Massage Therapy and Joint Play

I took a really good course last weekend that covered Joint Play. This is a really important part of everything from injury prevention to rehabilitation. A joint is the place where two bones meet and one of the bones moves around the other in it’s intended range of motion. A great example is the shoulder joint. The main shoulder joint is where the top of the arm bone attaches to the outside of the shoulder blade. As the arm moves around the socket at the outer part of the shoulder blade, there needs to be small motion that occurs inside the shoulder joint. That is the joint play.  If the end of the arm bone is the ball and the edge of the shoulder blade is the socket, good joint play range of motion ensures that the ball stays within the socket space no matter where the arms moves to. If that small motion isn’t there, the arm movement will stop and reach the end of it’s range prematurely and can mimic Frozen Shoulder. It’s like a hinge in a door that doesn’t move well, so the door doesn’t close. It feels like it catches or pinches causing local shoulder pain that can begin to travel causing neck, rib pain and headaches. A lot of my success with treating the shoulder is just returning that small essential motion in the joint. These small motions can occur in the jaw (TMJ), the spine, shoulders, elbows, wrists, hip, Sacroiliac joint, knees, feet to name a few. Each of these joints have their own movements and often any limitations can be restored. The treatment for restoring joint mobility is a little different from standardized massage therapy as the treatment is very regionalized but I feel like it is such a crucial part of getting to the cause of dysfunction/discomfort. There is always treatment to the surrounding muscle tissue, especially the symptomatic one in addition to the joint play treatment. I remember one teacher saying that if you have a painful/tired muscle, look to see what joint they move. For example, if you have a sore biceps muscle on your arm, I look at the shoulder and elbow movement. If someone has a sore front leg muscle, I look at the hip and the knee joint. It’s not well known that the ribs are also very mobile during torso and arm movement and breathing, and in our society, the ribs are commonly stiff and can benefit from mobilization. Very often, I have found that treating just the tight muscle may feel good for a shorter period of time, but can return if there is an involvement in the surrounding joints.

Having said all that, there is opportunity for pain to refer away from where the joint is not functioning properly. Neck joints in the spine can cause pain down the arms or produce headaches. Low back spine joints can refer pain into the hip or down the leg and mimic Sciatica. A stiff joint in the foot can produce pain that goes up the leg. There is a thought out there that you find the pain but look for the cause elsewhere.

Having joint play in my treatment tool box has vastly reduced pain and dysfunction with patients, increasing functionality and improving daily activities. It is a gentle treatment and follows with the Osteopathic process, which often reveals very good results. Be gentle and the body will let you do more. As always, the patient’s success is partly what we do in the treatments, but just as much, it is important for the patient to be involved so they can continue to improve at home with stretches, exercises and movement/posture changes. It continues with the philosphy that we were designed to move a certain way and very often dysfunction can occur when we don’t.

Trigger Point Therapy

Trigger Point Therapy is a tool in my treatment toolbox that I use often with helping to relieve pain symptoms that the client is experiencing. They can vary from localized pain of taut bands of muscles that can occur throughout the body from feet to the top of the head. They can also exist with symptoms like jaw pain, neck pain, headaches, pain down the arm or leg or into the hips. They occur where there is a taut band in a portion of a muscle. There is debate as to the actual physiology behind trigger points but the symptoms or undeniable. These taut bands (trigger points) in hypothesis occur when the muscle tightens/ shortens due to fatigue or being put into a shortened position for an extended period of time, trauma, dysfunction of a nearby joint that it is involved in movement or stabilization of including anything from foot, knee, hip, spine, shoulder, elbow or hand. Often it will produce a vague, dull achiness, which can help to differentiate is from a nerve related pain. When there is pain down the arm or leg, it can often be misdiagnosed as a nerve related pain but special assessment can be done to determine if it is nerve or trigger point related. The tricky thing is that the trigger point can refer pain to another area, making it seem that there is a dysfunction in that distal area. For example, the outside of the thigh muscles can refer deep achiness right into the knee. The rotator cuff muscle trigger points can refer down the arm to the hand. Neck muscles can produce head aches in different areas of the head by different neck muscles.

Each person experiences a reduction of symptoms in different ways so there is no one way to relieve a trigger point. In addition to releasing the trigger point, it is important to determine why that muscle, or portion of the muscle is tightening and help educate the client to avoid a reoccurrence in the future. Writing this entry reminds me of trigger points that can occur in the upper back and neck that can produce head aches. We are in a society that is spending a lot of time in a slight forward slouched upper back and head forward position and the end result is that the muscle in the back of the upper back and neck just get tired. Our heads are heavy and produce a greater force the more forward they are. Good upper body and head position is important as it dramatically reduces the exertion put on the upper back and neck muscles. It is part of the posture and movement pattern re-education that I teach in treatment so that a client can be empowered to make posture/ movement changes when the symptoms of trigger points occur (in addition to others). It’s about treating the symptoms, finding the cause and helping the client to make movement/ postural changes to avoid reoccurrence in the future.