Raquel Fermin, Registered Massage Therapist
2323 Smith St S4P 2P7 Regina, SK, Canada

ACTIVATE YOUR VAGUS NERVE The Vagus Nerve is the brain’s method of controlling the parasympathetic nervous system the rest and digest system. It is not the... only nerve controlling our ability to decrease stressors, but it is by far the single most important nerve due to its far reaching effects. The word vagus means wanderer, as this nerve wanders throughout the body to many important organs and imparts signals from the brain regarding their level of function. This nerve connects the brain to the gut (intestines and stomach), heart, liver, pancreas, gallbladder, kidney, ureter, spleen, lungs, sex organs (in females), neck (pharynx, larynx and esophagus), ears and the tongue. No other nerve in the body has such a broad and far reaching effect as the Vagus Nerve. FUNCTIONS: In the brain, the vagus helps control anxiety and depression. In the gut, it increases stomach acidity, digestive juices, and gut flow. In the heart, it controls heart rate variability, heart rate, and blood pressure. Vagus activation will lower the risk for heart disease and stroke. In the liver and pancreas, it helps controls glucose store and balance. In the gallbladder, it helps release bile, which can help you get rid of toxins and break down fat. Vagus nerve stimulation has the potential to help those suffering from various health conditions, including but certainly not limited to anxiety disorders, heart disease, some forms of cancer, poor circulation, leaky gut syndrome, alzheimer’s, memory and mood disorders, migraine’s and headaches, fibromyalgia, obesity, tinnitus, addiction, autism and autoimmune conditions. So how can we stimulate this nerve to ensure that this nerve is functioning optimally? Here are a few ways you can exercise and stimulate your vagus nerve: COLD SHOWERS Any acute cold exposure will increase vagus nerve stimulation. Studies have shown that when your body adjusts to cold, your fight or flight (sympathetic) system declines and your rest and digest (parasympathetic) system increases, which is mediated by the vagus nerve. MASSAGE You can manually stimulate your vagus nerve by massaging several areas. A foot massage can stimulate vagus nerve activity, as can massaging your neck. A neck massage along the carotid sinus (the right side of your throat near where you check your pulse) can also stimulate the vagus nerve. YOGA Yoga increases vagus nerve activity and your parasympathetic system in general. A 12-week yoga intervention was associated with greater improvements in mood and anxiety than a control group who just did walking exercises. The study found increased thalamic GABA levels, which were associated with improved mood and decreased anxiety. BREATHING TECHNIQUES Deep breathing is always relaxing to your body, but you can use other breathing techniques to stimulate your vagus nerve. Alternate nostril breathing or yogic breathing is a great way to stimulate the vagus nerve. Another breathing technique that you may never have tried is inhaling deeply and then closing your airway while pushing your breath against the inside of your chest and bearing down with your abdominal muscles (like you are trying to pass gas). This method of applying internal pressure from the lungs out to the surrounding organs stimulates the vagus nerve as it connects your heart, spleen, lungs, stomach, and small intestines.

SERRATUS POSTERIOR INFERIOR - OVERLOOKED CAUSE OF LOWER BACK PAIN You have a client who tells you this: 'I reached for something and suddenly I felt a sharp s...pasm in the lower part of my back, slightly to the side of the spine, at the bottom of the ribs, and when I breathe in really deep I can feel it'. Based on the above description you should suspect that you might be dealing with the Serratus Posterior Inferior muscle. Where is the Serratus Posterior Inferior muscle? The Serratus Posterior Inferior muscle connects the lower 4 ribs to four vertebrae (T11, T12, L1, L2) in the low back. What movements does the Serratus Posterior Inferior muscle control? Forced expiration (breathing out when breathing hard) Assists with twisting at the waist Assists with straightening the trunk (standing up straight) Activities that cause Serratus Posterior Inferior pain and symptoms: Twisting the body when lifting Overreaching overhead or to the side of the body Lifting something heavy using the back muscles instead of leg muscles Sleeping on a sagging or too soft mattress Trigger Points Trigger points in the Serratus Posterior Inferior may cause an uncommon local ache radiating over and around the muscle. This may extend across the back and over the lower ribs, even continuing through the chest to the front of the body. This discomfort is typically described by clients as a nagging ache. In many cases this pain remains after other trigger points have been inactivated. This should be a good indicator for the therapist to recheck the Serratus Posterior Inferior for undiscovered trigger points. Stretching for self-release of the Serratus Posterior Inferior Cross your forearms just above the wrist, at about chest height. Inhale deeply as you slowly raise them up until the area where the arms cross is level with your forehead. Now lower the arms as you exhale. Do this once or twice, allowing for a brief rest (a few breaths) before repeating. Do this exercise set several times a day.

