RECOVER: May 29, 2015

Reach for the sky....it's not always as simple as it seems

Spoiler Summary: It takes a finely tuned system to get your hands over your head....maybe that's why it's referred to as the shoulder "complex"....thankfully, it doesn't have to be as complicated for everyone..

For the last few weeks I've been writing about some of the various body areas that tend to get a little cranky over time.  I started from the center (spine) and now, move outward to the shoulder complex.  The shoulder complex includes 3 joints, 1 articulation, 15 different muscles and many ligaments.  It also houses a major nerve bundle and the blood vessels that supply the arm and hand.  So even though it's not actually called a complex because it's so complicated....it probably could be.

Shoulder pain is an incredibly common thing, with estimates as high as 67% of people being impacted per year.  Although there are many different injuries and diseases that can be included, many start as a movement disorder -- the shoulder just isn't moving like a shoulder should.  The bad news is: depending on the number of risks we are exposed to, it's fairly likely that most of us will have an episode of shoulder pain.  The good news is: if you know what to look for, the early warning signs of movement-faults are not that difficult to spot and correct.

Probably the most telling sign of a shoulder evaluation is how smoothly a person can bring their hands over their head from the side, as if to "flap their wings" into an overhead position.  In a balanced shoulder, the hand moves freely upward and the arm and shoulder blade are coordinated and smooth.  In a shoulder where the movement is impaired, there is usually a "catch" or a "hitch" in the motion, often when the arm is out to the side, parallel to the ground (90 degrees or thereabouts).  It might come a bit before and it might last a bit after in the range, but generally in that area, the motion is not as smooth and the person might compensate to achieve the overhead position or to avoid discomfort.

After looking at this motion, we often ask the person to put their hand behind their head followed by placing the back of the hand in the lower back.  These motions allow us to look specifically at "rotation", which is often restricted and causes problems.  If this is clear and moving freely, we might ask that they move the hand from these positions to test the strength of certain muscles or the stability of the joints.  As we note impairments, we might ask them to change their posture or change the angle a bit here or there so that we can tease out which is the offending muscle or structure.

If all goes well to this point, we might ask the person to perform any number of "special tests" where we are testing very specific combined motions or looking for very specific signs and symptoms.  And finally, we might palpate ("poke around") to look for tender areas which might signify areas that are irritated or inflamed.

One of the most common culprits that leads to shoulder pain is "forward & rounded" shoulder position -- when the shoulder blades round forward and the arms rotate inward slightly -- especially common in people who put in long hours doing tasks that require a forward position (from operating a tool in the road to a keyboard at the desk).  This change in position places the muscles and tendons at a different angle of pull and causes faulty mechanics, often resulting in pain.  If we notice forward/rounded shoulders but the person is otherwise able to "move well" (or when they re-establish normal movement and get to that point), we will often have them perform an exercise progression that is designed to ensure a long term fix - example video-short here.  If, on the other hand they have adopted that posture as a compensation, we will often given them exercises designed to obtain better mechanics first.

When all 15 muscles are pulling with the right force and firing at precisely the right moments, when the joints and the articulation are stable (but not compressed) and when the nerves and vessels are gliding without getting "snagged" or stuck, pain subsides because the shoulder is once again moving.....like a shoulder should.

It's a complex.....but if you know what you're looking at, it doesn't have to be complicated.  Here's to moving well - reach out if you need help.

Have a great weekend,

Mike E. 

CONNECT: May 22, 2015

It takes no more than a moment

Spoiler Summary:  Pause and reflect - thank you.

Life moves fast. Blink for just a second too long and you find yourself asking the child that you could swear you was just learning to walk, what they want to be when they grow up. Look away for another second and the people you were working alongside yesterday are telling you about what retirement is like and how even though they hate "getting old" it's not all bad. It seems like the clock just keeps spinning faster and the memories pile up fast.

Over the last few weeks I've been writing about some of the risks we all face from an injury/illness and "movement disorder" standpoint.  We've talked about the neck as well as the upper and lower back....and until a few minutes ago I had planned on moving on to the next area; not skipping a beat.....but then I started thinking about it and realized maybe the most important and compelling health &prevention topic that I could write about this week had very little to do with the shoulder....maybe the most important and compelling health & prevention topic I could write about was gratitude.

