Wednesday, January 28, 2015

New Year, New Resolutions, and (Avoiding) New Injuries (Part 2)

***Note: If you’re sitting at home reading this, snowed in by Juno and working up the energy to go shovel, take a minute to read about a few ways to avoid low back injury while you’re out there!

Now, I know you’ve all been anxiously waiting for Part 2 of last week’s Injury Prevention blog. Wait no longer! We’re back to finish up with warm-up exercises that prepare your body for a workout after a long day of sitting. Heck, these exercises can be used on a daily basis, regardless of your gym regimen, to relieve the sitting-induced discomfort that makes you want to throw your desk chair out a window. They are quick, easy, and kill many birds with just three or four stones. If you missed last week's discussion on just how bad sitting is for you, check it out. Also, if you haven’t taken a look at Dr. Luke's other tips for staying comfortable at your desk, take a quick peek at some point. They could change your life.

Since last week, I’ve had some time to think about how you might’ve reacted to the blog. I’m guessing that most of you were able to relate to it. You might’ve started out by thinking I’m some sort of awesome mind reader able to sense your pain, but you probably quickly realized that simple anatomy and biomechanics of the body explain it. Plus, I see patients coming into the office so often with the same sitting-induced complaints, that it’s kind of a no brainer!

A small percentage of you, however, might’ve read the blog and thought, “I have no idea what this chiropractor is talking about. I sit from 9-5 everyday and I feel great when I leave the office.” While I suppose this could be possible, (although I really, truly doubt it) I have some bad news for you anyway. How you FEEL at the end of your day doesn’t change what you’ve subjected your body to for the previous 10 hours. You’ve been sitting….at a desk….for 10 hours.  The damage has been done. Even if you’ve maintained what is considered perfect sitting posture the entire time, it doesn’t change the fact that our bodies just aren’t made to sit for extended amounts of time. Muscles and soft tissues react in a negative way, and your body changes whether you feel it or not. Unfortunately, in this case your body isn’t even giving you discomfort to act as warning sign anymore. Sneaky, sneaky.

Now that we’ve got that covered, let’s pick up where we left off. Let’s talk about three exercises that work to reverse the effects of sitting, anytime. All you need is a chair, a wall, a floor, and people who won’t make fun of you while you do them. (**NOTE: I have found that most people can tolerate these exercises with positive results, but make sure you check with your chiropractor to make sure they’re appropriate for you first. As always, if these exercises increase your pain, stop and check in with your chiropractor for further instruction.)

1. Cervical Retractions aka “The Triple Chin Move”
o   Purpose: Strengthen the weak muscles in the front of the neck, and stretch the tight ones in the back of the neck. This brings the head back, so that your ears sit over your shoulders where they belong.
o   Set Up: Sit up tall in a chair.
o   Technique: Place your pointer finger on your chin and guide your chin straight back to your spine. (Your neck should be doing the work, not your finger, and if you look in the mirror a nice triple chin should be forming.) Remove your finger and hold your head in place, ears over shoulders for 2s. Relax and let your chin fall into its normal resting place to complete one rep. Repeat 10-12reps.
o   Notes: You do not have to use your finger for the rest of the reps as long as you’ve got the movement down. During the 2s hold, you should feel the muscles in the front of the neck activating, and the muscles in the back of the neck stretching.

2. Pelvic Tilt
o   Purpose: Strengthen the weak core and glute muscles, and stretch the tight low back muscles.
o   Set Up: Find yourself a floor (please, not a couch or bed) and lay on your back with your knees bent and feet flat on the ground. Take a second to use your hand to find the natural space between your low back and the floor underneath you. Keep your hand under your back.
o   Technique: Draw your belly button into your spine in order to flatten your low back into the floor. (You should be squishing your hand underneath you.) Hold for 2s, and relax. Repeat 10-12reps.
o   Note: Tuck your buns under as you flatten your low back into the ground. Your pelvis should be close to lifting off the floor, without actually leaving the ground. This will help you activate the right muscles.

