Issue link: https://www.massageandbodyworkdigital.com/i/68174
ESSENTIAL SKILLS Using AIS to Address Pain and Resolve Injury AIS practitioner Roger McNear tells the story of one client, a sophomore in college, who had such severe shoulder pain he couldn't concentrate or sleep through the night. The student rated his level of pain as 10 out of 10. This young man had previously been highly active. In addition to competing as a distance swimmer, he also did triathlons, played tennis, and played the mandolin. McNear realized that all of these activities developed the muscles on the front of the client's body (referred to as the anterior chain), specifically the muscles on the front of the chest and shoulder. None of them helped to strengthen the opposing muscles at the back of the shoulder area (part of the posterior chain). Moreover, earlier treatment may have made the situation worse; the client's first therapist had worked almost exclusively with the anterior shoulder muscles. Through an assessment process, including AIS range-of-motion tests, it became clear that this individual was suffering from chronic injuries to two important muscle-tendon regions: the supraspinatus and the biceps. Damage to these structures was the direct cause of his pain. After performing the AIS exercise The first AIS hyperextension stretch and three additional starting positions. protocols on his neck, shoulder, and upper back area (attending to both the anterior and the posterior chains), the pain decreased significantly (from a 10 to a 6 or 7). After several more hours of work the next day, his pain level was down to a 2 or a 3. McNear taught him AIS stretching and strengthening techniques to do on his own, and then saw him again 10 days later. The pain had remained at a level 2, and by the end of the session the shoulder was no longer painful. In summary, this treatment not only resolved the direct cause of pain, but also helped begin the process of establishing muscular balance that would prevent similar damage from occurring in the future. An average person can lift about 10–15 pounds using this muscle. When we go on vacation, our suitcases usually weigh a good deal more (often 30–40 pounds). It is likely that dealing with the suitcase—lifting it, carrying it around, putting it into the trunk of a car, lifting it up to place it in the plane's overhead bin, etc.—was the precipitating event that led directly to the injury. What is causing the pain now (the direct cause) is the result of that event: tears in the supraspinatus muscle and/ or tendon and the resulting adhesive scarring. There may also be additional factors that predisposed this person to injury, such as a lack of strength or flexibility, muscle tension, or poor body alignment. These are indirect causes. Whether or not you can identify a specific precipitating event, it is important to resolve the direct cause of the pain. The necessary treatment may range from hands-on work to exercise therapy to injections to surgery, depending on the nature and severity of the injury. While AIS does not work in every case, it is a good place to start. AIS is noninvasive, and for some mild to moderate cases, it may be the only form of therapy required. Gentle, progressive stretching and strengthening exercises in the AIS protocols can help modify adhesive scar tissue and restore pain-free movement. In treating the supraspinatus muscle-tendon unit, the process includes a series of stretches referred to as hyperextension of the shoulder. In these stretches, the AIS practitioner assists the client to extend the arm straight back with the arm rotated in four different positions (Image 2). The strengthening component starts with a standing abduction exercise (moving the arm away from the body sideways, using a light weight), and then progresses to the same 90 massage & bodywork may/june 2010