Do We Really Need to Sit Up Straight?

Posture– or avoiding slouching—is often discussed by people who have lower back or neck pain.  People are often told to sit up straight, as poor posture has been thought to be one of the causes of back or neck pain. Research shows that people with low back pain may find certain postures painful, but it can’t be proven that the postures are the cause of pain.

Do We Really Need To Sit Up Straight?

Movement and changing positions can be helpful, as sedentary lifestyles are a risk factor for low back pain, among many other health conditions.

1. There is no single “correct” posture. Despite common posture beliefs, there is no strong evidence that one optimal posture exists or that avoiding “incorrect” postures will prevent back pain.

2. Differences in postures are a fact of life. There are natural variations in spinal curvatures, and there is no single spinal curvature strongly associated with pain. Pain should not be attributed to relatively “normal” variations.

3. Posture reflects beliefs and mood. Posture can offer insights into a person’s emotions, thoughts, and body image. Some postures are adopted as a protective strategy and may reflect concerns regarding body vulnerability. Understanding reasons behind preferred postures can be useful.

4. It is safe to adopt more comfortable postures. Comfortable postures vary between individuals. Exploring different postures, including those frequently avoided, and changing habitual postures may provide symptom relief.

5. The spine is robust and can be trusted. The spine is a robust, adaptable structure capable of safely moving and loading in a variety of postures. Common warnings to protect the spine are not necessary and can lead to fear.

6. Sitting is not dangerous. Sitting down for more than 30 minutes in one position is not dangerous, nor should it always be avoided. However, moving and changing position can be helpful, and being physically active is important for your health.

 7. One size does not fit all. Postural and movement screening does not prevent pain in the workplace. Preferred lifting styles are influenced by the naturally varying spinal curvatures, and advice to adopt a specific posture or to brace the core is not evidence based.

D. Slater et al. (2019) “Sit Up Straight”: Time to Re-evaluate. JOSPT.  49(8):562-564

Change Your Brain—Neuroplasticity Rocks!

As we get older, we unfortunately discover that our brains can slow down too.  Some studies that involve both humans and animals have shown that regular aerobic exercise like walking or jogging can give a boost to memory and cognition.  Aerobic exercise can increase the number of new neurons in the brain’s memory centre, and also decrease inflammation. It’s inflammation in the brain that can lead to the development of dementia.

Until recently, there has not been much research on how resistance training can affect the brain.  Obviously weight lifting builds muscles, but can it affect the cells and function of the brain?

An interesting study was recently published in the Journal of Applied Physiology, where the authors taped weighted pellets to the butts of rats, and had them train on a 100cm ladder. After several weeks, the climbing rats showed increased muscle mass.

A separate group of rats were injected with a substance that causes inflammation in the brain that created symptoms of early dementia. Half of these rats began weight training, and over weeks, the weights strapped to their butts became heavier to progress their strength training.

After 5 weeks, all rats were let loose into a maze where they were expected to run immediately for one dark chamber, and they would learn where that was located so that each time they were admitted into the maze, they should run directly there.  What they learned is that after a few repetitions, the cognitively impaired rats who did the weight training surpassed the speed and accuracy of the control rats . The authors of this study concluded that the weight training had restored the rats’ ability to think, since the untrained rats with mild dementia continued to lag far behind the others in their ability to find the dark chamber.

Upon examination of the brains of these rats, there was inflammation found  in the brains of the rats who had been injected with the chemical, but the brains of the rats who did the weight training showed a huge number of enzymes and genetic markers that would create new neurons, allowing the brain to remodel itself.

Obviously rats are not people, and it isn’t known that the brains of people who weight train would behave in the same way to lifting weights. It is fair to say that resistance training is beneficial for muscle mass and strength, for bone density and metabolism, and if it does help to protect the brain, so much the better!

At Elevation Physiotherapy & Wellness, our Physiotherapists are able to develop a resistance program that is individual for you, based on your own goals. Call us to talk about how we may be able to make your brain stronger!

