Uneven hips can throw the back out of natural alignment and cause back stiffness, tightness, discomfort, and pain. Hips that are off-balance unhealthily affect standing, sitting, sleeping posture, walking gait, and overall movements. Biomechanics issues cause the core and spine stabilizing muscles to become weakened and fatigued from overcompensating to keep the body up and moving. Over time this can lead to chronic pain in the back, hips, knees, and feet. Chiropractic care can restore proper hip and spinal alignment and wellness.
Contents
Uneven Hips
Misaligned hips can be caused by work or sports injury, exercise, vehicle collision, and/or general wear and tear. When hips are out of alignment, they have shifted from their centered position. They could be rotated forward or backward, forcing the spine and the lower limbs to compensate, resulting in the spine tilting that can make the legs appear uneven. Discomfort may be one-sided low back pain near the sacroiliac joint, causing a stiff/tight back, limited motion, and/or pain symptoms. Because the spine and lower limbs have to compensate for the unevenness, the shoulders and upper back, connected to the pelvis through the spine, are also affected and result in:
Back pain.
Hip and gluteal muscle pain.
Uneven leg length.
Knee, ankle, and foot issues and pain.
Uneven shoulders.
The shoulder blades can stick out on the side of the lower hip.
Rib discomfort and pain.
The rib cage could protrude out on one side. However, this could be due to advanced scoliosis.
Therapy
Staying active is recommended and includes stretching and core strengthening. General stretches recommended to optimize hip equity include:
Hamstring stretch
For this stretch, lie on a flat surface with your legs extended straight out.
Bend the right leg at the knee, placing the right foot on the ground.
Use a towel, belt, or band to grab and wrap around the left foot.
Keep the hip/buttock on the left side planted on the floor.
Slowly raise the left leg upward as far as possible until you feel the stretch.
Once you feel a stretch or restriction in the hamstring, hold the position for 30 seconds.
Repeat on the other side.
Perform 2 to3 times.
Hip flexor stretch
Kneel on the affected leg and bend the healthy leg out in front with the foot flat on the floor.
Back straight.
Slowly push the hips forward until you feel the stretch in the upper thigh and hip.
Hold the stretch for around 15 to 30 seconds.
Chiropractic Care
Chiropractic treatment is a highly recommended non-surgical option for uneven hips and pelvic tilt. Depending on the severity of the misalignment, underlying issues, and body scanning images, hip alignment treatment could include:
Soft tissue therapeutic massage
Chiropractic muscle release for tight hip flexors, quadriceps, hamstrings, and glutes.
Kiapour, Ali et al. “Biomechanics of the Sacroiliac Joint: Anatomy, Function, Biomechanics, Sexual Dimorphism, and Causes of Pain.” International journal of spine surgery vol. 14, Suppl 1 3-13. 10 Feb. 2020, doi:10.14444/6077
Lee, Jeong-Hoon, et al. “The effect of Graston technique on the pain and range of motion in patients with chronic low back pain.” Journal of physical therapy science vol. 28,6 (2016): 1852-5. doi:10.1589/jpts.28.1852
Patel, Rikin V et al. “Pelvic Tilt and Range of Motion in Hips With Femoroacetabular Impingement Syndrome.” The Journal of the American Academy of Orthopaedic Surgeons vol. 28,10 (2020): e427-e432. doi:10.5435/JAAOS-D-19-00155
Rivière, C et al. “Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review.” Orthopaedics & traumatology, surgery & research : OTSR vol. 103,4 (2017): 549-557. doi:10.1016/j.otsr.2017.03.010
Suits, William H. “Clinical Measures of Pelvic Tilt in Physical Therapy.” International journal of sports physical therapy vol. 16,5 1366-1375. 1 Oct. 2021, doi:10.26603/001c.27978
Many individuals do not realize they are in pain until they begin to feel symptoms of stiffness or tenderness in certain areas of their body. Many people have two most common complaints: back and shoulder pain. The shoulder and the back have a casual relationship that stabilizes the upper body and protects the spine’s thoracic region. When injuries or ordinary factors affect not only the shoulders but the back, it can lead to symptoms of pain and stiffness along the muscles, causing the development of trigger points along the upper back and shoulder muscles. One of the muscles affected by trigger points is the rhomboid muscles located in the upper back behind the scapula (shoulder blades). Today’s article looks at the rhomboid muscle, how superficial backaches and round shoulders can affect the rhomboid muscle, and managing trigger points associated with the rhomboid muscle. We refer patients to certified providers specializing in back pain treatments to aid individuals suffering from trigger points associated with the upper back along the rhomboid muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Rhomboid Muscle?
Do muscle stiffness in your shoulders seem to be causing you pain? Have you noticed that your shoulders seem more rounded than usual? What about the unexplainable upper backaches after being in a hunched position for a long period? Many individuals with these pain symptoms could be associated with the rhomboid muscles. The rhomboid muscles are a collective group of muscles important for upper limb movement and stability for the shoulder’s girdle and scapula. The rhomboid muscles consist of two separate muscles: the rhomboid minor and the rhomboid major, deep within the trapezius muscle and behind the scapula (shoulder blades). The functionality of the rhomboid is that they provide stability to the shoulder and when they are active, the upper arms move back and forth while walking.
How Superficial Backaches & Round Shoulders Affect The Rhomboid
While the rhomboid muscles provide stability to the shoulders, they can succumb to pain like any muscles in different body sections. Ordinary factors like a bad sitting posture can cause the upper back and shoulder muscles to contract and strain. Studies reveal that the effects of bad sitting posture can lead to the development of a forwarding head posture with rounded shoulders, causing pain in the rhomboid muscles. When the shoulder muscles, like the rhomboid muscles, experience this sort of change over time, it can increase muscle tone and continuous stress in the neck and shoulders. To that point, it can lead to various symptoms like pain, numbness, loss of functionality in the upper limbs, and nerve root symptoms. Other issues like back pain can also be one of the symptoms that can lead to referred pain in the rhomboid muscles and can potentially lead to the development of trigger points along the shoulders and rhomboid muscles.
