Tag Archives: Poor Posture

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An Easy Exercise to Prevent and Treat Shoulder Pain and Instability

Proper rotator cuff and scapular muscle strength is critical to preventing and treating shoulder pain.  In this video, I demonstrate one of my favorite rotator cuff and scapular stabilizing exercises using an exercise band.  It works the lower trapezius, deltoid and rotator cuff muscles.

The rotator cuff is a critical component to shoulder mobility.  It’s made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates, slides, and glides properly in the socket, which is made up of the scapula.  The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform their movements.

The scapulothoracic muscles are the lower trapezius, middle trapezius and rhomboids primarily and proper strength and function in these muscles is critical to insuring proper shoulder blade movement and general shoulder mechanics.  Weakness in these muscles is often associated with shoulder impingement syndrome.

Weakness in the rotator cuff or scapulothoracic muscles can lead to rubbing of the rotator cuff tendon on the bone or impingement of the bursa within the shoulder leading to impingement syndrome (which can eventually lead to fraying and tearing).  With proper muscle strength and balance, you can help reduce the risk of this occurring.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

For more information on how to address shoulder impingement, please refer to How Should I Treat Shoulder Pain and Impingement?

For an example of another shoulder exercise that can be helpful in improving rotator cuff and scapulothoracic strength, check out my video on How to Treat Shoulder Pain with an Exercise Band.

In addition to proper rotator cuff strength, it’s important to address adequate shoulder and thoracic (upper back) mobility.  Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  Subscribe and you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Which treatments have you found to be the most effective in dealing with shoulder pain?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Properly Perform I’s, T’s, and Y’s Exercises

The purpose of I’s, T’s, and Y’s exercises on an exercise ball is to address lower and mid trapezius and scapula muscle weakness and to generally activate the posterior chain (including the lumbar spine extensors).  Poor posture due to poor thoracic mobility and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.  Poor lumbar extensor strength is linked to low back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following: 

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing the I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Please refer to I’s, T’s, and Y’s Exercises for step-by-step instructions.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.

Version One:  Move your arms slowly up and down in each position of I, T, and Y.

Version Two:  Hold each position for the specified time.

To increase the difficulty for either version, add a 1-3 pound weight in each hand.  These exercises shouldn’t cause any pain in your neck, shoulder or upper/lower back. 

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including:  neck pain and headaches; upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

Be sure to check out my video post, How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain, in which I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.

When performing these exercises, it is important to understand that they should never be painful.  You may feel a mild to moderate discomfort because the exercises are difficult, but if you are experiencing pain (particularly, the pain you are trying to treat) please discontinue the exercise and speak to your physical therapist.

Have you tried the I’s, T’s, and Y’s exercises on an exercise ball before?  If so, what has your experience been like?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Neck Pain and Headaches? Work Your Core?!

You may have heard that if you suffer from low back pain (LBP) that you need to work your “core” muscles, but what if you suffer from neck pain (cervicogenic pain) and/or headaches?  Well then yes, you would need to work the core muscles of the neck.  Like the lumbar spine, the neck also has a group of core muscles that are specifically designed to insure proper cervical segmental stability and to maintain proper head posture.  When weakness and dysfunction are present within this group of muscles, there is often ongoing neck pain that can lead to headaches.

Muscles of the cervical neck “core” include the deep neck flexors and deep neck extensors.  Most people don’t know the names or how to spell these rarely talked about muscles.  For those who like the nitty gritty details, the deep neck flexor muscles include the longus colli and longus capitis.  The deep neck extensor muscles include the multifidus and the semispinalis cervicis.  The sub occipital muscles (including the rectus capitus posterior major and minor) and the obliquus capitus superior and inferior also play a role in cervical stability.  These muscles as a group make up the core muscles for the cervical spine.

When classifying muscles, and especially the cervical muscles, it can be useful to think of them conceptually as global movers and local stabilizers. 

Global movers are involved in the generation of torque and produce movement.  They function more like a light switch, either moving your head or not.  When dysfunctional, there are spasms, pain, and a restricted range of movement.

