Part three
Tag Archives: exercise
Lower back with sitting to standing?
Lower back with sitting to standing? Try this exercise. It’s both a posture and strengthening exercise. This is part one of two-part videos series.
Washing the Hair part 2 to help your neck pain
Here’s the second part of Washing the hair exercise. Use a rubber band to strength the neck, while learning proper shoulder position.
Clam Variation
The Clam exercise in a great exercise to help with strengthening the hip and lower back. Hip and Back pain can be helped with the Clam exercise.
The exercise above is a nice variation to focus on the buttock more. By placing the foot in front of the other foot will internally rotate the hip and turning off the front muscle making the back muscle (Glute Medius) the primary muscle doing the movement.
For more exercises go to my YouTube channel. Sikorsky Chiropractic & Fitness – YouTube or to my website Your Trusted Chiropractor Elgin Illinois | Sikorsky Chiropractic (drstevesikorsky.com)
Stand Up
Companies adopting the “standing at your desk” culture want to create an active workspace which is more collaborative and productive. This type of work environment is very attractive to a new generation who actively hedge against the burdens of disease later on in life.
To clarify, there is a difference between voluntary standing at your desk culture and occupational standing jobs. The former is clearly voluntary, and the employee can sit down when stressed. The latter makes it mandatory to stand at your desk for the duration of your work.
A study by the American Journal of Epidemiology found that workers who stand for long periods of time were at a higher risk of heart disease compared to their seated counterparts.
This means that even standing should be done in moderation at work.
For you to benefit from the “standing at your desk” culture, avoid common mistakes like pushing yourself to stand for long. You don’t have to stand all day to stay healthy. Start with 15 to 20 minutes a day and build up to two hours a day then four hours. They are called sit/stand desks for a reason, because you can adjust them to accommodate you when you are seated or standing.
To make it more bearable, you can play some music or interact more with your colleagues.
Also, makes sure the desk is the right height. If it’s too short you’ll ruin your posture but too high and you will feel it in your neck and arms. The correct position is having your elbow no more than 90 degrees and your eye line directly opposite your computer screen or just below.
On top of that, you want to pay attention to your posture to eliminate the chances of lower back pain. The right posture creates an S-curve to your spine. Using a standing mat gives you more comfort on the balls of your feet and reduces fatigue to the legs.
Experts recommend standing for 30 minutes per hour in order to get the type of health benefits you are looking for. This approach gives you half an hour of rest and half an hour standing to strike the best balance.
Some people believe that you don’t need a sit/stand desk to stand regularly. They believe that water and coffee breaks, bathroom breaks, and moving from one department to another to interact with a colleague provide plenty of standing opportunities to promote good health.
However, with the presence of phones and e-mails, we rarely have to get off our chairs at work to go and ask a colleague a question in person. Besides, how many bathroom breaks do you take? According to the Society for Human Resources Management, you can use the standing desk to promote an active workforce without relying on snacks and bathroom breaks to fill the gaps.
Finally, for the standing at your desk culture to succeed, there has to be a commitment to the initiative from the top down.
For example, it’ll be very difficult to encourage staff to stand at their desk or even use the trendy workstations with bicycles or treadmills attached when the managers never go near those things. After all, no one wants to seem like they are exercising when they should be working.
When an office decides to go down the path of an active working environment, everyone should be involved. Remember: standing desks are a powerful investment in employee wellness and health.
- Body is designed to sit and stand throughout the day. There are many ways to get your standing throughout the day without the need for a sit-to-stand option.
- Sit-to-stand options can be useful and make the ability to stand more readily available. If you do have this options, here is what you need to look out to ensure proper utilization.
- Most start at 15-20 mins within the hour in the beginning then it grows.
- 4-6 hours per day after 30 days.
- Start off slowly- taking breaks.
- Listen to your body.
- The flat surface and flat shoes (no heels!)
- Weight distribution right below hips and arms at a right angle looking straight ahead and slightly down.
- Don’t do continuous 8 hours of standing.
An Example of Gait Changes After Treatment
I recently posted a research journal that stated that after an injury patient’s gait might need to be retrained. Here is an example of a patient with a dysfunctional gait:
Take a look at this patient’s gait. Watch her left leg and then watch the right leg. The left knee tracks outward. Look at the patient’s knee. It points outward right instead of pointing forward. Look at the patient’s foot. This patient is towing off laterally and not getting into her big toe.
The second video is after treatment of adjustment to her foot, ankle and lower back, plus a week of home exercises along with some mental corrections. Patient was cued on the changes in her gait and how to improve the lower extremity function. We practiced in the office and the patient was sent home with some homework.
This is an example of how gait retraining can help improve a patient’s function. Strengthening the body is very important but strengthening dysfunctional movements will not progress the patient towards optimal.
Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19
| Another study showing that obese patients who got COVID-19 had a worse outcome . COVID-19 has brought to light that the more unhealthy you are the, the worse the outcome will be for you. Now is the time to get healthy. Start exercising! No matter what you do, it’s better than nothing. Make small changes to our diet and finally start to sleep more. These simple things can help change your life and put you on the road to health. It might not stop you from getting COVID-19 but you’ll be better able to fight off the infection. |
American Heart Association analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association’s COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group. They found:
| “Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years).” say the study authors. “Obese patients are also at higher risk for venous thromboembolism and dialysis.” |
If you need any help with your quest for health, call the office to make an appointment and together we can make a plan to improve your health. Now is the time to start so what’s holding you back? Pain? I can help with that as well!