Your Spine is Stronger Than You Think!

Low back pain is the leading cause of pain and disability worldwide. Statistically, the prevalence of lower back pain is increasing, so what are we doing wrong? Historically, people have often been told to rest or to strengthen their core muscles, and for many, that is not helpful advice to get to the root of the problem.

We need to change that message.  The structures in the back that cause pain, and the biomechanics of spine do not seem to be as important as we once thought they were.  We need to stop thinking that someone will break when their spine is put under load.  Our bodies are much more resilient than that, and it is never helpful to promote fear.  The spine is designed to move in all directions, and it is important that it does.  Telling someone NOT to move in a certain direction as it will damage the spine is both wrong, and can change their brain over time.  If someone is scared to move into flexion and tries to avoid it at all costs, when they have to move into flexion to tie their shoes, they will consistently be thinking that they could damage themselves.  Is tying up a shoe really dangerous?  No it’s not.

We can train ourselves to do almost anything, and the risk of injury is dependent upon much more than how we move.

Several studies have shown that spinal flexion cannot be avoided, even when trying to keep the spine in a “neutral” position with activities like squats, dead lifts, or a multitude of ab exercises.  If such movement cannot be avoided, no matter the loads or conditions, why do we teach people this will result in low back pain?  Fear and limiting beliefs about the fragility of the spine are hurting us more than actual movements.

People with low back pain need to hear reassuring, positive and empowering language.  A person who has lower back pain WILL get better; they WILL get back to what they love to do.  Almost everybody does.   As a Physiotherapist, it is important to ensure people with lower back pain are empowered to stay active and strong in ways that they enjoy.

One of the most important messages to convey to someone who is suffering from lower back pain is to remind them that they are strong, their spine is robust, and they will recover.  Each person needs to keep moving in ways that feel good, and temporarily avoid positions that seem to create pain.  The big word here is temporarily—once pain settles down, there should be no restrictions in movement.  Get back to everything!

The Shoulder Bone’s Connected to the Spine Bone…

So most people wouldn’t realize that your mid-back would be related to your shoulders, but if you’re sitting right now, try to slouch.  Go ahead, fully slump down… see how when you do that, your head pokes forward and your shoulders round inward?

Now from that position, try to lift up your arms overhead.  Hard to do, right?  That is because you need your mid-back to be fairly straight and your chin tucked to get full shoulder movement.

Most people spend too much time slouched forward, and over time your mid-back, neck and shoulders can tend to stay a bit rounded forward, or at least it feels stiff when you try to get out of that position. Your thoracic spine are the 12 middle vertebrae located between your neck and lower back, and connects to your ribcage. When it’s moving well, your back is happy and your neck and shoulders move well too.  If your mid-back doesn’t move well, you may develop some aches and pains.

Here’s why mid-back mobility matters:

  1. Improving your mid-back and shoulder mobility can help with headaches and neck pain.

Upright posture is important. When your thoracic spine is stiff, it’s harder to sit up straight and rotate your upper body. When your mid-back is rounded, your head automatically pokes forward, which can contribute to pain in the neck and even to headaches. But working on the mobility of your mid-back can give you more mobility in the shoulders and neck.

  • Better Overhead Movements:  when you’re slouching and your mid-back is rounded, you don’t reach overhead well.  You need a straight thoracic spine and tucking the chin back in order to achieve full overhead shoulder movements.  All of those people you see walking around with a forward head posture and rounded shoulders don’t have normal shoulder movements and can’t take a full deep breath.  True story.  Practicing an arch through the thoracic spine by relaxing over a foam roller can help improve mobility through the region.  Take a few deep breaths to encourage rib expansion while you’re there.
  • Smoother Breathing: When your thoracic spine is mobile, your ribcage can move well too, allowing your lungs to fully expand and your diaphragm to descend. This can translate to better performance in whichever activity you choose!

