Neck pain and the Head Righting Reflex

Neck pain is something that I see a lot of coming into the clinic The one common denominator is that more than often, the pain occurs as a result of the neck pulling the head straight because the shoulders are out of position. This leads to my previous blog with relation to the shoulder and shoulder pain.
People will describe achiness going down from the neck to the top outer edge of the shoulder or sharp pain that occurs when rotating or side bending in one direction.
In each ear, deep inside, in the Utricle and Saccule are small gelatinous masses called Otoliths, which have tiny receptor hairs attached to them. If the head is leaned to the side, the Otoliths will move to that side and initiate a response to the receptor hairs going down into the brain to tell the muscles on the other side of the neck to tighten to pull the head back to a level position. This is completely subconscious function so you are unaware that you are doing it. This is where the shoulder comes into play.
Lets say that your right low back is tight and pulls your torso to the right. If you do this, you will notice that your left shoulder is now higher than your right, and your head is now leaned to the right. The Otolith will indicate that your head is in that position and will tell your left neck muscles to tighten to pull your head level. Now the muscles are contracting chronically to keep your head level, which can cause eventual weakness and pain with the muscles that are contracting all the time. What this also causes is a curve in the spine, with the concave on the left side and convex on the right. This will cause pinching of the neck on the left side (especially on turning and side bending your head, like with shoulder checking when driving). There are small lateral joints in the neck called Facet Joints, which are now irritated as they are closer to each other on the concave side. The misposition of the joints vastly affect your neck mobility. Now, there is a little work done to relieve the pain with the neck muscles and to help to take the neck out of that concave/convex curvature but the big long term goal is to level the shoulders so the neck doesn’t have to tighten to relevel the head.
Part of this work is to identify why the shoulders are out of position. Many people are hunched forward so the shoulders are rolled forward, which causes the back neck muscles to tighten on both sides to pull the head straight. Alternatively, it could be a pelvic or (as I described earlier) low back tightness imbalance that leans the upper torso and back to one side or another.
Many people don’t notice the imbalance in the shoulders or back as the Head Righting Reflex will level the head so it is really hard to notice.
I’ve had a lot of success with treating the body as a whole to reduce the need for the neck muscles to tighten to pull the head back to level. Part of it is what I do, but most of the time, what I do is only necessary to make it easier for the patient to do what they need to do, so it is 50% me and 50% them. I’ve seen torso twisted around, pulled to the left or right or leaned forward or backward. Imagine that the head is a house and the shoulders are the foundation. If you want the house level, you need to level the foundation.

Pelvic Stability and Low Back Pain

I just took a great course a couple of weeks ago that focused on the position of the pelvis and it’s involvement in low back pain. The course provided a great way to assess the position of the pelvic bones (hip bones) and the sacrum (bone between the pelvic bones just below the lowest back vertebrae. It is important that the pelvic bones and sacrum be level as that is the position that the low back spine will continue upwards. So imagine that the hip flexor that attaches to the front of the right pelvic bone is tight and pulls the front of the right pelvis down and tilts the whole pelvis so it is facing more forward and to the right, that is how the spine will start going up. That means that your torso will be also more forward and leaned to the right. The body will immediately recognize this and tighten your left low back to pull your torso so it is back upright. This will cause pain in the left low back as it is chronically tightening.

The course I took covered over some really simple effective comfortable methods to reduce tightness of certain muscles that are pulling the pelvis out of alignment therefore reducing the need of back muscles  to tighten to pull the body back into alignment. Being able to identify the causes of pelvic misalignment allows me to give exercises that will hold the correction so that the client is able to keep up the changes over longer time for long term effects.

Identifying what postures or biomechanics can be contributing to the issue in the beginning are also reviewed to help hold the changes for longer term. It goes to back up that the pain you feel is often in a different area from where the cause is. Working in the area of discomfort is necessary to provide relief but would only be helpful for a short term and must be followed up with exercises at home and awareness of posture and biomechanics that, as describe above, can be contributing.

Here is a picture of the pelvis from the front and slightly above. The Sacral Promontory is where the L5 (lowest back vertebrae) sits and starts the spine upwards.

Massage Therapy and Fascial Release

I wanted to discuss my Fascial Release treatment today as one of the most important modalities that I use. It is quite a deep subject and I could go on for hours about it but just the basics I think will do and how it ties in with my treatment philosophies and how it is helpful for my patients is what I will focus on. Fascial, essentially, is what helps to create the structures in our body (bones, tendons, muscles, nerves, organs ect.) but it also helps to hold these structures together and is the reason for the shape that we are.

I thought that Wikipedia had a good definition so I hope they don’t mind if I borrow from them.

