Myths About Back Injuries

I discovered an interview, on YouTube,  of Dr Stuart McGill, a highly respected researcher in the study of spinal biomechanics.  He is at the forefront of understanding the effects of exercise and movement on the spine.  I have mentioned his research before in this blog.

The information mention in this video is too good to not share with you. I spent the time to transcribe everything that was said in the video and posted it here.

Myth #1: Back Injuries are rare

Most people will not get through out life without some element of back pain impinging on their activity.

Myth #2: You need a flexible back

Statistically, those who have more range of motion in their back have a greater risk of back disorders in the future.  So having a flexible spine is not protective. In fact, it’s quite the opposite.  The muscles of the legs, arms, shoulders and hips are designed to create force throughout a range of motion resulting in movement. Muscles of the spine, or core, or torso are designed to do quite the opposite; they stop movement.

Myth #3: To avoid injury, you need a strong back

Having a very very strong back is not really preventative for a back injury. What turns out to be important is the endurance.

Myth #4: Bend your knees when you lift

Proper lifting mechanics require you to actually lift with the hips, not with the knees. Otherwise, you will just end up with knee arthritis.

How do you do that?

Refer to video:
We are going to slide our hands down our thighs and go down a little bit more to grab the basket and slide it up your thighs and pull your hips through. (He is describing the hip hinge)

Myth #5: Suck in your belly to work your core.

This idea of drawing in your belly to activate a muscle called transverse abdominus when you are performing exercise is highly problematic and it’s a myth. When you measure the role of that muscle and the ability to stabilize the spine you do not want to suck it in; you simply stiffen the abdominal wall.

How do you do that?


So the stir the pot exercise requires the feet to be quite wide, she’s stiffening controlling through this part of her spine (abdominal region). And now she’s just going to swirl her elbows around in circles we call this exercise, stir the pot.

How else? (2:05)

(Patient in quadruped position) We are going to spend time to flex the spine and extend your spine. Finding that neutral position here which is lowest stress for her back.  At that point she stiffens her abdominal wall.  Then she is going to extend opposite arm and opposite leg moving about the hips and the shoulders; hold that posture for about 10 seconds.  We release the cramp? by having her sweep the floor with her knee and hand and back out again.  All motion taking place only at the hip and shoulder

How do you train harder?

So we are going to increase the value of this exercise.  She’s going to make a fist and co-contract and stiffen her arm all up through her back which brings up her upper back here.  Then she’s going to challenge the different neuromuscular components in her back by drawing squares with her arms and legs.

Myth #6: Sit-ups/crunches give you a six pack.

(Describing the crunch)  What she’s doing is flexing her spine like this,  stressing the posterior part of the annulus (intervertebral disc) which eventually if she does enough of them will cause the damage that we see here; namely a disc bulge.

What should you do instead?

We’ll shift her to a different style of curl-up.  Put her hands in the small of her low back to support her low back so it doesn’t flatten to the floor. And she will straighten one leg. And she is just going to up, just unweighting her head and shoulders; not too much. The motion is hardly moving at all.  And we will bring up the elbows (off the floor) and she is very stiff through this region (abdominal region) here.  She’ll count to ten and slowly put her head and shoulders down and rest and then release the contraction.

Can you avoid injury by not exercising?

Optimal back health doesn’t come from doing nothing.  It comes from doing the perfect optimized amount;  not too much and not too little.

If you want to learn more about back care check out Dr Stuart’s Website. This is not an affiliate link.

I hope you enjoyed

Dr Notley
Chiropractor/Athletic Therapist in Winnipeg since 2000

Back pain and driving

I was recently asked, on twitter , the question , “Is it bad for your back to be sitting and driving for long periods?”  As I recall, this question was asked by someone who commutes for about two hours each day (one hour each way).  When I started searching for information on this subject most of the research was on truck drivers, bus drivers or farmers.  The research most often was centered around sitting and whole body vibration while driving.