Other issues that can affect the rhomboid muscles are trigger points. Trigger points can be latent or active as they are tiny knots formed in the body’s muscle fibers. For the rhomboid muscles according to Dr. Janet G. Travell, M.D., when a person hears snapping and crunching noises during the movement of the shoulder blades, it may be due to the trigger points in the rhomboid muscles. Studies reveal that since trigger points can be either active or latent and elicit local referred pain, that can lead to muscle imbalance, weak and impaired motor function, and expose the joints to suboptimal loading. This means that trigger points in the rhomboid muscles can cause referred pain to the shoulder and mimic other chronic symptoms.
Stretching The Rhomboid Muscle & Managing Trigger Points-Video
Do you hear any snapping or crunching noises when rotating your shoulders? What about muscle stiffness along your shoulders or upper back? Or do you feel muscle aches from being hunched over for a long time? These symptoms could potentially involve trigger points associated with the rhomboid muscles. The rhomboid muscles help stabilize the shoulders and provide movement to the arms. When people overuse their shoulder muscles, it can cause the surrounding muscles to develop trigger points and inflict pain-like symptoms on the shoulders and upper back. Thankfully, all is not lost, as various treatments are available to relieve shoulder and upper back pain associated with trigger points along the rhomboid muscles. The video above explains where the trigger points are located on the rhomboid muscles and how to stretch that muscle to relieve trigger points from causing referred pain to the shoulders.
Managing Trigger Points Associated With The Rhomboid Muscle
Since the rhomboid muscles can become stiff due to overuse and could develop trigger points to inflict pain along the upper back and shoulders, this can cause many symptoms associated with pain and make the individual feel hopeless. Thankfully, various treatments can help manage trigger point pain associated with the rhomboid muscles. Studies reveal that thoracic spinal manipulation can relieve pain pressure sensitivity of the rhomboid muscles. Chiropractors are excellent when finding trigger points along the musculoskeletal system by utilizing spinal manipulation on the thoracic spine to loosen up the stiff muscles along the shoulders and upper back. Another way to manage trigger points associated with the rhomboid muscle is to stretch the shoulder muscles after a hot shower. This allows the muscles to relax and prevent future trigger points from forming along the rhomboid muscles.
Conclusion
The rhomboid muscles are a collective muscle group that has an important function in stabilizing the shoulder’s girdle and scapula (shoulder blades) while providing upper limb movement. The rhomboid muscles consist of two separate muscles: rhomboid minor and rhomboid major, which are behind the shoulder blades and deep within the trapezius muscles. When ordinary factors like poor posture or shoulder injuries affect the rhomboid muscles, it can develop trigger points that can cause stiffness in the rhomboid muscles. Various techniques can alleviate the referred pain along the shoulders, causing trigger points to develop along the rhomboid muscles. When these treatments are utilized on the rhomboid muscles, they can help prevent future shoulder issues.
References
Farrell, Connor, and John Kiel. “Anatomy, Back, Rhomboid Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 20 May 2022, www.ncbi.nlm.nih.gov/books/NBK534856/.
Haleema, Bibi, and Huma Riaz. “Effects of Thoracic Spine Manipulation on Pressure Pain Sensitivity of Rhomboid Muscle Active Trigger Points: A Randomized Controlled Trial.” JPMA. The Journal of the Pakistan Medical Association, U.S. National Library of Medicine, July 2021, pubmed.ncbi.nlm.nih.gov/34410234/.
Ribeiro, Daniel Cury, et al. “The Prevalence of Myofascial Trigger Points in Neck and Shoulder-Related Disorders: A Systematic Review of the Literature.” BMC Musculoskeletal Disorders, BioMed Central, 25 July 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6060458/.
Yoo, Won-Gyu. “Effects of Pulling Direction on Upper Trapezius and Rhomboid Muscle Activity.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5468195/.
Forklifts, also known as lift trucks, are used for loading, unloading, and transporting various goods and materials in construction, shipping, and retail industries. They are heavy-duty equipment and require extensive training to operate safely. Forklifts are involved in many serious workplace accidents causing thousands of injuries annually. Chiropractors specialize in injury care and rehabilitation from vehicle accidents and collisions. They can help restore optimal musculoskeletal function and health through adjustments, massage, decompression, and traction therapies.
Contents
Forklift Operation
The forklift is one of the most widely used pieces of equipment to raise, lower, or remove pallets, boxes, crates, or other containers and transport and stock goods and materials. There are a variety of lift trucks that include:
The weight, speed, and operation difficulty increase the risk of an accident, increasing the risk of injuries. Other factors include:
They can reach up to 20 miles per hour or more.
They have front braking systems making it harder to stop.
The weight distribution is in the back.
The rear wheels turn instead of the front, causing tip-overs.
Most carry their loads in front and can obstruct an operator’s view.
Lifting too heavy a load can destabilize a forklift and cause it to turn over.
Accident and Injury Causes
Federal work safety regulations require individuals to complete a training program to operate a forklift safely. The most common causes of accidents include:
Lack of training and experience.
Lack of safety equipment – helmets, seatbelts, grab handles, roll cages, cage guards, warning lights, and sirens.
Lack of maintenance – bent forks, no load backrest, unbalanced wheels, etc.
Improper loading – off center, damaged goods, loose loads.
Lifting, moving or tilting the mast too fast.
Riding with a raised load.
Speeding.
Improper backing-up techniques.
Poor communication.
Horseplay.
Giving rides.
Failing to immobilize the machine when the operator leaves.
Failing to pay attention to the position of the forks.
Failing to yield to pedestrians.
Traveling up or down unsafe inclines.
Driving off the side of a ramp.
Design or manufacturing defects.
Common Accidents
The most common type of accidents involve:
Tip-overs and Rollovers.
Falling off the lift.
Getting struck by falling materials or objects.
Pedestrian injuries like getting hit by the vehicle or tripping over the forks.
