What is TOS and how do us myo’s treat it? That’s what today’s blog is all about! If you have any hand or arm symptoms such as pain, numbness or tingling even if it only occurs at night it would be worthwhile having a read.
What is TOS?
Thoracic outlet syndrome is where the blood vessels and/or nerves become squashed between the first rib and the clavicle. This can result in numbness, tingling or pain in the neck, shoulder, arm or hand or a combination of symptoms in a combination of areas on down the same arm. If you’re experiencing any of these symptoms it can be diagnosed and treated. It usually takes a month or two to resolve. If your symptoms are severe we suggest going straight to a medical practitioner for scans and specialist opinion however if your symptoms are moderate or mild Myotherapy may be a quicker and cheaper alternative to alleviating your pain.
How does Myotherapy treat TOS?
We will first do some clinical assessment including a neural assessment to check what is causing your symptoms. Sometimes even though you have the symptoms of thoracic outlet syndrome, your pain and symptoms can be coming from elsewhere such as carpal tunnel, from the neck of referred pain and tingling from trigger points around the shoulder, neck, arm or forearm. Once we determine the true cause for your symptoms we can usually do some treatment straight away.
The treatment for TOS specifically involves treating the muscles and mobilising the joints involved in drawing the first rib and the clavicle closer together. These might include the scalenes or the pectoralis minor for example. Next we will work with you to develop a plan so it doesn’t become a recurring theme. This may involve simply identifying the cause and changing some habits however it may also include some home based exercises, self treatment with a self release tool or some specific exercises you will need to do under supervision. We take into account your busy lifestyle so don’t worry that you’re going to go home with a long list of exercises.
What is the best home treatment for TOS?
Want to try something at home to help? Find us on instagram or facebook @myothrive for tips such as spiky ball release for the pectoralis minor muscle. Because the pec minor attaches from the coracoid process which sits just under the collar bone, and then down onto the first couple of ribs, when it gets tight and short, it can lift the rib cage up causing a narrow space for the nerve, artery and vein to pass through. By gently releasing the muscle we can allow the rib cage to drop back to it’s usual resting place and give more space to the blood vessels and nerves. Overdoing this one will leave you feeling bruised so take it slow for best results.
If you want to organise a chat with one of the Myotherapists here at Myothrive, simply email us at [email protected] and we can organise a time. Want to book now? Here’s the link!
Headache Assessment Headache relief comes from a thorough assessment. We can tell in the clinic if your pain is musculoskeletal by taking a history of your headaches and assessing your joints, muscles and nerves. If we see anything of concern, we will refer you to your doctor with a letter of findings. “more common in […]
There are several reasons why you might experience pregnancy pains related to muscle, joint and nerve. Depending on where the pain is, the intensity of the pain and the type of pain will determine the best course of action to resolve your pain. If the following exercises don’t help or if your pain is intense, […]
Do you ever experience groin or hip pain during or after running, deadlifts or squats? Do you feel like you never get a good hip flexor stretch even though to you they feel tight? It might be a hip alignment issue. A hip alignment issue can lead to Femoral Acetabular Impingement (FAI) which means an impingement of the hip.
FAI can become a problem for active and sedentary people alike. It may be aggravated by activity, sitting for long periods of time, operating the pedals in a car and crossing your legs.
On the other hand, even if you don’t have any symptoms these exercises may improve the quality of your chosen exercise. Check out the video below where I demonstrate 3 simple exercises that are quick and easy to help get your hip alignment improving. Let us know your favourite by leaving a comment!
Think you might have FAI?
There are 3 main types of FAI but often aligning the joint can make a huge difference to pain and function. Often people we treat in the clinic avoid surgery and cortisone injections all together.
Cam – This type of FAI occurs from a bit of extra bone on the head of the femur which then jams on the hip socket (acetabulum) during activity. This type typically occurs in young athletic men.
Pincer – This occurs more often in middle aged women and is the least common type of the 3. This type is caused by extra bone around the lip of the hip socket at the front then as the femoral head rotates it catches or jams against the extra bone.
Mixed – This is a combination of the two previous types; cam and pincer. As described above it causes a catching or jamming in the front of the joint capsule.
