Performance, productivity and……….Posture?

productivity

The newest most powerful productivity hack could be standing right in front of you, quite literally! Our posture plays much more of a role than first thought and the science is clearly telling us why.

Task orientated people will agree they are most productive in the mornings. You’ve had a good night’s sleep, feel refreshed and the mind is clear to tackle the day ahead. In fact many of the world’s top entrepreneurs and business leaders advise scheduling key priority tasks in the mornings.

But where does the drive and productivity go by the afternoon and is there a way of bucking this trend of decreased efficiency?

Well the good news one simple free solution could change the way we work forever.

Lack of movement and prolonged sitting have a global effect on our health, much more than just causing muscle tightness and an aching low back. So much so that Dr. Camelia Davtyan, clinical professor and director of women’s health at the UCLA,  stated that “Sitting is the new smoking”.

So let us have a look at what sitting does to our body and more importantly our brain. A study conducted by Harvard University looked at the effect of a slouched sitting posture compared to a expansive upright posture (standing, shoulders back and chest out). The results were fascinating. Slouched sitting postures promoted feelings of inferiority, sadness and depression whilst expansive postures increased feelings of confidence and leadership abilities. The standing postures actually altered participant’s hormone levels by decreasing the stress hormone Cortisol and increasing levels of Testosterone. So something as simple as standing tall and pushing your chest out can change the chemistry in the brain. This theory known as Embodied Cognition explains how the mind body relationship is a two way street. The emotional experiences have a direct influence on the function of body and visa-versa the postures we adopt have a direct influence on our mood, concentration and productivity.

The lack of movement associated with prolonged sitting also plays a role in our brains stimulation. Nobel prize winning neurobiologist Roger Sperry discovered that 90% of the stimulation of the brain comes from movement of the spine. Prolonged sitting in a slouched position reduces this stimulation drastically. Conversely walking and gentle stretching stimulates the brain. Making movement a regular part of our day is is key to keeping productive.

Poor posture and slouching also has effects on our breathing. Over time prolonged sitting causes us to adopt a shallow breathing pattern resulting in a reduced oxygen intake. Common signs of this are feeling tired and sluggish mid afternoon and yawning in the middle of the day.

The running theme in all these studies is prolonged sitting decreases how well our brain and body functions. It’s like trying to drive a sports car with the handbrake on. So what small daily disciplines can we implement to take the handbrake off and tap into increased productivity and tangible results?

Here are my top five productivity hacks for ultimate performance and consistent productivity.

  • Implement the 30 for 30 rule – Move for 30 seconds every 30 minutes as an absolute minimum. Break your day into 30 minute chunks. Set a reminder and get up and move for 30 seconds. This movement stimulates and wakes the brain.
  • Stand for attention! Where possible work standing up. If holding a team meeting or taking a lengthy call do these standing. This reduces the postural fatigue making it less likely you will slouch when you sit down.
  • Chest up and out. Whenever you walk through a doorway raise your sternum by 2 cm. This small change in posture increases lung volume and releases hormones which increase confidence.
  • Utilise your lunch time. Changing your environment and moving for 20-30 minutes will make you more productive than if you worked straight through your lunch. The movement stimulates the brain, the new environment takes your mind off work preventing mental fatigue.
  • Box Breathe. When feeling tired or stressed close your eyes and breathe deeply from the diaphragm. Breathe in for 4 seconds, hold for 4 seconds, breathe out for 4 seconds and hold for a final 4 seconds before repeating 4 times. This not only increases oxygen uptake which will perk you up but also reduces the release of stress hormones.

As Jeff Olsen famously said “The following are easy to do and easy not to do”. These productivity hacks need to be replicated daily for tangible results. Don’t keep these a secret. Share them with your colleagues and enjoy improved posture, productivity and performance.

 

The Secret to Long Term Back Health

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Back pain and injury is one of the leading reasons people take painkiller and costs our economy $ Billions every year from time off work. In an age where we can land probes on Jupiter, decipher the human genetic code and restore sight with the use of stem cells how is it that we cannot prevent something as simple as back pain.

back pain stats

Describing a symptom like back pain as “simple” may be misleading and although the causes of spinal dysfunction can be varied the basic mechanism, more often than not, is a reasonably simple one. One that if addressed early can be prevented and if understood can lead to long term spinal health.

As I have alluded to in previous articles the key to a healthy spine is movement. But more importantly consistency of movement.  It’s the daily lack of movement that our back is subjected to that is dangerous and leads to pain and dysfunction.

