Chronic Neck Pain : Postural Causes and A Unique Fix
More Posture Exercises
**"Will cell phones, tablets, and text messaging make us a world of hunchbacks?"
Exercises for Strengthening the Core: see The Off-Balance Workout at WebMD—Activates deep core muscles that support posture. Improves balance to help prevent falls, especially important in reducing the risk of falls in the elderly with osteoporosis.(See the article: "Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial" M. M. Madureira et al.) And a bonus—provides weight bearing exercise to help increase bone density at the hip bones. The first exercise, the one-legged balance with eyes closed is particularly challenging and can be done anywhere as long as there's something to grab onto in case balance is lost. (Another simple weight bearing exercise for increasing hip bone density is stair–climbing. My hip bone density increased a couple years after moving into a 2 story house.)
Exercises for the Back and Shoulder Blade Stability:
Deep Back Extensor Activation and Strengthening (after Johnson's multifidus* exercise no. 1)
Purpose: To strengthen, and be able to locate and understand what activating the deep back extensors feels like.
— Stand (can be done sitting) and place one hand on the abdomen (at the belly button- Rectus Abdominis). Place the other hand on the lower back around waist level and feel for the vertical band of muscle in the groove on either side of the hard knobs of the spinal vertebrae.
— With one hand on the abdomen, squeeze the abdominal muscles and feel them tighten. With the other hand feel the lower-back muscles on either side of the spine also tighten. (Apparently the multifidus co-activates with the rectus abdominis, the "6-pack muscle" in front.)
— Hold for 3 to 5 seconds, relax, and repeat. Tighten muscles as much as possible. Work up to 20 contractions, once a day.
— Eventually learn to tighten the multifidus/deep back extensors all the way up the back and into the neck.
note: My experience has been that with practice it is possible to tighten the multifidus/deep back extensors with minimal tightening of abdominal muscles, and also to tighten them all the way up the back and into the neck (or at least it seems like I can).
*Multifidus—A series of small muscles that fill the groove on both sides of the column of spinous processes (bony extensions of the spinal vertebra that can be felt just under the skin) from the bottom of the lumbar spine to the top of the neck. Each small muscle spans from one to three vertebral joints, and as a whole, the multifidus helps interconnect and stabilize the entire spine.
Purpose: To further strengthen the back extensors of lower and upper back.
Single-leg extension hold while on hands and knees. (Quadriped with Leg Lift) This exercise produces less lower spine compression (< 2,500 Newtons) on the small facet joints than raising both arms and legs while lying prone (Superman Extension: 4,000 - 6,000 N), and is recommended by Stuart McGill in Low Back Exercises: Evidence for Improving Exercise Regimens.
— 1. Get down on hands and knees with palms flat on floor and shoulder width apart. Keep neck in line with back and maintain a neutral lumbar curve.
— 2. Breath out, and raise and straighten one leg, until in line with back.
— 3. Hold for 10 seconds.
— 4. Return to starting position and raise the other leg.
— 5. Repeat every day and build endurance with more repetitions. Stuart McGill believes that endurance of back extensors and stabilizers protects the low back more than maximal load/strength. And that endurance "should precede strengthening in a gradual, progressive exercise program (ie. longer-duration, lower-load exercises rather than high load low-repetitian exercises)
— Back Extension Exercises and Osteoporosis: Back extension exercises similar to superman extension exercises were used in a Mayo Clinic study aimed at preventing osteoporetic fractures. To further strengthen back extensors, weights in a small backpack were added. The results of one study suggested that people with osteoporosis who did only back extension exercises had decreased incidence of vertebral "wedging" and spinal compression fractures even 10 years after; but those who did flexion exercises such as sit-ups or toe-touches had increased incidence of "wedging" and spinal compression fractures. See articles by Senaki, M et al "Postmenopausal Spinal Osteoporosis: Flexion versus Extension Exercises," "Stronger back muscles reduce the incidence of vertebral fracture: a prospective 10 year follow-up of postmenopausal women," and an abstract,"Can strong back extensors prevent vertebral fracture in women with osteoporosis? [My thinking now on the superman extension exercise, is that the chest should not be raised more than an inch or two off the floor. Raising the chest higher hyperextends the lower back and puts tremendous stress on lumbar vertebral facet joints, which may predispose to arthritic degeneration/bone spurs and radiating nerve pain such as sciatica. Consult an orthopedist or physical therapist. Currently I use a back extension machine and only go far enough for my back to stay in neutral alignment.]
See the video of the prone "Y", "T", "W" and "L" positions for posture improvement:
Lie stomach down on floor, place arms in one of the positions, have thumbs pointing up, and keeping shoulders pulled down (not up by ears), squeeze the shoulder blades together while lifting arms and chest. [Do not lift the chest very high, an inch or two is enough. Try to avoid hyper-extending the back and over–stressing vertebral facet joints] Hold a few seconds then lower the chest.
"Y"—With arms in a large "Y" shape, thumbs up and shoulders pulled down, squeeze shoulder blades together while lifting arms and chest off the floor. Hold a few seconds, then lower.
"T"—With arms straight out at 3 and 9 o'clock, thumbs up and shoulders pulled down, squeeze shoulder blades together while lifting arms and chest off the floor. Hold and then lower.
