resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
December, 2013, Vol. 13, Issue 12
Timing is Everything: Shoulder Instability and Labral Tears
By Debbie Roberts, LMT
The greatest thing about being a massage therapist is you never know who you will help next. One minute, you could be holding the hand of a hospice patient and the next, a strained quadriceps muscle of a 6-year-old.I know all of you understand what I am talking about because, in our field, we have such an opportunity to treat a very diverse clientele. I had the opportunity to help a young football player hold onto his dream of being a quarterback, his future college scholarship and the opportunity for scouts to see him throw. My goal is to help you understand the mechanisms of shoulder instability, how to access for instability and possible tears and most importantly, why your understanding of timing can be critical.
The Shoulder Joint
The shoulder joint often has been referred to as a cup hanging on a saucer or a golf ball on a tee. What this describes is how vulnerable the glenohumeral joint is. The glenohumeral joint has the largest range of motion of any joint in the human body. The shoulder ball (humerus) and socket (glenoid) have little inherent stability. The lack of stability results in a GH joint prone to instability and dislocation.
The labrum, which is a fibrocartilage tissue that forms a ring around the glenoid, adds stability to this inherently unstable joint. The labrum is connected to the capsule that links the socket loosely to the ball. The biceps tendon also attaches to the top of the labrum ring. Together with the muscles of the shoulder, the capsule/labrum complex affords stability to the glenohumeral joint. Any injury to the capsule/labrum complex causes a patient to have shoulder pain and instability (dislocation or subluxation). Damage to the labrum and capsule is a common occurrence as a result of an instability event; the damage causes the labrum to detach from the glenoid and predisposes the shoulder to future events of instability and dislocation.
There are many kinds of labral tears, but this discussion will focus on one of the most common types involving throwing athletes called the SLAP tear: "Superior Labrum Anterior to Posterior." SLAP tears usually develop over time following repetitive use like in some of our golfing clients. But they can also occur when an athlete suffers direct trauma to the shoulder, just like my young quarterback.
He sustained two different tears as a high school quarterback. The first injury sustained was a small labral tear which the doctor told him he could continue to play with. The second tear wasn't yet discovered until his visit with me. Both happened as he was getting ready to release the ball. He described that his arm was externally rotated and raised to 90+/- degrees of abduction in the loaded position of cocking for a throw. Another player tackled him making contact with the arm which forced the arm backwards and further into external rotation. The blow took the glenohumeral joint beyond its normal joint range of motion. This type of impact causes the humerus to sharply rotate within the glenoid stressing tendon and ligament structures beyond their tensile strength. Tensile strength is the maximum stress that a material can withstand while being stretched or pulled before failing or breaking. Tendons have great tensile strength, but are practically inelastic and resistant to stretch. In injuries that involve a severe stretch, the muscle most likely is affected, and sometimes the tendinous attachment to the bone is affected. Tendons can also rupture. An example is when the Achilles tendon ruptures and the Gastrocnemius retracts with the soleus muscles going into spasm and acute pain.
Red Flag On The Play
The first red flag to take notice of is the way the injury happened. Anytime the shoulder is taken beyond its normal range of motion, there is potential for serious musculotendinous junction or ligament damage. I helped this boy's father out with some nagging elbow pain a couple of years ago so when his son was complaining of shoulder pain, he called me. They came into the office and told me he was having pain on certain movements, nagging pain in the back of the shoulder and the chief complaint was instability. He complained he could no longer do a bench press in his workout even when he lowered his weights. (Extra tidbit: A bench press exercise is not a good idea anyway for a valuable throwing shoulder because the bar doesn't allow for the natural rotation of the shoulder joint. The use of free-weights in a dumbbell press accomplishes the same strength goal without the potential risk of damage to the shoulder joint.)
It is always interesting to me the details left out by a client because they don't think it is necessary information to the treatment of massage therapy. He didn't tell me he had a previous tear. It was revealed during the assessments. Based on the red flags the assessments threw up, I asked him if he had ever been diagnosed with a labral issue. He looked at me and said, "yes, last year but the doctor said it was so small I could play. But this feels different and I can't throw as far or as hard (loss of power)."
Second red flag for you to take notice of is that instability is the main complaint and loss of power. This indicates a possible tear of either a muscle or the labrium.
The first assessment I performed was a length test asking him to show me his range of motion in abduction, adduction, flexion, extension, internal rotation and external rotation. I also asked him to stop at any range that caused pain and to point where he felt the pain was coming from. "There isn't any real pain it just feels unstable and aches in the back of my shoulder." I compared his active range of motion with his passive range of motion. On external rotation, he had a clunk and a slippage sensation. This is an orthopedic assessment called the "clunk" test. The third red flag for you to take notice of is a clunk, snap or pop which are signs and symptoms of a possible labral tear.
The second assessment was the use of manual muscle testing examining the strength of the shoulder complex. Manual muscle testing is used to determine the capability of muscles or muscle groups to function in movement and their ability to provide stability and support. I performed manual muscle testing to the shoulder complex of muscles which included supraspinatus, infraspinatus, teres minor/major, anterior deltoid, middle deltoid, posterior deltoid, upper trapezius, middle trapezius, lower trapezius, latissimus dorsi, pec major/minor and serratus.
When you perform manual muscle testing, there should be a definite feeling of a muscle locking into place without quivering. He had a trembling or shuddering feeling against my resistance not a firm locking in of the joint (instability).
The fourth red flag for you to take notice of is that during the manual muscle test, there was not a definite locking in place there was more of a wavering when the muscles were subjected to pressure. This can be an indication of a tear and/or extreme inflammation. For more information on how to perform manual muscle testing, I suggest reading, MUSCLES Testing and Function with Posture and Pain, Fifth Edition, Lippincott Williams & Wilkins, by Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, May McIntyre Rodgers, William Anthony Romani.
I explained to his father and to him the objective findings. I also explained that underneath my scope of practice, I am not allowed to diagnose. The reason for the assessment is to make sure they are a candidate for massage therapy and there are no contraindications to treatment. I explained that based on the instability, the poor muscle function test and his past medical history, I would recommend they go back to their orthopedic surgeon. There is always a possibility he might have done further damage since he received another direct blow to the shoulder. I told him, the sooner you get this taken care of, the faster you will be ready to play football next season and not miss out on your senior year of high school.
I received a phone call a week later from his mother thanking me immensely. She explained the new MRI showed an additional labral tear and a partial supraspinatus tear. She told me he was scheduled to have surgery right away so he would have time to rehabilitate and be able to play in his senior year. They were very grateful because they were hoping for a football scholarship to help out with the college tuition.
Without doing an assessment, you are guessing. Timing and rehabilitation are always critical when it comes to sports. Delaying the surgical intervention would have prolonged the client's recovery and return to play. He may have lost his window of opportunity to earn his chances of an athletic scholarship.
All red flags are contraindications for treatment and are indications for a medical referral. He has completed physical therapy. He is seeing me once a week for maintenance and is leading the way with his high school football team. Everything indicates he will get that college scholarship and who knows what is next. The scouts are looking at him!
Click here for more information about Debbie Roberts, LMT.
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