shoulder mobility

[dianneg]

Hello tribe-

Recently I thought I hurt my right shoulder. I felt tenderness and pain when I lifted my arm out to the side and overhead. But then after a few days as the pain subsided, I found that my shoulder would pop with a variety of different movements. It's still tender but I think that it is tender in the area where I had little range of motion before and perhaps it is getting used to the new movement? I'm not sure.

However, I had been practicing Warrior Wellness beginner as done by Coach Sonnon on the dvd but after a couple of weeks I realized that I had been moving through the joint mobility program with too much zealous so I modified the movements and brought much of the program onto the floor. It has been working great! Today I practiced the program standing up and I have to say that with this new mobility in my right shoulder I have less tension in my back when I do the variety of shoulder circles on different planes, especially towards the back side.

My question around all of this is I wonder what the connection is between mobility in the shoulder and mobility of the cervical or thoracic spine? I have a slight curve to the right at t6&t7. Could this curve have an influence in the lack of the range in motion I have in my right shoulder up to now? :?

dianneg

[Jarlo Ilano]

Dianne,

Hi! Sorry to chime in late here, I had read your post at work, then forgotten to post a reply when I got home (12 hour day... echh.)

Here is a little essay about joint noises I wrote awhile back, it may be useful to you.

http://www.circularstrengthmag.com/26/jarlo.html


Also yes, thoracic and cervical mobility is intimately related to shoulder mobility. One of my all time favorite courses I have taken was entitled Shoulder Girdle Pathology Secondary to Spinal Dysfunction.

Though there is a bunch of stuff I could tell you about it, you hit on one key thing in your post about your "curve" at T6,7. Full overhead reaching requires adequate thoracic mobility, particularly extension. The easiest example, that I'm sure you've seen before, is to slump forward with bad posture and attempt to raise your hands up as high as possible. You will feel as if your shoulders "lock" at a certain point. Straighten up and the movement becomes free.

Curves in the spine involve not just the sidebending that is apparent, but also the rotations that are necessarily concomitant with that sidebending. Conjunct motions is the term used for this. Sidebent to one side, usually means rotation to that same side, depending on the particular nature of the spinal dysfunction (its etiology, chronicity, and especially what theory of spinal mechanics you subscribe to!!). This creates compensatory changes up and down the spine and as a result it affects the extremities as well. Spinal dysfunctions also create other difficulties besides this strict mechanical example. Neuromuscular changes occur as well. (Controversial sure, but readily backed up not just anecodotally but by good expansion of anatomical knowledge).

To be less long winded. Yes, your shoulder mobility may be affected by some spinal movement restrictions. :wink:

Play with some thoracic and lumbar movements and see how that changes your shoulder motion. And let us know about it, I am very interested to see what you find out! :D

[dianneg]

Thank you Jarlo. This is very helpful.
So not only the joint of the shoulder mobility should be addressed but the spine mobility in relation to that shoulder? Well, needless to say my spine, as well as many I'm sure, has it's areas of dysfunction and I always find it helpful to know why I need to move it this way and that other than because it feels good!

This also begs the question: Are the feelings of stuckness in the spine say in thoracic extension true subluxaions or are they merely muscular weakness or a mix of both or something else entirely. As I practice yoga and work thru the joints as a warm up or sometimes as my whole practice it's easy to get frustrated when the spine doesn't move as easily as it had a couple of days ago. Perhaps this is way too broad to address but I just wondered about that phenomena.

I am scheduled for a chiropractic appointment today so I will ask him about my shoulder and let you know what he has to say and the progress here on out.

Thanks again Jarlo for your in depth and knowledgeable answer, I am grateful. :P

Dianneg

[kcsportsdoc]

Hi dianneg,

Not much to add to Jarlo's excellent assessment. But in response to your 2nd question:


This also begs the question: Are the feelings of stuckness in the spine say in thoracic extension true subluxaions or are they merely muscular weakness or a mix of both or something else entirely. As I practice yoga and work thru the joints as a warm up or sometimes as my whole practice it's easy to get frustrated when the spine doesn't move as easily as it had a couple of days ago. Perhaps this is way too broad to address but I just wondered about that phenomena

The answer is: maybe, maybe, probably and maybe. It's impossible to pin down definitely without hands-on assessment. Because of the interconnectedness of all the systems (muscular, fascial, skeletal, nervous system, etc.) you can't divorce out one system from the other. If there is a "true subluxation" as you say, why is that area subluxated? Some muscle or muscles may be holding you in fixation due to Residual Muscle Tension or Fear Reactivity, or may be too weak to maintain optimal positioning due to deconditioning. Assess your posture and motion: Where are the distortions/restrictions? Are there postures you adopt or activities you engage in that reinforce that "stuckness"? It might be instructive to tape yourself during your yoga practice, Warrior Wellness practice and during various static positions like sitting comfortable or standing. It may also bear fruit to examine the ergonomics of your work space. Irrespective of the specifics, optimal joint health requires mobility and balanced strength in the muscles around that joint. So in addition to your yoga and Warrior Wellness practice, you might investigate Body Flow and Coach Chomycia's Mobilized Strength.

