Thomas J DuBois's blog

Active Isolated Stretching

I have always been a strong advocate of stretching. For years I have stretched on a daily basis as part of a way to maintain my health. I stretch my clients. I have felt that no rehabilitation program, exercise routine, wellness program or approach to a healthy lifestyle can be complete without it. I regularly try to educate friends and clients who exercise without stretching. Our muscles just go through too many contractions on a daily basis to maintain their natural resting length without assistance from stretching. Also, through most of our daily lives we are doing a limited number of motions. Therefore we become flexible in some motions and habitually restricted in others. Most authorities have maintained the traditional belief that static stretching (applying a stretch and holding it) for 3 repetitions of 30 seconds is the most effective way of lengthening a muscle.

Two years ago, while in Cambridge, Ma I was introduced to a new form of stretching and strengthening by Dr. Ben Benjamin. It is called Active Isolated Stretching (AIS) and has been in development over the past 30 years by Aaron Mattes RKT LMT. It is referred to as active because the person receiving the treatment initiates the movement and force is only applied by the therapist at the end of the movement. This idea of an assisted stretch where the recipient does most of the work of going through the motion is effective by exploiting something known as Sherrington's Law of Reciprocal Inhibition. This law states that when we use one muscle (the agonist muscle) the muscle that opposes that muscle (the antagonist muscle) will relax. So when I use my Quadriceps muscle group which flexes my hip to move into a position that would stretch my hamstring muscle group (which is the antagonist muscle group to the quadriceps) my hamstrings relax and are therefore able to be lengthened further than they would without the use of the quadriceps. The stretches are referred to as Isolated because we introduce specific and minute angles to the stretch to not only isolate specific muscles within the group to be stretched but we are also able to stretch and lengthen specific parts of the muscle. One of the final differentiating factors to this form of stretching is how long we hold the stretch for. And this is where i was at first a skeptic. These stretches are only held for 2-3 seconds at a time and they are done in many repetitions. The reason for this lies in recent research that has shown that during a static stretch a muscle has a tendency to contract and we wind up stretching the tendons instead of the muscle. By stretching the tendons instead of the muscle we weaken the tendons making ourselves more susceptible to muscular injuries such as strains, and tears. By lengthening the muscle through AIS we make ourselves less likely to suffer from such injuries. These repeated stretches are not the same as bouncing in a stretch, which is harmful. Because we repeatedly take the muscle through it' full range the muscle is allowed to rejuvenate by taking in more blood and oxygen.

One of the even more interesting things about this form of stretching is that since it involves working with the nerve innervations of the muscle through Sherrington's Law of Reciprocal Inhibition, we actually facilitate a better link between the muscle and the brain. This gives people more control over their muscles and makes them more effective and less likely to suffer injury. Something that has also been particularly useful to me, is that through AIS I can work on Tissue that is far too deep for even the deepest massage therapist to reach.

After receiving a number of sessions and seeing the results of this stretching myself I have decided to pursue it further. Over the past two years I have been travelling to Sarasota, FL to study with Aaron Mattes, the developer of the technique. At this point I am using it on nearly all of my clients and have been pleasantly suprised at how my results are significantly better than they had been without Active Isolated Stretching. In fact with many clients, we are getting results that I never thought we could in a surprisingly short amount of time. Book a half hour or hour of Active Isolated Stretching today and see the difference it makes.

Body Mechanics

Body Mechanics refer to the study of how to properly use the body to correct and prevent postural problems, reduce stress and enhance physical capabilities. There are proper body mechanics and there are improper body mechanics. Much like there is a proper way to drive your car to help ensure it's longevity, the same is true for your body. In my profession i work with a lot of people who have pain that is related to their work. In many, if not most cases these pains can be associated with poor or improper body mechanics while working.

Whether it is lifting heavy objects and enduring physical labor or spending all day answering emails at a computer desk, there is a proper way to use your body in order to accomplish your tasks. There are also countless wrong ways to do so.

Too many people suffer back injuries, wrist problems and chronic pain from their work. Why should it be that your livelihood decreases the quality of your life? Pain takes away from our ability to enjoy life. In regard to our work, it also takes away our ability to be as productive as we can potentially be. Not to mention, pain can also be a financial burden in how much it can cost to receive treatment and care for the pain.

Let's start with the basics. Standing. Standing is something most of us have to do at some point during the day. When standing, our feet should be flat on the floor and our weight should be distributed evenly over each foot. We should avoid standing on one foot or on one and half feet. We should also avoid leaning into one hip. Many people resort to this sort of leaning for a position of ease but this sort of posture can be a causative factor in conditions such as tilting of the pelvis, sacroilliac joint dysfunction, functional scoliosis and many other conditions that cause back pain. The feet should be separated as well. I have heard many authorities claim that 12 inches apart is a good base, however this may vary depending on the size and proportions of the person. Shoulder width apart is an acceptable guideline. The back and neck should be held straight as though they are a continuous line. It is also a good idea to wear shoes with grip on the bottom too. This will ensure good footing and help to avoid a slip or fall which can induce numerous, less predictable strains on the body. Having good footing and a firm base also gives us the ability to have more strength in what we are doing with our upper body.

When walking, one should keep their back straight and avoid slouching or leaning too far forward or to the sides.

