This Is Not How You Treat Frozen Shoulder

My first thoughts (only my opinion) on seeing the picture above was, this is certainly not how you should be treating a patient with frozen shoulder or any problem for that matter. 

The photos above and below taken from  Twitter made me cringe. I am apalled at the amount of damage that had been done to the person's tissues. Manual treatment, at least at our clinics and most that I know, do not look at all like that. Now that patient has to also heal from the damage his therapist did on him!

There are already many physiotherapists worldwide saying there is no evidence supporting 'manual therapy' and that manual therapy does not work and is a waste of time and money. 

There are growing calls that physiotherapists should not be doing 'hands on' treatment. This will lend further support to what they believe. 

Everyone has a right to their beliefs and I always say that they just don't know what they don't know. For every physiotherapist that wants to be 'hands off' when treating their patients, there will be a physiotherapist (or more) wanting to do only 'hands on' treatment. 

If you really want to be pedantic, that's not the spiral line. I have attached a picture of the spiral line as intepreted by Tom Myers above. 

Reference

Kerry R (2019). "Hands-on, Hands Off: Is That Even A Thing?" Physio First

*The 'hands off ' approach usually means not doing manual therapy like mobilising (pressing, pushing) on joints, muscles, fascia etc on patients. It does not mean the physiotherapist does not touch the patient, assess or palpate the patient. They still do, it's just that after their assessment, they usually prefer to educate their patients (by talking) or teaching exercises to oversee a care management program that addresses thee patient's long term goals and needs.

Studying With Tom Myers Live Online

Looks like I've gotten myself much more screen time again during this circuit breaker period. I've signed up for a 'live' webinar taught by Tom Myers from May 15-17. Due to the unusual circumstances of the global pandemic, the course has to be taught over Zoom, of course.

This is actually the 3rd online course he's teaching since the COVID-19 started. I didn't sign up early enough for the first two and they filled up quickly. Due to high demand, they announced that Tom was teaching the same course for the third time, so I made sure I signed up straight away.

I've attended a few of the Anatomy Trains courses already, and previously one introduction course taught by Tom before. But when Tom is teaching, I just couldn't resist, even though I've learnt some of this material previously.

Tom says he misses using his hands during this pandemic

There's a slight hitch though. The course is taught from 10 pm to 12 am and from 3 to 5 am. I'll have to find a way to cope.

Picture of healthy fascia above.

Patient Has 'Tight' Upper Trapezius Muscles?

My patient came in to our clinic yesterday complaining of 'tightness' in his upper trapezius muscles. He saw me two weeks ago for his R knee pain and that had settled, but now it was discomfort in his upper trapezius area. He had been using the trigger ball in his upper trapezius area and there were marks all over the area.

Other than tightness, he was complaining of a deep ache and constant discomfort there. He thinks this sometimes causes him to have headaches and neck pain as well.

Upright scapula

What gave me the most clues was looking at him from the side view. While looking at him from his left side (I'm using the picture above to keep his identity anonymous), his trunk was tilting backwards with respect to his hips. However, when I got him to straighten up you can see his left scapula tilting forward (right side of the picture below).

See how his left scapula tilts forward

Having explained to him what I saw, I then proceeded to treat him. I did not do any deep tissue massages/ or release his upper trapezius muscles (the area of his complaint). Neither did I stick any needles there to relieve the 'tight' muscle tone. I did not even treat his neck.

So what did I do? I treated his Front and Back Arm Lines. Yes, you read correctly. I treated his arms. If you look at work done by Tom Myers, he's able to dissect the "arm lines" (see picture below) from a cadaver.

In the picture on the right, the Superficial Back Arm Line has been laid over a skeleton model to show the fascia connections.

My patient was amazed, fascinated and happy that I got him better just by treating his arms. He almost couldn't believe it.
Treating the Deep Front Arm Line is key to getting his condition better because of the anterior tilting scapula. Treat the cause of the problem, not the pain.

Deep Front Arm Line

Head, Neck And Jaw

Taking turns for a quick assessment

After Aized last week, yours truly attended the Head, Neck and Jaw course yesterday and today. This is the next course offered after we did the Shoulders and Arms course earlier in April this year.

Wow, time really flies, it's already October today.
It was a really interesting course looking at everyone's head, neck and into their mouths. Yes, you read correctly, we got to stick our fingers inside each other's mouths.

All five different necks

We learnt about the Masseter and Temporalis which are on our face and skull, we also learnt how to treat the Medial and Lateral terygoids, which are inside our mouths and how they connect to the neck.

Showing me my Lateral Pterygoids

Yes, we got right into each other's mouths.

Medial , Lateral Pterygoids

Back to work tomorrow. And if you need to get your head, neck or jaw treated .....

Change The Arms, Change The Neck

First assessment

Here's another patient who came in to our clinic complaining of neck pain, tingling, and sensations of electric currents/ pins and needles, down his left arm.

