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Saturday, March 19, 2011.

March 20, 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,

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