Getting caught in or compressed/crushed by the vehicle or objects.
Injuries
The most common injuries that result from lift accidents include:
Chiropractic therapy can help heal and rehabilitate musculoskeletal injuries. A chiropractic team will relieve pain symptoms and restore the body’s alignment and function. Treatment includes:
Adjustments
To gently realign joints.
Decrease pain.
Increase range of motion.
Improves posture.
Soft-tissue massage
To relax tight muscles.
Relieve spasms.
Release tension in the connective tissue surrounding the muscles.
Reduces pain.
Improves the range of motion of the spine and joints.
Exercises and stretches
To restore and maintain flexibility, joint stability, and mobility.
Joint bracing and taping
To support sprained joints or muscles during healing.
Health Coaching
Guides diet and nutrition to reduce inflammation and promote healthy eating to manage weight.
Forklift Fails
References
Bage, T et al. “Forklift-related lower limb injuries: a retrospective case series study with patient-reported outcome measures (PROMs).” Annals of the Royal College of Surgeons of England vol. 103,10 (2021): 730-733. doi:10.1308/rcsann.2020.7124
Born, C T et al. “Patterns of injury and disability caused by forklift trucks.” The Journal of trauma vol. 40,4 (1996): 636-9. doi:10.1097/00005373-199604000-00020
Hong, Choon Chiet, et al. “Forklift-Related Crush Injuries of the Foot and Ankle.” Foot & ankle international vol. 36,7 (2015): 806-11. doi:10.1177/1071100715576486
Ull, Christopher et al. “Injuries after Forklift Trucks Accidents – Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance.” “Gabelstaplerunfälle – Verletzungsmuster, Therapie und Outcome im berufsgenossenschaftlichen Kontext.” Zeitschrift fur Orthopadie und Unfallchirurgie, 10.1055/a-1402-1649. 19 Apr. 2021, doi:10.1055/a-1402-1649
Waters, Thomas et al. “Lower back disorders among forklift operators: an emerging occupational health problem?.” American journal of industrial medicine vol. 47,4 (2005): 333-40. doi:10.1002/ajim.20146
The low back is a common source of discomfort and soreness among volleyball players because of repetitive jumping, bending, and rotating of the trunk. Adolescents have an increased risk of this injury because their vertebral bones are still developing, which increases the risk for stress fractures. Chiropractic care, massage therapy, decompression, rest, and athletic training can help expedite pain relief and heal the injury.
Contents
Volley Back Pain
Muscle or ligament strains are the most common injury from repetitive jumping, bending, rotating movements, and hyperextension during serving, hitting and setting. This can lead to excessive compression forces on the discs and joints, causing reduced blood circulation, increasing the risk of overload injuries. One study reported that low back pain is experienced in 63% of players. However, if low-back pain is accompanied by pain that runs down the leg along with numbness or weakness in the foot or ankle, the issue could be a herniated disc.
Causes
One common reason is endurance imbalances in the muscles that stabilize the low back. The core muscles provide stability to the low back and spine for all movements. If imbalances are present, a player may spike or serve the ball with intense turning and arching. The added actions cause increased pressure in the joints and hip, gluteal, and leg muscles, affecting the spine’s stability.
The gluteals run from the back of the pelvis/hip bones down to the outside of the thigh.
The gluteal muscles prevent the trunk and hips from overbending forward when landing.
If the gluteal muscles do not have the strength and endurance to perform this motion, the upper body will bend too far forward, causing poor landing posture and decreased spine stability.
Anterior Pelvic Tilt
Studies have shown that players with low back pain tend to stand and land with an anterior pelvic tilt. This is an unhealthy posture when the front of the pelvis tilts forward, and the back of the pelvis raises. Landing hard with an anterior pelvic tilt causes increased arching and increases the pressure in the joints.
Chronic back pain
Warning signs of a more serious back problem include:
Pain that has lasted for more than 1 week and is not improving or getting worse.
Pain that prevents sleep or causes the individual to constantly wake up.
Difficulty sitting.
Back soreness when performing basic tasks and chores.
Significant pain on the court when jumping, landing, or rotating.
Chronic pain ranges from aches to shooting or throbbing pain that can run down the buttocks and legs.
Chiropractic Care
A chiropractor can alleviate volleyball back pain, rule out a more severe injury, such as a stress fracture or herniated disc, and provide a healthier and faster recovery. According to a study, athletes who received chiropractic care showed better speed and mobility. Quick reflexes and hand-eye coordination depend on an optimal functioning nervous system. 90% of the central nervous system travels through the spine. When one or more spinal segments are misaligned, the effect on the nervous system can seriously impact and disrupt nerve circulation, affecting speed, mobility, reflexes, and hand-eye coordination. Chiropractic adjustments will:
Relax and reset the back muscles.
Realign and decompress the spine.
Remove the pressure around the nerve roots.
Strengthen the core.
Improve and increase range of motion, strength, and overall endurance.
Anterior Pelvic Tilt
References
Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR. “Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain.” J Sport Rehabil. 2017 Sep;26(5):329-338. doi: 10.1123/jsr.2015-0171.
Hangai M. et al., Relationship Between Low Back Pain and Competitive Sports Activities During Youth, Am J Sports Med 2010; 38: 791-796; published online before print January 5, 2010, doi:10.1177/0363546509350297.
Jadhav, K.G., Deshmukh, P.N., Tuppekar, R.P., Sinku, S.K.. A Survey of Injuries Prevalence in Varsity Volleyball Players. Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 102-105, 2010 102
Mizoguchi, Yasuaki, et al. “Factors associated with low back pain in elite high school volleyball players.” Journal of physical therapy science vol. 31,8 (2019): 675-681. doi:10.1589/jpts.31.675
Movahed,Marziehet al. (2019). “Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain.”
