Two Predisposing Causes of Back Pain Everyone Needs to Know About

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This is probably the most important article I have written to date. I know most of you won’t read it because of its length. If you do read it, you will know more about the cause and prevention of back pain than most health professionals who treat this problem. If you or someone close to you has ever had their back “go out” or developed a chronic, recurring backache, this article explains why. I will also share with you the best thing you can start doing right now that has helped me and thousands of my patients overcome back pain. 

I have been treating spine problems for over 20 years and I have observed that back pain presents itself in one of three scenarios…

Scenario 1: You are getting yourself ready to go about your day, you bend forward to put on your socks or pick something up and all of a sudden your back “goes out” and you feel a sharp, stabbing pain. You have difficulty understanding how this could possibly happen. It wasn’t anything strenuous. “All I did was bend over!”

Scenario 2: You bend forward to lift something heavy and when you go to lift, again your back “goes out” and you feel a sharp, stabbing pain. This one you can understand. It was fairly strenuous. “Maybe I lifted the wrong way?”

Scenario 3: The muscles in your back begin to tighten up and you develop a deep dull ache. It may have been from some activity you did from the previous day or it started for no apparent reason. There was no immediate “incident” that set it off. It does get better, but always seems to come back from time to time.

I discuss more on why these scenarios happen later in the article.

If any of you have been lucky enough to experience all three scenarios like I have, you know how bad back pain can be, especially when it is so difficult and painful to get out of a chair, lift a leg up, or turn over in bed. There comes a time when your back becomes such a nuisance you need professional help.

You likely go one of two routes…

The Medical Route. You have a not so thorough exam, an x-ray or maybe an MRI and they don’t see any problems…no fracture, no bulging or herniated disc, no spinal degeneration (arthritis). They are unable to explain why you are in pain when they don’t see any problems on your x-ray or MRI.

MRI showing bulging and herniated discs

Or they do see a bulging, herniated, or degenerated disc and this is what they tell you. They are unable to explain why you have this “damage” in your spine. They commonly tell patients that the problem is due to “aging” or “normal wear and tear.” These are the lamest reasons I have ever heard since my time working in this field. Most patients buy into this line of thinking because it makes intuitive sense, but in reality it doesn’t. If this was true, we would find that EVERYONE has an equal amount of disc and joint wear in EVERY JOINT IN THEIR BODY AS THEY GET OLDER. We simply DO NOT SEE THIS! What we do see is wear and tear in selective joints in selective people. It is occurs in the joints that are least stable and have the worst movement mechanics, not aging and “normal” wear and tear.

The bottom line is signs of spinal degeneration and disc pathologies indicate a long-term “wear and tear” process…not a good thing. Spinal pathologies are mostly what conventional medical professionals are screening for and they aren’t too concerned about the predisposing causes I am going to talk about. In either case, they may recommend a course of anti-inflammatory drugs, a cortisone injection, surgery, or they send you off to physical therapy.

Or you decide to go the…

The Chiropractic Route. You have a bit more thorough exam and you may or may not have an x-ray, depending on the chiropractor’s philosophy and approach. The chiropractor may rub your back, put you on therapy machines and then “cracks” your spine in a few places. Not to say these don’t have some short-term, pain relieving benefits, but these do nothing to address the predisposing causes I am about to talk about.

The 3 Questions Most Spine Specialists DON’T Ask Themselves

Most medical professionals, physical therapists, and even chiropractors don’t ask themselves these questions about the patients they are treating:

  1. “Why did this patient develop a “damaged” disc?”
  2. “What is wrong with this patient’s posture and movement habits that has caused this to happen?”
  3. “What is the best treatment, exercises and movement habits I can teach this patient for the best recovery AND reduce the chances of this happening again?”

If these “specialists” do not ask themselves these questions, it will be very difficult for them to find the long-term solutions to their patient’s problems. Been there, done that! These are the questions that burn in my brain every day!

The Two Predisposing Causes of Back Pain

There are two predisposing causes of back pain that most people don’t know about, including many health professionals that treat back pain! The first one has to do with…

Ideal Static Alignment of the Spine and Posture

Alignment
When I am talking about alignment, I am referring to the alignment of the spinal column and posture. I am also referring to both “static” alignment, such as when sitting or standing still, as well as “dynamic”’ alignment, when our body is in motion.

Ideal alignment of our spine and body as a whole (posture) is vital for not only the long term health of our musculoskeletal system, but it is also a factor for our overall health as well.

Abnormal Static Alignment of the Spine and Posture

Many of us lose proper “static” alignment of our spine and posture due to the injuries we acquire throughout life. Sudden, traumatic injuries, such as a fall, sports injury, or car accident often cause the spine to shift out of place. Working, sitting, or sleeping in a bad posture for extended periods of time can do the same.

