Category: Therapy

Everyone Has One and It’s Time To Use It!

Everybody Has One and It’s Time To Use It!

By Michael P. Mansfield AAS, LMT, CNMT

Yes, everyone has an opinion. However, that is not what is being inferred with the title. This article is referencing the fact that everybody has a diaphragm. Yes, the diaphragm. A skeletal muscle connected to the entire circumference of the ribcage and several of the lumbar vertebrate. Its chief function is to lead the breathing process of the body.

There are 3 types of muscle tissue that comprise the human form

  • skeletal (Voluntary – the ability to move at will, controlling movement of the body)
  • cardiac (heart – involuntary/autonomic or functionally independent; not under voluntary control.)
  • smooth (blood vessels, arteries, and hollow organs – autonomic, or functionally independent; not under voluntary control.)

The diaphragm is a voluntary muscle. Simply put, if not used on a consistent basis, this muscle becomes weak. If the diaphragm is tight and weak from lack of proper use, it will hinder the function of the psoas. To illustrate this conundrum, tightly squeeze the top of a bicep (acting as the psoas) with your opposite hand (acting as the diaphragm), flex the arm a couple of times, noting the restriction of movement. Now relax the grip and flex the bicep again. There will be a considerable difference in movement, demonstrating how muscles with different jobs can profoundly affect each other.

Over time, this imbalance in the lumbar region can lead a chronic pain pattern. If the psoas becomes tight and weakened due to injury or lack of proper use, it will affect the diaphragm through inflammation, ultimately restricting breath – supporting the pain, spasm, pain cycle.

Inflammation of the muscles attaching to the lumbar vertebrae constricts the nervous tissue responsible for providing energy to the lower body, decreasing blood flow/oxygen available to the spastic tissue. This constriction manifests as pain and dysfunction. Diaphragmatically (belly) breathing relaxes the diaphragm, reduces the pressure placed on the psoas muscles, increases circulation and blood/oxygen levels, and ultimately maintains balance of the abdominal and lumbar region.

Compression of the vagus will trigger a fight or flight response. The brain senses there is something wrong with the body when this occurs. The vagus nerve descends off the brain, directly behind the large neck muscles, attaching to the esophagus, and travels through the diaphragm to the abdominal cavity.

Chest/shallow breathing constricts the vagus at the neck and diaphragm. When the brain senses the constriction the adrenals are brought into play to assist the body get out of its present predicament.
If the brain senses the body to be moving during the restricted breathing/vagal impingement, it will sense the body it attempting to move away from danger and adrenalin will be the primary hormone produced by the adrenals to assist in this function.

If the body is sedentary during the same scenario, the brain will sense the body is ill or injured, and the adrenals will primarily produce coritsol. The function of cortisol it to mobilize fat stores for energy (the body is ill or injured and food is not available) so the body does not use vital muscle tissue for energy.

Even though humanity inhabits a universal, human form, the human form is very much misunderstood by humanity.

The diaphragm is the primary respiratory muscle which DIRECTLY affects every system of the body. Not properly utilizing this muscle leads to small imbalances, leaving the body susceptible to a myriad of pathologies, and leading to more serious conditions .

Use your free time to learn more about how your body works, freeing up more time to enjoy how your body works. Stop, BREATHE, and BE!

Thoracic Outlet Syndrome or Lyme Disease?

Thoracic Outlet Syndrome or Lyme Disease?

Correct diagnosis equals effective treatment

 By Michael P. Mansfield AAS, L.M.T., CNMT

Summer is upon us and it is time to enjoy the great outdoors! For many, camping, hiking, and experiencing what nature has to offer are typical summertime activities. Most people are aware of the inherent risks of overexposure to the sun, dehydration, and protecting oneself from venomous creatures, and biting and stinging insects. For the latter, awareness of surroundings and the use of insect repellant are essential.

Summertime is also a prime time for humans to become host to ticks. Tick bites, while usually innocuous, can become debilitating if bitten by a deer tick (or blacklegged tick, Ixodes scapularis) carrying the bacterium responsible for Lyme disease, Borrelia burgdorferi. The tick must be attached to its host for 36-48 hours or more in order to transmit the bacterium.

A tell-tale symptom of Lyme disease infection may or may not include a red, expanding rash called erythema migrans (EM).