Our brain, muscles and joints adapt to the things we do every day. Muscles that are only used through a small range of motion, over time, will become short and tight. Muscles that aren’t used at all will become inactive, weak and ineffective. This will affect the movement and stability of the joints the muscles are attached to.

 

So what movements are you doing regularly and what patterns are you laying down for your body to remember?

The main culprit is prolonged sitting. The list of detrimental effects caused by sitting is long and not limited to the muscles and joints. Sitting causes the spine to be unsafely loaded leading to tightening of spine and hip muscles. These muscles which should be working to protect the spine from overload become ineffective.  All these actions are not conducive with a spine that can deal with the demands of daily activity.

 

Solution

The good news is the solution to the problem is completely simple but does require a change of mindset. A change to a routine of consistent and regular movement. Walking, exercise, hydration and stretching. Here’s some top tips to make this transition easy for you.

  • Monitor your steps and activity. Fitbit’s are great for this. They monitor how many steps you are doing per day and when you’re most active / inactive. iPhones now come with an inbuilt pedometer which you can access through the ‘Health’ app.
Pedometer App for iPhone

Pedometer App for iPhone

  • Involve walking in your commute to work. If getting public transport then hop off a stop early and walk the last 10 minutes to work. Do the same for the return trip home. If driving the car park it an extra few blocks away.
  • Get up every 20 mins at work. Sitting for longer than 20 mins is the critical period for the spine. You are more likely to encounter long term injury if you frequently sit for longer than this period. So get up often. Put the printer on the other side of the office so you have to get up and walk.
  • 15 mins of mobility / stretching a week. Yoga classes are great for keeping the joints supple, flexible and healthy. If you’re not a yoga sort of person then gentle stretching at home or as part of your normal exercise routine is easy and effective.

 

The list could go on for pages but the key is consistency. The small habits you do every day shape your future health. Start small. Implement one of these every day for a fortnight. Then add another to the list and so on. Don’t treat this like a detox or fad diet where you focus on it for a month then slip back into back habits. Make changes and try and keep them.

consistancy quote

 

For more information or to ask one of our chiropractors a specific questions please email us at chiroexercises@gmail.com

Txt neck – What’s really going on ;)

text neck

As a chiropractor I see people with all sorts of aches and pains but one trend I have noticed is neck pain and associated problems like headaches, migraines and jaw pain on the rise over the past few years.

Often ‘poor posture’ is the generalised cause but I feel a more specific cause is right under our noses, quite literally – smart phones.

So what’s really the problem with cell phones?

Firstly it’s important to understand how the neck and spine works to best appreciate how the use of phones is damaging our health.

The spine has a number of curves that act like a suspension system, evenly distributing weight and forces without overloading one area of the spine. The neck more specifically has a gentle ‘C’ shaped curve which keeps the head upright, eyes parallel and distributes the weight of the head through the spine.

The neck vertebra are unique in their structure. Their small thin structure allows for fast, intricate and accurate movements. The further down the spine the bones become wider and thicker, dealing with the increase load that is placed on them. Think of the neck as a formula 1 car, nimble, fast and delicate. The low back vertebra are more the off road 4×4 car, sturdy and hard wearing.

The problem comes with sitting and working with things in front of us. Over time we start to slouch with the head creeping forward, which undoes the natural curves of the spine. This places huge stress on the small neck joints, which in turn causes the surrounding muscles to get tight and stiff. With every inch the neck moves forward more weight and stress is being placed on the neck vertebra. Like holding a bowling ball close to the body and then further away, the work load increases even though the weight doesn’t. We are now effectively asking the formula 1 car to go off road, not a good idea.

Over the past few years a lot of money and research has gone into ergonomics, how we should be sitting, moving and lifting. No doubt driven by fear of future litigation when it becomes apartment that the deterioration of a generation’s health may be driven by the sedentary work postures we adopt. We now know how to set up our desk station and car seat to maintain good healthy posture. But is it possible to have good posture when looking at our phone?

There are two ways to tackle this problem. Firstly look at how we use our phones and secondly how much we use our phones.

Often we hold our phone below eye level causing the head to tilt forward, past the neutral position, the danger zone. Ideally we would keep the head in neutral whilst looking at our phone but this would result in people walking around with their phone out at eye level and I don’t see that catching on very soon. The potential for technology in eye wear is a real solution to this problem but until then we need to look at the amount of time we are on the phone. Looking down for short periods of time is very safe for the neck, in fact that’s what the neck is designed to do but prolonged (over 10 minutes) bending of the neck (looking down) is what causes the muscles and joints to over stretch. Limiting use to short bursts is ideal. If you love to catch up on social media at night then try lying on your back when looking at the phone. The solution however may be as simple of not using your phone as much as we are. Not a popular option but often the simplest solution is the best one.

