Treat Your Own Back (Orthopedic Physical Therapy Products, 2011)
McKenzie is a pioneer in the field of physical therapy. He offers very easy and practical advice on how to treat and manage low back pain. I recommend this book to anyone who has experienced low back pain or knows someone suffering from low back pain.
Q I suspect I have a left rotator cuff tear. I have severe pain especially when I move my arm outwards. It feels like a knife stabbing my left deltoid area with spasms. There is no swelling or bruising. The area is tender to touch. I have trouble lying on my left side at night due to discomfort. If I don’t move my arm, there is no pain. Ibuprofen is not effective. I have been applying ice. I haven’t seen my MD yet. When I raise my arm when I perform range of motion (ROM), I hear a cracking sound. It has been six weeks. Please advise, Dr. Ben! -Linda
A. Thanks for your question, Linda! Unfortunately, this is a fairly common scenario. Shoulder pain can be one of worst most intense pains a person can experience. It can be completely debilitating–rendering an arm almost useless in some cases. The shoulder is vital for any movement of the arm which includes the hand. It can even affect a person’s ability to utilize a computer mouse.
Linda doesn’t mention any specific causative factor which is common in these cases. She also mentions pain at night and pain with movement. Another very common symptom is where she describes the stabbing pain in the deltoid. The pain is almost always located down the arm into the deltoid area. Typically, it is located at the insertion point of the deltoid muscle. It can migrate even further to the elbow or hand.
In a situation like Linda’s, the source of the pain is rarely the deltoid and almost always the rotator cuff. The rotator cuff tends to “refer pain” into this region. Referred pain is a common phenomenon which occurs when the pain is being caused in one area of the body, but the pain is felt somewhere else. (An example of referred pain would be left arm pain or jaw pain which is present during a heart attack.)
Linda states that the pain is present when she raises her arm. This implies that she still has the ability to raise her arm, which tends to (but not always) rule out a full rotator cuff tear. Typically with a full tear, the person loses the ability to raise his/her arm. The level of pain on a full tear will vary depending on how acute or recent the tear.
To accurately diagnose Linda’s condition, I encourage her to seek treatment from her medical physician or physical therapist. Based on her reported symptoms, she is likely experiencing either a partial rotator cuff tear or shoulder impingement. Shoulder impingement can lead to an actual rotator cuff tear if it remains untreated. The key to treatment (with either a partial rotator cuff tear or an impingement) is to first address the pain and inflammation. Then the mechanical cause or causes which led to the injury must be addressed.
My Top Tips & Recommendations to Treat Shoulder Pain & Impingement include:
Reduce the Inflammation:
Address the Mechanical Causes:
Strengthen the Rotator Cuff:
Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover. My tips and recommendations are the first steps for treating and preventing shoulder impingement and pain. 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.
If your symptoms continue to worsen or you don’t improve, I highly recommend that you seek further medical treatment. Many times, a person will require medical intervention, which could include anti-inflammatory medications either orally or through an injection. A person may also need hands-on treatment from a qualified physical therapist to address other mobility issues in the shoulder, thoracic or cervical regions which are causing or contributing to the pain. Sometimes, surgical intervention is needed to repair a fraying tendon or an acromion which is hooked and causing the impingement.
Good luck, Linda! I hope you find the information to be helpful and provide some relief from the pain you’re experiencing. If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.
Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.
Balance is an important part of mobility. It is usually overlooked and taken for granted until mobility is significantly affected. Like all exercise, balance exercise should be fun and convenient. So, how do you use a common water noodle to improve balance? Let’s get started!
Integration of lower extremity muscle strength and range of motion (ROM) is important to maintaining good balance and mobility. Your calf muscles play an important role in balance. If your calves are tight, then you are more likely to tip over backward as you age. The strength of the calf muscles is also important for ambulation. Try these two exercises to stretch your calves. Hold each stretch for at least 30 seconds twice each leg.
Your ankles and calves work together to prevent falls which utilizes a reflex known as ankle strategy. It can help you recover from minor losses of balance. It is an essential front to back movement of the ankle. If you are pushed forward slightly, the ankle will bend and the calves will push you backward so you can maintain your upright stance. If you have tightness in your calves, loss of ankle ROM, weakness or poor sensation, then this crucial strategy is affected. The use of a water noodle can help address this issue. (You can purchase one at your local retailer or sometimes, even at the dollar store. I have cut mine down to about one foot in length to be more manageable.)