Lifting is an important activity to discuss. Many occupational injuries happen while lifting an object. When lifting an object, one should bring their body as close to the object as possible. When getting an object off of the floor, one should bend at the knees and the hips in order to bring themselves down to the object. Do not bend at the waist. Try to keep the spine straight. Also, once holding the object you should hold it close to your body by wrapping your hands around the object. The further away from your body you hold an object, the more potential for strain. When carrying the object, hold it close to your body. If an object is too heavy for you to lift or carry, then you should ask for help and avoid lifting it on your own. Even with immaculate body mechanics, lifting an object that is too heavy is likely to cause injury.

Pushing or pulling objects is also an activity wherein people commonly sustain injury. When pushing or pulling an object, use your body weight to do so. Do not just use the arms. Your feet should also be apart. Sometimes it may be more efficient to assume a lunge stance. This may give you a more power since you are pushing from a wider base. Do not bend at the back or waist in order to push or pull an object.

If you are in the sort of profession that does not include so much pushing pulling or lifting, except maybe paper and pen pushing, then you also need to keep body mechanics in mind. In fact, many people's injuries and painful conditions can be attributed to poor sitting mechanics. Sit on your chair with your weight evenly distributed over your sit bones and your feet flat on the floor, shoulder width apart. Your back and neck should be straight. Some suggest putting a rolled up towel or pillow behind your lower back for support. This can be helpful and if it provides relief I suggest to do it. If one can sit and maintain the curve in their lower back on their own, however, this is ideal. Sitting this way on your own, without the support will strengthen your lower back. It is critical that your lower back is in the proper position and the arch is maintained. Otherwise the lumbar support is a better option. Your chair should be positioned at such a height that your knees are almost level with your hips. They should be a little lower than the hips so that the thighs slope downward toward the knee. Your computer screen should be directly in front of you so that you are looking straight forward at it. You should not have to keep your head turned to look at the computer. If you have multiple things happening on your desk and need to turn to one side or the other often, try turning the whole body and chair, not just the head. The computer screen should also be positioned at a height so that the top of the screen is level with your eyes. You can use a paper holder so that whatever document you are reading off of is level with the computer screen. Also, if you use the phone, try to use the speaker phone. This will create less strain than holding it up to your ear all day. Avoid slouching or using armrests. Armrests have a tendency to be too high. This elevates the shoulders and can create tension there and in the neck.

If you are sitting, but not at a desk, the same body mechanics apply. If you are doing an activity such as reading or knitting, place a rolled up towel on your lap so you do not have to look downward at what you are doing. This will help you to avoid neck strain.

Body mechanics are important. They can ensure longevity and dynamism in our career. We are much more dynamic and productive when we are not in pain or paying for treatment. Life is also more enjoyable without pain. I hope that you will find this advice helpful and implement it in your daily life.

Piriformis Syndrome

The piriformis muscle is a small muscle that can sometimes cause big pain. Actually, it is very small sliver of a muscle located in the back of your hip region. This muscle is part of a group known as the deep six lateral rotators. This means it is one of six small muscles in your hip that are primarily responsible for turning your leg outward. This muscle is also very commonly responsible for causing sciatic pain that affects the hip and gluteal area, and even sends pain down the leg.

In most people, the sciatic nerve (the sciatic nerve is a very large nerve that comes from the lumbar and sacral vertebrae and later divides to supply most of the lower extremity with sensory and motor function innervation) travels under the piriformis muscle and over the sacrotuberus ligament. In some people the sciatic nerve actually passes through an opening in the piriformis muscle. In an even smaller percentage of the population the nerve actually travels over the piriformis muscle. When someone has piriformis syndrome, this means that the piriformis muscle is tight or in spasm and entrapping the sciatic nerve. This will cause pain in the hip and gluteal region and even will send pain down the back and side of the leg to the knee. In severe cases the pain may reach all the way down to the foot. It was originally thought that those in the second category, where the nerve travels through the muscle are the most unfortunate group. This makes sense, because any tension in the muscle will cause it to squeeze the sciatic nerve. These people may be the those who most commonly experience symptoms of piriformis syndrome however, those in the first category, where the nerve travels under the muscle tend to have the most severe symptoms when they occur. Although it is less common for these people, the pain tends to be much worse, when it does occur. This is because unlike in those cases where the nerve travels through the muscle, now the nerve is caught between the muscle and the sacrotuberus ligament. When the nerve is caught within the muscle, it is squeezed on both sides by soft muscle. When it is caught under the muscle it is pressed against the harder, less yielding sacrotuberus ligament.

Piriformis syndrome is very common. Of the many things that can cause sciatica, the piriformis is said to be the primary cause in 6% of cases. This means that it is probably a secondary cause in many more cases. I have seen many cases where someone has a bulging disc as their primary cause for sciatica but also have significant tension in the piriformis muscle. With these people, simply releasing tension in the piriformis muscle has decreased their pain significantly, indicating that the magnitude of their pain from the disc injury was amplified by the piriformis also entrapping the sciatic nerve.

People normally experience symptoms of piriformis syndrome when the muscle is tight. This can be caused by overuse of the muscle in activities that involve the lower extremities. Sitting for long periods of time or doing things that require us to turn our legs out for periods of time like riding a horse also contribute. Many times this muscle will go into spasm as a result of trauma as well. It is also very common that someone falls and hits their coccyx on the ground only to cause the piriformis to tighten up and send shooting pains down the leg. Other causes include sitting with the legs crossed, sitting on uneven surfaces and pelvic tilting.

