Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (13 page)

PART 3
TROUBLESHOOTING YOUR MUSCLES: THE “HOT SPOTS”

In chapters 8–14, we divide up the body into seven “hot spots”— neck, shoulder, elbow/wrist/hand, lower back, hip, knee, ankle and foot—where most musculoskeletal trouble turns up. All the damage we discuss is divided into three categories: Mostly Muscular; Muscle or Joint?; Joint/Orthopedic. The first and maybe most important thing we do is figure out how the three elements of the system—muscle, joint, bone—may be out of sync. (In some cases, nerve injury becomes a contributing factor.) Always, we treat as conservatively as possible, working first on the muscles if there’s a reasonable chance to fix the problem without drugs or surgery. Keep in mind, this book is a practical guide that covers many of the most common musculoskeletal problems, not a comprehensive orthopedic or therapeutic manual. If you have a serious injury, get help from a health professional.

At the end of each of these chapters, we hand you the tools of muscle medicine, taking you through our self-treatment program of hands-on self-treatment techniques, stretching, and strengthening, introduced here in
chapter 7
.

THE MUSCLE MEDICINE PROGRAM

In
our era, there’s no shortage of musculoskeletal expertise, from high-tech surgical advances to the latest variation of hands-on therapeutic techniques. The problem is, unlike in other areas of health care, a consistent strategy that governs how and when people receive treatment for their musculoskeletal problems is often lacking.

We’ll frequently see people with tight or inflamed muscles doing muscle conditioning work in physical therapy, but not getting better and putting themselves at risk for reinjury. Right therapy, wrong timing. The piece of the puzzle that’s sometimes missing is the treatment of those tight and injured muscles beforehand. You can’t stretch and strengthen damaged tissue (only the healthy tissue around it), but you can further irritate it.

THE STRATEGY

Over the past six years, combining forces to deal with our patients’ musculoskeletal problems and following their progress, or sometimes lack of progress, in therapy,
we’ve developed our own treatment strategy. Whether the patient is in prehab to prepare for surgery, rehab to recover from surgery, or doesn’t need surgery at all, our approach is the same. First we make sure the damaged or restricted muscles receive manual treatment. When the muscle damage has sufficiently resolved, we move the patient into the conditioning phase: stretching to restore a normal range of movement, then the strengthening work to build up the resiliency of the treatment area’s musculoskeletal system.

THE PROGRAM

We’ve discussed these ideas in a general way in
chapter 1
. In this chapter, we’re going to distill our strategy into a program the reader can use at home. Our program has the same three parts: muscular self-treatment, stretching, and strength work. It’s designed for several different groups of people: for the person with no health problems whatsoever who uses our muscle treatment and conditioning work as a prevention strategy; the person with minor aches and pains who has been cleared by a medical professional to work on these issues on his or her own; someone who’s currently being treated by a doctor but who has been cleared to supplement that treatment with our program; and lastly someone who has completed a course of medical treatment and has been cleared to do maintenance work on his or her own. Almost everybody can use it!

But, before we go any further, let’s take a closer look at those three areas—treatment, stretching, and strengthening—so you can see how our program evolved.

MANUAL THERAPY TREATMENT

A whole universe of hands-on therapies and therapists exists to treat your muscles. There is no central organization, so seeking out help can be daunting, even though there is no shortage of talented people. What follows are a few of the schools or traditions most accepted by modern medicine. Acupuncture and acupressure target precise spots on the body at which to apply therapeutic pressure, using needles (acupuncture) and manual pressure (acupressure). Chiropractic mobilizes joints and relieves nerve entrapments and muscle spasms. Physical therapy is an umbrella term. Some physical therapists are essentially rehabilitation specialists focusing on
muscle conditioning, while others use a range of hands-on techniques. Some individual styles of manual therapy have mostly emerged in the last six decades or so, often blending old and new techniques, and are practiced by health-care professionals from many different disciplines. A few of the most well known are Active Release Techniques (ART), Graston Technique, Myofascial Release, Orthopedic Massage, and Trigger Point Therapy. The granddaddy of hands-on work is therapeutic massage, which has been around in one form or another for centuries.

All of these approaches, from ancient to modern, have their particular methods

AUTO MANIPULATION

We have many patients who try to treat themselves by “cracking” joints, with self-massage, and by overstretching and pulling on their muscles and joints. There are several reasons why the wrong self-care is wrong for you:

1. “Cracking” your neck and back yourself is counterproductive. The reason patients have the feeling that they want to “crack their spine” is usually because there is an area that is immobile or too tight. Whenever there is an area of immobility, however, there is usually an area of hypermobility, or an area that’s too loose. So when a patient tries to release an area of tightness by “cracking” their neck or back, they’re usually causing the loose joint to move instead. This creates even more hypermobility, which loosens ligaments, destabilizes the joints, and makes the patient susceptible to calcification of the soft tissue around the joints, which may lead to osteoarthritis.