As a practical matter, ask if your D.C. knows how to recognize and correct a Ribcage Torsion. Due to neurological dominance (being right or left-handed) and repetitive movement patterns, a common, but oft-missed, postural distortion is a torsion of the thoracic cage. This can be difficult to spot on yourself, but basically one side of the ribcage will be higher than the other. This distortion can lead to other interesting symptoms like shortness of breath, reflux (G.E.R.D, "heartburn") or hiatal hernia due to "tethering" of the diaphragm.

Not everyone does this correction though, unfortunately. Jarlo, is there an analogous physical therapy treatment for this?

At any rate, I hope that didn't muddy the waters at all. I think you're on the right track. Sometimes progress is incremental and that can be frustrating. But you sound like you're definitely effecting positive change!

Feel free to pm me with any questions.

Best regards,

Kevin

[kcsportsdoc]

Hi dianneg,

Not much to add to Jarlo's excellent assessment. But in response to your 2nd question:


This also begs the question: Are the feelings of stuckness in the spine say in thoracic extension true subluxaions or are they merely muscular weakness or a mix of both or something else entirely. As I practice yoga and work thru the joints as a warm up or sometimes as my whole practice it's easy to get frustrated when the spine doesn't move as easily as it had a couple of days ago. Perhaps this is way too broad to address but I just wondered about that phenomena

The answer is: maybe, maybe, probably and maybe. It's impossible to pin down definitely without hands-on assessment. Because of the interconnectedness of all the systems (muscular, fascial, skeletal, nervous system, etc.) you can't divorce out one system from the other. If there is a "true subluxation" as you say, why is that area subluxated? Some muscle or muscles may be holding you in fixation due to Residual Muscle Tension or Fear Reactivity, or may be too weak to maintain optimal positioning due to deconditioning. Assess your posture and motion: Where are the distortions/restrictions? Are there postures you adopt or activities you engage in that reinforce that "stuckness"? It might be instructive to tape yourself during your yoga practice, Warrior Wellness practice and during various static positions like sitting comfortable or standing. It may also bear fruit to examine the ergonomics of your work space. Irrespective of the specifics, optimal joint health requires mobility and balanced strength in the muscles around that joint. So in addition to your yoga and Warrior Wellness practice, you might investigate Body Flow and Coach Chomycia's Mobilized Strength.

As a practical matter, ask if your D.C. knows how to recognize and correct a Ribcage Torsion. Due to neurological dominance (being right or left-handed) and repetitive movement patterns, a common, but oft-missed, postural distortion is a torsion of the thoracic cage. This can be difficult to spot on yourself, but basically one side of the ribcage will be higher than the other. This distortion can lead to other interesting symptoms like shortness of breath, reflux (G.E.R.D, "heartburn") or hiatal hernia due to "tethering" of the diaphragm.

Not everyone does this correction though, unfortunately. Jarlo, is there an analogous physical therapy treatment for this?

At any rate, I hope that didn't muddy the waters at all. I think you're on the right track. Sometimes progress is incremental and that can be frustrating. But you sound like you're definitely effecting positive change!

Feel free to pm me with any questions.

Best regards,

Kevin

[JasonE]

Yeah, Jarlo - Is there another treatment you know of for that?

I love it when you pros share all this info!! :D

[Jarlo Ilano]

Hi Dianne,

Have you read this book?
Anatomy of Hatha Yoga
http://www.amazon.com/exec/obidos/tg/detail/-/0970700601

I saw it the other night when we browsing at the bookstore. I only skimmed through it, but it seemed very thorough and interesting. This may be helpful to you because it is geared specifically for Yoga Instructors.

Anatomy Trains is another book you will see mentioned alot here. http://www.amazon.com/exec/obidos/ASIN/0443063516

Its great, and Tom Meyers also offers movement choices to address limitations aside from the bodywork possibilities.

I would suggest that whatever coursework you decide to choose, should include a significant variety for the first year or so, then you will have a good idea of what grooves in best for you. There are so many frameworks and theories for body movement/performance, and some are quite opposed to each other. In the end though, the "best" is what fits in to your personal style.