  • 70-80% of infected persons show signs of a rash, beginning at the tick bite, 3-30 days after being bitten.
  • Parts of the rash may be clear, giving the appearance of a “bull’s-eye”, and can expand up to 12 inches in diameter
  • Rarely itchy or sensitive, the rash may be warm to the touch.
  • Erythema Migrans lesions may on any area of the body.

Other symptoms 3-30 days post tick bite may include headache, fever, chills, fatigue, muscle and joint aches, and swollen lymph nodes. An untreated Borrelia burgdorferi infection may spread throughout the body producing specific symptoms that may come and go. Symptoms include severe neck stiffness and headaches due to meningitis, pain and swelling in the large joints, Bell’s palsy (partial paralysis of the facial muscles), additional EM lesions on other parts of the body, heart palpitations, vertigo, chronic fatigue, and fibromyalgia.

Long term infection of the Borrelia burgdorferi bacterium may lead to further neurological complaints such as shooting pains and peripheral neuralgia (numbness in the hands and feet), arthritis accompanied by severe pain and swelling (particularly in the knees), chronic fatigue, and memory loss.

Lyme disease is the most commonly reported vector borne illness in the United States. 94% of all cases reported in 2010 were in the following states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Hampshire, New York, Pennsylvania, Virginia, and Wisconsin.

Several years ago I had a client with the chief complaint of chronic neck stiffness and peripheral neuralgia. The symptoms had persisted for over 10 years, with a variety of diagnosis provided by health professionals. One such diagnosis was Thoracic Outlet Syndrome (TOS), made by doctors at an unnamed University Medical Center. My client was convinced TOS was a rare musculoskeletal condition and removal of a neck muscle (scalenus anterior) would relieve her symptoms. Although some relief was achieved, symptoms continued to persist after time.

Discouraged but not defeated, she hired a new doctor. Upon review of her history, the doctor noticed she was originally from Connecticut, leading to a round of questions regarding outdoor habits in CT, and if she had ever experienced the initial symptoms of Lyme disease.

As it turned out, she loves the outdoors and had experienced the initial symptoms (sans EM lesions) while in Connecticut 10 years prior. A blood test confirmed a chronic Borrelia burgdorferi infection. Treatment with antibiotics is now the correct course of action.

If you suffer from chronic symptoms aforementioned, and have visited or previously lived in a high risk geographical area for Lyme disease, it is entirely possible you may be suffering from a chronic Borrelia burgdorferi infection. Laboratory tests may confirm the infection and put you on the road to recovery. Have fun this summer and be safe. Stop, Breathe, and Be Well!

 

Adhesive Capsulitis aka Frozen Shoulder – Self Treatment

Adhesive capsulitis (aka frozen shoulder)

By Michael P. Mansfield AAS, LMT, CNMT

Adhesive capsulitis has been know as shoulder periarthritis and adherent subacromial bursitis, but the current common term used to describe adhesive capsulitis, is frozen shoulder. These terms describe both active and passive limited range of motion (ROM) of an affected shoulder, in all planes of motion. The ROM limitation can be from minimal to severe and pain experienced can also range from intermittent mild discomfort to a chronic, severe condition.

It is important to note (as in any musculoskeletal condition) that there may be an underlying pathology or condition that may either mimic or exacerbate the symptoms. It is imperative for a health care professional to know the full history of the client before proceeding with a diagnosis of adhesive capsulitis.

Cardiac disease (or recent surgery), cancer, pulmonary disease, neurological disorders (MS / MD), diabetes mellitus, and thyroid disease can either present as local or referred pain in the shoulder region. In the case of idiopathic (occurring for no apparent reason) symptoms, it is VERY important to rule out possible pathologies. (A dear family friend and breast cancer survivor was diagnosed with frozen shoulder, which would not respond to several treatments of conventional manual therapies. Turns out the cancer had returned, had spread to the bones, and her pain was a result of bone degeneration and not muscular spasm. Sadly, she lost her battle with cancer due to a misdiagnosis)

If there is a history of rotator cuff tears and/or surgery, the body (brain) may be guarding against further injury. If the emotions surrounding such an injury have NOT dealt with, the body will continue to protect against possible further injury. Anybody who has endured a prolonged case of frozen shoulder has experienced this mind/body dynamic, and can attest to the emotional ranges associated with loss of movement and pain.

