The Coach House Therapeutic Centre

Sunday, 8 April 2018

Arms, Shoulder and Neck Stretches

with Megan Prenty, RMT Yoga Teacher

Anatomy & Symptoms

1. Forearm Flexors

The Forearm Flexors are a group of four muscles that make up the inside of our forearm. These muscle all begin just above the inside of the elbow at the common flexor tendon on the humerus bone of the upper arm. This group of muscles runs along the palmer side of the forearm and attach along the bones of the wrist and the hand. This muscle group is predominantly responsible for extending the elbow and flexing the wrist, or bending the wrist to bring the palm towards the inner arm.

This group of muscles is commonly tight and full of adhesions in people who spend extended periods of time on a computer or engaging in other repetitive and fine motor skills with the hands or wrists. These repetitive motions can result in muscle shortening and tension which have symptoms that mimic, or can even cause, carpal tunnel in the wrist. This tension can also create nerve and vein impingements which can result in symptoms of numbness, tingling, shooting pain, and a lack of circulation in some or all of the fingers. These impingements can occur nearer to the elbow, as with pronator teres syndrome, or closer to the wrist, as with carpal tunnel.

Another common injury to this muscle group is medial epicondylitis, often known as golfer’s elbow, which is a form of tendonitis that affects the attachment at the elbow. You don’t have to be a golfer to get golfer’s elbow - in fact this condition commonly occurs in people who have repetitive elbow and wrist movements, particularly when coupled with palm-down weight bearing. Typically this is identified as pain at the inside of the elbow during or after elbow and wrist activity such as playing golf, tennis, weightlifting, wrist flexion, and other small movements like turning a doorknob, shaking hands, or using the hands while the palm is face down.

To stretch the Flexors of the forearm, we should bring this muscle group to a place of length. To do this, begin seated and bring the shoulder to 90 degrees with an extended arm and straightened elbow. Begin to extend the wrist backwards and pull the fingers towards the ceiling. Feel the stretch appear across the inside of the elbow along the forearm and to the wrist. Hold it for 30 seconds, then repeat on the other side.

Another way to perform this stretch would be positioning yourself on your hands and knees (see video for image). The elbow should be straight and the fingers should be pointing towards the knees with the eye of the elbow pointing away from the body. This version of the stretch will address both sides of the arms at the same time. To increase the line of pull, you can gently start to sit backwards lowering the pelvis over the hips until the stretch is comfortable through your arms. Ensure you hold the stretch for 30 seconds.

Trigger point balls are particularly helpful for manual release as they help to broadly focus on this group of forearm muscles. For more specific and isolated work through the arm, use a smaller ball - bouncy balls work great. To use a ball, straighten the elbow and gently roll the ball side to side horizontally across the inside of the forearm. Ensure that you work from just above the inside of the elbow and focus on the inside (pinky side) of the arm. When you find tender spots increase your focus there until the tension subsides. Ensure you roll the ball in small movements in a side to side motion. Your pressure should be a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time beginning with a suggested two and a half minutes each side and increase as needed.

Pro tip - if you sit at a desk, keep a bouncy ball close by and build it into your daily routine to ensure the arms aren't tightening and shortening through the work day and week.

2. Forearm Extensors

The Forearm Extensors are a group of four muscles that make up the outside of our forearm. These muscle all begin just above the outside of the elbow at the common extensor tendon on the humerus bone of the upper arm, running along the back of the forearm to along the bones of the wrist and the hand. This muscle group is predominantly responsible for extending the elbow and wrist, or bending the wrist to bring the palm facing away from the body with fingers pointing upwards.

This group of muscles is commonly tight and full of adhesions in people that spend extended periods of time on a computer or engaging in other repetitive and fine motor skills with the hands and wrists. These repetitive motions can cause muscle shortening and tension that can in turn cause trigger points and send pain along the back of the arm. This tension can create nerve and vein impingements which produce symptoms of numbness, tingling, shooting pain, and a lack of circulation in some or all of the fingers.

