The importance of Rib and upper back mobility

One constant that I’m finding in a lot of cases from low back pain to shoulder and neck pain is the decreased mobility of the ribs and mid/upper back portion of the spine. The body is intended to maintain some movement in this area, and in it’s absense, can produce symptoms above and below in the shoulder/neck and low back area. As we breath in and out, lean forward, back, side to side and rotate, the ribs will move in relation to each other and the vertebrae of the spine will move in relation to each other. There are several reasons that these areas can stiffen up from immobility of the area, trauma, surgery or past illness (perhaps bronchial or cardiovascular).

The body should be likened to a tree. A tree from the trunk up to the very top has the ability to be flexible along to entire length (obviously more flexible than other areas) but this flexibility is what helps it be strong so when a wind comes up, the forces are distributed along the entire length, so (unless there is an extremely strong wind) it should maintain it’s integrity. Now imagine that you put a metal collar around the middle 2/3d’s of the tree and not allow that portion to flex and reintroduce the wind to the tree. In the absence of the flexibility of the middle 2/3rd’s of the tree, the part of the tree just below now is having to bear the burden that the middle 2/3rd should be doing. The chance of the tree breaking just below the collar increases. Obviously, we will not “break” like a tree but in our instance, the forces inposed on the lower back in absence of good movement in the ribs and mid back will be present.
A person may have very tight shoulders that are pulled forward and a very stiff middle back. When I ask if they can pull their shoulders back, most of the movement involves arching at the lower back to bring the shoulders back. The lower back is an important area and needs to be kept in a neutral position while in a static position as well as movements but is often asked to move out of it’s optimal position to compensate for things like stiff mid back/ ribs or stiff hips.

An area that has become stiff is very difficult often to become aware of as the body is very good at compensating. Personally, I have had an issue with low back pain. My biggest improvement occurred when I worked on mobilizing my ribs, middle and upper back and increased my hip range of motion. Both my hips didn’t extend (move back) very well and my left hip didn’t turn inwards very well and my low back was doing that work. There is only up to 20 degrees of rotation available in the low back so it needs to be used sparingly and shouldn’t be used making up for lack of movement in other joints.
Part of my job is to ensure good movement in the joints that are lacking to the degree that the patient is able to maintain the proper range of motion at home with stretching. Often the less mobile joint is stuck enough that my work is needed to get it going to the point that the patient can maintain it’s flexibility at home.

The second part of the process is often harder and involves the patient being aware now that the joint or body part is now mobile and integrating it into their functional movements such as turning or picking something up or simply walking. A home exercise may be something as simple as sitting and placing your hands on the sides of your abdomen and turning but not allowing your hands to move so that all your movement is in your mid back, just to get the person used to being able to move through the midback.
Each case is different but the philosophy remains the same in that a body’s stability depends very much in it’s systemic flexibility and any rigidity can produce instability.

TMJ and Shoulder/Head Position

I have had people come in with complaints of jaw pain. There can be many reasons for this discomfort. It may come from sudden trauma like impact to that area. It may be from a recent visit to the dentist with work being done or simply having the jaw open for a long period of time. Trigger points (focused hyper-irritable points) in the muscles that move the jaw can refer pain to that area. There has been one consistant factor that I have noticed with people with jaw discomfort and it is the position of the shoulders and head in relation to the rest of the body. Most often the shoulders are rolled in and slightly forward and the head is also in a forward position.
There is an important relationship with head position and jaw position. The more the head is forward, the more the jaw will move back. Do a test on yourself. Gently close your teeth with your jaw relaxed and gently let your teeth touch each other so everything is relaxed and natural. Now jut your head forward slowly until it stops and your lower teeth should feel like they are moving back in relation to the upper teeth. At this point, the jaw joint (just in front of your ear) is being compressed in the same manner that if you were sitting and someone pushed your shoulders down, your spine would be compressed. Keeping the jaw compressed will doing simple actions like talking and chewing can put low grade strain on the joint and eventually causing problems down the line. This all ties in with the general benefits of good posture.
There is an interesting biomechanic that is not well known with the jaw as well. The joint is made up of two parts. One part has small forward and backward motions and the other is the “hinge” type movement that does the main opening part. When the jaw opens, first there is a slight forward movement, the the second joint hinges open (similar to a hinge in a door). The first forward movement is critical for good movement and if there is a “head forward – jaw back” presentation, then the jaw will not be able to make that first crucial jaw forward movement.
A “shoulder forward – head forward – jaw stuck in back position” can start often in the mid to upper back with tissue tightness and joint fixations that can be literally holding a person there making it very difficult for a person to get themselves in a position where they should be. That is where I come in to remind a patient where they should be and release the tissues and joints and give them home care to make it possible for them to be where they should be.
The biggest comment that I get when I reposition a patient to their optimal position is “that just feels weird” but often at the same time, there is better range of motion and less pain. So I tell them to use that as a beacon rather than the weird position that they feel in. Go where there is reduction of symptoms.
Watch out for things that draw your head forward. It is okay for short periods of time but things like computer use and work positions should have some attention paid to them.
Here’s a link to some good pictures of the jaw joint and some of the surround tissue that can become inflamed in the process.

http://www.google.ca/search?q=pictures+of+jaw+joint&ie=UTF-8&oe=UTF-8&hl=en&client=safari#biv=i|17;d|AGhp8EGhpOON2M:

It’s kind of a chicken and egg scenario. In my case, I assume it’s both the chicken and egg and cover both bases. Release the muscles and surrounding connective tissue, make sure the joint is positioned well and moving properly during it’s movement, ensure that the body is positioned well enough that the jaw is not forced into a position and will affect good motion and empower the patient to maintain that good position.

