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Shoulder pain can be complex because of how many parts of the body are required just to move your arm. The areas we look at are neck, shoulder blade, ribcage, shoulder and elbow/wrist/hand. If we look at all of these areas, we can fix recurring shoulder pain and can get you better faster saving you valuable time. Neck All of the muscles in your arm are controlled by the nerves that exit your neck. When you have an issue in your neck that will create a weakness in your arm. The weakest area or often the area that is working the hardest will get beat up and you will get pain. Tightness of the nerves in your neck/arm can also lead to loss of motion at your shoulder and weakness. Shoulder Blade Your entire shoulder girdle is only attached to your body through your collar bone, so an issue of your shoulder blade will affect the shoulder joint. The shoulder blade position can create impingement of the shoulder. If the shoulder blade is tipped down and the arm tries to go up it runs into the shoulder blade (acromion) and you get pinching/pain in your shoulder. Ribcage Weakness of the muscles of your ribcage creates issues with your shoulder blade motion as we just reviewed above. When you have a stiff joint in your back or a stiff rib joint you will have weakness of that area as well. Poor posture creates weakness of the shoulder blade muscles as well. Check out our posture article here. Shoulder The job of the rotator cuff is to hold the ball in the socket. (The shoulder is a ball and socket joint). When these muscles are imbalanced the ball moves around too much in the socket and the shoulder tendons get pinched and create pain. Having a strong rotator cuff keeps the ball centered in the socket. Shoulder blade position and neck involvement (nerves from the neck control the rotator cuff) also affect how strong these muscles are. Elbow/Wrist/Hand The important part about the elbow, wrist and hand is that if the muscles are weak you may compensate by overusing the next muscles up (i.e. the shoulder) leading to overuse injury. So there you go, a roadmap to fixing shoulder pain. Since everyone is different, we don’t use protocols and give out the same 5 exercises to everyone. We tailor a home program specific to YOU based on your evaluation. We will soon put out articles on the most commonly used exercises and little known exercises that are important, so check back soon for those articles. To schedule an evaluation or if you are still unsure about us a 30 minute discovery visit call 203-557-9111 or click here Thanks - Dave

Posture is the position you hold yourself or move in. The key to good sitting posture is the alignment of your spine and its ability to transfer the weight of your body to the ground. We are just fighting gravity and we want to teach you to do it the easiest way possible because most of you are working too hard or are too lazy. Bad posture can cause muscle pain (think the area next to your neck), low back pain or shoulder pain. It can also make you stiff, make you weaker (your core turns off) and can affect your digestion and breathing. We also look and feel better when your posture is good, there is research on this! The goal is to find a stacked and relaxed position think of a golf ball on a tee balancing there with no effort. Let’s begin from the bottom up as we want to build on a solid foundation. (A pyramid is super strong because of the huge base it has). Feet together Feet staggered Feet staggered Your feet can be even or staggered giving you three positions to use, crossing legs should be kept to a minimum and done on both sides evenly if done at all. Tucking your feet under your chair decreases your base of support making you tired faster. With good sitting posture your hips should be 1-2 inches higher than your knees. If your hips are too low your pelvis will roll backward and you will slouch, too high and your pelvis will roll forward and you will jam up your low back joints (think too tall or military posture). Adjust your seat as needed. (no pics/my bench has no height adjustments) Military Posture Slouched Neutral Posture To find pelvis and lumbar neutral you rock back and forth between a full slouch and too tall until you find the middle. This is a gray zone and not a single point so we don’t have to be ridiculously specific. We need options for movement. Normally in the clinic we strength test you to figure out exactly where this position is. We often have people feel the difference between sitting back towards your tailbone and toward the front of your sit bones (your pelvic floor). There will be less stress on your low back. Breathe in Relax belly Let breastbone drop Next is rib cage position, you take a large breath in (this lifts your rib cage), relax your belly (this gives you somewhere to rest your rib cage) then breathe out and let your chest drop onto your belly (it will feel like you are slouching but I promise you aren’t). If your pelvis is in the correct position (vertical) it is physically impossible to slouch. Getting out of the habit of holding your chest too tall is challenging for some people. Weight too far back (tailbone) Weight on pelvic floor (into feet) Next you want to get some weight back in your legs because most of us sit back toward our tailbones. We should have been designed with square butts instead of round butts and we wouldn’t have this problem in the first place. If you can lift your leg easily you are sitting too far backwards. Shift forward at your hip joints slightly by letting your pubic bone drop between your thighs. Your leg should now be heavy and you shouldn’t be able to lift it easily. We want weight to be into your feet not into your low back or neck. Shoulders rounded Shoulders too far back Weight in collar bones Now that your trunk is in a good position lets fix your shoulder blades. Your rib cage is shaped like a dome and your shoulder