Look in a mirror right now. Where is your head resting in relation to your shoulders? If your head posture looks similar to the picture above, you have a resting forward head posture. While this position is not inherently bad, a prolonged forward head posture often leads to neck pain and headaches. With my clients, I compare the forward head posture to a game of Tug-A-War between your neck muscles. In this game, the muscles on the front side of your neck are actively fighting against the muscles on the back side. If the head is positioned forward, the force of gravity makes the back muscles work significantly harder, often losing the game. In this post, we will cover the forward head posture, reasons to sit upright, and specific exercises to minimize neck pain and headaches. Reasons to Sit UprightThe other day, I was reading a book about the Alexander Technique. In the book, the author tells a story about a young boy who is sitting upright and alert in his classroom. The boy is wide awake, unlike his fellow classmates. However, despite the boy's attentiveness, the teacher scolds him and tells him to sit down because he is blocking the other children's viewpoint. The boy slouches, matching the posture of the rest of the class. Within minutes, his demeanor was tired and withdrawn. This story is important for several reasons. First, sitting upright changes our mood. When the boy slouched, he became removed from his present learning environment. This shows that sitting upright can literally change our biochemistry. Our posture changes how hormones are regulated in our body. Second, the teacher's response to his posture shows that our society has conformed to the slouched, tired posture.  Aside from changing our mood, sitting upright has positive effects on our spine, breathing pattern, and digestion. In the picture above, both my middle and lower back are rounded excessively. If the low back is rounded for long periods of time, extra stress is placed across this region. In this example, the hips no longer absorb the weight of the body, but rather the lower back absorbs this stress. When the middle back slouches, the head and neck must readjust by jutting forward so that our eyes can meet the world again. The above statements are very concrete. We can see and feel those differences simply by changing our posture. More abstract changes happen beneath the surface. For example, slouching forward from the middle back effects our respiratory and digestive systems too. As the upper back rounds forward, our upper ribs move closer together and the diaphragm has trouble assisting with the breathing movement. Other neck muscles take on new roles for breathing and become overworked. Decreased respiration leaves carbon dioxide in the lower lobes of the lunges and oxygen is not transported fully throughout the body. Additionally, the increased compression on the abdomen creates tension in the stomach and intestines, altering digestion. What Can We Change Today First off, it is important to note that having good upright posture will not solve all life's problems. As I tell my patients, "Your next posture is your best posture!" In other words, movement is the key to longevity. Movement almost always trumps static posture. However, being cognizant of maintaining an upright posture is beneficial. There are simple, daily steps that can be taken to have better resting posture. One important region to pay special attention is the middle back. As I discuss in a previous post on the middle back, "The thoracic spine - or middle twelve vertebrae of the spine - connect the neck to the low back. Anatomically this region moves less than its counterparts. The neck is designed for high amounts of movement in order to quickly look or turn. On the contrary the thoracic spine is built for stability. It houses the connections for the ribs, which protect the vitally important organs of the heart and lungs... A lack of motion forces the higher and lower connections (neck and low back) to move excessively. The excessive movement causes small amounts of repetitive trauma in the neck and low back eventually resulting in pain. " Below are two videos that provide a mix of mobility (a.k.a maintaining motion) and stability (engaging the shoulder blade) muscles. These exercises will help you sit more erect and maintain a healthy, upright posture!
Do you have neck pain? Check out Heafner Health's Top 5 exercises to treat neck pain while typing!
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Plantar Fasciitis: What is it?
