When to Use Ice or Heat for Injury & Pain

Whether and when to use ice or heat depends on many variables. It depends on whether you have an injury less or more than 48 hours old. It depends on the joint(s) in question – is it for your back or your knee? It depends on how you typically like or respond to either application. Do you have chronic pain, arthritic pain, or a recently pulled muscle? Mostly it depends on what has worked better for you in the past, especially if we’re talking upper back pain, neck pain or chronic low back pain. It can even depend on the season of year.

Having said that, the Official Rules are: Within the first 48 hours of injury, if there is no bleeding, RICE = Rest, Ice, Compression and Elevation of the body part. After 48 hours, apply heat.

In reality you can choose either after 48 hours.

But what if there is inflammation? Anyway, what is inflammation? I like what WebMD has to say about inflammation:

When inflammation occurs, chemicals from the body’s white blood cells¬†released into the blood or affected tissues to protect your body from foreign substances. This release of chemicals increases the blood flow to the area of injury or infection, and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling.

A couple of other things to keep in mind. Arthritic joints tend to prefer heat, especially in the winter. Hands too. I mostly suggest heat for neck pain and lower back pain. But some people prefer cold packs. Go with that.

Chinese medicine most always recommends heat.

In general, knees tend to do better with ice, especially after surgery or a TKR (total knee replacement). But if your joints are aging or arthritic, your knees might like a bit of soothing warmth better, especially in the winter.

In practice, I’ve found that shoulders do well with heat and ice. If the shoulder or arm pain is coming from your neck, you likely have cervical radiculopathy or cervical radiculitis. In this case, heat might be the preferred modality.

I usually ask people for their preferences. Do you usually use ice or heat on your low back pain? What works better for you? Then we take it from there.

You can also¬†alternate ice and heat¬†for short intervals. It’s called contrast therapy.

Except for the 48-hour rule, there’s room to experiment. So we’re back to where we started: the answer is . . . it depends.

 

About That Pain in Your Neck

Sometimes ordinary, every day¬†tension in your neck and shoulders suddenly descends¬†into neck pain. Maybe you can’t turn your head because of stabbing pain in your shoulder. Your neck is painfully stiff. Maybe you have pain shooting down your shoulder and arm. Is your sleep affected?

You’ve decided¬†it’s time¬†to get help and want to know more about it, including who can help.¬†In New York City and New York State you can see a Physical Therapist directly without going to a doctor¬†for a referral. Or you might prefer to¬†see your doctor first to get his advice and impression. Common diagnoses¬†for neck pain are cervical pain, cervical spondylosis, cervical arthritis and cervical radiculopathy.

I’ve made some notes below which I hope will help you on your journey of healing.

The Physical

  • You are getting older and your¬†disks and joints may be injured from misuse, overuse or just stiffness which can come with age. (NB this can be helped.)
  • You have a family history of neck pain and/or back pain. Does anyone¬†in your family have degenerative disk disease (DDD) also called Degenerative Joint Disease (DJD)? (Don’t worry: these are awful and unfortunate¬†medical names which basically just mean that your body is aging.) Likewise with a family history of cervical radiculopathy, cervical spondylosis and cervical osteoarthritis, you might be at a greater risk of developing neck pain. Genetics.
  • It’s possible you sleep in a way that irritates your neck muscles and joints. Is your pillow too hard, too soft, too high or too low? ¬†Did you sleep on your belly?
  • Overwork or strain from sitting hours at the computer.
  • Slouching.
  • From exercising – too much or too little.
  • You pulled a muscle in your shoulder or neck – not likely.
  • You were in a car accident or you fell and injured your neck. Do you have whiplash?
  • Your have a habit of holding tension in your neck and shoulders – not just a little but a lot. (Do you have¬†a super stressful job or life or both?) Do you hold your shoulders up around your ears?

