Umbilical Hernia?

So… I began a new chapter in my career.  One that involves another 8 years of study. When I first began this journey I attended a “knee course” in LA with Guy Voyer MD, DO.  I spent 27 hours that weekend re-learning knee biomechanics and knee anatomy.  There are structures that he described that are not in the medical anatomy textbooks in the US!   Needless to say, I was a little surprised, confused and bewildered at the same time.  That was June of 2010.   Since then, the level of insight and applicable anatomy/ biomechanics gets more and more insightful.  Here is but another example!

The level of anatomy and biomechanics far exceeds what I’ve been taught thus far.  By simply applying anatomy at its highest level, I have been able to assist patients with hernias, that I never understood before to be possible.

Patient:  Reports to my office complaining of an umbilical hernia that she got 14 years prior, from carrying twin girls.  She also has a more recently found inguinal hernia on the R, but that’s not for this blog!  Below is the picture of the size of her umbilical hernia.

After prescribing one abdominal exercise to properly close the hole at her belly button.  This is the after picture that I took 3 weeks later!

The original size was palpable and not visible.  In the ‘after’ photo, the hernia was no longer palpable outside of the belly button ring.

photo.JPGBefore                                                                                                  photo.JPGAfter

Side Effects:  a tighter overall abdomen as we ‘tightened her corset’ around her abdominal wall.

Next up.  Her inguinal hernia!  Please check the testimonial section of the website for her testimonial.

If you know any women or men with umbilical hernias, diastasis recti or other issues with the abdominal wall, please refer them in for a consult.

Please email me with any questions that you may have!

In Health.

Dr. Jason Amstutz DC, RTP, CCSP, CSCS


The final of a 3 part series on Function.  I could write a 10 part series, but I will save you all the boredom!

So… we’ve discussed what Function isn’t.  So how do we create it?  What are the parts involved?

Without plunging deep in the proverbial ‘rabbit hole’ we will keep it simple.

I’m going to argue the following

Structure Dictates Function!  Most of us have heard and/or used this before.  Its been a mantra of mine since I first graduated Chiropractic school.  Not until recent did I truely understand what 10% of this means.

The Structure:  primarily starting with the Pelvis.  (Without making this into an anatomy lesson, I will attempt to make this brief and poignant)

  • Based upon Tensegrity = Force of Compression (using bones) combined with Tension (using ligaments and fascia)
    Human as a Tensegrity Model!

    Human as a Tensegrity Model!

                                                                    copyright  T. Flemons 2006

Therefore…  The pelvis is literally the ‘center’ of the balance of the entire Tension and Compression (tensegrity) system!

Specific Example.  Scapula is directly influenced by the Pelvis via 1 direct link!  How is that?  Simple.  Latissimus Dorsi (lat) is continuous with the thoracolumbar fascia which is connected directly to the pelvis (1).  Continuous with the Latissimus Dorsi is LeBlanc’s Fascia, which connects directly to the scapula.

What does that mean for a patient or athlete?  A pelvis that is not properly balanced will directly cause a shoulder issue (of many varieties;  labrum tears, tendonitis, impingement, scapula dyskinesis, etc)

The basic KINETIC CHAIN theory that we have all learned or heard about, needs some clarifications.  Mainly that the CHAIN is not the ‘shin bone connected to my thigh bone’ approach, but better explained…’the shin bone is held in relationship to my  thigh bone via a vast complicated network of fascia and ligaments and muscles’ AND the mechanics of the knee (joint between the shin and thigh bones!) is NOT ONLY determined by the bony interface, but also highly influenced by the tension in the system in the anterior, posterior, medial and lateral sides (to simplify)…

This explains many more complicated interactions of the body that Dr Guy Voyer has been introducing to many Therapists, Doctors and High Level Trainers in the US and Canada.  If the structure isn’t properly balanced and mobile, proper Function isn’t achievable.

So if you’ve given up on your Shoulder, Lowback, Neck, Headache Pain OR you are desperately trying to get your 95mph fastball back, 4.1sec 40…or ….  Give us a call and find out exactly the disturbance in your Tensegrity system that is causing your pain!

In Health

Jason Amstutz DC, RTP, CCSP, CSCS

Somatherapy and Somatraining Student of Dr Guy Voyer.

Before Movement is discussed, should you first assess for muscle recruitment and muscle quantity? Function Part 2 of 3

Before ‘movement’ is discussed, should you first assess for muscle recruitment and muscle quantity?

