Shoulder Impingement

 

The majority of shoulder problems develop from micro-traumatic events occurring due to poor posture which results in abnormal shoulder mechanics. It is important for the patient to understand that shoulder pain is usually a symptom of deeper underlying problem that, unless corrected, may lead to significant shoulder injury.  Poor posture leads to a very predictable chain reaction of events that can lead to shoulder impingement, rotator cuff tendonitis, bursitis, or a rotator cuff tear.  Humans have a tendency to assume a posture in which we spend most of our time, for many of us that work on a computer all day, this leads to an increased thoracic curve (kyphosis), elevated and protracted shoulder blades, head-forward posture, and internally rotated shoulders.  This abnormal scapular positioning affects the biomechanics of the glenohumeral (ball & socket) joint.  Through the neurological adaptation of reciprocal inhibition, the internal rotating muscles of the shoulder: subscapularis, pectorals, lats, and teres major become dominant which in turn neurologically inhibits the scapular retractors, and external rotating muscles of the shoulder.  When the mid/lower trap, rhomboids, teres minor, and infraspinatus are neurologically inhibited, there is nothing to prevent the upward migration of the scapulas on the ribcage.  This upward migration eventually leads to a physical shortening of the upper trap and levator scap muscle which further contributes to the problem.  When the glenohumeral joint becomes internally rotated, it leads to an upward migration of the humeral head under the subacromial arch during overhead activities, which predisposes the supraspinatus muscles, and the tendonous attachment of the biceps tendon to painful tendonitis.

In order to accomplish long term correction of the problem, the following protocol should be followed:  Alignment, Inhibit, Activate, and Reinforce.  When referring to alignment, we want restore thoracic extension.  Without extension of the thoracic spine, it is impossible to retract and depress the shoulder blades.  To do this, we combine chiropractic adjustments if there is a true joint fixation and by incorporating thoracic extension over a foam roller.  It is also important to restore pelvic alignment as well, since the abnormal torso rotation that accompanies pelvic misalignment significantly impacts the ribcage and scapular positioning.  In reference to inhibition, we utilize ART (Active Release Technique) to the anterior neck muscles, pectorals, Subscapularis, Levator Scapularis, and the Upper Trap.  ART will help break up the fibrotic adhesion that have developed and also help elongate the chronically shortened muscles.  Next we want to activate the Rhomboids, Mid & Lower Traps through the use of MAT (Muscle Activation Technique).  Lastly, we want to reinforce the proper movement pattern through a functional movement pattern.

When you consider that 95% of what we do on a day to day basis reinforces Improper Movement Patterns, it goes without saying that we should make a conscious effort to incorporate this protocol into our exercise routine.

Lateral Chain Instability

The deep-lying gluteus medius muscle is normally associated with

movement and is usually trained in a standing or seated concentric

motion, but its key role in running is to act as a stabilizing force, to

slow the downward drive of the pelvis on the opposite side during

stance phase. It does this by decelerating lateral hip sway of the

weight bearing leg by eccentric muscle contraction.

This pelvic restraint prevents excessive hip sway of the type that is

classically known as “Trendelenburg gait”.

But even short of the tell-tale waddle of a Trendelenburg gait, there

are various adaptations that runners make to compensate for

weakness in the gluteus medius.

All these various compensations can develop into chronic injuries for

the runner, including SI joint dysfunction, TFL IT Band Syndrome,

Snapping Hip Syndrome, shin splints, over-pronation, ankle sprains,

and plantar fasciitis.

Now, before you rush out to your nearest fitness center and jump on

to the seated abductor machine to strengthen and tone your backside,

keep in mind that we really need to strengthen the muscle in a

dynamic position which means in the way in which we use it. In

order to do this, we want to simulate a running gate. Another important

consideration is the physiological adaptation referred to as

reciprocal inhibition. Simple stated, when one muscle is physically

tight and overactive, its antagonist or the muscle which has the

exact opposite function is neurologically inhibited, so it’s very difficult

to effectively activate the muscle you are attempting to strengthen.

Another important factor in effectively activating the gluteus medius

is foot mechanics. Over-pronation directly results in neurological

inhibition of the gluteus medius.
 

So, you might ask…how do I overcome this imbalance. The key

is to follow the strategy of restoring alignment, inhibit, activate, and

re-enforce. First, we want to restore proper alignment of the pelvis

by chiropractic manipulation, Muscle Energy Technique or some form of positional release.

Secondly, we want to inhibit the overactive muscles through the

use of Active Release Technique. Thirdly, we want to activate the

underactive muscle through Muscle Activation Technique. Lastly,

we want to reinforce proper movement patterns through corrective

exercise. Utilization of this system works synergistically to

get patients better faster and keep them better longer.

Plantar Fascitis

Plantar fasciitis is a common cause of pain on the bottom of the foot, particularly

the bottom of the heel. The pain is usually caused by the repetitive

strain to the connective tissue of the bottom of the foot due to improper

foot mechanics and typically effects long distance runners or individuals

that either over-pronate or over-suppinate. The characteristic symptom of

plantar fasciitis is burning pain on the bottom of the foot or heal, particularly

the first thing in the morning. There are several popular treatment

options including cortisone injections, night splint, custom orthotics, ultrasound,

and lithotripsy. However, for anyone that has experienced an

acute case of plantar fasciitis, these options can be costly and only minimally

effective. One of the most effective treatments is an athletic taping

technique called the Low Dye Technique.

The Low Dye Technique was developed

by a podiatrist and is an effective technique

at decreasing pain and returning

you to activity much faster than some of

the conventional treatments.

Once you are over the acute stage of injury, Active Release Technique

and Graston Technique can be utilized to breakup some of the fibrotic

adhesions that have developed from chronic wear and tear.

If you suffer from this condition and would like to find out if this treatment

option is right for you, contact our office for a complimentary consultation.