Muscle Balancing: The Knee

Knee pain is almost as common as back pain and can be just as debilitating. Simply put, knees are designed to fail. On a long-enough timeline, just about everyone on the planet would need knee replacements. So, because of this flaw in our manufacturing, I thought I would write a post on how you can start to decrease any existing knee pain and improve knee function.

The treatment methods I have listed below are to be taken only as a guide. Many knee injuries have a variety of commonalities, but every injury is a little different, so keep that in mind when trying these. Before starting any of these exercises, you should consult your primary medical practitioner. If anything results in an increase in pain or exacerbation of symptoms, stop the exercise and consult a medical professional.

The first thing that I have my knee patients do is ice. Ice is exceptionally important because it helps to modify pain, swelling, and inflammation. Check out this previous post for the best way to ice (http://doctorlynk.wordpress.com/2010/02/07/ice-for-injuries/)The most important of those three is swelling. The reason reducing swelling is so important is becuase it “turns off” muscles and decreases proprioceptive awareness (balance). This particularly applies to the vastus medialis oblique (VMO), which is part of the quadriceps muscle group on the front of the thigh.When the VMO loses strength, the entire knee becomes compromised in stability. The reason is because the VMO is the only muscle that has direct control over the patella, and without it the patella can track laterally and create impingement. Quadriceps strength is one of the most critical components of maintaining knee health.

Ankle Pumps – This is the easiest exercise to do to assist with swelling. It’s exactly what it sounds like: just pump your ankles up and down. It works best if you can elevate your legs above your heart to allow gravity to help remove some of the swelling from around the knee. I recommend a minimum of 500 per day. It sounds like a lot, but really it should only take 5-10 minutes out of your day.

Quad Sets – This is probably the most important initial knee exercises in physical therapy.

• Starting position?
• Roll up a towel and place it under your knee with the leg straight.
• With a straight leg and lifting your ankle up while straightening your knee by tightening the quads
• Hold for 10 seconds.
• Relax and repeat 10x at least 5x per day.
• You can increase muscle recruitment by rapidly tapping the VMO while holding the contraction

Bridges – This exercise is designed to increase the recruitment of your gluteal muscles. These are muscles you use every day and should be biased for activities like getting out of chairs, going up stairs, squats, lunges, etc. I’ve worked with multiple patients that significantly decreased their knee pain by increasing their recruitment of their gluteals.

• Lay on your back with your knees bent and feet flat.
• Draw your abs in like zipping up a tight pair of jeans.
• Squeeze your cheeks and lift your hips toward the ceiling.
• Hold for 5 seconds before slowly returning to the start position.
• Repeat 15x at least 3x per day.

If you feel like you are doing it with your back, that means your abs aren’t drawn in. If you feel like you are doing it with your hamstrings, then pick up your toes and only place the weight in the heel.

Face the Wall Squat – Most people with knee pain cringe at the idea of squats, but, most likely, they are doing them wrong. Here is a quick video of a wall squat demonstration http://www.youtube.com/watch?v=_1Zo2U42d1o. If you are still having trouble with this, get a chair in front of you against a wall, walk forward until your knees are against the edge of the chair and try your squats from there. This will prevent your knees from going forward over your toes, which is typically where the pain comes from with squats. Keep your weight in your heels, knees behind toes, use your gluteals to stand up, and keep your abs drawn in for safety of your spine.

Quick Kicks – This is the last exercise I’m going to recommend. It helps with joint stabilization and proprioception (body awareness). Stand next to something stable in case you need it for balance. Since this one is complicated, I will let my good friend Dr. Kareem Samhouri tell you about it in a video (sorry he talks a lot). Check it out here http://www.youtube.com/watch?v=QZnr07WIiiM. Try to spend 30 second in each direction on each leg, 3 times.

There are a lot of things that can transpire when dealing with knee injuries, so please use caution when trying these exercises and see a medical professional if you can.

Other resources: Robertson Training Systems (http://budurl.com/RobertsonTraining) – scroll down the page to “Bulletproof Knees”. The other products here are also phenomenal, created by possibly one of the best trainers in the nation, Eric Cressey.
I hope you found this information helpful and feel free to leave comments or ask questions below if you are dealing with knee pain.

