little known “muscle” series: IT band

This is a guest post from my cherished Hailey Paton, Physical Therapist Extraordinaire! (Her business card really says that! True story.)

I know you have heard people say, “maybe your IT Band is tight.” You nod your head in agreement and wonder what the heck he/she is talking about. You wonder if there truly is a band in your leg? Is it a muscle, tendon or ligament? What does “IT” mean anyway?  Well, let me set the facts straight!

The Iliotibial band (ITB), also referred to as the Iliotibial tract, is actually a fibrous band of fascia or connective tissue. The fascia acts as a reinforcement or protective layer to the muscles of the lateral leg. It is one of the thickest pieces of tissue in the body. In layman’s terms, the ITB connects at the top of the pelvis on the side and runs down the leg to insert just below the knee on the outside. At the insertion site, the band moves back and forth as we straighten and bend the knee. So you can visualize that when the band gets tighter the friction and rubbing at the knee will be more intense. The rubbing irritates the band and causes inflammation and pain at the knee. This pain is diagnosed as ITB syndrome. The causes of ITB syndrome include:

  • Overuse of the knee on hard surfaces or uneven terrain
  • Tightness of the ITB and surrounding hip musculature (ie. tensor fascia latae, gluteus maximus)
  • Leg length differences
  • Pronation of the foot
  • Knocked knees

You can grasp the importance of stretching and maintaining the flexibility of the ITB and surrounding musculature of the hip. The best two stretches I have found are seen here. In the first exercise you lay on your back with a band or towel wrapped around the foot and pull the leg straight up. Then, slightly cross the leg over your midline keeping it straight. Hold for 20 seconds and repeat three times.

The second stretch is performed in the standing position. Cross the tight leg behind the other and bend forward from the waist. Hold this position for 20-30 seconds and repeat 3 times on each side.

Susan here again: I always pay attention to the IT band during massage sessions. It’s tighter than it should be for many of us. And massage strokes aimed at loosening the IT band can help increase flexibility. I am always reminded my IT bands are tight when my son jumps on them when we’re wrestling. He always thinks it’s funny what a big reaction he can get from mom. Kids are helpful in so many ways, right?

little known muscle series – quadratus lumborum

Ah! Here’s a fascinating muscle. It’s wacky name is usually shortened to QL. And, crazy me – I’ve been thinking of it as a BACK muscle all along. Until I read this last night: “Although it would seem to be the deepest muscle of the low back, the quadratus lumborum is, strangely enough, the deepest muscle of the abdomen.” Trail Guide to the Body, Books of Discovery, 2005 (page 213). Okay, I know you’re all curious…so let’s jump right in.

Muscle mapquest: Put your hands on your hips. Where your thumbs naturally fall is one attachment of this muscle. As you’ll remember from geometry, a quadrangle is a 4-sided polygon. In this muscular quadrangle, 3 sides are attached to bones and 1 side is free. Hips anchor the muscle on the bottom. Going vertically, the muscle attaches to the 1st-4th vertebrae of the low back. On the top, it attaches to the lowest rib. If you’ve ever seen someone consciously or unconsciously rubbing their low back, this is basically the neighborhood we’re talking about.

What does it do? This muscle helps to extend the trunk (bend backward), laterally tilt the pelvis (think hula or Elvis), laterally flex the trunk (side bend). It also fixes the ribs for inhalation and forced exhalation. Ever sneezed in the morning before your back is “awake” and felt a twinge in the low back? That might be a slight strain on the QL.

Why should I care? Legitimate question. I’m glad you asked. This muscle is often implicated in low back pain. Low back pain is complex and can have many causes. Because the QL has the 3 attached sides, it acts as an important stabilizer muscle in the low back. The tighter it gets the more stable, or immobile, you can become. (Our goal should be stability without losing flexibility.) When the more superficial abdominal muscles are weak, this muscle tends to hold on even tighter. This can cause it to pull too hard on one of it’s attachments – the hip, the rib or the vertebrae. It can also be unevenly tight on one side causing an imbalance in the pelvis. One hip might be hiked up on one side causing trouble down the leg, into the knee, all the way to the ankle and foot. This might cause a lot of trouble if, for example, you’re a runner, especially at higher mileage.

