Pain in your shoulders can affect a wide range of activities. ART® providers treat cases of shoulder pain resulting from as little as working at your computer to participating in activities such as tennis, swimming, and golf. Shoulder pain is commonly slow to respond to traditional treatments, and if shoulder pain progresses, it can make simple tasks, such as reaching for things and sleeping, painful.
As with any type of injury, ART® first looks at the underlying cause of shoulder pain. The shoulder provides a great deal of motion for a single joint, and allows people to reach overhead, behind their bodies, across their chest, and to rotate their arms. The shoulder joint is comprised of the rounded end of the arm bone called the “humerus,” and the flat surface of the shoulder blade, known as the “scapula.” Because the shoulder is the joining of a flat and a round surface, it is a relatively loose joint, which is what enables it to provide such a wide range of motions. Stability and control of this motion is provided by the rotator cuffs and scapular stabilizers.
Shoulder injuries occur most often when significant stress or repetitive motion inhibit the rotator cuffs and scapular stabilizers from doing their job. Many people realize that sports such as tennis or golf can cause shoulder injuries easily. This is because these activities demand both a great deal of force from the rotator cuffs and scapular stabilizers, as their swinging motion requires the arm to reach far behind and in front of the body, and numerous repetitions of those motions.
What many people do not realize, is that shoulder injuries are often caused by the actions of their everyday lives. Any time you push, pull, lift, or carry anything with your arms, your shoulder muscles must contract to protect the shoulder. Even working at your computer requires a small ongoing contraction in the shoulder muscles. These may seem like small matters, but combined with the frequency with which many people complete these actions, these everyday activities can cause serious repetitive use injuries.
Inside the muscles and tendons, these motions cause small-scale muscle damages called microtrauma. If microtrauma is not able to heal, it can lead to the buildup of scar tissue also known as “adhesions.” Adhesions then contribute to the cumulative injury cycle, which can eventually lead to more serious injury, pain, and loss of function.
Traditional treatments for shoulder pain include rest, ice, anti-inflammatory medications, ultrasound, muscle stimulation, steroid injections, stretching, exercises, and if these don’t succeed, surgery is recommended. If these methods are effective, they often must be done over a long period of time, and can be costly both monetarily and in the amount of time away from activities. Many of these methods are only able to treat the symptoms of shoulder pain and not the cause.
Active Release Techniques® locates the exact location of the adhesions and releases them, thus eliminating the underlying cause of the pain. To do this, the ART® provider will apply very specific pressure while you lengthen and stretch the tissue. Because of the hands-on nature of ART® treatment, as the provider releases the tissue in one area they are able to determine the overall health of the muscles and tissues in the area and provide the most comprehensive treatment possible.
As we continuously seek to educate and inspire our patients and providers about all things ART, it is important not only to get to know the science behind ART, but also the people. Our talented team of providers is vital to helping as many people as possible live their lives without pain through ART® We’re proud of our team and all that they do to help their patients, so we want to spend some time here, sharing their stories and highlighting their accomplishments with ART® This week, Dr. Karl Tarkanyi has been kind enough to share some of his stories and experiences with us.
ART: Dr Tarkanyi, how did you get started working with A.R.T?
Dr. Tarkanyi: I had been in private practice as a Chiropractor for 5 years before I became certified in ART® A good friend I graduated with from Chiropractic School had strongly suggested that I get certified in ART® because of the results he was getting with it. I recognized that I could be getting better results for my patients, if I had a treatment modality to address the soft tissue components of their injuries. I did not have this after graduating from chiropractic school.
ART: You are now an Elite Provider, which means that you are full-body certified, and that you are part of our team that works with ART® corporate partners. When did you become full-body certified and how has that added to your practice?
Dr. Tarkanyi: I became full-body certified in 2005-2006. I’m not sure of the exact year. I received my ART® biomechanics certification in 2007 and you have to be full body certified before you can take that course. I became an elite provider shortly after that because I became the Elite ART® provider for Pepsi Co.- Detroit in January of 2008.
ART: Is there a particular ART® treatment or patient that stands out in your memory?