How to Self-Manage Heel PainGet the ankle moving! When ankle motion is limited, it changes how efficiently the ankle can move. A major cause of limited ankle movement is tightness in the calf muscles. If the calf muscles are tight, other structures—including the plantar fascia—may absorb extra stress. The plantar fascia can only tolerate extra stress for a certain period of time before it becomes aggravated. Keeping the ankle moving can help minimize the risk of developing heel pain. Heafner Health Advice: For this specific exercise, make sure you are driving your knee directly over the second toe. This will minimize the tendency to over-pronate (collapse through the arch). Do not forget about the Big Toe Limited extension of the big toe (bringing your big toe towards your nose) is often limited in people with heel pain. This typically occurs because extending the big toe while walking or running takes the slack out of the plantar fascia tissue, creating more tension. If local stabilizing muscles do not support the tissue, it can become irritated. Heafner Health Advice: Keep your heel together while lowering into the stretch. With the big toes and heels locked, the stretch will feel significantly greater in the foot and calf. We have addressed motion, now lets strengthen! Weak calf muscles are a major predictor of heel pain. If the calf muscles are not doing their job, other structures are at risk for injury. Additionally, people will weak calves commonly over-pronate because they cannot control their foot mechanics Heafner Health Advice: Keep your heels together while pressing up into the raise. When lowering down, move through the entire movement to work the calf muscles through their full range of motion. Strengthen the Small Foot Muscles There are 4 layers of ‘intrinsic foot’ muscles that help support the plantar fascia tissue. These small foot muscles help maintain the natural arch of the foot. If these muscles are not working properly, the plantar fascia tissue can be over-worked, which may result in pain. Heafner Health Advice: DO NOT SIMPLY CURL THE TOES! BE MORE SPECIFIC! Imagine the foot is a suction cup. During this movement you are lifting your arch off the ground while keeping your toes and heels suctioned to the ground. If the toes curl too much, the ‘suction effect’ would be lost. The missing link: heel mobility The plantar fascia attaches onto the heel bone (known as the calcaneus). When the heel bone does not move properly, the plantar fascia tissue can also become stagnant. Since the heel is the first point of contact while walking, proper motion is key. Heafner Health Advice: Do NOT overcomplicate this movement. Simply grab the heel pain and move it up and down! Go slow or fast; but make sure you move throughout the full range of motion. Dr. Heafner is an Author!The Yoga Fix book combines the physical therapy and movement expertise of Dr. Heafner with the skillfulness of yoga teacher Keith Allen. The Yoga Fix takes readers through 40+ poses, identifying both the Eastern and Western approaches to the practice. Yoga is not broken, but certain postures needed to be fixed! Whether you are new to yoga or an expert teacher, The Yoga Fix will help you safely take your practice to the next level.
Aging is inevitable, but it does not have to be painful! Did you know that people begin to lose strength and power in their 20's and 30's! What are you currently doing to maximize your health? Take this 8 question quiz to see how well you are treating your body as you age.  Click on the picture or HERE to access the quiz! More from Heafner Health Physical TherapyIs pain stopping you from activities you love? Invest some time in Heafner Health's recent blog posts IT Band Syndrome: Self Treatment Strategies
Shoulder Pain While Lifting
Office Exercises for Neck Pain from Computer Work
Contact Heafner HealthHeafner Health is conveniently located inside RallySport in Boulder, Colorado. All treatment sessions are 1-on-1. We treat everyone from top athletes to weekend warriors. No doctor’s referral is required prior to evaluation!
Front Plank Hip Extensions The front plank is known to be a good core exercise, but did you know that adding leg movements can significantly increase the glute activation too. Front planks with hip extensions has consistently been shown to have high activation of the gluteal muscles when tested using an EMG (a small needle measures the % of activation). Heafner Health Advice: In the clinic, I prescribe exercises such as this all the time. They are great for low back to leg disassociation (i.e. teaching the body how to isolate what is moving and what is staying still). However, the full plank with hip extension is a tough exercise. If you are not ready for this movement, start by performing a partial plank on your knees. If that is still to difficult, start on hands and knees. Work on extending one leg backward at a time while keeping your trunk stable. Side Plank Leg Raises The side plank leg raise has been shown to have high muscle activation of the outer glutes on BOTH SIDES simultaneously. In other words, both the top and bottom leg are getting worked together. Interestingly, THE BOTTOM HIP MUSCLES MUST WORK HARDER THAN THE TOP IN THIS EXERCISE! Heafner Health Advice: When performing the leg raise, point your toes up toward the ceiling without allowing the pelvis to roll backward. Pointing the toes up engages specific fibers of the gluteus