Manual Therapy and Joint Dysfunction

wellness 1989863  340 - Manual Therapy and Joint Dysfunction

Tight muscles create asymmetry and weak muscles allow for asymmetry in the myofascial and skeletal systems. Deep intrinsic muscle and bony skeleton are inseparable: What affects one person always affects another. Until the therapist devises a basic understanding of how tissue engineering affects mobility / stability in a reinforced framework, randomized deep tissue work is contraindicated. Massagers and body workers who specialize in chronic pain and postural problems gain by studying spinal biomechanics and learning to focus therapeutic intentions on myofascial and associated (articular) structures of the spine.

Manual Physical Therapy

Poor joint function and accompanying protective muscle spasms are commonly seen in clients who present long-term neck, upper shoulder, and arm pain. People who frequently hold the phone with one shoulder often develop chronic unilateral hypertonicity in the levator scapulae and splenius cervicis muscles. Due to their general attachment in the top three or four transverse processes of the cervix, one-sided contraction of the sidebend of these muscles and rotates the neck and shrugs to help secure the phone. Problems increase as deep spinal “groove” muscles such as rotatores, multifidi, and intertransversarii react to unilateral continuous hypercontractions. When over-stimulated, this fibrotic strip is notorious for locking in a closed facet on the ipsilateral side and open on the contralateral side.

Sensitive joint mechanoreceptors respond to continuous torsional loading by flooding the spinal cord with dangerous afferent messages that can cause the brain to further shorten this spinal rotator. Repeated exposure to the compressive strength of the unilateral prolonged sidebending of the neck also causes the degradation of the joint cartilage, which, in turn, promotes the build-up of adhesive tissue at the servicothoracic junction, namely, Dowager’s Hump.

Sacroiliac Joint Dysfunction

The brief conceptualization of the head being pulled forward is also pulled to the right sidebending and right rotation due to the combined hypercontraction of the levator and splenius cervicis muscles. When the client tries to raise his head from the flexed position to the extended position, the aspect on the right slides down on their lower neighbor as it should. But the right sidebent neck alters vertebral tracking causing the left side to “jam” when the head and neck try to bend backwards, namely T3, unable to move back to the proper closed position on T4. Since the T3 joint on the left cannot be closed accurately, it forces the T3 cross-section to rotate to the right.

To compensate, the T3 rib on the right is pushed into external rotation – Now the nagging pain begins. The long irritation allows these “dynamic duos” (vertebral / rib fixation) to feed on each other, creating reflexogenic inhibition of the surrounding paravertebral muscles, including the rhomboid and trapezius muscles. Retraining exercises to strengthen the weakened lower shoulder stabilizer muscles to help withstand the strong pull of the large chest are useless until both joint fixations are fixed. Pain between knives (double fixation) is one of the longest and most irritating joint-related problems our clients have ever experienced.

To help with this sad situation, the fascia of the splenius cervicis, the levator scapula and the anterior scalp on the right must first be lengthened.

The therapist may use a finger or thumb to shade the groove of the lamina bilaterally scanning in a lower direction until the bony knot on the right at T3 is neglected. Using light and sustained anterior / inferior pressure, the client is instructed to inhale a count of five, while carefully attempting to extend and rotate the left of his head against sustained isometric resistance of the therapist’s thumb.

When the bony knot pushes back against the resistance of the therapist, the release of the strong Golgi tendon organs is transferred via a transverse process to the adjoining spinal rotator muscles, creating increased capsule flexibility and subsequent joint decompression.

When the client exhales and relaxes, the post-isometric relaxation reaction further softens the muscles and joint capsule. Pressure from the therapist’s finger slowly erases T3’s rotation and increased tracking allows the face-to-face T3 on the left to slide smoothly down the T4.

If softening is immediately neglected in the surrounding spinal muscles following this technique, then the therapist is doing his best. Always look to see if the rib on the left has corrected itself by scanning prib oros with soft fingertips, superior to the lower, feel for the bumps around T3. If the slightly protruding rib bars are neglected, the ribs are still trapped in internal rotation. With your finger or thumb, simply release the intercostal muscles over the dysfunctional ribs medially in a lateral direction.