I recently did a shoulder workshop and thought I would share what we covered on here as well. The shoulder is a relatively sensitive joint, because of the many motions it is capable of. There are many tendons and structures within the joint that can be the root of shoulder pain including: rotator cuff muscles (supraspinatus, subscapularis, infraspinatus, and teres minor), biceps tendon, and ligaments attaching bony structures.
As you can see in the image above, it's a complex structure. Add to that the many movements we can use our arm for - internal and external rotation, reaching overhead, lifting items in front of us, reaching behind us, etc. it becomes very complicated.
The best thing we can do for our shoulders to protect that joint is make sure we are using good posture. Ideally, that means locking the shoulder down into a good position and then doing movements from that safe protected position. Whether it's weight lifting, lifting a pencil, or pushing something overhead, we want to maintain that locked and supported position of the shoulder.
In the photos above, you can see her shoulders are being drawn down her back and pulled towards her spine slightly, her hands are in external rotation (palms facing forwards). There is no forward shoulder roll, her chin is not poking out. From this position, you can safely use your shoulder and allow those tendons to glide and slide in the joint with minimal wear and tear on them. This is an exaggerated form to show proper shoulder positioning, but from here you can reach and lift safely. Another way to think about it is drawing your elbows down towards your hip, with a slight squeeze between the shoulder blades.
Go practice that in a mirror and see if you can feel or see a difference in good positioning vs. bad positioning.
As we are slowly approaching spring, I am seeing more people out on the trails running and I know people are starting to train for spring and summer events. With that in mind, I wanted to share some insight into core stability and the importance it holds for running form and avoiding back, hip, knee, and foot injuries.
An important test we use in our office, called Trendelenburg test or sign, allows us to tell if a patient is missing core strength and stability, gluteus medius stability, and allowing their hip/pelvis to drop with each step. A positive Trendelenburg sign indicates weak gluteus medius on the standing leg, allowing the opposite hip to drop when the leg is lifted.
With each step, a person with weak gluteus medius muscles is stressing the glutes and the core, the hip joint, and then on down the chain into the knee and ankle. The joints further down the chain (knee, ankle, foot) have to absorb and compensate for the stress on the hip joint.
A key to returning to full function after discovering this weakness is working on strengthening the hip abductors. Clamshell exercises used to be given frequently, but there are much more effect exercises such as glute med. leg lifts.The key here is in the photo you can see she turns her toe downwards before doing any leg lifting. So lying on your side, you will turn the toes down (internal hip rotation) on the leg you will lift, and then begin the exercise. Make sure your core is stable and your pelvis in neutral (neutral pelvis reminder article here) before you begin.
Gluteus Medius exercise:
10 large leg lifts (pictured above)
10 small leg lifts (6-12 inches lift)
10 forward circles
10 reverse circles
If you feel a burn before you are halfway done with this routine, try starting with 5 reps for each variation. Make sure to do both sides! While doing the forward and reverse circles, check in with your feet. Are they making jerky circles or squares? Focus on making as smooth a circle as you can, nice and slow.
This exercise should be done 2-3x/day, and may take several weeks of consistency before you notice any changes. This is not a direct core exercise but while doing it, you should make an effort to tighten those core muscles and really focus on a stable core while performing the exercise.
It's a new year and I'm excited to be bringing some new opportunities to you all. First and foremost, I intend to update the blog more regularly in the new year.
At Active Health Solutions, we are also beginning a foam rolling class (our first one is January 9th). It's an introduction to what we do for ourselves and what we teach in the office to our patients. We have a sign-up at the front desk, but you can also call to sign up. We are only able to take limited numbers due to limited space, so about 8 people per session. If you feel like you're not getting the most out of your foam roller or you know someone it might be beneficial for, come join us!
We are hoping to offer more classes this year, not limited to foam rolling. If you have something specific you would like to see, let us know!