First, stand on the water noodle. Very slowly and under control, try to keep your balance while you rock your feet back and forth (touching your toes, then your heels). Feel the motion of the feet and the control of the ankles. You can practice this exercise with your shoes on or off. For added difficulty, close your eyes!
A water noodle can also be used to work on proprioception and somatosensory integration for balance. Somatosensory is the integration of the neurological system (the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This also includes proprioception, which is the brain’s ability to know where the body is located in space. For example, if you close your eyes and lift your arms overhead, you know where yours arm are located. Practicing balance on a softer or unstable surface helps to train the somatosensory system and helps to work the smaller stabilization muscles in the ankle. This is also an excellent way to prevent ankle sprains!
Practice standing on the water noodle. At first, you may need to use your finger (or hand) on a counter top or chair for balance. Practice holding for 30 seconds to start. Then build up to holding the position for a minute. To increase the difficulty level, try standing on the water noodle with one foot, then gently touch the opposite toe on the ground and bring it back. The further the foot reaches out, the harder the exercise. Imagine the numbers on a clock and work your way around the clock and back, each time gently touching a tip toe and then returning the foot back to the standing leg. Repeat on the other side.
For additional information on the five different body systems which affect balance and how they work together to insure proper balance and mobility in our environment, please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? (Part II). If you desire specific advice, I highly recommend that you seek assistance from a qualified medical doctor or physical therapist that is well versed in balance related disorders.
One of the best ways to maintain your balance as you age is to remain active and move more! Balance is an integration of many body systems, so movement is an excellent way to work on all of the body systems!
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If you were born and raised in an industrialized nation (like the U.S.A.), then squatting was probably something you did as a child. As soon as you became school age, you rarely squatted again. In other countries around the world, squatting is a normal part of daily life. In countries such as India and in many Asian countries, it is common to see very aged individuals who are still perfectly capable and comfortable in a full squatting position. When was the last time you saw a 75 year old man in a full squat? (A full squat will vary from person to person, but typically your hips are well below your knees and your thighs are past a parallel position.)
Here are 7 reasons why we should continue squatting as a lifelong pursuit:
1. Maintain Lower Extremity Strength: The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.
2. Maintain Lower Extremity Range of Motion (ROM): Moving into a full squat position takes quite a bit of flexibility. Most children have no problem squatting. As we age, we tend to become less flexible which is primarily due to non-use. Physiologically, muscles, tendons, and ligaments lose some elasticity and can become stiff. The squat requires good hip mobility, knee mobility, lumbar and pelvic mobility as well as ankle mobility. It requires adequate muscle length and joint range of motion in all of the major joints of the lower leg and all of the major muscles of the lower limb.
3. Maintain Bone Density: Squatting activates the major muscles of the lower limb and trunk. The pull of the muscle against the bone stimulates the bone to grow and improve its density. Squatting is also a weight-bearing exercise meaning it is against gravity. If you add any type of resistance, then that load to the bone once again stimulates bone growth. Squatting is a fundamental movement to prevent osteoporosis.
4. Maintain Balance: Squatting activates the lower leg muscles. Adequate lower leg and trunk strength is a critical component to balance. It also activates the somatosensory system. This is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. (Please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II.)
5. Aids in Digestion: Many people in “civilized nations” might not know this little known fact, but incidences of constipation have increased since the advent of the toilet. This is because people are no longer squatting in the woods, over a hole, or some form of plumbing. The body’s colon has three major parts: the ascending, transvers, and descending colon. When you are in a full squat, the thighs put pressure on the ascending and descending colon, which stimulates the smooth muscles to move (this is known as peristalsis). When in the full squat position, the rectum (which is a short, muscular tube which forms the lowest portion of the large intestine and connects it to the anus) is allowed to straighten and unkink. Feces collects in the rectum until pressure on the rectal walls causes nerve impulses to pass to the brain. The brain sends messages to the voluntary muscles in the anus to relax, which permits expulsion. If you are experiencing constipation, take a walk and then spend time relaxing in a full squat position.
