Viewing entries tagged
pain

WTF is Manual Muscle Testing?!

1 Comment

WTF is Manual Muscle Testing?!

When you’re sweating through your workout at P4L, or if you’ve ever just walked by the gym and peered through the windows, you may have noticed a few coaches standing around and weirdly pushing on their client’s limbs and muscles. A client may be standing or sitting or even lying on a massage table as a coach pushes or pulls at an arm or leg from a multitude of awkward angles. What’s going on at P4L? It may look a bit strange, but what’s actually being done is a very cool tool called manual muscle testing.

Manual muscle testing is a diagnostic tool that comes from Applied Kinesiology with which a practitioner can evaluate whether or not a muscle is neurologically functional. It works by having a patient or client perform a muscle movement that the practitioner manually challenges so as to see whether or not the client can appropriately meet the resistance. Maybe it’s best to use an example to explain what I mean.

Let’s say I want to muscle test my client’s latissimus dorsi, or lat (a muscle located on the back side of the body). The client may be standing, seated, or even lying down and I’d begin by having her internally rotate her shoulder (so that their palm is facing away from their body, below).

Then, I’d instruct her to meet my resistance as I pull her arm away from her body into flexion and abduction (in front of and away from the body), thereby challenging her to adduct (pull toward the body), extend (pull behind the body), and internally rotate the shoulder in one motion, which are all the muscle actions of the latissimus dorsi.

This is why I have my client maneuver in such a specific way - so that I can target one specific muscle and challenge it to perform its main action by trying to pull it in the opposite direction of said action.

This is just one example, but we have muscle tests for all the major muscles of the body, so now that you know how it works, you might be able to see how manual muscle testing is a handy tool for thoroughly assessing a variety of movements from head to toe. We can test whether muscles can contract and relax properly, which is very important from a neurological standpoint. Clients can tell us if activating a specific muscle causes pain, which can lead us to the right steps for resolving and preventing that pain. We can look for areas of weakness or for weakness in specific muscles that may correlate to dysfunctions in exercise, which can then help us to correct movement.

Manual muscle testing is one of the many tools some of us use alongside our exercise programming and bodywork, and it has definitely been a useful one. It's helped some of my clients improve muscle activation, reduce or prevent pain, and achieve their goals. So the next time you notice a training session on the floor that looks a little different, just know that our clients and patients are (literally) in good hands. Maybe even give it a try yourself!


1 Comment

4 Tips for Rehabilitation

Comment

4 Tips for Rehabilitation

Many people who have pain from injuries, accidents, disease or just the activities of everyday life seek help to solve their problems. Often times, they’re able to see a physical therapist or another health practitioner who will diagnose what’s causing the pain, perform appropriate treatment, and give directions on how to proceed with rehabilitation. The practitioner may guide the patient in person through his or her rehab or may assign exercises for the individual to do at home at a certain frequency or for a specific length of time.

Physical therapy and rehabilitation are fantastic and help many people in pain, but they can at times be very monotonous and frustrating because being in pain is hard. Tasks and movements that were simple and taken for granted before now cause suffering and may even be impossible to do. Additionally, the rehabilitation process can be quite lengthy, especially if there is severe damage from injury or disease. Patients with pain often go through many emotional battles not just from the physical pain itself, but from the impact it can have on their lives.

But with diligence in rehabilitation, a strategic approach to the body, and the right mindset, most people can come out of pain. If you’re in pain, seek help from a health practitioner for guidance on what to do. And if you’re in the thick of recovery, hopefully, these tips can help you on your way.

1. Celebrate every victory, no matter how small.

If you were bedridden yesterday, be grateful that you can now get up. If you could barely stand yesterday, be excited about the fact that you can now jump. If you could slowly walk yesterday, be proud that you can now run. Even if you get up slow, or you don’t jump as high, or you don’t run as fast, progress is progress. Okay, we don’t usually heal overnight, but my point is that celebrating victories is about appreciating the details - maybe it hurts less when you try to touch your toes, maybe it used to hurt as soon as you lifted your arm and now it only hurts when you reach above your head. Manage your expectations and set realistic goals so that you won’t be disappointed and will stay motivated to keep pushing forward.

