5 Common Running Injuries, 1 Treatment Tool (Part 1 of 5)

Rectus femoris - Muscles of the Lower Extremit...

Rectus femoris plays a large part in PFPS, or runner’s knee syndrom

Running brings joy to many people.  But, it can also bring pain.  Poor gait, muscular imbalance, repetitive stress, improper shoes, etc., can all contribute to a less than blissful experience.  The constant pounding on the joints from the pavement can take its toll on the body when unmanaged.  The good news is that appropriate maintenance of the body can key in to long-lasting enjoyment of this healthy exercise.

There are a handful of running injuries that continue to be among the most frequent.  Here, we outline the top five painful jogging issues along with one simple tool to treat and relieve them all.  It’s called the Sciaticare Ball and once understood, this trigger point, acupressure and physical therapy tool can be used to relieve many body aches and pains.  The importance of resolving injuries immediately cannot be understated.  If one continues to push through the pain and the irritation, compound and chronic problems can arise to deter a quick recovery.

The top five running issues are:

  1. Patellofemoral pain syndrome – also known as PFPS or runner’s knee
  2. Iliotibial band syndrome – also known as IT band syndrome
  3. Plantar fasciitis/Achilles tendonitis – these two are typically interrelated
  4. Ankle sprain – along with ankle instability
  5. Hamstring tightness/pull – an important, and often neglected muscle in running

Below, we will address the first of the five pain conditions that runners often suffer.  The other parts will come in later segments.

1.  PATELLOFEMORAL PAIN SYNDROME (Runner’s Knee, PFPS) –  This has been defined as knee pain at or under the patella or knee cap.

Problem — The quadriceps muscle does the bulk of the work in the upper leg during the runner’s gait.  In general, the quadriceps muscle is more powerful than its antagonist, the hamstring muscle group.  Due to the nature of running, this imbalance can grow out of control.  The result is an overly powerful knee extension muscle group (when compared to the antagonist group).  Without going into the complexities of muscle control, spasm, reciprocal inhibition, etc., the quadriceps muscle continues to pull on the knee strongly without much oppositional vector force reaction from the hamstring group.  This repeated unilateral force can wreak havoc on the knee cap.  Pain directly over the kneecap (or a feeling like the pain is underneath the patella) is typically due to the rectus femoris and/or vastus lateralis.

Solution —  This is a two-part treatment.  The first part is treating the rectus femoris (RF) and underlying vastus intermedius (VI) for muscle spasm and tightness.  The second part is strengthening the hamstring group.  This second part is outside the scope of this article and will only be briefly touched upon in part 5 of this series.

Treatment –  Lie prone on a firm, flat, level surface.  Find the midpoint of the line connecting the ASIS and the patella.  This is the trigger point for the rectus femoris and vastus intermedius.  Place the Sciaticare Ball between this location and the floor.  The weight of the thigh should provide enough pressure to stimulate the trigger points found here.  Reach back and grab the ankle on the same side you wish to treat, and pull the foot towards the buttock to stretch the quadriceps.  Rock the leg back and forth over the tendermost areas.  Treat any other tender spots nearby in similar fashion.

A PDF of one simple exercise utilizing the Sciaticare Ball (complete with pictures) can be found here:

http://www.augustpoint.com/articles/sciaticare_quicksheet_rectus_femoris.pdf

The combined effect of stretching the quadriceps and massaging the trigger points in the quadriceps will keep muscles limber and loose.  It is possible to treat the quadriceps daily, as this large muscle group can quickly adapt and benefit.

Although it is possible that the runner’s knee is caused by weak quadriceps muscles, it is rarely the cause.  In many cases, the quadriceps tend to be either:  overpowering to the hamstrings, or inflexible.  It is not recommended to increase strength training for the quadriceps group until the trigger point is worked out and the muscles made more flexible.

This concludes part 1 of 5.

5 Ways to Simply and Effectively Treat Common Pregnancy Aches and Pains

English: Close up of the belly of a pregnant w...

Pregnancy Aches and Pains

A growing fetus can create joint and muscular problems for the mother-to-be.  As muscles, tendons, and ligaments in the body try to stretch and adapt, these tissues can get strained.  When overworked, the tissue pain will occur either in the attached joint, or in the muscle itself.