Interestingly enough, piriformis syndrome is often diagnosed when the problem is actually deeper. Often it occurs that a sprain in the sacrotuberous ligament is misdiagnosed as piriformis syndrome. For this reason many people will get treatment for piriformis syndrome and experience little results.

Luckily both of these conditions respond well to massage therapy. If the piriformis is the problem, then your massage therapist will work to lengthen the muscle and relax it through massage application and stretching. It is best to have a massage therapist who is trained in orthopedic massage. Massage can also work to help correct any contributing factors that may be part of the cause such as a pelvic tilt. If the sacrotuberous ligament is the problem, it is also important to have an orthopedic massage therapist who is familiar with the ligament and how to locate it. I would also recommend working with someone who is trained in Active Isolated Stretching. This will strengthen the ligament and protect it from being injured again. There is a principle in the body that describes the formation of soft tissue and bone. It says that tissue will develop along the lines of tension. This helps your body to form in the proper way. When you use your muscles, they create tension in a particular direction. This tension directs where more fibers are placed by the body. Active Isolated Stretching that places tension on the sacrotuberous ligament in the proper direction, will strengthen the ligament by encouraging the placement of more fibers by the body.

Many things can cause sciatica. Luckily, if the piriformis is what is causing it this is easily treated. In fact all causes of sciatica can be treated. If a certain type of treatment is not working, one should try something else, but never resort to just living with the pain. Something can be done.

Posture

"Sit up straight!" "Pull your shoulders back!" I'm sure these commands sound familiar. Whether it was your father, your mother, or your grandmother, most people have grown up being reminded of their posture. This is probably because those who were reminding us, were probably at an age where they were realizing the effects of bad posture themselves. In this case they were right in telling you to sit up straight. The extra energy it may seem to take to sit up straight at times may be nothing compared to the extra energy it can take to deal with the consequences of bad posture later in life. Posture is one of the key ingredients to a healthy and pain free life.

Why is posture so important? What is posture? Posture is how you hold your body up against gravity while standing, sitting or lying down. Good posture is a dynamic balance between three important ingredients. Those ingredients are the soft tissues (muscles, ligaments, tendons, fascia), the hard tissues (bone and cartilage), and the nervous system. When someone has good posture, they are holding themselves so that the skeletal system is aligned in such a way that creates the least pressure on joints, and the least tension or abnormal position in soft tissue. In good posture, all of the strain that is put on our body is distributed as evenly as possible. Any deviation from good posture, and you will have certain areas of the body taking significantly more strain than the rest of the body. Those who slouch are a perfect example. This is probably another thing that your mother used to yell at you for. In the slouch the head hangs down and forward and the shoulders roll forward. When people remain in this posture for years, their body changes to make this a more permanent position. The muscles in the front of the shoulder shorten, making it harder to pull our shoulders back when we wish to. In other words, the longer one deals with bad posture, the harder it is for them to fix. In addition to the muscles in the front of the shoulders shortening, the muscles in the back of the shoulder lengthen and have to work extra hard to do their job. For this reason they become strained and develop painful adhesion. The muscles in the back of the neck become shortened and tighten so increased pressure is placed on the discs of the spine. This also makes us more susceptible to arthritis in the spine. This description just shows the large amount of adverse effects that can come out of one example of poor posture.

One more example would be the knee. Examples of postural imbalances in the knee are knock knees or bowed legs. When either of these are present this can cause an imbalance in the muslces around the knee and an imbalance in the way the bones of the knee meet eachother. Often times this causes the bones of the knee to grind on eachother, eventually causing arthritis.

In addition to protecting us from injury, good posture helps us to feel better. In good posture, our muscles are used more efficiently. In poor posture, some muscles are being lazy and some are doing twice or three times the work that they normally do. This causes quick fatigue and soreness.

A good posture also ensures that we are breathing correctly and it also helps us to look better. People look best when they stand up straight. There is also increasing evidence that poor posture may lead to or exacerbate emotional stress. It is known and widely accepted that emotional stress can lead to bad posture, but poor posture is now also being looked at as a reason behind emotional stress. One explanation behind this would be that having poor posture in the upper back and neck can interfere with our breathing pattern. This can decrease the amount of oxygen in our blood and increase the amount of CO2. This increased CO2 increases the production of stress hormones and harmful catecholamines in the blood that are associated with stress. Another common outlook is that slouching can effect our self esteem since we have to look up at the world.

Below is a link to a page with 3 simple exercises to improve your posture.

http://www.bhg.com/health-family/fitness/workouts-programs/exercises-to-improve-your-posture/

Rotator Cuff Injuries

The rotator cuff tear is a very common injury. Statistics show that at any given time, 5-10% of the population has a rotator cuff injury. The rotator cuff is a group of four muscles that attach from the scapula (shoulder blade) to the upper part of the arm. These muscles are responsible for turning your arm in and out, raising it out to the side, extending it backward and even slapping it into attention at your side. One of the reasons that thes mucles are so commonly injured is that they are relatively small muscles whose actions are countered by relatively large muscles.