Many of us lose proper “dynamic” alignment because we have simply lost the ability to move correctly. We all learned to move and move flawlessly in our first few years of life when we went through the developmental milestones. After years of injuries, compensating for those injuries, and the impact a more sedentary, industrialized lifestyle has had on our bodies, we have paid the price by developing poor movement habits. The best example of this is when people lose the ability to move in their hip joints when they bend, squat, or twist their body. They compensate by bending and twisting more in their lower back. What happens over the long haul? You guessed it, back pain. Many people are in pain because they simply don’t move right!

Centrated Joint
Shoulder joint demonstrating proper dynamic alignment (centrated) when the arm is lifted overhead.
Decentrated Joint
Shoulder joint demonstrating poor dynamic alignment (decentrated) when the arm is lifted overhead.

 

 

 

 

 

 

 

 

 

 

 

Intra-abdominal pressure (IAP)

If we lose proper alignment statically or dynamically, there will be excessive loads (compression, tension, torsion, shear) on spinal tissues weakening them over time. This leads to scenario 1, 2, or 3.

The second predisposing cause of back pain has to do with…

Intra-Abdominal Pressure (IAP)
IAP is the mechanism that stabilizes our spine. It is essentially our “built in” back brace. This is the most important new discovery in the last decade and it is a game-changer for the difficult patients with back pain who don’t get completely better with chiropractic treatment, physical therapy, or their back pain always comes back from time to time.

IAP should be an automatic, subconscious activation of your core before and during every movement you make. The problem is, the vast majority of people who suffer with back problems have lost this automatic ability to create IAP when they bend and move. When IAP is insufficient, spinal tissues begin to pay the price.

Two Common Reasons Why People Lose The Ability to Create IAP

Pain, Trauma, and Injuries. Our bodies have unique ways of creating compensations for physical and emotional trauma. Unfortunately, one of them is an alteration in how we stabilize our core. The automatic ability of creating IAP becomes absent, delayed, or lost during movement. 

Poor Core Stabilization Strategy. Pulling the abdomen in and lifting the chest does not increase IAP and makes the spine unstable and more prone to pain, injury, wear and tear.

Cosmetic, Cultural or Learned Behavior. Some people “suck in” their stomach in an attempt to look thinner. Other people are taught to “suck in” or “pull in” their stomach as an exercise to activate their core. Even though some abdominal muscles are contracting when they pull their belly button towards their spine, they are contracting their muscles in the exact opposite direction that is needed to create IAP and increase spine stability. If this “pulling in” strategy becomes habit, it will have a destabilizing effect on the spine which will eventually lead to pain and wear and tear on spinal tissues.

How Problems With Alignment and IAP Lead to Back Pain: The 3 Scenarios

Problems with alignment and IAP create the perfect storm for the eventual development of back pain and the often associated “wear and tear” spinal pathologies (disc annular tears, bulging, herniations, protrusions, degeneration, arthritis, stenosis, ligament hypertrophy, etc.)

Alignment problems will predispose people to back pain because spinal tissues will be pre-stressed most of the time. Poor static alignment will expose certain discs, muscles, ligaments, nerves, etc. to higher loads compared to ideal alignment. Tissues under greater stress and strain will be more prone to injury, wear and tear and pain generation over time. The bottom line is poor static alignment will increase the likelihood of developing back pain in any of the three scenarios mentioned at the beginning of this article.

X-ray of a misaligned spine in one of my patients with multiple herniated discs and sciatica (leg pain)

IAP problems will predispose people to back pain because the spine is not stabilized properly during movement. Another way of saying it is, IAP takes stress off the spine. If you do not create and maintain IAP during movement, more stress is transferred to spinal tissues. This ends up creating thousands of micro “insults” (small injuries) to the spine every time you move, bend, lift, etc. You don’t feel them until your spinal tissues have become so weak and damaged to the extent that it only takes one more bend of your back to set it off…The straw that broke the human’s back! This is exactly what happens in Scenarios 1 and 2.

The Lumbar Extension Stabilization Strategy

Scenario 3 is like 1 and 2 in that it is usually a combination of an alignment and an IAP problem. Poor alignment stresses spinal tissues over time and eventually you feel tight muscles in your back or a deep, dull ache in your joints or discs. Lack of IAP also stresses spinal tissues. If you can’t create adequate IAP, you have an option to compensate for this by adopting a lumbar extension stabilization strategy. That is, you tighten up your lower back muscles causing it to arch too much to create some semblance of core and spine stability. Unfortunately, this is not an effective long-term solution to the IAP problem. If this strategy persists for too long, back muscles become chronically tight, overused and painful, spinal discs become injured because they are highly compressed, and low back pain eventually develops. This is an epidemic problem I see every day!

Alignment and Intra-abdominal Pressure:
The Keys to a Healthy Back

Now that you know alignment and IAP are the two predisposing causes of back pain, what can you do to fix these problems?

