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The Best ways to release tight shoulders

As addressed on our previous blog there are three main reasons why shoulder tightness develops

but…

How can we release tight shoulders?

1. If the problem is that the Chest muscles become overactive:

The pec minor muscles can become extremely tight when we spend countless hours sitting down. Habitually being in this position: sitting in cars, in front of computers, or the tv etc. leads to the muscle pulling the shoulder blade forward and eventually limiting full shoulder range of motion.

What to do?

                Activate the weak muscles that will limit chest compensation. It can be achieved through a sequence of posture Angel exercises:[if you are sitting constantly at your job try to put an alarm to do this sequence of exercises]

Start on the floor and week by week challenge your body to be able to do it seated against the wall:

 

2. Lat muscles become overactive:

Lats (lattisimus dorsi) tightness will limit shoulder mobility. Lats usually become tight when there are previous shoulder injuries, or the rotator cuff muscles are weak and the Lats have to compensate for this weakness.

How to know if your  Lats are the problem? here

What to do?

                If you have shoulder pain, get it treated through chiropractic care and soft tissue therapy.  Follow a protocol to strengthen the rotator cuff; incorporate internal and external rotation exercises to create a more stable shoulder: Shoulder Strength

 

Poor Mobility of mid back: Thoracic extension

This is actually the most common cause of shoulder impingement and tightness. Many people have lost the ability to extend their mid-back. This is because A: we sit too much, and B: our head is so much more forward that our mid back becomes rounded

 

What to do?

                Correct your posture, sometimes taking care of yourself does not have to be limited to when you are in pain, getting a chiropractic adjustment and making it a goal to correct your posture will lead to longevity of your spine and joints.

What does chest pain imply when is not heart related?

Most of the time chest pain is not due to a heart attack

Having chest pain is not something that anyone takes lightly. Most people’s reaction to experiencing chest pain is that of a frightened response: a heart attack. However, most of the time the chest pain that is experienced does not come from having a heart problem. Instead, it is due to rib cage misalignment and muscular tension.

Today we are going to cover where this pain comes from and what we can do to not only heal it but prevent it from happening. Pain in the chest that comes from the rib cage usually presents in the front of the chest over the sternum, or on the back between the shoulder blades.

It can be scary to have these symptoms. One way to know if this pain is due to joints and muscles is that if you move in certain patterns the pain quality changes: it either makes it worse or better. If the pain is constant and no movement changes the quality of the pain then it can mean that is something more serious.

Important things to rule out with chest pain besides a heart attack are pulmonary embolism and aortic dissection. A heart attack needs to be ruled out when it comes to chest pain.

Many people end up in the emergency room but are told that they just have a muscle spasm. Patients with chest pain go home from the ER or hospital with no definite diagnosis. Although this is considered good news, the pain can persist and if not addressed it can become quite chronic.

Where does the pain come from?

Rib cage pain comes from poor breathing patterns most of the time. There are two primary ways we tend to breathe. One way is when we use our chest for breathing so we elevate the rib cage by using our chest muscles. This pattern of breathing is inefficient it results in minimum breath into the lungs because we use the small muscles between the ribs rather than the diaphragm.

Belly or stomach breathing is the most efficient way to breathe. It uses the diaphragm to expand space so that the lungs receive the maximum volume of air.  Learning how to breathe into the belly instead of shallow chest breathing has many benefits. It has been shown to reduce symptoms of asthma and bronchitis for example. It reduces the muscular tension between the ribs and therefore it prevents the rib cage from misalignment and therefore pain.

How can the pain be treated?

When the rib cage is misaligned it can be corrected through chiropractic adjustments so that the pain subsides. Many times soft tissue is used to release the diaphragm and therapeutic exercises are utilized to re-train breathing patterns.

In practice, we teach patients different drills so that their breathing becomes more effective.

 

 

The Actual Cause of Sciatica and why Sciatica is not a great diagnosis

Getting the right diagnosis for sciatica is the key to a proper and effective treatment.

What is Sciatica?

Pain traveling down the leg caused by nerve irritation is a condition that is commonly seen in chiropractic clinics. The sciatic nerve originates from the low back and it travels down the leg all the way into the heel. When people present with this type of pain the most likely “diagnosis” is sciatica.