2. Pulling joints and muscles by overstretching can aggravate an existing problem or even a healthy joint. Stretch once or twice a day, after a warm-up or after exercise. Be specific with your stretch routine, and don’t overdo it or hold the stretches too long. See our description of proper stretching on page 72.

3. Constantly rubbing, pressing, and kneading your sore muscles can inflame and irritate them. When a professional works on your muscles, it’s for a short time, in a precise area, and in a precise way. A good practitioner should give you the proper self-care to give you relief between sessions.

and their own explanations for how and why they work. Some of them talk about manually breaking up microscopic scar tissue or “adhesions” (ART) or nodules of painfully contracted muscle (Trigger Point Therapy). But broadly considered, they’re all trying to do pretty much the same thing: relax tight muscles, relieve pressure on the joints and nerves, and, in most general terms, bring movement (and with it, blood flow and oxygen) to a musculoskeletal system that may have grown restricted and stagnant.

STRETCHING

As discussed, stretching has generated a lot of skepticism in the sports medicine world. Study after study has failed to find much benefit from it: it does not improve athletic performances nor reduce injury rates. But here’s the catch. The research has only looked at the traditional “static” form of stretching where you hold the stretch. (Picture a jogger with his leg up on the park bench and bending at the waist, reaching for his toes.)

The stretches we think are most generally valuable are “dynamic.” They incorporate movement, and the stretch is never held for more than a couple of seconds, if at all. So is static stretching bad? No. Static stretching has its uses, as do all the stretching styles. Once again, it’s a question of matching the right solution with the right problem. Here’s a quick and simple look at what’s available.

• Static stretching is the conventional and probably still the most popular way to stretch. The static stretcher typically brings the muscle right to the end of its range of motion and holds it there for twenty or thirty seconds. Over time, the muscles, tendons, and ligaments can lengthen, which increases flexibility, but flexible tendons and ligaments are not generally a good thing. Gymnasts, dancers, and martial artists benefit from this improvement in “end range,” but most athletes, recreational or elite, play sports that don’t need any special flexibility (distance running, cycling, etc.), so for them the argument in favor of static stretching isn’t strong. In fact, static stretching, rather than preparing the body for a workout, may weaken the muscle for a time, making it the worst possible pre-workout choice. Furthermore, even if an area of the body has been properly warmed up beforehand, a static stretch can trigger a muscle reflex that actually tightens the muscle, which may lead to irritation of the tendon/muscle area. In postsurgical
rehab, static stretching can be effective for breaking down or preventing the formation of scar tissue in order to bring a joint back to a normal range of movement.

• Dynamic stretches incorporate movement, usually emphasizing continuous, rhythmic motion (see the stretch exercises on page 53) that brings blood to the area, loosening and warming up muscles and tendons and preparing them for the increased effort of a workout. They also provide a safe way to relax muscles that have been stressed and shortened during a workout, for example, a run or weight-lifting session. They’re equally good for the nonathlete moving through the middle or senior years, as a way to counteract the tightening and stiffening of the connective tissue that occurs with age.

• Active-isolated stretching is a specific type of dynamic stretching (see the stretches at the end of the “hot-spot” chapters). The motion is rhythmic and the stretch is held for no more than two seconds. These stretches provide an effective way to restore a normal range of motion in targeted muscles without stressing tendons or triggering the body reflexes that tighten up muscles.

STRENGTH WORK

The muscles are one of the body’s shock absorbers and an important line of defense against damage to the joints. Building up strength in the muscles and connective tissues that stabilize and drive the joints is the goal of the final phase of our strategy and program. We’re not interested in pumping up “trophy” muscles in the gym. We want to balance strength in opposing muscle groups (agonist and antagonist) so that the joints have the necessary muscle support throughout their entire range of motion. Every form of strength work comes with built-in advantages and disadvantages. Understand which types of exercises will help you best meet your fitness goals.

• Weight machines in the gym often become the path of least resistance for the novice, but they can be the most limiting form of strength work. The machine controls the movement so only some of the muscles in a movement pattern are used. The machines can be useful, especially for seniors or people with joint dysfunction who may not be able to handle some of the other types of exercises. Working on a range of machines with a knowledgeable personal trainer can be a great start, but you should still try to supplement with other strength exercises.

• Body-weight exercises such as push-ups and core exercises on a stability, or “physio” ball, provide the best foundation for “functional” body strength and balance—what you need to negotiate in the real world. They work a range of muscles from different angles, especially the essential core muscles that stabilize the entire body. Movement-based exercise—for instance, swinging a kettle bell—provides a similar benefit.

• Resistance exercises using a rubber cable, an elastic band, or dumbbells allows you to isolate and develop specific muscles (hopefully after you’ve achieved a good all-around strength base). Because you have to control the movement of the exercise, unlike with machines, you’re also getting some benefit by working supporting neighboring muscles and core muscles.