 The Psychological

  • You hold psychological tension and stress in your neck. See above.
  • You are stressed / angry / sad / mad / anxious / depressed.¬† John Sarno, MD wrote extensively about the psychological influences, even causes, of our unacknowledged, unconscious, emotions and thoughts on our bodies – that these thoughts and feelings may be causing your neck pain and low back pain.
  • You are sticking your neck out, engaging in some new and uncomfortable activities which may be causing you stress.
  • You’re a parent
  • A student
  • You work at a stressful job
  • You don’t have a job
  • You have financial stresses
  • You get the picture.

What to do About It?

 

Sciatica, Herniated Disc and Back Pain

Sciatica
Sciatica

Searching for help and the right treatment for sciatica, back pain or a pinched nerve? (Your nerve isn’t really pinched though it may be compressed from a herniated disc.)¬†Sciatica can be¬†an irritating, ¬†painful, sometimes scary,¬†condition. I want to reassure¬†you that¬†it is possible to find effective treatment to manage and heal your sciatica – at least I’ve found this to be true in my¬†20 plus¬†years working as a¬†NY physical therapist, specializing in neck pain, spine pain and sciatica.

Do you have the hallmark signs of sciatica: pain, numbness, burning or tingling anywhere from your low back to your hip or further down your leg, even all the way to your toes on one side of your body? Do you have trouble walking, sitting, or exercising because of it?

Since sciatic nerve pain is most often associated with back pain, and since the causes of low back pain are not crystal clear, neither is the cause of sciatica. If you have a history of back pain plus radiating leg pain, has your doctor performed an MRI and found you have a bulging disc or herniated disc? Were you diagnosed with lumbar radiculopathy?

Physical therapists and other medical professionals describe sciatica as a set of symptoms, not a clearly defined disorder. When a patient comes in for treatment of her sciatica, a number of questions run through my mind. Is her low back pain or sciatica caused by a bulging disc or herniated disc? Does the pain arise because of an irritated or stuck facet joint (other joints on each vertebrae)? Or is her sciatica caused by inflammation or irritation anywhere in the low back or along the sciatic nerve in that one leg? Does she have arthritis in the spine or osteophytes? Does the pain arise from a biochemical reaction to injury? Or did she develop sciatica and/or back pain after taking a fall or some other compression injury to the buttocks? Even a tense muscle can pull the spine in such a way that you experience nerve impingement. Did you know that stress and how you work with it can be a huge contributing cause to pain? Then might you want to choose a physical therapist who, in addition to giving you the best treatment possible in nyc, also gives you the time and gentle care you need so you can work through all of the factors contributing to your pain and stress?

Sciatic pain can also be because of a tight or injured piriformis. This is called piriformis syndrome. What this means is that the piriformis muscle, a muscle deep in the buttocks, may be pressing on the sciatic nerve because of your structural anatomy or because you slipped and fell on your buttocks, or because the piriformis is overworked and tight, as can happen with dancers with overworked turn out. Most of the time, both in my experience and in the medical literature, the sciatic pain in your leg originates in your low back. The piriformis muscle is likely to be tight or implicated at the same time and needs to be treated as well.

Maybe you and/or your health care providers have thought that the pain in your buttocks was a hamstring pull, or the pain in the back of your ankle was achilles tendonitis. The missing link in treating plantar fasciitis may be related to the lower branches of the sciatic nerve. Is it possible you have a hip, leg, ankle or foot issue AND the nerve somewhere in the leg is out of whack? Oh yes. I have encountered this so many times in my physical therapy practice.

If you are treated for any of these seemingly unrelated injuries Рa pulled hamstring, calf, achilles tendon, or plantar fasciitis Рand the problem still lingers, you might want to consider seeing a physical therapist who is knowledgeable and skilled at treatment of peripheral or, in this case specifically, sciatic nerve pain.

