Taking Care of Your Joints

You are the best asset!

We go about our daily lives, awaken in the morning after a night’s sleep, get ready for work, stand in the kitchen, sit on a couch or chair, read the paper, go on our blackberry or other type of electronic device, laptops and home work stations, drive/walk/bus to work or school, sit at a desk all day, exercise and then come home make dinner and go to bed.  

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Do you ever think of how your body is aligned during all of these daily activities? We do! A large portion of patient care at Back to Health Wellness is understanding how you make use of your body during and night the day. We ask that you read on and learn how to be your own investigator and on how you keep your body aligned during the day and at night.       

Let us first understand the way in which our bodies work. If you maintain your body in a ‘neutral’ or normal alignment this will have the least amount of force exerted on your body.
This alignment allows the least amount of force or pressure to be placed on the joints, nerves, muscles, ligaments (attach bones to bones) and tendons (attach muscles to bones). Wow, would that not be great for our bodies to allow them to feel good! Often patients do not know how to achieve this. Read on and we will explain how! 

Proper Sleeping Techniques
Wow, did you know there is a technique for sleeping? I did not until I went into chiropractic and realized how many people hurt themselves while sleeping! A week does not go by without someone coming in and stating, “Something funny happened in my sleep." It is not funny when they are in pain.  

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Here are some things to think about for ergonomics of sleeping: do not sleep with your arm above shoulder height, do not place it under your pillow (this indicates that your pillow is too low for you), you should sleep on your back or sides and not your stomach (this is very hard on the neck, back, shoulder and knee joints and causes arthritis over  time), sleep with your body not twisted, you can use a pillow between your knees when you are on your side and a pillow under your knees when you are on your back, and your arms should be in a relaxed position and the wrists should not be bent.

The age and type of your mattress makes a difference as well.  The majority of mattresses only last 10-12 years. When looking for a new mattress look for a medium one that offers support.  If you go with a coil mattress ask for the greatest coil count, this gives you the greatest support.

Your pillow is important too! This normally last up to 2 years, if you have a water pillow they normally last 5 years. 

Feather pillows are not advised as they do not offer support; people normally fluff them up and the fluffing does not last long once you fall asleep. If you use a feather pillow try a water pillow instead as they are the same type of support system. 

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Back to Health has loaners for pillows if you want to borrow one ask at front reception.

Feet are the foundation for the rest of the body!

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Did you know that the average person walks about 250,000 miles in their lifetime? When a person weighing 165-170 pounds walks an average of 7.5 miles a day they will carry 500 tons a day on each foot! Your feet are remarkable pieces of equipment--they must act as rigid levers to propel the body forward and also act as a shock absorbers during the their initial contact with the ground. Their complex structure allows your feet to perform these functions very well; however, they are obviously subject to tremendous stresses, making them and the other body parts associated with walking the targets for many possible problems. 

If the alignment is off at the foundation the rest of the body will be under strain as well.  80% of people over the age of 20 will pronate (inward rotation after heel strike). This can cause strain on the plantar fascia of the feet, knees and even the hips and lower back. This is why we complete a gait analysis with all of our new patients. If the foundation is an issue it needs to be addressed by supporting with orthotics. These can sometimes be off the shelf or custom made.  

Proper Lifting & Bending Over Techniques and Proper Work Station Ergonomics

Lifting Techniques:
Never bend your back to pick something up, Hold the object close to your body, Don't twist or bend, Keep your eyes up, Plan ahead before lifting, Lift close to your body, Feet shoulder width apart, Bend your knees and keep your back straight, Tighten your stomach muscles, Lift with your legs, Do not lift and twist your torso, instead turn your whole body, Wear a belt or back support, get help if the load is too heavy.

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Ergonomic Techniques:
Have your monitor at eye level (your eyes intersect the middle of the screen), The monitor(s) should be straight ahead of you and not off to the side, Use a keyboard tray, Have your wrists straight and not bent up or down, Rest your wrists, The back of your chair should be slightly tilted back and the seat should be slightly up – as if you are reclining a bit (least amount of pressure on the lower back and hips), Use a foot stool.   

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Ergonomic Assessment:
Send pictures to Dr. Barbara Rodwin of yourself at your workstation and she can make recommendations!

