Do you find yourself turning your entire body just to look over your shoulder while driving? Or maybe you notice your neck doing most of the work during an ab workout. If so, you are likely dealing with a restricted and overactive neck. This is extremely common in a stress driven world where many people spend hours each day on computers and cell phones. Unfortunately, many suggested solutions fail to address the real cause of restricted neck mobility. Instead, they rely on passive stretching that acts as a temporary band aid for symptoms. Others avoid stretching altogether and are told to fix their posture or perform strengthening exercises like face pulls. Neither approach consistently solves the underlying issue and in some cases can make symptoms worse. Below are five exercises designed to target the most common contributors to restricted neck mobility, which tend to be faulty breathing patterns, limited rib cage movement, and repetitive movement habits. For best results, these exercises should be performed in the order listed. #1. Zercher band Breathing  [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] You might wonder why improving neck mobility starts with breathing and upper back expansion. There are two important reasons. First, the muscles that extend your neck and resist rotation attach all the way down into the middle of your upper back. If upper back mobility is limited, neck mobility will almost always suffer. Second, many muscles on the front and back of the neck act as accessory breathing muscles. This means they help move the rib cage to allow the lungs to expand. If the rib cage is stiff and cannot expand properly, these neck muscles are forced to work harder than they should. Over time, this leads to increased tension and overactivity. Zercher band breathing helps improve rib cage mobility and encourages expansion of the mid and upper back. Perform: 3 to 5 sets of 5 breaths #2. Staggered Stance DB Curls [embed]https://www.youtube.com/watch?v=o16wXhnkCs4[/embed] Biceps curls for neck pain might sound strange, but there is a method behind it. The arm position mirrors the previous exercise, and curling the weight encourages the shoulder to move down and away from the ear. Adding slight neck rotation introduces much needed movement while maintaining rib cage expansion. This position also places the upper trapezius, a common contributor to neck tightness, into a lengthened state. Breathing during the movement reinforces this position and helps reduce excess tension. Perform: 2 to 3 sets of 10 reps on the restricted sideBoth sides can be trained if needed #3. Lower Body Rolling [embed]https://www.youtube.com/watch?v=ZeugF67eiFw[/embed] The human spine is made up of 33 segments, with 26 capable of movement. Healthy motion depends on segmental movement, meaning each segment can move independently rather than the spine moving as one rigid unit. When segmental motion is lost, movement becomes stiff and robotic. This often shows up as turning your entire body instead of simply turning your neck. Lower body rolling teaches segmental movement from the bottom up. The motion starts at the hips and pelvis and finishes with the neck. An inhale at the end of the roll reinforces upper back and neck rotation. Perform: 2 to 3 sets of 6 rolls on the restricted sideBoth sides can be trained if needed #4. Rolling Arm Bar  [embed]https://www.youtube.com/watch?v=rfuEzHjiGro[/embed] Once you are comfortable with more passive or controlled neck movement, it is time to introduce more active motion. The rolling arm bar is an excellent tool for restoring and maintaining neck mobility. The kettlebell encourages shoulder reach, which helps maintain upper back expansion. This exercise uses the same bottom up segmental movement pattern as lower body rolling. Keeping your eyes on the kettlebell teaches the body to actively rotate the neck through a full range of motion. Neck fatigue is common at first, as you are retraining proper movement patterns. Most people notice improved baseline neck motion after performing this exercise. Perform: 2 to 3 sets of 6 rolls on the restricted sideBoth sides can be trained if needed #5. Turkish Get Up  [embed]https://www.youtube.com/watch?v=vPUD-Lqh6w0[/embed] Overhead shoulder movement is closely linked to movement of the lower cervical spine. This is why weightlifters often jut their head forward when pressing overhead. It helps maintain the relationship between shoulder and neck mechanics. The Turkish get up trains this relationship effectively. The kettlebell encourages shoulder reach and upper back expansion while keeping the neck moving in coordination with the shoulder. Maintaining your gaze on the kettlebell reinforces proper neck and shoulder mechanics. Looking upward also places the muscles on the front of the neck in a lengthened position. This movement ties together all of the mechanics addressed in the previous four exercises. Perform: 2 to 3 sets of 3 reps on the restricted sideBoth sides can be trained if needed Try this five exercise sequence to help restore neck mobility and reduce pain. If pain prevents you from performing these movements or symptoms persist, it may be time to be evaluated by a licensed professional. Reach out to Next Level Physical Therapy to schedule a free in person or virtual Discovery session.