2. Don’t fight through the pain.

We’ve all heard the phrase, “no pain, no gain.” Maybe in the past, we’ve been pushed and pushed by coaches while we work out to “Fight through the pain!” Understand that (hopefully) these are references to pushing through challenge and muscle “burn” and not the literal pain that we feel as sharpness, numbness, or tingling. If an exercise is causing pain, stop doing it. Pain is our body’s way of communicating that we’re putting ourselves at risk of harm, so if an exercise is causing pain, don’t do it, or regress the exercise. Do an easier version that doesn’t trigger symptoms and master that movement before attempting a harder progression. If an exercise is challenging and you feel your muscles working hard, then that’s great - you should practice that, and make sure that you’re getting plenty of rest and recovery as well.

3. Balance the injured and uninjured.

Lots of patients, very commonly, have an injury on only one side. For example, you might have sprained your ankle and then seen a practitioner. He or she recommends that you allow for some rest for healing and so that inflammation can go down and when that’s better, to do mobilization and strengthening exercises, then maybe some balance, stability and even plyometric work. This is all great and it helps with recovery, but what often happens is the formerly injured side heals and becomes better - stronger, more mobile, and more stable - than the uninjured side. While you do your rehab exercises, give both sides, including the healthy side, some love so as to ensure balance and symmetry.

4. Consistency, consistency, and consistency.

At the end of the day, successful rehab comes down to consistency. As with working out, you don’t get results with one good workout. You have to work out consistently, eat nutritious and healthy food consistently, and sleep well consistently to see results over time. You have to do rehab exercises daily because often times you’re trying to break strong compensation patterns, rebuild atrophied muscle, restore stability to important joints, and generally fix biomechanics. It takes great treatment, smart rehab prescription, careful but effective integration and a lot of diligence and commitment to healing and movement to get a worthwhile, long-term result.


Comment

What Is Carpal Tunnel Syndrome?

Comment

What Is Carpal Tunnel Syndrome?

Wrist pain is an extremely common complaint by many people because of the demands of our daily routines - working at a desk and computer, doing manual work with our hands, and just simply being on our phones for too long. I myself am no stranger to wrist pain as I took piano lessons for eleven years while simultaneously playing tennis competitively for five years through the end of high school. During my suffering, I quickly diagnosed myself as having carpal tunnel syndrome, which was an incorrect assumption that many people often make.

Carpal tunnel syndrome is a condition characterized by pain, numbness, or tingling in the wrist during gripping, wrist movement or even just to the touch. It’s caused by compression of the median nerve by the transverse carpal ligament (below). Doctors may recommend splinting the wrist, a cortisone shot, or anti-inflammatory drugs. However, if symptoms worsen, doctors may perform a surgery cutting the transverse carpal ligament to free the entrapment of the nerve.

Source: John Hopkins Medicine

Source: John Hopkins Medicine

The unfortunate truth is that most of these surgeries end up destabilizing and weakening the wrist because of the newfound lack of structural support from the ligament - even worse, the initial pain is still there. So what went wrong? The problem is that the site of pain is oftentimes not the source of pain. In this case, there was only treatment and intervention at the site of pain, without consideration to the body as a whole.

Very commonly, carpal tunnel syndrome-like symptoms are actually because of upper thoracic outlet syndrome. This is another condition in which an individual may experience pain, numbness, or tingling anywhere in the hand, wrist, arm, elbow, shoulder, or neck. This happens as a result of a nerve entrapment in the brachial plexus, a clustered network of nerves in the neck and shoulder, or anywhere along its nerve pathway (below). Usually, soft tissue release or massage around the plexus or on muscles along the nerve pathway will relieve pain that even a carpal tunnel surgery cannot. These muscles may include the scalenes, pectoralis minor, biceps brachii, and the wrist flexors to name just a few of the possibilities.

Source: Core Walking

Source: Core Walking

Sometimes, a carpal tunnel surgery is needed because there may truly be excessive compression of the median nerve at the wrist that massage may not be able to fix. But in most cases, carpal tunnel syndrome is a misdiagnosis that ends up hurting the patient more than helping them. If you have symptoms of pain or discomfort in the wrist or anywhere in the body, be sure to seek multiple opinions and try treatment and healing modalities less severe and irreversible than surgery.

