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I’ve Fallen and I CAN Get Up

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Are you living alone? If you were to fall, would you be able to get back up? The following videos will demonstrate techniques to help you regain your footing if you fall and find yourself without assistance.

Getting up off the floor can be done using a practical approach.


If you lived through the ’80s and ’90s, you might recall those medical alert commercials featuring an elderly woman who calls for assistance because she’s unable to get up after a fall.

The challenge of performing floor-to-stand transitions becomes especially concerning with age, particularly after a fall, where nearly 50% of individuals aged over 70 find themselves unable to stand up independently. What’s notable is that a significant portion of those who fall don’t sustain injuries; rather, they struggle with the task of getting back up on their own.

For individuals residing alone, such circumstances can lead to dire outcomes. Staying on the floor for an extended period can lead to dehydration, pressure ulcers, delirium, rhabdomyolysis, and ultimately, renal failure. In a study involving 125 individuals aged over 65 who experienced falls in their residences, it was found that half of those who remained unable to get up for more than an hour (referred to as “long lies”) had passed away within six months.

Considering the severe outcomes linked with prolonged periods of being immobile on the floor, healthcare providers ought to assess floor-to-stand transition times for individuals aged 50 and above. It is recommended that individuals in their 50s should ideally be capable of standing up from the floor in under three seconds, while those in their 60s should aim for less than four seconds. Individuals in their 70s and 80s should aim for transition times of five and six seconds, respectively.

If you have any questions, please call our office or visit our website at drstevesikorsky.com

  1. Ulbrich J, Rheja A, Alexander N. Body positions used by healthy and frail older adults to rise from the floor. J Amer Geriatrics Soc, 2000;48:1626-1632.
  2. Tinetti M, Liu W, Claus E. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA, 1993;269:65-70.
  3. King M, Tinetti M. Falls in community-dwelling older persons. J Amer Geriatrics Soc, 1995;43:1146-54.
  4. Bohannon R, Lusardi M. Getting up from the floor. Determinants and techniques among healthy older adults. Physiother Theory & Practice, 2004 Jan 1;20(4):233-41.
  5. Wild D, Nayak U, Isaacs B. How dangerous are falls in old people at home? Br Med J, 1981;282:266-268.
  6. Montero-Odasso M, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age & Ageing, 2022 Sep 2;51(9):afac205.
  7. Burton E, Hill K, Davey P, et al. The biommechanics of healthy older adults rising from the floor independently. Int J Environ Res Public Health, 2023;16;20:3507.
  8. Reece A, Simpson J. Preparing older people to cope after a fall. Physiother, 1996 April 1;82:227-35.
exercise

Every Move Counts: Overcoming the Inactivity Crisis

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walking

by Craig Liebenson

Over the last 50 years modern life has become primarily sedentary. Physical inactivity causes as much mortality as does smoking. With only 15% of our population meeting the World Health Organization’s (WHO) Physical Activity Guidelines (PAGs), addressing the inactivity crisis has become a major public health issue. Physical inactivity has many drivers – increased motorized transportation, prolonged static work postures and lack of green spaces as examples. Along with increased consumption of processed food and calories, the combination of moving less and eating more is a “double whammy” – increasing diabetes, obesity, heart disease, metabolic syndromes, neurodegenerative conditions (e.g. dementia and Alzheimer’s disease), osteoporosis and more. What can be done to bring physical activity back into our lives?

Our ancient ancestors from prehistory conserved energy for the inevitable hunting and gathering required for survival. Genetically we are programmed not only to rest, but to crave food. This survival programing, when combined with the easy access to refrigerated, processed and fast foods; sedentary occupations and transportation, has brought us to where we are today – diabetes rates skyrocketing from 1% to 10% in 100 years; obesity at an precedent 30% while steps a day on average have declined from approximately 18,000 steps a day to one third of that. 

