This is Part 1 in a series of posture articles I am writing for Dynamic Chiropractic this year. Enjoy!More
Improving posture requires working on your flexibility, checking out your home & work stations for poor ergonomics, and a strength training program. Tight muscles affect our posture, so you will need to use the foam roll on these as well as stretch them out.
Tight Muscle List: The hamstrings, which actually comprise of three separate muscles: the Biceps Femoris, Semitendinosus and Semimembranosus.
Rectus femoris, one of the four quadriceps muscles, which inserts into the patellar tendon, which connects the kneecap (the patella) to the shin bone.
Tensor Fasciae Latae (TFL) on the outside of the thigh.
Piriformis, which is in the butt region.
Adductors, the inner thigh muscles.
Gastrocnemius, the muscle in the back part of the lower leg running from just above the knee to the heel.
Quadratus lumborum, one of the muscles of the low back, a primary cause of lower back pain.
I typically see:
tight hip flexors, hamstrings, calves
tightness through the external hip rotators, leading to restriction in hip joint range
limitation of lumbar spine extension
stiff thoracic spine
protracted and elevated scapulas with weak lower trapezius and serratus anterior
tight and weak posterior rotator cuff
poked chin posture with associated weak deep neck flexors and overactive upper trapezius, levator scapula and rhomboid muscles.
Prolonged sitting has also been linked to hamstring strains. The lumbar spine stiffness associated with sitting leads to altered neural input into the posterior thigh, the theory goes. This can manifest as increased muscle tone of the hamstrings, which will alter the length-tension relationship and increase the risk of strain.
Hunched postures cause thoracic spine stiffness, shoulder imbalance and winged scapulas.
Each of my clients is encouraged to correct their posture, perform a daily flexibility program and take a look at the ergonomics of their work-stations to help them regain the alignment and muscle balances that are essential for them to achieve their best health.More
Combinations of muscle weakness and tightness cause musculoskeletal pain. The most difficult part of treatments are to the muscles that become inhibited, (restrained, blocked, or suppressed) because this requires patients to perform exercise at home on there own. Muscle inhibition is common in the neck, low back, and extremities.
Inhibition refers to the inability of a muscle to contract fully on demand. This inhibition is a neurological response and manifests particularly at the extreme ranges of motion – when the muscle is contracted fully. A muscle may have strength at the mid-range, but be very weak when moved into a shortened position; this creates instability at the joint. When the body senses instability, other muscles tighten up as a form of protection. To improve these muscle and joint imbalances I expect my clients to perform the exercises that I prescribe as part of my treatments.
Inhibitied muscles usually generate hypertonicity/tight muscles in adjacent regions of the body (low back & hip, neck & shoulders)). In other words, the relationship between weak and tight muscles is reciprocal. Inhibition is frequently found in muscles resulting from injury, inflammation or pain and that inhibition or weakness leads to reciprocal facilitation of its antagonist(s) muscles.
When a muscle has been over-stressed or over-worked, the result is altered feedback from the nervous system. This causes a reduced capability for the muscle to contract, from the instability through full physiological range. The end result is an inability for the muscles to properly stabilize joints. This is a major point that I want you to understand. I teach you stability (strength) exercises to train the weakened muscles to hold the joints in place again.
Again, please understand, hypertonicity in a muscle leads to blockage(s) or weaknesses in other muscles close by. Inhibited (weak) muscles are capable of spontaneous strengthening when the inhibitory reflex is identified and remedied (most commonly through joint or soft-tissue manipulation).
Muscle hypertonicity/tightness/spasm generates inhibition in surrounding regions of the body, and so spasm is treated first using the Deep Muscle Stimulator, warm laser, manipulation and deep soft tissue massage therapy.
The inhibited (weak) muscles are treated with exercise, rocker boards, wobble boards, and other tools. I prefer to teach clients bodyweight exercises, resistance band exercises, stability ball maneuvers and kettlebell training.
I pay a lot of attention to posture because the postural muscles tend to be short, tight and usually hypertonic. This is why some times I will teach you to stretch, and other times I will teach you to strengthen your muscles.More
CCA Journal article and photos: http://www.ccajournal.com/CCA_Spring_Journal.pdfMore
This article appeared in the California Chiropractic Journal
In-Office Rehab and Balance Training by Dr. Jeffrey Tucker, DC
The doctors that I get to teach, and those that I meet who include exercise therapy in their practice appear to create better client satisfaction and experience better patient retention. Patients enjoy the participation in their care that exercise therapy provides.
