AIS & bulging C3,C4

[Karla Reyna]

I have a client coming in dealing with a "severe sharp pain in her neck" right in the area of her bulging C3 & C4. She aggravates the pain with cervical rotation (bi-lat). Her doctor has had her in physical therapy in the past to do some strengthening and stretching, but at this time has not suggested any further procedures or treatment for the issue.

I have met her in a social situation before and I know she has a forward head position and ant. rolled shoulders so I am assuming that her pecs and ant. neck muscles are very tight. While I have taken Aaron's class twice, and anxiously await the opportunity to take the advanced class to learn more about utilizing his protocol with different conditions, I don't have much experience past using this for back issues, Carpal Tunnel, and inflammation issues. I know there is a contraindication for cervical extension for "severe cases of herniated disc", but in her situation, do you have any suggestions for utilizing Aaron's AIS protocol in a safe or effective manner?

From speaking to her on the phone I can see she is very protective of her neck and is bringing her MRI's and other medical records for review, so communication will be so important. Any bits of wisdom concerning this will happily be welcomed as well!

 

[Jakob]

AIS & bulging C3,C4

With this client, I'd get a detailed health history and take a good look at her MRIs and whatnot to gain an understanding of the bulge severity and location. If she can provide info (or better yet handouts) describing the PT exercises that were prescribed, that would help too.

Since she is probably guarding the neck area, I'd start with gently working through the Shoulder protocol, and have her learn to do pecs, biceps, and 1-2 other stretches for herself. Depending on how things go, you could do some forearm & hand stretching too. In doing the shoulder stretches, her neck will have to move somewhat, potentially reducing the level of guarding. It will also be a less-threatening way of getting her used to the basic AIS protocols so she understands the method before applying it directly to her neck. Of course, you will need to NOT be too aggressive about stretching her "good" areas, as soreness there might put her off the idea of trying it on her "bad" areas.

With the protracted shoulders and forward head carriage, this client is likely to also have issues with her pelvic muscles (hip flexors, glutes, etc.) and latissimus dorsi. Stretching these areas may be enlightening and helpful for both of you. Educate her about the possible connections and why working on those areas may be beneficial for her neck.

Of course, you probably want to have this client dressed in loose, comfortable clothing. Since your client will be active, keep the lights up and introduce her to any equipment (chairs, straps, ropes, etc.) you may be using during the session (i.e. "You'll be seated on this stool during the shoulder stretches. If necessary, I may use this foam roller to help stabilize your back during some stretches, and I will show you how to use a rope like this to practice some stretches on your own.") Pay attention to how this client learns and adjust your communication accordingly. Be prepared to provide photocopies of any stretches you give as homework.

Clients that are new to AIS sometimes have a hard time wrapping their minds around the idea of spending the whole session on stretching. Consider the possibility of starting with AIS for the shoulders (and whatever else), and using the remaining time for massage. That would give her something familiar to look forward to, and give you a chance to get hands-on with her neck to feel out the situation before stretching the area. (I've found that doing the massage first usually doesn't work so well. They get all comfy and suddenly it stops and they have to start doing all this unfamiliar stuff. )

Hope all that helps. Have fun and let us know how it goes!

 

[Lenieye_Moon]

AIS & bulging C3,C4

Thank you so much for taking the time to reply! So much good stuff.

I actually love the idea of spending a whole session doing AIS! Infact I find it hard to get the results I expect when I use it for back issues. The difficulty is getting the client to agree to it - which is probably due to my lack of confidence in my ability to efficiently and effectively use the work. While I have taken Aaron's class twice (and am getting ready to do it again in November), and I understand the protocol and worked on the form of the stretches, I have no background in kinesiology and nothing more than a very basic grasp of movement and dysfunction. So when I go back through my SOAP notes after an AIS session, I get lost as to exactly what is happening.

For example, I took a client to see Aaron last month when he was doing a class near me. I had been working on her awhile but couldn't quite get the relief she needed. I took notes while watching and mine matched about 90%, but what I missed was one area that made all the difference. I didn't get how the psoas was affecting the neck through the trunk and a few other things. And sadly I realized it wasn't due to my laziness, but worse, my ignorance. So I lack a lot of confidence and I'm not quite sure how to gain the skills and knowledge I need. I don't have anyone local to practice with or to get some feedback on my client cases.

