Dan has a Masters degree in Osteopathy and is an Anatomy in motion and Neurokinetic therapy practitioner and Yoga anatomy teacher. In his spare time he can be found exploring everything dance and movement based. He runs his ‘Daniel Baines Osteopathy’ clinics from Hastings, Eastbourne and the One Aldwych hotel health club on the Strand in London.

What, when and where was your first experience of complementary therapies?

While I was touring with the show Stomp the rough and tumble of flipping around a stage with dustbin lids strapped to my hands left me with a string of chronic injuries. I was lucky enough to meet a fantastic therapist who patched me up, and enabled me to extend my career by another 3 or 4 years. That experience inspired me to study osteopathy.

What made you decide to treat others?

I love working with people and am intrigued by the human body. I love the challenge of unravelling the story behind a patient’s presentation and to understand the compensations that have led them there. Most importantly I love being a small part in an individual’s journey to rediscovering their potential for pain free human movement. What and incredible honour.

What influenced your treatments the most?

I am blown away by osteopathic philosophy, however it was a chance meeting with my now good friend Chris (a non osteopath) that really inspired me my on my current journey and led me study Anatomy in Motion and then Neurokinetic therapy. He constantly challenges me to think outside of the box when treating and never ceases to amaze me when I get the chance to sit in and watch him work.

Describe holistic in less than 10 words

As soon as holism is described it has boundaries which prevent you from seeing outside of the box. In ten words holism to me is:

‘Being in the moment without rules or preconceptions and asking why’ 

(ok that was 11).

What role do your therapies play in the way you live?

Movement never lies, so I constantly watch people as they walk down the street, train in the gym or stand at a bus stop. I have found myself following people with a curious limp or interesting gait pattern and mapping there movement in my body to try and understand how they feel and to embody their pain. I guess it has kind of taken over how I live and turned me into a ‘movement stalker’. How very worrying.

What do you hope your clients to experience when they get treated by you?

My sessions are unconventional from a time and treatment perspective. By the end I want my clients to understand why they have pain, have home work to help manage it and have enjoyed the process of unravelling their jigsaw.

What is the most rewarding thing about what you do?

I get to geek out every day exploring the potential of the human body, while helping people move out of pain. 

Do you eat ice cream, drink coffee or any guilty pleasures?

Yes, yes and yes!

I am currently off alcohol for 2 months, but my weakness is King Cobra beer (hard to find but oh so worth it when you do) and Zaibatsu restaurant on Trafalgar Road in Greenwich (check it out on trip advisor and you will see why).

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Anatomy

Before opening the Pandora’s box that is the sacroiliac joint, lets start with the basics. What is a joint? A joint is the space between 2 bones. If you think about the hip joint, the two bones involved are the thigh bone (femur) and the pelvis. In this example the shape of the joint (a ball and socket) allows movement to occur in a big three dimensional circle and any combination of movement within.

The sacroiliac joint is a slightly different beast and to understand it we need to first look at the pelvis. The pelvis is made up of two halves,each half made up of 3 fused bones called the ilium, ischium and pubis. The front of the 2 pelvic bones are joined together at the pubic symphysis by strong ligaments (if you’ve ever been pregnant you might have cursed this joint) and at the back we have the junction that joins the sacrum at the bottom of the spine into the pelvis – the infamous sacroiliac joints.

What are the roles of the sacroiliac joints

The roles of the sacroiliac joints are to channel the force of the ground coming up through our legs and the weight of our body coming down through our spine, as well as to stabilise the junction between the pelvis and spine. The weight of our upper body and whatever we happen to be carrying passes down the spine until it comes to the junction of the sacroiliac joints where it now has the option of being shared, via the pelvis, down our 2 legs. The sacroiliac joints transmit this force and dampens it on the way through like a pair of mini shock absorbers. This journey can also be reversed as seen when our foot hits the ground and force is passed up.

How do they it do it?