"W"—With elbows tight to the body, thumbs up and hands straight, squeeze shoulders blades together and lift chest off the floor. Hold, then lower.
"L"— With elbows down at sides and forearms at 90 degrees. Imagine squeezing elbows together behind the back. Lift chest off the floor, hold and then lower.
Start with 8 reps, 3 to 4 times a week. Add 2 reps a week up to 12.
See similar exercises with instructions and illustrations in article by McNitt-Gray and Mathiyakom.
Transversus Abdominis* Activation (after Jemmett)
—Learn to do Kegel exercises first. Apparently, the Transversus co-activates with contraction of pelvic floor muscles. (see Kegels for Men, or Kegels for Women). One way to identify/feel the pelvic floor muscles is to try to stop the flow of urine during urination, but this is not something to do very often because of the risk of urinary tract infection.
—Jemmett advises gentle, gradual Kegel contraction and then with one hand on the transversus (a horizontal band/corset of muscle between lower edge of ribcage and top of pelvis, see illustration for location) to feel for tightening of the muscle. He says it is important to isolate contraction of the transversus, so with the other hand, check that the rectus abdominus (the "6-pack" area below breast bone in front) is relaxed.
—Do several short sessions a day.
—Then add Multifidus Activation. Jemmet advises learning multifidus activation with a partner, who would place a finger pad firmly into the groove of multifidus muscle alongside the central knobs of the spinal column and palpate to identify the part of the multifidus that is atrophied (smaller and softer) from back pain. Then one must learn to tighten that area by thinking about drawing it towards the spinal column (like tightening the buttocks).
*Activation and strengthening of the transversus abdominis and multifidus muscles are important parts of the Australian spinal stabilization method. The transversus is a wide horizontal muscle that acts to flatten the abdominal wall. Origin attachments are at the lower six ribs and a thick sheet of fascia/connective tissue that connects to spinal vertebra. Insertion attachments are at the front 3/4 of the iliac crest of pelvis and inguinal ligament. Weakness tends to increase lumbar lordosis. [However, studies by Stuart McGill show that the transversus abdominis is not as important as a spinal stabililizer as once thought.]
In a comparison of three stretches, a unilateral corner stretch was found best at lengthening the pectoralis minor. (Borstad and Ludewig, 2006)
— Place the forearm against a door frame, and have elbow at a 90 degree angle to upper arm. Make sure shoulder is back and humeral head does not jut forwards. (**Avoid forward shoulder to prevent overstretching the shoulder joint capsule – see precautions and images below)
— Rotate the body away from the arm by walking the feet around until a stretch is felt at the upper corner of the chest. (about 45 degrees of rotation... or less depending on the degree of stretch needed, see note below)
— Hold for 10 seconds.
— Repeat 3 times
— Switch to the other arm.
Important Note: To avoid over-stretch injury to the front of the shoulder capsule, rotate the body only until a mild to moderate stretch is felt in the chest.
Daniel's Comment: "The pec minor can be a good stretch for many. However if the scapula is much more out of place they tend to end up stretching their anterior capsule instead. A few PT's had me doing this as well and I began to lose sensitivity in my hand... A good way for people like who I 'used to be' is to have someone sort of pin down the scapula to the floor then employ the stretch. Even better would be to have someone do some manual therapy to loosen up that pec minor while pinning down the scap[ula] and stretching the pec. "
1. Hold arms straight out to the side just a little lower than shoulder height, elbows slightly bent, have thumbs up, palms facing front;
2. Squeeze shoulder blades together and rotate shoulders and arms back to stretch the front of the shoulder, hold 10 seconds; and repeat;
3. Return to starting point in "1." but rotate thumbs to the back so palms face up, and at the same time lift the chest. 4. Squeeze shoulder blades together and pull shoulders and arms back for a front shoulder stretch, hold ten seconds and repeat;
I do these every morning. It's like welcoming the new day.
Convert Thumbs-up, Palms-up, to an active chest stretch and back strengthening exercise by using a resistance band (Similar to a Bruegger Exercise)
1. Knot a resistance band so there's a loop at each end. Interlace a thick rubber band to get the knots to hold. (To make the loops without a knot, see these instructions)
2. Starting position: Thumbs up, elbows at 90 degrees, palms facing each other, and the loops across the palm.
3. Keep palms vertical or bend the wrists and turn palms up. (illustrations show palms–up, which is closer to the Brueggar Exercise) Pull hands apart by squeezing the shoulder blades together and rotating the shoulders outward.
4.When the band begins to stretch, very slowly continue pulling the arms apart.
5. Straighten the elbows and slowly pull the arms to the back as far as comfortable. Then hold at least 4 seconds.
Notes: Take at least 8 seconds to pull the arms apart after band tightens, hold 4 seconds and take another 8 seconds to return the arms to starting position. Repeat several times or until muscles become too fatigued to continue. Make the band shorter or advance to a stronger resistance band if 20 repetitions becomes too easy.
How to Improve Posture -- powered by ehow
**When using a cell phone for text messaging, anchor your upper arms close to your ribs and bend your elbows to raise the phone closer to your face. Then lower your eyes to see the screen, instead of bringing your face closer to the phone. Iif you still must tilt your head, avoid bending the neck forward and down, instead use the top-most “hinge” joint of the neck. But do try to have your arms and eyes do most of the work. For more....
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