Here’s another gem: if you’re a mom of young kids whom you carry, you could really benefit from learning about this muscle. Almost every mom I know juts a hip out to carry a kid, some more, some less often, but it’s pretty common. I always carried my son on my right hip. I guess it felt more stable on that side. I’m sure someone told me to be sure to carry the baby on both sides and to vary positions. But somehow, amidst all the advice I received, this piece did not make an impression on me. Consequently, I feel there’s still a deep-seated imbalance in the mobility of my hips. So, beware and be smarter!

How to care for your QL: A number of things come to mind. You know I’m going to say massage, so I’ll tackle that first. This is a muscle that’s easily worked in a massage session to great affect. Actually I have to laugh because when I’m working on the QL I often observe my client get very quiet as if concentrating. Then I hear “what is that?” It can be a hidden culprit to back discomfort, so be sure to ask for some work there in your next session. You can also massage it yourself if you stand with your back against a wall and position a tennis ball between you and the wall. Lean that low back into the ball with a degree of pressure that feels satisfying, but not painful. You can do this a 2-6 times a day as long as you don’t do it for very long (1 minute should be good). More than that and you’ll make yourself sore. Lastly, and most importantly, keep moving! We naturally lose our flexibility as we age. Unless we’re doing things to actively maintain or increase our flexibility, we will become stiff and immobile. This does not bode well for the QL. Do a little dancing: salsa, merengue, and hula come to mind. Simple side bend stretches are also great for the QL if you’re not on par with Oliver & Luda. Check this out ~

the end of the line: suboccipitals

In my last post I confessed that I have some tight muscles trying to get my attention. One of these groups of muscles is called the suboccipitals. As I’ve massaged hundreds of people’s suboccipital muscles, I’ve nicknamed them the end of the line. If all other muscles get tired and fatigued, these little workhorses will keep your head up.

They are tiny, but mighty. The 8 individual muscles form a triangle of sorts at the base of the skull (4 on each side).

Muscle Mapquest: take your hands and place them behind your head at the base (where head meets neck). Deep under layers of skin and muscle, your suboccipitals are hard at work. They connect the base of the head (the occiput bone) to the first & second vertebrae, and the first vertebra to the second vertebra. If you are lying down, it’s easier to sink your fingers in deep enough to feel them. If you’re sitting or standing, it’s hard to penetrate the more superficial muscles to feel these muscles distinctly because all the muscles are engaged and active.

Little muscles, big names: What they lack in size, they make up for in their super long names: rectus capitis posterior major (extends & rotates head), rectus capitis posterior minor (extends head), obliquus capitis inferior (rotates first vertebra), oliquus capitis superior (extends & bends head laterally).

Why they hurt: One can argue that the muscles that extend the head (this means to tip the head back), also must eccentrically contract to hold the head in place when we are bending forward or flexing the head. I would argue that this is why they get fatigued, sore and cranky! Our heads are heavy and often forward of where they should be. Because the suboccipitals are postural muscles they tend to become hypertonic (super tight) when they are overused or fatigued (Orthopedic Massage, Lowe 2009 p. 222). “Suboccipital trigger points cause pain that feels like it’s inside the head, extending from the back of the head to the eye and forehead.” (The Trigger Point Therapy Handbook, Davies 2004 p. 62)

Massage care and self-care: If you’re due for a massage and you think these are tight, ask your therapist (hopefully that’s me!) to devote some extra time to these workhorses. Here are some tips to self-massage them. Lie down on your back without a pillow. If you can heat the muscles first with some kind of heating pad, that will enhance your efforts. After heating them for about 5 minutes, scoop your hands under your head. You can press into the muscle bundle right at the base of the skull. You can tilt the head so that pressure is applied to one side for 30 seconds and then the other side for 30 seconds. Take a break and simply rest your head on the bed or floor. If you need a small support under your neck, use a rolled up hand towel. Resume massaging by gliding fingers from the base of the skull towards the neck. Glide up and down with a satisfying amount of pressure applied. You can push your fingers into the muscles from both left and right sides toward the vertebrae in the center. Rest. Tuck your chin, rotate your head side to side. Finish with more heat or try a few minutes resting on a flexible ice pack. Ice can be very soothing to muscles. These are great muscles, so let’s take good care of them! Let me know if you have any questions. 626-660-6856

little known muscle series – infraspinatus & teres minor

Time for another installment of … the little known muscle series. Today I’ll highlight 2 muscles that work in tandem. They are infraspinatus and teres minor.They are part of the shoulder’s rotator cuff.