The muscles of the rotator cuff are very commonly torn in athletic activities. The tell tale example is the overhand throwing action. This is one of the most common baseball injuries for pitchers. The reason for this is that the action of hurling the arm forward to throw the ball is carried out (or shall I say thrown out) by the large pectoralis major and anterior deltoid which are big strong muscles. Then once our arm is almost fully extended, it is the job of these small rotator cuff muscles to slow and stop the motion. With the strong muscles in the front having already created such a strong forward motion in the arm, this can be a one sided tug of war with the rotator cuff as the loser. Often times in this scenario the supraspinatus, infraspinatus, teres minor (most commonly the supraspinatus) or a combination of the muscles will tear. This can be anything from a small tear in only a few of the muscle fibers to a complete rupture of the muscle. This will lead to severe shoulder pain and possible weakness or loss of certain motions in the arm. If the muscle ruptures completely, there is little besides surgery that can be done in the initial phase. Other athletes who practice sports that involve use of the arms are also likely candidates for a rotator cuff tear. Tennis players and swimmers also very frequently develop this condition.

Other scenarios in which the rotator cuff is injured can include a near fall. When someone falls, they may put their arm out to brace themselves. In this case the shoulder can be dislocated and push into the rotator cuff causing tearing. Occupations which involve raising the arm, especially over the head are also prone to irritating the rotator cuff. Examples would be hairdressers, painters, waiters and waitresses, fruit pickers, tree pruners, and grocery store clerks.

Again if one of the muscles is completely torn, surgery will have to be the first method of treatment. Once the healing has progressed significantly, it can be treated in the same way as other rotator cuff injuries.

The most common types of rotator cuff injuries, which do not involve a complete rupture, but fiber tearing in the muscle, respond well to a conservative treatment that involves massage, stretching and rehabilitative exercise. Ideally, one should find a massage therapist trained in orthopedic massage. They will be able to assess and treat the rotator cuff correctly. Initially they will probably employ friction techniques to the site of the injury. The reason for doing this is to bring blood flow to the area where the tendon is torn. This will speed up the healing process by bringing the nutrients necessary for healing to the injury. This will also create a functional scar tissue. This is important because without the friction the scar tissue will form but in no specific manor. The fibers of the muscle and tendon are oriented in one direction. The new fibers being placed here as scar tissue will be placed down in any old direction without concern as to what the surrounding fibers are doing. This patches up the tear but causes the muscle to remain stiff, weak and vulnerable to subsequent injury. This friction therapy helps to make sure that the scar tissue fibers are placed in the right direction, thus ensuring the integrity of the muscle. Friction is a very important part of the treatment and may be a little uncomfortable. Let your therapist know if it is too painful though, as this may prevent the proper results from taking place. This friction therapy may be followed by stretching to ensure that the muscle is flexible and you have your proper range of motion restored. If you heal the muscle and do not restore the range of motion, then you have not healed the muscle. This is because, with the muscle shortened, if you perform any sudden motion that overstretches it, you will injure the muscle again.

Once healing has taken place then one should engage in strengthening exercises. This also prevents subsequent injury to the muscle.

Plantar Fasciitis

The Plantar Fascia is recognized as being the sheet of fascia that runs from the bottom of your heel to the metatarsal heads on the bottom of your foot, just before the webbing of your toes. It, like all other fascia in the body is a thickened area of connective tissue. This particular thickened area happens to be on the bottom of the foot. The plantar fascia is known to travel from the anterior calcaneus (Heel bone: The bottom front part is where the fascia is attached) to the heads of the metatarsal bones (right before the webbing of your toes), but is actually the continuation of a longer chain of fascia. The plantar fascia is really just a continuation of the connective tissue that makes up the achilles tendon and the connective tissue of the leg. If we really wanted, we could trace this chain of fascia through the back of the knee and up through the common hamstring tendon, right through the thoraco-lumbar apenuerosis and eventually on up to the head. But, for now we'll keep it simple.

So we have described this structure as a thickened area of connective tissue on the bottom of the foot, but why is it there. What is it's purpose. Well, just like most things in the body, there is no one answer for this. First of all, it provides a thickened area of padding to protect the structures on the bottom of our foot such as veins, arteries and nerves. The muscles of the bottom of the foot are also allowed some protection and given some directional guidance by the plantar fascia. The plantar fascia also, along with the muscles, provides tension thoughout the bone structure on the bottom of the foot to maintain the shape of the foot. Shock distribution is another, very important feature of the plantar fascia. The foot is the part of our body that makes contact with the ground. We stand on our feet, walk miles on them, run, jump and even get swept right off them. In all cases except the last one, the shock created by the impact of the foot hitting the ground can be quite severe. If it was not for structures like the plantar fascia that distribute shock, this would all be absorbed by the bone and fractures would be much more common.

