Thoracic Outlet Syndrome causes numbness, tingling and circulation problems in the arm. It usually just occurs on one side of the body and is caused by tightness in the scalene muscles in the neck. These muscle form a triangle which various nerves and vessels pass through. Tightness in these muscles causes compression which restricts blood flow and interferes with nerve function. Poor posture also contributes to Thoracic Outlet Syndrome. So we need to loosen these muscle up and improve your posture. In this video we'll go over some specific stretches to get to the root of the problem.
First there's an easy test to see if you have Thoracic Outlet Syndrome. It's called the Roos Test. Hold your arms at 90 degree angles like this. And open and close your hands for up to 3 minutes. If it reproduces your symptoms or if you can't hold your arm up for that long then there's a good chance you have Thoracic Outlet Syndrome. When you lower your hands compare the color. The affected side will often appear more pale due to lack of blood flow.
To stretch the scalenes tilt your head back and away from your problematic side. Then rotate toward your problem side and hold this position for 30 seconds. You should feel a good stretch in side of your neck. And sometimes it will cause some tingling in the arm. Start gentle, over time you will be able to handle a stronger stretch. If you don't feel a stretch usually you need to tilt your head further back or more to the side. Play with the angle of stretch until you get it right.
Get in front a doorway. Place your arms in the doorway and lean forward. You should feel a stretch in your chest as your shoulders are pushed back. Hold for 30 seconds and repeat 3 times. You can adjust the height of your arms in the doorway to stretch different parts of your chest. If you get pain or reproduction of your symptoms try different angles to get a more comfortable stretch.
With the head starting in a neutral position bend to the side while applying a gentle to moderate amount of pressure to the head. Hold for 30 seconds, repeat 3 times. To add intensity do the stretch while sitting on your hand and simultaneously applying pressure to the head. Perform these exercises 3 times a day to get relief from your symptoms.
Thoracic Outlet Syndrome is often accompanied by rib dysfunction because the scalene muscles attach to the first and second ribs. You may benefit from a rib manipulation to get further relief from your symptoms. And that's available here at Stronglife Physiotherapy.
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If you've ever had a crick in the neck you know it's pretty awful, especially when you turn your head real quick to the side. It hurts! A lot of people think: well maybe if I just don't move my head that direction it will get better. This is a bad idea. If you don't move your neck, you're going to get even more stiffness and the pain is still going to be there. Let's go over some things to help you get rid of that pain in the neck. First, start with a side bending stretch. You're going to bend your head to the side and apply a gentle pressure. Hold that for 30 seconds and repeat 3 times to each side. If you're getting pain, just keep it real gentle to begin with, and eventually you're going to be able to handle more pressure.
Next, try some rotation. So, starting with your head in a neutral, midline position rotate your head as far as you can without pain. Hold that for a few seconds, then return to midline. Repeat that 10 times to each side. Even if you only have pain going one direction. As your pain and motion begin to improve, increase that to 20 repetitions. If you need to you can perform this exercise lying down on your back which is sometime more comfortable.
Final exercise is isometrics. So you're going to take your hand and press it on your head. And push your head and your hand together. You're going to hold that for 5 seconds, and repeat that 5 times. You're going to want to do that to each side. Going back. and going forward. And yes, you're going to look awesome while doing these exercises!
Motion is the key to getting better, but not too much. You want to go up to the point of pain, or just shy of it. But not through it. Remember, with pain, you can go to it but not through it.
Most of the time you should be able to rid of the pain by doing what I've shown you. If not, come in for a visit. The sooner you come in, the easier it is to treat and the faster you get better. If it persists for several weeks or more, then it becomes more difficult to treat and can take longer to get better.
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Sciatica, or nerve pain that goes down the leg, can have multiple causes including disc herniation, spinal stenosis, a little pain in the butt muscle called the piriformis. In this video we're going to focus on piriformis syndrome which is sciatic nerve pain caused by the piriformis muscle being too tight. Now the piriformis muscle can cause problems because it passes right over the sciatic nerve. Therefore, when it gets tight it compresses that nerve. And this can be particularly problematic because we sit on that nerve and muscle everyday which, when it's irritated, can be quite painful. Symptoms of piriformis syndrome include pain in the buttock, pain down the leg, numbness and tingling into the leg and foot, pain with sitting especially but also with standing and squatting. It can sometimes cause swelling in the leg as well.