How to Fix Your Alignment
When the spine shifts out of place and becomes misaligned, it usually can’t go back into place on its own. This is where chiropractic comes in. And not just any chiropractor. It needs to be a “corrective” chiropractor. There are many types of chiropractors with varying philosophies and approaches. Corrective chiropractors are trained in the best methods to correct the alignment of the spine. There are several different corrective chiropractic techniques, but the one that stands above all others is Chiropractic Biophysics Technique (CBP). It is the most effective, scientific and researched method of all chiropractic techniques with over 200 studies validating its approach. For these reasons, I highly recommend a chiropractor trained and certified in CBP technique.

X-ray of one of my patients BEFORE CBP corrective care. He had multiple herniated discs, back pain, sciatica, and a failed back surgery.
X-ray AFTER a program of CBP corrective care. Back pain and sciatica resolved.

 

 

 

 

 

 

 

 

 

 

 

 

Find a CBP chiropractor near you

So if your spine is out of place and misaligned (x-rays and posture assessment will verify this), there is not much you can do about this on your own without the help of a corrective chiropractor. They need to determine from your x-rays and posture what spinal adjustments, exercises, or other treatment you might need to correct your spinal alignment to as near normal as possible.

How to Fix IAP
What you can work on and usually improve on your own (if you do it and implement it correctly) is your ability to create IAP when you bend, move, lift, etc.

Place your hands around your waist and cough or make a hard “CHA” sound. You should be able to feel how your abdominal muscles tighten up and pressure builds inside your abdomen. This is IAP! Two things have to happen to create good IAP. The diaphragm, which most people know as the primary breathing muscle, contracts and pushes down into the abdomen and at the same time the abdominal and pelvic floor muscles tighten up. This builds up pressure inside the abdomen which stabilizes and keeps the spine from bending when it shouldn’t bend. It also stabilizes the spine when the spine does need to bend. In both instances, it is this pressure that protects the spine from injury.

How to Assess Your Ability to Create IAP
Place your hands around your waist. Suspend your breath (no breathing), push out into your hands, and tighten up/flex your abdominal muscles at the same time. Think about tightening up your abdominals as if someone is going to punch you in the stomach. If you do it correctly, you should feel pressure build inside your abdomen (IAP) and all parts of your abdominal wall move outward and tighten up. If you are unsure, cough a few times and that is the feel you are looking for. You should feel symmetrical outward excursion and tightening of your entire abdominal wall, especially in your back where your thumbs are located, in the front where your fingertips are, and in the lowest part of your abdomen below your belt line just above your groin. If you find an area that is not pushing out or tightening up very well, these are the areas that you need to work on. You can make this an exercise by placing your hands in your weakest areas and pushing out and tightening up. Hold for a second, release, and repeat 10-20 times or until fatigue. You can do this multiple times a day, every day. It is important to practice this in all position…lying on your back, stomach, each side, sitting, and standing. 

As a side note, you should also be able to breathe into your abdomen (diaphragmatic breathing) at the same time you have created IAP. Here’s the test: Create IAP by pushing out and tightening up no more half way (less than 50% effort). Now breathe into your abdomen while you keep the pressure constant, especially on the exhale. This is very difficult for most people to do and is a further predisposing risk factor for back pain. The breathing component is beyond the scope of this article. I have written another article on this if you want to check it out…

Bad Back? It Might Be The Way You Breathe

If you practice creating IAP enough, you should be able to feel the pressure and tightening without your hands around your waist. Now it is time to use IAP when you move. For this new pattern to get automatically programmed into your nervous system, you need to consciously think about creating IAP right before every movement you make. And not only creating it, but MAINTAINING IT THROUGHOUT THE ENTIRE MOVEMENT! 

These are the most important times you want to do this:

Any time you have to bend or lean forward, such as getting in and out of a chair or your car, leaning forward to pick something up from a table or the floor (whether it is light or heavy), getting things in and out of the refrigerator, lifting up your legs to put on pants, socks, or shoes, during strength/weight training exercises, etc. If you have to hold your breath when you do it, that’s okay.

The goal is to have the awareness to recognize when you remember to do this and when you don’t. There will be times when you catch yourself “in the act” and realize that you forgot to do it. This will happen in the beginning. The important thing is you recognized it and you will remember next time. If you make a habit of doing this long enough, it will become an automatic, subconscious activity like it once was before. Now, each time you move you will be protecting your spine and not injuring your spine.

Many people have trouble knowing for sure if they are creating IAP and maintaining it properly. The best professionals to consult if you need help with this is a chiropractor or physical therapist who is trained in Dynamic Neuromuscular Stabilization (DNS). 

If fixing your bad back is a top priority, your best bet is to find a corrective (CBP) chiropractor who also uses DNS treatment and exercises. 

Research has verified what I have talked about in this article…that improper alignment and lack of proper IAP regulation are predisposing causes of back pain. I hope this article has given you a better understanding why most of us eventually suffer from back pain and why it is such an epidemic problem in our society.