Frozen shoulder can occur from overuse, chronic shortening, and injury. Common contributing factors of idiopathic frozen shoulder are chronic chest breathing, side sleeping with one or both hands under the head, overuse from repetitive motion, and poor office ergonomics coupled with extended sitting.

The deep muscles involved in mobilization of the shoulder are termed as the rotator cuff. The common action of the rotator cuff muscles is stabilization of the humerus (long arm bone) at the glenohumeral joint. The glenohumeral joint is where the head of the humerus meets the scapula (shoulder blade). In other words, the rotator cuff is responsible for the movement of the arm in all planes of ROM and just as importantly, keeps the arm attached to the body.

There are four muscles attaching directly from the scapula to the upper portion of the humerus, and the acronym for this group is S.I.T.S, which stands for Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. The Supraspinatus muscle is the most common of the four to be injured in a rotator cuff condition. When a rotator cuff injury is suspected, obtaining an MRI (Magnetic Resonance Imaging) of the affected area is the best course of action to determine the injury sustained and the extent of damage.

In order to access the S.I.T.S. muscles manually, the superficial fascia (membrane covering muscle tissue) and musculature overlying the rotator cuff needs to be significantly warmed, loosened, and treated. The superficial muscles of the upper back, shoulders and arms are the Trapezius, Rhomboids, Latisumus Dorsi, Deltoid, Bicep, and Tricep. Forced stretching, trigger point therapy, or ANY manual therapy which increases the pain response, will only result in exacerbation of the condition.

Furthermore, nerve entrapment by the neck, upper shoulder/back, and chest muscles limits the amount of energy available for the rotator cuff to operate correctly. When this occurs, the superficial musculature must pick up the slack and do the job of the rotator cuff, setting up a chronic pain/spasm/pain cycle. The continued weakening of the rotator cuff generally leads to a rotator cuff tear, which may or may not require surgical intervention.

If the rotator cuff muscles are injured either from direct trauma, overuse trauma, or chronic shortening, the larger muscles will take over the action of the smaller rotator cuff muscles, become overworked, and the signal to the brain will be of malfunction (injury) and the muscles will begin to guard against further injury, limiting overall ROM of the shoulder, helping to prevent further injury.

If the larger, superficial muscles are dysfunctioning, the smaller, deeper rotator cuff muscles pick up the slack, wear out quicker, and are only left to perform their common action. At this point, the brain is being signaled of the malfunction of the shoulder region, coupled with the client’s stress of the unknown, the shoulder goes into a protective mode. With increased pain and limited ROM, the brain senses injury and the muscles guard against further injury.

In either case, frozen shoulder always involves nerve entrapment which can lead to further conditions such as thoracic outlet syndrome, tennis/golfers elbow, bursitis, carpal tunnel syndrome, and trigger finger. These conditions may also appear while experiencing frozen shoulder.

Self treatment of frozen shoulder (once correctly diagnosed by a health professional) should begin with ice packs applied to the affected area (shoulder, neck, upper chest/arm, and upper back/arm). If the action is work related, a few days off may be necessary to break the pain/spasm/pain cycle. There are several other things that can be done to self treat this condition:

  • Ice massage of the shoulder, neck, upper chest/arm, and upper back/arm. Inflammation of these areas causes nerve entrapment. The use of heat acts as an analgesic. However, heat will only worsen an inflammation issue. Simply take a white balloon (colored balloons will transfer color to the skin if used with some lotions) and fill it (do not expand the balloon) to the size of a large lemon, release any air from the balloon to prevent air pockets, tie off and freeze. Once frozen, they can be used to massage over any sore or inflamed tissue. As a general rule, cease icing when the area becomes numb.
  • Epsom salt. Magnesium sulfate can be found at the grocery store. Follow the directions on the container for an Epsom salt soak. Ensure the temperature of the water is NOT hot. Hot water will exacerbate inflammation. Luke warm water is sufficient. This can also be combined with ice massage for contrast hydrotherapy. As a general rule in contrast therapy, ice should be applied 1/3 the time of heat. In this example 9 minutes Epsom soak to 3 minutes ice massage. For contrast therapy, repeat the process at least 3-4 times.
  • Stretch the affected arm , as well as the chest and neck. Nerve supply for the rotator cuff muscles originates from the neck area. The nerves exit the spinal column, combining in a bundle (plexus), passing through muscle and under bone to the upper arm, where the bundle divides to travel to the area it supplies with energy.
  • Massage the bicep, tricep, deltoids, shoulder and neck muscles with the opposite hand. After ice massage, gentle kneading of these areas will help the tissue become less inflamed.
  • Anti inflammatory medications may be necessary to assist your recovery. Do not confuse chemical applications as heat or ice therapy. Do not use heat or ice in conjunction with using chemical applications.