Here is what I learned from my research. You can read the abstracts at the end of the post.

  • Vibration produced while driving affects the spine by exciting a 4-6-Hz resonance on the lower back. The motor nerves in the lower back fire causing muscle contraction and ultimately fatigue. This leads to greater stress on the spine and intervertebral discs.
  • Sitting alone is not associated with risk of developing lower back pain
  • Sitting along with the exposure of whole body vibration and awkward sitting increased the risk of lower back pain four fold.
  • Helicopter pilots are the greatest risk for lower back pain.
  • Awkward posture is independently associated with the presence of lower back pain and/or sciatica
  • Sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.
  • A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue.
  • Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
  •  One study that looked are more than just driving and found the following: Lower back pain is associated with  poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. They found little evidence of vibration being a factor.
  • Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain.

 Conclusion

What I learned from this research is that no matter how strong or in shape we are our spine is at risk when driving.  It is even worse off if you are sitting with poor posture and if there are long exposure to whole body vibration.  In addition, these are not the only factors. There are also psychosocial factors that also influence the likelihood of having a back pain.  So if you sit with poor posture, drive for long hours daily, have poor mental health, smoke, are over weight, and you are tall you have an increased chance of having back pain because of driving.

So how can you prevent this? A few thoughts that pop into my mind as I read the research are as follows:

  • Sit with good posture.
  • Use a back support  to aide in maintaining good posture
  • Get out frequently to stretch your back. This may not be possible in all situations
  • Eat well, exercise, manage your weight and don’t smoke
  • Drive a vehicle with functioning suspension seating

I hope you found this interesting

If you have any questions feel free and contact me

Dr Notley

Winnipeg’s only dual credentialed Chiropractor and Athletic Therapist

Abstracts

Eur Spine J. 2007 Feb;16(2):283-98. Epub 2006 May 31.
Lis AM, Black KM, Korn H, Nordin M.

Abstract

Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.

Vibration of the spine and low back pain.
Clin Orthop Relat Res. 1992 Jun;(279):49-59.
Pope MH, Hansson TH.
Abstract

There are now many studies suggesting a positive relationship between both low back pain and spinal degeneration and exposure to whole body vibration. Such relationships appear to be particularly marked in drivers of tractors, earth-moving equipment, and trucks. There is a tendency toward a greater incidence of complaints as exposure increases. Vibration affects the spine by exciting a 4-6-Hz resonance that is related to the biologic “soft spring” between S-1 and the seat. The muscle nerves fire sequentially under vibration and fatigue. In animals, vibration exposure leads to pronounced creep, increased disk pressure, and changes in the levels of neuropeptides in the dorsal root ganglia.

Semin Perinatol. 1996 Feb;20(1):54-60.Wilder DG, Pope MH, Magnusson M.
Abstract

The risk of experiencing low back pain is associated with mechanical factors. Anatomic factors, such as advancing pregnancy, can also place extra mechanical stress on the lower back. Mechanical factors, such as those related to the workplace, can be minimized by ergonomic interventions. A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue. Interventions that reduce the jolt/vibration magnitude and duration of exposure will decrease the mechanical work performed on the intervertebral disc. Such interventions range from jolt/vibration isolating seats and vehicle cabs, to decreasing exposure time and maintaining simple supported postures during ingress and egress. Improvements in seat configuration can reduce the intervertebral disc pressure and the strain on the posterior disc.

Palmer KT, Harris CE, Griffin MJ, Bennett J, Reading I, Sampson M, Coggon D.Scan J Work Environ Health 2008 Oct;34(5):364-73. Epub 2008 Oct 14.
Scand J Work Environ Health. 2009 Jan;35(1):80. Harris, E Claire [corrected to Harris, E Clare].

