Lower back and hip pain that radiates down the leg. Ouch. Many of us experience this kind of pain, and the good news is in some cases there is something we can do about it at home.
Sometimes things are not quite what they seem. If you have ever felt pain in the lower back that shoots down your leg, you have probably heard the term sciatica. It is a diagnosis given by a physician that means you have a pinching of the nerve that runs down your leg. The diagnosis is required in order to really claim that you have sciatica because, as we will learn today, sometimes it's not really sciatica!
Your sciatic nerve comes out of the spinal column and runs down your leg, branching out to all the other little nerves. Anytime it gets pinched you will get tingling, numbness, pain, or even muscle failure of any area "down-stream" of the nerve.
Before we go any further, remember if you have any serious symptoms you need to see a licensed healthcare professional because there are a bunch of other things that could possibly be going on in this case and it's really important that you rule out some of the more serious things that might be blocking the nerve here.
The term "pseudo" means "fake", meaning it is not true sciatica. The terminology here is just a language quibble, but here's what it means: "True sciatica" is the nerve pinch as it comes out of the spinal column, and "fake sciatica" is the same nerve being pinched anywhere outside of the spinal column. The same nerve is being pinched in both terms, but to you the distinction is important: fake sciatica can be treated at home and with massage, stretching, and exercise... whereas true sciatica often requires medical intervention (you are dealing with the spinal column here, don't mess around with it if you don't really know what you're doing!).
One appropriate term we can use is "Piriformis syndrome" because it is often the piriformis muscle (a muscle that helps rotate your hip) that is actually pressing on the nerve.
A quick test that might help you determine whether you have true sciatica: the straight leg test.
You will simply raise (or have a professional assist in raising) the leg why lying down, and see if your symptoms occur/intensify as a result of the movement. If this test is positive (your symptoms are reproduced) then read no further, call your family physician or physical therapist and get a professional evaluation (please).
If that does not reproduce the symptoms, then you can poke around the hip bone and see if it's really tender. If it is, you probably are experiencing tightness of the piriformis muscle. Now let's get to fixing it!
Addressing the cause of the problem:
Pseudo-sciatica often comes from sitting at a desk too long, especially with a wallet in your back pocket. Holding one posture for a long period of time can make the rotators of the hip take on more of a postural role, causing it to tighten. Conversely, too much exercise can result in a type of overuse injury that also causes the muscle to tighten, especially if the exercise is a repetitive movement in the back/forward motion (remember the piriformis rotates the leg in the inside/outside motion) which causes the muscle to take on a postural support role. Similarly, a parent who holds their child on one hip will engage that posture shift, or a dancer who must maintain tone while the leg is extended, each have this feature of overuse in common for this particular muscle. When you know what causes the problem you can start to see the patterns that might contribute to it. For most people the first step is to add more movement to their lower body during their desk-sitting day. For athletes it means adding in some stretching and active resistance in the proper direction (the rotational plane) and regular maintenance of the hip muscles.
One of my favorite self-care tools is the tennis ball. For this trick I like to address all of the muscles that attach to the hip, but for the sake of brevity we will limit the current post to the gluteals and posterior hip rotators (just know addressing the quads and adductors is useful as well... because of the whole newtons 3rd law thing: each force has an equal and opposite reaction- in this case meaning the opposing muscles are contributing).
This self-massage is fairly simple. Place a tennis ball on the wall and lean against it. Or on the floor and lay on it... sideways, back, all around... you are feeling for some of the "X marks the spot" pictured above, and you can expect to feel radiating pain to the areas colored in red (not everyone will). You are going to find the sore spot and I would lean into the tennis ball for 15-30 seconds with moderate pressure, then ease up on the pressure and roll around a little as though you are pushing fresh blood into the area. The picture above shows gluteus medius and gluteus minimus, the one on the right shows the piriformis muscle. In the end the precision of tennis ball placement will come down to where you can feel it working. Sometimes that signal will be a sudden twitch of the muscle (it will withdraw as a protective reflex) or simply the signal will be dull radiating pain that mimics your pseudo-sciatica symptoms.
For this self-massage you don't want to over-massage the area, it will cause more harm than good (even though it might feel like you can keep going), limit yourself to 15-30 seconds in a particular area, then move to the next area around the hip joint. Wait a few hours before repeating the self-massage.
For all stretching and exercises I highly recommend employing the expertise of a Personal Trainer or Physical Therapist. Even as a therapist myself, I often find it very useful to get assistance from a colleague. So when you approach new stretches do so with caution. There are several variations for each stretch, for example if you can't do the stretch laying down, you can do it seated in a chair by crossing your ankle over your other knee, and leaning forward to stretch the hip.
Cross body stretch should only be done if there are no symptoms of lower back spinal injury. Even if you are injury free, remember you want to feel the rotation coming from the hip, do not let your lower back twist too much.
If you have a resistance band at home you can get some awesome stretches that are better than body weight alone. Again, exercise caution you don't want to pull too hard and injure the muscle. For this one you start with the band fixed to something (you can place it in the doorway if you don't have something to tie it to) and put your leg through the loop of the band, move away from the fixed point until there is some tension, then let the leg relax into the stretch.
Variations of the figure-4 stretch or pigeon pose: lying down, sitting, lunging, or even sitting in a chair. The main thing is that you get the ankle across your body while your knee rotates out. You should feel this in the back of the hip.
I hope this helps some of those frustrating instances of pseudo-sciatica! Please let me know if you have any questions or comments!
I am what you would call a "non-traditional" student. I didn't take the fast track to Physical Therapy and have a lot of variety in my background. Getting into a Doctorate of Physical Therapy program is extremely competitive, and since I did not have the proper background I had to learn a lot of the process on my own. In addition to that, I did not have a good undergraduate GPA, and many believe you must have a very high GPA to get into school. But I still got into 4 schools. So if you, or someone you know, is interested in getting into a Physical Therapy program, I am writing this post to hopefully help avoid some of the problems I encountered.