Today’s topic is low back pain, a common complaint in many demographics. There are a lot of root causes of back pain, including herniated or bulging discs, facet syndrome, osteoarthritis, and acute trauma. Another important point is that low back pain can be divided into two main locations – Sacroiliac joints (SI joint) and lower lumbar areas. The two areas are very close in location, but very different in anatomy. People often confuse SI joints with the “hip” area of the body. In reality, the hip is specifically the ball and socket joint of the femoral head that our leg hinges from.
The SI joints are located at the top of the pelvis, one on each side, where the pelvis and sacrum are joined. If you feel your hip bones (ilium), and move slightly in towards the middle of your back, you can feel two bony spots that are connected to the SI joints. It is a relatively stable joint, but when one variable is not functioning well, it can cause a lot of discomfort and lead to even more problems down the chain into the hip, knee, and ankle joints.
In office, an in-depth low back and hip exam is performed to determine where an individuals pain might be coming from – lumbar vertebra, SI joints, or hip joints. Then tests are done to differentiate nerve pain, muscular pain, ligamentous sprain, etc. From there, treatment usually involves myofascial release, chiropractic manipulation, and strengthening exercises. Often the treatments for many different disorders related to the back are similar, even though the specific diagnosis might vary.
At home, to avoid back pain, one of the easiest things every single person can do – whether you’re an Olympic lifter or jogger, weekend warrior or simply sit in an office all day – is start with your core. The core is key to a stable low back and pelvis and gives the body a stable support to bend, twist, and move from without hurting ourselves. Several key exercises to help your low back and decrease pain and wear-and-tear on joints are dead bug (link here), bridge (here) and side bridge (here).
The handouts linked above all have something in common, which is starting out by finding what we call a “neutral pelvis” (explained in detail here) and using abdominal bracing and breathing (found here). From there, with your pelvis stabilized, you can begin core work. People that proceed through these steps, focusing on stabilizing their core and using that stabilization technique through transitional movements (seated->standing, for example) often find great relief from low back pain.
Dead bug exercise is often a great starting place, and incorporates a lot of floor work that may feel silly at first, especially if you have been doing core work for a long time. This exercise targets specific parts of the core and creates a cylinder of support using diaphragm, abdominals, pelvic floor, and back muscles. From there I like to progress to bridge track. It works the core and also focuses on glute muscles and quadriceps, which are often inactive when they should be active. Neuromuscular retraining through these exercises allows your body to utilize important muscle groups that may not be in use on a daily basis.
Another helpful tool for decreasing low back pain is adding foam rolling into your daily regime. It can be painful at first, but rolling your glutes, IT bands, quads, and hamstrings can be beneficial for many people.
Recap on tools to avoid low back pain:
foam rolling the lower body and back
focusing on abdominal bracing with transitional movements
Today I want to talk about neck pain and some daily habits that perpetuate a common problem. Neck pain is a common complaint we see in our office, and can originate from many places. Our posture and daily habits contribute to the problem and can slow the healing process immensely. No matter where an injury originated – stress, whiplash, a fall, or another cause – our daily posture can vastly change the outcome of treatment for the good or bad.
Let's start with a little background information on the structure of the human neck and shoulders. Ideally, we would be in a position with a stacked spine, shoulders externally rotated, chin tucked in towards the body, as if a string was pulling your head and shoulders up from the ceiling. Our body is held in that position with postural muscles designed specifically to hold us upright against gravity. These muscles act like suspension cables on a bridge, tensioning the spine and holding it erect.
Our heads weigh about 10 pounds on average. When stacked over our spine, the suspension postural muscles have no problem holding it in check. The average 10-pound head is about the weight and size of a bowling ball. Now, imagine holding the bowling ball close to your chest. That’s pretty easy to hold for any length of time, right?
Now take that bowling ball and hold it straight out with your arms, as far from your body as you can. How long can you hold it out there, fighting against gravity? Let me tell you, even a strong athletic person feels the heavy weight really quickly. Pretty soon, your muscles are fatigued and it’s nearly impossible to hold the bowling ball up. That is exactly what is happening with your head and neck – the more forward the head, the heavier it is and the more strain on those postural muscles. Eventually they can’t hold the head up without intense pain anymore.