Again, stress can be a huge contributing factor in chronic pain. Huge. Most of us intuit this,¬†but we don’t know what to do about it. We also know that stress affects us physically, emotionally, mentally, or spiritually. Did you know that even your¬†beliefs about pain can affect its intensity and duration? The question is how do you work with the stress which may be exacerbating your low back pain, lumbar radiculopathy or sciatica?

This is where Yoga Physical Therapy in NYC comes in. In one-hour private  sessions, you learn to become aware of the stress in your body and then how to work with it. Your insights into your stress are gold. Here, you will be instructed in different strategies for relaxation and mindful breathing. A mashup of gentle, targeted exercises Рfrom yoga, Feldenkrais, dance, and physical therapy Рare prescribed for their healing effects. By learning to breathe with and into the pain during these gentle exercises, you are doubly empowered to decrease and manage your own stress and your pain.

What are other best¬†treatments for sciatica and back pain? Look for a physical therapist who knows neurodynamics, also known as nerve flossing or neural glides, who knows about¬†nerve massage, which together can be super effective in easing the sciatic pain. Gentle hip stretches are among the first exercises to do to soothe and open the body and mind. Maitland’s spinal mobilizations are hugely effective. So is myofascial release to the trunk, hips and leg. Often¬†yoga poses, like sphinx and cobra, are effective in the treatment of bulging and herniated discs. They don’t work for everybody. If they are the right treatment for you, they can help decrease¬†back pain and stiffness as well as relieve pressure on the sciatic nerve.

Each patient is unique and requires different treatment strategies. Therapeutic exercises need to be carefully chosen and monitored to see how they work for you at each stage of healing. I think of each exercise, carefully taught using a mindful breath, as a discreet dose of medicine. These exercises, knitted together with your ongoing feedback, are designed to ease and heal what hurts. Your feedback, questions and preferences are consulted at all stages of treatment. You set the tone and pace of your physical therapy, not the therapist. Not the insurance company.

As¬†most cases of sciatica, or lumbar radiculopathy,¬†arise¬†from the low back, the spine needs to be evaluated and treated. I find a gentle, thoughtful approach is best. Effective physical therapy treatment will work first to decrease the pain. There are stages of stretching and strengthening which come next. But first I’m concerned, as I imagine you are, too, with finding the¬†fastest and best ways to decrease your pain.

Sharon Gary, a NY physical therapist offering the best treatment practices in midtown Manhattan, will work with you one-on-one in private one hour sessions. Using these effective healing treatments, strategies and techniques, her approach with Yoga Physical Therapy has helped many people with herniated discs, low back pain, lumbar radiculopathy and sciatica.

 

Tips and Help for Surviving Neck Pain in NYC

Did you just wake up one morning with neck stiffness, neck pain? Or did you have a stabbing sensation around your shoulder blade and you can’t turn your head? Do you feel pain radiating to your shoulder, deltoid, wrist or hand? Chances are that these symptoms start in your neck.

Here are strategies to get through it and back to feeling great.

First, try to identify the cause of your neck pain. Did you sleep in an awkward position? Did you overexert yourself the day before? Spend too many hours at the computer leaning into the screen slumping in your chair?

Next, reach out to someone in your network to help you — a good massage therapist, acupuncturist, physical therapist, doctor or physiatrist.

Rest lying down on your back with head on a low pillow. Apply a moist heating pad for 20-30 minutes. Longer if you have the time. Constructive Rest, breathing and meditation can be extremely helpful. It is amazing how much mindful  breathing in a supported position can melt away overall body soreness and tension.

Feldenkrais arm movements. Make the arms into a shelf by holding onto the forearm/wrists perpendicular to the torso. Keep a loose hold on both wrists and let the arms fall to the side. Breathe. Breathe deeply. Alternate sides 3x. These are my favorite neck exercises, which really help with neck pain.