In this article, we are going to discuss what other movements to consider if you are dealing with movement related neck discomfort and chin tucks have not helped. If you are not sure what a chin tuck is or whether it might be useful for you, refer back to the previous article in this series to see if your neck pain solution might be that simple. At the end of Part 1, we discussed how chin tucks are an exercise that extend the lower cervical spine while expanding the back side of the upper cervical spine. This relationship is shown in Picture 1. [caption id="attachment_1580" align="aligncenter" width="790"] Picture 1: The orientations of the two regions of the neck in a chin tuck position, live in action.[/caption] A key concept introduced earlier is that this position is not harmful. In fact, it is commonly used by individuals who are producing large amounts of force. When the goal is to be strong or generate force, the body often limits available movement to improve output. Think about the last time you helped someone move a couch. If you tightened your body and lifted straight up and down, the task likely felt easier. If you lost tension, twisted, or had to reposition yourself mid lift, your strength and leverage were reduced. When the body moves away from positions that limit rotation, it becomes harder to generate force efficiently. This is why strength athletes such as powerlifters compress certain regions of their body during lifts like the bench press. They pinch their shoulder blades together and extend the lower back to reduce unnecessary movement and improve force production. For them, this is a performance adaptation. Over time, however, this adaptation can contribute to a reduced ability to rotate or turn the head. To move into any position, the body must be able to expand into that space. Chin tucks extend or compress the lower neck. To turn your head to the right, the right side of the lower neck must expand while the left side compresses. The opposite must occur to turn left. If your head and neck naturally sit in a chin tucked position even when you are not lifting or producing force, and you struggle to turn your head in either direction, chin tucks are unlikely to improve your neck mobility. In these cases, exercises that promote expansion of the lower neck are often a better starting point. An Alternative: The Alternating Frog Crawl A great movement to begin restoring this ability is the alternating frog crawl, shown below. A video of the alternating frog crawl exercise. This exercise offers several benefits for individuals who have difficulty turning their head or who have experienced neck pain for an extended period of time. First, it teaches you how to create pressure through the ground to expand the space between your shoulder blades and the base of your neck. Second, it challenges you to maintain that expanded position against gravity, which helps build endurance in the muscles that support your neck and head. As you step one arm and the opposite leg forward, one side of the neck experiences compression while the other side expands. These are the exact biomechanical demands required to rotate the head side to side. Key Takeaways There is nothing inherently wrong with the chin tuck position. It can be helpful in specific situations, but it is not a universal solution for neck pain. The goal is to have a neck that can move into positions that resist motion when strength is required and positions that allow movement when rotation and flexibility are needed. If you have been relying on chin tucks without improvement and still feel limited by neck stiffness, it may be time to try a different approach. Focus on exercises that restore your ability to expand, rotate, and adapt so your neck can move freely again.

