Floor Exercises for Upper Back and Neck Pain

Here are some of my more commonly prescribed exercises for neck pain, upper back pain, pain near the shoulder blades, and headaches. Exercises shown include the elastic band chin tuck, open book, and cat cow with cat camel variation. The chin tuck is also covered in another video, but this version uses the elastic band for increased resistance. The open book exercise helps with upper back and rib rotational range of motion. The cat cow and cat camel help with range of motion in flexion and extension. The chin tuck movement helps reduce our tendency to allow our chins to poke forward, the single most common postural fault. The open book movement is often helpful with rib pain and pain near the shoulder blades. It is a motion most of us would just not achieve otherwise. The same is true with cat cow and cat camel, but with the extension motion being needed by most people.

Chin tuck exercise laying on back

Good posture is a funny thing. Most people are pretty sure that they slouch, others feel that they are at least trying. The only people I see in my practice with good posture is people who have dance experience, usually ballet. I should note that not all dancers have good posture, but what they do have is good body control. The best yogis have good posture as well, but that is usually if it is their full time job. If I ask an average Joe or Jane what good posture is, the result is often ridiculous. But it is not really their fault, no one has shown them otherwise.

The biggest common denominator is the chin. Yes, the chin. it sticks out forward too much. The reason is obvious: people are often in occupations that demand that they sit and work on a computer, or sit and drive, or just plain sit. And now we have smart phones. One more reason to lurch into a forward head position for hours on end. Between computers, tablets, and smart phones, chiropractors will be in business for a very long time. So whats to be done about it?

The single best exercise that you can do is the chin tuck. But it is not as easy as it sounds. A visual description is best, so here is a video with the chin tuck exercise and some variations on it. The important thing to note is that the chin comes in and the base of the skull goes backward. The net result is no tilting forward, and no tilting backward. The best results are achieved if you can start the movement by contracting the abs. No big crunch or sit-up is needed, just a simple ab tightening. Timing this with your breath is important as well. Forced exhalation activates the core abdominal muscles, so I use this trick to our advantage. Another reason is that I know my patients, and the tendency for one to hold their breath is very common. So common, in fact, I would expect it to happen if I said nothing about it. The simple act of tightening one's abdominal muscles and continuing to breathe is actually very difficult for many. Add the chin tuck on top of that is even harder. The effort is definitely worth it, because if you cannot perform this exercise, you cannot have good posture.

The Link Between Pain, Dysfunctional Breathing, and Lack of Exercise

It may sound strange that teaching people how to breathe can decrease your pain. However, observing the similarities among my patients with asthma and feeling the same problems in my own past has afforded me some personal experience.

As an asthma sufferer myself, I can draw upon my own pain patterns and muscles weaknesses to derive a few conclusions. My patients often display the "inhalation posture". The elevated shoulders, excessive straight and broad upper back are the primary signs. They are stuck in this inhaling stance, as they are constantly trying to take in more air. Their bodies don't realize that what they really need is to exhale more.

Weaknesses in the internal and external oblique muscles are a good place to start. These muscles are key for forced expiration, so it is good to fire these muscles up before doing aerobic exercise. Focusing on forced expiration and trying to prolong this phase will keep you going longer than the gasping for air on the inhale. In fact, whatever core/abdominal exercise you like can be made much more effective just by following this pattern: exhale fully and forcefully on the exertion part of the exercise. For example, during a "crunch" exercise, lifting your upper body up is the "exertion" phase. Prolonging this part of the exercise and fully exhaling will really activate these muscles.

This link shows another excellent core exercise that is also easy on your spine:

https://www.youtube.com/watch?v=2fwjGJ2MDsA

(I am not affiliated with Aaron Swanson, but this video saved me the trouble of doing one myself. Thanks Aaron!)

Lastly it is apparent to me that many people that have not done any cardiovascular exercise in a long time have the weakest core muscles. People who run regularly typically have fair core strength. Sprinters will typically have the strongest. High intensity training will make you forcefully inhale and exhale. This does not mean that couch potatoes should immediately take up sprinting for exercise. It is always best to ease into it.

