As with much in life that we take for granted, we are not usually concerned with the mechanisms of how our bodies work and how they do what they do. Such knowledge is not required for use of these magnificent machines that have been freely given to us. But just as a wise consumer will care for her or his car in terms of regular scheduled maintenance, our bodies require ongoing attention in order to maintain proper function. The shoulder joint, in particular, requires such proper care.
The shoulder has the greatest range of motion of any joint in the human body. The shoulder is capable of 360º of mobility from front to back (the sagittal plane), 360º of mobility in the frontal plane, and 180º of mobility to the right and the left (horizontal plane). Taken together, these optimal ranges are termed circumduction. But the shoulder's remarkable capabilities come at a price. The shoulder girdle is the least stable joint structure and is readily subject to sprains (of the acromioclavicular joint) and dislocation injuries (of the glenohumeral joint). Additionally, the rotator cuff, the group of muscles that protect the shoulder girdle and move the shoulder joints through three-dimensional space, is commonly injured, owing to the substantial mechanical stresses involved in such extensive motion.1
We can help prevent such injuries by engaging in regular physical exercise such as yoga and strength training. These activities place weightbearing loads on the shoulder, progressively training the muscles, tendons, and nerves that supply the shoulder joint structures to handle mechanical stresses.2,3 As a result of such training, when called upon to manage the shock of an unusual mechanical force, the shoulder will be able to respond effectively while likely preventing injury.
The choice of yoga versus strength training is not mutually exclusive. Many people will enjoy taking one yoga class per week and doing two strength training sessions per week. For persons taking yoga class, the two strength training sessions could focus on (1) the chest and back and (2) the shoulders and arms. Almost every yoga exercise involves weightbearing loads on the arms. Regarding strength training, a representative shoulder program includes seated dumbbell or barbell press (for the entire shoulder girdle), standing lateral raise (for the middle deltoids), and seated bent-over raise (for the rear deltoids). If you're doing yoga, strength training sessions for the legs may not be necessary. Of course, a complete exercise program includes specific cardiovascular exercise such as walking, swimming, bicycling, or running.
It may not be possible to prevent every shoulder injury. Engaging in a regular program of vigorous exercise, including yoga, strength training, and cardiovascular exercise, is the best means of ensuring optimal biomechanical health and wellness and the best overall method for preventing injury.
Sources
1Camargo PR, et al: Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 5(5):634-644, 2014
2Miller RM, et al: Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. J Shoulder Elbow Surg 2015 Nov 24. pii: S1058-2746(15)00485-1
3Awad A, et al: Effect of shoulder girdle strengthening on trunk alignment in patients with stroke. J Phys Ther Sci 27(7):2195-2200, 2015
Strong bones are important for all of us, not only for the aging baby boomers about whom we're hearing so much lately. And, "strong bones" are much more than a marketing ploy cooked-up by the dairy industry and pharmaceutical companies.
Bones are incredibly dynamic, constantly reshaping themselves in response to physical forces. Bones provide structure for our bodies, and they carry our weight around as we move from place to place. Long bones such as the thigh bone act as factories to produce blood cells. So, bones are an important part of our overall health and well-being.
Lots can go wrong when your bones aren't strong. If you suddenly fall onto an outstretched arm, you'll probably be OK if your bones are healthy. If not, you'll probably be in a cast for four weeks to help repair a wrist or forearm fracture.
If an older person falls, hip fractures are the main concern. A fit, healthy person can usually walk away. With weakened bones, hip fractures can result in many other problems, both immediately and long-term.
Bones lose their strength due to a calcium imbalance and/or not enough physical exercise. For most of us, these factors can be corrected. The best approach, of course, is to be proactive and ensure enough calcium in the diet and regular exercise.
How much calcium and how much exercise? Recommended daily calcium requirements1 vary, and 1000 mg per day is a good ballpark amount. Dairy products are the best natural source of calcium, and dark leafy greens such as spinach and broccoli, as well as dried beans, are also good sources. Vitamin/mineral supplements typically provide 25-50% of the daily calcium requirement.