For these joints to do their job effectively they need incredible strength, and this begins with the architecture of the bones themselves. The 2 wings of the ilia create a beautiful funnel into which the wedge shaped sacrum nestles snuggly, while the rough joint surface of the bones enable them to lock into place like the cogs of a clock. A motor way of ligaments and muscles then surround the joints to fortify their strength during the critical moments of movement when they are exposed to the most load. There has been much wonderful work recently that has looked at how muscles are set up to work as fascial slings, enabling muscular contraction to create force closure and thus stability. We will look at some  of these patterns in the following vlog.

So do the sacroiliac joints move?

If you ever want to see fireworks outside of Guy Fawkes night, drop this question into a room full of therapists, light the touch paper and watch from a safe distance.

In a nutshell the answer is yes. There is no way near the same range of motion as a hip joint and as we age this movement is reported to become even less (until in some it can eventually even fuse) however without it we have bit of a problem. To figure out why the sacroiliac joints must move we need to go back to the anatomy of the pelvis and realise how it has evolved to function more efficiently. If our pelvis did not need to move it would be infinitely stronger if it was made up of one whole bone instead of two halves with a pubic symphysis at the front and a sacrum wedged between the two ilia. To understand why it is as it is, I want you to stand up and place your fingers just under the 2 knobbly bits on the front of your hips called the ASISs (anterior superior iliac spines of the pelvis) and cup the rest of the pelvis in a c-shape with your palms. With your hands in place now go for a little walk around the room and notice how these bones start to rock up and down with each step you take. Now repeat the walk and try to do so without letting the pelvis move at all. You should have found the latter near impossible (unless you were wearing a very tight pencil skirt) and instead noticed that your pelvis nods in opposition as your pelvic ring rotates, drops and hikes in response to the pull of your lower limbs as you move. If your pelvis was in fact solid it would have to shatter with each step you took!

The problem we face is that because the motion is so small and we can have both too much or not enough of it, we need an assessment that allows us to know when and where to start treating …

…and with that little teaser I will leave you on the edge of your seat until the next functional assessment video.

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Enjoy the ride and here we go…..

Anatomy.

Affectionately called the OA joint – the occiput (or back of the skull) sits like a foot ball on top of the 1st cervical vertebrae (the atlas). The Atlas has 2 cup shaped facets which allows the skull to gently rock and nod into flexion (chin pulled back towards neck) and extension (chin poking out). The two articulations are surrounded by joint capsules which effectively shrink wrap the joints for extra stability. These capsules often become fibrotic and stiff due to prolonged postures or trauma and subsequently limit our movement potential and the ability for the muscles on top to lengthen and shorten.

Movement

“When the occiput flexes on the atlas its convex joints glides in the opposite direction to the movement of the bone.”

In English this means that when your skull nods into flexion the condyles of the occiput glide backwards, elongating the posterior capsule and during extension the condyles glide forward stretching the front of the capsule.

When assessing this joint I often find the back of the capsule is tight which restricts the ability to lengthen the back of the neck. If you are sat at a computer all day and find yourself rubbing your thumbs into the back of your neck to loosen things off  you will know what I mean .

As well as flexion and extension we also have a few degrees of side bending and rotation at the joint. If we side bend the head to the right the occiput rotates to the left (we call this type 1 coupled motion) and during flexion this will emphasise the stretch on the back of the capsule on the left as well. If one side of the capsule is tight from a head trauma or a wonky work station set up, it can effect this coupled motion at the OA joint  and have a subsequent knock on effect through out the rest of the body.

Top tip – for any muscle geeks check out the tone in the sternocleidomastoid muscle whose concentric muscle action can create this same coupled motion of rotation and opposite side bending.

Self mobilising

Word of warning – if you have experienced a traumatic injury such as a whiplash or concussion or you are suffering from rheumatoid arthritis, you may have instability around this area so mobilising it would be a bad idea. Make sure you get checked out by a qualified health care practitioner first who can assess your upper neck complex.

