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It Hurts To Breathe Deep…Mid Back Pain

My wife received a call from a friend requesting that I help her with her back pain.  I agreed to see her.  I learned that she suffered from debilitating back pain in her mid back for the last eight months.   Bending to pick something up off of the floor, twisting, and deep breathing caused pain.  Secondary complaint was her neck pain. She could not rotate her head very far without pain.

She received long term treatment for her back pain to no avail.  Actually, her back pain worsened after treatment.

I palpated her mid back in the location that she indicated.  It was tender.  But, since she had been receiving treatment for so long in that immediate area, I decided to look for the culprit elsewhere.  I turned her over on her back and began looking for trigger points in her abdominal muscles and diaphragm.  It was almost immediate that we located 4 different trigger points that referred pain to the exact location in her back.  It was intense.

After relieving those trigger points I looked a little higher on her ribs for cardiac arrhythmia trigger points that usually mimic panic attacks.  Sure enough, they were there.  They cause a feeling of nervousness and trembling that is typical of such trigger points.

I worked on her for 20 minutes.  She stood up, tested it by bending over to pick up her shoe.  No pain.  She twisted above the waist.  No pain.  She took a deep breath.  No pain.

I questioned about repetitive activity that could put those abdominal muscles in such a shortened and twisted positioned that could be inhibiting her diaphragm from contracting enabling her to breathe properly.  When I put her in the specific shortened position as these muscles indicated she immediately knew that it was her hobby of quilting that was to blame.  Actually her posture while quilting was to blame.

Leaned forward, shoulders rounded and head forward all inhibited her breathing.  She was forced to breathe using her chest and neck muscles more than her diaphragm.  She had developed several trigger points in her abdominals and diaphragm that referred to her back. The problem was not in her back.

She is correcting her posture and breathing pattern with the homework that I gave her to do.  She may need a second appointment. But, then again, she may not.

Thank you SO much.  I feel so much better tonight, and I’m making a concerted effort to keep my posture correct – I have to ‘unlearn’ some bad posture habits.  You gave me a lot of good advice.

A Golfer’s Dilemma

I recently worked on a 60 year old gentleman, daily golfer, complaining of pain in his ribs, shoulder, elbow, forearm, hand and index finger. His index finger bothered him the most as it constantly popped (trigger tendon) and affected his grip and swing.

I began working on the larger muscle groups that affected his ribs. Working across his back to his side I found fascial adhesions, very tender, that restricted his backswing and follow through. Releasing theses adhesions on his larger back muscle, Latissimus Dorsi, and abdomen, External Oblique, corrected this for him. A specific stretch before and after a day of golf maintained his improved swing and follow through.

While working this area I found trigger points that referred pain to his elbow, hand and wrist. This didn’t totally ease his pain but it did diminish it. So, I looked at his rotator cuff muscles on the same side. Again I found trigger points in his Infraspinatus muscle that referred pain to his shoulder and his elbow, also alleviating his pain.

I then worked down his arm to his biceps, and other elbow flexors. You guessed it. The trigger point discovered there referred pain to the rest of his wrist and finger. He was 75% better after the first treatment.

He returned the same week. We did the same treatments. We added specific treatment on the forearm, his wrist and finger extensors. No more pain. I taught him some stretches to do before he teed off and upon completing 18-27 holes (walking of course).

He is able to maintain his improved grip, swing and game with the warm up stretches and finishing stretches.

He didn’t have to quit playing.



I Injured My Back as a Teenager

The human rectus abdominis muscle of the human...

Image via Wikipedia

A young man, 30, made an appointment as a last chance in finding relief from his back pain before surgery. As a teen he hurt his back in a fall. Physical therapy taught him some coping skills at best. As a steel worker in his 20’s, his back continued to hurt him. He later took an office job. His pain got worse. Surgery was his recommended course of action.

Due to the location of his pain, straight line across his low back and straight line across his lower thoracics, mid back, I went directly to two specific trigger point locations on his abdominals.  He worked out a lot and put a significant amount of time working on his abs.  He did have a 6-pack.  This was another indicator that I might find the culprit in his abdominal muscles.

“It’s my back that hurts. Why are you working on my stomach”, he questioned with disbelief.

I replied, “If I work exactly where you hurt, 75% of the time I am working in the wrong place. It may feel good or right for me to work on the location of pain but I am more than likely NOT working on the cause of the pain. Plus all of the sitting you do followed by all the ab work you do in the gym, I think these muscles are shortened and may have trigger points that can refer to the back.”