Abstract

RESULTS:
Strong associations were found with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole-body vibration were weak and not statistically significant, and no exposure-response relationships were found.
CONCLUSIONS:
Little evidence of a risk from professional driving or whole-body vibration was found. Drivers were substantially less heavily exposed to whole-body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole-body vibration is not an important cause of low-back pain among those referred for MRI.

Lings S, Leboeuf-Yde C. Int Arch Occup Environ Health. 2000 Jul;73(5):290-7.

Abstract

RESULTS:
Twenty-four original articles concerning the association between whole-body vibrations and the lower back were retained for use. The quality of the papers was mostly low, but improved with time. Only seven articles passed our predetermined quality criteria. Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
CONCLUSIONS:
Despite the lack of definite evidence, we found sufficient reasons for the reduction of whole-body vibration-exposure to the lowest possible level. If new knowledge is to be produced, good prospective studies with repeated measurements of exposure, analyses of work postures, and clear definitions and subgroupings of low back pain are needed. Other research in this field should be given up, and the resources used for more important issues, as the size of the problem of whole body vibration is probably on the decrease because of the technical prophylactic developments that are already in progress.

Med Pr. 2011;62(2):187-202.
[Article in Polish] Solecki L.

Abstract
A literature review was performed for the years 1990-2007. It covered reports addressing the problems associated with the prevalence of low back pain and musculoskeletal disorders among farmers. In addition, the anticipated relationship between low back pain and whole body vibration in farmers was evaluated based on 12 reports for the years 1987-2009. The review confirmed that the prevalence of back pain is significantly higher in farmers exposed to whole body vibration than in the control group (not exposed to vibration). The frequency of back pain is related with whole body vibration, as well as with prolonged sitting position, wrong body posture and physical work load (especially lifting and carrying loads). The prevalence of these symptoms increases with the increased vibration dose and duration of exposure. Disorders in the lower section of the spine were associated with age, accidents (concerning the back), cumulative dose of whole body vibration, and overload due to wrong body posture. Long-term exposure affecting the whole body is harmful to the skeletal system (degeneration of the spine). The results of the study suggest that the repeated or constant exposure to mechanical shocks may increase the risk of low back pain. The investigations confirmed that there is a dose-response type of relationship between exposure to whole body vibration and pain in the lumbar section of the spine.

Semin Perinatol. 1996 Feb;20(1):38-53. Bovenzi M.

Abstract
Occupational exposure to whole-body vibration (WBV) and postural stress in a driving environment may contribute to an increased risk for low back pain (LBP) disorders. In two epidemiological studies of bus drivers and tractor drivers, LBP disorders were found to be associated with age, back accidents, cumulative WBV dose, and postural overload. A review of the literature showed that the exposure-response relationship for WBV and injuries to the lower back is not fully clarified. There is a shortage of information on the health risk from WBV in female workers. Because it is estimated that several thousand women are exposed to intense WBV in the workplace, the health effects of WBV on female reproductive organs and vertebral column should be carefully investigated.

Ugeskr Laeger. 1998 Jul 13;160(29):4298-301. [Article in Danish] Lings S, Leboeuf-Yde C.

Abstract
Whether exposure to whole body vibration (WBV) in transport vehicles and moving machinery constitutes a health risk is unclear. The literature on this subject is vast, but most is of limited scientific value. A recent review covering the literature up to 1992 has been used as a basis for a further search concerning the period 1992-1996. Fifty-three articles were found: 14 epidemiological studies, 15 human laboratory experiments, four animal experiments, seven field studies and 13 reviews. Almost all epidemiological studies yielded insufficient information and had methodological shortcomings. Of the reviews, only three were critical. Experimental data support the hypothesis that WBV can have a negative effect on the spine. Epidemiological studies have shown drivers to have an increased prevalence of low back pain, probably in a dose-related fashion. Hence, it is likely that long-term exposure to WBV can contribute to back disorders. Present studies do not allow for a quantitative specification of the association between exposure and effect.