Regarding exercise, both the American Heart Association2 and the American College of Sports Medicine recommend 30 minutes of exercise, five days a week. This takes some effort and planning, particularly if regular exercise is a new addition to one's routine. By making the effort and spending the time, we're saying "yes" to health and wellness, empowering ourselves as well as our family and friends.
Importantly, regular exercise in combination with sufficient dietary calcium is the key. Taking calcium alone will not be effective in maintaining strong bones. Unless long bones are undergoing consistent mechanical stresses, as with exercise, there's no need for them to use the calcium that's available. Exercise plus calcium makes the difference!
Core strengthening3 is a hot topic in the world of fitness - Pilates training and its offshoots. But the principles of core strengthening have been around for many decades - dancers, gymnasts, boxers, and wrestlers have been doing these things all along. Only the term "core fitness" is new.
Core fitness turns out to be critically important for all of us. By adding a handful of core exercises - 10 minutes at most - to your regular routine, you will profoundly improve the mechanics of your lower back, hips, and pelvis. And, these remarkable exercises improve the efficiency of your heart and lungs. A very big "bang" for your exercise "buck"!
Your chiropractor will be able to provide expert advice and guidance on these nutritional- and exericise-related topics.
1Daly RM, et al. Long-term effects of calcium-vitamin-D3 fortified milk on bone geometry and strength in older men. Bone 39(4):946-953, 2006.
2Haskell WL, et al. Physical Activity and Public Health. Updated Recommendations for Adults from the American College of Sports Medicine and the American Heart Association. American Heart Association, 2007.
3Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 85(3 Suppl 1):S86-92, 2004.
1. Why stretch? Stretching lengthens muscles and improves flexibility. Also, stretching the big leg muscles - the hamstrings, calves, and quads - simultaneously loosens and lengthens the muscles of your lower back. So, when you stretch, you're helping your back!
2. When to stretch? Recent exercise physiology studies show that static stretching is best done after exercise. Pre-exercise "dynamic warm-ups", such as torso twists, arm circles, and light jogging, prepare the body for work. Importantly, for those of us with back issues, it's still a good idea to do the familiar static stretches even before the dynamic warm-up!
3. Don't rush! Stretching is as important as what you're going to do after you stretch. And, if you rush, you might pull a muscle or worse. Be sure to include 10 to 15 minutes of stretching as part of your exercise time.
4. Stretch gently and slowly. You're not trying to accomplish anything while stretching. In other words, you're not trying to stretch "this much" or "this far". Nice and easy does it. Stretching is a Zen activity. There should be nor "effort".
5. Pay attention! If your mind drifts, you're headed for a pulled muscle.
6. Visualize! See (in your mind) what you're doing. Hold a mental visual image of the muscle group, where it comes from, where it goes. Visualization helps establish a brain-muscle connection, making your muscles much smarter!
7. Stretch your hamstrings first. Lie on your back with one knee bent [start with the left leg bent; you'll be stretching the right hamstring]. The left foot is on the floor and the left knee is bent approximately 90 degrees. Holding behind the right knee, gently bring that knee to your chest. Alternate this chest movement with a movement that begins to straighten the right leg in the air. The eventual goal on straightening is to achieve a 90 degree angle (or close to this) between the leg and your torso.
8. CAUTION - Progress may be quite slow. Remember - you are where you are. Stretching is gentle and slow. Alternate the bending and straightening movements gently, achieving a slightly greater straightening each time. You should work each leg for between three and five minutes.
9. Calf stretches - face a wall and place both hands lightly on the wall. Keeping both feet facing front, bend the front knee and place the foot of the leg to be stretched directly behind you. Your weight is being supported by the front leg. The back knee is pretty straight and the back heel is on or close to the floor. Maintain the stretch for 10 seconds, feeling the stretch in the calf as the back heel reaches toward the floor.