If you like this post, share it. Comment on it. Email me if you have questions about it. Thanks for reading…
Dr. Ryan Hamm
drhamm@drryanhamm.com

Dr. Ryan Hamm


Dr. Ryan Hamm is a chiropractor in Arlington Heights and has been treating disorders of the spine and extremities for over 25 years. He specializes in posture and movement rehabilitation to resolve painful conditions of the musculoskeletal system. Dr. Hamm has been studying the most critical components people need for ideal posture and movement to minimize joint wear and tear. He has an Advanced Certification in Chiropractic Biophysics (CBP) Technique and he is a Dynamic Neuromuscular Stabilization (DNS) certified practitioner.

References
Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the lumbar intervertebral disc: Clinical considerations for the doctor of chiropractic. J Manipulative Physiol Ther 1999; 22(2): 96-104.

Troyanovich SJ, Harrison DE, Harrison DD. Review of the Scientific Literature Relevant to Structural Rehabilitation of the Spine and Posture: Rationale for Treatment Beyond the Resolution of Symptoms. J Manipulative Physiol Ther 1998;21(1):37-50.

Harrison DE, Colloca CJ, Keller TS, Harrison DD, Janik TJ. Anterior thoracic posture increases thoracolumbar disc loading. Eur Spine J 2005:14:234-242.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART I: Spinal Canal Deformations Due to Changes in Posture. J Manipulative Physiol Ther 1999; 22(4):227-234.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART II: Strains in the Spinal Cord from Postural Loads. J Manipulative Physiol Ther 1999; 22(5):322-332.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART III: Spinal Cord Stresses from Postural Loads and Their Neurologic Effects. J Manipulative Physiol Ther 1999; 22(6):399-410.

Harrison DE, Betz J, Ferrantelli JF. Sagittal spinal curves and health. JVSR 2009 July 31, pp 1-8.

Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: Implications for the Ideal Spine. Spine Journal 2005; 5:297-305.

Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.

Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. J Spinal Disord 1998; 11(5): 430-439.

Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. , J Orthop Sports Phys Ther, 2012;42:352-362,

Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. In vivo measurement of the effect of intra-abdominal pressure on the human spine. J Biomech. 2001;34:347-353.

Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture. 2000;11:92-101.

Hodges PW, Eriksson AE, Shirley D, Gande-via SC. Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005;38:1873-1880. https://dx.doi.org/10.1016/j. jbiomech.2004.08.016

Hodges PW, Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000;522 pt 1:165-175.

Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89:967-976.

Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80:1005-1012.

Kolar P, Sulc J, Kyncl M, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. 2010;109:1064-1071. https://dx.doi. org/10.1152/japplphysiol.01216.2009

What is CBP?

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CBP, or Chiropractic Biophysics, is an advanced chiropractic technique that restores the alignment of the spine and posture to a normal position for better health.

Many chiropractic technique groups claim to restore spinal alignment. However, very few have researched their methods to verify this. CBP is one that has. In fact, CBP is one of the most scientifically validated techniques in the chiropractic profession. They have over 230 papers published in the medical literature verifying the reliability and effectiveness of their methods (1). CBP is one of the very few techniques that have shown their methods actually correct spine alignment and posture.

X-ray of one of my patients BEFORE CBP corrective care. He had multiple herniated discs, back pain, sciatica, and a failed back surgery.
X-ray AFTER a program of CBP corrective care. His back pain and sciatica completely resolved after the alignment of his spine was corrected.

 

 

 

 

 

 

 

 

 

 

 

 

CBP Assessment of Alignment 

In the CBP approach, the alignment of a person’s spine and posture is compared to a scientifically validated model of ideal spinal alignment established by Harrison (2-6). 

Normal Posture and Spine Alignment

Alignment is assessed with x-rays and posture analysis. This identifies abnormal posture, the exact direction and degree of spine displacement/misalignment, including any abnormalities of the natural spinal curvatures.  

Normal neck curvature (left image), loss of the normal neck curve (middle image), and reversal of the normal neck curve with advanced disc degeneration/arthritis (right image)

CBP Correction of Alignment 

Once the exact type, direction and degree of misalignment is identified, CBP doctors restore proper alignment with mirror image adjustments, exercises, and if necessary, traction.

Mirror Image Adjustments

Mirror image adjustments involve placing a person’s spine and posture in the exact opposite position of their misalignment (the mirror image) and introducing a stimulus into the body to “reset” normal alignment (the adjustment).  If a person’s lower back is misaligned to the left, for example, they will be positioned to the right prior to the adjustment. Mirror image adjustments are performed using a hand-held adjusting instrument, manual manipulation, or with a drop table, a special table with sections that “drop” during the adjustment.

A patient with a left translation (side shift) misalignment of the back.
The patient is placed on the table with his spine and posture in the “mirror-image,” or opposite direction of the misalignment before the adjustment is given to “reset” his alignment.
After the “mirror-image” adjustment, his spinal alignment is “reset” and corrected to normal.

