Archive for Physical Therapy

Exercise in the Office

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The Office Slump

OK, so we all don’t look that bad (or cute) sitting in the office.  But isn’t sitting pretty different from moving?  Of course it is–and this is one of the great problems in sitting.  The side effects of how we sit and and the amount of sitting that many of us at the office do is very detrimental to our health.

Problems with Sitting

First of all we are sitting too much and moving too little.  So one way to deal with this problem is to change positions frequently and go take a break.  (There is an excellent video on how to sit that was posted in the past.  We will not cover that topic here.)

Also sitting often in a slumped position changes our breathing options.  We breathe in a more shallow and irregular manner.  We don’t energize our system with proper deep diaphragmatic breathing like we would if we were moving more.

Sitting in a chair all day or a good number of hours shortens our joints and surrounding tissues so that our body starts to resemble this fairly bent or flexed posture.

Most important here is that our nervous system adapts to this static posture and we actually loose options to move and feel.  This effect bores through many more systems than just the so called musculoskeletal system.

Sounds terrible, yet why don’t we change our behavior?  We naturally resist change.  We really operate and behave based on habits.  Changing habits is not easy as we all know.  Without a good reason and without a practice–we just will continue in our habit.

There is nothing another person can do for us.  We have to make our own assessment of ourselves.  Ask ourselves if we want something different.  If we do, then discover a deeper reason for change and then start a practice that supports these differences.

Office 5 Exercise

You will feel better and be more alert at work if you body, breath and mind are doing their full job.

Here is a video that shows you several simple exercises you can do without leaving your chair.  How easy is that!

Explanation of Some of the Exercises

Are you still sitting while reading–I’m sure sitting while writing.  How long has it been since we changed our position and took a break.

These movements are very effective in creating the difference our system needs to reset itself and receive the benefits of movement (and decrease the negative sitting effects).  Feel free to modify them

  1. The first movement stretches the spine like a cat.  It uses deeper breathing as a focus that follows or leads the movement.  This forward and backward arching of the spine is a primary direction that is strongly embedded in the nervous system.  By altering in a rhythmical way this powerful direction, you will strongly turn up the nervous system while you counteract the forward posturing from sitting.
  2. The second exercise opens up our hips–which is so important in establishing a proper sitting foundation.  These split leg movements done on the chair are very accessible to all (unless there are arm rests, oh well).  The extension and stretching of the rear hip is very helpful to balance out the prolonged hip flexion that is required by sitting.
  3. The third is simple a progression of the second.  You add a bowing of the body to the side.  This sideways direction is quite stimulating as we are often just stuck in a forward direction in sitting.  If you again work with the breath as you expand the lateral/side wall of the chest, you will also expand the breath.  Remember deeper breathing is better breathing.
  4. The fourth exercise uses twisting.  Now we all have heard of the dangers of twisting the spine while it is bent and flexed.  This is very true in overstretching of the lower back or lumbar spine.  Here the split leg position will often counter rotate the pelvis and you should try to work on twisting from the chest and not the waist.
  5. The last exercise is just fun.  If you do it so that you keep your chest (and weight) over your hands and bend your elbow a bit, it will really exercise your trunk and upper body.  In sitting we don’t do anything to express the upper bodies system–keypading and mousing do not count  : o )

Some times you will find yourself just stretching in you chair.  Great idea.  Try just turning in your chair if doesn’t have arm rests and go into that split leg position.

I’m sure you can figure out other variations you could do as well.

Key point here is to do.  So right now try out these movements and see if you don’t feel better.

Stop Neck and Back Pain

What is Going On?

Things were much simpler when we were younger–do you know what I mean.  Now days we are looking for the cure of our ailments and troubles of the world.  Well stop right now and open a different book or URL than what you are reading at this moment.

What we can do here?   We can look beyond what we are noticing as far as the pain.  Pain in a chronic area of the neck and/or back is poor prognosticator of the problems location.  Always consider the adjacent body areas in figuring out what to address in correcting and alleviating this common problem.