Scand J Work Environ Health. 1999 Oct;25(5):387-403.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM.

Abstract
This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.

Get in Shape without Injuries

Jake Peavy InjurySo you want to get in shape but you haven’t exercised in years, or maybe ever. Getting started is a daunting task and you are motivated to get moving, which is great, but you are also worried about getting injured which would put your goals on hold.

What does it mean to be in shape?

Being in shape can be either individually defined or defined by achieving a pre-determined standard. A pro hockey player has to be in a different type of shape than a marathoner. In addition, we don’t have to be in the same type of shape as the pro athletes to consider ourselves in shape. The problem with a pre determined standard is that we push ourselves to achieve that goal possibly more rapidly than our body is capable of achieving which leads to the body breaking down and injuries happen.

So how can you get in shape without getting hurt?

Here are some of my tidbits of advice on preventing injuries.

Play Safe

Simply put, exercise in an environment that you can control. Make sure the surface you are exercising on is clear of debris, the surface is even and you have adequate gripping for your feet (surface/shoes). If you plan to go on a bike ride choose a safe route rather than one in high traffic or on a challenging off road path (not that off roading is a bad activity, it’s more of a safety issue). Many people get hurt because they don’t watch where they are going and what they are doing. Be aware of your surroundings.

Be Well Rounded

We tend to do the things we like to do and neglect the things we find are difficult, boring or tedious. This can result in imbalances and repetitive strain. For example, the body builder may be very strong and has big muscles but if that is all he does he may not have the flexibility to move those muscles through a full range of motion. The aerobics instructor may be able to exercise for 90 minutes but can she carry the 30lbs bag of dog food to the house?

When it comes to being in shape, developing a program that addresses the different aspects of being in shape; muscular strength, muscular endurance, flexibility/mobility, aerobic endurance and anaerobic endurance helps you to be able to handle a variety of physical feats.

Start by taking one or two categories of fitness, as you develop a habit for exercising, then add another category of fitness. Most people getting in shape would do well with developing aerobic endurance/muscular endurance along with flexibility and then adding the other aspects of fitness as they become more fit. This gives you variety, lessens repetitive strain and helps with the monotony of performing the same program over and over.

Start slow and go slow

When starting an exercise program we have a tendency to push ourselves harder than our body is capable of handling. We want to get in shape now and we will push ourselves to achieve it. We buy DVDs of the next greatest workout program guaranteed to loose weight. We jump full into the program only to discover our body is not yet ready for that type of program. You may not have the physical ability to perform the exercises, your technique may be horrible or your body fatigues too quickly and
you get hurt. Start with the basic of all exercise, walking, biking, basic stretching, body weight exercises and then slowly increase the volume, intensity or complexity of the activity.

It is generally accepted that increasing your volume or intensity of exercise, every week or two, by 10 percent is a safe approach.

Eg. Lifting weights by increasing only the volume:

Week one: 1 set of 10 repetitions – total 10 repetitions
Week two: 1 set of 11 repetitions – total 11 repetitions
Week three: 2 sets of 6 repetitions – total 12 repetitions
Week four: 2 sets of 7 repetitions – total 14 repetitions
Week five: 2 sets of 8 repetitions – total 16 repetitions
Week six: 3 sets of 6 repetitions – total 18 repetitions

You have to remember that getting in shape does not have an end point. Once you are in shape you can’t just stop, you have to continue to maintain. Take it slow and you will still achieve your goals.

Technique Technique Technique

Don’t perform any exercise if technique is poor. It is better to build your body on a strong foundation than on a weak foundation. It is better to perform 5 high quality repetitions than it is to perform 10 poor quality repetitions.

Also, performing exercises that require you to be quick but alters your technique should be avoided until technique is perfected. If you need to cheat to complete a repetition or if your movement becomes faulty, stop. Find someone who is trained in recognizing poor movement (personal trainer, athletic therapist, some chiropractors, and some physiotherapists). It is better to pay for this service now than when you have to pay for help in the healing process of your injury.