It's true, there is a growing body of evidence from places like the University of California, University of Miami and University of Pennsylvania that shows the impressive power of thankfulness and the value of practicing it regularly. The action, literally of giving thanks, has been shown to be extremely healthy for each of us and the effect spills over to the people around us.  

And so, this week, I'm suggesting a totally different set of exercises than I might normally.  They probably won't make your shoulder range of motion improve, but they have the power to do a world of good.  In the spirit of memorial day, please consider saying thank you.

That's it, just as simple as it sounds. Take a minute on this holiday to really say thanks.

It might be in the form of a letter that never actually gets sent.  It might just be a mental thank you to someone you've never met.  Or it might be taking a second with your family to think about how different things could be if there wasn't anyone to thank in this particular situation.  So, amid the noise about the unofficial start of summer or in the middle of the yard work (or any other number of activities planned), I hope you'll take a minute to pause and say a genuine thank you.

• Life is not always easy; sometimes it's hard to keep up....and yet, we are free to live it anyway.  
• We have our challenges; every single one of us....and yet, we have the liberty to try to overcome them.  
• We are not always happy....and yet, we still have the right to pursue it nonetheless....building our own pile of memories while indebted to those who sacrificed theirs.

To the family and friends of those who have fallen, on behalf of my team -- we remember and we thank you.

- Mike E.

MOVE: May 15, 2015

Intersections - proceed with caution

Spoiler summary - Intersections can leave you injured and in pain if you're not paying attention....and it's not only when you're driving.  

In 2007, 40% of crashes and more than 20% of fatalities happened at intersections (reference) - that's 2 out of every 5 incidents - which is pretty staggering if you think about how many different types of controls (stoplights, signs, traffic control officers, etc) are in place.....but since the brain/body doesn't do nearly as well with multi-tasking as it does with a singular focus, maybe it shouldn't surprise anyone.  

In many ways, the lower back is the intersection of the body - something like a 5 way stop: The torso, left and right upper extremities as well as left and right lower extremities all coming together, often doing their own thing.  Somehow, not unlike the police officer directing traffic at a complicated and busy intersection, it's the job of the lower back to keep things under control but still moving with a predictable flow.

The lower back is made up of 5 bones sitting atop the pelvis (a platform made by the lowermost section of spine and the hips).  To successfully manage the intersection, it needs to be both flexible and stable, so the upper body can be positioned to do work and not crumble in the process. To make it even more complex, it is built to do this while the lower body is doing something entirely different.  Think about a person dribbling a basketball or, say, a hockey player skating backwards while generating enough power to put-in an overtime game-7 goal (congrats Rangers fans): the upper body is doing one thing, while the lower body is doing something else.  If the lower back is too flexible in this case, the upper body crumples forward and timing is off (often a source of pain); but if not flexible enough, the strain and shear of moving with force or speed causes pain.....so the balance is critical.

Generally speaking, it is in this balance (or perhaps imbalance) that most frequently see issues when people ask us to evaluate their lower back.  Either things are a bit too flexible and muscle timing is off, or things are not flexible enough and tissues strain which causes compensations in movement and eventually pain.  The tricky part is, that although entirely different, both can cause the similar discomfort.  This is one of the reasons back pain is one of the most perplexing (and disheartening) ailments faced by adults all over the world -- statistically almost every single one of us will have at least one episode -- that's the bad news.  The good news is, over the last 20 years, the research has clearly shown that if you pay attention to the signs/stop-lights and occasional traffic-cop, you can determine the pattern, act on it quickly (for best results do so in the first few days) and correct the movement-fault with no permanent impact.  The even better news, which wasn't always thought to be the case, is that most people, even those with longstanding back issues CAN improve by correcting the pattern and restoring normal movement.

Being able to recognize the pattern is not simple, but it's often the key to success. The following questions can help point you in the right direction:

1. Does your discomfort change with movement? Better or worse?

2. Does your discomfort change with sitting versus standing? Which is worse?

3. Does your discomfort travel or radiate?  To where and is it an occasional zap or steady?

4. Do you find that stress plays a role?

5. Is it impacting your sleep?  If so, more "toss and turn" or "it wakes me up"?

6. How long are you typically sitting each day (including commuting time)?

7. Is your discomfort "seasonal" (winter vs. spring)?

8. Does discomfort come in "episodes" (lasts for 3 days vs. weeks vs other)?

9. Was there a specific trigger or was it gradual?

10. Do you know your pattern and how best to control it?

____________________

What about Prevention?  What about a person who doesn't ever want to experience back pain (or had an episode but never wants to have it again)?