Fascia (făsh’ē-ə), pl. fas·ci·ae (făsh’ē-ē), adj. fascial (făsh’ē-əl) (from latin: a band) is the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds musclesbones,organsnervesblood vessels and other structures. Fascia is an uninterrupted, three-dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior. It is responsible for maintaining structural integrity; for providing support and protection; and acts as a shock absorber. Fascia has an essential role inhemodynamic and biochemical processes, and provides the medium that allows for intercellular communication. Fascia functions as the body’s second line of defense against pathogenic agents and infections after theskin. After injury, it is the fascia that creates an environment for tissue repair. So a fascial adhesion which occurs post injury, can affect the repair of that same tissue.

Where I come in to all of this is that if there is a discontinuity or change to the function of the fascia, it can effect the body in many ways, including the functions stated above. I concentrate more on structural fascial and myofascial (fascia that surrounds the muscle) in the way that they affect movement and posture and balance, which is what I see come into the clinic quite often.

Another groups of conditions that has begun to trickle into the clinic are conditions arising from disfunction to the fascia surrounding the organs. The organs that I traditionally deal with are the liver, gall bladder, stomach, lungs, large and small intestines, bladder, prostate, uterus. This form of treatment is very non-invasive (for those of you who saw the bladder/prostate and cringed). The bladder/prostate work can be accessed in the lower abdomen area just below the belly button. With their respective attachments, each organ has a movement is must be allowed to do during both it’s functions and during general body movements. Clients have come in with complaints attached to digestion such as reflux, gas, constipation, diarrhea, dry stool which can all be attributed to adhesions somewhere along the course of the digestive system. Constipation, for example can be a spasm causing the valve between the small and large intestine.  It’s a newer approach to adhesions causing trouble with the functions of organs.

As example as what can happen with tight abdominal fascia, think what would happen if you had some of those full body pajamas on and you’re sitting in a chair. You spill some sticky glue on your front but you stay there for a while, until the glue hardens. When you go to sit up, the now inelastic fibers of the front of your pajamas  will make it difficult to stand up straight because they won’t stretch. It also affects the way that the rest of the pajamas pull to compensate. This is an extreme example, but shows how restricted fascia can affect a local area and also affects the chain of fascia around the rest of the body.

Again, I could go on for a long time about different effects of dysfunctional/adhered fascia, but in a nutshell, Fascial adhesions don’t let things happen that need to happen and puts the body into a state of imbalance and dysfunction. My job is to locate the adhesions and release them so that the normal function and movement occurs and allows the body’s natural balanced position occur easier. It is an interesting process as often the best approach is a much more gentle approach. I hold the pressure to release the adhesion and often it won’t move for at least a minute, then slowly, the adhesion begins to unwind, producing a significant release allowing movement of the structures surrounding it. Often I combine other modalities with fascial release including trigger point release, muscle energy techniques, joint play to name a few. With fascial release, toxins are always released so I always flush out the area to return the venous circulation to the heart to be expelled.

Breast Cancer and Bra Straps

I found some interesting information regarding the connection to tighter bra straps, reduction of movement of lymph and cancer. Have a look at this write up. Please google as much as you can to gather more information but I think it it is something that is worthy of your time. Movement of lymph from the breast tissues is very important.

http://www.healingcancernaturally.com/breast-cancer-bras-lymph-nodes.html

About my Treatment Philosophies

I wanted to spend the next little while discussing some of the types of treatments that I use. As every client is different with what they come in with, it is important to have as many types of treatment modalities as possible in your tool box. You can have patients that come in that are under a lot of stress that may need to just bring themselves down again with relaxation in mind, to athletes in the off-season/during season training/pre-post competition to client that are suffering acute or longer term chronic injury. With therapy, I want the client to understand exactly what it happening with them so 1)they understand how what they are doing can be contributing to the injury 2) to understand the treatment I give and why I’m going what I’m doing 3)they understand why I am giving the exercises and how it will help. I am a firm believer that my treatment will only be 50% of their success and the more they are involved, the longer term the effects will be.

Clients may come in with varying degrees of a type of injury so there is not one approach to helping them. My approach is I focus on mobility, support and balance. When the body is balanced, the joint range of motion is better and the muscles are in a neutral position and will be stronger (not stretched or shortened).  Many times the body is pulled out of it’s ideal balanced position for long enough that the unbalanced position is what seems to be normal and that is why it often ends up being a chronic condition that ends up surfacing seemingly out of nowhere.

The types of modalities I use include Deep Fascial (connective tissue) Release, PRT (passive release technique), Muscle Energy, Joint Mobilizations, Standard Stretching, demo of the exercises to be done at home, Postural and Range of Motion Assessment. Over the next little bit I will cover each of these modalities and explain how they can be helpful in achieving a well supported strong balanced body.

The Physiology of Oxygen / Carbon Dioxide

Carbon dioxide is the waste product of the respiritory system, and of several other chemical reactions in the body, such as the creation of ATP. Pure carbon cannot be transported in the body, so CO2 is one form it takes that is water soluble. Levels of CO2 also tell the body when it needs more oxygen.

