In this issue, Mike O’Hara, PT discusses the importance of strong, well-functioning upper back muscles. Exercises, including video, are presented. Jeff Tirrell gives us ways to keep all those New Year’s fitness resolutions, and Mike gives fitness tips to make your program more successful.
Every winter, in our physical therapy clinics, we treat numerous snow shoveling related lower back, neck, and hip injuries. These patients shoveled snow one time and suffered pain so intense that it required medical attention. All of these problems could have been avoided with some preparation, alteration of technique, and common sense.
Athletes prepare for performance with a series of warm up activities specific to their sport. A baseball player, soccer player, or boxer would never walk into a competition “cold” because they know the risk of injury is much higher if they do not warm up. Despite this knowledge almost everyone shovels snow without any type of physical preparation. They pull on their coats, grab the shovel, and without any preparation, charge into an extremely challenging activity. A snow shoveling warm up of simple stretches and mobility drills takes five minutes and can greatly reduce your chance of injury.
Poor mechanics when shoveling snow is often the cause of spinal injuries. Combining spinal flexion (forward bending) with loading (shovel full of snow) and rotation (twisting) is the ergonomic “perfect storm” for lower back pain. When you lift a big scoop of snow and twist to throw it sideways you create the force combination that can damage the lower lumbar discs and joints. Push the snow, and if possible, avoid lifting and throwing. Keep the spine long and straight and bend at the hips and knees so the legs can help perform the work. Keep your arms wide on the handle and your neck relaxed. Frequently switching the shovel to the other side spreads the cumulative loads evenly across the body. The loads on the shovel should be manageable. You are better off lifting less snow and working longer than lifting more and adding greater compression to the spine.
Choose the right equipment. Many snow shovels are just too heavy. I recommend using a light plastic or aluminum shovel. Some steel shovels can weigh well over nine pounds and this extra weight can create too much stress on your body. Wear boots that prevent your feet from slipping. You must be able to grip the ground to properly transfer force through the legs when shoveling. Wear good gloves and purchase a shovel with an end handle if you have any problems with grip strength or arthritis in the fingers or wrists.
Live to Shovel Another Day
Finally, if the heaviest object you have lifted in the last six months has been the television remote, you should just hire someone to shovel the snow. Shoveling snow is a demanding work activity that requires a moderate amount of fitness. One of the best reasons to exercise on a regular basis is that it enables you to safely perform tasks such as shoveling snow. The vast majority of snow shoveling injuries happen to people who lead sedentary lifestyles.
-Michael O’Hara, P.T., OCS, CSCS
We are beginning to win the battle against the myth that sit-ups and crunches are a worthwhile fitness activity. Take the time to read the December 21, 2015 Wall Street Journal article by Rachel Bachman, “Why You Can Stop Doing Sit-Ups.” In physical therapy, I treat the patients who in a valiant, but misguided, effort to regain fitness launch into a series of crunch/sit-up exercises only to wake the next morning with debilitating lower back or neck pain. The numerous reasons you should avoid crunches and sit-ups are listed below:
Most fitness clients are already spending too much time in a forward bent, slouched over posture. Their cervical, thoracic, and lumbar vertebrae are bent forward for hours a day– sitting too much, driving too much, texting too much… Many are proud at how easily they can fold their thoracic and lumbar spine over and “palm the floor.” The last thing they need is to pull the ligaments, discs, and joints of their spine into further flexion with crunches and sit-ups.
Your Mother’s Eyes and Your Grandma’s Spine
As we age, our spines tend to fall into the flexed over, end-range alignment of a sit-up. Why would you want to accelerate the pace of this degeneration by performing activities that accentuate the slumped over, forward flexed, spinal posture of old age?
The One True Belly Fat Reducing Exercise
Your abdominal muscles, or “six pack,” will not become more visible with lots of crunches, sit ups, rip twists, belly blasters, or any other targeted training. There is no such thing as spot reducing. The ‘table push away’ is the best exercise to improve the visibility of any muscle. Unfortunately, it is the least utilized exercise in America.
Abdominal Muscle Biomechanics
The function of your abdominal muscles is not to create movement but rather prevent movement. They work with a team of other muscles to act as anti-extensors, anti-rotators, and anti-flexor muscles. The six pack muscle, or rectus abdominus, makes up a portion of the cylinder of muscle that serves to support your spine in a tall and stable position. Think “movement preventers” and not “movement producers.” Crunches and sit-ups train your abdominal muscles to do the wrong thing.
The Pros Don’t Use Them
I cannot think of any athletic activity that emulates the motion of a crunch or sit up. It will not improve your ability to run, jump, throw, or compete. The strength and conditioning coaches who get paid big money to make athletes more successful and keep them injury-free do not use crunches, sit-ups, or other repeated trunk flexion exercises in their programming.
