Posted by DrTucker in Articles by Dr. Tucker, Blog, Posture, Treatment on 02 23rd, 2012 | no responses
Thoracic spine article I wrote in Dynamic Chiropractic magazine
Posted by DrTucker in Articles by Dr. Tucker, Blog, Core training, Fitness & Exercise, Rehab Exercises on 02 23rd, 2012 | no responses
Here’s a link to an article on golfing I wrote in Dynamic Chiropractic magazine:
Here’s the link to a recent article I wrote on Plantar fasciitis in Dynamic Chiropractic magazine
An article I wrote on posture published in To Your Health magazine:
Posted by DrTucker in Articles by Dr. Tucker, Daily Exercises, Fitness & Exercise, Rehab Exercises, Shoulder on 12 7th, 2011 | no responses
To Your Health December, 2011 (Vol. 05, Issue 12) Share | By Jeffrey Tucker, DC, DACRB
The most common injury sites for golfers are the low back, shoulder, knee, elbow and wrist. Golfers who have low back pain demonstrate a decrease in range of motion for hip internal rotation on the lead leg (left leg for a right-handed golfer) and lumbar extension, and decreased activation and/or timing of the abdominal obliques, erector spinae and knee extensors. A good golf swing uses the left side of the body as much as the right. The hips initiate movement into the ball. The feet pushing against the ground cause a ground reaction force that sequentially travels up through the hips, the trunk and finally out the arms. The most noticeable difference between pros and amateurs is trunk rotation. Trunk rotation and flexibility are enormously important in golf. Older and less skilled players tend to use less than half the trunk rotation of younger or more skilled players.
Golfers who are looking to maximize their performance and avoid and/or rehabilitate following common golf-related injuries should try these exercises in consultation with their doctor of chiropractic:
Active Warm-Up Exercises Bend forward at the hips to touch the fingers to the floor.
Step into a stride position, extending the right leg (lunge).
Lift the right arm, rotate the spine and the head – hold this pose for 10 seconds.
Return to the stride position.
With hands on the left thigh, drop the back knee toward the floor and reach both arms overhead.
Twist the torso toward flexed front knee and hold.
Return to the hip flexor stretch position then put both hands on the floor.
Go to push-up position.
Sweep the left foot across in front – sit into the stretch and hold for 10 seconds.
Return to the push-up position.
Step forward into a forward bend and hold.
Sit into a deep squat with open knees.
Lift hands overhead, stand up and bring arms back to your side.
Now repeat this on the opposite side: Bend forward at the hips to touch the fingers to the floor. Step into a stride position, extending the left leg (lunge). Lift the right arm – rotate the spine and the head – hold this pose for 10 seconds. Return to the stride position. Hands on right thigh, drop the back knee toward the floor and reach both arms overhead. Twist the torso toward flexed front knee and hold. Return to the hip flexor stretch position then put both hands on the floor. Go to push-up position. Sweep the right foot across in front – sit into the stretch and hold for 10 seconds. Return to the push-up position. Step forward into a forward bend and hold. Sit into a deep squat with open knees. Lift hands overhead, stand up and bring arms back to your side.
The shoulder is the key anatomical structure involved in every phase of the golf swing. If you’ve suffered a shoulder injury related to golf or are just looking to improve shoulder rotation and performance, ask your doctor of chiropractic about these exercises:
Wing stretch: Place the back of your right hand on the outside upper gluteal (buttock) region so the elbow sticks out to the side. The back of the hand touches above your “pants pocket” area. Grab the right elbow with the left hand and pull it the elbow forward, simultaneously resisting the pull by stabilizing your shoulder girdle backward on the stretching shoulder. Hold this stretch for one minute.
Open book: Lie on your left side with your knees bent and your arms straight out in front of you, palms together. Keeping your knees on the ground, take your top arm and rotate your upper body all the way in the opposite direction. Perform 15 reps. Repeat on the other side.
Thoracic rotation: Get down on all fours, place your right hand behind your head, and point your right elbow out to the side. Brace your core and rotate your right shoulder (think about moving through the shoulder blade) toward your left arm. Follow your elbow with your eyes as you reverse the movement until your right elbow points toward the ceiling. That’s one repetition. Do 20 reps right and left.