6. Prevents Osteoarthritis: There are many potential causes, like trauma or infection, for osteoarthritis. Trauma can be from a one-time accident or due to accumulated trauma or over-use syndrome. Just as common as over-use causing osteoarthritis is under-use. A joint cannot remain healthy if it does not move through its full available range of motion (ROM) on a regular basis. If you never move into a full squat, then you likely never take your knees or hips through their full ROM. According to osteoarthritis statistics, countries in which people still rest and spend extended time in a full squat have the lowest incidences of osteoarthritis. Squatting does not cause arthritis; it actually protects the body from it.
7. Fundamental to All Mobility: Maintaining your ability to squat, and (more importantly), come up from a squat is vital. Your ability to do so is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position. This means he/she cannot get up and down from a chair, a toilet, or even the bed. If you cannot perform these activities safely and independently, then you will need additional care. Typically, it is a major sign of failing health when an aged and infirmed person loses the ability to care for him or her due to weakness and other factors. (This statement is not directed at someone who has suffered a spinal cord injury or has some form of paralysis which affects his/her ability to utilize lower extremities.) The squat is a critical exercise to maintain mobility and function as we age.
Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age. Your ability to perform a squat is fundamental to how you are able to function throughout your life. Keep squatting!
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Q Are there any kinds of specific mistakes we parents make with our kids in regards to their bone, joint, and muscle health? I know diet is huge, but what about general wear and tear on their bodies? Should I be purchasing good quality shoes for my 7 year old daughter (who is not involved in organized sports, but she goes to P.E. and plays outside a lot)? Should my kids have inserts in their shoes? Should I tell them to stop popping their knuckles, shoulder blades, and necks all of the time? I suppose what I’m asking you is whether or not you ever encounter injuries in adults (acute or not) which could have been prevented if they had made different choices in their younger years while their bodies were still growing. -George
A. Thanks for your question, George! This is a large topic to cover, but an important one. As a parent, I want to insure that I do everything I can to help my child live a long, rewarding, and healthy life. For the first time in history, today’s youth are expected to have lower life spans and more health problems than their parents. This is primarily due to the rise in childhood obesity and diabetes. It is projected that nearly one third of American youth will be diabetic in the coming years. Worse than that: after only five years of diabetes, a person of any age will start to experience negative, and typically non-reversible changes to his/her health, including damage to nerves and the vascular system. This problem is now at epidemic proportions for America’s youth.
As parents, we CAN make a difference! The following recommendations can help to optimize your child’s body and health without excessive wear and tear. (As for popping knuckles and other body parts, research is inconclusive about whether or not it’s harmful. Don’t encourage it, and hopefully, over time it will become less habitual.)
Your child’s path toward a healthy lifestyle started before he/she was born. What mom did when the baby was still developing in the womb continues as the child ages. What we teach and demonstrate to our children is likely what they will do as they grow into adulthood. Start by modeling the behavior that you want your kids to use in order to thrive. It is never too late to implement new and healthier behaviors! The earlier we start, the better it is for the child. Encourage movement, activity, and be mindful not to project any negative body insecurities (particularly with girls). The main goal should always be health and fitness and never a focus on appearance.
Thank you, George, so much for this question! As parents, we CAN make a difference!
If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.
In last week’s blog post, I answered a reader submitted question from Kay regarding worsening balance and what we can do to improve our balance. The blog post addressed five different body systems which affect balance and how they work together to insure that we have proper balance and mobility in our environments. In case you missed it or would like to review the five systems, please refer to Q & A: How Do I Improve Balance? (Part I).
This week, I will offer specific suggestions on how you may improve balance in each of the five body systems. If you require specific advice, I highly recommend that you seek advice from a physical therapist or a qualified medical doctor who is well versed in balance related disorders.
Muscle Strength and Range of Motion (ROM) – Without adequate strength, you are unable to balance. These specific exercises can help to improve balance. If your balance may be due to an issue in this area, then the next step is to narrow down as to why. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.
Stretch your calves. If your calves are tight, you are more likely to tip over backward as you age. It also affects your body’s normal ability to balance and recover from a loss of balance via what is known as an ankle strategy. Hold each stretch for at least 30 seconds twice on each leg.
Get stronger hips. An easy way to work on strengthening this area is to get into a quarter squat and walk sideways. Keep your toes pointed forward and go both directions. (Add an exercise band for more of a challenge.)