Chin tucks, a common exercise that involves drawing the head straight back as if creating a double chin, are frequently prescribed for people experiencing neck related symptoms. Video 1 above demonstrates one of our physical therapists performing the movement. Video 1: The “Chin Tuck” exercise. Chin tucks can be effective for symptom relief in individuals with neck pain, neck pain that travels into the arm, headaches, or general aching in the back of the neck. Some people notice improved neck motion and a reduction or complete resolution of pain when performing chin tucks. At the same time, I regularly meet patients who have been doing chin tucks for years and are still seeking help for ongoing neck discomfort. The goal of this article is to make sure your time and effort are spent on strategies that actually move you forward. So let’s get into it. When is doing chin tucks useful?  There are a few key heuristics I use to determine when chin tucks are likely to be a good investment of time. 1. You Have a Directional Preference for Your Neck or Arm Pain Many individuals with neck pain also experience symptoms that travel into the arm or hand. A directional preference means that moving your neck in one direction makes symptoms worse, while moving it in the opposite direction makes symptoms better. For example, looking forward or down may increase neck or arm pain, while moving the head backward reduces it. If performing chin tucks and holding the end position for a few seconds improves your symptoms, that is a good sign. Continue performing them and monitor whether your discomfort decreases and your neck movement improves over time. Even if chin tucks do not reduce neck pain directly but lessen arm or hand symptoms, that is still a positive response. This phenomenon is known as centralization and is strongly associated with improved outcomes in neck pain. 2. Your Neck Endurance Needs Improvement When neck pain has been present for a long time, it is common for people to move their neck less. Over time, this leads to reduced capacity and endurance in the muscles that support the neck. The Neck Flexor Endurance Test, shown above in Video 2, is a tool sometimes used to assess how well someone can maintain a specific neck position. [embed]https://www.youtube.com/watch?v=0JEWM_McBmM[/embed] Video 2: The Neck Flexor Endurance Test  If a person struggles to hold this position for less than 30 seconds, or especially less than 10 seconds, it is often worthwhile to focus on building endurance of the deep neck flexor muscles. In these cases, chin tucks can be a helpful way to improve local neck strength and endurance. However, if someone does not demonstrate a directional preference and performs well on both neck flexor and extensor endurance tests, chin tucks are unlikely to significantly move them closer to their goals. When is doing chin tucks not useful?  I frequently see individuals who already hold their neck in a chin tucked position during standing or other upright activities. They often resemble the position shown in the image above. [caption id="" align="aligncenter" width="681"] Graphic 1: Doing more chin tucks won’t be useful here.[/caption] The lifter shown above is already performing a chin tuck due to the demands of the bench press. If this same neck position shows up during daily life and the individual also has neck pain, reinforcing that position with more chin tucks is unlikely to change the outcome. In these cases, the more important question becomes why high force activities like the bench press drive the neck into this position in the first place. We will dive deeper into that topic in the next part of this series. Key Takeaways Chin tucks are not a magic exercise. They are simply a tool that moves the body toward a specific position. They can be helpful if you have a directional preference that improves neck or arm symptoms when moving into a chin tucked position. They can also be useful if you have poor endurance of the deep neck flexors and need to rebuild local capacity. The most important takeaway is understanding your unique starting point and matching the intervention to that presentation. In Part 2, we will discuss when chin tucks are unlikely to be the answer and what to consider instead.

