Assessments are undeniably important to reduce compensatory movement patterns that can increase the risk of injury when engaging in remedial exercise or athletic activities. I have many different techniques for assessing my patients.
I prefer to begin with a static postural assessment, looking from the front, side and back view.
I begin at the feet and look for any eversion of the foot in relation to the tibia. I also look for ankle pronation or supination, as well as excessive ankle dorsiflexion or plantarflexion.
At the knees, I look for valgus or varus stress, tibial torsion in relationship to the femur, internal or external femur rotation, and any excessive knee flexion or hyperextension. At the hips, I look for any abnormal elevation, anterior or posterior pelvic tilt, pelvic rotation or lateral flexion. When assessing the upper body, I look for any thoracic offset, rotation or flexion. I also check the shoulders for rounding or unusual elevation discrepancy. When assessing the head position, I check to see if the ear is in line with the shoulder, noting if there is a forward head posture.1-2 In addition, I will check to see if the load-bearing joints appear forward of the lateral malleolus or if the person appears to have a side lean.
Read More… http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56277
In my 30 minute one-on-one sessions I include flexibility, core work, (but not just core work, I help you get at the deep core), balance, plyometrics, agility, strength, and cardio. I offer variety and knowledge to train you better than anyone else. Different tissues in the body each respond to different workouts based on the principle of specificity or specific adaptation to imposed demand. Including a wide variety of workouts prevents muscle imbalances and ensures that you are improving in all areas of our targeted goals – flexibility, endurance, neuromuscular coordination, body fat loss, posture, strength, and power.
I teach you how to use free weights, kettlebells, bands, and body weight. We have fun and the 1/2 hour goes by very fast.
Call 310-470-4511 and speak to August or Angie for an appointment.
Sitting for long periods during the day predisposes people to injuries like low back strains and neck strains. It also can adversely affect your sports performance. Let’s see, you get up in the morning and go sit down to eat, then you get in your car and drive to work where you sit in your chair most of the day. Need I go on… yes! Large chunks of your day are spent sitting hunched over a computer, or slumped on the sofa. Unless you move around enough, you will feel some or all of the following problems:
- tight hip flexor, hamstring and calf muscles
- tightness through the external hip rotator muscles, which can lead to restricted movement at the hip joint
- reduced extension through the lower back, causing stiffness in the mid (thoracic) spine
- tight and hunched shoulders with weak lower shoulder muscles
- tight and weak muscles at the back of the shoulder
- “poked chin” posture and muscle imbalances in the neck and upper shoulders
Prolonged sitting is linked to hamstring strains, lower back stiffness, nerve irritation, and headaches to name a few things.
1. In a nutshell, what causes bad posture? Americans spend an average of eight to ten hours each day at work. During our work time, we often sit unconsciously in improper body positions and engage in repetitive movements that create muscle imbalances leading to poor posture; poor self esteem; psychological distress & depressive symptoms; lack of a variety of movement in our activities of daily living; overall poor flexibility.
2. What negative effects does poor posture have on the body? “To live a long, active, energetic life, few things matter more than good posture” – American Journal of Pain Management; Nerves get abnormal tension placed on them and can cause inefficiencies within the neuomusculoskeletal system; muscle imbalances and joint dysfunctions associated with poor posture can create areas of too much motion in certain spinal segments causing instability. These areas may then wear out prematurely, while other areas may have too little motion in the spine causing range of motion/mobility dysfunctions; anytime we have an asymmetry in the body we are more susceptible to injury – overactive muscles vs underactive muscles can cause asymmetry; poor posture can cause incoordination of muscles and balance systems of the body; I think one of the reasons actors and actresses have “presence” when they walk into a room is because many of them have been trained in proper posture.
3. How does one start to improve their posture? Look at the foot/ankle for pronation issues and use an insert or orthotic if necessary – this can help improve gait and posture; improve faulty breathing patterns, especially paradoxical breathing; improve your balance by training it – for example, standing on one leg while maintaining good posture is a simple exercise maneuver; Engage in consistent use of the foam roll to provide self-myofascial release and self massage; stretch overactive (tight) muscles; perform isolated muscle strengthening of weak muscles and movement patterns; use bodyweight, free weight or kettlebells to perform whole body exercises; consult with a practitioner who understands the concepts of good posture – when I teach other doctors, I call this being the “muscle whisperer” – understand what the muscles are saying while performing a posture evaluation.
4. What are the top 3 things to remember when attempting to improve your posture? 1. Become aware of the things that you are doing, even the things that you don’t even know you are doing that are contributing (harming) to your posture. 2. Think of staying in a ‘tall spine’ posture (while sitting, standing, exercises); take frequent breaks from siting and use the Brugger’s postural relief position as one of the those style of breaks 3. Know what it feels like to be in proper posture alignment and frequently try to duplicate that feeling – sometimes clients don’t even know what good posture feels like and looks like.
