What about SCARS? - How to take Self Soft Tissue Work Further!

One of the biggest trends and continues become a tool that every trainer utilizes is Self Myofascial Release. SMFR (Self Myofascial Release) education and implementation is a great advancement in the health and fitness industry because it is in the best interest of our clients, we are obtaining greater goals, and decreasing pain!

A story about fascia.........

Fascia is a thick membranous envelope with a lubricating fluid. This is a continuous tissue that extends from head to toe, front to back, surrounding every orgran, blood vessel, nerve, muscle, EVERYTHING!.

The purpose of the Fascial System: The Support and Lubricate. An example of this is to create a gliding in between tissue, orgrans, and bone without any "catch"

Pull on a persons arm, they feel it in their shoulder and neck, even if only the skin is in traction. In health, fluids flow with relative ease from one fascial compartment to the next. When a traumatic injury pattern is established, the fascia may twist and compress. The exchange of fluid may become compromised, and physiology may be impaired.

What if there is an Adhesion between Neighbouring Tissues?

There will be pain in the area, due to friction of the surrounding tissue's, and there will be dysfunction along the myofascial chain.

An untreated scar will cause this. After the scar has become adhesed, it will bind all the tissue's, decrease the fluid, and increase the friction. No matter how many passes or SFMR techniques you perform, this will not decrease!

A common treatable scar that we see on a weekly basis at DT&R is a Scar from Appendix Surgery. Patients usually come into our office complaining of shoulder or knee pain, and after evaluation, we discover an adhesion, "unhappy" scar.

This scar sits right at the change of direction in the Anterior Spiral Fascial Chain and will cause a inferior tension on the Shoulder Joint, and Superior tension on the opposite knee!

Now, if you are a trainer or coach reading this blog, SCARS can cause havoc and headaches if you are trying to get your clients tissue to become more "pliable".

We receive emails from trainers all the time asking what the next step is and what to do if you came across a road block in SMFR....

The best way is to refer out, and get the scar to become pliable and moving better, then the practitioner should send that client back to yourself to work on the rest of the Soft Tissue and Myofascial Work.

What will the practitioner do?

- Graston or SASTM Technique
- Massage: Frictions around the Scar or Adhesed area
- Osteopathy: Scar Work (In my opinion, one of the best routes to go!)


How do you know if the scar is adhesed?

There is a simple way to assess if a scar is adhesed and causing issue or not.

1) Find the Scar
2) Go 2 Finder breathes Medially, Laterally, Inferior, or Superior from the scar site
3) Slightly contact skin and Fascia, then apply tension distally from the Scar
4) DOES IT MOVE??

If it does, there is an adhesion present. Refer or work with a practitioner that performs scar work, or Myofascial Release. Once treatment is underway, start to foam roll, use the stick, and other other tool become mobile, strong, and healthy!


On a separate note, we are going to dive into more BUSINESS info on here. If there is anything that you would like covered, post it at the bottom.

Adductor Exercise Protocol and Cool Video's!

Here in Southern Ontario we are a hockey nation. It has been a great start to the year, the Maple Leafs are 4-0 (best start since I can remeber......), a few of our players are already in talks with Junior Clubs, and the Canadian Human Performance Centre and DT&R are expanding rapidly!

With the cold weather, hockey arena's back open, and hockey fever in the air, there seems to be a new wave of injuries that we are seeing in our clinic: Adductor Strains.

If an athlete comes into our facility with a "Groin Pull", it brings 2 conclusions to mind:

1) There is an imbalance present that is creating stress through the adductor muscle group

2) There is an improper conditioning and exercise progran implementation. (1 usually is lead into #2)

Most patients that come through our office, currently or have recieved regular manual therapy for the problem. This usually consist of a modality like ultrasound or laser on the affected area, massage thechniques or active release, and maybe some taping.

These athletes always seem to come back with the same complaint...........GROIN PAIN!

Why don't we fix the root of the problem so this never comes back and the athlete gets back to play or life at optimal performance??

A few Things to look for with "Adductor Pain":

1) The strength and muscle firing of the QL on the same side of the dysfunction. This could also lead to an imbalance in the pelvis which will cause dysfunction. There is a strong Osteopathic relationship between the QL and Adductor Group. Working and relieving one group, can counter balance the other, and vice-versa..


2) Pelvis Alignment. In my personal experience, the Innomonant or hip bone on the side of the dysfunction has an Anterior Rotation and Superior Shear. This will show as unlevel and ASIS (anterior superior illiac spine)

3) The Glute Max and External Rotaters are tight and weak. Yes, this is possible to have both present at once. This will cause a External Rotation of the femur resulting in excess force and strain through Adductor Magnus.

4) The Pubic Symphisis Joint. NO ONE EVER ASSES THIS JOINT. Either because the practitioner is nervous or unaware, it must be assesed and treat for every condition in the body!

5) Ankle Mobility. If the is a lack of Dorsi Flexion at the Sub Talar Joint, there will be an excess of Knee Flexion and Internal Rotation, thus causing a shear at the knee, and more stress through the Adductor Group.


