I have a new client who is complaining of numbness just below her right shoulder blade. She is young and has three kids under the age of five years. The smallest is permanently on her right hip, which explains the muscle imbalance. If I work with her on the imbalances, will the feeling come back or should she see a doctor?
Thank you for your question. Your client’s problem is common and usually caused by poor postural positioning/motion. Although I can’t give you exacts, I will describe to you where to start. A numbing usually means a nerve is involved. If we are to focus on the area you have mentioned, the first place to address is the dorsal scapular nerve at the rhomboids. The dorsal scapular nerve pierces the middle scalene and then travels on the anterior side of the levator scapulae and rhomboids, supplying them both. The nerve can become entrapped under the levator and rhomboids, requiring a release to enhance the relative motion between the levator and rhomboid. This is a common region for chronic tension and pain, especially if your client’s shoulder is being pulled forward and down when holding her children. Although, many other structures can easily be involved in the same complaint, this should give you a start to your “referral conversation.” I would use the above information to refer to a therapist that specializes in Active Release Techniques of the upper extremity (www.activerelease.com). They will appreciate your referral and most likely send you clients for your specialty. The key to being a great trainer is knowing when to refer out. Once you have resolved her immediate issue, design a program that deals with her functional patterns of movement. Stay away from isolated movements that will “drive” her into greater forward positioning. Good luck!