3.  Wall Angels
o   Purpose: Strengthen the weak mid back muscles, and stretch the tight chest muscles. ADDED BONUS: This exercise incorporates the previous two moves, accomplishing a ton all at once.
o   Set Up: IT’S A LONG ONE, so hang in there. Find a clear wall to lean your back against, feet together and 12in from the wall. Take inventory of what is touching the wall. The goal is to have everything from your buns to your head flat against it, but at this point it’s probably just your buns and your mid back. To remedy that, pull your belly button in to the spine and flatten your low back into the wall like a Pelvic Tilt. Hold. Bring your shoulders back so they flatten against the wall. Hold. Bring your chin straight back to your spine like a Chin Retraction. Hold. Flatten the backs of your hands/arms against the wall down by your sides. Hold. This is the posture you will maintain throughout the exercise, so KEEP HOLDING! I know you think I’m crazy by now. Bear with me…
o   Technique: Start the exercise by slowly moving your hands/arms up the wall like you’re making a snow angel, or like you’re under arrest! Only go as high as you can until you feel yourself breaking good form and body parts start lifting off the wall. When you reach that point, slowly glide your arms back down the wall to your sides. Reset your posture if necessary, and repeat 10-12reps.
o   Notes: While you may only get your hands to shoulder level at first, it’s OK! As you get both stronger, and more flexible, this range of motion will improve. If you can get your hands up over your head with your entire back side still pressed against the wall, you’re amazing! Remember, these exercises become worthless when your form breaks, so if you feel that happening, reset and continue.

4. Treadmill Walking or Walking Lunges
o   The tight muscles in the front of the hips haven’t been addressed yet. They need a little TLC before you start squatting, running, etc. Start with some slow walking on the treadmill, making sure to take long, easy strides. Over the course of 5-10min, you can increase the pace to a brisk walk, before you eventually begin your run. You can also do some walking lunges (on the ground) to open up the hip muscles. Ease into them, slowly lowering into the lunge and stretching the hip of the back leg before you push back up. 20-30 lunges should get you warm.

Phew! You did it! See what we just did there? We’ve taken all of the muscle tightness and weakness described in those Upper and Lower Crossed Syndromes caused by sitting, and addressed it in some way. If you work through this set of exercises 1-2x before your workout, those muscles will have seen some action before you torture them with weights or put them through long strides on the treadmill. You’ll have better flexibility, range of motion, and muscle activation going into your workout, and any muscle that has the chance to (literally) warm up to your exercise routine will treat you much better in return. Not only that, but if you do these exercises each day that you’re at your desk, you’re actively working to reverse the effects of sitting on a daily basis! That’s an amazing way to prevent injury, both short and long term. And remember, if these exercises are very difficult for you, and not getting any easier with practice, your chiropractor may be able to address any restricted motion in the spine that is hindering your mobility. Now if you’ll excuse me, I’ve got some exercises to do!

-Dr. Doscher

Wednesday, January 21, 2015

Upper and Lower Crossed Syndromes

New Year, New Resolutions, And (Avoiding) New Injuries (Part 1)

“Ok, THIS is the year. I swear. It’s time to be healthy. No more cookies. No more chips. DEFINITELY no more ice cream. AND I’m going to the gym. Everyday. Maybe twice a day. I’m very serious. Have I mentioned that THIS IS THE YEAR?!”

Sound familiar? I’m guessing almost all of you have heard someone resolve to make similar changes since the first of the year. Maybe that someone was you? Personally, I’m a big fan of resolutions and their ability to change the trajectory of our lives when we commit to them. The New Year happens to be a fantastic time to take inventory of our finances, relationships, lifestyle, and health. Obviously, one of the most common commitments for people to make is to workout more. Why do you think gyms love January 1st? More members, more money! The problem is, when we jump into a new activity that our bodies aren’t used to, it’s a shock to the system. Now originally, this blog was supposed to be about common injuries sustained at the gym when we throw ourselves into our New Year’s resolutions. What I realized, however, is that the potential for injury starts well before we step foot in the gym. Remember the desk that most of you are tethered to 40+ hours/week? We need to address that first; the desk, all of the sitting, and what it does to our bodies by the end of the day. Once we understand that, we can figure out how to counteract the effects of sitting and prepare for exercise. (Coming in Part 2!) This way, we have at least half a shot of getting through a workout injury free!