In the meantime here are some great stretches to help alleviate the tightness that comes from txt neck.
Stretches to help with the problem:

Rolled up towel:

Lying on the floor and placing a tightly rolled up towel under the neck for 2 minutes can help undo much of the stress from a forward head position. Great to do before bed.

rolled towel under neck

 

Movement:

Introduce movement every 20 minutes. This can be as simple as rolling your shoulders, going for a 30 second walk, standing or stretching.

Rules:

Have rules about phone use. Commuting to work – then listen to a pod cast and put your phone away. Try and refrain from looking at your phone whilst walking along the street.

phone rules

And most importantly seek professional advice from a Chiropractor, Physiotherapist or Osteopath if you are experiencing neck pain and headaches. Don’t reach for the pain killer, you’ll only delaying the inevitable.

hp-chiropractic

 

If you enjoyed this article please check out our archive for more like it. If you’d like more info please contact us via email at chiroexercises@gmail.com.au

You are only as young as your spine.

floss

Without fail twice a day ,like most people, I spend 2 minutes brushing my teeth, it’s a social norm. It’s hygienic, stops bad breath and prevents our teeth decaying. We value our teeth so much that we will also go for a check-up with our dentist a couple of times a year just in case there is decay or damage we can’t see. And quite rightly so.

But what are we doing to prevent the same decay happening to our spine. After all the teeth and spine are both made of the same material, bone. If you compare the role of both it soon becomes apparent that our spine plays a much more important role in our survival than our teeth. If you had to live without one you wouldn’t get very far without your spine.

Functions of the spine

  • Houses and protects the spinal cord. Communicating signals from the brain to the rest of the body, without which we wouldn’t be able to function.
  • Maintains our frame: This gives us strength, mobility and durability.
  • It is an attachment point for our muscles and ribs.

So the problem arises from the lack of feedback regarding the health of our spine. Unlike our teeth, we cannot see the daily health of our spine. In fact, the scary truth is that the spine can slowly degenerate over many years with no signs or symptoms at all.

 
“But I don’t do anything strenuous enough to cause decay to my spine”.

Unfortunately this is a common misconception, the truth is the less activity you do the quicker your spine is affected by osteoarthritis (degeneration); a moving door hinge will rarely rust. Sitting at work is enough to speed up degeneration in the spine. I have seen numerous people in their mid-20’s and 30’s who present to me with mild to moderate back pain that they attribute to posture and sitting at work. When we look at their spine on X-ray I am shocked at the rate of degeneration. Their spine is that of a 50-60 year old, all because they weren’t looking after themselves. Osteoarthritis of the spine cannot be reversed. Treatment and maintenance can help prevent progression of the degeneration but once you’ve got it, you’re stuck with it.

Rarely though, I am pleasantly surprised and see elderly people who have looked after their spine and have little degeneration and great movement, they are also healthy and happy. So what’s their secret? Consciously or sub consciously they all follow these four key principles

  1. Move often and move safely. Sitting for longer than 20 minutes causes undue stress on the spine. Get up and move as much as you can. Take part in regular exercise; this can be walking, yoga, pilates or going to the gym but move frequently!
  2. Don’t ignore your core. Your core brings strength to your spine. You need it like you need the tyres on your car.
  3. Eat well. A balanced healthy diet is needed for the health of all the cells in the body, including the bone cells. Smoking, excessive drinking and sugary foods deteriorate the health of bone making it easier for them to degenerate irreversibly.
  4. Get a regular check up with a chiropractor. Chiropractors specialise in the function of the spine and nervous system. This is our bread and butter, like a dentist is with teeth. Get a check-up regularly throughout the year to keep you at your best

Doing all the above regularly can make the difference between keeping mobile and having great quality of life into your later years versus being immobile, in pain and house bound. As a dentist once said “you only need to floss the teeth you wish to keep”, so go and floss your spine daily by doing these 4 healthy habits.

 

Written by Dr Callum Forrest MChiro, DC

For more information on how to keep your spine healthy or for the details of a great Chiropractor near you email us at: chiroexercises@gmail.com

The Pain Game

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(c) Can Stock Photo Inc. / kikkerdirk

We’re led to believe that experiencing pain is a dangerous phenomenon and should be suppressed by any number of medication currently on the market. If you’ve got a headache take a headache pill, joint ache take a pill or rub pain relieving cream into the area etc.

