Tag Archives: alternativeptfortworth

Spinal Strengthening, No Equipment Required

Simple spinal strengthening is an important key to resolving neck and back pain. It’s all about symmetry. Not only symmetry right to left but front to back as well. As my OT friend says “the world is in front of us,” making it difficult to balance spinal flexion with extension. Over flexion promotes postural pain and overuse pain syndromes in the neck and back. One of my token soap boxes is that God made our bodies to move in all planes so we must continue to utilize every plane to prevent pain and treat pain. In the present age we utilize our extensors less for climbing trees and swinging and over use our flexors for sitting and reaching.

Done a back bend lately? Pretended to fly like superman? Well tusk tusk! Spinal strengthening doesn’t require equipment, and the exercises are simple but the difficulty is unbelievable. The deep and superficial back extensors, deep abdominals (transverse abdominis, obliques), and pelvic floor are the focus in these exercises as they are the core of the core. Here are some beginner exercises:

Tummy Tuck (Transverse abdominis): This is the exercise that prefaces ALL movements. Simply pull your belly button in very gently without holding your breath. Another way to do it is by gently pushing your back into the floor without holding your breath. It may take practice before you can do it while breathing! This can be done sitting, standing, lying, and walking. Do this throughout the day.

ab_brace

Pelvic floor: This exercise also prefaces ALL movements. Gently contract the pelvic floor as if you are stopping the flow of urine. Hold for 1-3 seconds. This can be done throughout the day as well.

Prone press up or cobra pose: Gently press up using your hands, do no lock your elbows out, your back will have to work to maintain this position. Hold 3-5 seconds and repeat.

cobra

Prone chest lift: Tighten your glutes and lift your chest keeping your arms by your side. Hold 3-5 seconds.

chest lift

Prone arm lift: First perform one arm at a time, advance with arms in a “T” position, and the hardest will be with the arms up by your ears at the same time. Hold 3-5 seconds.  Head can rest or elevate with the lift.

 

Prone leg lift: Perform one leg at a time. Progress by lifting both legs. Hold 3-5 seconds.

 

Plank: Raise your hand if you love planks! HA! Up on your hands or down on your elbows and lift your booty up in the air. Keep you abs and glutes engaged, no sagging. Hold 10-30 seconds.

 

Bridge: Lying on your back with knees bent. Simply lift your hips up in the air. This exercise can get fancy by straightening one leg after the hips are lifted. Hold 3-5 seconds.

bridge

Bow Pose or Half Bow Pose: This is the pose I dread in yoga class! Grab your ankles with your hands and push your legs out lifting your body into a bow or ball shape. Hold up to 30 seconds.

 

Back Extension Stretch: Sitting with legs crossed or up on your knees. Place your hands on your back or on your ankles (depending on how flexible you are), and bend back, let your head fall if comfortable. Hold at least 30 seconds.

 

Repetitions will vary–as few as 3 or as many as 20. Perform these exercises or some variation every week. The important thing is that you use this information to adjust your exercise routine to include specific, deep, spinal strengthening. Spinal strengthening will decrease pain and improve movement patterns which will likely result in heavier lifts (if that’s your goal) and more effective exercise.

Knee Pain: Look Above and Below

“My knees never bother me”—said no one ever. Everyone has experienced either a complex knee injury or a simple tweak that is now haunting. “Oh great, my knee doesn’t hurt anymore”…<perform max squat clean>…”Never mind.” Here’s another scenario—”I’ve never had knee pain”…<gain 10 pounds>…”Why do my knees hurt all the time?!” The knees and low back are the middle ground, Switzerland, neutral territory. With neutrality comes comprise. Our knees and back compromise when the feet, hips, and upper body battle.

Look above and look below. What does this mean? It’s important to look at the joint or structure above the knee pain and below it to fully treat the problem manifesting in the knee.

In the foot, we’re looking for over-pronation (flat feet, knock knees) or under-pronation (rigid feet, bow legged). A simple correction to a neutral foot position may remedy knee pain. This may mean changing shoe type, getting new shoes, or getting a running/walking shoe evaluation (done at many running stores on a treadmill for free).

In the hip, we are looking for a neutral pelvis, leg length, muscular weakness (typically the gluteals in adults), and muscular tightness (quadriceps, hamstrings, gluteals, piriformis), which may be affecting knee position and function. Correcting leg length in athletes may greatly reduce knee and back pain.

Here’re a couple of tips to deal with knee pain:

1)  Stretch—seriously, at least 1-2 times a week spend some quality time stretching. Stretches specific to the knee include: hamstrings, quadriceps, gluteus, piriformis, gastrocnemius, and soleus.