medius, which are important for protecting the knee joint. Single Leg Squats The single leg squat can be intimidating exercise. It requires balance, single limb strength, coordination, and a bit of a confidence. To make the movement easier, I suggest using a chair or bench press to start. The chair will provide a cue to sit backward into the movement, which engages the glutes more. Heafner Health Advice: IT IS COMMON TO SHIFT YOUR WEIGHT ONTO YOUR TOES. Be sure to keep the weight in your heels to make the glutes engage more! Additionally, avoid letting the knee collapse toward the midline and try to maintain level hips. Pelvic Drops The gluteus medius muscle is an important stabilizer of the hips while walking and running. This muscle keeps the hips level from side to side and controls the pelvic sway. In this exercise, we are retraining the pelvic drop throughout it’s full range of motion, effectively working the glutes from a shortened to lengthened position. Heafner Health Advice: During the pelvic drop exercise, there will be a tendency to drop your shoulder toward the standing leg. Do NOT let this happen! Keep your body weight centered. Only move the pelvis! Skater Squats While the skater squat has slightly lower gluteal activation than other exercises mentioned above, it is a great functional exercise that can be incorporated into any routine. The exercise challenges single leg balance while stabilizing the core and actively isolating movement in one leg. Heafner Health Advice: Skater squats challenge the glute muscles on both legs simultaneously. TWO COMMON MISALIGNMENTS: 1. On the standing leg, do NOT let the knee collapse inward. 2. As the moving leg kicks backward, keep the hips pointed forward. Do NOT rotate from the low back. About Heafner Health?
Heafner Health is a cash-based Physical Therapy and wellness practice located in Boulder, CO. HH specializes in Physical Therapy, manual and manipulative treatment, and pain management. We continually strive to improve your overall health. HH's mission is to optimize the way you move to promote health and longevity. We look forward to helping you reach your health and fitness goals! -Jim Heafner PT, DPT, OCS Injuries from Running Happen ALL the Time!
Pre- and Post- Run ExercisesFront Hip Mobility Using a Foam Roller Have you ever noticed how runners tend to crouch forward later in a race? When fatigue begins, the force of gravity naturally pulls the body into a slightly crouched position. This position allows the hip flexors and quadriceps to become stiff and tight. This exercise helps improve extensibility in the hip flexors and front hip joint capsule. Heafner Health Advice: When performing this movement, you should feel that ‘good uncomfortable’ sensation as if you are sliding over a tight muscle. IT SHOULD NOT BE PAINFUL THOUGH! The combination of movement with the foam roller will allow the joint and muscles to gain mobility. Following this exercise, be sure to add other front hip mobility exercises to maximize results. Downward Dog Calf Stretch The calf muscles create power and speed production for runners. However, these muscles commonly become stiff and tight since they are constantly being used. When stiffness develops, their ability to generate power changes. Additionally, excessive calf tightness may alter running mechanics placing increased stress across the knees or low back. Heafner Health Advice: I always recommend doing this flossing movement when first warming-up the posterior chain. The flossing motion helps relax the nervous system to allow for more extensibility of the calves and hamstrings. Finally, try to avoid rounding through the low back during this stretch. Bend the knees and raise the hips toward the ceiling. Side Plank Clamshells The gluteal muscles, specifically the gluteus medius (the outer hip muscle), are important for keeping the pelvis level while running. If the glut medius is not firing, other muscle groups must work harder and pelvic muscle imbalances can occur. Heafner Health Advice: The side plank clamshell exercise engages the obliques and gluteal muscles. Since it is a compound, coordinated movement, people often cheat out of the movement. When performing this exercise, avoid letting the pelvis rock backward. Keep the spine long. FOCUS ON MOVING THE HIPS INDEPENDENTLY OF THE TRUNK. Pike Planks on a Swiss Ball Pike planks have been shown to target the lower abdominal muscles. The lower abdominals work directly with the low back and help corset the spine. This action from front to back provides increased stability to the spine and minimizes the risk of low back issues in runners. Heafner Health Advice: Draw in your belly button towards your spine prior to performing the pike movement. This subtle draw in will engage the deeper core muscles and improve stability while moving on the unstable swiss ball. Banded Ankle Mobility In the Downward Dog video above, I introduced the calf muscles and the importance of ankle flexibility for runners. The banded ankle mobility exercise gives you another option for improving the range of motion in the ankles. Heafner Health Advice: Either find a firm strap or use a mobility band with minimal resistance. Place the strap directly over the front of the ankle joint where the skin crease occurs. Press into the strap while keeping the heel on the ground. If you like these videos and exercises, check out other recent posts from Dr. Heafner!