Send the following:
Two from the side          
One of the top part of you including the monitor, the other of the bottom part of you including your feet. 
One from behind
Showing your head and the monitor.

Immune System

VITAMIN D: WHAT YOU NEED TO KNOW

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Low dietary intake and limited sun exposure have led to an epidemic of vitamin D deficiency. Health experts now advise adults to regularly check their blood levels of vitamin D and to address deficiencies with supplemental vitamin D.

Vitamin D plays many essential roles throughout the body—enhancing calcium absorption, contributing to healthy bone mass, supporting immune function, quelling inflammation, and helping to fight cancer. Clinical studies support vitamin D’s role in preventing and treating colon and prostate cancers, and emerging studies suggest vitamin D may help avert cancers of the breast, ovaries, head, and neck, among others. 

Vitamin D quells inflammation that may exacerbate chronic heart failure, and in combination with other nutrients, benefits people with chronic heart failure. Vitamin D also shows promise in preventing both type I and type II diabetes, and offers important support for immune health. Vitamin D may help prevent wound infections and flu, support the body’s defense against tuberculosis, and boost immune function in patients with kidney failure. 

Vitamin D likewise may help to alleviate Seasonal Affective Disorder (SAD), a type of depression experienced during the winter months due to decreased sunlight.

Looking for Natural Alternatives for a Cold or Flu?

The immune system is a very complicated mechanism within our bodies.  When off, it creates havoc for us! Traditional medicine offers us medications when ill which do not allow our own immune system to fight the offending pathogen. Have you ever thought of using natural products that aid your body in increasing its own natural immunities?

There are many ways  to prevent colds and flus naturally!  You can have a natural flu shot, take a prevention flu product weekly, take vitamins/anti-oxidants, use a neti pot weekly, and there are many more natural remedies. Interested? Email Dr. Rodwin to find out how! Dr.Rodwin@back2health4you.com

Foods that aid in helping the immune system

1. Nuts provide protein and are a rich source of mono-unsaturated heart-healthy fats that may actually decrease bad cholesterol and reduce heart disease risk by up to 25 percent. Nuts also provide vitamin E, folate, potassium and essential nutrients such as copper and magnesium for helping the immune system.

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2. Get pumped up for pumpkins. Pumpkins are abundant in beta-carotene, an important antioxidant. One cup of cooked pumpkin has only 40 calories and provides 4 grams of fiber.

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3. Apples have it all -- great taste, good looks and health claims that can't be denied. Apples are a low-calorie choice with antioxidants, fiber, vitamin C, and phytochemicals that reduce your risk for many chronic diseases. 

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4. Enjoy the red and green. Brightly colored foods such as red beets, apples, cherries, pomegranates, and cranberries provide an abundance of vitamins A and C, which are important for a strong immune system, along with other phytochemicals important for disease prevention. Green produce such as spinach, broccoli, avocados and pears also contain these important nutrients. Avocados in particular help increase the absorption of nutrients from other foods when eaten at the same time. 

5. Vitamin C is a powerful antioxidant. 
Foods rich in vitamin C: Red and Green Hot Chili Peppers, Guavas, Bell Peppers, Fresh Herbs (Thyme and Parsley), Dark Leafy Greens (Kale, Mustard Greens, Garden Cress), Broccoli, Cauliflower, Brussels Sprouts, Kiwi Fruits, Papayas, Oranges/Clementines, and Strawberries.

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Acupuncture for the Immune System

It’s flu and cold season. Also known as the season for drugging yourself silly and making yourself go to work even when you’d rather curl up in bed and do nothing for 48 hours. But it doesn't have to be that way. If you’re looking for a method to fill in the weak gaps in your immune system and promote relaxation and pain relief, you’re looking for acupuncture. How does acupuncture boost your immune system and prevent colds?

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From the standpoint of the ancient practice of medicine, the reason why acupuncture works is because of the manipulation of energies in the body. Everyone has varying weaknesses in their energy; places where the Chi naturally has problems. Acupuncture can address these weaknesses in the same way a vaccine addresses weaknesses; by boosting energy and giving the body what it needs to strengthen itself. At the root of it all, we see the movement of energy. When the body’s Chi is moving sluggishly and brokenly, the body falls prey to viruses more readily; when the body’s Chi is in balance, the body stays healthy and can fight off viruses.

