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

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.

402d1_ab4d4a74292cf43c_cat-cow.xxxlarge

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.

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.


Tight Hip Flexors: A catalyst for dysfunction

As a Chiropractor I see clients present every week with a similar pattern of musculoskeletal dysfunction. Often masked by differing presenting symptoms the same underlying bio-mechanical cause can be identified more often than not.

The spine, hips, knees, pelvis and sacrum are all strongly influenced by one of the biggest groups of muscles in the body. This group consists of the Psoas, Iliacus, Rectus Femoris and Sartorius muscles and is commonly termed the Hip Flexor complex. Responsible for bringing the knee towards the torso, these groups of muscles are very important in walking, running, squatting, lunging, balance and spinal stability. Often thought of as a secondary cause of dysfunction the hip flexor complex plays a more prominent role than it’s often given credit.

Hip-Flexors-200x200

The problem starts when the hip flexor becomes chronically tight. This doesn’t happen overnight thankfully but after prolonged hip flexion repeated daily. Most commonly this is from sitting. A large percentage of the population spend a significant part of their day sitting, whether it be in the car, at work or relaxing at home. Sleeping in the foetal position also promotes prolonged hip flexion

Over the past decade the detrimental effects of sitting have been a hot topic of research. In 2013 Dr. Camelia Davtyan, clinical professor of medicine and director of women’s health at the UCLA Comprehensive Health Program dubbed ‘sitting as the new smoking’ because of its effects on our overall health.

Focusing on its effects on the spine sitting causes the hip to be flexed, normally at 90 degrees, causing the hip flexors to become slack and bunched. Like brining two ends of a tightened rope closer together. Spending large amounts of time with the muscle in this position will cause it to adopt a chronically short and bunched (tight) position. The rope becomes shorter. This becomes a problem when we need to use the hip flexor through the hips full range of motion.

The Iliopsaos muscle, one of the big players in the hip flexor complex, attaches from the lesser trochanter of the hip to every segment of the lumbar spine. A hip flexor which is shortened will become taught during standing placing stress on the spine. Walking and running will increases this stress further. The long-term effects of tight hip flexors are an anterior pelvic tilt, which is when the pelvis tilts forward due to the pulling from the tight muscles. Alteration of the pelvic biomechanics due to this tilting has a number of knock on effects:

  • The hamstrings become chronically pulled placing them at tension even at rest (increased risk of hamstring strains).
  • The Lumbar Lordosis (low back curve) is increased placing stress on the lumbar facet joints altering the load distribution of the lumbar spine.
  • Reciprocal inhibition of the Glutes. The tightening of the hip flexors reduces the activation of the muscles primarily responsible for hip extension (glutes). This causes them to become weak. It also alters the firing patterns of the posterior muscles of the hip. The hamstrings often become the dominant hip extensor instead of the glutes. I will discuss this hamstring dominance in more detail in my next article.

This is often when people present to their chiropractor with back pain, flank pain and/ or hip pain. Sometimes it can present as recurring hamstring strains, more commonly seen in soccer players.

 ant pelvic tilt                                   

So its clear to see how the chronic shortening of the hip flexor can lead to a cascade of musculoskeletal issues which if treated in isolation may bring about temporary relief but do not address the underlying cause of the problem.

So how to we over come this?

Whether symptomatic or not people who spend a lot of time sitting should be doing the following regularly to prevent long term issues creeping in.

Stand and move often: Break the monotony of sitting and its damaging effects. If possible use a standing desk. If not then set a reminder on your phone or computer to get up and move every 20 minutes. This has been shown to help reduce the effects of prolonged sitting on the muscles, ligaments and spinal discs and well as giving the hip flexors a chance to lengthen.

20-minutes

Stretching or yoga regularly. Unfortunately stretching for 10 minutes once a week is not best. Spending small amounts of time every day stretching the hip flexors will have a greater influence in restoring a good functional length. After all we do the things that cause them to tighten every day without fail.

hip-stretch-main

 Gluteal activation and strengthening. Keeping the Glutes activated and strong is very important for the stability of the pelvis and low back. Glute bridges, Quadruped Hip Extension, Single legged Glute Bridges and Clam shells are all great at activating and strengthening the Glutes

glute bridge

                                                                      Glute Bridge

quadruped leg ext  Quadruped Single Leg Extension

single legged glute bridge Single Legged Glute Bridge

Core stability. The core is a general term given to a large group of muscles that work together to bring stability to the spine and pelvis. Core stability exercises re-establish the correct firing pattern of these muscles that is often altered with the biomechanical effects of tight hip flexors. The dead bug is a great exercise which can be stripped down or built up to meet the conditioning level of your patients.

dead-bug

 Dead Bug

See your Chiropractor: As I mentioned at the beginning of this article the hip flexors are involved a lot of the time but not all the time. All of the above tips are great but if you have to sit everyday for long periods of time there is no substitute to seeing your chiropractor regularly for an adjustment.

Exercise Compliance

For the health professionals reading this who regularly give their patients homework (exercises, stretches or nutritional advice) I’m sure you can agree there is nothing more frustrating than the patient reporting they feel no better at their next visit then only to confess that they haven’t done what you’ve asked them to do.

There are always a number of different reasons for this but have you ever thought about how you present the information and tasks to your patients in the first place?

If you present the information to patients in one format only then there is no wonder why their compliance is poor.

As humans we learn using three main techniques. Auditory, Visual and Kinesthetic. Everyone will favor one of these three techniques when learning whether they know about it or not. A quick summary of the three learning techniques:

Auditory Leaners:

  • Learn by reading out loud and repetition
  • Listen to material. Prefer audio books

 Visual Learners:

  • Likes to be shown tasks.
  • Prefer diagrams, pictures, charts, videos and demonstrations.
  • Like to write out notes and instructions

 Kinesthetic / Tactile:

  • Learn by doing
  • Hands on approach.
  • Likes to show actions for understanding

Prescribing a simple stretch exercise can therefore be done in three very different ways.

  1. Auditory leaners: Tell them the steps/ instructions and ask them to repeat them to you to check for understand.
  2. Visual learners: Need a diagram of the stretch, possibly a video and a demonstration from you.
  3. Kinesthetic learners: Need to do the stretch in your office in front of you to check for understanding.

Presenting all your information in these three ways should be a priority. After all the more the patient follows your home advice, the quicker they will feel better, the higher in their estimation you are and the more likely they are to refer friends and family in to see you.

But how do you know what type of learner your patient is?

The best way to do this is to ask the patient. Many people know which way they prefer their information to be presented. If they are unsure give them the options of how you have the information to hand. And if they’re still unsure make sure you give the homework to the patient using all three techniques. Demonstrate, ask them to repeat the instructions, get them to do the exercise in the office and give them a diagram of the exercise to take home.