Cheers to your health,

Lynk

Improve your breathing

There can be a variety of different reasons why someone may have trouble breathing, and you should definitely consult a medical professional if you are having trouble because it could be some serious. Now, with that out of the way, I can talk about a few simple things that you can do to help to improve your difficulty with breathing whether it is simply from being deconditioned, having exercise induced asthma, or something more problematic like chronic bronchitis or COPD.

Lets start first with a little bit about your lungs. Basically, the lungs work with like a black smith bellows. As you breathe in, the diaphragm contracts and it generates a vacuum inside your lungs by opening space and lowers the pressure (like pulling apart the handles of the bellows). As a result, air travels into the lung to equal out the pressure by comparison with the higher pressure outside. As you breathe out, the diaphragm relaxes and air flows out of the body without much muscle contraction. This is called quite breathing and generally requires very little effort, but leaves a certain amount of “dead air” in your lungs that does not supply oxygen to the body.

However, once someone starts to exert themselves and the body requires more oxygen, the need for effective breathing is critical for the continuation of activity. This involves the ability of your body to forcefully exhale or breathe out. By increasing your ability to exhale you can get rid of more of the de-oxygenated air (dead air) and have more space for oxygenated air. So, here are two quick things to help with improving your breathing.

1. Diaphragmatic Breathing - http://doctorlynk.wordpress.com/2010/07/24/diaphragmatic-breathing/
2. Balloons – Yes, go out and buy a bag of balloons and blow up at least 10 per day (you can just keep blowing up the same one until it gets easy and then start another one). By blowing up balloons you will work on exercising the muscles used the exhale (transversus abdominis, intercostals), which allows you to create more space for oxygenated air when you breath in. As you continue to work on this the muscles will become more effective and allow for increased tolerance of higher activity and better lung function. It can also help you clear out fluid that is in the lungs if you are sick (just be prepared to cough a lot).

I hope that everyone can find this tip useful and if you have any questions feel free to post below.

Cheers to your health,

Lynk

Headache Relief Without Medication

Cervical headaches, also known as cervicogenic headaches or “Rams Horn” headaches, plague a huge number of people with limited benefit through medications such as anti-inflammatory drugs, muscle relaxers, and migraine medications. They typically present with pain starting the back of the head that can then wrap up or around the skull and typically end behind the eyes.

The cause of these types of headaches can be multifactorial, but usually it is caused by compression of the suboccipital space between your second cervical vertebrae (C2) and the base of the skull. On either side of there are 4 muscles (see figure below) that help control the movement of the skull, C1, and C2. Also in this area is a nerve called the suboccipital nerve the travels up the back of the head and refers in the “Ram Horn” pattern. The nerve can be trapped by these muscles as well as by the upper trapezius. Furthermore, restrictions through this area can create blood flow impingement for the brain and contribute to headaches.

The good news is that there can be simple muscle energy techniques to help reduce and possibly even eliminate your headaches. One such exercise called a neck retraction can be found through a previous post that I wrote. Now, onto the good stuff.

First, you have to do a quick assessment. Easiest way to determine how to treat the headache is by feeling which side the pain is on. Many times these types of headaches will pick a side to affect. If you have only one sided pain or pain is worse on one side, jump right to Step 1. Otherwise continue reading here.

If you cannot determine which side is the primary source of pain or the feeling is like a metal band or vice on the base of your skull, you can assess with movement. Start with your head in a neutral position. Turn your head to one side and then look down as if you are trying to smell your own arm pit (breathing optional). While keeping your head in this position turn your head and look up toward the ceiling without letting your head move away from the shoulder. Feel for how far you are able to turn your head away from your shoulder. Now, repeat this to the opposite side. Most likely you are going to find that there is one side more limited. Great! That means you have the information on which side to start treating.

The side that you want to treat is the direction (left or right) that had more difficulty looking up toward the ceiling. So, if you had more difficulty when turning to the right toward the ceiling, that is the side to start treating.