Basic Anatomy

Our spine is an interesting and integrated structure composed of three primary curves.  Most people who have neck (cervical) pain or lower back (lumbar) pain do not think of the thoracic spine.  This thoracic spine is conveniently “surrounded” by the neck and lower back spine.  This arrangement of the anatomy is a key in addressing these pains.

Remember the spine operates as an integrated structure.  This means that each area is functionally related to the others.  You must not just think that the anatomical structure as the cause of the pain–follow the connections.

Advice for Stopping Chronic Neck and Lower Back Pain

Let’s be practical here.  First you should have had a thorough medical and movement assessment.  This means that if you are having chronic pain (longer than 3 months) you should get medically cleared by your doctor.  Next it would be great to have a qualified Physical Therapist or movement expert screen and assess how your structure is moving and working.

Often in my practice I find that the thoracic area is really neglected.  It becomes stiff and a poor transmitter of spinal forces.  The areas of the cervical and lumbar are performing way too much work (many times this is in one or two directions though).  Remember the place that is complaining is certainly not the only place that should be looked at.  A myopic view of pain often distorts the larger view of functional relationships of important adjacent regions.

Exercise Approach

One simple set of exercise you can immediately start is shown below.  Here you are using sidelying to work on moving and mobilizing the thoracic spine in a variety of directions.  During these movements you are learning much more than might be evident.  A primary direction of movement is in rotation or twisting.  During this twisting of the chest you are learning to stabilize the lumbar area.  Over time you will get a very good sense of how much we over rotate the thoraco-lumbar to lumbar area.  Therefore you can appreciate how under used the thoracic are becomes.

Also you can use a foam roller very nicely for this thoracic area.  The below video emphasizes thoracic extension.  There are many variations.  One not shown is just to use the roller to massage the back muscles here.  Most people find it very useful.

 

 

There You Have It

Try these ideas for a chronic problem with your neck or lower back.  Go slowly as with anything different or new.  Don’t try to perform the exercise.  Rather use these as movements to explore your own body and what you are noticing.  Your job here (should you accept this “Mission”) is to make a change by feeling something you haven’t felt before.  This work should be in the direction of making you more comfortable and more freely moving.  So use these movements as guidelines and not just a prescription of “exactly” what to do.  That being said, please try it out this way for several weeks before you become too creative.

Remember to work with your breath once you have the basic movements.  Stay in this sidelying position for awhile–you will be greatly benefited by putting in 15-30 minutes.  These longer times really benefit from proper diaphragmatic breathing–this type of breath is not the belly expansion but the sides and all around the lower rib cage.  There is an extremely important relationship with the breathing and the thoracic spine.  It is a much more detailed topic than will be covered here.  It is one of the keys to unlocking chronic pain.

 

Train and practice daily.  Go and try out these movements.  Write to me what you have learned.

Ouch! My Back

Geez My Back Hurts (again)

Low back pain can be very frustrating.  Make sure you rule out any medical condition that may be underlying these symptoms.  The next issue is to get a proper mechanical evaluation.  Sounds practical but a lot of us are not getting the proper evaluation.  So the help offered becomes anecdotal and lucky at best.  Does this treatment or that treatment work best?  What should I do to get better?  Nothing seems to work, Egads!

Evaluate the problem

We often start with some type of complaint.  In this case–my low back is hurting.  If it is a chronic problem make sure you have looked at more than just mechanical problems.  As said before, get clearance from your medical practitioner at some point.  Also life style plays an enormous role here.  Do not under value things like proper sleep and nutrition.  Much more could be said on this but it will have to wait till later.

Mechanical evaluation

Here I am thinking about movement of the body through space.  Specifically we pay attention to the pain most of the time (and sometime all the time).  We need to also look at what movements and/or postures worsen and lessen the symptoms.  This question of what (movements) make it worse and better are critical to evaluating and then re-evaluating this type of condition.

