Fix Your Posture, Fix Your Pain Seminar/Workshop

Transcription

1 Fix Your Posture, Fix Your Pain Seminar/Workshop Hamilton Health Sciences July 2014 Jean LaFleur CAT(C), CSCS, NSCA-CPT, FMS-1, B.HK, Dip SIM Learning Objectives 1. Postural syndromes: Upper and Lower cross syndromes (UCS, LCS): Do these syndromes apply to me? 2. Forward Head Posture 3. Causes of Upper and Lower crossed syndromes. 4. Ideal posture and Work place posture. 5. Upper Crossed Syndrome and Forward Head Posture 6. The neck and its connection to UCS. 7. Stretching for tight Upper Crossed muscles. 8. Lower Crossed muscles(lcs) Tight vs. Weak 9. The Knee and its connection to LCS. 10. Stretching for tight Lower Crossed muscles. The Upper and Lower Crossed Syndromes: Vladimir Janda s model of crossed syndromes shows that specific muscles in front of the body pull the body forward and can ultimately render the body shorter. According to Janda, when upper crossed muscles such as the pectorals, upper trapezius, latissimus dorsi, SCM s, levator scapulae, anterior scalenes, suboccipitals and subscapularis muscles are stressed, they become neurologically facilitated and tight. These slow-twitch, fatigue-resistant muscles are labeled tonic or hypertonic, and will be named short and tight in the presentation. Inversely, Janda also found that the antagonists to the tonic muscles such as the longus capitis, longus colli, hyoids, serratus anterior, rotator cuff, rhomboid major, lower and middle trapezius actually weaken when exposed to the same stress. These second set of muscles are labeled phasic, and will be named weak and inhibited in the presentation. The last century has witnessed a dramatic conversion of our culture to flexion addiction. Flexion just means bending your spine by crunching or moving your rib cage closer to your pelvis whether in lying or standing, or sitting. This pervasive and insidious postural disorder is mainly due to our general transition from being an active group (years ago) to a sedentary bunch of sitters. As such, our muscles have adapted by neurologically shortening and compromising the length of our hip flexors (iliopsoas and rectus femoris). These short hip flexors pull the hip (ilia) forward and down resulting in an excessive lumbar lordosis (curve in lower back) when standing. This aberration of posture is referred to as lower crossed syndrome. Compensations from this exaggerated lordotic condition reverberate up the spine often causing the following: 1

2 Forward Head Posture (FHP): It is a common understanding that the human head weighs approximately 8 lbs or so. In those with forward head posture, (FHP), the weight of the head bearing down on the joints of the neck and upper back (thoracic spine) is at a minimum of 12 lbs. For every inch of FHP, it can increase the weight of the head on the spine by an additional 10 pounds ( Kapandji, Physiology of Joints, Vol. 3) Once the ear has passed the mid-line of the shoulder by 3 inches or more, it has noted in the research that the human head has an equivalent load of 42 pounds on the spine. Complications from Forward head postures: A head in FHP can add up to 30 lbs. of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. A FHP can also result in a loss of a 30% vital lung capacity. As we lose the natural curve in our cervical spine, this blocks the action of the hyoid muscles, which help lift first rib during our inhalations. The entire G.I system (particularly the large intestine) may become agitated from FHP resulting in sluggish bowel function and evacuation. Causes of FHP, Upper Cross and Lower Cross syndromes: Prolonged sitting postures (at work and home) Forward-Head-Sitting Postures: Sitting on a couch, with head propped up and forward ahead of shoulders. This is also seen with people who read in bed. Flexion work with exercise: crunches from floor, sit-ups, some moves from Pilates, or any movements that encourage the lumbar spine to flex (bend) initiated by the contraction of the abdominals. A poorly designed work station. Weak abdominals: poorly recruited or trained abdominals Weak abdominals due to the reciprocal inhibition from surgical scars. Procedures that have penetrated all the layers of the abdominal wall can leave a scar that will tether to itself the fascial layers and compromise the muscle s function by being compressed. - Procedures such as C-sections, hysterectomies, or other abdominal surgeries such as appendix removal, and hernia repairs can leave scarring that can negatively affect abdominal function. - Weak lumbar ( lower back) musculature (poor strength endurance) Spinal osteoporosis: complications from spinal osteoporosis can lead to compression fractures in the thoracic vertebrae which can alter the alignment, curve and function of the thoracic spine. Exercising on abdominal or trunk exercise machines while sitting, and attempting to stabilize the core under the machine s load. Ideal Posture The body s centre of gravity is balanced over the centre of the mid-foot. Proper alignment is observed from the mid-line of the ear, down to the shoulder, through to the hip, through the knee, to the mid-foot. Good posture allows: - Better breathing: by allowing better expansion of the lungs, and better mobility of the ribs. - More energy and concentration from increased oxygen uptake from enhanced ventilation capacity. - Enhanced aesthetic appearance through being taller, clothing fitting better, and being taller is the new thin!!!!! 2

