Many times I will see a client when they are on the road back after an injury. A common injury that I have a lot of success with is with the shoulder. The shoulder is a complicated complex that involves many muscles and includes movement of the shoulder blade in respect to the ribs underneath, mobility of the collar bone with it’s two joints on each end, upper vertebrae of the Thoracic spine and of course, the joint, which we all connect with as being the shoulder (where the arm attaches to the shoulder blade). The only part of the whole shoulder that really connect with the rest of the spine is where the collar bone attaches to the breast bone. Other than than, the shoulder relies on muscles, ligament and other connective tissue. It is a very mobile joint.
The main concern with the shoulder complex is that during the injury time, the person will probably not move the shoulder joint through it’s full motion and to protect it, will pull the shoulder forward and inward. It may often be limited to 25 – 50% of it’s movement. There is a law called Adaptive Shortening. This relays that if tissues are in a shortened position for long enough, in this case Chronic Protective Spasms from the injury, then the tissues will stay in that shortened position. This includes the capsules that surround the joint, ligaments, muscles and tendons. Tissues can also compress the nerves in the area possibly affecting nerve conduction. This is where my training in Fascial Release really comes into play. It is my job to release all the connective tissue or Fascia that is restricting normal range of motion of all joints involved. The most common presentations that show post shoulder injury are when the shoulder blade is stuck by it’s surrounding tissues not allowing it’s normal motion during shoulder movement and tissue that pull the Glenohumeral Joint forward and inward dramatically affecting that joints movement.
Once the shoulder becomes mobile, exercises are given to help to help to return it back to function. Again, this is a very mobile joint with lots of joints involved so the exercises are done slowly and gradually. Pool exercises and mobility while laying on the floor are good to start with reduced gravity. Having the shoulder back in neutral position is key so having the client be aware during the day of keeping the shoulder is a better position will determine how quickly the client is able to get back to normal function. Unfortunately, pain and injury will reduce movement dramatically. Sometimes this is necessary but if the person can move the area gently, it encourages circulation to the area, which is beneficial to the muscles and nerves in the area. Part of the assessment is to see what the person is able to do.
Below is a picture in general with respect to the shoulder complex. You can see how the arm attaches to the shoulder blade. The Acromion of the shoulder blade attaches to the Collar Bone that attaches to the Breast Bone or Sternum and is all controlled by ligaments, muscles, tendons and joint capsules.
As I’ve mentioned in the past, I had an MRI that discovered a low grade L4/5 disc bulge that made itself present earlier this year. I also have issue with low back pain resulting from very tight hip flexors. There is a big connection with tight hip flexors and forward rotation of the pelvic bone on the same side and an unbalanced lumbar spine. I went for a 60 km or so bike ride today with lots of hills and such. It was a great bike ride on a beautiful day but on the way back, I could feel my low back start to ache. Not in acute spasm, but just a dull ache that was kind of annoying. It didn’t feel quite right so I looked in the mirror and noticed that my left pelvic bone was tilted forward a bit that indicated that the hip flexor on that side may be tight. On palpation of the left hip flexors I noticed that they were. I did some gentle hip stretches including the hip flexors and did some manual massage to release the hip flexors and the back is feeling much better now. I’m going to get some work done tomorrow to make sure that everything is behaving itself but today was a reminder that I need to keep up with my hip flexor stretches every day, even though it may not be feeling too bad.
When something is flared up, it is wise not to stretch the area too hard as you may flare up the issue. Just a gentle light stretch for a minute or so, making sure it isn’t painful should be helpful with gentle range of motion of the area to keep it mobile. Pain is odd in the way that it makes us stop completely when light movement is good to keep the circulation moving in the area to aid with healing.
I have done entries in the past about natural inflammatories including Tumeric, Serrapeptase and also Bromelain. This entry is more about Bromelain. As well as being a natural antiinflammatory, it has been described as a Natural Anticoagulant (that breaks down the blood clotting protein Fibrin. It also aids with digestion by enhancing the effects of digestive enzymes Trypsin and Pepsin.
Above is the link discussing more about Bromelain. There is information at the bottom with studies linking Bromelain to Anti-inflammatories, Osteoarthritis and Anticoagulants. A major source is found in the center part of the Pineapple that usually gets taken out in canned pineapple. Buy the whole fruit and pop it in the blender where you can puree it and you won’t notice that you are eating the center as it may not be as tasty as the outside part.