Simple categories can give practically anyone some guidelines to finding ways to change this condition.  One of the most popular underlying reasons for Low Back Pain is related to flexion problems of the spine.  I will try to keep it fairly simple here or make it as easy for myself to explain one of the popular scenarios we see today.

Flexion problems mean forward bending and sitting that causes an increase in the low back symptoms.  In this post, that means that the opposite direction of extension or straightening of the spine does not cause pain and/or alleviates it.  So one will usually notice that they are worse during or after sitting or when they lean forward to write/shave/clip toe nails, etc.  Often they are better if they walk around or lie down flat.  There are many variations to this problem and a good evaluation will figure it all out.

A good test that I include in my evaluation is a standing flexion and extension test (among many others).  For this example, let’s say that in standing, you try to bend forward keeping your knees straight.  Notice how far you bend before you first feel an aggravation of your symptoms.  Note the distance down the leg you are able to reach and remember it.  Repeat it a few times just to see if movement and symptoms  improve, worsen or stay the same.

Again to keep it simple, let’s say that when you bent forward you were limited to reaching 4 inches below your knees before you said, “Ouch” (meaning it worsened your symptoms and you didn’t want to reach any farther).  Now you have a movement paired with your symptoms.  This is very important.  This will become your simple re-test when you decide on a treatment.

A proper evaluation will include more movements to better determine what to do and what to not do.  Again the evaluation is critical and the first step.

Strategic Perspective

Now if you find yourself seeking treatment before you have done a proper evaluation, you will do yourself a disservice.  Do not ask what exercise should I be doing until you have enough information related to movement.  Exercise is not magic.  It is movement based to help alleviate the stresses and strains of both pre-existing and current problems.

It is interesting to note that many pre-existing conditions (i.e. in this case a movement dysfunction) can go undetected for years without seemingly causing any problems.  Once you have symptoms, especially chronic ones, you need to deal with many of these pre-existing conditions and patterns.  That’s why it is so important to have a regular program of practice where you are always working with yourself and making discoveries and changes along this route of your movement in life.  Otherwise we get caught at these stressful times of our lives without the proper tools or even the time to work on these multi-layered problems and movement dysfunctions.

Treatment

So if in this case let us say we have someone who is flexion intolerant.  This means as said above, that bending forward activities or postures aggravate their symptoms.  So one approach would be to do backward bending activities.  This makes a lot of sense.  This simple advise would also include to stop doing or curtail/lessen the flexion activities and postures.  Also one would find it very difficult to stop sitting all together.  Then another strategy would be to do things that neutralized the effects of the flexion pattern many times throughout the day.  One can use a combination of many of these strategies.  They don’t all have to be used all the time.  Many of us find a limited amount of time and focus for these practices.  So be practical.  Some days rotate in the things you were not able to get to on the previous day.  Always do something everyday.  Just modify it.  Your retesting will show you if you are doing enough, too much or something needs to change.

Now in this case the evaluation showed some adjacent areas of mechanical dysfunction in the chest or thoracic spine.  Also there were movement dysfunctions in the frontal plane (side to side movements vs the sagittal plane–forward/backward movement as described previously) of the hips and lumbar through thoracic spine.

An interesting note is that sometimes you do not want to start movement exercises  in the place of the reported symptoms.  It could be that a person is too irritable.   It could be that greater movement dysfunctions exist in adjacent areas.  It could be that through experience in certain cases one has found it better to start in these non-traditional areas.  For a variety of reasons, we will be starting at increasing mobility of the adjacent areas (i.e. the thoracic/chest spine) and increasing the stability in the local and symptomatic area (i.e. the lumbar to hip area).

We will work at the start in the sagittal/front to back plane.

Here in the below video we start with prone lying on the belly/chest area first.  In asana work this position is called Makarasana (crocodile pose).  It is an excellent rest/restore and recovery position.  The position in this case eases the symptoms and the diaphragmatic breath is just an excellent support for healing.

