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Chronic Upper Trap / Levator pain
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Chronic Upper Trap / Levator pain - September 18, 2000 6:33:00 PM
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RehabEdge
Posts: 18
Joined: May 2, 2000
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Forum,
What have you found to be the most effective tx approach to chronic non-radicular muscular pain in the upper trap and levator scapulae (triggered by prolonged automobile driving or sitting at a computer)?
Do you target posture, trigger points, neural tension, weakness, flexibility, etc.?
We would like to hear what you have found to work for you. How did you discover this approach? Is there currently any research available to evaluate your approach or do you think that your approach would be a good topic for future research?
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Re: Chronic Upper Trap / Levator pain - September 19, 2000 7:43:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
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Even with chronic sx, I work toward correction of whatever cervical/thoracic joint dysfunction is present (mobs and stab as necessary), do specific soft tissue techniques, and teach self Rx, and proper posture and ergonomics. That's pretty routine. Of course, dependent upon findings at assessment, other factors may need to be addressed ("neural tension", UE flexibility, strength, etc.) And perhaps because of my particular interest in relaxation training they all get the lecture and instruction in breathing and relaxation strategies.
Were you looking for something more specific?
I was pretty general. And I guess I answered "all of the above".
Betty
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 4:07:00 AM
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mcap
Posts: 652
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Mr. or Ms. Moderator:
I usually use McKenzie evaluation and treatment for the cervical spine along with general conditioning and exercises. I find it to be quite effective and most McKenzie clinicians will tell you that it is more effective for the C-spine than the L-Spine.
That having been said...I will admit that I am not aware of any efficacy studies for McK and the cervical spine. There is almost nothing about the c-spine in terms of any treatment in the literature. The c-spine is the L-spine's poor little brother. It causes far less disability, and therefore is not the focus of most spinal research.
If I am stupid enough to continue and try for a PhD, this may be something I look at.
mcap
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 4:08:00 AM
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mcap
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Group:
P.S......I mentioned McKenzie!!!!!!!!!!!!!!
The alarms are going off in Cuyhuga Falls right now. I am counting down the seconds until Barrett posts a disagreement [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 4:09:00 AM
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mcap
Posts: 652
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Also.....
I forgot to state that most pain in the levator scap, upper trap is referred pain from the C-spine - at least I think so.
mcap
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 6:39:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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mcap,
I don't have a problem with what you say about McKenzie's method, but I'd like to know what you think is wrong, why you think that and how you came to your conclusions. As far as I'm concerned, the question itself is the kind of thing that keeps therapists from thinking about the fundamental issues of pain's origin. I never bother to answer stuff like this directly. I start asking questions, questions the therapist should have already asked.
I was walking through a Brookstone store a couple of days ago and must have seen a dozen devices for sale that were designed specifically for this kind of chronically painful problem. What does that imply about our profession's impact?
I understand that this approach on my part can be kind of irritating.
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[This message has been edited by Barrett (edited September 20, 2000).]
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 7:48:00 AM
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mcap
Posts: 652
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Barrett:
On the contrary....Although I often disagree, I enjoy your comments and crtitiques. I actually wish that this forum and PTs in general were a lot more contentious. It is the only way to grow.
I think many therapists don't know it but they are afraid to ask the toughest question....Is what I am doing of value and how much and is it worth it!!!!
I welcome any and all challenges.
mcap
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 8:26:00 AM
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edilling
Posts: 139
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From: pullman,wa,usa
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Vladimir Janda proposes the "upper crossed syndrome": Forward head and increased cervical lordosis/thoracic kyphosis leading to muscle fatigue from lengthened anterior upper cervical and posterior thoracic and shortened posterior mid cervical and anterior shoulder girdle (that's where the term upper crossed syndrome comes from). His contension is that if you lengthen the shortened muscles and "shorten" or strengthen the llengthened muscles you will eliminate the pain syndrome.(please correct me if you know different) He has written numerous articles (they may be purchased in a compendium from OPTP) reguarding this subject. This compliments Kendall's work on posture as well.
With this in mind I focus on ergonomics, posture, stretching, relaxation, strengthening-- in that order. I try not to put my hands on them unless there is a delay in their progress or other obvious need. The less I am involved in the actual treatment, the more the patient will realize that it is completely up to them to resolve their symptoms. (sounds like McKenzie if you think about it)
I doubt that this is too far off from the "standard of care" in PT. I believe that the abundance of off the shelf items only reflects the desire of people to avoid the personal commitment needed to address the causes of their symptoms and not the ineptness of PT. (Everyone knows how to loose weight but that does not stop them from buying magic pills and fad diets) It does point to the inability of the profession to market thier strengths and have a greater impact on this syndrome than currently.
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 8:32:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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By the way,
Mcap-- you are wrong. [IMG]http://www.rehabedge.com/forums/tongue.gif[/IMG]
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Re: Chronic Upper Trap / Levator pain - September 20, 2000 11:08:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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edilling,
Don't we know that there is no relation between a muscle's length and its strength? Hasn't this been disproven several times? Didn't Kendall's book remain unreferenced for this very reason?
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Re: Chronic Upper Trap / Levator pain - September 21, 2000 6:25:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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[QUOTE]Originally posted by Barrett:
edilling,
Don't we know that there is no relation between a muscle's length and its strength? Hasn't this been disproven several times? Didn't Kendall's book remain unreferenced for this very reason?
