Keepin’ the Curve

When a client comes in with neck or low back pain, part of my work is to reduce the trigger that is causing the problem. More than often, posture is a contributor. As in my previous post, bad posture will stretch certain muscles and weaken them (example again is that the bicep muscle on your arm is stronger when the elbow is at 90 degrees, rather than when it is straighter). With the low back pain, I will ask the client to lean forward as if they are picking something up, and as most of us do, they don’t bend at the knees and recruit them,  but more importantly they don’t keep the inward curvature of the low back. Owww, look at those poor stretched low back muscles with no help from the legsYay, look at the flattened back, strengthening the back muscles and the right leg helping out

 

 

 

 

 

 

 

photo-256The first picture shows me picking up a box with knees straight and all the bend going on in the low back. With enough weight and repetition, this can result in disc bulging and nerve irritation so it’ realllly good to avoid this if you lift quite a lot during the day. 

The second picture, I am bending the knees with one leg forward to help to take some of the weight away from the back and consciously keeping my back flat or with as much curve as possible so I’m at least not stretching those low back muscles and opening the vertebrae leaving myself open to disc issues. 

The third picture is the best way to pick up something where the upper body remains as vertical as possible and the legs and knees do all the work. Some clients have reported though that it is difficult to do with bad knees. Find out what is best for you. 

Generally, tight hip muscles and hamstrings will make the low back bend early as well but most of all it’s just habit and as I have learned, the body will let you know in no uncertain terms that it isn’t happy with you. 

It’s interesting that now I am careful with how I lean forward, people ask me if I have hurt my back, as if a back issue is the only thing that has made me move correctly. In my case, this is true, but interesting anyways.

Thought of the day: MUSCLES IN STRETCHED POSITION = WEAKER MUSCLES + CONTINUOUS APPLICATION OF LOAD ON THESE MUSCLES = SPASM AND PAIN

The thing with application of a continuous load on a weakened muscle (poor posture in sitting or standing) is that it is probably manageable and doesn’t present acutely, but then it is the sudden movements that often are the straws that break the camel’s back. It is similar to running a marathon (probably manageable) but then having to run a 100 meter dash at the end of it would put some muscles into acute trauma with pain and spasm.  An example is sitting poorly in front of a computer all day, and our muscles are exhausted from holding us up, then at the end of the day doing some heavy lifting, and that is what will cause the issues. It is not so much the lifting or sitting poorly separately, but put them together and this can cause problems.

Gooooooood fats

I was listening to the radio and the discussion was about fats and the importance of them. As most of us know, there are good and bad fats. Two items that were interesting were 

1) Everything in moderation was the general consensus of the public and the experts being interviewed. Fats are important to the brain. 

2) There was special attention in the discussion about the importance of fats for children when they grow up and the job of fats as the body is growing and developing. 

Here is some more information about Fats:

 

 Balance is the key to making fat work for you. There are two important considerations:

 a) Consume a variety of good fats. These include unrefined oils, such as extra virgin olive and safflower and sesame. Fats from butter, meats, eggs and dairy are good as well, as long as they are part of a balanced diet.

 b) Avoid hydrogenated (or partially hydrogenated) fats. These include margarine and many of the fats used to make breads and other products (read labels). Hydrogenated fats can disturb the metabolism of fats in the body. Also, fried or cooked fats should be avoided for similar reasons.

Why are fats so good? Here are ten reasons:

1. Fat as a Source of Energy.

The body uses two main fuels for energy: carbohydrates and fats. The energy is obtained by changing carbohydrates to sugar (called blood sugar or glucose) and fats to fatty acids. However, fats can provide more than twice the energy of sugar.

 Therefore, it makes more sense for the body to use fats whenever possible. One important factor related to this is a moderate level of activity, such as easy, aerobic exercise.

