Neck pain often begins much further down

Neck pain is one of the more common reasons that someone may come in for therapy. Often it is the dull, achy general pain that occurs more at the end of the day. When I hear that, I think that it may not be a disfunction in the structure of the body, but simply that the muscles have been working hard all day and they are a little tired and sore. If a muscle is contracting constantly, it has a reduced capacity to bring in adequate Oxygen and ability to remove the muscle waste byproducts, which in turn does not allow the muscle fibers to repair themselves. Having this occur over a long period of time can cause many issues which ultimately result in symptoms like neck pain, headaches, dull achy pain to the arms, nerve compression and joint issues and sharp pain between the shoulder blades.

I have talked in the past about the importance of adapting your environment (work or home) to your balance position. For example, when sitting in front of a computer, having feet in front, good pelvic balanced position, finding the center of your torso balancing (so that you’re not falling forward or back), then doing the same with the head (making a nodding movement to find the point when your head does not fall forward or back). When you find this general balanced position, then you place your computer screen in a position where you can see your screen comfortably. Often this involves raising your screen up to eye level and about 2 feet or so away from you (a glare protector is good as well) so that you can see the screen and the font easily. Then you can place the keyboard at belly level so when you type, your elbows are back allowing the shoulders to stay back and open.

Like any position change, this will feel weird at first, but trusting that you have a good balanced position will make a huge difference in the amount that your neck and back muscles need to work, allowing them to bring in oxygen and get rid of the CO2 so they are healthy and happy. The important thing to be aware of, is the reduction of pain and other symptoms.  That is the ultimate reward for the body, and the body needs rewards to stay in a new position.

I find more and more that the pain is never where the original dysfunction is. I find that the pelvis is the center of the universe posturally. At least 8/10 times, when some has neck pain or similar it is simply because the muscles are working hard to correct the head position. For example, many times, a client’s pelvis may be raised on the right side, the body will attempt to corrcct that by pulling the torso to the right when sitting or standing. If you try leaning to the right, you will notice that your left shoulder raises and your head falls to the right. There is a sensor in each ear that ensures that if this occurs, muscles will tighten to make sure that the head is (as close as possible) rebalanced so it is level with the horizon. As above, when you are leaning to the right, your left neck muscles will tighten to pull your head straight. Very often you can’t tell that this is all going on because all that the brain is concerned with is that the head is now straight, no matter what unbalance and compensation is going on farther down in the neck and low back.

These are all side to side compensations. Now imagine that you are leaning forward on the computer working. Now your back neck muscles are working as you head is in a forward position and they are attempting to level your head on a side to side orientation. If they are doing this all day, they will become very tired and cranky causing the neck pain/headaches/arm aches/upper back pain.

So when someone comes in with neck pain, I often start by checking to see if the pelvic bones are balanced and getting an idea of the whole picture, then working up. Sometimes a person can get away with this for a while, but something very simple like a move in the wrong direction or sleeping in a strange position can set it off.

Good posture, balance, flexibility, and strength are the key to avoiding a lot of pain and dysfunction. It’s good to start from the bottom and work up to the top. To cap it all off, our heads are extremely heavy and we’re not doing out neck muscles any favors by making them hold up our heads in bad positions.

Getting your bike tailored to fit you

On my bike rides I was feeling like my back was really tightening up 2/3’s or so into the ride so I decided to go and get my bike fitted to make sure that everything was where it should be to make my rides more comfortable and efficient.

I went to see Bill at the Trek Store in the Songhees, just across the Johnson Street Bridge near Spinnakers (?) in Victoria. Having your bike fitted is really not something that you can do on your own. Bill pointed out that my setup needed to be changed in two ways:

1) That I need to move my seat a little more forward so the down stroke  was more over the pedals and therefore will produce more power

2) That I needed to reduce the “tilting back” of my seat as it naturally opened up my low back subjecting it to unnecessary strain and weakness.