Another common injury to this muscle group is lateral epicondylitis, commonly known as tennis elbow, which is a form of tendonitis that affects the attachment at the elbow. You don’t have to play tennis to get tennis elbow - in fact this condition commonly occurs in people who have repetitive elbow and wrist movements, particularly when coupled with palm up weight bearing activities. Typically this is identified as pain at the outside of the elbow during or after elbow and wrist activity such as playing tennis, weightlifting, repetitive wrist extension, and other small movements such as turning a doorknob, shaking hands or using the hands while the palm is face up.

To stretch the Extensors of the Forearm we should bring this muscle group to a place of length. To do this begin seated and bring the shoulder to 90 degrees with an extended arm and straightened elbow begin to flex the wrist forwards and pull the fingers towards the floor. Feel the stretch appear along the outside of the elbow along the forearm and to the wrist and hold it for 30 seconds. The repeat on the other side.

Another way to perform this stretch would be kneeling on hands and knees (see video for image). The elbow should be straight and the fingers should be pointing towards the knees with the weight through the back of the hand. In this posture the eye of the elbow pointing towards the body. This version of the stretch will address both sides of the arms at the same time. This is a very sensitive so be sure the line of pull is comfortable. To increase the line of pull you can gently start to sit backwards lowering the pelvis over the hips until the stretch is comfortable through the arms. Ensure you hold the stretch for 30 seconds.

Trigger point balls are helpful for manual release particularly to get into this group of forearm muscles broadly. For more specific and isolated work through the arm use a smaller ball - bouncy balls work great. To use a ball effectively straighten the elbow and gently roll the ball side to side horizontally across the back of the forearm. Ensure to work from just above the outside of the elbow and focus on the inside (pinky side) of the arm. When you find tender spots increase your focus there until the tension subsides. Ensure you roll the ball in small movements in a side to side movement. Your pressure should be a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time beginning with a suggested two and a half minutes each side and increase as needed.

3. Biceps Brachii

Commonly known as the Biceps, this muscle runs from the top of the shoulder blade and inside of the shoulder joint capsule and then along the front of the upper arm, attaching just below the elbow on the Ulna bone of the forearm. Biceps is responsible for multiple actions: primarily it is responsible for supinating the forearm (turning palm upwards) and flexing (bending) the elbow, and also assists in flexing the shoulder.

This muscle is commonly the cause of shoulder pain that originates from the front of the shoulder. This pain is most often from chronic muscle shortening or a tendonitis of the Biceps. Chronic muscle shortening is commonly seen in computer users and athletes. When the arms are held with a bend at the elbows the muscle is in a shortened state; being in this posture for prolonged periods can create a chronic shortening. Muscle imbalances also occur commonly in weightlifters who omit stretching and don’t equally focus on exercising the Biceps antagonist muscle Triceps. Tendonitis of the bicep tendon is common in people who do work with repetitive elbow bending, especially if the muscle is under load as when lifting is occurring.

To stretch Biceps Brachii we must bring the muscle to a place of length. Begin with your hand on a table or stool with your fingers pointing behind you. Begin to straighten the elbow and bring the shoulder into extension by leaning forward. A line of pull should develop from the top of the forearm, across the elbow, and up the front of the upper arm to the shoulder. Once you feel a comfortable pull up the front of the arm hold it for 30 seconds before repeating on the other side.

Trigger point balls are helpful for manual release. To work with a trigger point ball use one hand to apply pressure as you roll the ball horizontally left to right along the front of the arm from the shoulder and work the way down just past the front of the elbow. Ensure your pressure is a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time beginning with two minutes each side and increasing as needed.

4. Triceps Brachii

Triceps Brachii are commonly referred to as the Triceps, and are a large muscle that makes up the bulk of the back of the upper arm, working in opposition to the Biceps. The Triceps muscle has three different heads which connect the back portion of the scapula (shoulder blade), along the back of the long bone of arm - the Humerus and the back of the Ulna of the forearm. Triceps Brachii has several functions but primarily extends or straightens the elbow. Triceps also has an important role in arm stabilization when the forearm and hand are engaging in fine motor movements as well as a supporting function in adduction of the shoulder.

Common conditions affecting this muscle is Tricep tendonitis at the portion of the muscle near the elbow. Another common injury affecting the Triceps comes from over-stretching, particularly when strength training through this muscle has been lacking. Typically injuries in Triceps are seen in athletes, particularly in sports which incorporate weight bearing and throwing movements.

