Tag: flexibility

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Exercising With Arthritis

 

We have all different levels of fitness. Some individuals have been exercising for years, while other individuals have never exercised a day in their lives.  We are all at different levels in terms of our cardiovascular fitness, our muscle strength and flexibility and our overall health.   It is quite important to remain active in spite of arthritis.  In fact, movement in people with arthritis is crucial to health and well-being.

Despite what we once thought, it is my experience that it is possible to modify the severity of certain types of arthritis.   In my mind, arthritis, chronic pain and other autoimmune diseases are the result of multiple factors.  All these factors such as genetics, environmental exposures, nutritional deficiencies, dietary influences, and gut health to name a few factors, all line up as if you were to “win” in the slots.  When this potent combination occurs in your body, havoc ensues.   The result is inflammation and chronic disease.   While you can’t change your genes per se, it is now thought that you can change or modify your gene expression.  In addition, you can certainly modify some of the other risk factors just mentioned to offset the severity of your debility.

In most cases, moderate exercise is essential to health and well being.  Proper, varied forms of exercise raises heart rate, raises endorphins, improves muscle strength, improves balance, improves flexibility and increases blood flow throughout the body including the muscles and joints.  In the case of arthritis, there is inflammation in the joint capsule and the bones themselves which leads to severe pain and often deterioration.     The nerve endings in the joint become super sensitive and pain can be unbearable.

Believe it or not, your choice of diet can directly impact your ability to exercise. When you consume an Anti-Inflammatory Diet, often you will notice you will able able to exercise with less pain is because this diet eliminates many known triggers for arthritis.

 

Some examples of arthritis triggers include:

  • Fried and processed foods
  • Thought to be due to compounds called AGE – (advanced glycation end products) These products are the result of heating, grilling, and frying foods.  The body utilizes pro-inflammatory molecules called cytokines in an effort to break them down and the result is excess inflammation in general as well as in the vascular system (blood vessels).
  • Sugary foods
  • Dairy
  • Alcohol
  • Foods/Oils with Omega-6 fatty acids – such as vegetable oil (safflower), corn oil, fried foods, certain nuts and seeds, mayonnaise

 

Some examples of beneficial foods include:

  • Foods containing high levels of Omega-3 Fatty acids – (ex. salmon, herring)
  • Avocados
  • Flax seed
  • Cherries and other berries (contain anthocyanins that are thought to be anti-inflammatory)
  • Leafy vegetables, broccoli – contain vitamin D
  • Green tea – has EGCG (epigallocatechin-3-gallate) a powerful antioxidant
  • Vitamin C containing foods (ex. papaya, brussel spouts, broccoli, citrus fruits)
  • Garlic, onions and leeks

 

It is very important to listen to your body.  Pay attention to the foods you are eating and the way you feel.  Often times, foods that are considered healthy may cause issues for you.  If you suffer from arthritis, try rotating your foods (i.e. do not eat the same food everyday).   If there are certain foods you think might bother you, wait 3 days in between eating them.  Then pay attention to the way you feel when you re-introduce those foods.  If you notice you have more difficulty with pain or decreased ability to exercise try eliminating the offending foods for a week or two.

Typically, it will take several weeks of following the diet closely before you see results with regard to decreased pain from inflammation.

When exercising with arthritis, it is important to modify your exercises as per trainer recommendations.  If exercises hurt, if possible, discuss with your trainers to find another way to exercise that muscle group.  In the beginning, there may be some exercises you simply cannot do.  What is important is that you are attempting to exercise.  With each passing week you will find that you can do a little more than the previous week.  Progress may be slow, with ups and downs.  As always, if despite closely following the diet, you are still having issues, it might be time to seek the advice of a health care professional.

Hamstring Injuries

 

The hamstring muscles are actually a group of 3 muscles located in the back part of your upper leg. The hamstrings muscles originate from the pelvis (buttocks) and the femur (leg bone) on the backside of the leg and cross the knee joint to insert on the medial (inside) and lateral (outside) part of the leg just below the knee. The main jobs of the hamstrings are to extend (straighten) the hip and to flex (bend) the knee.   In addition, some of the hamstring muscles play a role in rotating the lower leg.