Do your upper shoulders and neck ache!?Many people develop muscle tension in the neck and shoulders from working at the computer for long periods of time. It almost seems like this posture is inevitable and gravity is dooming us all! Stiffness at the base of the neck is often due to a lack of mobility in the upper back or upper neck. When someone adopts a forward head position, several joints are placed in an inefficient position, which limits their full movement. DECREASED MOBILITY often = PAIN and STIFFNESS. Fortunately, there are solutions, but it does take time and awareness to break these habits.
‘Chicken Wings.’ In previous videos, I have mentioned that the region of the spine just below the neck becomes very stiff in people who spend hours typing, texting, etc… For example, imagine someone with their chin pressed forward looking intently at a computer. If this part of the spine remains stiff for years, it can sometimes develop into the ‘humpback posture’ seen later in life (many of my female clients ask me how to avoid this posture- this exercise can help!). Heafner Health Advice: Perform mobility exercises on the middle back EVERY day. Our societal and technological demands naturally place us in unnatural prolonged postures. When performing the shoulder chicken wings, use the pressure on your hands to help expand the upper chest. Press the back of your head into your hands throughout the motion. THIS IS AN EASY EXERCISE TO PERFORM AT YOUR DESK! Cow Pose with Neck Rotation Both flexion forward and extension backward are so important for the middle back. If these motions cannot occur, stress often translates to the neck, shoulders, or low back. THIS IS WHY MOST PEOPLE HAVE NECK OR LOW BACK PAIN & NOT MIDDLE BACK PAIN. Heafner Health Advice: When performing today’s exercise, move fully into the Cow pose first. Tension should be felt in the middle back as if a heavy weight is sitting between your shoulder blades. If stress is noted in the low back, draw in the abdominals. Be sure to keep your neck long (and not arched back). With the chin tucked, rotate your neck side to side. Upper rib mobilizations Heafner Health Advice: The upper ribs often become stiff and tight in people with neck tension. Grab a partner or simply use a barbell at the gym. Use the bar to open up the ribs and decrease tension across the shoulders. Thread the Needle I have recently treatment 3 people with neck pain that did not have a neck issue at all! All of their pain was rooting from stiffness in the upper and middle back. For example: have ever noticed that your neck feels stiff when looking over your shoulder? You are not alone. In order for you to look over your shoulder, the neck and middle back must work together! Heafner Health Advice: Thread the Needle targets extension and rotation of the middle back. A KEY COMPONENT THAT IS OFTEN MISSED make sure your eyes are following the thumb. This ensures that your neck is rotating! Also, don’t let you hips drop to the side at the ends of the movements. Quadruped T’s (a.k.a All 4's position) This exercise targets the middle back stabilizers while maintaining a tucked chin position. The T’s motion engages the middle portion of the Trapezius muscle, which helps hold the spine and shoulder blades in an upright posture. If the middle trap is weak, the head and neck often suffer! Heafner Health Advice: When starting out, place a small hand towel underneath the chin to avoid the forward head posture. This cue will open up the back of the neck and further isolate the mid trap muscles during the arm lift. We Treat Neck Pain in 2-3 visits!While neck pain is common from typing and texting, we see many cyclists, runners, and recreational athletes for neck and shoulder issues as well. If you are having neck tension, contact Heafner Health today for an evaluation!
Do you have pain in the front of your shoulder?