Eliminate Imbalances

Injuries can be the result of joint immobility, muscle inflexibility, poor muscle motor control or poor strength. Having someone assess you to discover these imbalances may help prevent further injury. Don’t over work the show off muscles (chest, arms, quadriceps), this causes imbalances. I often recommend a two to one ratio of exercise between the show muscles (front) and the opposing muscles. Don’t perform the same mode of exercise over and over, this causes imbalances and repetitive strain. Change it up.

Stretch the Tight Stuff

For the general public and for athletes these are the most common muscles that I find that are inflexible:

  • Suboccipital muscles
  • Chest/pectoralis muscles
  • Piriformis muscle
  • Hip flexors
  • Calf muscles

These muscles are often a problem in those who have jobs that require them to sit for long periods of time or with those with poor posture.

Don’t over stretch muscles that are already flexible. This may lead to hypermobility which can be another cause of injury.

Strengthen/Activate the Weak Muscles

Muscles I find that are typically weak are as follows:

  • Deep neck flexors
  • Rhomboids and trapezius muscles
  • Serratus anterior
  • Core muscles (glutes, abdominal muscles etc)
  • Tibialis anterior (shin muscles)

Get Balanced

One of the leading cause of falls in the elderly is poor balance. Balance, or proprioception, tells our brain where our body is in space which then helps the muscles around our joints to help keep up upright. Training with dumbbells or one legged activities helps develop proprioception.

A good way to start developing your balance is by, each morning while your brush your teeth, stand on one foot when you brush the top row of teeth. When you brush the bottom row, switch to the other leg. As you get better at this, and you can stand without wavering, then close your eyes. As you improve, then other more challenging activities can be added.

Learn to Hip Hinge

Back, knee, ankle and foot pain may be a result of poor motor control at the hip. I see this in many injured people. Poor squatting technique and poor lifting techniques is often a result of poor movement at the hips. In the case of lifting injuries the back flexes more than the hips thus causing more strain on the back. Many people can’t complete a full squat without knee pain. Often, this can be associated with poor movement at the ankle and at the hip.

Vary your Volume and Intensity

In the art of strength and conditioning, strength coaches develop programs in the attempts to improve performance but also to prevent over training. This type of training approach is called periodization. In essence, it is a program that has changes in either volume of work or the intensity of the work. Over the course of a training period, say 6 weeks, you would see throughout the week the intensity/volume change. One day would be harder than average, another day may be lighter and another might be average but by the end of that training program the athlete is capable of performing more work or work at a higher intensity. Training at high intensity all the time can wear down the body and cause injury or ove rtraining.

Recognize Over training

The signs of over training are as follows:

  • Difficulty sleeping
  • Elevated heart rate
  • Getting sick more frequently
  • Unable to accomplish workouts you used to perform
  • Fatigue, lack of interest to work out, depression
  • Decreased appetite
  • Weight loss
  • Increased rate of injury

I suggest monitoring your heart rate every morning upon waking. Monitoring yourself now will allow you to see your heart rate decrease as you get in shape. If you are over training or you are coming down with a cold your morning heart rate may be approximately 10 beats a minute higher than normal.

Don’t Exercise Through the Pain

Pain that persists after a warm up, worsens throughout the workout or results in increased pain after a workout should be avoided. Working through the pain may only result in being out of commission for a longer period of time.

If you can, reduce the volume and intensity of your exercise by at least 50%. If pain still persists then seek treatment. In the meantime, as you heal, choose different exercises that do not cause pain.

Reduce the Stress on the Joints

Every time we run/jog there is a significant increase in force on the body (about 2 to 3 times your body weight. Our joints have to be able to withstand these forces or else they are going to get damaged. If you have joint pain or want to prevent joint pain chose exercises that are less stressful on the joints. Speed walking is far better on the joints and actually burns more calories. Other exercise methods are exercising in the pool (pool running) or using a stationary bike or elliptical. As your conditioning
improves as well as your strength then it may be possible to increase the stress on the joints, depending on the reason for joint pain.