The Sciaticare Ball, by August Point Wellness, is a simple, versatile tool that can help ease the aches and pains during the second and third trimesters, when the fetus is nearing its maximum size.  The Sciaticare Ball is designed to provide accurate therapeutic pressure (through the user’s own bodyweight) to relieve muscular tightness and spasms.  The Ball is meant to be used as often as possible during pregnancy to help keep muscles loose and promote healthy blood circulation.  Here are 5 key ways the Sciaticare Ball can simply and effectively treat the common muscular aches and pains of pregnancy:

1.   Sciatic pain – The Sciaticare Ball was originally created to treat sciatic pain, hence the name.  In the last trimester, women are forced to change sleeping positions frequently.  One of these positions, side-sleeping, pulls at the lateral hip and gluteal muscles which can compress the sciatic nerve to cause pain to shoot down the legs.  Stretching the hips may not be physically possible with a prominent baby belly, but with the Sciaticare Ball, muscular trigger points and acupressure points in the hips and glutes can be easily deactivated for this pregnancy related sciatica.

Treat the gluteus minimus, gluteus medius, and piriformis muscle trigger points.  Also treat nearby tender points in the gluteal region.

2.  Low back pain – Low back pain is probably the most common complaint during pregnancy.  The location of the growing baby coupled with the stretching of the abdominal muscles force the lower back structure to handle tremendous upper body support duties.

To treat low back pain, use the Sciaticare Ball in a seated or lying position.  Treat the quadratus lumborum, gluteus medius and soleus muscles.  These three muscles are key to maintaining an upright posture.The erector spinae of the back can also be treated as they also assist to carry extra muscular load.

3.  Upper back pain – As breasts increase in size, shoulder stabilizer muscles must work to keep the shoulder blades retracted.  Tired muscles in the upper back will cause one to slouch and lead to aching pain between and around the shoulder blades.  Since the upper back is easily accessible, there are a multitude of upper back acupressure and trigger points that can be massaged away using the Sciaticare Ball.

Use the Sciaticare Ball in a standing, seated or lying position.  Treat the rear head of deltoid, supraspinatus, infraspinatus, rhomboids, erector spinae, and upper trapezius muscles.  Take time and work these points often for relief.

4.  Foot pain – As the feet bear extra weight, the muscles are put under more pressure during walking.  Keeping the lower leg and foot muscles loose and supple will reduce the heart’s effort in pumping blood throughout.  The benefits gained from treating the lower leg and feet are tremendous, such as: lowered blood pressure, improved lymphatic drainage (less edema and swelling), reduced fatigue, alleviated plantar fasciitis and foot pain.

Treat these muscles with the Sciaticare Ball in a standing, seated, or lying position.  Roll the arches of the foot on the ball to treat intrinsic foot muscles.  Treat the popliteus, gastrocnemius and soleus muscles while sitting on the floor with the legs straight out in front.  Daily deactivation of these muscles will do much to improve overall health during pregnancy.

5.  Neck pain –  With the entire spinal column curving to accommodate a baby, the cervical spine must adapt as well.  Thus, neck pain can often become an additional burden during pregnancy.  If neck muscles get tight enough, they can contribute to sleep problems (insomnia), headaches, and balance issues.

The easiest way to treat the neck muscles with the Sciaticare Ball is to lay down on the floor and cup the ball with the hands.  Place the Ball behind the neck and use the hands to push the ball into the acupressure or trigger points in the back of the neck from the base of the skull down to the shoulders.  Treat the suboccipital muscles, levator scapulae, and upper trapezius muscles.

  

The Sciaticare Ball is a wonderful addition to an overall prenatal program and gives the pregnant mother the power to treat some of her conditions herself and in the privacy of her own home.  With the valuable reward of learning how to focus on her own health, the mother can become more in tune with herself and her baby during the entire prenatal period. The Sciaticare Ball can also be used in conjunction with a mother’s alternative health care provider’s natural and drug-free prenatal treatment plan.

