Yola's Caring Touch Massage

12/16/2025

📌 𝗔𝗰𝗿𝗼𝗺𝗶𝗼𝗰𝗹𝗮𝘃𝗶𝗰𝘂𝗹𝗮𝗿 (𝗔𝗖) 𝗝𝗼𝗶𝗻𝘁 𝗜𝗻𝗷𝘂𝗿𝗶𝗲𝘀: 𝗔 𝗖𝗼𝗺𝗽𝗿𝗲𝗵𝗲𝗻𝘀𝗶𝘃𝗲 𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄

■ Acromioclavicular (AC) joint injuries, often referred to as "shoulder separations," range from mild ligament sprains to severe dislocations requiring surgical reconstruction.
■ These injuries are prevalent, accounting for approximately 9% of all shoulder injuries in the general population and up to 40% in elite athletes involved in contact sports.

🦴 𝗔𝗻𝗮𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗙𝘂𝗻𝗰𝘁𝗶𝗼𝗻

■ The AC joint connects the clavicle (collarbone) to the acromion of the scapula (shoulder blade), linking the upper extremity to the axial skeleton.
■ Stability is provided by two primary ligament groups:
□ AC Ligaments: These control horizontal stability. The superior AC ligament is the largest and most critical for preventing posterior clavicle translation.
□ Coracoclavicular (CC) Ligaments: Comprising the conoid and trapezoid ligaments, these are the primary vertical stabilizers.
■ The clavicle acts as a strut, and the AC joint allows the scapula to move and adjust to the shape of the thorax during arm movement.

💥 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺 𝗼𝗳 𝗜𝗻𝗷𝘂𝗿𝘆

■ AC joint injuries are most commonly caused by direct trauma, such as a blow to the lateral aspect of the shoulder with the arm adducted (e.g., a fall). This force drives the acromion inferiorly relative to the clavicle.
■ Less frequently, indirect trauma from a fall on an outstretched hand can drive the humeral head up into the acromion.

🧭 𝗖𝗹𝗮𝘀𝘀𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻 (𝗥𝗼𝗰𝗸𝘄𝗼𝗼𝗱 𝗦𝘆𝘀𝘁𝗲𝗺)

■ Type I: Sprain of the AC ligaments; CC ligaments are intact. No X-ray displacement.
■ Type II: Partial tear of AC ligaments; CC ligaments intact. Minimal displacement.
■ Type III: Complete disruption of both AC and CC ligaments. The clavicle is elevated (25–100% increase in CC distance).
□ Type IIIA: Stable without scapular dysfunction.
□ Type IIIB: Presents with persistent pain and scapular dyskinesis.
■ Type IV: Posterior displacement of the distal clavicle through the trapezius muscle.
■ Type V: Severe superior displacement (>100% increase in CC distance) with significant skin tenting.
■ Type VI: Rare inferior displacement of the clavicle into a subacromial or subcoracoid position.

🩺 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗿𝗲𝘀𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀

■ Patients typically present with pain, swelling, and a deformity (step-off) over the AC joint.
■ Physical examination may reveal a "piano key sign," where the elevated clavicle can be pushed down and rebounds upon release.

🔍 Provocative Testing

■ Cross-body adduction test: Adducting the arm across the chest elicits pain.
■ Paxinos sign: Squeezing the acromion and clavicle together provokes symptoms.
■ O'Brien active compression test: Can distinguish AC pathology from labral tears.

🖼️ Imaging

■ X-ray is the primary diagnostic tool.
■ A Zanca view is specifically recommended because it allows for accurate measurement of the AC and CC distances and comparison with the uninjured side.
■ An axillary view is critical to rule out posterior displacement (Type IV).
■ MRI is reserved for unclear cases or to identify concomitant injuries like labral tears, which occur in nearly 20% of acute high-grade dislocations.

🛠️ 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗲𝘀

🟦 Nonoperative Management

■ Standard for Type I and Type II injuries and the majority of Type III injuries.
■ Protocol: Immobilization in a sling (days to weeks), pain management, and physical therapy focused on scapular control and restoring motion.
■ Outcomes: Most patients recover fully within 6–12 weeks.
■ Type III Consensus: These are generally treated nonoperatively first. If the patient has persistent pain or scapular dyskinesis (Type IIIB) after 3–6 weeks of rehab, surgery may be considered.

🟥 Operative Management

■ Surgery is typically indicated for Types IV, V, and VI, and for Type III injuries that fail conservative care.

🕒 Timing

■ Acute (3 weeks): Ligament healing potential is low. Reconstruction usually requires a biological graft (allograft or autograft) to augment stability.