Your background doesn't matter
Having a diverse background might even be helpful. Taking some time to work teaches the importance of showing up on time, interacting with coworkers or customers, and other skills that you can apply to any field. Admissions knows this, but you can remind them in your essay, too.
I studied music and anthropology during my undergrad, became a massage therapist, and held jobs as a line cook, flower delivery guy, music teacher, and even a farm hand. I was all over the place, and none of it included anything particularly athletic. But it turns out, Physical Therapy is a very diverse field- it's not just for athletes. Many people don't know that there is physical therapy for heart health, for neurological rehab, for pediatrics, a hand/wrist specialization, for acute trauma, and there may be more opportunities for specialization opening up in the future.
Typically students study exercise science or kinesiology (the study of movement) during their undergraduate degree, and will have experience in sports. Those who study just about anything else are still considered "non-traditional" although I think that designation is starting to wane as more specializations emerge in the field.
The GPA that counts- Prerequisites
You don't have to have a perfect GPA. As I looked through most schools, their average GPA was around 3.8 which is pretty high for someone looking more around the 2.8-3.0 range. Some schools really weigh this number heavily, but others are starting to realize there are more metrics to look at. This means a couple things to me- I don't have to have perfect grades, but I need to show that I've been busy being a good contributing member of society.
Looking into DPT programs, there are a set of prerequisites that are common across all programs in the country. I picked two programs I wanted to get into and made a list of their prerequisites. I read over that list so many times that even two years later I can recite each of them to you by memory. My goal was, even though I had a low undergrad GPA, I could show I was serious if I got straight A's in my prerequisites. So that's what I did.
Getting straight A's was no easy task. I was not a straight A student in the past. For most classes I took a "good enough" attitude and a C grade didn't bother me. Aiming for good grades showed me the absolute difference in effort required, and understanding of the course material. At this point, I would be fairly comfortable saying that I really didn't learn much from classes that I got a C in during my undergrad. However, classes that I forced myself to get an A in I now feel very comfortable with, and feel like I have a much better grasp on the subject matter.
How to get a great grade for those who are not straight A students: the time to form new habits. Here is what worked for me:
1. Decide it's possible, and I'm going to make it happen. 2. Get a tutor. 3. Prepare for tutoring. 4. Assume I must self-teach the material. 5. Make a schedule and block off time for study.
The first step is fairly self-explanatory. I had to convince myself I could do it. Even when I thought "this is too big of a task, too many things to juggle" then I would turn around and say "well, I'm going to do it anyway, because that's how I'm going to get to my goal. This is what I want to do". Part of that process was becoming interested in whatever subject I was learning. I never had an interest in Chemistry before, in fact I considered myself quite bad at it. So I decided consciously to approach it like a child, a clean slate, and allow myself to be amazed at even very simple things. How amazing is it, how actually amazing, that people were able to look at teeny tiny little objects and realized they were bound together by some kind of force, and they were able to find ways to measure those forces? How actually amazing is it that those little interactions even exist? Once I became interested, I knew the biggest hurdle was overcome. The rest is just putting pieces into place.
The second step I can't emphasize enough. It's so important to get some 1-on-1 time with someone. I can't stand the lecture format where someone just reads the book to you while you fall asleep. It's not a way to learn. Who learns that way? I know some people must because it's still around, but I don't. And I bet a lot of non-traditional students don't learn this way. At all. I could start another post entirely about how much I disagree with the format of lecture in classrooms but that's for another time. Tutors are so helpful, but it requires finding a good one. I know what I'm looking for: sufficient understanding of the subject matter. Many free tutors don't understand the material that well, so I paid for one. The first couple didn't know their subjects that well either, so I paid more for a tutor, and found a good one. Think about how much the class alone is costing, how much the textbook costs, and investing in the local student population seems like a very reasonable investment.
The third step involves struggling with problems before seeking help. Each session I came prepared with a list of questions. I did not expect my tutor to teach me from scratch, I used the tutor to figure out where the flaw in my thinking was. I highly suggest this approach to any student- try to figure out a problems, then when you are stuck, have an outside source available to point out where you have taken a wrong turn. You won't take that turn again. The absolutely underrated power of a tutor. Plus, if I'm getting charged by the hour you bet I'm going to get as much out of the session as I can.
The fourth and fifth steps are just discipline steps. I knew to get straight A's I could not play the blame game, I could not find ways to cheat the system (or I didn't want to), and I wanted to know I'd done everything I could to get that grade. I blocked off my schedule for study time, and set specific goals for each study session. Doing this every single day, even on weekends, eventually lead to study habits that I never had before. The concept of self-teaching became a powerful tool as well. I learned how to look up videos and online programs that I could use to understand material. I know some people can understand it from one read-through the book, but certainly not me. Read, take notes, pull up a video, take notes on that, then attempt to teach the subject to make sure I really knew it well enough. I would teach the wall, it doesn't matter, just explain it to something.
The GRE test is also required, and scores must be fairly good here to be competitive. This one really counts more than anything. My personal approach and suggestion for a cheap way to prepare is to get Magoosh vocabulary, use vocabulary.com to review vocabulary every single day for 30 minutes a day (block it off) and use Khan Academy to prepare mathematics. These are just repetition sections, the equation for success here is simple: put in the time. And yes, it's a LOT of time. The essay portion is hard to prepare for, but searching for examples online might give you an idea. It's a think-on-your toes portion. I don't write great essays, as you can probably see in this blog (hah!) so find some good advice there from a professional. I definitely suggest using at least 3 months of preparation, at a minimum of an hour a day to prepare for the GRE. You can retake it, but just put the time in the first time and get that good score.