Some of the latest ‘hot topics’ in the rehab and training world, uses movement quality as a sign of DYSfunction or lack of function.  Take a moment and think about that…kinda makes sense but has some inherent holes.

#1 what about the structure itself?  If the structure is limiting the ‘movement’, you are not going to fix it via bettering the movement… a cyclical argument perhaps?

#2 Retraining the movement pattern in the absence of proper balance in the Tensegrity matrix of the body, makes it another bandage!

Now.  Ignoring movement patterns for this blog, lets look at proper recruitment and quantity of muscle.

Proper recruitment:  We are not talking about ‘recruitment patterns’.  We are talking about what percentage of the specific muscle needed for an action, are actually being recruited for the action.  The body and especially athletes are master compensators.  Therefore, they can get by with minimal recruitment and still ‘function’ at a high level and appear ‘strong’ in the process.  For example…can the athlete maintain a stable single leg stance (no contralateral hip drop) for all 4 quarters of the game, instead of using Trendelenburg as a 1 repetition test?

Quantity of muscle?  Too many times I have examined athletes, and patients alike, and noticed that the quantity of muscle is lacking in a specific area.  For example…a runner that has no ‘glutes’???  Let’s not argue about recruitment here, but simply that they have ‘no butt’… glute max, glute med and glute minimus!  Argument:  to stretch and/or recruit muscle fibers when they are overall lacking, seems to be another limiting concept of correction, training etc.   Doesn’t it?    Furthermore, to train those muscles (which are small and lacking) in a complex movement/exercise like the lunge or any squat variation, seems like a bad idea due to the reinforcement of the already existing compensation?  All quad? or quads and TFL?  which we have probably already found Tight and Sore…

The point:  All of the ‘new’ concepts out there don’t take the place of using sound clinical judgement in your approach to an athlete/patient.  Do they?

If your treatment or training seems to lack this type of analysis, please come in for an examination and find out what your true limiting factors are!

In Health,

Dr Jason Amstutz  DC, RTP, CCSP, CSCS

SomaTherapy and SomaTraining Student of Dr. Guy Voyer

What is function? Part 1 of 3

Sometimes its easier to describe what something ISN’T before you define what is is.

Function is an example.  What function isn’t!

Muscle mass ≠ Function

Speed ≠ Function

No pain ≠ Function

Only Function = Function!

In other words.  You can muscle mass, speed and no pain and still not be 100% functional.

Lack of function, is much easier to identify.  It comes in many, many forms.  From decreased speed on a fastball, volleyball spike  OR decreased times in the 100m or 1000m OR decreased vertical jump, to name a few.

The point is simple.  The lack of function doesn’t automatically lead you to the answer.

So the next time your shoulder, lowback or performance suffers, seek the proper Functional Assessment and don’t simply treat the pain or joint!

Call us at 949-722-7070!  We will identify the functional deficit and Correct it.

In Health and Performance.

Jason Amstutz DC, RTP, CCSP, CSCS

The Shoulder: Overkill on Rotator Cuff Exercises with Baseball Pitchers?

This is a quick shoulder blog…
Anatomy facts;
1. Scapula is the largest SESAMOID bone in the body.
2. Proper tension (i.e. strength, flexibility, tissue quality) must be maintained in the system (Kinetic Chain) for maximum function and performance.
3. Scapula is directly linked with the pelvis. Therefore, improper pelvic mechanics can significantly affect the Scapula and the shoulder.
4. 2 separate and important muscle groups: interscapular muscles and the rotator cuff muscles.

Training/Rehab Common Protocols;
1. improve posture of the cervical spine… decrease forward head carriage (FHPosture is related to the Gravity Line and we should be strengthening the lower abdominals with most athletes with FHP).  A proper gravity line assessment and proper examination of the Sacral, lumbar, thoracic and cervical curves will provide the proper info.
2. Improve rounded forward posture of the throwing arm (especially)

3. Strengthen the rotator cuff musculature

4. Strengthen the interscapular muscles…rhomboids, middle and lower traps, levator scap, upper trap.

This is where I would like to spend some time and more detail.   Classic strengthening includes Y’s, I’s, W’s, T’s,  and rows of all types.  There is potentially a flaw in the methodology!