Dr. Tarkanyi: I could tell a hundred stories! But my favorite goes like this: the patient had been struggling for years with a painful elbow. Classic “tennis elbow.” He had done physical therapy, steroid injection, and tons of over-the-counter meds without much success and thousands of dollars spent. He finally came to me after reading about ART® on the internet and decided to give it a try. My evaluation revealed that he certainly had a bad elbow, but also had a great deal of shoulder dysfunction that was driving the inflammation in the elbow. I worked on him for about 6 visits over a two week period. I fixed the shoulder dysfunction and the elbow pain. He’s a client for life.
ART: What do you enjoy most about being an Elite Provider?
Dr. Tarkanyi: I enjoy the puzzle. To be really good at ART® you have to have command of anatomy. We all have the same parts, but none of us are alike. Each “elbow” case is different in its presentation, history, and treatment. I enjoy the task of figuring out the puzzle each patient presents and the appreciation I get when I get results.
ART: What type of ART® treatment do you provide most often?
Dr. Tarkanyi: I work on the shoulder and neck a lot. So the ART® protocols for the rotator cuff muscle and the cervical spine. Specifically, the complex protocols that emphasis the movement between adjacent muscles.
ART: What kinds of hobbies and interests do you have outside of work?
Dr. Tarkanyi: I am married and have 4 kids, ages 11,9,8, and 6, so my family keeps me quite busy. We enjoy the outdoors, swimming, and having adventures together.
Dr. Tarkanyi is an Elite Provider from Novi, Michigan at Chiropractic Performance Solutions. His work, both at his own practice, and with an ART® corporate partner, is an excellent example of how ART® can help people get back to living full and active lives.
ART® providers are experts in soft tissue care, but some of the ailments they treat are not what you would expect. Headaches are one such example of a malady that many people may not realize is connected to the health and function of their soft tissues. Headache treatment, in fact, tops the list of conditions where patients experience dissatisfaction with their care. Like with issues that are more apparently connected to the soft tissue, ART® is able to resolve headache injuries more effectively because we find the root of the problem and fix what is causing it.
When we start looking at the underlying cause of headaches, we are examining the muscles, joints and nerves in the neck, also known as the cervical spine. There is a high demand on the muscles and joints of the cervical spine to support the head protect the spine. Headache symptoms are often caused when these muscles are not as strong, flexible, or coordinated as they need to be. This process is called “referred pain,” a complex neurological process, wherein pain is felt in a different place than where it is occurring. Scientific studies have shown that disorders of the neck muscles and joints cause referred pain in the head.
Neck injuries can be caused by anything from poor posture, to repetitive use when participating in certain sports, or a previous injury. These causes often lead to microtrauma, which are small scale damages that can occur in muscles, tendons, ligaments, and joint capsules. This microtrauma does not create pain, but over time can cause scar tissue to build up into something we call “adhesions.” Adhesions can lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow, which places more strain on the neck muscles, causes more microtrauma, and creates a repetitive strain cycle. These adhesions can also cause nerves to get stuck to surrounding muscles and structures, which irritates the nerves and can create headaches as well.
Headaches are often treated with anti-inflammatory medications. When they occur frequently, doctors often prescribe stronger medications, and occasionally suggest invasive procedures such as a joint block. These methods often do not resolve headaches long term because they only address the symptoms, and don’t treat the underlying causes: muscle tightness, scar tissue adhesions, or nerve entrapment. These underlying causes can be hard to detect using diagnosis methods like x-rays or other forms of medical imagery, but fortunately, can be felt manually by a skilled ART® practitioner. A.R.T providers can feel where the underlying causes of headaches are occurring and release the scar tissue adhesions to create a long-term solution to headache relief.
ART® has a long history working with athletes of all kinds, and was actually developed when the founder, Dr. P. Michael Leahy was working with elite athletes to help them get back to peak performance more quickly. No matter the kind of athletic endeavor in which you partake, knee injuries are a common frustration that can be resolved with ART® In addition to being extremely prevalent, knee injuries can also be some of the most nagging, because they can take a long time to come back from, and can stop people from working out or training for weeks or months.
The knee must support body weight as well as flex and extend to generate the propulsive forces needed to move the body. To help the knee serve its very important function, it is surrounded by a complex group of muscles that must be strong, flexible, and coordinated enough to protect and stabilize the knee.
