Seasonal Tension Patterns – Part 2

Heli shoulder stretchBy Helgrit Howard, Ph.D., R.MT. and Tad Howard, R.M.T., P.T.

As discussed in Part 1, we observed, that we had to address certain problems more in our clients during different times of the year and we discussed the winter/spring season already. Here is what we observed for the rest of the year:

June/July: sore and/or swollen knees

The many clients who suffered from pain, stiffness and swelling in their knees early in the summer had just started exercising again, after spending the winter and early spring without much physical activity. Most of them took up vigorous exercise regimes or long distance running without allowing their bodies to ease into the process. Too much exercise too soon. Their ligaments, tendons and joints were simply not conditioned enough to withstand the strain that was put upon them. Those Structures in the body that are not directly supplied by blood take longer than muscles and the circulatory system to adjust to new stresses (4). In fact, it can take month till the tendons have grown thicker, become more elastic and better load bearing.

The pain in their joints put most of those clients off further activities and consequently, I countered fewer and fewer clients with knee problems as the summer went on.

August/September: sore feet

During the warmer month, people in Illinois walk a lot more than during the colder seasons. Enjoying long walks with friends and relatives over the weekends, it was not surprising that not only did we see more people with sore feet at this time of the year, but they also tended to see us earlier in the week, just after their weekend hikes.

October to Spring: shoulder and neck problems

As the weather cooled again, people tended to become less physically active. The colder temperatures made them hunch their shoulders in an attempt to stay warm. And then there is of course the stress of the holiday season, all factors that made many want to pull their shoulders to their ears and to curl their chin to the chest. Muscles such as levator scapulae, trapezius, sternocleidomastoid, scalenes, subclavicularis, seratus anterior and pectoids were the main muscles hat people used to hold themselves in this protective posture and those were also the muscles that gave the longest lasting relieve if treated by a combination of muscular relieve and stretching.

Interestingly, we encountered different seasonal problem clusters in Colorado. We practiced in areas of the Rocky Mountains where many people are physically active all year round, be it with sports or working on their houses and farms. Not surprisingly, the seasonal problem clusters in Colorado tended to be mostly connected to various types of physical activities such as sports, building and farming. For instance, in the winter we saw many people with knee, shoulder and wrist problems related to skiing. During the road and mountain biking season we saw more people with tightness in their calves, a combination of overuse and dehydration. In the summer we saw various clients with pain in their backs caused by falls during building projects.

It is of course much easier to see the correlation between physical activities and seasonal problem clusters. Problems in the body caused by luck of physical activity and seasonal stress are somewhat harder to trace to their origin, but I hope that this article has helped to get a better understanding of some of the mechanisms that may be involved in the formation of common problem clusters.

 

(1) Spine. 2007 Jul 1;32(15):1687-92. Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg D, Richardson CA. Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia. j.hides@shrs.uq.edu.au

(2) Diagn Interv Radiol. 2007 Sep;13(3):144-8. CT measurement of trunk muscle areas in patients with chronic low back pain. Kamaz M, Kireşi D, Oğuz H, Emlik D, Levendoğlu F. Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey.

(3) Br J Sports Med. 2008 Oct;42(10):509-13. Epub 2007 Dec 7. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. Hides J, Stanton W, Freke M, Wilson S, McMahon S, Richardson C. Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.

(4) www.gesundheit –aktuell.de. Sport: Langsamer Einstieg in den Frühling

Seasonal Tension Patterns – Part 1

Seasonal tension patterns

By Helgrit Howard, Ph.D., R.MT. and Tad Howard, R.M.T., P.T.

Throughout our practice of massage we often noticed that clients present particular problems more frequently at certain times of the year. For instance, within a few weeks several of our clients came to us with pains in their knees. Then there were month when no one seemed to have any problems with their knees. Other problems in the body, such as tensions in the shoulder and neck, lower back pain, swelling in the legs and feet and blocked sinuses, to name but a few, all seemed to present themselves predominantly in clusters.