🔧 Surgical Techniques

■ Anatomic CC Reconstruction: Recreates the conoid and trapezoid ligaments. This restores both vertical and horizontal stability better than older methods.
■ Hook Plate Fixation: Uses a metal plate to lever under the acromion; often requires later removal and has high rates of subacromial impingement or osteolysis.
■ Weaver-Dunn (Nonanatomic): Transfers the coracoacromial ligament to the clavicle; biomechanically weaker, may lead to residual instability.
■ Arthroscopic vs. Open: Arthroscopic techniques may result in less early postoperative pain; long-term outcomes often similar.

🏅 𝗣𝗿𝗼𝗴𝗻𝗼𝘀𝗶𝘀 𝗮𝗻𝗱 𝗥𝗲𝘁𝘂𝗿𝗻 𝘁𝗼 𝗦𝗽𝗼𝗿𝘁

■ Return to Play: Rates 76% to 100%.
■ Timeline: Around 4 months for surgical patients; varies by sport and position.
■ Complications:
□ Operative—higher rates: infection, hardware failure, loss of reduction.
□ Nonoperative—cosmetic deformity, possible persistent instability or pain.

12/16/2025

𝗨𝗻𝗱𝗲𝗿𝘀𝘁𝗮𝗻𝗱𝗶𝗻𝗴 𝗣𝗮𝘁𝗲𝗹𝗹𝗼𝗳𝗲𝗺𝗼𝗿𝗮𝗹 𝗣𝗮𝗶𝗻 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲: 𝗔 𝗖𝗼𝗺𝗽𝗿𝗲𝗵𝗲𝗻𝘀𝗶𝘃𝗲 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗚𝘂𝗶𝗱𝗲

Patellofemoral Pain Syndrome (PFPS) is a prevalent and often persistent condition, frequently referred to as "runner's knee," though it affects a much broader population. It is defined as an umbrella term for pain arising from the patellofemoral joint (where the kneecap meets the thigh bone) or adjacent soft tissues.
This guide explores the anatomy, causes, diagnosis, and evidence-based management of PFPS.

🦴 1. 𝗧𝗵𝗲 𝗔𝗻𝗮𝘁𝗼𝗺𝘆 𝗼𝗳 𝘁𝗵𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺

■ To understand the pain, one must understand the mechanics. The knee consists of two major joints, but PFPS is localized to the patellofemoral joint.
■ The Mechanism: The patella (kneecap) sits within the trochlear groove of the femur. In a healthy knee, the patella glides smoothly over the femoral cartilage, lubricated by synovial fluid.
■ Stability: The joint relies on a complex system for stability. The joint capsule and medial collateral ligament provide structural support, while the retinaculum (ligamentous bands) and patellofemoral ligaments ensure proper tracking during movement.

❓ 2. 𝗪𝗵𝘆 𝗗𝗼𝗲𝘀 𝗜𝘁 𝗛𝗮𝗽𝗽𝗲𝗻? (𝗘𝘁𝗶𝗼𝗹𝗼𝗴𝘆)

■ PFPS is rarely caused by a single event. It is typically multifactorial, resulting from a combination of overuse, anatomical abnormalities, and muscular imbalances.
■ The Core Issue: Patellar Maltracking
Abnormal tracking causes excessive stress on the cartilage and is often described as the patella being pulled too far laterally.

■ Contributing Factors

■ Muscle Imbalance: Weakness in the Vastus Medialis Obliquus (VMO) combined with a tight or dominant Vastus Lateralis pulls the patella laterally, increasing pressure on the joint surface.
■ The Hip Connection: Patients often demonstrate weak hip abductors and external rotators, causing thigh adduction and internal rotation during activities, altering knee mechanics.
■ Tight Structures: A tight iliotibial (IT) band, hamstrings, or calf muscles can increase posterior force on the knee or pull the patella laterally.

🔍 3. 𝗜𝗱𝗲𝗻𝘁𝗶𝗳𝘆𝗶𝗻𝗴 𝗣𝗙𝗣𝗦: 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀 𝗮𝗻𝗱 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀

■ PFPS is characterized by a gradual, non-traumatic onset of pain located around or behind the kneecap (peripatellar or retropatellar).

■ Common Clinical Signs

■ The "Cinema Sign": Pain experienced when sitting with the knees flexed for long periods.
■ Activity-Related Pain: Symptoms worsen with stair climbing, squatting, running, or kneeling.
■ Pain Behavior: Walking downhill often loads the joint more than walking uphill, provoking pain. Conversely, pain walking uphill may indicate gluteal impairment or tight calves.

