stretches - Ask Dr. P - The Pain Doc

Quick Exercises to Prevent Neck and Back Pain if You Sit Often

by Pain Doc | Feb 10, 2020 | Uncategorized

Did you know that by natural design, the human body is optimized for STANDING and WALKING, not sitting and lying down?

The evidence is longer and stronger legs for standing and walking compared to the arms. Your femur, tibia and fibula (leg bones) are longer and thicker than their counterparts; respectively the humerus, ulna and radius bones of the arm. Millions of years of evolution made our species homo sapiens develop this bi-pedal frame in order to survive and thrive. No other animal as far as we know has a frame like ours.

But there’s a problem: the bipedal design of man evolved during a time when there were no desks, computers and automobiles whose operation is better suited for sitting. Back then, there was only rough terrain to walk for miles in order to seek shelter and food. There was fast prey to subdue by foot in order to not starve.

Fast forward to today: just about all occupations these days involve using a laptop. White collar jobs, and increasingly blue collar jobs require sitting at a desk. Sitting is required for operating airplanes, trucks, and cars. To add to the problem, food is plentiful; overall less nutritious and higher in calories — no need to walk that much (expend calories) to get it while it packs on the pounds. Humans are much heavier than they were millions of years ago, on average, and it’s not due to muscle. This makes standing less tolerable, and makes sitting feel better on our feet.

ape to human

So the combination of frequent sitting and weight gain, which places more pressure on your joints, is a harmful combination that leads to pain and injury, affecting tens of millions of people. Osteoarthritis is the gradual degeneration of the joints, particularly the weight-bearing joints (hips, knees, feet, lumbar spine) and it is hastened with obesity and sedentary living.

Here are the detrimental things that happen in your body when you sit for prolonged periods throughout the day:

The pressure to your lumbar discs increases. Sitting removes back support from your legs, pelvis and abdominal muscles, which contract less when you sit.
Your postural muscles turn off somewhat, and as a result you burn less calories. Some studies connect this to a rise in bad cholesterol levels in the blood.
When you bend your neck to look at a monitor screen while sitting, it creates forward head posture. This strains the neck and upper shoulder muscles, and compresses the neck vertebrae; hastening osteoarthritis in the cervical spine. It can even cause tension headaches.

Sitting is an inescapable part of life. The key is to compensate for it by standing and walking when you can. Neutralize its effects. There are many ways to do this while living a modern lifestyle: walk to work, walk during lunch breaks, take the stairs instead of escalator, and do 15-minute workouts right in your office or work area, to name a few.

Drs. Brent and Tiffany Caplan, integrative medicine practitioners based in Ventura, California recommend the following simple stretches to do to counteract sitting:

Let’s talk about creep. No, I am not talking about a person unwelcomely staring at you all night from across the bar. I am talking about a constant load of stress applied to soft tissues (muscles, ligaments, fascia, discs) over an extended period of time resulting in a progressive deformation of those soft tissues. This can lead to muscles or ligaments changing their functional resting length and adaptively shorten or lengthen. These imbalances will lead to degeneration of your spine and will also set you up for future injuries. Creep to your intervertebral discs, the cushion between each spinal segment, may cause them to deform eventually leading to a herniated disc.

A common position that we are constantly in, as working professionals or students, is sitting. The sitting position, especially if in a poor slouched posture, puts an overload of strain in your neck, mid back, and lower back. It may also affect how well you are breathing. Poor respiration will lead to a decrease in oxygen supply to your body and brain!

So now that we know about creep and sitting how do we prevent it? The answer is simple. You should not sit for more than 20 minutes without taking a micro-break. These include Brügger’s relief position and the standing overhead arm reach. No pain should be felt during these movements. These movements are beneficial if you have any back or neck pain or want to support your spine and prevent any degeneration or future injury.

Bruggers exercise

Brügger’s relief position:

Do while standing or sitting on the edge of your seat.
Relax arms at side and turn palms outward, spread fingers, bring shoulders down and back, tuck your chin (attempting to make a double chin, not looking down but straight ahead).
Now exhale repeatedly as if trying to make a candle flame flicker but not go out. Be aware to make sure you are stomach breathing and not chest breathing. (To test this put one hand on your chest and one hand on your stomach. You should feel your stomach rising up and down as your inhale and exhale but your chest should remain still).