Sometimes it can be difficult to tell if the sciatic nerve pain is coming from the piriformis or from the spine. But in general piriformis syndrome will feel like it originates in the buttock not the spine. Also with piriformis syndrome you usually won't get weakness in the leg whereas you can if it has spinal origins.
In some people sciatic nerve pain can be caused or aggravated by sitting on a thick wallet. Make sure to remove your wallet from your back pocket if you suffer from piriformis syndrome.
Piriformis syndrome can also be accompanied by S.I. joint problems, so if you feel like this is the case see my S.I. joint correction and exercise videos for help with that.
To get some relief we're going to do some exercises. We'll start with releasing and stretching the piriformis muscle.
Get on a foam roller in a figure 4 position and lean towards the affected side. Roll slowly 10-20 times. WARNING: this can be pretty intense! Don't beat yourself up too much! You can ease your pressure by pushing more with arms and opposite leg. It can also be performed with a tennis or racquetball, but these are likely to be even more intense.
Follow up the foam roller release with a targeted piriformis stretch. While lying on your back or sitting in a chair, get in a figure 4 position and pull your knee toward your chest. You should feel this stretch in your buttock where your pain begins. If not you may need to adjust the angle of your hip or pull harder until you do. Hold this stretch for 30 seconds and repeat 3 times. If you need to get a little more aggressive this can be performed standing with your leg in the same position up on a table or a bed.
Next while you're on your back hold your hip at 90 degrees and extend your knee while actively pushing you ankle back until you feel a moderate to strong stretch. If this causes your leg pain, don't push it too hard. Just go up to the point where your symptoms begin, or just short of that point. Hold for 5 seconds and repeat 10-20 times. This exercise can flare you up if you push it too hard, but if done correctly it can really reduce your nerve pain.
Last we'll do an exercise that activates the piriformis and gluteal muscles. While lying on your back, perform a single leg bridge. Lift your hips as high as you can off the table without aggravating your pain. Hold for 5-10 seconds. repeat 10-20 times.
Do these exercises 2-3 times per day. If there is any particular exercise that seems to give you more relief you can do it even more frequently. Try to avoid positions or activities that aggravate your pain the best you can. If you have to sit for prolonged periods during the day get up every 30 minutes or so and walk for 2 or 3 minutes or do some of your stretches to help break the pain cycle.
These exercises have worked quite well for my patients in the clinic and I hope they do the same for you. If you need more help, dry needling effective in getting that piriformis muscle to let go, which is available here at Stronglife Physiotherapy.
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AJ here, with Stronglife Physiotherapy. Back pain during pregnancy is extremely common and popping Tylenol all day long isn't the answer when it comes to getting relief. In this video i'm going to show you how to prevent back pain during pregnancy and how to get relief from back pain if you already have it!
Lower back pain occurs in up to 80 percent of pregnant women. That's almost all of them! And if you have had back pain before becoming pregnant there is an 85 percent chance that you will have it during your pregnancy. There are multiple causes of lower back pain in pregnant women. One major factor being a growing belly that pulls the spine forward exaggerating the curvature in the lumbar spine which can lead to pain. To counteract the weight of the belly there is a tendency lean back to balance yourself which also exaggerates that lumbar curvature, leading to more pain. Hormonal changes are also likely playing a role in your pain. Relaxin is a hormone that causes the ligaments to become more relaxed or elastic, this allows the pelvis to expand during childbirth, allowing the baby to pass through. The amount of relaxin in your body increases to about 10 times the normal level during pregnancy. This causes the joints to be not quite as stable and can lead to pain, particularly in the pelvis. In fact, what many women think of as low back pain is actually pelvic pain coming from the SI joints.
So how do we prevent the pain or get relief once it has settled in? There are a few simple exercises that can help. These exercises are very safe for you and baby, but if you have any concerns or have a complicated pregnancy, talk to your doctor first. Now I don't have a pregnant lady to demonstrate these, so you'll just have to imagine me as a very large, masculine, pregnant woman.
While laying on your back with your knees bent, tilt your pelvis back causing the small of your back to flatten and press your back down. Hold for 5 seconds and repeat 10 times.
