Just as we have the carpal bones of our wrist that form a tunnel in which artery and nerve and tendons may become impinged and cause pain and numbness, the tarsal bones of the ankle along with a retinaculum, connective tissue, can also impinge the tibial nerve. Tarsal Tunnel Syndrome is no where near as common as carpal tunnel syndrome, but it can be very debilitating to those that endure it
Yes, I have a brother.
The following conversation via email:
JE: Gotta testymoanial fer ya.....I can shake your hand but I can't turn a door knob. Rode the Harley to Daytona and back. Started getting cramps at the neck shoulder junction. Neck / shoulder stretches dint do nuthin. By accident I found that stretching the white side of my forearm cleared it all up. Who'd a thunk it!
Now fer a ?. Got back and went to work. Found that I could squezze big things but small motor function was shot. Weak as a kitten. Couldn't screw a screw, turn a knob, could barely write, couldn't even take the gas cap off. As last week wore on, the weakness has faded somewhat, but I still have trouble time to time. I've stretched everything I can find but the prob persists. 'Sup widdat? Sister Laura (also a therapist) says my flexors are #$%&$, but to ask you cause yer a dang jeanyus.
Bobby: Laura, I agree with flexors. Especially if it’s both hands. If only right hand look at extensors for throttle...…wrist extensors. Supinator and digitorum below lat condyle. If only right look at radial nerve irritation …anywhere from scalene to wrist. Include stretching the forearm flexors and neck at the same time. Possible diaphragm from riding so long causin scalene to work overtime breathing. Possible that vibration caused ulnar nerve irritation. Possible that the forward flexed posture of riding served to develop trigger points in your medial rotators, thus referring to your hand.
... reach behind you like your getting something out of the back seat. Put your palm flat on the wall. Turn to the opposite side and look over opposite shoulder as if to look in your back pocket. Yeah, that felt good dinnit? Hold that stretch for several seconds, come out of it then do it again. Repeat until fine motor function returns.
JE: Wow. You were right Laura, he are a geenyus. Just lookit all them fancy words. I'll bet he even knows what they mean too. But that stretchy thing pulled all kinda thangs in my fingers forearm and neck. Dunno how I missed all of them, but I know whar they at now by golly! Ya'll rekun doing that afore and after each ride will handle thangs? Or more oftener?
Bobby: Stretch before you ride. Stretch after you ride. If you take breaks, stretch while on break. If your not planning on taking breaks, then TAKE a break to stretch.
JE: Sounds doable. If ridin by myself the breaks are when I feel like it. In a gaggle of bikes, the breaks are when the lead guy breaks or the smallest bike runs outta gas. For some reason that always seems to be way after I'm ready to break. Oh well, thats life in a society I guess. Druther be a nomad searching for some place to pillage and wimmen to dominate.
You gotta git a bike so we can go do $*%@. Thanks Bro Feel better already!
Ken, a fireman, came to me with plantar fasciitis, a painful inflammatory condition that affects the bottom of the foot and the inside of the heel. Walking, especially in the mornings, was excruciating. To Ken, the pain was so debilitating that he couldn’t complete his drills and training. Without successful treatment, Ken was facing a temporary layoff from a job he loved!
I used ice massage on Ken’s foot to numb the pain and reduce the swelling. I utilized a tool that produced friction on his heel and stimulated the tissue to repair itself. Friction stimulates collagen regeneration. I found several trigger pointsand very tender points in his calf muscles. The treatment was uncomfortable, but he was determined to do whatever it took to take care of the problem and to keep his job.
I also taught Ken how to stretch his calf muscles properly. After a second visit to satisfy myself that Ken knew exactly what to do to maintain his progress, Ken was happily finished with my services.
When I saw Ken at church later the same week, he was walking without a limp! Ken was able to complete his training and drills. Although he has to keep doing the stretches to stay pain-free, he is once again fit and ready to do whatever the job requires.
Headaches are very common among a significant percentage of people. Most treatments include medication. Most treatments attack the symptom and not the cause.