For more information, or to find out how to use the Sciaticare Ball, please visit us at:

http://www.augustpoint.com

Related Links:

Effective Pregnancy Hemorrhoid Acupuncture Points (augustpoint.wordpress.com)

Brachialis, The Baby Carrying Muscle

In His Arms

In His Arms (Photo credit: Kate Dreyer)

One of the ways that adults carry their little one is by placing the child on a flexed forearm and pulling him or her close to the body. The bulk of the supported weight is over the lower arm.  This position stresses the muscles that work to maintain this position.  Many times, the parent doesn’t have the strength or stamina to keep the arm flexed for long periods of time.  But they try their best to hold their child, especially if baby cannot walk yet.  Thus, the weak and/or tired muscles can be injured to the point where the act becomes difficult or painful.  Although the biceps (as well as the brachioradialis) participate, the dominant muscle used to carry your baby is the lesser known brachialis.

The brachialis is a thick muscle that lies underneath the biceps on the lower half of the humerus.  Like the biceps brachii and brachioradialis, the brachialis assists in flexing the elbow.  Unlike the biceps and brachioradialis, the brachialis has only one function.  This single function causes the brachialis to be engaged during every elbow flexing motion.

Typical problems with the brachialis can be seen with weakness and/or discomfort in picking up a heavy baby, carrying groceries, or holding arms outstretched.  Some brachialis problems make straightening the arm difficult.  Pain is typically felt in one or more of the following locations:  anterior portion of the shoulder, outer portion of the upper arm, inner portion of elbow crease, and in the thumb.

Brachialis problems can exist as trigger points, or tender areas in the muscle.  The good news is that moms, dads, and relatives can work out these trigger points on themselves and bring significant relief in a short amount of time.  The brachialis muscle can be easily massaged with the thumb of the opposite hand.  The first place to treat is the outer portion of the arm between the biceps and triceps.  Located on the lower half of the humerus bone, the brachialis feels lumpy to the touch.  Massage this area, especially working the area near the outer edge of the biceps.  The next place to treat is inside the elbow crease. Because the brachialis attaches to the ulna just below the elbow crease, it’s possible to address brachialis tenderness from this spot.  Use the thumb to massage around the medial epicondyle, paying particular attention to the muscular area just toward the inside.

English: Location of UCL injury

English: Medial Epicondyle (Photo credit: Wikipedia)

Other ways of treating the brachialis are by using a massage tool.  August Point Wellness offer a multipurpose trigger point massage tool called the Sciaticare Ball that can treat brachialis pain as well as many other muscular complaints.  Other useful hand tools assist in applying firm pressure to massage away trigger points.  A massage therapist or acupuncturist can professionally assess your pain and treat not only the brachialis, but the surrounding areas as well.  Most times, a few visit will be required to fully relieve the pain and discomfort.  Exercise and stretching should also recommended to help keep the brachialis muscle strong and allow you enjoy carrying your baby for longer periods, pain free.

Related Material:

Brachialis Muscle Trigger Point Therapy Using the Sciaticare Ball

The Soleus Muscle, The Second Heart

Deep and superficial layers of posterior leg m...

Soleus

The heart is an amazing organ that pumps between 5 and 7 thousand liters of blood a day.  Yet, it is not the only pump in the body.  While the heart pumps blood out towards the extremities, deep muscles assist in pumping blood back towards the heart.  One of the most important muscles for assisting blood flow back to the heart is the soleus muscle of the calf.

The soleus muscle is a large flat muscle in the lower leg.  Part of the soleus can be palpated directly, while the rest lies underneath the gastrocnemius muscle.  The location of the soleus muscles are important.  They are on the extreme distal end of the body and furthest away from the heart.  When standing upright, the soleus resides at the body’s lowest gravitational point.  These two factors put the soleus in an ideal position to work synergistically with the heart as an efficient pumping system.  The heart pumps arterial blood, while the soleus pumps venous blood.  But, this occurs best when the soleus muscle is healthy and supple.

Problems with the soleus are a frequent cause of pain and suffering.  Athletes and inactive people can both be affected.  This happens because the soleus is used in many activities, such as walking, running, and cycling.  It is a hardworking muscle that tends to get heavy use and very little care.  Most people don’t take enough time to stretch and treat the soleus.  Hence muscle tightness and trigger points can form, causing the soleus to hinder circulation rather than help.

