Sports Injury

What to expect with a trigger point massage.

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A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

After treatment, it is usually recommended that the client apply moist heat to the area treated.

Trigger points in the deltoid muscle.

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The deltoid is the the muscle that is most often thought of as the “shoulder.” It is the diamond shaped muscle that caps the shoulder joint. It originates on the clavicle, the acromion, and the spine of the scapula. It inserts on the deltoid tuberosity of the humerus. As a whole unit the deltoid laterally abducts the humerus at the glenohumeral joint. The anterior portion of the delt forward flexes the arm, as well as horizontally flexing the arm across the chest. Since the deltoid is involved in almost all shoulder movements it is especially prone to trigger points. Points in the anterior deltoid refer into the anterior and lateral shoulder. Trigger points in the posterior deltoid refer pain into the posterior shoulder with spillover down the lateral arm.

Another tunnel injury? Seriously?

~ Dr. Robert Speirs DC ~ Leave a comment

Your radial nerve begins in your neck and travels past your elbow en route to its final destination in your hand. Just beyond your elbow, this nerve passes through a 2-inch area on the back of your forearm called the “Radial tunnel”. “Radial tunnel syndrome” means that your radial nerve has been compressed or irritated within this space-leading to forearm pain or hand weakness.

Radial tunnel syndrome is thought to result from muscular overuse, especially prolonged or excessive wrist extension or rotation. The most common cause of compression comes from excessive tightness in a muscle called the “Supinator”. Workers whose jobs require heavy or repetitive wrist movements are at an increased risk for this disorder. Occasionally, the radial nerve can become irritated from direct compression by a tight band or brace. The condition may be more common in those who have diabetes or thyroid problems.

Symptoms from irritation of the radial nerve depend upon which specific nerve fibers are irritated. The most common symptoms include pain, numbness, tingling or decreased sensitivity along the top of your forearm radiating toward your hand and thumb. The symptoms often mimic those of “tennis elbow.” When the nerve fibers that control muscle function become compressed, you may experience weakness when trying to extend your fingers, hand or wrist. Seventy percent of radial tunnel patients also have problems in their neck or upper back.

Conservative treatment of radial tunnel syndrome is generally successful. Fixing the problem means limiting excessive or repetitive wrist movements, especially extension and rotation. In severe cases, a splint may be necessary to limit your motion. Try to avoid compression of your forearm, particularly from tight bands or braces. Use of a tennis elbow brace will likely aggravate your symptoms. You may find relief by applying ice or ice massage to the area for 10-15 minutes at a time.

Trigger points in the pectoralis minor muscle.

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The pectoralis minor is a small strap like muscle that is underneath (deep) to the pectoralis major. It originates on the third to fifth rib, near the costal cartilages. It’s insertion is on the coracoid process of the scapula. It acts to draw the scapula forward, downward, and inward at nearly equal angles ( think of rounding or shrugging your shoulders forward). This muscle is very often shortened and tight in people due to the high prevalence of desk jobs. This muscle pulls the shoulder blade forward resulting in the muscles in the back(rhomboid and mid traps) being chronically strained. Trigger points that form in the pec minor primarily refer pain over the anterior chest and shoulder, with spillover down the medial arm. Trigger points in the left side can mimic angina.

Cubital Tunnel Syndrome…. Ever heard of it?

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Your cubital tunnel is the groove on the inside of your elbow, also called the “funny bone.” The funny part about the funny bone is that it is not actually a bone but rather a nerve, called the ulnar nerve. Your ulnar nerve begins in your neck and passes through the cubital tunnel on its way to your hand.

When you flex your elbow, the ulnar nerve is required to both stretch and slide through your cubital tunnel. If your ulnar nerve is “stuck” in the tunnel and does not glide when you flex your elbow, this leads to traction and irritation of the nerve. This is called “cubital tunnel syndrome.” The nerve may also be irritated from direct compression, like leaning your elbow on the edge of a desk or from arthritic spurs. Cubital tunnel syndrome is the second most common nerve compression problem in the arm, behind carpal tunnel syndrome.

