Blog Archive - 2014



Basic Anatomy
The “rotator cuff” is the most common cause of problems in the shoulders, yet many people don’t understand how the rotator cuff works and how to protect themselves against injury (or further injury) to it.  The rotator cuff is a group of muscle tendons that attach to the head of the humerus (the upper arm bone).  The four muscles that form the rotator cuff are primarily responsible for stabilizing the ball and socket joint of the shoulder, as well as rotating and abducting the upper arm:

  1. Supraspinatus:  The most commonly injured rotator cuff muscle, supraspinatus lays along the top of the shoulder blade and lifts the arm out to the side.
  2. Infraspinatus:  A large, flat muscle that covers most of the shoulder blade, this muscle rotates the humerus laterally, or away from the body.
  3. Teres Minor:  A smaller muscle that runs along the lower edge of the shoulder blade, this muscle also participates in rotating the humerus laterally.
  4. Subscapularis:  A large, flat muscle that lines the underside of the shoulder blade, subscapularis rotates the humerus medially or toward the body.

All four of these muscles together help to keep the relatively shallow ball and socket joint of the shoulder stable during any movement.
The most common injuries to the rotator cuff are muscle or tendon tears, tendinosis (chronic injury to the tendon), and tendinitis (inflammation of the tendon).  As mentioned earlier, the supraspinatus tends to be the most commonly torn of the four muscles, but tendon injuries happen to the entire rotator cuff group. 
Treatment and Rehabilitation
The most important – and often the most difficult – element to treating any kind of rotator cuff injury is rest.  Rest refers less to total activity and more to the activities that are probably the cause of the problem in the first place.  Unfortunately, these injuries often come from movements during work, sport or hobby, and it can be difficult to find a way to rest.  But in order to return to full function, rest is essential.  In most cases, along with rest, soft tissue work and physical therapy can rehabilitate the rotator cuff fully.     
Ideally, the best way to prevent rotator cuff problems that are NOT caused by acute injury (a fall, lifting something heavy, etc.) is to keep all the muscles of the shoulder strong and flexible.  This is especially important if you engage in any kind of repetitive motion in your day to day life, which most people do.  For example, a house painter who uses his dominant arm in the same repetitive motion daily needs to pay special attention to strengthening and conditioning all of the muscles of the shoulders, as well as adequate time for rest of the shoulders throughout the day by interspersing other work activities with the painting, as possible.
Posture (and ergonomics) is another important aspect to preventing injuries to the rotator cuff.  While the four muscles of the rotator cuff work to move the arm, they are not the only muscles to do so.  Among the many muscles of the shoulder, two very important muscles that provide enormous support to the shoulders are the lower Trapezius and the Latissimus Dorsi (see figure below).  The former connects the shoulder blade to the mid-spine and the latter connects the humerus to the lower back.  Because of the mechanics of shoulder movement, these two muscles can contribute greatly to take load off the muscles/tendons of the rotator cuff during shoulder movement. 
Paying attention to posture during any activity, especially lifting and reaching, will also help take stress off the rotator cuff muscles.  In addition to the large muscles mentioned above, supportive posture requires an active and engaged core - the muscles from the middle of your chest down to the bottom of your pelvis.  Supportive posture also allows your entire body to be balanced, and the more balanced your body is during a movement, the less your muscles have to work against gravity, and the more efficient they can be.  This can help prevent both acute and chronic injuries to the rotator cuff.     
Please note that this article is for educational purposes only, and should not be taken as medical advice for any specific individual.



Soft tissue is everywhere in your body.  From the surfaces of your bones, to fascia, muscle, tendons, ligaments, aponeuroses and more, these tissues are what keep you moving every single day.  But most people don't learn much about their soft tissues, so it can be especially frustrating to go through the process of rehabilitation after even the smallest injuries.  

The body is amazingly adept at healing itself when it comes to soft tissue insults and injuries, although its priority is speed rather than quality of healing.  In addition to initiating the well-recognized inflammation response, the body also stabilizes the injured area using pain (to keep you from over using it), scar tissue, and activation of muscles around the injured area.  For the long term, however, without the right stimuli that injured area is usually not able to fully return to its pre-injury function.

So what are the right stimuli?  Physical activity and rest.  Activity is essential for soft tissues to maintain their flexibility, proper tension, strength, and most importantly, proper recruitment.  Recruitment means the order in which various muscles activate during a complex activity.  After an injury, recruitment patterns are almost always disrupted, and the longer a person is in pain or unable to move properly, the less likely proper recruitment will resume without help.  Physical therapy with a quality manual physical therapist is the best way to get this activity while healing.