  1. #1 flaw.  What is the strongest and most powerful scapula adductor?  Middle and lower trap?  Nope.   Rhomboids.
  2. Any of the aforementioned exercises that are performed below the scapulohumeral angle do not maximize the stress to the interscapular portion of the chain, mainly the rhomboids.  That potentially eliminates any exercise below the T’s.  Those exercises that are performed at greater than 100 degrees of ABD are still in.
  3. Now.  How do we perform the exercise?  With dumbbells?  bands? balls? None of the above…  How about with just performing scapula protraction and retraction while leaving out the RTC (rotator cuff) and only using isometrically for now.
  4. Training volume and goals… i would argue (based upon my studies with Guy Voyer DO,MD) that we need to consciously shorten the rhomboids to retract the scapula AND with this kind of isolation, we need to perform hundreds of reps.

Next time you are spending countless hours strengthening the RTC.  See how you could better strengthen the chain via some proper rhomboid exercises and see how throwing velocity improves!

Find a qualified SomaTrainer to properly learn this protocol or come in for an assessment!

In Health,

Dr Amstutz DC, RTP, CCSP, CSCS

Do you have shoulder pain that is not getting better with rest, ice, ultrasound, e-stim, adjustments or physical therapy?

Do you have shoulder pain that is not getting better with rest, ice, ultrasound, estim, adjustments or physical therapy?
Precision is paramount to how to treat shoulder pain or weakness.

If you have pain raising your arm above your head and your doctor/therapist thinks that strengthening your shoulder is the answer, it may be time for another opinion.
If you have received countless numbers of the same ‘adjustment’ for your condition and its not resolving, it may be time for another opinion.

Precision in determining the CAUSAL tight structure (often not the muscle that appears tight) CAUSING your pain or dysfunction is the tricky part of shoulder treatment and diagnosis.  IF the ‘tight structure(s)’ is/are not firstly loosened via treatment (myofascial stretching, some type of manual therapy, etc) then all other exercises, stretches, adjustments are futile.

Shoulder Case from today:  55 yr old female with history of R shoulder pain for two years.  Pain with reaching behind her, pain with raising arm to the side, inability to put her arm up her back, put her shirt on, etc.  MRI showed only a little bursitis, X-rays negative.  Treatment consisted of 3 months of physical therapy (ultrasound, e-stim, mobilization, stretches and exercises) with no relief.  1.5 years of chiropractic with no relief.  Ultrasound guided subacromial bursae injection, w/ no relief.

After examine today… TIGHTEST STRUCTURE = capsule of the shoulder!  Until the shoulder capsule is pliable, elastic and lengthened properly, that shoulder will never get better.  No matter how strong her rotator cuff is… no matter how many adjustments to the ‘shoulder’ are performed.  No matter how long she ‘stretches her pec minor’ (as she described to me).  After one treatment today, she could raise her arm above her head without pain!  Other tight structures that were treated… falciform ligament (of the shoulder), conoid and trapezoid ligaments.

If you are or anyone you know is struggling with  a chronic or acute shoulder pain, please have them call the office.

Restoring proper movement to the shoulder is our expertise.  And your body’s job is to heal it, once the structure is properly balanced.

Call the office and get back in the Game!!  949-722-7070

Dr. Amstutz  DC, RTP, CCSP, CSCS

GIRD and Scapula Dyskinesis??? Shoulder Pain in Throwing Athletes

I must get this question/ previous diagnosis on young athletes weekly!!
I think every MD, DC, DO, PT etc is now aware of the paper written in 2003 regarding this ‘breakthrough’ on shoulder mechanics. The brief synopsis: GIRD (glenohumeral internal rotation deficit) was found in throwing athletes who had poor mechanics. SICK scapula/ Scapula Dyskinesis was also found in many athletes with shoulder pain, which is simply defined as…”a scapula that doesn’t move correctly”…

My Issue: These findings… rotational deficit of the throwing shoulder into internal rotation (tight external rotators) and a malpositioned scapula DO NOT describe what the actual problem is. Its merely an observation!

The FIX! the proper combination of tension and flexibility to the scapula (b/c its the largest sesamoid bone in the body…) via proprioception, specific strengthening, myofascial stretching, joint pumping and joint manipulation to the proper constituents. If ALL of these are not part of your current or previous treatment plan, you need to give us the opportunity to teach you how to permanently correct your shoulder mechanics.

Any questions? Please call for a proper shoulder assessment and find out how treating the falciform ligament (of the shoulder complex), the conoid ligament and the trapezoid ligament will improve the scapula function in just one treatment!

In Health.

Dr Amstutz