Step 1: Lay on your back with a thin pillow under you head and your shoulders.
Step 2: Place two fingers on your temple of the side that you are treating.
Step 3: Place the other hand on the side of the head above the ear.
Step 4: Without moving your head, look with your eyes only as hard as you can as if you are trying to see your fingers on your temple. Hold for 3 seconds.
Step 5: Without moving your head, tip to the left against your other hand. Hold for 3 seconds

Repeat Step 4 and 5 for 3 repetitions each and then retest your motion and see how your headaches feels. Hopefully, your motion will be better and your headache will be reduced. If there is no change, repeat this to the other side by looking and tipping in the opposite directions as before. Repeat up to 10x to the affected side to alleviate headaches and follow up with neck retractions from this post. This is effecting the suboccipital muscles (top left of the picture) to decrease pressure over the nerves causing the headache.

In case the above exercise didn’t work, try laying on a hard floor and place a golf ball under one side of the base of the skull. This may be a little tender to start with, but allow the weight of your head to sink into the golf ball. The goal of this is to slowly gap the space between the top vertebrae and the skull. Allow at least 3 minutes in this position, and its probably good to do this on both sides. You can also try this with two golf balls, but this gets a little uncomfortable.

Now, here is the last quick trick to try to alleviate those painful tension headaches. Feel on the back of your neck just below the base of the skull. You should feel a bump right in the center, that is C2. Trace down the center of your neck with your finger until your get to a second bigger bump. This will likely be C6 or C7. While laying down gently stroke downward from C2 to C7 with two fingers. Repeat this process for 2-3 minutes. This is working to decrease tension through a structure called the ligamentum nuchae that attaches to the base of the skull.

Hopefully one or all of the tricks above can help you to alleviate your headaches. If you have any questions feel free to contact me anytime.

Cheers to your health,

Lynk

Diaphragmatic Breathing

Here Are 3 Reasons YOU Need To Know About Diaphragmatic Breathing

1. Low Back Pain
2. Improve Fat Loss
3. Heal Injuries Faster

What is the Diaphragm and what does it do?

• The diaphragm is a muscle that separates you heart and lungs from you other internal organs and is the primary muscle responsible for proper breathing.
• It attaches to the inside of your ribs and spine and moves toward the center of your body where it attaches to a tendon.
• As you breath in, the diaphragm contracts and moves downward to allow for your lungs to expand in your chest cavity and take a a full breath.
• As you breath out the diaphragm relaxes and moves back up to the starting position.

Why is it important to practice diaphragmatic breathing?

• Relaxes the entire body and nervous system, where tensions and anxieties are held
• Relaxes the heart, reducing blood pressure
• Increases oxygen levels to our cells
• Supports process of detoxification
• Assists with digestion
• Helps to reduce back pain by stabilizing the spine and core
• Expand the working capacity of respiratory system
• Enhance left and right brain interaction
• Balances the level of acidity and carbon dioxide of blood
• Clarity of Thought
• Focus/Awareness

How does this improve fat loss and healing time

• Improving the strength of the diaphragm assists with maintaining appropriate position of the spine and ribs.
• Maintaining appropriate position of all of your joints is critical for having a higher metabolism
• Higher oxygen levels in the body allow for a greater amount to be available for all activities including exercise.
• Without higher levels of oxygen your capacity for exercise will be limited as so will your results
• Your body runs on two things, oxygen and glucose. If you take out one you can forget about burning those extra calories for weight loss.
• Increased oxygen levels provide more oxygen for healing injuries because without oxygen injuries will take a much longer time to heal.
• Lastly, stress reduction that occurs with diaphragmatic breathing lowers stress hormones in the body that impede both healing of injuries and fat loss.

How to perform diaphragmatic breathing

• Sit in a relaxed and comfortable position that is slightly reclined.
• Place one hand on your stomach between your solar plexus and your belly button.
• Place your other hand at the top of your chest.
• Slowly breath in through your nose and into the hand that is on your stomach. Try to keep the hand on your chest relatively still. You stomach should expand as you breath in.
• Once you have take a full breath in, slowly breath out through pursed lips like breathing through a coffee straw. As you breath out, gently draw your stomach in as if you are zipping up a tight pair of jeans.
• Repeat 10x, at least 10x/day.

As you improve your awareness of the diaphragm you will be able perform this exercise without the use of your hands and in a variety of positions. Also, by incorporating diaphragmatic breathing into your rest during exercise you can improve the quality and decrease the time of your rest periods.

Hope everyone found this information to be helpful!