Next when one props up on the elbows, there is a further exaggeration of the backward bending nature of the spine.  Remember that this position of backward bending does not aggravate the symptoms.  But look in the video and note that the person finds it a bit uncomfortable.  We do not eliminate the posture but just modify it with supportive pillows based on his symptoms.  We always have to be ready to listen and modify based on movement and symptoms.

Next we work in the  frontal and transverse (rotational)  plane (exercises shown in side lying).  Quickly we will using all the planes as it will be part of the demands of some of the movement re-education patterns/exercises.

Here in the below video is an interesting way that seems to be very helpful for a variety of mobility problems in the thoracic area.  I have used this position for neck, shoulder and back symptomatic problems as they relate to movement dysfunctions of this chest/thoracic area.

As you watch the example of the below video keep in mind some of the above information.  It is only one approach.  There are many ways to start.  My point here is that they should be based on an appropriate evaluation and constant retesting.

Sagittal Plane and Frontal/Transverse Plane Movement Training Video

The next two video are dealing with hip flexion (forward movement) and hip abduction (outward movement).  Here the emphasis is on creating activation of the leg in the direction of limitation while the spine remains extended and stable.  Quite a bit of stabilization training of the trunk, pelvis and lower extremity are emphasized in these next two videos.

Hip Flexion with 40 inch Band Video

Hip Abduction with 40 inch Band Video

Conclusion

The “ouch” of the pain usually cannot exist when you improve dysfunctional movement patterns.  Remember one of the keys is to identify what movements and postures have set us up for these problems.  Have a way of noting a movement or movements that correlate with worsening and improving your symptoms.  Then use these as a way of retesting as you explore better ways of moving through life.

Moving in these ways described above is a good start.  Let it be only a start.  Start identifying lifestyle issues that mirror the same problems.  All of this takes us on a journey deeper within ourselves.  You can stop at any time or continue.  A continued journey becomes an expanded practice.  Discoveries that lead us to ourselves at deeper levels become an awakening of the richness of our true lives.

Good luck in wherever you practice leads you.

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

 

Restoring Movement to the Neck

The Neck

The neck is about one of our most used connections of the spine (and well used in our lexicon)  It is designed to be mobile and capable of great feats of movement and stability.  Just remember the days you’ve arisen out of bed–even before getting up–you notice how stiff you became over night.   Sometimes we say life is a pain in the neck.  Some folks even still neck around a little.

The neck is just not an anatomical structure to be described of bones and soft tissues.  It is a highly functioning arm of the nervous system and ourselves.  Here I am concerned with looking at how to restore movement in the lower neck (in a particular direction).

Mechanical problems

In my practice of Physical Therapy, many people who come in with shoulder and neck problems usually have a problem in moving their lower neck and upper back spine.  This area seems to become easily rigid.  We often see degenerative changes of the spinal segments at the segments just above this juncture of neck and upper back.  We often label seven neck segments with the top one starting as number one.  So the fifth and sixth segment are very popular in showing these degenerative changes.  To me this means that the area below is not participating in allowing movement to continue through these lower segments.  By the way, we don’t just move our necks.  Our bodies don’t move the neck.  Our movements take place in the spine.  Our patho-anatomical  medical approach (getting a diagnosis of a problem based soley on the anatomy that has a dis-ease vs including a functional evaluation or how it is working in daily usage) can distort our perspective of how we look at how what is going on ie the problem.

Of course, the  direction of mobility problem can be different for different causes and different people.  Here I wish to share my observations of the problem at moving through this juncture of the neck (cervical spine) and upper back (upper thoracic spine).  This junction is easily referred to as the cervical-thoracic junction or C/T junction.

What I find is that many people do not have very good side bending of the lower neck.  They often over move in the segments above.  Also when you observe those with pain and dysfunction of the neck and shoulder complex, it is worth evaluating how well they are side bending at this lower neck to C/T area.

