An update on life and thoughts on stiff upper backs

055F337F-1859-4789-9A6B-C21C41B26486Hello and good evening/afternoon/morning to those of you who still follow my blog (although it’s been dormant for a while) and to those who perchance have happened upon my writings.

 

Between my recent readings which have included Tribes (Seth Godin) and The War of Art (Steven Pressfield), maturation in my work as a strength and conditioning coach, and recent entrance into the gauntlet of fire that is the first term of my DPT (doctorate of physical therapy) program, I’ve felt a calling to write more. If I want professional writing to be a part of my career, I’ve come to the realization that I should approach writing as a regular endeavor rather than “waiting” for the perfect inspiration to strike. Here it goes.

My aim of today’s post, and the others to come, is to share:

  • my journey in education and life
  • my raw opinions, thoughts, and unanswered questions on topics relating to physical therapy, movement, mindset, nutrition, and training
  • some insights and tips I think could benefit other practitioners, athletes, and everyday folks in the realms of physical, mental, and emotional self-care

I go through phases of curiosity over different areas of the body and pathological movement patterns I see around me. As of late, upper back “tightness”  (specifically in the region of the top three or four vertebral segments of the thoracic spine) has been on my radar (although, I really dislike the use of the word “tight” as a qualification due to its ambiguity but at this point, I don’t know a better alternative), and I’ve been seeing needs to remedy it everywhere. My mom who is a runner swings her arms from her glenohumeral joints while her scaps and upper back remain fixed and the other day, woke up at 4:30am up with a non-traumatic spasm in her upper back and neck that was so bad she was nauseous and couldn’t move for hours. My dad and two of my training clients, all of whom spend long hours seated at computers, lack rotation in those upper thoracic segments and have recently developed anterior/middle shoulder aching and pinching sensations in the proximal regions of their shoulders. I, personally, have also worked around my own cervicogenic “tension” headaches that occur from workouts or during times of stress (read: sitting in school or studying for long hours) for the last couple of years, and I believe a stiff upper back to be a contributor.

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The cluster of associated signs includes some degree of an anterior head carriage, tight upper traps/pec minor/levators/scalenes/SCMs SCOMs, and/or internally rotated shoulders (yes, I’m pretty much describing upper cross syndrome). Really, who doesn’t have some degree of UXS nowadays?  With such prevalence, I think it’s important for me, as a practitioner, to learn how to address it, but I get frustrated because I haven’t figured it out yet (and I don’t think that many practitioners have either). I’m constantly running into sticking points with myself and my clients, and I think that sticking points arise when a prescribed intervention addresses a symptom of a problem rather than the root cause or only part of a more complex root cause. For example, massaging an individual’s tight levator might provide temporary relief, but without addressing the reason that muscle is tight, it will undoubtedly get tight again. Performing a thoracic spine mobilizing intervention (i.e., spinal manipulation, “open the book,” “thread the needle,” etc.) may be a good step in the process of alleviating upper back issues but if the root cause is related to suboptimal respiration mechanics (for example, excessive use of accessory musculature), the 20,000 breaths an individual takes in a day utilizing those dysfunctional mechanics are going to quickly revert any progress made until addressed.

As I type these thoughts, the conclusion I’ve arrived at for today (and it may be different tomorrow) is that the best way to address upper back “tightness” is

1) to learn how to differentially assess each of these areas, including breathing, soft tissue quality, strength/capacity of affected musculature (MMT), mobility, and mechanics in a way that helps identify weak/dysfunctional links and address those specifically.

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and

2) continue learning and refer to other practitioners when problems arise that are out of your scope

As a final thought, any interventions/treatments done only once will not completely solve problems that have occurred over many days/months/years. Consistency with an intervention over a period of time is the only way to create and enforce the desired adaptations.

What are your thoughts on this topic? How do you assess and approach it? Do you run into sticking points with your clients/self?

Yours in Movement,

K8

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Your ability to sit on the floor and get back up is more important than you may think!

Getting to the ground and back up is a fairly complicated motor skill which can vary in difficulty based on one’s surroundings and physical limitations. There are many ways to accomplish this task involving movements such as squatting, lunging, kneeling, or bending over, and it requires lower body mobility, strength, and stability as well as a certain amount of comfort being on the floor. Not only is one’s ability to get to the floor and back up an important predictor of mortality, but it is also crucial for many activities of daily life as well as for recovery in the event of a fall (de Brito et al., 2012; Wang et al., 2016). Fall risk is a great concern, especially in older adults due to the injuries, disability, and reduction in quality of life that a fall can cause. Many studies have reported that reduced muscle strength in the lower extremities raises the risk of failing (Wang, D. et al., 2016).

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A study by de Brito et al. (2012) scored 2,002 adults ages 51 to 80 years old on their ability to sit down on the floor and get back up. They were scored out of 10 possible points and deductions were made for the use of another body part or the floor for support while getting down or back up. The researchers followed up with the individuals over the next six years, and 159 of the participants died. Every point increase in a person’s test score correlated with a 21% reduction in his or her risk of death in the next six years. While this is a correlation study and evidence of correlation isn’t evidence of causation, the association between movement ability and mortality is hard to ignore.

Try it out now. Start by standing up. Sit down on the floor using your hands or other objects as little as possible. Every time you use something for assistance, subtract one point from five. Stand up from the floor using as little help from hands and objects as possible. Subtract one point from five each time you use hands or objects for assistance. Add your results from getting down (a number out of 5) and getting up (a number out of 5) for your score out of 10. Each point less than 10 increases the probability of death in the next six years by 21%. Are you ok with your score? Keep reading to learn how to improve!