You can click on my resume at the end of my signature and see the variety of continuing education I've been lucky enough to attend. Some approaches were significantly different than the way I practice now, but I still learned a bunch from being exposed to them. I've settled in to some tried and true methods for myself, but still bust out something out of the ordinary every once in awhile. I think you will find a way for yourself too.

I give that preface because you should realize that my perspective is going to be different than others because of my particular background. (Not just from other professions, but even with physical therapy itself...)

In regards to the "true subluxation" question....

If indeed you feel that in some sessions you are more free than others, than there was no subluxation, instead there were musculo/fascial restrictions that you had "released" at that point, yet they returned at some other time. (Dr. Kevin Cooper's above post is a great one!)

My personal definition of subluxation is most likely different than the chiropractic definition. I believe a true sublux means that that particular joint is "off axis" and may not be able to resolve through personal movement, but only with direct manual intervention.

Whether that is the case with you would require personal assessment. Regardless of this however, movement exploration can only do you good!

Have a great day!

[Jarlo Ilano]

Kevin,

Good stuff! Thanks for sharing! I definitely need to learn more about chiropractic work.

Kevin and JasonE,

As for the analagous physical therapy treatment for ribcage dysfunctions... Do you mean exercise wise? Or do you mean the full scope of physical therapy treatment for this?

Orthopedic manual physical therapy is a subset of physical therapy in general (which includes neurological rehab, pediatrics, burn care, etc.,). So, continuing education after initial training is what most therapists go through once they figure out what they like. I decided I liked this route about a year out of school.

The general philosophy of musculoskeletal assessment by a manual therapist involves the determination of the specific mobility restrictions of the joint/body part in question. There are then a big mess of techniques developed by people to address the restrictions. Whether it be direct manipulation, soft tissue work, or specific exercise/movements.

In my personal case, alot of what I do involves amalgams of osteopathic theory, soft tissue manipulation, PNF, and joint play assessments. This is specific manual work. I then add on exercise techniques. (Which is why I was attracted to RMAX in the first place...)

I am not exactly sure how joint dysfunction is assessed by chiropractic. I had the nice opportunity to work with chiropractors about 6 years ago. I was sharing space in a building owned by one, and he and his colleagues sent some patients my way. I also went for a few sessions with one of them. A really nice guy, with a great care and concern for all his patients.

That was quite early in my career, so my manual handling skills were just beginning. So I couldn't really analyze well what my chiropractor friend was doing to me.... But looking back, it was different in many ways from what I do now.

Wow, sorry to write so much, but I guess what I am trying to say is that the analagous physical therapy treatment is dependent upon which particular therapist you would be seeing that day! :lol:

[dianneg]

Whoa! Thank you guys so much! This certainly opened a can of worms or in this case butterflies :wink: !

This is what I found out from my D.C.: I have a compression in my shoulder in the area of the coracoid process and it is inflamed (possibly from doing a shoulder roll from a threading the needle position :lol: ). As well, my upper trap and levator scapulae are tight on the right side. He said this may also be contributing to the compressed area. My doc was able to bring movement in the region of C7/T1--which is generally locked up for me and he rarely can get much movement there.

Kevin:
I believe you got it when you said

Some muscle or muscles may be holding you in fixation due to Residual Muscle Tension or Fear Reactivity, or may be too weak to maintain optimal positioning due to deconditioning.
I have lots of tension and I'm sure Fear Reactivity here and I will take into consideration your ideas for self observation. I am currently investigating stretching and strengthening exercises for this area as well and have found this one which may address it:

Lie on back with arem in stick em' up fashion w/ shoulder blades together and down towards pelvis, tuck chin in and exhale lift head off floor and lower on inhale 12x.

Turn head left exhale lift head while watching left elbow, inhale lower head 6x each side.

These are done in order to strengthen the sternocleidomastoid muscle which in turn I believe would stretch the levator scapulae. Does that sound accurate?

Neck traction without weight has also been of help but recently I haven't been too faithful with this method.

Jarlo,
Yes, I have Anatomy of Hatha Yoga--what a great book, thick with knowledge yet I have to admit a bit disorganized. Anatomy Trains immediately went onto my birthday wish list!!!

Your resume is impressive, to say the least, you are well rounded in your studies and experience. I will certainly, as you mentioned, try to find what best fits my personal style through exploration. Thank for sharing.

I just realized that the work I am doing now has been most beneficial and that comes from lots of home and self-study, teaching and reading and corresponding with all on this forum who have so much to share. This is school in and of itself.

I pray that I will be able to join you all at a Rmax seminar one day to meet everyone in person and have a real-time conversation :wink: .