Observation hours can be difficult to get. They are important to make sure you know what you are getting into. Admissions wants to know that you've looked at the field in a variety of settings (usually 2 or more settings are required) and you need to spend a sufficient amount of time there (100 hours or more) to get a good idea about why you are really going to school. This is a point where it helped me to think "this is just a step to weed people out. Don't let them weed you out" and that motivated me enough to cold-call half the Physical Therapy clinics in the greater phoenix area.
Many people going into PT have connections in the field, through family members or friends. I had none, really. So I introduced myself as a student wanting to learn and get into a DPT program, and often that was sufficient enough to get involved with some observation hours. Many clinics will not allow student observers, but there are plenty of places that understand that student observation is part of the process to get into school for all students.
I also felt like this was a good opportunity to get to know some of the professionals in the area, so I treated the experience as though I may want to network with the therapists in the future. I tried to be attentive and ask questions when appropriate, which lead to a letter of recommendation from one of the therapists.
Oh yeah. You have to have letters of recommendation. So the above step is pretty much mandatory. I'm pretty awful at interacting with authority figures, so that one was a big step for me into a very uncomfortable zone. I couldn't rely on natural people skills (not my strong suit), so I went with my strength: my background knowledge of anatomy and biomechanics from my massage therapy training. Most therapists actually really enjoy being asked some technical questions: "what muscles are we targeting here, what is the goal of that treatment, what is something you commonly see that you could avoid?"
I had zero preparation going into observation. Nobody tells you how to observe. What do you wear? Do you just stand there for hours? Do you help out? Are you allowed to talk to the patients or touch them? I had no idea, so here's what I learned: at least in Arizona it's pretty much business casual (slacks and a polo shirt), you stand quietly and ask questions when they aren't busy, you can help out with folding sheets and towels, you usually can not touch the patients and you want to keep your conversation with them non-invasive. It turns out it's really situational, in some clinics you can say something as innocuous as "hey how is the treatment coming along?" and get the response "I'm terminally ill how do you think I'm coming along" and that shuts you up pretty quick. Some patients have a great sense of humor about their condition, others are very depressed about it. I feel like the more variety of people you get to be around the better insight you will have into being around a variety of human conditions.
I applied to 18 programs across the country. I knew my chances of getting into my top choices were very slim. I recall having many people go "Oh you'll get in, you are smart, don't worry."
No. Listen. This is difficult. I've seen people with much higher GPA's and test scores get denied multiple years in a row. So I cast a wide net, and I wasn't picky about which school I got into.
To choose the schools to apply to, I pulled up a spreadsheet of prerequisites. These can actually be found in a handy pdf file on the APTA website for comparison. I went through every single program in the entire country, and made a list of the ones that I had or was close to fulfilling the prerequisites for. From there I had to narrow it by minimum GPA. On each programs list, I had to go to their individual website and find their minimum admission requirements. Some required a minimum of 3.2 GPA to even be considered. This is a hard cap, don't bother pleading with them. I didn't meet those, so I had to scratch them off my list. Some have other minimum requirements, and I had to check each of those for every single program I wanted to apply to. I came up with a list of 30 schools I could apply to, then narrowed it down to 18 based on what I thought I could possibly get into based on GPA and GRE scores. I included my top 5 schools as a "just in case" sort of application. Spoiler: I didn't get into any of my top choices. That doesn't matter. I got into a program, and so now I get to go get a degree that I can use to start advancing a career.
Applications are expensive. Just to give you an idea, I spent around $1400 just on applications alone. Of course you have to come up with this money while going to school full time and getting your observation (unpaid hours) and pay your other school costs. Anyway, what I'm saying here is it's a big tidal wave of responsibility and it all happens in a very short period of time. So I had to make extra sure this was exactly what I wanted to do.
Summary of Advice
One of the best things you can ask a therapist is "what would you do differently, knowing what you know now?". Having gone through the application process, here's what I'd tell myself if I could go back 3 years:
Make a list of prerequisites for multiple schools, not just one.
Block off time for studying, invest in a good tutor.
Start getting observation hours early.
Start studying for the GRE early. Take the GRE early, a year before applying if possible.
Apply early. As soon as the application cycle opens in July, get that application out there.
The neck can be a particularly annoying place to get that nagging ache and feeling of tightness. It can be distracting and hard to work out. I personally get frequent headaches as a result of neck tension, and have tried many things to help relieve the tension that builds up in the neck as a result of posture, stress, and just living life. Today I'll go through a few of the self-help tricks you can use to loosen up your neck, with a focus on the base of skull muscles, the suboccipitals, and the other muscles that also connect to the area.
As always, I really really recommend seeking out a professional if this is an ongoing problem. Some of the techniques here I am passing along as they have helped others, but they don't work for everyone, and I often find myself going to a well-trained therapist in order to finally find relief from this problem. Additionally, it's good to screen for other, more serious problems. If your neck is so tight you can't move your head and you have a bad headache with it, you need to hop a ride to the Emergency Room, meningitis isn't something to mess with.
We'll start with a look at the muscles in the neck, then a few tricks on how to find some relief for neck tension. If you need to, you can review my post on "How Muscles Work", and we will be talking about some of the Trigger Points in the neck if you need a brief review see my post on "Trigger Points".
The suboccipital muscles lie just beneath the base of the skull, you can feel them when you run your hand along the underside of the bony back of your head.
The pattern of tension can develop from the posture a lot of us use every day: looking down. When you jut your head forward and look down at your phone, your book, your computer, it really puts strain on the suboccipital muscle group. To help correct this, we will use a combination of direct self-massage, some mobility stretching, and a few exercises to help diffuse the tension and allow some of the other muscles to do their job if this area is being a little overactive.
