Archive for April 2012

Strong Back and Improved Posture

Proper Posture and Strength

You need to have sufficient strength in order to have good posture.  Many people put the cart before the horse.  Here I am referring to thinking that you just need to work on your posture.  How many times have you seen people (most of us) just try to sit better and in seconds to minutes find ourselves back to a comfortable slouch.  Ouch!  On the other end of the spectrum there are many who are really strong and their posture is abysmal.

We need to work on this from many perspectives.  Here we will start with assuming that you want to improve your ability to sit better and longer (with less pain and discomfort–looking beautiful, etc).  Alright, once you have a goal that will allow you to train this aspect, we can start.

Problems

  • We complain of back pain when sitting
  • We often do not have the muscular strength and endurance to sit properly.
  • We often over correct at the thoraco-lumbar region (the area where the rib spine meets the lower back)
  • We don’t have the proper guidance for proper sitting
  • We do not practice regularly

One of the biggest problems and complaints that I hear regularly about sitting–is the discomfort one gets from trying to maintain the proper position.  This is certainly true for those doing sitting meditations.  This group of folks usually know that proper sitting will allow them to breath properly with the diaphragm.  Good, deep diaphragmatic breaths will allow the body and mind to begin to settle down.  Good posture definitely facilitates this diaphragmatic style of  breathing.

Those not meditating can still benefit greatly by taking a very similar approach.  If the spine is erect and the shoulder and pelvic girdles and associated limbs are positioned well, it is much easier to have a sense of ease in this position.  You will find that the better that your body alignment is the better and more comfortably you can sit.

We can find out how to sit better.  There are many pictures of the ideal out there.  But sitting is a very dynamic activity.  The body that cannot sustain the activity returns back to it’s default posture of usually being slumped.  Then we often try to correct our sitting by straightening our spine from the mid to low back region.  This over activates the back extensor muscles that many complain of during their good intended corrections.

Strengthening the Upper Back

There is a video below that will go into a bit of the detail to help with strengthening this upper back area.  I often teach someone to work with a pivot prone or candelabra position or simple called the New York position.

This exercise with a mini-band is quite helpful.  The one thing that is good here, is that the mini-band can travel easily with you in a pocket, bag or purse.  Frequent use of it is helpful in retraining the movement pattern.  What I have found is that people still are way too weak in the upper back area to help in postural retraining.  The following video is another way.  I also have been using these 40 inch long and 1/2 inch wide cords for a pretty good test of the upper back.  It allows me to standardize what I expect now with most people.

In the video you will see this pulling apart motion of the band.  Watch carefully the testing protocol.  It is simple, but do not re-grab the band in a different way.  It is the wrapping of the band around the thumb and hand that really asks for a lot of external rotation and scapular stabilization.  This position is with the arms away from the body.  I am finding so many people are extremely weak in this pulling motion.  They all are so much stronger in the pulling motions that mimic a row.  Rowing strength does not seem to be a correlate for proper upper back strength in posture.  Remember the the lats are internal rotators of the arm.  If you row, you get better at rowing type movements.  Proper posture of the upper back requires external rotation of the upper arm and strong and enduring scapular stabilization.  This means the mid and lower trapezius fibers and rotator cuff must be activated in a particular manner and direction.

Also for you folks who do mainly asanas for your exercise, you really lack pulling strength.  There is an overabundance of forward pressure with the upper body in asanas.  There is an absolute lack of pulling strength in asanas.  (so much for balance, heh)

Of course proper mobilization of the thoracic or rib spine into extension is quite helpful.  Also evaluating for an improper head and neck position is critical.  There is much work to be done.  Remember that strengthening has to be coupled with proper retraining of ones postural habits.  Postural habits can be influence by a large number of other factors to include:  psycho-social, cultural, medical and other biomechanical issues.  Our work has just begun.

Video of Strengthening the Upper Back and Improving Posture

Conclusion

Go have some fun training this upper back area.

I have used many companies to purchase bands from–below is a listing of the three most popular ones I use:

  1. PerformBetter.com—-You should see the Superbands listed–I’d buy 1/2 and 1 inch sizes
  2. ResistanceBandTraining.com
  3. IronWoodyFitness.com

Start your training and let me know how strong you get.  Now if you practice your posture, do you find it much easier to sustain it?   Now that’s skillful training.

Best of efforts–peter

Shoulder Rehabilitation

Shoulder Rehabilitation

Recently I had the opportunity while in India to work with a variety of people.  In the video that follows, this person was well recovered from a fracture of the proximal humerus.  They were still experiencing pain upon end range movement.  Here we will look at only one of the functions that proved bothersome–overhead movements with the left arm.  Their range of motion in this direction (shoulder flexion) was fairly good, though lacked the last 10 degrees–which were also a bit painful.

One thing to check is to see if the shoulder blade is participating sufficiently in these movements.  Since stretching of the arm overhead proved painful and since her prior rehabilitation had taken her in this direction, I thought we would explore more approximation or pressure into the shoulder joint.  (and this compressive movement was not painful and helped her to improve)

This concept of compressing the joint in these weight bearing positions that you will see in the video is a very good alternative for improving pain free terminal flexion.  Often in hatha yoga where there is today and emphasis in stretching, the stability work that is needed is often marginalized.  (This post is not about yoga but focuses on a case example of rehabilitation).

Another important aspect here is the emphasis on testing before and after exercises.  This testing can be accomplished quickly and easily before and after your session.  You will see it at the beginning of the video.  It would be wonderful if people found out things that they could not do easily and then determine the exercises that would help them function better (i.e. less pain and more gain).  In other words don’t just perform a bunch of exercises without seeing if they are appropriate and giving you the results that you want and need.

Also this is not a complete program, it is a first example of where one might start out in their journey of recovery.

Lets take a look at the video:

 Mobility

You can see there is not an emphasis on stretching out the shoulder at this point.  The place that we try to increase mobility is at the thoracic spine or rib spine.  This associated area of the middle back is often left out with rehabilitation of the shoulder.  Of course one should test the ability of rotation to take place here before prescribing the exercise.  Do note how much shoulder mobility is asked for in the down shoulder.  For some people you will need to support the space between their armpit/rib area and the floor.  For some people, without using the support–they will have too much stress on the bottom shoulder in flexion and abduction–they will not be able to relax or benefit from the spinal rotation.

It is interesting to note that in the side lying movement of reaching and rolling of the upper body–this person had difficulty in stabilizing the pelvis and lower trunk while accessing the middle spine area.  Again this difficulty is fairly typical.  We often over move from the lumbar and pelvic area especially in the side lying position.

There are many variations in sidelying that can be very helpful here.  This is only one of them.

Stability

From the above instability of the pelvis and lower trunk, you can see that this area will need to be addressed in follow up routines.

Notice the weight bearing aspect of being on hands and knees and prone on elbows (supported cobra asana).  These are just excellent positions to stimulate the shoulder complex and begin teaching stability.  Always consider there to be 3-5 ways to regress and progress any exercise.  That gives you a much wider appreciation of the functional relationships that are involved in rehabilitation.  It is also quite a challenge to come up with this range of movement possibilities.  This challenge is mainly for those who are teachers, trainers and therapists.

Conclusion

Do try out some of these movements.  You will find out that working with the mini-bands in the prone on elbow position can be fairly challenging.  Many people are quite weak in external rotation when the elbows are away from the body.  This variation opens up so many more ways to activate the rotator cuff musculature and the scapular stabilizers than just the standard “cuff” exercises with the elbow fixed to ones side.

This routine is only a beginning.  I hope it will be a continuation of the progress that has been made.

Best in Training–peter