In today’s world of technology and working from home, posture has become a buzzword with a largely negative reputation. We are constantly surrounded by messages about what makes posture good or bad and why it is supposedly the root cause of all aches and pains. You have probably heard it all. Pull your shoulders back. Stand up tall. Stop looking down at your phone. Or the personal favorite, posture correctors that promise to fix everything by doing the work of your muscles for you. Have neck or back pain? It must be your posture. Fix your posture and the problem goes away. With so much information floating around, it can be difficult to separate what actually helps from what does not. You can spend hours researching neck pain and still walk away without a clear solution. The truth is that the body is far more complex than finding one perfect posture to solve every issue. We are built to move, adapt, and function dynamically. Everything in the body is designed to work together. Because of that, the solution to neck pain is rarely as simple as just having better posture. Take a look at picture 1 above. Every time you move your shoulder, your shoulder blade, also known as the scapula, must move as well. If we look at the muscles that surround the scapula, particularly the levator scapulae and upper trapezius, we can see that they attach on one end to the scapula and on the other end to the cervical spine. This means that every time you move your shoulders and use these muscles, you are also influencing your neck. If you are dealing with neck pain, pause for a moment and consider a few questions. Do you feel stressed and notice that you hold tension by keeping your shoulders shrugged? Do you spend hours typing at a keyboard that is positioned too high, forcing your shoulders upward all day? Do you feel limited when trying to reach overhead or behind your back? If any of this sounds familiar, the true contributor to your neck pain may be the position of your shoulders and the constant tension in those surrounding muscles. The second picture above shows the muscles of the neck from the front. This includes the sternocleidomastoid muscles, the scalene muscles, and again the upper trapezius. In addition to helping move your neck, these muscles also assist with breathing. Before diving deeper into this, it is important to understand what normal breathing should look like. Ideally, during an inhale, the rib cage should move outward and upward. During an exhale, it should move downward and inward. When breathing with the diaphragm, there should be noticeable rib cage movement with each breath. Sometimes this breathing pattern becomes inefficient. The rib cage no longer moves as it should, and the diaphragm is not used effectively. When this happens, the body often relies on the neck accessory muscles to help drive breathing instead. These muscles are relatively small and not designed to handle high demand. If they are asked to assist with roughly twenty two thousand breaths per day, they will struggle to keep up. Over time, this leads to increased tension in the neck and upper shoulder region and eventually pain. While bad posture is an easy explanation for neck pain, it is often an incomplete one. The body is far more interconnected than posture alone. Many muscles attach different regions of the body together, meaning dysfunction in one area can show up as pain somewhere else. Understanding this makes it clear why neck pain is rarely as simple as it is often presented. If you are dealing with chronic neck pain, it is important to zoom out and look beyond posture alone. You may listen to the advice to pull your shoulders back, but if your rib cage mechanics or breathing patterns are contributing to your pain, that solution will fall short. If this sounds like you, consider being evaluated by a licensed professional who can assess how your entire body is moving and help identify the true root cause of your neck pain.

There is much more to elbow pain than blaming the sport you play or the equipment you use. If you have experienced elbow pain, you have likely heard terms like tennis elbow or golfer’s elbow. Despite being named after sports, neither condition has much to do with the sport itself. Yes, golfers and tennis players commonly experience elbow pain, but there is another major common factor these sports share that is far more relevant to elbow pain. That factor is often the key to finally resolving it. When searching for solutions, you will find no shortage of advice. Stretch your forearm. Perform isometrics. Strengthen your grip. Unfortunately, many of these recommendations miss the real issue and often fail to resolve the pain long term. Anatomy Overview Golfer’s elbow, also known as medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner portion of the elbow. Tennis elbow, or lateral epicondylitis, involves stress and pain in the wrist extensor tendons that attach to the outer elbow. While symptoms vary depending on which side of the elbow is affected, common aggravating activities include gripping, pushing or pulling, and throwing motions. A commonly referenced concept in physical therapy is the joint by joint theory. This theory suggests that joints throughout the body alternate between primarily requiring mobility and primarily requiring stability. For example, the wrist and hand need a high degree of mobility to perform daily tasks. The next joint up the chain, the elbow, is designed more for stability. The elbow is primarily a hinge joint, meaning it mainly moves through flexion and extension and has limited rotational capacity. When excessive motion occurs outside of this hinge function, problems tend to arise. This contrasts with the shoulder, which sits above the elbow and requires a large amount of mobility to function properly. This creates a challenging situation. The elbow, which is not built for large amounts of movement, sits between two highly mobile joints. When mobility is lost where it is needed most, the body compensates by finding motion somewhere else. Often, that compensation shows up in the joints closest to the restriction. A Shoulder Issue Masked as Elbow Pain  One of the most commonly missed components in resolving stubborn tennis or golfer’s elbow is shifting the focus away from the elbow itself and asking why the elbow is being overloaded in the first place. Frequently, limited shoulder motion in specific directions forces the elbow to make up for that lost movement. This results in increased stress and strain at the elbow joint and its surrounding tissues. A helpful example of this can be seen in baseball pitching mechanics. A pitcher who lacks adequate shoulder external rotation to reach the proper arm position during the throwing motion often compensates by creating excessive motion at the inner elbow. This results in a gapping force that places high stress on the wrist flexor tendons. Over time, this excessive load can lead to tendon irritation, tendonitis, or even damage to the ulnar collateral ligament that may require surgical intervention such as Tommy John surgery. In this scenario, the elbow is not the true problem. The lack of shoulder motion forces the body to find movement in the next available place, which happens to be the elbow. Addressing factors like forearm flexibility and tendon strength may provide temporary relief. However, those components are usually far more effective once the underlying shoulder mobility limitations have been identified and addressed. The next question then becomes how and why shoulder mobility was lost in the first place. To learn more, refer to our article on the missing piece in resolving shoulder pain.

