Motion Stability's Blog


Natural Nerve Pain Treatments by charlestlee

image source: espaifisioterapeutes.com

Brian Yee PT, MPhty, OCS, FAAOMPT

In Physical Therapy, nerve pain can be treated naturally through techniques called ‘neurodynamics’. According to a colleague of mine, Michael Shacklock in Australia, there are three major areas to address. This includes the mechanical impingement sites, the nerve itself, and the tissue the nerve innervates.

First, nerve pain can be caused by a tissue that pinches on it. This could be a herniated disc, a muscle spasm, or arthritic changes in the spine. Such treatments as mechanical traction or soft tissue massage around the pinched area of the nerve can alleviate the nerve pain.

Second, the nerve itself can become injured. Physical Therapists use manual therapy techniques to mobilize the nerve itself to reduce its pain and improve it mobility. Similar to having a knee surgery, it is important to calm the swelling and pain down while progressively improving the range of motion back to its normal length. Nerve is just as much of a connective tissue as ligaments or tendons are.

Lastly, when nerve pain occurs it becomes inflamed, a term called neurogenic inflammation. Like a hose spraying with water, when the nerve is inflamed it sends inflammation to its termination sites – such as muscle, joint, or ligaments. It is important to improve muscle or joint restrictions that surround the nerve to fully treat the nerve pain and its residual effects.

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What are the treatment options for back pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

Accurate diagnosis of the sources of back pain will indicate the type of treatment you should receive. However, after structural reasons of back pain have been ruled out (such as a herniated disc), the majority of patients are diagnosed with ‘non-specific low back pain’. 

What we find clinically is that traditional interventions such as medications and injections, although perhaps needed and based on a physician’s recommendation, provide short-term relief.

There is growing research and clinical attention on trying to diagnose or sub-group ‘non-specific low back pain’. This can include movement dysfunction, fascial restrictions, muscle control dysfunction, myofascial trigger points, psychosocial variables, pelvic pain, nerve referred pain, or internal/systemic issues such as referred pain from internal organs or hormonal/vitamin deficiencies.

It is important to find a clinician that is able to differentially diagnose the various contributing factors of back pain, and then be able to provide effective treatment for those sources – and then coordinate with other practitioners that can address other needed areas. Especially in chronic low back pain management, a multi-disciplinary team of health practitioners is usually needed.



What Exercises for My Core Can Help Prevent Lower Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.

Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine – eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back – regardless of how strong your core is.

As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist – such as a Physical Therapist – to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.



Could Uneven Shoulders Indicate Any Issue? by charlestlee

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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.



What Can I Do to Prevent an ACL Injury? by charlestlee

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? by charlestlee

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.



Why should I work with a rehab specialists for back pain? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

A rehabilitation specialist is able to identify reasons why your back pain is occurring based on the way the you move, palpation of the involved tissues, and rule out serious medical pathologies such as spinal based cancers. Back pain can derive from multiple sources including a herniated disc, a joint injury, a muscle strain, or referred pain from such things as vitamin D deficiency or internal organ issues.  If your back pain is due to musculoskeletal causes, the rehabilitation specialist should then be able to provide an accurate treatment plan that addresses the underlying causes of your pain and provide education, exercises, and ideas how to get your back to the functional or sports related goals you have.