To open up the OA joint my favourite go to is the sagittal cog exercise. To start with lie on the floor so you have feed back from the ground and start to gently rock your pelvis forward and back wards (anterior and posterior tilt). Assuming you have a beautiful chain reaction of joints that can open and close you will start to feel your skull nodding in time with your pelvis. If all is feeling well nod one side of the pelvis  forwards then the other and feel how this emphasises one OA joint over the other. Voila a DIY assessment to check your own mobility. If one side feels stiffer try rotating your head 30 degrees to that side and then continue your pelvic tilts. This will line the facet joints up with gravity and allow you to really mobilise into the area. If it still feels a bit sticky then nothing beets a pair of well trained hands to gently tease a little more range that can then be integrated back into movement.

Integrating from head to toe

Time to throw in a bit of Anatomy in Motion gait mechanics. This always helps me to make sense of how the body functions as a unit and why it adapts to keep going.

There are three cornerstones that I always cross reference when assessing and treating, these are the heel bone (calcaneus), the pelvis and the skull. What ever phase of gait we are in, these 3 bones always do the same thing. As the skull mainly nods on the axis to keep your eyes level with the horizon (think about bobbing on a horse while looking straight ahead) I like to checkin with the pelvis to see if it can tilt anteriorly and posteriorly and the heel to see whether it can plantarflex and dorsiflex (this is basically the standing up version of the sagittal cog above).

There have been many occasions when one of these three have disrupted this harmonious relationship causing the others to move more or less in response. Here is a short video showing this relationship in a split stance.

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The Anatomy

Hopefully you can make out from the doodle above (sorry for my appalling drawing skills) that the superficial transverse perineal muscle (coloured in red) attaches from ischium to ischium on the bottom of your pelvis (just inside and slightly forward from your sit bones.) Its role amongst other things is to help support the perineum and the sphincters that sit within it. During episiotomy surgeries this muscle is cut to allow baby and mother a somewhat easier journey through labour, stitches then follow to tidy things back up and motherhood begins. The adductor muscles that are injured during a groin strain also have a direct fascial link to this superficial pelvic floor layer. In either case if you have chronically ‘tight’ adductors and no amount of soft tissue work or of foam rolling can make your inner thighs any looser then it may be time to start looking a little higher up at its fascial neighbour the superficial transverse perineal muscle.

Body phase II

When our bodies experience trauma do they ever really heal or do we just become really good at adapting and off we trot with the same body but just phase II of it? Imagine for one moment that you are a pelvic floor with an incision down the right side and a right hip facially connected to it. Would you chose to stretch and expose the surgery or protect it and keep it closed? In clinic I often observe the latter, resulting in a movement strategy that avoids placing any tension through the tissues both during the acute stages of healing  (useful) as well as long after the heeling has taken place (maybe not so useful). In the second scenario the strategy becomes a habit or a form of ‘movement amnesia’. When an area is not moved the nerve receptors in the area are not stimulated and the brain quickly forgets that there was ever a muscle or joint there in the first place (try taping two fingers together and see how long it takes for your brain to begin recognising them as just one digit).

To continue being successful post trauma (after all our driving instinct is one of survival) other joints and muscles now have to pick up the extra work and the muscles around the hip joint become unbalanced (some are facilitated and some become inhibited) resulting in an un-centred joint that becomes painful and can eventually result in future joint compression and unbalanced wear. The same is true for a right sided groin/adductor strain. The last thing that you want to do is hit box splits and stretch it as it hurts and will very likely tear some more. In both examples the bodies strategies are similar…avoid moving the injured part and re-callobrate around it as body phase II.

In the short term acute phase, reduced movement and exposure to load are important as the tissue is repairing itself, HOWEVER if scar tissue is robbed of low level force due to immobilisation or fear of movement, it no longer has the stimulus to realign its collagen fibres resulting in haphazard, shortened, week tissue which further restricts movement – and so the cycle continues. When we suddenly need to ask this now weakened tissue to help out as we accelerate to avoid a bicycle jumping the lights or during a weekend kick around with the kids, we are now faced with 2 possible scenarios:

1. Stress exceeds capacity and the groin “goes” again.
2. The other areas of the body no longer have the capacity to help out and we run out of movement options. In clinic people will present with hip pain, lower back pain, knee pain, neck pain, issues with continence and pelvic discomfort. It is like a water pipe in a closed central heating system that can no longer hold the pressure asked of it and the weakest link (that cheep plastic compression fitting from B and Q) goes pop.