These 3 types all describe bone issues however often the pain is from other tissues around the area including ligament, tendon and muscle. Better hip alignment helps reduce the bodies protective mechanism. If movement begins to feel easier and pain begins to reduce, we know we are on the right track!
If these exercises didn’t help your hip alignment or hip and groin pain we have a lot more tricks in our Myotherapy bag. Reach out and we can have a conversation or click here to book. We offer both online and face-to-face consultations.
What to learn more? Check out this other articles.
Femoroacetabular Impingement (FAI) also known as hip impingement is a problem among active and sedentary people alike. Symptoms may include pain in the groin or hip area and restricted hip range of motion (ROM). It may be aggravated by activity (both intense and endurance types), sitting for long periods of time, operating the pedals in […]
CR Stretching or Contract-Relax Stretching is a form of stretching where you hold the muscle in a state of contraction for a period of time (usually around 5-10 seconds) then on the relax phase (usually around 3-5 seconds) you move the joint to it’s new longer range and repeat. Repeat this contract-relax phase for 3 to 5 times until the muscle no longer increases in range. Follow this by holding the last position for 30 seconds. Sounds easy enough, right? But what is actually happening and why choose this form of stretching over dynamic stretching or passive stretching?
What happens when you stretch?
We used to think that stretching was causing a change in the structure and length of a muscle. We now know that stretching is more to do with the nervous system than the muscle. Our bodies are adaptable to our environment and within certain limits we can either shorten or lengthen a muscle over time depending on what feedback the nervous system is receiving.
So what is actually happening? When you hold a stretch, your nervous system gives feedback to your central nervous system that tells it is safe to “let go”. The central nervous system then sends a signal back to the muscles instructing them to lengthen a little bit. When we contract-relax stretch we fast track these messages. Holding the final position for 30 seconds also helps the nervous system to think of this as the new normal. If repeated often enough, i.e. daily for a period of 6 weeks, you should see significant gains in flexibility.
Factors that affect flexibility
Factors that can limit a person’s flexibility include:
previous injury to the muscle that has caused scar tissue (scar tissue lays in a cross fibre pattern unless stretched during the repair phase)
elasticity of the skin
temperature of the tissues on stretch (warmth increase flexibility)
time of day (most people are more flexible in the afternoon)
age (pre-adolescents are typically more flexible than adults)
gender (females are typically more flexible than males)
and the most important factor, ones commitment to achieving flexibility!
Who choose CR Stretching?
When considering what type of stretching is most suitable, always consider the sport or activity you want to master. If you are wanting to weight lift, you don’t just want length in the muscle but you also want strength, therefore dynamic stretching using your weight lifting in conjunction with lengthening the muscle may work best. If doing gymnastics you need strength at end range so passive stretching is not enough to keep injuries at bay, you again need a slower version of dynamic stretching to keep the strength in the end range of your stretch ability.
Contract Relax stretching is a great choice for people wanting to increase their flexibility. Try stretching at night after all your training and work for the day is done and focus on balancing your body out. For example, my hip flexors are short compared to my hamstrings when compared to standard range of movement charts. As much as I’d achieve the splits a lot quicker if I stretch my hamstrings each night, it would do no good for my gym and running technique so I choose the slower pathway to flexibility over injury!
You can also choose a CR stretch when preparing for strength training. Once you have completed the round of contract-relax stretching and held the last position for 30 seconds or so, you simply need to activate the muscle to be ready for strength training. You can do this by holding one last contract phase for a period of 10-30 seconds. This sends signals to the brain to get ready for contractions rather than stay relaxed. Passive stretching before working out before activating the muscle can leave you vulnerable to injury.
The most common desk related aches and pains we hear of in the Myotherapy clinic are neck, shoulders, back and wrists not to mention headaches! Here are some simple stretches you can try and see if they help alleviate your aches and pains. But first a couple of ground rules. If you have any medical […]
Short calf muscles, mainly the deeper soleus muscle can easily hold back your squatting ability. When this muscle is short you will have trouble letting the knee travel past your toes. In a normal squat (and particularly once you add load) in order to bio-mechanically keep everything aligned, the knee needs to travel past the toes […]
Shoulder posture is often overlooked until pain hits. We use our shoulders so much without realising. Every time we are at the computer mousing or typing away, every time we reach for our cup of coffee, every time we pick up the kids, the washing, the toys lying around and if you’ve made some time for yourself, every time you do your HIIT workout or yoga routine. We all know by now to relax the shoulders down away from the ears (hopefully without pinning them!) so I’ve focused this blog on a few different tips. Hope you get benefit and please if you have any questions, email me, I love questions!