Eat Well

Though many people exercise at the same time as restricting calories we need to adequately fuel our body so that it can refuel and repair our body. Recent research has even found that those who restrict their fat consumption below 30% tend to have a great chance of injury. If you are looking at building muscle to help with fat loss then ensuring adequate protein in your diet is important. Amino acids are the building blocks of muscle.

Take a Break!

Even the best athletes take a break from time to time. We get stronger and more fit when we rest. Constant training prevents you from recuperating therefore having days of rest or light activity can help you improve and prevent injury. Every six to eight weeks take a break and just go for a light walk, lift some light weights, do some light yoga.

Conclusion

Remember, not all injuries are preventable. When starting take it slow, be well rounded, work on imbalances, perform with excellent technique, vary your workout and every once in a while take a break.

Getting in shape is not a race and you don’t win because you get there first. You win because you get in shape and become healthier.

I hope this keeps you safe as you start your exercise program.

If you have any questions feel free and ask/

Dr Notley
The only Chiropractor/Athletic therapist in Winnipeg

Ask the Chiropractor: Common Exercises

I am often asked what my most common exercises are for my patients depending on their ailments. I decided to put this list together for you. Make sure you check out my most common stretches as well.

Deep neck flexors 

Chiropractor exercise - Quadruped neck retraction
Neck retraction

The deep neck flexors are at the front of the spine, immediately infront of the vertebrae. These muscles are often weak and inhibited after a motor vehicle accident. They are also inhibited and deconditioned if you sit or stand all day with your head forward infront of your shoulders. These muscles are associated with a flattening of the cervical spine (loss of it’s natural backwards curve) or a reversal of the cervical spine (forwards curve; kyphotic). The neck retraction exercise to help stretch out the suboccipital muscles helps to activate the deep neck flexors as well.  Another more challenging exercise for the deep neck flexors is the quadruped neck retraction exercise (note: arm is behind back only to show movement of neck).  You can build on this exercise by adding resistance by using tubing draped over the head and held by the hands). You can also work on the neck retraction followed by turning the head as in this video.

Rhomboids and Trapezius muscles

The rhomboids are often over looked. It is rather easy to over look then because they are found on our back side between our shoulder blades.  These muscles are often inhibited by inactivity and are cause of rounding of the shoulders.  Poor activity of these muscles means poor mechanics at the shoulder which can lead to shoulder injuries such as impingement syndrome or shoulder bursitis.  To train these muscles I perform T’s and Y’s.  My favorite piece of exercise equipment to perform these two exercises on the TRX suspension trainer, but you can also use elastic exercise tubing.




Serratus Anterior

Serratus anterior is found on the side of our ribcage and travels up into our armpit and attaches to our shoulder blade.  One of the jobs of this muscle is to hold the shoulder blade against our ribcage. Weakness of these muscle leads to our shoulder blades popping up off of our rib cage as we do a pushup. Another job this muscle has is to aid in abducting out shoulder blades as we raise our arms over head. Any weakness or dysfunction in this muscle can cause a movement dysfunction at the shoulder which can lead to shoulder injuries.  The scapular pushup is an excellent way to start training this muscle.  If you can’t perform it on the floor then try performing it against a wall or with your elbows on a bed/bench.  Check out this video as well

 
Four for the Core

As mentioned in my previous blog post, the plank, side plank, bridge and the McGill crunch are my four preferred exercises to give to my chiropractic patients.  Check out my Four for the Core here
 
Tibialis anterior (shin muscles)

The muscles at the front of the shins are responsible for lifting the foot up. They are also responsible for aiding in maintaining the arch in the foot while walking or running. strengthening these muscles so they can handle the repetitive strain of long walking or running is important for preventing walking/running injuries such as shin splints. Perform this exercise by standing with your  back resting on the wall and feet out from the wall. The further away from the wall you are the harder the exercise will be, especially if you have a shoe with a heel.  With the body straight,  lift toes up off the ground.