Exercise Balls. I have nubby balls, and balls made with spikes to dig into the trigger points. Get some small balls to place under your shoulders, neck or back to dig into the painful or tight spots, wherever they help with the pain. You will want to use balls smaller than tennis balls. Golf balls are the perfect size but much too hard. You can probably find¬†a rubber sports ball that’s the perfect¬†size in your the¬†gym section of big box stores or in a local sports store. Rubz for instance should be perfect.

Heat or Ice for at least 15-20 minutes. Different people respond differently to ice and heat. If you have an electric heating pad with a sponge for moist heat, or a microwavable heating pad, lie on it for 15-20 minutes, longer if you have the time. If you prefer ice and have gel packs, great. If not, many use a large bag of frozen peas or corn as an ice pack. You can also make your own by throwing 8-12 cubes of ice into a drip free plastic bag. If using ice, be sure protect your skin with a moistened towel.

Finally, don’t forget to take an anti-inflammatory medication, depending on your beliefs about medication. Your doctor may recommend something – use¬†what¬†works best for you. Many people swear by ibuprofen (Advil, Motrin and store brands). Or you might prefer Naproxen, aspirin or Tylenol. There are any number of topical creams or patches from the drugstore that may help. A homeopathic cream with arnica used by many people is¬†Traumeel.¬†If you live near Chinatown, you can find some great remedies there. Take something that works for you that will take the edge off the pain so you can begin to work your way through it. Tumeric is known to be good for pain. Lavender and chamomile teas before bed are relaxing.

Another tip. Paradoxically, I have found hip stretches to be great relievers of neck pain — secretary stretch, hip stirs, knee-to-chest stretch and the wonderfully relieving figure-4 stretch (sometimes called thread-the-needle).

How Your Breath Moves Your Body

MRI of Breathing
Martin Uecker/BiomedNMR

Inhaling
Watch in the gif to the left how the rib cage expands and rises with each in-breath as the organs below the diaphragm* are pushed down to make room for air to fill the lungs. The diaphragm, the primary breathing muscle, is a mushroom-shaped structure. It lies under your ribs and above the liver, stomach, spleen, intestines and other organs. The diaphragm works like a bellows. When it contracts and moves down, more space is made available in the chest for the air to rush into the lungs. And below the diaphragm, your belly expands, the digestive organs and pelvic floor move downward – functionally making room in the body to receive life-giving oxygen in the lungs.

Exhaling
As the air in your body is exhaled, the diaphragm moves up to push the air out. It is restored to its resting position and so are the other organs. Your ribs and belly relax.

As you look at this gif, try to feel your body moving as you breathe. Feel the rise and fall of the breath as you inhale and exhale: in your chest, the belly, sides and backs of your ribs and spine. Can you feel these areas of your body move with your breath?

Most of us inhibit breathing as we negotiate our daily stresses. We habitually hold tension throughout our bodies. However, we can learn to disinhibit, or relax, our breath and our bodies, and when we do, we will feel the benefits: decreased tension, enhanced energy and more.

This is where integrative and holistic practices like Yoga Physical Therapy come in. Learning to feel the breath in the body is a subtle, yet powerful, yoga and¬†mindfulness tool to restore health and integrate mind and body. It’s a way to investigate and gain understanding within your own experience of how your mind and body work together. It’s key in¬†working with pain. Mindfulness practices bring awareness and acceptance – sometimes even surprising and powerful realizations – to aid in your¬†recovery from¬†acute or chronic pain, especially neck and back pain.

Sharon Gary of Yoga Physical Therapy, one of the best integrative and holistic physical therapy practices in NYC, integrates healing exercises and activities with mindfulness breathing to open, relax and work deeply in healing your pain.

 

*In this gif, the diaphragm shows as black space because the settings of the MRI were set to visualize other structures.

Are you getting the best Physical Therapy in NYC?

How¬†to get rock star Physical Therapy when all you’ve been getting is factory made.