Chiropractor Jeffrey Tucker, DC Los Angeles, California
Build a tall spine
- good posture is good body mechanics – you should look symmetrical, without a forward head posture, have level shoulders and a level pelvis; no sway back, flat back, or rounded shoulders; and feet pointed relatively forward
- be aware of things you didn’t know could harm posture like sleeping on your stomach and wearing worn out shoes
- stay in a “tall-spine” posture, and take breaks from sitting after more than 30 to 60 minutes
- stand up and raise hands above head with arms extended and elbows in line with ears; bend backward as far as possible, making sure hips go forward and arms go backwards; repeat ten times
- duplicate that feeling of proper alignment, when your muscles feel properly stretched and the joints feel like they are moving and gliding
- if you notice feet and angle rotation issues, use an insert or orthotic to improve gait, posture, and faulty breathing patterns like tightness in the neck and shallow breathing from slumped posture
- improve balance by standing on one leg while maintaining good posture, or perform the cobra yoga pose, which engages the muscles of your upper, middle, and lower back; gluteals; and rear shoulders
- [cobra yoga pose] lie on your stomach with the tops of your feet contacting the floor, buttocks squeezed together, belly button drawn in towards the spine, and arms along your side; point thumbs upward, while lifting upper body off the ground; maintain tight buttocks and feet in contact with the floor; pause at this end position, squeeze should blades together and directing hands toward your feet; repeat 10 to 15 times for one to three sets, with 30 to 60 seconds between sets
By Dr. Jeffrey Tucker
My personal in-office experience of patients that present with pain after a motor vehicle injury is consistent with a 2010 study by Hincapié CA, et al. I find most patients report pain in multiple body areas and that isolated neck pain is extremely rare. Hincapié CA, et al report 86 percent of 6481 Saskatchewan residents that responded reported posterior neck pain, 72 percent indicated head pain, and 60 percent noted lumbar back pain. Ninety-five percent of claimants reported some pain within the posterior trunk region, comprising the posterior neck, shoulder, midback, lumbar, and buttock areas.
Regarding cervical rehab for these patients, in the past I’ve used everything from bodyweight isometrics and elastic Thera-Bands to strengthen the neck; dumbbells and kettlebells to strengthen the upper body; low load exercises for strength and motor control concepts performing 10 repetitions of deep neck flexor activation against an inflatable blood pressure cuff and a whole lot more.
All of these are effective at reducing acute and chronic neck pain. Oh, I can’t forget teaching patients all the foam rolling, stretching, warm-ups and cool downs I can get them to do. I can probably do an entire seminar on rehab compliance at this point.
My treatment choice has always depended on the individual patient, whether they are young or old, active or inactive, conditioned or deconditioned. Truthfully I don’t see a significant difference between the different treatment modalities. Most patients obtain clinically important improvements at 6 weeks after the beginning of treatment and exercise programs. I think that is in line with what most practitioners were taught to expect. However, I still see that 10% (plus or minus) or so of clients take a lot longer than 6 weeks to resolve and have on-going residual complaints and problems. On the other hand, I love treating chronic pain patients that come into my office that were not originally treated by me – those who had previous chiropractic care, acupuncture, medical care or physical therapy without active rehab (they just received passive modalities). With some new tweeks on rehab, I expect good results with these individuals. My hands-on treatment over the past few years seems to include more cervical mobilization (stair-stepping technique), lower cervical manipulation (rather than upper cervical manipulation), thoracic manipulation, and I continue to do a lot of specialized deep soft tissue therapy for pain reduction. The deep tissue work is especially valuable to the upper cervical region. Over the last few years, I’ve added warm laser, but it is so unpredictable who will benefit and change and who doesn’t, I’m losing interest in the whole “laser” thing for the cervical region.
One of the most helpful things I’ve learned in the last five to six years is Dr. Kim Christensen’s Neuromobilization technique. If you have a patient with radiculitis, this technique can produce some clinically important reduction of pain immediately posttreatment. The biggest changes in my cervical treatment come in my rehab. Helpful strategies in the past several years include using the NASM protocol for the ‘overhead squat’ as a diagnostic tool and treatment guide, and using the Functional Movement Screen (FMS) as a predictor of risk for injury.
My latest rehab management strategies for MVA & cervical spine patients:
Manual therapy: lot of personal thought and patient time figuring out manual maneuvers and stretches to influence the fascia – that thin fibrous layer consisting of longitudinal and transverse connective tissue fibers. Restrictions seem to show up everywhere. Along the sacrotuberous ligament, the thoracolumbar fascia, the latissimus dorsi muscle, the spinous processes of all of the thoracic vertebrae, the angles of ribs, the serratus muscle, the splenius capitis muscles and the deep fascia of the neck.