Gait – a whole body experience

While every one is slightly different there are definitely patterns that start to appear when you begin to watch people move. I have filmed a quick video below which might be easier to visualise rather than to read.

Hopefully you can see how an issue in your pelvic floor or groin could cause anything from plantar fasciitis and varicose veins on the right, all the way up to shoulder pain and sacroiliac joint discomfort.

How do I approach things

Well I guess the answer is “it depends”. Everyone is unique in their history as well as where they are in terms of time scale (a recent acute trauma would be handled very differently to a chronic long term issue) so please please get assessed by a good health care practitioner before just diving straight in (google and youtube do not count). That being said…

Post pregnancy I like to treat the episiotomy scar tissue (or any pelvic floor tearing for that manner) directly. This can be done very non invasively using P-DTR techniques which are incredibly fast and effective and we often see immediate changes in movement as soon as we reassess. Hips start to move and pelvises start to swing symmetrically from side to side.

In the case of an adductor strain we may need to figure out why the adductor was susceptible in the first place. Was it just a simple case of too much load to a tissue that was not prepared for it or was the adductor compensating for something else (I often see this with chronic ankle sprains on the same side) and it just did not have the capacity to help out any longer?

In both of the above cases I start tinkering with movement as soon as possible to create resilience, confidence and more movement options. If you tried the experiment mention above where you tape up 2 fingers and notice that they quickly behave as one, this movement exploration is equivalent to noticing the tape, removing it, then wiggling the two fingers till they once again feel separate.   In the videos below I run through a couple of quick exercise examples I like to use (shout out to Gary Ward, Diane Lee and Andrea Spina who inspired them).

Half – Janu Sirasana

This stretch works on lengthening the adductor muscles and all the fascial connections up into the pelvic floor. This is great if there is a history of chronic scaring post surgery. Go gentle.

Happy baby pose

This is a modification of the happy pose in yoga. It might get some funny looks but when performed gently separates the attachment points of the superficial transverse perineal muscle and gives it a lovely gentle stretch. It also a great place to observe how when you inhale you can feel the pelvic floor lengthen like a balloon being blown up which then relaxes as you exhale.

4 point kneeling adductor PAILs

This is similar to a happy baby pose but in kneeling. When approached methodically it allows us to introduce load to the injured area while staying within the capacity of the damaged tissue. It is a little like training in the gym. Over do it and the body suffers; under do it and nothing happens at all; hit the sweet spot and your body adapts by getting stronger and fitter.

Shift/lateral lunge

The final video is ‘shift phase’ from anatomy in motion. This is not only a whole body exercise but is the first one which lengthens the adductors in the frontal plane (from side to side) but also in the sagittal plane (by tucking the pelvis under into a light posterior tilt). With a little playful exploration this posterior tilt can give the most lovely deep stretch. Its a little like hearing a note played on a violin compared to the same note on a cello. It just feels deep and heavenly. Add a little rotation to open up the inguinal area at the front of the hip and this somewhat complicated exercise can be right on the money.

Conclusion

“If you do not move it you loose it.”

Don’t let your pelvic floor hold you back and stop you from moving. A little gentle, pain free movement exploration can often create a ‘safe space’ where your pelvis can once again be reunited back with the rest of the body.

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While I will be the first to admit that I do not practice  regularly enough myself (my Lululemon mat is currently strategically placed under my treatment room door to block the winter breeze inviting itself in) I have spent time getting my head around the differences between a ‘downward facing dog’ and a ‘cat cow’ and the kinetic chain of relative joint motions and muscle reactions involved in these poses. When we know what we are asking all our joints to do during a pose and how a limitation in one area can effect another, it soon becomes possible to figure out who isn’t playing game when we move and who has to take up the slack. Let me give you a clue…that painful meniscus or achey shoulder joint is probably not the culprit and more likely the area that is over working in order to pick up the slack.