Local stabilizers are the deeper muscles that control segmental movement and neutral positioning of a joint and the head.  Their activity is tonic (always on).  It’s like a light switch that is always on, but with a dimmer controlling the intensity.  Local stabilizers operate at much lower levels of contraction for long periods of time.  Dysfunction in the local muscles results in the inhibition of muscle function, delayed timing or recruitment of when the muscle is stabilizing which causes loss of segmental control and poor cervical vertebral joint positioning.  This is often associated with chronic neck pain and headaches as well as muscle spasms in some of the larger muscles (such as the upper trapezius) as it attempts to compensate for the underlying muscle inhibition.

The neck presents a unique challenge of both mobility and muscularly speaking.  It requires intricate muscular control to balance the weight of the head in space.  The neck also moves the head through a large range of motion available; all while positioning it accurately to allow us to use our senses (sight, smell, hearing, and taste) most effectively.

Mobility and stability are both vitally important to how the neck functions.  This is why the deep segmental stabilizing muscles are extremely important.  These deep core muscles (also known as the “inner unit”) have been shown to weaken in the presence of neck pain or injury regardless of the cause.  As part of a compensation pattern, one will often find that the prime mover muscles at the front of the neck, called the SCM (sternocleidomastoid muscle), become overactive trying to protect the neck.

Unfortunately, this creates excessive shear and compression forces on the neck which brings the head forward into the poking chin posture.  This dysfunction pattern tends to persist even when the pain subsides unless properly retrained.  This may explain why so many people experience recurrent episodes of neck pain.  Discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

Most of the time neck pain is mechanical in nature.  This means that there is a structural or mechanical issue affecting proper motion in the neck leading to either neck pain or headaches.  Since the trigger is mechanical (starting or worsening with certain movements), it can just as easily be reduced or eliminated if the correct movements can be initiated.  Mechanical neck pain is often experienced as cervical pain, headache pain or other correlated pain patterns in your upper back and down your arms (even to your fingers).

Neck Pain (Cervicogenic Pain) Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck that extends between your shoulder blades and upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the sub occipital area) or in the upper trapezius area.
  • Pain down one or both arms.  It can be felt as far as your fingers.
  • Stiff neck.
  • Altered or blurred vision as well as nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop neck/cervical derangements or dysfunction.  Examples include: motor vehicle accidents; sports; falls; sleeping on a poorly fitted pillow; poor posture; and carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to minor anatomical differences.  Men tend to have muscular necks. Women tend to have longer more slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Neck Pain (Cervicogenic Pain) and Headache Pain

Research suggests the most effective management of neck pain conditions include both manual therapy (hands-on mobilization) and manipulation with specific exercises.  If you have to choose one or the other, I find that a correctly designed and implemented exercise program to be the most effective over the long term.

The first step to designing a treatment plan is by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  This is also known as establishing a directional preference.  You might be moving in the wrong direction if the pain spreads away from the spine and down into the upper back or arm.  Stop that particular movement, and try the opposite direction.

In my experience, most episodes of cervical pain and headaches tend to respond better to cervical extension biased movements and improvements in posture.  Gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hands, fingers, shoulder blade/upper back or the headache gets worse, then the condition is worsening (peripheralizing).  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck  by Robin A. McKenzie.

Once you have determined a directional preference, then you can focus on the deep core and stabilizer muscles.  For my initial neck core strengthening exercises, please refer to Deep Neck Flexion Exercises.

Once you’re able to engage the deep neck flexors, you can next progress into strengthening your scapulothoracic and postural muscles.  Be sure you are engaging the deep neck flexors during these exercises to insure proper stability of the neck.

For the I’s, T’s, and Y’s exercises (as shown below), work up to holding each position for 30 seconds.  Repeat 3 times.  Keeping the correct posture and deep cervical flexor muscles engaged during this exercise is critical to engaging the full core of the neck.