■ Diagnosis

■ Diagnosis is primarily a process of exclusion — ruling out other pathologies like patellar tendinopathy or meniscal tears.
A diagnosis is supported if there is:
■ Retropatellar or peripatellar pain.
■ Reproduction of pain during squatting or activities that load the joint in a flexed position.

💪 4. 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁 𝗮𝗻𝗱 𝗥𝗲𝗵𝗮𝗯𝗶𝗹𝗶𝘁𝗮𝘁𝗶𝗼𝗻

The gold standard for treating PFPS is exercise therapy. Combining hip and knee exercises is superior to knee exercises alone.

🧱 A. The Rehabilitation Pillars

■ Quadriceps Strengthening: Strengthening the quads is essential. Exercises must be pain-free.
■ VMO Focus: Rehabilitation should aim to improve firing speed and endurance. VMO exercises are most effective in the range of 0 to 30 degrees of flexion. Pain and swelling can inhibit the VMO, making pain reduction necessary.

■ Hip Strengthening: Targeting hip abductors and lateral rotators leads to better functional outcomes and reduced pain.

■ Proprioceptive & Functional Training: Patients often have decreased proprioception. Functional strength training and proprioceptive drills improve neuromuscular control and are highly recommended.

🔄 B. Open vs. Closed Kinetic Chain

■ Both Open Kinetic Chain (foot free) and Closed Kinetic Chain (foot fixed) exercises are effective.
■ Open Chain: Should be performed in a pain-free range, typically between 40° and 90° of flexion.
■ Closed Chain: More functional but requires careful load management.

➕ C. Adjunct Therapies

■ Foot Orthoses: Prefabricated orthoses can enhance functional performance and may help prevent osteoarthritis in the long term.
■ Taping: Patellar taping is recommended as an adjunct to exercise to help manage pain and alignment.
■ Electrotherapy: Generally not recommended as a primary treatment. However, specific electrical stimulation of the VMO may be considered to address neuromuscular imbalances.

■ 🚫 5. 𝗪𝗵𝗮𝘁 𝘁𝗼 𝗔𝘃𝗼𝗶𝗱

■ Painful Exercises: Pain inhibits muscle function (specifically the VMO) and prolongs the condition.
■ Ignoring the Hips: Treating only the knee often results in suboptimal outcomes.

🚆 𝗦𝘂𝗺𝗺𝗮𝗿𝘆 𝗔𝗻𝗮𝗹𝗼𝗴𝘆

■ The patellofemoral joint is like a train on a track.
■ The patella is the train, and the femoral groove is the track.
■ Muscular imbalances act like a mechanical failure pulling the train off-center, creating grinding and pain.
■ Rehabilitation focuses on fixing not just the train but the control systems — the hips and thigh muscles — to ensure smooth movement.

10/26/2025

Classification of specific LBP with an emphasis on pain origin. Symptomatic IVD degeneration with discogenic LBP is characterized by inflammation, a high-intensity zone, neuroinflammation-induced innervation and vascularization, and central sensitization for the development of pain

10/26/2025

◾ The sclerotomal pain distribution pattern is a key component used to characterize referred leg pain associated with lumbar degenerative disc disease or discogenic pain

⚙️ Characteristics of Sclerotomal Pain Distribution

◾ Nature of Pain: Referred leg pain associated with lumbar discogenic disease is always somatic in nature and sclerotomal in distribution

◾ Location: When discogenic pain involves the legs, it is usually referred to the lower extremities, generally above the knees

◾ Pattern and Localization: This type of pain expands into wide areas and can be difficult to localize. However, while the boundaries of the pain are difficult to define, patients are typically able to confidently identify its center or core

◾ Sensation: Referred leg pain is often described by patients as a deep tissue pain resulting from a sensation of expanding pressure

◾ Clinical Presentation Context: The presence of referred leg pain in a sclerotomal distribution, coupled with axial midline low back pain, is part of the specific diagnostic criteria for lumbar discogenic disease

🔍 Distinction from Radicular Pain

◾ Origin:

Sclerotomal pain is somatic in origin

Radicular pain results from compression of nerve roots

◾ Distribution:

Sclerotomal pain follows a sclerotomal, non-dermatomal pattern

Radicular pain typically follows a dermatomal pattern

◾ Quality:

Sclerotomal pain is dull, aching, and gnawing in the low back, with deep tissue pain or expanding pressure in the leg

Radicular pain is a thin band of pain with a lancinating quality, often described as electric and shocking

◾ Neurological Signs:

Sclerotomal pain shows an absence of neurological radicular signs, such as motor, sensory, or reflex changes

Radicular pain is associated with possible motor, sensory, or reflex changes, and often presents with positive signs like straight leg raise or Lasegue’s sign

◾ Sclerotomal pain distribution patterns in referred leg pain of discogenic origin by vertebral level👇

10/06/2025

Six Clinically Recognizable Pain Distribution Patterns in Lumbar Spinal Stenosis

■ 🧩 Overview

Based on a study of 2,379 patients with lumbar spinal stenosis (LSS) presenting to a secondary spine center in Denmark, six clinically recognizable pain distribution patterns were identified using digital pain diagrams.