I have looked for kinesiology classes, but each one I found I'd have to be enrolled in their PT or Ex. Science program. I am working on my Personal Trainer certification so I can implement strength work into sessions - and I was hoping to understand movement a bit more. Which I do, but not enough.

Even basic things are confusing. How do I tell if a muscle is weak or simply tight? Do I assume because a muscle is tight it IS weak? While I have picked up some dysfunction patterns through the years there has to be guidelines so I don't miss so much!

I have a client who came to me telling me his L psoas constantly tightens up (due to an old injury) and he always has to see a MT who spends so much time working on it to get it to release although it only takes her minutes to release his not-as-tight R psoas. I did the psoas-illiacus stretch on him and the L almost had full ROM, but the R barely moved! During the rest of the stretches he had pain every time he had to engage the psoas it caused him pain. The pelvic area opened up beautifully and by the end of the session he was shocked to find when he palpated his L psoas there was very little pain. There was very limited ROM in the L lat glute, piriformis, ADductor & inner/outer ham (and more, including a diff pattern on the R) and I can understand the lessening of pain in that we released many of the muscles that are pulling on it, but I am assuming the continued pain he feels when engaging this muscle is due to weakness. I could be completely wrong. However since I do know the difference between tight and not tight tissue, I will continue to work to release what I find to be tight. Not very efficient, eh? Nothing that could inspire confidence in a client (or myself). But he is a client who has patience and is allowing me to try to learn what I can while we work. Ignorance is NOT bliss!

Any advice for books, DVDs, learning materials to help me understand Aaron's work better so I can move forward in this work?

 

[All Star]

AIS & bulging C3,C4

Wow, Jason & Vita, great posts! You can tell if a muscle is tight by having the client perform active and passive ROM using Mattes method of muscle isolation. A tight muscle will not be able to perform to the range, in PROM a tight muscle will prevent its aneforum.xxxonist from performing full range.

You're spot on, a muscle can be weak and tight. You can use resisted ROM to determine if the muscle is weak.

 

[Pompal 09.]

AIS & bulging C3,C4

Wow, Jason & Vita, great posts! You can tell if a muscle is tight by having the client perform active and passive ROM using Mattes method of muscle isolation. A tight muscle will not be able to perform to the range, in PROM a tight muscle will prevent its aneforum.xxxonist from performing full range.

You're spot on, a muscle can be weak and tight. You can use resisted ROM to determine if the muscle is weak.

Thanks for your time Kathryn! I've never gotten a real straight forward answer regarding does tight always equal weak. Tight tissue I understand, but in my state it is considered out of my scope of practice to determine if a muscle is weak or say anything to the client regarding strength of a muscle. That will change once I have my personal training certification and I am able to expand my scope of practice. *whew*

And just to clarify as to what you're saying... a tight muscle isn't necessarily weak, but resisted ROM is a test that can determine the strength of a muscle. Correct? And of course that makes complete sense. Aaron has helped me with issues I had regarding weak ankles by (in the beginning) using resistive ROM. Of course these days I'm doing the same exercise with additional weights and no sprained or broken foot for an entire year!

I love his board! It's a safe place to feel "stupid" and learn.

 

[bleh^^]

AIS & bulging C3,C4

Kathryn - Wonderful way to bring concise clarification to such a fundamental question! I'd have spent another 10 sentences...

Vita - I am learning every day... and I often face my own ignorance when confronted with client issues. Today I had a former training client return to me with clean MRIs but unrelenting pain in her thighs. I was excited at first, as all signs (and the other info she provided) indicated that it was likely to be a simple musculoskeletal issue like tight hip flexors or whatever. Then we got to the palpatory portion of the assessment... she was extremely tender to even very light pressure applied to her quads, and could not even tolerate me elevating her legs to see if positioning would reduce the sensitivity. Yet, she can do whatever she needs to do... functionally she seems fine, just out of shape.

Baffled, I ended the assessment and referred her back to her neurologist to get some tests that had been recommended, and to a naturopath who can evaluate her nutrition and do a more wholistic assessment. I told her to call me when she has the results of the additional tests, to let me know how things go with the naturopath, and to do as much activity as she can tolerate. She was embarassed about her pain (some family and friends gave her grief) and the best I could do is acknowledge that she's not imagining it and reassure her that there is still good hope for a pain-free future. *shrug* She knows I am ignorant of the cause of the problem and how to solve it (I told her so myself), but she trusts my judgement anyway.