Sheikhhoseiniet al. (2018). “Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain”
The body has various muscle groups that work together to make each section of the body move. The arms, shoulders, and neck muscles in the upper half of the body allow mobility and range of motion without discomfort. The muscles in the midsection protect the vital organs and spine while assisting in rotation. And the low half of the body, which includes the hips, legs, and feet, helps the body to move from place to place. However, just like all muscles, injuries can occur to the body and cause issues if they are not taken care of immediately. This allows the muscle fibers to develop myofascial pain syndrome or trigger points, causing overlapping risk profiles at risk of developing pain in the affected area. For the upper body, when trigger points affect the shoulders, it can lead to referred pain that can affect the arms. Today’s article examines the shoulder muscle known as the subscapularis muscle, how trigger points are associated with the subscapularis, and ways to manage trigger point pain on the subscapularis muscle in the shoulder. We refer patients to certified providers specializing in musculoskeletal pain treatments to aid individuals suffering from trigger points associated with the subscapularis muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Subscapularis Muscle?
Have you been feeling a constant ache in your shoulder muscles? Does your wrist seem to hurt, making it hard to grasp objects? Or Do you feel pain in your triceps or shoulder muscles? Individuals experiencing these symptoms might risk developing trigger points associated with shoulder pain along the subscapularis muscle. The subscapularis is the largest, strongest muscle of the rotator cuff that lies in the anterior or front of the scapular surface and provides shoulder movement while helping maintain glenohumeral joint stability. The best way to describe how it looks is that it seems like a chicken wing. The subscapularis is also part of the rotator cuff muscles, which includes the teres minor, supraspinatus, and infraspinatus muscles, and is active when a person swings their arms forward. When issues affect the shoulders, it can lead to referred pain affecting the upper extremities, including the hands, arms, and even the shoulders.
Trigger Point Associated With The Subscapularis Muscle
When injuries affect the shoulders, the muscle fibers that help stabilize the shoulders begin to develop small nodules, known as trigger points, that can invoke pain from the shoulders to the wrist, causing referred pain. The subscapularis and its tendons become affected when it becomes injured and can be prone to tearing. Studies reveal that when the subscapularis tendon has partial tears in the rotator cuff, it would be considered forgotten with “hidden lesions” that can overlap pain symptoms in the shoulders.
Active trigger points in the subscapularis muscle can mimic other pre-existing conditions affecting the shoulders. Once the subscapularis tendon has partial tears in the muscle, it can develop trigger points along the subscapularis muscle and become active, causing various shoulder conditions. One of those conditions is frozen shoulders, and studies reveal a strong association between the subscapularis trigger points and the frozen shoulder. The “frozen shoulder” or adhesive capsulitis of the body is a common shoulder condition often characterized by pain, restricted range of motion, and a high morbidity rate. When a person is dealing with a frozen shoulder, it is often mistaken for shoulder stiffness as it doesn’t respond to non-invasive treatments. All is not lost, as there are various ways of manage active trigger points associated with the subscapularis muscle.
Massage Technique For The Subscapularis Muscle-Video
Have you been experiencing a limited range in your shoulders? Do your hands and wrist ache all the time when grasping items? Or does the pain seem to affect your biceps and shoulders constantly? These symptoms are signs associated with triggering points affecting the shoulders and the subscapularis muscle. The subscapularis muscle resembles a chicken wing, is in front of the scapula, and is part of the rotator cuff muscle group. When the shoulder gets injured or suffers from a traumatic event, it can later develop tiny knots known as trigger points to cause pain and stiffness to the muscle and affect a person’s mobility. To that point, it can mimic other chronic conditions that had pre-existed before the shoulders were affected. Thankfully, there are ways to manage trigger points associated with the subscapularis muscle along the shoulders. The video above explains how pain can be reduced along the subscapularis muscle through a massage technique.
Ways To Manage Trigger Point Pain On The Subscapularis Muscle
Since trigger points mimic other conditions, they can be difficult to diagnose and cause referred pain down the arms. Fortunately, there are ways to manage pain associated with trigger points on the subscapularis muscle. Studies reveal that clinical approaches like mobilizations, stretching, or massaging may help decrease shoulder stiffness while improving pain symptoms in patients with stiff shoulders and posterior shoulder tightness. Incorporating these techniques allows the tight, inflexible muscles to become loose and reduce the effects of referred pain caused by trigger points. To that point, it provides mobility and range of motion back to the shoulders and the subscapularis muscle.
Conclusion
The subscapularis muscle is located in the front of the scapula and resembles a chicken wing. This subscapularis is the largest and strongest of the rotator cuff muscles, providing shoulder movement and joint stability. When issues affect the shoulders, it can lead to referred pain that affects the hands, arms, and shoulders. These are trigger points and can cause overlapping symptoms of stiffness and pain in the shoulders and subscapularis muscles. Fortunately, there are therapeutic ways to manage the pain associated with trigger points along the shoulders and subscapularis muscles. When patients incorporate stretching, massaging, or mobilization techniques, a pain specialist can help reduce the trigger point pain and bring back mobility to their shoulders.
References
Aguirre, Kenneth, et al. “Anatomy, Shoulder and Upper Limb, Subscapularis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 7 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK513344/.
Arjun, M V, and S Rajaseker. “Association between Subscapularis Trigger Point and Frozen Shoulder: A Cross Sectional Study.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, Oct. 2021, pubmed.ncbi.nlm.nih.gov/34776170/.
Look how young children position their backs. There is a natural S curve, and their movements are effortless. As the body ages, too much sitting, slouching, and inactivity can cause muscle fatigue and tension leading to posture issues. Rounded shoulders describe a resting position that has shifted the shoulders out of the body’s natural alignment, which can worsen if left untreated. Chiropractic care can realign the shoulders, as well as the spine, and restore musculoskeletal health to optimum levels.