blade and collar bone are a “V”. We want the “V” to sit on top of the dome. Sit too tall and the V falls backwards. Slouch and the V falls forwards. We want weight in the collar bones not in the neck muscles (traps). The most commonly missed posture correction is arm rotation (external rotation), people pull their shoulder blades back but they fall right back off, if you add rotation outward it locks your shoulder blades onto your rib cage. The correction is shrug, rotate your arms out then drop. (make sure your upper arm bone rotates out). Now you should feel weight in your collar bones. Full chin tuck Relaxed out, chin dropped Lastly let’s fix your head and neck position (put the golf ball on the tee). Most people’s golf ball is ready to fall on the floor (good thing our head is attached to our bodies). You tuck your chin back as to make a double chin and then relax out until there is no tension. You head should now be balanced you’re your body. Some people will need to let their chin drop as they hold it in the air. If you do this let your chin drop towards the ground until the base of your skull feels relaxed. Ideally you would place some support at your sacrum which is at your belt line. This will support your whole spine helping it to not collapse. Support can also be used for your arms with arm rests, you want to slightly unload your arms so the weight is into the arm rests. Good sitting posture is stacked and relaxed and uses support when available. That’s it you should now be able to have someone do a handstand on you like cirque du soleil. I bet you look and feel better already. Sitting posture is a work in progress for most people. I teach my patients that I want them in good sitting posture 51% of the day, which is realistic for most people. That way you are in good positions more often than bad positions. So, there you have it a very complicated and long answer to the question… where is good sitting posture? If you have back or neck pain and would like to learn more about how we can help please click the link below or call 203-557-9111 https://www.manualtherapyspecialists.com/contact-us-phone

The concept of neutral spine varies in different practices such as yoga, Pilates or even the way it is taught by different physical therapists. Generally, it is accepted as the natural curve of your spine. The most common definition I can find is a slight curve in the low back. Well that’s not very specific. I propose that neutral spine is where the spine is the most stable. From another perspective the position that allows the most deep core muscles to fire will be the strongest, most stable and most efficient leading to the least likelihood of injury. So how do we find this position? Yoga or Pilates practitioners may place a bowl on your stomach and have you tilt forward or backward to find the center of the extremes of motion but how do we know you are in a neutral spine. It is a good guess but may not work for everyone. In Pilates there is often a debate between flat back (imprinted) and neutral spine though neutral spine is becoming more accepted. In Pilates laying on your back having the ASIS (front outside of hip bone) and pubic symphysis (pubic bone) level is another method. Anchoring the tailbone and having L2 touch the mat is another method. In standing the ASIS (front outside of hip bone) and PSIS (bone where the dimples are in your low back) are level. We are on the right track as there is some specificity. Relax the back says neutral posture is one in which you maintain a 128-degree angle between your torso and thigh and a 133-degree angle between your hamstrings and calves. Well there are some numbers but nobody is going to carry around a protractor to measure that angle. Enough about everyone else, lets hear what I have found to work on hundreds and hundreds of patients. I will make a few assumptions: 1. In neutral your spine stabilizer muscles are at the best length to produce the most force i.e. they work the best in that position and have less likelihood of injury (straining a muscle). 2. In neutral you facet joints will be able to take up a lot of load as they are in the “middle” position and that will unload the discs optimally. (you are less likely to herniate a disc). 3. The system is in balance, move too far out of this position and you will either injure the muscle, joint or disc. What I use is a percentage of pelvic tilt and perform a muscle test to find your individual “number” for how much tilt puts you in the most stable position. So instead of trying 4 different ways we have a definitive way that can identify your individual neutral and how to repeatably find it. The average person will be in the 40-60% range and your chronic over-tilters may need 20-30%. A weak and older person with stenosis (narrowing of the space where nerves exit) may need 60-70%. So there you have it a fool proof way of finding pelvic neutral. We can use this same method to find out where neck neutral is and ribcage/thoracic neutral. I find that often women or men that have pain with yoga or Pilates are simply trying too hard to force a position that they shouldn’t be in and we have to teach them where their true neutral is. We teach a relaxed and stacked form of posture not forced posture. As with forced posture you will get tired eventually and fall into worse posture. Another important part of neutral spine is ribcage position, you can be in pelvic neutral but not thoracic neutral. We will cover this and review breathing mechanics in a future article. Heal faster, find the root cause of your pain and learn how to prevent it from coming back. To make an appointment or find out more about our services call 203-557-9111 or email us at info@manualtherapyspecialists.com If yo are experiencing low back pain or feel you have a weak core click the link below to see how we can help or call 203-557-911 https://www.manualtherapyspecialists.com/contact-us-phone