KNEECAPS NEED RELIEF

Palpating the patella
(WVSOM)

The patella is different. Most bones meet other bones via joints but not the kneecap. It floats in the tendon of the quadriceps femoris muscle that straightens the knee. Most tendons connect a muscle to a bone but not the patellar tendon. Much of it stretches from the kneecap to the tibial tuberosity. Most bone and joint problems are not easily treated by self-administered manipulation but not patellofemoral syndrome. It responds quite well to the sequence of position of ease, stretch, and joint mobilization provided below.






DOCTOR'S NOTE: Seek evaluation by a health professional if your knee pain occurred following a knee injury or if you are unable to stand on that leg.








PATELLA POSITION OF EASE

Right patella position of ease (WVSOM)

1. Lie on your back with the legs straight;
2. Place your foot on a pillow and allow the leg to relax. If knee pain is no better, add a second pillow;
3. When comfortable, take a few deep breaths and rest in that position for 2-5 minutes;
4. Slowly remove your foot from the pillow and proceed to the HAMSTRING STRETCH, or roll to one side before getting up;
5. Use this position of ease 2-4 times a day before stretching or as often as needed for pain relief.



Left hamstring stretch (WVSOM)

HAMSTRING STRETCH

1. Sit with one leg straight and the hand on the same side on the floor behind you;
2. Keeping the leg straight, reach with the other hand toward the foot as far as you can comfortably go;
3. Take a few deep breaths and stretch for 10-20 seconds;
4. Repeat for the other side if needed and then proceed to the PATELLA MOBILIZATION;
5. Do this stretch 2-4 times a day.









Right patella mobilization
(WVSOM)

PATELLA MOBILIZATION

1. Sit with your legs straight and a hand on the floor behind you;
2. Use the web of your other hand to push the kneecap down toward the big toe as far as it will comfortably go and hold it there;
3. Gently push the lower leg on that side up toward the ceiling until knee pain occurs;
4. Slowly release and repeat 2-5 times;
5. Do this self-mobilization 2-4 times a day.

TENNIS ELBOW ANYONE?

Wrist extensor muscle tenderness (WVSOM)

Whether or not from the sport, lateral elbow pain from strain of the wrist extensor muscles is a common and self-treatable problem if you can restore normal movement and avoid the repetitive arm use that caused it.









DOCTOR'S NOTE: Seek evaluation by a health professional if your elbow pain is associated with banging the arm, hand numbness, or arm weakness.









Wrist extensor position of ease
(WVSOM)

WRIST EXTENSOR POSITION OF EASE

1. Sit with the involved arm resting on a table or counter and your palm facing upward;
2. Place a small pillow or rolled up towel under the wrist and allow your hand to fall back over it;
3. If still painful, add a second pillow under the forearm;
4. When comfortable, take a few deep breaths and rest in that position for 2-5 minutes;
5. Slowly turn the hand over and proceed to the WRIST EXTENSOR STRETCH;
6. Repeat this position of ease 2-4 times a day or as needed for pain relief.



Wrist extensor stretch
(WVSOM)

WRIST EXTENSOR STRETCH

1. Sit with the involved elbow resting on a pillow, the arm straight, and your hand hanging off the table or chair arm with palm facing downward;
2. Use your other hand to slowly bend the hand downward as far as it will comfortably go;
3. Take a few deep breaths and stretch for  10-20 seconds;
4. If no increase in pain and the elbow is still stiff, proceed to the RADIAL HEAD MOBILIZATION;
5. Do this stretch 2-4 times a day.

RADIAL HEAD MOBILIZATION

(WVSOM)

(WVSOM)

1. Stand with the involved elbow bent with the fist facing your upper chest;
2. Rapidly straighten the elbow as far as it will go by throwing the hand forward as you turn the fist to face upward;
3. Repeat 2-3 times if needed;
4. Do this self mobilization up to twice a day.