Tight, stiff soleus muscles can radiate pain to the heel, ankle, and as far away as the lower back.  Complications from soleus tightness include:  ankle instability, calf cramps, varicose veins, phlebitis, lower leg edema, low blood pressure, orthostatic hypotension (postural hypotension), and hypersensitivity of lower back.  Pain that is mimicked by tight soleus muscle include:  plantar fasciitis, heel spurs, stress fracture, shin splints, Achilles tendonitis, and thrombosis.

Treatment for the soleus muscle should begin with natural therapy.  Home treatments such as strength training, stretching and self massage should be done regularly to maintain the muscle’s pliability, density, range of motion, and function.

At August Point Wellness, we believe that many of the soleus muscle issues can be addressed through acupuncture, massage therapy, and stretching.

An example treatment that we would use to address tight soleus:

Pain Trying to Undo Your Bra Strap? It Could Be This Pair of Muscles…

Infraspinatus - Muscles of the Upper Extremity...Infraspinatus Muscle

“It hurts when I try to undo my bra.” Or “Taking off my shirt is painful.” Or “Combing my hair hurts my shoulder.” Or “I have problems reaching behind my back.” These are common complaints for trigger points in the rotator cuff muscles, infraspinatus and subscapularis.

There are 4 rotator cuff (RC) muscles that assist in movement at the shoulder (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles hold the head of the humerus in the glenoid cavity, as well as provide mobility. An imbalance in rotator cuff muscles can be painful, as well as severely limit the joint range of motion (ROM). That imbalance can also lead to trigger points that are painful when touched.

Two muscles that tend to get stress and overwork injuries are the infraspinatus and subscapularis. These are two of the four rotator cuff muscles in your shoulder. When there is difficulty raising the arm above the head or behind the back, doctors
typically diagnose frozen shoulder. Frequently enough, I hear other diagnoses such as bursitis, adhesive capsulitis, neuritis, etc. attached to the one for frozen shoulder. Muscle relaxants and anti-inflammatory meds are sometimes prescribed without regard
for more effective, natural methods of relief.

The function of the infraspinatus is to externally rotate the humerus. (It’s the kind of motion that allows you to bring your arm back to throw a ball.) The function of the subscapularis is to internally rotate the humerus. (This is the forward and downward motion of throwing a ball.)  As you may know, these muscles are antagonists to one another. Each opposes the function of the other. This concept is important, because the health of one muscle will usually affect the health of the other. (It’s a yin-yang theory of balance.)  Therefore, treatment of both the infraspinatus and subscapularis are imperative in a complete healing plan.

The infraspinatus is located on the shoulder blade itself. The muscle above the spine of the scapula is called the supraspinatus (‘above the spine’), while the muscle below the scapula is called the infraspinatus (‘below the spine’). If one is flexible enough, he or she may be able to reach over their shoulder with the opposite hand and palpate the infraspinatus muscle.  One of the key causes for tight infraspinatus muscle is holding the arms out in front for extended periods of time.

Acupuncture and massage are two extremely effective methods for treating the infraspinatus trigger points. Stretching after each therapeutic treatment is important to help relax musculature and improve circulation.  To treat the infraspinatus at home, while you are between your physical therapy, acupuncture, or massage treatments, invest in a tool to help you work out trigger points in the infraspinatus.  August Point Wellness carries the Sciaticare Ball, an effective trigger point relieving tool for many different musculoskeletal trigger points.  Instructions on how to use the Sciaticare Ball for infraspinatus can also be found on our website here.

The subscapularis is a slightly more difficult muscle to address.  Located under the scapula, this muscle is the largest and strongest of the rotator cuff muscles.  Along with acupuncture and massage therapy treatments, the sufferer should also learn to stretch the subscapularis muscle.  (Sometimes stretching alone is NOT enough to release the muscle spasm.)  The most effective method that I have found to stretch the subscapularis is the broomstick stretch.  If you do not have a broomstick handy, you can try the subscapularis doorway stretch.  (For now, Google these stretches for images and videos on particular stretches.  I hope to add images to this post soon!)

With the way most people use their shoulder, a strength imbalance causes the subscapularis to be strong, while the other three RC muscles are weak.  Therefore, after the trigger points have been worked out of the RC group, one should begin strength training on these muscles.  Exercises that isolate the individual RC muscles are a great start.  Pair it up with exercises that stabilize the scapula and regain strength and flexibility in your shoulder!