Why does it occur? 1) Stiffness in the middle back 2) Weakness of the back shoulder blade muscles- middle and lower trapezius 3) Weakness of the Serratus anterior (Google it!) 4) Poor resting posture of the shoulder How Can You Self-Treat Shoulder Pain?Mid Back Extension Over a Foam Roller To better understand shoulder mechanics, let’s do a quick test. First, slouch down and try to raise your arms overhead. Second, sit upright and raise your arms overhead again. Hopefully you had further range of motion while sitting up tall. Why? THE POSITION OF THE MIDDLE BACK DETERMINES HOW MUCH SHOULDER MOTION IS POSSIBLE! Since many people naturally rest in a rounded shoulder posture, the middle back is often slouched. Attempting to lift a weight from this position can place extra stress across the front of the shoulder. Do this exercise PRIOR to lifting to open the mid back. This will protect the shoulders DURING the workout! Dolphin Presses The shoulder blade muscles (in the back) are arguably the most important muscles for raising the arm overhead. One of these muscles is called the Serratus Anterior. It is known as the Boxer’s muscle because they often have strong Serratus muscles from the punching motion. I often refer to the Serratus Anterior as the glutes of the upper body. Both muscles provide stability to their respective areas of the body and are frequently under-utilized. Without this muscle, the shoulder blade tips forward and limits full arm movement. Dolphin presses are an advanced exercise that work the Serratus Anterior muscle in an overhead position Chin Nod with Shoulder Flexion Have you ever noticed how far your head presses forward when texting or working on the computer? The habits we develop while performing repetitive tasks transfer to our habits when we move. As the head moves forward, the shoulders naturally round forward and the middle back slouches. As we discussed in Day 1, THE POSITION OF THE MIDDLE BACK DETERMINES HOW MUCH SHOULDER MOTION IS POSSIBLE! This exercise keeps the chin tucked as the arms raise overhead. If you notice the head starting to jut forward (think of THE TURTLE COMING OUT OF THE SHELL), extra stress is placed across the neck. Keep the chin tucked against the foam roller as the arms lift. Rotator Cuff Warm-up with Dowel Warming up the rotator cuff should be a must for any adult. When you are younger, you can get away with jumping right into a sport or exercise; however, with age the muscles are less elastic and slower to adapt. Warming up the rotator cuff will provide added stability and protect the front of the shoulder while lifting. Using a dowel will ensure that the arms move in a single plane of motion. All 4's Arm Raises Before reading this, shrug your shoulders up toward your ears. This engages the UPPER TRAP muscle. Now, draw your shoulders down and together away from your ears. This engages the LOWER TRAP. Both muscles must work together when lifting overhead. This exercise targets the lower trap muscle. In all fours, alternate raising the arm while drawing the shoulder down and back at the top of the movement. ATTENTION: it is easy to cheat this movement by shrugging the shoulders toward the ears. What is the IT Band?
The IT Band does NOT stretch! Foam Rollers and side stretches are NOT permanent solutions! How to Treat IT Band SyndromeSide plank clamshells This exercise targets the outer hip muscles, known as the hip abductors. These muscles are really important for stabilizing the hips and keeping them level. Adding the side plank targets the internal and external obliques as well. How does it prevent IT band tightness? The IT band attaches to a hip flexor muscle (tensor fascia latae muscle) on the front of the hip. This hip flexor also turns the leg inward (imagine the movement of the knees collapsing together). In many people, the tensor fascia latae works really hard (i.e lots of knee collapse). Consequently, the gluteal muscles in the back stop doing their job. The clamshell specifically targets the outer gluteal while turning off the front hip flexor (research has proven it!). Strong gluteals + Minimizing tensor fascia latae muscle activation = less IT band tightness! Hip Kicks in a Hover Plank Hip kicks (similar to the bird dog exercise) are great for strengthening the gluteal muscles, specifically the gluteus maximus. This powerful muscle helps stabilize the knee and low back! Adding the hover plank targets the core muscles to a greater demand as well. How does it prevent IT band tightness? Many people with IT band tension have trouble isolating their core muscles from their legs. For example, they may have increased trunk sway while running. The plank keeps the spine in neutral while moving the lower body. This movement teaches the trunk to remain stable while the legs alternate. Hip Clocks The hip joint is built for mobility. Unfortunately, most people sit to much and move to little. Hip clocks are a Heafner Health favorite because they target both hip internal and external rotation. How does it prevent IT band tightness? The hip joint and surrounding muscles contain tons of small receptors that communicate with the