Tip 1. Fix shoulder blade alignment
Did you know that your shoulder blades are not fixed to your rib cage? This is key, because it means it’s all up to the muscles to hold them in place so if you’re not aware of their positioning, they could be doing all sorts of things! Winging (the inner border of the shoulder blade lifts off the rib cage) is one of the most common postural concern of the shoulder blade.
Correct Winging with this routine…
To fix winging of the shoulder blades you first need to find awareness of them. To do this try these cues:
Widen your upper back by thinking of stretching your shirt sideways
Imagine you’re trying to blow up balloons that exist under your arm pits without using your chest muscles (this is hard but good!)
Before you start this next one, sit up tall and bring your ribs back over your hips (i.e. no flaring ribs). Next, hold onto the front edge of your seat, gently pull towards yourself and imagine the shoulder blades gluing firmly onto the ribcage.
No you know what you’re feeling for you can try incorporating your new skill into your workout routine. Try using a band to activate the muscles before you start your workout. Simply use the cues above for 1-3 set of 10 light pulls and 10 light pushes with a band (start with yellow, the lightest band and work your way up as you improve. Bands available at Myothrive). Then keep the cues in mind as you perform your workout. If you lose your awareness you can come back to the basics until you feel it again. Over time your shoulder blade posture will get better and better!
Tip 2. Fix Rounded Shoulders
Rounded shoulders can happen in two ways. It can come from the shoulder blades when weak lower trapezius muscles are combined with tight pectoralis minor muscles. We are going to focus on this problem today as the second problem takes a bit more assessment and specific exercises.
The other way you can get rounded shoulders is from the shoulder joint itself which is a ball and socket joint. The shoulder is the most moveable joint in the body in terms of its available range of motion. It doesn’t have much ligament support and is really reliant on the muscles and tendons to hold everything in position. This means if one of the muscles gets tight, or if ones gets weak then the shoulder can become slightly out of position. The most common movement we see is when the head of the arm (the ball) moves forward in the joint (the socket). This can lead to impingement, bursitis and tendinopathy or in short, pain and inflammation! As I mentioned, this second way of shoulder joint movement takes a little more assessment and personalised exercise prescription, so if you think this might be you, it might be worth booking in an Online Consultation with one of our musculoskeletal professionals here at Myothrive.
Try this routine…
To fix rounded shoulders we want to take a 2 pronged approach. One, we want to release the tight muscle at the front (pectoralis minor) and second, we want to strengthen the weak muscle at the back (lower trapezius).
Release pectoralis minor with a spiky ball, lacrosse ball or tennis ball either on the floor or against the wall. Below is a picture of the trigger points you are trying to find. Place the spiky ball against the trigger point then come to the wall or floor to add pressure. Next, move your arm up and down the wall to assist releasing the trigger point. You can simply hold the trigger point if you prefer. 60 seconds is plenty and a max of 3 spots. Pro tip: use a yoga block or book to add distance between yourself and the wall or floor.
2. Stretch pectoralis minor – see this post for three ways to stretch pectoralis minor.
3. Strengthen lower trapezius – see this post for ways to strengthen lower trapezius or find us on instagram or facebook for videos and pics (@myothrive)
Try these cues for during your workout to help shoulder posture:
Think of keeping your collar bones smiling 🙂
Keep the front of your shirt wrinkle free
Wear a tight shirt, if you feel your shirt starting to stretch around the shoulder or shoulder blade adjust until corrected.
Pro tip: Make sure not to over correct or pull your shoulders back unnaturally, this will work against your efforts. Just let it all happen naturally with time, with these tips you will get there!