If you have a lot of tension here, it may take a lot of pressure to get into the deep layer of the suboccipital muscles. While you can try massaging these muscles with just your hand, it will certainly be a lot more comfortable to use a rounded tool, such as the knobbler, or a tennis ball. Laying face up, move the tool just below the base of your skull, to either side of the spine (not ON the spine) and let the weight of your head gradually increase pressure on the neck muscles. You can press and hold on a particular spot, or rock back and forth slowly to loosen up the neck. As you become more familiar with the feeling, you can apply more pressure safely to help release the tension, but I don't recommend pressing for more than 30 seconds at a time at this pressure.
Another phenomenon of pain in the neck is that sometimes where you feel it doesn't necessarily mean that's where it's tight. Pictured above is the trapezius muscle, and it is common for the tension coming from your mid back to actually create enough tension to "pull" all the way up to the neck (the red spots in the image show the referral zone- the pain felt some distance from the trigger point). When you are working your neck, don't leave out these spots, also accessible with a tennis ball (what a versatile tool)!
Simply shift the tennis ball (or whatever tool you are using) to the ares indicated by the X's in the above picture and let your body weight sink into the ball. It may help to visualize your muscles slowly releasing or melting away under the pressure.
To find these spots most accurately, note their location to the nearest bony landmark (like the upper edge of the shoulder blade (5), lower edge of shoulder blade (3), just on top of the bone of the shoulder blade (4), and be careful of the bone on number 6).
Exercise and Stretch
As we've discussed in the past, there are two ways movement works in our muscles: we can aim to stretch (lengthen) a muscle, or we can exercise (contract) a muscle. Many people use the word stretch and exercise interchangeably, but they are not the same.
Both can be useful for helping with neck pain, but the most evidence points toward exercise as being a long-term relief strategy.
When beginning new exercises I always always always recommend working with a professional who can guide you through the steps. They will help you to make sure you are going through the motion in a way that will best recruit the muscles we are trying to target, as well as avoiding injury and addressing concerns you may have as they arise. Remember, exercises are specific to the muscle you are working- running won't strengthen your arms, for example. Don't "wing it", learn the correct movements that will target the neck muscles and supporting groups, and the right weight and speed of contraction to get good results.
Look over this helpful guide written by a personal trainer for some of the exercises that are commonly recommended for this muscle group. The goal here is to help strengthen some of the muscles on the posterior neck and upper back. The reason we want to do this is because these muscles are stressed from holding your head up and forward all day!
Think of it like this: as your head leans forward, the muscles in the back get longer, but they still have to do their job of stabilizing your head. So these muscles are already stretched, what we want to do is strengthen them.
The main goal will be to introduce exercises to strengthen them.
I have to emphasize this. Many people find stretching easier, you just relax and let the muscle lengthen. But again, you need these muscles to get stronger to get the best relief. If you just stretch them, all your doing is making a long muscle longer. You need to add exercises.
OK now that I've called stretching nearly useless, I need to walk that comment back- no it's not. You probably need to do them both, it's just that people tend to ignore the exercise portion of this advice. So let's get into the stretching part!
To stretch the suboccipital muscle group, simply grab a towel and fold it up so that you can still get a handle on it. Place it on the base of the skull just under the curvature of the skull, and do two variations:
1. pull forward and down
2. pull forward and up
There is a drawback to doing this by yourself. When pulling up, you are looking to cause gentle traction on the top of the neck. When you do it yourself you are using the muscles that lift your arms, which means you can't fully stretch them because you are also contracting them. A professional therapist can help a lot in this way.
This article has a few other tips for some self stretching for the neck.
The physiotutors have a great video on fixing trapezius tightness that goes along with this very well.
And check out this video for a few more tips on stretching your neck using a towel.
I hope this helps with this pesky problem! Please let me know if you found any of these tips useful, or if you feel like you understand how your neck works a little better!
This is a follow up to the first post on benefits of exercise, which can be found here.
So you’ve heard exercise is good for you, and you’re like “yeah it’s probably good, but I’m fine, it can’t be as good as just having the evening off to chill at home” which is more like something I have said and I’m projecting it onto you. If you are also like me, then you also need sufficient evidence before you’re going to make any lifestyle changes. So here we go...
Today’s post is the meat-and-potatoes of 'why' exercise is good for you, but maybe more importantly 'how' it is good for you. In most cases, a “trust me, this works” is not really sufficient for us to really understand how something works, and we have a much deeper respect when we see the -why and how- it works.
Ok, exercise is a little good for me.
No, hold up. It’s actually got some amazing nuances to how it changes your mind and body. The Academy of Medical Royal Colleges released a report going so far as to call it the closest thing to a “miracle cure”. (http://www.aomrc.org.uk/publications/reports-guidance/exercise-the-miracle-cure-0215/) This report was not just based on a few case studies, but many randomized controlled trials and meta-analyses. Ok maybe not total-miracle-cure-for-everything, (https://www.bmj.com/content/350/bmj.h1416) but we have a LOT more evidence for the benefits of exercise compare to, say, some supplements that seem to come in fad cycles. And the best thing is that I’m not trying SELL you anything, this is literally something you just go out and DO. (On the other hand, I really promote the use of a personal trainer on occasion to check up on your form and muscle engagement, as well as the "do as much as you are able" mentality for your particular circumstance.)
Inactivity is a natural result of convenience. But being inactive has become such a problem that many big research groups have given it the pleasant term “Sedentary death syndrome”. (https://www.ncbi.nlm.nih.gov/pubmed/15317985) The phrase is to give you an eerie feeling for a reason: It describes “major public health burden due to its causing multiple chronic diseases and millions of premature deaths each year”. Meaning not just one or two diseases, but like, a BUNCH of them. Even for diseases that don’t necessarily have a direct link to being sedentary, research is pointing more to the likelihood of a sedentary lifestyle making matters much worse.