Comment

Bodywork to Make Your Body Work

Comment

Bodywork to Make Your Body Work

Almost everyone in San Francisco leads a very active lifestyle. From working the 9-5 to working out (hopefully), running errands, being outdoors to get fresh air and sun, and enjoying all the fun activities that the city constantly has to offer, San Franciscans are extremely social and busy people. We’re great at doing our work, being in school, and going out to do the things we love. Sometimes, though, we’re not so great at taking a step back to slow our lives down and take care of ourselves. We work hard and play hard, but we don’t always do enough for our “rest and digest” - our down time, our sleep, our nutrition: our recovery.

In previous posts, we’ve talked a lot about nutrition, sleep, and mindset, and these are all great and necessary elements to improve our general well-being and aid in recovery so that we can do what we do best: be active. So this time, I want to talk about another great way to recover, rest, and relax. I want to talk about massage.

As many of you know, massage is a great tool for relieving tension and tightness in the body, but people still have many misconceptions of what massage is.

Some people are afraid of massage because of a bad experience and say things like, “It was so painful! I think my body is just too sensitive to receive massage.”

Or, on the other end of the spectrum, some people say “I don’t feel like anything happened. They just rubbed lotion on me and that was it.” Many people don’t know that massage has the potential to reduce or even completely relieve pain. I think that it’s really unfortunate that not all people know how great it can be, so I want to break down a few different styles of massage and bodywork so that everyone can understand how this healing modality can play a vital role in your rest and recovery.


(Swedish) Relaxation Massage

The most prevalent form of massage for relaxation and enjoyment is Swedish Relaxation Massage. Swedish Massage is characterized by long, flowing, strokes that are firm, yet gentle. The massage therapist typically uses the palm and “heel” of his or her hands to glide across the skin over muscles and joints to lengthen and soften the tissues. Some type of lotion or oil is usually used and sessions can last from 30-90 minutes in a relaxing and soothing environment. This type of massage, or bodywork, is not as targeted as other modalities, but is effective in integrating multiple body parts in flowing moves to relax the patient and improve circulation and blood flow. Studies have even shown that Swedish Massage can help to reduce fatigue, depression, and anxiety - very relevant for the busy and often stressed-out San Franciscan.

p4l-massage

Deep Tissue Massage

Deep tissue massage is characterized by its concentration on the deeper layers of muscles and fascia. For deep tissue massage, the therapist typically uses knuckles, fist, or elbow. Typically, deep tissue massage requires little to no oil or lotion compared to Swedish, but that doesn’t mean it can’t be relaxing as well. This is the style of massage that some people might say is really painful, but proper deep tissue massage should sink slowly into muscle and fascia so as to not cause the body to tense up and “fight back”. This modality is great for breaking up adhesions and to really get noticeable softening of dense or knotted tissue.

p4l-massage-room

Clinical Bodywork

The last form of massage or bodywork I want to tell you about is clinical bodywork. Clinical bodywork is, as the name suggests, more clinical in its style and is a bit different from other types of massage, especially relaxation. Clinical bodywork is typically much more targeted, like deep tissue, and the emphasis is not on relaxation, but on helping the patient come out of pain from some type of injury or disease. During a clinical session, there is more communication between the patient and therapist to problem solve, and the practitioner will use a variety of tools to address the pain. These tools can include different massage modalities such as deep tissue, pin and stretch, myofascial release, and even Swedish relaxation strokes if appropriate. But, the practitioner might not be limited to just massage techniques and may incorporate other elements such as lymphatic drainage, cupping, special assessments, stretching, rehabilitation exercises and neuro-techniques to name a few. 

p4l-bob

Conclusion

Here at Perform for Life, we’re all about our training, education, and community, but we also really love to show our care for our athletes by providing clinical bodywork. We see and care for so many of our athletes going through pain from injury, disease, stress, and overwork and we want to make sure that everyone takes care of their bodies. We might do a great job at being active and working out hard, but it’s important to know when to let our bodies rest, relax and recover, and massage is a great way to do so.

From Swedish relaxation to clinical bodywork, there’s a type of massage for everyone to help with relaxation and even pain. Keep in mind that I’ve only gotten to talk about a few modalities of bodywork and that there is so much more out there. So, if these don’t work, don’t stop searching. Stay active but listen to your body and take great care of it - it’s the only one you’ve got.



Comment

5 Ways to Resolve Your Immobility

Comment

5 Ways to Resolve Your Immobility

Do neck tension or pain and lower back pain sound familiar to you?