2)  Joint mobilization—Try a gentle knee mobilization with a towel roll hold 30 sec to 2 minutes and repeat as feels comfortable.

3)  Strengthen—Target the gluteus medius, gluteus maximus, and hamstrings.

4)  Good shoes—don’t wait until the tread wears off or until your pinky toe is sticking out to get new shoes. Generally, for those exercising daily, this means zapatos nuevos every 6 months.

5)  Correcting leg length—this may be as simple as adding an insert or heel lift in the shoe of the short leg. For significant discrepancies (greater than 1cm) the use of a shoe cobbler may be beneficial to build the shoe up from the outside.  Many times shoes can be altered (even cute sandals) with no apparent, aesthetic, difference.

heel lift

6)  Knee sleeves—I know I know…I hate to rely on supportive devices but my left knee has converted me. For those of us squatting (especially below parallel), lunging, and lifting regularly, a knee sleeve can alleviate pain during these tasks. DO NOT wear the sleeve 24/7 unless recommended to do so by a PT or physician.

knee sleeves

7)  Allow time to heal—for a solid 10 WHOLE days after the initial injury, avoid movements that exacerbate the pain. In this time, you are stretching, strengthening, and mobilizing pain limited or pain-free. You may implement knee sleeves if returning to the activity continues to cause some pain.

8)  Maintain a healthy weight—fast every now and then. From my observation, the leading cause of knee pain is carrying around too much weight. The quantity of food I can consume in one sitting has changed drastically since fasting (I’m a small lady but I can eat!). Over one year, I worked my way up to tolerating a liquid only fast for 24 hours about once a week. If I have a crazy hard workout planned on a fasting day, I definitely throw some protein powder in the mix. I also allow myself to fail if it’s getting too hard and I need dinner—I just pick it back up again next week. This practice and regular exercise keep me in check.

**all of these recommendations are in the absence of a severe injury that requires medical attention such as a fracture, or ligamentous tear. You’ll know its severe if the pain intensity stays the same and function continues to be inhibited or impossible.

How to Heal Yourself: A quick crash course

As a physical therapist, my career is to help people discover what needs to be done to heal. There are however several concepts I use over and over that can be taught in a preventative way and administered independently. Every person possesses and is made of healing energy. Therefore, every person has the ability to heal themselves to some degree. A skilled therapist should always encourage and teach the patient how to maintain therapeutic gains. This blog was inspired by two books I am reading: Becoming a Supple Leopard by Dr. Kelly Starrett and Dying to Be Me by Anita Moorjani. The important thing about self-healing is that you have to practice it every day. I’m a bit of a hypocrite in saying this but at least try MOST of the time…I’ve noticed a difference with this approach and am striving to make it an everyday occurrence. Below I’ve outlined several techniques I use to self-heal:

Physical Therapist are skilled practitioners who utilize joint mobilization to regain functional, pain free mobility. In the absence of severe impairments, a healthy person may be able to administer joint mobility techniques to prevent injury and to make athletic gains.

Foam Rolling: I think the most universal piece of equipment for mobility and pain reduction is the foam roll. You can pretty much hit it all with the roller. Smaller, pin pointed areas are a bit more difficult to target. The most important thing to remember about foam rolling is to concentrate on a specific area for a bit. You don’t want to roll your entire spine or body at once. Pick a segment no more than 6 inches or so, and hang out until the tissue releases (this may take up 2 minutes or more–for me, it’s AT LEAST 40 seconds but may vary by person). There are about a million things and ways to roll. I’d search the internet and find some you feel are right for you.

**Rolling can be very uncomfortable, it’s important to breath, relax, and find your happy place. I promise, you will feel so much better once the tissue releases.

Lacrosse Ball and Shiatsu: Rolling on the lacrosse ball allows a targeted release. I use the ball if I’m trying to release trigger points around the shoulder blades, mobilize a rib or specific spinal segment, and mobilize the shoulder. If you can’t fathom the idea of being active anymore in one day, I recommend a shiatsu massage pillow that allows you to be more passive in the mobilization. I use my shiatsu pillow about once a week to release tension in my neck and shoulders.

Yoga (Yin Yoga): Many, if not all, of the mobilization positions are adapted from traditional yoga poses. You may not be able to fully get into each pose but simply do what your body will allow. Modifications such as props, pillows, and foot stools can be used so that you can hang out for a while to reach the release we are looking for. YouTube has great beginner Yin yoga videos that I’ve used effectively. Pick the video that suits your body.