Not enough? Studies have shown that acupuncture helps the brain increase the body’s level of T-cells; cells which destroy bacteria and harmful viruses in the body. It is thought that acupuncture does this by provoking the body’s immune response through the use of the needles: the body thinks the needles are a threat and marshal their white cell and T-cell count to fight them off. However, the effect of this lasts days after the acupuncture session and so works on viruses and bacteria as well.

So, sick and tired of being… well, sick and tired? Acupuncture may be a great way to fill in the missing gaps in your immune system and keep you healthy this flu season!

Getting a Good Night’s Sleep

Sleeping postures and pillows

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We spend approximately one third of our lives sleeping.  Sleep allows our body to restore itself for the day both energy wise and physically. 

Common sleeping positions often lead to poor sleeping posture, neck and back pain when sleeping, pressure on the different joints of the body, and injuries due to sleeping.  With respect to our sleeping position we should either sleep on our sides (with a pillow between knees) or back (a pillow under knees) and never on our stomach.  Sleeping on the stomach reverses your spinal curves and places a lot of force on the joints of the body. 

Are you sleeping properly? If you are not you can injure yourself and interfere with your body’s recuperation time.

We should never sleep with our arms up above chest height, with our hands under our pillow, or with our legs rotated forward and bent too high.  Your body should be in a straight alignment.

Your pillow should be replaced every 1 – 2 years unless you sleep with a water pillow and these last normally 5 years. The pillow should be at a height so that when you lie on your side your neck and head are straight and not bent down or up.  If you are wondering about your pillow please bring it in and Dr. Barbara Rodwin can check the height and age of it for you.  We have pillows to loan out, ask the front desk about borrowing one if you would like to.

Sleeping Tips:

You should try to go to sleep at the same time each night.  The room you sleep in should be as dark as you can make it.  Do not sleep with your cell phone under your pillow as studies have indicated that the cell phone emits harmful radiation that can damage your brain and lead to brain cancer or tumors.

If you have problems falling asleep or you wake up in the middle of the night you can take natural supplements to aid in getting a good night’s sleep.  These can include: melatonin, 5-HTP, taurine, magnesium, Phosphatidlyserine, and several other ones. 

If you have problems sleeping email Dr. Rodwin and she can make suggestions to ensure you obtain a good night’s sleep!

Mattresses

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Mattresses last for 10 to 12 years.  If yours is older than this, it is time to replace it. A mattress is important to getting a good night’s sleep and allows our body to feel good!  There are so many types in this day and age to choose from. You should ensure you do your research before going out to look for one and understand the warranty and exchange policy the company offers for the one you purchase.

There are basically three comfort preferences: soft (Pillow Top), plush and firm. There are also varying forms of the Pillow Top. Learn about the support system- foam or innerspring.  A good support system provides good support whether your mattress is a pillow top, plush or firm. Never put a new mattress on an old foundation. You can also look at purchasing a latex or memory foam mattress. Mattress buying is the most important decision you will make in furnishing your home, since you and your loved ones will spend close to one-third of your lives sleeping on your mattresses. For a mattress that costs $1,000, you spend approximately three cents a day. Aim to buy the best mattress you can for the money.

For more information on mattresses please ask Dr. Barbara Rodwin.

The Top 11 Causes of Low Energy 1.   Low Iron 2.   Thyroid Dysfunction 3.   Vitamin B12 Deficiency 4.   Insufficient Magnesium 5.   Stressed Adrenals 6.   Food Sensitivities 7.   Missing Essential Fats 8.   Low Coenzyme Q10 9.   Chronic Bowel Issues 10. Dwindling Sex Hormones 11.  Not getting a good night’s sleep

Are you tired of feeling tired? If you are find out how to increase your energy! Ask Dr. Barbara Rodwin.

Preparing for Winter Sports

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It’s that time of year to begin thinking about and preparing for winter sports. Skiing, snowboarding, ice skating, ice hockey, and snow shoeing are some of the most popular activities that tend to start as we head into winter.  If you don’t take the time to properly prepare the body for the stress placed on it during these activities (some more than others), then you are setting yourself up for muscle aches and soreness and also pre-disposing the body to injuries.