I developed an expertise in headachesearly in my pain management practice. I truly believe that if I cannot get rid of a headache that there is something a little more serious that may be wrong, and I will refer to your doctor quickly. Honestly, 99%, meaning there was 1 out of 100 that stumped me, was caused by muscle tension. This muscle tension was caused by bad posture, prolonged shortening or overuse/misuse at work, play, sleep, ...…etc.
Typically, my line of questioning begins with:
1. Where does it hurt?
2. What type of work do you do?
3. What position do you sleep in?
4. How do you sit at your desk, couch, car…, ...etc.
5. What do you spend most of your time doing?
The following Case Study is a good example of finding a simple cure for a headache.
A Kindergarten Teacher, Linda, who was in her early 20’s came in for treatment for debilitating daily headaches. She appeared to be stressed. (No kidding.) Fidgety. Pacing. Linda had been trying different medications for several months. The meds would take the edge off of debilitating pain, but did not keep the headaches away.
We designed a treatment plan to target the nervous system and promote relaxation so that she could sleep better. The plan also included targeting specific muscles that are generally associated with her typical headache. During treatment, we discovered trigger pointsin her neck and shoulders that mimicked the headache pain.
Figuring out why the muscles had shortened in the first place was a mystery. My never-fail questions failed. Driving posture? Sleeping position? Work activities? So far, we were hitting a dead-end.
Linda is a teacher, and not just any teacher, she's a Kindergarten teacher. What could Linda be doing teaching kindergarteners that would shorten neck and shoulder muscles? Is there anything unusual that Linda would do during her day that other teachers might not do? One of my greatest joys is finding out the root cause of pain. It’s almost a euphoric feeling to know that I’'m on the right track, as ideas begin to take shape.
"When you talk to your children one-on-one and you want to look them in the eye, do you kneel on the floor or do you bend forward with your hand on your knees and look up at their face?"” I asked.
Her answer, "I bend forward and move my head so that I am looking up"?”
The ah-ha moment!
We lengthened the muscles, which had shortened with the awkward position. Linda started taking a knee when she talked to her kids. The headaches disappeared. No more need for medication. And Linda did not have to come back to see me.
Oh, and she started sleeping better. Good productive sleep took care of her stressed appearance, fidgety and pacing.
Case Study #1: A mechanic, John, is scheduled for carpal tunnel surgery in a few weeks. I found trigger points in lats, back muscle, and subscapularis, rotator cuff, that refers the identical pain to his wrist. The supervising physician agreed that I had found the source of pain, but also believed that John had suffered with the symptoms for so long that surgery was still a must. This does happen. Still, carpal tunnel surgery, more often than not, only treats the symptoms.
Case Study #2: A teacher, Mandy, is scheduled for surgery in a few weeks. I found trigger points in her upper traps, shoulder, that refers the identical pain to her wrist. Mandy condition developed from writing overhead on a white board in her classroom. I treated her three times. The pain left! Mandy’s doctor cancelled the surgery.
Case Study #3 A massage therapist, Autumn, had carpal tunnel surgery 4 months prior to seeing me. The searing pain had returned with the same intensity. Working as a massage therapist contributed to the strain in her neck and schoulders.I found trigger points in her shoulder and neck that sent the identical pain to her wrist. I treated her twice. The pain disappeared.
Case Study #4: A Typist, Beth, was scheduled for surgery in a few weeks. I found trigger points in her neck that sent the identical pain to her wrist. I treated her twice. The Dr. cancelled the surgery.
Case Study #5: A Sonographer , Jessi, has pain in her wrist. She was told by her family doctor to see a specialist. When she came to see me, I found trigger points in her neck, shoulder and back that sent the identical pain to her wrist. Her pain disappeared. I am still waiting to hear the end of the story.
Penny had undergone surgery for an aneurysm five years earlier. Post surgery, she developed a constant cough. Every 30 seconds to a minute she had to cough. Her surgeon was inclined to believe that the surgery caused nerve damage. Penny did not want to undergo another surgery.
She spent the following years coughing every minute of the day. This interrupted all aspects of her life, sleep, work, home.
When she entered my clinic, and before we were introduced, I could actually see the tightness in her neck muscles. She explained her history and chief complaint. We started work promptly.
