As a therapist it REALLY sucks when you can't figure out what's 'wrong' with yourself or find someone who can. A year ago in April on the day after I started my first full-time therapy job I was hurt by the 'star' therapist using a traction technique with a towel for a neck complaint I'd made. I had swelling on my spine the next day and lost most of my hand grip in both hands for about six weeks and had to quit the job. The dramatic loss of strength was enough that I shifted my work to barefoot massage and lost about 6 months total before opening my own practice/clinic. Ever since getting hurt I aspire to skills that are sensitive and precise and where the client is in good communication or resonance with the therapist. With stretch therapy it really goes another level in where the client is in charge of their therapy.
So picking up more than a year later with the same initial challenge I had when I asked for the therapists help... a deep ache I feel in the shoulder/low neck, vague tingling down the back of arm and into pinkie fingers. My grip is fine and after last weekend in Phoenix with Kit and feedback that my shoulders are relatively mobile, my scalenes checked out OK and the regimen of neck stretches outlined in ONBP feel great, incredibly useful and energize me however I've still had this persistent daily neck/shoulder/arm complaint...WHAT TO DO?
Yesterday it occured to me to look up Serratus Posterior Superior an interestingly adapted breathing muscle group deep to levator and rhomboids connected to the ligamentum nuchae. Here's an excerpt from Simon & Travell and from an August 2008 article in Massage Today by David Kent, LMT
"Common causes of trigger points in the serratus posterior superior muscles include illness and certain movements and postures. According to Simons and Travell, "Trigger points in the serratus posterior superior muscles are activated by overload of the thoracic respiratory effort because of coughing...and by paradoxical breathing (use of diaphragm and abdominal muscles out of phase)."1
Trigger points in the region can also be brought on by poor movements and postures caused by "sitting for long periods writ-ing at a high desk or table, when the shoulders are elevated and rotated forward to permit the arms to reach the high surface; repeatedly reaching to the rear of a high work surface...and protrusion of the thorax against the scapula by scoliosis," among other things.1 However, "scalene trigger points may mimic, in part, the pain pattern of the serratus posterior superior [Fig. 2]. The neck should always be examined for scalene trigger points if a trigger point is found in the serratus posterior superior."2
Anatomy: The serratus posterior superior is cover by two layers of muscle. The superficial layer is formed by the trapezius. The second layer is formed by the rhomboid minor that covers the upper half of the serratus posterior superior and the rhomboid major that covers the lower half. (Fig. 1)
The serratus posterior superior attaches at midline to the lower portion of the ligament nuchae, the spinous processes of the C6-T2 vertebrae and the intervening interspinous ligaments. The muscle fibers run at an approximately 45-degree angle, inferiorly and laterally, to attach on the 2nd-5th ribs. The lateral portion of the serratus posterior superior is covered by the scapula. (Fig. 1)
The serratus posterior superior also crosses over two muscles of the erector spinae group: the longissimus thoracis and iliocostalis thoracis. Some describe the serratus posterior superior and serratus posterior inferior acting as retinacular tissue directly super-ficial to the erector spinae; functionally this would help increase the force generated by the erector spinae.
Function: The serratus posterior superior raises the ribs to which it attaches, subsequently expanding the chest and aiding respiration. Other muscles that act synergistically with the serratus posterior superior include the scalenes, diaphragm, intercostals and levator costae muscles.
Using the principles and pure enjoyment of the stretching I experienced with Kit, here's where I went with this today rather than hang out in 'tolerance'. As a muscle group that work hardest to raise the ribs up and back for increased breathing capacity I started with taking the DEEPEST breath I could and hold the breath. Definitely feeling the ache up under the shoulders and neck. So simply clasping my hands behind me and reaching down with considerable effort towards the floor depressing the shoulders onto the ribs I feel an intensification of feeling -- yes definitely getting some feedback in this area.
Then hopping into a chair and trying my best by grasping both sides of the chair, leaning out until I'm in a stretch then taking the deepest breath I can and leaning out even further, letting my head hang forward. This is starting to feel like a REAL stretch! See the image of me grabbing the underside of a chair on both sides and leaning the head out forward and to get the ligametum nuchae end of the SPS to take up. Getting traction! Fine tuning this by first wriggling a while in the lean playing with the tilt of the hip and the curve of the spine to dig out some underlayers. Then I added the tail tuck via the contraction of all the muscles of the pelvic floor with that extra maha bandha sensation to seal the deal pulling along the longitudinal spinal ligaments too. Very sore! Feels good.
Then extending my standing version clasping hands behind me and playing with the bandhas, relative position of shoulders etc. I'm building a much better map of the territory. In one case I'm drawing the shoulders down and forward against the movement of SPS up and back and added a deeper flexion of the ankles on the front to tension up the fascia from the heel up along the back that much more by standing on my anatomy books!
It's hard to convey in words how big a deal this is for me since I've been stuck here for so long. I feel better and interestingly I feel better about myself. I feel relief from the constant ache and shoulder/neck alignment seems 'better' and yes I feel sore however I was able to work tonight without feeling so bound up on a number of levels including moving forward past the place I was hurt before.
I welcome any feedback on this post. Here's a few images to picture it all. The 3D image is a screenshot from a very amazing free anatomical visualization tool at www.zygotebody.com. The spider looking 8 digit muscle on the upper ribs is SPS. The referral image showing yellow came from a website called pressurepointer.
Having fun with it. -Michael