Muscle mapquest: These muscles are found on the back of the shoulder blade. They lie at an angle more or less pointing up towards the top of the arm bone.

What do they do? As part of the rotator cuff, they work to stabilize the arm in the shoulder joint. Our shoulder joint is designed to allow for maximum range of motion. The trade-off is decreased stability. In addition to ligaments, there are 4 main muscles serving to stabilize the joint. Infraspinatus and teres minor partner with supraspinatus and subscapularis to accomplish this stability. Each of these muscles has its own action. Infraspinatus and teres minor laterally rotate the arm bone (humerus) in the shoulder joint. They also adduct, extend and horizontally abduct the arm. **Anatomy nerds see below for more detail on these fascinating actions.

The other main function of infraspinatus and teres minor is to act as brakes. Other muscles that move the arm are much bigger and stronger, like the pectoralis major, a big chest muscle. Pectoralis major is an antagonist to our subject muscles, as well as latissimus dorsi and teres major (in rotation). An antagonist in anatomy terms is a muscle that does the opposite action. To understand this important braking action, imagine a baseball pitcher throwing a 90-mile-an-hour fastball. It’s a wonder his arm doesn’t just fly out of the socket right behind the ball. Well, this demonstrates the action of the infraspinatus and teres minor. They stomp on the brakes so as to prevent dislocation, tears and sprains. At least they try to!

Why they are sore: Because these muscles are smaller in relation to their bigger antagonists and because they are typically weaker and less developed than the big guns, it’s not uncommon for them to be sore upon palpation (touching them) or massage. They can also be overwhelmed by sudden loads or overexertion. They are sore on most people I see for massage. And most people are surprised. “What’s that?” they ask. I don’t massage any MLB pitchers, so why are they sore on the average person? They are sore on most people because everything we do is in front of us: driving, working at the computer, doing the dishes, holding kids, etc. Our forward activities cause us to curl inward in our posture and this puts these small muscles in a constant stretch position. This makes them cranky. Weak, underdeveloped muscles tend to be sore because they are overpowered by their antagonists. Here’s what we can do to make them happier –

Loosen them: Massage is great for loosening up these muscles and for simply drawing our attention to them. If we don’t know a muscle is sore, we probably won’t pay any attention to it. Between professional massages, you can massage these muscles yourself at home. All you need is a tennis ball and a wall. Stand with your back against a wall. Place the tennis ball between you and the wall with the ball positioned where your shoulder blade is. Push your weight into the ball and roll it around until you find a spot that feels sore. This is a great way to massage your back in general. To find this infraspinatus and teres minor spot, I find it helpful to raise my arm to the side so it’s parallel with the floor. I scoot the ball over so that it’s at the edge of the shoulder blade along the border. When I find a “hurt so good” spot, I move my body so the ball massages the spot in a circular motion. Limit your tennis ball massage time to a short amount, like a minute or two. You can repeat it throughout the day, but keep it short each time otherwise you’ll make yourself really sore. Trust me – respect the tennis ball!

Strengthen them: A healthy shoulder has equally strong and developed rotator cuff muscles that stabilize the arm in the joint. If you participate in a sport or hobby that is shoulder- or arm-intensive, it would be smart to make sure you develop strength in all the rotator cuff muscles. A good trainer, physical therapist or even massage therapist can help you figure out what exercises you can do to strengthen what’s weak. You can also spend some time learning about medial and lateral rotation, abduction and adduction, flexion and extension, etc. and put together a regimen that addresses each action. Most men I know are interested in developing a super-burly looking chest by developing pectoralis major, and neglect these important stabilizer muscles. Don’t be like most men! Be smarter.