Knee injuries are so common because the knee is interconnected with other joints, namely the hip and the ankle, as a part of the kinetic chain. The knee is a hinge joint that is designed to move backward and forward, but the other joints in the kinetic chain, the hip and ankle, move front to back, side to side, and around in circles. Understanding how pain in one joint can come from elsewhere in the kinetic chain is an important part of how ART® providers diagnose a soft-tissue injury. Very often, knee pain is symptomatic of issues in the adjacent muscles or joints. If the hip or foot has even a minor issue such as over-tightness, weakness, muscle imbalance, or faulty alignment, it can overload the bones and ligaments in the knee, and places even more demand on the muscles around the knee as they try to keep it from moving from side to side or twisting.
When there is a problem anywhere in this kinetic chain, the knee is often the first place to develop pain, even if it is not the source of the problem. This is referred to as movement compensation. The forces generated by any athletic activity do not get properly distributed and they become focused at the knee. For this reason, when diagnosing knee pain, ART® providers know that they must examine the entire kinetic chain, and not just the knee and its surrounding muscles. Treatment that focuses on just the knee often results in re-injury because the root of the problem is not addressed.
Traditional treatments for knee pain often involve some combination of heat, ice, ultrasound, muscle stimulation, steroid injections, exercises, and sometimes even surgery. Many of these methods are ways to temporarily relax the muscles, and all of them deal exclusively with the knee and the muscles surrounding it. These treatments often take a long time to see significant results, and even then those results are temporary and the injury usually recurs. This is because the root of the problem has not been addressed, the entire kinetic chain has not been examined, and scar tissue has not been released.
An ART® provider watches you move and examines the entire kinetic chain using tactile observation to feel the texture and tension of each muscle, and releases the scar tissue that sustains the injury with palpation. This assures that the root of the problem is addressed and keeps the injury from happening again. Best of all, ART® treatment delivers noticeable results in just one 15-minute treatment and can resolve the injury completely with just 3-4 treatments, so you can get back to your active lifestyle as quickly as possible.
One of the most common injuries that ART® providers treat, indiscriminate of their work setting, is lower back pain. Accordingly, it’s no surprise that lower back pain is the most commonly recorded musculoskeletal disorder. In the United States alone, it is the culprit of $100-200 billion in medical expenses each year. 80% of the U.S. population is affected by back pain at some time in their life. The high prevalence of back pain has enabled us at Active Release Techniques® to spend a lot of time studying the causes and most effective treatment protocols for each individual cause.
Back pain results from a wide array of working circumstances including heavy or repetitive lifting, over-reaching working in an awkward posture, and remaining bent over or seated for too long, just to name a few. These tasks create scar tissue, which causes pain, weakness, and reduced range of motion. Because of the large variety of behaviors causing back pain, cases of back-related MSDs can be found in nearly any workplace setting, from offices to factories. Whether the activity causing the pain is sitting, reaching, or lifting, pain origination is frequently linked to doing any of these activities with an awkward posture. Additionally, as people age, their incidence of back pain rises as does the cost, which increases at a greater rate due to the increased time, medication, and procedures necessary for their recovery.
Sitting puts twice as much stress on your back as standing, and when you slouch that stress is compounded. Further, sitting in a slouched position over-stretches the ligaments in your back. Not only do sitting and slouching add stress, they also prevent nutrients from getting to the discs in your spine. Excessive sitting can also cause pain in your hips and pelvis because it tightens and shortens the tendons in that region, placing even more pressure on the lower back. Pain resulting from maintaining an awkward posture, such as crouching or bending for an extended period of time, is often caused by some variation on this same reasoning.
Back pain as a result of heavy or repetitive lifting is also frequently a function of lifting with an awkward or incorrect posture. The weight being lifted adds additional stress to the spine, and awkward posture exacerbates the issue by causing muscles, tendons, or ligaments to over-stretch or tear.
So many of the things we do every day can build up scar tissue over time and cause back pain. Luckily, ART® can help, not only to relieve your pain and release your scar tissue, but also, through our onsite wellness programs, suggest things that you can do to prevent that scar tissue from building up in the first place.