Of course there are problems of stability in the mid neck and also upper neck.  There are sometimes mobility problems of the upper cervical region as well.  Note the junctional areas of the spine are very important in transmitting forces THROUGH the area (versus into the area).

Example of Moving the Lower Neck Spine

Here is a short video I did in working with someone.  I hope it will explain a bit about how you might start to work on learning to move this area.  Note it spends most of the time trying to coach one to move the lower area while learning to stabilize the above area.  It seems un-natural for many who have a movement deficit in this area.

Remember the learning is not just about correcting and moving better.  Ideally one must spend a good amount of time feeling and practicing these directions.  Often it takes some coaching.  A mirror can be invaluable in this type of training.

Conclusion

Enjoy the practice.  Those who don’t move this lower neck area well will be rewarded with proper practice.  You will find that once you can create some movement here sometimes your shoulder and neck problems become less.

Try it out and let me know what you find.

Shoulder Stabilization in Asana/Posture and Movement

Shoulder Stabilization in Posture and Movement

In Yoga and many times in athletics/sports, we are often looking at physical flexibility.  This is great in the proper context.  Flexibility which is certainly stressed in yoga asanas has it’s compliment in stability.  We often talk a good line about balancing the body.  Often in practice we don’t notice what kind of balance we are creating or have created.  Since I often hear instructors in yoga class repetitively encouraging a student to go farther into the asana, I wish to focus on this incomplete perspective.

We will look at a case example from my Physical Therapy clinic.  Before moving into looking at this specific example of shoulder instability, let’s speak more of this flexibility vs instability issue.  Is it that one is better than another.  (of course it is and of course it is not)

Posture or Asana Guidelines

This is old material for many who know it, but a brief review will be stated.  The first of the three Yoga Sutras of Patanjali on asana starts out as:

Sthira-sukham asanam

Asana or posture is steady/stable and easeful/comfortable.  I don’t know how many teachers and students who can recite this and more, still persist in having someone focus over and over again in trying to stretch further.  Many people will look at a picture of someone who has tremendous physical flexibility, and they will effort to accomplish more range of movement.  (Just like in the picture of their mind)

This perspective of overdoing the flexibility aspect of asana is not being balanced out by proper training of the needed stability.  There must be good reasons why such an authoritative text like the Yoga Sutras has started out with stability and not about flexibility per se.  (I know the context is stability of the mind–but we are starting with the body part of the mind here)

Developmental Guidelines

When babies start to move around, what is the first thing they do?  In one way they start just moving.  They seem to come equipped with great flexibility, right? (Wouldn’t some of us love to have that now days.)  Well they don’t get very far until they develop significant stability.  They do a ton of core work on their backs while seemingly flaying around their limbs for example.  I will not get into the large amount of work they do sucking and orienting their eyes and head, etc.  I just want to focus on this idea and observation–they don’t get up and get around until they develop their stability.

So if someone has the proper mobility then stability comes in conjunction to complete many of the functional movement patterns or exercise/sport  patterns that we are involved in.  What if we don’t have the flexibility, let’s say for the a particular asana.

We need to have movement.  What is the relationship with movement and stability?  Does one come before another?  Well—it depends.  (great words of wisdom : ))

Flexibility Problems and Of Course Stability Problems

Flexibility and Stability are both needed.  It is the prescription of how, when, and where–including dosage amounts and timings.

For the past several weeks I have been seeing a client for shoulder and neck pain.  Basically when he raised his arm above shoulder level in abduction, he has a painful arc of movement from about 110-150 degrees.  Also this is his limit of movement on first examination.  He can stretch it farther into the ends of range to 160, but it is just more painful in this case (not a true painful arc, per se).  His neck movements were slightly limited in rotation and side bending away from the affected side.  Mainly stiff lower cervical segments as a group.  Also his thoracic spine rotation was markedly restricted bilaterally.