Now, one of the main problems with fascia is that it is avascular. Meaning, it does not receive a significant amount of blood supply. This means that when the tissue is injured, it may take a very long time to heal. Sometimes years. There are many people out there today who have had cases of plantar fasciitis that never seem to go away, or when they do, they come right back. The plantar fascia is made of connective tissue. This means that if you hold it in a shortened position for too long, it will shorten and become tight. Stretch it too far, too fast and it will tear. Apply this stretch to the tissue while it is shortened and you are even more likely to tear it. Whether shortened or stretched out this tissue has potential to tear where it is weak. In most cases, however, this tearing happens due to tension in the fascia. Overuse of the lower extremity from standing, walking, running and jumping can all produce this tension. Normally, this tension creates a higher arch around the instep of the foot. It is also speculated that this tension decreases the blood supply to the tissue even more. As we use the tissue and put demand on it, the tissue is constantly breaking down. In most cases this is repaired with nutrients brought via the blood supply. However, in the case that the tissue is too tight or is being overused, then the blood may not be able to replenish the area fast enough and small tears turn into larger tears and never adequately heal. This creates the constant pain on the bottom of the foot that is normally located toward the front of the heel. If the tension is not decreased then the condition can worsen. The constant pull of the plantar fascia on the calcaneus (heel bone) where it attaches, encourages calcium to be deposited and a bone spur (in this case known as a heel spur) can develop. This significantly increases the pain that most people with plantar fascia already deal with. This is because they are now stepping on an extra piece of bone that pushes into the already irritated fascia every time you take a step.

Now all of this sounds very daunting but there is hope for those who suffer from plantar fasciitis.  This is an overuse condition so one of the first prescriptions (besides commonly prescribed non steroidal pain meds) is to decrease the offending activity. It may be excessive running, walking, hiking, athletics or even standing. Unfortunately, since most of us use our feet to get around all day, offending activity cannot always be eliminated completely. For this reason it is necessary to take other measures in managing the condition. Stretching the plantar fascia is important. We must encourage the tissue to lengthen. Not only the plantar fascia though. The muscles of the posterior calf and leg should also be stretched. I mentioned earlier that the connective tissue of the plantar fascia is continuous with that of the back of the calf and leg. So, when these muscles tighten, this can produce tension in the plantar fascia as well. Actually, for best results a stretching routine for the entire lower extremity should be employed. I would recommend finding a therapist or trainer who is trained in active isolated stretching. In my experience this has the potential to produce faster results than conventional passive and static stretching.

Massage is very helpful and arguably essential in the proper healing of plantar fasciitis. Massage will help to lengthen the tissue of the plantar fascia and posterior calf. Massage will also decrease any muscle adhesions in the foot or lower leg that are contributing to the tension. Friction applications employed by an orthopedic massage therapist will help to break up scar tissue (which is a quick tissue fix but impairs further healing) and encourage tissue to orient itself in the proper fashion. The plantar fascia is made of fibers that run from the heal toward the toes. When scar tissue forms the new fibers are not necessarily laid down in this fashion but are laid down in all different directions. Again this is a quick fix but it impairs further healing and makes the tissue less flexible. Massage encourages the fibers to be laid down in the proper direction known as a functional scar tissue. Friction applications also bring blood flow to the tissue. This brings the nutrients necessary for tissue repair making the repair process much quicker.

Heat is also a good treatment for plantar fasciitis provided the tissue is not inflamed. More often than not the tissue is not inflamed (this being a primary reason that anti-inflammatory pain medications frequently do not provide relief). Actually it is being found that although previously thought of as an inflammation in the plantar fascia, most cases of plantar fasciitis are a breakdown and tearing - of the tissue without any inflammation present. For this reason, heat is normally a good option, bringing much needed blood flow to aid in the healing process. A good home remedy is to fill a water bottle with hot water and roll it on the floor under the arch of the foot. This is often times good to do prior to stretching.

In addition to this, it will be good to continue some type of routine in order to prevent the condition from occuring again. Although this condition happens to athletes who overuse their lower extremity, it is good to have some level of exercise routine for the feet and legs. However, you must make sure to gradually work into an exercise routine, because overdoing it from the get go can create the condition again. Stretching should be done before and after the exercise routine.

Chondromalacia Patella

Another condition that I see a lot as an orthopedic massage therapist is chondromalacia patella. The words chondromalacia patella themselves may have absolutely no meaning to you so to put it simply this is osteoarthritis of the knee. Not just any part of the knee, but particularly the backside of the knee cap known otherwise as the patella. Osteoarthritis is a wear and tear condition that many people consider to just be a result of life. While this may be quite accurate, (because in my opinion whatever happens in life, your fault or not, is a result of life) most osteoarthritis is the result of muscle imbalance around a joint. In this case the joint is the knee. Also, in this case the muscle imbalance is normally found in the vastus medialis oblique muscle.

Again, Chondromalacia Patella is an osteoarthritis on the underside of the knee. The surfaces of many of your joints in your body are coated in what is known as hyolin cartilage. Hyolin cartilage is a very slippery substance (unlike the granular rough bone it covers) that is actually thirty times as slippery as a block of ice. It is because of how slippery it is that it is used to cover the surfaces of our bones at joints. This allows easy gliding movement of the joint surfaces. Osteoarthritis occurs when there is too much pressure on the joint surfaces creating increased friction on these surfaces. Eventually the hyolin cartilage starts to degenerate and break down. The more it degenerates, the more painful and stiff our joints get. The other substance that is used to lubricate our joints is synovial fluid which is produced, in part by the hyolin cartilage (the other part is produced by a synovial membrane in the joint capsule). So the decrease of hyolin cartilage also decreases the other lubricating factors that go into joint movement, making movement more painful and stiff.

