Dr. Marc Ellis is an instructor at Gwinnett College – Sandy Springs. Dr. Ellis has been teaching Clinical Pathology and Case Management/Assessment to our massage therapy students for over a decade. At the time he started, the College was named the Rising Spirit Institute of Natural Health. In addition to instructing at our campuses, Dr. Ellis has been successful in both education as well as a Chiropractic Doctor. He is a Fellow of the American College of Functional Neurology, a Diplomat of the American Chiropractic Neurology Board, an Assistant Professor for the Carrick Institute of Graduate Studies, and also founded the Georgia Chiropractic Neurology Center in Roswell, Georgia.
Recently, Dr. Ellis traveled to Ulm, Germany, to attend the Connective Tissues in Sports Medicine 2017 conference. He made a presentation at the conference titled, “Examination of Fascial Tension Concomitant with Movement Can Improve Myofascial Care in Athletes – A Case Study.” The study presented is as follows;
Background
Aberrant movement can cause decreased performance in athletes. The central nervous system must always be involved in the modulation of movement. This is done via the deformation of tissues in the body and their effects on the peripheral receptors which in turn send afferent information to the central nervous system (CNS). The CNS will then integrate that information and change the depolarization rate of motor neurons. The synchronization of this process determines effectiveness of the athlete’s movement. Alterations in fascial pliability can cause inefficient movement patterns that can affect an athlete’s performance or induce pain during specific movements.
Case Report
A 57 year old, right handed male golfer presented to the office with complaints of left shoulder pain and limited range of motion for the past 2 years. Examination revealed the patient had Adhesive Capsulitis with 20′ of abduction, 70′ of shoulder flexion, 15′ of extension and 10′ of internal and external rotation. The patients’ primary goal was to be pain free and to be able to play golf again. Myofascial treatments were performed over the course of 10 visits and full range of motion was restored to the shoulder. Upon playing golf the patient continued to have pain and a “catch”in the posterior left shoulder during the backswing phase of his stroke. He pointed to an area around the axillary triangle at the site of pain and restriction. Fascial treatments were performed on the muscular fascia of the Teres muscle group but there was no improvement in the fluidity of movement or pain. As the patient replicated his backswing it was observed that the hypodermis lateral to the lower one third of the scapula did not move correctly. There was a restriction in the tissues’ ability to slide anteriorly and superiorly as it should when the backswing is performed. Light inferior and medial traction was placed on this tissue and the patient could then only abduct their shoulder 90′. Myofascial release was performed at the level of the hypodermis and the fascia profunda of the mid back approximately at the level of the scapula. After the treatment, the patient could fully abduct his shoulder while the hypodermis was being tractioned. He could perform his backswing more smoothly without pain and could golf. During a one month follow up visit he reported that his backswing was still smooth and he did not have pain in the shoulder.
Conclusion
Patients often have numerous fascial adhesions which can contribute to the difficulty of determining which adhesions are contributing to the patient’s primary complaint. Their problems can be so diffuse that it would be prohibitively time consuming to treat all the adhesions that are present. The astute practitioner must be able to determine which adhesions are the primary contributors to the problem and treat them. The evaluation of tensional forces on the fascia concomitant with movements can be an efficient method in determining the primary lesions, thus directing the practitioner to the most effective treatment.