3 Recommended features for an ergonomic work station: The seated posture is supported by the chair, level of the table and computer, and placement of the keyboard. Notice that the arms are supported by the arms of the chair relieving the neck muscles that would have to suspend the weight of the arm while the worker typed. Upper Cross Syndrome UCS is a combination of a group of over-excited (facilitated) muscles in the front of the body, pulling the body forward, and ultimately down. Forward heads and rounder shoulders are the most common postural faults. This distorted pattern has the tight line running through the levator scapula, upper trapezius and pectorals which causes shoulder elevation and a forward tilt of the scapulae (shoulder blades) The weak line crosses through the deep neck flexors and over-stretched lower shoulder stabilizers (rhomboid major and lower trapezius allowing this asymmetry to occur). Neck pain is quite common for those possessing UCS, mainly due to the muscle s (levator scapula, and Upper trapezius) inability to compensate for the line of pull. Potential injuries from this postural syndrome: Shoulder pain, neck pain, upper back (thoracic) pain, headaches, etc. The first order of treatment is to correct the lengthtension or short-tightness of the affected muscles. Stretching enables muscles to be more extensible. Important Stretching Principles (for all stretches) 1. Be specific for optimal results. - Identify the specific muscles to be stretched (done for you) - Isolate the muscles to be stretched by precise localized movements (instructed for you in the hand-out and videos. 2. Increase local blood flow and oxygen to the tissues before and after activity and stretching. The contracting muscles are major vehicles used to deliver blood and oxygen. Repetitive muscle contractions deliver greater amounts of blood and oxygen to the specific muscles more rapidly i.e; Head Rolls: 8 rotate right- 8 rotate left 3. Establish a proper breathing rhythm when stretching. Inhale as the body part returns to the starting posture, exhale during the work phase of the stretch. 4. For maximum results: stretch gently for 2-3 seconds duration, release the pressure, return to the starting position, and repeat the prescribed number of repetitions. Stretch the muscle only to the point slightly beyond mild irritation. Be sure to not over stretch the muscle as this can cause muscle soreness from tissue tearing. 5. For more sensitive neck muscles: repeat 3 sec stretches for 12 repetitions. 6. For larger muscles groups such as the muscles in the thighs (quads or hamstrings) you hold the stretches for 5 seconds, return to starting position, and repeat 10 repetitions. 7. Some stretches may also be held statically for 4 x 30 seconds. 3

