brain-3168269_1280 - pain neuroscience

Pain Science — just as Colorful, Convincing, and Vocal as the Old Guard

“Given that the physical therapy profession has clearly been wrong so many times before, why do the current pain science advocates appear to suggest that this time we have it right?” Should therapists be so “…blinkered by a single approach or school of thought that they deny, or cannot see, the value of another?”

Acromion Process and Head of Humerus. Permission Joseph E. Muscolino. Kinesiology - The Skeletal System and Muscle Function, 3rd ed. Elsevier, 2017).

Six Causes of Shoulder Impingement Syndrome – Part 3

Another reason for shoulder impingement syndrome to occur is insufficient elevation of the clavicle. Most of scapular upward rotation is actually caused by elevation of the clavicle at the sternoclavicular joint, so if clavicular elevation is prevented for any reason, shoulder impingement syndrome can occur.

The Pectoralis Minor. Permission Joseph E. Muscolino. The Muscular System Manual - The Skeletal Muscles of the Human Body, 4th ed. (Elsevier, 2017).

Six Causes of Shoulder Impingement Syndrome – Part 2

For scapular upward rotation to occur, scapular downward rotator musculature must lengthen. If scapular downward rotation muscles are tight, they might not be flexible enough to allow for scapular upward rotation, thereby causing shoulder impingement syndrome to occur.

Shoulder Impingement Syndrome. Permission Joseph E. Muscolino. Kinesiology - The Skeletal System and Muscle Function, 3ed (Elsevier, 2017).

Six Causes of Shoulder Impingement Syndrome – Part 1

Shoulder impingement syndrome is a condition in which the distal tendon of the supraspinatus and the subacromial bursa become impinged between the head of the humerus and the acromion process of the scapula. Following are the six major causes of shoulder impingement syndrome.

Permission Joseph E.Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2015)

Low Back Pain: Time to Consider Massage and Exercise as Effective Treatments

So if we say that the cause of most low back pain is not understood, it should mean that we do not know what mechanism is causing the low back pain most of the time. But that is not true. We can often palpate tight myofascial tissue or a dysfunctional joint that is causing back pain.

Hamstring Group. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2015)

Five Muscles of Sacroiliac Stabilization – Part 3 – Hamstrings

The connection between the hamstrings and the sacroiliac joint is through what is known as the superficial back line myofascial meridian/anatomy train. If the hamstrings are tight, their tension pulling force will be exerted through the sacrotuberous ligament and onto the sacrum.

Musculature of the Pelvis and Hip Joint. Permission Joseph E. Muscolino. The Muscular System Manual - The Skeletal Muscles of the Human Body, 4th ed. (Elsevier, 2017).

Five Muscles of Sacroiliac Stabilization – Part 2 – Coccygeus and Others

The coccygeus and levator ani are technically muscles of the pelvic floor, however, they are also muscles whose contraction forces cross the sacroiliac joint and therefore often tighten when a sacroiliac joint condition exists. The coccygeus attaches from the sacrum and coccyx to the ischial spine of the pelvic bone.

Musculature around the Sacroiliac Joint. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Five Muscles of Sacroiliac Stabilization – Part 1 – Piriformis

Even when the original reason for the sacroiliac stabilization is valid, often the human body overdoes it and tightens the musculature excessively and/or keeps it tight long after it needs to be, so the musculature becomes stuck in a chronic pattern of hypertonicity.

Text Neck Posture. Permission Joseph E. Muscolino. www.learnmuscles.com.

Text Neck and Neck Pain… and Neck Dysfunction

With any imbalanced posture (postural distortion pattern), including text neck posture, asymmetrical pathomechanical forces are placed into the tissues of the body. These forces have to have an effect. I believe it is impossible to argue that pathomechanics do not lead to dysfunction.

Forward Head Posture. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Forward Head Posture

The neck and head do not contribute to the generation of pressure, so head and neck posture should be whatever is most comfortable and least stressful. Forward head posture, a common postural distortion imbalance pattern that occurs is caused by a flexion of the head and neck.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Deep Strokes

To transition to perform deep strokes and maintain proper body mechanics, it is necessary to transition from being perpendicular to be slightly horizontal to glide along the client’s body. However, minimize the horizontal direction or pressure into the client’s tissues will be lost.

Back Postures. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Use Body Weight

An excellent demonstration of the force that can be generated by using body weight is to lean down onto a bathroom weight scale that is placed on a table that is positioned as various heights. Simply relax and lean into the scale with your body weight and notice the force that you generate.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Support Your Treatment Contact

Bracing the contact means that the two hands must work together instead of each contacting the client separately. Less area of the client’s body will be covered this way, but stronger and more efficient pressure will be created at the area that is being worked, which is more important when deep pressure is needed.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Apply Pressure Perpendicularly

Maximal pressure for the effort used is achieved if the angle of your force into the client is perpendicular to the contour of the region being worked. To apply this concept of working perpendicularly, the client’s back and pelvis can be divided into separate regions based on the curve of each region.

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Neck Deep Pressure Massage: Step by Step – Engage the Tissues

Being able to feel tissue tension barrier is the one most crucial aspect for a clinical orthopedic manual therapist performing deep pressure massage. From a mechanical standpoint, it is only pressure beyond the tissue tension barrier that effects therapeutic change (this is not necessarily true neurally).

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Neck Deep Pressure Massage: Step by Step – Deep Stroking Massage

When performing deep pressure massage, deep stroking massage must originate from your core by further rocking your pelvis and extending your spine forward. Short deep strokes to the neck between 1 and 2 inches (2-5 centimeters) in length allow you to preserve optimal body mechanics.

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2015).

Neck Deep Pressure Massage: Step by Step – Contacts

Even perfect body mechanics cannot eliminate all physical stress to your body when doing massage. Ideal body mechanics merely minimize the stress. For this reason, when doing massage, especially deep pressure massage, it is wise to alternate which treatment hand contact you use during a session.