It took less than 2 minutes to find the first trigger point in his rectus abdominus muscle that referred pain to his mid back. Working that trigger point referred pain straight through to his back and felt like “a rod going all the way through, just like it does when it hurts real bad”. The pain left.

Working on his lower abdominals elicited the same response for his low back, again “like a rod going straight through just like it does when it hurts”. Again, his pain was alleviated.

I also performed a pin and stretch on his deeper psoas muscle, a primary hip flexor, which mimicked even more familiar pain. Again, “that worked, I don’t hurt”.

I taught him some stretches to do in order to maintain his pain free status. I also showed him how to find these trigger points on his abs so that he could treat himself when he hurts.

He walked out without any pain.

Daytona Bike Week

Yes, I have a brother and he really talks and writes like this.

The following conversation via email:

JE: Gotta testymoanial fer ya…..I can shake your hand but I can’t turn a door knob. Rode the Harley to Daytona and back. Started getting cramps at the neck shoulder junction. Neck / shoulder stretches dint do nuthin. By accident I found that stretching the white side of my forearm cleared it all up. Who’d a thunk it!

Now fer a ?. Got back and went to work. Found that I could squezze big things but small motor function was shot. Weak as a kitten. Couldn’t screw a screw, turn a knob, could barely write, couldn’t even take the gas cap off. As last week wore on, the weakness has faded somewhat, but I still have trouble time to time. I’ve stretched everything I can find but the prob persists. ‘Sup widdat? Sister Laura (also a therapist) says my flexors are #$%&$, but to ask you cause yer a dang jeanyus.

Bobby: Laura, I agree with flexors. Especially if it’s both hands. If only right hand look at extensors for throttle……wrist extensors. Supinator and digitorum below lat condyle. If only right look at radial nerve irritation …anywhere from scalene to wrist. Include stretching the forearm flexors and neck at the same time. Possible diaphragm from riding so long causin scalene to work overtime breathing. Possible that vibration caused ulnar nerve irritation. Possible that the forward flexed posture of riding served to develop trigger points in your medial rotators, thus referring to your hand.

… reach behind you like your getting something out of the back seat. Put your palm flat on the wall. Turn to the opposite side and look over opposite shoulder as if to look in your back pocket. Yeah, that felt good dinnit? Hold that stretch for several seconds, come out of it then do it again. Repeat until fine motor function returns.

JE: Wow. You were right Laura, he are a geenyus. Just lookit all them fancy words. I’ll bet he even knows what they mean too. But that stretchy thing pulled all kinda thangs in my fingers forearm and neck. Dunno how I missed all of them, but I know whar they at now by golly! Ya’ll rekun doing that afore and after each ride will handle thangs? Or more oftener?

Bobby: Stretch before you ride. Stretch after you ride. If you take breaks, stretch while on break. If your not planning on taking breaks, then TAKE a break to stretch.

JE: Sounds doable. If ridin by myself the breaks are when I feel like it. In a gaggle of bikes, the breaks are when the lead guy breaks or the smallest bike runs outta gas. For some reason that always seems to be way after I’m ready to break. Oh well, thats life in a society I guess. Druther be a nomad searching for some place to pillage and wimmen to dominate.

You gotta git a bike so we can go do $*%@. Thanks Bro Feel better already!


A large percentage of the time, a significant majority, when people come to me for sciatic pain, it turns out to be a Gluteus Minimus trigger point. This muscle is nicknamed the “sciatic mimicker” as it refers pain down the leg identical to that of sciatic nerve impingement.

Less often, but still more often than true sciatic nerve impingment in the low back and sacrum, is Piriformis Syndrome. The piriformis is a muscle deep to the glutes that serves to rotate the hip laterally, outward. Both are menacing culprits that cause debilitating pain.

I had back surgery in January of 1997 due to a ruptured disc at L4-L5. The pain associated with this injury was so severe that I needed help taking a shower, going to the bathroom and even dressing myself. I know your pain. The day of my scheduled surgery, I crawled into the hospital and walked out 6 hours later. I did not even need the prescribed drugs I was sent home with. I didn’t take the first pill. The surgery was needed and was very successful.