Other Treatments for Neck Pain (Cervicogenic Pain) and Headache Pain:

  • Focus on your posture.  Poor posture is the bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this leads to muscle weakness and dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches using foam roller exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Manual Therapy.  An osteopathic physician, physical therapist or chiropractor can use manual therapy techniques.  This includes joint mobilization and manipulation which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Massage.  Although massage can be a form of manual therapy, it can also be thought of as separate intervention.  There are many types of body workers that can utilize many different forms of massage or manual treatments.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a massage therapist, body worker, physical therapist, athletic trainer or friend who is skillful in body work or massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Other self-mobilization tools.  Many times, a friend or massage therapist isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called the Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms.  They can also mediate the pain response helping to reduce neck pain or headache pain.  You can apply a small amount of topical agent directly over the pain area if it’s accessible and not near your eyes.  (Please use common sense).  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel, Arnica Rub (Arnica Montana, an herbal rub), and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt and Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD or DO).  If you are suffering with neck pain and headaches, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very effective treatment for those suffering with neck pain and headaches.  The American Physical Therapy Association (APTA) offers wonderful resources to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Neck pain and headaches can be difficult to manage, but with proper care, most of the pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, then assess how well they worked for you.  If the technique helped, continue with it then implement another strategy.

If you suffer from neck pain and headaches, which treatments have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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What to do about TMJ Pain

Pain in your jaw or side of your head is often associated with temporomandibular joint syndrome which is also known as TMJ pain.  It’s often referred to as TMJD or temporomandibular joint disorder.  The causes of TMJ pain can be highly variable and are often multifactorial.  Pain can be mild to very severe.  Learn how to recognize the symptoms of TMJ pain and how to determine the possible cause so that you can implement simple treatment techniques.

Symptoms can include:

  • Pain in your jaw near the ear
  • Clicking or locking of the jaw
  • Pain can be on one side or both
  • Pain in the ear, face or neck
  • Pain while chewing (particularly, more difficult to chew food such as meat or raw vegetables like celery)
  • Headache pain

Potential Causes and/or Risk Factors for TMJ Pain:

  • Direct trauma, where the jaw was directly injured
  • Grinding your teeth
  • TMJ can develop rather quickly if there are other precipitating factors.  For example, if you were to eat a series of meals that required excessive and difficult chewing.
  • Over extending the jaw
  • Hypermobility (in the jaw or in general) which allows for excessive movement in the temporomandibular joint
  • Postural dysfunction (poor posture)
  • Muscle spasms within the muscles of mastication or the chewing muscles
  • Cervical mal-alignments
  • Rheumatoid arthritis
  • Osteoarthritis
  • Certain connective tissue diseases

Although TMJ is diagnosed in both men and women, it appears to be more prevalent in women.  This may be due to gender differences as women tend to have more laxity and movement in joints than men.  It may be due to a combination of other anatomical and genetic differences.

Treatment for TMJ Pain

In most cases, a combination of interventions from your dentist and from a physical therapist (PT) is the best approach.  The most important aspect of treatment is to determine which factors lead to the pain originally.  Was there one direct causative factor, such as trauma, or is the pain associated with multiple risk factors?  Due to the multifactorial nature of TMJ, often multiple treatment interventions are needed.

It’s important to have a thorough dental examination to determine if there are any specific tooth or jaw alignment issues.  The dentist can also take an X-ray of the jaw to help confirm that the diagnosis of TMJ is in fact orthopaedic in nature and not related to something more serious (such as an infection or abscessed tooth).  If grinding or clinching your teeth at night is associated with the pain, then the dentist can make a night splint.

From a physical therapy standpoint, it’s important to not only to address the TMJ joint, but also the head, neck, and spine.  Any muscle pain or dysfunction issue can be treated with massage and soft tissue mobilization.  The treatment may be intraorally to gain access to some of the deep muscle of mastication or may include addressing muscles on the outside of the head, neck, and face.  Proper cervical vertebral movement will also be checked and any cervical dysfunction should be addressed.

General treatment strategies for TMJ pain include:

  • Night splints.
  • Use of NSAIDs, such as Ibuprofen, to address pain and inflammation.
  • Ice to address pain and inflammation of the joint.  I recommend icing no more than 3-5 minutes at a time because the joint is small and superficial.
  • Massage.  Many trigger points and muscle spasms will refer pain into the head and/or jaw.  Since the likely areas of dysfunction are either cervical or intraoral, it’s best to contact a physical therapist or bodyworker that is specifically trained to treat this condition.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  • Exercise.  A primary treatment modality and prevention technique is exercise.  This can be broken down into two primary areas: jaw mobility and cervical dysfunction. 
    • Specific exercises to address jaw mobility:  In this exercise, you will hold your tongue at the roof of your mouth and slowly open your jaw.  Only open as far as you can while keeping the tongue at the roof of the mouth and stopping before any clicking or grinding.  It’s best to perform this exercise while looking in a mirror to insure symmetry of your mouth when opening and closing it.
    • Specific exercises to address cervical dysfunction (if present):  Often TMJ pain is associated with a cervical related issue.  I often have my clients perform this cervical retraction exercise.  Sit up straight, and retract your chin straight back with your mouth lightly closed with your tongue resting on the top of your mouth.  Repeat 10-20 times.