However, sciatica is not a true diagnosis because it only describes the symptoms.  Pain from irritation along the path of the sciatic nerve.  The diagnosis does not address the actual reason why the sciatic nerve is irritated. Unless the cause is addressed, sciatic episodes are bound to continue

There are 3 mainstream accepted causes of sciatica:

  1. Disc Bulge and/or Herniation
  2. Bone Spurs and Disc degeneration
  3. Muscle spasm/contracture that pressed down on the nerve

Have you been told that your sciatica is due to a Disc Bulge or Disc Degeneration?

Disc degeneration is a common occurrence in our population. However, the majority of people with disc bulges and degeneration have no symptoms. Systematic reviews of imaging (MRI) of the lumbar spine in people with no low back pain or sciatica found that most people who had disc bulges had absolutely no symptoms.

The question then is…

Why if most people show some type of disc herniation do some have pain like sciatica and others do not?

The real reason that some people develop sciatica and others do not is that the nerve and disc are irritated by the way we move not by the fact that there is a bulging disc in the spine.

It is the position of the spine through movement that causes the irritation and sciatica to flare up. If people have the proper alignment and core engagement: when they are walking, running, bending forward or moving objects – the spine does not cause a compression on the disc, thus preventing it from irritation and pain.

In clinical practice, we use the McKenzie test to determine if the root of the pain is actually due to the nerve being irritated from the spine instead of the hips. This test allows us to observe the movement of the spine as the core is tested for engagement.

Piriformis Syndrome: It might be at the hips

Once spine involvement has been ruled out as the culprit of the pain we examine the hips. One of the hip muscles that will cause sciatica-type of pain is the piriformis muscle. The nerve travels below this muscle and if the piriformis is too spastic it will press on the nerve and cause a shooting type of sensation. Usually, carrying body weight on one side more than the other will cause the muscle to be spastic and therefore irritate the nerve. Alignment of the hips, as well as re-training of the hip muscles, will lead to positive outcomes when it comes to piriformis syndrome.

Finding the root cause is the first step towards an effective treatment.

The Often Missing Piece of Core Training

The ability to activate the core muscles during movement is perhaps the most vital factor in keeping a healthy spine. Countless of clinical studies have been done to determine what really causes low back pain and how it can be prevented, well it turns out that the main reason why people injure their backs has not so much to do with what they are doing but more importantly how they are doing it.

Sometimes due to the level of injuries on the low back, many practitioners advise against certain movements, specific exercises that are believed to be “high risk” like squats or deadlifts.  However, this really goes against what the studies show because it is not a particular movement that is to blame for injury to the low back. The injury is caused by the quality of the movement. In other words, it is how poorly we move that causes pain. Our body was designed to move, but if we do not know how to use it properly it will signal pain as a response.

That being said, it is our core activation that dictates the quality of movement, and therefore the health of our spine.  Now, most people think that a strong core is a solid visible set of 6-pack achieved by crunches, ab roll outs, and planks; however, this is a very common misconception. The visibility and definition of a muscle have nothing to do with how strong it is. A patient can have a very strong core and not show one single abdominal muscle.

Another common misconception about the core is that it can be trained effectively during isolation movements. However, it is important to keep in mind that we are not training our core to gain “strength” in those muscles per say.  We are training to learn how to active the core throughout a movement.

These are two completely different concepts. The use of core exercises like planks become valuable to the extent that we can develop an understanding of what it feels like to active the core,  how to do it, what it should feel like.  However, they have little to no purpose if we don’t have proper core activation.

The case of having great core contraction on isolation exercises like sit-ups and planks but poorly being translated into a healthy spine is far too common.  The reason is that the main function of the core is misunderstood and therefore ignored during training.  The main function of the core is not to help us sit up from a laying down position (like in a crunch), but it is actually breathing.

How we breathe is dependent on our ability to use our core, specifically the diaphragm.  If we breathe the correct way by engaging our belly muscle (the diaphragm) then we are using our core on a consistent basis, if on the other hand, we use our chest to breathe then our body hardly ever uses the core and therefore it forgets to use it. Especially, as we try to move whether that is through loaded exercises like squats or when we try to bend forward to pick up an object.

Activating a strong core has more to do with our breathing because that is its main function. As we have pressure built up in our belly from breathing, the spine is protected as a side effect.

Here is a common test we use in practice to test core activation:

We ask the patient to lay down face up, and we bring the legs up to 90 degrees, placing our hand beneath the low back we ask the patient to lower the legs in a controlled  manner, poor core activation will be noted as the patient tries to arch their back to control the movement losing contact/pressure over the testing hand.

