Re: physical therapy/shoulder - Suggestions

[Guest guest]

Some questions for you first about your daughter.

You said that her PT " feels her collar bones are malaligned, and

that her rib is pushing her shoulder up and out of place. " Was this

just some kind of subjective statement or did she do any tests or

take Xrays to confirm that assessment? Also, which rib(s) does

she " think " is/are involved? Do you know which muscles are getting

the deep massage and electrical stimulation, also, what kind of

electrical stimulation? What is the PT trying to achieve with the

electrical stimulation? Relax muscles? Move bone? Is she just doing

the massage and electrical stuff to try to " move the rib forward " or

is she doing anything else? And finally, when you say the PT is

trying to move the rib forward so " her shoulder will go back in

place, " are you referring to the shoulder joint itself or the

scapula in back? And I do have some question/concern about exactly

what is meant by " moving the rib forward. " I don't have a problem

with techniques that allow the rib to passively move forward, such

as relaxing contracted muscles that are pulling it out of place. I

do have a problem with the notion of manually trying to push or

force it back in place depending on the training and skill level of

the practitioner/therapist.

I am doing a lot of guesswork here just based on my knowledge of

anatomy and your description, but I can tell you that the specific

problem/treatment will vary depending on particular rib

involvement. The first rib is very short, attaches in front at the

sternum beneath the clavicle, and in back at C7. Passing as it does

beneath the clavicle makes it somewhat difficult to effectively

access in front, acts as a culprit from time to time in various

entrapment or impingement syndromes in conjunction with the

clavicle, and can cause shoulder problems by applying pressure

against the clavicle. This in turn translates along the clavicle to

the acromioclavicular joint where the clavicle joins the scapula at

the shoulder.

Ribs two through eight all curve around, back to front, and pass

under the scapula. If any of these ribs sublux or separate, they can

apply outward pressure against the scapula, which in turn affects

the shoulder joint. As for the clavicle itself, they can and do get

out of alignment.

And finally, we need to talk about the actual shoulder itself, the

glenohumoral joint, as in the joint socket for the arm. My point

here is, what exactly is subluxing in your daughter's shoulder? Is

it the scapula-clavicular connection discussed above? Or is the arm

dislocating at the shoulder? Because if it is the arm, then some

other muscles/issues come into play. Specifically, we now start

talking about the rotator cuff muscles: supraspinatus, teres minor,

infraspinatus, and subscapularis, plus specific fibers of the

trapezius.

Part of the confusion I am having with this is trying to match the

treatment you describe with the condition/problem you describe. I

can understand deep tissue work if the rotator cuff muscles are

involved or if the PT is trying to relax some of the back and

shoulder muscles that attach directly to the scapula. (I would not

use deep tissue myself in this case but I can understand the logic).

I can't understand deep tissue at all if the ribs and/or clavicle

are the problem.

If you have been following my posts at all, you can probably guess

that the approach I would personally take very heavily involves

energetics. Keep in mind that I have had the training in

the " standard stuff. " I do very little of the " standard stuff "

anymore because the deeper I get into energetic modalities the more

effective I find them to be and with far less trauma to the person I

am working on. I can quite frankly get results with them that I

simply cannot achieve with the standard techniques. And very

frequently I get those results in literally a matter of minutes

compared to session after session of doing standard things with

little or no results.

Given that, these are the things I would personally do or suggest.

For the clavicle itself, assuming that it is in fact misaligned or

subluxed, I would use a Polarity/MFR technique called bone two-

pointing, very similar to the Rib Head Release.. This is really

complicated and difficult to understand – take the tips of fingers

two and three of one hand and place them with moderate to firm

pressure at the end of the clavicle at the sternum. Take the tips

of fingers two and three of the other hand and place them with the

same pressure at the other end of the clavicle where it connects to

the scapula – and then simply maintain that pressure with focused

intention. That's it. Simply holding the two spots and letting

your mind wander all over the place, or carrying on a conversation

with someone else in the room, or watching TV while you are doing it

isn't going to work. You NEED to be mentally grounded and centered

and concentrate your attention on what you are doing. But, usually

within about two minutes, you will feel kind of a wobbly motion in

the clavicle and it realigns itself. This is a technique that she

can do on and for herself.

If the ribs are out, the same technique can be used. You determine

finger placement by palpating along the sternum and spine for tender

points. Because of rib curvature, the tender point in back will be

an inch or so higher than in front, depending on the person's torso

length and space between ribs. Depending on which ribs are

involved, your daughter may or may not be able to reach the back

spots herself and may have to have someone else do it for her.

And an acupressure technique I learned in my last class –

specifically for rib and shoulder problems. There are two points –

Heart 1 and Bladder 15. Raise your arm and put your hand on the

back of your head. Now take your other hand and slide your fingers

along the edge of the pec muscle at the edge of the chest to the

hollow at the top of the armpit. Heart 1 is in that hollow.

Bladder 15 is located about one and a half thumb widths out from the

spine level with the 5th thoracic vertebrae, in other words, between

the 6th and 7th ribs. This is one that my instructor personally

uses for shoulder dislocation problems (and she is a PT with 17

years experience). In fact, in that class, my left first rib was

out she used this technique to help one of my classmates put it back

in.