  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area which will directly affect the positioning of the jaw.  Proper posture allows for the optimal alignment of your spine, head, and jaw.  This is particularly important when eating.  Poor posture is almost always associated with muscle knots and trigger points.  Subscribe to my e-mail list to gain immediate access to my FREE resources including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.
  • Acupuncture.  I am personally a big fan of acupuncture.  It’s very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, TMJ pain from muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Relaxation.  TMJ associated pain is often a condition associated with individuals with a high amount of emotional stress.  This is likely due to associated jaw clinching.  It’s important to address the underlying emotional stress that maybe contributing to the condition.  This may include counseling, deep breathing techniques or performing my recommended stretches and exercises for neck and shoulder pain to generally help alleviate tension.  The importance of addressing any and all contributing factors (including any psychological factors or emotional stress) cannot be overstated.
  • Speak with your Physical Therapist, Physician, and/or Dentist.  If you are suffering with TMJ pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  In severe cases, there are a myriad of surgical procedures that can be attempted to address the issue.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your dentist and/or physician’s opinion as well).

Although TMJ pain can be difficult to manage, don’t give up hope!  Most TMJ pain can be cured or effectively managed with proper care and by addressing the likely causative factors.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

Have you ever experienced TMJ pain?  If so, which treatments strategies have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Treat Shoulder Pain with an Exercise Band

Proper rotator cuff and scapular muscle strength is critical to treating shoulder pain.  In this video, I demonstrate one of my favorite rotator cuff strengthening exercises by using an exercise band.  It works both the lower trapezius and rotator cuff.

The rotator cuff is a critical component to shoulder mobility.  It’s made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates, slides, and glides properly in the socket, which is made up of the scapula.  The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform their movements.

When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.  With proper muscle strength and balance you can help reduce the risk of this occurring.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.  For more information on how to address shoulder impingement, please refer to How Should I Treat Shoulder Pain and Impingement?

In addition to proper rotator cuff strength, it’s important to address adequate shoulder and thoracic (upper back) mobility.  Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Which treatments have you found to be the most effective in dealing with shoulder pain?  Additional discussion can help others to manage his/her pain.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain

In this video, I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.  Poor posture (due to poor thoracic mobility) and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following:

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing these I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.  Move your arms slowly up and down in each position of I, T, and Y.

For an advanced version, add a 1-2 pound weight in each hand.  To make it even more challenging, hold for time.  These exercises shouldn’t cause any pain in your neck, shoulder, or upper/lower back.

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including: headaches; cervical pain, upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

In addition to muscle weakness leading to common aches and pains, poor mobility in the thoracic spine is also a common contributing factor in the pain syndromes mentioned above.  If you want to learn how to stretch and self-mobilize the thoracic spine, be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Do you have a favorite “go to exercise” that you use to treat neck, shoulder, and upper back pain?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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What’s inside of the Treating Low Back Pain during Exercise and Athletics Video Package?

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues?  It affects nearly 80% of the U.S. population at one time or another.  It’s one of the top reasons for physician and physical therapy visits and one of the most common reasons for missed work days.  The best training plan in the world won’t do us much good if we’re unable to implement that plan due to pain and/or injury.

WomanWithLowBackPain

When reviewing research or anecdotal evidence online, there is no shortage of articles, blogs, and opinions regarding low back pain (LBP).  But what about a specific resource for the athlete, the weightlifter, the CrossFitter or the runner who is experiencing low back pain during exercise?  How does an athletic population know how to handle episodes of LBP?  What specifically can an athlete or active person do to avoid low back pain to lessen the risk of injury and lost training days?  Is there a specific step-by-step plan that really works?