Wrist pain, especially on the thumb side of the wrist, can range from a persistent nuisance to something truly limiting. For some people it is an annoyance, while for others it becomes debilitating and interferes with daily activities. You may have already tried stretching the muscles on the front of the wrist, icing the area, or even wearing a brace or splint. While these strategies can provide temporary relief, wrist pain often requires a more deliberate assessment to ensure you are addressing the right components at the right time. So where do you start? Use the simple screens below to begin understanding what movement options your wrist and hand currently have available. This helps prevent wasting time chasing the wrong issue. Understanding How Your Wrist Moves  Below are simple self exams you can use to get a clearer picture of how your wrist moves and which motions may be limited. [caption id="" align="aligncenter" width="1500"] Figure 1: Movements at the wrist. Source: https://www.crossfit.com/essentials/movement-about-joints-part-3-wrist.[/caption] The wrist is capable of flexion and extension, as well as radial deviation, which is movement toward the thumb side, and ulnar deviation, which is movement toward the pinky side. The wrist joint itself is formed by the connection between the carpal bones of the hand and the radius and ulna of the forearm. (Figure 2) [caption id="" align="aligncenter" width="1024"] Figure 2: Bony Anatomy of the Wrist and Hand. Source: https://www.assh.org/handcare/servlet/servlet.FileDownload?file=00P5b00000tFPX8EAO[/caption] Step 1: Assess Your Wrist Motion Take your wrist through each of the motions listed above. Pay attention to whether any movement reproduces discomfort near the radius. Also notice which motions feel limited compared to the others. In many cases, wrist pain near the radius is associated with limited wrist extension and limited radial deviation. To better understand why those limitations exist, it is important to consider the position of the hand relative to the wrist. This brings us to the Pistol Test. If you have a positive Pistol Test, your hand is positioned in more internal rotation relative to the radius. This biases the wrist toward flexion rather than extension. Many people with this presentation notice wrist pain when trying to extend the wrist, such as at the bottom of a pushup or during weight bearing positions through the hands. When the hand is internally rotated relative to the wrist, it is like starting wrist movement partway up the range instead of from neutral. Imagine the wrist as an elevator in a ten story building. Starting on the fourth floor and trying to go ten floors higher quickly leads to a hard stop. That same type of constraint can create a jam where the wrist meets the hand when end range extension is challenged. Instead of relying solely on icing or bracing to avoid painful positions, it is often more effective to address the movement limitations creating the problem. In other words, take the elevator back to the ground floor. Step 2: Restore Hand Position The first goal is to improve the ability of the hand to externally rotate relative to the wrist. Staggered stance curls are a useful exercise for this. Use a light weight and hook your thumb behind the dumbbell handle. This helps lock in external rotation of the hand while you perform the movement. [embed]https://youtu.be/N4WWxUmvcw8[/embed] Step 3: Rebuild Wrist Motion and Load Tolerance Once hand position improves, restoring wrist extension requires learning how to internally rotate the radius relative to a fixed hand. The low oblique sit with pronation is a helpful drill for this. This side plank variation uses a towel to keep the hand fixed while the forearm rotates. [embed]https://youtu.be/D7LhuuTcMD0[/embed] After you have recaptured hand position and learned to move the radius relative to the hand, it is time to challenge wrist position under load. Bear crawling is an effective progression at this stage. [embed]https://youtu.be/1HdyUZsZr_c[/embed] As you load one side, focus on feeling your weight shift from the outside of the hand toward the inside without losing contact along the outside edge of the hand. Start by understanding what motions your wrist can and cannot perform, then train the specific movement strategies needed to restore those motions. Giving your wrist more freedom to move is often the key step toward lasting wrist pain relief.