So we made the changes and my first initial thought was that it felt really weird, which is normal as I had it in the other position for pretty much years and years. With these sorts of things, you really have to trust the math and the position will feel more normal over the period of a week or so with constant riding.

We also curled the brake levers and gear shifters more forward so that my wrist are not extended too much which can manifest their own issues over a long period of time.

My initial feeling is that maybe there is too much body weight forward on the handlebars but that may be just something to adapt to. I’m going back in a week and we can go over things like that.

It is something that I should have done a while ago and recommend that people that ride 3 – 7 times per week should absolutely do, so call and set up and appointment with Bill Fry at The Trek Store at 250-380-7877. It is quick, easy and will save a lot of grief in the future.

Check out their website at http://www.trekbikesvictoria.com/    as they have lots of great information and clinics available and fantastic inventory.

Oxygen and Carbon Dioxide in the body

Carbon dioxide is the waste product of the respiritory system, and of several other chemical reactions in the body, such as the creation of ATP. Pure carbon cannot be transported in the body, so CO2 is one form it takes that is water soluble. Levels of CO2 also tell the body when it needs more oxygen.

In the human body, the oxygen is absorbed by the blood stream in the lungs, being then transported to the cells where an elaborated change process takes place.

Oxygen plays a vital role in the breathing processes and in the metabolism of the living organisms.

Probably, the only living cells that do not need oxygen are some anaerobic bacteria that obtain energy from other metabolic processes.

Here is an really good link to a page that discusses how the body brings in Oxygen and rids itself of Carbon Dioxide:

Water goooooood

As I was writing in my last entry. I lead you to a link about the benefits of water but I though I’d just put it all here to make it easier.

Before you read. Make sure you don’t do this:    http://www.metacafe.com/watch/2535483/world_record_a_guy_drinking_2_liters_of_water_in_1_sec_very_amizing/

Happy reading:

Good water is essential to body cleansing. It’s obvious. It sounds like a truism. Your body goes down fast without water. Making up almost three-fourths of the body, every cell is regulated, monitored and dependent on an efficient flow of water. Not one of the processes in our bodies could take place without water. Water is something that we take for granted. But how many of us really understand how essential water is or what happens to our body if it doesn’t receive pure water every day, free of chemicals and pollutants?

– Water is the adhesive that bonds your cell architecture. When you get enough water fluid retention decreases, and gland and hormone functions improve.

· Water regulates your body temperature, maintains your equilibrium and helps the liver break down and release more fat.

· Water carries every nutrient, mineral, vitamin, protein, hormone and chemical messenger in your body to its destination.

· Proteins and enzymes, the basis for your body’s healing capacity, function efficiently only when you have enough water.

· Your daily energy depends on water, because your body’s chemical reactions are water-dependent. Just like a hydro-electric system, the energy generated by your body’s water is used by your two vital cell battery systems, ATP and GTP.

· Your brain tissue is 85% water. Messages from your brain to everywhere else in your body are transported on “waterways.”

Water is essential to the cleansing processes of your body.

-It lubricates and flushes wastes and toxins from all cells.
-It cleanses the internal organs.
-It helps eliminate toxins from the bloodstream.

Drinking enough water is critical to keep your skin soft and supply, your brain sharp and your elimination systems regular. But there’s another side to the water story. Most Americans have reduced their intake of fats (including the good Omega-3 fats) to the point that their bodies don’t hold and use the water they do take in. It’s one of the reasons I recommend adding more sea greens to your diet for moister skin, shining eyes and lustrous hair…. a quality of sea plants known since ancient Greek times.

How much is enough? Your body needs about three quarts of replacement water every day under normal conditions. Strenuous activity, summer temperatures, or a diet that’s high in salt increase this requirement. Your foods provide up to 11/2 quarts of water per day. (Fruits and vegetables are more than 90% water. Even dry foods like bread are about 35% water.) Water for metabolism is produced as part of the food digestion process, yielding as much as a pint per day.

Water is critical to your detoxification program!