The problems with NOT exercising:
May be traced to ‘the cause’ of many chronic diseases
The benefits of exercising:
Reduction of chronic inflammation
Reduced risk of chronic disease
Reduced risk of cardiovascular disease
Lower mortality risk
Improved cognitive function/prevent decline of cognition with age
Improve functional capacity
Relieve some types of pain
Improve glucose tolerance and insulin sensitivity
Improved immune function
It's not all about cosmetics, it's truly about health. Your body changes in response to exercise in ways that improve anxiety/depression, balance hormones, increase brain function and memory, reduce inflammation, keep you from getting sick, and also the extra benefit of being able to keep doing stuff when you get older. Like not falling over. Additionally, these effects of exercising regularly are still there even if you are overweight. (Yes, really.) Today's post is on the many amazing benefits of that thing that most of us totally hate... Exercise!
Fundamentals of Health: Sleep, Exercise, Diet
The first post will attempt to persuade you to the idea that exercise is a fundamental part of the puzzle of health and well-being. The second post will go into a small sample of the vast amount of research and data-driven analysis on the many ways that exercise benefits us.
As a massage therapist, I encounter all sorts of imbalances in a persons body. As much as we want to blame it on having bones out of place, blame it on genetics, or posture, or just blame it on atmospheric pressure... many minor imbalances can be corrected with exercise. As much as I love my clients coming to me for repeat treatment for problems that pop up over and over again, I really do want people to be healthy and have the tools to take care of themselves.
There are two main points I want to make in this post.
About 3 times a week for 30 minutes is all that many of us need for many of the benefits associated with exercise. After that much time, the benefits start to plateau, so unless you are looking to compete in a sport, your general maintenance can be done in as little as 30 minutes 3 times a week if you are able to do a vigorous workout for 30 minutes, or 5 times a week for moderate intensity. (1) The benefits do continue as you add more time exercising (up to a point) but this number (3x30) is a really good starting goal, especially for those with a sedentary lifestyle.
Types of exercise
As for the different types of exercise, there are some simple categories: endurance training, strength training, and stretching. Endurance training helps your heart health, immune system, and brain function, strength training (when done correctly) helps keep you upright and balanced, strong, and is good for your immune system and your brain/memory too. Endurance refers to high repetition (doing the same movement over and over again), and your muscles adapt by using oxygen more efficiently. Strength training refers to lower repetitions with higher weight (8 to 10 repetitions). This can be done by lifting weights, using a resistance band, or your own body weight. Each type give different benefits, so it is recommended to include some of each in a weekly routine (2).
Invest in your health
"I can exercise on my own, why would I need to employ someone to help me exercise?" To learn the things you don't know that you don't know. In other words, to help become well balanced, invest in a few training sessions with someone who can help customize a well-balanced routine for your specific body type. For example, you may not know that "the rhomboids retracts the scapula and rotates it to depress the glenoid cavity, functions to stabilize the scapula against the thoracic wall, is antagonized by the serratus anerior, and can be effectively targeted to help upper-crossed syndrome and neck pain" but you don't have to know what all that means if you have a trainer who instead says "Ok we're going to pull your arm backward for this exercise and it's going to help your back and neck". Let someone else do all the research and then boil it down for you. Invest in the person who is willing to do that, because it's saving you a ton of time and will leave you more well-rounded as a result.
Maybe you are clued into the idea of "buy local" ... it helps support your local vendors, you can feel all warm and fuzzy about buying from a local source and helping your home town economy. You can do this by finding a local personal trainer as well. Just like any other business, there will be good and bad representatives of the field. My best recommendation is to actively look for a class you can take (such as yoga, pilates, zumba) for the community exercise aspect (especially if you are very introverted) and a 1-on-1 trainer such as a personal trainer, who has proper certification, and expertise in working with people like yourself.
Things to look for: You want your trainer to be knowledgeable, especially if you have any chronic conditions that need to be taken into account. A good trainer will know that you need to be pushed in order to grow, but will know how to do it in a way that will avoid injury. The risk of injury can be minimized, but not completely avoided. The second part of the equation is that you need to communicate with your trainer.
You don't have to see your trainer 3 days a week for 30 minutes, you could see them once a week, or twice a week. Or see them once a month for a 'check up' depending on whether you are a self-motivated person. My recommendation would be to see someone twice a week for a month, then scale back to check-ups. I feel like this is a great way to get comfortable with their routine, see the progress you get in a month, then evaluate. Just remember, if your goal is muscle growth, you need to expect several months to see real progress. For those who have a sedentary lifestyle, you will see a lot of progress in your first couple months, though.
The second post (Coming Soon™) will start getting into the hard-hitting research on things like the benefits of exercise on chronic inflammation, depression, anxiety, oxygen usage in tissues, immune function, memory and brain function, adaptations to bones, muscles, nerves, hormones, and all the other stuff that you just can't wait to hear about! So stay tuned!
This post is intended for those who have irritation or discomfort near the shoulder blade without a clear cause (such as posture from being sedentary). If there has been trauma to the back or shoulder, or very sharp pain, I highly recommend contacting a professional. This post will have a few tips for things you can do for self-maintenance at home, from quick pain relief to more long-term techniques to keep the discomfort at bay. I must add extra stress on the long term techniques, especially for those who often are at the computer or looking down at their phone a lot. This pain pattern might also be explained by something called Upper Crossed Syndrome if you are interested in more information.
To see what may be causing the pain at the shoulder blades, I recommend looking over my first post on the topic.
This post is in no way meant to replace professional advice, and please be very mindful that you do not have other conditions going on (such as osteoporosis) before following any of this advice, and for heck's sake get an actual evaluation from a Physiotherapist if the pain is really bothering you. With that being said, here are some things you can do at home to help with mild discomfort of the inner shoulder blade.