Self-Mobilization: Some of you may be totally turned off by anything CrossFit related but I’M TELLING YOU Dr. Starrett is a physical therapist who has developed a series of joint mobilizations that REALLY WORK and can be done outside of the clinic. They are grounded in the same principles PTs all over the world use. Like I said, a healthy person can safely perform these to reduce pain, increase range of motion, and improve athletic performance.

Flossing, Cross Friction, and Scar Massage: When muscles are tethered down due to scaring, or tightness associated with habitual postures, trigger points, and chronic inflammation it is important to restore the natural glide between our skin, fascia, and muscles. Nothing is meant to be stuck together. Voodoo flossing, cross friction massage, and scar massage all target the restoration of soft tissue gliding. The principles are pretty simple and you can google these techniques to learn more. Anyone with a significant scar should definitely make sure that thing is moving adequately.

Energy Healing: The power and ability to heal ultimately lies within us. Negative thoughts, feelings, and emotions can quickly manifest to disease. Being disconnected from your God self and tethered to your earth self creates a path toward destruction. Worldly things are destructible but heavenly are eternal. We have the ability to harness the eternal and utilize high vibrational energy to evoke healing and ease. Anita Moorjani in her book describes a near death experience that illuminated her life and life purpose. Love and knowing that we are all connected residing in God’s presence is key. By truly believing this alone can raise your vibration and decrease disease. Anita does not describe specific techniques but encourages living life fearlessly.

I truly believe positive thinking can change illness. I did not say cure but change it. Again, there are many, many ways to improve your thinking without a near death experience. Mediation and prayer are a great start, realizing that no matter what state you are in, you have the ability to help and create positive change in people…you are so valuable to this universe! Chakra balancing, Reiki, Kundalini yoga, and other energy healing practices exist and may aide you in discovering your higher self and purpose.

Rotator Cuff: Core stability for the shoulder

Most people associate any type of shoulder pain as a problem with the rotator cuff. It’s important to understand that the rotator cuff is not one muscle but a combination of muscles that surround the shoulder and scapula. These muscles act with the ligaments and labrum to stabilize the shoulder and allow it to function in all ranges. Its job is pretty intense because the shoulder must be very dynamic. If the shoulder is injured, often the elbow, wrist, and hand cannot do their jobs. Various other muscles help to stabilize the shoulder as well, so don’t get hung up on strengthening only the rotator cuff. The rotator cuff and scapular stabilizers are much smaller than the overlaying musculature (deltoid, biceps, triceps, pecs) and are often under strengthened and prone to over-use type injuries. Poor posture and poor body mechanics anger small, stabilizing muscles because they are forced to work like the big guys.  A good yoga and meditation practice will assist you in relaxing over worked muscles.  Gentle strengthening, stabilization, and balance will advance your shoulder strength and reduce over use pain.

Guys…everyday cannot by bicep day. Girls…everyday cannot be leg day. Take at LEAST one day a week to incorporate these small, but difficult exercises into your strengthening program to improve lifting strength, and to decrease nagging shoulder, and even neck and mid back pain.

I don’t care how strong you are, scapular strengthening is hard, so use light weights and/or bands. Also movements are small because the muscles are small, so don’t substitute large movements utilizing large muscles.

Two bands are utilized in these pictures.  We have them mounted to a peg board in the garage.  I would recommend a very light band, a light/medium band, and a medium/firm band for these exercises.  If the bands are too firm, an injury or larger muscle substitution occurs, which defeats the purpose.  There are a variety of ways to set the bands up.  Perform 8-12 repetitions of each exercise:

External rotation: Facing toward the bands, lift the arms to 90 degrees and gently rotate, pulling backward.

ER

Internal rotation:  Face away from the bands, elbows up at 90 degrees.  Gently pull forward rotating the arms down.

IR

Single arm external and internal rotation:  Keep the elbow by the side.  Gently pull in with the hand closest to the band (internal rotation) or pull out with the hand farthest from the band (external rotation).  This is a very small movement!

IRER

Scapular protraction or Serratus Anterior punch: Gently push your shoulder blade out.  This is a very small movement as well.

serratus

I, T, Y, W: Starting point (1st picture).  I (2nd picture) pull the bands by your sides squeezing the shoulder blades and sticking the chest out. T (3rd picture) arms are raised to 90 degrees, gently pull the band back squeezing the shoulder blades together.   Y (4th picture) arms are up at 90 degrees, gently pull the band up forming a Y squeezing shoulder blades down and in.W (5th picture) pull the band back forming a W with the arms pull the shoulder blades down and in.