Do this for 10 seconds every 20 minutes.

standing overhead arm stretch

Standing overhead arm reach:

Stand up and gently raise both arms above your head with palms facing forward and elbows slightly bent.

Take a deep breath in through your nose and hold the breath while reaching up as high as you comfortably can (a stretch should be felt in your lower back).
Hold for a couple seconds then release the breath through your mouth and go back to the starting position.

Do 10 repetitions every 20 minutes.

Now you’re done and your micro-break only lasted 30 seconds, totaling a mere 1.5 minutes per hour, to maintain your health and prevent spinal injuries.

Dr. Brent Caplan & Dr. Tiffany Caplan
Central Coast Center for Integrative Health
1730 S Victoria Avenue, Ste 230
Ventura CA 93003

Best Exercise for a Strong and Functional Low Back – Russian Kettlebell Exercises

by Pain Doc | Dec 18, 2014 | Uncategorized

Russian kettlebell exercises are a great way to strengthen and condition your pelvic stabilizers, promoting a strong back that is less prone to movement-caused injury.

The pelvic stabilizers consist of all the muscles connected to the pelvis working in synergy to enable you to lift, push and carry (perform work). They include:

Erector spinae group (quadratus lumborum, multifidi, rotatores, iliocostalis)
Abdominals (rectus abdominus, obliques, transverse)
Gluteal muscles
Quadriceps muscles
Hamstrings
Hip rotator muscles

In this video, I demonstrate the proper form for doing these exercises:

Think of your pelvis as a powerful hinge; a “bio-mechanical hub” that connects your torso to your legs. The pelvis’ engineering enables you to stand upright and bear a load by serving as an anchor/ attachment point (resistance-counter force) for the muscles performing the work. It is truly a biological marvel and should be targeted for exercise so that one can meet the physical demands of life more easily.

Examples of common activities that heavily rely on pelvic stabilizers:

Standing up from a seated position; sitting from a standing position
Bending down and lifting something from the ground
Putting your carry-on luggage in the overhead bin of an airplane
Lifting up a child
Throwing a football
Jumping across a puddle

The exercises involve moving a kettlebell, which resembles a cannon ball with a large hand grip, by using the power generated from pelvic thrusting. The repeated thrusts are created by alternating antagonist-agonist* function of the pelvic stabilizers.

*Muscles work in pairs. The muscle that is undergoing a concentric contraction (getting shorter as it contracts) is called the agonist while its counterpart, referred to as the antagonist offers stabilization and measured control of the movement. Muscles switch from being agonist to antagonist and vice versa, depending on the movement. Examples: biceps-triceps, quadriceps-hamstrings.

Although it looks like the arms are involved due to their obvious swinging motion, they are actually not being exercised. The arms serve to connect the weight to the pelvis structure, like a piece of rope. The kettlebell “drags” your arms with it and moves via inertia after being propelled by the rhythmic pelvic thrusts.

Initiate the thrust with your leg muscles, driving power through your feet and channeling it into your pelvis and core to swing the weight forward. Do not use your arm muscles to swing the weight, and try to keep your lower back straight. The worst thing you can do is put too much load on your lower back muscles in the flexion position– this can cause a severe back injury, so avoid doing this.

The benefit of developing your pelvic stabilizer muscles’ strength and coordination is that it will be much easier to move your body; to make it do work. Going up stairs, getting out of and into your car seat, and lifting and carrying heavy things will be much easier. You’ll be pleasantly surprised!

Kettlebell exercises burn up a lot of calories, so they are also good for weight loss.

Remember to use good form and start out with a light weight, working your way up as you develop muscle strength and coordination. Kettlebells can be as light as 2 pounds and as heavy as 50 pounds. The one I am using in the video is a solid 40 pounds.

Simple But Powerful Posture Correction Exercise You Should Do Daily

by Pain Doc | Jun 27, 2014 | Uncategorized

The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life. And it’s my desire to share with you some of these simple changes.

Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures? If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not. The same goes for your body, but the stakes are a lot higher.

One Popular Reason Why People Develop Pain

The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently. At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.

However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years. This is where problems start to manifest.

You see, health problems such as degenerative disc disease take years to develop. Take an x-ray or MRI of your neck or low back, and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.

So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.

You see, as long as you are alive, your cells have the capacity to regenerate or transform. Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.