Take a second to think about how you spend most of your day. Are you imagining yourself not only at your desk, but also in the car and then on the couch after work? Don’t worry. You’re among the majority. (Actually, I need you to worry JUST a little bit because all that sitting is making your body pretty unhappy with you. But again, don’t worry because there are ways to make improvements!) The problem is, when you force your body into one (poor) posture all day long, eventually your body adapts. Trust me when I tell you that these particular adaptations are not in your best interest. And I’m sure you started your day with the best of intentions! You got to the office, sat down in your (hopefully ergonomically sound) desk chair, and situated yourself the way every “Proper Sitting Technique” article ever written has instructed you to. Your posture is perfect…for about the next 12 seconds. Then someone calls, so you shove the phone between your ear and your shoulder in order to continue typing. You get tired and distracted and before you know it you’re hunched over your computer, shoulders are rounded forward, your head and chin are jutting out toward the screen, and you’re cursing at whoever made the chair because obviously they didn’t SIT in the chair before they mass-produced it.  Combine all that with thinking you’re doing yourself a favor by jumping head first into a workout after 8 hours at your desk, and we’ve got a problem.

Your discomfort, and this posture, actually has a few names. They are the Upper and Lower Crossed Syndromes. These syndromes both describe the adaptations that the soft tissues/muscles have made in response to the hunched-over posture you’ve subjected them to while at your desk. They describe the pattern of some muscles contracting, shortening, and tightening all day, while others are stretching, weakening, and underutilized. To get an idea of which muscles are doing what, imagine looking at someone from the side (their profile) and drawing one X right through their upper body, and another through the lower body. Get it now? Upper and Lower CROSSED Syndromes. Pretty creative, right? You can draw a diagonal line through the weak muscles (front of the neck and down through the body to the muscles between the shoulder blades), and another through the tight ones (chest muscles up through the body to the back of the neck), front to back.

In Upper Crossed Syndrome, the muscles in the front of the neck are responsible for neck flexion (chin to chest) and chin retraction (chin straight back to the spine). Go ahead and sit up tall and a place your pointer finger on your chin. Now push your chin straight back to the spine (you should see a nice double chin forming), remove your finger, and hold this position. Do you feel the muscles in the front of the neck activating to keep your head back, ears over shoulders? Now relax and jut your chin forward. Those same muscles go totally slack. This is the exact position you end up in at your desk. Those muscles don’t do any work all day long, and as a result get progressively weak over time. Now the muscles in the back of the neck are there to lift the chin up and extend the head back. When your chin is jutting forward, however, those muscles are back there just holding on for dear life. They’re keeping your head up so that you can see the computer screen, and not just the floor of your office. Expecting these posterior neck muscles to work non-stop during your work day is crazy! They end up tightening and shortening, and causing all sorts of neck tension and headaches.

The chest and back also suffer. With your shoulders rounded over a keyboard all day, your chest muscles shorten and tighten. Opposing this are the muscles of the mid back that are trying to pull your shoulders back and shoulder blades together. Because of your position, they can’t, and just like the anterior neck muscles, when they aren’t used they give up. They get weaker. The problem is that the changes to the muscles that I just described aren’t transient. They don’t just ‘go back to normal’ once we shut down our computers and stand up. Those changes have now affected your posture, and pretty soon you’re just as “hunched over” when you’re up and walking around as you were at your desk.

As I’m sure you can imagine, Lower Crossed Syndrome follows the same pattern in response to habitual sitting. A diagonal line of weakness can be drawn from the abdominal muscles, down through the body to the glutes. Another can be drawn for the tight muscles from the front of the hips up through the low back. Our abdominal muscles aren’t engaged to keep us sitting tall, and thus they weaken. The low back muscles, on the other hand, work all day long to keep you upright as you lean forward toward your desk. Your glutes aren’t activated at all when you sit contributing to their weakness, and sitting in a chair all day with our hips flexed means the anterior hip muscles shorten and tighten over time. When you stand after a long day, muscle adaptations have occurred and you’re walking around with a lot less mobility in the hips and low back, while other muscles aren’t doing their jobs! Bad combo.