To stretch Triceps Brachii we must bring the muscle to a place of length. Begin by bringing one arm up above your head, tuck your chin in, and bend this arm at the elbow while tucking the hand along the upper shoulders. With your opposite arm grab the elbow and pull into the midline of the body. A line of pull should develop from the back forearm, crossing the elbow and up the back of the upper arm to the shoulder. Once you feel a comfortable pull up the back of the arm, hold it for 30 seconds before repeating on the other side.

Trigger point balls are helpful for manual release. To use a trigger point ball for Triceps, pin the ball between yourself and a wall of on the floor with the ball at the back of the upper arm. If this is the first time you have done this stretch or if your tricep is actively hurting, I suggest starting with yourself leaning along the wall so you can adjust your depth with more sensitivity. Ensure your pressure is a comfortable depth as you work on each side. Gently roll the ball from side to side horizontally as you move it from the top of the upper arm to the bottom of the elbow along the back of the arm. Make sure to work both sides of the arms for an equal length of time, beginning with two minutes each side and increase as needed.

5. Deltoids

The Deltoids are a small muscle in the shape of an inverted triangle that sit at the top of the upper arm. This fan shaped muscle attaches from the clavicle in the front of the body and wraps around the side of the body to include the outer portion of the acromion and spine of the scapula. This muscle inserts in the Deltoid tuberosity which is a small bump in the outer portion of the top third of the upper arm. This muscle is responsible for abduction of the arm away from the body. When this muscle is isolated into different fibers (anterior, lateral and posterior) it supports the muscles of the rotator cuff as well as abduction of the arm.

The Deltoids can be overworked and cause painful contractures and trigger points when we carry weight with straight arms. Because the Deltoids are responsible for moving the arm away from the body they engage and contract to be able to hold weight with a straight arm without it bumping into the body itself. Especially if we carry a great deal of weight at once, say carrying all your grocery bags in one trip when really it be best if it was two or three trips. One way to avoid this common injury is to not overload the muscle. Reduce your carrying weight where possible and when you do carry heavy loads insure to stretch afterwards.

To stretch the posterior portion of the Deltoids, we must bring the muscle to a place of length. Begin by securing the shoulder towards the hips and ensure space between the shoulder and the ears. Bring this arm across the chest, gently secure this arm with the other hand. A line of pull should develop from the back portion of the upper arm where it meets the shoulder. Once you feel a comfortable pull up the top of the back portion of the shoulder hold it for 30 seconds before repeating on the other side

Trigger point balls are helpful for manual release. To use a trigger point ball use one hand to apply pressure as you roll the ball horizontally left to right along the side of the upper third of the arm. Ensure your pressure is a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time beginning with one minutes each side and increase as needed.

6. Upper Trapezius

This is a large, broad diamond-shaped superficial muscle which covers most of the upper back. Trapezius runs from the base of the skull and attaches on the lower thoracic (mid back) vertebrae as well as extends outwards to attach along the spine of the scapula (shoulder blade). This muscle is primarily responsible for moving the scapula and supports the weight of the arm.

Common conditions affecting the trapezius muscle include myofascial trigger points. Due to poor posture, this muscle is often over lengthened, weakened, and susceptible to small tears which cause painful adhesions and knots in the muscle. These trigger points, or muscle knots, are common causes of muscle pain and are the source of tension headaches which wrap around the side of the head like a question mark. The upper portion of Trapezius is often tense in people under stress and those who sit for prolonged periods.

To stretch the Upper Trapezius we must bring the muscle to a place of length. Begin by securing the shoulders towards the hips and ensure length through the neck. tilt your head to one side, bringing your ear toward the shoulder. A line of pull should develop from the lengthened shoulder, up the neck, to the base of the skull. Once you feel a comfortable pull up the side of the neck from the shoulder and hold it for 30 seconds before repeating on the other side.

Trigger point balls are helpful for manual release particularly to get into the neck muscles broadly. For more specific and isolated work through the neck use a small ball - bouncy balls work great. To use a ball use one hand to apply pressure as you roll the ball from the shoulder along the side of the neck from the shoulder to the ear. Ensure you roll the ball from the front to the back of the body. Ensure your pressure is a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time, beginning with one minutes each side and increase as needed.