 If the body cannot burn fat for energy (due to a lack of dietary fats or exercise), two things may happen:

 a) It may be forced to use more sugar for energy, potentially affecting blood sugar. In some people, this low blood sugar may produce mood swings, fatigue, clumsiness, headaches, depression, allergies or other symptoms. However, if enough fat is converted to energy, blood sugar will be kept more stable, allowing the body to have an almost unlimited supply of energy. This will leave enough blood sugar for the brain and nervous system, which relies solely upon sugar.

b) In order for the body to use rather than store fats, they must be balanced. This means a variety of natural fats in the diet. The nutrients necessary for fat utilization must also be present. These include thiamin, riboflavin and niacin, and the minerals zinc and manganese.

 2. Fat for the Hormonal System

One of the body’s important life supports, the hormonal system, is dependent upon fats for good performance. This includes the production of hormones for the glands of the adrenals, thyroid and thymus (immunity) as well as the sex glands. In the adrenals, for example, cholesterol is needed for the production of testosterone, progesterone and cortisone. Niacin and phosphorous are two nutrients which help make this possible.

These hormones help immunity against invading bacteria and viruses, replace worn out cells, temperature, weight control, blood pressure, the nervous system and many other areas. Without the presence of fats hormonal imbalance can develop.

3. Fat as an Insulator

The body’s ability to store some fat makes most climates on earth suitable for life. Normal fat deposits in the skin help prevent too much heat from escaping the body in colder environments and provides some protection from the heat in warmer climates.

Cholesterol and other fats serve as a protective barrier, making the skin resistant to substances that could cause harm, such as chemical pollutants and excess water.

In addition, fats in the skin help protect against dehydration by preventing too much bodily water from evaporating. One symptom of dehydration is dry, scaly skin. A certain amount of evaporation is normal, but fats prevent as much as 10-20 times more water from escaping the body.

4. Fat for Support and Protection

When we exercise, walk down a flight of stairs, and especially if we fall, a great amount of support and protection is needed. Fats help provide this protection, acting much like the packaging material one might use when mailing a fragile gift.

Fats support and protect the vital parts inside the body including the kidneys, adrenals, stomach, intestines, pancreas, uterus and ovaries. Stored fats help prevent these organs and glands from “sinking” lower and lower as a result of the daily downward stress of gravity. This “visceroptosis,” as it’s called, could adversely affect the organs and glands within the abdomen (as well as create an unsightly abdominal protrusion).

In addition, fats protect the lining of the stomach and intestines from irritating substances in the diet, such as alcohol and certain spices.

5. Fat and Prostaglandins

Scientists now understand that the hormone-like substances called prostaglandins (PG’s) are necessary for all cell function. They are produced in the body from fats in the diet and help regulate blood pressure, steroid production, immunity, water balance, pregnancy and lactation, and other life support systems. The PG’s also control free radicals, which, when in excess, may contribute to certain disease states.

6. Fats as Regulators of Vitamins and Minerals

Fats help the body utilize certain vitamins and minerals. Cholesterol (and sunlight) is important for the production of vitamin D in the skin. Absorption and utilization of vitamins A, D, E, and K are also highly dependent upon fats.

Calcium is a “hot” item these days, but the importance of fat for calcium utilization if usually forgotten. PG’s help get calcium into the cells of the muscles and bones. If the right fats (and PG’s) are not present, calcium may go unused. Fat dependent vitamin D is also necessary for proper calcium use.

7. Fats for Pregnancy and Lactation

Fats are a vital part of a healthy pregnancy as well as lactation. During pregnancy, fat physically protects the fetus. This protection is similar to what was discussed above. The fetus also develops its hormonal system after the mother’s, which is fat dependent.

During breast feeding, the baby gets PG’s and cholesterol through the mother’s milk, protecting the baby against allergies, asthma, and intestinal problems. These vital fats are not available to the body except through breast feeding. This natural method also promotes the mental health of the baby.