10. Quad stretches - stand on your left leg, placing a hand lightly on a wall to support the upright posture. Grasp just above the right ankle with your right hand and bring that heel close to the right buttock. The quadriceps is stretched by bringing the right thigh in line with the left thigh, just as if you were standing on both legs. The knees should also be close, in a line. You should feel a stretching sensation down the right thigh. Imagine a straight line running from your right hip socket all the way to the floor.
1Ferreira GN, et al: Gains in flexibility related to measures of muscular performance. Clin J Sport Med 17(4):276-281, 2007.
2Peeler J, Anderson JE: Effectiveness of static quadriceps stretching in individuals with patellofemoral joint pain. Clin J Sport Med 17(4):234-241, 2007.
3Behm DG, et al: Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exercise (36(8):1397-1402, 2004.
Repetitive stress injuries are typically very difficult to treat successfully. These injuries are the result of actions done repeatedly, frequently, and consistently over time. They've taken a long time to build up and, therefore, the healing process also requires a fair amount of time. Shin splints, iliotibial band syndrome, and rotator cuff syndrome are examples of common repetitive stress injuries. These problems are also known as overuse injuries. Tennis elbow is another common injury that is likely caused by repetitive stress.
Tennis elbow usually involves pain on the outer bony surface of the elbow joint (the lateral epicondyle). A variant involves pain on the inner surface of the elbow (the medial epicondyle). Regardless, tennis elbow pain interferes with many activities, not only those involving tennis and golf. Even the simple act of firmly twisting the lid on a difficult-to-open jar can cause significant pain. Driving for more than 30 minutes and prolonged keyboard activity are other examples of activities that may become quite troublesome when one is hampered by tennis elbow. Treatment usually involves rest, anti-inflammatory medications, and even injections of steroid compounds.1,2 But such treatments tend not to provide more than short-term relief. Ultimately tennis elbow may be frustrating and disheartening, as there doesn't appear to be an effective solution.
More useful treatment for repetitive stress injuries involves directly addressing the source of the problem. In the case of tennis elbow, mechanical issues in the forearm itself need to be corrected. For those whose painful elbows are in fact caused primarily by tennis or golf, focusing on sound technique will often help to provide significant relief. For example, in both sports, if lines of force generated by the arm muscles and lines of force generated by the forearm muscles cross at the elbow, significant pain is likely to develop over time. Learning how to generate parallel lines of force will help solve the problem, and such a solution may require the services of a coach.
For the rest of us, there are additional specific solutions. First, trigger points in the major forearm muscle bundles need to be treated.3 Trigger points in themselves may be very painful, and a trigger point also causes chronic fatigue in the muscle of which it is a part. When you try to use such a pre-fatigued muscle, damage to the muscle fibers and the tendon may result. Over time the involved region, such as the elbow, becomes chronically painful. Manual trigger point treatment relaxes chronic spasm and helps restore normal muscle tone. Increased blood flows to the muscle belly, and the involved muscle fibers have an opportunity to regain their normal length and to heal. The second specific solution is to use a narrow (1.5-inch thick), nonelastic elbow brace placed approximately 1 inch below the elbow. The brace will shorten the contractile length of the major forearm muscles, allowing them to achieve relative rest. The combination of trigger point therapy and appropriate use of a specific elbow brace will help to achieve long-term resolution of painful, difficult-to-treat tennis elbows.
1Childress MA, Buelter A: Management of chronic tendon injuries. Am Fam Physician 87(7):486-490, 2013
2Coombes BK, et al: Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751-1767, 2010
3Ajimsha MS, et al: Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch Phys Med Rehabil 93(4):604-609, 2012
As the recent AHCPR report states, "In the areas of training, practice and research, chiropractic has emerged from the periphery of the health care system and is playing an increasingly important role in discussions of health care policy." And, notes a March 1998 article in Business and Health magazine, "Many companies say chiropractic coverage has lowered their medical and workers' comp costs, while raising overall health and productivity. 'It's one of the best benefits possible from a quality, quantity and pricing perspective,' says George McGregor, president of [a firm that is a third-party administrator]." The article also cites an Oregon study, which found that median work time lost for employees with back injuries who used chiropractic care was only 9 days as compared with 34.5 days for workers who used medical care.