Maybe you’ve told yourself you’re too busy with work, but when you get home from a long day at work, the last thing you want to do is get moving. Or perhaps you’re exploring a new city, but after walking 12 miles, you notice your knees and calves aching. Even driving aggravates your right shoulder or upper back!

If you notice discomfort in reaching for something in the food cabinet, putting on a shirt, or reaching behind you in the car seat, perhaps you are being limited by your lack of mobility.

Below are some simple ways you can add effective mobility work either at home, in your office, or in your hotel room - and all you really need is a foam roller and a band or light dumbbell (if you’ve got one of those on the go).

Give them a try and see how they go!

1. SHOULDER MOBILITY and/or OVERHEAD MOVEMENT

Do you feel limited when you’re lifting overhead? Perhaps you’re trying to improve your throwing arm so you can win that San Francisco City Rec League game.

  • Foam roller serratus slide and lift off - similar to the video linked, but at the top of the slide, you lift one arm off the foam roller at a time OR better yet, do it on the ground like this.
  • This is great to improve your mobility, stability, and motor control. The serratus anterior muscle is a big player in overhead motion.
  • This exercise focuses on upward rotation and posterior tilt of the scapula - as we want the scapula to be able to move in this motion when going overhead.

2. THORACIC SPINE EXTENSION & ROTATION

Do you sit 8 hours a day at work? Do you notice your shoulders rounding forward or feeling slouched forward?

  • Thoracic spine (t-spine) extension on the foam roller: I’m sure most of you have seen or done this exercise at P4L, as this is a fantastic exercise for those of you with desk jobs or a job that requires bending over often.
  • (Banded) Thread the Needle
    • Adding a band to the exercise helps reach deeper ranges - just tie a band to a something sturdy and hold onto the band as you reach under
    • Rotation can be quite effective in improving T-spine extension as well, so this is a great exercise to help improve both.

3. PEC LENGTH

Do you notice your shoulders rounding forward or feeling slouched forward?

  • Eccentric dumbbell fly on roller - I love this one when I really need to open up my shoulders and lengthen my pecs.
    • Chronically tight pecs can lead to rounded shoulders and even neck and/or shoulder pain  (the pec minor attaches on your scapula, and when tight, can round your shoulders forward). Paired with the t-spine extension or rotation, these mobilities are a great way to counteract the effects of sitting at a desk all day!

4. HIP INTERNAL ROTATION

Does your job require you to sit all day? Do you feel like your hips are always tight? Perhaps you have been dealing with some low back pain or even some knee pain.

  • Supine 90/90 hip IR breathing - (for hip IR, walk the feet outwards, keeping the knees against the foam roller) - this is what I learned in the Clinical Athlete Weightlifting Seminar that I attended a few months ago.
    • Poor breathing patterns can actually have an effect on mental well-being and are linked with anxiety, depression and chronic stress. The process in which the diaphragm pulls air into the lungs is crucial in creating trunk stability, and trunk stability are crucial in stabilizing the spine and generating force at the hip or shoulder, which translates directly to workouts.

    • Proper breathing pattern maintains posture. Your body should be able to support itself without much effort - you shouldn’t need to clench your butt cheeks and pull your shoulders back to maintain proper posture. If you’re doing it right, you should just be there naturally.

    • This is good for getting you set in a more neutral position and opening up your hip joint internal rotation. Breathing plus internal rotation tends to be very beneficial for improving your hips’ ability to internally rotate, and gets the pelvis positioned more neutrally (the primary hip flexor, the psoas major, flexes and externally rotates. If chronically tight, it can cause long-term external rotation of the femur).

5. GLUTE ACTIVATION

Do you every feel like you spend most of your day sitting and working? Do you feel like your hips are always tight? Perhaps you’ve been dealing with some low back pain or even some knee pain.

  • Sidelying clamshell - another golden nugget I learned from Dr. Quinn Henoch, DPT at the Clinical Athlete Seminar. This, along with rolling out the tensor fascia latae (TFL) and iliotibial (IT) band can help desensitize the hip before using the clamshell to activate the glutes.
    • Weak and/or inhibited glutes may be related to your low back pain. Try this pairing out if you’re experiencing some low back pain and notice your glutes are “sleepy”.
    • Sure, you have your bridges and clams, but this pairing of exercise and self-myofascial release is extremely effective. Some glute activation in those exercises is great, but it’s even better when you can also maintain breathing patterns and trunk position.



Comment