Adductor Prevention is important to keep athletes on the field or ice. We should always be assessing biomechanics of the lower extremity, and muscle strength test to keep our patients and clients healthy.

Here is a video protocol. It is a basic stream of exercises for the readers at home that would like to prevent this injury:




2. We have just launched a great video with Mindi Obrien from Team Obrien Fitness and Dynamic Rehab. Rachel LeBlanc, Canada's newest IFBB Pro flew in from New Bruinswick (Far East Coast) over the summer to recieve treatments and workouts. Check out the video!




3. For all the Manual Therapist that read this blog, we are working on a new project that is going to take your business and practice to the next level.........that is all we are going to unleash now........

Why are we still chasing neck pain?

Everything I read online, from blogs, twitter, accounts, and articles, everyone seems to be a true advocate of find the dysfunction, treat the dysfunction, and pain will go away!


When it comes to the neck, all these rules seemingly disappear!


When a patient/client with chronic posterior neck pain (fairly common now in our society), most practitioners seem to work strictly on those muscles, the ones in pain!


Why do we do this? Does it Help Our Patients?


Most professionals do not truly understand the neck or sometimes weary of entering the anterior structures because there is so much “stuff” located here, like the brachial plexus, important arties, and lymph nodes.


There are many important structures that need to be addressed when dealing with posterior neck pain. For the purpose of this informational blog, we are only going to go through two:


Two anatomical components that we should look for when treating chronic neck pain or even shoulder pain is Cervical Fascia and Longus Colli Muscle. Working on those muscles in the back of the neck will only create instant pain relief.......and only last for a few hours.


First to the Anterior Fascia Structures: We are going to focus on Deep Cervical Fascia


Most of us tend to think of the myofascia, or the fascia, in terms of the musculature. The fascia, in its broader context, lines all the body structures, including the muscles, joints, and bones. Consider the middle cervical fascia, a structure that connects a whole series of muscles throughout the front of the neck


The deep cervical fascia surrounds the body of the vertebrae in the cervical spine. The Anterior part of this fascia extends down to the first rib. Motions palpate the cervical spine and look for the most restricted region from C2 down. On a personal note, I look to start laterally and move medially.


The correction of this fascia can follow the assessment.

The second anatomical structure that should always be assessed and treated with neck complaints is the Longus Colli muscle.


The deep flexor muscles of the neck are often referred to as the abdominals of the neck. Proper strengthening, manual therapy, and motion of these muscles are vary important for stability of the neck, and balance.

They lie right over the anterior cervical vertebrae. To get to this muscle, push aside the trachea and apply gentle pressure with your fingertips. Be wary of the carotid artery and internal jugular vein






Here is a great video that is for strengthening of the deep muscles of the neck:













Another Great way to Stretch Anterior Neck Muscles:

Sit or stand with your right hand around

your neck and your fingers and thumb on

the muscles on either side of your throat.

You may place your left hand on top of

your right for support as shown. Start with

your hands close to your chin and begin

with your chin at your chest

Slowly bend your neck backward as

you simultaneously slide your hands

toward your chest, stretching the muscles

on the front of your neck.

CAUTION: Always move slowly when doing neck stretches.

Try to elongate your neck so you don’t compress your vertebrae

(bones). Read all the instructions and cautions thoroughly

before beginning. You should never feel pain!

Misunderstood Rehabilitation of the Shoulder

One of the most common injuries we see here at the Dynamic Clinic is shoulders. We have seen everything from adhesive capsulities (aka Frozen Shoulder), Tendinitis, Bursitis, a humerus split in half like a piece of chopped wood, Labral Issue's, pretty much everything in our therapy school books and beyond!

In my opinion, the shoulder is one of the most complex joints in the body to rehab and can be affected by every other part of the body.

One of the major issues with the shoulder is the neighbouring anatomical structures like the Thoracic Spine, and Visceral system need to be dealt with during rehab.

Also, the shoulder is a major pivot point of all Myofascial Chains of the body. An adhesion or lesion at the shoulder can cause a ripple effect along any fascial chain, causing dysfunction at multiple different area's. If there is an adhesion or lesion present somewhere else in the body (Liver, or opposite hip most common), than this can cause dysfunction in the shoulder.

In this blog post, my goal is not to go to far in detail about everything that can affect the shoulder, but to educate on the Rotator Cuff. Everybody has heard of the infamous "rotator cuff". Most of us think that is one muscle that rotates the shoulder, or more specifically the Glenohumeral Joint.

The rotator cuff is actually comprised of 4 separate muscle, all with separate actions. Across the board, the rotator cuff primary job is to actually stabilize the shoulder, THEN rotate.

Every wants to do rotation exercise, and more specifically, External Rotation before the muscles can even do there primary job.

Prior to any shoulder rehab or workout protocol, we must first asses 4 different componants:

Prep Workout Prior to Shoulder Rehab:

1) Make sure there is No Myofascial Adhesion's, ANYWHERE!

2) Make sure there is proper Thoracic Spine Mobility, if not, fix it.

3) Make sure proper body alignment. Hips, Legs, Shoulders, and Clavicle.