 

Checkpoints for a Better Squat

I do not think there is another exercise as complete as a squat. We use it in practice every day to assess mobility, stability and core control from our athlete to our non-athlete patients; we see it as the most complete test of functional movement.

Progressing on strength and form takes focusing on the weakness or limitations that prevent someone from achieving good form.

We use a set of checkpoints to help improve form and prevent injury

Here are some of the common faults and what these typically mean when done improperly:

  1. Lack of Ankle Mobility

Do we have the mobility to approximate our shin to our toes?

 

This is where we typically start, without proper ankle mobility, the depth of the squat and torso control are compromised.

  1. Knee Mobility- How close can we approximate the calves to the thighs?

  1. Hip mobility- Can we flex our hip to approximate our chest to our thighs, without torso flexion

  1. Lack of Core Control, Engaging our core and having proper thoracic extension are the most important part of the squat, as these keep the spine from flexing and causing injury. If both of these areas are addressed and the patient still presents with a slight rounding of the low back and pelvis aka “butt wink”, we then delve further into the mobility of the hips in all ranges of motion.

  1. Engaging the glute medius to keep the knee joint and hip joint from rotating throughout the movement, the most telling sign that someone has lack of glute medius activation is the deviation of the knee throughout the squat.

 

 

There are different things that can be done to assess and correct the squat. We understand that although these are common patterns, it is important to evaluate each patient in an individual approach to design the best treatment and programming for ideal results.

 

 

 

 

 

Why does your Hip pop?

“Clicking” and “popping” joints are generally disregarded as insignificant by many practitioners. However, we want to shed some light on why joints should not “pop” and what to do about it if you have snapping joints.

Ligaments and tendons create stability and support for the joints of the body. Snapping hip is a condition in which a “popping” sound is heard through movement of the hip joint. The sound is produced by a lax or overstretched ligament as it displaces on top of the bone. “Clicking” noises indicate that the joint is unstable and not completely supported, which leads to extra wear and tear of the joint. Sometimes it presents with pain and eventually will lead to instability and injury.

Ligaments usually take a longer time to heal on their own because of limited blood supply in comparison to other tissues.

There are 4 common types of snapping hip:

  1. Side Hip Snapping: usually this is caused by a lax TFL (tensor fasciae latae) tendon. Some people might want to stretch their IT-band or foam roll the side of the leg since it usually presents with a feeling of tightness over the area. Yet we do NOT recommend doing this since the ligament is already lax or overstretched. Instead, we suggest focusing on re-setting or adjusting leg length, rehabbing the tendon and creating greater stability on the glute medius. Favorite Exercise: Clam shells and body weight lunges.
  2. Front Hip Snapping: the quadriceps and hip flexor tendon runs from the front of the thigh to the pelvis. When lax, it will cause the hip to snap in the front. Deep soft tissue over the hip flexor area works well to release some of the spasms that cause laxity on the tendon. Moreover, to create a more stable joint, the psoas muscle should be targeted. Strengthening a weak psoas muscle, which is a major hip flexor, will help heal the tendon faster.
    • Test your Psoas Strength: Stand with your back against the wall, raise one of your legs with a 90 degree knee bend at the hip crease and hold it for at least 30 seconds. Test both legs and if either of them is shaky or you are unable to hold it for that long, it would be considered weak.
  3. Snapping on the back of the hip: a lax hamstring tendon can cause snapping at the back of the hip. This is a presentation commonly seen with a previous hamstring sprain/strain that never quite healed properly. Deep soft tissue, to increase proper healing, is a must for the chronic relentless injuries. Chiropractic adjustments are utilized to create better stability on the SI (sacroiliac) joints. We also focus our rehab with isometric and eccentric holds on the hamstrings. Favorite exercise: Eccentric Glute-ham raises or Nordic curls.
  4. Intra-Articular Snapping Hip: this is the most complicated and serious cause of snapping hip. It could be caused by an acetabular labral tear, which can cause pain in the groin area.  Injury to the cartilage can also lead to snapping hip.

The best way to determine the cause of a snapping hip is to do an exam by a qualified healthcare practitioner. Most of these diagnoses can be treated with chiropractic care and physical therapy. It is important to address a snap in the hip as it eventually leads to instability and injury.

Hip Hinge and its Relationship to Low Back Pain

hiphinge

 

Hip Hinge is the name given to describe the maximal range of motion achieved through a hip bend with minimal knee bend.

