Multiple TPs referring to one area

[Jakob]

I have a client who has been having spasms in her left subscap and rhom major where it attaches close to the inferior angle of the scapula. When I apply pressure to her diaphram on the left side, her psoas on the right, her adductors on the left, scalenes on the left, all refer pain back to where she spasms. She is a 63 year old female with mild scoliosis at T11-L2. This is the first time I've encountered something like this. I work all the referral points before actually going to her subscap and rhoms. Seems to help. Any other suggestions?

 

[nikkidavis26]

Multiple TPs referring to one area

In my practice, I have many similar experiences with clients who when working seemingly unrelated parts of the body (but we know they're all related!) there are referral issues. Mostly it is due to tightness in the fascia itself and not a specific muscle. If you haven't already, you might want to check out Thomas Myers Anatomy Trains books. If you aren't squeamish, you would also like his dissection video where he and a prosector ( a person who prepares cadavers for dissection) dissect and show the fascial lines in the body. These lines make up our muscular system and Thomas Myers has done phenomenal work showing how they connect and function in the body. Somehow watching the video really made the lines (drawn in the book) seem more real.

Anyway, if you aren't familiar with the work, one of the lines of fascia with the muscles is the spiral line, this includes the rhomboids, the abdominal aponeurosis to the opposite iliac crest. Then, also there is the front functional line which includes the shaft of the humerus, latissimus dorsi, and runs in the opposite leg to the adductors. The scalenes are part of the lateral line starting at the occipital ridge and coming down the lateral side of the body (excluding the arms). If you think about these fascial lines, the referrals your client gets into her armpit and back make more sense. Her mild scoliosis, if not structural and may be created by or is contributing to the tension in these lines. What would be interesting is to discover how those areas have become shortened in her life, what types of physical activities she currently does and used to do, how she moves during the day. Those are all clues that you can learn to help your client from regaining those issues when you have helped them to release.

Any myofascial or other modalities can help release that tension, active engagement type work to the areas that refer with awareness of where the lines are located and how they work is a great way to start. Another thing to keep in mind is that pain doesn't usually signify an area that needs work, so although she gets spasms in her subscap and rhomboids, that probably isn't where the issue is and, as you've already found in your sessions, once you relieve the real culprits her symptoms will improve. And it's easy to forget when it comes to our work that often when we help someone with a tension issue, the problems will return if the client doesn't change whatever movement patterns or habits that created the issue in the first place.

 

[BB(Inspectah Deck Stan)]

Multiple TPs referring to one area

Nice thoughts from Kathryn. I concur. Clinical reasoning and approach to treatment will vary depending on what conceptual construct(s) you are most familiar with. Anatomy Trains has some great ideas about how disparate areas may be related in unexpected ways. I think orthopedic massage is another direction worth exploring. Orthopedic assessment techniques may be useful. Whitney Lowe has a good reputation for teaching orthopedic testing, assessment, and clinical reasoning. James Waslaski is renowned for his comprehensive orthomassage treatment protocols (his DVDs are excellent).

I would need a lot more health history on this client before trying to decipher what you are finding. Things like injury history, how long she's had scoliosis and at what age it was diagnosed, has she had kids and what birth method(s) were used, etc. I'd also take a sharp look at her posture and activity patterns. Does she have rounded shoulders? Does the left differ from the right, and in what way? What other structural deviations exist and how do those affect her movement patterns?

If you haven't gone into her health history far enough to answer all those questions in some detail, you may be trying to work without a critical piece of useful information.