Contents
Rounded Shoulders
Rounded shoulders are an excessive thoracic kyphosis referring to an uneven forward rounding or curvature of the middle and upper back. Rounded shoulders shift out of proper alignment with the spine, causing posture-related problems like shoulder/neck/back discomfort, tightness, stiffness, and pain. Overall unhealthy posture contributes to the following:
The head constantly being in a forward or backward position
Headaches
Body aches and pains
Muscle fatigue
Chronic back soreness
Bent knees when standing or walking
Body movement dysfunction
Joint problems
Potbelly
Rounded shoulders
Body responses to rounded shoulders include:
Chronic musculoskeletal aches and pains
Breathing problems
Limited body function
Impaired mobility performance
Increased mental and musculoskeletal stress
Causes
Rounded shoulders are typically caused by unhealthy posture, but can also be caused by muscle imbalances from, for example, overfocusing on building chest strength but neglecting the core and upper back. Other causes include:
Standing and sitting for long periods
Stress
Lack of physical activity
Environmental factors
Too much exercise, sports, and physical activities
Musculoskeletal Imbalance
Postural imbalances anywhere in the body can cause rounded shoulders.
For example, when an individual tilts their head forward to look at their phone, the upper back has to round forward to hold the head. Constantly tilting can begin to generate an unhealthy muscle memory causing the neck and shoulder muscles to remain in a semi-flexed position that starts to become the norm.
Another example is when the arms are held out and in front for prolonged periods, like driving, typing, and cooking, the chest muscles get shortened. As time goes on, this causes the shoulder blades to move forward on the ribcage, making the upper back and shoulder area hunch awkwardly and unhealthily.
Stress
When the brain perceives a threat, the body physically prepares to take action through the fight or flight response. Common reactions include:
Jaw tensing
Tightening the abdominal muscles
Holding one’s breath
Rounding the shoulders
Stressors can include:
Job worries
Money issues
Relationship problems
Family responsibilities
All can cause changes in the body that result in rounded shoulders.
Environmental Factors
Respiratory conditions like asthma, COPD, and allergies can affect the body’s breathing and the ability of the diaphragm to contract and relax correctly.
Ribcage restrictions caused by chronic breathing problems can result in the thoracic/middle back tightening up, causing excessive shoulder rounding.
Exercise and Physical Activities
Exercise and physical activities can contribute to rounded shoulders because of the long periods of spinal flexion. These can include:
Bike riding, martial arts, and swimming.
Knitting requires the arms to be out in front.
Gardening requires kneeling and being hunched over.
Chiropractic Treatment
Chiropractic adjustments, therapeutic massage, and decompression therapy can unlock tight shoulder and chest muscles. A chiropractor uses gentle targeted adjustments to relieve pain, restore function, and retrain the muscles.
The doctor will look at the individual’s resting position while standing.
An individual with slumped shoulders can slouch, even when standing up straight.
Their hands will likely face behind them, with their thumbs pointed at each other.
Once the adjustments are made, a correct standing posture will make the hands face the body with the thumbs facing ahead.
Exercises will be recommended to strengthen the core and stretches to maintain the adjustments.
Posture Chiropractic
References
Fathollahnejad, Kiana, et al. “The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.” BMC musculoskeletal disorders vol. 20,1 86. 18 Feb. 2019, doi:10.1186/s12891-019-2438-y
Go, Seong-Uk, and Byoung-Hee Lee. “Effects of scapular stability exercise on shoulder stability and rehabilitative ultrasound images in office workers.” Journal of physical therapy science vol. 28,11 (2016): 2999-3002. doi:10.1589/jpts.28.2999
Kwon, Jung Won, et al. “Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders.” Journal of physical therapy science vol. 27,6 (2015): 1739-42. doi:10.1589/jpts.27.1739
Lee, Do Youn, et al. “Changes in rounded shoulder and forward head posture according to exercise methods.” Journal of physical therapy science vol. 29,10 (2017): 1824-1827. doi:10.1589/jpts.29.1824
Park, Sang-In, et al. “Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.” Journal of physical therapy science vol. 25,11 (2013): 1359-62. doi:10.1589/jpts.25.1359
The rotator cuff works together with the shoulder, providing movement and a full range of motion. The shoulders are one of the largest and most complex joints that can succumb to injuries that can make the shoulders unstable and cause unwanted pain-like symptoms to affect not only the shoulders but also the arms and the neck. These pain-like symptoms are caused by myofascial pain syndrome or trigger points. Trigger points can create small knots along the muscle fibers in any muscle group and causes referred pain to different locations in the upper body. One of the muscles that can be affected by trigger points is the teres minor muscle. Today’s article examines this muscle, how trigger points affect the teres minor muscle, and managing trigger points associated with the teres minor muscle. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points associated with shoulder joints and the teres minor muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Teres Minor Muscle?
Have you been experiencing shoulder pain? Do you feel a tingling sensation that runs down to your fingertips? What about spasms or stiffness in your shoulders? Most of these symptoms are caused by trigger points associated with shoulder pain along the teres minor muscles. The teres minor muscles are part of the muscle group that supports the rotator cuffs. These muscles include the subscapularis, teres minor, supraspinatus, and infraspinatus and together assist in stabilizing the shoulder joint and even help perform arm movement. For the teres minor, this muscle is a narrow intrinsic shoulder muscle that extends from the lateral border of the scapula (shoulder blade). The teres minor is deep to the deltoid muscle as it has functions parallel to the other rotator cuff muscles, especially the infraspinatus. Studies reveal that even though the teres minor is often overlooked in normal shoulder function. To that point, the teres minor muscle becomes a key component for maintaining shoulder function when the other rotator cuff tendons fail from pathology that affects the shoulder and the rotator cuff joint.
How Do Trigger Points Affect The Teres Minor Muscle?
When pathology begins to affect the body, it affects the shoulders and the rotator cuffs. When pain affects the rotator cuffs, trigger points can develop and cause associated pain-like symptoms along the shoulders. Shoulder pain is the third common disorder in the musculoskeletal system. When the corresponding muscles in the shoulder are affected, trigger points can mimic other conditions that make it difficult to diagnose. According to Dr. Janet G. Travell, M.D., many patients often complain more of the pain rather than the restricted motion of their shoulders. This is due to the infraspinatus muscle being affected by active trigger points, causing referred shoulder pain. To that point, infraspinatus-referred pain dominates and releases tension to the parallel muscle fibers, the teres minor. Other issues like hypertrophy can also affect the teres minor when there are rotator cuff tears. Studies reveal that when the rotator cuff suffers damage and begins to tear, it could potentially lead to teres minor hypertrophy and cause referred pain-like symptoms along the upper arm. Fortunately, there are ways to manage trigger points associated with the teres minor to alleviate the pain.