Mirror Image Exercises

Mirror image exercises complement the adjustments by having the person perform exercises in the exact opposite direction of their misalignment. Mirror image exercises are designed to strengthen postural muscles and retrain the brain to “hold” the body into a properly aligned position.

A patient with a left translation misalignment of the back.
The patient performs a “mirror-image” exercise by shifting his back to the right.

Mirror Image Postural and Spinal Curve Traction

Depending on a person’s posture and spinal curvature, traction may be necessary to correct posture and the natural spinal curvatures.  Traction provides a slow, sustained stretch to the spine which allows it to gradually reshape and remodel into a more normal, aligned position.

CBP neck traction device designed to restore the natural neck curve to normal

In summary, CBP is a higher level of chiropractic that has helped countless people overcome chronic, painful conditions and improve their overall health by simply correcting their posture and spinal alignment to its proper position. 

Find a CBP chiropractor near you

For further reading on CBP technique, go to:
https://www.idealspine.com/pages/cbp_technique.htm

Dr. Ryan Hamm


Dr. Ryan Hamm is a chiropractor in Arlington Heights and has been treating disorders of the spine and extremities for over 25 years. He specializes in posture and movement rehabilitation to resolve painful conditions of the musculoskeletal system. Dr. Hamm has been studying the most critical components people need for ideal posture and movement to minimize joint wear and tear. He has an Advanced Certification in Chiropractic Biophysics (CBP) Technique and he is a Dynamic Neuromuscular Stabilization (DNS) certified practitioner.

References

  1. https://idealspine.com/cbp-research/
  2. Harrison DD, Janik TJ, Troyanovich SJ, Holland B. Comparisons of Lordotic Cervical Spine Curvatures to a Theoretical Ideal Model of the Static Sagittal Cervical Spine. Spine 1996;21(6):667-675.
  3. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.
  4. Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE. Can the Sagittal Lumbar Curvature be Closely Approximated by an Ellipse? J Orthop Res 1998; 16(6):766-70.
  5. Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. J Spinal Disord 1998; 11(5): 430-439.
  6. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. J Spinal Disord Tech 2002; 15(3): 213-220.

 

5 Exercises You Should Avoid and The Best Exercises to Replace Them With

Version 2

In fitness and exercise, there are hundreds if not thousands of exercises to chose from to improve your strength and conditioning. Just about every exercise has its benefits. However, there are several common exercises where…

  • The benefits are not worth the risk of injury 
  • The exercise does not transfer very well to support the most common movements we perform on a daily basis

I will admit I have performed most of these exercises in my fitness program in the past. Not knowing it at the time, some of these exercises promote muscle imbalance, undesirable movement patterns, and create significant stress to tendons, ligaments, and joints.

In this article, I explain why these exercises are not the best and show you replacement exercises that are safer, less stressful to your joints, and will have better “exercise transference” to reinforce the movements you perform at home, at work, and in your chosen sport.

1. Shrugs

This exercise can promote 3 problems… 

  • A muscle imbalance between the upper traps (they become tight) and the mid-lower traps (they become weak). Many people are already upper trap “dominant” from stress, shoulder injuries, neck pain, etc. The last thing these people need is shrugging exercises that perpetuate this problem.
  • Poor posture of elevated shoulders and forward head posture. Most people shift their head forward during the shrugging motion. This will create, and is often a sign of an imbalance between neck extensor muscles (back of neck) and deep neck flexor muscles (front of neck), a common cause of neck pain and headaches.
  • A non-ideal upper extremity movement pattern. If you are holding something in your hand, such as a purse, bag of groceries, or bucket of water, and you have to place it on a table or countertop, wouldn’t you bend your elbow when you lift it up? What is the natural motion of your arms when you pull up a pair of pants? Get the idea? There are few instances where we would lift an object up to or above waist level without bending our elbow.

Here is a better replacement exercise that is similar to how we naturally lift our arms and hands up…

Modified Upright Row

 

1st Phase: Lifting to the Hips.  There should be no “shrug” in this phase. If there is, it is a sign of a dysfunctional shoulder. To correct this, think about lifting with your elbows while keeping your shoulders down.
2nd Phase: Lifting to the Ribcage. This is when a subtle, natural shrugging motion comes in. Try not to make a deliberate shrug, just let it happen naturally.

The keys to this exercise… 

  • Avoid over-gripping the weights with your hands
  • Maintain a slight chin tuck without tilting your head down. This will ensure your neck stabilizing muscles are activated
  • Engage your abdominals without pulling them in
  • Think about performing the lift with your elbows instead of your hands 

I recommend performing this motion first without weight until the movement feels natural and fluid. Then use light dumbbells to add resistance. You can gradually increase weight over time as long as proper form is maintained.