brain. These receptors are a key component of muscle memory. When the hip loses rotation, the small receptors become less sensitive and communicate less with the brain. This leads to overall less awareness and perception of the hip joint and decreased ability to target specific muscles. Single Leg Bridge Research has shown the single leg bridge to be a good glute strengthening exercise. ATTENTION: it is easy to cheat this movement by using the low back or hamstrings! Heafner Health recommends to start with a smaller lift and be sure the hips drive the movement. How does it prevent IT band tightness? Glutes, glutes, glutes! Stronger muscles on the back of the body will keep the trunk upright and in good alignment. Additionally, the bridge opens up the front of the hip joint and provides a stretch to the hip flexors. Hip Flexor Stretch The IT band does not stretch! Seriously, it is impossible. It can withstand THOUSANDS of pounds of strain. However, tissue around the IT band does get tight and needs mobility work. The hip flexor stretch opens the front of the hip and allows for better mobility of the hip. The added side bend increases the tension across the outer hip muscles. How does it prevent IT band tightness? As mentioned on Day 1, the hip flexors work hard and often become shortened. When shortened, they do not allow the leg to fully extend backward. For example, a runner trying to take a full stride may be limited by tension in the front of the hips. Since the IT band attaches to the hip flexors, the tension translates down the outer leg and can cause knee pain. Movement is the Key to Longevity!-Dr. Jim Heafner PT, DPT, OCS
Do you have recurring low back pain?Nearly 80% of the population will experience low back pain at some point during their life. Of the 80%, nearly 1/3 of those people will have a recurring episode of pain. This means if you have low back pain, you will likely experience it a second or third time. This information is not meant to be scary or threatening. The body is not fragile or frail. Pain or tension is simply an alarm indicating something may be wrong. Even in the presence of pain, the spine is extremely strong and resilient! However, this information should be a call to action. If you are experiencing any low back pain or discomfort, DO SOMETHING ABOUT IT! The symptoms will not disappear. You need to change your daily habits or routine. It is important to incorporate new healthy movements and positions for your spine. What should I do for daily maintenance of the low back?I was recently working with a middle aged man who was experiencing tension on the right side of his low back. He described the sensation as 'grabbing' or 'catching' when lifting or going up the stairs. Additionally he reported a lack of power from his leg muscles. After watching his movement analysis and going through a few basic tests, the source of the symptoms was quickly diagnosed. His low back pain was due to a lack of mobility. In other words, his spine and hips lacked adequate movement. The exercises below were performed on his initial physical therapy visit.
Why these exercises?There is a popular phrase in the fitness and rehab community that states, "mobility before stability." In other words, we need to get tight or stiff areas moving better before we can strengthen them. With this particular person I was treating, he needed mobility exercises first. Once the motion in the hips and spine improved, I finished the treatment with the fourth exercise, the bird dog, We needed to build a foundation of mobility before strengthening in his new range of motion! Dr. Jim Heafner PT, DPT, OCS Medical Disclaimer:
The above information is an example rehab program. The information contained herein is not intended to be a substitute for professional medical advice, diagnosis or treatment in any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition or before engaging in any physical fitness plan. "My hamstrings are tight... and I stretch all the time!" |
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Take Home Advice
1) Perform dynamic joint mobility exercises as part of your warm-up and cool down. Instead of isolating one muscle group and stretching for 30, 60, or 90 seconds, I recommend only holding the end-range of a mobility exercise for 1-2 seconds.
2) Perform joint mobility exercises first, then static stretching second. Targeting the joint first will allow the muscles to get further into the stretch.
3) Find a daily mobility and maintenance routine! This routine should incorporate whole body movements (like the exercises above) and last approximately 10-15 minutes.
2) Perform joint mobility exercises first, then static stretching second. Targeting the joint first will allow the muscles to get further into the stretch.
3) Find a daily mobility and maintenance routine! This routine should incorporate whole body movements (like the exercises above) and last approximately 10-15 minutes.
Reference:
Myers, Thomas W. (2011). Anatomy Trains. London: Urban & Fischer.
Myers, Thomas W. (2011). Anatomy Trains. London: Urban & Fischer.
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