The point of all this is to show you how far from normal your bodies are functioning after a long day (or after 20 years) of sitting.  (As a chiropractor who takes care of people all day long who are coming in with desk-related aches and pains, I think it’s kind of my job to do so!) Just as you can imagine it’d be a bad idea to get up from your office chair and start sprinting, our bodies are also not 100% ready to walk into a gym and start with a set of dead lifts. This doesn’t mean that you shouldn’t go to the gym though. In fact, it’s a great idea. We just need to PREPARE for it. Next week we’ll talk about some quick things to do before your workout to attempt to un-do the sitting, and warm up. In the meantime, Dr. Luke wrote a great blog called “Sitting Is The Problem.” ( Take a minute to look over some of the other problems that sitting can cause, as well as some great tips for making your 10hr day at a desk more manageable. Check back next week for Part 2, and until then get up out of the chair that you’ve been sitting in to read this blog, and take a lap!

-Dr. Doscher

Wednesday, January 14, 2015

Shoveling and Low Back Pain

It’s that time of year again here in the Northeast. Temperatures have dropped, snow has started falling in sheets, and it seems like every other day we’re outside bundled up in our winter gear trying to clear that snow out of the driveway and off the front steps. It’s an inevitable part of living in Massachusetts. Injuring yourself while making sure you can get out of your house and off to work, however, doesn’t have to be. As a chiropractor in Boston and a resident of this very cold state, I can tell you it is this time of year that brings more people into the office with household-related injuries than any other season. The ‘simple’ (read: rarely simple, usually exhausting, and hardly ever fun!) act of shoveling snow ends up injuring more people each year than even I can believe!

A recent study published in the American Journal of Emergency Medicine reported an average of 11,500 shovel-related injuries in the ER each year. While fractures, cardiac events, and cuts or bruises were all identified as reasons for seeking medical attention, not surprisingly low back injuries were among the most common. Approximately one third of the injuries reported in the ER were low back in nature! Those low back patients are the very same patients walking through our doors, wondering how they managed to hurt themselves shoveling. Let’s take a look at the most common injuries we’re seeing, and how to prevent them!

How many times have you come in from shoveling and thought, “Wow. I’m going to be sore tomorrow”? No matter how you slice it, shoveling is a form of exercise, and a unique one at that. Like any other form of exercise, if it’s new to you (or perhaps, it’s the first snow of the winter) your muscles are not accustomed to what you’re about to put them through. Let’s start with some general biomechanics:

Each time you bend forward to scoop snow, the muscles of the low back and the hamstrings have to stretch and lengthen to get you closer to the load you’re about to lift. If you continued this forward movement, though, you’d end up face-planting! In order to prevent that, those same muscles have to quickly contract and shorten to stop you after a few inches of forward bending. Now you’ve got snow (ie. weight) loaded on the end of the shovel, a few feet away from your body. Not only do your core muscles have to stabilize you, but those same low back and hamstring muscles have to continue to contract even more forcefully to lift you and the snow upright. Lastly, you’re probably twisting to one side to toss the shoveled snow out of the way. Repeat this stretch, contract, and twist combination another 900 times along the length of a driveway, and you’ve got yourself a workout! (Incidentally, this is probably the WORST way to approach shoveling, but also the most common. We’ll make sure to address good technique shortly J.) This repetition of movement resembles most exercises at the gym, and as a result the muscle fibers of the low back and legs react the same way. Each time the small individual muscle fibers that make up a muscle are stressed during exercise, they are subjected to damage on a microscopic level, aka micro tears. The body recognizes the damage and sends extra blood, nutrients, and waste clean-up to the area to help heal, rebuild the muscle, and make it stronger. A by-product of this is inflammation. Now, inflammation tends to get a bad rap, but (when under control in the right circumstances) it’s actually a very normal and healthy part of healing. Inflammation helps to heal those muscle fibers, but is also perceived by us as tenderness or pain. So, you shovel for the first time this year, or the snow is exceptionally heavy, or you’re out there every hour because it’s falling THAT fast, and you end up sore because it’s new to your muscles in one way or another.

Some muscle soreness is generally not the end of the world, but severe tightness or pain definitely isn’t normal. What you should really be aware of is the potential to cause a true sprain/strain injury of the low back by overdoing it. Remember how we talked about a muscle’s ability to shorten and lengthen? Well, sometimes if we stretch too far or too quickly, the muscle tendons or ligaments of the low back can be over-stretched or torn past the point of the normal micro tearing we just talked about. We end up with a sprain or strain. Both injuries result in lots of muscle spasm, excess inflammation, and pain. Lift more snow than you’re used to, or twist to toss the snow aside before your body stabilizes itself, and the next thing you know you’re really injured!