Your preparation should include the following:

1.   Stretching and strengthening

2.   Preparing yourself and winter gear

Strengthening and Stretching 

Many winter activities use the strength and power of the lower body. The lower body holds the largest and strongest muscles, which many of us neglect all summer. Come first snowfall, we are out there on the mountain unable to participate to our full capacity because our legs become tired after two runs.

Strengthening your muscles before the season starts will also help prevent injury. Our joints endure a tremendous amount of pressure and instability in many winter activities. If we have strong muscles, ligaments and tendons surrounding the joints, there is less of a risk of injuring the joint. For example, many of us know of someone who has torn the ACL or meniscus in the knee while downhill skiing. This injury can be prevented if you have a strong quadriceps and hamstring muscles surrounding the knee joint because these muscles do not allow the knee to torque in a way that will tear those ligaments. Being strong going into your winter season of fun will also help with your recovery process. Many of us have woken up after a day of fun unable to hop out of bed. Muscles have memory and must practice to remember. They get used to the movement and the way they are required to fire to move properly. The more you do it, the easier it is and the less sore you are!

Strengthening: Snow Sport Circuit

• 10 min warm-up (running, cycling, cross trainer)
• 10 calf raises
• 10 push-ups
• 10 lunges on each leg
• 30 bicycle crunches
• 10 box jumps (or tuck jumps)
• 10 triceps dips
• 10 single leg squats on each leg
• 10 bridges
• Repeat 3 times
• 5 min cool-down

Stretching

Think of a top down approach:

• Neck and Shoulders
• Back and Sides
• Thigh and Extensors
• Gluteals and Hamstrings
• Lower Legs and Feet

Preparing Yourself and Winter Gear

1.  Be sure your diet is adapted to the physical activity.

2.  Drink lots of water and drink it often to avoid becoming dehydrated, which can be caused by physical exertion and the cold.

3.  Protect your’s and your children’s faces with sun block (adapted to your skin type) and renew its application throughout the day, even when it’s cloudy or overcast.

4.  Never leave without your sunglasses.

5.  Check weather, snow and ice conditions beforehand and dress, wax and sharpen accordingly.

6.  Wear a helmet!

7.  Maintain your chiropractic and other treatments!

Headaches and Migraines

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Chiropractic aids in alleviating headaches and migraines.

If you have a headache or migraine, you're not alone. Nine out of ten Canadians suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache or migraine? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative. Research studies show that chiropractic spinal adjustments - the primary form of care provided by Doctors of Chiropractic - may be an effective treatment option for tension headaches and headaches that originate in the neck, face or jaw.

It is advised to have a biomechanical exam to determine the cause of your headaches or migraines. After this exam, Dr. Barbara Rodwin will often adjust these regions. Recommendations  such as  massage, food testing, supplements, changes to sleeping positions, proper pillows, ergonomic changes, mouth guards, x-rays, neurological consult, stretching and strengthening the involved areas, may also be suggested. Headaches or migraines are often caused by many factors combined and these all need to be addressed to help resolve the issues.

HEADACHES AND MIGRAINES ARE MULTI-FACTORIAL. THEY CAN ORIGINATE IN THE JAW, FACE, NECK AND SHOULDERS. 

Nutritional Supplements for Headaches and Migraines


Dr. Barbara Rodwin will determine from nutritional analysis if nutritional supplements are required to aid a patient in alleviating their headaches &/or migraines.

Some of the nutritional supplements that Dr. Rodwin may suggest are: magnesium, fish oil, coenzyme Q10, melatonin, Vitamins B, C, D, and E. A Daily Food Analysis is completed to determine the deficiencies. 

Food Sensitivities:
Also, foods can trigger headaches and migraines. Dr. Rodwin may suggest testing for this. 

Massage therapy for headaches and migraines

Trigger points in the neck and shoulder muscles contribute to headaches

Massage therapy is very effective in reducing the trigger points (knots) in the muscles that are involved with headaches and migraines. Tension builds in our bodies every day due to stress; positions we put ourselves into when we work, sleep and perform everyday activities; from old injuries/accidents and falls. This tension causes the muscles to shorten and build up these knots. Massage on these areas can aid in resolving the knots. Also the Active Release Technique is effective to reduce these adhesions.  After a massage the joints of the spine often need to be addressed as well to restore the alignment to the vertebrae that are pinching the nerves which cause the headaches/migraines. Ask your massage therapist about this.