MASSAGE THERAPY FOR EDEMA Edema is a condition where there is accumulation of fluid in the tissues resulting in swelling. Edema usually affects the dependent ...parts of the body such as extremities. The causes of edema are various medical conditions and massage therapy may not benefit in systemic causes of edema. However, massage therapy can be beneficial in local causes of edema. Massage should always be started after the patient has consulted with his/her health care provider. Patient should always get massage done by an experienced and qualified massage therapist, because if massage is done by an amateur or if done incorrectly, it can cause more harm than good. Lymphatic Massage involves a light touch massage therapy which helps in enhancing the functioning of the lymphatic system. It is also known as Lymphatic Drainage Massage or Manual Lymphatic Massage. If there is a problem in the functioning of the lymphatic system, then it leads to swelling, headaches, cramps, fluid retention, fatigue, lethargy, joint pain, and repeated cold and flu infections. The lymphatic massage technique involves stimulating the lymphatic drainage system. This helps in encouraging the drainage of accumulated fluids and helps in restoring the normal function of the lymphatic drainage system. Lymphatic massage technique involves gentle touch with the massage strokes directed towards the heart (direction of the lymphatic flow). Preferably one finger should be used to perform these massage strokes. The massage strokes should be short and in one direction beginning with the affected limb lying closest to the trunk. BENEFITS OF LYMPHATIC MASSAGE * Lymphatic massage therapy should be done by trained and professional massage therapists only. * Only light pressure with circular rhythmic movements should be used in order to stimulate the lymphatic system in improving its function. * Lymphatic massage, when done properly, helps in removing the blockages present in the lymphatic system. * Lymphatic massage helps in increasing the lymph flow in the body which in turn helps in removal of waste and toxins from the body and enhances metabolism and makes the immune system stronger. * Patient feels very rejuvenated, energetic and relaxed after a lymphatic massage. Patient may also feel thirsty and must drink lots of water.