The knee

We are going to begin our journey down at the knee, and more specifically at the meniscus. First a gentle reminder of its anatomy.

The knee joint is made up the femur, tibia and the patella. It is predominantly a hinge joint so if you look at it from the side you will notice that it flexes and extends, however if you cross one leg over the other to stabilise the thigh and keep the ankle flexed you will also notice that you can rotate the tibia a little  as well (notice the little is in bold!) Rotation is important as it allows the knee to lock up into full extension (saving energy when standing) and to unlock as we walk to unleash a cascade of bone motion and subsequent muscle reaction which enables locomotion.

Our meniscae sit on top of the tibia and resembles 2 C shaped rubber washers which shock absorb through the knee, guide movement and create stablity. We have a medial and lateral meniscus within which the 2 condyles of the femur nestle ready to roll and glide as they move on the tibia below. All being well the meniscae can distort and change shape a little to accommodate the movement of the femur on the tibia and we have a happy knee…then we decide to attempt the Lotus! (ok I am scare mongering a bit for dramatic effect, but in my experience most bodies do need more preparation before attempting this advanced pose).

Lotus

The lotus position has become the poster pose for Yoga studios up and down the country. It looks incredibly impressive so who would not want  to be able to fold their legs like they would fold their arms and sit in calm serenity?

“My knees only feel bit achey afterwards, and that slowly dissipates after walking around…surely that is a ‘hurt so good’ as opposed to a ‘hurt so bad’?”

Then one day “POP!”

As someone who has spent the last year recovering for medial meniscus problems (even the thought of a basic Child’s pose would fill my knees with agony) I implore you – please learn from my mistakes and treat your knees from this day forwards as your best friends. I promise that you will not realise how much you miss them till they do not do the stuff you need them to do. Yoga should not hurt, and if it does your body is sending you a message:

“Oi – you up there! If you keep doing this to me day in day out we are going to have a problem. I am not supposed to move in this way and I am doing my best to help out but I can’t keep helping for much longer!”

So how do we figure out a solution?

Hip Hop Pop

In order to even contemplate a full lotus your hips have to be incredibly flexible and if they are not then this is where you are going to invest your time. Resist the temptation to jump ahead to desert before you have finished your main course!

If you look at the video below of myself and my good friend ‘Bendy’ demonstrating a lotus you will notice how much the hips have to be able to externally rotate. To put this in context I was reading an article which stated that in order to do a half bound lotus standing forward bend you need 145 degrees of hip external rotation. This means that if you were standing up you would have to be able rotate your hips so that your knee caps and feet were actually pointing behind you. I am not sure I have met any one with such impressive contortionist skills.

So what happens if we do not have the pre requisite hip rotation? Well we can crank on our  lower leg and crow bar the foot on top of the thigh, which looks kind of similar, however we are now asking the knee to make up the range of motion that is missing at the hip. The result is a knee that has to rotate and side bend (adduct) into a pathological range, with a meniscus that is sandwiched in the middle between the femur and the tibia and wrenched and squeezed till… “POP!”

Another point worth mentioning is that if we then proceed to move into a forward bend, then the pelvis is going to rotate over the femurs, which will require even more relative external rotation at the hip joints. You can experience this by lying on your back and pulling your feet up and together and letting your knees and hips drop out (kind of like a lying Baddha Konasana) and notice how far your knees are from the ground. Now sit up tall on your sit bones and see how far the knees then rest off the floor. Now if you are slightly more flexible you can hinge forward by tilting your pelvis and see what happens to the height of the knees from the floor now (make sure you hinge from the pelvis instead of just flexing your back). Unless you are super flexible you will hopefully notice that each progression needs more and more rotation at your hips as the pelvis continues to move over the femurs.

