Location Update

At the end of October I will no longer occupy my wikiup office.

Appointments with me can be made at the Airport Health Club or the Fountaingrove Golf & Athletic Club.

You may schedule online at the airport health club (see above link) or at my other locations by texting me, emailing me (see contact form), or calling.

Neck and Shoulder Pain – Santa Rosa, CA

Why do I have Pain in my Neck/Shoulder?

There are a few muscles that attach to both the spine and the scapula, but by far the most problematic related to neck pain is the levator scapula. I see this muscle causing problems, in varying degrees of severity, with nearly every client that walks in the door. For some, the muscle is very tight but not painful. For others it is very painful. Why does this happen? If I had to bet, I would put all my chips on stress & computer use.

Sometimes this pain pattern gets referred to the face, and will look like this:

LevScap-RefferedPain

Stress

Modern life is extremely stressful in comparison with where we evolved from. This may seem counterintuitive – we live longer and have fewer threats to our safety. However modern life places constant small stresses vs. occasional acute stressors that our ancestors faced. Our body’s stress response from an angry or urgent email is identical to a caveman facing a mountain lion, though less intensity. If both happened once, obviously the encounter with the mountain lion would have a much more profound effect on the body than the urgent email. However multiply that email several times a day, add in other stressful events and news media scare tactics and we can quickly see that the total stress we incur is much higher. Not to mention that encountering a mountain lion is immediately followed by intense physical exercise, whereas an urgent email at your desk is followed by continuing to sit at your desk…which leads me into my next point.

Computer & Phone Use

Poor posture at the computer/phone places an enormous load on the levator scapula. The human head is rather heavy, and acting across the long lever arm that is the neck, the forces on the levator scapula to keep the head upright can be enormous.

Head-Weight

We know from the law of repititive motion (insult = (number-of-reps*force)/(amplititude*rest)) that this position with it’s high force, low amplitude and low rest are a recipe for high insult to the muscle. As we know from the model for cumulative trauma disorders – this leads to adhesions, fibrosis, and inflammation in the local area, and also eventually, weakness in the muscle itself. Weakness that can then contribute to pain elsewhere in the body as compensation patterns set in.

Solution

Fibrosis in the levator scapula can be solved in about 5 minutes of targeted ART work. The remainder of the session can be used to eliminate the related compensation patterns, and teaching at-home care methods for keeping the levator scapula healthy. A cortisone injection in this area will reduce the inflammation, but will not address the underlying structural problem in the muscle itself. Furthermore cortisone injections compromise connective tissue strength – which is the last thing we want. We want the levator scapula to be STRONG and HEALTHY so it can continue to hold your head up so that when you choose to use terrible posture at the computer you CAN – but hopefully you choose not to.

Be pain free, move easier, and perform better. Contact me here to set up an appointment.

Nerve Pain – Fixing Entrapped Nerves

Nerves are an integral part of our motor control system, but sometimes they can be a source of pain. The best solution is not to cut the nerve or burn the nerve or shut down the nerve with a shot, as that would compromise our motor control and sensory experience. Solving a nerve problem first involves identifying what the problem is.

Peripheral Nerve Entrapments

Nerves must move, stretch, and glide along an often circuitous path as they branch and split to the various parts of the body, carrying vital sensory information to and from the central nervous system. Sometimes, due to inflammation or injury, a space that the nerve passes through may become compromised and stuck. In these cases, movement will be normal until suddenly it becomes painful – characterized by a sharp stretching feeling or shooting pain. This is the body’s way of protecting itself. The pain signal is there to prevent you from performing the movement so the nerve won’t be severed or damaged.

In cases like these, whole muscles or sets of muscles will be shut down through certain ranges of motion to prevent stretch of the nerve. This is also part of the pain pattern, and won’t resolve until the irritation to the nerve calms down.

The Solution

Resolving a nerve entrapment case requires some patience – but significant relief can usually be had in just three to four sessions. In the case of radial, ulnar, or median nerve entrapment the approach needs to address all entrapment sites. The process usually goes like this:

  1. Decompress the neck by addressing muscular problems there
  2. Free the nerve roots near the scalenes
  3. Address the various entrapment sites in the shoulder, arm, forearm, and hand
  4. Reinforce with ART Long Tract Nerve Entrapment Protocols
  5. Assign neck decompression homework using a device like this

Sometimes a few days of rest from activity is required, as inflammation of the nerve is common. The nerve responds to the stress of being stretched by initiating an inflammatory response, and this can irritate the nerve along it’s entire tract. Freeing it at every entrapment site and giving some time to heal yields lasting results.

Get out of pain, move easier, and perform better. Contact me here to set up an appointment.

Cumulative Trauma Disorders – Why do I have Painful Muscles?

Cumulative Trauma Disorder is the affect that acute injury, repetitive trauma, and constant pressure or tension has on nerves, muscles, and bones. This affect is best understood in the terms of a cycle the Cumulative Injury Cycle. This cycle separates cumulative-trauma disorder from other injuries.

Injury Types

  • Acute Injury – Muscle and fascial tearing from an acute injury causes immediate inflammation and white blood cell proliferation, fibroinogen secretion, and adhesion formation start. If not treated correctly, the cumulative-injury cycle begins.
  • Repetitive Motion Injury – Repetitive-motion injury is a function of specific physical factors that can be measured. To understand how repetitive-motion injuries occur it is helpful to review the model of repetitive motion. This model isn’t linear or exact, but proportional.