The prevention and rehabilitation strategies outlined in my rehabilitation guide, Treating Low Back Pain during Exercise and Athletics, answer those questions.  You will learn how to safely self-treat your low back pain and helpful methods for a speedy recovery.  (Not to mention, possibly saving you time and money by avoiding a physician visit!)

The good news is that participating in sports, running, CrossFit, and weightlifting doesn’t increase your risk of developing LBP.  On average, being in good health, physically fit, and active actually decreases your risk.

The Treating Low Back Pain (LBP) during Exercise and Athletics Video Package includes:

Treating Low Back Pain during Exercise and Athletics eBook

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In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain.  LBP has reoccurrence rates as high as 90%.  If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management.  Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level.  Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics.  An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Want to peek inside the video content?  Watch now as I describe what really the “core” is and why it matters.

Preventing and Treating Overtraining Syndrome eBook

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In this BONUS eBook, you’ll learn how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  Topics include:

  • How to recognize the warning signs.
  • Specific strategies for OTS prevention.
  • How to self-treat OTS.
  • How to safely overreach.
  • A complete guide to Foam Roller Stretches and Mobilizations with photos and detailed exercise descriptions.

Is your low back hurting? Are you ready to take your training to a new level?  What are you waiting for?  Let’s get started! 

Purchase Package

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The Number One Reason Preventing You from reaching your Exercise Goals

We all know the importance of exercise, fitness, and generally staying active.  For some of us, we look to exercise and fitness as a way to have fun and stay in shape.  Others use activity to help manage stress or chronic illnesses such as diabetes, osteoporosis or heart disease.  Exercising and staying active is an important component to aging well.  It can be very disappointing when you don’t meet your training or exercise goals.  One of the most common reasons for not meeting goals is also one of the most preventable reasons:  injury!  Nothing derails a perfectly developed training plan like an injury.

The most common injury for those in the western world is low back pain (LBP).  LBP is estimated to affect nearly 80% of the U.S. population at one time or another.  And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.

Risk Factors for Low Back Pain (LBP):

  • Sitting too much.
  • Slouched sitting.
  • Prior episodes of LBP.
  • Smoking.
  • Poor core and back extensor muscle strength.
  • Lack of a proper warm up and a cool down.
  • High training volumes with inadequate rest (overtraining syndrome).

Some of the specific risk factors for LBP are also risk factors for other types of injury.  Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to injuries such as:

  • Iliotibial band syndrome (ITBS)
  • Hip bursitis
  • Runner’s knee (Patellar Femoral Pain Syndrome)
  • Piriformis syndrome
  • Meniscal injuries in the knee
  • Achilles tendinitis
  • Plantar fasciitis

Although this is not a complete list, it highlights many of the most common injuries affected by weakness in the core and pelvic/hip muscles.

Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise).  The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability.  (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Imbalances or a lack of strength within the core musculature often times will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces.  Over time and many miles, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.

As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of an injury.  In the majority of cases, I find that a component of hip and core muscle weakness has led to the injury.

The good news is that this is a completely preventable problem.  Most of us already know that we need to cross train and that proper core strength is important.  However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).

Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles.  The most important factor in meeting your goals is to be consistent in your training by avoiding injury!  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional and unnecessary costly medical bills!

BUY NOW

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The 3 Most Common Mistakes Athletes make that can cause Low Back Pain

Whether you are an athlete or weekend warrior, we all want to perform our best.  Many of us live for the weekends so we can participate in the next run, Spartan race, CrossFit Team WOD, or any number of other adventures.  However, no one is immune to one of the one of the most prevalent medical conditions treated in the United States and throughout the western world–low back pain (LBP).

If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical.  Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services.  More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content!

The 3 Most Common Mistakes:

 

Sitting too much.

Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP.  Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments.  It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.

Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting whether it’s at our job or traveling each weekend for destination races and events.  Even worse is sitting with chronically poor posture.

  • Limit the amount of sitting that you spend at one time.  Ideally, move from your sitting position every hour to walk preferably.  If you aren’t able to walk, then try to shift your position at least once every twenty minutes.  Frequent position changes can help you to avoid LBP.  Avoid a long car trip directly before or after a long run, race or event.  For destination events, it’s best to arrive at least a day or two early and wait a day prior to returning home.
  • Sit with correct posture.  Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Not training the core properly or adequately.  Don’t forget the back extensors!