How do you know if you are getting great Physical Therapy?¬†Wouldn’t you like your¬†physical therapy to help you heal, feel better AND¬†help you understand your body better at work, home and play? Sharon Gary at Yoga Physical Therapy will give you all of this.

You might not be getting the best Physical Therapy NYC has to offer if your physical therapy looks like the following:

‚Äʬ†How much time does your Physical Therapist spend¬†with you one-on-one? Is it only 5 to 15 minutes?

‚Äʬ†Is most of your physical therapy time spent with a hot or cold pack, maybe some electrical stimulation for 15-20 minutes, maybe some¬†ultrasound, then maybe a little¬†massage – if you’re lucky?

‚ÄĘ After these¬†modalities,¬†are you sent to do your exercises on your own, without supervision or ongoing instruction by your physical therapist? Are you then directed to ride a stationary bike for 10 minutes¬†or some other activity without supervision.

‚Äʬ†Does your Physical Therapist just hand you¬†a pre-printed sheet of exercises to do on your own in the clinic or for your home program?

‚Äʬ†Does your physical therapist observe¬†you while you do your exercises? Give you adequate instruction?¬†Does your Physical Therapist progress your exercise program, gradually increasing its intensity, as you heal?

‚Äʬ†Are your exercises healing? Do they feel good? Do they feel right? Do they feel too hard? Do they hurt? ¬†[Hint: good Physical Therapy is usually NOT painful or super hard.]

SG_Office_001

‚Äʬ†Do you feel confident you are doing your exercises correctly? Does your physical therapist spend time working¬†with you to help you find the inner feel, the inner logic of each exercise?

‚Äʬ†Does your physical therapist include the use of a mindful, gentle breath to enhance your exercises’ effectiveness, especially if you have chronic back or neck pain? Does she give you breathing strategies and activities to help you find relaxation inside your own body¬†– ¬†essential tools to empower you to ease your pain?

‚Äʬ†Does she work intensively¬†with you, guiding¬†and giving you personalized feedback on¬†how you move and perform each and every exercise, both in the clinic and for your home exercises?¬†Are her instructions clear and easy to follow? Does she take the time to teach you the best way to do the exercises on your body? Help you learn about your body for the long-term? How could you be getting the best physical therapy in NYC if not?

‚ÄĘ Does she give you help with your alignment? Does she make sure you are finding ease of movement and not creating more strain?

‚Äʬ†Are you getting effective manual treatment to aid¬†the healing process, and to help¬†resolve pain, swelling or inflammation?

‚Äʬ†Are you receiving¬†a personalized home program to help you¬†relieve pain between sessions?

‚Äʬ†Does your home program help you manage and ease pain and tightness? Does it¬†help you balance and strengthen your connections with your body?

Okay, that’s¬†what great physical therapy does not look like.

So then what does the best physical therapy look like?

The best physical therapy treatments are¬†one hour long, with you and only you in Sharon Gary’s dedicated office space. She sees one patient at a time so she can really listen, see and treat you. Sharon doesn’t run around seeing other patients. She doesn’t use electrical stimulation or ultrasound. Though the machines might feel good, they don’t do a heck of a lot. If you need hot or cold, she will suggest¬†ways to apply it at home.

In Sharon’s opinion and experience there are too many other hands-on, manual¬†treatments which feel better and do better than the machines. Even more importantly, these manual treatments are¬†more effective in helping¬†you¬†heal, feel better, and decrease pain. Sharon might treat you with myofascial release, targeted therapeutic massage, trigger point massage, gentle joint mobilizations to release joint restriction or strain-counterstrain techniques.

For the therapeutic exercise component of treatment, Sharon uses a gentle approach with mindful breathing to soften the body. These exercises are designed to heal, decrease stress and tension, and to empower you to work with managing and decreasing your own pain, especially neck pain, back pain and sciatica.