Rest, while sounding simple, is much more involved than simply not being active.  The body conducts most of its repair functions when the nervous system is in certain states, states that occur during deep sleep, some meditative activities, and therapeutic massage.  But manual soft tissue work like massage goes a step further than simply supporting the body's own self-repair by affecting how scar tissue gets applied, removing adhesions between various tissues, and relieving spasms in the affected muscles.  All of these things help the body be able to get the most out of the activity part of rehab.

More important than focusing on activity or rest alone, is the proper mix of the two.  Every person and every injury is different in its ideal "balance point" of activity and rest, and that proper balance changes throughout the process.  The best way to know what and how much to do is to surround yourself with a team of professionals that you trust, and follow their recommendations.

In our youth, we become accustomed to healing from musculoskeletal injuries quickly and (what we assume to be) permanently.  But when it comes to your soft tissues, time is actually what proves how well you have healed from the insults and injuries of the past.  Since you only have  one body to use for an entire lifetime, paying attention to how you address musculoskeletal pain now will certainly affect your quality of life in the future.



We deal with a lot of pressure in our lives.  Pressure to achieve, pressure to conform, pressure to be the best, and so on.  And sometimes, varying levels of pressure can be helpful to motivate us.  But when it comes to soft tissue healing, the standard of “no pain, no gain” is not always best.

Muscles are not “dead” tissue, clay to be molded and pounded into the right shape and consistency.  They, and other soft tissues, are live and responsive to stimuli.  They exist within the body in layers, all connected and in communication.  If the pressure is too deep for what those tissues need, you may actually cause more damage to the tissue!  To help them repair, heal, and get back to normal function, a quality massage therapist might use varying amounts of pressure in different areas according to how the tissues are responding.  Sometimes this can be heavy pressure, but often it is lighter than might feel satisfying for our pressure-accustomed mind.  

When you are in pain and your goal is to find relief of pain, the most effective techniques toward that goal may surprise you.  If you are used to deep pressure massage and believe that “if it doesn’t hurt, it’s not doing any good”, consider how effective those deep pressure massages have been for you in the long term. While you may have felt satisfied after the massage, do the same areas tighten right back up soon after your appointment?  Do you feel like no massage therapist has ever been able to get “deep enough”?  If so, I encourage you to be open to more possibilities in finding longer term relief.  You might be surprised at how effective massage therapy can be when heavy pressure is not the only option.  The most important thing is that you stay in open communication with your therapist and let him or her know what sensations you are experiencing, both during and after your massage session.



Published in Ocala's Village Crier Newspaper (July, 2014)
Many people I come across think that massage therapy is very similar to tenderizing meat; if I rub and pound on it enough it will get softer and everything will feel better.  While it is certainly true that my choice to put pressure on a certain area or my choice of what direction to stroke an area of a muscle impacts how the muscle fibers, fascia, tendons or ligaments lay physically, most of my job is actually to convince you (usually at a subconscious level) to change what is happening in your body.

Soft tissues are full of nerves - nerves that connect to your brain and conscious control, and nerves that control reflexes. These nerves are what control how, when, and how much your muscles contract and relax. Manual work like massage therapy is essential to help keep the scar tissue that gets laid down after an injury stay out of the muscle's way, to separate soft tissue fibers that have become stuck together, and to encourage fibers of the same muscle group to remain in the same direction. But massage therapy can do much more than affect the physical attributes of the tissues. 

With the appropriate feedback from therapeutic touch, your nervous system can start to change how muscle fibers or groups are stimulated. If you and your massage therapist are working intentionally together throughout your sessions, your attention and awareness significantly improves the potential for long-term effectiveness. This is not to say you should not "zone out" or relax; in fact, a relaxed body and calm mind are the essential environment for this kind of attention. 

Why is it important for you to understand this concept? So that you can be more intentional with your bodywork. If you are going to spend time and money receiving therapeutic touch, you probably want to get as much out of it as you can. It is important that you recognize your role in the work so that you can provide your therapist with honest and helpful feedback to continually refine the work. As a therapist, I cannot feel the sensations that you feel in your body, or know your level of body awareness. Even more than your feedback to me, when you recognize your role in your bodywork session, you are more likely to be aware of and carry through the results of your massage into your everyday life, which means you will start to feel more permanent changes. Finally, understanding this concept helps you eliminate any lingering ideas of massage therapy being a luxury, recreation, or some kind of reward. 