There are a number of different common causes for Chondromalacia Patella, but one thing that most of them have in common is increased pressure on the surfaces of the joint. This increased pressure can be created by a number of different scenarios. For one, kneeling for extended periods of time is an avoidable but common factor leading to osteoarthritis in the knee. Many people have occupations that require them to spend extended periods of time on their knees. Roofers, plumbers, tilers and painters are all examples. The simple wearing of knee pads while working can make a drastic difference in the amount of degeneration that is caused by this work.

Another very common cause is what is known as lateral patellar tracking. Your patella (kneecap) sits between two bones. The femur, which makes up your thigh, and your tibia which along with the fibula makes up your lower leg. At the end of your femur, where your knee is, there are two big rounds knobs called condyles on the left and right sides. The area between those condyles is where the patella sits. In a healthy state, the patella glides up and down between these condyles when we bend and unbend our knee. In many cases however, a muscle imbalance (usually a weakness in the Vastus Medialis Oblique and adverse tension in the Vastus Lateralis) causes the patella to move to the side. Now, instead of gliding between these condyles on a surface that is covered in slippery hyolin cartilage, the patella grinds (instead of glides) over the rough bony surface of the condyle. This causes the cartilage on the patella to wear away. This muscle imbalance involving a weakness in the vastus medialis oblique (VMO) can be caused by a number of things. Most commonly, it is previous injury or under use. Injury and pain around the knee cause the VMO to become weak and improperly perform it's job. This is why chondromalacia itself will, in many cases, further weaken the VMO and exacerbate itself. For this reason, the use of ice and anti-inflammatory measures will be useful in managing the condition. Injury also causes swelling of our knee which normally prevents us from being able to completely straighten it out. Straightening our knee is called extension and it is during the last 15 degrees of extension that our VMO is most active. So injury and swelling of the knee cause under use of the VMO and cause it to weaken. Under use of extension in our knee, as in those who spend too much time sitting, can also cause a weakness in the VMO.

Weakening of the VMO can be avoided in the case of injury if VMO excercises are done as soon as one can perform them. This usually means once the swelling has subsided. Proprioceptive massage techniques will aim at tonification of the muscle. Massage and stretching can also address the adverse tension that builds up in the Vastus Lateralis and encourage a proper muscle balance acting on the knee. Wider hips are another, less preventable scenario causing Lateral Patellar Tracking.

One more scenario that commonly causes Chondromalacia Patella is sustained knee flexion. In other words too much time with the knee bent. This can occur from sitting for long periods of time or having tight hamstring muscles that keep the knee in a slightly bent position, even when standing. This bent position keeps the patella pressed against the bone, slowly degenerating the cartilage. To avoid this, one can try to spend less time sitting, and if one has to sit for extended periods of time, try getting up at from time to time and stretching your legs a little. You can also use chairs that have a rounded edge as opposed to a sharper edge that digs into the back of your legs when you are sitting. This constant pressure of the sharper edge creates recurring trauma to the hamstrings causing them to remain tight. Massage and stretching will also be essential to help the hamstring muscles find their proper motor tone and remove any trigger points harbored in the muscle.

When people have chondromalacia patella, they normally have pain felt behind the kneecap. This pain can be very severe, however, and seem to occupy the entire area of the knee. The pain seems to be worse with the knee bent. For this reason, ascending or descending stairs can be very painful along with getting up or down from a seated position. People with chondromalacia patella also report pain when sitting for a long period of time. That pain is then normally relieved by getting up and moving around.

For those with Chondromalacia, exercise is essential. You must get out and move your leg. Motion is what helps facilitate the release of synovial fluid by the joint surfaces and synovial joint capsule. Those with arthritic conditions who do not move their body will rapidly get worse. A simple walking routine may be just enough to help keep the pain at bay. Most people report that walking also helps to give them some instant relief from their pain.

Disc Injuries

One of the most common injuries to the spine is the Degenerative Disc Disease. Many people have or know someone who has "slipped" a disc in their back or have heard someone refer to a bulging disc as to why they have trouble tying their shoes. It is so common that by the age of fifty, 85% percent of the American population will have shown signs of DDD.

When someone refers to a disc injury, they are referring to the degeneration of Intervertebral discs. The intervertebral discs are like little fibrocartilage spacers between each one of your vertebrae. They are made of cartilage and are softer than bone. This allows the spine to be as movable and mobile as it is. If the spine were made of just bone without these spacers, movement would be near impossible. These discs also provide some absorption and distribution of the shock and compressive forces that our spine can be subject to from things like walking, running, jumping, horse back riding etc. Throughout life, our discs are subject to wear and tear from the activities of daily living. Things like bending forward or twisting our torso can wear away at the disc material slowly and gradually. Actually, DDD is very common. There are many people who have disc degeneration and show no symptoms. This is because the disc itself rarely produces any pain. There are very few nerve fibers innervating the disc itself, so pain is not normally felt in the disc. Occasionally, the degeneration of the disc will cause the musculature surrounding the disc to become tight and produce pain. This sort of secondary pain is very easily treated with massage and stretching. Other than this secondary muscle tension, DDD does not normally cause painful symptoms until there in impingement on an adjacent nerve root. Impingement on the nerve root can be the result of a few different scenarios. For example, the material in the center of the disc (nucleus pulposis) can protrude from the disc after enough compression and press on an adjacent nerve root. Also, between each vertebrae is a space for the nerve roots to exit (the intervertebral foramen). Since the disc is a spacer, disc degeneration decreases the space between the vertebrae. This can narrow the space where the nerve root exits, making impingement of the nerve in this area more likely. Impingement will be even more likely if there is the development of bone spurs. This is common in the later stages of disc degeneration, especially if significant muscle tension is present. This nerve involvement in DDD will cause pain in the back, buttock and all the way down the leg to the foot at times. The pain can be sharp and shooting or be a constant dull ache that I have heard described as similar to that of a toothache in your leg. Once nerve involvement is present there is almost always muscle tension that develops around the injury and along the pathway of the nerve. This muscle tension creates tight, sore parts of the muscle that radiate pain, known as trigger points. DDD is most common in the lower back but can happen in the neck and very rarely the mid-back.