8. Fats and X-Rays

Fats help protect the body against the harmful effects of x-rays. There may be two reasons for this: 1) through physical protection of the cells – fats are a vital part of the cell’s outer wall, and 2) by controlling the excess free radicals which may be generated when x-rays are taken.

9. Fats and Digestion

Fats are important for proper digestion. Lipase and bile, two vital fatty substances, help in the digestion and absorption of dietary fats and vitamins A, D, E and K.

Lipase, a digestive enzyme produced by the pancreas, can also be found in certain foods such as avocado and olive oil. Eating these foods may be an aid to both digestion and overall fat metabolism.

Bile, produced in the liver arid stored in the gall bladder, is highly dependent upon fat for its use. Bile helps the large intestine work properly, including the production of vitamin B12, the control of cholesterol, and waste removal.

10. Fats Taste Good

Anyone who has tried to make a delicious meal knows the importance of fats for good taste. The palatability of good food as a result of the presence of fat may be the difference between a healthy appetite and a poor, unhealthy diet.

In summary, fat is important for good health. Dietary fats, however, must be balanced, to include a variety of natural oils, butter, meats, eggs and dairy in moderate amounts. Many people avoid fats because of misinformation and fear. As time goes on, the “low fat” trend will disappear, as much research has already shown the benefits of this necessary, healthy substance.

Most cholesterol is made by your body, with only a small amount coming from food. Even your heart cells normally make cholesterol! When you eat less cholesterol, the body makes more.

Whole milk, beef fat and chocolate have been shown to lower blood cholesterol! These fat facts are reported in medical journals such as the Lancet, New England Journal of Medicine, and Nutrition Reviews.

Grind dem Seeds

There are lots of really healthy things that we can put into our meals that help with digestion, cardiovascular, nervous system ect. and one of my favorites are Flax Seeds. Such a little seed that does so much good. One thing that I didn’t realize until now is the importance of grinding the seeds in a coffee grinder or equivalent. Apparently, the outside shell is so tough, that the seed can go right through the system without being broken down. 

So there ya go. A little thought for you if you are a fan of the seed and want to get the most out of it. Below is what they say are the benefits:

 

  • Rich in alpha linolenic acid, omega-3
  • High blood pressure – Significantly lowers  when sprinkled on oatmeal each day
  • Anti-inflammatory effects
  • Protection against heart disease, cancer and diabetes
  • Rich in beneficial fiber
  • Effectively lowers risk of breast cancer
  • Boosts immune system
  • Helps manage weight
  • Enhances memory, mood and attention
  • Fights constipation, diarrhea and IBS
  • Helps lower cholesterol
  • Reduces symptoms of menopause
  • Helps with asthma, migraine headaches, arthritis

Information on Head and Shoulder Forward Positions

My experience with my clients is that we have become very much “Shoulder Forwardâ€? and/or “Head Forwardâ€? in our posture. Ideally, there should be a straight line down from our ear to our shoulder joint to our hip joint to our knees then to our ankles. If the Shoulders and/or Head fall in front of that line, the body can end up working too hard to compensate for this difference. 

There are two general rules that apply with muscles:

 1) If a muscle becomes stretched, it will weaken and vastly increases the chance of it going into spasm as it tries to do the job that it is responsible for. Example is that the bicep muscle on the arm is stronger when the elbow is at 90 degrees than when the arm is nearly straight. Give it a try.

2)If a muscle is shortened, it can become congested with waste byproducts that can cause pain, as well as not being able to bring in adequate amounts of oxygen necessary for the muscles to do their work. 

There are  many manifestations of a “Head and Shoulder Forward Positionâ€?  and can include the following:

A shoulder that is turned inwards can increase the risk of “pinchingâ€? of structures at the shoulder joint, during movement, causing local sharp pain. This will reduce the amount that the shoulder can be brought forward and to the side over 70 – 90 degrees, then slowly reducing motion in the shoulder more and more, very often predisposing the client to Frozen Shoulder Syndrome

A shoulder turned inwards will stretch the Rotator Cuff muscles from the back of the Shoulder Blade to the arm. These are very important muscles for stability of the shoulder and arm during movement, and when stretched will become weaker, causing Trigger Points (or hyper-irritable points in the muscle) that can produce pain down the arm as well as spasm during arm movement. 