Cheers to your health,

Lynk

Secrets to Healing Injuries Faster

Working in physical therapy has allowed me to treat pain, weakness, limited ROM, and improve function through hands on techniques and guided exercise. However, not everyone has the ability to go to a professional and many injuries can be taken care of with some basic home remedies that I have listed below.

1. R.I.C.E. – Rest, ICE, Compression, and Elevation. Resting allows the natural healing process to take place for the body to reduce inflammation and heal the injured area. Ice helps to improve blood flow, decrease pain, and modify swelling. Compression helps to decrease swelling and depending on the injured area, helps to take stress away from the muscles or joints. Elevation helps to decrease swelling, particularly around injured joints because swelling decreases muscle activation as well as influx of oxygen and nutrients to heal the injured area.
2. Muscle Activation – Activation of the muscles around the injured areas helps to maintain the neurological connections as well as maintain ROM of the injured areas. Additionally, activation of muscles helps with restoring blood flow to bring more oxygen and nutrients into the injured areas to help with healing. Now, if the motion causes significant pain (>3/10 pain on a scale of 0/10, 0=no pain, 10=ER) then it is better to go back to number 1.
3. Cardio – Cardiorespiratory exercise helps to increase blood flow to the injured areas for more oxygen and nutrients (assuming that is does not aggravate the pain). A large portion of back pain can be eliminated with 2 months of consistent cardiorespiratory exercise.
4. Posture – By placing and keeping the body in the correctly aligned position, the joints of the body and the muscles are in their optimal position of function. This allows for balance around the joints to take place and decrease overall tension through the body. Decreased tension allows for faster healing. (Muscle Balancing One, Two, Three)
5. Seek Out a Professional – If all of the above methods fail, seek out professional help from your primary health care provider. For most aches and pains dealing with the spine or joint I would say go to a physical therapist or a chiropractor. If possible, go to one that has only 2-3 patients per hour and they should be able to give you a ton of information on your injury and answer all of your questions. If they don’t, ask! Because the more you understand about your injury, the more likely it is you will be able to do everything right to let it heal faster. Also, they should give you exercises to do after the first visit. If they don’t, ask! I prefer professionals skilled in myofascial release, trigger point release, and active release therapy.

Cheers to your health,

Lynk

Muscle Balancing for the Low Back

Ok, so we have talked about the neck and the upper back in    Part 1 and Part 2. Now, its time to talk about one of the most injured and problematic areas of the body, the lower back. To give you an idea about how much lower back pain affects the general population, it is the number two reason for missed work just behind the common cold. Eighty percent of people at some point will experience low back or lumbar spine pain. This post is going to discuss some basic anatomy, common problems, and some easy things that you can do to help with your back pain (easiest is to check out this post). I apologize in advance for the length of this post, but trust me when I say there is a ton of information that you don’t want to miss! If you are just looking for the exercises, jump to the bottom where they are listed. As always the information here is not a substitute for seeing a medical professional and should be cleared with your attending health care practitioner before performing. Additionally, this is be no means all the information on the topic.

Anatomy

The lumbar spine consists of 5 stacked vertebrae (back bones) that sit on top of the sacrum (triangle shaped bone at the bottom of your spine that is attached to your tail bone). The sacrum then attaches to your innominates (bones that you touch when putting your hands on your hips) to create the sacroiliac joint. The reason I mention this area is that it is many time mistaken for lumbar spine pain and we will discuss the presentation of those symptoms and how they differ from lumbar spine pain.

Given the number of muscles that attach to the lumbar spine it would take me forever to try to deal with them all so I am going to try to cover some of the more important ones. First, the two large bands of muscle that you can feel on the sides of your spine are known as the erector spinae. Their primary job is to extend (bend backwards) the spine. Despite their size, they are primarily only problematic because they spasm to protect the spine, but they are rarely the problem. Muscles that do typically cause problems are the multifidi, quadratus lumborum, and iliopsoas.

The multifidi are small muscles that cross 1-2 joints in the spine and assist with rotation and extension of the spine. These muscles run all the way up the spine and if problematic can result in rotations in the spine that cause pain and a variety of other problems. The quadratus lumborum (QL) is a muscle that attaches to the ribs and the top of the pelvic bone in the back. When both sides are contracted together they cause flexion (bending forward) of the lumbar spine, but individually will cause side bending of the spine. The iliopsoas is primarily a hip flexor (knee up), but since it attaches to the lumbar spine and the pelvis it can rotate one or both and is a very commonly missed muscular restriction.