A sample treatment that I may use in my clinic would be:

  • Acupuncture – SI9-SI12, GB21, Rhomboid Motor Points (MP), UB10, Subscapularis MP, LI16
  • Massage Therapy – Entire Rotator Cuff Set, Pectoralis Minor, Serratus Anterior, Upper Trapezius
  • External Liniment/Rub –  Sciaticare Penetrating Muscle Rub applied over  muscles for faster healing and improved blood flow.  Patient would apply Sciaticare PMR daily and massage into area to promote circulation and healing.  Application of Sciaticare PMR before any rehabilitation exercises would be recommended as well.

This type of frozen shoulder pain usually requires 4-6 treatments to really improve ROM and show results.  Obviously, your results may differ.  You may need to modify your posture, work ergonomics, and lifestyle as well.

The Sciaticare Ball – PRODUCT

At first glance, the Sciaticare Ball looks more like a dog toy than a bona fide massage therapy tool. It’s a textured rubber ball connected to a two foot length of rope and a wooden handle.  But, don’t let the looks fool you.  With the proper direction, this “toy” can relieve a lot of muscular pain.  The idea for the tool came when it’s creator, Dylan Jawahir, L.Ac.,L.M.T., couldn’t find the right tool for his patients to use between office visits to massage out their sciatic and low back pain.

“I would offer my patients a tennis ball rolled in a sock, or a rubber hi-bounce ball to massage out their sciatic and low back pain.  But, patients would come back to my office and tell me that they couldn’t get the ball in the correct position, or they couldn’t keep the ball in place when trying to work out their own acupressure points.” Dylan says.  “After hearing quite a few complaints, I decided to develop this tool.  Later, I found that it was useful for much more than sciatica and low back pain. That was when I thought it would be a great idea to put together a list of typical problems and how the Sciaticare Ball could be used to treat them.  It quickly blossomed into the Sciaticare Way.”

The Sciaticare Ball can be used on musculature from head to toe.  If the user can get in the right position, the Sciaticare Ball will take care of the rest.  Using the theory of acupuncture points coupled with that of trigger points, Jawahir has compiled a list of muscles that can be massaged and treated with the Ball.  Problems such as knee pain, plantar fasciitis, cervicogenic headaches, winged scapula, tennis elbow, golfer elbow, etc. can be treated just as easily as sciatica and lumbago.  The beauty is that free step-by-step instructions are available on the website (http://www.augustpoint.com/products.php) and can be downloaded for each of these common complaints.  The manufacturer claims that example videos will be uploaded by December, 2011.

Another great feature of the Sciaticare Ball is that it can be used practically anywhere.  The user can massage out pain while sitting, standing, or lying down.  Very little active pressure is required to work out the acupressure (or trigger) points.  Gravity does most of the work.  The size of the Sciaticare Ball makes it easy to drop into a workbag and take it to the office.  Plenty of office personnel could benefit from using a Sciaticare Ball for 5 to 10 minutes a day on the typical shoulder and back pain that accompanies long hours in the cubicle.  The Ball can also be used at home, on a bed, or while lying on the couch in front of the television.

The Sciaticare Ball is currently sold for $19.95 and ships for $6 flat rate.  The Ball is available directly from August Point Wellness as well as Amazon.com.  It is very durable and looks to be able to withstand years of use.  It also carries a 100% money back guarantee.

The Sciaticare Ball is worth well more than the listed price.  In fact, the value of this product along with all of the free instructional media available far outweighs most of the other products available on the market today.  As both a practitioner-oriented and patient-oriented product, the Sciaticare Ball caters well to both.  Many acupuncturists, doctors, massage therapists, physical therapists, Pilates instructors, etc. are looking for a tool to complement patient office visits with patient self-care.  The Sciaticare Ball fills that need.  The informed consumer can also pick up the Sciaticare Ball and begin using it by studying the free downloaded material from the product website.

The Sciaticare Ball is the rare product that can be used by just about anyone.  It’s intuitive.  It’s simple.  It’s effective.  The Sciaticare motto states “Empowering you with the tools to enhance your health and wellness”.  That’s just what this product does.  It gives people the power to understand their own health through education knowing that it will go a long way towards giving people the power to control their own health.