While lying on your back, or sitting down, wrap a belt around your thighs just above the knees and press your legs outward against the belt. Give it a good hard push or as much as your pain will allow. Hold for 5 seconds and repeat 10 times. This strengthens the muscles around your hips and pelvis allowing them to stabilize more effectively.
Now while lying on your back, or sitting down place a ball or pillow between your knees and squeeze your legs together compressing the ball or pillow. This doesn't need to be an all out effort but give it a good hard squeeze or as much as your pain will allow. Hold for 5 seconds and repeat 10 times.
The last exercise is a pelvic bridge, while lying on your back with your knees bent lift your hips as high as you can. Hold 5 seconds, repeat 10 times. If this is too difficult or painful you can do a glute isometric by wrapping your hands around your knee and pressing your leg down into your hands. Hold for 5 seconds and repeat 10 times on each leg. This can also be done in a seated position.
If you are in your second or third trimester You'll want to limit the amount of time spent on you back with these exercises, especially if you get some discomfort or feel light headed. Just roll onto your side for a few minutes or sit up until it passes.
These exercises can be very helpful in preventing and reducing pain during your pregnancy. Physical activity in general, such as a regular walking program, is also very helpful in preventing pain and has many other benefits during pregnancy. If you have access, a pool can be especially helpful in reducing pain and getting some pain free exercise.
Just remember, most back pain goes away soon after delivery and when you're holding that little baby in your arms, it'll all be worth it!
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AJ here, with Stronglife Physiotherapy. Sir Isaac Newton once said: "If I have seen further it is by standing on the shoulders of giants.” One of the giants in the physical therapy profession when it comes to low back pain is Dr. Stuart McGill. He's fixed the backs of professional fighters, olympians and other elite athletes allowing them to return to high level competition. He has what he calls the big 3 exercises for spinal stabilization and in this video we're going to show you how they're done.
Dr. McGill emphasizes that the muscles of the spine are designed for stabilization or rather, to prevent too much motion from occurring. Exercises and activities that have a lot of motion through the spine like full sit-ups can cause excessive strain and lead to potential injury. He also makes the point that endurance is especially important in these muscle since they are postural muscles, which means they are required to stay activated for long periods of time through out the day.
Get on your hands and knees. Find your neutral position by fully extending the spine then fully flexing the spine. Your neutral position should be somewhere in the middle but still have a slight curve in the low back. Stiffen your core, lift your opposite arm and leg and hold for 10 seconds, bring the arm and leg down without putting any weight on them. Then raise them again and repeat 5-10 times on each side. For added difficulty form circles or squares with your arm and leg.
McGill Curl Up
Lie down flat on your back. One leg straight and the other bent. Place your hands under the small of your back for lumbar support. Lift your head and shoulders slightly. Hold this position for 10 seconds, repeat 5-10 times. Get on your side with your top foot in front and supporting yourself on your elbow. You can place the top hand on the opposite deltoid to help support the shoulder. Lift your hips to straighten your body, keep your core stiff and your back and your hips straight. Hold for 10 seconds, repeat 5-10 times. Work up to a minute long hold. If this position is too difficult or painful, it can be performed from your knees instead of from your feet. But you'll want to eventually work up to performing it from your feet.
These are 3 great exercises to help improve your ability to stabilize your spine. If you have low back pain do them 2-3 times a day. Once your pain is gone, do them 2-3 times per week as a maintenance program to prevent the pain from returning.
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AJ here, with Stronglife Physiotherapy. I'm going to show you two techniques to correct your SI joint dysfunction. A lot of people are able to get rid of their SI joint pain with these techniques so I hope you find them useful as well. They work by using your body's own musculature to reset the joint. Sometime you'll hear or feel a pop, click or shift in the pelvis region. And that's OK. That what we're going for.
First, while sitting, push your legs apart and use your hands to resist the motion and hold for a few seconds. Then put one or two fists between your knees and squeeze nice and hard. Usually it's best to do two or three cycles of this.
Second, lay down with your knees bent. Put one hand on top of your knee, and the other hand behind the other knee. Now push against your hands in opposite directions and hold for a few seconds. Repeat twice, then reverse your hand position and repeat twice on the other side.