Other important muscles are the abdominals. Now, I know that everyone wants the 6-pack, which is the rectus abdominis, but functionally it is only used for bracing and not stabilization of the lumbar spine. The more important muscles for lumbar spine stabilization are the obliques (internal and external) and the tranverse abdominis. These muscles together create stability in the lumbar spine and are critical for prevention and treatment of injury.

Now that we have talked about muscles, lets quickly cover how the joints and nerves work in the spine. The spine is built with bones stacked on top of discs with small flat joints on the back on either side called facet joints. Between the discs and the facet joints exists a space called the intervertebral foramen for the nerves to exit from the spinal cord and travel down to the lower extremities. The intervertebral foramen is typically where nerve entrapment happens that results in the type of pain more people refer to as sciatica where the pain travels down the back of the leg.

Because there are multiple joint surfaces in the spine it leads to a variety of possibilities as far as problems that can develop. Each vertebrae is capable of rotating, side bending, shifting forward, backward, or sideways independently of the surrounding vertebrae. Unfortunately this is never the only problem. One thing that is sometimes ignored in the spine is that one joint affects all joints. Your spine, skull, and pelvis make up what is known as your axial skeleton. One of the goals of the axial skeleton is to make sure your eyes are kept level and centered. The reason I mention this is that many problems in the spine are due to incorrect alignment that is the result typically of overuse and/or trauma. When injury occurs, a part of the spine comes out of alignment. The extreme example of this would be scoliosis.

For example, you are shoveling snow and just as you lift a heavy load you turn to throw it and experience pain in the lower back. Likely what happened is that one of the vertebrae rotated out of place. Over the next few days the pain subsides and life returns to normal. The problem is that the vertebrae didn’t rotate back. Your body adapted around it to make the rotated position the new normal position. Now, if this was the only thing that happened, your head and body would always be rotated in the direction of the rotated vertebrae, but we all know that is not the case. What happens instead is that the body will rotate another vertebrae above or below the injured segment to keep the eyes level and centered. I hope this explains the statement that I made before about how one segment affects all segments.

Common problems

Joint and Soft Tissue Inflammation - This one is probably the most common, particularly after car accidents, falls, and repetitive trauma like poor lifting mechanics or poor posture. Inflammation results in pain, swelling (decreases muscle contraction), redness, warmth, weakness, etc. Symptoms include tiredness in the low back toward the end of the day, mild to moderate pain, a feeling of weakness in the lumbar spine, pain with bending, lifting, and twisting, etc. This can be linked with some of the problems below, but can be more easily mitigated with rest, appropriate body mechanics, and corrective exercises that will be discussed below.

Herniated Disc – This is one that many people have heard about, but has incredible variation in how the problem presents. First, I want to preface this description with something about MRIs. If you performed and MRI on 100 people, almost 50% of them would present with some level of herniated disc in the lumbar spine, but have zero symptoms. So, just because the MRI says that you have a herniated disc, does not mean that the disc is the cause for your problem. Herniated discs are caused when the hard outside of the disc is damaged and the soft inside pushes toward the damaged area. This then displaces the disc in the spine and can result in anything from localized pain, numbness, tingling, muscle weakness, sharp shooting pain into the leg(s), and much more. The reason for the neurological symptoms (numbness, tingling, shooting pain, etc.) is because of the close proximity of the disc with the nerves. Herniated discs frequently cause nerve compression that causes pain and other signals to travel along the path of the nerve down through the lower extremities. Typically the symptoms above are alleviated through extend positions of the lumbar spine such as standing, laying down with legs straight, and laying on the stomach. The extended positions compress the back side of the disc and shift the herniation forward away from the damaged area and nerves. Now, this is not always the case, but it is typically the most beneficial for individuals with herniated discs

Stenosis – This problem is more associated with individuals over the age of 50. The reason for the older population being affected by this is because of the progressive loss of disc height that decreases joint spaces in the spine. Decreased joint space leads to pain and inflammation. Most of the time this presents as stiffness and pain more so in standing or laying with your legs straight. Positions that alleviate pain are usually sitting or laying on your back with your knees bent because these positions will open up the facet joints to increase space and decrease joint pressure.