Hopefully you’re seeing it’s important to give your shoulders and thoracic spine a little love.

You might be surprised at how much improving your thoracic spine and shoulder mobility makes you feel better — at the gym and in your day to day life.

3 Exercises to Help You Slow Down and Settle Your Mind

Are you feeling tire, stress, and have no energy?  These restorative exercises can help relieve tension in your body, improve sleep quality, improve movement, increase blood flow, tap into your central nervous system, and calm your mind. 

ELEVATION-Physiotheray-diaphragmic breathing

Diaphragmatic Breathing:

  • Sit in a comfortable position and cross your legs
  • Place 1 hand on your lower ribs and the other on your abdominal muscles
  • Take a deep breath in and make sure your hands move outward, expanding your torso
  • Take a long exhale, making sure your hands and your abdominal muscles move inward
  • Once you feel your belly is expanding and contracting well, rest your hands on your thighs and close your eyes
  • Take about 10 deep breaths

Hip Flexor Release:

  • Lie on your back and lift your hips to slide a yoga bolster or folded blanket under your tailbone
  • Relax your hips and gluteal muscles and try to keep your pelvic neutral as you pull one knee towards your chest (using your hands around your thigh), and bring the opposite leg off the floor and straighten the knee
  • Keep your chin tucked and ribs down while you take several deep breaths in this position
  • Switch legs

Child’s Pose:

  • Start on your hands and knees, keep your knees wide and bring your big toes together
  • Sit your hips back towards your heels, rest your trunk downward and stretch your arms in front of you
  • Rest your forehead on the floor or a yoga block in front of you, take several deep breaths over 1 minute

The Evidence is In: Slouching IS the Culprit!

Lower back pain is prevalent and patients frequently seek help to deal with the pain and functional limitations that arise.  It sounds oversimplified, but commonly lower back pain begins without any trauma, but more due to the cumulative effect of too much lumbar flexion each and every day—sitting in slouched posture at the computer, sitting to eat all meals, brushing teeth, washing feet, doing laundry etc.  We don’t get out of that position very much and over time, the back can become aggravated as a result.

A recent study provided information about the type of movements of the lumbar spine performed by 208 pain-free individuals over a 24-hour period, and the proportion of time spent in flexion and extension.

 Main Results:

The median total number of movements with a change in the lordosis angle greater than 5° was approximately 4,400 within the 24 hour period. Most of these occurred within a small range of movement.

On average, full flexion was achieved 50 times within the 24 hour period, whereas full extension was achieved 0 times.

94% of the day was spent in the 0-50 degree range of flexion and 2% of the day (24 minutes) was spent in any extension relative to the standing position.

Conclusions: The data illustrated the spine mainly moves through a small range of movement during normal daily activities, the minimal amount of time spent in any lumbar extension, and the majority of time spent in flexion.

A huge 66% of the movements occurred within a very small range – only 5 to 10 degrees of movement. It appears that those movements are occurring within the flexion range, but of course may not be at full end-range. It is good to finally have some evidence about the number of movements and the type of movements that an individual without symptoms performs in a normal 24 hour period. What this research does not tell us is if individuals with lower back pain have a different movement pattern.

Physiotherapy for people with lower back pain often involves education on correcting sitting posture using a lumbar support in chairs to prevent slouching, and various spinal mobilizations and exercise into lumbar extension to lessen or abolish the pain and functional limitations due to living in flexed positions!  Back pain can often be completely abolished when lumbar flexion positions can be avoided for a short time, and repeating lumbar extension movements.

Could Low Impact Sports like Cycling and Swimming Put your Bones at Risk?

A new study in the British Medical Journal looked at the bone density of elite cyclist and runners, and found that the cyclists had thinner bones than the runners, even though many of the cyclists also lifted weights.  The sports we do make our skeletons adapt in different ways over time.