Band diagonal raise: Attach a band or handle to the low pulley of a cable station. Standing with your left side toward the pulley, grab the handle with your right hand in front of your left hip and bend your elbow slightly. Pull the handle up and across your body until your hand is over your head and your thumb is pointing up (a Statue of Liberty pose). Return to the starting position. Complete 10-15 reps and repeat with your left arm.
Scaption: Perform this exercise standing in front of a mirror to monitor their form. Hang the arms down by the thighs and rotate both hands to a thumbs-up position. Retract and depress the scapulae as you lift the arms up to shoulder-height at a 45-degree angle from the trunk. The arms should make a Y in front of them. Make sure that the upper trapezius isn’t pulling the shoulders into the ears. If it is, work on pulling the shoulders down in order to push the arms up. Perform two sets of 15 reps per set.
Lie face down on a bench with your upper shoulders off the bench to perform these exercises, which involve raising the arms / shoulders to mimic the shape of a Y, T, W and L (e.g., arms up over the head forms a Y; arms straight out to the sides forms a T; etc.). Standing Y-T-W-L exercises can also be performed using a stretch strap, which allows you to maintain a consistent arm position.
One More Great Exercise:
If you’re suffering from increased thoracic kyphosis (rounded upper back / shoulders), protracted shoulder blades and/or forward chin position, ask your doctor of chiropractic about this corrective exercise: Stand, feet together, looking straight ahead. The feet should remain in this position for the duration of the exercise. Put one hand beneath your collarbone and one hand on your belly button. Keeping your hands in that position, lift the chest with the hand under the collarbone while simultaneously pulling down with the belly button hand. This will help to lengthen the spine and reduce the slouched position. Holding the achieved position, level the pelvis by raising the middle of the pelvis with the lower abdominals. Lengthen the neck by slightly tucking the chin and imagining the crown of the head is being pulled toward the sky. Bend your knees very slightly, just enough to remove any tension from the posterior knee. Holding the achieved position, lean forward slightly to shift the center of gravity to the midfoot instead of the heel. Practice this frequently to improve posture. This opens the chest and allows for more natural breathing as well. While non-golfers may not realize it, the physical challenge of golf can be more daunting than the mental part of the game, particularly if you don’t use proper mechanics during every part of the swing. Injuries are common, which will either affect your game dramatically or stop you from playing altogether.
Talk to your chiropractor about these and other exercise strategies to improve your golf game and avoid injury. ——————————————————————————– Jeffrey Tucker, DC, is a rehabilitation specialist who integrates chiropractic, exercise and nutrition into his practice in West Los Angeles. He is also a speaker for Performance Health/Thera-Band, NASM and FMS.com .
By Melissa Heyboer
There’s much more to rehabilitation than just improving what was once a painful injury. While recovering from muscle and joint pain is important, so is the need for improving a patient’s flexibility and range-of-motion (ROM).
Whether your patient is looking for relief from sprains, strains, disc injuries, or joint dysfunction, or if a patient simply wants to improve their overall well-being, bettering ones flexibility and ROM has unending benefits.
According to Gregory H. Doerr, DC, CCSP, ART, CKTP, developing better flexibility and greater ROM ultimately helps improve dysfunctions of the body — but it can also help prevent them.
“Inflexibility and loss of ROM leads to immobility of tissue, which leads to a number of joint and soft tissue dysfunctions,” said Doerr, “including fibrosis, tissue hypoxia, and the production of inflammatory markers including substance P and CGRP.”
Ultimately, he says, this can lead to pain and fear avoidance.
Steven Weiniger, DC, says the most important thing is that improving flexibility and ROM promotes symmetry of motion and, ultimately, helps the patient. ROM should be the first phase of rehab as you can’t advance to balance, strength and function until ROM is improved.
“Your body is made to move,” Weiniger said. “If your body is moving asymmetrically, your muscles will get strong in the way you’re training them to move.”
This creates added stress on the joints and they break down, he said.