There is plenty more information about Bromelain if you google it. Once again, as I’ve written before, standard medical practice may not have the background to comment on Bromelain. My belief system with these products is that if there is enough information about it, and it doesn’t hurt to take it, then it is worth doing.
There are sources that provide Tumeric and Bromelain together. If you are in Victoria, it can be purchased at the Vitamin Shop in the downtown area. There is a strong link between inflammation and Free Radicals in the body so a natural approach is beneficial in keeping them at bay.
In this post, I wanted to talk about exercise and the body awareness. This is the ability to be able to listen to what your body is telling you. Very often, training can surface the philosophy of “No Pain, No Gain”. This is probably the worst philosophy when you are working your way up to a goal, whether it be push ups, swimming/running/cycling. Often I have told patients that it is best to totally under-do their goals while they find where they are in their training setup. For example, when someone is starting a running program, beginning at a 3 – 1 ratio for walking and running. So, walking 3 minutes and running for 1 minutes, then go back and forth between the two. Then you can finish and say “wow, that was really easy”. Progress to walking to running at a ratio of 3-2 and go from there. During this time, always be aware of your comfort level and stop running to a walk if you are feeling discomfort. Good therapy can help your get your body ready for the training. In my clinic, I often hear that people are pushing themselves to reach their current goal. Also, they may be in a group that they need to keep up with. That social pressure can interfere with your bodies progression to the goals set.
Very often, injury can occur when you become tired as your primary movers become tired like hip flexors, calves ect., and other muscles that aren’t supposed to be primary movers have to kick in to help the body run. Injury is not always sudden and can evolve slowly then can arise when least expected.
I had a conversation with a client about running. They said that they were feeling pain and difficulty with running with the group but “managed to keep up”. I said “why don’t you just say to the group that if you feel like you can’t keep up, you will just carry on your own to your comfort level”. They mentioned this to the group that she felt was a little faster than her. It turns out that 1/2 of the people were suffering like her and pushing themselves to hard but no one said anything. It’s good to be open about where you are with those that you exercise with.
You will reach your goal faster if you listen to your body. If you don’t, you may injure yourself and that can put your training on hold for a while, which I know from personal experience is very hard.
In my clinic, I have seen many cases of the above come into the clinic. Generally, Tendonitis is irritation of the tendon, Bursitis is inflammation of a kind of pad that sits on a bone that a muscle runs over and inflammation can also occur where the tendon attaches to the bone. Each condition will be treated differently in terms of reducing the inflammation but the cause has been fairly consistent and that is the property of the muscles themselves.
Essentially, in my opinion, the issue with all three conditions is that the muscles have lost their elasticity due to inflammation and adhesions within the muscle belly itself and creating too much tension where the muscle becomes a tendon, where it travels over the bursa (fat pad) or where it attaches to the bones. This will cause inflammation at these 3 points causing the tendonitis/bursitis/bone inflammation.
A muscle the becomes adhered also loses it’s ability to properly lengthen and shorten making it a weaker muscle not able to contract properly. An adhere muscle will traditionally not receive as much blood with oxygen and as a consequence may have increased levels of metabolic waste creating an acidic environment in the tissue causing pain and further tightness.
Part of my treatment is focused on releasing the adhesions within the muscle belly, and any adhesions between that muscle belly and any other tissues surrounding that muscle belly, to return circulation to the muscle and some light stretching with some home care to maintain a flexible strong muscle.
Inflammation is useful generally only in acute circumstances but can tend be become chronic and can really affect you physically, emotionally and pathologically. Above is a link that discusses different ways that inflammation can be connected to free radicals and the effect of free radicals on the body.We all know about how bad free radicals are. I was just introduced to Serrapeptase recently to aid with reducing inflammation. Interestingly enough, this is a substance that was offered to my dad 30 years ago, that aided with his recovery from cancer, by a German doctor named Hans Nieper. There is well documented research from Europe and Japan as to the effectiveness of Serrapeptase.
Wikipedia has some good information on Serrapeptase at
I think there will always be an argument about whether or not the research is good or bad and whether is may work or not with different opinions from people with different areas of specialties. I have adopted that if it doesn’t hurt, it is worth trying. If you are starting something new, always check with your doctor that it may not interrupt or worsen any condition that you may currently have. It has been described as an effective alternative to NSAIDS and other pain relievers for conditions like rheumatoid arthritis and similar.