SHOULDERING THE LOAD

(WVSOM)

Does the top of your shoulder hurt whenever you try to raise your arm out to the side and over your head? If so, you probably have impingement syndrome, a pinch of the supraspinatus tendon as it passes under the point of the shoulder. This common and disabling condition can be relieved with self-administered manipulation but with just one catch - the catch will return with continued reaching upward.














DOCTOR'S NOTE: Seek evaluation by a health professional if your shoulder pain is associated with arm weakness, shortness of breath, chest pain, arm swelling, or dizziness.









Supraspinatus position of ease (WVSOM)

SUPRASPINATUS POSITION OF EASE

1. Sit with the involved arm resting on a table, counter, or the arm of a chair;
2. Place a pillow under your arm and hand;
3. If pain is not relieved, add a second under the arm and hand;
4. When pain is relieved, rest in that position for 2-5 minutes;
5. Slowly remove pillows, lower arm, and proceed to the SUPRASPINATUS STRETCH;
6. Use this position of ease 2-4 times a day or as needed for pain relief.






Supraspinatus stretch
(WVSOM)

SUPRASPINATUS STRETCH

1. Grasp the involved arm just above the elbow with the other hand;
2. Allow the involved arm to relax and use the other hand to pull it across the chest as far as it will comfortably go;
3. Take a few deep breaths and stretch for 10-20 seconds;
4. Slowly lower the arm and proceed to the SHOULDER MOBILIZATION;
5. Do this stretch 2-4 times a day.









Shoulder mobilization
(WVSOM)

SHOULDER MOBILIZATION

1. Sit or stand with a weight in the hand of the involved arm and the other arm leaning against a counter or wall;
2. Allow the arm to hang freely and move the hand in small circles for 20-30 seconds;
3. Move the hand in small circles in the opposite direction for 20-30 seconds;
4. Do this mobilization 2-4 times a day.



THE NECK BONE'S CONNECTED TO THE ARM BONE

Palpating for scalene muscle tension (WVSOM)

Neck pain going down the arm can be from a pinched nerve in the neck, which deserves evaluation by a health professional to determine cause and severity. More often, neck and arm pain are from muscle tension at the top of the shoulder without or with mild nerve compression (thoracic outlet syndrome) that can be safely treated with self-administered manipulation. The exercise routine provided below addresses the three musculoskeletal causes of thoracic outlet syndrome, namely scalene or pectoralis minor muscle tension and first rib elevation.





DOCTOR'S NOTE: Seek evaluation by a health professional if your neck and arm pain are associated with neck injury, arm weakness, fever, night sweats, weight loss, shortness of breath, cough, chest pain, or palpitations.








Left scalene position of ease (WVSOM)

SCALENE POSITION OF EASE

1. Lie on your back with the head resting on a pillow;
2. Allow the head to roll to the side of neck pain;
3. If pain is still present, add a second pillow under your head;
4. When pain is reduced, rest in that position for 2-5 minutes;
5. Slowly roll to one side before getting up;
6. Proceed to the SCALENE STRETCH;
7. Use this position of ease 2-4 times a day or as needed for pain relief.




Right scalene stretch (WVSOM)

SCALENE STRETCH

1. Sit with your back straight and the hand on the side of arm pain holding onto the chair;
2. Hold the top of your head with the other hand;
3. Allow the head to slowly fall away from the side of pain as far as it will comfortably go;
4. Take a few deep breaths and stretch for 10-20 seconds, letting the weight of the arm move the head rather than pulling. Stop the stretch if arm pain and/or numbness get worse;
5. Repeat steps 3-4 with the head bent slightly backward;
6. Proceed to the PECTORALIS STRETCH;
7. Do this stretch 1-4 times a day.




PECTORALIS STRETCH

Pectoralis stretch (WVSOM)

1. Kneel with your hands flat on the floor slightly in front of your head;
2. Slowly squat back toward your heels as far as you can while keeping the hands in place and allowing the chest to drop down toward the floor;
3. Take a few deep breaths and stretch for 10-20 seconds. Stop the stretch if arm pain and/or numbness get worse;
4. If no increase in arm pain and/or numbness after stretching, proceed to the FIRST RIB MOBILIZATION;
5. Use this stretch 1-4 times a day.