What is the reason that DDD is so common? For one, our back is an area that takes a lot of wear and tear. Running, jumping, twisting, bending and movement in general all produce some level of wear on the spinal structure. Not to mention other movements and injuries can create tension in the muscles of the back. This tension creates more pressure on the discs. Fortunately, if our discs have adequate nutrition (good blood supply) then they can be fairly resilient to these stresses. Unfortunately, though, most people's discs do not have adequate nutrition. The reason for this is that the blood vessels that feed the discs are very small and easily clogged to the point where no blood is passing through. These small arteries can become clogged in people who otherwise do not show signs of high cholesterol and it has been seen in children as young as 12 years of age. This is a reason that a diet high in fiber and low in cholesterol is beneficial to our back. Exercise also helps to ensure that these arteries are clear and helps to ensure blood flow and nutrient supply to the disc. Massage is another way to help ensure proper blood flow to the disc. Massage will also decrease tension in the muscles surrounding the injury, which will decrease pressure on the disc. This decrease in tension can significantly decrease the symptoms that are associated with DDD.

One other reason that this degeneration is so common is due to the fact that most of us do not use our body correctly. Most of us have jobs where we are sitting for long periods of time and if that is not the case it is likely that our job involves lifting of some sort. If you have a job in which you are spending long hours in a seated position, this is not good for your discs. Try to make an effort to get up and move around at different points during the day. Go for a walk and do some stretching or yoga at breaks. If you have a job where you are lifting, you need to make sure you are lifting correctly. Even if you don't have a job where you are lifting there is a good chance that you will be doing some lifting at home or elsewhere. It is not always the heavy piano that does it either. I have seen many more cases wherein someone "slips" a disc due to lifting something as light as a flower pot. This is because of accumulated degeneration over years of wear and tear. After years of wear and tear, all it takes is a the wrong motion. That motion usually involves bending forward. When we bend forward we increase the pressure on our discs by about 190%. That is without the added weight of an object in our hands. If we are lifting something, then the pressure is increased by even more. Any twisting motion added to the bending increases pressure. I know you have heard it before but it cannot be reiterated enough times. Lift with the legs. Squat before you grip something then grip it. Try to keep the back and neck as a straight line as you stand up and maintain the curve of the lower back if possible. If you are lifting on a regular basis, consider wearing a brace.

As mentioned before, aside from nerve pain, most of the pain associated with DDD is a result of the secondary muscle tension that occurs in response to the disc degeneration. These muscles then harbor trigger points which can cause pain to spread out at a considerable distance. This muscle tension also increases any pressure that is being placed on the nerve root. Again nerve pain can cause muscle tension along the entire distribution of the nerve root. The piriformis muscle often becomes tight, producing pain that mimics that of the nerve root. For this reason, massage can be very helpful in treating the symptoms of DDD. Your massage therapist will take measures to decrease these trigger points and tension in the surrounding muscles. This will often times significantly decrease the amount of pain that one experiences with their degenerative disc disease since muscle tension can account for most of the pain. This decrease in muscle tension also takes pressure off of the nerves. A good massage therapist will also pay attention to the rest of the muscles along the distribution of the sciatic nerve. Your massage therapist will also likely assess and help you address any postural problems that could be contributing to your pain.

Along with massage it is important to have an exercise routine for the lower back that includes stretching and this exercise routine should be part of a full body exercise routine in order to achieve the maximum benefit. Again, diet and exercise are also very important to ensure that the disc has proper nutrition.

Prevention

In my profession I see a lot of people who are in pain. This means the majority of the clients that I see have already injured themselves. Over time, I have been able to get a lot of practice at treating many common orthopedic injuries. Although orthopedic massage can be very effective and play an important role in the healing of these injuries, regular massage treatments are a good way to prevent pain. In fact there are many who claim that massage is even more effective as a preventative measure than a healing aid in most types of injuries and dysfunction. Massage can help maintain our body in an optimum condition so it is less susceptible to injury, dysfunction and pain.

The most common injuries in the body are simple strains and sprains of muscles, their attaching tendons, and ligaments. These very often happen due to Improper muscle tone. Improper muscle tone means that our muscles are too tight or too weak, or a combination of both. This creates adverse tension within our muscles, compensation patterns which affect other muscles and muscle imbalances around joints. All of these scenarios lead to pain. Tension can lead something as simple as a muscle strain or as serious as a tear and even arthritic pain. This can also lead to myosfacial pain which many people know as overall feelings of achiness and tension. Weak muscles do not adequately perform their job. This means that other muscles have to substitute or compensate. These muscles then are overloaded and can develop tension and pain. Muscle imbalances cause improper motions around joints. This is the basis for most arthritis in the body and can be the root of many muscle injuries.