Surprise – these exercises actually feel good! They are a¬†mashup of¬†yoga, Feldenkrais, Somatics, sometimes dance, and physical therapy. Rest assured that Sharon will work with you to carefully teach you the details¬†of each exercise according to your muscle and bony structures. As you learn to perform these exercises with precision, you will also be taught how to breathe with each exercise to optimize its effects. This is relaxing and healing for body and mind. Once you feel confident with these exercises we worked together on in the clinic, these and only these exercises will become¬†your home program – an important, if not the most important part of your physical therapy. Sharon will either draw stick figures to describe the home exercises, or if you like, she’ll video you doing them on your smart phone.

Then at the beginning of the next treatment, Sharon will check in with you to see how you’re doing. Is the pain decreasing? Increasing? What’s your impression of how you’re doing? What works and doesn’t work for you? When you have questions about the exercises, she will help answer them.

Your physical therapy treatment is designed to be progressive. Only after the pain has significantly gone down, and only when you say you’re ready, we slowly advance the exercises to strengthen and balance your body.

Healing with physical therapy takes time – your valuable time.¬†To optimize your time and healing, wouldn’t¬†you prefer to work with an experienced, integrative Physical Therapist who really hears you, who incorporates¬†mindful breathing into discrete exercise instruction, who is skilled¬†at using¬†mind-body and holistic tools, one who has an arsenal of manual skills? If you’re truly looking to the best Physical Therapy NYC has to offer, wouldn’t this be the only way to go?

 

The Best Way to Relax

When you are suffering from neck, back, hip or shoulder pain, even if you’re just plain tired, Constructive Rest, practiced just 10 minutes a day, is the way to go.

Constructive Rest, pictured below, is a resting position of the body, in which the arms and legs are supported rather than held by the muscles of the neck and spine. By relieving the spine of the weight of the legs at their articulation with the trunk, the pelvis, trunk muscles, fascia and internal organs are also given a chance to rest. As the weight of the arms across the chest presses into the articulation of the shoulders where they meet the trunk, chronically tight and overworked neck, shoulder and back muscles are given an opportunity to reset, too.

Basic Position: open your feet hip-width apart with the heels outside the toes in a slightly pigeon-toed position. Let your knees fall together so your legs support one another. Cross and drape your arms one over the other, resting them on your chest like empty coat sleeves. Your hands should be relaxed and open, falling off the arms.*

In The Thinking Body, Mabel Todd, who originated Constructive Rest, recommends it for “relieving the spine from strain of leg weights and favoring a return of blood to heart.”¬≤ She describes how, throughout nature, cycles of work are always followed by a dynamic pause, or rest. Different from sleep, these dynamic rest periods are intrinsic to life — from the tiniest cells to the heart, lungs, digestive and neuromuscular systems. The moment of rest and silence in the lub dub of the heart is when the heart’s atrial chambers fill with oxygenated blood in preparation for the next squeeze of the heart, which then sends newly oxygenated blood out to each and every cell in the body. It is a dynamic pause.

Lulu Sweigard, a student of Todd’s, wrote in the Human Movement Potential that “the distribution of its structural weight should balance the body so that no muscle work need be added to maintain equilibrium in the position.”¬≥ What we are seeking to accomplish with Constructive Rest, then, is to bring the body into effortless mechanical equilibrium.

Constructive Rest creates an opportunity for the spinal curves, from head to tailbone, from left to right, to relax and lengthen onto the even surface of a supportive ground. Tense muscles, tissues, joints and organs throughout the body can relax and literally unwind from the demands of maintaining an upright position against gravity.

Remember, the point is to be absolutely comfortable and use as little muscular effort as possible to maintain the position. If you don’t find this position comfortable, perhaps another variation on Constructive Rest might work better for you.

Practicing Constructive Rest only 10 minutes a day has delicious effects. By supporting your body in dynamic relaxation, you can unwind from pain and fatigue while you tune into your breath and your body, relax and let go.**

______________________

NOTES AND REFERENCES

* Try not to forcefully bend your arms or hold your arms in place by gripping with your hands.