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But what is the pain trying to tell us?
Pain is the way the body can communicate injury, infection and dysfunction to the conscious part of the brain. Is this something you really want to ignore? Unfortunately turning down the pain doesn’t address its cause but purely the symptoms. Its like disabling the fuel warning light in your car. It doesn’t address the fact you’re nearly out of petrol.

It’s therefore fair to say that PAIN IS NOT THE PROBLEM. It’s just an alert telling us there’s more going on.

But how accurate is pain as an indicator?
Although essential for our survival pain isn’t particularly good at telling us what the problem is, in fact at times it can be quite misleading. For example we have a huge amount of pain receptors in our mouth and lips. Biting your tongue can be extremely painful for a reasonably small amount of damage done while other people experience minimal pain after rolling their ankle which can cause significant damage to the ligaments.
With spinal dysfunction pain can also be quite misleading. Our spines are an incredibly strong, flexible structure which is comprised of a number of extremely versatile tissues. It is very difficult to damage a healthy functioning spine. Pain arising from the spine is often the last part of a bigger picture of dysfunction to arrive. Postural issues, prolonged sitting, incorrect lifting, previous injury etc can grumble in the background slowly disrupting these strong tissues causing us minimal to no pain. In fact slight stiffness might be our only conscious indicator. And then one morning we bend to put our shoes on, pick something up, twist awkwardly and ouch PAIN! When asked what caused the pain we attribute the putting on of our shoes when in fact it’s been building momentum over a long period, like a car rolling down a hill with no brakes. The putting on of the shoes was the final straw.

What separates chiropractic from other health modalities is we address the underlying cause of your problem and although we are compassionate about the pain you’re experiencing we know there’s more going on. In fact getting rid of your pain can often be the easy part, correcting its cause is where we stand head and shoulders above other practitioners.

hp-chiropractic

As mentioned earlier pain is the last thing to show itself with musculoskeletal conditions and is the first to go. Unfortunately that doesn’t mean the problem has gone and unless the underlying dysfunction is addressed a relapsing cycle of painful spells is likely to occur with no real progress being reached. You’ll be treading water. That’s not how we, as Chiropractors, work.

The Pain Game is a multi billion dollar industry.  Why? Because pain will always comes back if you don’t address its cause and masking pain may lead to further injury and the cycle starts all over again.

What’s your strategy to tackle pain? But more importantly what’s your strategy to address the cause?

Early morning exercises: The hidden danger to your back.

early morning run

Its important to say at the beginning of this article that the people who get up early before work or on their day off to exercise should be commended and this article is not meant to discourage. My aim is that it highlights a couple of easy to do actions which could prevent low back and disc injuries creeping in.

To fully understand the concerns with early morning exercise we need to review the anatomy and physiology of the spinal discs in the low back. The discs primary role is to aid the spine in distributing weight and force evenly through the body. It was often thought that their main role was shock absorption but this has since been dis-proven and they are now more accurately described as force distributors.

The discs are made of two types of tissue. A toughened rope like outer structure called the Annulus fibrosis and a softer toothpaste like inner structure called the Nucleus pulposus (see picture below). Over time poor posture, prolonged sitting and repetitive movements can cause small tears in the outer tougher Annulus. With repeated tears over time the inner Nucleus will migrate to the outside of the disc. It is at this point symptoms are felt as the disc presses on surrounding sensitive tissue and nerves.

05-6_Lumbar_disk

The discs absorb its nutrients and water when we are sleeping and non weight bearing. These nutrients are vital for the health and strength of the disc. Like a sponge filling with water the discs become saturated. On waking first thing in the morning the discs are at their fattest. We are actually slightly taller first thing in the morning compared to last thing at night. This though can be an issue when wanting to do strenuous exercise. When the discs are fully saturated more pressure and stress is exerted on the Annulus during compressive loading. This means that excessive stresses and strains through the disc could cause tearing of the outer fibres and/or bulging. Exercises like running, squats, dead lifts, lunges and jumping place large compressive loads on the spine and discs and therefore could cause problems. Morning sit ups are definitely not sensible, no matter what the Rocky training montages may suggest.

So should I completely avoid doing these exercises during my morning routine?

