Clinician Chat: A Different Point of View

Q: You’ve mentioned that your treatment perspective is little different than some providers, can you explain how your point of view differs?

Synergy Therapist: Simply put I look at the body as a whole. Instead of focusing on the area in pain I look at how the body moves. Is it balanced? Where are the restrictions in the movement? Are there posture problems which would affect other parts of the body? This is different because traditionally providers only look at the affected area.  That means that the underlying issues (see a picture of the out-of-whack skeleton) may not be addressed.

pelvic tilt

Classic example: you come in with shoulder pain unless your underlying postural issues are addressed the shoulder pain may come back.

Q: Let’s just say a person came to you with shoulder pain, how would you start your evaluation?

Synergy Therapist: First I look at three basic things- how the person sits, stands and walks. Most people don’t know that you should sit the way you stand- with a natural “S” curve to your back. If you sit incorrectly (see a picture of cute kid) your body will have to compensate in other areas which will eventually affect the way you stand and walk. In a standing position, I can assess the symmetry of the body and trace patterns of dysfunction. Walking provides me insight into how the body moves against gravity. After all the body is designed to move so why not look at what it’s supposed to be doing?

Q: Why do you think this perspective is so rare?


Poor posture puts your spine into a “C” shape instead of the naturally stronger “S” shape.

Synergy Therapist: People learn by comparing new information to things they’ve already learned. Sometimes the things we see don’t fit into the box and then we’re faced with a choice. Do we discard it as being impossible or do we take the chance and try to learn something new? Most past medical studies were done on cadavers, which is great for a start but it has a flaw… cadavers don’t move! Fortunately, there is research being done that focuses on how the body moves with living people. I am continually learning from the people I treat and from the research of others- the body is amazing and our understanding of it has just begun!

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Traumatic Injury Profile: Mixed Martial Arts (MMA)

mma-mixed-martial-arts-news-479763-0-s-307x512 To kick off (no pun intended) our new “Injury Profile” series I thought “Why not start with a sport that causes a      ridiculous number of injuries?”.  So I looked into MMA- not to surprising the potential for injury is limitless and a  little gross…

 What is it?

Mixed Marital Arts (MMA) started in the early 1990’s and is one of the fasted growing sports in America with a  viewing audience rivaling wrestling or boxing. Similar to wrestling and boxing the goal is to incapacitate your  opponent either by knocking them unconscious,  beating them to the point they can’t fight any more or injuring them to the point the doctor says its to dangerous to continue. In an effort to keep things from getting too barbaric there are few rules: no headbutting or throat grabbing etc. That being said broken arms, legs, ankles, noses and jaws are pretty common.

What kind of injuries are typical of this sport?

Given the nature of this sport that question seems kind of ridiculous… there are so many different kind of injuries possible, either from the fights themselves or all the rigorous training involved in preparation. Broken bones, sprains and muscle tears are a given but scar tissue and other symptoms can develop from other traumas too. To cover the basics take a look the highly technical illustration below:

MMA injuries

What kind of long-term problems can result from these kinds of injuries?

Scar tissue build up can cause chronic pain and limited mobility. Also repeated head injuries can lead to headaches, tinnitus (ringing in the ears), hearing loss, disrupted vision, sinus problems and TMJ (jaw) dysfunction. Trauma to the neck and spinal column can lead to nerve damage which can lead to numbness and tingling down the arms and legs as well as digestive disruption. As if all that wasn’t bad enough, current studies show that fighters with a long career (over 10 years) show damage to  the caudate (vital for learning and memory), putamen (regulates movement) and amygdala (involved with emotions and memory).

How can therapy help?

When treating such involved traumas there are several techniques that the staff at Synergy can use. Craniosacral therapy is great for relieving chronic pain as well as helping injuries to the brain and spinal column heal. Myofascial release can reduce scar tissue and improve range of motion. Visceral manipulation can help release abdominal trauma’s as well as helping to release pain throughout the body.

Synergy Healthcare has a team of highly trained physical and occupational therapists who are ready to help with all kinds of injuries. We also can help with post-surgical rehabilitation and sports performance. Have any questions? Email us at or give us a call at (509) 413-1630.

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Yoga for Chronic Low Back Pain A Randomized Trial

Helen E. Tilbrook, BSc, MSc;

Ann Intern Med 2011; 15: 569-578.


Background: Previous studies indicate that yoga may be an effective treatment for chronic or recurrent low back pain.

Objective: To compare the effectiveness of yoga and usual care for chronic or recurrent low back pain.

Design: Parallel-group, randomized, controlled trial using computer-generated randomization conducted from April 2007 to March 2010. Outcomes were assessed by postal questionnaire. (International Standard Randomised Controlled Trial Number Register: ISRCTN 81079604)

Setting: 13 non–National Health Service premises in the United Kingdom.

Patients: 313 adults with chronic or recurrent low back pain.

Intervention: Yoga (n = 156) or usual care (n = 157). All participants received a back pain education booklet. The intervention group was offered a 12-class, gradually progressing yoga program delivered by 12 teachers over 3 months.

Measurements: Scores on the Roland–Morris Disability Questionnaire (RMDQ) at 3 (primary outcome), 6, and 12 (secondary outcomes) months; pain, pain self-efficacy, and general health measures at 3, 6, and 12 months (secondary outcomes).

Results: 93 (60%) patients offered yoga attended at least 3 of the first 6 sessions and at least 3 other sessions. The yoga group had better back function at 3, 6, and 12 months than the usual care group. The adjusted mean RMDQ score was 2.17 points (95% CI, 1.03 to 3.31 points) lower in the yoga group at 3 months, 1.48 points (CI, 0.33 to 2.62 points) lower at 6 months, and 1.57 points (CI, 0.42 to 2.71 points) lower at 12 months. The yoga and usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher pain self-efficacy scores at 3 and 6 months but not at 12 months. Two of the 157 usual care participants and 12 of the 156 yoga participants reported adverse events, mostly increased pain.

