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Chest or stomach breather? How an altered breathing pattern causes pain

Chest or stomach breather? How an altered breathing pattern causes pain

Belly breathing

The way you breathe impacts you from a muscle and joint perspective. Poor breathing mechanics can lead to neck pain, core stability issues, low back pain, and other issues. Who knew that a simple in-out process could be so complex?

Normal breathing, also known as lung ventilation, is an automatic and seemingly effortless action. Breathing involves inspiratory (breathing in) expansion and expiratory (breathing out) contraction of the rib cage. The act of normal breathing has a relatively constant rate and volume, or amount of air that enters the lungs.

However, breathing is a coordinated effort! The act of breathing requires our lungs to expand as well as a series of coordinated muscle efforts. Starting from the chest wall, the rib cage, movement of large and small muscles, nerve signaling, ligament stretch, and even the spine. Although we often think of our lungs as being within our chest, the top of our lungs extends quite high: almost to the very base of our neck and shoulders.

When breathing issues arise and the lungs aren’t the cause, other sources like the muscles and bones must be taken into consideration. In medical literature, the term “dysfunctional breathing” refers to a group of disorders: paradoxical breathing (upper chest breathing), erratic breathing, breath holding, and breathing too deeply or erratically (hyperventilation syndrome). For this article, we will focus on the first: paradoxical breathing. While these disorders can create significant oxygenation deprivation problems, the focus of this article will be on the biomechanical effects of poor breathing mechanics.

It is important to assess breathing mechanics to determine if someone is using the appropriate muscles to engage in this vital task. Breathing is a complex activity involving the rib cage, joints of the spine and ribs, ligaments, connective tissues, muscles, and the lungs. Breathing performance is drastically affected if one or more of these structures are injured, damaged, or otherwise unable to work properly. One such common condition is upper chest breathing.

What is chest breathing?

Paradoxical breathing, or chest breathing, is a sign that you aren’t breathing properly. Chest breathing refers to chest, midback, and lower neck muscles that become overworked due to poor biomechanics.

Normal breathing involves expansion and contraction of the rib cage with our breath. Breathing also uses the diaphragm, a dome-shaped muscle located at the base of our rib cage below the lungs and heart. The diaphragm is a major muscle mover that works with the lungs to inhale and exhale. During inhalation, the lungs expand, and the diaphragm pushes down to make room for the lungs to expand with air. This presses the rib cage outward. During exhalation, the diaphragm muscle moves up to its starting position, which helps move air out of your lungs and brings the ribs inward.

During paradoxical breathing, this action is reversed. During inhalation the lungs still expand but, the diaphragm contracts. During exhalation, the lungs relax, but the diaphragm expands.

As a result, the chest and lower neck muscles become overactivated. This targeted group of muscles work together to compensate for the diaphragm. They help inflate the lungs by pulling on the rib cage to expand the upper portion.

These extra, or accessory breathing muscles in the chest and lower neck still have their own responsibilities to perform as they help with our breathing activity. The result is tight, achy muscles that aren’t effective at either job. The upper back and thoracic spine may also become stiff due to poor muscle engagement from the diaphragm, resulting in muscle tightness. Sometimes, this can even extend into the low back!

By itself, chest breathing is not necessarily a bad or pathological condition. Certain scenarios are noted for chest breathing: some examples include a sudden sprint across a lawn or a pang of anxiety while taking a test. However, when chest breathing becomes our normal method of breathing, the result is the upper chest expanding and contracting with each breath while the abdominal area does not function properly. The diaphragm is not used well during chest breathing.

What can happen from chest breathing?

Chest-focused breaths tend to be short and quick. Chest breathing uses only a small portion of the lungs and delivers a relatively minimal amount of oxygen to the bloodstream. The result is poor oxygenation to the body’s soft tissues.

In addition, excessive chest breathing causes the muscles of the chest, neck, upper back, and lower back to work too much. This can lead to tightness and strain to these areas due to overuse. The muscles become tight and ropy to the bare eye.

Chest breathing is a form of diaphragmatic dysfunction that can have many causes including trauma to the chest wall, mineral deficiencies, weak respiration muscles, sleep apnea, and nerve injury.

Symptoms of chest breathing can include:

  • Frequently waking up at night
  • Shortness of breath
  • Excessive sleepiness that doesn’t respond to additional sleep
  • Diminished or poor exercise performance
  • Muscle soreness in the neck and chest
  • Abnormally fast breathing
  • Poor posture in the upper back
  • Rounded shoulder posture
  • Tight musculature along the front of the neck

Do I have chest breathing?

Maybe.  Here is a simple test and exercise you can do at home to improve your breathing.