CATS (cranial adjusting) technique for headaches/migraines

The cranium or bones of the skull can go out of alignment when we undergo a vigorous shake, bang your head on a trunk or shelf, whiplash, and fall and hit our heads. Dr. Barbara Rodwin can evaluate the motion and condition of these skull bones. If there is a bump, or other changes to these skull bones Dr. Rodwin can adjust them to aid in resolving the headaches and migraines.

Ask for your skull or head to be examined!

Acupuncture for Headaches and Migraines       

                 

Clinical research indicates that acupuncture is very effective for headache/migraine sufferers. In a study published in the issue of Cephalalgia, scientists evaluated the effectiveness of acupuncture in the treatment of migraines and recurrent headaches by systematically reviewing 22 randomized controlled trials. A total of 1,042 patients were examined. It was found that headache and migraine sufferers experienced significantly more relief from acupuncture than patients who were administered "sham" acupuncture.  

In another study, published in the June 2003 Issue of Medical Acupuncture, doctors found that acupuncture resulted in the resolution or reduction in the frequency and severity of cluster headaches, and a decrease or discontinuation of medications. It was concluded that Acupuncture can be used to provide sustained relief from cluster headaches and to stimulate adrenal cortisol to aid in discontinuing corticosteroids. 

Taking Care of Your Feet

Flooring and Our Feet

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Over the last few decades flooring has changed substantially in our homes. In the 80’s and 90’s we had carpeting throughout the majority of the home. This carpet quite often had a thick under padding to add cushioning and softness to the floors. We now have changed the flooring significantly to much harder surfaces. For example, we now have hardwood, laminates, ceramic tiles and other hard materials. This change in flooring has caused a lot more of the population to experience foot discomfort. 

The reason the harder flooring in the homes may create issues for some is due to the lack of shock absorption the flooring provides.  

Some of us have a very high heel strike force. This higher heel strike on a ceramic tile means the structures of foot are under strain because there is no shock absorbed by the tile and this is then transferred directly to the foot. 

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This can cause a repetitive strain in some on the structures of the feet. These structures include the Plantar fascia under the heel that inserts in the ball of the foot, the Achilles tendon at the back of the heel and even up into our lower leg/shins. 

Another part of the foot under strain can be the metatarsal bones under the ball of the foot. Often as we age we lose the fat pad under the ball of the foot because the arch (transverse) that runs across the ball of the foot drops. 

The feet/flooring issues may arise with lifestyle change, such as when the person has retired or is home on a maternity leave, and this can mean they are now spending a lot more time in the home on those harder surfaces and thus can experience more discomfort. Often when the person is on maternity leave they are also carrying around the weight of a baby putting even more pressure on the feet.

 

SOLUTIONS: 

1. Wear footwear indoors.  This can be indoor use running shoes or slippers/Crocs that have a lot of shock absorption.  This also will put padding between the foot and the floor.

2. Choose “softer flooring”.  For example, choose laminate flooring for the kitchen that looks like ceramic tile.  Cork flooring, although more expensive, is softer than the hardwood flooring. 

3. Place soft mats on ceramic or hardwood.  If you tend to stand at the sink to do dishes place the mat under yourself.  Move the mat around to in front of the stove when needed.  Very good quality foam mats are now available for this purpose.   

Taking Care of Your Feet

Why do my feet go numb on the elliptical machine or with cycling?

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There are 2 arches in our feet. There is the one most of us think of that runs the length of our foot and there is another less known one that runs across the width of the foot at the “ball”. This is called your metatarsal or transverse arch. Most of us don’t realize this arch can fall or drop. 

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Often the only symptom we may notice is our shoe size increases by ½ a size. This sometime occurs during or after a pregnancy, with higher impact activities, or even just with age. Our feet have receptors on the bottom that bypass our conscious control and we will alter the way we walk to avoid any foot pain. When the transverse arch drops we may push off involving the big toe to avoid the dropped bones in the ball of the feet. A callus may develop on the big toes but you experience no discomfort. However, if that arch has dropped and you have to load the ball of the foot, like on the elliptical or while cycling, the toes may go numb. The reason that occurs is the nerves that run between the metatarsals in the foot get compressed and numbness results. 