Without delay we found trigger points in several muscles of her neck that caused the feeling of needing to cough. Her cough was not productive, it was just a tickle in her throat that made it feel like she needed to cough. We determined that the position that she had to be in on the operation table was the weightiest factor in the shortening of these neck muscles as well as the consequent development of trigger points.
We never completely got rid of her cough but did reduce the intensity and frequency by 90%. Her happiest report was that she was able to eat Doritos again without having to cough. Her testimony is below.
I cannot say enough of what Neuromuscular Therapy has done for me in the short time I have been in this treatment.
I had surgery in 1997 due to an aneurysm in the back of my left eye. I had some kind of trauma to my throat or a slight stroke about three months after. Since, and for nine years now, I have been enduring a constant need to cough. Over the years the cough had become so severe that my physical health was affected. The nerves and muscles were so tight in my neck and in so much stress that I often felt like I would probably have a major stroke in my throat. I felt I was a hopeless case.
It is amazing how much my cough has improved with this therapy. The stress I had in my neck and throat is at a level that has given me a new positive outlook. I have also learned therapy I can do at home that helps in maintaining my cough and the stress in my throat. I have been impressed how knowledgeable the therapists are in dealing with my particular situation. They listen to me, change the type of therapy as needed or indicated and it is working.
I know I will have to continue these treatments to keep me from regressing back to where I was. I just wished more people knew about this kind of therapy so they could see positive results as I have. It has certainly changed my life.
A young man, 30, made an appointment as a last chance in finding relief from his back pain before surgery. As a teen he hurt his back in a fall. Physical therapy taught him some coping skills at best. As a steel worker in his 20’s, his back continued to hurt him. He later took an office job. His pain got worse. Surgery was his recommended course of action.
Due to the location of his pain, straight line across his low back and straight line across his lower thoracics, mid back, I went directly to two specific trigger point locations on his abdominals. He worked out a lot and put a significant amount of time working on his abs. He did have a 6-pack. This was another indicator that I might find the culprit in hisabdominal muscles.
“It’s my back that hurts. Why are you working on my stomach”, he questioned with disbelief.
I replied, “If I work exactly where you hurt, 75% of the time I am working in the wrong place. It may feel good or right for me to work on the location of pain but I am more than likely NOT working on the cause of the pain. Plus all of the sitting you do followed by all the ab work you do in the gym, I think these muscles are shortened and may have trigger pointsthat can refer to the back.”
It took less than 2 minutes to find the first trigger point in his rectus abdominus muscle that referred pain to his mid back. Working that trigger point referred pain straight through to his back and felt like “a rod going all the way through, just like it does when it hurts real bad”. The pain left.
Working on his lower abdominals elicited the same response for his low back, again “like a rod going straight through just like it does when it hurts”. Again, his pain was alleviated.
I also performed a pin and stretch on his deeper psoas muscle, a primary hip flexor, which mimicked even more familiar pain. Again, “that worked, I don’t hurt”.
I taught him some stretches to do in order to maintain his pain free status. I also showed him how to find these trigger points on his abs so that he could treat himself when he hurts.
He walked out without any pain.
NO REPEAT VISITS.
A dear friend that I treat for debilitating back pain shared thoughts, realizations, about the words we speak, or don't speak to ourselves. I was blessed. I have a lot to learn concerning blessing myself with my words. Enjoy.
"Spiritually, I'm learning to bless my back the same way I bless Stormy, our crippled goat. I give her extra love and attention because she's the wounded one...just like Jesus going to the 1 and leaving the 99. I don't know when I started doing this,but, in my heart, I've seen my back as the enemy instead of the wounded one. I had Stormy in my lap in the pasture one day and was telling her how special she is and how happy I am that she was born and came into our lives and how we didn't mind at all the special care, that we loved her best. In that moment, I had an epiphany that there was nothing in anything I said to her that I felt or said about myself and my back. It stunned me. So, I've changed the rudder of this ship to bless the wounded parts and when I'm exercising to be visualizing a healing back and muscles that work and a back that is estoring. I wish you'd write an article on it. Being around so many
injured people, I'm not alone in this kind of thinking. We even
label body parts as "the bad knee and the good knee". We slip
into that thinking without even realizing it."