SHOULDER HYPERMOBILITY - ANATOMY, CAUSES, EXERCISE Joint mobility and muscle, tendon and ligament flexibility occur along a spectrum with everyone displaying ...individual levels of mobility/flexibility; hypermobility is an extreme form of connective tissue laxity which can cause structural dysfunction, pain and a multitude of long term problems. You can’t change your natural predisposition toward hypermobility but you can change how you control it. Women have a higher pre-disposition towards symptoms of hypermobility, due to their individual levels of oestrogen, progesterone and relaxin produced within their bodies during the menstrual cycle and pregnancy. Men, due to their hormonal make up, display lower levels of individuals with hyper-mobility. Hypermobile people feel tight; it’s most likely that muscles are fighting to hold joints together because tendons are lacking tension. At best, stretching is only going to feed into the dysfunction. Some individuals have more congenital laxity than others. This essentially means their tendons and ligaments have a bit more give to them. As a result, they can have substantially more flexibility because of the lack of passive stiffness. This means the muscles have to work harder to create stability at the hypermobile joints. This can often be accompanied by feelings of pain in end ranges of movement and general fatigue. KNOW THE SHOULDER To understand how your shoulders can lose stability, it helps to first understand their basic structure and proper functioning. There are five parts of the shoulder joint: 1. The scapula (or shoulder blade): The scapulae are flat bones in the upper ack that connect the arms to the trunk and serve as the foundation for the shoulder joint. The scapula transfers force from the shoulder joint to the trunk. 2. The glenohumeral joint: This ball and socket joint is where the head of he humerus (upper arm bone) meets the shoulder blade. It allows for tremendous range of motion but tends to be unstable because the contact area between the humerus and the shoulder socket is very small. 3. The rotator cuff: The muscles and tendons that make up the rotator cuff compensate for the glenohumeral joint’s lack of stability by pressing the humeral head into the joint during heavy lifting and high-speed activities. It’s like a set of magnets that suck the humerus into the shoulder socket for added stability. 4. The shoulder capsule: This ligament tissue encapsulates the head of the humerus and attaches to the shoulder socket through a layer of cartilage called the labrum. The shoulder capsule is the primary source of structural stability in the glenohumeral joint. 5. The scapular muscles: The muscles that connect the shoulder blades to the rib cage, spine, collarbones and upper arms enable the shoulder blades to move in various directions. They also stabilize the shoulder during movements such as throwing. Ideally, each part of your shoulder would do its job exactly as described, but the relationship between mobility and stability can go bad when one or more elements of the shoulder structure loses its ability to function optimally. ACTIVATION / STABILISATION Activation and stabilization become increasingly important for the individual with instability or hypermobility. However, the approach to stabilization is similar to any client working on a corrective shoulder program. Shoulder stability begins with scapular stability. If the client demonstrated more downward rotation of the scapulae, instead of the scapula truly sliding down the ribcage, emphasis should be placed on teaching proper depression. Further, optimal retraction and protraction must be taught. Single Arm Depression (monitor the position of the shoulder blade to prevent downward rotation): 12 reps with 5-second isometric hold, repeat on other side Modified PlankDepression Protraction: 12 reps with 5-second isometric hold The rotator cuff is also important as these muscles provide additional stabilization to make up for the lack of joint integrity. Two methods for taking advantage of rotator cuff activation in the client with joint hypermobility are compression and distraction. Supine Distraction/Shoulder Packing: Stabilise shoulder as partner pulls up. The shoulder should remain retracted and properly depressed: 12 reps with 2-second isometric hold, repeat on the other side Static Push-up with Arm Lifts: Lift the arm as high as possible while maintaining shoulder stability. Alternate sides for a total of 16-20 reps An often-overlooked technique which cannot be forgotten in the hypermobile client is perturbation training. Perturbation is when something stable is pushed out of balance and then must return to its stable state. There are many different highly-effective methods of perturbation training, such as the Body Blade that generates a wave action to increase stability demands. However, if a tool like the Body Blade is unavailable, then a simple resistance band or tubing can suffice.

WHAT DO YOUR FEET TELL YOU? The feet tell you a lot about what’s happening above them, at rest and during movement. The posture (position) your feet are ...in is the result of what’s happening upstream. Your foot position is intimately related to how well you control the position of your pelvis and how well your hips are able to function as a result of this. The stability, strength, and control of your hips and pelvic musculature determines whether you can maintain control of every joint beneath them, and therefore maintain the desired position of your joints at rest and during movement. It comes down to having control over your joints, and attaining/maintaining the desired joint positions as you move. The feet can grant your body a huge amount of stability IF they are in a good position. If you can use your hips and pelvic control to get your feet where you want them, then they have a huge amount of intrinsic muscles that can work to your advantage. But the feet need to be in a desirable position (posture) in order to work optimally. All of this can be worked on and changed. The body changes and adapts to what you expose it to. Learning to control your body requires attention and focus at the start, but is essential for overall musculoskeletal/joint health.

EXTENSOR POLLICIS BREVIS Anatomical snuff box. A. When the thumb is extended, a triangular hollow appears between the tendon of the extensor pollicis longu...s (EPL) medially and the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) laterally. B. The floor of the snuff box, formed by the scaphoid and trapezium bones, is crossed by the radial artery as it passes diagonally from the anterior surface of the radius to the dorsal surface of the hand.