Tip 3. Fix Head Forward Posture
If you have head forward posture it can place extra stress on the muscles around the shoulders which can lead to poor shoulder posture. This can happen in two ways. Firstly, it can cause the muscles that attach from the neck to the shoulders to work under stretch or work in positions that make their job more difficult. This in turn can create pain and trigger point activity in those muscles but like a cascade effect can also create tension and compensation in other muscles around the shoulders and shoulder blades.
Secondly, the nerves that come out from the neck down into your shoulders, upper back and arms can be put under stress. When these nerves get stressed they send signals that tell the muscles they are in control of to tighten. This is a protective mechanism because all the nerves feel is danger, they don’t necessarily know what is wrong or where. This over reaction can create a lot more pain than you bargained for.
Try this exercise…
This is one of my favourite exercises to help head forward alignment and thus, shoulder posture! Sit or stand in front of a mirror, imagine your chin is sitting on a shelf. Gently slide your chin back off the shelf until you feel the first point of resistance. Do 5-10 repetitions. I like to do this throughout my day by incorporating it with going to the bathroom. Doing small amounts more often will have a quicker effect.
Once you’ve been doing this for about a week or 2, you can try adding some over pressure to push slightly beyond that first point of resistance. If you have neck pain or suffer from headaches, just stick to the basic or come get some personalised advice from us by booking a Online Consultation. Here’s some more tips to help correct a head forward posture.
A few more tips…
Seeing is believing! Set up your video camera and watch yourself at your desk, watching TV, on your phone or doing a workout. Sometimes simply seeing what you’re doing incorrect can help you to adjust. Record yourself again doing it correctly so you can associate the new feeling with the correct head posture.
Lift your gaze. Get your screen higher whether it’s your desktop, laptop or iphone, try using books or pillows to prop up the screen to a better height. Same when you are working out, lift your gaze slightly until you feel your head is alignment with your spine. This one tip can help your shoulder posture a lot!
Strenghten your neck muscles. People have generally become a bit scared of working out the neck muscles in fear that it will create neck pain. It’s quite the opposite, weakness is associated with far more pain than strength! A great neck workout is to lie face down and perform your head retractions explained above. Just imagine sliding your chin off the shelf. Start with 1 set of 5 and work your way up to 3 sets of 10 over time. This can be done on hands and knees rather than on your belly if you prefer just try to resist dropping your head to far forward on the relax phase though!
Just like adults, children and adolescents can also experience musculoskeletal imbalances, conditions and pain. So how do you tell what your child is going through and what health professional to take them to?
If you child has been complaining of severe pain following a fall or injury it may be worth a visit to the doctor to rule out a fracture. If you’re not sure, come to us first to avoid exposing your child unnecessarily to radiation associated with scans. We will be able to assess whether it’s something that needs further investigation.
Other pain in children or adolescent that may be encountered include; growing pains, sprains and strains, muscle cramps, tight muscles from sport, joint alignment issues, scoliosis and other conditions such as childhood forms of arthritis. Some of these conditions we will be able to treat and some we will need to refer to your doctor or a specialist.
So how exactly can a Myotherapist help?
Step 1. Assessment
The first step in treating pain in children is to talking to your child about their pain complaint. Sometimes they need a bit of help from you (parent or guardian) but we try to develop a good relationship with your child by encouraging good communication with us directly. We might ask questions about your child’s pain; how long as the complaint been occurring? How long does the pain typically last when it comes on? Have you had this in the past? What type of pain (or can you think of another time you have had this kind of pain)? When do you notice it the most? Is there anything that relieves the pain?
Once we have an understanding of what has been going on, it gives us ideas of what things to check. This helps us rule out more serious conditions or confirm something that we can treat on the day. The assessment might be getting them to do a specific movement, it might include testing joint, nerve or muscle or getting them to do an exercise to see if it helps.
If we find something we are unsure of we will refer you to the appropriate health care professional such as a GP. If we find something we can help with we will move on to the treatment phase of the consultation.
Step 2. Treatment
With pain in children and adolescents, it’s really important to try to empower them to learn about their bodies and treat themselves. That’s why we try to stay as hands-off as possible. Treatment will usually start with specialised movement therapy or instructing them where to place a spiky ball to help. Upon reassessment if progression is slow then we will become more hands on. This hands on treatment may include joint mobilisation (not cracking), dry needling (if when discussed child and parent is not apprehensive), trigger point therapy and massage/myofascial release techniques.