Improve your quadriceps and buttock muscle strength by doing sit to stands. This is exactly as it sounds. Sit down, and then stand up. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds. The CDC’s 30SecondChairStandTest .pdf file provides further instructions and norm values for your gender and age. Scoring below your norm values indicates you are at higher risk of falling.
Stand on one leg. I would recommend being near your sink in case you lose your balance. On average, you should be able to hold a single leg stance for at least 30 seconds.
Somatosensory – The somatosensory system is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This system will be challenged as you work through the other activities suggested. If you’re a diabetic, you must keep your blood glucose ranges within the parameters set forth by your physician in order to help minimize damage to this system. Most importantly for all of us, continue to live a healthy lifestyle.
Eyesight – My first and most obvious suggestion is to visit your ophthalmologist to make sure your eyes are healthy. If you are using corrective lenses, confirm that they are functioning effectively for your needs. You can also work on Vestibular Ocular Reflex (VOR) by performing the following exercise. Hold your thumb or colored object out in front of you and practice moving your head up and down, to the left and right, and at diagonals as you keep focused on the object. Then practice moving the object while your eyes track it in all directions. Finally, try moving the object opposite the direction you move your head while still keeping focused on the object. If you are advanced, try reading a few words while you perform these.
Vestibular – If you’re experiencing vertigo or dizziness, ask your physical therapist to screen you for Benign Paroxysmal Positional Vertigo (BPPV), which is fairly common and easy to treat. Otherwise, it’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more. Try the VOR exercises described above. Try moving your head while you stand on one foot. Moving your head, jumping, and any bouncing activity in general not only stimulate the musculoskeletal system, but also the vestibular system.
Central Nervous System – Live a healthy lifestyle and move more. The brain needs to be challenged. Think “heart healthy” because anything that keeps the vascular system healthy is also good for the brain. Also, don’t forget to drink plenty of fluids. Like other systems in the body, the brain is primarily water. Dehydration affects your balance in many ways (including the vestibular system) and also increases your risk of blood clots and strokes. Discuss with your medical practitioner any changes, new onset of dizziness, or poor balance as it can be a sign of something more severe or could be a side effect from a new or old medication.
The key to helping someone improve balance is to understand why his/her balance is worsening in the first place. Balance is affected by any one or a combination of the body systems listed above. The brain integrates the information within one’s environment. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits. That is usually the most difficult part. If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue.
If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.
QI have noticed worsening balance, but my knee hurts, and it is hard to do anything. I have also seen balance problems in my mother and daughter. What can we do to improve our balance? -Kay
A. Kay asks a very fundamental and important question. Balance is a very important factor in our mobility, and mobility (at its basic level) is life. The difficult part is that balance is a very complex issue. It is not something we are born with; it is something we develop. We are born with many of the basic components of balance, yet it takes many years to develop into what we would consider to be “good” balance. Kay’s question also touches on a huge issue facing many of our loved ones and our healthcare system in general. The fundamental reason for the question is how balance affects our mobility and how balance relates to fall prevention.
Before we can adequately answer the question, let’s establish what “balance” is and which body systems affect balance. Let’s also discuss why balance is so important–particularly as we age. We are concerned about balance because we are concerned about falling (and we should be). Falling is the number one cause of hip fracture. Nearly 20% of all hip fractures in the elderly will result in death within the first year, and 50% of people will never regain their prior level of function.
Poor balance and the fear of falling are one of the primary reasons for declining mobility with aging. Lack of mobility leads to further decline including: even worsening balance; worsening arthritis and pain; and negative effects on diabetes, heart disease, and osteoporosis. It generally leads to a declining quality of life. Mobility is an important element of life. The worse one’s balance becomes, the more difficult it is to be mobile.
Understanding Balance
Balance is primarily affected by five different body systems working in combination with each other:
The key to helping someone improve balance is to understand why his/her balance is worsening in the first place. Balance is affected by any one or a combination of the body systems listed above. The brain integrates the information within one’s environment. Determining the best intervention to address balance-related issues can be difficult and is typically multifactorial. The first step is to determine what the primary cause is for the decline in balance.
Now that we understand some of the basic components to balance it is easy to understand why answering Kay’s question is more difficult than you might expect. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits. That is usually the most difficult part. If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue. Thank you, Kay, so much for this question!