Sacroiliac Dysfunction – This problem tends to be misinterpreted as lumbar spine pain, but the problem is lower than the lumbar spine in most cases. What happens with this pathology is that rotation occurs with the sacrum or pelvis that changes the pelvic position and likely leg length. This change in leg length and rotated pelvis result in pain and an off center base of support for the rest of your body. If you stand with one knee bent and the other straight you can get a feel for what that might do to your back. The classic presentation for this is pain at or below the belt line and aggravated most with transitional movements (sitting to standing, laying to sitting, etc.) and changes in position, particularly sit to stand. Patients of mine have also stated that they feel like that have to sit on their hands to get comfortable. If you place your hands on your low back and feel for the two bony knobs that are approximately at your belt like. Just below those two bones on either side are your sacroiliac joints where you sacrum connects with your pelvis. If your pain is here, then likely the problem is coming from an misalignment of your pelvis and not from the lumbar spine. Of course there are exceptions to this and that can be determined by your primary care medical professional, but in general that is likely the cause for your pain.

Now onto the fun stuff!!!

Activities to avoid – Bending, lifting, twisting

Flexion with twisting and the addition of weight, especially when performed repetitively, is the most common cause for back injuries. What this combination movement does is take out 50-75% of the joint and muscular support of your spine and place it in a high risk position for injury. Also under the “bending” category is long duration sitting. Usually with prolonged sitting people tend to slump down in the the chair or hunch forward. Both of these positions will cause increased compression on the lumbar spine and sacroiliac joints. If this is the standard position of sitting everyday, it is a repetitive stress to the spine that will dramatically increase the likelihood for injury.

Body Mechanics

Sitting – If you click on the image to the right it will enlarge in another window so that you can read the details of the work station set up. The same posture also applies for all other sitting activities, just without the computer

Lifting – I thought instead of describing the great details of a correct squat for lifting I would borrow a video lift from YouTube that you can view here on correct squat form. Yes, I know there are a ton of variations to the squat, but this one covers the basics.

Being aware of your body position is critical for avoiding lower back pain and injury. The more that you practice the correct body mechanics the more it will become part of your daily routine.

Exercises – Ok, I decided to go a little overboard (in case you hadn’t already noticed)

The exercises below are some of the basic exercises that can be performed to help treat and prevent low back pain. By creating core strength around the lumbar spine through the abdominals, pelvic muscles, and low back muscles you can reduce pain, and prevent injury. If any of the below listed exercises cause you pain or increase in pain, please do not perform them and consult your primary care medical professional.

Knee Rocks - easy exercise that can create decrease nerve firing to reduce pain and muscle spasm while gently working on the mobility of your lumbar spine

1. Lay on your back with your knees bent and feet flat
2. Gently rock your knees together side to side 5 degrees to the right and left
3. Be sure to keep the motion equal to each side, if one side is more limited, make the other side equally as limited
4. Repeat for 5 minutes
5. Perform in the morning and evening or any other time when you experience pain

Pelvic Tilts – Strengthening of your transverse abdominis is critical for maintaining core stability. This exercise is given to all low back pain patients on their first day.

1. Lay on your back with your knees bent and feet flat
2. Gently draw your belly button to spine like zipping up a tight pair of jeans
3. Try not to roll the hips back as this will activate the rectus abdominis, instead focus on drawing everything in like a corset
4. Hold for 10 seconds
5. Repeat 10x
6. Repeat at least 5x/day

Bridges – strengthens the core (obliques and multifidi) as well as strengthening the gluteals for increased pelvic stability

1. Lay on your back with your knees bent and feet flat
2. Draw stomach toward your spine like zipping up a tight pair of jeans
3. Squeeze your gluteals and lift your hips off of the table
4. If you feel more strain in the low back or the back of the thighs then the gluteals are not being recruited properly. Stop, reset, and try again with more emphasis on the gluteals squeezing together to lift the body
5. Hold the this position for 5 seconds
6. Repeat 10x
7. Repeat at least 3x/day

Standing Extension – the typical go to exercise for low back pain that benefits from extension

1. Stand with feet shoulder width apart and hands on your hips
2. Squeeze your gluteals together and hold
3. Gently lean backwards extending your lower back, but not from the hips
4. Slowly move back to the starting position
5. Repeat 10x
6. Repeat everytime you move from a sitting or laying position into standing.