These findings highlight that heterogeneous pain presentations are common in people with LSS and that pain distribution is often more complex than the "textbook" presentations of central or lateral stenosis.

■ 🔹 Class 1: Bilateral posterior leg pain

This pattern was present in 11.4% of the patients (n=272).

It represents pain located in the back of both legs.

This distribution is often considered a "textbook" LSS pain pattern associated with central canal stenosis, where multiple nerve roots are involved.

■ 🔹 Class 2: Bilateral posterior and anterior leg pain

This pattern was identified in 8.7% of patients (n=207).

It involves pain in both the front and back of both legs.

The presence of anterior leg pain in a bilateral pattern illustrates a more complex pain presentation than is typically described.

■ 🔹 Class 3: Unilateral posterior leg pain

This was the most common pattern, found in 26.1% of the patients (n=620).

This class describes pain in the back of a single leg and is often associated with lateral stenosis affecting a single nerve root.

The researchers specifically distinguished this class from Class 4 to highlight the difference between unilateral posterior leg pain with and without a focus on low back pain.

■ 🔹 Class 4: Unilateral posterior leg pain with low back pain

This pattern accounted for 21.0% of the patient sample (n=499).

While other classes also included patients with back pain, this class was named to specifically highlight the combination of unilateral posterior leg pain and low back pain.

Patients in this group reported slightly lower mean leg pain scores compared to the other classes.

■ 🔹 Class 5: Unilateral anterior and posterior leg pain

This pattern was identified in 22.9% of patients (n=545).

It describes pain in both the front and back of a single leg.

The study notes that the proportion of patients with this pattern was greater than the combined proportion of patients with both types of bilateral leg pain (Class 1 and Class 2), underscoring the significant heterogeneity in LSS pain presentations.

■ 🔹 Class 6: Multisite pain

This pattern was found in 9.9% of patients (n=236).

This class had a higher proportion of females (58.9%) than other groups.

Patients in this group also reported slightly greater social isolation scores and were more likely to have experienced pain for more than 12 months.

The identification of this pattern may help clinicians differentiate LSS from other conditions, such as multi-joint osteoarthritis.

■ 🩺 Clinical Relevance

These identified pain distribution patterns may represent clinical LSS phenotypes that could help improve diagnosis, patient-clinician communication, and treatment decisions.

-----------------

⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

09/28/2025

If you haven’t gone to Big E this year or want to go again, I have a free ticket, and today is the last day. I am in the office if anyone would like to grab it and go 🙂
Txt or call 413-530-8200 to double check if it is still available.

09/23/2025

09/15/2025

🔗📃 Cervicogenic Vertigo 👇

📌Summary :

Vertigo and dizziness are one of the commonest and least understood symptom.

Meniere’s disease, Benign Paroxysmal Positional Vertigo (BPPV), and cervicogenic dizziness are classified as separate entities.

132 patients with vertigo were examined for neck, shoulder, and muscle tightness/asymmetry.

Most patients with Meniere’s Disease (80–88%), BPPV (66–75%), and cervicogenic dizziness (90%) had neck pain/headache with neck tightness or asymmetry.

Vestibular dizziness of Meniere’s Disease, BPPV and Cervicogenic Dizziness may be spectrum of the same disease with underlying myofascial problems.

Meniere’s Disease needs to be revisited as Cervicogenic Hydrops.

>>>

📖 Introduction

Meniere’s Disease and BPPV are two leading causes of peripheral vestibular vertigo.

Cervicogenic dizziness is characterized by imbalance, unsteadiness, disorientation, neck pain, limited cervical ROM, and may be accompanied by headache.

Diagnosis of cervical vertigo is challenging and made after excluding other causes.

Study undertaken to examine association between cervical signs and vestibular vertigo (Meniere’s disease, BPPV, cervicogenic dizziness).

✅ Conclusion

Vestibular dizziness of Meniere’s Disease, BPPV, and Cervicogenic Dizziness may be spectrum of the same disease with underlying myofascial problems.