Maybe Not Now, but Soon and for the Rest of Your Life
Your lumbar spine hates repeated flexion. It really hates it if you throw in some rotation along with compression from an exterior load like a medicine ball, weight plate, or kettlebell. Lumbar spine injuries are cumulative. The stresses build up until one day you bend over to pick up a pencil and your back “goes out.” Crunches and sit-ups serve to accelerate the rate of accumulated spinal stress. I know you have a friend who does one hundred twisting, medicine ball crunches a day and has never had a problem. I have a friend who has smoked for twenty years and says he feels fine.
To read Rachel Bachman’s article, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
Most of the fitness clients I work with want better posture, movement, and performance. Most of the physical therapy patients I work with want their pain to go away and never come back. Almost everyone has heard that having strong abdominal muscles is a good thing. Many well-intentioned fitness enthusiasts injure their lower backs and ruin their posture with improper abdominal exercise activities. A simple exercise that fixes all of these problems is the Bird Dog.
Bird Dogs Build Core Coordination
The spinal column is controlled by a cylinder of muscles made up of the abdominal muscles in the front and sides, the lumbar muscles in the back, the pelvic floor on the bottom, and the respiratory muscle (diaphragm) on the top. These muscles never work in isolation. They function as part of a coordinated team to transfer forces and create joint stability. Core coordination is essential for better movement and pain-free living.
Bird Dogs Reverse Spine Muscle Atrophy
Each lumbar vertebrae is covered by layers of interwoven muscles that travel in multiple directions. Ultrasound imaging of the muscles around an injured spinal segment- dx sprain, bulge, post-surgery, slipped disc, lumbago, etc.—reveal that atrophy (shrinkage) of the muscles can set in fairly quickly. Long after the pain has resolved, the atrophy will persist unless some sort of rehabilitative training is performed. Bird dogs build these atrophied muscles back to normal size and strength.
Bird Dogs Help You Move
Every time you exercise, your neural system uploads motor control patterns that, for better or worse, alter how you move. Save good patterns and you move better, save bad patterns and you move worse. The Bird Dog exercise reinforces the opposite shoulder to hip connection through a stable and resilient spine. We need this pattern of movement to successfully throw a punch, toss a ball, and save us from a fall.
“But I Don’t Feel The Burn.”
This is the statement I often get from the patient laying on the treatment table with back pain. They are reluctant to abandon the traditional sit ups, crunches, and various versions of disk herniating spinal flexion exercises that have helped them return to physical therapy. I don’t believe the sensations that occur with fifty crunches are the abdominal muscles singing. I think the abdominal muscles are screaming “Where are my teammates?” and “Would you please stop?”
Bird Dog Performance
Set up in a quadruped position, the hands under the shoulders and the knees under the hips. Your fingers are facing forward and the elbows are slightly flexed. It is important to keep your neck in line with your body– do not look down towards your chest or up towards the ceiling. Brace the abdominal muscles and hold your back stationary. Lift the right arm into the air to a point 45° off the midline of the body. Make sure to lead with the thumb. Extend the left leg backward by hinging at the hip. Push out through the heel of the foot and do not let the hip rotate outward. Keep the body stable and hold this position for 5 seconds. Now perform the same motion with the left arm and right leg.
Start with five repetitions of five seconds on each side and gradually ramp up the duration of the holds to ten seconds. As ten second holds become easy, add a resistance band to the exercise. Before adding duration or resistance to the bird dog, become more graceful and steady through the exercise. Program two or three sets of the Bird Dog into your training sessions.
Be mindful of your performance of the Bird Dog. Pay attention to how your body moves and feels during the exercise. Use a mirror to monitor the position of your spine. The lower back should stay still as the arms and legs move. The body should not rotate or wobble. Do not point the toes- keep the ankle dorsiflexed and push out with the heel by actively contracting the gluteals and hamstrings. As you get better at the exercise, you should feel a better connection of the shoulder girdle to the torso and hips to the pelvis.
Mastery of the Bird Dog takes time. Work on this exercise for six weeks and I believe you will be surprised by the changes in pain and movement capacity.
To view video demonstration of the Bird Dog, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
We all want fitness results, and we want them now. We want to look, move, and feel better in two weeks. We know it took us years to get into this overweight, weak, and deconditioned state, but we have a wedding in three months, a reunion in six weeks, and a date next Friday.
Unfortunately, many of the physical problems that slow our progress toward specific fitness goals will not resolve with two or three exercise sessions a week. Postural deficits, faulty motor control, mobility limitations, and joint restrictions require daily attention to elicit any meaningful change. Short bouts of focused training, interspersed throughout the day, will produce the best results. In physical therapy rehabilitation, we prescribe home exercise programs that are performed up to every two hours to reduce pain and restore function. Fitness clients will more rapidly reach their goals with some daily Nano Sessions of exercise.
Nano Office Session
A rounded shoulder, forward bending thoracic spine posture is delivered free of charge with your new smart phone. This posture has become nearly universal, and it brings with it a gigabyte of shoulder, neck, and head pain problems. Fitness training at the gym often feeds into this postural problem- sit ups, crunches, spin bike, heavy bench texting, etc… Combine this with an eight hour office day of computer entry and number crunching and you create a postural deterioration feedback loop that needs a killer app. This Nano Training session can help.
