resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Correcting Dysfunctional Movement Patterns – Is Local Treatment Enough?
It is widely believed that mechanical, non-traumatic back pain is largely related to dysfunctional or compensatory movement patterns the body has adopted over time.
Meat in the Middle
Have you ever wondered what's the truth about meat? Is it really as bad as many people think?
Treating Menopausal Women in Your Practice
I love what I do for a living. It's a great way to trade health for bread. And no topic of health, with the right bedside manner, is taboo.
Peer Points: Promoting TCM Knowledge
When Elaine Wolf Komarow, LAc, received her first acupuncture treatment in 1989, she said it changed her life. "I felt more aware, calmer, and happier. I was so fascinated by the changes that I began to learn everything I could about the underlying philosophy of Chinese medicine," said Komarow.
Following the Thinking of the Classics
I have heard about the "best time of day" to carry out certain examinations or therapies. For example, I remember making a note years ago that early morning is the best time to take someone's pulses.
The Power of Mu Xiang to Treat Irritable Bowel Disease
Bloating and gas pain is something that everyone has had to deal with at one point or another; however, that's usually reserved for holiday dinners and other large gatherings.
Drug War Rages in Wisconsin
Based on its actions over the past 15 years (review the sidebar in the app version of this article), controversy and the Wisconsin Chiropractic Association seem to go hand in hand.
Chinese Medicine: The Natural Way to Children's Wellness
As a child, I did not like going to the doctor. For the most part, when I had to go I wasn't feeling good to begin with, and I was heading into a sterile environment to be awkwardly probed by a man in a white coat for a very short, impersonal period of time.
Chronic heightened emotional states create a perfect breeding ground for illness. Through my practice I noted the increasingly obvious relationship between one's mental focus on negative thinking, emotions, resistance to experiencing feelings and disease.
Alcohol Consumption Strongly Linked to Risk of Colorectal Cancer
Alcohol intake is one of the primary risk factors for many human cancers, and is strongly associated with cancers of the oral cavity, pharynx, larynx, esophagus, liver, breast, and notably, the colon and rectum.
The McGill Approach to the Lower Back (Part 1)
Stuart McGill, PhD, brings a unique combination of tools to the table. He is a scientist who also functions as a clinician. He describes himself as a medical consultant who is referred challenging patients. He is both evidence based and practical.
Giving Chiropractic Some Much-Needed PR
Public relations has not always been the chiropractic profession's strong suit, a shortcoming that has subjected the profession to countless attacks on its legitimacy and seemingly perpetual confusion among the public and the health care world as to the skills and services doctors of chiropractic provide.
Micro-Needle Dermal Roller Use in the Treatment Room
Recently micro-needle dermal rollers have been getting a lot of media attention. As a practitioner who specializes in acupuncture facial rejuvenation, I know that skin needling with a dermal roller (also known as collagen induction therapy), promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter.
It Pays to be a Foodie
If there is an inner foodie in you, just waiting to burst out—this article is for you! Do you want to know how I know? I'm that girl. My middle name might as well be "Foodie." I love food! And if my patients are any indication, many of them do as well.
Capturing the Essence of Tai Chi
Over the last 12 years, I have been working on one of the few documentaries about Tai Chi. It's called The Professor: Tai Chi's Journey West and it's about Cheng Man-Ching who moved to New York in the 1960s.
Treating Chronic Depression with Acupressure
In Traditional Chinese Medicine there already exists a comprehensive theory linking the body and mind.
Inspire Your Patients to Make Healthy Choices
Have you tried to get your patients to change their eating habits or their diet and couldn't get them to succeed? Were they confused and unsure of what the right thing was to eat? You are not alone!
"Turn, Turn, Turn"
Many people are credited with saying, "If you remember the '60s, you really weren't there." Given the fact I didn't become a teenager until 1970, I actually do remember the '60s (or at least part of it). And as a child of the '60s, I was, of course, influenced by the music.
The Acupuncture Now Foundation: What Our Profession Needs
Although acupuncture is growing in popularity it continues to be underutilized due to misunderstandings about its true potential. Only a fraction of those who could be helped by acupuncture know enough to seek it out.
Acupuncture Detox as Part of Drug Rehabilitation
In the U.S., more than 2,000 alcohol and drug rehabilitation programs have added ear acupuncture to their practice. The development of the protocol was determined by Lincoln Hospital as it delivered 100 acupuncture treatments daily.
Five Element Acupuncture Can Enhance Your Practice
For eight years I have been teaching and supervising TCM students at an acupuncture college in Colorado, in Five Element acupuncture.
Introduce Your Patients to Collagen Induction Therapy
Cutaneous (skin) aging generally occurs from either intrinsic or extrinsic processes. Intrinsic aging results from natural skin tissue damage and degeneration.
Implications of Section 2706: The Non-Discrimination Provision Survey
In late April 2014, NCCAOM diplomates received an email survey with the subject line: "End discrimination against acupuncturists" polling CAM practitioners for a Request for Information from the Department of Health and Human Services, released in mid-March.
News in Brief
Foundation for Chiropractic Progress Enrolls Second Group Member; Focus on Chiropractic Education at WFC-ACC Conference in Miami; Are You Ready for Another "Have-a-Heart" Campaign?
The Bottom Line ... From a Surgeon Who Knows
Regardless of individual relationships between providers, there continues to be a type of Hatfield-McCoy feud between the philosophies of medicine and chiropractic, particularly when it comes to musculoskeletal ailments.
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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