Stress and Breathing

Psychological and emotional stress can have as much effect on breathing as physical stress. Recent studies suggest that merely paying attention to you breathing can have a positive effect in respiratory stability (Applied Psychophysiology and Biofeedback June 2007, Volume 32, Issue 2, pp 89–98.)

Without regulation, many of us would fall into a breath pattern that is a result of our daily stressors. This increases the production of cortisol in our bodies, which increases the heart rate and blood pressure. This system is designed to help us survive dire situations. Think of a caveman who suddenly see a predator and needs to run as fast as possible. The increased heart rate and blood pressure assist the body in getting moving more quickly. Rarely do we need this biological response in today's society. Yet, we are all too often stuck in this pattern.

Most patients have a posture that show a lack of exhalation. What I mean is the patients will usually display elevated and forward shoulders. This is the position we are in when we forcefully inhale. Along with this posture comes overactive levator scapulae, sternoclaidomastoid, and pectoralis minor muscles. In addition, they're often weak in certain core muscles involved with exhalation. Those are the rectus abdominus, external oblique, internal oblique, and transverse abdominus. This is how the breathing dysfunction can cause pain. It is through the over-activation of accessory muscles of inhalation, and under-activation of the muscles of exhalation.

Ideally, the shoulders do not elevate nor push forward. How can one avoid this? Simply by monitoring. Periodically check your posture. You can do this while we at the computer, or driving, or even while exercising. Make sure the shoulders are relaxed. Do not push the shoulders backwards in an attempt to get to perfect posture, as this still creates too much tension.

So, in summary: keep calm, and exhale.

Poor Posture and Breathing

From the first second a patient walks into my office, I am doing an assessment on their posture, movement patterns, and breathing patterns. If I stop to say "...and now I will do a posture assessment", it is guaranteed that the patient's posture changes. I will often do this anyway. This is because most people don't really know what good posture is. They couldn't show me good posture even if I offered them a million dollars.
Try this experiment. Slouch as much as possible in the seated position. Now try to take a full breath. It just doesn't happen. Now sit up straight and try again. Better, right?
Now try to find the best posture for your breathing. Experiment by tilting your pelvis forward and backward and deep breathe in any variation of upright posture that you can find. When assessing your full breath, judge by how much each position allows you to breathe sideways (think of breathing into your armpits). Avoid lifting the sternum or shoulders. Now try tilting your ribcage forward and backward. Lastly vary the position of the head. The best position is often the one where it feels like the base of the skull moves backwards, giving you a slight chin tuck. This is ironic because many people will reflexively poke their chins forward when their breathing increases. This has the opposite end result.

You will find the best posture is neutral where the ribcage is over the pelvis and the head is over the shoulders. The shoulders must be relaxed and not forced backwards, nor jutting forwards. Most of us will either slouch or be excessively upright. The forced upright position shown above will often be combined with a slight forward lean. This posture feels like "good posture" yet causes many painful syndromes. This is why we include posture coaching as part of the treatment plan at Schafer Chiropractic. A little knowledge can go a long way.

The Link Between Pain, Stress, and Breathing Muscles

Try this test:
Take a deep breath. Did your shoulders lift upwards? Did your chest lift upwards? Did your pelvis move? Did your chin tilt up? All of these indicate dysfunction breathing patterns, as they are artificially lifting the ribcage, rather than expanding the ribcage.
Now put your hands under your armpits and try to inhale by expansion (in circumference), without lifting upward. Don't worry, you are not the only one who has a hard time doing this.

Any clinician who is worth their salt will tell you there is a link between breathing and pain patterns. The first clue is that the most commonly tight and short muscles are the ones that are "accessory muscles" to inhalation. These are the scalenes, sternoclaidomastoid, pectorals, latissmuss dorsi, and serratus muscles.

The second clue is that the most commonly weak and atrophied muscles are the accessory muscles of exhalation. These are the external oblique, internal oblique, transverse abdominus, and rectus abdominus.

However, the real pain is in the dysfunctional accessory muscles, which include levator scapula, upper trapezius, and several subocciptal muscles. It is common for patients to use these muscles when I test their breathing in my office. These are usually the most painful, and indicate that the dysfunctional breathing has been present for a long time. This is why so many people have neck pain, headaches, and pain along the shoulder blades.

The next step is to find out why it is happening. The answer is usually stress, poor posture, or lack of exercise. Often it is a combination of all three. More information on these causes will be the topic of subsequent blog posts.

Finding a chiropractor who can re-align the spine is easy. Not many will give you home exercises to help correct the reasons for the misalignments. Even fewer will give you postural coaching. Rarely will any clinician look at your breathing. If your does not, give us a call at (616) 301-3000.

Back to school, not back in pain

Back to school should not mean a pain in the back. As the parent of an 8 year old, I am often amazed at how much stuff she can fit in her backpack. The weight of the pack seems to increase yearly. The big question is - How much is too much?
The weight of the pack should not be more than 15% of the child's body weight. So multiply your child's weight by .15. That means a 60 lb child should not carry more than 9 lbs. The incidence of low back pain in children is on the rise, and this looks to be one major factor. I know my daughter has considerably more homework than I had at her age. Her pack is filled with completed projects, notebooks, shoes, etc.
It is wise to consider a few more things than total weight, however:
-Foremost, make sure they wear both straps. Wearing only one strap will obviously create an unbalanced body.
-Keep the heaviest objects closest to the part of the bag touching the child's back. This ensures best weight distribution in carrying the load.
-The bottom of the bag should not pass the child's waist. If it does, the child will need to lean forward too much.
-A bag with a waist strap keeps the load closest to the body. Again this means the lightest effective load and less strain for your child.
Lastly, consider cleaning out the backpack weekly. Not only will your child have a lighter load, you may come across a few permission slips or upcoming projects that your child may have forgotten to mention to you. (If your child is anything like mine.)

Shoulder Rotator Cuff Injury Due to Poor Posture?

Yes. Posture has a profound affect on how you use, or overuse your body. And yes, posture is often the biggest reason why people develop shoulder rotator cuff injuries. The proof is simple. Let's look at the most commonly given exercise for the supraspinatus muscle. This muscle is one of the rotator cuff muscles, and helps hold the humerus head in the socket of the shoulder joint.

Note the angle that this person's shoulder is in. It is slightly forward, as if he is slouching.

Not surprisingly, the shoulder joint works best when you are in an upright position. In this position, the deltoid and the upper trapezius muscles do the heavy lifting.

With the body in a slightly forward slouched position, the heavy lifting is now done by the supraspinatus and infraspinatus muscles. Why is this bad? These muscles are much smaller than the heavy lifters. That is why they fatigue more quickly. It is a simple case of muscle strain due to poor body mechanics. Certainly not all cases of rotator cuff damage occurs this way. Repetitive stress can occur with or without poor posture, as can traumatic accident. Most cases in which I have observed rotator cuff injury, the patient does not have any accident or trauma to report, nor any reason why they shoulder be having shoulder pain. If this sounds like you, try standing up straight. If that doesn't help, call a good chiropractor. Posture coaching, shoulder, neck, and upper back adjustments, and rehabilitative exercises will get you on your way to being pain free.

Malicious Migraines

The term migraine is often mistakenly used to describe a severe headache. Although not all severe headaches are migraines, most migraines are severe. As the diagram shows, the typical pattern of pain is felt above, near, or behind one eye. Half of the face is usually affected. Most of those affected will also have abnormal visual disturbances without any other explanation. These "aura" can take many forms (see Table 2).

The aura is often preceded by light sensitivity, loss of appetite, dizziness, or depression. During the migraine, continued nausea and light and sound sensitivity is also common. The interesting part is that these symptoms occur in slightly more than half of migraine sufferers, but not all. Even the location of pain is not 100% consistent. There is no definitive diagnostic test to confirm or deny the presence of a migraine. This means we still know very little about why they happen, and what makes them different from other headaches.

What we do know, however, is what typically triggers a migraine. Allergies, stress and abnormal hormone levels are the most common triggers. Allergies can be food (chocolate, red wine and MSG are the most common), or seasonal (mold, pollen, grass). Just like with sinus headaches, an air purifier in the bedroom can be of great benefit. Steering clear of perfumes, scented laundry products, and and scented soap will help prevent chemical triggers.

