All Posts tagged flexibility

Flexibility (Dr. Tucker is quoted in this article)

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 mheyboer@chiroeco.com.

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Stiffness

Sometimes patients have to take a step backward to move forward, and sometimes their voyage is not so much about discovery as rediscovery. Stiffness is not the major chief complaint I hear from clients, but it is often checked off on their intake forms. Stiffness can be associated with pain, inflammation, fatigue, and any other complaint that bring clients in my office. The most common reason for stiffness is the effects of immobilization of the joints and muscles. The spinal joints, hip joints, knee joints, shoulder joints, and ankle joints are the most commonly involved. Muscle and joint pain commonly originates from bad habits of sitting, standing, sleeping, and walking. Stiffness has real consequences if ignored.

A Functional Workout

It doesn’t matter if my client is young, middleaged, or a senior citizen; I use the functional training approach as part of my treatment, especially for relief of stiffness. I  start my rehab recovery teaching patients body-weight maneuvers and floor exercises. Then, I progress patients to use bands. I incorporate Thera- Bands for rehabilitation, functional movement training, sport-specific conditioning, and group classes. The next progression I use is to free weights and Kettlebells. Our profession was inundated with laser therapy and decompression tables, while the strength-training world was invaded by Kettlebells. I like to think that I have access to every kind of equipment out there, but through it all, I am still a big proponent of the minimal and inexpensive need for equipment in “authentic” functional training, like Thera-Bands. Thera-Bands can provide the basis for an authentic functional workout limited only by the imagination and knowledge of the practitioner. Functional exercise is based on its outcome, not how the exercise looks. Don’t ask me how to activate specific muscles (that question was answered years ago). Instead, ask: Why did this person lose the movement pattern in the first place?” Thera-Bands help me get rid of stiffness and improve functional strength, which is usable strength. Functional strength is hard to measure. That’s why I attempt to identify it by using many unorthodox movements, such as assisted posterior reaches. his exercise is one of the best methods of developing functional abdominal strength in overhead athletes, or athletes in sports that bring the arms overhead, such as tennis and basketball. Stand on both legs (eventually progress to one-legged stands) facing away from a Thera-Band firmly held in place. Hold the band in both hands, and extend your arms straight up above your head. Bring the hips forward and the hands back. Lean backward as far as you can without feeling pressure in your lower back. Engage the lower abdominals to return to the starting position. Using the Thera-Bands, I teach movements that train the body to do what it was meant to do. These  can simply be broken down into four pillars: 1) Standing and locomotion (gait). One of my favorite exercises that improve the hip rotator stabilizers (gluteus) is to have clients wrap the Thera-Band (usually the green band) around the ankles and walk sideways across the room or down a hall to activate the gluteus. This one maneuver alone has helped more patients improve altered gait than any other. 2) Movements that lower or raise the body’s center of mass, such as squatting, lunging, and climbing. I have clients stand on a band and hold the ends of the band in their hands while doing squats, and perform an overhead press on the way up. 3) Pushing and pulling, such as standing rows and pressing maneuvers. 4) Rotation. These are changes in direction. For example, torso rotation and proprioceptive neuromuscular facilitation (PNF) band chops are a functional way to train the abdominals.

Everyone talks about the core, which includes the major muscles attached to the trunk, above the ischial tuberosity, and below the superior aspect of the sternum. Approximately 87% of the core muscles are oriented either diagonally or horizontally and have rotation as one of their actions. Our body was made for rotation,  yet very little rotational training is addressed in today’s standard training protocols. Thera-Bands make rotational training easy. The most annoying things about the bands is getting the latex powder on your clothes and occasionally the bands break while you are in the middle of a set. An advantage to band assessing and training is the observation of symmetrical or asymmetrical movements. The link between uncontrolled spinal and joint intersegmental translation or uncontrolled range of motion, and the development of musculoskeletal pain and degenerative pathology, is well-known. Often, patients are not even aware of the bad movement pattern that they are doing over and over that is causing the stiffness. Sometimes, it is only clearly seen when the muscles fatigue and pain sets in. The inefficient control of muscles and bones, poor movement habits, and poor posture give rise to very subtle and unique imbalances in the body-stability system. This puts mechanical stress and strain on the joints; and the muscular, neurological, and connective tissue systems of the body. This leads to cumulative microinflammation, which leads to pain and pathology. This predisposes joints to early aging and stiffness. A significant amount of injuries and stiffness occurs in clients with right- to left-sided strength and flexibility imbalances. My recommendations with the Thera-Band are to put the core first and to look for the following asymmetries:

Core Stability 

 

 and realizes how critical it is for the inner core of the body—namely, those joints closer to the spine, to be supported by the postural muscles designed with strength. You can create strength using the tubing made by Thera-Band. If you don’t tend to strengthen, the natural progression is for the body to lose it.

 

 

Stretching

I usually recommend that stretching is the last thing a person does once he or she is pain-free. I see many patients that injure themselves from overstretching in yoga class and with Pilates. Stretch to increase flexibility, but don’t overdo it. I encourage patients to feel the muscle barrier and don’t go past that point. Otherwise, you start pulling on the ligaments and these were not meant to be pulled apart. Neuromusculoskeletal function involves a complex integration of proprioceptors facilitating; muscles reacting and joints moving simultaneously in sagital, frontal, and transverse planes of motion in a groundforce kinetic chain reaction response. This is facilitated by the moving body in relation to the ground and gravity. Use Thera-Bands to put patients through movements that allow you to see how an individual can control outside forces that are irregular in intensity, speed, load, symmetry, nd direction, just like sports and real life.

Flexibility

The purpose of flexibility varies for the different muscles around the joints. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, hips, trunk, scapula, and humerus. Freedom of movement needs to be symmetrical.

General Muscle Strength

Once the foundational issues of consistency, core stability, flexibility, and balance control are being implemented, I then look at the bigger picture of the “outer core.” The rest of your body will need strength to carry you into your 80s and 90s. Performance as you age will be improved

 

 

Jeffrey Tucker, DC, DACRB

has been in continuous private practice for over 25 years in Los Angeles. His practice includes stretching,  yoga, Kettlebells, & FMS training. He teaches courses in rehabilitation. Contact him at www.DrJeffreyTucker.com 

 

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Anti-Aging Exercises

One Leg Stand

Attempt to balance on one leg, with eyes closed. Shoes off!

Hold for 20 seconds.
Repeat 3 times per side, per set.
One set per session.
Complete 1 session per day.

Step Down/Step Up

Stand on chair or 18″ stool. Slowly bend right leg, lowering other foot to the floor. Return by straightening front leg.

Repeat 20 times per set.
Two sets per session.
Complete 1 session per day.

Deep Squat

Stand with feet shoulder/hip width apart. Squat deeply, as far as you can. Keep head and chest up and heels on the floor.

Build up to 50 squats per set.
One set per session.
Complete 1 session per day.

Opposite Arms/Knees

Lie on back with feet flat, arms straight up and palms together. Slowly rotate head and hips to one side, arms and shoulders to the opposite side. Feet will fall to the side following knees and hips.

Repeat 20 times per side, per set.
One set per session.
Complete 2 sessions per day.

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