Tuesday, December 4, 2007

Shoulder Pain and Impingement - A Simple Answer

Shoulder pain from impingement (meaning the pressing on the soft tissue of tendon, muscle, or nerve by bone), sometimes called “frozen shoulder” is a common problem. This occurs with great frequency in modern society because of a combination of factors, some anatomical, others arising from posture, exercise, and overuse. The pain involved in shoulder issues can range from mildly uncomfortable to completely debilitating. Complications can include pain, numbness and tingling in the elbow, wrist and hand and affect the thoracic outlet for the nerve trunk and artery for the entire arm.

There are several anatomical reasons for shoulder impingements. The first is that in order to have its range-of-motion the shoulder joint has it uses muscles and bones to provide stability. It has to be stable throughout wide ranges of motion in different directions so it cannot use a ball-in-socket joint like the hip. The fifteen muscles that cross the shoulder and provide for its movement capacity. They work in concert like a small orchestra, supporting and giving way to each other in a finely tuned manner. If imbalanced, the entire assembly will be affected. Even a small imbalance can eventually have a profound effect.

Another anatomical issue is the small amount of clearance between the bones of the collarbone and ribcage. The nerve trunk, artery for the arm and a tendon pass through a space less an inch across. The space can shrink from poor form in exercise, bad ergonomics (a forward leaning posture or too much extension of the arms at the keyboard) or overusing a set of muscles in comparison with their balancing set in the “orchestra”. Decreasing the space just a few fractions of an inch can result in pain, blockage of blood and nerve impulse flow. The normal operating tolerance for that outlet is very small, and like a car’s valves, operating without sufficient clearance produces overheating (inflammation) and potential damage. Once pain and loss of function begins, further muscle contraction and “guarding” of the painful arm progresses to more and more pain.

Classic “frozen shoulder” or adhesive capsulitis comes from tissues within the joint capsule of the shoulder that “glue” together, resulting in complete immobilization of the joint. This is not the case in most painful shoulders, especially if addressed early in the progression of the problem. Usually it is impingement of the tendon of the supraspinatus muscle of the shoulder causing the pain. If inflammation and tissue damage is kept at a minimum, functional recovery can proceed quickly.

Restoring the balance of range-of-motion to the muscles that provide stability and motion for the shoulder can relieve impingement very quickly and easily, when A Gentle Truth restores the perfect pattern memory for the area the body has stored. Often in less than 3 Gentle Truth sessions, pain relief is followed by movement recovery, then exercise and postural correction for long-term stability.

Sunday, November 11, 2007

Arthritis is not a "Final" Diagnosis

Arthritis has many forms and etiologies. All of these affect the joints through inflammation, stiffness, and degeneration Bowenwork can be effective in its application with three forms of arthritis especially. These are Osteo-Arthritis Rheumatoid Arthritis and Spondylosis.

Osteo-Arthritis said to affect close to 16 million American and is responsible for 7 million visits to the doctor each year. In the case of Osteo-Arthritis, there is joint inflammation brought about by wear and tear resulting in cumulative damage to the joint-protecting cartilage. This tissue cushion between the hard bony surfaces of a joint is compromised. This can lead to inflammation and stiffening of the joint. There can also be bony adaptation on the condyles, or ends of the bone. These can be spots of thickening or spurs where extra calcium has been brought in by the body at the points of greatest stress. If there is pain associated with the inflammatory process or spurring the muscles serving the joint can become reactive and tighten up. This can lead to further pressure on the joint and further tightness. This can lead to atrophy of a joint that is not being used due to pain, stiffness and inflammation.

Osteo-Arthritis is the most common diagnosis of joint and muscle pain from a primary care practitioner. The usual prescription is anti-inflammatories, rest, possibly heat on the joint and “ getting used to it, it’s a consequence of getting older”.

In Bowenwork it has been found that quite often that the gloomy forecast that one has to “get used to it” isn’t necessary. In many cases there has been found great relief from pain and inflammation along with recovery of lost ranges-of-motion. How can this be possible?

Quite often there has been more muscle reaction and inflammation than cartilage or bone damage and Bowenwork has an immediate relaxing effect on contracted muscles, as well as great enhancement of drainage of joint edema by the lymph system of the body. Even with cartilage damage and bony spurring Bowenwork has been effective in relieving pain and restoring capacity. There is even some evidence that under the right circumstances the spurring is reversed, the calcium being reabsorbed in the same process which all bones are completely replaced every seven years.

Rheumatoid Arthritis is considered an autoimmune disorder where the immune system of the body attacks the tissue of the joints. It affects 2.1 million Americans. The tissue of the synovial capsule of the joint becomes inflamed from an attack by the body’s own immune system, causing swelling fluid accumulation. The inflamed tissues release enzymes that cause an erosion of cartilage, which can continue down to the bone. Fibrous scar tissue can develop to connect the raw ends of the bone,

Bowenwork can help clients suffering from Rheumatoid Arthritis specifically in pain and inflammation reduction because of its enhancement of lymph flow and its balancing of the body’s autonomic nervous system. Bowenwork takes the body out of Sympathetic- “pain reaction/spasm” dominance and brings it back to Parasympathetic- “recovery reaction” dominance.

Spondylosis is a term used to describe Osteo-Arthritis of the spine. The same idea of joint “wear-and-tear” comes into play here, but with added consequences. The spine is the central support structure where posture and movement begin and end as well as the highway where nerve impulses are transmitted. When there is damage, perceived or true, there can be more serious reactions ranging from pain, loss of range-of-motion, neurological symptoms, even organ system reactions. What is interesting is that the arthritic changes seen on x-ray do not have an n exact correlation with pain or loss of function. High amounts of bony change may show no external symptoms, and vice versa. X-rays of 25-50% of people over 50 will show signs of Spondylosis. X-rays of 75% of people over 75 will be positive for Spondylosis-and most people will never experience arthritic pain. So a diagnosis of spondylosis is not a final judgment.

Bowenwork has shown that in addressing cases of spinal Osteo-Arthritis that the body can and does release unnecessary muscle contraction/spasm, reduce or completely relieve pain and help the body restore more normal organ function, along with diminishing localized inflammation.

Copyright 2007Kevin Minney

Source: Pathology for Massage Therapists, Ruth Werner

Pub. Lippincott, Williams, and Wilkins 1998

If you want to find a Bowenwork practitioner near you use for a referral.

I maintain a Bowenwork practice in the SF Bay Area.

Kevin Minney