1. Topical Analgesics
One of the easiest ways to deal with aching muscle pain is to just cover it up for a little bit. Of course this won't help in the long run but if it's driving you crazy, or just needs some time to heal, topical analgesics can help.
Some common recommendations:
and a host of others. Some people find pain relief from simple peppermint essential oil. Try one or two out, and see how you respond.
2. Hot/cold pack
The next simple thing to do is add some heat and cold to the back.
Prepare an ice pack in the freezer (or a bag of iced peas) and use a dry towel so the ice does not make direct contact with the skin (and also to hold it in place easier).
For heat, soak a towel in hot water, wring it out, and toss it in the microwave for a minute or until hot.
To alternate heat/cold, simply leave the cold on for 3 minutes, then put the heat on for 3 minutes, and repeat alternating a few times.
The idea behind this: heat causes expansion of blood vessels, cold causes contraction of blood vessels. By alternating them you are expanding and shrinking the blood vessels, and for some this can create a relief from pain.
3. Self-massage and Stretch
You can work on your own back and shoulder blade using a tool such a tennis ball. I have also used a theracane, a curved tool that you hold onto, with good results.
The Painotopia website has as great guide on how to locate the muscles you want to massage.
First you can try some trigger point therapy on yourself. This may provide temporary pain relief but I caution against using this method long term. Since the rhomboids are already elongated, you are effectively making a long muscle even longer. Actually, for most people, the better, longer lasting treatment (that nobody wants to hear), is building the strength of the muscle. (ref: J Phys Ther Sci. 2016 May; 28(5): 1636–1639) Which we will get to later.
Place a tennis ball on the wall and lean your back against it to hold the ball on the wall. Adjust the location of the ball so that it is right at the shoulder blade where the rhomboids attach (as shown in the picture), and check for any tender spots. When you locate the tender spot, lean into the ball to create a deep pressure and hold that pressure for 30 seconds. You want to feel a deep radiating 'ache' but it should not really be painful (if it is, stop). You need to make the distinction between good ache versus burning stabbing pain, the latter meaning you should stop immediately.
Now do the same thing for the spot at the infraspinatus, moving the ball onto the shoulder blade. This one can take your breath away, trust me I know. It can also really help to release this trigger point for a number of issues. You'll look for a really sensitive spot and lean into it for 15 to 30 seconds. The possible locations are marked as X's on the image below.
Next, do the same for the teres major/minor muscles (you'll be hitting part of the latissimus dorsi muscle as well). For this one place the ball on the wall and lift your arm overhead. The ball will almost be in your armpit but don't let it go in the actual pit, keep it on that muscle that makes the back border of the armpit. You might have to roll up and down the muscle slowly til you find that tender spot, then press and hold on it.
Next we will work the front of the shoulder. Go to a wall corner or door frame, place the ball on the upper pectoral near the shoulder, and lean forward. Let your arm hang next to you so that you're not activating or straining it, just relax into the pressure (the area marked by the X below). The reason we use a wall corner here is so you can lean past the wall. This works well in a door frame, so your torso leans forward while your shoulder stays on the frame. Next, remove the ball and position your arm fingers pointing up on the door frame, and lean forward slowly to stretch the pec muscle.
Lastly you can try a self massage for the scalenes. In order to do this safely, start with very light pressure, and if you don't know how to apply a lot of pressure with the finger tips, you will simply use friction (moving the fingers back and forth over the muscle) to help loosen up the area. I highly recommend finding a professional massage therapist or physiotherapist to work on this area for you.
Using the opposite hand, put the fingers on your collar bone (right hand if touching your left collar bone) and move back just a bit so your fingers sink into the groove. Press down slightly, then move your finger tips left to right (not too rapidly) for about 30 seconds. Tilt your head back, your chin going in the opposite direction from your collar bone, to stretch the scalene muscles.
You can also add a passive stretch by simply laying back with something under your back. Use a foam roller or thick pillow, lay flat on the floor with the pillow under your mid-back parallel with your spine, and allow your shoulders to fall back, and lay in this position for 10 minutes or so.
4. Exercise for the shoulder
Using exercise for shoulder mobility is going to be the best way to stabilize the shoulder, keep it toned, and keep it from aching from posture. In my experience, the mid back pain most often comes from being immobile or sedentary.
In this section I will recommend a couple different types of exercise, one of which is resistance exercise. The reason this is important is that it helps to cue the muscles to contract against some kind of resistance, which will be important for it to hold that shoulder in place without pain down the road.
What a lot of people don't realize is that you can use a personal trainer for a sort of check-up, like you would a dentist. It is really helpful to have someone there to make sure you're doing the movements correctly, that your mind-to-muscle connection is happening, and that you're using the right progression in exercise. So I recommend finding a good personal trainer who knows the importance of these things to do a session or two with, even if you are a self-motivated person.
These exercises will target the muscles around the shoulder blade using body weight or resistance. There are all sorts of machines you can use for adding resistance, and if those interest you I recommend hiring a personal trainer for a session or two to learn how to use the machines properly, or ensure that you are targeting the correct muscles. For home use, I recommend dumbbells or a resistance band. Either way, start off light and gradually increase the resistance you are using.
Rows are any movement that pull your shoulder blades back together. You can use a resistance band around your feet, you can put the resistance band in the door, or you can lean forward and use a dumbbell. You can adjust your arms to change which muscles you are targeting. For this particular target, keep your arms about shoulder height and pull the elbows back, focusing on pinching the shoulder blades together. It may help to have someone behind you touching your rhomboids- this will help your brain to make sure you feel the contraction occurring in the rhomboids and not just the rotator cuff. It is a common mistake to only rotate the arms instead of pulling the shoulder blades back (the latter is our goal here). While this will target the rhomboids and part of the trapezius muscle, other shoulder stabilization exercises that you might learn from a person trainer will benefit you in many ways to have a well-rounded and stable shoulder.