“The chiropractor comes into the game when the person says my back or my neck keeps going out. That’s where the kinetic chain is buckling due to the asymmetric force from the muscles that have been trained to move asymmetrically.
This is where low-cost flexibility and ROM tools can come in handy.
“A person’s perception of how they are moving is often not accurate, which creates problems when performing exercises or treatment programs,” Weiniger said. “Even though the exercise is, in theory, designed to be a good exercise, it’s moving the body without symmetry. [Flexibility and ROM] tools facilitate the creation of that symmetry of motion.”
Fortunately, as a chiropractor, incorporating flexibility and ROM exercises and tools for the upper and lower extremities is not only easy, but can enhance your bottom line and broaden your patient base.
“I think providing these tools in your office can be used to differentiate yourself from other practitioners,” said Jeffrey Tucker, DC. “This type of system can help teach clients how to improve posture; and it helps neck and back pain patients.”
Tucker also suggests incorporating flexibility and ROM into a group class for your patients. “Clients want one-on-one motivation,” he said. “I sell higher quality lifestyle; it’s not about fitness. Emphasis is placed on practical, functional every day skills. It builds trust, it gives you an opportunity to have better communication with clients, and it creates value.”
Weiniger adds that with the right tools, patients can also reach their goals and improve the flexibility and ROM of both their upper and lower extremities from the comfort of their homes.
“Tools are nice because it provides structure and a point of responsibility,” Weiniger said. “They bought it, and they have it, and it lets them have an objective metric.”
Patients need to understand that at-home flexibility and ROM exercises have the same benefit as rehab elsewhere.
“We already know that our in-office methods of manipulation, mobilization, and modalities improve pain and function,” said Tucker. “If you do not teach clients to perform corrective exercises at home, you will miss the opportunity to allow patients to ‘turn on’ the nerves and muscles prior to workouts; enhance the excitability of the neuromuscular sequence; improve the recruitment of the muscle bundles and fibers; enhance muscle sequencing and movement patterns; improve coordination; and increase ROM.”
Weiniger says that adding flexibility and ROM exercises to your practice is not only beneficial for improving motion, but it helps build the doctor-patient relationship.
“Bottom line is that we are entering a time where people are going to be more responsible for their health,” said Weiniger. “By selling the patient an inexpensive tool to help strengthen their body, the person is going to value the doctor better.
“There are some residual benefits to selling it, but the goal is to build the doctor-patient relationship so the patient can see you as a coach and teacher as well as a doctor who values the patients own best interest.”
With so many inexpensive options out there, Doerr says it’s easy for chiropractors to embrace active rehab — like the tools needed for flexibility and ROM exercises — in their practices.
“As chiropractors, we have mastered the art of passive care,” Doerr said. “It is time we evolve to match the evidence currently available and move our practices into the evidence-influenced age.
“We often fail to realize that the key to new patients and more referrals is not associated with marketing teams, coaches, or gimmicks, but with positive outcomes in a faster time period. Active protocols assist us in achieving this.”
BIO] Melissa Heyboer is the associate editor of [ITAL]Chiropractic Economics[/ITAL]. She can be reached at 904-567-1540 or firstname.lastname@example.org.
By Jeffrey Tucker, DC, DACRB
When I was in chiropractic college more than 25 years ago, I was taught to use isometric exercises for whiplash trauma recovery. The technique was pretty simple: Place one hand on the back of your head and push the hand and the head against each other. Keep the neck in a neutral position and don’t let the head move backward. Build up to tension in 2 seconds, hold the tension for 6 seconds and gradually relax over 2 seconds, and then repeat for 10 reps. The exercise was also performed in flexion, rotation and lateral bending.
This form of exercise involves the static contraction of a muscle without any visible movement in the angle of the joint; the length of the muscle does not change. We’ll call that technique “old school” because the old German model (Hettinger and Muller) of 6-second actions was used in the original experiments and was adequate for strength gains, but was insufficient to cause hypertrophy in muscles. If you were looking to get big, this was not the technique.