Left rib 1 mobilization
(WVSOM)

RIB 1 MOBILIZATION

1. Sit with one hand firmly holding the top of the other shoulder at the base of the neck on the side of neck and arm pain;
2. Slowly move your head in a circle, bending away from the hand, forward, toward the hand, backward, and away from the hand again;
3. Repeat 3-5 times as one smooth movement until you feel the first rib move;
4. Do this mobilization up to twice a day.

THE NECK BONE'S CONNECTED TO THE HEAD BONE

Normal neck motion
(David R. Beatty, drawing by
William A. Kuchera, DO, FAAO)

Neck stiffness and ache along with associated back of the head pain are most often caused by muscle spasm and joint stiffness that can be safely treated at home. Occasionally, however, headache will have a more serious cause.

Seek evaluation by a health professional if your headache is associated with:

• a blow to the head
• confusion or dizziness
• explosive beginning
• fever, chills, sweating
• progressive worsening
• severe neck stiffness
• visual changes
• worsening with cough or sneeze
• worst headache ever

CERVICAL POSITION OF EASE

Posterior cervical position of ease (WVSOM)

1. Lie on your back and insert a small pillow or rolled up towel under your neck;
2. Allow your head to fall back over the pillow and rest on the floor;
3. If the neck still hurts, slowly turn the head away from the side of pain until it decreases;
4. Once neck pain is gone, take a few deep breaths and rest in that position for 2-5 minutes unless dizziness, blurred vision, or nausea develop;
5. Slowly remove the pillow and roll to one side before getting up;
6. Proceed to the CERVICAL EXTENSOR STRETCH;
7. Use this position of ease 2-4 times a day or as needed for pain relief.



Cervical extensor stretch
(WVSOM)

CERVICAL EXTENSOR STRETCH

1. Sit with your feet flat on the floor and the back straight;
2. Place your hands on the back of the head;
3. Keeping the back straight, let the chin drop down toward your chest, allowing the weight of the arms to pull your head downward;
4. Take a few deep breaths and stretch for 10-20 seconds, avoiding pulling on the head with the arms;
5. If no increase in pain, proceed to the LEVATOR STRETCH;
6. Do this stretch 1-4 times a day.



Right levator stretch (WVSOM)

LEVATOR STRETCH

1. Sit up straight with your feet on the floor and hold onto the chair with one hand;
2. Hold the top of your head with the other hand;
3. Allow the head to slowly fall first forward and then to the side away from the tight muscle as far as it will comfortably go;
4. Take a few deep breaths and stretch for 10-20 seconds, avoiding pulling on the head with the arm;
5. Repeat for the other side;
6. If no increase in pain, proceed to the CERVICAL JOINT MOBILIZATION;
7. Do this stretch 1-4 times a day.



Right cervical joint mobilization (WVSOM)

CERVICAL JOINT MOBILIZATION

1. Lie on your back and use one hand to grip both sides of the back of your neck just below the tight area;
2. Use your other hand to gently and repetitively move the head into sidebending around the hand at the back of the neck;
3. Repeat for the other side if needed;
4. Do this joint mobilization up to twice a day if helpful.



RIB TIPS FOR CHEST WALL PAIN




Rib angles are the prominent posterior parts
(David R. Beatty, drawing by William A. Kuchera, DO, FAAO)

Upper back and chest aches are often caused by rib joint stiffness or muscle spasm. However, it is better to first consider heart and lung causes before assuming what seems like rib pain is really coming from the ribs.










DOCTOR'S NOTE: Seek evaluation by a health professional if rib pain is worse with a deep breath or exertion, or is associated with a blow to the chest, shortness of breath, cough, dizziness, fever, fatigue, or weight loss.