Definitely not. It is important though you take the time to prepare your body for the demands of these exercise. Spending the first 30-40 minutes of the morning weight bearing (standing and walking) allows the discs to adapt to the pressures and loads not experienced during sleep. This will actually remove some of the water from the disc but in doing so allowing it to be more strong and stable. Discs can also be put under huge stress from sitting so people who have a long commute to work or those to tend to sit down early on should take note. I advise my clients to have their breakfast standing if possible. This will help the disc adapt to the stress of weight bearing without stressing it enough to cause an annular tear. After weight bearing for the first 30-40 minutes a thorough warm up is needed. Don’t start with a weighted bar when doing squats or dead lifts. Use body weight and dynamic movements which increase in range as the warm up set progresses ie. Cat Camel.  If running, spend the first part fast walking slowly building to your running pace over 5 minutes.

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Although swimming doesn’t put as much compression through the spine as the other exercises described I would still follow the advice just to be safe.

In conclusion early morning training is a great way to start the day and can give you an energy boost which is felt for the rest of the day but rolling out of bed chucking on the trainers and hitting the gym hard is not the way to do it. Give yourself time to adapt. Walk and move then spend time warming up with dynamic body weight exercises. It might meaning having to get up a little bit earlier but it could mean the difference between staying fit and healthy and having a disc injury resulting in time off work and exercise.

Stressful Breathing

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Humans incredible ability both chemically and physically to react to external stressors has enabled us to develop into the most dominant species on the planet. The intricate cascade of chemical reactions that occurs every second of every day allows us to move, communicate, learn, heal and live all the while keeping our bodies within its normal range via the mechanism of homoeostasis.

The bodies sensitivity and reaction to a perceived external stressor, whilst the driving force to our evolution, can have detrimental effects on our health.

Throughout humans evolution stress has always been something that would lead to a physical action. For example seeing a predator would cause us to run away (or run towards it). This system is called the Sympathetic Nervous System or the more commonly known as the ‘Fight or flight’ response. On seeing something dangerous our brain stimulates different parts of the body to release hormones to ready us for action. These hormones increase our heart rate, divert blood away from digestive organs to the muscles where it will be needed and readies us for action. The main player in this system is the chemical cortisol. The big daddy of stress hormones. And the system has worked beautifully for hundreds of thousands of years.

There is a problem however. The brain is unable to differentiate between a real perceived physical stress or danger ie: Big lion just walked into the room, and non physical stress ie: Printer has jammed for the third time today and you need to print a very important document for your boss, oh and its 5pm on a Friday! Either way the same chemical cascade occurs.

The cascade of chemical reactions, if repeated numerous times a day, can lead to health problems. It is known to increase heart rate, blood pressure, decrease the immune response, cause nausea and  headaches. It can reduce our bodies ability to digest food and absorb its nutrients. This can lead to diarrhoea, bloating, flatulence and indigestion. It also has huge effects on our mood leading to irritability, short temper, agitation, inability to relax, feeling overwhelmed and depression. From a musculoskeletal view point it tightens muscles, particularly our fight muscles (Upper Traps, Scalenes and Rhomboids) and flight muscles (Gluteals, low back extensors and hip flexors) which has an affect on the function of our frame.

Stress also has an effect on our breathing cycle. Normally the main respiratory muscle, the diaphragm, contracts and relaxes drawing air into our lungs allowing them to fully expand. The abdomen should expand as air is taken in. Shallow breathing or ‘stress breathing’ is driven by the Intercostals and Scalene muscles not the diaphragm. It draws less air into the lungs with more upper chest and shoulder movement than abdominal expansion. The reduced oxygen intake can have an effect on our concentration, sleep quality leading to lethargy, headaches and a further increase in heart rate.

So how do we overcome the shallow breathing?

Firstly its important to address the stress in our lives. Unfortunately most of us are unable to quit work and live on a desert island free from stress and the worries of everyday living.

Wishful thinking

Wishful thinking

What we can do though is simple daily actions that reduce the Sympathetic response to everyday perceived stress. Coping mechanisms, mediation, breathing techniques and daily exercise are a few of the most popular. Acupuncture, mindfulness and visualisation techniques are also becoming more popular with large corporate industries offering many of these to their employees. A health happy employee after all is going to be more efficient in the long term.

A simple and effective technique which I use with many of my patients is diaphragmatic breathing. This not only reduces stress by taking our focus away from the daily grind but also re-trains the body how to breath effectively, efficiently and correctly.