So how can we work towards the necessary hip mobility required to achieve this monumental feet?  Like I mentioned above, I teach anatomy to yoga students and treat a lot of people who enjoy yoga, but I do not regularly practice yoga myself, hence a good teacher will be able to guide you through the progressions necessary to explore your hips and eventually lotus. I personally enjoy  the work of a Canadian chiropractor called Andreo Spina who looks a lot at how to improve flexibility and more importantly how to create strength in that new found range. The video below is how I start to coach people to own their hip external rotation so this might be an exercise you might like to explore.

One final thought is that not all hips are built the same. The anatomy of the hip socket and rotations through the femur and tibia can be different from person to person and some people may simply not be built for extremes of external rotation. Sometimes we just have to accept the hand that anatomy has dealt us and move on gracefully (maybe an even greater achievement than actually mastering the pose itself).

Conclusion

The Lotus position is not inherently bad for the knees, it is just that some hips are not ready for the Lotus. Earn the movement pre requisites necessary then get a good teacher to guide you through the techniques. Enjoy.

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If you suffer or have suffered with back pain take the time out to watch this as it will really help put your mind at ease.

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(P.S. latin words and anatomical names have been spared in the name of understanding all this stuff!)

The spinal column

The spinal column is made up of a series of bones (called vertebrae) all of which have a slightly different shapes and functions. These vertebrae all stack up to form the cervical spine (neck), the thoracic spine (mid back), the lumbar spine (lower back) and the coccyx and sacrum.  A well functioning spine should move with fluidity and ease enabling  us to walk, sit and dance (apart from my brother who could have a spine like a slinky and still dance like he has 3 left feet).

Each vertebrae is made of a dense bone outer shell with a lighter more honeycomb textured inner shell (malteser any one?) This structure allows our bones not only to be strong but also light, with ability to absorb force if we were to jump up and down or run. Each vertebrae is made up of a bony ‘body’ behind which you can find a hole called a foramen. When you stack all these vertebrae on top of each other the holes line up and become the spinal  canal through which the spinal cord runs .

The spinal cord

The spinal cord ferries information from our peripheries to our brain and then returns information back from the brain telling all the various areas of the body how to react. The nerve ‘tributaries’ that carry this information are called spinal nerves and they wind their way back from all round our body  and up through holes at the side of the vertebrae where they  join the spinal cord. The information itself is detected by receptors that are attached to the spinal nerves and are scattered everywhere from the skin’s surface to inside blood vessels and organs. These receptors detect information such as temperature, pain, vibration, stretch and even tickle and itch. When you witness a dog pushing its side into you as you give it a good scratch you are seeing this relay of itch information to the brain which results in a messaged being sent back “go on muscles lean into it and enjoy yourself!”

Discs

In order to allow the spinal bones to move on each other and to absorb force, they are separated by a series of ‘rubber washers’ called discs. Each disc is made up of a fluid filled sac called a nucleus and a strong fibrous outer band called the annulus which covers it and glues it to the vertebrae above and below.

Interesting fact

These discs fill with water every night as we lie down making us a little taller when we first get up in the morning. This is why people with back pain are often advised against strenuous exercise or stretching first thing in the morning as the discs are already taught.

Disc ‘bulge’

When we have a disc ‘bulge’ the nucleus starts to protrude through a tear in the tough annulus coating and can eventually reach through into the spinal canal where it can press on the spinal nerves. When these nerves are pressed upon they create a predictable pattern of weakness, lack of sensation and pins and needles, very much like a hose which is kinked and unable to transport water. When this happens in the lower back it can press on the tributaries that make up the sciatic nerve, creating that familiar pattern of ‘sciatica’ that can refer all the way down into the feet.

Here is a nice little you tube animation which demonstrates what happens when you have a a disc issue.
https://youtu.be/33LsxW-Zq0s

Ligaments

Ligaments are like little straps that attach bones to other bones. The vertebrae are connected by capsules and ligaments which then help stabilise our bony spinal column. When these ligaments are continuously stretched (think bad sitting posture or a compensation around another injury such as an ankle sprain) then these ligaments can become painful and lax. When ligaments experience a gentle stretch they can feed back information telling the brain which muscles need to work, but over stretch them and they become unhappy. A lot of what we do in clinic is to work out why these ligaments keep getting stretched, then we use hands on techniques and movement to straighten everything up and allow the body to find its centre.

Muscles

Muscles attach all the way up the spine at various different depths and, very much like ligaments, need to experience being loaded as well being unloaded.  If they are chronically stretched (for example if someone has their work desk set up so they are always rotated to one side) the stretched muscles will start to become painful and prone to tearing, while the shortened muscles will become congested. By finding a more balanced resting posture we can then remove the trigger to tissue pain and allow the body to do what it does best and start to heal.

Conclusion

So that was a quick whistle stop tour of getting to know your back anatomy. Once you know what is lurking around in that unknown area between your head and your pelvis, then things becomes a whole lot less scary. As a therapist all we do is find out the trigger that keeps causing things to be painful and remove it for a while while your body naturally gets better. Add a dash of movement to synchronise bones, muscles, ligaments and  nerves to coexist in harmony and we have our selves a treatment plan.

I hope this cleared things up a little bit and allowed you to picture what is going on back there. If you know any one who might benefit from this little guided tour, please feel free to share.

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3 ways to treat frozen shoulder

Although this can be a stubborn issue to treat in clinic I find a 3 pronged approach to be very successful.

1) Soft tissue work

Massage and stretching is as old as the hills, and for good reason – it works! Focused hands on work along side sound clinical reasoning is always my first go to with any shoulder problem. Without movement, tissues around the shoulder joint lay down collagen in a haphazard pattern which leads to fibrosis and restricted motion. Using external pressure via massage and internal tension from muscle contraction (see the work of Andrea Spina and his Functional Range Release techniques) we can positively impact this collagen formation, begin to create space for movement and improve the flow of healing blood into the area. When we have worked on the muscles we can then begin to get deeper into the joint capsule itself using lovely distraction and rotational movements to work on the inner fascia of the capsule and gently encourage it to stretch. For a shoulder that has not moved in a while this gentle articulation can feel phenomenal.

2) P-DTR

I have written about Propriceptive deep tendon reflex therapy here, but in a nut shell this technique allows us to work on the nerve receptors that surround the shoulder joint and that feed information back to the brain. With frozen shoulders I find that the receptors which monitor stretch are incredibly important and working on these can often result in a staggering increase in range of motion nearly instantaneously. Although the exact cause of frozen shoulder is not entirely known, we often uncover a history of immobilisation of the joint or an incident of falling on an outstretched hand. In such cases we can stimulate the receptors that detect pain by putting a gentle thrust through the joint and seeing whether they are still causing an issue, resulting in the muscles locking down around the area or becoming inhibited and weak. Again this can be incredibly powerful when it comes to freeing up more motion.

3) Movement

Although I have put this last this is the most powerful tool of all and if I was only allowed one of my 3 go to s this would be my modality of choice. Assessing and treating with movement allows us to work on the soft tissue and the nervous system all at the same time and to start tying together the reasoning behind why the shoulder became compromised in the first place and where to start the process of unravelling it. Using Gary Wards Flow Motion model of gait we can see where the inner capsule of the shoulder should spiral and decompresses as we walk, which then allows us to use exercises as we would massage to work deep into that capsule as well as into the connecting structures of the neck spine and all the way down into the feet. A truly whole body solution.

Movement is also the glue that ties together all the work that we have done on the couch. Without movement ‘speaking’ to the structures we have worked on in clinic, it is highly likely that the new found range will shrink back to where it was. It is a real use it or loose it situation where tissues can now be restructured along the lines of force that exercise homework creates enabling the patient to become their own therapist. This is often where manual therapy on its own struggles to create lasting results.

Conclusion

A frozen shoulder can really start to affect a person’s quality of life, be it sleeping, exercising or even getting dressed in the morning. Unfortunately there is not always a quick fix to the problem but there are ways to gently offer back mobility and to empower the person suffering with movement strategies to help fast track their own recovery.

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