Treating Myofascial Teres Minor Pain- Video
Feeling aches and pain when you are rotating or lifting your shoulders? What about feeling pain in your upper arm? Or do you feel tenderness on your shoulders or upper arm? Many people experiencing pain along their shoulders might be due to trigger points affecting the teres minor muscle. The teres minor muscle is part of the rotator cuff and helps stabilize the shoulders to prevent instability. When factors cause dysfunction in the rotator cuff can lead to the development of trigger points associated with the teres minor muscle, causing overlapping referred pain to the shoulders. Studies reveal that individuals who overuse their shoulder muscles can make them hypersensitive to mechanical pain. To that point, this allows active trigger points to play a role in the development of shoulder pain along the teres minor muscle. The video above shows where the teres minor muscle is located and how to release the trigger points from the muscle to reduce pain in the shoulders and the upper arms while preventing disability.
Managing Trigger Points Associated With The Teres Minor Muscle
When many individuals suffer from shoulder pain associated with trigger points, they often explain and show their primary doctor where the pain is. Their doctors then examine their patients to pinpoint where the issue is before diagnosing the symptoms that are affecting them. Once the symptom is diagnosed as trigger points associated with shoulder pain, doctors would refer their patients to pain specialists like chiropractors or massage therapists to manage and reduce trigger points affecting their shoulders. Many pain specialists will use various techniques to relieve shoulder pain associated with trigger points. Studies reveal that the effects of dry needling on active trigger points in the teres muscle are effective for improving pain intensity, inter rotation range of motion, and extensibility on the shoulder. Other ways to manage trigger points associated with the teres minor muscle include:
Reducing or avoiding excessive or repetitive load on the muscle
Have a correct sleeping position to prevent shortening the shoulder muscles
Applying a hot compress on the muscle to relax the stiff muscle and reduce trigger points from forming further
Doing stretching exercises to relieve shoulder tension
Incorporating these can help restore shoulder mobility and prevent future trigger points from forming and causing shoulder pain.
Conclusion
The teres minor is part of a muscle group that supports the rotator cuffs in the shoulder. These muscles stabilize the shoulder joint and help perform arm movement. The teres minor is a narrow muscle extending the scapula’s lateral border (shoulder blade). When pathologies begin to affect the muscles in the shoulder area, it can lead to the development of trigger points along the teres minor muscle and cause referred pain along the shoulders and upper arms. To that point, many individuals will regain their range of motion in their shoulders without pain. Various treatments can help reduce the effects of referred pain along the shoulders and manage trigger point pain associated with the teres minor muscles.
References
Ceballos-Laita, Luis, et al. “Effects of Dry Needling in Teres Major Muscle in Elite Handball Athletes. A Randomised Controlled Trial.” Journal of Clinical Medicine, MDPI, 20 Sept. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8466529/.
Juneja, Pallavi, and John B Hubbard. “Anatomy, Shoulder and Upper Limb, Arm Teres Minor Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 15 May 2022, www.ncbi.nlm.nih.gov/books/NBK513324/.
Ortega-Santiago, Ricardo, et al. “Pressure Pain Hypersensitivity and Referred Pain from Muscle Trigger Points in Elite Male Wheelchair Basketball Players.” Brazilian Journal of Physical Therapy, Associação Brasileira De Pesquisa e Pós-Graduação Em Fisioterapia, 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7351965/.
Tokish, John M., et al. “Teres Minor Hypertrophy Is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair.” Orthopaedic Journal of Sports Medicine, SAGE Publications, 29 July 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4968368/.
Williams, Matthew D, et al. “Understanding the Importance of the Teres Minor for Shoulder Function: Functional Anatomy and Pathology.” The Journal of the American Academy of Orthopaedic Surgeons, U.S. National Library of Medicine, 1 Mar. 2018, pubmed.ncbi.nlm.nih.gov/29473831/.
Training means engaging in activity for fitness purposes or improving performance skills. Sports training is a process of preparation aimed at strengthening and maintaining high performance in sports activities. It is used by scientists and experts in sports science, biomechanics, exercise physiology, sports psychology, and fields like yoga and kinesiology. Regardless of fitness level, physical training, or exercise program, general sports training principles include:
Progression
Periodization/Regularity
Overload
Variety
Recovery
Balance
Specificity
Designed to improve fitness and performance, it includes strength training, conditioning, cardiovascular training, corrective and restorative exercises, mental and psychological training, and nutritional/health coaching.
Contents
Sports Training Principles
Progression
To improve fitness levels, an individual needs to increase the intensity and duration of their training routine gradually. Gradual and systematic increases in training stress maintain tissue overload and continue the body’s training adaptation. Training variables must be increased to induce further transformation. These include:
The rate of progression is important as progressing too fast can result in injury, while going too slow can delay improvement goals.
Periodization and Regularity
Maintaining a consistent exercise regimen is important, with training occurring at regular intervals.
Training three-five times each week is recommended.
Ensure adequate sleep to train at optimal levels.
A proper nutrition plan to operate at high capacity during training.
Varying training variables like activity, rest, frequency, intensity, and duration help maintain optimal stimulus and address goal adjustments to avoid overtraining, injury, and burnout.
Overload
Overloading occurs when the training exercise is more than an individual’s body can take. Challenging an individual’s current fitness and performance levels generates improvements. For example, soccer players alternate between sprinting, jogging, and backpedaling during games. They do 40-50-minute jogging sessions daily to maintain stamina and endurance.
This means pushing the body, so the heart works at a high percentage of its maximum capacity.