If you were to assess how great a pitcher in baseball truly is, you might find yourself looking at a lot of statistics, most notably ERA or earned run average. With the goal of striking out every batter who steps into the box, pitchers must not only possess elite skill and talent, but also the ability to generate an incredible amount of power. That power is repeated roughly one hundred times per game. Across sports, very few athletes are required to produce such high levels of force as frequently as baseball pitchers. When athletes specialize as pitchers at a young age and play across multiple teams each year, the volume of throwing and cumulative stress placed on the elbow and surrounding structures can take a serious toll. For a long time, this was believed to threaten a player’s future in the sport. These issues often begin as lower level conditions such as Little League Elbow, which is typically the result of inadequate rest between pitching outings, or acute bursitis, which involves inflammation of a localized fat pad. Over time, the elbow must repeatedly absorb tremendous force across seasons. This repetitive overhead throwing stresses the tendons and ligaments responsible for elbow stability and increases the risk of more serious injuries, including damage to the ulnar collateral ligament. As UCL injuries have become increasingly common in younger athletes over the past several years, organizations such as the American Sports Medicine Institute, USA Baseball, Little League Baseball, and Major League Baseball have implemented pitch count guidelines in an effort to protect developing players. Despite these efforts, higher level athletes continue to face significant risk. The Ulnar Collateral ligament (UCL) injury The ulnar collateral ligament is one of the most commonly injured ligaments in repetitive overhead and throwing athletes. To tolerate the high forces required to throw a baseball sixty feet, the ligament gradually stretches and elongates. Eventually, it may no longer be able to maintain the structural integrity of the elbow. Like most ligament injuries, UCL damage exists on a spectrum. Injuries can range from a mild sprain with inflammation to a complete tear that compromises elbow stability. UCL Symptoms Include:  Pain with throwing or inside of the elbow Instability  Decreased strength or power in throwing Increased sensitivity around the ulnar nerve “funny bone” causing numbness and tingling in the ring and pinky finger Diagnosis and Treatment A UCL injury is diagnosed based on a combination of clinical presentation, physical examination findings, and diagnostic imaging such as X-ray or MRI. The next steps depend on the severity of the injury, healing potential, inflammation levels, and response to rehabilitation. Further assessment by a physical therapist or athletic trainer is often necessary to determine whether throwing mechanics, body positioning, sequencing, or compensatory strategies are placing excessive stress on the elbow. In many cases, limitations in shoulder mobility prevent a pitcher from generating force efficiently. When this happens, the body looks for power elsewhere. That power often comes from the inside of the elbow. Normal pitching mechanics already place approximately 300 newtons, or about 67 pounds, of torque on the inside of the elbow. Now imagine how much additional stress accumulates when mechanics are inefficient and that load is repeated one hundred pitches per game over the course of an entire season. Tommy John and His Influence Named after former Los Angeles Dodgers pitcher Tommy John, this surgical procedure has dramatically changed the outlook for throwing athletes. Once considered a career ending injury, UCL reconstruction is now a well established option for athletes who fail conservative treatment. Tommy John surgery involves replacing the damaged UCL with a tendon graft, often taken from the forearm or hamstring. This is followed by an extensive rehabilitation process that progresses through multiple phases and typically lasts between six and twelve months. What was once viewed as the end of a pitching career is now often seen as a pathway back to competitive play. Today, UCL reconstruction is commonly performed and heavily emphasized in rehabilitation and sports medicine education. If you have questions about UCL injuries, Tommy John surgery, or elbow pain related to throwing, consult your primary care physician or visit Next Level Physical Therapy. We are always happy to discuss your concerns and help guide you in the right direction.