In next week’s follow up post, Q & A: How Do I Improve Balance? (Part II), I will offer very specific and practical approaches to improve balance in each of the five categories. Stay tuned!
If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.
Most of us think stretching is stretching is stretching. Who likes it? Why do we need it? Yes, some days I’m personally still in that camp! Stretching is actually more nuanced than that. The real question is: why are you stretching in the first place?
There are potentially different reasons to stretch. One reason is to decrease pain. Stretching an ailing muscle or muscle spasm can activate internal stretch receptors in the muscle tendon unit, which helps the muscle to relax. It can also change the blood flow to the area or affect the input on the nerve–all resulting in some pain relief.
We instinctually want to stretch. Consider yawning. Our outward arm motions during a yawn are nothing more than primitive stretch reflexes. Babies begin stretching in utero! We continue to voluntarily stretch for the rest of our lives (or in the case of a yawn, involuntary). Animals (dogs, cats, horses, and even birds) also stretch daily.
Stretching releases positive endorphins and neurotransmitters in the brain which helps us to feel better. Depending on the location of the stretch and the intensity, it can cause relaxation or alertness.
Stretching is used to improve range-of-motion (ROM) of a joint, but why? The most common reason is that the joint ROM is limited and is somehow affecting performance of a desired activity.
Stretching is also used as a preventative measure. For example, if ROM is limited asymmetrically (unequally) in the hamstrings, then it could lead to a pelvic torsion and low back pain. Another example is a shoulder which has limited ROM, yet a person continues to reach up overhead or perform an overhead weight lifting technique. If the individual doesn’t have adequate ROM to perform the lift, then either he or she will perform the lift incorrectly (risking injury). The body will be forced to compensate somewhere for the lack of shoulder mobility (again, likely leading to injury).
As a physical therapist, I work weekly with people who have injuries from compensating for lack of ROM and mobility in the body. This problem is prevalent due to current American culture. We spend most of our day either sitting (driving, working on the computer, watching TV) or hunched over while sitting or standing (washing dishes, picking up children, general slouching). As a society on average, we don’t move or stretch enough to live healthfully. A joint must go through its full ROM on a daily basis to remain healthy. Without the full ROM, a nutrient rich and internally lubricating fluid known as synovial fluid cannot properly circulate and coat the joint surface. Over time, this will lead to stiffness, dysfunction, and joint deterioration such as arthritis.
One potential issue to address is that all stretching methods aren’t created equal and certainly aren’t appropriate in every circumstance. The research indicates that stretching, when done improperly or at the wrong time, can either help or inhibit performance.
Let’s review five different methods of stretching or improving ROM:
Static Stretching – Static stretching is basically holding a tissue in an elongated form. This can be performed across one joint or multiple joints, depending on the muscle or tissue being stretched. The minimum length of time should be 30 seconds to around 60 seconds at a mild to moderate discomfort. If you want to maximize results, then the stretch should be held for a longer duration of at least five minutes. Typically, this is not practical for most people. Static stretching before your athletic performance causes loss of performance. If the goal is to gain ROM, then static stretching should be performed, but only after the activity or at a separate time.
Dynamic Stretching – This is a more active type of stretching where you are moving in and out of your available range of motion. This can be progressed into ballistic stretching, which is taking a joint actively and usually quickly, through its available ROM and into a near end range stretch without exceeding the physiologic maximum ROM for the joint or muscle/tendon tissue. As a warm up, dynamic and ballistic stretching can improve performance and joint ROM. If the goal is to prepare for an activity, then a dynamic warm up should be performed. Ballistic stretching is not indicated for novice athletes or beginning stretching. It is definitely not indicated when recovering from injury.
Myofascial Release with Foam Rolling – Research is limited presently, but it indicates that foam rolling can help improve joint ROM without the deleterious effects of static stretching. It can be performed prior to athletic performance and not provide a negative effect. Clinically and personally, I find foam rolling to be an effective method in improving ROM. Foam rolling should be a frequent post-workout activity, and at times, it would be indicated as a pre-workout activity. It is also a fantastic way to release stress and tension, and it may improve recovery times. (Please refer to a recent post, Does Foam Rolling Help or Hurt Your Performance?)