I = NF / AR

Model of Repetitive Motion

I = Insult to the tissues
N = Number of repetitions
F = Force or tension of each repetition as a percent of maximum muscle strength
A = Amplitude of each repetition
R = Relaxation time between repetitions (lack of pressure or tension on the tissue involved)

Examples
Vibration results in high Number of repetitions with low Amplitude and low Relaxation time, causing high Insult. Poor, static posture produces high Force with nearly zero Amplitude and Relaxation time, causing high Insult. Someone who is weak will use a high percentage of their maximal strength to accomplish tasks, causing high Force and high Insult.

Constant Pressure/Tension Injury
These two factors decrease circulation and compromise cell recovery. Three major results are cellular retention of calcium, poor repair, and altered function. This injury type, by definition, does not require motion. An isometric contraction, or muscle tension of poor posture are good examples of the mechanism of injury.

The Cumulative Injury Cycle
The cyclic nature of injury — one factor triggering the next in a circular series — has been described for many years. The components of the cycle are defined as follows:

  • Weak And Tight Tissues – Repetitive effort, for example, tends to make muscles tighten. A tight muscle tends to weaken; a weak muscle tends to tighten. And on it goes.
  • Friction — Pressure —Tension – As a result of weak and tight tissues, internal forces rise. Friction, pressure, or tension can be present at the same time. If one or more of these factors is high, an acute injury and inflammation can result – even without external forces being applied.
  • Decreased Circulation – Edema – The affect of increased forces on the tissues is decreased circulation. If pressure is applied over one of the vulnerable, low-pressure lymphatic channels, the result is edema. External forces – in the form of a constant-pressure or tension injury – may also decrease circulation or cause edema.
  • Adhesion — Fibrosis – Cellular hypoxia, from restricted circulation, causes fibrosis and adhesions to occur in and between tissues. When the friction-pressure-tension factor is severe, or when an acute injury occurs, two additional factors come into play.
  • Tear or Crush – The physical disruption of the tissues — microscopic or macroscopic — can occur with sufficient force. This can be an external force, acute injury, or it can result internally.
  • Inflammation – This results from the injury and starts the adhesion process. The cycle progresses then to the “weak-and-tense” phase. There are many extrinsic factors which affect the cycle, but, they do it in predictable ways. Smoking, for example, tends to decrease ciculation, helping to perpetuate the cycle. Diabetes has a similar affect. Thyroid deficits tend to increase tension in the musculature and therefore influence the “weak-and-tense” factor of the cumulative-injury cycle. Hormonoal changes as with hysterectomy, excessive body weight, and pregnancy — lead to predictable alterations to the involved factors. The cumulative injury cycle is defined with two possible routes: the inflammatory cycle and the chronic cycle. Each is independent of the other, however, they both may be present together.
  • Conditions – The cumulative-injury cycle is self-perpetuating. It worsens the symptoms and syndromes of cumulative-trauma disorders with a downward-sprial effect. These include carpal tunnel and cubital-tunnel syndrome, epicondylitis, tenosynovitis, myofascitis, bursitis, peripheral-nerve entrapment, thoracic-outlet syndrome, Dr Quervain’s disease. None of these conditions are a cumulative-trauma disorder without the affects fo the cumulative -injury cycle.

 

Source: http://www.solsantacruz.com/Cumulative-Trauma-Disorder-Defined.pdf

Plantar Fasciitis

Plantar Fasciitis, more than any other problem I encounter is something that many people have just resigned themselves to dealing with. There can be many causes, some of them take a long time to resolve and others take less time. As a general rule, the longer you have been dealing with the condition the longer it will take you to get out of the condition – though there are many notable exceptions to this rule. [Read more…]

Sciatica & Pseudo-Sciatica

Sciatica can be described as pain in the lower back, buttocks, and various areas of the leg & foot. Sometimes nerve symptoms will arise, like weakness, numbness or tingling when moving the leg.

The sciatic nerve is a large – about the diameter of a dime. It runs down the back of the leg, supplying innervation and sensory information for much of the posterior chain. [Read more…]

Knee Pain – Why Surgery Often Isn’t the Answer

The knee joint is arguably the most stable joint in the body – why then is it often the source of pain?

We assume what we know

Most people with knee pain immediately assume the problem is something they have heard about before – an ACL tear, MCL tear, meniscus tear. These are the knee injuries we hear most about, so we naturally assume those are the problems we have. There are plenty of other reasons one can have knee pain. [Read more…]

P-DTR – A Treatment Modality from the Future

Throughout human history there are examples of pioneers who turn our understanding of something upside down. Whether it’s Copernicus, Isaac Newton, or Albert Einstein – all of these great minds had one thing in common: thinking outside the box.

In terms of fixing the way people move, I believe another great pioneer has been working diligently amongst us to completely reinvent the way we treat the human body. This man is Dr. Jose Palomar. [Read more…]

What Causes Low Back Pain? – Part 1

To say that low back pain (LBP) is public health problem would be a huge understatement. Here are some quick stats from wikipedia:

  • Approximately 9 to 12% of people (632 million) have LBP at any given point in time
  • Globally, about 40% of people have LBP at some point in their lives
  • The majority of LBP does not have a clear cause
  • LBP is often a person’s first reason to see a medical professional as an adult
  • In 1998, it was estimated to be responsible for $90 billion in annual health care costs

Let’s explore the possible reasons from an engineering and evolutionary perspective. [Read more…]