** Other benefits may be similar to those of meditation and yoga where lowered stress levels, decreased anxiety, lower blood pressure, decreased heart rate, improved mood and energy levels are well documented. However, to discuss these bonus effects is beyond the scope of this article.

¬Ļ Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.

² Todd, Mabel Elsworth, The Thinking Body: A Study of the Balancing Forces of Dynamic Man,  Dance Horizons, Incorporated, 1937, p.290.

³ Sweigard, Lulu E., Human Movement Potential: Its Ideokinetic Facilitation, Harper & Row, Publishers, Inc., 1974, p. 216

Variations on Constructive Rest

In a previous blog post, The Best Way to Relax, I described the many benefits of Constructive Rest. Here, I wish to offer a few variations on the basic position, pictured at left. At different times, or because of your body type, you might find one of these variations more comfortable. And comfort is what we’re looking for here.

  • Try placing a small pillow under the head if you have a deep chest (thoracic kyphosis) or forward head. If you notice your chin is pointing towards the ceiling and your head is cocked back, you need a pillow. If you simply feel strain in your neck or back, try a pillow. It should be as small as possible to comfortably support your head and neck. The goal is to support your body’s neutral alignment in a comfortable, balanced way so that you can let go of all muscular holding.
  • If the backs of the hips are tight (this is true for many men), try lining up your knees with your hips and ankles rather than trying to force the knees together. Then cross the arms over your chest. If your legs stay in place on their own without drifting to the sides or falling open, this may be the optimal position for your body.
  • If you have a large chest, or if for any reason you are simply uncomfortable crossing your arms over the chest, try resting your arms about 45 degrees away from the trunk of your body with your palms facing up. Allow the weight of the arms to release into gravity.
  • You can loosely tie your thighs together with a scarf or theraband to keep legs from falling open.
  • If the floor feels hard or uncomfortable, try putting more padding down.
  • Sometimes a small pillow placed under the pelvis or low back may feel good.
  • Another approach to Constructive Rest is to prop the legs, bent 90 degrees at the hips and knees, onto a chair seat or sofa. Open the arms out to the sides, palms up, or cross your arms across your chest as in the basic position.

Whichever adaptation you choose, try lying in the same position for 10 minutes a day for a few days. Notice the difference in how you feel.

_______________________

* Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.

Is Your Posture Causing Shoulder Pain?

Have you been taught by your Physical Therapist, Yoga teacher, Pilates teacher or trainer to press your shoulders back and down for good posture?

What if, instead, you were to ease your shoulders up; rotate them slightly back to open the chest; and then allow them to gently drop into place. Then forget about them and move on with your day.

Up and open, not back and down?

Shirley Sahrmann, an influential Physical Therapist, first introduced me to this concept. Her work emphasizes that many, if not most, pain and orthopedic problems are created and maintained by faulty postures and movement patterns.* When I volunteered to be a guinea pig in her continuing ed class, she curtly informed me that I hold my shoulders in an overly depressed position. Really? But wait — I learned to do this as a dancer for good posture. Now you’re telling me that the years-long habit of pressing my shoulders back and down may actually have caused chronic shoulder pain and dysfunction?

Have you never secretly wondered about the instruction to “press your shoulders back and down” — that it sounds, and looks, just a little like the old military instruction “stand up straight, chest out, shoulders back.” Though well-intentioned, it may not be the best advice to correct either internally rotated shoulders or an habitual slouch. Yes, it might facilitate chest opening and elongate tight pectoralis muscles. You may even activate the posterior shoulder blade and postural muscles, like the lower trapezius. Unfortunately, the rhomboids may also become overly activated, too. According to Shirley, shortened rhomboids are not desirable. Besides, you are probably freezing other shoulder blade muscles, like the important serratus anterior, into a chronically tense and overly elongated position. This is NOT desirable. Muscles need to be free and balanced to move bones, especially those of the shoulder blades.