Determining the proper intensity level depends on various factors, including age, weight, and overall fitness level.
Excessive overload and/or inadequate rest can result in overtraining, injury, and decreased performance levels.
Variety
Becoming bored with physical training can happen very easily when performing the same routine.
Mixing things up by breaking up the routine and doing other activities is important.
This prevents boredom and can increase motivation to help achieve maximum results.
Recovery
Rest periods between physical training are essential for repairing muscle damage and removing metabolic waste.
The recommended recovery time is between 24 and 48 hours after training.
Alternating more difficult training exercises with easier exercises or alternating muscle groups so as not to work out the same muscles can also achieve recovery.
Not allowing the body to recover properly can lead to muscle fatigue, increasing the risk of injuries.
Balance
When developing a physical training program, it’s important to ensure the whole body is being worked out equally to achieve a balanced fitness level.
Balance routines for the upper and lower body.
Components of a balanced exercise plan include Strength, Cardio, and Flexibility training.
For example:
One day of aerobic exercises for cardio.
One day of rest.
One day of resistance training for strength.
Stretching at the beginning and the end of workouts to relax muscles and maintain flexibility.
Specificity
The principle of specificity recommends that individuals gear their training toward specific goals.
Specific training consists of exercises to develop specific strength, specific muscle groups, and specific motor abilities required for a sport.
Incorporating specific motions and sports tasks generates neuromuscular and metabolic adaptations and muscle memory.
Chiropractic Therapy
Sports chiropractors work closely with massage therapists, performance coaches, athletic trainers, and medical doctors with a diverse treatment approach that is applied based on the needs of the individual. Chiropractic will:
Improve performance.
Reduce the risk of injury.
Alleviate muscle stress.
Expedite injury healing.
Maintain body alignment.
Sports Chiropractor Rehabilitation
References
Kasper, Korey. “Sports Training Principles.” Current sports medicine reports vol. 18,4 (2019): 95-96. doi:10.1249/JSR.0000000000000576
Maestroni, Luca, et al. “Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance.” Sports medicine (Auckland, N.Z.) vol. 50,2 (2020): 239-252. doi:10.1007/s40279-019-01195-6
Ralston, Grant W et al. “Weekly Training Frequency Effects on Strength Gain: A Meta-Analysis.” Sports medicine – open vol. 4,1 36. 3 Aug. 2018, doi:10.1186/s40798-018-0149-9
Schleip, Robert, and Divo Gitta Müller. “Training principles for fascial connective tissues: scientific foundation and suggested practical applications.” Journal of bodywork and movement therapies vol. 17,1 (2013): 103-15. doi:10.1016/j.jbmt.2012.06.007
Van Proeyen, Karen, et al. “Beneficial metabolic adaptations due to endurance exercise training in the fasted state.” Journal of applied physiology (Bethesda, Md.: 1985) vol. 110,1 (2011): 236-45. doi:10.1152/japplphysiol.00907.2010
As the body’s most mobile joints, the shoulders are surrounded by muscles, tissues, and ligaments that help support the shoulders and the rotator cuff in mobility function, thus ensuring the shoulders remain in a stable, normal position. As a complex structure that is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blades), and the clavicle (collarbone), the shoulders provide a wide range of motion without feeling pain. When injuries affect the muscles, tissues, and joints of the shoulders, they can potentially develop tiny knots along the muscle fibers and invoke pain-like symptoms on the upper extremities of the body. To that point, it affects not only the shoulders but also the arms and the hands. Today’s article looks at the infraspinatus muscle, how shoulder joint pain is associated with trigger points, and various treatments to manage trigger points related to the shoulder joint. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points related to the shoulder joints and the infraspinatus muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
What Is The Infraspinatus Muscle?
Do you feel stiffness along your shoulders or upper arms? Does it hurt when you rotate your shoulders? Or have you been experiencing a tingling or numbing sensation traveling down your arms? Many people who experience shoulder pain might be due to trigger points affecting their infraspinatus muscles. The infraspinatus muscle is a muscle that looks like a thick triangle that covers the front of the scapula. The infraspinatus is a part of the rotator cuff muscles or commonly referred to as SITS:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
These four muscles provide the functionality to the rotator cuffs in the shoulders to allow the arms full range of motion. Studies reveal that rotator cuff activity from these muscles is crucial for normal shoulder motion. To that point, the infraspinatus plays a vital role by providing dynamic stability while producing external rotation at the shoulder. However, traumatic forces can affect the infraspinatus muscles causing lesions and other conditions to affect the shoulders and rotator cuffs, causing pain-like symptoms to the upper half of the body.
Shoulder Joint Pain Associated With Trigger Points
Since shoulder pain is the third most common musculoskeletal disorder, the underlying causes are rotator cuff disorders and referred pain in the neck. When traumatic factors begin to affect the shoulder muscles and the rotator cuff muscles, it can potentially lead to the development of myofascial pain syndrome or trigger points along the muscle fibers of the shoulders. Referred pain causes pain in one area of the body when in actuality is affecting the other side of the body. For trigger points associated with shoulder joint pain, studies reveal that myofascial pain from trigger points in the infraspinatus may give rise to referred pain in the arms, shoulders, or even the cervical spine in some patients. To that point, trigger point pain associated with the shoulder joint may mimic carpal tunnel symptoms around the wrist. When trigger points mimic other chronic conditions, it often makes it a bit harder to diagnose the symptoms.
Treating Trigger Point Release On The Infraspinatus Muscle-Video
Have you been dealing with pain-like symptoms in your wrist? Do you feel muscle stiffness when rotating your shoulders? Or have you been experiencing numbness or tingling sensations from the shoulders to the fingertips? If you have been experiencing any of these symptoms, it could be referred to pain from trigger point pain associated with the infraspinatus muscle on the shoulder joint. Trigger points form tiny nodules along the taut muscle fibers of the affected muscle area. The video above explains where the trigger points are located on the infraspinatus muscle on the scapula (shoulder blades) and how to release the trigger points. All is not lost, as various treatments can help manage trigger points associated with the shoulder joint. Studies reveal that chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points, causing referred pain along the arm down to the fingertips. To that point, pain specialists incorporate and apply acupuncture or dry needling on the trigger point can help improve pain and disability for many individuals with shoulder pain.