Here’s how you do it:

  • Lying on your back in a quiet peaceful place. This can be in your bed or on the living room floor as long as it’s quiet.
  • Have a pillow behind your head and get comfortable.
  • Place your hands on your lower abdomen.
  • The diaphragm should contract downwards towards the belly button when breathing in, causing the abdomen to come out, NOT the chest up and out.
  • Focus on this movement of the diaphragm and abdomen by taking slow deep breaths in. Taking 5 seconds for the in- breath, 5 seconds out. Do this for 5 minutes

This can take time to get right but the action of focusing on the breathing cycle is enough to reduce the sympathetic response even if not done 100% correctly. Doing this every evening is a great way of de-stressing after a long day at work. It can also be done sitting. If work’s getting too much, turn off the monitor, close your eyes and focus on your breathing for a couple of minutes. It can be done on the bus or train so you feel relaxed before walking in the front door. I have had patients tell me how this has improved their relationship with their partner as they feel less stressed before getting home and less likely to argue over the small things.

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Stress breathing is linked with poor posture. A predominance to slouch when sitting makes it difficult for the diaphragm to fully expand and contract further encouraging the secondary respiratory muscles to be used. Learning how to set up the work station, car seat, and sitting posture at the dinner table is important. The core muscles, which support our spine and frame, tend to switch off after 20 minutes of sitting. This increases the likelihood of adopting poor sitting posture. Getting up and moving for 2 minutes can help re-activate the core and prevent poor posture creeping in.

But what is a chiropractor doing giving stress advice?

To provide the best possible care to a patient I feel I need to look beyond the presenting symptoms and to the underlying cause of the problem. Often that involves looking at posture, lifting technique and exercise routine but it should also include their nutrition and possible emotional drivers. Although my focus is predominately on the musculoskeletal issues at work it would be unethical of me to ignore these other factors as they play such a big part in the recovery process.

In summary stress is often an inevitable part of life whether you like it or not but our perception of stress and how it effects our health is completely up to us. It shouldn’t be viewed as a sign of weakness but embraced as the incredible evolutionary response that has kept the human race the most dominant species on the planet.

Thoracic Dysfunction – My clinical observations

evolution-man-computer

Whether the presenting complaint or a cog in the chain of dysfunction I have found a restricted hyperkyphotic thoracic spine a recurrent finding in patients of all ages. Seemingly caused by the repetitive demands of daily life i.e. sitting, driving, and poor posture, this is one of the most important areas to address with patients. This article will go into detail why I think this is the case and how I go about treating it.

The knock on effects of a restricted hyperkyphotic thoracic spine are numerous. Lets go through a few of them:

  • Increased degenerative changes to the thoracic, lumbar and cervical spine. The curves of the spine work as the body’s suspension system. Beautifully distributing load,weight and forces through the frame into the ground without over-loading one area. The thoracic spine is the middle link in this suspension chain. An increase kyphosis and reduced flexibility of the thoracic means that this load cannot be distributed evenly instead being focused on key linkages of the spine, namely: C/T junction, mid-lower thoracic spine and lower lumbar spine.

  • Altered respiratory function: Reduced thoracic mobility will in turn reduce rib motion and lung capacity. The accessory respiratory muscles become over activated (Sternocleidomastoid, Scalenes group and Pectoralis minor) and the primary respiratory muscle (diaphragm, intercostalis, upper abdominals) become tight. This is a hot topic for research with some links between chronic disease and increased kyphosis being found.

  • Reduced scapular and shoulder function. An increased kyphosis is often accompanied by tight anterior neck and chest muscles. The shoulders becomes drawn forward placing the scapulars in a chronically protracted position. The scapular stabilisers become weak and under-activated whilst the upper traps become over-activated. This position of the scapular shortens the rotator cuffs leading to trigger points, shoulder pain and possible knock on effects of sub acromial bursitis and rotator cuff tendinopathy.

  • Forward head position: The anterior position which the head tends to adopt with this presentation can often lead to headaches, reduced concentration, migraines and neck pain. This in itself can lead to reduced sleep quality and fatigue.

So the chronic effects of a forward drawn / slumped posture are much more than just low back or shoulder pain. Worryingly this is becoming more common in children who are picking up bad postural habits from sitting at school and having to carry a heavy backpack. Highlighting the importance of correct posture to kids and showing them how to effectively pack their back packs to reduce strain on the spine is tremendously important in the prevention of long term dysfunction.

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I like to use the following analogy to describe the issue with my patients.