Neck pain and difficulty turning

To follow with my previous post about form and function, I wanted to discuss the problems with neck pain and spasm with difficulty turning the head. Often I might find that there is an imbalance with the shoulders and that the neck is extending the twisting to compensate so that you are looking straight forward. This reaction is subconscious and we don’t realize that we are doing it. We only know that our neck really hurts.

My job would be to help to realign the vertebrae in the neck using tissue release and other techniques to allow the movement necessary to return the neck to it’s original position but also to consider why the shoulders are out of position, forcing the neck to do what it is doing to compensate. There may be something further down that is pulling the shoulders out of position, so we chase the cause as far as it goes so that the trigger doesn’t pull your neck out of position again. As in my last post, part of the success is me and part will be the patient as we stretch, strengthen and create awareness of what they might be doing that causes the trigger to re-occur. Some triggers are completely avoidable, and some are only modifiable (if that’s a real word). It is very difficult to stop doing what we might have been doing for years and years so we need to use discomfort as a reminder that we have fallen into this pattern again. Pain isn’t such a bad thing if we know what it means and how we can change to reduce it.

I have seen a cases where there is a fallen arch in the right foot. This translates to the right pelvis being rotated forward, pulling the whole body forward and turned to the left, so the right low back tightens the pull the body back up right. It often might go too far so that the left shoulder is forward and higher than the right shoulder so your head is tilted to the right. The left neck muscles tighten to pull the head so it is level (subconscious righting mechanism) so the vertebrae in the neck are compressed on the left and open and unstable on the right with there being a possibility of pain occurring on either side for different reasons.

This whole thing can cause foot, knee, hip, low-mid back, shoulder and/or neck pain just because of one little fallen arch. If I only look at your neck, I’m probably not doing you a favour. We need to look at the whole body to see the general picture.

Crazy these bodies we have.

Effective Hip Stretches

I’ve found a web page which has a great hip flexor and hip stretch. I like it as it goes through 3 main types of stretches with good discussion about stretching only to the level that is good with you and that the stretches are held for a long period of time. I always believe that a stretch needs to be held for at least 2 minutes for the tissue to remain in the stretched position. This is a really good long deep stretch.

I believe that when beginning a stretch program, you almost need to do it religiously for at least 2 weeks to a month without expectation of results, as sometimes it takes that long, therefore there isn’t an disappointment for lack of progress during the beginning.

The teacher in the video has been doing this for a long time so don’t be disappointed if you can’t stretch as well as he. Just be patient and stretch as your level. Once a day is nice. Watch some t.v. while you do it. Click on “web page” on the first line of my entry or go to:

Enjoy!!

Form and Function

A really important philosophy that I follow with my treatment is simply to help to return the body back to position in which it is supposed to be in. In this position, the muscles aren’t working hard to hold up the body (as they would be if the body is out of balance) and all the joints and tissue are soft enough that the body moves well in the planes that they are intended to move. If I have someone come in with discomfort, I am aware of the symptoms, but I take myself back to this philosophy with the confidence in the body’s natural ability to self-heal when it is in its optimal position. My success with patients in the past reveals that half the success is what I do and the other half is home care and self awareness of posture to maintain the progression during the last treatment and help the body to normalize to this “new” optimal position.

Being out of position can occur from the feet up to the head. Maybe your foot is rotated out, your pelvis is turned one way or the other. Perhaps the low back had too much of an inward curve or the mid back has too much of an outward curve, or the right shoulder is turned in too much. When things like the above happen, the body is working hard elsewhere to bring the body back up so that you’re not leaning in one direction or another.

I find this philosophy has applied especially to the way that shoulders may be pulled out of position by upper back, and how neck pain occurs due to misaligned shoulders and low back pain reacts to mispositioned pelvis. If your neck hurts, then you don’t connect it to shoulder position. If your back hurts, then you wouldn’t think “hmm, my pelvis may be out of position”. That’s my job. My job, essentially, is to say “hey, your back hurts, and this is what I’m seeing. You should be in this position. I’m going to loosen tissues to make this position easier for you and give you stretches and strengthening exercises so that this good position is easier to hold. And were going to focus on things that you do during the day, that can be contributing to your issues to see what can be changed or altered”. Patient knowledge and education is so important so that you know what we’re doing and why we’re doing it. Otherwise home care and exercises don’t mean anything and you may end up not doing them as you’re not making the connection.