Regular, quality massage therapy is intentional work that we do together to aid your body in maintaining good health and preventing injury. So enjoy your next massage - relax, enjoy the touch, take the time to rest -and give yourself the opportunity to create change in your body through your attention.



appeared in the July 2014 edition of Ocala's Village Crier Newspaper...
For many, the term "posture" often brings to mind stiffness and pain.  The image of good posture is almost always of someone pulling their shoulders back, pushing their chest out, and keeping their neck stiff, while sitting or standing still.  But using efficient posture is not a static exercise, nor is it just something that you do to look good.  Poor posture can lead to muscle pain all over your body, give your organs less room to move and breathe, lead to problems in the discs of the spine, contribute to nerve impingements, and cause you to feel tired.

So what is posture?  Practicing efficient posture is the act of balancing against the force of gravity with the least amount of effort.  Because of our bipedal design, our bones stack on top of each other.  It is a very efficient design that minimizes the impact of gravity and allows us great freedom of movement.  But that great design becomes a disadvantage when we lose the alignment of the column and we have to start dealing with the multiplying effect of gravity.

What happens when the column is not held straight because it is affected by poor posture or injury?  The well-designed alignment of the bones can no longer stay stacked up against gravity easily.  When this happens, the muscles have to act to help the body stay upright.  The problem is, these muscles are not designed to do this.  The ones we are most familiar with – our movement muscles – are designed to help us move, not keep us upright.  For example, a person who sits in front of a computer most of the day often sits a bit hunched over with their head forward, disrupting the stacking of the column.  When this becomes a pattern, certain muscles are constantly doing a job they were not designed to do, and they get tight and painful.  On top of that, circulation and lymph flow get restricted and other muscles get weak or overworked as they also compensate for the lack of balance. 

Improving your posture is an individual exercise, since it depends so much on how you have been using your body throughout your life.  It involves attending to old or existing injuries and gaining sensation and control over postural muscles that may not be working as well as they could be, as well as relieving tight muscles and places where tissues have stuck together.  Massage therapy is one of the best ways to relax and rejuvenate these muscles, and with a therapist that understands posture, you can even start to change your postural patterns.  In addition, you will also gain the enormous benefits of calming your mind, relieving the effects of stress, and improving your energy level.
If you think you could benefit from more efficient posture in general, or even for a specific activity like golfing or swimming, join us for our free Muscles in Motion class in June and July.



Today we are bombarded with information about what we should and should not do for health.  It can be difficult to figure out what is right for you and what is simply the latest fad.  However, when we find out about a disease or deficiency, or sustain an injury, we cannot afford to trivialize it.  If we do, the problem will likely come back, with more intensity, sometime in the future when the body can no longer scramble things together to make it work.  

Despite our relatively cushy lives today, our bodies still function in a way that emphasizes survival.  Many of the reactions that our bodies have - to injuries, stress, overstimulation - can be frustrating to us because they get in the way of life so significantly.  We get frustrated because healing takes so long, or because 10 years later we start to feel pain from an injury we thought was healed.  Or we are so caught up in our day-to-day lives that we just cannot be bothered to have to adjust to accommodate long-term healing and rehabilitation.  And how many of us wonder why our digestive system is just not as efficient as it used to be?

The body is not designed to save for the future.  In the interest of survival, it will do whatever it needs to in order to stay breathing, moving and aware.  Often this means sacrificing longevity and long-term health for immediate function.  When a muscle gets pulled, for example, the body's priority is to stabilize it and keep the muscle intact, not maintain its flexibility, suppleness and strength.  Or when there are not enough of a nutrient in the system, it uses what it can get to address the most pressing needs and sacrificing other needs, usually leaving us unaware of the deficiency.  The body does not know the difference between a "minor" injury or deficiency and a "major" one - the response to any kind of injury is effected with the same urgency.

But the conscious mind does know these differences, and so we have to make conscious choices to address these issues with a long-term view rather than an immediate one.  It is not enough to simply be free of the pain from an injury or disease; pain-free does not mean healthy.  What is really important is providing the time, expertise and patience to first eliminate pain, then restore function, and integrate the body's movement again.  Armed with this knowledge and with the aid of trusted professionals, we can stay healthier longer.  

You only get one body and need it to last your lifetime.  So instead of hoping a problem might just go away or heal itself, help yourself out with conscious attention.