Question
Before I did ask you a few questions about the 1st rib. Thanks very much. These are the kind of the answers that I am so looking for.

If I did not tell you I am now 40 years old. And do have some other problems of the body that ive been working on.

When pressing on the right QL or illocostallis lumborum performing self myofascial release with a foam or pvc pipe or a jack knobbler pyramid shaped massage tool.  I can get refereed pain in the it-band area of that same right leg about 5 inches up from the knee. So I am almost sure that this would be a latent trigger point that I have found. But I did read most of the trigger point manual vol 2 (lower body) - travel and simmons. In this it shows the referred pain pattern from the QL or illocostas lumborum to just above the crest of the illium. Or if the other trigger point to pain around the greater trochanter would be felt.

Now im definitely getting referred pain in a different area. Perhaps I have developed a trigger point in a different muscle that I don抰 know? Or something else? Actually I did many many PVC pipe rolling on the it band. I actually thought before that my problem would have been in the it band being too tight. But ive built up to rolling with PVC pipe with very little discomfort. Sometimes when I was walking around I would get pain in this it band as well. Well im now thinking that its all starting from the ql area. Also ive noticed that some of the trigger points if that is what they are even when apply great pressure for say 1 minute I can not get them to reduce in pain. Now how is that possible? I thought the GTO would be sensing the increased pressure and telling the brain to release.

Also have been really trying to correct my forward head posture. When I look around at the general public this would appear to be epidemic. My case is a little bit different from what ive seen as more of  the old people forward head posture they also have quite a bad case of rounded over shoulders. Ive debliberatly done a lot of rowing movements with weights, bands to help stop the pecs from rounding the shoulders.  Now I do know all about how the body compensates the double S curve of various spine areas and if for example someone has a bad case of over exaggerated lordosis of the lumbar then chances are there will be a exaggerated Thoracic  khysosis. I already realize that sleeping on too high or any pillow, bending over with the head at a computer screen too long are factors to be avoided. Is a forward head posture an unavoidable part of aging? Just what could you suggest that I could do to help minimize this?

And one last quick question. The more and more that ive looked into what in my body is not working normally the more I got to say ive found a lot of dysfunction. Things like functional scoliosis, super overtight muscles, 1st rib, forward head posture, anteriorly rotated pelvis, etc. now I realize that the body never works in isolation but ive discovered tons of dysfunction. Now in your practice in say middle aged people just what is an average number of these kind of dysfunction to have? Near perfect, a few abnormalities, or quite a few abnormalities?

Thanking you in advance.


Answer
Dear Jii,

WOW, WOW, WOW!!  What do you do for a living, are you in healthcare, or do you just sit around and read Travell and Simmons for fun?  I have to say that you have a really good understanding of body function as well as anatomy/physiology in regards to trigger point/golgi tendon organ, because your assessment was fairly correct.  I also agree with your assessment of pain referral, but bear in mind that these pain patterns are variable from one person to another, and as you had mentioned the muscular levels overlap which may give you the diagnostic impression that the QL is the problem, but the illiacus muscle may be involved as well. I would recommend that you also incorporate stretching for the ITB, TFL, QL, Illiacus, and psoas and glute muscles.  

In regard to why a trigger point will release, the GTO concept is correct, but there is another point.  Look up "NIMMO TECHNIQUE".  This is a basic technique of applying constant pressure to a muscle spasm or trigger point which will rob the immediate tissue of its blood supply and therefore all of its oxygen and nutrition.  When this happens the contracted muscle has to release due to the physiological loss of substrates for contraction.  In addition the GTO is being stimulated as well as the muscle spindle.

Forward Head posture: This is not an inevitable part of aging, but rather is cause from environmental factors as you have inferred, and yes it is epidemic...just look at students, and videogamers in their teens...environmental factors. What I would suggest for you is to get a spinal evaluation of the neck as well as the lower body to check the actual measured amount of anterior head translation in relation to the thoracic spine, if you truly have a rotated pelvis or whether it is an anterior pelvis.  Often a pelvic translation will cause a cervical translation (forward head posture).  There are published spine normal and ideal values.  I actually work with patients on this issue everyday.  

Check out www.idealspine.com for a more thorough and detailed explanation of the normal spinal model.  In addition you can find a qualified doctor to structurally remodel the spine back to a normal and possibly ideal position.  This type of work is very specific and your spinal angles, translations, rotations all need to be measured before any treatment should be initiated.  What to do at home, head retraction exercises, head extension exercises, and stretching of the scalene muscles will help to alleviate the forward position functionally, but the ligamentous complex will need to be addressed for further improvements.

The average "middle aged" patient in our practice has multiple problems, but this is why they are in the practice!!  If my patients would listen to what I say more often and follow my advice, they wouldn't be in the office as much.  I have found that most people want to think they are getting healthier, but don't really want to do what it takes to achieve true health...whether that be spinal health, fitness, nutrition, etc...  Most people have neglected themselves so much that they have a host of problems by the time they reach their forties.  

On the other hand Jii, I do see people like yourself who absorb as much information I can give them, and work on improving their overall health.  These patients do very well under care.  Your specific case...ribs, head translation, pelvis, etc... these are all straight forward biomechanical problems that can be effectively addressed and corrected.  you may not be able to correct them 100%, but you should be able to attain 75-90% improvement with the appropriate treatment and lifestyle changes.

Remember:  www.idealspine.com  ...I think you will really be impressed with the bredth of research information and the application of such to the human frame.

Respectfully,
Dr. J. Shawn Leatherman