Irritation of the ulnar nerve in the cubital tunnel causes pain, numbness or tingling that radiates from your elbow into your fourth and fifth fingers. Your symptoms can vary from a vague increased sensitivity to pain. The symptoms are common at night and are often progressive over time. In severe cases, you may begin to lose grip strength and fine muscle control.

Cubital tunnel syndrome is commonly seen in baseball, tennis and racquetball players. Workers who keep their elbows flexed such as holding a tool or telephone, or those who press the ulnar nerve against a hard surface like a desk, are at an increased risk for this disorder. Cubital tunnel syndrome affects men three to eight times as often as women and is more common in those who have diabetes or are overweight.

You should try to avoid prolonged elbow flexion or direct pressure over your elbow. Our office may prescribe a nighttime elbow splint that limits flexion.

Trigger points in the pectoralis Major muscle.

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The pectoralis major or “pecs” is commonly thought of as the chest muscle. It originates on the clavicle, sternum, costal cartilage , and the external oblique aponeurosis. It inserts on the intertubercular groove of the humerus. Its main actions are to adduct the shoulder and to internally rotate the humerus. This muscle gets chronically shortened by a rounded shoulder forward posture such as from prolonged sitting. Tightness in this muscle can cause strain in the rhomboids and traps. When trigger points form in this muscle they refer pain into the anterior shoulder, as well as the anterior chest and medial aspect of the arm. Trigger points in the pecs can also cause nipple hypersensitivity. Trigger points in the left pec muscle can mimic heart pain.

Feels just like Carpal Tunnel but isn’t Carpal Tunnel……

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Your Median Nerve begins in your neck and travels down your arm on its way to your hand. This nerve is responsible for sensation on the palm side of your first 3 ½ fingers and also controls some of the muscles that flex your fingers. The median nerve can sometimes become entrapped near your elbow as it travels through a muscle called the “pronator teres”. Compression of the median nerve by the pronator muscle is called “Pronator Syndrome.”

Pronator syndrome is often brought on by prolonged or repeated wrist and finger movements, i.e., gripping with the palm down. Carpenters, mechanics, assembly line workers, tennis players, rowers, and weight lifters are predisposed to this problem. The condition is more common in people with excessively developed forearm muscles and is also more common in your dominant arm. Pronator syndrome most often affects adults age 45-60 and females are affected about four times more frequently than males. People who suffer from diabetes, thyroid disease, and alcoholism have an increased risk for developing pronator syndrome.

Pronator syndrome produces symptoms very similar to a more common cause of median nerve compression called “carpal tunnel syndrome”. Symptoms of pronator syndrome include numbness, tingling, or discomfort on the palm side of your thumb, index, middle finger, and half of your ring finger. The discomfort often begins near the elbow and radiates toward your hand. Your symptoms are likely aggravated by gripping activities, especially those that involve rotation of the forearm, like turning a doorknob or a screwdriver. Unlike carpal tunnel syndrome, pronator syndrome symptoms are not generally present at night. You may sometimes feel as though your hands are clumsy. In more severe cases, hand weakness can develop.

To help resolve your condition, you should avoid activities that involve repetitive hand and forearm movements. Perhaps the most important aspect of your treatment plan is to avoid repetitive forceful gripping. You may apply ice packs or ice massage directly over the pronator teres muscle for ten minutes at a time or as directed by our office. In some cases, an elbow splint may be used to limit forearm movements. If left untreated, pronator syndrome can result in permanent nerve damage. Fortunately, our office has several treatment options available to help resolve your symptoms.