Improving your understanding of kinesiology is tremendously helpful. As a massage therapist, I am constantly grateful for my experience as a personal trainer, and for my experience doing a multitude of different activities throughout my life. Experiencing the movements of an activity makes it much easier to understand the orchestration of what tissues are working, or under load, or whatever, in different positions and movements. The more active you are as a person, in general, the easier it is to develop a good sense of your own body and imagine it performing tasks you have not yet tried for real.

In his book Job's Body, bodyworker Deane Juhan has some incredible descriptions of human movement that may help you better visualize what is going on with a client. (Juhan's book is excellent for other reasons too, but that's a good one.) I have also found better-quality anatomy atlases to be invaluable aids that I return to again and again, such as Rohen, et al's Color Atlas of Human Anatomy That one is GREAT, with unbelievable photographs and tons of goodies like dermatomes, clarified illustration of angles of muscle pull, etc. There are others, but that's my current favorite. The Color Atlas of Human Anatomy, Volume 1, Locomotor System is pocket-sized but also a phenomenal reference for understanding how our tissues work together to create movement.

Oh, and watching Aaron work sometimes leaves me feeling like a moron. The man works minor miracles on a daily basis, and usually makes it look easy. If I was half as good as he is, I'd be more than twice as good as I am now! :

 

[Coconut Guy]

AIS & bulging C3,C4

Thank you again, Jason for the encouragement and the resources. You and Kathryn have been invaluable this week.

Yup, I feel like a moron - particularly next to Aaron. But I'm determined to learn and improve because I see so much value in this modality so I'm gearing up to feel stupid an awful lot over the next few years, and be okay with it. I spent the first AIS class overwhelmed, the second one feeling the pieces of the protocol and stretch angles fall into place and I'm hoping this third one will allow me to explore a little deeper and feel prepared for the advanced class.

I'll be running out for some new books today! I still pull out my trail guide a few times a week to practice palpation and my Netter's book is so pretty to look at (is it weird to keep an anatomy reference as a coffee table book?!?), but they're not cutting it for what I need now. I'm still on the search for a kinesiology class or resources. Someone mentioned Thomas Myer's "Anatomy Trains". Are you familiar with this by chance?

 

[sweetsupplies85]

AIS & bulging C3,C4

Anatomy Trains is the source reference for information about Thomas Myers' approach to structural integration. He has developed a good working hypothesis for understanding lines of pull, functional chains, and how fascia (and embedded tissues) are connected in various patterns that impact structure, function, and wellbeing. It is loaded with interesting explanations and observations of physiological phenomena, though I have seen it criticized as placing too much emphasis on fascia and not enough discussion of other relevant tissues. I have no doubt you will find it interesting and potentially useful. The first edition is good, but a 2nd edition was released recently - I'd get the newer version, as Myers updates his material.

I also have the Anatomy Trains DVD-ROM software. It is very interesting and helpful in understanding the action of various muscles in common movements. One feature I really like is the ability to view 3D images of various chains of muscles/fascia from nearly any angle, and initiate movement in various ways to see what muscles are contracting or stretching (the tissues change color to show this during movement). The downside is that the software is a bit spendy, but if you are really into the AT concepts it is probably a must-have item.

The only formal AT training I've had so far is a 14.5 hour workshop with Eli Thompson a while back. Eli is a good instructor and we learned some approaches to client assessment, understanding some of the various anatomy trains, vocabulary and general protocols, and a variety of hands-on techniques that might be used in a structural integration session. It was a good intro to the material, but I'd definitely want to do a full seminar before trying to incorporate much of it into my practice.

 

[SDgO1]

AIS & bulging C3,C4

Yes, the anatomy trains stuff is fun but it's not what I would consider a kinesiology class. In fact, if you look at the way fascia is dissected and taught by Meyers the idea of kinesiology as we know it is a mute point. I've enjoyed learning the in depth postural evaluations and then as Jason mentioned, you learn more about the theories and practice of structural integration.

Boy, I wish I could afford these dvd's for studying kinesiology at home: http://www.primalpictures.com/products.aspx

 

[mommy811]

AIS & bulging C3,C4

Kathryn,

Those videos are amazing! I may just have to suggest them to the director at the school where I teach (lymphatic drainage) in hopes I can go and enjoy them in my spare time. :grin: Or I may just have to save my pennies for the functional anatomy title.

Thank you for yet another wonderful resource!