Description: Breathing test to assess if patient is a stomach breather or chest breather.
How to perform:

  • Lay on a comfortable surface on your back with your knees bent.
  • Place one hand on your chest and the other hand on your stomach.
  • Take 5 normal deep breaths and take notice of your breathing.

Up to 80% of breathing should come from the belly rising and falling; 20% should come from the chest rising and falling.

Chest breathing is more dominant than belly breathing when the belly barely moves. Here, the upper chest expands more than the abdomen, and the shoulders elevate towards the ears during inspiration. Excessive chest breathing causes overuse of the neck musculature and can lead to pain syndromes in the neck, shoulders, and upper back.

Here is a video from our friends at ChiroUp you can reference for proper breathing patterns initiated at the abdomen:

Breathing Evaluation – YouTube

How can I learn more about changing my chest breathing?

There are a few quick exercises you can perform to help begin retraining your diaphragm and other breathing muscles to work effectively.  Here’s a common one:

Corrections for Chest Breather:

  • Place a light book over the stomach and focus on elevating and lowering it during inspiration and expiration.
  • Lay on back.
  • Push belly outward.
  • Pull belly button down towards floor.
  • Repeat ten repetitions for two sets.

If your chest breathing has occurred over time or because of trauma, nerve injury, or other causes, other interventions may be required.  It is not uncommon to manage this condition with targeted exercises, postural improvements, and even changes to your workplace setup to help proper muscle function.

How we address chest breathing

Our goal is to not only provide you with the correct diagnosis of your breathing pattern, but also determine the underlying root cause and create an individualized treatment plan specifically for you.  We have many tools in our toolbox to conduct an effective evaluation and create an appropriate treatment. 

Conservative care is a keystone for our Boca Raton Sports Chiropractic practice. We have many treatment options for you! A few ones include specific stretches for muscles and tendons of the affected muscle, joint mobilization of the thoracic spine near the ribs, tendon loading and specific exercises to strengthen the surrounding muscles, hands-on soft tissue work into muscles, changes in exercise routine or modifications at work or at home, home exercise and stretching programs, and more.

All of these depend on if your chest breathing is caused by poor biomechanics of the muscles and joints. If your chest breathing is caused by mineral deficiencies, we may need to co-manage your care with a primary physician or specialist to determine the best course of action to address the root cause. If there has been trauma to the chest wall, such as a motor vehicle accident, a full examination is imperative and may require imaging. The best way to determine your treatment approach is to make an appointment in our office for a full evaluation.

If you are dealing with poor exercise performance due to chest breathing, muscle tightness of the chest wall, upper back, or neck, excessive daytime sleepiness, or other symptoms of chest breathing, give us a call. We are happy to evaluate you and often can provide you with a same-day examination.

Call our Sikorsky Chiropractic Clinic at 847-695-0464 or schedule online!

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. 

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. 

Understanding lower back pain.

I treat a lot of lower backs. Many times the cause of the pain is from moving incorrectly. Bending or twisting wrong 10,000 time can lead to acute pain, much like a fall or car accident can.

Half of my job as a chiropractor is teaching patients how to move and use their body correctly again.

The following information is from a great book meant for the non-physician to help resolve their own back problems. The book is by Stuart McGill PhD and is called “Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you.”

Back Mechanic by Stuart McGill - A Comprehensive Review
The book cover., Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you.”

I highly recommend this book if you have suffered or are currently suffering from low back pain.  I have taken multiple classes from him.  A lot of what I teach patients comes from his research.  The end goal is to remove the stressors and spare your spine with proper movement and strengthening exercises.

“Many back pain sufferers would experience a huge breakthrough in their recovery if they only realized that is was their flawed movement patterns that kept them pain-sensitive. Much like a scab forming on our skin, our backs are constantly trying to patch and health themselves. We, however, by continuing to repeat harmful movement patterns in our daily lives cause re-injury. We are essentially “picking the scab.” It is unreasonable to expect the body to heal if we continue to provoke it in the same way that led to the original injury. Continued provocation of pain sensitizes the nerves so that the pain is triggered with even less stimulation. Remove the provocative motions and we can find the solution.

Here’s how pain sensitivity works: people increase their sensitivity through repeated stressful and painful loading. These muscles and joints are loaded with sensors: pain sensors, pressure sensors, force sensors, chemical sensors. Some detect carbon dioxide; some detect pain, some sense histamine for inflammation. Human joints are packed with sensors that relay position and movement information to the brain. These signals travel along the sensory nerves. Along the highway of nerves, there are checkpoints or “gates,” at junctions. According to the Gate Theory of Pain, the idea is, to flood the checkpoint with “good information,” in other words, signals associated with pain-free movement. In this way, there is no more room for the pain signals as they are crowded out.