Ironically, people are living longer – thanks to reduced infant mortality and modern medical marvels such as in our emergency rooms. Yet, we are “older younger”, so our health span is less even while our life span has increased dramatically. Fortunately, there are some simple measures that can help us increase our physical activity (PA). 

Three Steps to Take
According to the WHO, 3 physical activity targets are necessary to significantly improve our health: 

  1. 150 minutes per week of aerobic exercise
  2. 2x per week strength training
  3. Avoidance of prolonged sitting or standing
  4. Aerobic exercise
    30 minutes per day for 5 days per week achieves the 1st WHO PAG. This is by far the most important for its potent effect on reducing cardio-vascular disease. Any activity which gets your heart rate up will suffice. Simply “huff & puff”. This can even occur in installments such as climbing stairs or any 10 minute interval.
  5. Strength training
    2 times per week strength training involves progressive resistance exercise of the major muscle groups of the body (arms, trunk, legs). Resistance should be sufficient to gradually increase the effort required to complete a set of repetitions. These fatiguing repetitions should be stopped just short of failure – typically a set should be stopped with 1-3 repetitions in reserve (RIR) before “failure”. A good rule of thumb is an appropriate weight should be “tough at ten” reps. 
  6. Avoiding prolonged sedentary postures
    Getting up every hour or two is optimal. Micro-breaks of brief walking is all that is necessary. Getting up for 15 minutes every hour is recommended for “active recovery”, even with just a light stroll. This will help your metabolic health and reduce the risk of Type 2 Diabetes.

How Will You Benefit?
People exercise for different reasons: to lose weight, get stronger or improve their overall health being a few of them. Meeting the WHO PAGs lowers your risk of “all-causes” (cancer, heart disease, etc) mortality by about 40%. Even if you only meet the aerobic guidelines you lower your risk by 29%. Meeting the aerobic guidelines is associated with a lower risk of metabolic diseases such as type 2 diabetes mellitus, all-cause mortality, cardiorespiratory disease and coronary heart disease related mortality. 

Muscle mass begins to reduce after the age of 30 and becomes measurable in the 4th decade, decreasing at nearly 1% a year. By the age of 60 we lose 1.5% a year which increases fall risk. As we age our decreases in strength and power occur many times faster than the loss of muscle mass. This leads to functional impairments and heightened fracture and frailty risk.  


Figure 1
Summary of reduced risk of all-causes mortality associated with meeting the PAGs (Zhao). 
Strength training – 11% lower risk 
Aerobic training – 29% lower risk
Both strength & aerobic training – 40% lower risk

What Are Your Goals?
If we want to be above average 90 year olds we won’t get there if we are average 50 year olds. What are your goals? Let’s look at a few and how PA influences your likelihood of achieving these goals.

a) Cardio-Vascular Health
Cardio-vascular disease is our #1 killer. A number of tests such as blood pressure, cholesterol, HDL/LDL ratio, triglyceride count, resting heart rate and VO2 max are excellent metrics of heart health. 

“V02 max is the maximum amount of oxygen your body can utilize during exercise. It is a standard measure of aerobic fitness. Specific aerobic training methods can increase this number significantly. Compared to those in the highest 2.5% V02 max category, those in the lowest 25% category are 5 times more likely to die over 10 years. There is practically NOTHING in medicine that results in this magnitude of a survival advantage.” Paddy Barrett, M.D, (2022). 

Once we realize that our ability to function independently is directly related to how active we are, it is easy to conceptualize the value of staying active and training for the game of life. Specifically, to keep our biological age lower than our chronological age. This can be detailed in terms of specific goals or targets we’d like to maintain as we age, such as:

  • To briskly climb stairs
  • Walk 3 mph up slight incline (5% grade)
  • Walk 3 mph on flat ground

Figure 2
According to neuroscientist Louisa Nicola, to build your VO2 max, 80% of your aerobic training sessions should be low-intensity (challenging but conversational). The popular interval training does not build this base and should be avoided by people just starting to become active. While for those who build a solid aerobic base in low intensity training (often called Zone 1-2 training) it can be added and performed 1-2x per week at most for at least 6 months. 

b) Body Composition
To gain lean muscle mass, “Participation (>2 years) in either aerobic, resistance, or tai-chi exercise was linked to higher lean mass and lower body fat than sedentary controls…As little as 60 min per week had similar benefits to much higher ‘doses’.” (Leong, 2023).