4) Make Sure there is adequate mmobility at the Clavicle, if not, always check Subclavius Muscle. If the clavicle is "locked", you will be in a nasty surprise for your shoulder(s).

Once these have all been worked on and cleared up, it is now appropriate to work on Shoulder Stability.

Our rule of thumb is the make the joint stabilized, then we can go for mobility.

On Friday October we are going to release a T-Spine Warm Up and Mobility Protocol, than a week today, we are going to release the ultimate shoulder rehab protocol.


Stay Tuned to this blog!


2. My partner in business, Taylor, has finally decided to start her own blog and twitter! We have been working towards this day for 2 years now.

Taylor focus her business and practice towards working with females. You can check out her website at http://www.the1000dollarweightlosschallenge.com/

Blog: http://www.tayjarvis.blogspot.com/



3. Our BP video of Kasia Sitarz is finally up!



We will be posting videos every few weeks to show her rehab and performance progress.



On a side note, as I type this blog, there is 3 packed, high energy boot camps going full tilt right now in the Canadian Human Performance Centre. I love this atmosphere! If you are in the GTA or Burlington/Hamilton Area, come check these camps and workouts out!

The Forgotten Foot Pt.1 and My Top 5 Blogs!

The Forgotten Foot...is an anatomical structure that influences the entire body.

Up to 25,000 steps per day (Average 10,000, but in our line of work it is a bit more!), Responsible for our Vertical Equiliberum, has proprioceptors that balance the ENTIRE body, and EVERY MYOFASCIAL CHAIN has a connection here.

So why does every trainer/therapist overlook this area when it comes to exercise programs and rehabilitaiton?

In Exercise and functional rehab, our goal is to create a balanced body. I am not talking about balancing on a BOSU (which you will never see in our facility!)  I'm talking about balance as One Unit working together in movement, digestion, power, and cohesiveness!

To create that type of body or to rehab any low back, shoulder, and visceral dysfunction we need to always start by assesing and look at the foot first.

Besides the static function of absorbing gravity and create propulsion simultaneously, here are some interesting facts that we should know when talking about the foot:

A) The Sinus Tarsi, located between the Talus and Calcaneus, has the intraosseus talcalcaneal ligament which houses proprioceptors responsble for balanceing the entire body. Opening up this area can increase venous drainage of the entire foot!

B) Has a Diagram (Plantar Diaghram: Muscles that run horizantal and repsonsible for pressure regulation). This diaghram works with the Pelvic Diaghram, Thoracic Diaghram, and Cranial Diaghram.

C) The Subtalar Joint: Most Critical Joint in the Body.

D) Talus Bone. Has no muscle attachments (Hint: Every important bone in the body that should have great mobility, does not have muscle attachment). This bone is a POSTURAL BONE, relates to C1, T4, and L5. Having postural issues? - No one has shown you to check mobility at this bone, eh?

E) In Chinese Medicine and Merdian Therapies, each line (which ends at the Toe) corresponds to every organ vital to survival: Spleen, Liver, Stomach, Gall Bladder, and Bladder. MYOFASCIAL Adhesions, will cause a "block" in each orgran.

F) EVERY MYOFASCIAL CHAIN IS CONNECTED TO THE FOOT!

Think you have other issue's with your client or yourself that you can't figure out? Thought you did soft tissue work and mobility stuff everywhere possible? Check the integrity of the feet!

Even if you don't know anything about the foot, start to incorporate Stick Work and Golf Ball Rolling across your feet.

Stick Work on Feet

Having problems squatting or lunging? - Work on Ankle Mobility:





Pt.2 - We are going to write about Myofascial work, and chains that influence our feet!



2. My Top Five to Read Blogs:

Everyone who has access to internet or even a cell phone seems to have a blog of some kind. We are all experts in our own way, most bloggers just seem to write, and not be in the trench's, some (the good one's) produce blogs because they are passionate, love to educate and are damn good at what they do!

Here are my Top 5 Blogs:

1) Rachel & Alwyn Cosgrove.

http://alwyncosgrove.com/
http://www.rachelcosgrove.com/

2) Eric Cressey.

I have been following this blog since I was a 6am to 10pm Trainer at a major gym club. Now I run a full health care clinic & gym and now more than ever I get more information from Cresset.

http://www.ericcressey.com/

3) Mark Young.

One of the funniest and most informative blogs in the fitness Industry that I have come across! He is also a local guy from the area.

http://www.markyoungtrainingsystems.com/

4) Thommas Plummber

If you are in the fitness industry and have no idea who this guy is, you better start reading up!

http://www.thomasplummer.net/blog

5) Mike Reinold - Physical Therapy

One of the most up to date and useful information in the alternative health care and rehabilitation scene!

http://www.mikereinold.com/


3. On Tuesday, we filmed a great workout with Kasia from Body Movement Therapeutics and her correctice exercise program going into her show 5 weeks out. For corrective exercise, soft tissue work, and dynamic stuff, this was a killer workout. I have been getting facebook messages and emails since the afternoon that we filmed it. The YouTube Clip will be up Sunday.

Kasia Sitarz
http://www.bmtherapeutics.com/