All his movements demonstrated poor sequencing of the scapular component.  He was very weak in scapular retraction against resisted rowing movements, especially on his affected side.   (The gleno-humeral joint was  also anteriorly subluxed slightly)  He was unable to retract or move his scapula’s together with resisted pulling movements when his forearms were more vertical.

I often use a mini band at this point to see if they can maintain their forearms in more of a vertical position as they pull the band apart and try to retract the shoulders.

Often they are grabbing this mini-band with their hands vs just wrapped around their wrists.  You can see here that the band is at the top of the chest level.  If you try to have them start at their nose level and then try to pull it apart–you will often see them only able to pull it while allowing it to come to their chest level again.  Their scapular stabilizers with abduction of the arms are quite weak.  The classic testing of shoulder stability with the elbows at the sides of the trunk are for very weak folks.  Much of compromised work is with the hands/arms raised over his head.

Flexibility and Stability Retesting

Once I found both a flexibility and a stability problem, I will start to stimulate one area like the above scapular retraction with the mini bands.  (As this scapular component could be at the base of his flexibility problem–as the shoulder blade is literally the base of the arm AND it was the most asymmetrical problem).   Then I will retest their original complaint.  In this case, he had pain with limited shoulder abduction.  He immediately showed improvement.  So then just for an experiment in his case, I tried doing some gleno-humeral (shoulder ball and socket) mobilization and mobility exercises.  He didn’t respond as well upon retesting.  I  also tried improving his thoracic rotation.  We used combined active movements of rotation and side bending of his trunk in sitting.  He improved in shoulder abduction a few degrees, but not nearly the improvement as seen with the direct scapular resistance.

This particular fellow is rock climber and surfer, etc.  He is very active and very strong in other ways.  In other words, when I asked him to do a push up, he just dropped to the floor and pushed away with no problem.  Please note that in this push up position, he locked his upper arms in close to his side.  His scapula’s were quite stable, with no winging or instability.  Very impressive.

Note that his instability (and seemingly inflexibility) is when his arm and hand are above his head.

Stability Rehab

This client case is just to emphasize that some people will have a lack of movement.  Their lack of movement does not always respond to stretching.  In this particular case it made no difference, except it was actually more uncomfortable with end range stretching.

He has responded well to starting with side plank positions.  He is fairly unstable and has very weak endurance in this side plank position.  The forward plank did not demonstrate enough change.  The bulk of his program that has proved most helpful has been with these pulling movements at different angles.  We often focus on holding the pulling movement and then working on eccentric/concentric contractions of this movement pattern.  We change the angles over time, trying to find the weakest and most unstable position.  We back away from it slightly and work before that place and after that place and then through that place that is difficult.  He still uses thoracic mobility exercise to his advantage too.

Limitation of Yoga Asana

He has done very well.  It is interesting to note that in traditional Yoga Asanas:

…most asanas develop forward pressure movements involving the upper body

He was originally trying stretch it out for weeks and weeks.  There wasn’t much change.  All forward pressure movements did not significantly help him either.

Summary

Realize this is a case example–speaking to the importance of assessing both mobility and stability.  Certain protocols/sports/movement paradigms are biased in direction of movements and particular activities.  These are constraints that can lead to significant imbalances.  It is not that something is bad or good for you directly.  There has to be an evaluation of what are your weaknesses and strengths.  Often we are involved in activities that strengthen our strengths and do not do much for our weaknesses.

I know that in other people, they have more of a mobility restriction in their particular case.  Therefore work more on mobility.  Remember it is identifying the problem(s) and then a key is to RETEST.  This retest provides the feedback.  It isn’t this paradigm vs that paradigm.  These topics of controversy, if they truly are, only should lead to examination not to reverential following.

Strengthening your ability to observe is paramount.  Also you must ask a lot of questions.  Be systematic in your focus of questions and answers–(most really are not–their mind immediately jumps away to a more familiar aspect of their inquiry–more to say about this in another post)

OK, make some comments.  Share what you find works.  Let’s build a community together.

Strong Mind and Body–Peter