This patient works as an electrician and often has to be in awkward positions running electrical wires. He feels worse after prolonged time spent looking upwards - mostly due to running ceiling electrical wires.

He was referred to our clinic by another friend who had seen us and gotten better without needing surgery as suggesting by his surgeon.

Just like the other lady who had neck pain, I didn't treat his neck. Just treated his arms and shoulder girdle.

Have a look at the picture after treatment.

After treatment

You can see quite an dramatic change not only in his neck but in his rib cage and hips too. Even his nephew who came with him was amazed at the change.

Before and after

Have a look when I put both pictures together above. Quite a big difference? All done in less than an hour.

What did I do? No mobilizations or manipulations of the thoracic and cervical spine at all. Just treating the arm lines as seen in the picture below except for levator scapulae. Left that out as I wanted to "exclude" the neck.

Superficial and deep back, front arm lines

Not The Neck, Not The Leg, But The Arms

This patient who came in recently this week complaining of neck pain, was a really interesting case.

She had pain in the cervical spine (neck) area with numbness and tingling sensations radiating down to her right arm and thumb. Sleeping on her right side made the pain worse.

Remember I had written about my patient with neck pain and I made her better by treating her leg. Well, this particular patient's presentation was definitely different.

This patient of mine lives on a yacht in the One 15 Marina Sentosa Cove. Recently it's been raining and she's had to work a lot harder cleaning her yacht so there won't be stains. Because of the proximity of the refinery nearby, whenever it rains it makes their yacht very dirty. Her husband cleans the hull, and she needs to polish the silicone joints.

She had also seen the spine surgeon and he sent her for an MRI just to be sure. Here's the whatsapp message I received from the doctor telling me my patient had R spinal exit stenosis from prolapsed discs in her neck.

That was a big clue for me as her neck didn't didn't seem particularly "bad" upon palpation. Her upper limb tension tests elicited some tenderness as well.

Superficial and deep front, back arm lines

So I treated her arm lines instead of treating her neck. Yes, at no point did I treat her neck, just her arms and nothing else.

When she sat up, her first comment was "it's like a whole weight have been lifted off my shoulders".

Surprised? I was, but I was hoping for a good result since she told me about all the extra cleaning she did earlier. Treating her arms was key in her case, not her neck.

Shoulders And Arms

Really heavy ....

It's back to learning as I attend another course with Anatomy Trains. This time as you can see it's on the Shoulders and Arms.

How do all the scapulars compare?

It's fairly intense in terms of theory, videos to watch and lots of practical as well. Looks like the next couple of days will pass fairly quickly.

New vocabulary

New participants to meet, new terms to get used too and new ways to "body read" each other. Looks like I may have to burn midnight oil to review everything we've done today.

Tensegrity Of The Spine

Lining up half the participants to compare their necks and backs

After Aized and Rachel did Arches and Legs last week, it's the turn of the three amigos this this two days as we do "Tensegrity of the Spine" over the next two days.

Range of movement in the spine

This course is very intense and heavy going as there's a lot of rationale behind the theory involved. Everyone (yes, you read correctly) got lost at some point today, including yours truly.

Let's hope we get a clearer picture tomorrow.

Storm Before Floss Band Course

Storm outside our clinic

There was a big storm before the Floss band course today and maybe that's why the turn out was less than normal. But it certainly didn't dampen our spirits. We had a chiropractor, physiotherapy students, a Singapore Cycling Association coach, another strength and conditioning coach from CrossFit Fire City and personal trainers.

Flossing Ben's knee

As usual, I took the time and effort to explain Tensegrity, what and how our fascia functions and the Pain Gate Theory (by Ronald Melzack and Patrick Wall, 1965) so that the participants understand how the Floss band works. And they can in turn explain to their patients, athletes and friends what the Floss band does.

Can't touch my head

A big thank you to Amy, Danny, Ekina and Jane for coming to get the clinic ready for the course. That allowed me to eat after I saw patients in the clinic from this morning. And for packing up after, so I can see another patient.

A big thank you to everyone who came despite the heavy storm before. Hope everyone learnt useful strategies that you can use use in your own area or work, play and training.

Please contact them at Sanctband Singapore for the next Floss band course and if you need to get the Floss bands.

A big thank you to everyone who came despite the heavy storm before. Hope everyone learnt useful strategies that you can use use in your own area or work, play and training.

Learning From Tom Myers

With Tom Myers

I spent the last 2 days at the Anatomy Trains BodyReading Masterclass with the man himself,Tom Myers.

Having done some Anatomy Trains courses previously, some of what we learnt was revision, but mostly what Tom went through was new, highly enlightening and a different perspective.

Sharing center stage with Tom on Day 1

Next up for Day 3-4 tomorrow on "Resilience: Taking the strain and coming back stronger." Stay tuned.