More than thirty-five years ago, when I was a teenager, going to the gym and working out was for kids and parents who already had an active lifestyle. The typical ‘old school’ gym program included a ten minute bike or treadmill warm up, a 40-50 minute strength training regime—usually in a muscle group split, and then on “off-days,” 20-30 minutes of cardio.
Today’s ‘new school’ exercise programs consists of foam roll therapy (self myofascial release) for 10 minutes, stretching of overactive muscles for 5-10 minutes, core stability exercises for 5-10 minutes, balance training for 5 minutes, reactive training and speed, agility and quickness training for 5-10 minutes, intense strength training for 20-25 minutes, metabolic/cardiovascular training for 10-15 minutes and 5 minutes for cooling down.
Many clients that come to us may already be doing any or all of these exercise strategies on their own at home or in the gym. My role as a rehab specialist is to write corrective exercise programs, teach clients how to perform the exercises and guide them into progressions that help eliminate pain.
Additional therapeutic goals may include injury prevention, decreased body fat, increased lean muscle mass, increased strength, increased endurance, increased flexibility, and enhanced performance.
You can have a very successful exercise practice in your office using Therabands, especially the ones with handles, a barbell, dumbbells, kettlebells, a sturdy exercise bench that inclines, a swiss ball, a wobble board, or rocker board, or bosu.
I break up each of the “new school” categories of exercise in my in-office treatment sessions. After the acute care phase, I start by training clients in the use of the 3-foot-by-6-inchwide foam roll. This method of self myofascial release is used to inhibit overactive muscles. Holding pressure on the tender areas of tissue (trigger points) for a sustained period of time, usually 30 seconds per tender point,can diminish trigger point activity. Patients are expected to use the foam roll at home on their own. This is followed by a session where I teach clients how to stretch.
Following use of the foam roll, the application of a lengthening technique (static stretching) resets the muscle lengths and provides for optimal length-tension relationships. Once patients are foam rolling and stretching at home, the subsequent in-office session is used to teach isolated strengthening exercises. This session time is used to teach clients how to isolate and exercise a particular muscle. For example, a common underactive muscle is the gluteus medius. The side lying hip abduction exercise would be taught to increase the force production capabilities through concentric-eccentric muscle actions.
Isolated exercises focus on the muscles of the body that have synergistic function of the stabilization and mobilization system.
Additional sessions are required to train clients in integrated dynamic strengthening exercises. This will ensure an increase in intra- and intermuscular coordination, endurance strength and optimal force-couple relationships that will produce proper arthrokinematics.
An important exercise therapy often overlooked by clinicians, is that prior to resistance training, balance training should be performed, because it has preconditioning effects
on strength training. Our everyday clients face the challenges of keeping balance to perform activities such as playing with their children or grandchildren, walking on uneven surfaces or even taking a walk in their neighborhood.
‘New school’ exercise programs realize balance is a skill-related component of physical fitness. It is important to incorporate balance training in every client’s corrective exercise program as an integrated component to a comprehensive training regimen.
Balance can be influenced by many factors. As we age, our ability to balance or maintain postural control decreases. Watch seniors maneuver steps and stairs. Those who lack the ability to decelerate and control their center of gravity have a significant risk potential of a devastating fall. Prior injuries, especially after ankle sprains, ligamentous injuries to the knee, and low back pain can also decrease an individual’s ability to balance.
A joint dysfunction in the ankle, knee, shoulder, or low back can lead to muscle inhibition. An acute joint injury may cause joint swelling, which results in an interruption in the internal communication process of the body–sensory input from receptors such as articular, ligamentous, and muscular mechanoreceptors to the central nervous system. In turn, this changes our proprioceptive capabilities. When sensory input to the central nervous system is altered, our movement system may become imbalanced.
Repetitive recruitment of the wrong muscle fibers, in the same ROM/Plane of motion and at the same speed, creates tissue overload and eventual injury. Consequentially, this can lead to neuromuscular inefficiency, resulting in decreased balance and postural instability.
Recovery from injury needs to include repairing faulty movement patterns (alterations in stability) and correcting inefficient neuromuscular control. Through balance training,
the central nervous system can be exercised to change and improve a lack of joint stabilization that is causing functional instability.
Don’t forget to address balance as a component of a training program. Balance training may be used not only for reconditioning clients post injury, but also as a preventative measure to increase postural stability and reduce the chances of injury.
Dr. Jeffrey Tucker, D.C., D.A.C.R.B, is
a rehabilitation specialist, author,
lecturer, and healer best known
for his holistic approach in supporting
the body’s inherent healing
mechanisms and for integrating
the art and science of chiropractic,
exercise, nutrition and attitudinal
health. He instructs for the National
Academy of Sports Medicine and
the Chiropractic Rehabilitation Association.
He practices in West Los