Monthly Archives: October 2013
At Fix Body Group we are bombarded weekly by injuries and trauma to the shoulder, especially the rotator cuff muscles. Most people have heard of injuries and tears to the rotator cuff. Whether you are a Crossfit athlete, baseball fan, desk jockey or weekend warrior in a local gym, everyone fears the rotator cuff and the pain and suffering an injury there is supposed to coincide with. However, as we will describe below, often these injuries are extremely treatable and have a very high success rate, if the proper approach is taken.
While by nature, especially compared to the hip or other joints, the shoulder in naturally less stable, these type of injuries are often very preventable and can also be healed very successfully with conservative physical and manual therapy methods. We employ a mix of sports therapies, A.R.T. , massage, and chiropractic work to help re-balance the shoulder by strengthening weak muscles and relieving tightness and scar tissue buildup in tight muscles, ligaments and tendons.
Lately, we’ve encountered a number of problems that have to do with one rotator cuff muscle in particular, the subscapularis. The subscapularis, or “subscap” as it’s often called in short, is extremely important for both normal function of the shoulder joint, and also the healing of an injured shoulder. Because it lies beneath the scapula (and thus derives it’s name), and posterior to the rib cage it is very hard to access and treat, except by the most skilled and knowledgeable of therapists. Many doctors, massage therapists and PT’s don’t really know how to access it for manual therapy, and there are few ways to really create a positive response in this muscle otherwise.
The subscapularis will become very tight in swimmers, ballplayers, surfers, boxers, Crossfit athletes, and anyone who uses a mouse, keyboard, or steering wheel for long duration. You might know this muscle is affected if you have trouble bringing your arm up overhead and rotating externally, as if winding up to throw a baseball. If you have trouble with these motions please consider getting an assessment to find out if this muscle, or another rotator are compromised. This muscle is not easily stretched or lengthened at home, and is best treated using an advanced manual therapy technique such as Active Release Technique as we do here at Fix Body Group. Many of our desk jockies, Crossfitters, and professional fighters can attest to the powerful change that can be made on this muscle, and ultimately the entire shoulder joint.
A recent review on research of shin splints (or medial tibial stress syndrome) in the journal Sports Medicine has given many athletes suffering from the condition little hope. Dutch researchers concluded that, “no intervention has been proven to be effective for medial tibial stress syndrome.” In the study, groups of people received various common treatments for the injury in contrast with those who did not.
Examples of the treatments used were leg braces, ice massage, ultrasound, extracorporeal shockwave therapy, and iontophoresis. The study concluded by recommending short periods of rest from weight bearing activity to allow the bone to heal. This is standard advice in the medical community, and the treatments studied in the article are also typical, if conservative methods for sports medicine practitioners.
The problem with approaching this sort of injury with conservative, standard treatments and rest, is that it fails to decipher how the injury occurred, and if it will return once the activity is resumed. Most injuries don’t just come about in one location independent of everything else going on in the body. An injury like shin splints is the final product, which is the painful conclusion, but usually a progressive buildup of other developments in the body lead to it.
This project also neglected to study whether other treatments such as A.R.T., Myofascial release techniques, massage, and changing of running mechanics, and corrective exercise would help heal the injury quicker. In my experience, this sort of injury when treated holistically and by addressing biomechanics, can be resolved very quickly. Weekly, we see runners in our clinic with shin splints that are resolved in a few treatments, and often can continue to train through the injury and treatment process.
Here’s my standard approach to treating shin splints:
1. Look at the patient’s biomechanics: Often there is too much pronation, or external rotation of the legs. At what angle does their lower leg contact the ground? Often it will be an angle greater than 90 degrees. Often there is glute weakness and some tightness in the anterior hip.
2. Corrective exercises and strength training for the weak muscles done daily at home. Stretching and foam rolling for the tibialis anterior and posterior, soleus, and peroneals and quadriceps.
3. Myofascial release and A.R.T. for the lower leg and quadriceps, TFL, and psoas.
4. Running on soft surfaces only, depending on severity and treatment frequency
5. Address shoe choices and recommend changes depending on the type of runner, mileage, training surface, and biomechanics
6. Ice cup massage for the shin, compression socks if travelling or sitting a lot.