[/QUOTE]
Hi! This is my first time posting. I was not aware that there would be no relation btwn ms length and strength. If someone, for example, had a shortened subscap, ER would be limited. Therefore, throwing would be less forceful, right? (By the way, I find this forum to be very interesting as well as amusing.)
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Re: Chronic Upper Trap / Levator pain - September 21, 2000 6:52:00 PM
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mcap
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Joined: February 8, 2000
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Edilling:
What.....I am wrong....how dare you challenge me [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
But seriously.....if I understand you correctly, you are saying that the abundance of off the shelf products does not reflect the failure of PTs it reflects the failure of patients to follow through with what we ask them to do.
I agree that compliance is always an issue. But you are kind of proving my point. Your contention begins with the assumption that PT is an effective intervention in most cases. You are not asking the dreaded question, is it REALLY effective? I don't have an answer but research evidence seems to be lacking.
mcap
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Re: Chronic Upper Trap / Levator pain - September 22, 2000 6:35:00 AM
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mcap
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SJ:
Happy Friday!!!!! [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Sorry about your identity crisis. But your concern is a valid one. We suffer from encroachment because we are not unique. When you go to PT you may occaisionally get a massage person or an osteopath in disquise.
Iv'e always thought that PTs should position themselves as the masters of biomechanics and exercise based interventions. But many of us are drawn to other techniques.
Why do your patients keep coming back? Because you are good and you are probably helping them. BUT....without research, we don't know where the help ends and the placebo begins.
But don't dispair on this lovely friday!!! Are we any different than the rest of medicine? Has chiropractic manipulation ever proven to be anything but short term benefit?? Look at surgery, has any proceedure ever been subjected to placebo controled trials. In a recent study, people who received sham arthroscopy for the knee did quite well.
The difference is that in Medicine there are more people at least looking for the truth. And....there is a lot more money power and influence in other disciplines so they don't face the same amount of scruitiny.
Have a good weekend.....
mcap
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Re: Chronic Upper Trap / Levator pain - September 24, 2000 4:39:00 PM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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You wrote, “Granted, the Medline isn't all encompassing, but I would have expected something. Those two women put a lot of time and effort into their work (a lot of their life?).”
With this comment I think you’ve hit uoon a major problem. I wrote about it six years ago in an essay called “The Fatal Heuristic.”
I pointed out that there was no evidence for what Kendall said about strength and posture. As far as the concept of “stretch weakness” goes, it was an idea, I guess, related to length-tension curve but was never demonstrated to be true. In fact, in “Electromyographic Analysis of Hip Abductor Musculature in Healthy Right Handed Persons” (Neumann et al Physical Therapy Vol. 69 No. 6 June 1989) it concludes; “…statistical analysis did not support (the concept of) stretch weakness.” I’ve never seen another study that included a look at this. There’s a pile of literature indicating that strengthening regimens don’t alter posture or necessarily lead to pain relief. I carry it with me when I teach in what I call “the red file.” I set it out but people rarely look at it. I have many of these references on my web site.
The problem I referred to earlier is this: The possibility that Kendall was wrong has, in my experience, produced a great and (I assume) embarrassed silence. Disproving Kendall’s notion has proven fairly easy, though a bit delayed I think. But wasn’t it Kendall’s responsibility to prove herself correct first? Why wasn’t she made to do this? I think that some combination of long tradition, Kendall’s notoriety and continued influence and the fact that our profession is more likely to be driven by sociological rather than scientific forces has led to this, and will continue to perpetuate it.
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[This message has been edited by Barrett (edited September 24, 2000).]
[This message has been edited by Barrett (edited September 24, 2000).]
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Re: Chronic Upper Trap / Levator pain - September 26, 2000 5:31:00 PM
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metapod
Posts: 11
Joined: July 8, 2000
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It is clear that the topic has strayed from it most important objectve which is to examine pain. Pain is the focus of phystical therapy treatment. The debate of strength and length is not relevant and does not take into account issues of muscle energy and the bodys intrinsic energetics.
Any therapy to the levator and the trapezii must consider the balance of different tissues. Not only muscles but also internal organs and energy fields of various body centers. If one of these influences is aberrant then the body will be out of balance and pain or dysfunction is the result.
Brookstone products are inferior and will never suffice for chronic pain. Only a skilled therapist hands can absolve pain from a body out of balance.
The discussion of stretch weakness per se is absurd. There is obviously no such thing. Such issues cloud a necessary link between patient and healer. To understand this link, the healer must clear the mind and sense with her hands the tension, adhessions and trigger points that afflict both muscle bone and nerve. Is this not the kind of therapy we all need to administer to be successful and fulfilled?
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Re: Chronic Upper Trap / Levator pain - September 26, 2000 8:30:00 PM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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metapod
I strongly disagree with your statement "only a skilled therapist's hands can absolve pain from a body out of balance" I myself was out of "balance" last week throwing up all night with a cold, yet today I feel great without the aid of a therapist. I have countless patients whom I have barely touched that have returned to full function (not because of my skill, but because of their own ability to heal themselves). While I do use my hands in a skilled way, I could not imagine that this is the "only" way to healing.
This kind of statement leads patients towards a dangerous path of co-dependence where their only avenue towards "true health" lies not in themselves but in your hands. Good for business, Bad for patients.
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