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