Thanks guys! :D :D :D
peace,
dianne

[dianneg]

Whoa! Thank you guys so much! This certainly opened a can of worms or in this case butterflies :wink: !

This is what I found out from my D.C.: I have a compression in my shoulder in the area of the coracoid process and it is inflamed (possibly from doing a shoulder roll from a threading the needle position :lol: ). As well, my upper trap and levator scapulae are tight on the right side. He said this may also be contributing to the compressed area. My doc was able to bring movement in the region of C7/T1--which is generally locked up for me and he rarely can get much movement there.

Kevin:
I believe you got it when you said

Some muscle or muscles may be holding you in fixation due to Residual Muscle Tension or Fear Reactivity, or may be too weak to maintain optimal positioning due to deconditioning.
I have lots of tension and I'm sure Fear Reactivity here and I will take into consideration your ideas for self observation. I am currently investigating stretching and strengthening exercises for this area as well and have found this one which may address it:

Lie on back with arem in stick em' up fashion w/ shoulder blades together and down towards pelvis, tuck chin in and exhale lift head off floor and lower on inhale 12x.

Turn head left exhale lift head while watching left elbow, inhale lower head 6x each side.

These are done in order to strengthen the sternocleidomastoid muscle which in turn I believe would stretch the levator scapulae. Does that sound accurate?

Neck traction without weight has also been of help but recently I haven't been too faithful with this method.

Jarlo,
Yes, I have Anatomy of Hatha Yoga--what a great book, thick with knowledge yet I have to admit a bit disorganized. Anatomy Trains immediately went onto my birthday wish list!!!

Your resume is impressive, to say the least, you are well rounded in your studies and experience. I will certainly, as you mentioned, try to find what best fits my personal style through exploration. Thank for sharing.

I just realized that the work I am doing now has been most beneficial and that comes from lots of home and self-study, teaching and reading and corresponding with all on this forum who have so much to share. This is school in and of itself.

I pray that I will be able to join you all at a Rmax seminar one day to meet everyone in person and have a real-time conversation :wink: .

Thanks guys! :D :D :D
peace,
dianne

[kcsportsdoc]

You know, we all must really want to get our points across, because we each post everything twice! :lol:

dianneg,

The stretches sound good. They will definitely stretch the levator scapulae. I also like these two seated stretches for the SCM, scalenes and cervical paraspinal muscles. To stretch the left sided structures, sit on a kitchen chair holding the bottom of the chair with your left hand. Lean to the right, you will feel a tractioning in your left shoulder and trapezius the farther to the right you lean. With your right hand, gently (veeeeeeeery gently), pull your head to the right. This gives you a tremendous stretch in the left SCM and scalene muscles, so be very gentle, very gradual and exit (and enter) this stretch slowly and smoothly. To target the paraspinals, do the same stretch, but this time look to the right and pull your chin down to your armpit. Do these bilaterally. Just make sure to respect the power of this stretch. Pavel Tsatsouline loves this one as a "headache buster". You can do this one passively or with an isometric contract/relax. As for the coracoid inflammation, I'm a little suspicious about an impingement of your supraspinatus tendon (the supraspinatus is one of your rotator cuff muscles, forgive me if you know this already). But I'd like to see how you make out with the new stretches and Multi-Planar Mobility work. Please keep me posted.

Jarlo,

Man, you and I would get along like a house afire I think. :D You can work on me anytime. And I hear what you're saying about differing approaches based on the practitioner. That's one of the challenges that faces chiros, you could see 20 different chiros and have 20 totally different experiences. Yet, it's all technically considered the same thing. I consider myself to be on practically another planet compared to some back-crackin' mill. *sigh* Well, it's incumbent upon us as Tribal types to let people know that there are such better options for them.

Respect.

Best,

Kevin

[dianneg]

Hi Kevin-
Thank you for the exercises. I'll definately try them and let you know how they go.
Are you originally from Norwood? I grew up in Quincy. It's funny to me that when you reach out on the web you actually can meet neighbors that perhaps you would have never met otherwise.

much appreciation for your time.
dianne

[kcsportsdoc]

Hi Dianne,

8) I actually grew up on the left coast, and have been on this side of the country for 8 years now.

But you're right. It's a small, small world out there. :D I hope to see you at an RMAX event soon!

Best,

Kevin

[Jarlo Ilano]

Dianne,

Sounds like you are on a great path. Let us know how your shoulder gets along!


Kevin,

Yes, I'm sure it would be great to hang with you sometime. I see alot of great things happening with manual and exercise therapy as we go through our careers!