we feel the tension in some areas of our bodies, and are “out of touch” with others. One of the delicate balances of practicing bodywork is introducing clients to that “out of touch” tension… bringing them into contact with tension that they’ve never felt before… so that it can be released. The delicate balance comes into play because this is not necessarily a comfortable process. Reading the client’s entire system is essential, as is a deep and profound respect for the person’s well being on every level.

Another aspect of interest is the relationship between the scalenes and the breath. One of the primary actions of the scalene muscles is to elevate the first and second ribs to allow for breathing. When these muscles are chronically tight and constricted, the lungs will not expand to their optimal capacity, and restricted breathing results.

Considering the importance of the breath, those little scalene muscles become even more important!

A simple self myofascial stretch can bring a bit of easy release into the scalene area. Please proceed extremely gently with this exercise, and as always consult your health care provider if you have any questions or concerns.

Place your fingers just above the ridge formed by your collarbone. Using gentle pressure, begin to sink your fingers down into the soft tissue. Hold until you feel a release. Breathe, stretch, and repeat on the other side.

This stretch, while not necessarily going directly *into* the scalene muscles, will release the connective tissue that surrounds and moves through them. It’s an easy way to bring a bit of release to this area.

myofascial release of scalenes

 

A qualified bodyworker or physical therapist can further release these incredibly important muscles.

Get to know your scalenes. Now that you’ve been introduced to them, start to notice them throughout your day. You may find that you can’t feel them, at first. Bringing sensory awareness to an area that has not been “felt” for some time is a process… but it’s one you can do, through awareness and practice. And once you “turn on” the feeling in these amazing muscles, you’ll have an awesome tool to help you with your ongoing wellness plan (not to mention, improved posture!)

Meet your scalenes… they’re glad to know you. I think you’ll like them, as well.