Meniere’s Disease needs to be revisited as Cervicogenic Endolymphatic Hydrops.

Most vestibular disorders have postural problems with neck pain, headache, neck tightness, shoulder asymmetry.

Postural problems with underlying myofascial issues cause inner ear affection and vestibular symptoms.

Structural Rehabilitation by Myofascial release therapy has potential to revolutionize treatment.

📌 Key Takeaways

▪ Strong association between vertigo syndromes (Meniere’s Disease, BPPV, Cervicogenic Dizziness) and neck pain, headache, muscle tightness, and postural asymmetry.
▪ 81.8% of patients across all groups had neck-related symptoms and signs.
▪ Meniere’s Disease may not be purely idiopathic but linked to cervical and myofascial problems → proposed as Cervicogenic Endolymphatic Hydrops.
▪ Vestibular vertigo and cervicogenic dizziness are likely a spectrum of the same disease with underlying myofascial pathology.
▪ Myofascial release manual therapy (“Structural Rehabilitation”) showed significant improvement in posture, neck alignment, and dizziness.

>>>

🩺 Clinical Implications

▪ Vertigo patients should be screened for cervical spine dysfunction, posture, and myofascial tightness.
▪ Neck and postural rehabilitation should be integrated into management, not only vestibular-focused therapy.
▪ Myofascial release therapy is valuable in treating dizziness and preventing recurrence.
▪ Rethinking Meniere’s Disease as cervicogenic in origin may improve long-term outcomes and reduce progression.
▪ Interdisciplinary care (ENT + physiotherapy/manual therapy) is crucial for comprehensive vertigo management.

-----------------
⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.

Link to Article 👇

09/15/2025

The vertebral column

09/11/2025

🩻 Stages of Bone Fracture Healing

🔴 Inflammatory Phase (up to 2 weeks)
🟥 After a bone fracture, an inflammatory response occurs that lasts for two weeks
🟥 This phase starts an intricate network of proinflammatory signals and growth factors
🟥 Polymorphonucleate (PMN) cells and macrophages are recruited to endocyte microdebris and micro-organisms derived from the fracture
🟥 The damage to the blood vessels results in edema

🟠 Endochondral Bone Formation (2–3 weeks after fracture)
🟧 During this process, the MSCs are recruited in the injured site and begin to differentiate into chondroblasts (condrogenesis)
🟧 Chondroblasts proliferate into chondrocytes, resulting in soft calluses
🟧 Chondrocytes synthesize and secrete the cartilage matrix, containing type II collagen and proteoglycans

🟡 Hard Callus Formation (3rd–6th week)
🟨 The cartilage undergoes hypertrophy and mineralization in a spatially organized way
🟨 New MSCs are recruited which differentiate into osteoblasts, leading to the formation of interwoven bone (hard callus)
🟨 Mineralized bone formation is induced by the signaling of factors such as BMP, TGF-β 2 and -β 3 in the cartilaginous callus

🟢 Bone Remodeling Phase (8 weeks up to 2 years)
🟩 Communication between osteoclasts and osteoblasts mediates the replacement of the braided bone with lamellar bone
🟩 This occurs through two key activities:
🟩 Removal of the bone (resorption) by the resulting osteoclasts of the hematopoietic line
🟩 Formation of the bone matrix by the mesenchymal line osteoblasts

09/11/2025

09/10/2025

HEALING OF MUSCLE {SPECIAL TYPE OF WOUND HEALING}

🦾 Skeletal Muscle

Cut → fibers retract

Held together by stromal connective tissue

Filled with fibrinous material + polymorphs + macrophages

Macrophages clear damaged fibers

📍 If muscle sheath intact:

Sarcolemma tubes containing histiocytes appear along endomysial tube

⏳ After 3 months → properly oriented muscle fiber

Example : Zenker’s degeneration of muscle in typhoid fever

📍 If muscle sheath damaged:

Disorganized

Multinucleate mass

Scar composed of fibrovascular tissue

Example :Volkmann’s ischaemic contracture

>>>

🌀 Smooth Muscle

Limited capacity

In large destructive lesions → permanent scar tissue

>>>

❤️ Cardiac Muscle

Healing → fibrous tissue

If endomysium of individual cardiac fiber intact → regeneration

📌 Clinical Relevance for Physiotherapy

Skeletal muscle injury (sports, trauma, surgery): outcome depends on sheath integrity → physiotherapy promotes proper alignment & prevents contracture

Smooth muscle injury: usually not physiotherapy-related, except in pelvic/uterine recovery

Cardiac muscle: rehabilitation focuses on cardiac function compensation (not regeneration) after infarction