In the human body, the oxygen is absorbed by the blood stream in the lungs, being then transported to the cells where an elaborated change process takes place.

Oxygen plays a vital role in the breathing processes and in the metabolism of the living organisms.

Probably, the only living cells that do not need oxygen are some anaerobic bacteria that obtain energy from other metabolic processes.

Here is an really good link to a page that discusses how the body brings in Oxygen and rids itself of Carbon Dioxide:

Me and the Ginger Tea

I’ve wanted to write about this for a while. It’s never fun when you first feel a cold coming on and you wonder what you should take, so I thought I would pass on what seems to have always worked for me. It is pretty simple too. When I feel it coming on I take a couple of grams of Vitamin C (2000 mg), chop up some fresh ginger root and put as much in hot water as I can and just drink ginger tea with honey all day. Since I have done that, I have never felt anything settle in. Maybe it’s just the Vit C, but Ginger also has very potent anti viral properties that are good for colds and flus.

Click here for more infomation on ginger. It’s really good stuff.

Importance of staying mobile post exercise

I was treating at the Ironman in Penticton in August and being there is always an experience. Essentially, the meat of it is that in 30 degree celcius temperature, 2800 people or so swam 3.8 km, rode 180 km and 42.2 Km run. To regular Joe and Joettes like that, this seems inconceivable, but to an Ironman/woman, this is the result of training, often from short runs, to 10 km, to half marathons, full marathons, half thiathlons, full triathlons to the Ironman races. We worked with the athletes for the days upcoming with preparations to help them to get ready then helping them after the race.

A significant part of all this was helping them was just after the race when they came in. Many of them were so tired that they had trouble getting on the table. The treatments were mostly limited to flushing out the muscles and helping to bring blood to the muscles to aid in repair and reducing pain. Many of them wanted to lay down to rest after but my suggestion to them was, if they were able to, to go down to the lake and move about in the water. The best thing that you can do after heavy exercises, whether it be running/biking/swimming or a weight workout, I have found that a good cool down with low intensity exercises or movements. Moving about in the water allows the body to move circulation around better and helps it get rid of Lactic Acid and CO2, which is a cause of Delayed Muscle Soreness, that you feel a day or two after. Essentially, muscles short contraction and lengthening from simple movement provides the pump necessary to bring in circulation. Shortening brings in the blood, drops off the oxygen, picks up the carbon dioxide (waste byproducts), then lengthening pumps out the CO2 rich blood out to the lungs to be breathed out.

When I do a long bike ride, I ensure that I spend 5 minutes at low intensity high reps before stopping my bike ride and I have noticed that the day after I am much less sore and noticed less fatigue, that allowed me to go biking the day after.

Another thing that I do, of course is an Epsom Salt Bath, which floods my muscles with magnesium, that in turn, remove calcium from the muscle cells allowing them to relax. Take a look at a good movie explanation at http://www.youtube.com/watch?v=5guQwhRhV60

Good Cross Country Tires

I picked up a new set of tires lately. I had some tires that had quite an aggressive tread on it which was really good if I was off-road all the time but I often find myself doing 60 + km bike rides and the tires just weren’t good for that type of riding. I went to my bike Sugar-daddies at the Trek Store in Victoria and got some cross country tires.
The tires that I got were the Kenda Karma L3R Pros. These are great tires for on-road riding and mud/ hard packed riding. I haven’t ridden on loose gravel. There were complaints that the side walls were too thin but I think that was one thing that I liked about it for my style of riding as I can put up the pressure to 80 psi (I usually have mine at 65 or so) and it is very firm, but the sidewalls flex if I hit a bump but only at harder hits.
I’ve noticed a huge difference in my energy levels post rides in that I’m not too tired and can ride a lot faster and longer so it’s really good for me. I’ve done some off roading and downhill/rock climbing and really like what I’ve experienced so far. These are Kevlar tires and I have some super aggressive Kevlar 2.5 ” tires that are super easy to switch if I’m going up to the Hartland Dump or something like that so good to have a backup . Great tires for the intended riding.
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Keeping the discs clean

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I’ve just installed some 7″ disc brakes. I had a thought that maybe I would like to get the hydraulic brakes, that uses hydraulic pressure as opposed to cables, but opted to get  the Avid BB7 mechanical disc brakes and would recommend them to anyone. They are very efficient brakes in the dry or wet weather.

One recommendation from the bike dealer was the importance of keeping the discs clean. Often things like grease and oil can get on the disc and get on the brake pad and it can be very difficult to clean. So each ride I wipe down my brake disc when I get home. It takes two seconds (margin of error of 1 minute) with a clean cloth and some plain-jane Isopropyl alcohol.