I may write an article on it one day. But I don't think I can say it any better!
A team of therapists and I were working on several teachers at a local high school for Teacher Appreciation Day. A football coach, Mike, took a seat in front of me. I asked him if he had any trouble spots or pain. Mike admitted to significant shoulder pain.
“But you can’t fix it. It’s been going on for three years. I haven’t been able to throw a football since then”. Mike was quick to tell me.
I love a challenge. I immediately put my thumb on a specific rotator cuffmuscle.
“Is this your pain”? I asked, but his reaction was extreme enough that he didn’t need to use words.
“”YES! You’re on a nerve or something”!
“No, Coach, that’s a trigger point in your lateral rotators. It’s the muscle that puts the breaks on when you follow through throwing a football”.
He was skeptical. “I still don’t think you can fix it, but go ahead”.
Five minutes later he sat up and showed me how far he could raise his arm, as if to throw a football.
“I can only reach this high”. Coach lifted his arm just so.
“I can’t take it this high”, he started to demonstrate. His arm floated on up as if there was never a problem.
“Hey, wait a minute! I can… Look at this… and it doesn’t hurt”! he practically sputtered.
I smiled knowing this was one of the reasons I do what I do. Giving a football coach back the ability to throw a football again is what it’s all about.
Coach comes to the clinic now. We released his shoulder pain so that he can continue to do what he loves.
“Now, if you can fix my back pain, I’ll give you a million dollars”! he said on one of his visits, still sure that he had me stumped.
Thirty minutes later, after I released trigger points in the muscles of his low back and glutes, a sheepish coach asked, “Will you settle for a steak dinner”?
I love what I do.
BTW...If you're reading this, Coach, I never did get that steak dinner!
Krige Schabort was an avid surfer growing up in Cape Town, South Africa. He also enjoyed rugby and squash, and become active in the South African military as a young man. In 1987, during a Cold War battle with Angola, a bomb from a Russian fighter plane hit Schabort. He nearly died, and was saved by an adrenaline shot to his heart. When he woke up days later, he learned that both of his legs and one finger had been amputated.
As a disabled athlete, Schabort broke South African swim records and competed in wheelchair basketball. But it was in his first wheelchair race in 1988 that Schabort found his passion.
Schabort moved to Cedartown, Georgia, with his wife in 1997. Now sponsored by wheelchair manufacturer Invacare, Schabort has repeatedly won the Cleveland,LaSalle Bank Chicago, Pittsburgh, Detroit, and Columbus Marathons, among others. He placed third in the marathon at the 1992 Paralympic Games in Barcelona with a 1:30.23 and second in Sydney in 2000 with a 1:29.28. In 2004, he was accepted into the Honolulu Marathon’s Hall of Fame, after winning for the seventh year in a row.
Schabort has also racked up many 10K victories, and holds the world record for 10 miles with a time of 35:18. During the 2002 New York City Marathon, Schabort set a new course record with a time of 1:38.27. The next year, he won the race again and broke his own record with a 1:32.19 (since broken).
At 44, (2007) Schabort is still a top contender amongst a stacked class of racers…
Addendum by Bobby Lewis, LMT, Corrective Bodywork
shared with permission
I met Krige when he first came to my clinic seeking help with his training and performance in the upcoming Paralympics Games. He was in training for the Paralympics Games. As a hand cycling athlete, he wanted to increase his ability to contract his abdominals as well as improve his range of motion with his shoulders. He had specific groin pain as well.
We designed a treatment plan to include myofascial release at the hip and through his abs in order to lengthen the muscles that had been shortened from repetitive use. On the first visit of several, we discovered trigger points in his abs that referred pain to his groin as well as to his foot! Yes, his foot! The trigger point referred to what is called a “phantom pain.” When these trigger points were released, his abdominal muscles lengthened. The range of motion in his shoulders increased so he would have great “reach and pull.” Krige reported greater strength during daily training. He went on to the Olympics and competed very well.