Our Exercise Of The Month: Dead Bug

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Begin lying on your back with your right arm reaching overhead and your left leg flat on the table. Your right knee should be bent 90 degrees and your hip 45 degrees. Place your left wrist beneath your back to prevent your back from flattening against the ground. Slowly begin by raising your left knee and right arm at the same time until your hand touches your knee. Be sure not to lift your head or allow your spine to flatten against the floor. Return to the start position and repeat for three sets of 10 repetitions on each side, twice per day or as directed.

Golfer’s Elbow? Thats a thing?

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Most of the muscles that flex your wrist are attached to a bony bump on the inside of your elbow called the “medial epicondyle.” Sometimes, through injury or overuse, the site where these muscles originate can become irritated or inflamed. This condition is called “medial epicondylitis”, or “golfer’s elbow.”

Although the condition is named “golfer’s elbow,” over 90% of those affected

are not even athletes, much less golfers. Nonetheless, the condition is more common in certain sports, especially golf, throwing, bowling, football, archery, and weight lifting. Occupations that require heavy gripping or repeated hand movements, like carpentry or typing, can predispose you to this condition. Smokers and people who are obese are more likely to experience this condition.

Medial epicondylitis is the most frequent cause of pain on the “inside” of your elbow but is 3-10 times less likely that its “outside” counterpart- lateral epicondylitis (i.e. “tennis elbow”). Medial epicondylitis is most common between the ages of 40 and 60. The condition strikes the dominant arm in over ¾ of cases. Your symptoms will likely include a dull aching pain over the bump on the inside of your elbow that becomes more intense with use. As the condition progresses, you may notice grip weakness or limitations when shaking hands, grasping objects, and opening jars. Be sure to tell your doctor if you notice numbness or tingling traveling toward your hand.

If left untreated, medial epicondylitis can last indefinitely. Studies show that up to 40% of untreated patients suffer prolonged discomfort, some as long as three years. Fortunately, conservative treatment like the type provided in our office is effective for relieving this condition. Our office may prescribe an elbow “counterforce brace” to help dampen stress to the irritated area. This type of brace should not be used in patients who have numbness or tingling radiating into their fingers. Some patients may benefit from a “wrist splint” that is used at night to allow your tendon to heal in a lengthened position. Using ice or ice massage over your elbow can help limit pain. Your home exercises will play an important role in your recovery.

Initially, you may need to avoid activities that cause an increase in pain, like gripping, lifting, golfing, throwing balls, or swinging a racquet. Be sure to warm up properly and stretch prior to any heavy physical activity. Smokers would benefit from quitting. Overweight patients should consider increasing their aerobic activity to shed excess pounds.

Our Condition of the Month: ITB Syndrome

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Iliotibial Band Syndrome

Your iliotibial band is a fibrous band of tissue running from the crest of your hip, down to your knee. A muscle near the crest of your hip called the tensor fascia lata, attaches to this band to help control movements of your leg. Your iliotibial band passes over the point of your hip and over another bony bump on the outside of your knee called the lateral epicondyle. When the band is too tight, it can become painfully inflamed as it repeatedly rubs over the top of either of these bony projections. Irritation at the bony bump near the knee is called iliotibial band friction syndrome.

The condition usually presents as pain on the outside of your knee that becomes worse with repetitive knee flexion or extension. This condition is the leading cause of lateral knee pain in runners, especially slower “joggers.” The pain usually develops 10-15 minutes into the workout. You may sometimes feel or hear a click during movement. Symptoms generally ease at rest. Running on slick “wintry” surfaces may aggravate the condition. Excessively worn running shoes may be a culprit.

This problem is commonly caused by weakness in your gluteal muscles. When these muscles are weak, the muscle that attaches to your iliotibial band must contract harder to stabilize your hip. Having one leg longer than another is a known aggravating factor.

Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track, as well as wet or icy surfaces. Runners should reverse directions on a circular track at least each mile. Bicyclists may need to adjust seat height and avoid “toe in” pedal positions. Avoid using stair climbers or performing squats and dead lifts. Sports cream and home ice massage may provide some relief of symptoms.