The spine is influenced by muscles at the front and back to keep us upright. Like the guide wires of a tent these need to be pulling evenly for a balanced, stable platform. Prolonged sitting, slouching, working with laptops, carrying bags etc cause the front muscles to become tight, pulling the mid back and shoulders forward. This is the same as tightening the guide wires on one side of the tent only. As you can imagine this causes the spine to be unbalanced. The body tries its best to correct this by recruiting other muscles but adopting the troublesome postures everyday means it is in vein. Chiropractic can help re-establish the normal balance and movement to the spine and muscles. When you’re moving better and more balanced we will then look to strengthen the muscles which have become weak to get you more stable.

This can be elaborated or stripped back to suit the needs of your patient.

How do I tackle this postural epidemic.

Firstly its important to mention that this pattern of symptoms is not caused by the dysfunction of the thoracic spine alone. As I mentioned in my earlier article :Tight Hip Flexors: A Catalyst For Dysfunction, prolonged sitting causes shortening of the hip flexors which has numerous knock on effects. I have found that addressing this dysfunction in conjunction with the thoracic spine has great outcomes.

When treating patients with this presentation I focus on a few key areas.

  • Correct spinal restrictions / dysfunction with adjustments.

  • Release anterior tight muscles (Psoas, Pecs, abdominals, Scalenes, SCM) with soft tissue techniques (Active release, PIR, massage, Dry needling, Graston technique – all work well)

  • Home exercise prescription: Hip flexor stretching, pectoral stretching- 3 x 30 second holds twice every day. Foam roller thoracic extension stretches. Ergonomic advice

Once the patient is moving better I start to incorporate strength and stability work.

  • Dead bug exercises,

  • ‘Y’ exercises for scapular stability,

  • gluteal activation exercises (see What is Hamstring Dominance?)

  • Bruggers relief position whilst at work – every hour for the first week. Progression to Bruggers relief with theraband.

  • All the while continuing with the home stretching

Of course every patient is different with their presentation. The stresses and strains they put on their bodies will be unique to them and their bio-mechanics. The above treatment techniques are a rough guide to what I have found useful. However assessing the bio-mechanics of a patients feet, pelvis, looking at their pillow, exercise routine and stress levels are also useful to rule out other possible contributing factors.

Education is also a key step in the long term health of any patient. A real understanding of the importance of good posture, keeping mobile and functional is just as important as any home advice. Arming the patient with knowledge and tools so they can go onto educate their family, friends and colleagues is a duty of care we should all be implementing.

Encouraging Yoga, Pilates and exercises classes are a great way for patients to stay mobile in a fun structured way. Encouraging mobility exercises as part of their already existing exercise routine is a great way for patients to stay compliant. Patients who have to make changes in their routine to accommodate their exercises tend to give them up.

In summary the numerous knock on effects of a dysfunctional thoracic spine means that its correct identification, treatment and rehabilitation is crucial for the health of our patients. This includes looking beyond the thoracic spine as the sole area of dysfunction. Giving our patients the tools and education on how to prevent recurrences empowers them to take control of their own health and function.

The perfect core exercise

I often get asked “what’s the best exercise for the core?”. Many people have their own opinion on this. Simply typing “Best Core exercise” into Google results in hundreds of variations of exercises which all claim to be the best.

To understand which exercises are better for building core strength and endurance we must first understand what the core is comprised of and it’s role.

What is the core and what’s it’s role?

The core is a name for the group of muscles encasing the torso which assist in the maintenance of good posture, balance and stability of the spine and frame, especially during movement. It is also key in the safe distribution of forces through the spine, preventing one area becoming overloaded and injured.

Often thought of as just the abdominal muscles its clear from this definition that the core is made up of many muscles which work together to bring about stability. These include gluteals, hip flexors, abdominals, obliques, erector spinae’s to name just a few.

Core muscles

Core muscles

The demands placed on these muscles will vary depending on the movement and activity undertaken. The core must therefore be able to cope with a large range of movement patterns. Finding a single exercise which is able to do this is almost impossible. So the real answer to the question ‘What’s the Best Core Exercise?’ – There isn’t one. Some exercises are better than others at challenging the core muscles in different planes and movements but a strong functional core will need to be trained using many different exercises.

Many gym goers are guilty of spending 5 minutes on their “core” at the end of a session only to do sit ups and the plank. Never straying from these two household favourites. This begs the questions:  are these functional? Do they provide the balance and stability the spine and frame requires? Almost definitely no. A core routine should involve movement based exercises demanding strict form and should never be rushed.

Below are three of my personal favourites which I find are under utilised.

Dead Bug:

This exercise is great. It challenges the low back stabilisers, abdominals and scapular stabilisers . It can be progressed or regressed to suit the needs of anyone and everyone.