Two years later Krige returned to my clinic again for help in strengthening and training for an upcoming triathlon. He had limitations in his over-hand free-style stroke which limited his ability to turn his head to breathe during the swimming competition. He had pain in his neck on one side and headaches. The problem was rooted in the medial rotators of his shoulders. His lats had also shortened. With myofascial release, neuromuscular therapy and MET stretches, we lengthend his Lats. We did the same treatment on the neck muscles that rotated his head to the opposite side.
After his first visit, Krige went directly to the pool to train. He returned the same week for more treatment and was happy to report that he had taken a full minute off of his best time! Kriege attributed this to his ability to reach further with the one arm and the ability to turn his head without limitation or pain, in order to breathe. Each week thereafter he reported a continual drop off of his best time.
Krige is a determined human and a remarkable athlete. He knows firsthand the value of supplementing his training with manual therapy and giving himself the winning edge in competition. It has been an honor to be a part of this championship athlete’s journey.
I recently worked on a 60 year old gentleman, daily golfer, complaining of pain in his ribs, shoulder, elbow, forearm, hand and index finger. His index finger bothered him the most as it constantly popped (trigger tendon) and affected his grip and swing.
I began working on the larger muscle groups that affected his ribs. Working across his back to his side I found fascial adhesions, very tender, that restricted his backswing and follow through. Releasing theses adhesions on his larger back muscle,Latissimus Dorsi, and abdomen, External Oblique, corrected this for him. A specific stretch before and after a day of golf maintained his improved swing and follow through.
While working this area I found trigger points that referred pain to his elbow, hand and wrist. This didn’t totally ease his pain but it did diminish it. So, I looked at hisrotator cuff muscles on the same side. Again I found trigger points in hisInfraspinatus muscle that referred pain to his shoulder and his elbow, also alleviating his pain.
I then worked down his arm to his biceps, and other elbow flexors. You guessed it. The trigger point discovered there referred pain to the rest of his wrist and finger. He was 75% better after the first treatment.
He returned the same week. We did the same treatments. We added specific treatment on the forearm, his wrist and finger extensors. No more pain. I taught him some stretches to do before he teed off and upon completing 18-27 holes (walking of course).
He is able to maintain his improved grip, swing and game with the warm up stretches and finishing stretches.
He didn’t have to quit playing.
NO DRUGS !
NO CARPAL TUNNEL SURGERY !
My wife received a call from a friend requesting that I help her with her back pain. I agreed to see her. I learned that she suffered from debilitating back pain in her mid back for the last eight months. Bending to pick something up off of the floor, twisting, and deep breathing caused pain. Secondary complaint was her neck pain. She could not rotate her head very far without pain.
She received long term treatment for her back pain to no avail. Actually, her back pain worsened after treatment.
I palpated her mid back in the location that she indicated. It was tender. But, since she had been receiving treatment for so long in that immediate area, I decided to look for the culprit elsewhere. I turned her over on her back and began looking for trigger points in herabdominal muscles and diaphragm. It was almost immediate that we located 4 different trigger points that referred pain to the exact location in her back. It was intense.
After relieving those trigger points I looked a little higher on her ribs for cardiac arrhythmia trigger points that usually mimic panic attacks. Sure enough, they were there. They cause a feeling of nervousness and trembling that is typical of such trigger points.
I worked on her for 20 minutes. She stood up, tested it by bending over to pick up her shoe. No pain. She twisted above the waist. No pain. She took a deep breath. No pain.
I questioned about repetitive activity that could put those abdominal muscles in such a shortened and twisted positioned that could be inhibiting her diaphragm from contracting enabling her to breathe properly. When I put her in the specific shortened position as these muscles indicated she immediately knew that it was her hobby of quilting that was to blame. Actually her posture while quilting was to blame.
Leaned forward, shoulders rounded and head forward all inhibited her breathing. She was forced to breathe using her chest and neck muscles more than her diaphragm. She had developed several trigger points in her abdominals and diaphragm that referred to her back. The problem was not in her back.
She is correcting her posture and breathing pattern with the homework that I gave her to do. She may need a second appointment. But, then again, she may not.
Thank you SO much. I feel so much better tonight, and I’m making a concerted effort to keep my posture correct – I have to ‘unlearn’ some bad posture habits. You gave me a lot of good advice.Blessings, Michele