Limitation: There were missing data for the primary outcome (yoga group, n = 21; usual care group, n = 18) and differential missing data (more in the yoga group) for secondary outcomes.

Conclusion: Offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care.

Andre A. Broussard, D.C.
Broussard Clinic of Chiropractic & Acupuncture
6701 Aberdeen Avenue, Suite 7
Lubbock, Texas 79424

Synergy Healthcare offers physical therapyoccupational therapy and massage therapy in Spokane Valley, WA. Our highly trained therapists are ready to get you back on track fast! We try to prepare helpful articles that can help enrich your life. Have a question you want answered? Email us at or call at 509-413-1630 for more information. Comment below or give us a shout-out on Facebook– we love to hear whats on your mind!

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Pec Minor- the Hidden Culprit of Rotator Cuff Injuries

Pec Minor

One of the chest muscles, pectoralis minor, is attached to the scapula on the front of the shoulder, at the coracoid process under the lateral clavicle.  If it stays in a shortened position or if it is overused then it will pull the scapula forward.  From this pull, the shoulder and the humerus will be internally rotated.  The rhomboids and the trapezius will react by laying down adhesions to try to keep the shoulder and the arm from drawing forward into this internal rotation.  Which is why most people have knots all along their shoulder blades.  The supraspinatus, which is the main culprit in 90% of all rotator cuff injuries,  relies on the humerus for an attachment site for its tendon.  The tendon comes off the shoulder in a relatively straight angle (somewhat like drawing a line through your body from shoulder to shoulder).  If the humerus is r

otated then the supraspinatus tendon will be under increased pressure and it can be irritated by the acromion process as the tendon passes underneath at an angle.  Most of the time treatment is directed towards the painful area of the shoulder, but the main contributing factor may be the pectoralis minor.   Which is why some treatment of  rotator cuff injuries are either unsuccessful or why symptom relief may be short-lived.  As the use of computers increases, we see this condition increasing  in great numbers because typing and using the computer mouse keep this muscle in a shortened position.  So remember to take breaks when needed and make sure to incorporate a stretching routine, like yoga at our Spokane Valley location, to your everyday activities.
Synergy Healthcare offers physical therapyoccupational therapy and massage therapy in Spokane Valley, WA. Our highly trained therapists are ready to get you back on track fast! We try to prepare helpful articles that can help enrich your life. Have a question you want answered? Email us at or call at 509-413-1630 for more information. Comment below or give us a shout-out on Facebook– we love to hear whats on your mind!

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Postural fascia

This article is from a book that I continually find useful in the treatment of soft tissue.

There are specializations of fascia, such as plantar, iliotibial, gluteal, lumbodorsal, cervial and cranial which stabilize and permit maintenance of upright posture.  Some of the fascia specializations of the body are referred to as ‘postural fascia’ because they have a special postural function and are among the first to show changes in the presence of postural defects.  They assist in producing the necessary stabilization and, at the same time, permit motion initiated by muscular activity.  Fascia is supplied with sensory nerves and many of its specializations previously mentioned are characterized by stress or tension bands of varying thickness.

     Wherever the deep fascia is subjected to tension, it is reinforced in some way;  for example, it may be further strengthened by depostion of paraneural bundles of collagenous fibres so that they form a definite aponeurosis.  Dr. Leon Page (Academy of Applied Osteopathy Yearbook[1952]) points out:

     The cervical visceral fascia extends from the base of the skull to the mediastinum and forms compartments enclosing the oesophagus, trachea, carotid vessels and provides support for the pharynx, larynx and thyroid gland.  There is a direct continuity of fascia from the apex of the diaphragm to the base of the skull.  Extending through the fibrous pericardium upward through the deep cervical fascia the continuity extends not only to the outer surface of the sphenoid, occipital, and temporal bones but proceeds further through the foramina in the base of the skull around the vessels and nerves to joint the dura.

     Thus it can be seen that the respiratory movements or the positions of the head and neck could have an influence upon the intracranial structures purely through continuity of fascia as well as upon the thoracic visceral and vascular structures.

     This provides part of the rationale behind cranial manipulative techniques.  At birth much of the connective tissue is loose and poorly defined. Abnormal tensions during development may result from trauma, faulty nutrition, wrong use, etc.  and encourage posture bands to become fixed in states of unequal tension.  This may result on shortening and thickening of fascia and of the osseous structures into irregular patterns.  Structural imbalance increases the load on postural muscles and fascia with consequent reinforcement of these abnormal states.

     It should be recalled that in humans the degree of hip extension required for the upright posture is dependent on the hamstring and gluteus maximus muscles which initiate knee joint extension together with the quadricep femoris.  The tensor fascia lata provides the opposing force for the hypertensors.  These all deserve attention in diagnostic and therapeutic terms.

References:  Book:  Chaitow, Leon.  Soft Tissue Manipulation:  A practitioner’s guide to the diagnosis and treatment of soft tissue dysfunction and reflex activity.  Rochester, Vermont:  Healing Arts Press.; 1988.

Synergy Healthcare offers physical therapyoccupational therapy and massage therapy in Spokane Valley, WA. Our highly trained therapists are ready to get you back on track fast! We try to prepare helpful articles that can help enrich your life. Have a question you want answered? Email us at or call at 509-413-1630 for more information. Comment below or give us a shout-out on Facebook– we love to hear whats on your mind!

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