2. Super man
Lying on the floor, lift your arms up and pinch the shoulder blades together, hold for two seconds, then return to the floor. Don't let your head come back, focus on just pulling your shoulder blades together. Repeat 8 to 12 times and rest.
3. Scapula Push-up
This one is a fantastic shoulder isolation exercise. I have found it to be very useful, just follow the video.
These are just 3 ideas for waking up the rhomboids and trapezius in your back, and if that is the source of your pain, the exercises will really help more than anything in reducing your pain, and helping you to feel like your shoulders and back are more supported.
For more exercise ideas, have a look at a few of these links:
Upper back pain, the pain between the shoulder blades, is one of the most common complaints I hear as a massage therapist. For some it is a persistent and debilitating problem, for others it is an annoyance that disappears on its own after a few days. There are several ways to address upper back pain, such as seeking out a massage therapist, physiatrist, personal trainer, physical therapist, or chiropractor, but in today's post we will be focusing on ways to manage self-care, and so we will be focusing on the muscles that cause or assist with this problem.
To see what to do to help fix it, visit my second post in the series.
Usually posture is given the blame for the pain one gets in the upper back, but for most people "sitting up straight" is not a fix for this problem. Generally instead of referring to correct posture, I will instead refer to staying in one position for a long period of time. In the first part of this post we will get into some of the muscles of this group, theories for why this pain occurs, and the second part we will cover some ways to manage or fix the problem. Knowing why/how it occurs is useful for correcting the problem, so we will cover that first.
The muscles of the upper back and shoulder attachments are going to be our focus here for one simple reason: they are what you can control and work on yourself at home, or with limited assistance. Some of this pain may be explained by something called the Upper Crossed Syndrome which I encourage you to click and take a look at.
Yes, I want you to really look at the picture of the muscles here, to get some insight into what's going on in the back. Also, because how the muscles lay and how they work is really really cool. First, look at the direction of the lines. This is showing the direction the muscles will contract (I covered this topic in my muscle function post for more information). The mid back pain you feel is probably somewhere around the rhomboids muscles (major and minor, but I will simply call them rhomboids), so find that in the picture and take note that the fibers run from the shoulder blade to the spine. This means the rhomboids pull the shoulder blade toward the spine, that's their job. More importantly you should note that this also means that the lines of the fibers do not pull the shoulder in any other direction. Notice also that the Trapezius muscle has a similar fiber direction, so it also pulls the shoulder blade toward the spine. Take note of the muscles of the rotator cuff (which I have written a separate post about if you want to review it). You'll recognize them when we get to 'fixes' in the second post on this topic.
The antagonist of the rhomboids is the serratus anterior. Just stick that in the back of your mind for now, we will visit it again in the second post.
Now the front side of the shoulder blade is going to be noteworthy as well. One of the main reasons that 'posture' is blamed on upper back pain is because when the shoulders round forward on the front of the body, the back of the body becomes elongated. Essentially, that means your rhomboids have to maintain constant tension, which may be one of the reasons they start to get sore.
The powerful pectoralis major muscle of the chest (your 'pecs') pull strongly on the shoulder in the forward motion, and the rhomboids must oppose this action to keep the shoulder blade in place.
Also remember that sometimes the problem is not necessarily where you feel the pain. For a review on that topic, read my post on "What are Trigger Points?"
The second post will cover tips on how to help relieve some of the discomfort.
Many of us just go about our day using our muscles, and we don't need to think twice about how they work, they just do! But if we want to know how to treat problems when they arise, it really helps to understand their basic function. Today's post will be for those who have not studied muscle physiology before, and it may come in handy for future posts about how to work on your own trigger points at home, how to determine the direction you would stretch a muscle, or otherwise just be interesting to learn.
Contraction of individual fibers/groups
A muscle's action is to pull its ends together. On a large scale, the muscle attaches to bones and across a movable joint, pulling one side of the joint closer to the other... and on a small scale each tiny muscle fiber contracts to shorten the small band of muscle. It contracts in one direction, that is, the direction of its fibers. The protein filaments that make up the muscle fiber start at a maximum length and contract by pulling(1) the outside bands closer to the center. There are many of these microscopic fibers in each muscle, and nerves feed into them in small groups called "motor units". The interesting thing about these small groups is that they follow an "all-or-none" principle, meaning that if the nerve sends the signal to contract, then they all contract, or none of them do. But since the groups are relatively small, you can only use a few motor units to lift something light, and then recruit more and more muscle fibers when you lift something heavier.
Energy needed for contraction
For the muscles to contract, they must use up energy. I will devote a separate post to cellular respiration, the means of creating the energy we use. Basically, energy is stored in the muscle ready to use in two forms: creatine, and a form of glucose (a sugar aka carbohydrate, it is stored as glycogen in the muscle) that your muscles will use as a quick burst of power, but will only last a short time. This energy is quick but inefficient, and produces lactic acid which can be used for more fuel. When you have used up all the sugar storage, your body can then start to convert fatty acids into sugars to restore the sugar levels ready for more energy. In longer endurance activities, more fats are burned than sugars, and the energy production is much more efficient than quick/powerful movements. Proteins can be used for fuel too, but that usually means your body is breaking down muscle to use for energy to keep you alive, which is usually a bad thing. Similar to how sugars can be stored in the muscle for energy, oxygen can be stored as well for the more efficient energy production process.
To conduct the signal for contraction, Calcium, some neurotransmitters such as acetylcholine, and hormone regulation (such as epinephrine, insulin levels) are all important parts of the process as well.