I prefer a variation of this technique in which you put your heel on the opposite knee and push down with your heel while simultaneously pushing up your knee, so that your legs are pushing against each other. Repeat a couple times on each side. This technique generates more force, which is often needed to get the desired effect.
I hope you find these techniques useful in getting rid of your SI joint pain. Please like and subscribe, and stay strong!
This may seem like a funny question to ask, but plenty of people ask it. There's the obvious answer: You get better!
Unfortunately the answer to this question isn't always straight forward. Recovery can depend on how recent the injury occurred and if you've been pushing through pain for a long time prior to seeking (or during) treatment. It will also depend on if you're getting the right kind of treatment. It's easy to get discouraged, especially if you've been dealing with the pain for a long time.
For acute pain which has been present for days or a few weeks you can often see rapid progress, sometimes even after just one treatment! Pat yourself on the back for grabbing the bull by the horns and taking control of your pain early on!
With appropriate treatment and as long as you follow the plan you should see steady progress. More severe injuries can still take a while but in general it won't be hard to see progress. Keep in mind that most tissues should heal (under ideal conditions) in 4-6 weeks. Bone healing takes a bit longer, 6-8 weeks.
There can be underlying factors that caused you to become injured such and muscular weakness. Even though your pain may go away, it takes time to build strength, so be patient AND consistent with your exercises.
Your progress will be delayed if something is repeatedly aggravating your pain.
For Chronic pain that has been going on for several months or more you need to take into consideration that your condition gradually worsened over a long period of time. Had you come in when your pain first began you probably would have seen more rapid progress and resolution (tisk tisk!)
For many people, improvement will be a roller coaster ride with ups and downs. One day you'll be feeling great and singing praises to your physical therapist as some kind of miracle worker.
The next day you may have a flare up and curse your physical therapist as some kind sadistic witch doctor (we get called a lot of things).
Don't get discouraged! On your good day you were probably feeling so good you decided to conquer the world and tackle that giant to do list that you've been in too much pain to do, or maybe you decided to try running again. Maybe you even felt great while doing these things but the next day you're hurting so much you feel like you're back to square one.
This is a common cycle when rehabbing an injury. If you're on the right track you'll notice that you seem to be having more good days than bad days. Your pain will still be there but not as intense, or you may forget about the pain for a while. You'll still have bad days (frustrating, I know) but try to see the big picture. Think about where you started and where you are now. Make sure you're following the plan.
If you take an honest look at your situation and see that you've made no progress or even gotten worse after several visits then something needs to change. You may be doing too much, or too little, or you may need to see a different therapist, or sometimes a different type of provider.
Here are some tips to ensure you make good progress:
Low back pain got you down? It'll get better on it's own, right? Maybe if you just take it easy and pop some ibuprofen. Sometimes it does, and sometimes it doesn't. Seems like a gamble. How much money are you willing to put on the line?
A study published in the December 2012 issue of Spine compared the costs associated with low back pain in over 32,000 patients. They compared those who started physical therapy early (within 14 days) with those that delayed physical therapy (after 14 days but within 90 days). Those who got to physical therapy within 14 days were much less likely to have an MRI, return for more doctor visits, have surgery, or be put on addictive opioid pain medications AND on average spent $2700 LESS!
Often we are able to resolve back pain in just a few visits if we catch it quickly, like the study suggests. Don't waste your most precious resources: money and ESPECIALLY time on being down with back pain. Get the treatment you need and get it fast! Get PT first!
I am often asked about cold laser therapy and how it can help. The short answer: it relieves pain and inflammation by improving microcirculation and stimulating accelerated healing. For those of you looking for a little more information; read on!
It has been shown to reduce the ability of local nerves to transmit pain to the brain which often results in an immediate decrease in pain. 1, 2
When I first bought the laser I was excited to try it on anything and everything. Three months prior to buying the laser, I injured my back diving off a high dive causing me to hyperextend my spine. The injury wasn't serious, but for those three months it was naggingly present every time I extended my back. The first time I used the laser, the pain was reduced by at least 50%! Not bad for a couple minutes of laser treatment! Over subsequent weeks I continued laser therapy and some foam rolling exercises and the pain went away.
