Carlina Soderberg, Licensed Massage Therapist

03/19/2025

There's a key spot in your lymphatic system commonly referred to as the "waterwheel". It's a spot below the ear with multiple lymph nodes and is a spot to which much of the head and face drains. When congested, it often results in neck, jaw and throat pain.

03/19/2025

Organs can refer sensation to areas of the skin. This is called visceral referred pain, or VRP. P-DTR (one of the techniques I use) actually treats dysfunctions of these organs via the VRP sites, providing different stimuli to the skin to stimulate different neuro pathways (sympathetic and parasympathetic).

02/26/2025

🚀 Promising Breakthrough in Fascia Research! 🧬✨

A research team in Virginia, USA has developed a revolutionary microscopic imaging technique that unveils the stunning architecture of the extracellular matrix of fascia like never before! 🔬👀

I can’t help but think that legendary matrix pioneers Alfred Pischinger and Hartmut Heine would have been just as thrilled as I am! 🤩 Can’t wait to see what groundbreaking insights this cutting-edge tool will reveal in the coming years—how the ECM adapts to mechanical forces, biochemical shifts, and other biological influences.

Stay tuned! 🔍🔗 More here: Nature Article

02/26/2025

One of the most common reasons for limited dorsiflexion of the ankle is a lack of posterior talar glide. When the talus can't glide posteriorly, the front of the ankle jams when you attempt to dorsiflex -- like trying to close a drawer that has clothing hanging out of it. Using a strap to assist with posterior glide makes for a useful stretch. Here's a video of it. The guy shows two versions. Do the second one. Some use stretchy bands to do it, but I prefer a non-stretchy yoga strap. You can also do it from a kneeling position. https://www.rfr.bz/fe73df7

02/26/2025

Tensor Fasciae Latae and Gluteus Maximus Muscles: Do They Contribute to Hip Abduction?

Analysis by Physio Meets Science

“👉 The classic hip abductors include the gluteus medius (Gmed) and minimus (Gmin) muscles. They are innervated by the superior gluteal nerve (SGN). These muscle groups are highly important to function of the hip joint and are relevant for a stable stance and locomotion (https://pubmed.ncbi.nlm.nih.gov/19136181/, .hhttps://pubmed.ncbi.nlm.nih.gov/30182152/ hhttps://pubmed.ncbi.nlm.nih.gov/21212373/ https://pubmed.ncbi.nlm.nih.gov/21212373/, https://pubmed.ncbi.nlm.nih.gov/16255022/).

👉 Thus, good abductor strength is essential for locomotion without walking aids (https://pubmed.ncbi.nlm.nih.gov/15001980/). Furthermore, abductor function is crucial for more demanding movements such as fast walking, walking uphill, running, squatting, and climbing stairs (https://pubmed.ncbi.nlm.nih.gov/12127184/).

👉 The tensor fasciae latae (TFL) and the gluteus maximus (Gmax), innervated by the superior and inferior gluteal nerves (SGN/IGN), respectively, are located in immediate anatomical proximity. They are discussed to partially compensate for the function of the classic hip abductors. Nevertheless, the main function of the Gmax is extension and external rotation of the hip and the main function of the TFL is flexion of the hip and stretching of the fascia latae with stabilizing effect on the knee (https://pubmed.ncbi.nlm.nih.gov/22109658/).

📘 In a brand-new study, Hoch and colleagues (https://pubmed.ncbi.nlm.nih.gov/39733244/) intend to investigate the amount of abduction force generated by the TFL, the gluteus medius and minimus, and the Gmax. This knowledge may help to understand the compensatory mechanisms that occur when the hip abductors are insufficient. Specific training of these potentially compensating muscle groups can, therefore, be a decisive component in the treatment of patients with hip abductor insufficiency, for example, in the treatment and rehabilitation of patients with neurological diseases, regarding preparation (prehab) for patients undergoing hip surgery or in the case of already established irreversible weakness.

👫 Participants:

➡️ Ten healthy adults (5 males, 5 females) aged 22–29 years participated.

➡️ Exclusion criteria were a history of the lower extremity, hip, or lower back pain, resp. surgery, neuromuscular disorders and pregnancy.

💡 Experimental Setup:

➡️ Sequential nerve blocks were applied to weaken the TFL, Gmed/min, and Gmax muscles selectively.

➡️ Abduction forces were measured in the lateral decubitus position under three hip positions: 30° flexion, neutral, and 30° extension.