7. Levator Scapula

Levator Scapula is a small muscle that runs from the top of the shoulder blade to the sides of the top four cervical vertebrae. This muscle connects the back body at the shoulder blade to the neck. As its Latin name suggests, Levator Scapula is responsible for lifting the shoulder blade.

Levator Scapula syndrome can result in those who sit for long periods with poor posture. Forward head carriage and slouching posture through the back will irritate this muscle causing localized and referral pain, inflammation of the muscle, stiffness, and decreased range of motions. The increased tension on this muscle from poor posture can create adhesions and trigger points which can result in pain and tension related headaches. Dysfunction and adhesions in this muscle is commonly associated as a cause of localized neck pain and headaches.

To stretch Levator Scapula we must bring the muscle to a place of length. Begin by securing the shoulders towards the hips and ensure length through the neck. Bring one ear towards the same shoulder as your head tilts to one side just as with the upper trap stretch. From this position turn your chin towards your armpit and tuck it in slightly. A line of pull should develop from the top of the shoulder blade and travel up the neck to the side of the neck. Once you feel a comfortable pull from the shoulder to the side of the neck and hold it for 30 seconds before repeating on the other side.

Trigger point balls are helpful for manual release, particularly to get into the neck muscles broadly. For more specific and isolated work through the neck use a smaller ball - bouncy balls work great. To use a ball bring yourself into the stretch and use one hand to apply pressure as you roll the ball from the top of the shoulder blade and along to the side of the neck. Ensure you roll the ball in small movements side to side. Your pressure should be a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time, beginning with one minute each side, and increase as needed

8. Scalenes

Scalenes are a group of three small muscles (anterior, middle, and posterior) that run along the front of the neck. These muscles originate on the cervical vertebrae two through seven and attach to the first and second rib. The primary action of this muscle group when engaged one side at a time is to bend the head to the same side. When contracted bilaterally this muscle group helps to lift the first and second ribs during inhalation.

This muscle is a common location of impingement in thoracic outlet syndrome. In this condition, muscles that are overly shortened or inflamed can press on the nerve, arteries, and vein bundles where they exit the neck and travel down the arm. Symptoms of thoracic outlet syndrome include pain and weakness that travels along the neck to the arm. Nerve symptoms like shooting pain or numbness can also be present. This injury commonly occurs from repetitive movements with the arm and neck, as well as poor posture. Scalenes are at risk of becoming short and tight especially in people with asthma or during cold and flu season when people are forcibly coughing.

To stretch Scalenes we must bring the muscle to a place of length. Begin by securing the shoulders towards the hips and ensure length through the neck. Bring one ear towards the same shoulder as your head tilts to one side just as with the upper trap stretch. From this position turn your chin towards the ceiling. A line of pull should develop long the front of the neck to just below the collarbone. Once you feel a comfortable pull from the shoulder to the side of the neck and hold it for 30 seconds before repeating on the other side. Ensure to take deep and comfortable breaths while in the stretch.

Trigger point balls are helpful for manual release particularly to get into the neck muscles broadly. For more specific and isolated work through the neck use a smaller ball - bouncy balls work great. To use a ball bring yourself into the stretch and use one hand to apply pressure as you roll the ball along the front of the neck working from the collarbone to the outside upper portion of the neck. Ensure you roll the ball in small movements in a side to side movement. Your pressure should be a comfortable depth as you work on each side. Work both sides of the arms for an equal length of time beginning with one minute each side and increase as needed.

While stretching is generally safe for everyone, it is best to talk to your doctor or medical health professional before undertaking a new exercise routine. This is especially true if you have any pre-existing conditions, injuries, or particular concerns. If you have questions about anything mentioned in this blog or for booking contact email Megan directly by e-mail: megan@thecoachhousetc.ca

Namaste

Megan Prenty RMT, YT

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Wanting more resources like this one? Be sure to check out the rest of the series - the Lower leg , Thigh self care , Glute and Hip self-care and Trunk -back and chest.Be sure to follow The Coach House on Facebook and Instagram to keep in touch and get notifications of new blog posts.

Disclaimer: The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for general educational purposes only. This information shouldn’t take the place of seeing your primary care provider for individualized health recommendations.