At Active Release Techniques®, a big part of our mission is to make our revolutionary approach to resolving musculoskeletal disorders (MSDs) accessible to as many people as possible. Here on the blog, we want to take the time to talk about MSDs, their causes, and how ART® works to treat them. This week we’ve put together an introduction to provide background knowledge for anyone who wants to know more about what ART® does and how it works.
Every muscle in the human body works through a combination of expanding and contracting alongside nerves, ligaments, and tendons. Ligaments connect together two bones at a joint, while tendons connect muscles to bones. Together these elements make up the system that provides movement, strength, speed and flexibility in your body. Musculoskeletal disorders occur when a part of this system doesn’t function properly. Sometimes they occur because a muscle is too tight, sometimes they occur because a muscle has been stretched too far, and other times it is because tissues get stuck together or don’t properly slide on top of each other. Often MSDs cause muscles to put too much pressure on a particular nerve causing pain and weakness.
When MSDs occur, scar tissue is formed. Scar tissue can be formed through performing a motion with a small amplitude or range repeatedly, or when a larger motion is completed with a great deal of force. Once scar tissue is formed, muscles and tendons become tighter resulting in a cycle of re-injury. ART® interrupts that cycle with scientifically applied manual therapy to quickly and effectively resolve soft tissue injuries.
ART® providers are trained to use their hands to feel the muscle tissues in a patient’s body using ART’s palpation technique. Each provider knows exactly where each muscle, tendon, and ligament belongs, how tense tissue should feel, what tissue texture should be, and how each tissue should move. As a patient describes the problem, the ART® provider begins to zero in on the area affected, feeling the muscles and tissues as the patient moves to determine the precise area from which the problem is radiating and where scar tissue has formed. ART® providers’ hands-on approach results in every soft tissue diagnosis being specific to each individual patient. Instead of sending a patient to a doctor’s office or hospital for an expensive medical imagery diagnosis, an ART® provider can spend just a few moments listening to the patient and feeling the movements of their soft tissue structures. Unlike a patient who walks away from a physician or hospital with a general diagnosis (e.g. sprain or carpal tunnel syndrome), a patient seeing an ART® provider not only knows the name of the condition, but also precisely where and why it is occurring. Even better, having received all of this information, the patient need only remain with the provider for a few more minutes to also receive the necessary treatment to resolve the malady.
During treatment the provider will use precisely directed tension combined with very specific patient movements to resolve the issue. In all, there are more than 800 patented ART® treatment movements (called “protocols”) that every ART® provider must know. Treatments usually take less than 15 minutes to administer – less time than many patients spend in the waiting room of the average hospital or doctor’s office. Additionally, considering that diagnosis and treatment of injuries usually require separate appointments at hospitals or doctors’ offices, the relatively brief ART® care process is quite efficient comparatively, with no wait between diagnosis and treatment. ART® also eliminates the costs of a diagnosis using medical imagery technology, medication to keep pain at bay until treatment can be administered, and the elevated cost of an invasive or surgical solution. While patients often require an average of four ART® treatments to resolve an issue completely, the first treatment delivers relief from symptoms and the ability to return immediately to an ordinary workload, and the entire process comes at a much lower cost than the typical treatment process involving advanced medical technology and pharmaceuticals.
MSDs are one of the most common causes for visits to doctors’ offices in the United States. By resolving these MSDs with Active Release Techniques® , we can relieve pain quickly and effectively while preventing more costly and invasive procedures.
As a part of our mission to be the first choice in soft tissue healthcare, we are excited to be starting our Active Release Techniques® blog for our providers, our corporate partners, and, of course, our patients. We’re creating this blog with weekly installments to keep you all updated on the latest ART® news and developments, keep you informed about soft-tissue injuries, prevention, and treatment, and to help you get to know us as an organization and as people.
It seems only fitting that for our first post, we sit down with ART® founder Dr. P. Michael Leahy to ask him about his 30 year journey with ART, his recent Super Bowl experience as ART® provider for the Denver Broncos, and where he hopes to take the future of soft tissue healthcare.
ART: It’s a pleasure getting to sit down with you. Thank you for making the time.
Dr. Leahy: No problem, thank you.
ART: First, since I’m sure it’s on everyone’s mind, I have to ask what’s it like being the ART® doctor for the Broncos at the Super Bowl?
