Motion Stability's Blog


Could Uneven Shoulders Indicate Any Issue?

image source: helloamanda.com

Brian Yee PT, MPhty, OCS, FAAOMPT

Uneven shoulders can be observed in a couple of planes. One of the most common observations is when one shoulder looks higher than the other. This could indicate either a structural, muscular or neural imbalance.

Structurally, the patient may have a leg length discrepancy or a scoliosis that causes the shoulders to be raised on one side.

Muscularly, the shoulder blade or scapula has multiple muscles that stabilize it in position. Muscular imbalances can easily occur that cause certain muscles of the scapula to pull it in a certain direction. For example, in many single arm-dominated sports such as baseball or tennis, the dominate arm tends to over-develop the latissmus dorsi which is your ‘wing’ muscle. With more muscular development it actually pulls the shoulder blade down. In standing postures, most of these athletes will look like their shoulder is lower on the same side. This can create problem for the lowered shoulder, especially when the arm is required to repetitively raise over their head. With the shoulder lowered it takes greater work of the opposing muscles to raise the arm overhead. Over time, it can cause poor shoulder mechanics and lead to injury of the shoulder.

When someone has chronic nerve symptoms in their neck and arm due to a radiculopathy or pinched nerve in their neck, many times you may see that the shoulder on the same side looks elevated. This is due to the adaptation of the muscles to shorten or spasm to elevate the shoulder girdle and allows more room for the nerve to conduct. Patient’s with this pattern often feel tight in their neck and upper shoulder. When they try to stretching the muscles it makes their nerve symptoms worse. This happens because the muscle is not tight but in protective spasm keeping the nerve from being injured further. In this case it is important to treat the nerve first before trying to lower the shoulder girdle.

Advertisements


What Can I Do to Prevent an ACL Injury?

Brian Yee PT, MPhty, OCS, FAAOMPT

An ACL injury is usually due to the knee going into excessive valgus (knee turning inwards) and/or some type of rotary /pivot force. Many people focus on training the musculature around the knee such as the quad and hamstrings. This does help, but one must also consider the stability of the joints above and below – which would be the hips and ankle/foot complex.The knee can be viewed as a junction between two different stilts. If the hip is not stable or has excessive mobility, or the foot / ankle is not supportive such as excessive flat feet or stiff ankles from an old ankle sprain – it can place excessive valgus force at the knee – possibly leading to increased stress to the ACL.
Training thus should consist of hip and thigh training that does not promote internal rotation/valgus to the knee – such as gluteus medius / lateral hip stabilization, as well as improving ankle mobility/foot stability exercises. Once proper movement patterns are established, progression to higher level plyometrics, as well as sports specific training should be introduced.



What Can I Do For Plantar Fasciitis?

Brian Yee PT, MPhty, OCS, FAAOMPT

Pain in the arch or heel of your foot is commonly diagnosed as ‘plantar fasciitis’. However, there are several reasons that can cause pain at the bottom of the foot.

Plantar fasciitis: Usually due to an over-stretched arch. Treatment by taping, manual therapy, orthotics, and use of night splints can provide short-term relief. Long term prognosis is based not only treating the plantar fasciitis itself, but also restoring proper mechanics of the entire leg.

Nerve Pain: The tibial nerve, which is a branch of the sciatic nerve can cause symptoms in the bottom of the foot. The key to treatment in nerve injuries is to determine why and where the injury occurred and treat the nerve accordingly.

Muscle Trigger Points: According to Travell and Simmons, muscle trigger points in the calf and foot muscles can cause referred pain to the foot. Soft tissue techniques and intramuscular manual therapy can be used.



Play Golf? Avoid Lower Back Pain With These Stretches.

Brian Yee PT, MPhty, OCS, FAAOMPT

There are numerous studies that have come out recently that show the loss of lead leg internal rotation of the hip in the golf swing has a high prevelance of low back pain in golfers. This is due to the lead leg in the golf swing acting as your swivel / finishing point in the swing. With limitations in the hip, the back has to work harder to finsh the swing. 

You should work on the foam roll to loosen the lead leg hip musculature, knee to chest and pirformis stretches can also help.

Standard back stretches can help alleviate your back after golf, but consider the causitive reasons why your back is hurting in the first place. I work at a Nike Golf Performance Center called Terminus Club (www.terminusclub.com) we utilize 3D Motion Capture Reality systems to analyze your swing, as well as utilize a Physical Therapist to determine the physical limitations of the body. From there we tailor your swing based upon who you are as an individual and not just the way a PGA Tour swings.



Will I Need Physical Therapy After Hip Replacement Surgery?

Brian Yee PT, MPhty, OCS, FAAOMPT

It is recommended that you work with a skilled Physical Therapist after hip replacement surgery. The Physical Therapist will coordinate with the operating surgeon to improve your hip range of motion, strength, and progress your weightbearing and walking on your hip appropriately. They will also demonstrate to you safe and proper movement with your hip with functional activities such as sitting to standing, getting in / out of cars, and progress you back to your other functional and recreational goals.



How Does Posture Affect Back Pain?
Brian Yee PT, MPhty, OCS, FAAOMPT

The way you sit and stand significantly affects your back. Especially for prolonged duration, the tissues around the spine experience what clinicians call ‘creep phenomenon’.

Think of a cold piece of taffy. As you hold it, warm it up, and then hold it by its ends, it slowly stretches and lengthens. Very similarly, the tissues in the back can due the same thing. The fascia, muscles, nerve, joints all experience increased strain when the spine is statically held in one position for a long duration of time.

When you then place yourself in a poorly sitting or standing posture, that then accentuates the amount of tissue loading that is placed on the spine and its surrounding tissues. The ‘creep phenomenon’ is then accelerated and tissue breakdown and injury can occur quicker.

Correctly changing your postures can significantly place less stress on your spine.

Please consult with an appropriate practitioner to discuss proper ergonomics/postures.



How Can a Weak Core Lead to Back Pain?
Brian Yee PT, MPhty, OCS, FAAOMPT
According to Panjabi’s model, we can view spinal stabiilty based on 3 key elements:

1. Passive Structures: The spinal column itself and the ligaments, fascia and other static tissues that hold it together.

2. Active Structures: The muscles that surround the trunk and pelvis ‘actively’ contract to provide muscle support.

3. Cognitive / Motor Control: The brain has a way to coordinate how muscles will be used to anticipate how the spine is used with functional activities.

The passive structures and the spine itself is limited in its ability to stabilize the spine, especially in dynamic function or prolonged positions such as standing or sitting. The brain thus needs to coordinate the proper timing of muscle contractions and muscle forces to hold the spine together. Without proper muscle control and force the vertebrae of the spine will have increased shearing, torque or compression eventually leading to such things as vertebral degeneration, herniated discs, or other structural issues that may lead to back pain.

The notion of the ‘stronger you are – the better you’ll be’ needs to be carefully considered as it is more important to develop stability in the core that is efficient and properly coordinates with proper movements in your upper and lower body. There are many disciplines out there that teach movement patterning and stabilization, this can include pilates, yoga, functional movement training, feldenkrais, janda approach, and more. Each discipline has their specific methods, while there are also similarities. Please consult a qualified physical therapist or other health practitioner to learn more about proper movement training to stabilize your core.