🦵 Muscle Weakness Induction:

➡️ Nerve blocks were confirmed via electromyography to ensure selective muscle paralysis.

📊 Data Collection:

➡️ Maximum voluntary isometric contractions (MVICs) were tested using a dynamometer.
➡️ Statistical significance was determined using one-way repeated measures ANOVA.

📈 Results:

✅ General Observations:

▶︎ Hip abduction force was highest when all muscles were intact and significantly reduced following muscle-specific nerve blocks.

✅ Tensor Fasciae Latae (TFL):

▶︎ TFL contributed to abduction force primarily in 30° flexion, reducing it by 15% after paralysis.
▶︎ Its role in neutral and extended positions was negligible (-6,2 -12%).

✅ Gluteus Medius and Minimus (Gmed/min):

▶︎ Gmed/min were the primary contributors to abduction, accounting for over 60% (61,5%-63,3%) of force across all positions.

▶︎ Paralysis resulted in a two-thirds reduction in abduction force, rendering some participants unable to complete tasks in certain positions.

✅ Gluteus Maximus (Gmax):

▶︎ Gmax contributed significantly to abduction, with force reductions ranging from 43% to 56% across positions after paralysis.

▶︎ It was especially relevant during hip flexion.

🔑 Conclusion

✅ TFL: TFL has a minor role in hip abduction, mainly during flexion. Its primary function remains hip flexion and stabilization.

✅ Gmed/min: These muscles are the dominant abductors and crucial for hip stability and locomotion.

✅ Gmax: Previously underestimated, Gmax emerged as a significant contributor to abduction, particularly in flexed positions. Strengthening Gmax may help compensate for hip abductor insufficiency.

⭕ Limitations:

▶︎ The study measured abduction in specific, static positions, limiting real-life applicability.

▶︎ Compensatory mechanisms for chronic muscle weakness were not evaluated due to the acute nature of nerve blocks.

▶︎ No differentiation between different parts of the specific muscles.”

- Physio Meets Science

📸 Illustration: https://link.springer.com/chapter/10.1007/978-3-642-00897-9_2

http://www.secretlifeoffascia.com

02/26/2025

02/26/2025

There are four types of Thoracic Outlet Syndrome (TOS).

1. Anterior scalene syndrome
2. Costoclavicular syndrome
3. Pectoralis minor syndrome
4. Cervical rib

All types are neurovascular compression syndromes of the brachial plexus of nerves and/or the subclavian/axillary artery and vein.

Anterior scalene syndrome occurs between the anterior and middle scalenes.

Costoclavicular syndrome occurs between the first rib and the clavicle.

Pectoralis minor syndrome occurs between the pectoralis minor and the rib cage.

Cervical rib type is caused by genetically having a rib (piece of bone) off the C7 transverse process.

The first three types can all be helped with manu and movement therapy! 👍🏽

03/19/2024

🤓🔬 Delve into the intricate motion patterns and distance changes of the acromion in relation to the distal clavicle. Discover the relationship between the acromioclavicular kinematics and its clinical treatment!
https://ow.ly/IecU50QPA9e

02/01/2024

Tendon Structure in Health & Disease: Analysis by Physio Meets Science

💡 Summary based on Scott (2015, https://pubmed.ncbi.nlm.nih.gov/26390273/)

👉 The classic description of the tensile load-bearing region of tendon includes 3 main components:

1️⃣ type I collagen fibers (70–80% of the dry weight of the tendon and represents almost 95% of the total collagen. Other collagens include collagen types II, III, IV, V, VI, IX, X, XII, and XIV) longitudinally oriented;

2️⃣ a well-hydrated, noncollagenous extracellular matrix (rich in glycosaminoglycans); and

3️⃣ cells. The predominant cell population in healthy tendon is traditionally categorized as collagen-producing fibroblasts, responsible for the synthesis of the collagen fibers and extracellular matrix. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505234/ https://pubmed.ncbi.nlm.nih.gov/26390273/)

👉 Prominent features of chronic tendinopathy histopathology (FIGURE 1) include the following:

▶︎ a disorganization of collagen fibers,

▶︎ an increase in the number of vessels and sensory nerves, https://pubmed.ncbi.nlm.nih.gov/17604979/, https://pubmed.ncbi.nlm.nih.gov/23609815/, https://pubmed.ncbi.nlm.nih.gov/15958764/

▶︎ an increase in the hydrated components of the extracellular matrix, https://research.monash.edu/en/publications/human-tendon-overuse-pathology-histopathologic-and-biochemical-fi