CHEST POSITION OF EASE

Anterior thoracic position of ease (WVSOM)

1. Lie on your back with 2 pillows under your head;
2. Roll your head to the side of rib pain;
3. If pain is not reduced, add another pillow and slide the pillows down to support your upper back as well as head;
4. When rib pain is reduced, take a few deep breaths and rest in that position for 2-5 minutes;
5. Slowly straighten the head and proceed to the LATISSIMUS STRETCH, or roll to one side before getting up;
6. Use this position of ease 2-4 times a day or as needed for pain relief.



Left latissimus stretch
(WVSOM)

LATISSIMUS STRETCH

1. Stand with your feet shoulder width apart and place one arm behind the head;
2. Grasp the elbow with the other hand. If you have trouble reaching the elbow, grasp the wrist instead;
3. Slowly lean your trunk away from the side of the arm behind the head as far as you can comfortably go;
4. Take a few deep breaths and lean farther to stretch for 10-20 seconds;
5. If no increase in pain, proceed to the SUPINE THORACIC/RIB MOBILIZATION;
6. Do this stretch 1-4 times a day.





THORACIC/RIB MOBILIZATION SUPINE



Supine thoracic/rib mobilization (WVSOM)

1. Lie on your back on a firm surface with the knees bent and fingers interlocked behind your head;
2. Push your elbows together. For rib treatment, roll the arms to the side of rib ache;
3. Use your arms to pull the head forward while simultaneously lifting the pelvis until a single vertebra or rib is touching the floor;
4. Rock the pelvis up and down to roll the vertebra or rib over the floor until a joint mobilization is felt;
5. Repeat steps 3-5 for other achy vertebrae or ribs;
6. Do this mobilization up to twice a day.

UNWINDING THE UPPER BACK




Thoracic motion (David R. Beatty,
drawing by William A. Kuchera, DO, FAAO)

There's a reason why stress often produces upper back pain. The nerves of the sympathetic nervous system, which respond to physical, emotional, or internal stress, originate in the thoracic spine and can trigger muscle spasm in response to any of those stressors.


DOCTOR'S NOTE: Seek evaluation by a health professional for upper back pain associated with respiratory, heart, or gastrointestinal symptoms that can refer pain to the thoracic area.

THORACIC POSITION OF EASE

Position of ease for right upper back pain (WVSOM)

1. Lie face down with a pillow or two under your shoulder on the side of back pain and the arm resting comfortably;
2. Turn your head to the side of back pain and allow it to rest on the pillow;
3. If back pain is not reduced, add another pillow under your shoulder;
4. When back pain is reduced, take a few deep breaths and rest in that position for 2-5 minutes;
5. Proceed to the THORACIC FLEXION/EXTENSION STRETCH or slowly roll to the side before getting up;
6. Use this position of ease 2-4 times a day or as needed for pain relief.

THORACIC FLEXION/EXTENSION STRETCH

   

Flexion stretch (WVSOM)

1.   Kneel with your arms straight and hands shoulder width apart;
2. Arch your back slowly upward while tucking the head and tailbone downward;
3. Take a few deep breaths and stretch for 5-10 seconds;



Extension stretch (WVSOM)

4. Arch your back slowly downward while curling the head and tailbone upward;
5. Take a few deep breaths and stretch for 5-10 seconds;
6. Repeat the flexion and extension stretches 3-5 times;
7. If no increase in pain, proceed to the STANDING THORACIC MOBILIZATION;
8. Do these stretches 1-4 times a day.



Middle thoracic mobilization
(WVSOM)

THORACIC MOBILIZATION STANDING

1. Stand with arms hanging by your side;
2. Swing your arms to one side as far as they will go, allowing the back to follow the arms;
3. Swing your arms to the other side as far as they will go, allowing the back to follow your arms;
4. Repeat arm swing back and forth 3-5 times, increasing speed each time;



Upper thoracic mobilization
(WVSOM)

5. For the upper back, clasp your hands behind the head and swing your arms to one side as far as they will go, allowing the head and back to follow;
6. Swing your arms to the other side as far as they will go, allowing the head and back to follow;
7. Repeat arm swing back and forth 3-5 times, increasing speed each time;
8. Do these mobilizations up to twice a day.