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!
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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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Heafner Health Physical Therapy Blog Posts:
Healthiest Sitting Posture While At Work
We have all heard about the negative effects of prolonged sitting. In fact, some people argue that sitting is the new smoking. Unfortunately, chairs are not going anywhere, so we need to make sure we are sitting in a healthy position for our spines! In this post, I will discuss how to sit in a healthy posture to minimize the negative effects of the chair. Continue reading...
We have all heard about the negative effects of prolonged sitting. In fact, some people argue that sitting is the new smoking. Unfortunately, chairs are not going anywhere, so we need to make sure we are sitting in a healthy position for our spines! In this post, I will discuss how to sit in a healthy posture to minimize the negative effects of the chair. Continue reading...
Knee Pain? Consider this Sleeping Adjustment
I was recently teaching a workshop at a local gym when I asked the audience, "Who here has knee pain?" Nearly two-thirds of the crowd raised their hands. While this number may seem alarmingly high, greater than 60% of people report knee pain at some point during their adult life. Generalized knee pain is the 3rd most common reason Americans visit their doctor each year. In the clinic, I find that women are at a greater risk for knee pain than men. Simple postural cues and sleeping adjustments can be made to minimize the stresses placed across the knee each day. Continue reading...
I was recently teaching a workshop at a local gym when I asked the audience, "Who here has knee pain?" Nearly two-thirds of the crowd raised their hands. While this number may seem alarmingly high, greater than 60% of people report knee pain at some point during their adult life. Generalized knee pain is the 3rd most common reason Americans visit their doctor each year. In the clinic, I find that women are at a greater risk for knee pain than men. Simple postural cues and sleeping adjustments can be made to minimize the stresses placed across the knee each day. Continue reading...
A few weeks ago I was working with an individual who has experienced back pain for the past 20+ years. Recently he experienced an acute flare-up of his chronic low back pain. During this acute episode he stated, "I must have a spinal cord injury...the pain is excruciating...unbearable." Fortunately, a quick neurological screening revealed intact functioning of the nerves and muscles. Upon further questioning, the client said "when I am having the intense pain, it is like I am lost at sea."
The phrase 'lost at sea' resonated within me for hours after the treatment. When I imagine being lost at sea, I picture Tom Hanks in the movie 'Cast Away.' The movie character was alone, desperate, and literally fighting for his life. He had minimal outside resources and his only companion was a hand-printed volleyball. Tom Hank's character was physically and psychologically exhausted.
To describe one's pain as being 'lost at sea' depicts the intensity of the person's situation. As a chronic pain practitioner, when I hear expressions like this, I immediately know there is a emotional aspect to this acute flare-up of pain. From a treatment perspective, I must integrate and acknowledge the patient's biology (environment, past history, etc...) in addition to any physical impairments that are present.
Words and statements such as the one above make my role as a physical therapist greater than simply a triage expert after an injury. Physical Therapists play large roles as diagnosticians, coaches, counselors, and motivators. If you are experiencing any long standing pain, find a healthcare practitioner who has time to perform a thorough evaluation to investigate the true causes of your pain!
Words and statements such as the one above make my role as a physical therapist greater than simply a triage expert after an injury. Physical Therapists play large roles as diagnosticians, coaches, counselors, and motivators. If you are experiencing any long standing pain, find a healthcare practitioner who has time to perform a thorough evaluation to investigate the true causes of your pain!
Want to learn more about movement and pain?
Check out Dr. Heafner's Anatomy of Human Movement.
Use Promo Code: Save10 today for $10 off at checkout! (promotional offer valid until 3/10/17)
Check out Dr. Heafner's Anatomy of Human Movement.
Use Promo Code: Save10 today for $10 off at checkout! (promotional offer valid until 3/10/17)
How Common is Low Back Pain?
80% of people will experience low back pain
What are the Common Causes of Low Back Pain?
- Prolonged postures (Ex: sitting for long periods while working)
- Repetitive movements (Ex: running, lifting, or biking with improper form)
What Can You Do to Prevent Back Pain?
Studies have shown that poor hip strength, decreased motion in the middle back, and decreased motion in the hips are all risk factors for having low back pain.
You do not have to live with low back pain. In many instances, it can be fixed with proper movement patterns.
- Improve the timing & activation of the gluteal muscles
- Make sure the middle back has healthy movement
- Perform regular hip mobility exercises
You do not have to live with low back pain. In many instances, it can be fixed with proper movement patterns.
Proper Movement is the Cure!
Questions? Email: jim@heafnerhealth.com
"2017 is about committing to your health & getting back to the activities you love. You know it needs to be done...let's get after it!"
Last week, I was working with a 42-year old male who had intense low back pain. He presented with 8/10 pain (10/10 being the worst) and literally hobbled into my physical therapy clinic. While we quickly started managing his symptoms, we also identified several long-term reasons he kept experiencing low back pain. Most importantly, he told me that his pain was not allowing him to pick up his young child from the ground, golf more than 7-8 holes, and enjoy his family trips to the mountains (he really loved cross country and downhill skiing). |
THERE IS A REASON 80% OF PEOPLE SUFFER FROM LOW BACK PAIN & OVER 33% HAVE A SECOND EPISODE OF PAIN. HEALTHCARE PROFESSIONALS ARE NOT ADDRESSING THE CAUSE OF OUR CLIENT'S PROBLEMS.
The reason he was experiencing low back pain was because he spent the majority of his day in a flexed low back posture. He rode his bike to work, would inevitably sit in a slouched posture at work, and found himself working late night in bed on his computer. All of these activities biased his low back into a flexed position. When he needed to pick something up off the ground, his body performed the same flexed pattern, which eventually became painful. Through good communication identifying which activities increased his symptoms, within minutes we were able to decrease his pain by 50%.
"The reason he was experiencing low back symptoms was because he spent the majority of his day in a flexed low back posture. He rode his bike to work, would inevitably sit in a slouched posture at work, and found himself working late night in bed on his computer. All of these activities biased his low back into a flexed position."
He is experiencing minimal pain throughout the work day after our the first 3 sessions. We are finally addressing the cause of his pain, and getting him back to enjoying his normal activities. Through targeted hip strengthening, we are addressing the issue preventing him from skiing. Additionally, he has begun using a small pillow under his low back while at work to avoid the chronic flexed position. These modifications and exercises are enabling him to return to his activities.
Pain management is only one aspect of physical therapy. The bigger and more creative goals therapists create revolve around returning people back to their normal life. |
If you are experiencing pain that prevents you from performing the activities you love, visit Heafner Health Physical Therapy and Movement Specialists. Stop managing your symptoms, and address the problem.
All treatment is 100% one-on-one. We specialize in the treatment of Orthopedic injuries including joint sprains and strains, low back pain, knee pain, shoulder and neck issues, and more.
Through a combination of hands on techniques (mobilizations and manipulations similar to what chiropractors perform) & patient education, we will correct the problem & give you solutions to prevent reoccurrence in the long term.
Reach out via email: jim@heafnerhealth.com OR set-up an appointment directly.
In either case, mention this post and receive $50 off your initial evaluation.
All treatment is 100% one-on-one. We specialize in the treatment of Orthopedic injuries including joint sprains and strains, low back pain, knee pain, shoulder and neck issues, and more.
Through a combination of hands on techniques (mobilizations and manipulations similar to what chiropractors perform) & patient education, we will correct the problem & give you solutions to prevent reoccurrence in the long term.
Reach out via email: jim@heafnerhealth.com OR set-up an appointment directly.
In either case, mention this post and receive $50 off your initial evaluation.
Movement & proper education are the cure!
Heafner Health is a Physical Therapy and wellness practice located in Boulder, CO. Heafner Health specializes in Physical Therapy, manual and manipulative treatment, and pain management. We continually strive to improve your overall health. Heafner Health'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
-Jim Heafner PT, DPT, OCS
We have all heard about the negative effects of prolonged sitting. In fact, some people argue that sitting is the new smoking. Unfortunately, chairs are not going anywhere, so we need to make sure we are sitting in a healthy position for our spines! In this post, I will discuss how to sit in a healthy posture to minimize the negative effects of the chair.
Sitting decreases metabolism, increases one's risk of blood clots or pulmonary emboli, & places extra stress on muscles and joints.
Since the hip bones are the only fixed point grounded to the chair, a good sitting posture should begin with the hips and pelvis in a neutral spine position. To find a neutral pelvis, first identify both of your sit bones. Next, slightly roll the pressure onto the front portion of the bones. This action should tilt the hips forward, creating a small curve in the low back. It is important to only be slightly forward on the hip bones. A common sitting misalignment is excessively rocking the pelvis forward (seen in left picture below), which forces the low back to arch excessively. Those who have a tendency to over arch their low back will feel added tension or spasms as they attempt to sit upright.
Next, draw in the lower abdominals by bringing the belly button toward the spine. This action corsets the lower back and provides stability to the spine. Finally, it is important to lengthen through the middle portion of the spine. In the clinic, I have found the best cues to be "open up through the upper chest," and "imagine someone is pulling a string connected to the front of your shirt collar up toward the ceiling." When performing this action, the shoulders will naturally fall into a proper posture. It is not necessary to draw your shoulder blades back. After the chest is upright, refocus the attention to the neck by giving a small chin nod. The chin tuck prevents stiffness in the upper back and can reverse the 'hump back' posture that is commonly seen in older individuals.
Maintaining this perfect sitting posture is difficult. Often times, we find ourselves slowly slipping back into the old, comfortable habit. While this is not ideal, it is inevitable. To decrease this from occurring, I recommend placing a small towel or pillow in the fold of the low back. The pillow will help maintain the natural curve of the spine and keep the pelvis from tilting backward.
Top 3 Seated Postural Cues
While having a good seated posture is important, the most beneficial thing someone can do is simply stand up! As I have mentioned in a previous post on posture, "the best posture is one that requires regular movement." At Heafner Health, I recommend standing every 15-20 minutes and performing basic corrective exercises every 2 hours.
-Jim Heafner PT, DPT, OCS
-Jim Heafner PT, DPT, OCS
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