Pregnant and in Pain? The Sciaticare Ball Can Help!

For many women, pregnancy comes with a list of aches and pains.  As a woman’s body prepares itself to carry a baby, her bones and ligaments adapt to support the additional weight.  This changing of body position is necessary, and at times, it can also lead to an unpleasant prenatal period.

Two of the most common pregnancy complaints that I see in my clinic are: lumbago (low back pain) and sciatica.  These are typical issues that arise during pregnancy.  Why?  First, the upper half of the body has to adjust to carrying an additional load (i.e. baby), one that increases significantly during the second and third trimesters.  The body tries to balance this load by increasing lumbar curvature.  The new weight distribution puts more strain on the low back when the woman is standing upright.  Secondly, while the baby is growing inside the womb, the hips are opening and adjusting to make room.  The woman’s hips tend to spend more time externally rotated (knees and feet pointed away from midline).  With the external rotation of the hips, the muscles surrounding the sciatic nerve get shortened.  If shortened for extended periods of time, the hip muscles can start to spasm and pinch or irritate the sciatic nerve.

I’ve spent much time treating sciatic pain and back pain for pregnant women and great relief can be found in acupuncture and massage therapy.  These are natural, drug-free ways of reducing pain and treating many issues that arise throughout the entire 10-month journey of pregnancy.

Though, sometimes a pregnant woman will have flare-ups of pain at times that make it inconvenient for her to visit my office for treatment.  To mitigate these painful occurrences between acupuncture treatments, I started looking for a way to allow the sufferer to address sciatic and low back pain on her own.

I developed a tool that allows pregnant women to treat their own lumbago and sciatica pain between their office visits.

It’s called the Sciaticare Ball.

The Sciaticare Ball is an acupressure tool, massage tool, and trigger point tool.  It treats stubborn, tight muscles that cause body aches and pains.  The Sciaticare Ball is a versatile tool that can treat the difficult sciatic and lumbago conditions.  But, the Sciaticare Ball treats much more!  Visit our website for FREE information regarding the multitude of other uses for the Sciaticare Ball:  August Point Wellness Website

I’ve seen the other products on the market.  Comparatively, the Sciaticare Ball provides more accurate and precise treatment of your stubborn muscles to: increase blood flow, relieve pain, and reduce swelling.  The Sciaticare Ball is easy to use and accommodates the reduced mobility of a pregnant woman.  The Sciaticare Ball can be used while laying down, sitting, or even standing up.  Stay healthy before, during, and after your pregnancy with the Sciaticare Ball!

The Sciaticare Ball is a serious tool for serious pain.  I highly recommend checking it out.  I’m sure you will find it to be more valuable than any other self-care massage tool you own.

Interested in Improving Your Balance? Treat the Suboccipital Muscles.


Suboccipital triangle

Image via Wikipedia

There are two groups that I think are more interested in balancing on two feet than anyone else.  Athletes and the elderly.  The athlete is on one end of the spectrum, trying to push the limits of physical activity and improve center of gravity.  The other end of the spectrum are the elderly, who are usually just trying to keep that brain-body proprioceptive loop functioning enough to prevent possible fall or other injury. Both parties can benefit from gaining a more stable foundation to sustain and encourage movement.  Therefore, athletes and the elderly can benefit from “tuning up” the balance “sensors” of their bodies.

One important set of balance “sensors” are a group of muscles called the suboccipitals.  The suboccipitals are a group of 4 muscles (rectus capitis posterior minor, rectus capitis posterior major, obliquus capitis superior, and obliquus capitis inferior) located inferior to the base of the skull.  These suboccipital muscles are literally sensors for positioning and orienting the head in 3-dimensional space.  In fact, the muscles contain a much higher density of muscle spindles than most muscles in the body.  The inordinate amount of muscle spindles in the muscle tissue substantiate the idea that the primary function of the suboccipital group is to send spatial data to the brain and the secondary function of the suboccipital group is movement of the head.