The main summary here is: sugars tend to feed your quick/powerful muscle fiber types, fats tend to feed your endurance muscles. Part of the explanation of fatigue is running out of these nutrients in the muscle, and despite eating the nutrients there is only so much your blood can carry to every muscle in your body to restore the energy supply.
Muscle contraction is an electric process, using chemical transfer from nerves to start the electric signal to contract. In the mid 1780's the discovery was made that frog legs would jump when a wire sent electricity through them.
Types of contraction
Muscle contraction during movement comes in two flavors. We call them "concentric" for when you shorten the muscle, and "eccentric" for when the muscle is elongated but still firing. You can think of the concentric portion as your biceps lifting a weight, and the eccentric portion as your biceps slowing the fall of the weight as the elbow straightens.
The third type of muscle contraction is isometric, where you are just holding the weight and keep it from moving.
Changes to muscles
When you use a muscle, you make it stronger. Even more interesting is that a trained muscle group can adapt to store more of the fuel needed for energy production. Other changes include an adaptation of the nervous system, muscle fiber types, enzyme content of the muscle, and hormone adaptations that allow the muscles to function more efficiently. This will be explored in more depth in the future.
Contraction by reflex
One of my favorite features on the subject of how muscles work (and one that will get several of its own posts in the future) is that the skeletal muscles can be voluntarily contracted, contracted by external electric pulse, or contracted by reflex. I'll tell you why that's exciting to know, but to do that, a little about how it happens:
In your muscles and tendons are special cells that receive information from the surroundings. They cause an automatic response when they detect changes in muscle length or tension. So when someone drops a heavy book in your hands, part of the response isn't something you even think about, your arms automatically lift up in response to the sudden weight in your hands (sometimes more than necessary). The knee-tap test (very useful video) your doctor does, when he/she taps a tendon on your knee and makes you kick, is an example of this reflex. The other reflex forces your muscle to relax to protect itself against damage from contracting too much. It inhibits contraction without you even having to think about it.
The really cool thing about reflexes is they happen automatically, you don't have to think about them! The other cool thing is that your massage therapist can take advantage of this information to help your muscles relax. This works because when you contract your biceps on the front of your arm, your triceps on the back of your arm must relax or else your arm doesn't move anywhere. The inhibitory signal is sent through your nervous system to relax the muscles opposite of those that are contracting. This is an automatic process, so it can sometimes help with muscles that are too tight, and in managing cramps. The next time you get a charlie horse, you can try identifying the group that is cramping, then contract the opposite group in order to attempt to force the signal to relax the cramping muscle.
There is a certain amount of contraction that goes on throughout the body at all times, this is called the resting tone of the muscle. The partial contraction helps with posture, it keeps you from flopping around like a rag-doll. When you stretch your muscles, you are not actually elongating the muscle itself (which would cause damage or tearing of the muscle) but you are removing the inhibitory nerve signal to maintain tone. So stretching is more of a nervous system function than an actual change to the muscle structure (or at least it should be, injury would result from elongation of the muscle).
This post is full of links that will take you much deeper into each subject, and I will be expanding on each subject more in the future! Please let me know if you found this post helpful and tuned with the right amount of introductory information for how muscles work.
An interesting muscle group that deserves it's own post. This muscle is sometimes involved in lower back pain, leg and knee pain, and causes a forward rotation of the hips. It's often involved in overuse injuries, or when lifting something while twisting the trunk of the body, and can sometimes manifest as a 'twinge' in the lower back.
If you've had a session with me (or another therapist) for lower back pain, you may have heard about this muscle. It's a difficult one to describe without the use of visual aid, so in today's post we will unpack what the Psoas muscle group is, and some tips on how to keep it healthy.
The psoas muscle group is a combination of the iliacus and psoas major, and is generally called the Iliopsoas. I often simply say "psoas" to imply both muscles. The psoas originates at the lower spine, and sort of 'fuses' with the iliacus muscle at the inner thigh (a spot on the femur called the lesser trochanter).
It's a little difficult to explain because it is on the front side of the spine. So to actually palpate the muscle, we have to do so through the abdomen. This can seem fairly invasive compared to other treatments, but can be done safely and effectively with manual therapy. There are even some guides on how to do some self treatment.
The iliopsoas is a hip flexor, which means it helps lift your leg forward, or bring your knee toward your chest. It also has a little role in rotating your leg outward, too. Knowing those directions will help when we want to stretch this muscle, because in order to stretch it we have to move it in the opposite direction to how it normally contracts. In day-to-day life the iliopsoas muscles help us maintain our posture, walk, run, and stabilizes the lower spine. They are innervated by the L1-3 and femoral nerves.
When the psoas is tight, it can contribute to a number of problems. One of the most common is Lower crossed syndrome, where the pelvis tilts forward, resulting in a curved and strained lower back. In some cases it can show up as locked lower back with the head tilting forward like a hunchback. In both cases, getting psoas work (massage, stretching, trigger point work) can be beneficial.
Testing the psoas muscle can be helpful to determine the cause of knee and leg pain as well as lower back pain. The hip flexor muscles can be indicated in patellofemoral pain syndrome.
Trigger point work and stretching for the psoas can help to relieve lower back pain, groin and leg pain, knee pain, and can help to correct issues further down the leg and foot, as well as the upper back.
The psoas is in a short position when we are sitting, so for many of us it seems that it is no surprise it might be tight. Moderately stretching this muscle group is useful for most people as a form of general maintenance, and massage can be a great way to help keep the muscle in healthy tone. (I always caution against over-stretching)
The psoas can be stretched by bringing the leg back as in a deep lunge, either standing or kneeling down.
What's going on with me, research articles, interesting little blurbs. This blog is an attempt to consolidate research into an easily digestible format.
Alex Moon has been a Licensed Massage Therapist since 2012, did his undergraduate studies at Utah State, and is currently working on his Doctorate in Physical Therapy.