In a rehabilitation practice, it is not our job to train muscles for the sole purpose of making them bigger. The contemporary approach is to help train clients to improve movement patterns. Patients notice benefits to strength and power of “movements” – this is called “functionality.” Functional training is any training that improves the ability to perform a target activity.
Enter “new school” isometrics or maximal intensity isometric training (1-5 reps with 90 percent to 100 percent of your max), using sets lasting 20-120 seconds. This will stimulate strength, endurance and hypertrophy. This technique can be used in the early stages of rehab and then combined with repetitive-effort isotonics (6-12 reps with 70 percent to 90 percent of your maximum).
As an example, consider a patient who was involved in a rear-end motor vehicle accident. We’ll say this patient is a 50-year-old female who sustained an injury to her neck, her right wrist is splinted due to carpal sprain, and she is deconditioned. In this case, there are numerous advantages of starting with isometrics in her rehab, along with a few disadvantages:
Isometrics: Advantages and Disadvantages
- An injured or immobilized extremity can be tensed while in a cast or in a splint after the immediate pain has subsided.
- Ideal for people with no exercise experience.
- Can be used early in a rehab program.
- Great way to teach proper biomechanics.
- Helps prevent muscle and strength losses.
- Achieves maximum muscular contraction and increases strength faster than any other form of training.
- Builds strength in isolated areas or muscle groups without moving the joints (It may increase muscle size and develop more efficient muscle contractions).
- Works muscles with more intensity in a shorter period of time.
- Prepares the musculoskeletal system for more advanced activities.
- Increases neurological strength, recruits more muscle fibers for each movement.
- Good for enforcing movement patterns (especially in youth).
- Isometric workouts can be fast and can be done anywhere.
- Safer than conventional training (doesn’t involve movement).
- Dramatically improves conventional training; improves lifts by as much as 14 percent to 40 percent.
- Potential of reducing muscular endurance. (Progress patients to isometrics to avoid this.)
- Potentially reduces speed of muscle response, which will slow you down.
- Generally boring to perform.
- Increases blood pressure, which could lead to ruptured blood vessels or irregular heartbeat.
- Strength gains achieved occur only within 20 degrees of the angle; there is approximately a 10-degree overflow on each side of the muscle fibers being used.
This “everything old is new again” program still encourages active participation of the patient during recovery, provides patient education on proper posture and body mechanics, highlights proper nutrition, and teaches corrective exercise therapy the patient can do at home on her own.
Isometrics and Resistance Testing
Isometrics can easily become part of the exam process itself. You can test what you want to test and the tests are reproducible. The test and the exercise can involve the length of time the patient can hold a pose. As strength increases, time under tension will improve and this becomes an objective finding. For example, resistance in isometric exercises typically involves contractions of the muscle using the following (the neural patterns used in #2 below may have a bigger impact on concentric strength and #3 below on eccentric strength and muscle mass):
- The body’s own muscle (e.g., pressing the palms together in front of the body at varying heights).
- Fixed structural items (e.g., pushing against a door frame). You can push or pull against an immovable resistance (e.g., pushing against the pins in a rack). Thus, there is no actual external movement while you are attempting to move the resistance.
- The use of free weights, kettlebells, weight machines or elastic tubing (e.g., holding a weight in a fixed position). Hold a kettlebell weight in your hand with the weight at your side. Your objective is to prevent it from going down and avoid shifting your posture. Once again, there’s no external movement; however, your intent is no longer to move the load, but to prevent its movement.
- Pressure-type equipment that has a digital readout of maximal force (grip strength).
“Static hold” isometric exercises can also be included in patients’ isometric routines. For example, during a set of rows, I have some clients hold their shoulder blades together when the handles are closest to their chest to “squeeze” the interscapular muscle in an effort to further strain the muscle. Depending on the goal of the exercise, the exertion can be maximal or submaximal.
A Treatment Plan Based on “New School” Isometric
Let’s create a treatment plan for our 50-year-old patient involved in a rear-end motor-vehicle accident using “new school” isometrics. Here are some beginning exercises I use for cervical spine rehab patients who are deconditioned:
Stability Ball Bridge
- Head and upper back on a stability ball.