Like most things - prevention is less complicated - but it takes consistency.  Here are some considerations:

1. Movement is key - the more you sit, the more you compress your lower back like a spring.  Even "good posture" can produce significant force at the lower back.  Movement helps distribute the force to other areas and give the stressed-tissues a break while improving circulation and lowering emotional stress (all good things for the back). Move frequently (at least a few minutes every hour) and consider a walking program (ideally 40 minutes per day).

2. Maintain flexibility - however this DOESN'T NECESSARILY mean "touch your toes".  In fact, this common stretch (perhaps the most common) can be the source of pain (see # 6 below).  If you're not sure what you're doing, let us know - or try this dynamic warm-up that some of your colleagues are doing daily and getting great results.

3. Maintain strength - however this DOESN'T NECESSARILY mean "sit-ups and crunches".  In fact, these common abdominal exercises can make things worse depending on your pattern.  Let us know if you need guidance.

4. Stay hydrated - the soft tissues of the body rely on water; this is especially true in compressed tissues of the lower back.

5. Avoid smoking - the connection between smoking and lower back pain is well documented.  It's a circulation thing and more.

6. Get your sleep but minimize forward bending first thing AM - we are often stiff in the morning as our tissues rehydrate when unloaded during sleep - this is good; however, since forward bending places a significant stress on the tissues, doing-so while stiff can be a trigger for discomfort.  Giving the body a warm-up period prior to aggressively flexing forward in the AM has been shown to lower "pain-days" in even the most disabling back pain cases.

7. Fuel better - if vessel damage is happening in the heart, it's also happening in the vessels that supply the lower back (and everywhere else for that matter).  Gradual onset lower back pain is considered by some as an early warning sign of circulation disorders.  Consider a fueling strategy (more plants!) that lower inflammation and improve vessel health - you might be surprised by the results.

________________________

Of course, with as common an issue as lower back health can be, this is just the tip of the iceberg.....please don't hesitate to reach out to the team with questions.

Have a great weekend,

Mike E.

RECOVER: May 8, 2015

On down the line - the thoracic spine

 

Spoiler summary: the upper back is not just the source of "bad posture" but the stable platform for the entire upper extremity and more.

In a recent post, I wrote a little bit about neck pain and some of the key "move right" factors that associate with it.  I reiterated that forward head posture tends to be the most common stressor that we see, and that it can cause pain all the way into the head and neck.  Unfortunately, it doesn't end there. Compensation in the way we move travels both ways... Which leads us to the upper back (a.k.a. the thoracic spine).

When people picture someone in "bad posture" they often think of the upper back. We imagine a rounded upper back and forward hunched upper body.  This of course makes total sense since the spine moves very similarly to a chain, link by link each segment pulled along for the ride -- where the head goes, the upper back follows. However, it's not just the head. Research has shown anything anchored to the spine can pull on it enough to change our movement patterns (often resulting in pain). For example, the arms and shoulders working forward will also tend to put this force on the upper back and the more time we spend in this position, the more likely it is to happen.  It's of course not the only thing that we see in this body area, but it's one of the most common.

So what's the problem?

One of the main issues that we see in our work and therefore complaints of discomfort that come with it, is that as the spine rounds the shoulder blades tend to fall forward and toward the outer edge of the ribs.  It's a bit of a downward spiral: the head and shoulders pull the spine forward, which makes us round, which makes it more difficult to keep the head and shoulders back -- and on it goes.  This position not only stresses the muscles of the upper back, which tend to have tender spots, but also increases the likelihood of extra pressure at the shoulder, elbow and hand. Everything from pain when a person lifts their arms to radiating pain in the elbows, forearms and hands can result.  This is especially true in the dominant hand since we tend to use it more frequently to complete tasks.

So how do we interrupt this pattern and right the ship?