Insulin sensitivity and impaired glucose tolerance can be mitigated with increased PA, “a direct link between physical inactivity and visceral fat has been established”. Decreasing your steps per day from 10,000 to 1500 after just 2 weeks was shown to impair glucose tolerance as well as postprandial lipid metabolism. A 7% increase in intra-abdominal fat mass, visceral adipose tissue increases, and BMI decreased. (Pedersen, 2019). 

c) Healthy Longevity
Women in particular benefit from increased aerobic and resistance training activity. Falls, fractures and frailty are major killers over the age of 65. Post-menopausal hormonal shifts accelerate losses of bone density (osteoporosis) and, according to neuroscientist Louisa Nichol, “loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population”. Here is a chart with sample exercises to build muscle mass and strength necessary to prevent falls, fractures, and frailty (Devries, 2023). 


Figure  3
Single leg standing balance is a key functional capacity that correlates with this. 20% of people in their early 60s can’t stand on one leg for 10 seconds. 50% of 70 year olds. 90% of 80 year olds. (Araujo, 2022).


Figure 4
If you could perform the 10 second single leg balance test, the probability of you being alive seven years later is over 90%. If you can’t, it’s only 65%.

Why Is It So Hard to Sustain New Physical Activity Habits?

There are many reasons why, in spite of the obvious benefits of PA, so few people avoid a sedentary lifestyle:

  • Social constraints (cities built for cars instead of pedestrians or bikes; lack of green spaces, safety, etc). 
  • Lifestyle factors (home and work stress, lack of sleep, not enough time, etc.)
  • Embodied beliefs (being told certain fear producing narratives such as hurt = harm, that you have a diagnosis of arthritis – eg wear & tear, you’re out of alignment or have postural or movement dysfunctions that need to be “corrected”, etc.)

Nobody should feel that they are lazy or weak if they are not more active. World PA and health experts are focusing more attention on simple messages like “Every Move Counts”. Yes, more is usually better but the biggest gains accrue when a person shifts from being sedentary to becoming more active. As an example, walking 10,000 steps per day is more beneficial than walking 5,000. But the health benefits of a bump in volume from 2500 steps to 5000 steps is far greater, so one should never feel it’s NOT worth it to make small changes!


Figure 5
“There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with risk of all-cause & CV mortality, incident CV disease, type 2 diabetes, & selected cancer sites.”

“Compared with the least (1895 steps), the first quartile (4000 steps) had a 37% lower risk for all causes of death (HR = 0.63, 0.57-0.71)”. Since the World Health Organization has promoted “Every Move Counts”, the biggest net improvement in health comes from simply avoiding being sedentary and STARTING to get active. This is a very important message since many people believe if they don’t do MORE it’s not worth doing ANYTHING (WHO 2020).

Dose-response association between the daily step count and all-cause mortality: A systematic review and meta-analysis (Liu).


Figure 6
It’s not only the volume of activity, but the duration that matters. While accumulating long bouts of aerobic training  has great value, even just performing short “movement snacks” of just 10 minutes  duration has great utility (Chastin).  

Aerobic Training Made Simple
Low intensity aerobic exercise short of the fatigue threshold has potent benefits. This form of exercise used to be called Long Slow Duration (LSD) training, low intensity training (LIT) or what is now popularly called Zone 2 training. According to Alan Couzens, (PhD, 2023), the health and performance benefits include improving one’s:

  • Aerobic capacity 
  • Resting heart rate
  • Recoverability
  • Metabolic flexibility
  • Mitochondrial density
  • Fat burning (fuel partitioning)

“Unfortunately, many novice athletes barely train or are prescribed zone 2 training. Therefore, they don’t develop a good “base”, thinking that the only way to get faster is by always training fast. Doing this won’t (lead to) improve(ment) nearly as much as if they trained Z2 in large amounts.” Louisa Nicola, (PhD, 2023)

“The misconception that you need to be exhausted, sweaty and breathless to gain benefits from exercise is probably the greatest prevailing exercise myth that exists today and it leads many gym goers chasing fatigue instead of real progress.” Kevin Carr (2022).

“Group exercise classes (Peloton, Soul cycle, orange theory) tend to have the everyday person train too hard. Why? People judge the value of the workout based on their effort. Sweat and hard work = good workout. Most training should be pretty comfortable, but easy doesn’t sell.” Steve Magness, author, Do Hard Things (2022).

How do you know if you’re performing your aerobic activity at a low enough intensity to build a base of aerobic capacity? According to Siren Seiler (2023), “Recently I have been checking that I really am at “talking pace” by speaking out loud in full sentences during long LIT rides on my trainer. I hope the neighbors cannot hear me because they probably already think I am pretty weird”. Others say maintain a pace where you can speak but not while chatting endlessly. Some offer the guideline that you should be able to breathe exclusively through your nose. 

According to Gordo Byrn (2022), “Why Focus on Easy Pace”? 

  • Because you might not have it 
  • Because your easy capacity indicates your likely stamina at higher intensities
  • Because your easy fitness is what enables you to absorb, and recover from, all training

When you have a strong aerobic foundation, you can burn more fat via fat oxidation and delay tapping into glucose stores which lead to lactic acid build up and insulin sensitivity. 

Strength Training Made Simple
When it comes to strength or resistance training (RT) minimal-dose approaches have the potential to minimize various barriers to participation and may have positive implications for the feasibility & scalability of RT.

“…brief but frequent minimal-dose RT approaches (i.e. resistance ‘exercise snacking’) may provide additional benefits for interrupting sedentary behavior patterns associated with increased cardiometabolic risk. Compared to traditional approaches, minimal-dose RT may also limit negative affective responses, such as increased discomfort & decreased enjoyment, both of which are associated with increased training volumes & may negatively influence exercise adherence.” (Fyfe, 2021)

As an alternative to performing strength training 2x per week, you can spread out your sets across the week. Here is a guideline, “Regarding weekly training volume, current guidelines recommend performing 2–4 sets per muscle group for 2–3 times a week, which corresponds to a weekly training volume of 4–12 sets per muscle group.“ (Iverson, 2021)

Assuming you are performing the following 6 patterns – upper body push (overhead)/pull/press (horizontal)/carry and lower body squat/hinge that means just 6 X 4 or 24 sets of progressive RT each week can build muscle mass, strength and power (see Figure 2). 

Game Plan for Lifestyle Change
A popular myth is that exercise has to be long duration or high intensity. In fact of the three variables – frequency, duration, intensity – it is frequency that is the first level to pull. So frequent “micro-breaks”, or, “movement snacks” can be used to perform recovery, easy or steady aerobic activity, as well as resistance training snacks. 

Think of the following guidelines: 

  1. Get up for 15 minutes every hour of sitting or standing and perform active recovery
  2. Engage in easy & steady aerobic exercise (power walk, bike, hike, easy jog, swim, ruck) for at least 30 minutes a day, 5 days a week. This is a pace where you can carry on a conversation. Easy being easy and steady being challenging. Heart rate should not go above 60-80% of your maximum. 
  3. Engage in strength training either 2x/week or in exercise snacks for 5-8 minutes, 1-3x a day. These strength exercises can include weights or even bodyweight (push-ups, lunges, stair climbing). None of the resistance exercises should be to failure. This means you can perform your final repetitions with good form and without holding your breath or grunting. 
  4. Perform high intensity interval training aerobic exercise at most 1x a week or perform a small volume of sprints 2x a week (5-8 reps). 
  5. Perform sports you enjoy frequently (tennis, pickle ball, golf, soccer, etc)

References:
Araujo CG, de Souza E Silva CG, Laukkanen JA, Fiatarone Singh M, Kunutsor SK, Myers J, Franca JF, Castro CL. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022 Sep;56(17):975-980.

Barrett, Paddy, M.D. Twitter. (2022).

Chastin SFM, De Craemer M, De Cocker K, et al. How does Light-intensity physical activity associate with adult cardiometabolic health and mortality? systematic review  with meta-analysis of experimental and observational studies. Br J Sports Med  2019;53:370–6.  

Devries MC, Giangregorio L. Using the specificity and overload principles to prevent sarcopenia, falls and fractures with exercise. Bone. 2023 Jan;166:116573.

Fyfe, J.J., Hamilton, D.L. & Daly, R.M. Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations. Sports Med (2021).

Iversen, V.M., Norum, M., Schoenfeld, B.J. et al. No Time to Lift? Designing Time-Efficient Training Programs for Strength and Hypertrophy: A Narrative Review. Sports Med 51, 2079–2095 (2021).

Leong LC, Swee KNL. The effects of community-based exercise modalities and volume on musculoskeletal health and functions in elderly people. Frontiers in Physiology. 14:2023

Liu Y,  Sun Z,(2022) Dose-response association between the daily step count and all-cause mortality: A systematic review and meta-analysis, Journal of Sports Sciences, 40:15, 1678-1687.

Pedersen BK. The Physiology of Optimizing Health with a Focus on Exercise as Medicine. Annu. Rev. Physiol. 2019. 81:25.1–25.21.

WHO. Every move counts: launch of the WHO guidelines on physical activity and sedentary behaviour Nov 26, 2020.

Zhao, M. Vetrank, S.P, Magnussen C.G, and X, B. Recommended physical activity and all cause and acute specific mortality in US adults: prospective cohort study. BMJ. 2020. 370.

exercise

Which Lifestyle Changes Can Make You Live Longer?

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Movement is Medicine.

Here’s a good article from zerohedge.com

Lifestyle and habits can have a big effect on our health – and our life expectancy. A recently released study that followed U.S. veterans of the age group 40 to 99 between the years 2011 and 2019 is attempting to show just how much.

As Statista’s Katharina Buchholz details below, according to mortality trends collected among 719,147 veterans and lifestyle factors assessed among 276,132, being physically active lowered the risk of death among the sample population the most – by 46 percent – opposite someone with no healthy habits and factors.

Infographic: Which Lifestyle Changes Can Make You Live Longer? | Statista

You will find more infographics at Statista

The study applied the Department of Health’s recommendation of 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week as a threshold participants had to meet to be classified as physically active.

Never smoking shaved off 30 percent off the risk of dying, while eating a diet that includes many plant-based foods lowered the risk of death by 21 percent. The recommendation here is to stick to healthy plant-based foods instead of just any.

Not engaging in frequent binge drinking and getting restorative sleep of seven to nine hours (by not undercutting the hours of one’s usual sleep) could be expected to lead to a mortality risk decrease of 18 and 19 percent, respectively, according to the study. Having positive social interactions lowered the risk of dying by just 5 percent.

The study also shows how combining different lifestyle factors can add up.

Adopting just one led to a lower mortality risk in the study group of 26 percent on average. Adopting six positive habits even led to a decrease of 73 percent. The study also included the factors depression/anxiety and opioid addiction. Being free of either was associated with a decrease in mortality of 29 percent and 38 percent, with opioid disorder therefore scoring lower as a harmful behavior than physical inactivity.

Adopting or being free of all eight factors was associated with a lower risk of dying of 87 percent.

If you have pain that’s preventing from exercising and moving to your fullest capacity contact our office and we’ll do the best to help move better.