Crossed Flexion – great exercise for stenosis to increase core strength and open the lumbar spine

1. Lay on your back with your knees bent and feet flat
2. Place the left hand against the right knee and press them together by tightening the abs in a diagonal pattern
3. Hold for 10 seconds
4. Then perform on the opposite side
5. Repeat 10x on each side
6. Repeat 5x/10 (most important in the morning and evening with knee rocks and pelvic tilts

Plank – one of the best core exercises (way better than sit ups or crunches)

1. Lay on the floor face down
2. Prop yourself up on your elbows/forearms with your toes into the floor
3. Lift your pelvis off of the floor to make your body like a board
4. There should be a straight line from your shoulder, through your hip, and to your ankle
5. Keep the abdominals zipped in with gluteals squeezed
6. Feel for the abdominal tremble
7. Hold for 60 seconds (60 seconds is required to be able to test the true core muscles be fatiguing the larger compensating muscles)
8. If this position is too hard, try it with your arms straight or on a stable elevated surface

I hope that you enjoyed this post and that you have gained more knowledge about the lumbar spine. If you have any questions or comments feel free to leave them here.

Cheers to your health,

Lynk

PS: If you are interested in a high quality injury guide that was put together by a fellow doctor of physical therapy check out http://drkbackinjuryguide.com.

Muscle Balancing Further Down the Spine

Ok, so in the first post I talked about the importance of muscle balancing and how it can improve performance, decrease injury, and decrease pain. Plus, there was an exercise that I gave to start working on muscle balancing and posture. In this post I am going to talk about the shoulder and how working on muscle balancing in this area can affect your shoulder, neck, mid-back, lower-back, and pelvis.

The shoulder girdle, consisting of the shoulder blade (scapula), arm bone (humerus), collar bone (clavicle), and rib cage, has a significant impact on postural position. Not only does the shoulder girdle have influence over the rib cage and mid-back, it has direct attachments to the neck, and lower back. These muscular attachments are critical components of shoulder motion and maintaining postural position.

If you took a look a the postural position of most people, you would likely find their head to be in a forward position, shoulders shifted and rounded forward, increased forward rounding in the mid back, and a flattened or arched lower back. Currently, I would like to focus on the forward shoulder position. This forward or protracted position of the shoulder does a variety of things to the body that I would like to illustrate. First, the forward position of the shoulder forces the head into a forward position. This happens because the body always wants to try to keep the eyes level with the horizon and balanced. So, rather than looking at the ground when you round your shoulders forward, you tip your head up to keep you eyes level.

Go ahead and try this right now. Sit or stand in tall posture, then let your shoulders round forward, but pay attention to what happens to your head and neck. What likely happened is the the rounding forward of your shoulders caused a rounding of your mid back and a lifting of your chin to keep your eyes level. This causes compression at the cervical spine and an opening of the thoracic spine (mid-back), both of which cause increased stress of the joints. It also causes the muscle on the front of the body (pectoralis major, pectoralis minor, abdominals, upper trapezius, muscles on the back of the neck) to shorten, and muscles on the back of the body (middle trapezius, lower trapezius, rhomboids, latissimus dorsi, muscles of the mid back) to lengthen. This change in muscle position is a critical component because in my last post I talked about how muscles that are not in the optimal position are weaker. On top of this the body then interprets this position as the new normal and takes away your ability to reach a correct postural position and be able to hold it because the muscles become shortened on the front and weak on the back.

Of course the problems don’t stop there with bad posture. In correct posture, your humerus can hang on the scapulae with minimal muscular effort and minimal stress to the joint and rotator cuff muscles. However, when your shoulders round forward it changes the joint mechanics of the shoulder joint. Now the rotator cuff muscles (particularly supraspinatus, most commonly torn rotator cuff muscle) have to work overtime to maintain the joint position. This continuous taxing of the muscles causes them to weaken, become, inflamed, and painful; thus, you can create a cycle of swelling and inflammation in the shoulder that can lead to a variety of different injuries and symptoms that can become very costly and painful to deal with. So, let me show you how to work on correcting this ticking bomb.

Now the forward head position can be helped through the neck retractions that I made in the previous post. The shoulder position, however, requires some different exercises. Specifically, I would like to start off with an exercise for the middle trapezius. This muscle is one of the primary muscles that retracts the scapulae to restore the normal position.

1. Squat down with hips back and chest facing the floor
2. Keep your head down (not looking up), gluteals tight, and abs drawn in
3. Start with you arms straight down in front of you pinkies out
4. Leading with shoulder blade pulling together and down, raise your arms out to the sides keeping pinkies out/up
5. Be sure not to let your shoulders raise up toward your ears
6. Return to start position by letting the shoulder blades slowly move apart and repeat 10x
7. Repeat this at least 5x per day

“The posture you lift in is the posture you stay in.” This is something that I have learned over time. Sitting up straight for hours on end will not correct your posture. Most people, if places in the correct posture, will return to their normal position in less than 3 minutes, but if the muscles that hold you in correct posture are regularly trained, then it is far more likely that you will be able to hold that position for longer with less effort.

Hope that you have found this information helpful, and please feel free to comment or sign up for the e-mail to get notified when I make new posts.

Cheers to your health,

Lynk

PS: Here is a link for an injury guide for the shoulder that was put together by my good friend Dr. Kareem Samhouri http://DrKShoulderInjuryGuide.com

The Importance of Muscle Balancing

In physical therapy I regularly come across all sorts of injuries, surgeries, and ailments that people present with, but one of the most come things that almost everyone has is an imbalance in their musculature.

Ideally, your body should be balanced from top to bottom, left to right, and front to back. If you are balanced in all directions, not only does it significantly reduce you chance of injury, but current injuries that you may have can be improved through muscle balancing. Balanced muscles around a joint give increased stability and protection for that joint as well as decreasing the regular stress that occurs in that joint because it can be placed on the muscles. Additionally, correct alignment improves performance by allowing the muscles and joints to be placed in optimal positions for the greatest range of motion and strength production. There are even some schools of thought that believe a good portion of disease and injuries are preventable through restoring appropriate alignment of the body.

Imbalances in the muscles of the body can cause significantly increased stress through the joints of the body from head to toe, literally! That increased joint stress significantly increases the likelihood for injury. We live in a forward moving and mirror obsessed society. Computers and long car rides place us in compromised posture for hours at a time. This results in forward head posture, rounded forward shoulders, flattened or extended back, forward rotated pelvis, and increased weight bearing through the balls of the feet. All of these postural deviations cause neck pain, shoulder pain, back pain, decreased breathing capacity, knee pain, and foot pain.

The good news is that all of these pains and problems can be corrected through exercise alone. Utilizing the right exercises you can work to restore the appropriate alignment of the body to decrease current pain and decrease the likelihood of future injury. Many of the exercises that I am going to write about are easy to do, but critical to restoring correct alignment. So, here is the first exercise to start with to begin correcting your alignment. This one is working on restoring normal head position over the shoulders to decreasing neck pain, headaches, and that tight feeling everyone gets across their shoulders.

Neck Retractions

1. Lay on a pillow with the bottom edge of the pillow under the shoulders and the head at the top of the pillow
2. Gently press the back of your head into the pillow giving yourself a double chin
3. Avoid tipping the head up or down
4. Hold the press for 10 seconds then relax
5. Repeat 10x
6. Repeat 5x/day
7. This can also be done in the car at red light (only at red lights) by pressing your head against your head rest or against a wall with a pillow or small folded towel behind you head

Keep watching the blog for more exercises to help decrease your risk of injury and improve your posture for more effective training. Sign up at the top of the page to receive e-mails when more posts go up.

Cheers to your health,

Lynk

Ice for injuries

Check out this article on icing of injuries to help with healing. Its got some good information about the most effective icing methods that are very practical and effective.

http://ezinearticles.com/?Best-Icing-Method—5-7-Minutes-With-Ice-and-a-Wet-Paper-Towel&id=3671198

Here is icing in a nut shell.

1. Fill up a thin plastic bag with ice
2. Place a soaking wet paper towel on the outside of the bag
3. Place the bag of ice with the wet paper towel side down directly on the skin where there is pain or swelling
4. Keep in place for 7 minutes
5. Perform at least morning and evening or anytime there is an increase in pain

Cheers to your health!

Lynk