The most common thigh injury is a hamstring strain.   These injuries can often occur when the hip is flexed and the leg is extended, as in a single leg front kick. This is because 2 of the 3 muscles that make up the hamstring group cross over two joints (the hip and the knee).   These muscles are maximally stretched when the hip is bent and the knee is straight, and if movements are quick, the muscle can get strained or even tear.

Certain physical findings can increase your chances of getting a hamstring injury, such as:

  • Tight hamstring muscles – (inability to completely straighten your knee on standing)
  • An imbalance between the muscle strength in the upper leg (hamstrings and quadriceps)
  • Tightness of the quadriceps or hip flexor muscles (inability to completely stand up straight while the legs are straight — you will notice that you bend forward at the hips slightly if your legs are otherwise straight)
  • Insufficient warm up before exercising
  • Poor muscle coordination
  • Muscle fatigue
  • Muscle strength or flexibility imbalances

Usually a hamstring injury will present with pain on the backside of the upper leg, possibly with swelling, bruising, and an associated popping sensation at the time of injury.   If the hamstring muscle is fully torn, there may be an obvious mass which is actually the muscle contracting into a “ball”.

Treatment of hamstring injuries can be broken down into the acute phase that occurs immediately after injury and for the first 2-3 days. The sub-acute phase that occurs for several days to a few weeks after injury and the chronic phase that begins several weeks after injury.

Acute treatment of a hamstring injury generally follows the acronym PRICE.

Protection – In a severe hamstring strain or tear, an individual may require a crutch or a cane to protect the injured leg while walking.

Rest – for the first few days, remain off the injured leg as is possible, as this will enable the hamstring to begin healing.   The caveat is that stretching muscle begin shortly after injury because the muscle will scar down as it heals leading to further muscle tightness and predisposing you for another injury.

Ice– using a plastic bag filled with ice and water for 20 minutes 3 times a day is helpful to further reduce swelling. Heat is initially not recommended because heat increases the blood flow and is thought to worsen swelling. However, a few days after an acute injury heat can be helpful as heat increases blood flow to the injured area and helps with healing.

Compression – An ace wrap or compression dressing should be applied to the upper part of the thigh to prevent further swelling.

Elevation – Elevating the injured leg helps to further prevent swelling.

As mentioned above, hamstring injuries require both stretching and strengthening in order to recover. The main issue is that after a tear or strain, the muscles heal by scarring down. This scarring results in decreased flexibility of the muscle.

One big mistake athletes and weekend warriors make after sustaining a hamstring injury is to return too quickly to their prior level of activity. It is very important to only return to exercise after the pain has subsided. This is because if you return to exercise too early, you will change your biomechanics (i.e. alter your posture or positioning) to compensate for the pain. This altered position or step length while exercising can allow the muscle to shorten. When the muscle heals and contracts (shortens and scars down) you are then at increased risk for a repeat strain or tear.   Typically it takes at least 4-6 weeks for the muscle to properly heal.

It is helpful to begin stretching and strengthening exercises under the supervision of a qualified physical therapist so that you do not re-injure yourself and you can recover optimally. It is possible to regain or even surpass your pre-injury strength and flexibility with a proper treatment regimen.

PRP or Platelet Rich Plasma injections are sometimes recommended for assistance with tissue repair and quicker recovery time. However, an article published in 2015 from the Department of Sports Medicine at St Lucas Andreas Hospital in Amsterdam, reviewed the data for the treatment of hamstring injuries and found that lengthening exercises (stretching the hamstrings) provided the quickest return to play time, but did not affect re-injury rate. PRP injections did not improve outcome or re-injury rate when compared to controls. Therefore, at this time, it appears that a physical therapy regimen focusing on first stretching the hamstring muscles, then strengthening them (while maintaining improved flexibility) provides the best chance for recovery and return to exercise.   It was also suggested in this study that progressive agility training and trunk (core) strengthening and stability might reduce re- injury rates.

As always, if you suspect you might have a hamstring injury or other leg injury it is important to be evaluated by a trained health care professional. It is quite possible that you will be referred to a physical therapist for optimal treatment that includes a both a stretching and strengthening regimen. While initially your treatment will focus on the injured muscles, it will be important to analyze and treat your body mechanics to prevent repeated injury.