Now, if we look at the suboccipital muscles as we would any other muscle group in the body, we can assume that fatigue, tension, and strain can occur from overuse and/or neglect.  Tightness and tension of the muscles can present with symptoms of dizziness, visual disturbances, and balance problems.  The above symptoms occur because the brain interacts with both the suboccipitals and the eyes in such a way that both organs work to help you focus on objects, track objects, and predict motion of objects relative to your body position.  (In a football example, what this means is that when your suboccipitals are functioning correctly, you can better “lock in” the football’s trajectory with your eyes and move your arms and feet towards catching it.)  Also, a group of nerves pass through the suboccipital area (suboccipital triangle) on their way back into the spinal column.  Compression of the nerves tend to compound the above said symptoms and, if severe enough, can cause occipital neuralgia.  Another interesting fact is that cervical vertebrae C2 and C3 are connected to the dura mater of the spinal cord in this location.  So, if the muscles attached to these vertebrae are pulling to one side or the other, the spinal cord is affected and could trigger headache and migraine symptoms.  Needless to say, the suboccipital muscles are important structures that contribute heavily to proper balance.

Recommendations for treating these muscles are stretching, manual therapy, and some form of alternative therapy, and some self-care tools.  Stretching will keep the musculature limber and promote good blood flow.  A manual therapy such as massage or trigger point therapy will usually result in reduction of headache and dizzy spells.  A trained massage therapist will be able to address these muscles very successfully as well as point out other issues with the surrounding musculature.  Craniosacral therapy is also a very beneficial technique that can release the suboccipital structure and realign the cervical vertebrae.  Acupuncture is a very effective alternative therapy that can assist in the treatment and prevention of proprioceptive and visual problems that may occur with tight suboccipital muscles.  Well-placed needles are able to access the muscular trigger points deep into the neck and results can be similar or more effective than that of massage.  Lastly, a self-care tool should always be in the home for when a recurrence of pain from strain or overuse arises.  We promote an August Point Wellness tool for this, the Sciaticare Ball.  It’s an intuitively simple tool with a wide variety of uses.  Releasing trigger points in the suboccipital area is just one of the uses for this physical therapy tool.  Please read our Sciaticare Ball technique for the Suboccipital Squeeze at http://www.augustpoint.com.

Proprioception – the awareness of the position and movement of the body in 3-dimensional space.

Suboccipital triangle – triangular pattern comprising 3 of the 4 suboccipital muscles.  Rectus capitis posterior major, obliquus capitis superior, obliquus capitis inferior comprise the triangular formation.

A Personal Story – Wrist Pain to No Pain, a 5 Year Journey

This is a story of my own wrists and the pain that I had been suffering for the past 5 years. I began my life’s journey of learning and understanding natural medicine about 8 year ago.  I enrolled in a massage therapy program at a local college to begin to understand the wonders of the human body.  About a year or so after I completed the program, I began working part-time as a licensed massage therapist.  I enjoyed every minute of serving people and watching them heal and remove years and years of pain from their body.  But, during my first year of massage practice, I began to develop wrist pain.  This was a huge concern and had the potential of taking me away from doing something that I loved.

As an initial investigation into the wrist pain, I looked at all of the things that I was using my hands for.  I was a heavy duty martial arts practitioner, hitting the heavy bag 3-4 times a week.  I was doing weightlifting, stretching, and yoga exercises in the gym 2-3 times a week.  I was turning a wrench and lifting heavy parts on an old 4×4 truck of mine.  I was also mountain biking on the weekends whenever I could get out and ride.

All of this was causing me to use my wrists and hands on a daily basis, some of which would have me at full range of motion (ROM) with pressure applied for minutes at a time.  The pain would come and go from time to time, but became a constant ache and pain.  In the span of a few months, I was unable to rest my palms on the floor and assume a push-up position at all without significant pain. Therefore, I had to scale back on many of my favorite activities to allow the problem to work itself out.

At first, the pain was significant on the right hand and very mild on the left hand.  It sounded logical because I do many activities with my right hand.  Made sense.  But, the fact that the pain was bilateral got me thinking that there was a systemic problem.  I thought that I was getting some form of arthritis.  Before the age of 30?  Crazy to think, but I was recounting to myself the frequency with which I’ve used my hands for so many things.  Made sense.  I thought that I might have a case or rheumatoid arthritis (RA) due to the bilateral nature of the issue.  But, RA usually affects more small joints and is progressive…and I wasn’t that old! Carpal Tunnel Syndrome (CTS) also crossed my mind, but I didn’t have the tingling and numbness in the first 3 fingers usually associated with CTS.

