Victory's Flexible Friends

Posted by Nell Mead at 08:00 on 17 Aug 2011

For the past few weeks, as I’ve been working to turn Victory into a larger and more interdisciplinary practice, I’ve been having fun doing some “quality control” – making sure that the practitioners I want to be associated with Victory are at the top of their game. So, all in the name of benefiting you, the client, (naturally!), I’ve been swapping treatment sessions with Victory’s sports massage therapists, and with The Foundry’s trainers. I’ve not yet been disappointed, and I’m quite sure you won’t be either.

This past week, I’ve branched out a bit. Pilates teacher Laura Hogg used to work at The Foundry but has now set up her own, more spacious, centre just a few minutes away in Shoreditch. I’d been wanting to meet her for ages, so grabbed the opportunity when she rang to request some physio treatment, to ask if she’d be happy to swap sessions with me.

I’ve never really done much formal Pilates or yoga, though I’ve learned some of the basic exercises over the years as I’ve expanded my knowledge of physiotherapy and core control. But last week I Laura gave me my first Pilates lesson (which was excellent – highly recommended!); and this morning I also met her colleague Jo Lawson, a yoga teacher from New Zealand.

Both Laura and Jo are very bendy, which makes the shapes they can contort their bodies into really rather lovely to look at, and inspirational to try to replicate. But they’re also both very encouraging and sympathetic to those of us who are not quite as flexible. And – somehow – after repeating the moves a few times, I gradually felt myself becoming, if not quite graceful, then slightly less rusty!

One of Jo’s stretches, which we did when I mentioned an old shoulder injury, was completely new to me, and I thought it was brilliant so with her permission I’d like to share it with you. You may well need some assistance with this at first (I did!) but after a bit of practice it should get easier.

• To stretch your right shoulder, sit on the floor with your legs out straight in front of you and toes pointing at the ceiling. Pull your right foot all the way into your groin.

• Then reach your right arm out towards your left foot, making sure your right shoulder is inside your right knee.

• Next, twist your shoulder inwards so that your right thumb rotates anticlockwise towards the floor. Lean your upper body forward and reach your arm around your raised right knee, so that your hand reaches as far round your back as you can manage. You should feel an agreeable pull between your right shoulder blade and your spine, as your shoulder blade is pulled forward to accommodate your knee.

• Your next move is to reach round behind your back with your left hand, and try to grasp the fingers of your right hand with your left.

• Seen from behind, the stretch should ideally look like this.

• However, most of us won’t be quite that flexible, especially at first. So if your fingers can’t reach each other, you can hold a towel or strap in your hands, and gradually work your fingers closer together. At first you may need a helpful someone to place the strap or towel into your hands behind you.

Relax into the stretch for a couple of breaths, focusing on allowing your muscles to relax and lengthen. Then let go of your fingers, unwind and repeat on the other side.

When people ask me – as they frequently do – whether they should choose yoga or Pilates, I often respond somewhat glibly (and generally, I think, truthfully) that it doesn’t really matter which you do as long as you find a good teacher. Now, with Shoreditch Pilates and Primal Yoga round the corner, I’m delighted to be able to say that I think I’ve found excellent teachers for both disciplines, and I’ll definitely be going back for more: see you in class!

*Thanks to Jo for kindly agreeing to model at a moment's notice!

Shoulder pain - an underdiagnosed dysfunction

Posted by Nell Mead at 14:00 on 18 Feb 2011

This post is triggered by Dave Thomas of The Foundry, who commented yesterday on Facebook following a therapy session with me that “if you haven’t had your subscapularis walked on before, it’s a treat!” It seems to be a relatively unusual technique, but one of my favourites, and this is why.

The subscapularis (aka subscap, to rhyme with hubcap) is a triangular muscle which sits between the ribs and the shoulderblade (scapula) – its name meaning literally “below the scapula”. With its base covering the entire of the inside edge of the scapula, it narrows to a tendon which attaches to the inner part of the humerus (upper arm bone) and the shoulder joint capsule. Its role is to twist the arm inwards (place your hand on your stomach and try to push through to your spine: you’re using your subscap) and to pull the humerus forward and down when your arm is raised, thus preventing your shoulder from dislocating.

It’s one of the four muscles that make up the rotator cuff, (the others being supraspinatus, infraspinatus and teres minor, if you’re interested!) but far less frequently torn than the more vulnerable supraspinatus and infraspinatus. Probably because of this, it’s a muscle that’s often ignored by therapists when treating sore necks and shoulders, but in my view that’s a mistake. Good subscap function is essential to good neck and shoulder function, and I have a few theories as to why this is the case.

One theory is the effect that subscap has on the ribs. As I’ve mentioned, subscap sits between the ribs and the scapula. Normal shoulder movement depends on the scapula being able to glide freely over the ribs. When muscles are sore, they tend to tighten up and develop trigger points – isolated areas of muscle spasm; and subscap is no exception. It’s my belief that tightness and/or trigger points in subscap can be partly responsible for dysfunctional movement of the scapula over the ribs. This in turn places excessive strain on the rib and shoulder joints, leading to pain in the upper back, neck and/or shoulder.

I believe that another problem with subscap trigger points is the effect these have on blood flow and nerves. I suspect that when a muscle is tight, its spasmed fibres affect not only each other, but also other local structures such as blood vessels and nerves. In the case of subscap, this could – theoretically - affect the axillary (armpit) artery and the ulnar branch of the brachial plexus – the nerve that goes down to the inside of the elbow and the ring and little fingers. It’s certainly noticeable that patients often comment that they feel odd sensations in these areas, as I release their tight subscaps; or that once I’ve finished, they feel a rush of heat to the area (increased blood flow?)

Releasing the subscap is pretty tricky to do on your own. I often use my heels to release subscap in my patients – most therapists use their fists or fingers, but it’s hard to do that without jabbing your patient and causing more discomfort than necessary. If I have to release your subscap, I’ll ask you to lie on your back with your hand behind your head. This brings the edge of your scapula out to the side of your body, and I can then fit my heel between the edge of your scapula and your ribs, and use my bodyweight to stretch and massage the subscap, gently and rhythmically until the spasm subsides.

Not only does this tend to release the subscap spasm, it also frequently seems to relieve neck pain and increase in rotation at the neck, which is a great side effect. I’m not sure whether this is also due to better rib mobility, or whether there is some sort of chain reaction going on whereby the subscap release causes a release in the levator scapulae – any bright ideas gratefully accepted!

After I’ve released your subscap, I’ll show you how to stretch it yourself, using a chair, Swiss ball or yoga brick, so that you can maintain the improvement at home. 

If you're having problems with a shoulder, please e-mail me for advice or for an appointment.