The sensation of this simple pain-free motion dominates the information traffic on your sensory nerves with feel-good kinesthetic sensory information that identifies position, length, and force. Finding and repeating pain-free motions in your back will cause the remaining painful activities to hurt less. Read the previous sentence again – it really is that important.

By discovering and engraining positive movements for your back, you will find that the pain often dissipates and then disappears entirely. This is because when we remove pain triggers and stop “picking the scab” we give our tissues a chance to rest, heal and regenerate. Simultaneously our sensors for pain are actually being desensitized. Master this, and you have mastered your back pain.

For those of you that have a known type of injury, a name to attach to your condition, your personal recovery strategy should always begin with avoiding the aggravating posture for your unique spine is key to getting yourself back on track.

Various symptoms of back pain have a distinct and known cause (although this information is not widely known making this book uniquely valuable). Injuries can be avoided if we avoid the injury mechanism itself. Here’s a recap of some pain avoidance strategies, as well as an introduction of some that will be discussed later. The knowledge in this chapter will provide the foundation that will help you:

  1. Locate and eliminate the cause of your pain- get an appropriate assessment that provides a specific diagnosis (Make an appointment or start with reading chapter 6).
  2. Increase your consciousness around what movements and postures cause you pain.
  3. Develop replacement postures and movement patters that enable you to function pain-free.
  4. Stabilize your torso, core, and spine to remove painful spine joint micro-movements.
  5. Develop a daily exercise plan that includes walking.
  6. Mobilize your hips and use your hips to lift.
  7. Learn to create power at the ball and socket joints (hips and shoulders).
  8. Learn exercises that are based on patters of movement: push, pull, lift, carry, lunge, squat, etc.
  9. Make healthy spine choices when sleeping, sitting, or engaging in more demanding activities.

You’re on your way to learning the secrets of a pain-free lifestyle! Let’s make it happen!

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!

Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19

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.

  1. The United States opioid epidemic – PubMed (nih.gov)
  2. 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
  3. 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
  4. 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

Lack of Sleep Makes You Crave Sweets

Not getting enough sleep can have negative effects on your health. They can be weakened immune system, increased risk for diabetes, heart disease and poor coordination. Add one more increased craving for sweets.

Insufficient sleep is linked to increased caloric intake and to obesity.

In a randomized crossover study, 24 people slept for either five or eight hours per night for three consecutive nights.  The shorter sleep increased objective sweet-taste preference and intake of calories and carbs at the buffet meal.

While shorter sleep was associated with an overall increase in caloric intake, it affected different individuals very differently. Some ate a lot more (up to +679 kcal), but some actually ate less (down to −261 kcal).

One of the simplest thing you can do to improve your health is to sleep 7-8 hours a day.

Acute Sleep Curtailment Increases Sweet Taste Preference, Appetite and Food Intake in Healthy Young Adults: A Randomized Crossover Trial – PubMed (nih.gov)

COVID-19 and Obesity

The one sure thing about Covid-19 is the more unhealthy you are the worse the outcome will be if you get Covid-19.

Fat male stomach

According to the CDC: Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.

91 percent of Covid_19 deaths in Cook County had comorbidities. Comorbidity rate of Cook County victims with COVID-19 listed as primary cause of death, Mar. 16 – Jan. 1 (Wirepoints Source: Cook County Medical Examiner)

This study: Morais AHA, Passos TS, de Lima Vale SH, da Silva Maia JK, Maciel BLL. Obesity and the increased risk for COVID-19: mechanisms and nutritional management. Nutr Res Rev. 2020 Nov 13:1-13. doi: 10

It found: “The SARS-Cov-2 infection has become pandemic, overlapping with obesity and its co-morbidities. Obesity and its co-morbidities create an unfavourable inflammatory environment that enhances the risk of severe COVID-19. Therefore, obesity must be recognised as an independent risk factor for COVID-19 severity to better define public health policy and protect susceptible individuals, including specific social distancing measures. These measures can also contribute to preventing collapse of the health care system. Further research should define proper therapeutics for COVID-19, and nutritional therapy is an essential measure for treating COVID-19 in patients with obesity.”

Losing weight and getting healthy-along with the standard practices of social distancing, mask wearing, washing your hands and keeping your hands from your face and mouth- will help you fight Covid-19!

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.

Photo by Sabel Blanco


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:

  1. 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.
  2. 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

  1. Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.
  2. “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
  3. Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research5, F1000 Faculty Rev-1530.
  4. Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.
  5.  Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.
  6. 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.
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