The Most Common Postural Problem ( that you've probably never heard of )

Many of my patients have alternating symptoms of neck pain, shoulder pain and low back pain. They come to my office for the symptom that is currently the worst, and tend to downplay the symptoms that are currently minimal. They don't realize that all of the symptoms are related to the same dysfunction. Their spine is too straight.

When you look at a spine from the front, you want it to be straight (see pic below). But if you do see curvatures here, it is called scoliosis.

When you look at a spine from the side, there are normal curvatures. In the picture below the person is facing right. The forward curve to the neck and low back are called lordosis. The backward curve of the upper back is called a kyphosis. The pelvis tilts forward slightly as well. These are all natural and necessary for normal pain free function. These curvatures, along with the intervertebral discs, help to provide normal movement as well as shock absorption.

Many of us have lost touch with our bodies to the point where WHAT WE THINK is straight and upright really IS NOT. This is most common in those that have a job which requires them to sit. Sitting usually tilts the pelvis back, slouches the low back, and gives our upper body a slight forward lean. With good intentions, many of us try to correct this posture. But instead of tilting the pelvis to initiate the change, we straighten our upper backs. This eliminates the natural and necessary kyphotic curvature.

This dysfunction results in elongated low back and neck muscles that can't do their job. Muscles get weaker as they get longer. They tend to fatigue more quickly. This position also puts more pressure on the intervertebral discs of the neck and low back. So not only can your muscles hurt, but your joints as well. The muscles around the shoulder blades (scapulae) also become painful because the joint surfaces don't match up. The scapulae have a concave underside to them, which glides along the ribcage. The backside of the ribcage should be convex to match the surface, as in the picture below. But with a flat back, it is not. As the scapulae are pulled away from the ribcage, the muscles are elongated. Again, an elongated muscle is weaker, and fatigues more quickly.

Flat back posture also makes it difficult to take in a full breath, as the ribcage cannot fully spread out like it should. Altered breathing patterns result in fatigue of the muscles of the neck and low back, as these are relied upon more often. This spinal flattening plus a slight pitch forward is the most common postural problem I see in the office today. I know what you are thinking - "What can I do about it?" Stay tuned. You get your answer in my next blog.

Washboard Abs vs.Strong Core

I must admit I don't have "washboard abs". I have what you would call a "two-pack" instead of a "six-pack". But is having washboard abs really the same thing as having a strong core?

To answer that question, one must first define what "core" means. I don't always agree with Wikipedia, but here is what they have to say on the matter: "Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. The lumbar muscles, quadratus Lumborum (deep portion), deep rotators, as well as cervical muscles, rectus capitus anterior and lateralis, longus coli may also be considered members of the core group. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius."

So there is well over a dozen muscles listed there, even if you don't include the latissimus dorsi, gluteus maximus, and trapezius, which I do. There also a few more I would add to the list such as serratus anterior. I understand the temptation to look at what you can most readily see and identify it as the "core". But we all need to get over this idea that sit-ups, crunches, or planks are the go-to core exercises for someone trying to decrease their pain levels through core muscle development. It is my humble opinion that the world of fitness, exercise science, and physical therapy have been overly influenced by the bodybuilding. The idea that we need to "isolate" one muscle at a time is quite ridiculous. In real-life scenarios, muscles don't work in isolation. Therefore training and developing them in this way is likely to end up in pain and dysfunction. Certainly the muscles look good on bodybuilders, but these folks are not as athletic as they look. Just ask one of them to run and you will see what I mean.

Here is a link to my Youtube channel. In it you will find the three core exercises I give the most : Up Dog, Side Bridge, and Bird Dog. I explain them in the videos, and in previous blogs as well, and there is no need for redundancy. Notice that none of these three main core exercises directly targets the abdominus rectus muscle. This is because the abdominus rectus muscle is one of a dozen core muscles, and is not THE important muscle. But, of course, it is still wise to train this muscle. The best way to train them is to do "Frog Abs". This exercise, like most of my core exercises, puts you into a position and hold it for three audible breaths. The breaths are very important, and it is necessary to keep them audible for two reasons. Not doing so will lead to holding your breath, guaranteed. The second reason is because it helps to stimulate the core muscles, many of which are involved with forcible inhaling and exhaling. Passive breathing (what you are likely doing right now), does not stimulate these muscles.

Click here to see Frog Abs video.


The video posted above also shows a hip position that minimizes low back pain. The turn out of the hips fires up the gluteal muscles, so that they work in conjunction with the abdominus rectus. Otherwise it is possible that the low back muscles fire up instead of the glutes, creating low back tension. Also, the lack of movement minimizes any risk of jerking your head forward, and injuring your neck.

Doing planks can be a good core exercise as well. Yet there is one inherent problem with it. The person doing it can't see their own back. I think if they did see it they would be surprised. Most people have such a gap between the shoulder blades (scapula) and their ribcage, that you could stick your fingers in there and pick them up like a suitcase. This is a sign of weak serratus anterior. Scapular winging has other possible causes, but weak core is the most common.

I guess I can't expect too much from people. They have been taught the same core exercises for decades, and now Dr. Schafer wants to start from scratch. I get it. I don't have the washboard abs, so what do I know about core muscles, right? Well, for starters, I don't have back pain.

Top 5 Running Mistakes

In the fall of 2010, I started training for the Grand Rapids Marathon in 2011. I had never run for exercise before. Gradually and slowly increasing my distance allowed me to complete the goal. However, it took me 12 months to get there, and more importantly, to do it without injury. Here I am in the final stretch, when my daughter decided to join me. When we crossed the finish line, she was quite upset that she did not get a medal. I tried giving her mine, but to her credit, she would not take it.

I try to inspire people to exercise in whatever capacity they can. I want to help my patients help themselves. When they do, I know that their long term success in fitness and health will translate into less pain overall. Yet there are always road blocks on the journey. Knowledge is key. If you want to run for exercise but are afraid, don't be. But be smart about how you train. And don't expect to go from running 0 miles to 26.2 overnight. So here are the most common mistakes made by beginners, and by those who just haven't done it for awhile.


1. Too much too soon.
This is easily the most common problem. Everybody has physical limitations. Testing your limits occasionally is good, but don't do it every time you run. Follow the 10% rule- don't increase your total weekly mileage or pace by more than 10% per week. That means you can't jump from running 1 mile to running 2 miles. Nor should you run 2 miles twice in one week, and then three times the next. It is the same principles for increasing your pace. Expect injury if you go from 14 minute mile (4.3 mph) to a 10 minute mile (6 mph).

2. Stretching but not strengthening calves.
It is just as often that I find weak calve muscles as I do short and tight calve muscles. It is also possible to have both. To test yourself, see if you are able to stand on one foot, then lift the heel. A surprising number of people can't do this. Compare right foot to left foot for how high the heel goes up. Usually you will feel one foot is not as strong, and your balance is worse. For this problem, do one leg calf raises at the bottom on the stairs, and hang on to one railing for balance if you need to. You can do the same on a curb with a signpost nearby. Go through a full range of motion up and down and pause briefly at each end. Think of it as an exercise that something between stretching and strengthening. Not only can weak calves lead to plantar fasciitis and achilles tendonitis, but it can also create overuse injuries at the hip or knee.

3. Stretching hamstrings with knees bent
Going down to touch your toes is probably the most common stretch done by runners. But in trying to push the limits of how far down they go, they will often unknowingly bend the knees. If you cannot fully straighten your knee, then you cannot correctly push off every time you stride. Your push-off will become a twist-off as the hip muscles try to make up for lack of knee motion. This can lead to hip or knee pain. Instead, try putting one leg on a chair or bench. Make absolutely sure your knee is straight. Then bring your toes toward you. If you still don't feel much stretch then stick your butt and chest out. When done correctly, even a contortionist will feel the stretch.

4. Foot Midline Crossover.
If you frequent a shoe store where they have a video treadmill setup, try using it the next time you are there. You don't need to be a specialist to see how one foot will be in the middle of the treadmill and the other will be out near the edge. If you can, ask the salesperson to drop a line down the center of the treadmill running surface, and count how many times each foot touches the "midline". I have seen many injuries on both the midline foot and the lateral foot. The midline foot supports more weight, but the lateral foot has to push harder to complete the same movement. Once again, the overuse scenario can produce pain at the foot, knee, or hip. One way to help overcome this is by "straddling the line". Find a high school track to run on. When you do, see if you can keep your right foot on the right side of the line, and the left foot on the left side of the line. This is surprisingly difficult for most people.

5. Doing the same run every time you run.
You will help stave off injuries if you can vary the terrain, distance, and pace of your run. If you do not, you are setting yourself up for a repetitive stress injury . Try running on a trail. You will notice your foot lands in a slightly different position every time. Many roads have a slant or a pitch to them to help water run off. Running on the same side of the road every time can create problems as your body tries to adjust for that slant. Try alternating types of running shoes, with different heel heights and arch supports. This will again vary the positions of your foot for every stride. Varying the pace and distance also can help. There are plenty of free couch to 5k running logs you can find online. Use those as a general guide, but listen to your body.

You are different. Your body is unique. Not everyone can or should do marathons, but most people can and should run. Especially if they like to.