If getting down to the floor and/or up is nearly impossible for you: 

Here are three simple exercise progressions you can work through over the next 6-8 weeks.

  1. Sit to stand
  2. Lowering and raising in a split stance (similar to a lunge)
  3. Step ups

Sit to stand

Select a box or chair that is a comfortable height. Sit down to it and stand back up without using your hands or assistance. Progress to tapping your butt on the box instead of entirely transferring your weight onto it, and gradually lower the box to increase the distance you raise and lower yourself. This increases comfort with getting down to and up from progressively lower seats and strengthens the leg muscles necessary to do so. If you progress to the point where you can lower and raise yourself to a point at more than 90-degrees of knee flexion, progress this exercise to include lying down. In this variation, sit/squat down to the low position, transfer all your weight to the box, and lie all the way down. To reverse the movement, sit up from lying supine and squat up from that position.

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Lowering and raising in a split stance

Slightly lower and raise your body (bending the front and back knees) in a split stance position using TRX straps for support. With practice, increase the distance you lower and raises your body, and then decrease the amount of assistance used to stabilize from two TRX straps to one strap to no assistance. This exercise increases comfort and stability in the split stance position one uses to get up from the ground, and it strengthens the leg muscles which are important for the movement.

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Step ups

Step up to a small platform using one leg. Similar to the other exercises, this will increase leg strength, stability in a single leg stance, and comfort in a movement pattern one can use to get up from the ground. Progress by increasing the repetitions of step ups performed on each leg and the height of the platform you are stepping up to.

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The next step:

Once you can get down to the ground and back up with relative ease, I’d suggest including a Fall Matrix in your workout warm-up once a week.

  1. Start standing. Place one hand on your same-side knee. Lay down, with your back against the floor and stand back up without removing the hand from your knee. Then lay down with your stomach on the floor without removing the hand from your knee, and stand back up. Optional: Lay down with your right side on the floor, and stand back up. Then repeat on the left side.
  2. Repeat these 4 variations touching the other side’s hand to its same-side knee.
  3. Repeat these 4 variations touching one hand to the opposite side knee.
  4. Repeat these 4 variations touching the other side’s hand to its opposite side knee.

Progress these exercises by touching your hand to a body part lower than the knee, for example, place your hand below the knee, on your shin, on your ankle, on your toes.

Like many things with our bodies, if you don’t use it, you lose it. Get on the ground and back up regularly so you don’t lose your ability to!

References
de Brito, L. B., Ricardo, D. R., de Araujo, D. S., Ramos, P. S., Myers, J., & de Araujo, C. G. (2012). Ability to sit and rise from the ground as a predictor of all-cause mortality. European Journal of Preventive Cardiology. doi: 10.1177/2047487312471759
Wang, D., Zhang, J., Sun, Y., Zhu, W., Tian, S., & Liu, Y. (2016). Evaluating the fall risk among elderly population by choice step reaction test. Clinical Interventions in Aging, 11, 1075-1082. doi: 10.2147/CIA.S106606

A Case For Crawling…In Your Workout!

When was the last time you crawled?

On your hands and knees or hands and toes?
Forward, backward, sideways, clockwise, counterclockwise?oksanakuzmina7

Many haven’t crawled since they learned to walk as babies.

Go crawl right now. On your hands and toes, down and back in the nearest hallway. I DARE YOU!

I bet it’s harder than you thought it’d be!

Crawling is called a primitive movement (along with rolling, pushup, and quadruped). It’s a basic, yet critical, pattern we learn during our physical and neurological maturation as it develops the strength, coordination, and stability that translate into higher level activities such as running and climbing.

Crawling is similar to many things in life; if you don’t use, it you lose it! Your body forgets how to crawl, how to recruit muscles in those fundamental patterns, how to stabilize your body in dynamic positions, and how to coordinate arm and leg movements. Your ability to move (pain and injury free) deteriorates from there because the foundation is gone!

I’ll show you how to start rebuilding your foundation. The most fundamental of the many styles of crawling is the bear crawl (or table top crawl).

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In this crawl, the opposite arm and leg move together. The left leg and right arm “step” forward, then the right leg and left arm “step” forward. The challenge is keeping your back straight and hips level through the movement. With clients, I’ll place a foam roller or light, plate-like object on their lower backs while they crawl, forcing them to stay level during movement to prevent the object from falling.

From Eric Cressey’s High Performance Handbook I learned a variation of this crawl where you inhale as you take each “step” then hold the position in place as you exhale,”crunching” your ribs down toward your pelvis.

Once you master forward crawling, then comes backward crawling, sideways crawling, and circular crawling….next add resistance!

Resistance can be added as a weight plate on top of your hips, resistance bands around your hips or shoulders, towing a kettle bell behind you, etc. Just don’t venture there until mastering the basic technique!

I like this video of some other crawling variations:

Here’s your challenge: 

  • Add 3 sets of 20 steps of bear crawls into 2 of your workouts this week, in your warm up or as a superset to another exercise.
  • Post a video and tag or hashtag K8IrelandActive bear crawling!
  • Comment below with your thoughts on crawling after giving it a try.

For more reading about crawling check out:

Functional Movement

Marks Daily Apple