Lets start with the name: cold laser. Sounds chilly, right? Well it definitely is cool (cold laser pun) but it's not actually cold. It's called a cold laser to distinguish it from lasers that generate heat. While there are benefits from applying heat to the body, that is not how cold laser therapy works. It works by using laser light to stimulate cells within the body. Each cell in our body has something called mitochondria, which is the part of the cell that is responsible for energy production. Each mitochondrion has a photoreceptor which is basically a light sensor. When we stimulate this light sensor (with the laser) it increases energy production thereby helping the cell work faster to do it's job. See the research here: 1, 2
Laser light also causes changes in circulation by stimulating the release of nitrous oxide. When nitrous oxide is released in the blood, it causes vessels to dilate (expand). This allows for more blood to enter and leave the area which allows for more rapid delivery of nutrients and clearing away waste products. See the research here: 1, 2.
This type of laser has also been studied for its wound healing properties and was found to help wounds heal faster by reducing inflammation and increasing collagen production in the wound. Collagen is one of the primary proteins involved in wound healing. See the research here: 1, 2, 3
To summarize: cold laser therapy has been studied extensively and has been found to be effective in treating a wide variety of conditions and has many actions that are beneficial for the healing of our bodies. Other main benefits of cold laser therapy is that it is extremely safe (much safer than any medication), it is painless, and doesn't take very long to administer.
Below you will find a list of conditions that can be effectively treated with cold laser therapy and if you click on each one your will find research supporting its use for that specific condition.
Carpal Tunnel Syndrome
Mention this blog post for a free laser session!
I just finished reading Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain=for Life by Dr David Perlmutter. This book is all about how the bacteria in your gut can influence your health. I found this book to be fascinating but If you're anything like my wife, you appreciate the information, but would never read the book. So in writing this, I hope to allow you to extract some actionable info without having to invest the time to read the book.
The bacteria inside our body (about 100 trillion cells!) out number our own cells and can have a profound effect on our health. This includes both physical AND mental health and there is some amazing research to back this up. For example when bacteria from the gut of overweight people was transplanted into mice they very quickly began to gain weight. Another study found that people taking probiotics (in yogurt) had reduced negative thoughts associated with sadness compared to those who did not get the probiotics. Another study showed that the byproducts of bad gut bacteria injected into healthy puppies almost immediately (and temporarily) produced many characteristic symptoms of autism.
According to the author he has successfully treated many conditions by rehabilitating the gut bacteria. Some of these include: ADHD, depression, obesity, metabolic disorders (type 2 diabetes), Multiple Sclerosis, various autoimmune and neurological diseases, Autism (not a cure but very beneficial for behavior). As good as it is to treat these conditions, one of the main ideas is that we can prevent many diseases from ever occurring. As they say: an ounce of prevention is worth a pound of cure!
Gut bacteria influence the levels of inflammation in our body. Higher levels of inflammation are linked to many things including brain disease (such as Alzheimer's), depression, heart disease, chronic pain and auto immune conditions (in which the body attacks itself). Having the right kind of bacteria lowers our levels of inflammation.
Here are a few golden nuggets to help you raise an army of good bacteria in your gut:
1. Take a probiotic daily - look for one with a high count (many billions) and a variety of strains but especially these powerful 5:
2. Drink filtered water: the chlorine in our water helps make it safe to drink but also kills beneficial bacteria in our body. Filtering the chlorine out helps the good guys inside us survive.
3. Eat fermented foods. This is one of the best ways to introduce beneficial bacteria into our gut. Examples: kimchi, sauerkraut, kefir, yogurt, and pickled foods (in brine not vinegar)
4. Diet: eat vegetables, legumes, natural fats, meat, eggs, low carb/low glycemic index foods. Good bacteria thrive on the fiber and other nutrients. Eating sugary, high carb, and processed foods give fuel to bad bacteria.
5. Avoid inappropriate antibiotic use (like for minor coughs and sniffles). Begin aggressive probiotic therapy after antibiotic use.
6. Consider eliminating or at least reducing wheat/gluten from your diet. The wheat of our time is nothing like what our ancestors ate and is likely the source of many modern diseases.
I would highly recommend this book to anyone trying to lead a healthy life, but is definitely a must read book if you are struggling with a neurologic or autoimmune disease without many treatment options or have a child with autism. For more information go to Dr. Perlmutter's website which is a great resource. I would also recommend his other book Grain Brain for the vast benefits that can come from eliminating gluten from your diet.