Balancing (sensorimotor training) exercises as early as possible. I start patients standing with a narrow stance, progressing to tandem stance and single leg stance. The progression includes the use of foam under each foot to augment postural instability. Manipulate visual inputs (focusing on a point 2 meters away on the wall at eye level and under, with eyes open (EO) plus eyes closed (EC) conditions). I use 30 second bouts.
Stretching exercises is still part of many cervical rehab programs but dynamic stretching and mobility of the thoracic spine to influence the cervical spine is enhancing rehab routines. Mobility needs to be taught before stability. We have to reduce neck/shoulder stiffness and enhance neck range of motion. The static stretches for the levator scapulae, suboccipitals, SCM, pectoralis minor, and scalenes continue to be at the top of the list. I am enjoying using the stretch strap from Theraband.
Strengthening exercises after the deep neck flexors (DNF): Sometimes I begin with the head positioned against gravity to enhance isometric strength of the neck extensor muscles. I still do typical strengthening exercises for the paraspinal muscles and shoulder girdle muscles (upper and middle trapezius, rhombo-serratus). These exercises help increase the sustained isometric effort tolerance of the neck muscles. Progression includes unstable surface
and escalating resistance and movement pattern improvement. I begin my corrective exercise strategy with bodyweight, progress to Therabands resistance, then progress to free weights and kettlebells.
Oculomotor and head/eye exercises
: In the upright, sitting and supine positions I teach patients eye tracking while moving the head. This involves coordination exercises and re-establishing proper movement patterns.
The progression includes increasing neck rotation amplitude, instability on a stability ball and augmenting neck muscle activity with the head in a weight-dependent position. For the past few years I’ve been using the overhead squat for cervical evaluation. Dr. Christensen and I wrote a chapter on the cervical spine in Mike Clark’s new book. In the past we used the overhead squat as a movement pattern to evaluate the ankles, knees, and lumbopelvic-hip complex. Now we use it to evaluate the cervical spine as well. Just think of it as closely rel ated to the supine cervical flexion movement pattern. Have the patient perform the overhead squat. Observe them from the front and side. The normal pattern would be for them to lead with the posterosuperiour aspect of head. If the SCM’s and subocciptals are dominating, they will lead with their chin. This is a faulty pattern. Remember these muscle actions:
Antomical action of longus capitus and colli (cranio-cervical flexion) nods the chin.
SCM extends the cranio-cervical region and flexes the neck.
Scalenes are neck flexors.
During the overhead squat I seem to find a lot of overactive SCM, anterior scalene, and suboccipital muscles.
Here are a couple of corrective exercises:
Scalenes and hyoids can be short, limiting cervical extension. Hyoid stretch: teeth touching – extend the neck – open mouth and your head extends further. The stretch is close the mouth = fascial stretch of hyoids. To find out if it‘s articular, perform the chin tuck and extend the cervical spine over the upper thoracic region.
4 Point Kneeling: The head and neck are passively positioned in neutral alignment, then the patient actively moves (turning side to side, looking up and down) and attempts to return to neutral position. Perform this procedure twice. Notice if they can come back to the neutral position. Score: Good = the patient accurately and confidently returns to the neutral position both times without making adjustments. Average = the patient returns to neutral position with reasonable accuracy but lacks confidence – may need to make several adjusting movements or is “not quite sure.” Poor
= the patient cannot return to the neutral position and is often very unsure of the correct position as evidenced by the vacant facial expression that frequently is associated with performing this test.
I’m sure there are dozens of specific treatments, exercises, and natural remedies out there for our patients. I’d be interested to know about them, but if you’re following the rehab model in all its facets – manipulation/mobilization, modalities, diet, activity, exercise, leisure, sleep, stress prevention – I think you’ll find we do so much good!
I have new material to share with you.
Dr. Jeffrey Tucker can be contacted at:
11600 Wilshire Blvd. #412, Los Angeles,
CA 90025, phone 310.473.2911
and on the web at www.DrJeffrey-
1. J Occup Environ Med. 2010 Mar 30. Whiplash
Injury is More Than Neck Pain: A Population-
Based Study of Pain Localization After
Traffic Injury. Hincapié CA, Cassidy JD, Côté P,
Carroll LJ, Guzmán J.
2. Comerford lecture notes 2009.
Dr. Tucker completed Chiropractic training at Los Angeles College of Chiropractic.
He has a post graduate Diplomate degree in Rehabilitation and is certified in
chiropractic spinal trauma. He is a past-president of the Santa Monica Chiropractic
Society. Dr. Tucker served on the Chiropractic Rehabilitation board. He is a
member of the California Chiropractic Association and the American Chiropractic