2. Lateral and Front Raises

There are 2 problems with this exercise…

  • It creates high amounts of stress on the shoulder joint and rotator cuff. The further away the weight is from the body, joint stress rises exponentially. The stress on the shoulder quadruples compared to an alternative exercise where the weight is kept a closer distance from the shoulder.
  • A non-ideal upper extremity movement pattern. If you have to lift something up and place it on a shelf, are you going to perform a front or lateral raise to do it? Likely not. You will bend your elbow and keep the object close to your body until that final reach to put the object down.

Here is a much safer shoulder exercise. It is a modification of the traditional shoulder press…

Modified Shoulder Press

Use a comfortable amount of weight that you can easily complete 10 repetitions. Start by holding the weights in front of you with back of hands facing forward. If you have good shoulder flexibility, elbows should be touching. If they do not touch, bring them together as far as possible without straining or forcing them together. As you press the weight overhead, the elbows move outward and upward in an arcing motion and the hands rotate so the hands face forward at the top. The arms and hands will reverse in the same movement path coming down. 

 

 

 

I recommend performing this motion first without weight until the movement feels natural and fluid. Then use light dumbbells to add resistance. You can gradually increase weight over time as long as proper form is maintained. Be sure to maintain a slight chin tuck without tilting the head down. Make sure your abdominals are engaged without pulling them in and your ribcage does not lift up during the overhead press.

3. Supermans

This also includes any lumbar extension exercise, such as performed on a Roman chair or weight machine.

This exercise poses 3 problems…

  • It creates a significant amount of compression (pressure) on the lumbar discs. This can lead to disc bulging, herniation, degeneration and low back pain. 
  • Muscle imbalance between the abdominals and lower back. Most people use all back muscles and very little abdominal muscles in this exercise. Any exercise of the trunk should involve all of the muscles being activated at the same time.
  • An incorrect core stabilization strategy. When we have to stabilize our core, we should simultaneously engage our abs, diaphragm, pelvic floor and to a lesser extent, the back muscles. This creates intra-abdominal pressure (IAP) which protects the spine. Arching the low back  (lumbar extension stabilization strategy) is not an ideal way to stabilize the core and the spine can become damaged and painful over time. 

2 Predisposing Causes of Back Pain Everyone Needs to Know About

Here are a couple alternative replacement exercises that work the entire core, especially the abdominals… 

Low Kneeling Plank

Start with elbows and knees shoulder width apart. The elbows and knees can be closer together (lengthwise) in the beginning, then gradually farther apart to increase difficulty. 

The keys to this exercise…

  • Head and spine are kept in a straight line 
  • Slight chin tuck with the back of your head pulled up towards the ceiling
  • Engage your abdominals without pulling them in
  • Focus on breathing into your entire abdomen
  • Watch out for your head and chest dropping to the floor and collapsing in between your shoulder blades (spine sinks between the shoulder blades)
  • Hold the correct position until fatigue or until you are unable to maintain proper position.

Plank on Hands and Knees

The keys to this exercise are similar to the Low Kneeling Plank. Start with hands and knees shoulder width apart. The hands and knees can be closer together (lengthwise) in the beginning, then gradually make them farther apart to increase the difficulty.

The keys to this exercise…

  • Equal support on the inside and outside of the heel of the hands
  • The entire hand is in contact with the floor
  • Head, spine and eventually the thighs are kept in a straight line 
  • Slight chin tuck without tilting the head down
  • Engage your abdominals without pulling them in
  • Focus on breathing into your entire abdomen
  • Watch out for your head and chest dropping to the floor and collapsing in between your shoulder blades (spine sinks between the shoulder blades)
  • Hold the correct position until fatigue or until you are unable to maintain proper position.

A traditional plank on elbows and toes or hands and toes can also be used (not shown). The same rules apply for this exercise as the ones previously mentioned.

4. Knee Extensions and Hamstring Curls

These 2 exercises promote…

  • A muscle imbalance between the the quad/hamstring group and the glutes. Many people are quad/ham dominant because they have lost their ability to activate their glutes. These exercises commonly involve little use of the glutes which can perpetuate the muscle imbalance.
  • A non-ideal lower extremity movement pattern. Unless you are involved in any sports that involve kicking, these exercises do not offer much benefit in real life scenarios. Most movements of the lower body, such as squatting, involve simultaneous bending of the hip, knee, and ankle. They also involve simultaneous use of the glutes, quads, hamstrings, and other muscles. No muscle in the legs works in isolation, so why should we train them that way?

For the legs, your best bet is to stick with traditional squats, split squats, or lunges.

Squats

 


 

The keys to these exercises…

  • Your center of gravity (body weight) stays evenly distributed between the heels and balls of feet in the squat, heel and ball of front foot in split squats and lunges. This weight distribution must be maintained going down and coming back up
  • In split squats and lunges, 80 percent of your weight should be on the front foot, 20 percent on the back foot
  • Maintain ideal foot/arch position (no rolling in/out) and knee alignment (knee does not deviate in/out) throughout the entire movement
  • Create and maintain good intra-abdominal pressure IAP (engage abdominals without pulling them in) throughout the entire movement

5. Crossover Reverse Lunges

This is a high risk exercise for a knee injury. During the exercise, the femur is in full internal rotation on the tibia and the hip is outside the knee. This is a decentrated position of the lower extremity. In other words, the foot, knee and hip do not stay centered/aligned during the movement. In this exercise, the torsion (twisting) stress is borne on the meniscus, medial collateral and anterior cruciate ligaments. This is the most common position for tearing/injuring these structures. 