 

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Hip Hinge is a movement that is used on exercises such as deadlifts. More importantly, it is a movement that protects your back from getting hurt when picking up objects from the floor. One too many times we have patients walk in saying, “I just bent forward to pick something light up and it felt like my back went out.” We can usually imagine that as the patient bent forward to initiate the movement, there was almost no use of their hips in the process. In fact, our lower backs are not meant to carry the weight from a forward bent position. Not during normal life activities and especially not during exercises like deadlifts or kettlebell swings. Instead, we should rely on bigger muscles, our powerhouse posterior chain: the glutes and hamstrings to execute the movement.

There are different reasons why we do not hip hing

e as we bend forward. The most common reason is that we lack the mobility or range of motion to get there. Although it is a natural movement that everyone should be able to perform, most of us, due to lack of activity or sitting too much, have to re-train our body to learn the correct movement. Another reason why this is so common is that we never do it; when we do not do something regularly we lose the ability to perform the movement. What makes people even more prone to injury is when they keep using the same incorrect pattern of bending their backs under load instead of creating a hip hinge. Whether that is lifting a heavy object or performing deadlifts for reps, with an improper form it just leads to back pain.

How can we improve the Hip Hinge?

You always hear “use your legs” but what does that really mean and how do you engage your legs without overstressing your low back?
First off, I always start my patients off with the cue “weight on your heels”. When you feel your weight on your heels, you will have more activation of your posterior chain (glutes and hamstrings).

Secondly, you must be reminded that as you bend forward there should be minimal knee bend. This is not a squat. Once you bend your knees, you lose tension in your hamstrings, glutes, and your low back musculature wants to compensate for the slack. Think “soft knees” not fully extended knees.

Thirdly, keep your “chest up” or lead with your chest, this will help to prevent a rounding of the mid and low back spine, thus keeping tension on your strong posterior chain.

Lastly, think, “Press your feet into the ground” as you stand up instead of, “Pull the weight off the ground.” When you shift focus to your feet, you will be less likely to use your upper body to initiate lifting the weight off of the floor.
For most people it takes doing some drills until the movement pattern is achieved.

Here are some of our favorite drills:
1. Use a PVC pipe:
standingpvcpvc

2. Use a bench in front of your knees to limit the knees shifting forward
standingbenchbenchhip2

3. Bar only RDLs
standingrdlrdl2

4. Back wall touches
standingwallwalltouches

Why you cannot build performance on top of pain

When it comes to exercise, there are some thresholds of discomfort we should surpass if we want to enjoy the results that come from training. Pushing limits of being uncomfortable to reach new levels of mental and body strength will lead to general good outcomes.

However, there are some signs we should NOT ignore if our actual goal is to improve in performance. Pain is one of them. We cannot build performance on top of dysfunction; eventually, it’ll just lead to cycles of injuries and setbacks. Imagine trying to build more stories on a building with bad foundation.

There are ideal movement patterns for all exercises and for different types of bodies. If a dysfunctional movement pattern is developed over time. For example: preforming excessive low back flexion on a squat. Adding more weight or load to that movement will not bring strength without dysfunction.

Similarly, if you cannot fully flex your shoulders to be in alignment with your ears without bending/extending your back, the problem will only worsen if you add weight to overhead movements. The bar will continuously end up in front of the body or cause excessive extension on the low back.

Once used to an exercise regimen, it’s common to see an unhealthy pattern of people endure or “put up with pain” during certain movements. It’s what we sometimes call “tolerable pain: it hurts when I deadlift but it is not too bad”. Instead of being a struggle to have to deal with aches and pains, it becomes a struggle to lower the weight or learn the reason behind the pain.

This is the reason doing screenings of movement patterns give an advantage beyond just treating and preventing pain. If performed with clinical accuracy, it has the potential to improve performance.

Most of us associate pain with a sign that something is not functioning right, but many are unaware that pain shows up after 60% of function has already been lost. Therefore, we can continue to move incorrectly and not present with any actual pain until the repetitions are one too many. It is then that the pain presents but the dysfunctional pattern had been there all along.

Moving beyond a mentality of Pain

We aim to help our patients create a mentality that goes outside the cultural accepted belief – that only when the body hurts is when it requires attention. Definitely the first goal of any treatment is to relieve pain. However, a complete treatment aims to address the actual cause which can be almost always linked to poor movement patterns developed from muscle imbalances, less than ideal spinal care, improper muscle activation etc.

To transition someone from pain into performance is our ultimate goal. Creating a consciousness of actual health and well-being that extends beyond injuries and leads to reaping the results of dedicated training.