Another potential injury commonly associated with shoveling is a disc injury. Intervertebral discs are the cushions between each bone (vertebra) of the spine, responsible for shock absorption. Think of a disc as the body’s equivalent of a jelly donut; squishy jelly inside, dense dough outside. The jelly inside the donut has room to move around within the confines of the dough as it’s squeezed (loaded) and pressure changes. When we bend one way, the jelly naturally moves in the other direction to relieve pressure. Sometimes, however, if the pressure pushing the jelly around as we move is great enough, that jelly can start to seep into the dough and get pretty messy. In our bodies, when the gelatinous inner substance of the disc (normally contained by the tougher outer layers) starts to push outward, the disc ends up injured and inflamed as it bulges. Less commonly, it can even push through those outer layers resulting in a herniated disc. Despite the amazing ability of these discs to withstand forces, there are circumstances in which they are more vulnerable. For instance, sitting increases the pressure in the disc far more than standing does. The same is true for forward bending. Bend forward with a load, or bend and twist, and you’ve now put your discs in the most stressful positions possible. Sound familiar? Bending forward with your shovel, loading it with heavy snow, and then lifting it and twisting to toss it aside is the trifecta of movements that put the discs at the greatest risk of injury. Injuring the outer layers of the disc can cause immense pain, inflammation, and spasm in the low back. Herniating a disc, however, means nearby spinal nerves or the spinal cord may be affected. Injury to these structures can result in all of the discomfort we just mentioned, plus pain, numbness, and/or tingling into the legs. It’s a much more severe injury to sustain.

Now that we’ve covered all of the big, bad stuff that COULD happen, let’s try to prevent it! Here are some tips for tackling the snow safely:
·      Avoid Shoveling: If you have a snow blower, you’re one of the lucky ones! Use it! If not, please continue reading…
·      Warm Up: We’ve already established that shoveling is a form of exercise. Just like we get our bodies warm before lifting weights, we should be doing the same before shoveling. Take a couple of laps up and down the driveway to get the muscles warm and prepped for activity.
·      Salt/Sand: Use it to make sure you have good footing and balance, allowing your muscles to activate normally. Slippery surfaces make you unsteady and can catch your muscles off guard, leading to injury.
·      Ergonomic Shovels: They make shovels with curved handles and adjustable lengths for people of all heights so you’re not bending as much. While you’re at it, chose a lightweight shovel. The snow is heavy enough!
·      PUSH the Snow: Pushing the snow out of the way instead of lifting it is a lot easier and requires much less bending and stress on the low back. When you have to lift it, try a little less snow.
·      Technique: Start by squaring your body off to the load, keeping it in front of you. Use one hand closer to the blade and one hand near the handle. Keep the low back as straight as possible. Brace your core (imagine someone is about to punch you in the stomach and tighten your abs for protection), bend at the hips and lift with the legs to minimize the amount of pressure on the low back and in the discs. Keep the load as close to you as possible for more control and less strain on the muscles. Instead of twisting and tossing the snow, pivot to where the snow will be discarded and deposit it. This helps reduce the added pressure on the discs created by forward bending combined with twisting.
·      Pace/Rest: Sometimes taking a break makes all the difference. Give your body a chance to regroup, and head back out. Also, instead of trying to lift 12in of snow at once, take a few off the top each time to make it lighter and more manageable.
·      Remember: Heart issues have been reported in association with shoveling and the cold weather. If you have a history of cardiac issues, check with your doctor for clearance. If you notice any cardiac symptoms while shoveling, seek medical attention immediately.

Now, if somehow you still find yourself injured or uncomfortable, there are ways to heal more quickly. Your chiropractor has the ability to evaluate the severity of your injury and treat appropriately. Muscle spasms can be reduced, mobility can be restored, sprains/strains can be healed, and even minor disc injuries can be addressed with various techniques. More importantly he or she should be able to give you the appropriate strengthening exercises once healed, to prevent further injury. After all, it’s a long winter with plenty more snow on the way, and your driveway isn’t going to shovel itself! Stay safe out there!

-Dr. Doscher