Rhomboid Decelerator Dysfunction Syndrome
By Dr Seymour Pisarek DC, RTP, FIIT
Canadian Chiropractor- Vol 6, #1, February 2001
Dr. Seymour Pisarek is a 1981 CMCC graduate practicing Chiropractic and Trigenics® at Pro-Fit Sports Performance Enhancement and Rehabilitation Facility located at York University in Toronto, Ontario. Dr. Pisarek is a published writer with the Alternative Medicine Digest, and Canadian Chiropractor magazine: Volume 6, N°1. He is a research consultant for the Trigenics® Institute with a specific interest in rotational sports related injury and rehabilitation. He has treated numerous Golf Professionals and instructors from top Ontario Golf courses, as well as top ranking NHL players from the Toronto Maple Leafs, Carolina Hurricanes, Boston Bruins, and Phoenix Coyotes
Abstract: The Rhomboid Decelerator Dysfunction Syndrome is caused by dynamic loading stress placed on the rhomboids during the deceleration phase of movement. This is most prevalent when decelerating from a rapid extending movement of the arms with a rotational component of the thorax. It can also be caused by cumulative strain resulting from repetitive deceleration of smaller movements involving the rhomboids. In addition to the presenting picture below, the following procedure is useful to provide relief for almost any patient complaining of pain and stiffness in the upper dorsal spine just medial to the vertebral border of the scapula.
NB: Trigenics® procedures are primarily noted as either Trigenics® strengthening (TS) or Trigenics lengthening (TL). Although differing in the main purpose of their application, both procedures have a cumulative relaxatory effect on the target muscle. In this article, an example of only the Trigenics strengthening procedure is presented.
History: One of the most notable areas where this syndrome can develop is in conditions resulting from speed of rotational sports, such as golf. Trigenics® is able to play a definitive role in the treatment of many these types of conditions. With golfers, the purpose of the following Trigenics® procedure would be to open up the posterior compartment of the golfer’s swing follow-through. This, in turn, promotes a balanced transition of movement and synchronized swing delivery.
The patient with this syndrome may also present with a chronic pattern of cumulative or repetitive strain injury, often related to their work environment. This is where habitulization or poor postural decompensation from cumulative rotational stress has led to the development of neuromyofascial lesions. With chronically hypertonic and overfacilitated rhomboid muscles, there is a milieu of recurrent pain and dysfunctional patterns, most notably: segmental vertebral anteriority, restricted protraction, abduction of the scapula, and compensatory muscle recruitment. The patient may also present with chronic-tension-type headaches, non-abating upper back and trapezius stiffness/fatigue, and crepitus with shoulder girdle movements.
Treatment: For this procedure, treatment does not require the patient to remove any clothing or to sit upright. The treatment involves the application of a number of simultaneous procedures:
Proprioceptive Dynamic Acupressure (PDA) applied to specific Myopoints for the Rhomboid group (Agonist)
The patient’s integration of Autogenic breathing
The patient’s activation of antagonistic muscles through voluntary contraction
Light resistance by the Trigenics® practitioner of patient movement to facilitate enhanced Reciprocal Inhibition of the agonist
Gradual increase in PDA to facilitate a Neuromyol-reduction. When moving to the compensatory areas, the Trigenist continues to apply slightly different directional applications of Trigenics® to create a layering relaxation effect throughout the affected musculature.
It is important to note that the intended goal of patient movement in Trigenics® is not to “strip” the muscle but rather to enhance activation of reflexogenic myoneural pathways involved with muscular relaxation. Carefully controlled resistance further complements this process. In addition, the Trigenics® Proprioceptive Dynamic Acupressure technique applied during activation of reciprocal muscular innervation enables the practitioner to palpate more deeply with less, or sometimes, no, pain experienced by the patient. Trigenics® PDA requires very specific, learned palpation skills, which require the practitioner to constantly change the amount and direction of digital pressure in order to increase the therapeutic benefit. The change of the digital force and direction directly reflects the elicited reflexogenics response of the dynamic muscle.
BENEFITS AND RESPONSE TO TREATMENT
Restoration of optimal muscle resting tone or Gamma Bias (2)
Restoration of intra-articular mobility and joint biomechanics (2)
Restoration of unimpeded myofascial glide via neuromyol reduction (2)
Inflammation reduction (2)
Restoration of tissue flexibility and increased range of motion (2)
Decreased pain and spasm (2)
Increased muscle strength and/or length (2)
Results: Within one treatment, the patient will usually feel a dramatic reduction in pain as well as a significantly increased range of motion. (treatments are normally 10-15 minutes) A series of applications will often be required for the patient to feel completely free of any restriction and pain, but the patient will be well aware that the treatment will soon bring them sustained relief. Trigenics® is also noted for its immediate long lasting effects.
Synopsis: Trigenics® is a uniquely interactive and integrated therapy, which synergistically combines aspects of both eastern and western manual medicines. The key componenets of Trigenics® involve practical applications of current neurophysiology applied simultaneously with specific applications of manual meridian therapy. The three main components are 1) neuromyogenics, 2) acugenics and 3) autogenics. (see the glossary) (1). In this article, we have focued more on the western neuromuscular components of Trigenics® through practical application relating to the case study of a Rhomboid Decelerator Dysfunction Syndrome (RDDS).
Overall, results with Trigenics® in both injury rehabilitation and athletic therapy have been quite remarkable. One explanation for this may be related to the “…direct myoneural relation-ships that exist between higher sensorimotor function and the prioprio-mechno receptors.” (2) It is suspected that seemingly superior results attained with Trigenics® are due to the non-linear cascade of neurophysiological reactions, relating to these relationships, which inevitably occur when this cumulative treatment is applied.
Acugenics: the application of Proprioceptive Dynamic Acupressure (PDA) on a specific localized area of moving muscle or acupuncture meridian point to create a state of enhanced muscular relaxation and/or accentuated meridian myopoint stimulation
Autogenics: patient focused, treatment area target visualization with controlled deep breathing to create an autonomic response in order to enhance treatment.
Neuromyogenics: the utilization of Reflexogenic Neuromyology in Trigneics to create an immediate reduction in the target muscles gamma bias. The two main neuromuscular reflexes used for treatment are the Reciprocal Inhibition Reflex and the Inverse Myotatic Reflex. Neuromyogenics involves interactive patient participation.
Myopoint: an abbreviated term used to denote the “Neuromyo-acugenic point”. This term is used to identify the specific location of the target area used to apply PDA in Trigenics. Myopoints share common locations with any of the following: the “palpable band”, the muscle “lesion”, neuromyofascial lesions, the muscle “knot”, acupuncture meridian points, trigger points, tender points, areas of muscle spasm/hypertonicity, neurolymphatic points, neurovascular points.
Austin, AO., Trigenics® Procedures, Module 1, Second Ed, pg 12
Allan N., Trigenics® Neurophysiology, a description and preliminary thoughts towards a rationale, Trigenics Clinical Applications Module III, 1st edition, pp 48-49.