DL: Incredible. That defense last night was unbelievable. I don’t have a voice anymore. When you work with a team you’re a part of it, and the players treat you that way. It’s all heightened at the Super Bowl since the stakes and emotions are so high, but it’s an incredible feeling getting to help players stay in the game and solve an injury that they thought maybe wouldn’t get solved.
ART: What do you do as an ART® provider at big games like this?
DL: I usually see 35-40 players for treatment before the game and then anywhere from zero to around 12 players during the game. Sometimes I’ll watch a particular player to see how they move if I know they have a certain issue. Half the time, though, I get to be a fan.
ART: Has ART® always worked with elite athletes?
DL: Yes. When I started out as a chiropractor I worked with track and field athletes, and I realized that doing the things that were common then, like giving ultrasound, etc., might help them to some degree and eventually, but not usually in time to help them compete in an upcoming competition. I needed to come up with a faster and more effective way solve their soft tissue injuries. That’s when I started applying what I knew about engineering to my chiropractic work.
ART: You were a pilot and engineer in the Air Force; why did you decide to leave that and become a Chiropractor?
DL: I was a pilot in the Air Force for 7 years, but I had always been interested in medicine, so after I was done with the Air Force I decided to go into medicine. My twin brother was in chiropractic school, and I thought that was something I never, never wanted to do, but then I went to visit him, and I saw what he was doing and I thought that really was what I wanted to do.
ART: And how did you go from working with track and field athletes to building ART®?
DL: Well, three guys in New York and New Jersey hounded me for about a year to do a seminar. I didn’t even know if anyone would show up, but I decided to do it. Anyway, we sold out the room we held it in and I realized there was a market for teaching ART® After that first seminar, though, I also realized that I needed more than just some cursory notes that I had prepared, and that it was going to need to be a much larger course. When we first started seminars I was really demanding, even more than I think I am now, about how much information people needed to know.
ART: What kind of people do you think make the best providers?
DL: What’s great about our providers is that because of the nature of ART®, it takes time and it’s hard, we tend to attract really great people. What they care about most is caring for their patients. Most ART® providers are unbelievably dedicated.
ART: How do you motivate providers?
DL: I think that passing the knowledge is the biggest motivator. At seminars, the whole time they’re learning protocols they are realizing how they can use what they’re learning on patients that they have on Monday. Sometimes at seminars the doctors will bring me a live case that they haven’t been able to solve, and I work with everybody to show them how I can solve it. I think it’s motivating to see what can be done with ART, and that you can learn to do it too. It is also motivating to be a part of something bigger than yourself. When they realize ART® isn’t just learning all the protocols, it’s a movement.
ART: ART® isn’t easy. What advice do you have for providers who are struggling to learn the ART® protocols?
DL: Some of our best providers are the ones who fail at ART® at first. That’s because the ones who 'get it' consider the skill learned and move on, and sometimes they don’t keep working as hard. But the providers who fail at first, they work even harder to improve. I think all ART® providers should work like that.
ART: How did you start teaching ART® internationally?
DL: If you count Texas and Canada as different countries, the growth was just natural, but Europe was an experiment. We had some European providers that were coming to the US for seminars, so I just said 'let’s have one in Rome.' I didn’t know if even one person would show up. We started in Florence and we rode bikes from town to town for ten days. There were five instructors, and it was just like a vacation in Italy. I told them whatever comes in from the seminar, we’ll divide it among the instructors, but it might be nothing, and then you have to pay your own expenses for the trip. Fortunately, the seminar made enough to cover everyone’s expenses and a little extra. That’s how we started in Europe.
ART: Moving forward, what do you hope for the future of ART®?
DL: I think about the changes we’ve made already. The whole chiropractic profession has changed. No one used to do soft tissue and now almost everyone does. We’ve made a significant difference in the lives of about 50 million people already. ART® also has the potential to have huge economic ramifications. Half of the problems we deal with are neuromusculoskeletal. If even half of those could be treated with ART® instead of other therapies and surgeries, that would be a huge savings in healthcare.That is potential for big change. When I think about what ART® could do, my hope is that a whole lot of people will not lose their jobs, work in pain, or quit their sport because of soft-tissue problems.
ART: That sounds like a great mission. Thank you so much for taking the time to talk with us today.
DL: Of course, thank you.