Just because you can get your body in a certain position does not necessarily mean you should apply load (add resistance) in this position. In my opinion, the benefit of this exercise is not worth the risk of injury.

The safest and least stressful exercises on the knee requires ideal alignment of the lower extremity…knee stacked over the foot, hip stacked over the knee. 

The replacement exercise is a straight step-back reverse lunge.

Reverse Lunge



If you are new to this exercise, I would recommend doing this as a split squat first, then add the dynamic step-back during each repetition.

The keys to this exercise…

  • 80 percent of your weight should be on the front foot, 20 percent on the back foot 
  • Your center of gravity (body weight) stays evenly distributed between the heels and balls of the front foot. This weight distribution must be maintained throughout the entire movement
  • Maintain ideal foot/arch position (no rolling in/out) and knee alignment (knee does not deviate in/out) throughout the entire movement
  • Create and maintain good intra-abdominal pressure IAP (engage abdominals without pulling them in) throughout the entire movement

Exercise should be about building your body up without breaking it down. If you workout smart, focus on form and listen to your body, you can reap the benefits of exercise without creating muscle imbalance, succumbing to injury and developing pain.

You can work out hard, but most importantly, work out SMART!

10 Benefits of Chiropractic During Pregnancy

There are many benefits of chiropractic care during pregnancy. What are they and how does it help, check out this wonderful infographic.

How can you go wrong with a safe, natural approach to keeping the body aligned and working properly during pregnancy? Whether you are pregnant or not, chiropractic care should be an integral part for anyone who wants to have a healthy body.

Source: momlovesbest.com/chiropractic-during-pregnancy

What is DNS?

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In short, DNS is a treatment, exercise and rehabilitation method that reprograms the brain to restore posture, stability and movement throughout the body. The DNS approach is so groundbreaking and has such a powerful influence on improving movement that it has been integrated into the exercise and rehabilitation programs of olympic and professional level athletes. 

DNS, or Dynamic Neuromuscular Stabilization, is a relatively new, advanced method of assessing and treating conditions of the muscles, joints and nervous system. The major premise of DNS is poor posture, faulty movement, and improper joint stabilization is the source of most painful and degenerative conditions of the musculoskeletal system. 

DNS Rationale

In the DNS approach, an individual’s posture and movements are compared to that of an ideally developed child. 

During the first few years of life, the central nervous system (CNS) is developing a child’s movement program. In 13 short months, infants progress through the developmental movement “milestones.” They go from lying helplessly on their back to rolling over, crawling, sitting upright and eventually walking. 

This programming of the CNS develops stable, properly aligned joints, ideal posture, and flawless movements that are meant to last a lifetime. 

Unfortunately, the injuries and pain one accumulates throughout life causes changes in the CNS which alters the movement program. Movement compensations develop to protect what hurts. Compensations are protective in the short term, but at the same time they are destructive by creating abnormal posture, unstable joints, and strained muscles.

When compensations persist long-term, unstable joints and strained tissues wear down over time leading to chronic pain and degenerative conditions, such as arthritis, tendinitis, bursitis, disc bulging, herniation, degeneration, and so on.

DNS Assessment, Treatment and Exercise

Through assessment and testing, DNS practitioners are able to find the source of pain by identifying where incorrect movements and improper joint stabilization are taking place.

Once these areas are identified, the patient is placed in developmental positions that will have the most profound influence on improving their posture, stability and movement. During treatment, the DNS practitioner gently contacts various parts of the body to create a sensory input into the CNS to “reboot” the movement program. This process often requires active participation of the patient to further enhance the reprogramming process.

Dr. Ryan Hamm being treated at a DNS course in a modified 3 month position (left) and a 7 month side position (right) to improve the stability of the neck, shoulders and core at the same time.

DNS exercises are a vital part of the treatment program. They are performed in developmental positions, the same positions in which the movement program was originally “written.” 

Patients are treated and perform DNS exercises in developmental milestone positions to relearn how to stabilize their body and move like they used to.

The exercises are dynamic and retrain the neuromuscular connections to reinforce the new patterns of movement and joint stabilization, hence the creation of Dynamic Neuromuscular Stabilization.

By restoring posture, stability and movement back to the way it was originally programmed, patients are able to stop chronic pain and the progression of degenerative conditions.