Massage and bodywork techniques address muscle tone. Massage can lengthen and relax muscles that are too tight. Many times these tight muscles harbor what are known as trigger points or myofascial adhesions. These trigger points are areas in the muscle that become so tight that blood flow to a part of the muscle is impeded causing a lack of oxygen in the muscle tissue. This causes "knots" or nodules to develop and the area becomes sore and sometimes radiates pain. Massage is also very effective at eliminating these trigger points. Massage can also help to ease muscles that have been overworked by compensating for injured muscles. Often times, after an injury, we create muscle imbalances by favoring one side of our body. By overusing the uninjured side we then make ourselves more susceptible to injury on that side. Massage can help to control how much of a detrimental effect this compensation has on our body. Massage can help take the tension out of overused muscles and bring blood flow to the muscle tissue and adjacent structures, making them less likely to suffer injury. Muscle imbalances can also be addressed very effectively by massage treatment. Massage helps to lengthen and relax tight muscles acting on a joint. Most massage therapists and bodyworkers are also trained in strengthening techniques for muscles which are weakened around a joint as well. The symmetrical manner in which massage is given also encourages the body and it's muscles to find their proper balance. Overall, massage encourages a relaxed and healthy muscle tone which is your best way of making yourself less injury prone.

These are only a few ways that massage can help prevent us from suffering injury. In addition to these massage encourages us to breathe deep, relax and allow our nervous system to go into a parasympathetic state. This encourages the body to heal itself by creating a proper environment for healing to take place. One can obtain the preventative benefits of massage by getting frequent massage. Once a week is ideal, but once a month is sufficient for many and is also better than nothing. You can't really get too much, and if only done every once in a while, it only helps. Although massage becomes more and more effective at treating injury all the time, it may be even more effective in making sure they never happen. 

Breathe

We spend all day breathing. It is arguably the most important thing that we do. I can't really think of many things that I would choose to do instead of breathing if given the choice. As important as it is, how much time do most of us actually spend thinking about our breathing? For most of us, not much time at all is devoted to actually paying attention to our breath. Not much time is actually spent making sure that we breathe deep into our lungs, descend our diaphragm and expand our abdomen. So, since we are not making sure that we are breathing correctly, most of us are not.

So what does it mean to breathe correctly? When you take a deep breath your lungs fill up with air and expand. For this reason, space has to be created within the chest for this expansion. Ideally, our diaphragm muscle, which makes up the floor to our rib cage, will descend into the abdomen in order to make room for our expanding lungs. After this, the chest will expand and the shoulders may raise slightly, if at all. There should be little to no raising of the shoulders on taking a deep breath.

Unfortunately, most of us do not breathe this way. Our fast paced lifestyle keeps us from paying attention to our breath. It also puts our body into a state that prevents us from breathing deep and encourages us to breath shallowly. For many of us this means we are never using our diaphragm and never fully expanding our rib cage. This causes our diaphragm to develop adhesion and become restricted. This prevents it from working correctly whenever we do try and take a deep breath. Because our rib cage never fully expands this causes the ribs to lose their normal mobility, also restricting breathing and in many cases causing upper back pain. This type of faulty or shallow breathing pattern causes us to instead raise our shoulders in order to accommodate the expanding lungs. This very quickly causes tension in the muscles and connective tissue of the neck and shoulders. Actually, most people with upper back and neck tension  have a shallow breathing pattern. This in part do the fact that shallow breathing causes upper back and neck tension. It is also due to the fact that pain in the upper back and shoulders can cause changes in our breathing. With that said, most people who have tension in the upper back and neck would benefit from correcting their breathing pattern.

Correcting your breathing pattern can take time but often times you will start to notice results shortly after starting. Especially if you are consistent in your efforts. First of all, it is important to breathe deep. We should try, at various times throughout the day, to bring our conscience to our breath and make sure we are taking slow deep breaths.

Diaphragmatic breathing exercises are very helpful. If you know breathing exercises than they will probably suffice. Other options are to take classes in Qi Gong or Yoga. There are yogic breathing exercises known as pranayama which are very good for retraining the diaphragm. If you don't know any diaphragmatic breathing exercises, you can try this one. It is very simple yet effective at releasing and retraining the diaphragm. Lay on your back with a pillow underneath your upper back and head. Allow your arms to hang straight out to both sides so that your chest is open and your hands are as far away from your body as possible. Laying like this engages the diaphragm and forces you to use it. Lay like this for five minutes and focus on breathing deep. Try doing this daily. It is a reletively easy exercise to add to your morning routine.

Massage can also help with the breathing pattern. Most massage therapists are trained in diaphragmatic release to help improve your breathing pattern. massage can also treat the upper back and neck muscles which have become strained as a result of the faulty breathing pattern. Massage can also address any postural problems which may be contributing to the shallow breathing pattern.

Paying attention to one's posture is also important. Postural dysfunctions like slouching can also restrict our breathing pattern.

It may be too obvious to state, but one should refrain from smoking as well, as this will severely inhibit the breathing pattern.