I,T,W,Y

Additional Information:

The rotator cuff consists of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.

Other important shoulder/scapular stabilizers include: Teres major, subscapularis, latissimus dorsi, infraspinatus, teres minor, posterior deltoid, serratus anterior, levator scapulae, rhomboid major and minor, middle and lower trapezius.

Neck and Shoulder Pain

Nagging neck, mid back, and shoulder pain often impedes, disrupts, or prevents peaceful sleep, and makes sitting, standing, and working in an upright position pure torture.  No matter the cause of the pain, I have created a simple list of easy, in the moment fixes as well as advanced techniques to take it a step further.

As is my soap box–the majority of our pain is a result of some habitual posture.  Balance and symmetry are key here to shift spinal pressures.  When pressures are shifted, the spine gets to “breathe.”  It is extremely important to get up and move out of habitual postures every 15-30 minutes.  You can try the following stretches while taking your posture break:  Standing pec stretch for the anterior neck, an upper trap stretch for the side of the neck, and a back extension stretch for the thoracic spine, and a wall pec/side/anterior neck stretch.  Hold each stretch for approximately 30 seconds to 2 minutes.

trapstanding pec stretchstanding back extensionwall pec

My seconds soap box–Sit with good posture.  Poor posture places more harmful stress through your spine than lifting heavy objects.  Hers how to sit with good posture:

  1.  Scoot your butt all the way back in the seat
  2. You may place a towel roll in your lumbar spine (optional)
  3. Place your shoulder blades on the seat back.  This is the most important step for neck pain sufferers!
  4. Adjust your workstation to accommodate this.  This is the only that position allows your neck muscle to relax.

Here are some additional exercises:

Upper trap stretch with 1st rib mobilization:  The first rib and clavicle often become elevated with neck tension.  Use a belt to mobilize the rib and clavicle down.  This will give an even deeper trap stretch.  belt trap

Self lateral neck traction:  If the pain is present predominantly on one side of the neck or mid back try this: Lie on the non-painful side with 1-2 pillows at your shoulder (not your head). Now hang your head and relax. This acts to open up the painful side of the neck and mid back. Also, this is an easy position to rest in.  This is a form of lateral decompression.  Hold 2-5 minutes.self lateral traction

Eagle pose arms only: Hold for a few breaths or 30 seconds. Now move the arms up for 30 seconds, and down for 30 seconds.  This stretches the posterior neck and shoulder.eagle pose arms only

Decompress with a shoulder stand and/or plow pose: Both act to provide traction through the neck and spine.  Hold 30 sec to 2 minutes

shoulder standplow pose

Floor Pec stretch:  This opens up the shoulders and lengthens the anterior neck.  Hold 1-3 minutesfloor pec

Threading Pose:  This stretches the back of the shoulders and neck.  Hold 1-3 minutesthreading

Towel Roll (rolled hand towel, you may also duck tape it for durability):  Rest with a towel roll running down the center of your back (vertically) or running along the shoulder blades at the most painful area of the mid back (horizontally). This mobilizes painful vertebrae and compresses painful trigger points.towel

Breathe: Take several deep breaths throughout the day. Send the breath to the painful area. Inhale 3-5 seconds, hold 3-5 seconds, and exhale 3-5 seconds, focusing on relaxation on the exhale.  Repeat 3-5 cycles.breathe

Strengthen the rotator cuff.  You can google specific exercises.  I like I, T, Y, rows, and external rotation.  (I will update my shoulder blog soon with specifics on this!)

Relax the jaw: Throughout the day and when trying to drift to sleep, remind yourself to relax the muscles around the jaw and let it drop slightly.relax jaw

Shiatsu massage pillow and Lacrosse Ball:  You can buy shiatsu massage pillows on amazon.com, I recommend one that has a timer to prevent skin breakdown if you fall asleep.  Using a lacrosse ball against a wall or lying down, find the nauseating trigger points around your scapula (shoulder blade), upper traps, and posterior neck.  Push the ball into the trigger points and hold 30sec -2 minutes OR until you feel a relaxation.  lacrosse

Reduce the Pillowage:  People with neck pain typically need to sleep with a flat pillow, tempurpedic pillow, or no pillow at all.  If you sleep with multiple pillows start slowly reducing that number.

Chakras:  Investigate the balance or malady present in the heart, throat, third eye, and crown chakra.  Clear energetic blockages or buildup that may  be present from early childhood or from the recent past or present.