Proprioceptive Neuromuscular Facilitation (PNF) – PNF stretching is a very quick and effective method of utilizing the body’s neurologic stretch receptors within the muscle and tendon units to assist in producing increased ROM. There are many different types of PNF stretches and exercises. The most basic and easiest to utilize individually is a technique known as Hold/Relax. Move the extremity and joint to a point of feeling a mild stretch, and then lightly resist any further stretch for approximately 10 seconds. After 10 seconds, progress further into the stretch and hold for approximately 30 seconds. I tend to work in sets of three to four when performing this technique. It is also important to remember that it should never result in pain, only a stretching sensation.
Neuromobilization or Neural Gliding – This is probably the least understood of all methods to improve ROM. There are many factors to consider regarding neural mobility. First, the nerves are covered in a protective sheath which is meant to be very flexible. Unfortunately, when the sheath is irritated or damaged, it tends to lose its flexibility. This typically leads to neural pain. Sciatic nerve pain from a bulging disc is an example of when this may occur. Trying to directly stretch a nerve is a bad idea as it usually makes it worse. Specific neural gliding and mobilization techniques have been developed to assist with improving ROM and pain. As a physical therapist, I use clinical signs to help guide my treatment diagnosis, which ultimately can help guide the treatment for the client. If you are experiencing neural tightness and pain, please seek medical advice to insure you are getting proper care. There are times when neural tension can be present without pain or other symptoms. It may be caused by poor spinal alignment, poor posture, or other medical illnesses.
The science of stretching is as diverse as the reasons why you may want or need to stretch. Stretching is critical to maintaining flexibility. Flexibility is a critical component to a healthy and optimally functioning body. Although flexibility and stretching are often overlooked, they are truly critical to optimize health, prevent injury, and maximize performance. Stretching should never be done to the point of causing pain. It is possible to cause injury by over aggressively stretching. The best results are usually through consistency and a mild to moderate stretching sensation.
Please email contact@thephysicaltherapyadvisor.com if you have a question that you would like featured in an upcoming blog post.
QHey, Ben! I am SO EXCITED that you are doing this blog! I think you can help so many of us who are clueless and trying to figure things out, all the while making things worse.
What would you suggest for those of us who have been (shamefully!) too sedentary for too long and desire to get back to a pain-free, in shape lifestyle? Where do we start? Arthritis and excess weight make much exercise seem daunting. I am deathly afraid of injury because I need to care for my family. Here is what I’ve been doing lately:
I need to do more!! I need to lose 80 lbs., but I can’t yet do the heavy cardio stuff because I don’t want to get hurt. I’m 45 years old this year. I hurt when I move. Please help me get started with something that will lead to fitness if I stick to it! Thanks, Ben.
-Erin
A. Thanks, Erin! This is a wonderful question because there are many of us who feel exactly the same way you do. There are many points to ponder about this question, but let’s first acknowledge the positive. You are aware of your need to address this issue. It is not too late–45 years is not old (especially when you consider you are likely to live into your 90s). You are already taking action!
Where we are now in our physical lives is the sum total of choices we have made, and a few random events all sprinkled with the genetics we inherited. We need to accept ourselves for where we are presently and acknowledge that our fitness and our health is not a destination, but a journey. Each person’s journey is different. We need to be realistic with our goals and give ourselves time to undo what we have done to ourselves for years. Let’s get started!
Alexis and I out on an evening stroll/bike ride.
Healthy living is something to strive for. To be healthy, we need to address all aspects of our bodies. We need to work on cardiovascular health, which is best done by HIT followed by regular movement and activity; weight training; good sleep of seven to nine hours on average; plenty of water intake; and healthy eating. Remember our physical bodies are only part of the equation. Let’s not forget the social, psychological, and the spiritual aspects that must also be in balance.
Injury is always a concern when we start something new, but it is a risk that we must take. We either risk orthopaedic injury from an active lifestyle or we can guarantee an unhealthy life full of heart disease, cancer, depression, and diabetes. However, we must be smart about our activities and slowly taper to a level that is appropriate for each of us. As a physical therapist, I see just as much arthritis and debility in people who didn’t move much in life as those who over-did. Our bodies must move to be healthy. Lack of movement and activity doesn’t prevent orthopaedic breakdown.
This question hit at the heart of what I hope to address on The Physical Therapy Advisor blog. This answer is by no means all-encompassing. I will continue to address these topics. Thank you, Erin, so much for this question!
If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.