When talking to fellow Massage Therapists we learned that many of them can relate to this experience. We often hear as the explanation for this clustering of problems that the universe is trying to teach us something. However, our observations suggest, that the underlying cause is much less mystical. After studying this event for many years we came to the conclusion that many of the common occurrences of physical problems can be explained by the seasonal changes in people’s habits and the seasonal effect of the environment. Here are some examples of the seasonality of problems we observed in Illinois:

  1. Winter and Spring: stiffness and/or pain in lower back
  2. June/July: sore and/or swollen knees
  3. August/September: sore feet
  4. October to Spring: shoulder and neck problems

After discussing their problems with our clients and working on their problems, we came to the following conclusions about each of above mentioned seasonal problem clusters:

Winter and Spring: stiffness and/or pain in lower backHip imbalance

During the colder month, clients who complained about stiffness or pain in the lower back tended to spend most of their waking hours sitting. Physical activity was limited to walking to and from the car, shopping, walking around the house and office. Not surprisingly, I noticed that those clients had very tight hip flexors; especially psoas was always very tight. If the person spent much time driving an automatic car, then the psoas muscle on the right hand side was usually tighter than the left side. Releasing psoas brought the most and longest lasting relive to the lumbar region of the back. Which is not surprising as psoas arises from the bodies of T12 through L5, runs anterior to the pelvis, posterior to the inguinal ligament, and inserts on the lesser trochanter. This large muscle plays a major role in hip flexing activities such as sitting and driving. If psoas is activated and shortened over a long period of time without relieve from stretching and exercise it will set in this pattern and consequently restrict the movement of the lumbar vertebrae and the hip. Of course, Psoas is not the only muscle in play here but it is one of the most influential ones and, unfortunately, it is often overlooked by therapists, because it is not an obvious, external muscle.

The shortening of muscles with certain activities is well documented by many researchers. For instance, in a study conducted in Turkey on patients with chronic low back pain (2), researchers found that chronic low back pain was connected to atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles.

In an Australian study, Hies et all (1) found in their assessment of trunk muscles during prolonged bed rest that bed rest resulted in selective atrophy of the multifidus muscle. Their results also suggested a shortening of the trunk flexor musculature (psoas, anterolateral abdominal, and rectus abdominis muscles). Some of the changes resembled those seen in low back pain and may explain the negative effects of bed rest seen in low back pain sufferers.

In an MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain, Hides et al. (3) showed clearly that asymmetrical use of the body leads to asymmetry of trunk muscles and deficits of motor control. For instance, the quadratus lumborum and lumbar erector spinae plus multifidus muscles were larger on the same side to the dominant arm and in the subgroup of fast bowlers with low back pain, the asymmetry in the quadratus lumborum muscle was the greatest. The internal oblique muscle was larger on the side opposite to the dominant arm.

If very contrasting activities such as prolonged bed rest and cricket can lead to a shortening of muscles, it is also very possible that prolonged sitting can achieve the same and consequently create a structural imbalance in the muscular-skeletal system. The stress caused by this imbalance is then experienced as stiffness or pain.

In Part 2, we will focus on the seasonal effect of the rest of the year.

 

(1) Spine. 2007 Jul 1;32(15):1687-92. Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg D, Richardson CA. Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia. j.hides@shrs.uq.edu.au

 

(2) Diagn Interv Radiol. 2007 Sep;13(3):144-8. CT measurement of trunk muscle areas in patients with chronic low back pain. Kamaz M, Kireşi D, Oğuz H, Emlik D, Levendoğlu F. Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey.

 

(3) Br J Sports Med. 2008 Oct;42(10):509-13. Epub 2007 Dec 7. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. Hides J, Stanton W, Freke M, Wilson S, McMahon S, Richardson C. Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.

 

(4) www.gesundheit –aktuell.de. Sport: Langsamer Einstieg in den Frühling