Sunday, 1 April 2018

Back and chest self care

Back and Chest Stretches

with Megan Prenty, RMT Yoga Teacher

Anatomy & Symptoms

1. Quadratus Lumborum

This is a broad muscle that connects the pelvis to the ribs and covers the lower portion of the back. Quadratus Lumborum attaches from the top of the pelvis and along the twelfth ribs. This muscle is responsible for several actions including spine stabilization. When this muscle is contracted on one side it is responsible for same- side lateral flexion (side bending) and if both sides contract then Quadratus Lumborum will help with spinal extension.

This muscle is commonly associated with low back pain and is often impacted when people sit for prolonged periods of time. Weakness through the core and low back muscles, as well as extended shortening, can cause continued contraction in the muscle leading to spasm, tension, adhesions, and muscle fatigue. Poor posture will exacerbate the tension along the Quadratus Lumborum.

To stretch Quadratus Lumborum, we must bring the muscle to a place of length and do the opposite of its function. There are several stretches that will address this muscle. When stretching begin seated and lean to one side. Bring your arm over your head to help open fully through one side of the ribs. Keep the shoulders square. One side the Quadratus Lumborum will compress while the other expands. Ensure that you take steady, deep breaths here as this muscle assists with expiration. These stretches should induce a stretch through one side the low back. Once you find the line of pull, hold the stretch for 30 seconds before releasing.

When stretching both sides congruently, begin seated and twist to one side. Turn your shoulders, chest and belly button to one side so as to feel an opening through both sides of the lower back and hold for 30 seconds. Repeat this facing the other directions as well. Ensure that you take steady, deep breaths here as this muscle assists with expiration.

Trigger point balls are helpful for manual release. To use a trigger point ball between you and the floor or wall, place the yoga tune up ball between your hips and rib cage along the low back. You can roll gently from side to side along the affected muscle with a comfortable depth.

2. Latissimus Dorsi

This is a large broad muscle that connects the back of the arm to the lower spine and top of the pelvis. This superficial muscle of the back makes up the largest muscle of the upper body. This muscle is responsible for extension, internal rotation, and adduction of the shoulder joint while also facilitating extension of the spine and side bending. This muscle assists in forced exhalation as well as passively assisting with inspiration. Injuries to Latissimus Dorsi are uncommon, however tension in this muscle is commonly associated with causes of chronic low back or shoulder pain.

To stretch Latissimus Dorsi we must bring the muscle to a place of length and do the opposite of its function. When stretching one side at a time begin seated and lean to one side. Bring your arm over your head to help open fully through one side of the bodies ribs. From the side bending posture square your shoulders over your knee, allow the chin to tuck in and feel the back round. You will feel a line of pull develop from the back of the arm through the side back body all the way to the low back. Tuck the chin in and allow the back to round. Ensure to take steady, deep breaths here as this muscle assists with breathing. These stretches should induce a stretch through one side the low back. Hold this stretch for 30 seconds before repeating on the other side.

3. Lumbar Spine Erectors

This is the lower body portion of a group of spine stabilizing muscles that connect the pelvis to the vertebra of the thoracic and cervical spine. The Erectors as a group originate at the top of the pelvis and extend vertically through the lumbar, thoracic, and cervical regions on either side of the spine. This muscle group is made of three smaller muscles that function together to extend the spinal column and passively provide stabilization for the spine.

This muscle group is commonly associated with low back pain and is often impacted when people sit for prolonged periods of time. Weakness through the core and low back muscles can cause continued contraction in the muscle leading to spasm and trigger points. Excessive shortening of the lumbar portion of this muscle is common and results in increased postural and muscle imbalances throughout the pelvis and trunk. Trigger point or muscle knots will send referral pain along the spine. Typically tension and pain in the back will occur with forward bending exercises.

When stretching both sides of the lumbar Erectors congruently, begin by laying on your back. Pull your knees towards your chest to facilitate a rounding through your lower spine. Allow your arms to reach for your shins and and hold for 30 seconds. Ensure you take steady, deep breaths here as this muscle assists with expiration.

Trigger point balls are helpful for manual release. To use a trigger point ball between you and the floor or wall, place the yoga tune up ball along either side of the lower portion of your spine. You can roll gently up and down along the affected muscle with a comfortable depth.