Adhesive capsulitis aka Frozen shoulder can be very painful and greatly restrict normal functioning. Obtaining a correct diagnosis of this condition is the first step to recovery. Diligent treatment and care will ensure a complete recovery. Be well.

 

Compassion Fatigue

Compassion Fatigue

You Are Not Alone

By Michael P. Mansfield AAS, LMT, CNMT

Helping or being assistance to others who have suffered trauma is an honorable means of serving others. However, in providing support for a trauma survivor does not come without cost. Health professionals, caregivers, and emergency responders (police, firefighters, EMS) are at risk of suffering trauma vicariously. Compassion Fatigue, known as a secondary post-traumatic stress disorder, arises from working with those who have suffered from traumatic life events. No one is immune Secondary Traumatic Stress/Vicarious Traumatic Stress (STS/VTS).

In discussing the dynamics of STS, one must first explore transference and counter-transference. Generally these terms relate to the field of psychotherapy, but for all intents and purposes, health professionals, caregivers, and emergency responders fulfill a quasi-role of therapist when assisting others who have suffered trauma.

By definition, transference is the identification of childhood emotions of the client mistaken as emotions toward the therapist. These emotions can be friendly, hostile or ambivalent. Counter-transference is much the same, where the therapist identifies with similar emotions and mistakes these emotions as those associated with the client.

Whether providing care for a recent trauma survivor or one who is experiencing Post Traumatic Stress Disorder (PTSD), Trauma Specific Transference (TST) can occur: where the individual assisted places the caregiver into the role of rescuer, perpetrator, or supporter. Likewise, the caregiver may fall into the role of fellow survivor, supporter, or rescuer through counter transference.

Those suffering from STS, exhibit symptoms such as hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. Often self-medicating with illicit drugs and/or alcohol enters into the picture in order to abate the emotional impact experienced. In turn, the STS sufferer experiences a decline in physical health and damage to personal and professional relationships, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt.

Treatment of STS includes professional counseling, attending support groups, realizing the impact of working with traumatized individuals, attending workshops, limiting exposure to traumatic materials (e.g. books, television shows, and movies), exercising spiritual practices such as prayer, and staying connected to others.

Prevention of STS begins with maintaining clear boundaries between home and work. Additional prevention measures are scheduling time off work, engaging in regular physical activity, journaling, pursuing hobbies, meditation, listening to music, socializing with family and friends, informal group therapy with coworkers, eating a balanced diet, getting plenty of sleep, performing group guided exercise (Yoga/Thai Chi/Zumba), deep breathing exercises, and receiving professional massage therapy and/or Chiropractic sessions.

Amongst the aforementioned prevention techniques, deep breathing is free, can be performed at any time, and impacts the entire body exponentially. Deep breathing, correctly utilizing the diaphragm, affects every system of the body directly.  Proper utilization of the diaphragm (diaphragmatic breathing aka belly breathing) releases pressure from the cervical and lumbar spine, freeing up entrapped nervous tissue, reversing the fight or flight environment perceived by the brain, and thus reducing anxiety and depression.

Diaphragmatic breathing (aka belly breathing) is simple to perform, yet awareness needs to be developed. Most people either shallowly or chest breathe and quite often, and need to retrain themselves to make full use of their diaphragm. This is carried out by placing your hands on your abdomen, breathing in through the nose until the abdomen extends fully, and passively exhaling the breath through the mouth. Through continued practice, this form of breathing becomes more automatic, becoming a first line of defense in the prevention if Secondary Traumatic Stress.