Dead Bug

Dead Bug

Dead bug progression

Dead bug progression

Single Legged kettle bell Dead lift:

Balancing on one leg stresses the stabilisers and can highlight any discrepancies when comparing left and right sides. It challenges the core in a different way to floor based exercises. Again this exercise can be progressed to suit all levels.

Single legged Kettle bell deadlift

Single legged Kettle bell deadlift

Cable machine wood chops:

The variability of the weight and angle of the chop means this exercise is great for challenging many of the core muscles in differing planes.

Cable machine wood-chop

Cable machine wood-chop

Its also important to point out that the core is never trained in isolation. Going to the gym and strengthening legs, chest and arms, if done correctly, will use the core. Running on the treadmill requires the core to maintain upright posture and form. Swimming lengths of the pool requires the core muscles to keep your torso rigid whilst the legs and arms remain mobile. Everything we do involves the core. Being strict on form and posture during all exercises is a great way to work out your core. Once a core exercise has been mastered add weights to increase the work load.

In Summary a good core should be able to cope with the demands of many movements. Training should therefore reflect this with exercises that challenge the core muscles thought differing movement patterns, which can be progressed.

There is no such thing as the ‘single best core exercise’. Its a myth invented by the quick fixers of physical training. Incorporating core exercises throughout a workout as well as being strict on form and posture during training will give a good base to work from.

What is Hamstring Dominance?

In my previous article I discussed the role of the hip flexors in musculoskeletal dysfunction. The knock on effect of chronically tight hip flexors are numerous but two very important ones, which I only touched on last time, are weak under activated gluteal muscles and hamstrings that become dominant in hip extension.

oi_gluteusPosterior-Oblique-Subsystem

The Gluteus Maximus is the main hip extensor in the body. Attaching from the  ilium, sacrum and coccyx  it inserts into the outer aspect of the hip. It’s needed in nearly all movements. The gluteals also bring about stability of the Sacro-iliac joint via its influence on the thoracolumbar fascia and the posterior fascial slings.

Although the hamstrings also influence the hip into extension the Gluteus Maximus is the main player in this movement.

Hamstring dominance is when the Gluteus Maximus doesn’t initiate hip extension, instead leaving the work to the hamstring muscle.

But why does this happen?

The mechanism behind this is called reciprocal inhibition, where a tight / over activated muscle inhibits its antagonist. In this case the over activated and tight Hip flexor inhibits the activation of its counter part, the Gluteus Maximus. In doing so the hip extension movement pattern, over time, has become initiated by the hamstring instead of the Gluteus Maximus.

Not only can this lead to an overuse strain of the hamstrings but due to the Gluteus Maximus’ key role in spinal stability it increases the chance of injury to the lumbar spine and sacrum.

Hamstring dominance can be tested for with the patient prone and asking them to actively extend the leg. Not always easy to see with the naked eye, feeling the hamstrings and Gluteus Maximus muscles during the active hip extension can be quite revealing. The Gluteus Maximus should be the first to contract followed by the hamstrings but with hamstring dominance its the other way around.

How do we get the Glutes firing again:

Gluteal activation exercises are well documented but often under utilised. To become hamstring dominant the neuromuscular pathway needed for hip extension has been re-learnt using the wrong muscle group. So to re-establish the correct movement pattern this neuromuscular link is best established through repetition. Addressing the tight hip flexors with stretching is important but strengthening of the Glutes will also be needed. As mentioned in the last article the main four I encourage patients to focus on are

1.Gluteal Bridge.

glute bridge

2.Quadruped Hip extensions

quadruped leg ext

3. Single Legged Bridges

Single legged glute bridge

4.Standing functional reaches

Standing Functional Reach

Performing these regularly in isolation will encourage the Gluteus Maximus to take back its role as the primary hip extensor. Performing these as part of a warm up before weight lifting, running or sporting activities is a great way to re-establish the neural pathways that have been lost over the months or years of deactivation.

This doesn’t sound like chiropractic?

Some may think that the topics I write about aren’t chiropractic but I certainly don’t agree with that. As a chiropractor I am concerned with the function of the neuro-musculoskeletal system which includes the relationships between the nervous system, muscles and joints. Having an understanding of the chronic repetitive nature of many of the  presenting complaints allows the cause of the problem to be addressed rather than purely the symptoms. And if this understanding means using research and techniques devised by physiotherapists, osteopaths and chiropractors then that’s what I’ll do.

You can find a handout on these glute activation exercises in the ‘Material for patients’ tab at the top of the page.