- Torso in a “table top” pose.
- Contract the gluts to create a bridge.
- The glutes should be the primary muscles recruited (also some abs and quads).
- No low back discomfort and no hamstring cramps.
- As the patient progresses, they can keep their head off the ball.
- Build up to holding each “squeeze” from 10 seconds to 30 seconds. Perform five reps.
Supine Gut Contractions
- Supine position, legs extended.
- Contract the glutes to create a bridge.
- The buttocks should be the primary muscles recruited.
- No low back discomfort and no hamstring cramps.
- Maintain the cervical spine in various angles of slight flexion and extension.
- Build up to holding each “squeeze” from 10 seconds to 60 seconds. Perform five reps.
Sustained Wall Sit
- Back/shoulders/head flat against wall.
- Hip/knee/ankle flexed to 30 degrees. Progress to 60 degrees and then 90 degrees.
- Progress to one-leg wall sit.
- Maintain this position and add wall angels.
- Build up to holding the wall sit pose with the thighs parallel to the floor for 2 minutes. Perform one rep.
Sustained Plank (Isolates pecs and core)
- Use two 25-pound kettlebells or stands that are about 18″ off the ground. (Push-up bars work great.)
- Slightly wider than shoulder-width apart.
- Hands below the nipple line.
- Keep back flat and cervical spine in neutral.
- Keep body/torso in alignment.
- Build up to holding the plank for 1 minute. Perform two reps.
Upper-Body Arm Hang (Advanced)
- Pull up on the bar and keep eyes horizontal to bar.
- Hand/wrist in neutral position.
- Elbows at 90 degrees.
- No movement in body.
Anterior Abdominal Wall
- Supine, knees bent; strap legs in while leaning on bolster.
- Must keep the ear/shoulder/hip in alignment.
- Remove support.
- Time begins when position can be maintained.
- Make sure the lower back does not hyperextend and the cervical spine stays in neutral.
Other testing and exercise examples include: sustained side bridge (right and left)), sustain V sit (test) and sustained back extensor (test). Patients enjoy it when I instruct them to hold a weight at a certain position in the range of motion and time them for form; for example, holding a “heavy” kettlebell statically in the “rack” position (thumb pointing to the clavicle with the elbow into the body) for a certain amount of time. They then progress to walking around with the kettlebell in the rack position while maintaining good posture. The next progression is holding the kettlebell overhead and walking around. This builds core strength.
Other exercises include pushing or pulling against an immovable external resistance (e.g., heavy-band pulls/pushes). I try to get patients to hold the pose for 10 seconds and then 20 seconds, eventually getting to 60-plus seconds. Example exercises using bands or kettlebells include the following:
- Use a band with handles.
- Stand in a staggered leg stance.
- Grasp the handles at shoulder height with elbows bent.
- Brace your abdominals as you push the band (tubing) upward, extending the elbows.The arms are angled in front of the ears.
- Maintain proper cervical posture (do not allow forward head).
- Double-leg stance.
- Grasp the handles at shoulder height with elbows bend.
- Brace your abs as you push the tubing upward, extending the elbows.
- Arms are hiding the ears (the movement is straight upward).
- Maintain good cervical alignment.
- Wide stance.
- Grasp the handle with both hands.
- Begin at the left knee level and rotate your trunk to the right.
- Continue to look at the handles as you lift your trunk and rotate upward and to the right.
- Stretch the tubing across your body.
- Keep the elbows straight.
- Keep your eyes and head turned upward.
- Wide stance.
- Grasp the handle above your shoulder by extending and rotating your trunk.
- Continue to look at the handles as you pull the tubing downwards.
- Rotate and bend your trunk.
- Stretch the tubing across your body.
Dr. Jeffrey Tucker is a rehabilitation specialist, lecturer and healer best known for his holistic approach in supporting the body’s inherent healing mechanisms and integrating the art and science of chiropractic, exercise, nutrition and attitudinal health. He practices in West Los Angeles and lectures for the National Academy of Sports Medicine and the American Chiropractic Rehabilitation Board. For more information, please visit www.drjeffreytucker.com.