Tuesday, 27 November 2018

5 Neck and Shoulder Things

I'm often asked what the most common injury that I get in my practice is. As it turns out, I'm a shoulder and neck guy. A large part of my practice involves treating body builders, rock climbers, trades workers, hairstylists, and elderly who experience pain in this area.

(Funny enough, I always thought that I'd be a knee-guy while in college, due to my running background. What's more, the shoulder was the most difficult joint to get my head around in school. I guess studying actually pays off?)

Go figure.
The neck and shoulder are closely related, with dysfunction or symptoms in one often causing symptoms in the other. With that being said, here are some go-to thoughts regarding the health of these joints.

Your Posture Probably Isn't The Problem

I speak a lot on the fact that there is poor correlation between bad posture and future incidents of pain. There are too many individuals out there walking with forward heads and shoulders but no discomfort and vice versa.

Instead, we've linked lack of variety in posture closer to pain. Good or bad, spending too much time in a single position is not what the body craves, and this often is the route to muscular tension and discomfort. This is why it's recommended to take regular movement breaks while at work. It doesn't take much.

Stretching Does Not Make Unstable Joints Happy

Thank goodness, the fitness industry seems to be tapering off a bit from the whole mobility craze that it went through. But I digress, I still see numerous individuals trying to stretch and traction their shoulders to proper health.

No, I'm not saying that joint mobility isn't important. But fairly enough, we went through a bit of an epidemic of fitness buffs non-specifically stretching their joints to the point of laxity with bands. Shoulders often hurt because they're, in simple terms, too loose. And stretching something in this condition will not improve the situation.

Warm Up, But Not Just Your Rotator Cuffs

So we turn to strengthening and warming up. Many individuals think that the rotator cuff muscles are the end-all for shoulder health. After all, their function is to stabilize the head of the humerus (the ball) in the socket.

However, what we don't always realize is that rotator cuff muscles are often simply overworked. Proper strength to control the movement of the shoulder blade is vital to shoulder health, so warming up and exercising the ability to protract, retract, and glide the scapula is key.

Your Upper Traps Are Not Your Only Traps

The upper traps seem to be the bane of many people's existence. The stress tension collects there, they take over other muscles' jobs, and the pain can be excruciating. And stretching often doesn't seem to have an effect.

Well, we know that muscle tightness is neurological. Sometimes, a muscle will present as tight because its opposing muscle is weak. The lower traps oppose the upper in part of their function, with the middle traps assisting the two. I frequently find these middle and lower traps weak in clients who complain of upper shoulder tightness, and so this is an important area to keep in mind.

Keep That Neck Strong

The muscles at the front of your neck are important for maintaining stability and control of that area of the spine. These are also one of the muscle groups that commonly become weak throughout our sedentary lifestyles.

I had to insert this somewhere.
Drawing your chin in like a drawer (or the double chin position) contracts those deep neck flexors at the front. Having these guys strong will prevent the neck muscles in the back or others from the shoulder from tensing up to try and create that stability on their own.


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Tuesday, 20 November 2018

The Memory Of Pain

Remember that time, years ago, when you hurt your back while bending over?

Well, your back remembers it too.

You may have heard of the term "muscle memory" in the past. It's a loose term defining the body's ability to remember past motor patterns, often triggered subconsciously as soon as the right environment presents itself. For instance, someone may not have ridden  bike in 30 years, but as soon as they feel the seat, pedals, and handlebar, all the balance and coordination comes rushing back to them and off they go.

Now imagine if, instead of that feeling of the bike seat and pedals, the trigger you felt was bending forward. And instead of the ability to ride the bike, the signal that your brain digs out of storage is pain.

This is one of our BIG contributors to chronic pain. Very often, our past experiences of what caused pain in the first place, no matter how long ago, can amplify pain we feel in the future as a conditioned response. In the same way that Pavlov trained dogs to salivate at the ring of a bell, regardless of food actually being present, the nervous system can be trained to pump out pain signals, regardless of an appropriate trigger.

This concept is closely integrated with the one showing expectations of pain causing increased pain. In this example, your back is conditioned to have an exaggerated guarding response to bending forward. What's more, this bad habit is further encouraged by the fact that you've explicitly been avoiding flexion, essentially confirming your nervous system's irrational fear of the movement.

Hopefully, this helps to create an understanding of why pain can be persistent long after tissue has healed and appropriate triggers are no longer present. There are definitely subconscious and conscious factors at play here. (Along with the physical side, which, I'm not ignoring. Don't worry!)

With this being said, this is the reason why a lot of the rehab that I do with clients doesn't necessarily involve strengthening, but instead reteaching and reassuring them of movement and ranges that has been, inappropriately, acting as triggers. This goes for active and nonactive populations as well; it's incredible how many gym rats I need to teach how to round their backs again.


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Tuesday, 6 November 2018

Does Weather Really Affect Pain?

We're into November and the weather is continuing to change. Rain, cold, fog and, depending on where you live (probably not Victoria), snow!

On that subject, there are those of you who might swear that you can predict the changes in weather based on the way your joints and muscles feel. "My elbow hurts; it's about to rain!" We've all heard those wives tales in the past. Is there any science that backs this phenomenon up, though?

My neck hurts! Either it's about to rain or Thor is coming!

Looking at what the research has ruled out first, there is very little support for any effects from weather on muscular pain. Low correlation between environmental changes and lower back pain has been found. Similarly, rheumatoid arthritis isn't shown to be reactive to climate conditions either.

On the other hand, there is some evidence that links temperature and pressure changes to migraines. The research needs to be expanded on to exactly narrow down the cause-and-effect, however. Let's also remember that very little is known about migraines in the first place, so we have very little knowledge of what multitude of factors could be at play here.

Osteoarthritis pain is one of the more-researched types of pain that is looked at in terms of weather. So far, there isn't a lot of evidence leaning toward one side or the other, but there are some studies suggesting that there may be a minor relationship between the climate and joint pain. Keep in mind that there are as many studies claiming the opposite as well, though.

My fingers predict a 72% chance of rain with a high of 10 degrees.

One limit of the research, too, is that they have been unable to factor in psychological contributions to pain. The belief of weather-changing effects on pain is one that has been so heavily ingrained into several cultures. As a result, there's potential that any physiological changes could be triggered purely by the intensity of those beliefs.

Surprisingly, though, there isn't even a great link between weather and fibromyalgia, which we know has major psychological contributions. In that circumstance, we might have expected this condition to be one of the most-affected by weather, but it seems to not be the case.

So what can we conclude from all of this? Well, as far as the scientific research shows, there's only minimal, if any, support for the effects of weather on nearly any type of pain. This could be a frustrating read for many of you, as we certainly all have friends or family that are able to predict weather changes with eerie accuracy, though. One explanation could simply be that individual variance between people could show a link in a very minority of cases, but the fact is that this link does not seem to exist across the board.


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