The solution to this may be to add metatarsal pads to the footwear to splay the metatarsals thus take the pressure off the nerves.  

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Adhesive metatarsal pads are available here!

The Shoulder

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Shoulder Mechanics

Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to perform a number of activities. Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured. The shoulder is made up of two main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round, and it fits into a socket in the scapula. The scapula extends around the shoulder joint to form the roof of the shoulder, and this joins with the collar bone (clavicle). Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle. Four muscles begin at the scapula and go around the shoulder, where their tendons fuse to form the rotator cuff. When the shoulder moves, the end of the humerus moves in the socket. Very little of the surface of the bones touch each other. Ligaments and muscles keep the humerus from slipping out of the socket and keep the clavicle attached to the scapula.

To keep shoulders healthy and pain-free, it's important to know how to spot and avoid common injuries.

Recommended Treatments for Shoulder Injuries

Signs that you should seek treatment include:

1. Shoulder pain that persists beyond a few days

2. Recurring shoulder pain, even if it has a history of settling on its own

3. Inability to carry objects or use the arm

4. Injury that causes deformity of the joint

5. Shoulder pain that occurs at night or while resting

6. Inability to raise the arm

7. Swelling or significant bruising around the joint or arm

8. Signs of an infection, including fever, redness, warmth or swelling

Dr. Rodwin can assess your shoulder problem and will recommend treatments specific to your issues based on her diagnosis which may include: chiropractic adjustments, massage therapy, Active Release Treatment, acupuncture, stretches, etc. It is very important to seek out treatment early on before the problem becomes a chronic issue.

Common Injuries of the Shoulder

Bursitis: The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is an inflammation of a fluid-filled sac, or bursa that lies between tendon and skin or between tendon and bone. Normally a bursa protects the joint and helps make movement more fluid.

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Rotator Cuff Tear: A Rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.

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Shoulder Instability: Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition

Shoulder Dislocation: A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

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Shoulder Separation: Also called an AC separation, these injuries are the result of a disruption of the Acromio-clavicular joint. This is a very different injury from a dislocation!

Arthritis: Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. Arthritis is a gradual narrowing of the joints and loss of protective cartilage in the joints about the shoulder.

Frozen Shoulder: Also called 'adhesive capsulitis,' this is a common condition that leads to stiffness of the joint.

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Motions of the Shoulder Explained

Normal movement of the shoulder requires fluent action at four different joints and these often are out of alignment with shoulder problems.

• Scapulo-thoracic Joint: Movement of the scapula (shoulder blade), gliding on the rib cage and with the thoracic spine (midback).  Normal motion is: for every 2/3 of gleno-humeral elevation (shoulder), there is 1/3 of scapulo-thoracic (midback with shoulder blade) elevation. Movements occurring here include elevation/depression, retraction/protraction and superior/inferior rotation. When someone undergoes a shoulder injury their body adapts and switches the mechanics from 2/3 shoulder motion to 1/3 shoulder motion and from 1/3 midback-shoulder blade motion to 2/3 midback-shoulder blade motion. Commonly this movement is not fixed completely for patients that have shoulder problems and this is the main reason why their problem does not go away.  The thoracic spine (mid back) needs to be treated as well to aid in resolving their shoulder issues.
• Acromio-clavicular Joint: Movement about this joint is very slight- but this synovial joint actually allows small amounts of superior and inferior glide.  When this goes out of alignment there can be discomfort or pain in the front of the shoulder.
• Sterno-clavicular Joint: This refers to the joint of the acromion at the manubrium of the sternum. Movements allowed here include elevation/depression, anterior/posterior translation and small amounts of rotation.  Problems in this area can lead to discomfort/pain in the front or the upper back area.
• Gleno-humeral Joint: Movement of the head of the humerus in the glenoid fossa.  Problems with this joint can lead to muscle imbalances and tightness in the muscles in the shoulder.

It is important with shoulder problems to evaluate the motion of all these shoulder joints to aid in resolving the shoulder problem.