Make sure to take a look at my blog post on starting exercise and preventing injury.

Dr Notley
Treating necks, backs, headaches, and other musculoskeletal injuries as a Chiropractor/Athletic Therapist, in Winnipeg, since 2000.

Ask the Chiropractor: Common Stretches

  I often am asked by my Chiropractic patients in Winnipeg, “What stretches do you recommend?”   These are the most common muscles that I find to be tight in my Chiropractic patients, as well as, my  favorite stretches to help release tension and improve flexibility in these muscles.  

Suboccipital Muscles

The suboccipital muscles are located at the base skull/top of the neck.  They have a tendency to be a source of pain locally and a source of headaches. They are often a problem because many of us tend to slouch. If you slouch and you have to look at a computer screen your head has to extend backwards (relative to the neck) to be able to see the screen. This causes the muscles to be perpetually under contraction.  To stretch these muscles perform the double chin exercise.  

This is also a great exercise for those who have a cervical disk herniation or derangement.  If you have neck pain that hurts when you perform this exercise but the pain decreases as you repeat the exercise this is an excellent exercise for you.   This is also one of the stretches I get for people who need to work on their posture.

Chest/Pectoralis Muscles

The chest muscles are made  up of two different muscles, pectoralis major and pectoralis minor.  Pectoralis major is the big chest muscle that we can see.  Pectoralis major goes from the sternum/ribs and crosses the shoulder.  Pectoralis minor is found deep to pectoralis major and goes from the ribs to the shoulder blade (scapula).  When tight pectoralis major rounds the shoulder inwards.  Pectoralis minor, when tight pulls the shoulder blade up and over the rib cage.  Both of these muscles can affect the mechanics of the shoulder.  Tightness in these muscles is also associated with neck tightness. These muscles are often inflexible while the muscles in the mid back are weak; an imbalance occurs.  The likely reason is that we use the muscles in the front of our body so much and do very little activity for the upper backs muscles. Performing the stretch while squeezing the shoulder blades together will help with the inflexibility of the chest muscles and will help with activating the muscles of the middle back. Try out this corner stretch.

Piriformis Muscle

The piriformis is often sources of tightness in the back side of the hip. The piriformis often can be a source of pain in the buttocks or causing pain down into the back of the thigh. It may also be a cause of “sciatica”-like pain pain. The piriformis muscle travels through the same hole in the pelvis that the sciatic nerve travels through.  Myofascial muscle tightness can affect this nerve and cause similar pains as that of true sciatica.  Click here for a full description of the piriformis stretch.

Hip Flexor Muscle

Sitting for long periods of time shortens the hip flexors.  The hip flexor muscles attach onto the spine as well as the pelvis.  This can alter the function of the spine as well as the pelvis this can result in problems in the lower back as well as the hamstrings. The kneeling lunge is my favorite exercise to give for inflexible hip flexors.   If you have a job that requires you to sit for long periods of time or you are bent over a lot during your sporting activity (hockey players and cyclists)) then this stretch is for you.

Calf Muscles

Wearing shoes that have a heel constantly keeps our calf muscles in a shortened position. In addition, having a job that requires us to sit all day causes our calf muscles to be shortened.  Now, considering being a runner who runs several miles, the calf muscles get over used and at the same time are inflexible. This may explain why people develop different types of tendonitis such as Achilles tendonitis.  In addition, tight calf muscles will affect the mobility of the ankle so when you squat you will have a faulty movement pattern which can lead to injuries at the knee.  Try performing this calf stretch with your lead leg both straight and bent.

  I hope you found these exercises useful  

Dr Notley