Fast forward a few years and I had modified almost everything that I did with my hands.  I knew exactly how to position my hands for the least amount of pain and what my “new” range of motion would be before pain was aggravated.  I would never use an open palm to support any weight whatsoever.  Push-ups were done closed fisted.  Yoga postures were done without an open palm.  No more than 3-4 massage clients a day and definitely no more than 8-10 in a week.  I got massage on my forearm flexors and extensors regularly and used acupuncture and stretching to keep the wrists limber.  But, even with all of the management of my wrist and the care I took to try and heal them, nothing really reduced the pain.

Then last year, I decided to get some x-rays on my wrist joints to see what would come up.  Desperate, I was looking for some answers.  Of course, something was found.  I had the beginning of degenerative joint disease (DJD) on my right hand.  The doctor pointed out that there was some DJD that could be giving me wrist pain.  But, there was no answer for why my left wrist was in pain.  So, I resolved myself to just treating my wrists and hands with care and just trying to reduce the wear-and-tear on the joints.

Fast forward to just a few months ago. I was perusing a trigger point manual and found an interesting piece of information that I know I had overlooked before. There’s a muscle underneath the scapula called the subscapularis. It’s a fantastic muscle that hides underneath the scapula and works with 3 other muscles (supraspinatus, infraspinatus, teres minor) to make up the rotator cuff muscles. A tight supraspinatus can refer pain to the rear shoulder area and to the wrists. A balanced rotator cuff has all 4 muscles with fairly equal musculature to keep the shoulder joint stable and the upper arm in the shoulder socket, so to speak.

Well, I had multiple ortho-neuro tests on my rotator cuff muscles done and there was a fair amount of strength in each.  Nothing seemed to be too out of balance.  Being a massage therapist that I am, I palpated each of the muscles for tenderness.  When I touched the subscapularis, I almost went through the roof.  It was extremely tender.  So, I got to massaging it once a day and stretching it out 3 times a day.  The right subscapularis was much more tender than the left one, but both needed heavy work.

After a week of consistent massage and working to release the subscapularis, the pain in my wrists began to diminish.  Today, I can actually do a push-up with my wrists flat on the ground without pain in my left wrist and with very minimal pain in my right.  I’ve gotten my hands back.  I couldn’t believe the transformation.  I no longer feel like my wrists are going to give out.  I continue to work on strengthening the supraspinatus, infraspinatus, and teres minor muscles of the rotator cuff and stretching my subscapularis.

So, I guess there are a few things I’ve learned about my situation as well as some other situations that warrants some comments.

1.  If you have pain that begins in the back of the wrists that feels like carpal tunnel but isn’t, check the subscapularis muscle for tightness.  This muscle usually overpowers the other 3 in the rotator cuff and can refer pain to the back of the shoulder and to the back of the wrist.

2.  If you have frozen shoulder (aka adhesive capsulitis) and/or one shoulder is higher than another visually, there could be a subscapularis problem.  Don’t forget about it.  Just because it’s not a superficial muscle, doesn’t mean that it doesn’t need work.  A tight subscapularis does not need strengthening before you release the trigger points.  Strengthen the other 3 rotator cuff muscles and work out the trigger points of the subscapularis first.

3.  Find a good stretch for the subscapularis muscle.  I like the broomstick stretch, personally.  Also, look for rotator cuff exercises that work on the lateral rotation of the arm.  On most people, lateral rotational strength is much weaker than medial rotational strength of the upper arm.

4.  Just because you are active, does not mean that you can’t have this problem.  It has more to do with imbalance of muscle structure rather than strength of musculature.  I’ve seen subscapularis problems in 60 year olds and also in 30 year olds (myself included!).

5. Many activities will strengthen the subscapularis while neglecting the rest of the musculature supporting the shoulder girdle.  Make sure that you make up for weakness in other muscles, by focused weight training.

6.  I’m sure this subscapularis scenario gets misdiagnosed often.  I can see it getting diagnosed as carpal tunnel syndrome, arthritis, pinched nerve, etc.  This is why I’m posting this.  I don’t want to see more people get put on medications, or have surgery done, or just suffer for something that can be fixed with a bit of massage and exercise.