Sometimes treatment will include a few different approaches but rest assured we will always explain what we’ve found and discuss the treatment plan with you as we go. We then like to retest and make adjustments throughout the treatment to make sure the pain is reducing and the range of movement is increasing. Again always discussing with your child and yourself as we go.
Step 3. Management
Next we will talk about things that are going to be helpful at home for your child’s pain complaint, we like to call this a “Remedy Routine”. This may include applying heat or ice to an affected area. It may include and exercise to stretch or strengthen, mobilise or align. It may include self treatment with a spiky ball or foam roller, it may include a care plan where we check in on their musculoskeletal complaint more regularly (this is ideal for more persistent problems). We will also answer any questions you have and make sure we have set an achievable plan that will fit into their schedule and into your life as a parent/guardian too.
We have built great professional relationships with some local sporting clubs including a gymnastics and acro club, a cricket club and some dance studios.
The clubs find their members are away less from injury when working with us and the parents find they are more confident in the clubs because they know we can offer advice and help out where needed.
We have been treating pain in children and adolescents since starting the Mount Waverley clinic in 2012. Over the years we’ve found the most common issues are posture at school and when doing study at home; not understanding how to control their bodies properly for particular sports or activities; and overuse from having breaks over school holidays, for example, then amping up training regimes when returning from the break. If this sounds like your child then get in contact and find out more about how we can help 🙂
We believe keeping your children active and happy is important to their overall health & development.
Just remember, persistent pain in children is not normal and should always be checked out. Email [email protected] if you have a specific question or click here to make a face to face or virtual booking. Virtual consultations are great for kids because we get to see their environment where they study or play and give them exercises that they can comfortably do at home. Best of all you don’t have to drive them to another appointment!
Why is my ankle stability important? Whether you enjoy running, gymnastics, lifting weights or walking the dogs, ankle stability is important. Even moving from standing to sitting and vice versa requires some ankle mobility and stability. We want your ankles to be strong and flexible. Keep reading to learn how to test your ankles and […]
I’ve labelled this blog Myotherapy & Osteopathy because they work so well together. I personally get a Osteopath treatment every 1-3 months and I get a Myotherapy session every 2-6 weeks depending on how much training I’m doing and if I have any niggles from old injuries. Many of our current patients use both Myotherapy […]
Whether you enjoy running, gymnastics, lifting weights or walking the dogs, ankle stability is important. Even moving from standing to sitting and vice versa requires some ankle mobility and stability. We want your ankles to be strong and flexible. Keep reading to learn how to test your ankles and also watch the video to learn the first steps of getting for stability.
How do I test my ankle stability?
Stand close to a wall or something you can grab onto if you loose your balance. Stand on one leg for 30 seconds. Now try the other side. If that was easy now try with your eyes closed. Be mindful you may loose your balance so make sure you are in a safe environment or we can go through it with you in the clinic. Again aim for 30 seconds each side. If you found you were wobbly on either of these exercises then it’s time to focus on building some ankle stability for yourself. You wouldn’t build a house without a good foundation and we shouldn’t expect our bodies to perform well if we aren’t taking care of our standing foundation, our ankles and feet. Watch the video below to take the next step!
What if I have an injury?
If you are suffering with any sort of pain related to or that may be coming from your feet / ankles. I suggest making a session with us to fully assess how to best remedy your individual situation. We can offer consultations both in the clinic and online for your convenience. Look forward to helping you become pain free and thrive!
Do you ever experience groin or hip pain during or after running, deadlifts or squats? Do you feel like you never get a good hip flexor stretch even though to you they feel tight? It might be a hip alignment issue. A hip alignment issue can lead to Femoral Acetabular Impingement (FAI) which means an […]
Why is low ab strength important? Lower abdominal (low abs) strength is really important for activities of day to day living and even more important if you’re participating in sport or general exercise. Test if you have weak lower abdominals as it can reflect in poor posture, sore lower back and tight hip flexors, legs […]