Fans Of The Hip

Fans of the hip 

Yes, that's the title of the latest course  I am attending. But I'd like to say that we (staff at Physio and Sports Solutions) are fans of learning too. Yes, we are always striving to be better physiotherapists so we can get better at treating our patients.

At lunch, a fellow physiotherapist at the course was asking me why I wasn't  "growing" or opening more clinics. He mentioned that "lots of people" would want to partner us to have more clinics. To which I said we do not wish to be the biggest (physiotherapy chain of clinics), we just want to be the best at treating the cause of  your pain. That's why we keep learning.The lecturer did a great job explaining how the sacrum sits between the 2 hip bones

Ting Jun is the sacrum sitting between Derek and I (the 2 hip bones) in the picture below. For example if I shift forwards and Derek goes back (to simulate forward and posterior tilt in the pelvis) Ting Jun (the sacrum) will really feel unstable.

See the apprehension in her face

Last day of the course today. Back to work tomorrow.

Patient Has Neck Pain, But I Treated Her Leg

Last year I wrote about how your hips are connected to your shoulder, which turned out to be a really popular post.

Well, today I had a patient who told me she had neck pain as well. This was after I treated her for her plantar fasciitis problem and knee pain. I had only 2 mins left before my next patient. Here's a screen shot of the video I took before I treated her neck pain.

Before -12:58 pm

Here's the before video.

After treatment at 1:05 pm. Here's the screen shot of the video after at 1:05 pm.

After - 1:05 pm

Believe it or not I treated her leg, yes you read correctly. Watch the video how her neck range changed, without me going near her neck at all.

Many thanks to my patient for allowing me to post the images and videos.

Want to know what I treated? Here's a clue, look at the picture below.

SFL

Arches And Legs

It has been a big learning week for us. Aized attended the Anatomy Trains Structure and Function course last Friday to Sunday. And Ting Jun and I went for the next part on the "Arches and Legs" for the past three days.

Some of it has been revision of earlier concepts, while incorporating more in depth details as well.

Here are some pictures from our past 3 days at the course.

Feet and arches

Let me have a look too

 Deep in thought

When it comes to learning and making ourselves better physios, we make sure we do not cut any corners. As a team, we've spent lots of time going for courses, discussing difficult cases and sharing what we've learnt with each other to improve ourselves.

Majority of our patients are by "word of mouth" referrals. A patient comes and sees us in our clinic, they get better really quickly and they then refer their families and friends to our clinic.

So please come and see us in our clinics and we'll do our best to help you.

Looking forward to using what we've learnt at work tomorrow. Yes, back to work tomorrow.

How Your Hips Are Connected To Your Shoulders

Yes, our shoulders are connected to our hips! Definitely if you refer to work done by Tom Myers in his Anatomy Trains book.

If you look at the picture above, you can see that the right Vastus Lateralis (outer thigh muscles) through its fascial attachments are linked to the buttocks then through the thoracolumbar fascia across to the opposite (left) rib cage, shoulder and arm.

If I say it simply, it means your Vastus Lateralis actually attach to your arms! Or if I put it in a different way, your arms don't end at your arms. They end at your legs.

Another look at the connection

So supposing you have a rotated/ and or unstable pelvis (or hip), this can affect your shoulder and change the biomechanics in your shoulders and cause pain.

So in order to treat your shoulder pain, I'm not really crazy if I assess your hips before I look at your shoulder.

Just ask Bertrand, without really assessing his shoulder pain, I made his shoulder better just by taping his hip. 

Now when you come and see us in our clinics, you know why we look at your hips first if you have shoulder pain.

I Bit Off More Than I Could Chew Today

I kinda bit off more than I could chew today..... yes I'm writing that down again to remind myself not to do it again.

Waiting ..... for me to be ready

On Saturday afternoons when we have the Floss band course at Sports Solutions, I normally stop seeing patients half an hour before so I can get my act ready.  I have to get the computer and projector ready, whatever anatomy models I may need, laser pointer etc as well as eat some lunch.

Today, I had a patient who was gonna take part in a race tomorrow. And that patient requested that I do some taping as the last time we did the taping, the patient was able race pain free. The only time I could spare to do the taping was the half an hour before the course.

That of course ate into preparation time and I was late for my own course right here in the clinic. I wasn't happy with myself! As someone who takes care to always be early for my patients and appointments, I messed up.

A thousand apologies to all who turned up for the course today. I promise it will not happen again. And by the way we had a chiropractor (for the first time) who turned up for the course today too.

Right in the thick of action

Capt America watching ...while Trevor doesn't

The physio students having a go

A big thank you to Danny, Ekina and Jane who came really early and got the place ready for the course again. Couldn't have done it without them. And for helping me tidy the place after too. Please contact them at Sanctband Singapore if you want to attend the next course.