Carpal tunnel syndrome is a collection of symptoms that most commonly appear in the thumb, index finger, and middle finger on the palm side of the hand. The hallmark symptom is aching, tingling, or a loss of sensation in those three fingers specifically. These symptoms most often occur because the median nerve is experiencing prolonged compression as it passes into the hand through the carpal tunnel. The carpal tunnel is a narrow passageway formed by bones and connective tissue near the wrist that also contains several tendons and muscles, along with the median nerve. Because this space is small, even subtle changes in position or tissue behavior can increase pressure on the nerve. (Figure 1). [caption id="" align="aligncenter" width="600"] Figure 1: Anatomy of the carpal tunnel region and the median nerve. The nerve in the middle that runs to the thumb and middle finger is the median nerve. Source: https://qph.fs.quoracdn.net/main-qimg-2effc0be8c4ff02f065339aebda08596-c[/caption] The most common treatments I see recommended include prolonged static stretching of the muscles on the front of the wrist and forearm, active range of motion exercises for the wrist and hand in all directions, stretching of the thumb muscles, and tendon or nerve gliding activities. What all of these interventions have in common is their shared goal of reducing compression on the median nerve. Nerves thrive on movement, blood flow, and adequate space. The intent behind these treatments is sound, which is why the surgical option for severe cases involves cutting the connective tissue that runs across the carpal tunnel to create more room for the nerve. While there is nothing inherently wrong with these approaches, not all interventions produce the same effect. If the goal is to create space around the carpal tunnel, it is critical to consider the relationship between the position of the hand and the wrist. Many of the muscles and tendons that influence carpal tunnel pressure either cross through the tunnel or attach directly to the bones of the hand and wrist. Static stretching primarily increases a muscle’s tolerance to being lengthened. According to current research, it does very little to change how muscles or tendons behave or function in daily movement (PubMed ID# 28801950). In addition, applying prolonged tension to a nerve that is already compressed can be similar to stretching an already tight rubber band. Increasing tension does not reduce stress on the structure and may actually worsen symptoms. Rather than focusing solely on muscles that are labeled as tight, it is often more effective to focus on positioning the bones of the hand and wrist in a way that reduces tension on the nerve. This approach helps “unstretch” the rubber band and gives the median nerve more room to move freely. The image below shows an example of a thumb that is internally rotated relative to the wrist, highlighted in yellow. The blue arrow shows a thumb that is better able to externally rotate relative to the wrist. (Figure 2) [caption id="" align="aligncenter" width="960"] Figure 2: An example of differing thumb and wrist orientations. Source: https://i2.wp.com/plasticsurgerykey.com/wp-content/uploads/2020/06/10-1055-b-002-98003_c049_f001.jpg?w=960[/caption] Can you see how stretching the muscles of the yellow hand might produce a completely different result than stretching the blue hand? Applying the same solution to two different presentations does not lead to the same outcome. In the next part of this discussion, we will explore how to create a more effective strategy to improve space and movement around the median nerve. This approach may help reduce or eliminate carpal tunnel symptoms by addressing the specific presentation shown in the yellow hand.