For a healing program, several types of water are worth consideration:
· Mineral water comes from natural springs with varying mineral content and widely varying taste. The naturally occurring minerals are beneficial to digestion and regularity. In Europe, this form of bottled water has become a fine art.
· Distilled water can be from a spring or tap source; it is “de-mineralized” (only oxygen and hydrogen remain). Distilling is accomplished by boiling water, then converting to steam and recondensing it. It is the purest water available, ideal for healing, but not for longterm use because it can demineralize the body.
·Sparkling water can come from natural carbonation in underground springs, but most are artificially infused with CO2 to maintain a standard fizz. This water is an aid to digestion, and is excellent in cooking to tenderize and give lightness to a recipe.
·Artesian well water is the Cadillac of natural waters. It always comes from a deep pure source, has a slight fizz from bubbling up under rock pressure, and is tapped by a drilled well. Artesian water never comes in contact with ground contaminants.

Beyond buying bottled water, you can also take steps as an individual to conserve water and diminish pollution of ground water supplies:

– Use biodegradable soaps and detergents. Don’t use water fresheners in toilet bowls.
– Don’t pour wastes like paints, solvents, and petroleum based oils into drains.
– Use natural fertilizers such as manure and compost in your garden.
– Conserve water – use what you really need for a shower, a bath, laundry or cooking.

So be sure to get enough water every day, but make sure it is the right kind of water which can cleanse and heal the body, not toxic or polluted water which destroys health.

Low Back Pain and my long ride today

As I’ve mentioned in the past, I had an MRI that discovered a low grade L4/5 disc bulge that made itself present earlier this year. I also have issue with low back pain resulting from very tight hip flexors. There is a big connection with tight hip flexors and forward rotation of the pelvic bone on the same side and an unbalanced lumbar spine. I went for a 60 km or so bike ride today with lots of hills and such. It was a great bike ride on a beautiful day but on the way back, I could feel my low back start to ache. Not in acute spasm, but just a dull ache that was kind of annoying. It didn’t feel quite right so I looked in the mirror and noticed that my left pelvic bone was tilted forward a bit that indicated that the hip flexor on that side may be tight. On palpation of the left hip flexors I noticed that they were. I did some gentle hip stretches including the hip flexors and did some manual massage to release the hip flexors and the back is feeling much better now. I’m going to get some work done tomorrow to make sure that everything is behaving itself but today was a reminder that I need to keep up with my hip flexor stretches every day, even though it may not be feeling too bad.

When something is flared up, it is wise not to stretch the area too hard as you may flare up the issue. Just a gentle light stretch for a minute or so, making sure it isn’t painful should be helpful with gentle range of motion of the area to keep it mobile. Pain is odd in the way that it makes us stop completely when light movement is good to keep the circulation moving in the area to aid with healing.

Walk, Don’t Run

In this post, I wanted to talk about exercise and the body awareness. This is the ability to be able to listen to what your body is telling you. Very often, training can surface the philosophy of “No Pain, No Gain”. This is probably the worst philosophy when you are working your way up to a goal, whether it be push ups, swimming/running/cycling. Often I have told patients that it is best to totally under-do their goals while they find where they are in their training setup. For example, when someone is starting a running program, beginning at a 3 – 1 ratio for walking and running. So, walking 3 minutes and running for 1 minutes, then go back and forth between the two. Then you can finish and say “wow, that was really easy”. Progress to walking to running at a ratio of 3-2 and go from there. During this time, always be aware of your comfort level and stop running to a walk if you are feeling discomfort. Good therapy can help your get your body ready for the training. In my clinic, I often hear that people are pushing themselves to reach their current goal. Also, they may be in a group that they need to keep up with. That social pressure can interfere with your bodies progression to the goals set.

Very often, injury can occur when you become tired as your primary movers become tired like hip flexors, calves ect., and other muscles that aren’t supposed to be primary movers have to kick in to help the body run. Injury is not always sudden and can evolve slowly then can arise when least expected.