▶︎ a breakdown of tissue (tendon/endotendon/paratendon) organization, (https://search.worldcat.org/de/title/human-tendons-anatomy-physiology-and-pathology/oclc/35103208) and

▶︎ haphazardly arranged proliferation of smaller, type III collagen fibers. (https://pubmed.ncbi.nlm.nih.gov/24571576/, https://pubmed.ncbi.nlm.nih.gov/12867575/)

👉There are frequently areas of cell death (eg, hypocellularity, https://pubmed.ncbi.nlm.nih.gov/16567784/) or, alternatively, of fibroblast reaction (eg, hypercellularity with rounded tenocytes and adhesions, https://pubmed.ncbi.nlm.nih.gov/3071152/).

📌 Indeed, it is typical to find both degenerative and reactive changes within the same biopsy, even in very severe, long-standing cases. It is also postulated that there is a resident population of fibroblast-like cells within tendons that, after injury, can differentiate into several lineages (osteoblast, chondrocyte, adipocyte, tenocyte), leading to metaplasia (eg, bony, cartilaginous, or adipocyte transformation, https://pubmed.ncbi.nlm.nih.gov/12837285/). Metaplasia is not usually discernible on imaging, unless the ossification is advanced, but is frequently encountered in biopsy specimens (reviewed in Lui, https://pubmed.ncbi.nlm.nih.gov/23671126/).

👉 The implication is that patients with chronic symptoms and evidence of structural change on imaging typically have profound underlying abnormalities that will not be quickly resolved, and that are associated with the loss of tendon function.

✅ At the cellular level, several authors have reported increased numbers of leukocytes (especially macrophages and mast cells) in chronically painful tendons (rotator cuff, patellar and Achilles tendons, https://pubmed.ncbi.nlm.nih.gov/24096896/, https://pubmed.ncbi.nlm.nih.gov/25081311/, https://pubmed.ncbi.nlm.nih.gov/20595553/, https://pubmed.ncbi.nlm.nih.gov/15958764/) as well as increased numbers of vascular cells (endothelial and smooth muscle, https://pubmed.ncbi.nlm.nih.gov/18067512/).

🔥 However, compared to the more immune-driven pathologies, such as rheumatoid arthritis, with measurable systemic inflammation, the number of leukocytes is small. In other words, there is indeed an inflammatory reaction within chronically painful tendinopathy, but to a lesser extent than that of immune-driven rheumatological disorders.

✅ Macrophages with accumulations of hemosiderin in their cytoplasm are more prevalent in tendinopathic than in normal tendon (https://pubmed.ncbi.nlm.nih.gov/9174456/); hemosiderin is an indicator of prior injury that resulted in an activation of the innate immune response. At a biochemical level, the cells in painful tendons produce increased levels of glycosaminoglycan and inflammatory mediators such as substance P and prostaglandin E2 (PGE2, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714045/, https://pubmed.ncbi.nlm.nih.gov/24563019/, https://pubmed.ncbi.nlm.nih.gov/12072760/, https://pubmed.ncbi.nlm.nih.gov/9820287/).

✅ Substance P is released by peripheral sensory nerves (https://pubmed.ncbi.nlm.nih.gov/21678472/) and repetitively stretched tendon fibroblasts (https://pubmed.ncbi.nlm.nih.gov/21625050/, https://pubmed.ncbi.nlm.nih.gov/22069500/), and activates local mast cells that may contribute to pain and fibrosis (https://pubmed.ncbi.nlm.nih.gov/22343473/). Tendon cells derived from tendinopathic tendon produce more PGE2 than cells from healthy individuals, indicating a chronic upregulation (https://pubmed.ncbi.nlm.nih.gov/12072760/).

📣 Taken together, the evidence suggests that during the rehabilitation process, any worsening of edema, morning stiffness, or delayed-onset pain should be closely monitored and controlled, as inflammation could drive the tendon further down the pathological path. An early return to sport before adequate tendon load-bearing capacity is a significant risk factor for recurrence of Achilles tendinopathy (https://pubmed.ncbi.nlm.nih.gov/23770660/).

📷 Illustration:
Pereira, H. et al. (2023). Foot and Ankle Tendinopathies. In: Longo, U.G., Denaro, V. (eds) Textbook of Musculoskeletal Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-20987-1_59
https://link.springer.com/chapter/10.1007/978-3-031-20987-1_59

02/01/2024

Just because you CAN tolerate pain, that doesn’t mean you should. Pain can subconsciously change the way you move, leading to tissue stress elsewhere and potentially additional injury.