For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing. Get rid of them, and you’ve got a better chance.

A Simple Exercise to Do Daily if You Sit a Lot

Back to those “lifestyle modification” tips that can help you avoid a life of pain.

Here is today’s example, an exercise called Wall Angels. If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these. When done regularly, they can help restore and maintain good posture.

Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset. It is critical to have good posture if you expect to achieve optimal health in your life.

Give it a try; all you need is an empty wall with no obstructions:

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This Device May Help Heal Weak, Bulging Lumbar Discs

by Pain Doc | Jun 12, 2014 | Uncategorized

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It is estimated that at any given time, about 40% of the adult population experiences lower back pain. That means, today when you walk on a busy street full of pedestrians, four out of ten people you see are experiencing some degree of lower back pain. 50-85% of all people will experience lower back pain at some time in their lives.

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For many cases of low back pain, the source of the pain emanates for the intervertebral disc, or IVD. This is the fibro-cartilagenous material that connects vertebrae together and is responsible for bearing most of the weight placed on the spine. Its architecture is designed to absorb shocks using the incompressible nature of water (hydrostatic pressure), which is mostly contained in the nucleus pulposus of the disc. The nucleus serves to redistribute and dampen the forces placed on the spine so as to avoid damage. This comes in handy when walking, jumping, sitting, standing, and of course picking up heavy things.

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Problems arise when the disc weakens, allowing internal derangements to occur. Basically this means shifts in the shape of the disc that alter the proper alignment and movement of the spinal joint segment, and/or block or partially block nerve pathways, causing nerve root impingement and pain down the leg.

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One of the home care accessories I prescribe for my low back pain patients is the PosturePump™ Spine Retrainer. This innovative device helps to rehydrate weak and bulging disc derangements by increasing the space between vertebrae using an air bladder controlled by a hand aspirator. As the disc volume increases, a negative pressure develops and a pressure gradient forms, which draws fluids (capillary blood), nutrients, oxygen and reparatory cells into the disc. This can help the disc regenerate, and the lumbar extension forced by the PosturePump™ Spine Retrainer can mechanically force the posterior disc bulge back to center at the same time, relieving symptoms.

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Even if you don’t have a bulging disc, the PosturePump™ can serve as a good preventive measure to keep your discs healthy and strong.

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Watch the video to see how this works.

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If you have recurrent pain of any type, stay tuned for further posts…you just might run into something that will make a significant impact on your quality of life. Please consider sharing this information, as it may be helpful to someone in your social circles. Thanks for reading!

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Dr. Perez

What Should You Do For Neck Pain?

by Pain Doc | Jan 8, 2012 | Neck Pain

A recent study in the Annals of Internal Medicine compared the effectiveness of chiropractic spinal manipulation, pain medications, and home exercise and advice in treating biomechanical neck pain.

The study participants were 272 people between the ages of 18 and 65 who complained of non-specific neck pain for 2-12 weeks. They were divided into three groups, one of which took medicine only; one which received spinal manipulation to the neck only, and a third group that was just given home exercises and self-care advice. Participants were asked to rate their pain at 2 weeks, 1 month, 2 months, 3 months, 6 months, and one year. The method the study used to grade the pain was subjective rating (probably using a visual pain scale between 0 to 10, with 0 being no pain and 10 being the worst pain) and a Health Status questionnaire asking them their level of ability to engage in certain activities.

The patients treated by a chiropractor experienced the highest rate of success with 32 percent saying they were pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced pain.

The conclusion of the study was that for participants with acute (recent onset) and subacute (usually meaning lasting more than two weeks) neck pain, chiropractic spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of home exercises and advice resulted in similar outcomes at most time points.

My comments:

Biomechanical neck pain can lower the quality of life significantly. Imagine having to struggle to turn your neck all the time, and having to avoid exercise, sports and many recreational activities due to neck pain. According to the researchers, neck pain affects 70% of adults at one point in their lives.

From my experience, biomechanical neck pain typically arises from some type of past trauma, and it doesn’t have to be major. Examples include car accidents, sports injuries/impacts, horseplaying as kids; and hard impact generating activities such as running, horseback riding, parachuting, gymnastics, boxing, martial arts, and cheer leading.