4 UCS and Forward Head Posture (FHP) Muscles associated with chronic pain: Levator Scapula Upper Trapezius Sub-occipital muscles ( Head extensors) Stretches for muscles: Levator Scapula stretch: To stretch: rotate your head to one shoulder as much as comfortable, and drop the chin down to the shoulder. At the same time, use the opposite arm to reach behind your head, hence, rotating the scapula upwards and placing greater tension on the muscle. Hold stretch for 3 seconds, return to starting point, and repeat for 10 repetitions. Upper Trapezius stretch: Sidebend your head (ear to shoulder), and then drop your chin down to your chest. Apply this stretch slowly and gently, switch sides. Apply this stretch for 3 seconds x 10 Sub-occipitals stretch: Chin-Tucks for FHP To stretch: take two fingers and push gently onto the front of your chin. Allow your chin to sink backwards as your head rotates slightly, and you feel a stretch behind your skull. Hold stretch for 3 seconds and repeat for 10 repetitions. Pecs Major and Minor stretches: (Recommended for those with FHP and Rounded shoulders) Pec Major: To stretch: Place your shoulder joint up against a corner of a wall, elevate your elbow at the shoulder level. Step on the other side of the corner (as in picture above) of the wall, where your trunk is already facing the opposite direction of your shoulder. Do not allow your shoulder to lose contact with the wall. Squeeze your shoulder blade in and down towards your spine. Now, as you take a deep breath in, gently, turn your sternum away from your shoulder until you feel a stretch as you exhales. You will feel a stretch across your front chest and pecs. Apply the stretch for 5 seconds, and switch to the other side. Repeat 10 repetitions for each side. Pec Minor: Place right hand on the back of your neck, and elbow above your shoulder level by about 3 to 4 inches. Apply the same technique as in the Pec Major stretch. Utilize the exhale to increase the distance you gain as you rotate your sternum away from the shoulder. Hold the stretch for 5 seconds, return to starting position, and repeat 10 repetitions for each side. 4

5 Front (Anterior) Chain stretch: (Pecs, the abdominal connections to the Pecs) - Stand in a door way. Place your elbows at or just above shoulder height. - Using your rear foot, push yourself forward slightly until you feel a stretch across your chest and front shoulder. - Back off from the stretch slightly, take a deep breath, and take up the tension in your chest and rib cage by shifting your weight even further forward into the stretch as you exhale. - Hold the stretch for 5 seconds, return to the starting position, and repeat for 10 repetitions. Abdominals/Upper Thoracic Spine stretch: Begin this stretch by sitting on a fitted-for you stability ball. This stretch addresses most of the tensions incurred by the abdominal and muscles of the rib cage. Walk forwards, and lay back on ball until your head and upper spine and shoulders are resting on ball and in a supine position. Keep the back of your skull on the ball as your now take small steps backwards, further adhering each spinal segment to the ball until you reach your tailbone. Keep your hips elevated to start, until you are comfortable with the stretch and position. Progressions: You can extend the arms overhead, when you feel comfortable enough, you can then extend the legs out, thereby fully extending your spine overtop of the ball. Progress through this stretch slowly, until you feel a comfortable stretch through your abdominals, front hips, rib cage, neck muscles, chest muscles, etc., You may hold this stretch for a longer interval (20 to 30 seconds). Repeat 3 to 4 times. Lower Cross syndrome The tight-line traverses the iliopsoas or centre of the front hip (hip flexors) and lower back (lumbar erectors), while the weak line connects the abdominals and glute muscles. In this lower crossed pattern, the short and tight iliopsoas tilts the pelvis forward (anteriorly), creating an excessive lumbar lordosis (curve). This also creates excessive tension in the lumbar muscles which hold this bowing pattern. The weak abdominals and gluteal muscles, unable to stabilize the pelvis, allow the dysfunctional swayback pattern to develop. ( see image below) Prolonged sitting also perpetuates the slumping which eventually flattens or reverses the normal lumbar lordotic curve. This often results in the flat-back posture with compensatory losses of normal spinal curves. Lower Crossed Syndrome and Tight muscles Ilio-psoas (hip flexors) Rectus Femoris and Quadriceps 5