Proper core and lumbar extensor strength is the key to preventing an episode of LBP, which is estimated to affect nearly 80% of the U.S. population at one time or another.  In general, most of us don’t spend enough time strengthening our core muscles (particularly, the back extensors).

The core muscles are part of the body’s natural method of stabilizing the spine.  The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine.  Ligaments and boney articulations are also important in spinal stabilization.  Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

The Multifidus Muscles

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above).  The TVA wraps all the way around the stomach and attaches to the spine.  This is what helps to form the cylinder.  When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core muscles.  These muscles are responsible for movement of the trunk and spine as well as aiding in stability.  The inner core muscles do not actually produce any trunk or spine movement.  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those that work on core strength may not be performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.  To learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.

Not performing a proper warm up. 

An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level.  A proper warm up should include:  a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.

Cardiovascular Warm Up

To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine.  I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body.  It starts to prime the nervous system for activity.  It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury).

The cardiovascular warm up will vary and is dependent on your activity or sport.  I will typically start by performing a light jog or possibility some jumping jacks.  Then I may progress into some more intense heart rate increasing exercises, such as  jump roping or any other form of standing movement (jumping, bounding, and burpees), in order to increase my heart rate.  The goal is to increase your heart rate and promote blood flow throughout the body.  The warm up shouldn’t be overly intense.

Dynamic Warm Up

After my initial cardiovascular warm up, I progress into my dynamic warm up series.  This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.

The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity.  This will almost always include the hamstrings, hips, and pelvis.  Adequate lower leg mobility is important in order to perform your specific exercise or activity.  The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.  More mobility in the lower legs and pelvis means less need for mobility in the spine.  This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury.  You want to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.

Within the dynamic warm up, you would perform exercises such as:  forward and backward leg swings; side to side leg swings; squats with rotation; and press-ups.  Utilizing a foam roller as part of a warm up is acceptable.  However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.

Spine Specific Warm Up

I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups.  Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention.  Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury.  The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine.  It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.

Sport Specific Warm Up

This warm up will vary significantly depending on the type of endeavor you are about to participate in.  For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition.  For runners, the warm up varies.  Are you racing on a flat course or are you heading out for a very hilly trail run?

Examples of running specific exercises include:  butt kickers; strides or bounding; and warm up sprints.  Even running a little on the actual terrain you will be competing on is a good idea.

It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level.  A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury.  Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.

Don’t skip the warm up regardless of your training or event time and/or location!  You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.

An inadequate cool down is another common mistake.  Be sure to take the extra time to cool down and stretch.  Start with a slow jog, and then progress to walking until your heart rate returns to normal.  This is an excellent time to utilize the foam roller as well as performing static stretches and press-ups.

It’s important to identify the common mistakes that can cause LBP.  By implementing these prevention strategies, you can avoid injury and keep training.  Fitness is a lifelong pursuit.  If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

BUY NOW

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Hip Flexor Pain and Pain in the Front of the Hip

Pain in the hip flexor or front of the hip/leg can be associated with several possible causes.  When you experience pain in the front of the hip, and it doesn’t have an obvious mechanism of injury (such as tripping in a hole when running), then it’s almost always a repetitive motion injury or related to poor posture and/or biomechanics.

The location of pain in the hip flexor region can range from mid-thigh to the groin area to the lower stomach (from the belly button to the PSIS, which is the posterior superior iliac spine) or the front of the pelvic bone just up and lateral to the groin area where the primary hip flexor (psoas) originates.

Common potential reasons for pain in the front of the hip include:

  1. Femoral Stress Fracture
  2. Hernia
  3. Femoral Acetabular Impingement (FAI)
  4. Groin Muscle Strain
  5. Low Back Pain (LBP)
  6. Hip Flexor Strain

I will cover each one of these in more detail.

There are many common reasons to develop pain in or around the hip flexors.  Often the cause for the pain is nearly identical (overuse).  It’s important to get the proper diagnosis to insure that you’re treating the right structures.  Continue Reading