What is Lower Crossed Syndrome?
Lower crossed syndrome is something I see -or a version of it- in almost every lower back patient I treat.
If one muscle is weak another muscle has to do more and becomes over worked. In turn becoming tight and painful.
I’ve heard this about 1,000 times- “I keep stretching muscle ‘x’ but it’s always tight.” Maybe it’s not a stretching problem. It could be a strengthening problem. By strengthening the weak muscles you will help “turn off the overactive muscles”.
I have not had a patient with chronic pain that had strong abdominal muscles. It’s a very common problem.
When the abdominal muscles are inactive and not supporting the spine, while the spinal erectors are pulling the lumbar spine forward, it results in something called hyperlordosis.
This means that the spine in the lower back has an exaggerated curve, which can result in accelerated degeneration of the joints of the spine.
At the same time, the hip flexors are facilitated and are chronically tight while the gluteus muscles are inhibited and have reduced activation.
This leaves the back muscles to do most of the work to extend the spine instead of the gluteus muscles keeping the pelvis level. The muscle of the back are good a stabilization and less effective as a prime mover.
The overuse causes painful and tight muscles.
Treating a patient who has a lower cross syndrome, is three parts:
1) Chiropractic adjustments help improve spinal biomechanics
2)Then education on the correct exercise to strengthen weak muscle and stretches to the tight muscle.
3) Poor movement patterns will be addressed. Improving how a patient moves will help prevent injuries in the future.
If you think you’re suffering from lower crossed syndrome call the office today! We will get you on the road to recovery.
Chiropractic Care Lowers Opioid Use
Chiropractic is the best choice for drug free health care. The United States opioid epidemic is well documented. (1) Seeing a chiropractor is a great way to treat pain without pain medicine. Chiropractic care with a good home exercise program is a great way to treat most conditions. Throw in some movement correction and ergonomics now we’re talking about great care.
“Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription.” Pain Medicine (2)
“Offering (chiropractic) services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.” Journal of Primary Care & Community Health (3)
“Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription” Archives of Physical Medicine and Rehabilitation (4)
Here at Sikorsky Chiropractic we use adjustments, exercises, ergonomics, movement corrections to help patients become pain free.
Chiropractic first, medicine second , surgery last resort. We are always putting the patient first.
- The United States opioid epidemic – PubMed (nih.gov)
- Whedon JM, Toler AW, Kazal LA, Bezdjian S, Goehl JM, Greenstein J. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. Pain Medicine. 2020 Mar 6. Link
- Prater C, Tepe M, Battaglia P. Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain. J Prim Care Community Health. 2020;11:2150132720953680. doi:10.1177/2150132720953680 Link
- Louis CJ, Herrera CN, Garrity BM, McDonough CM, Cabral H, Saper RB, Kazis LE. The association of initial provider type on opioid fills for individuals with neck pain. Archives of Physical Medicine and Rehabilitation. 2020 May 11. Link
McKenzie Exercises and Lower Back Pain
The visual that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back. Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode. Feelings of pain and helplessness are some of the reasons why low back pain is of the most common causes for patients to seek emergency care!1
In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months2,3! That’s pretty… painful to think about, actually.
On top of this, chronic low back pain is considered the second most common form of disability worldwide,3 and one of the most common causes for adults to see a family physician.4
In the past, patients were told to “take it easy” during a flare-up of low back pain. They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax spasming muscles and ease pain to more tolerable levels.
However, times have changed. Treatment guidelines instead recommend specific exercise4, gentle stretches, and other ways of staying active during the recovery process. Total bed rest is to be avoided.
In my practice everyone who come in with lower back pain get homework (exercises) to do. No mater how much pain they are in.
Why the change?
Part of the reasoning is anatomical. Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles5.
Superficial muscles are used to perform motions like bending and twisting. These muscles are strengthened by exercise that places stress on the muscles. Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.
Deep muscles, on the other hand, help stabilize the spine and maintain posture. Physical activity such as yoga, walking, and more, helps keep them in shape. Picture the jogger going for a mile or two before breakfast: they’re working on deep muscle strength.
A common scenario is bending over to pick something off the floor. You may hear a “pop” in your low back, followed by pain and muscle tightness. You’re bent over, unable to fully stand upright, and your world suddenly hurts no matter what you do. You go to bed – and stay there, unable to move because movement equals pain. You call out of work because you can’t get out of bed. You remain largely sedentary for a week, under the guise of “waiting it out.”
When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength. This is a process known as atrophy.6
As the pain subsides and the person feels some improvement, activity is slowly resumed. In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back. Although they can function in this capacity, superficial muscles are NOT well-adapted for this function! These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.
This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries.7,8
There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine. Doctors of chiropractic regularly prescribe exercise to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness.8
Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury.4 “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.
McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care.
In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely.
When you are experiencing a disc bulge or herniation, the disc material will often protrude posteriorly. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. Although in some severe cases surgery is necessary, the body has the ability resorb the disc naturally. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.
McKenzie extension exercises work because they force the spine to go into an extended position (when referencing the lumbar spine this means an “arched” back position.) This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This was visualized in the anatomical section of the course. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.
Before performing these exercises there are a few things you should pay attention to:
- While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.
- If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving. Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely
How do we perform these exercises?
You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.
If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises.
A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.
Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember – it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.
References
- Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.
- “Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
- Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530.
- Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.
- Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.
- Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.
- Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.
- “Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain.