Don’t Get “Trapped” Working the Wrong Muscle!

This month we will be talking about an important muscle that is often forgotten and underused…The lower trapezius.  In a society that is always focused on what is going on in front of us (computers, cell phones, life in general) we tend to forget about working our postural muscles.

An important muscle that aides in proper posture, shoulder motion and spine mechanics is the lower trapezius.  This muscle helps to stabilize the shoulder blade to prevent things like neck tension and shoulder injuries like tendonitis and impingement. These are often lingering issues that are hard to treat without attention being given to the lower trapezius muscle.

Thankfully the gym is a great place to work this muscle, but often times people are not properly targeting the lower traps.  Instead, the exercises that are being performed are working the already overactive upper and middle traps and rhomboid muscles.

Lower Trap Activation

1. Position your feet hip-width apart and relax your upperand middle traps (the area where your neck and upper back meet.)

2. As you perform the rowing motion with resistance bands or a cable machine, feel you lower traps activate by pulling your shoulder blades down and in towards midline.

3. When activated properly, you should feel this near the bottom of your shoulder blade.

4. Repeat 10x and perform 2-3 sets a few days a week.

Encouraging runners to take it one step at a time, or in this case, one leg at a time...

 

We often see runners in our office for chronic overuse injuries like IT band syndrome, shin splints and piriformis syndrome.  One of the conversations we have with these athletes’ is what type of resistance training are they doing to help prevent injuries?

In most cases, the answer is “What resistance training?” and in others it’s a quick set of push ups and sit ups before or after a run.  We like to introduce these athletes to a program that is specific to their sport and will help them perform better and prevent nagging injuries. 

Given that running is comprised of repetitively striking the ground with just one foot at a time, the main goal of a runner’s resistance training should be focused on unilateral (one sided) exercises.  Unilateral strength training will help to control hip hiking, knee valgosity and over pronation during your gait cycle.  These are common findings in runners with the overuse injuries listed above.

Below is a list of unilateral exercises for runners to incorporate into their training routine: 

 

Split Squat

 

One Legged Deadlift

Pistol Squat



The Importance of Thoracic Spine Mobility

In the fitness world there is a large emphasis on flexibility, but sometimes we leave out the important aspect of mobility.  Flexibility refers to a muscle’s ability to move through a range of motion, whereas mobility is concerned with a joints motion and how easily it can move and glide in relation to surrounding joints. 

The thoracic spine, or the mid back, is an area that often times lacks proper mobility.  The is not a surprise considering that most people spend their day in a hunched forward position while working on a computer, driving in a car, or sitting in a classroom.  This hunched position leads to tight pectoral muscles, fatigue in the paraspinal muscles (the postural muscles that line your spine), and a lack of extension in the thoracic spine.

So how could this be affecting you and your workouts and daily life? 

The motion in our body is part of a kinetic chain.  When one area of this chain is not moving properly, that motion will be compensated for in another area of the body.  In this case, the two areas most commonly affected by a lack of thoracic mobility are the shoulders and the low back. 

 A lack of extension in the thoracic spine will make motions like deadlifts and squats more challenging and cause the low back to move more to achieve the same range of motion.  Over time this increase in low back range of motion can lead to instability and increase risk of strains, sprains and chronic low back pain.  Additionally, the shoulder blade and shoulder joint rely heavily on proper thoracic mobility.  When this motion is compromised during exercises like an overhead press, you are putting your shoulder at a greater risk for problems like impingement, tendonitis and rotator cuff injuries. 

How to Improve Thoracic Mobility:

An easy way to improve thoracic mobility is to use a foam roller and stability ball to achieve flexibility and mobility in the upper back.  We encourage this to be done in two ways, actively and passively.  Actively, you can foam roll along the upper back to increase flexibility in the muscles surrounding the thoracic spine.  Passively, you can lay on a stability ball with relaxed shoulders for 60-90 seconds to stretch the shortened pectoral muscles and encourage extension in the joints of the thoracic spine.  




Everyone's Favorite Exercise - The Squat

Boot camp, yoga, strength training, Barre, boxing and kickboxing.  No matter what your favorite workout routine, there is an exercise that is unavoidable while at the gym: the squat.  The squat is one of the most functional movements and we are forced to do it multiple times a day, even outside the gym!

Imagine what you have to do to get up and down from a chair… thats right, you have to squat.  Considering how many times we use this movement, it would be wise for us to make sure we are performing it well.  By using proper form, we will be able to enjoy the exercise more and prevent the aches and pains that come with using improper form. 

There are multiple aspects that go into performing a proper squat, but there are a few common mistakes that are made that can be easily corrected.

Squatting 101

1.Position your feet hip-width apart and make sure your weight is through your heels (you should be able to wiggle your toes during the entire range of motion). Toes should be pointed outward slightly.

2.Your first movement should be a hinge at the hips.  The hips should travel down and back like you are sitting in a chair.

3.As you lower down, your chest should stay up as if your are sliding your back down an imaginary all.

4.In the lower half of your body, you should focus on keeping your hips, knees and ankles in a straight line and not allowing you knees to track forward over your toes.

1.Full range of motion for a squat is when your hips and knees pass the 90 degree mark.

2.To return to your starting position, focus on actively contracting your glutes to take pressure off the low back.


 

Skipping Leg Day Due to Knee Pain During Squats and Lunges?

 

Mr. T obviously doesn’t like this idea, and neither do we!

In most cases, non-traumatic knee pain (ie. pain that did not start from an outward injury) is caused by an imbalance between the group of muscles that affect the knee joint.  This group is known as the quadriceps, which is actually composed of 4 muscles.  For the purpose of knee pain, the inner and outer muscles (Vastus Medialis and Vastus Lateralis) are usually the areas that harbor this imbalance.  Most of the time there will be a lack of activation in the Vastus Medialis and too much activation or tension in the Vastus Lateralis.

 

This imbalance causes the knee cap to be pulled unequally during knee bending activities (squats, lunges, mountain climbers, etc.) which irritates the joint capsule, tendons, and ligaments that cross the knee joint.  This constant irritation and inflammation leads to thickening in the joint capsule and tendons.  This thickening will manifest itself as tightness, aching and even the all too common “cracking” noises that some people hear while performing a squat or lunge motion.

So how can we fix this?  The name of the game is BALANCE!  We want to strengthen the inside of the knee and relax the outside of the knee.  Three important activities to relax the outside of the knee are releaseing the tension in the Vastus Lasteralis and IT band through foam rolling or other soft tissue treatment (hint, hint ART works great), strengthening the glute muscles, and strengthening the vastus medialis.  By strengthening the glute muscles, the structures on the outside of the thigh (Vastus Lateralis and IT Band) will not be as easily stretched during knee bending activities.  Strengthening the inside of the knee (Vastus Medialis) keeps the knee cap in a central position when we bend and extend the knee joint. The combination of these activities will help to reduce the irritation on the joint capsule so you can get back to leg day at the gym!

Sleeping on the Stomach

How the Neck is Affected From a Musculoskeletal Standpoint 

The point of this is not to get into topics like sleep apnea or facial wrinkles and their relation to sleeping on the stomach, but to give a couple of reasons (which may seem obvious) why your aches and pains may be related to or aggravated by sleeping on the stomach.

Sleeping habits are often very hard habits to change because ultimately we need to be able to get a good night's sleep so that we can feel awake and focused the next day to take on our daily routine.  If sleeping on the stomach provides the best position for someone to be able to achieve this state of relaxation and go through the stages of the sleep cycle so that they can feel rejuvenated the next day, then it hard to convince that person to sleep on their side or back.  UNLESS they are experiencing musculoskeletal pain that may be aggravated by or related to this sleeping position.  

In the prone or face down sleeping position, it is almost impossible to not have our head turned in one direction or the other.  Over time, muscles on one side of the neck are stretched and lengthened while the muscles on the other side are contracted and shortened.  The curve, which is supposed to be a reversed C-shape, slowly straightens over time in this position.  This most likely will translate to aches and pains in this area over time as the muscles and joints of the neck will have a hard time finding a normal resting position.  Most of the rotational range of motion of our spine is present in the neck.  If compromised, we start to compensate with moving other areas of our spine to make up for the lack of range of motion.  

The neck holds up the head, and the curved spine provides shock absorption and muscle attachments that serve as levers to move our head around.  The joints take on more stress as our head moves forward with straightening of the curve and our muscles start to pull in less natural plains, causing strain to the whole joint complex.   Losing the curve in the spine actually increases the load on the spine!  Think about holding a 10 pound bowling ball straight up in the air supported by your wrist and forearm.  Now flex your wrist forward slightly and feel how much the stress on your wrist and forearm increases.  Imagine this daily while upright with your head (bowling ball) on your spine (wrist and forearm).  Not only will the stress of the load irritate the joints and muscles, the muscles in the back of the neck will have to work harder and more often just to hold the head upright.  Then, when we get into daily activities like texting, looking down at the computer, working out, or playing a sport, the joint complex has to work that much harder.  

With the joint complexes taking on more stress, we face a higher risk of musculoskeletal injury and earlier onset degeneration/arthritis.  Most of us do not have perfect spines or perfect cervical curvatures, whether it is congenital, from a sports injury, or due to a fender bender, but we can help ourselves by improving our sleeping posture.

KS

 

 

New Moon Half Marathon rain video

Dr. Vogel waiting out the storm under the treatment tent while the runners take cover

Our treatment tent proved to be very useful as a storm rolled in about 15 minutes before the start.  After a brief delay, the live music began and the runners filed into the starting area.  They were rewarded with pizza and beverages for their hard work!

Link (copy and paste to view): https://www.youtube.com/watch?v=pSgLOQo5ufU

#raisethebar #newmoonhalf

The K.I.S.S. Concept

In our busy world the K.I.S.S. (Keep it Simple Sweetheart) concept is something that most of us forget to incorporate into our daily life.  With all the technological advances we have made it makes sense that more complicated should be better, right? In regards to mobility work this is not the case.

Most mobility issues (or for the lay person, joint or muscle tightness) come from the resting position of a muscle, or group of muscles being too short. Take your hip flexors for example. We sit all day long and therefore this muscle gets use to being shortened and intern adopts this length as its new resting positions. When we go to call on this muscle to perform a complex action like a squat, or even a more complex exercise like an overhead squat, it only makes sense that this muscle will not be able to perform like it should.

So what do we do? Stop doing squats and overhead squats? No way! We re-educate that muscle what its resting position should be through a SIMPLE mobility sequence and muscle activation exercises. See the attached article that details this simple squat mobility sequence and provides pictures for each step in the process. Before you know it you will be returning your muscles to their proper length and improving your performance in even the most challenging movements!

 

http://breakingmuscle.com/mobility-recovery/a-simple-4-step-mobility-system-for-every-lifter

X T C

For back and side core activation.

An easy way to activate your posterior and side core/dorsal sling musculature before even getting out of bed in the morning.  This especially important because we generally do not think about activating our back and side musculature in relation to our core.. While it is common to perform morning stretches such as bending over and touching the toes and leaning to one side or the other with our arm reaching towards the sky, how about activating these muscles before we start to use them? (especially if you like to work out in the morning or have a physically demanding occupation)

You can do this in bed before you even get up.  Do about 10 gentle pulses into the bed/ground with each.  No need to strain with this exercise. 

X: Lay on your back with your arms and legs laid out to your sides so that you look like an "X" when viewed from above.  Push your arms and legs into the ground at the same time using your shoulders, back, butt, and legs. 

T: Lay on your back with your arms straight out to side and your legs together and straight so that you form a "T" when looking from above.   Push your arms and legs into the ground at the same time using your shoulders, back, butt, and legs. 

C: Lay on your side with both arms out in front of you angled at about 45 degrees from the shoulders (between straight over your head and straight out in front of you).  Have both thigh and legs together and straight but angled at about 45 degrees from the hips (between straight down and straight out in front of you).  Push into the ground with your arms, shoulders, torso, hips, and legs.  Repeat again on the opposite side. 

You have now activated your back and side musculature (longitudinal sling and dorsal oblique sling) before getting out of bed.  In a front-sided dominant society where we are constantly using our chest and abs, we can't forget about our sides and back.  If the front side becomes too dominant, we start to have joint dysfunction that can lead to problems in the neck, shoulders, back, hips, etc.   Every little bit of core activation helps, event if it is a simple activation exercise like this one!

 

Weight rooms and running paths…Do they mix?

Absolutely! Research has shown that weaknesses or imbalances in the hip  (ie. the abductor, adductor, and flexor muscle groups) can lead to overuse injuries in running athletes. These imbalances will affect the rest of the lower extremity and can manifest in overuse injuries like IT band syndrome, runners knee and other forms on tendonitis.

Having the movement patterns of your main stabilizing muscles functionally assessed can help to determine what muscles need activated or strengthened. Then a simple set of hip strengthening exercises can be added to your training routine to help treat or prevent overuse injuries. This way you can keeping doing what you love…RUNNING!

“Although no cause-and-effect relationship has been established, this is the first study to show an association between hip abductor, adductor, and flexor muscle group strength imbalance and lower extremity overuse injuries in runners. Because most running injuries are multifaceted in nature, areas secondary to the site of pain, such as hip muscle groups exhibiting strength imbalances, must also be considered to gain favorable outcomes for injured runners. The addition of strengthening exercises to specifically identified weak hip muscles may offer better treatment results in patients with running injuries.”

Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Niemuth, Paul E. PT, DSc, OCS, SCS, ATC*†; Johnson, Robert J. MD‡§∥; Myers, Marcella J. PhD¶; Thieman, Thomas J. PhD. Clinical Journal of Sport Medicine: January 2005 - Volume 15 - Issue 1 - pp 14-21

Relax!

Try this out.. walk up to a colleague/friend/family member who is standing or sitting in a conversation or working at their desk.  Say "Hi," put your hand on his/her shoulder and say "Relax."  Most likely their shoulders will drop on both sides.

Most of us have, will have, or have had neck and upper back tightness at some point.  Stress, posture, activity, and body type all play a role, but we can consciously relax these muscles (upper trapezius, levator scapulae, rhomboids) throughout the day to ease this constant tension.  Constant tightness/tension from a slight muscle contraction held for long periods of time in this area can cause feelings of stiffness, tightness, fatigue, burning, restriction,  cramping, sensations into the shoulders and arms, headaches.. any of which can increase irritability and overall discomfort.

How did you sleep last night? Back, side, or stomach?

We spend about 1/3 of our day sleeping.  Our sleeping posture is just as important, if not more important, than our daily posture, whether sitting at a desk or standing.  Basic understanding of posture is that we should "sit up straight" or "stand up straight."  At least this is what I was always told by elders when I was growing up. 

Obviously, there is more that goes into it, but that is the basic idea.  The same goes with sleeping.  Think about standing up straight with feet at shoulder width, slight bend in the knees, facing forward, ears in line with the shoulders, arms by your side with palms facing forward (although most of us will have our palms facing our side or even behind us -- this is a topic for another day).  You are basically standing in "anatomic position." 

We want to try to stay as close to this as possible when sleeping, which could potentially be very tough since it is not easy to change one's sleeping habits.  The basic idea is to keep your body as neutral as possible.  If laying on your back, have your head supported just enough so that is not over-extended with your chin jutting out or hyper-flexed with your chin pushing down towards your chest (a cervical pillow can help -- but its easy to buy the wrong kind if you don't know what you are looking for, but that's another topic for another day).  Try to keep your arms by your side, not flexed into your chest with your wrists flexed (always try to keep the wrists straight) or behind your head.  Try using a small pillow under the knees.  Just like standing, we want to keep our knees slightly flexed while sleeping. 

If you are a side sleeper or tend to roll over to one side or both sides throughout the night, the same concepts hold true.  You may need an extra pillow to support the head while on your side to keep your head supported in neutral position, not leaned too far to the side your are laying on or being jammed into the opposite shoulder that is up in the air.  Try to avoid pulling your arms into your chest with your wrists flexed (especially if you work on a computer all day, try to keep your wrists straight since they are constantly being flexed all day).  You will have to bend your elbows or flex your shoulder in this position so that you don't fall onto your stomach.  The most important part if you have low back or hip pain is to try to keep both legs shoulder width apart by using a pillow between them, and try not to flex your top leg if your other one is straight.  We are better off slightly flexing both hips and knees then having one straight and one flexed since this puts uneven stress on the pelvis and lumbar spine.  Keep the legs as straight as possible, as too much flexion will put constant pulling stress on the low back and pelvis and jam your hips (and hip flexors).  If you sit at a desk an/or work at a computer, then you are already in that position most of the day.  We want to try to avoid that position while we sleep, as the hips and back don't get the rest they need, increasing our chances of having chronic low back and hip problems. 

Never sleep on your stomach! (will go into more detail at a later date)

KS

 

Sitting in a chair for long periods of time at work? Couch in the evening? Long car rides?

From now on, think about where your hips are compared to your knees while sitting.  Are they above or below?  You can improve your low back, hip, or knee condition just by avoiding sitting in a low sinking chair, which puts your hips below your knees, putting a constant stretch/pull on your low back and hip musculature and compressing your "knee joints".  Sustained posture like this, although it may feel comfortable at the time, will eventually lead to problems over time and is most likely contributing/worsening any low back, hip, or knee pain you currently have.  The same concept applies to driving, especially if you do it for long periods of time.

Although not always avoidable, just being aware can help you correct these postural situations in the future.  

 

Work on your glute activation!

"Pain developers demonstrated a ‘top-down’ muscle recruitment strategy with lumbar extensors activated prior to gluteus maximus, while non-pain developers demonstrated a typical ‘bottom-up’ muscle recruitment strategy with gluteus maximus activated prior to lumbar extensors."

This is an excerpt taken from Altered muscle recruitment during extension from trunk flexion in low back pain developers by Erika Nelson-Wong et al.  Volume 12, Issue 10 of Clinical Biomechanics Dec. 2012.  

With low back pain patients, we discuss the importance of glute activation from the 1st visit on, whether you are bending, lifting, walking, standing from sitting, reaching, going up and down stairs, etc.  Think about how often you do any of these motions throughout the day.. Although they may not individually seem forceful enough to cause low back problems, think about how each individual motion is repeated throughout the day every single day for your whole life!  

Save your back by performing glute activation and strengthening exercises!  

Golfer's elbow and tennis elbow...Can chiropractic care really help?

The answer is an overwhelming YES! Medial and lateral epicondylitis (to the lay person - golfer's and tennis elbow) is the result of repetitive micro traumas to the muscles, ligaments and tendons of the elbow and forearm. These micro traumas cause the body to lay down scar tissue that hinders motion in the muscles and the joints of the arm. The best treatment for these injuries is restoring proper movement in the injured muscle and the elbow joint so the arm can perform its normal activities. Soft tissue manipulation and joint mobilization has been shown to reduce the pain associate with these injuries and restore normal range of motion so patients can return the playing the sports that they love!

 

http://www.anatomy-physiotherapy.com/articles/musculoskeletal/upper-extremity/elbow/337-does-effectiveness-of-exercise-therapy-and-mobilisation-techniques-offer-guidance-for-the-treatment-of-lateral-and-medial-epicondylitis-a-systematic-review

Chiropractic care can reduce your knee pain from arthritis!

"A short-term manual therapy knee protocol significantly reduced pain suffered by participants with osteoarthritic knee pain and resulted in improvements in self-reported knee function immediately after the end of the 2 week treatment period."

Click on link below to see full study.