Are you Treating the Problem or The Result?  Shoulder problems are incredibly common among the athletes and active adults we see. As therapists, we regularly encounter diagnoses such as shoulder impingement, tendonitis, and rotator cuff injuries. These conditions are often blamed on weak rotator cuff muscles, scapular winging, or muscle imbalances. One major thing to understand about these diagnoses is that they are not the actual problem. They are the result. They are the result of deeper rooted movement habits and mechanics that often go unaddressed in traditional rehabilitation. Common solutions for these issues are often just as short sighted. Stretching, rotator cuff strengthening, and general strength training are frequently prescribed, yet they often miss the mark when it comes to truly resolving pain. Why? Because they address symptoms rather than the cause of the faulty mechanics, overuse of certain muscles, or positioning muscles in disadvantaged positions. To understand the biggest missing piece in resolving shoulder pain, we first need to understand how the shoulder actually works. A Quick Anatomy Lesson of the Shoulder Complex  The shoulder complex is made up of four major components: the glenohumeral joint, which is the ball and socket, the scapula or shoulder blade, the sternum and clavicle, and the rib cage. Shoulder movement in any direction requires rotation of the humeral head within the glenoid socket. Because the shoulder has so much freedom of movement, stability of the joint must be maintained. This is why every shoulder movement is accompanied by scapular movement. Since the socket of the shoulder joint is part of the scapula, its motion is essential for keeping the humeral head centered within the socket during movement. When the humeral head does not stay centered, issues such as shoulder impingement, proximal biceps tendonitis, and rotator cuff injuries can occur. For the shoulder to move well, the scapula must move in coordination with the humerus. The scapula has a natural curvature and sits on a rib cage that also has curvature due to normal thoracic spine shape. The rounded rib cage and curved scapula allow these structures to stay congruent and permit normal scapular rotation in support of shoulder movement. The position of the rib cage and its ability to expand properly to support the scapula is essential for normal shoulder motion without compensation. Rib Cage Position and Expansion  Under normal circumstances, the rib cage should be able to expand in all directions during breathing. With each inhale, the lower ribs should move outward in what is known as bucket handle motion, while the upper ribs and sternum move up and outward in a pump handle motion. The back side of the rib cage should demonstrate similar movement, particularly in the upper ribs. When the rib cage lacks these normal movements, scapular position and shoulder mobility are negatively affected. For example, when the back side of the upper rib cage becomes restricted or flattened due to chronic tension in the upper back, scapular movement becomes limited. A curved scapula resting on a flat surface cannot move or rotate the same way it would on a rounded, congruent rib cage. Without proper scapular movement, the shoulder either loses access to normal motion or must rely on compensatory mechanics. Repeatedly moving into ranges you do not truly have or compensating for restrictions is exactly what leads to repeated stress in the same tissues. This often shows up as shoulder impingement, biceps tendonitis, or gradual wear of the rotator cuff tendons. How Rib Cage Mechanics Are Lost Loss of normal rib cage mechanics is commonly seen in resistance training. Many gym movements emphasize pulling the shoulder blades back and down for stability. Whether pushing, pulling, squatting, or deadlifting, rib cage and scapular position often remain the same. A similar issue comes from the common advice to pull the shoulders back and down for good posture. Spending excessive time in a retracted scapular position limits normal scapular motion and flattens the upper rib cage. This forces the shoulder to compensate to achieve desired movements. The Solution To truly resolve shoulder pain, you must start at the source. While factors such as rotator cuff strength, dynamic stability, and local tissue irritation matter, they should not be addressed in isolation. If you do not resolve what led to these issues in the first place, you are simply treating symptoms. To improve shoulder joint mechanics and motion, proper scapular movement must be restored. Normal scapular movement depends on a rib cage that is positioned correctly and able to expand in all directions to provide a stable foundation. Once this foundation is in place, other components of shoulder rehabilitation can be addressed with much greater success. Below are 2 examples of drills to implement into your program to improve ribcage expansion: Seated Zercher Breathing Video [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] Seated Back Expansion Video  [embed]https://www.youtube.com/watch?v=24K6f7OMDXE[/embed]