WHAT'S BEHIND YOUR KNEE? The popliteal fossa is a mostly fat-filled compartment of the lower limb. Superficially, when the knee is flexed, the popliteal foss...a is evident as a diamond-shaped depression posterior to the knee joint. The size of the gap between the hamstring and gastrocnemius muscles is misleading, however, in terms of the actual size and extent of the fossa. Deeply, it is much larger than the superficial depression indicates because the heads of the gastrocnemius forming the inferior boundary superficially form a roof over the inferior half of the deep part. When the knee is extended, the fat within the fossa protrudes through the gap between muscles, producing a rounded elevation flanked by shallow, longitudial grooves overlying the hamstring tendons.

POOR POSTURE MIGHT BE THE CAUSE OF EXHAUSTION, PAIN AND INDIGESTION This is all important because chronic poor posture can lead to low energy. Muscle fibres ...become shorter and contracted. The body automatically uses energy to maintain the contraction in the shortened fibres. At times this can lead to chronic fatigue, headaches, unexplained aches and pains throughout the body and occasionally digestive problems. Long term rounded shoulders create compression through the lungs and could lead to habitual shallow breathing. This restricts oxygen distribution in the body, and can also leave us vulnerable to infections as we’re not doing deep breathing that can cleanse the lungs. The knock-on effect of compression through the body can generate a slow and sluggish digestive system and increasing fatigue. While the tight, short muscles burn up energy, the weak, long muscles don’t ‘fire’ properly. These weak muscles must re-establish both their strength and nervous system responses to regain their functionality.

HEADACHES AND MYODURAL BRIDGES Recent anatomical studies have found that the deep suboccipital (top of the neck) muscles are connected to the dura matter (t...he covering of the spinal cord) by ligaments. Pulling on a suboccipital muscle moves the dura matter, in cadavers. The suboccipital muscles often atrophy (waste away) in headache sufferers. Can headaches be affected by using Active Release Techniques (ART) on the the suboccipital muscles: superior oblique, inferior oblique, rectus capitis posterior major and minor? The suboccipital muscles are important little muscles which control fine neuromuscular control of the head. Recent studies have added to our knowledge of the possible connections between headaches and the myodural bridges: Enix et al did microscopic evaluations to confirm that ligaments called the myodural bridges emanate from the suboccipital muscle bellies, and attach to the dura mater in 75% of specimens. These myodural bridges have a hypothetical role in human homeostasis, and they may contribute to certain neuropathological conditions as well. The presence of a neural component within the myodural bridges suggests that they may serve another function aside from simply anchoring the muscles to the dura mater. Such a connection may be involved in monitoring dural tension and may also play a role in certain cervicogenic pathologies (neck pain and headaches). They noted that manual traction of the rectus major in cadavers resulted in gross dural movement from the spinal root level of the axis (C2) to the spinal root level of the first thoracic vertebra. Fernández-de-Las-Peñas found that the greater the headache intensity, duration or frequency, the smaller the cross sectional area of the rectus minor and rectus major muscles. He also foundthat there was a correlation between hyper-tenderness and atrophy of the rectus minor. In these cases pressing on the rectus minor reproduced the patient’s headaches. The rectus minor was also found to have atrophied by Hallgren, in chronic head pain sufferers. He proposed a theory that whiplash could lead to nerve damage which causes the rectus minor to atrophy. His photo in the picture shows the myodural bridge. ART is a hands-on soft tissue treatment of ligaments, muscles, tendons, and nerves. It provides a quick way to make a tight muscle loose, as well as treating conditions such as: tennis elbow, frozen shoulder, shoulder tendinitis, and plantar fasciitis. The technique involves the therapist putting pressure on a tissue, while the patient stretches to move the tissue slowly out from under the contact. The treatment hurts a bit, but only in a way that makes the patient know it is working. The technique works by increasing the nervous system’s tolerance to stretch.