Shoulder Forward position will shorten and thicken the Pectoralis Major and Minor muscle in the front of the chest. The Nerve that travels down the arm travels underneath this muscle on the way to the arm, and if compressed by the Pec Minor Muscle, will produce pain, weakness and tingling to the arm and hand. 

A head forward position will shorten muscles in the front of the neck.                                                                             -One neck muscle, the Sternocleidomastoid, can remain in the shortened position, causing symptoms like Headaches, nausea and has been tied to Migraine headaches with it’s proximity to the Carotid Artery.           -Another set of muscles called the Scalenes are important breathing muscles , and when shortened can cause pain in the chest, between the shoulder blades, down the arm and can cause headaches. The Scalene muscles can also compress the nerves going down the arm, like the Pectoralis Minor, causing similar pain, numbness and weakness in the arm and/or hand. Similar Trigger Points in the Pectoralis Major (chest muscle)  and Subclavius (muscle just under the collar bone), can produce vague, dull achiness in the shoulder and upper arm. 

The is supposed to be a small curve in the neck area of the spine that is designed to properly take the weight of the head. When the head is forward, it reduces this curvature reducing the efficiency of the lower cervical (neck) spine. With other factors in play, the discs that lay between the lower neck vertabrae can become dysfunctional, impinging on nerves in the neck as the nerve travels out to areas like the shoulder or arm. 

In my experience, our heads are realllly heavy. To have it in a forward position, unnecessarily stretches, weakens and taxes our lower back neck muscles, and forces our upper neck muscles to stay in a tightened, shortened position to pull the head up so that it is level with the horizon. This chronic neck tightening can cause headaches, neck, shoulder and joint pain.

The more that the head is forward, the more our jaw is retracted (pulled back), shortening muscles in the jaw, causing a predisposition to TMJ (jaw pain).

There is a general rule that when a joint is out of neutral position, movement in all planes is reduced. As the shoulder movement is reduced in “shoulder forward positionâ€?, the same applies with reduction of movement in the neck when it is in a forward position. The only issue with this is that other parts of the body nearby have to compensate to complete the desired movement which can start secondary issues. This is especially true with head rotation from left to right. If we are head-forward and there was no compensation, we would be looking down at the ground. To deal with this, the muscles at the top of our neck tighten so that we are looking at the horizon in front of us. Yet also at the top of our neck (C1-C2 vertebrae) is also where at least 50% of our head rotation occurs. If the muscles at that level are tight pulling our head up to look at the horizon, it will affect this important area for head rotation, causing our lower neck to work harder to make up for this lack of rotation at the top of the neck, disposing it to strain, headaches, degeneration ect. 

It has been proven that a person in a Head Forward Position will breath more shallowly and will be more of a chest breather as opposed to a abdominal breather, which can contribute to unnecessary Sympathetic Nervous System Firing. 

In my experience, a person with Head and Shoulder forward position can also experience mid and low back pain as well. Each person is different as to what part of the lower body ends up supporting the upper body. 

In my clinic, prevention is my focus is to help the client to identify the postural misalignments and to help them through treatment and homecare exercises/ alterations in daily activities to achieve a posture that will reduce the possibility of any of the above conditions from occurring. Changing postural alignment issues is difficult because they feel normal. Often I bring the person into alignment and they report that it feels unnatural. This is why it is important to be aware as much as possible. Leave yourself notes everywhere so you become more and more aware of how you are positioned. When you are balance, you reduce joint wear, nerves can travel without compression from surrounding tissue, muscles are balanced so they are stronger, circulation travels to their tissue and the above are key to a strong, flexible, painfree body.