6 Tensor Fascia Lata (TFL) Hamstrings and Lower back muscles (highlighted in red) Lower crossed syndrome and the knee Much has been documented about lower extremity muscle imbalances, joint dysfunction and the net result on the knee. For the purposes of this presentation, the author supports the model that the knee often falls victim to the imbalances from the joints above and below it. For example, if the glute muscles on the side of the hip (glutes medius) are weak, they will allow the knee to buckle in (valgus) and create stress on the inner ligaments, joint capsule, meniscus, etc. In this case the glute muscles are unable to stabilize the pelvis adequately to prevent the knee from caving in. On the other hand, if the ankle does not possess enough mobility as in the ability to keep one s heel flat on the floor while squatting and maintaining proper posture, then the ankle joint and the surrounding musculature will force the knee to compensate by taking on the load of the movement or changing the way the knee moves entirely. Heel lifts are added to the subject s squat pattern because of a lack of dorsiflexion or ankle mobility. Without this compensation, squatting will force the knee forward and exposing it to an increase compressive load at the patellar ligament. There are many other examples of the knee s poor adaptation to its neighboring joint s lack of mobility or stability. Recommended stretches for optimal knee function and hip balancing. Hamstring stretch: Elevate your foot onto a bench, or chair. Perform a pelvic tilt by arching your back towards the opposite wall. Increase the tension of the stretch by pushing your chest out and forward, pushing your butt back and not, by reaching down to your leg or foot. Quadriceps stretch: (If overly tight, these muscles can compress your knee joints) Place your foot on a bar, bench, or chair, or simply grab it with your hand(s). Maintain the alignment of your thigh with your belly-button. Perform a posterior pelvic tilt until you sense tension in your quad muscle. Bend the other leg enough to lower your pelvis to place tension on your quad muscle. Maintain these two adjustments throughout the stretch. 6

7 Ilio-psoas (Hip Flexor) stretch: (Right hip:) Kneel on right knee, place your left foot diagonally out, wide enough to support a weight shift. Your feet should be squared to the front. Perform a strong posterior pelvic tilt. (Maintain this adjustment) Push the top side of your head up towards the ceiling- with an extreme effort. Finally, push your hip forward by contracting your glute muscle, and maintain a pelvic tilt with an extreme effort. Rectus Femoris Stretch: Relieving the tension from this muscle will help with resolving any pain that eminates from the front part of the knee cap (patella-femoral syndrome) Kneel on right knee. Grab the right foot with the right hand, and pull towards the outer aspect of your right hip. Ensure you are beside a wall to maintain your balance with the other hand. Perform a strong pelvic tilt (posterior). Remain tall through your trunk. Lumbar erectors stretch: The lower fibers of the erector spinae muscles are a close second in creating the lower cross syndrome. Seated on SITS bones, spread your legs slightly wider than hip width. Extend both arms in front of your chest, locking out your elbows. Fully extend your wrists, fingers, and hands. Turn your arms outward (external rotation), turning your thumbs out. With an extreme effort, push through the long axis of your arms, through the heel of your palms. Slump your lower back by performing a pelvic tilt, with an extreme effort. TFL stretch ( stretching this muscle will help relieve I-T band syndrome or pain on the outside of the knee) Wrap your right leg around the front part of your left knee. Make sure the back of your right knee makes contact with the front of your left knee Remaining tall, bend your left knee and shift your weight through your hip to the left. You should feel a stretch on the outer part of your hip- this is the gluteus medius muscle By turning your left foot inwards slightly to 1 or 2 o çlclock, you will feel the stretch now in your front pocket area. This is the TFL muscle. Hold this stretch for 5 seconds, switch legs, and repeat for both legs 12 repetitions. Switch legs. References Be sure to submit your address on the sheet so I can send your videos on the proper stretching of postural-tight muscles. 1. Advanced Myoskeletal Techniques. Dalton, E, PhD. Second edition Excerpts from Your Body Back to Balance Seminar, River Oaks Community Centre, Oakville, ON, Kapanjdi-The Physiology of Joints. Vol

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