4. Cervical Spine Erectors

This is the upper body portion of a group of spine stabilizing muscles that connects the pelvis to the vertebra of the thoracic and cervical spine. The Erectors as a group originate at the top of the pelvis and extends vertically through the lumbar, thoracic, and cervical regions on either side of the spine. This muscle group is made of three smaller muscles that function together to extend the spinal column and passively provide stabilization for the spine.

Common dysfunctions of the upper portion of the Erectors includes excessive lengthening and weakness from sustained slouching seated posture. This muscle imbalance increases risk of tears and injury in the muscles of the shoulder and rotator cuff.

When stretching both sides of the cervical Erectors congruently, begin seated. Tuck your chin in towards your chest and begin to flex your neck forward to facilitate a rounding through your cervical spine. If you do not feel a gentle pull up the back of the neck allow your arms to reach for the back of your head and gently rest there (without pulling) then hold for 30 seconds.

Trigger point balls and bouncy balls are helpful for manual release. Place the ball in your hand and gently roll it along either side of your spine at the back of your neck. You can roll gently up and down along the affected muscle with a comfortable depth.

5. Pectoralis (Major and Minor)

The pectorals are a group of two muscles which make up the chest portion of the torso. Pectoralis major is the larger and more superficial chest muscle. Pectoralis major runs from the 7th rib, along the surface of the sternum (breastbone) to the clavicle and attaches at the front of the shoulder joint. This muscle has several actions and is responsible for moving the shoulder joint forwards into flexion, for helping to abduct the arm, and to internally rotate the arm. Pectoralis minor is the smaller and deeper chest muscle it runs from the 3rd, 4th and 5th ribs and attaches to the coracoid process of the scapula (shoulder blade). This smaller muscle is responsible for depressing the shoulder and assisting to keep the scapula on the trunk.

Typical dysfunction seen in the pecs comes from poor posture which contributes to and over shortening of these muscles. Prolonged seated postures encourage and rounding through the back that causes the muscles of the chest to shorten as the shoulders round forwards. This shortening causes contractures, spasms and trigger points. Athletes in contact sports or weight training may subject themselves to strains of Pectoralis major if too much weight is borne too quickly or if a traumatic impact occurs locally.

There are several ways to stretch the pecs. Begin this stretch addressing the pectoral muscles begin by laying your arm and chest along the wall. Slowly begin to peel your chest away from the wall and begin to square your shoulders. This will bring a stretch through the front of the chest and shoulder along pectoral muscles on the arm that is on the wall, hold for 30 seconds and repeat on the other side.

The Pectoral muscles cover a great deal of upper portion of the trunk. To ensure you stretch all parts of the muscle, it is suggested that you stretch with your arms at several angles. The stretch should be performed with the arms at 110 degrees, 90 degrees, and 70 degrees. In each posture, the arm is secured on a door frame with the shoulders squared. Begin to slowly lean forward to increase the stretch through the same side of the chest. Hold the stretch for 30 seconds before repeating on the other side.

Trigger point release for Pecs:

Trigger point balls are helpful for manual release. Come into a position of stretch for the Pectorals and place the ball between your chest and the wall, gently leaning into the ball. You may stay stationary or you may choose to gently roll the ball from in front of the armpit forwards over the front portions of the ribs.

6. The Diaphragm

The Diaphragm muscle primarily assists us with the actions of breathing and lays across the inside of our thoracic cage. This muscle is a dome shape that runs along the inside of the rib cage above the abdomen. When this muscle is functioning it creates a vacuum effect that supports both inhalation upon contraction and exhalation when relaxed.

Due to poor posture and prolonged sitting we often see muscle imbalances and tension in the diaphragm. Those who have an inactive lifestyle or a great deal of stress may impact the use of the diaphragm. To learn more about the Diaphragm and how to support its best function check out our blog post on belly breathing.

Namaste.

Megan Prenty RMT, YT

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Wanting more resources like this one? Be sure to check out the rest of the series - the Lower leg , Thigh self care and the Glute and Hip self-care. Be sure to follow The Coach House on Facebook and Instagram to keep in touch and get notifications of new blog posts.