You will need a resistance band or tubing and a doorway. It takes daily training to eliminate postural deficits. Perform this program twice a day. Two or three gym workouts a week are not enough. I understand you can set an alarm on your smart phone as a reminder that it is time to stand up and move through your Nano Session.
Office workers perform so many tasks with the arms forward and head down that they develop restrictions in the muscles in the front part of the shoulders and chest. Use a doorway stretch to reverse this adaptive shortening. Stand up with the elbows placed just below shoulder level against the doorjamb. Step one foot forward through a doorway. Hold a gentle stretch for ten seconds and then lower the arms and rest. Perform two or three ten second stretches.
The stretch should be felt across the front of the shoulders and chest. Go easy. Stop at the first point you feel a stretch. If you are grimacing in agony, then you either have a shoulder problem or you are being too aggressive with the stretch. As the stretch gets easier, try working the elbows higher up the doorjamb.
Postural Band Aid
One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid. This exercise takes less than thirty seconds to complete and can be performed at any work sight. Take a short length of tubing or resistance band and stand up. Assume a tall posture with a proud chest and the head pulled back. Hold one side of the band in each hand and keep the elbows by the sides. Pull the band apart so that your arms form a letter W with your body. You should feel a tightening of the muscle between your shoulder blades. Hold the band apart for three counts and then slowly release back to the starting position. Repeat for eight to ten repetitions.
To view video demonstration of the above exercises, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
Posture correction is a war, and you must fight the battle every day. You need to frequently awaken the dormant scapula and spinal muscles that hold you in a proper tight and tall posture. You cannot undo the adaptive shortening and weakness that is created by eight hours a day of gaming, computer working, texting, and driving with two or three exercise sessions a week. To make a lasting change in posture, you need to fight back with several exercise bouts a day.
One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid. The exercise takes less than thirty seconds to complete and can be performed at any work sight. Take a short length of therapy resistance band and stand up. Assume a tall posture with a proud chest and the head pulled back. Hold one side of the band in each hand and keep the elbows by the sides. Pull the band apart so that your arms form a letter W with your body. You should feel a tightening of the muscle between your shoulder blades. Hold the band apart for three counts and then slowly release back to the starting position. Repeat for eight to ten repetitions. Perform this exercise three or four times throughout your workday.
To view video demonstration of this quick, effective exercise, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
For the last two years, Janet had been “bothered” by lower back and hip pain. When the symptoms made walking and getting out of bed difficult, she sought medical attention. Janet had X-rays and Magnetic Resonance Imaging of her lumbar spine that showed she had some arthritis and stenosis in her lower back. She, then, underwent ablation of nerves in her lumbar spine and injections into her sacroiliac joints. These treatments decreased the pain in the lower back, but pain in the left hip and sacral region persisted. Three months after her last injections, Janet was referred for physical therapy.
On her initial physical therapy evaluation, Janet had none of the pain that caused her to seek medical attention. She stated the pain was present in the morning and with prolonged standing. She could stand for no more than ten minutes when the pain would become so intense she had to sit down. Sitting for fifteen to twenty minutes would resolve her pain. Janet had good spinal mobility, excellent hip range of motion, and normal strength in both legs. Her core stability was limited to a poor grade, but otherwise, she passed all functional tests. On further questioning about her lifestyle and activities, Janet failed a big test.
Janet: I walk on a treadmill every day.
Physical Therapist: How long do you walk?
Janet: One or two miles.
Physical Therapist: I thought standing caused you to have pain?
Janet: I do not have pain if I hold onto the rails.
Treatment: Stop walking on the treadmill.
Janet was skeptical. After all, walking was good exercise, and she wasn’t in pain if she held the rails. How could something good for you perpetuate the pain? Janet, however, was willing to try anything to get rid of her pain, so she agreed to a one week break from the treadmill. Ten days later Janet was pain- free.
When you walk on a treadmill you perform 2,000-2,500 step repetitions per mile. With every step taken, you must decelerate and then accelerate one and a half to two times your body weight. Holding onto the rails or the console of the treadmill can easily add 10-15% more load through your spine and pelvis. A woman who weighs 135 pounds walks with a fifteen pound weight vest on her back when she holds onto the treadmill. Torso and pelvic girdle rotation is a key component of normal locomotion–watch any speed walker. Holding onto the rails restricts the free flowing, rotational component of gait. Thousands of repetitions of a restricted gait pattern, with extra load, performed on a daily basis, can create lots of pain problems.
Treadmill gripping is a common driver of pain problems. As is often the case, the pain is not experienced during the treadmill exercise session, so the patient does not connect the activity with the symptoms. Patients with head, neck, lower back, and leg pain symptoms often have this same well-intentioned exercise habit.
-Michael O’Hara, P.T., OCS, CSCS