Stress triggers may come in the form of biomechanical (excessive physical exertion, spinal misalignment and poor posture), emotional (loss of a loved one, life changes), or mental (work/other). Fluctuations in hormones during the menstrual cycle is a very common trigger for females, and is usually the most difficult to overcome. With all of these possible triggers, one can see the benefit of keeping a migraine journal. This often helps identify patterns and point the migraine sufferer to the source.

From the chiropractic perspective, spinal adjustments can help decrease biomechanical stress. Improving posture and relieving nerve pressure will decrease migraine severity by 50% on average. To a migraine sufferer this is an enormous improvement. For emotional and mental stress, meditation is most helpful.

In summary, if you really have a migraine, it may take a while to find your triggers, but it is well worth the effort.

Chiropractic and Headaches Part 2: Sinus Headache

The second moat treatable headaches that we see here at Schafer Chiropractic is the sinus pressure headache. These headaches typically feel more like pressure rather pain. The location is also different, as it is usually more centrally located at the forehead, whereas tension headaches will typically feel more like a band all across the forehead.

The treatment approach is also much different. Seasonal allergies like tree pollen, weed, grass and mold are often the biggest trigger. Herbal antihistamines such as Ortho-Molecular's D-Hist are very good at helping with flare-ups without making you feel tired nor "wired". Certainly we cannot control mother nature's eternal succession of airborne plant pollen, spores, and seeds. However, considering that you are likely spending about 1/3 of your life in bed (sleeping, of course), it stands to reason that this is a good place to control your environment. Using a air purifier here is often very helpful at easing your symptoms.

It is also important to remember that PV=nRT. What's that you say? Can't remember your high school physics? Without going into details on the "ideal Gas Law", just know that air pressure is related to humidity. Higher humidity makes us feel our sinus pressure more. Once again, we cannot control the weather, but perhaps a dehumidifier in your home or bedroom would be a good idea. This is particularly true for us in west Michigan.

I know what you are thinking-do chiropractic adjustments help? Yes! Although the mechanism is still not well understood, i have seen many patients' sinus passages clear after an adjustment. Having a tissue nearby is essential, as it is sometimes instantaneous and dramatic. I should note that this does not always happen, and it is often hard to predict if it will.

Stay tuned for our next post. Part 3 : Migraines

Chiropractic and Headaches Part 1

About one day per week, previous patient who has overcome their back pain comes to my office with a new symptom - a headache. Usually this patient has already been to the ER and/or their primary care physician, and been prescribed a pain medication with an anti-anxiety medication. It is surprising to me that the patient never considers chiropractic care, until they have become dissatisfied with their current treatment. It is surprising to them that I treat many patients with headaches. So here it is- Yes! chiropractic care can help headaches!

The chart above is a good start for figuring out what kind of headache you have. Although I can help the vast majority of headaches, I want to give patients a good idea of how much improvement to expect. In my experience, chiropractic care can help tension headaches the most. The "tension" can often be traced back to a problem in the neck. Poor posture, excessive computer work and texting leads to an excessively forward positioned head. Imagine holding a bowling ball up against your belly. This is not too difficult as it is close to your center on gravity. The more you bring the ball forward, the heavier it gets. This is exactly the same as holding your head out forward, as many of us do. And yes, the head weighs on average about as much as a bowling ball, about 10lbs. The muscles that hold the head up are under increased stress just to maintain an upright position. Also, because the head is forward, the muscles at the base of the skull have to pull even harder to keep your head level so you can look forward. Otherwise you would be looking downward.

Tension headaches also are greatly affected by stress levels. All sources will affect the body and pain: physical, emotional, psychological, etc. As a doctor I have no magic wand that I can waive to instantly remove stress. However, the best advice I can give is to consider meditation and breathing techniques. Excessive stress will often result in overuse of the accessory breathing muscles. These muscles are the "fight or flight" breathing muscles, that affect the neck, ribcage head and shoulders. Meditation can also improve sleep, another source of stress.

