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Common Faulty Movement Patterns Involving the Shoulder and Neck

Some of the most common problems that we see are due to poor motor control, especially of the scapula. Just an anatomy and biomechanical review: The shoulder complex is comprised of 3 very important joints that all need independent motion. These joints are the Glenohumeral Joint (the joint that you mostly hear about with injuries), the Acromioclavicular Joint (the bony connection to the rest of the body), and the Scapulothoracic Joint (the problem child). Problems arise when we do not know how to control the muscles influencing movement of these joints. The lack of control is due to compensation or poor motor strategies over time. The most common compensatory presentation that is seen is best described by Janda. He terms the condition Upper Cross Syndrome. Simply explained, the Pecs, Upper Traps, and Levator Scapulae are all tight (or neurologically facilitated), while the Deep Neck Flexors, Middle/Lower Trap, and Serratus Anterior are all weak (or neurologically inhibited). View picture below for reference.

 

 

Here is a question to ponder for the colleges: How do you think constant use of secondary respiration muscles influences the neurological tone in Janda’s facilitated muscles? Are we creating a lower threshold for activation of these muscles in other daily activities?

The painful source of this type of presentation can be anterior shoulder pain, upper trap pain, neck pain, headaches, TMJ dysfunction, etc. The painful source is determined by which structure is compensating the most and what daily activities you find yourself doing most. We preach this often, but Band-Aid care will not fix this issue. Adjustments, soft tissue work, single joint exercises and dry needling is not what you should be seeking for care. This, like many other conditions, is due to how you use your body. Stability of the scapula through an overhead range of motion is easier said than done! The goal is to change your movement strategy. By default, tone and trigger points will dissipate… for good, unless poor movement strategies are resumed.

The goal of treatment should always be fixing the problem long term. This can only be done by changing the way your brain chooses to move your body through space. It is our goal to make sure you can continue to swing a golf club for the rest of your life, to not be in fear of picking up children and grandchildren, and to be the weekend warrior you’ve always dreamed of being.

 

 

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.

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Knee Pain

Common Faulty Movement Patterns Involving the Knee

Everyone at some point in their life has had knee pain. Most commonly this pain is at the front of the knee and may hurt walking up and down stairs. Knee pain comes and goes but it is a huge sign that biomechanically something isn't right. The knee is considered a stable joint because its plane of motion is mostly in one direction. Muscles that surround “stable” joints have a unique ability to produce tremendous torque. Torque at a joint is simply movement in one direction in a period of time. The knee, for example, is able to extend very quickly and forcefully due to its “stable” joint position. Another way of saying this is that there is less variance of joint position so the muscles can fire maximally with one purpose. The only problem with this joint stability is that our muscles surrounding our knee are not very good at stabilizing joint position. This is usually because we are not often in “unstable” joint positions at the knee where the muscles are forced to stabilize.

The opposite is true at the hip and ankle. These joints have many planes of motion which force the muscles surrounding to stabilize at each joint position. The muscles surrounding these mobile joints are not as capable in providing torque, but rather are great at providing stiffness. This is because the muscles at these joints are forced to act as stabilizers more often on a daily basis. Stiffness is achieved when muscles from either the side of the joint (the antagonists) contract in synergy to provide less movement at the joint. Now don’t get confused, the muscles around the hip and ankle are not there to limit movement but rather stabilize the joint through a large range of motion. With this being said, there are many instances where different levels of torque and stiffness at each joint are needed simultaneously and independently. A problem occurs when range of motion or muscle control is lost. Let's say we have someone with anterior knee pain. Yes, most likely rectus femoris or your quad is tight. At this point you must ask, “Why is my quad tight?” This could be because of a lack of hip extension, a lack of dorsiflexion in the big toe (not kidding), or multiple other reasons. After this you must ask yourself, is this a joint problem or a motor control problem. Do you have the joint range of motion but not able to use the range of motion through a functional movement? Are you not able to get into glute extension because of a lack of a stable core and subsequent lumbar extension and anterior pelvic tilt? The point is that something simple such as knee pain cannot be simply looked at as overuse. Getting a massage, dry needling, stretching, or simple single joint exercises are not going to fix the cause of your problem. A biomechanical problem needs to be addressed by analyzing biomechanics, not chasing pain. The key to getting out of pain and staying out of pain is realizing the difference between the cause and source of pain. No one has to live with knee pain. Make sure you are getting the care you deserve and get back to doing the things you love to do.

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.