Accountability

When I am treating a client, I discuss the process of their road to recovery. I think the most important thing for them to understand is that most times, success cannot be achieved without contribution also from the client. 

I feel we have been raised to believe that if we experience pain, the solutions have been medication or surgery or similar so we do them and we are better and go on our way. Generally pain is a message from our body that we need to make personal changes to avoid further injury. As someone that has low back pain, it become apparent to me that I need to make some changes and that treatments from various modalities are simply not enough. The pain taught me that my biomechanics need to be better when I am treating, I need to strengthen my core much more (because as a cyclist, my limbs have become stronger than my core and that is like the branches of a tree being stronger than the trunk). So this is something that I pass onto my clients. They cannot expect to simply come in, get treatment, have the pain go away and they can continue what they are doing. They need to watch what they do and make sure the body is strong enough to do it. Full understanding of what is causing the issue and why it is that they are doing the exercises is key as well. 

Keep moving!!! Very often, at work, clients find themselves in one position for hours on hours and often that may be ok for one day or so, but if the person does that 5 days a week, the issue can compound.

Adapt your environment to you…don’t adapt yourself to your environment (if you can). The most common example of this is working with the computer. Very often the keyboard and the monitor maybe positioned poorly so that you are leaning forward and turning your shoulders in, which can cause issues over longer periods with neck and shoulder stabilizers fatiguing. I will do an entry soon that discusses good strategies for the computer screen and keyboard positioning. 

The main purpose though with this entry is to stress the importance of being aware that you are ultimately the source of your own well being and we, as therapists, help to reduce pain, make you aware of the source of the pain, give you home care activities to remain strong and mobile and to assess periodically to make sure that the body isn’t falling back into the position that caused the initial issue.

 

Here is a cross section of Fascia and how it is intregrated with muscles

Here is a cross section of Fascia and how it is intregrated with muscles

A lot of the work that I do now involves what is called Myofascial release. This is working with releasing the connective tissue that makes up muscle tissue and separates different muscle bellies. Normally, these separate muscle bellies do different things so it is important that they don’t become adhered to each other. Conditions like immobility, dehydration, trauma or other injury can cause this fascia to adhere these muscle bellies together. When they are stuck to each other, this reduces the ability of the muscle to get rid of CO2, to bring in oxygen, which cycles the immobility of the muscle  and increases pain in the area. 

Sometimes the adhesion can occur within the muscle tissue (intramuscular adhesion), between muscle bellies (intermuscular adhesion), or surrounding more that one muscle bellies like around the quadraceps (extramuscular adhesions). Muscles can become adhered to other muscles, to bones, to ligaments to surrounding organs in the torso. 

An analogy I like to use with Intramuscular muscle adhesions is that it is like pouring glue on a bungy cord. You want muscle to be like a bungy cord. If it is rope like, there is risk of continued trauma/tearing and other conditions like bursitis, tendonitis and inflammation at the point where the muscle attaches to the bone. 

The thing with release of connective tissue, is that it is like stretching leather. It’s not about force, but about the amount of time that it is held. Often, when I find restriction in the fascia, often I will hold it for 30 seconds to 1 minute before it starts to release and the muscles separate from each other. My rules of thumb is that the client is comfortable, taking deep breaths and the release is held for at least one minute. This way, the release is bound to be longer lasting and there is less trauma. 

Sometimes, there is an expectation that there needs to be pain for it to be effective. This kind of treatment requires that the client isn’t in too much discomfort. Too much discomfort can set off protective spasms (by the nervous system) of muscles that you are trying to release. 

Another rule of thumb is that the pressure is half the pressure usually expected for twice as long, so you still get there but with less trauma. 

As you can see by the picture, there are also nerves and arteries/veins running through the fascia, so adhesions can also affect the circulation and nerve impulses to the muscles and skin, causing weakness and numbness/tingling.  

Any questions you have about Fascia Release, please call me anytime for more information.