A second, possible cause of biomechanical neck pain is ergonomic in nature; meaning, related to positioning of the body. Long hours of desk work keeps the head relatively stationary (static) in a single position, allowing gravity to pull down on the head, over time altering the weight distribution on the joint surfaces of the bones that make up the neck. Such an “activity” also promotes muscle deconditioning around the neck. The term “deconditioned” means that the muscle is slower to respond to nerve commands, so it loses some ability to support, guard and protect the cervical spine (neck).

The worst combination is someone who has a history of impact trauma to the neck who later gets a job that involves working at a desk for long hours at a time. The trauma history sets the stage for neck pain, and the static positioning of the head accelerates the process over time.

The pain in biomechanical neck pain frequently originates in the joint surfaces of one or several cervical vertebrae, commonly the posterior facet joints (also called the zygapophyseal joints). This is where most of the movement occurs when turning and bending the neck. Orthopedic surgeons sometimes prescribe a facet block for neck pain, which is an injection of pain medications directly into the joint, usually guided by video fluoroscopy. If the patient has degenerative disc disease, pain can emanate from the intervertebral discs, either as a disc herniation or internal tear of the disc. If this is the case, neck surgery is typically the last hope. The disc herniation may be able to be reduced by surgery, but if the surgeon feels that the disc is beyond repair, discectomy (total disc removal) with surgical fusion is usually performed. However, this is like trading one evil for another. Surgeons know that when you fuse two vertebrae together, the vertebrae above and below the fusion bear an increased burden of providing the movement lost by the two fused vertebrae. This will lead to accelerated degenerative changes to those areas as well, over time.

Neck pain can also emanate from the surrounding muscles and fascia. Myofascial trigger points are focal, tender spots along a muscle that are believed to develop from trauma or microtrauma. They may actually be a concentration of nerve endings on the muscle that developed following an injury. These are best handled through manual therapies such as chiropractic, massage, exercises and stretches.

Some people get inexplicable muscle spasms of the neck. This is usually accompanied with a migraine or tension headache. A muscle spasm occurs when the nerves that control the muscle misfire, causing the muscle to maintain a constant state of hypertonus (involuntary contraction). This results in muscle pain, fatigue and low grade inflammation. Sometimes the spasm can be so intense that anti-spasmodic medications, ice, heat, and rest have no effect. In cases like this, botox injections are sometimes used. Botox injections are comprised of a weakened strain of the Botox bacteria, which has the effect of muscle paralysis.

Lastly, it should be mentioned that a poor, nutrient-deficient diet and smoking can make neck pain worse by denying the body critical nutrients needed for repair and maintenance of muscles, ligaments, tendons, nerves and bones.

The study, while emphasizing that chiropractic manipulation was superior to medications in reducing neck pain among participants, also mentions that home exercises and advice were just as effective. It therefore seems natural that a combination of spinal manipulation and home exercises would be a good strategy to reduce or eliminate biomechanical neck pain.

If you are experiencing non-specific neck pain (don’t really know what caused it) for over two weeks and desire to try chiropractic, it’s important to choose a good, qualified chiropractor. Some of the signs of a good, reputable chiropractor are:

1. Doesn’t try to convince you to purchase a long-term treatment program involving multiple adjustments per week.

2. Asks you about your complaint: the nature of your symptoms, how they started, how long you’ve had these symptoms, how they affect your ability to do certain things; and questions regarding your general health.

3. Gives you his/her diagnosis and uses standard orthopedic terminology that is consistent with what you are coming in for (doesn’t go off subject). It meshes with the information you provided in #2 above. You feel that the chiropractor listened to you, and responded with a meaningful solution that is clear to you.

4. Gives you a treatment recommendation the same day: the type of treatment and a brief description of it (spinal adjustments, modalities, supports); what to expect from the treatment, and approximately how long it will take. The chiropractor should also disclose potential risks and side effects of the treatment. In my opinion, six treatments followed by a re-evaluation is a sensible treatment approach for most cases of subacute, musculoskeletal pain.

A chiropractor like this may or may not have a lot of reviews on the internet. Use your judgement, ask friends and co-workers for referrals, and by all means, don’t be afraid to change chiropractors if your first choice turned out to be bad.

Regarding home exercises and advice for treating biomechanical neck pain, stay tuned! I will be putting up an information-packed neck pain relief video on this topic shortly.