Motion Stability's Blog


Could Uneven Shoulders Indicate Any Issue? by charlestlee

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.

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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.



Will I Need Physical Therapy After Hip Replacement Surgery? by charlestlee

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 Can a Weak Core Lead to Back Pain? by charlestlee
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.



How Is Rehabilitation Used to Treat Neck and Back Pain? by charlestlee

In Physical Therapy we treat neck and back pain by the following interventions:

1. Examination: Take a thorough subjective and physical examination to determine the causes and severity of pain. The examination helps determine what specific interventions need to be done. Each patient is unique in the medical history and interventions should also be individualized to the patient’s progress.

2. Reduce Pain: Especially in more severe pain complaints, it is important to reduce the symptoms to allow for the patient to simply feel less pain. This can include manual therapy to decrease muscle spasms, restricted joint mobility, or decrease nerve irritation. Modalities such as ultrasound, electrical stimulation and traction can also be used.

3. Restore Motion: As pain decreases, it is the goal for rehabilitation specialists to restore patients back to their functional activities. Mobility / range of motion is important to allow the patient to move again. Manual therapy, exercises including stretches and stability training, posture and gait/walking education are all necessary to improve the patient.

4. Improve Stability and Strength: In the neck and back there are key muscles that are designed to stabilize the spine, while others provide power and torque. In chronic pain conditions, it is important to improve the efficiency of muscle function rather than just ‘get people stronger’. Such muscles as the longus colli in the neck, shoulder blade / scapular stabilizers – such as the lower trapezius, or trunk stabilizers -including the transversus abdominis, multifidus, obliques, and gluteal muscles are all necessary to provide proper stability for dynamic function. Rehabilitation specialists have strategies to improve the stability of these muscles.

5. Function / Sports Specific Training: Once basic stability has been established, it is important to provide the patient the tools to return to full work, functional, and sports-related activities.



Custom Orthotics and Low Back Pain by charlestlee

image source: doctorsorthotics.com

Brian Yee PT, MPhty, OCS, FAAOMPT

The way the foot contacts the ground significantly affects the way your back absorbs compression to the spine. People who are flat foot footed can lead to decreased hip stability and motion. This is due to the foot not being able to provide proper support each time you step or stand on them. Over time the entire leg musculature, most importantly in the gluteal muscles lose their ability to provide proper support. This can lead to increased stress to the back…like jamming your thumb into a wall a thousand times over…you back gets ‘jammed’ or compressed.

Proper orthotic fitting can help the feet be placed in better alignment and thus provide proper support for the rest of the legs and ultimately the spine to be in a more efficient position to function during the day.

You should also consider that the bottom of the feet are highly sensitive with proprioceptive receptors..which detect spacial awareness. If the foot has better sense of its position, typically the rest of the body will also have better proprioception and spatial stability. It is thought that poor proprioception can make people more susceptible to injury. Orthotics can provide better proprioception.

There are many theories of how orthotics should be made. Please consult with various health practitioners to see what their opinions are about the design of the orthoses.



Can high-arched feet have any complications? by charlestlee

image source: amazonaws.com

Brian Yee PT, MPhty, OCS, FAAOMPT

People with high-arches typically have less give in their foot as compared to those with flat arches. It can affect different body parts. With a more rigid support at the arch there tends to be greater forces dispersed at the heel and ball of the foot. Whether it be callouses, neuromas, or spurs many times they are formed due to excessive forces on that area. People with high-arches also tend to walk on their outside of their foot This makes them have more weight-bearing forces to along the outside of their legs. Commonly you see associated problems with ankle sprains, lateral knee pain such as iliotibial band syndrome (ITB), or lateral hip pain. There is also a tendency for people with high-arches to be generally stiff in their joints and muscles. This is due to a greater amount of ground reaction forces not being absorbed in the foot and sent higher into the legs, back and trunk as weight-bearing occurs.

Physical Therapy typically focuses on improving the soft tissue and joint restrictions that are associated with the rigid / high-arched foot mechanics. Use of proper shoe wear and possible orthotics can help reduce the stresses on people’s feet as well.