Next blog: Migraines

Sweet Spot

I consider myself to be an eternal student. I think it is wise to keep in mind that there is always something more to learn on any topic. It was in this vein that I enrolled in a coaching certification course put on by USATF (USA Track and Field). I had the opportunity to learn and discuss running biomechanics with people who have coached for decades. The biggest question on my mind was foot strike. So I asked several people how do they teach new distance runners to run? What footstrike has given athletes maximum efficiency and minimal injury? The most experienced coach in the group told me about the "sweet spot". This spot is "just behind the forefoot".
Just to back up a minute here, I have heard and read many different interpretations as to what the best running foot strike is. Some say that the forefoot is best because the big calf muscles absorb the shock of impact, and not the heel. Others say that the human body has evolved a physiological heel pad under the calcaneus bone to absorb this shock, so we should use it. A few say runners should run in whatever style feels natural. Most would say that they strike with their "midfoot". This last description never sounded plausible to me. I always thought this was impossible because you can't land on the concave part of your foot. The "midfoot" is the arch and is concave. But the way he described the "sweet spot" made me realize something. That is, when your foot has already started the motion of moving front to back, then it is possible to strike on the backside of the convexity. The convexity is the ball of the foot (see diagram). I don't think I would call this "midfoot", but maybe since that term has no real anatomical definition, this is what "midfoot strikers" are talking about.

By describing the sweet spot as he did, this gave the new distance runners a cue to start the foot moving backwards before the foot lands. Why is this helpful? A good analogy would be a canoe. A moving canoe has momentum, just as you do when you run. If you stuck out the paddle straight into the water it would slow you you down. Starting the paddle moving back first and then dipping it in the water helps maintain momentum. Conversely, heel strikers will typically fully straighten their leg when they land. This is akin to sticking the paddle in the water and slowing down the canoe.
This is not to say that this is the best for everyone. I still believe that if you are a slow runner, and are experiencing no problems, heel striking may be alright for you. There are other factors involved that may predispose you to injury if you do anything else. However, if you are concerned about performance, you should find your "sweet spot".

Do you know why you hurt?

The most common reason that people come to see me is because they don't know why they hurt. Yes, sometimes auto accidents, slips and falls, and various other accidents can create enough pain that they want relief. But what is more concerning to most is when there no accident or fall, and no other obvious reason why they should be hurting. So what's the cause? Why do they hurt?
Core weakness is usually the culprit. Many people know that their core is weak, and others are insulted by the suggestion. "But I do 200 sit-ups every day" or "But I can plank for 2 minutes". These exercises are not bad, but they may not be what is needed. Most "core" exercise that people do work primarily the abdominus rectus, aka, the "six pack". This is one of a dozen muscles that need attention. It does not need ALL of the attention.
Additionally, an inability to activate your core muscles during everyday activities is a problem. When tested individually, these muscles may not show signs of weakness nor pain. Poor posture in different positions is usually a much better indicator of how they no longer function synergistically. A simple test you can give yourself is to do what ever core exercise you are familiar with. A crunch, perhaps, is a good example. When you do a crunch, do you hold your breath? Try it again while breathing normally.
Now try sitting with "crunch muscles" tightened, but without holding your breath. Now try it standing. And walking. Using your core muscles should not be an all-or-nothing response. What I mean is that there should be level of mild activation where they provide support, but is still comfortable enough for you to maintain a comfortable breath for a long time. Holding your breath is not the same as "activating your core".
This is usually most important when dealing with patients who are required to sit in front of computers for 40 plus hours per week. If this sounds like you, and you have upper back pain/neck pain, shoulder pain or headaches, you need our help. Call (616) 301-3000 and make an appointment for a full evaluation.

Runner's Rule

As a chiropractor who happens to have a lot of patients who run for exercise, it has become clear that many are unaware of one very simple principle of running. USA Track and Field coaches call this the "Law of Progressive Overload". I like calling it the "10% Rule".
Simply put, your body cannot sustain increases in mileage or speed in excess of 10% per week. What does that mean, you say? It means that if your "long run" of the week is 5 miles one week, the next week's "long run" should be no more than 5.5 miles. It also applies to the total miles per week, and/or the average speed.

One can expect that the body will break down somewhere if this rule is broken. It will find your weakest link. You may develop knee pain, hip pain, foot pain, low back pain, or maybe even hamstring pain. As the weather improves over the next few months, please keep the 10% Rule in mind.