For more information about DNS, go to rehabps.com

Find a DNS Practitioner

Dr. Ryan Hamm
Dr. Ryan Hamm is a chiropractor in Arlington Heights, IL and has been treating disorders of the spine and extremities for over 20 years. He specializes in identifying and correcting posture and movement dysfunctions that contribute to painful conditions of the musculoskeletal system.
Dr. Hamm has an Advanced Certification in Chiropractic Biophysics (CBP) Technique and he is a certified Dynamic Neuromuscular Stabilization (DNS) practitioner.

Dr. Hamm Receives Certification in Dynamic Neuromuscular Stabilization (DNS) From Prague School of Rehabilitation

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Dr. Ryan Hamm has become the first health care professional in Arlington Heights and the Northwest Chicago area to become a certified practitioner in Dynamic Neuromuscular Stabilization (DNS).

DNS is a new, advanced method of treatment, exercise and rehabilitation that involves retraining the brain to restore posture, stability and movement throughout the body.

“After countless hours of study and practice, it is an honor and a privilege to be a part of this prestigious group of chiropractors, physicians, and physical therapists from around the world. This post-graduate program has completely changed how I move and how I see movement in my patients. DNS has allowed me to solve some of the most difficult musculoskeletal cases coming into our clinic. I want to thank all of the DNS instructors for an amazing educational experience!”

*Photo with Pavel Kolar, head professor of DNS and Alena Kobesova, associate professor.

 

 

5 Steps For Safe Lifting To Avoid Back Pain

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Do you want to know why some people’s backs “go out” when bending and lifting something up? They bend and lift with bad form and do not activate their core properly.

Here are five important steps you need to take when lifting to avoid a severe episode of back pain:

  1. Position your body’s COM (center of mass) directly above the object you are lifting.
  2. Get equal pressure on the heels and balls of both feet.
  3. Keep your knees centered above your feet.
  4. Make your spine long and straight with no bending or arching.
  5. Create and maintain IAP (intra-abdominal pressure) before and throughout the entire squat and lift. Create IAP by tightening up your abdominals as if someone is going to punch you in the stomach. No sucking in your abs! Your entire abdominal wall should push out and firm up.

Creating and maintaining IAP is one of the most critical parts! Many people do not create IAP or lose it somewhere during the movement. When this happens, stress suddenly occurs in the spine and this is the reason why many backs “go out.”

How to Test Your Diaphragm for Breathing and IAP

Most people who end up in my office with back pain bend and lift with bad form. This is what causes tight muscles, discs to herniate, degenerate and spines to “wear out” over time.

We have a unique and different approach because we look for poor posture and movement patterns that are causing the pain. We then teach patients exercises that retrain their brain to move with better form to avoid future episodes of back pain.

If you or someone close to you is suffering with ongoing back problems, contact us to see if we can help.

 

8 Natural Alternatives to Flu Shots

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Many people are looking for more effective, natural alternatives to flu shots. This comes in the wake of their questionable effectiveness and their potentially harmful side effects.

Is the flu shot worth the risk and how much protection does it offer?

If you follow these eight steps, you can make your immune system stronger to stave off colds and the flu this winter and year round.

Take Vitamin D.  Vitamin D3 (cholecalciferol) supplements are 8 times more effective than flu shots!  Take 1,000-5,000IU/day (children), 5,000IU/day (teenagers), 5,000-10,000IU/day (adults).  Have blood levels tested to achieve 50-80ng.

Eat Less Sugar, Grain and Processed Foods and Eat More Fruits and Vegetables.  Sugar, grains and processed foods cause systemic inflammation and impair immune response making it much easier to get the cold and flu.

Drink Green Tea Instead of Soda.  The polyphenols in green tea are antibacterial, antifungal and antiviral.  They have been shown to block viruses from spreading to other cells.

Get Your Chiropractic Adjustments!  Several studies have shown spinal adjustments stimulate the immune system into action to fight foreign viruses and bacteria.

Get Regular, Good Quality Sleep.  Try to get 6-8 hours a night and go to bed and get up at the same time every day. 

Reduce Stress and Have Effective Tools to Manage Stress. When stress builds up it wears on your immune system making you more susceptible. Make an effort to find solutions when stress builds up before it breaks you down.

Exercise on a Consistent Basis.  Exercise helps boost your immune system, increases circulation of immune cells, and is a great stress reliever.

Be Aware of Sick People Around You and Wash Your Hands. When you are around coughing sick people, avoid breathing in their germs. Also, wash your hands to reduce the chance of spreading viruses to your nose and mouth. Avoid anti-bacterial soaps as they are no more effective than regular soap and they contribute to antibiotic resistance.

 

Sources:

  1. American Journal of Clinical Nutrition, March 10, 2010.
  2. Brennan PC, et al. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. JMPT, 1991;14:399-408.
  3. Brennan PC, et al. Enhanced neurtophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. JMPT,1992;15:83-9.
  4. Selano JL. The effects of specific upper cervical adjustments on the CD4 counts of HIV positive patients. Chiro Res J, 1994;3:32-9.
  5. Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, et al. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008;16:5.
  6. Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat, 2010;18:26.

 

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