This forward heard posture causes something called “Upper Cross Syndrome”. Essentially upper cross syndrome means the muscles at the front of the chest and at the back of the neck become chronically tight and shortened. The muscles between the shoulder blades become chronically weak and inhibited.
Our environment of sitting in offices, typing on computers, texting, looking at tablets and phones contributes immensely to a society predisposed to neck pain, shoulder pain, and upper back pain. That’s right, I’ll say it again, poor posture leads to neck pain, but also back and shoulder pain!
How do we fix this problem?
The answer is a combination of things including but not limited to:
Postural evaluations and consciously deciding to make a change.
Move. Change your position at your desk, go from seated to standing, do some stretches, and resume work. In an hour, repeat.
In-office chiropractic treatment including myofascial release and personalized strengthening exercises
Check in every hour while on your computer or sitting at your work desk, or even standing at your work desk (yes, standing workers can have poor posture too). Roll your shoulders back, tuck your chin in towards your spine, stack your head over your shoulders, and add some thoracic extension.
Stretch the posterior neck muscles and pec muscles. Strengthen the muscles between your shoulder blades and the deep neck flexor muscles. Shoulder blade strengthening is one of the most important and most neglected, and can be accomplished through exercises such as rowing and other similar exercises. Here are some links to some great handouts: cervical strengthening, my favorite back strengthening, and cervical stretches.
One of the most important aspects of our posture is constant variation. A sedentary lifestyle will perpetuate pain and injury. Changing your posture every 20-30 minutes (before you notice discomfort) will help immensely even if it’s only a 10 second stretch. Setting an alarm in your phone or downloading an app that reminds you to move can help if you’re a technologically inclined person. Write a sticky note if that helps and stick it somewhere obvious in your workspace. Get creative!
The conscious decision to change your behavior takes time to show improvement. It’s likely the body is so used to the habits it has formed, it will take months to realize that you are unconsciously sitting, standing, and moving with new and improved good posture.
Come see me in office to work through your imbalances and get some exercise handouts showing exactly how to strengthen the weak muscles in your back and neck to support good posture.
I’m excited to introduce myself to you all and start this blog at Active Health Solutions. My name is Maya Radonich, and I’m a Doctor of Chiropractic joining the AHS team. My full bio can be found on our website here. I recently finished school in Portland, OR at Western States University, where I’ve been full-time learning about chiropractic, injury rehab, and sports medicine for the past 3 years. I’m so excited to finally be in practice and seeing patients here in Anchorage!
I’m originally from Anchorage and grew up like many Alaskans - skiing, biking, hiking, and adventuring all over the state. That led me into skiing for the UAA cross-country ski team for several years during my undergraduate studies. Having sustained many over-use injuries from training and racing, as well as several concussions and assorted other injuries, I have been a patient of chiropractic for a long time. My focus is mainly on sports rehab, but I treat a wide variety of things in practice.
Most importantly, I understand that when athletes are injured, the last thing they want to do is take time off from training. I do my best to get people back to full speed with as little impact on training as possible. I focus on teaching patients to strengthen weak areas that are the root of their injuries, and not just chasing the pain they may be having. Treating pain as well as the root cause of the pain goes together in our practice.
I am joining two awesome chiropractors at AHS – Dr. Michael Fleming and Dr. Ben Cain. Our office focuses on chiropractic sports medicine and rehabilitation. We treat all areas of the body including but not limited to full spine, ribs, extremities, and jaw. We see all types of injuries walk through the door ranging from acute injuries like falls or crashes, to chronic over-use injuries such as rotator cuff pain and postural dysfunction. Our docs use a variety of techniques to perform myofascial release, chiropractic manipulations, instrument assisted soft tissue therapy, kinesiotaping, and therapeutic exercises for rehab. More on what we offer can be found here.
Thanks for joining me on this blog, and look for more posts soon about the types of injuries we treat and the rehab that goes along with them!