Quick relief of symptoms and sustained effectiveness have long attracted consumers to chiropractic care. In fact, in just one year -- 1997 -- more than 20 million adults used chiropractic services. The 1994 AHCPR guidelines for low-back pain concluded that spinal manipulation, chiropractic's primary treatment technique, is one of only three treatments whose effectiveness is substantiated by rigorous research. According to a 1992 RAND Corp. study, patients see a chiropractor primarily for low back pain and neck pain, though many seek chiropractic care for mid-back pain, extremity problems, headaches and other symptoms as well.
Because back pain is so pervasive in our society, a recent study published in the British Medical Journal pointing out that back pain doesn't go away that easily confirmed what chiropractors have always known. Only 25 percent of low back pain sufferers had fully recovered 12 months after their first visit to a general practitioner, the study said. This low number is in conflict with the commonly-held notion that low back pain episodes go away by themselves after a month. "This hardly comes as a surprise to low back pain sufferers who have been told by their medical doctors not to worry - the pain will go away on its own," said Dr. Michael Pedigo, president of the American Chiropractic Association. "In many cases, further treatment is necessary."
Doctors of chiropractic have long understood the cyclic nature of low back pain, and perhaps this is one of the reasons they consistently rate higher than MDs in patient satisfaction in this area. In a recent Gallup poll, 90 percent of all people who visited a chiropractor agreed that their care was effective.
Successful outcomes in both effectiveness and patient satisfaction, have paved the way for chiropractors to enter the mainstream of health care services. Some have even begun to collaborate with medical doctors in integrated health care practices. As reported in the May/June 1998 issue of Health magazine, the prestigious Texas Back Institute (TBI) at one time included only surgeons and other M.D.s. Then, about ten years ago, when TBI's medical doctors discovered chiropractic's success with lower back pain, they hired their first chiropractor. Now, according to one administrator quoted in the article, about 50 percent of the Institute's patients see a chiropractor first when beginning their treatment. Also, the Washington Post recently reported on the success of the 5-year-old company, American WholeHealth, whose clinics incorporate a consumer-driven mix of traditional medical and alternative health care including chiropractic.
Due to years of criticism -- and even an illegal boycott by the American Medical Association -- chiropractic training was sometimes called into question. However, the fact remains, chiropractors must complete a minimum of 6 and, on average, 7 years of college and post-graduate study to earn their degrees. Their education includes at least 4,200 hours of classroom, laboratory and clinical experience, and as much -- and sometimes more than -- course work in anatomy and physiology as most medical doctors. After they receive their degrees from one of the nation's 17 accredited chiropractic colleges, they have to pass rigorous exams and be licensed by the state before they can open a practice. The practice of chiropractic is licensed in all 50 states, and in 1994 there were approximately 50,000 chiropractors licensed in the United States. This number is expected to double by the year 2010, according to the 1997 AHCPR report.
"These recent surveys and reports finally vindicate the chiropractic profession after years of enduring doubt, questions and criticism about our training and practices," said Dr. Pedigo. "What the health care and medical communities are just beginning to accept is what our patients have known all along -- that our treatment is safe, effective and highly successful at improving their quality of life."
A person with an exercise- or sports-related injury has many questions: When can I start exercising? When can I get back to my sport? What can I do to prevent this from happening again? The answers to these questions are relatively straightforward. But for some, injuries continue to happen. Which leads to the key question: Why did this happen to me?1,2
This is the hardest to answer. Some injuries may occur even when you're doing the things you're supposed to be doing. Sometimes you just have to shrug your shoulders and move on. But it's also very important to continue to try to discover the underlying causes.
If we dig deeper, we'll find that there are three main sources of training injuries: (1) under-preparation, (2) over-training, and (3) lack of focus or not paying attention.