Besides, holding almost any muscle in a static position isn’t usually a good idea. It can create a new host of problems.

Ask yourself, is it possible that pressing your shoulders back and down may actually increase tension in the cervical/shoulder complex and contribute to neck strain and pain? Might it also cause you to press the top of your shoulder, the acromion, down onto the humeral head, creating a moment of impingement within the shoulder joint, contributing to wear and tear of the rotator cuff or a frozen shoulder? The shoulders, particularly in men and women in their 40’s, 50’s and 60’s, not infrequently become problematic through impingement syndromes, frozen shoulder or rotator cuff pulls, strains and tears.

Just for now, try easing your shoulders up, back and then relax them into gravity, easing them into place. You can accomplish the same desired goal of decreasing rounded shoulders, while at the same time creating more relaxation and ease in your neck and shoulders.

 

___________________

*This may or may not include athletic or other kinds of accidents and injuries caused by sudden impact.  Having said that, even a sudden injury or accident can be contributed to by the habitual strain caused by faulty posture, poor training, conditioning or ineffective movement habits.

Degenerative Disc Disease – Neck and Back Pain

Is Degenerative Disc Disease Causing My Neck & Back Pain?

At the age of 42, after an MRI, I was diagnosed with Degenerative Disc Disease. I also had two bulging and one herniated disk. I went home, crawled into bed and cried, convinced that my body was aging beyond repair, and it would be all downhill from there. That was fear. Not fact.

What I now¬†know and want to share with you is that degenerative disc disease may just be a normal part of aging, not a disease at all! “Consider the results of a major 2014 review by Brinjikji¬†et¬†al: signs of degeneration are present in very high percentages of healthy people with no problem at all. ‘Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.*'”

The Bad News    

Yes, your neck or back hurts and your doctor just told you that you have a condition with the word¬†‚Äúdegenerative‚ÄĚ in it. You can‚Äôt even bend down to feed the cat in the morning because your back is so stiff and painful. Or¬†maybe your problem isn’t so much having¬†back pain, but your foot is numb. Or you have pain, numbness or tingling in your buttocks, knee or calf. It‚Äôs been going on longer than you care to admit and nothing seems to make it better.

The Good News

Remember:¬†that MRI is not the whole story. In fact studies show that there is a low correlation between a scary MRI and low back pain. “Low back pain experts have long understood that you simply cannot reliably diagnose low back pain either with MRI, or with X-ray.

Okay fine, you say, but¬†you still have¬†back pain, which is why you got the MRI in the first place. Here’s where the good news comes in.¬†You can get better. More likely than not, you can return to a completely pain-free life. With the right treatment and a few targeted exercises, you can restore¬†flexibility to your spine and become stronger than you‚Äôve ever been. You will probably need to learn a few postural adaptations, especially at your computer, along the way.

The other good news is that this is a wake-up call while you’re still fairly young. Treatment might include gentle back and hip flexibility exercises using¬†a gentle, healing¬†breath to ease your body and mind. You might learn¬†a few¬†postural tips¬†and¬†appropriate core strengthening exercises. Later your treatment might include yoga back strengthening with other exercises to make your hips and legs stronger. You might find that not only do these exercises¬†make your back feel better, you look better, too. And who doesn’t want that? With a stronger core, you might find you have more energy. (P.S. the core refers not only your belly muscles, but all of the muscles surrounding your pelvis – side hip muscles – glutei medii and minimi, the glutei maximii (your glutes), your pelvic floor and efficient, coordinated use of your breath with movement.) The strengthening usually comes after we’ve got a handle on your pain. (Beware treatments that load you up with weights for strengthening from the get go – I’ve had too many patients come to me after that kind of therapy. Their pain didn’t improve or sometimes it got worse.) Continue reading “Degenerative Disc Disease – Neck and Back Pain”