3 years later, while in school leading to my present career, I encountered the identical symptoms. Surgery was again recommended. My instructor, Heather MMerrit Morgan, DC,

had me visit her Chiropractic office for assessment and treatment. She determined that, among other issues, the cause of my back and leg pain was chiefly due to Piriformis Syndrome, a tight piriformis muscle that was entrapping the sciatic nerve that courses under it before it travels down the posterior thigh.

She taught me how to stretch this muscle and to change my posture and habits to prevent it from shortening.

No surgery.

When it reoccurs, at the most, once a year, I spend more time stretching my piriformis and glute minimus muscle. I am able to maintain my pain free status with stretches and monthly therapy.

No surgery.

Saturday, March 19, 2011.

Upon arrival Nina reported the newfound ability to turn and breathe on both sides while swimming. Progress. Also, she hasn’t had a headache in two weeks. Initially she thought it was the swim cap that was causing her headaches, as her head would start hurting at the end of her training in the pool. Previously we found several trigger points in her neck and shoulders that referred pain to the same location as her headaches. We lengthened her traps and normalized the trigger points causing the headaches.  It wasn’t the swim cap afterall.

Chief complaint for todays’ session was her wrist pain. Nina knows that it is the posture on her bike that is the culprit.  At the end of riding and sometimes during the ride, her wrist will go numb. Her posture while biking, upperbody weight supported by her hands, wrists extended and radially deviated, created opportunity for the extensors of the wrist to become shortened and ischemic.  Her pain, in the “anatomical snuff box”, between the extensor tendons of her thumb at the distal end of the radius, was a direct result of prolonged shortening and contraction of these muscles.

Palpation of the brachioradialis, extensor carpi radialis longus and brevis created the same pain pattern. Working the extensors of the wrist alleviated the pain. Pectoralis Major and subscapularis also referred to the arm , forearm and wrist. This was consistent with the prolonged shortened posture of biking miles.  Passive and Active Engagement methods, Pin and Stretch, to the forearm, pecs and subscap as well as trigger point therapy on the same muscles produced positive results.

Due to the forward head posture of biking, I checked the SCM, suboccipitals and longissimus capitus in order to preempt headaches that could arise from this posture. As expected, palpation of these muscles all elicited eyebrow headaches. Although Nina has not complained of this type of headache, it would have been a matter of time before she did complain of such pain. Hopefully this has been arrested and corrected as a latent trigger point as opposed to an active trigger point with headaches.

Most of our time was spent on the forearm, neck and shoulders due to the wrist pain. The last few minutes were spent on the quads. Very tender to the touch. Not quite DOMS, delayed onset muscle soreness, as she was not aware that they were sore, but on its way to becoming an issue. Warmed up the quads and lengthend with PNF.  Prone with heel to the glutes did not stretch her quads so we did a side lying position with an extended hip before flexing the knee.  GOOD stretch.  Will spend more time on lower extremities weekly for a while.

Nina will stretch before and after riding, as well as daily and periodically throughout each day to assist in correcting an upper crossed syndrome, forward head posture .  Homework is to include stretches of the

  1. wrist extensors
  2. pecs and other medial rotators of the  shoulder
  3. and short and tight cervical extensors.

Strengthening to help correct the upper crossed syndrome is indicated for:.

  1. scapular retractors,middle traps and rhomboids
  2. as well as the cervical flexors, longus coli and capitus,

Plantar Fasciitis, A Fireman’s Nightmare!

Ken, a fireman, came to me with plantar fasciitis, a painful inflammatory condition that affects the bottom of the foot and the inside of the heel. Walking, especially in the mornings, was excruciating. To Ken, the pain was so debilitating that he couldn’t complete his drills and training. Without successful treatment, Ken was facing a temporary layoff from a job he loved!

I used ice massage on Ken’s foot to numb the pain and reduce the swelling. I used a tool that produced friction on his heel and stimulated the tissue to repair itself. I found several trigger points and very tender points in his calf muscles. The treatment was uncomfortable, but he was determined to do whatever it took to take care of the problem and to keep his job.

I also taught Ken how to stretch his calf muscles properly. After a second visit to satisfy myself that Ken knew exactly what to do to maintain his progress, Ken was happily finished with my services.

When I saw Ken at church later the same week, he was walking without a limp! Ken was able to complete his training and drills. Although he has to keep doing the stretches to stay pain-free, he is once again fit and ready to do whatever the job requires.

No splint.
No meds.
No surgery.

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