Treatments Managing Trigger Points Associated With The Shoulder Joint
When many individuals are dealing with trigger point pain associated with the shoulder joint, they sometimes believe that it could be something that is affecting their heart. Now, why would the heart be associated with the shoulder joint? This is due to somato-visceral pain (the affected muscle is causing issues to the corresponding organ) that is causing referred pain to affect the heart. When patients go to their primary doctors, they go through an examination to see what the issue is, and this allows the doctor to go through a clinical process to come up with a diagnosis of what is going on, which in this case is trigger points associated with the shoulder joint. Once the doctor diagnoses the issue, they can refer their patients to a pain specialist like a chiropractor, massage therapist, or a physiotherapist to manage the trigger points in the affected muscle area. Chiropractors, massage therapists, and physiotherapists utilize various techniques to relieve trigger points from the infraspinatus muscle in the shoulder joints. Some of the available treatments that are used to manage trigger points associated with the shoulder joint include:
Stretching
Ice/Heat Compress
Spinal Adjustments
Acupuncture
Trigger Point Injection
Conclusion
The muscle known as the infraspinatus is part of the rotator cuff that works along the shoulder and looks like a thick triangle on the scapula or shoulder. This muscle helps the rotator cuff activity for normal shoulder motion by providing dynamic stability while performing external rotation on the shoulder. When traumatic factors affect the infraspinatus muscle, it can develop trigger points along the muscle fibers of the infraspinatus muscle and cause referred pain along the shoulders and down to the arms. Fortunately, various treatments available can manage trigger points and relieve the pain from producing more issues along the shoulder. To that point, many individuals can have normal shoulder function without pain.
References
Ha, Sung-Min, et al. “Selective Activation of the Infraspinatus Muscle.” Journal of Athletic Training, National Athletic Trainers Association, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3655748/.
Kamali, Fahimeh, et al. “Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes with Unilateral Shoulder Impingement Syndrome.” Journal of Sport Rehabilitation, U.S. National Library of Medicine, 30 Nov. 2018, pubmed.ncbi.nlm.nih.gov/29364040/.
Meder, Marek A, et al. “Reliability of the Infraspinatus Test in Carpal Tunnel Syndrome: A Clinical Study.” Journal of Clinical and Diagnostic Research : JCDR, JCDR Research and Publications (P) Limited, May 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5483796/.
Williams, Jeslin M, et al. “Anatomy, Shoulder and Upper Limb, Infraspinatus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 13 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK513255/.
Chiropractic treatment focuses on the musculoskeletal and nervous systems. As with all body systems, specific nutrients protect and increase their functional strength. Various chiropractic-recommended supplements can help in the treatment of musculoskeletal issues and help transform an individual’s health.
Contents
Chiropractic Education
Chiropractors study food-based supplements that are bio-available to cells and are easily absorbed by the body. These food-based supplements and vitamins are seen as food by the body. Supplements are used in detoxification to overcome nutritional deficiencies and enhance an individual’s diet by taking nutrients to optimum levels. Immune system health can also be strengthened by keeping the body resistant to diseases.
Functional Nutrition
Chiropractic medicine study’s all the building blocks of the body that, include:
Holistic nutrition teaches that the body heals from within, which is why healing the gut first, is essential to healing the rest of the body and maintaining health.
Recommended Chiropractic Supplements
Dietary supplements that directly impact the health of the musculoskeletal and the nervous system.
Potassium
Potassium is an important regulator of nerve impulses.
Electrochemical signals or action potentials use potassium and sodium to generate responses from cells in the nervous system.
Potassium is necessary for turning off nerve impulses and preventing the uncontrolled signaling of nerves.
Uncontrolled signaling can lead to movement disorders.
Calcium
Calcium is necessary for the regulation of the action potentials throughout the body.
Calcium helps initiate action potentials and helps the cells return to a normal state afterward.
Calcium contributes to the development of the nervous system helping guide the nerve cells.
Calcium is a major element of bone health to repair bones’ and facilitate regrowth.
The body will take the calcium from the bones if there is a calcium deficiency.
Vitamin D
One of the most important nutrients for bone health.
Vitamin D helps promote bone development and growth.
Facilitates calcium absorption helping the body process and absorb the calcium.
B12 is essential to the function of the nervous system and the body’s metabolism.
B12 breaks complex carbohydrates into more simplistic glucose for basic functions.
B12 helps maintain the nerve insulator myelin, which is necessary for nerve transmission.
B12 deficiency has been linked to the loss of myelin and can lead to serious conditions like Alzheimer’s.
B12 shots deliver the nutrient directly to the bloodstream bypassing the absorption process necessary for oral supplements.
Vitamin K
Vitamin K helps balance and facilitate calcium absorption.
Vitamin K helps strengthen bones and increase bone density.
Often recommended for individuals with osteopenia and osteoporosis to help prevent fractures.
How To Choose Supplements
References
Lee, Mi Kyung, et al. “The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network.” Chiropractic & manual therapies vol. 26 7. 20 Feb. 2018, doi:10.1186/s12998-018-0175-1
Nguyen, Douglas L. “Guidance for supplemental enteral nutrition across patient populations.” The American journal of managed care vol. 23,12 Suppl (2017): S210-S219.
Pludowski, Pawel, et al. “Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence.” Autoimmunity reviews vol. 12,10 (2013): 976-89. doi:10.1016/j.autrev.2013.02.004
Song, Yong-Ak, et al. “Electrochemical activation and inhibition of neuromuscular systems through modulation of ion concentrations with ion-selective membranes.” Nature materials vol. 10,12 980-6. 23 Oct. 2011, doi:10.1038/nmat3146
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