The good news is, it doesn't have to be complicated if you deal with it early.  Taking a break to unwind achy tissues on a regular basis by squeezing the shoulder blades together in the back and extending the spine can go a long way to maintaining tissue balance.  Spending a few minutes exercising the lower trapezius or serratus anterior muscles which help combat these stressors, can be done without equipment on your floor at home.  Making sure your work set up is as close to the body as safely-possible keeps leverage against these tissues to a minimum and is a great personal ergonomic strategy.  And finally, anything that promotes better circulation (MOVE: cardiovascular exercise, FUEL: low inflammatory diet, RECOVER: stress reduction ENDURE: lowering environmental exposures like smoking andCONNECT: even laughing with friends) can all have an impact.

The equation doesn't have to be complicated....balance theELEMENTS and the body can do extraordinary things from the very top and on down the line.  Let us know if you have questions.

Now go do something extraordinary,

Mike E.

ENDURE: May 22, 2015

Stronger through Adversity...

CLIENT SPOTLIGHT: Jenna Ferreira

Three years ago, when then HS frosh Jenna Ferreira found us, we knew we encountered a special kid.  Having recently gotten unfortunate news of being cut from the HS volleyball team, she came determined to work harder...get stronger, faster and more prepared for the next year's tryout.  Suffice it to say, we were pretty impressed by the drive of such a young athlete...but maybe more impressive was the upbeat positive mindset she seemed to carry with her day in and day out...most especially in light of the recent adversity she had faced.....entering a new school and not making a team she had been targeting since the 6th grade when she first began playing.  Of course, knowing what we know now...we might just say, "That's just Jenna".

But "just being Jenna" is something pretty darn special...and her story from the last couple years is a great one...but more than that...an important one for us to learn from and share with other young athletes to do the same...and it's earned her our 2nd "Client Spotlight" feature of the year!

You see, maybe unlike typical athletic-related news...this story isn't about titles or championships...it's not about new records or personal bests.....it's a story about lemons and lemonade....one about taking the perceived personal bad and making it an actual community good.  It's about becoming stronger through adversity....not just for yourself...but for the greater good.....and it's about doing the right things for the right reasons.

A girl with "volleyball in the family", Jenna battled through being cut as a freshman and did in fact achieve her goal and earn a spot on the JV squad as a sophomore.  She recalls, "I literally jumped....I think my mom started to cry, and she called my aunt.  We were so happy...I had worked so hard to get stronger here (Pro-Activity) and improve my skills with my club team...it was just great".  But that was just the start of a HS career that's been marked by gaining strength through adversity....

After a solid sophomore season, and training-filled off-season, Jenna was notified entering her Junior year (this past year) that she had again failed to make the team...and just about then, something clicked.  "I have to admit it was very hard and upsetting, but I took a step back, and looked at the bigger picture.  I've always been someone who tries to look for the positive, so I really focused on my mindset and decided that this presented me an opportunity to get more involved in school and community service, and a couple days later Coach (Hissner) asked me to stay on as team manager.  I loved the girls on the team, and being a part of it, so I accepted."

But Jenna didn't just take on the role as team manager.."one day when we were on the bus, coach called me up and asked me if I could lead Spike for a Cure (a charity student volleyball tournament), so of course I said yes.  Sophie (Kerschner) helped me a lot, and we had 80 teams with over 750 participants, and my classmates and I raised over $27,000 for the Jason Schaible memorial fund.  We're so proud of what we were able to accomplish for a great cause."

Jenna with principal Richard Bergacs, Vince Schaible, & coach Kirk Hissner

Throughout high school, and most notably and recently her experience at "Spike for a Cure", Jenna soon found that leadership and serving her classmates, the community, and the greater good is where her true passion and strengths lie.  "It's like I get the same rush from helping others as I would when we'd make a big play in volleyball.  I think it's something I want to do for my career, and if I gave up on volleyball entirely after not making the team last year, I'm not sure I would have realized it this soon."  Apparently Jenna's classmates tend to agree, having just elected her President of the incoming Senior class.

As we wrapped up our discussion, I asked Jenna to sum it all up for me, so that I, along with our staff, and clients both youth and adult, might learn from the 17 year old sitting across from me.  She smiled humbly and said, "It's all about the mindset.  Each set-back can push us forward to get stronger.  I know it sounds cliche but if you keep a positive outlook, you can achieve anything."....I couldn't agree more!

Three years ago, when Jenna found us, we knew we encountered a special kid...which just didn't know how much her story would remind us about the bigger picture when faced with adversity, and inspire us to continually look for the opportunity to grow stronger through it.

Happy Training,

-E