I had a conversation with a client about running. They said that they were feeling pain and difficulty with running with the group but “managed to keep up”. I said “why don’t you just say to the group that if you feel like you can’t keep up, you will just carry on your own to your comfort level”. They mentioned this to the group that she felt was a little faster than her. It turns out that 1/2 of the people were suffering like her and pushing themselves to hard but no one said anything. It’s good to be open about where you are with those that you exercise with.

You will reach your goal faster if you listen to your body. If you don’t, you may injure yourself and that can put your training on hold for a while, which I know from personal experience is very hard.

Our concert Jan 18, 09

So we had our concert in Victoria at the Lutheran Church of the Cross. It was a fantastic venue. Very bright and the acoustics we’re amazing. We were raising money for the Special Needs Music Therapy Dept at the Victoria Conservatory of Music so we raised around $500 for it. We didn’t tell them we were raising money for them so it was fun surprising them with the money. 

For me personally, it was a little mixed. I felt a bit off balance with the performance. I didn’t organize it as well as it could be done ie: someone to collect the money, the introduction stuff with the concert, you know “hi, welcome, please turn your phones down, info on intermission, okay we’re finished now thanks for coming”. Little stuff like that. My warm up felt really good but then there was the adrenalin that kicks in when you start performing. It robs you of moisture in the mouth so you get a really nice dry mouth. I felt that it really affected my resonance, clarity and control of my high notes. I got through it okay but it could have gone a little bit better. I guess it all comes to practice and performing in front of people more and more and really paying attention to my technique. It will come around and get easier and easier. I do feel much more at ease in front of people so I’m getting there. It’s a funny thing as breath is the big key but it’s almost like asking someone to breath slowly and comfortably while on a roller coaster. The ride will get easier, I just have to do it more often.

Massage Therapy and Core Stabilizer Activation

I have had some low back issues lately. They have been occurring occasionally with severe acute presentations. I had an MRI done and discovered that I have a moderate L4/5 disc bulge. Part of my issue is that my core muscles were not strong enough to stabilize my spine. I am now doing specific exercises to help to strengthen these muscles but like any muscle that is being strengthened, that didn’t fire properly before, needs to be taught to fire properly. On closer analysis, I’ve come to realize just how much my muscles were not firing when they should. 

I went for a bike ride today. What I experienced is that my back muscles were working hard with the position that I was riding in, but my abdominals were not firing or working as they should. This ride I decided to not fire them intentionally, but to use them by keeping my pelvis tilted in a neutral position and not allowing the torso to rotate at all when I was riding. To control this, requires good core stabilizer control. It also requires that my hip muscles (glutes, quads, hamstrings, tfl) allow proper movement of the hip joint. Tight muscles around the hip always cause excess compensatory movements in the spine.  

I have also come to realize how tight my hip flexors are after my rides. That is a big contributor to my issues with spine stabilization as the hip flexors attach to the spine, usually at around 20 – 30 degrees from the spine.  My low back felt a little bit tight after the ride so I spent some time stretching my glute muscles and hip flexors and I’m consciously keeping my core muscles tight and I’m doing very well. 

In my experience, dysfunction in other areas often cause problems with the back. Strength, mobility of all surrounding areas and awareness of an triggers during the day that can be accentuating the pain can really help with progress for a healthy back for years to come.

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.

Okay, I need to apologize to the MRI community

I was a little bit harsh with my review of MRI’s in general. It was the way that the MRI was interpreted originally to me that I wasn’t impressed with. I had a copy of the MRI sent to my clinic and we had a good look at it. Turns out I have an L4/L5 posterior disc protrusion that is irritating the L5 nerve. It is a moderate bulge and can be rehab’d. I need to avoid the activities that can trigger the continued bulging for about 3 months and really rehab my back and make it strong. There is a disc waiting for me at the hospital to actually view so I’m looking forward to that. 

So I publicly forward my apologies again to all those who do MRI’s as it was the original interpretation and not the report itself.