Under-preparation means doing things you're not ready to do. People who have never done aerobic exercise go out and try to run five miles. People who have never done strength training go to the gym and try to lift weights that are too heavy. People who have never taken a yoga class go to one, like it, and then go every day for a week.
These exercise patterns can be dangerous, physically, and may directly lead to injury. A 16-year-old teenager has some leeway and can get away with making a variety of training errors. This may even be true for those who are in their mid-20s. But persons who are older need to train on a trajectory. Good principles to follow include starting slowly, starting with the basics, and making sure to include rest days in your training program. Build up your strength and stamina. Doing more than you're ready to do will send you straight to your chiropractor's office or even to the hospital.
Over-training means doing too much. Most of us are guilty of this. For example, you love to run, you build up your weekly mileage to a good level, but then you keep piling on distance. All of a sudden you've got a stress fracture in your leg or a bad strain of a calf muscle.
How do you know when you're over-training? The key is to train smart, and to be aware of the possibility of over-training. The temptation to do more is always there, but the result is never good. The short-term gratification is completely outweighed by the frustration and loss of conditioning resulting from injury-enforced down-time.
What about focus and paying attention? Many injuries happen during normal training because the person's mind wandered off. People pay more attention to the TV or to their incoming text messages than they do to the equipment they're using or the weight they're lifting. The result is an injury, sometimes a bad one. In fact, you're very unlikely to sustain an injury during normal training if you're completely focused. Maintaining focus is part of the discipline of training.
But even if a person is doing all the right things, aren't there underlying issues that may predispose that person to injury? The easy answer is "yes". The hard part is to accurately assess and possibly diagnose such issues.3
A big part of the assessment process is the acquisition of knowledge. In the realm of exercise and fitness, some personal knowledge of biomechanics can go a very long way toward preventing injuries. Your chiropractor can help you learn more about human biomechanics and physical performance.
Eat more vegetables. Stress less. Take the kids out to the park more often. You may already have a long list of resolutions for the new year. This year, honor your spine, too. With the help of your doctor of chiropractic, these simple steps can promote a healthier back for the new year.
Do you wake up with aches and pains? It could be time to purchase a new mattress or pillow. The American Chiropractic Association (ACA) recommends finding a mattress that evenly supports your whole body. There should be no gaps between you and the mattress when you lie down. When choosing a pillow, select one that supports your head and neck in alignment with the rest of the spine, whether you sleep on your side or back. Keep in mind that what works for your partner may not work for you- there isn't one mattress or pillow that fits everyone. Simple adjustments, such as adding foam padding, can help tremendously.
Americans spend an average of 44 hours at work every week- often behind a desk. To avoid poor posture that can lead to tension, back pain, and joint problems such as carpal tunnel syndrome, check that your chair is the right size and adjusted correctly, says the ACA. Do your feet rest comfortably on the ground? Does the chair offer lumbar support? Are you able to tilt or swivel easily while performing tasks at your desk? Also, be sure you have adequate light (so that you aren't straining to see documents or a computer screen), adjust your computer monitor so that it is at eye level, and wear a headset for longer telephone conversations. And don't forget to take frequent breaks and stretch throughout the day.
Many back injuries are caused by improper lifting of items such as luggage, backpacks or briefcases, storage boxes, or even groceries. But knowing how to lift properly can prevent serious injury. First and foremost, don't bend from the waist. Keep your back straight, and squat to reach the item. Then, keep it close to your body as you lift, and avoid twisting motions. When traveling, check all bags that weigh more than 10 percent of your body weight.
Eating a balanced diet and getting regular exercise helps your body stay toned and tension-free- and promotes a healthy weight and a happier spine. Smart exercise and a good diet can also prevent osteoporosis, which affects over 20 million American women. To start, the ACA recommends eating out at restaurants less (to reduce the amount of unhealthful fats and sugars you consume) and adding more fresh fruits, vegetables, and whole grains to your diet. Aim for a minimum of 20 to 30 minutes of exercise, three or four days a week.