Uncategorized, exercise

Some of the health benefits of exercise.

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The Importance of Exercise as We Age

We all know that exercise is crucial to staying healthy and living longer. As we age, we tend to slow down more and become sedentary. Sometimes that can be due to health problems, weight gain, or pain issues – other times it can be because we become increasingly worried about falling and sustaining an injury.

However, countless studies prove the health benefits associated with physical activity, and how these become even more important as we age. Going for a brisk walk, a jog, or even a gym workout a couple of days a week helps improve mental and physical health, both of which will help you maintain your independence as you age. And the good news is, it is never too late to start! 

Below, I have outlined some of the most common benefits of physical activity as we get older.

Helps prevent or delay diseases

Regular physical activity can help prevent a large number of the most common health conditions, like diabetes and heart disease. Overall, it helps improve your immune function, which becomes increasingly more important as we head into middle age. As little as a walk in the park a couple of days a week significantly increases your ability to manage or delay potential issues.

Lowers the risk of falling

As we age, our bodies weaken. An excellent way to stay active and keep your independence as you age is to build muscles and exercise. With regular exercise comes improved flexibility and balance, as well as quicker recovery time if you do fall or sustain an injury.

Helps loss or maintain weight

When we reach 40, our metabolism naturally starts slowing down. We have to work harder, and smarter, to keep the weight. Physical activity builds muscles and burns calories to help you maintain a healthy weight as you age.

Improves bone density

Get those walking shoes on and start walking! Walking and jogging are both weight-bearing activities that can help you increase the strength in your bones and reduce the risk of osteoporosis and fractures. 

Improves your mental health

Why do we always feel so much better after exercising? Well, it is because our body produces endorphins when we engage in physical activity, which in turn reduces our stress levels and leaves us feeling happier and healthier. Physical activity has also been linked to better sleep, another factor that is increasingly vital as we age.

Increases cognitive ability

Regular exercise helps improve and enhance your cognitive function as we age. In fact, there are plenty of studies that suggest that physical activity lowers the risk of dementia later in life.

Helps you stay social

Fitness is a great way to meet new people. Whether you join a gym, a walking group, or outdoor fitness classes, the chances are high you will find like-minded people to enjoy the activity with. As we age, it is vital to maintain an active social life to lower your risks of loneliness and depression. Find an exercise routine you like and enjoy it with friends!

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chiropractic

Does that finding on an MRI mean that where’s your pain is coming from?

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I have ordered a lot of MRIs during my chiropractic career. I have order less as I progressed thru my years of practice. I have found that most people will have some changes on an MRI. The most common finding includes, arthritis, disc bulging and disc hernation.

If your over 40, good chances that you’ll have some changes/finding on an X-Ray of MRI. I can only think of two recent patient that had no finding on their MRI.

Does a finding on an MRI mean it’s the pain generator? No, it does not. As a doctor we should treat the person in front of us and not an image.

If the symptoms warn it or patient fails to progress at all, then advanced imaging might be needed. The most common advanced Image is an MRI. Magnetic Resonance Imaging (MRI) is a non-invasive imaging technology that produces 3d images of the body.

Here a great study that showed most people have finding and asymptomatic

“We performed MRI examinations on 98 asymptomatic people. The scans were read independently by two neuroradiologists who did not know the clinical status of the subjects. To reduce the possibility of bias in interpreting the studies, abnormal MRI scans from 27 people with back pain were mixed randomly with the scans from the asymptomatic people.”

“On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”

So, if you have finding on a MRI and are having symptoms. maybe the pain is coming from the finding or maybe it not. The important thing is to treat the person as a whole and not just a finding.

Ref.:

N Engl J Med. 1994 Jul 14;331(2):69-73. Magnetic resonance imaging of the lumbar spine in people without back pain. Jensen MC1, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS.

neck pain

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

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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!

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Stand Up

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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. 
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Understanding lower back pain.

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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!

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An Example of Gait Changes After Treatment

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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.

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

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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