Comments? Questions? I hope this is helpful. Now go enjoy this amazing range of motion you’ve been given!

** Anatomy nerds: To understand rotation of the arm stand with arms hanging at your sides. When you laterally rotate your arms you rotate them so that your thumbs turn away from your body. The opposite would be medial rotation (rotate them so that the backs of your hands turn in toward your legs). Adduction is seen when you start with arms straight out to the sides at 90 degrees. Bring the arms down to the body. Extention is the action of moving the arms behind your body from a starting position of arms hanging at your sides. To see horizontal abduction, start with straight arms out to your sides at 90 degrees. Move the arms back behind the body in the same plane. Get the picture?

little known muscle series – sternocleidomastoid

This is a great muscle that I’m so excited to acquaint you with!

First the anatomy mapquest: Go to the mirror. Put your hand to your forehead. Press your forehead against your hand, providing resistance with your hand. Do you see 2 muscles pop out on the sides of your neck? They run from behind the ear to the collarbone, forming a “V.”

These are your sternocleidomastoids, or SCM’s for short. Nice to meet ‘cha. No, el placer es mio. Fantastic muscles, really. Let’s take a closer look at what they do and how they help or sometimes hinder us.

Our SCM’s bend our necks to the side and rotate our heads. When working together they can also flex the neck and lift the sternum (breastbone) when you take a deep breath. This post may be a little dry, so activate your SCM’s now by taking a deep breath so you don’t fall asleep. Believe me, these are great muscles to learn about because they are little buggers when overly tight.

Rarely do we think “Gee, the side of my neck feels tight.” When we feel neck pain, it’s usually in the back of the neck, yes? These SCM guys are like magicians who make their pain magically appear elsewhere. The technical name for this is referred pain*. Their typical referral pattern is to throw pain up to the head, sometimes a headache-y feeling above the eye or tenderness and soreness behind the ear at the base of the head. Do those places sound familiar? Let’s explore a bit further. Discomfort when you massage them or an activation of these headache-y feelings I mentioned above likely indicate that these muscles need to be loosened up.

I’m going to lead you through a quick exercise to explore your very own SCM’s. It can feel strange to massage your neck, but your body is great at protecting delicate structures like your windpipe and carotid arteries. If you feel woozy, feel a pulse, or feel an overwhelming “yucky” feeling you should stop and I can walk you through it in person. Kick in your intuitive sense, heed any warnings your body is giving you and you should be fine. I’ve led at least 40 people through this self-exploration without any trouble, so I take some confidence from that experience.

Okay, now that I’ve freaked you out, let’s move on! Tilt your head to the left, take your right hand and reach across to the muscle on the left. It can be helpful to do this at the mirror so you can see the muscle pop out as described above. When you find the muscle try to gently pinch it between your fingers. Think of the motion of turning a key in the ignition. Can you tell if you just have the skin versus the muscle? If not, try gently pinching the muscle while pushing your forehead into your other hand like you did to make the muscle pop out initially. If you have just skin you won’t feel the muscle engage while you pinch it. If you have the muscle you will feel it engage or contract under the fingers that are pinching it. Once you’ve found it, you can progress from a gentle pinching to more firmly massaging it. Try doing this from the attachments at the collarbone and breastbone up towards the ear. It is usually most sore half way up the muscle.

Massaging this muscle regularly will help loosen it up and decrease any pain it’s causing you. When I notice my SCM’s have gotten tight I try to massage them a couple times a day for about a minute each. That’s a reasonable amount. Sometimes when they feel really tight and I remember to massage them they can feel a little extra sore for a day or two while they release some of the chemical “toxins” built up in them. This is normal. If you have massaged them and have any concerns, write me or talk to your doctor. I am not a doctor and am not diagnosing or treating you medically through this post about SCM’s. I’m just sharing with you something I’ve learned about the amazing human body.

One of the reasons I think these muscles get overly tight and cranky is that they are engaged more often than they need to be. I lump them into the category of what I call “concentration muscles.” Have you ever found yourself concentrating on a task like driving, typing or reading blogs on the computer and noticed that your head is way far forward? When we are concentrating on something visually, somehow our body shoots that heavy head forward to “help out.” This causes muscles like the SCM’s to work overtime. And when they work overtime they do not get paid time and a half; they just get cranky. I hope this post helps you learn more about your body, how it functions and how to be more comfortable and relaxed.

I owe a lot of my understanding about these important muscles to my fabulous massage training at the Brian Utting School of Massage, hands-on experience with many clients, my own mischievous SCM’s, and a great book titled The Trigger Point Therapy Workbook by Davies and Davies (New Harbinger Publications, Oakland, CA 2004 pp. 51 – 55).

* Referred pain is in action when men having a heart attack feel pain down the left arm or women feel low back pain during their menstrual cycle.

little known muscle series – subscapularis

This is the first is an occasional series about muscles most of us are unaware of…that is, until they get cranky. In each article, I hope to explain a bit about the muscle, it’s function and importance and how I address it during a massage session to my client’s benefit.

We’ll start with one of my favorites: subscapularis. Subscap for short. Now, for those of you who can’t remember high school anatomy class, I’ll start with the basics. Where in the world is it? Subscap is found on the front side of the shoulder blade, the side that is up against the back of your rib cage. This should immediately tip you off as to why this is a little known muscle! It attaches to the top of the arm bone, the humerus. It rotates the arm medially. That means that if your arm is hanging by your side, palm towards your leg, this muscle rotates the elbow backwards so that your hand is now facing the back of the body. Hopefully that’s clear.

Subscap is part of the rotator cuff. That may be a familiar term to some who have had shoulder injuries or strains. Subscap has 3 buddies that make up the rotator cuff (infraspinatus, teres minor, and supraspinatus). These muscles help stabilize the arm in the shoulder joint. One of the main reasons rotator cuff injuries are not uncommon is that these 4 muscles help stabilize a joint that has a great deal of range of motion. That range of motion comes at the cost of stability, especially when the muscles are weak, given a sudden jolt or load, or subjected to repetitive overuse. Fans of baseball are very familiar with pitchers experiencing rotator cuff injuries.

What I’ve found in my massage practice is that the rotator cuff muscles are worth checking into if a client is experiencing upper body strain or fatigue, if they clock long hours in front of a computer or steering wheel, and if they walk around with shoulders high and the head out in front of the body. I’ve found that when the subscap is tight, the shoulders ride high. When the subscap is able to release some of its tension, the whole shoulder can drop and relax.

So, how do you get to it if it’s up against the back of the shoulder blade you might fairly ask. I like to joke with my clients that the spa portion of the massage is about to end when we address subscap. If you were floating lazily on a cloud of relaxation, this is sure to bring you back to earth. One of my client’s likes to say this about working his subscaps: “You like to see grown men cry, don’t you?” Perhaps. Don’t worry, I never just spring subscap on clients. Anyway, here’s how we get to it. This next part is like anatomy mapquest:

with my client lying face up on the table,

I take the arm out from under the sheet,

bring it a little bit away from the body,

bend the elbow slightly and

put the hand on a towel on the table near the side of the body.

I put a dab o’ lotion in the armpit area and

slide my flat fingers in towards the subscap.

I am now gently “pinning” the muscle.

I instruct my client to push down with the hand.

This contracts the muscle (medial rotation) and stretches it.

Repeat, being sure to breathe and smile.

For some people this is very intense and has the feeling that we’re deep inside the body. For others it’s no big deal. We know it’s important work when it’s more intense. Sometimes I can feel the muscle twitching and then giving up its death grip on the shoulder. In combination with other upper body massage work, addressing this muscle can leave you feeling fantastic and much freer in the neck and shoulder region.

So, there you go! Let me know if you want to explore subscap during a massage session sometime (if you’re a local reader, of course – it’s very tricky to work on from a distance!). Do you have any rotator cuff stories to tell? Use the comments below to tell your tale.