Exercise is necessary for bone health—studies have long shown that children who are consistently active develop thicker, stronger bones than those who are sedentary.  Many scientists agree that activities that involve sprinting or jumping will make the body increase the number of bone cells to prepare the bones to tolerate those forces. Even middle-aged or older people can maintain strong bones if they maintain activities that put more force through the skeleton.

Researchers are still not sure what activities build the bones enough—some studies show that running generates enough force to remodel bone, and other research says that it does not.  It’s the same with weight training. Several studies have raised concern that non-weight bearing exercise like cycling and swimming may actually be helping the bone to get thinner because they put so little pressure through them.

A Norwegian study looked at the bone density of 21 elite runners and 19 road cyclists in their 20’s.  Despite the fact that the cyclists trained much more than the runners and many more of them did weight training, they had noticeably different bones.  All of the cyclists had thinner bones than the runners, and more than half of them met the criteria for low bone mineral density.

This research can’t tell us why the cyclists’ bones might be thinner—both eating too little and sweating too much have been shown to cause bone loss.  This research points to serious cyclists needing to combine other activities that are weight-bearing through the bones.

Physiotherapists are experts on optimal cross-training for athletes to prevent overtraining certain muscles or building imbalances from those sports or activities that use the same muscles over and over.  If you’re a serious athlete, check in with your Physio to find individualized activities and exercise to complement your own sport

The Fascination with Fascia

Elevation Physiotherapy & Wellness :: The Fascination with Fascia

New research indicates that certain cells found in the fascia communicate directly with the nervous system, each other, and with every other organ in the body. If this is true, this thinking challenges what we thought we knew—the central nervous system may not be the one in control of all of the body systems.

It used to be thought that the fascia was just a wall of tissue that surrounds everything—lining the walls of the trunk and pelvis, wrapping around muscles and organs.  This new research is showing that the fascia is more like a highway where cells live and where nutrients and waste can travel to other cells or directly to the lymphatic system. If true, it makes sense that the fascia would play a significant role in our immune system and overall wellness.

There are different types of fascia—superficial or deep, dense or non-dense.  The fascia of the nervous system is called meninges, the fascia surrounding the lungs is plurae, and the pericardium surrounds the heart.  Are all of these different types of fascia connected and working together on some deeper level?  Do they communicate amongst each other, and to the body as a whole?  We don’t know that yet for sure.

Sue Hitzmann, creator of ‘The Melt Method’ to address fascia, feels that it is key to keep fascia hydrated, and not just by drinking a lot of water.  Injury to the fascia through trauma or injury can cause it to become stiff, and just drinking water would be like running a faucet over a dry sponge.  It would take gentle manipulation of the fascia to “loosen” or mobilize the tissue and increase the intracellular fluid.

The research shows that our fascia is filled with proprioceptors which tell us where our body is in space. When proprioception goes awry because of injury to the fascia from muscle overuse, improper movement, and/or posture, the fascial layers no longer glide smoothly or work properly. The central nervous system would then take over, and if this goes on for too long, it becomes overworked and can contribute to neurological disorders or autoimmune disease like lupus, rheumatoid arthritis and fibromyalgia.

Wouldn’t it be great to use non-pharmacological treatments that could tap into our bodies’ own natural defenses against degenerative diseases. We know that eating right and moving help keep us healthy into old age, but we must move well and keep our fascia pliable and nourished. 

Exercises for Lower Back Pain Are NOT Created Equal!

Elevation Physiotherapy & Wellness :: Exercises for Lower Back Pain Are NOT Created Equal!

Research has shown that people suffering from lower back pain should focus on just two things:  keep moving, and be careful with sitting posture and avoid slouching.  There has been more recent research studying if specific directional exercises are more valuable to get rid of pain, or if general stretching and strengthening around the spine is more effective.

A directional preference is described as when repeated lower back movements in one specific direction (eg. arching the back) demonstrates quick improvements in pain and range of motion that remain better as a result.  This phenomenon doesn’t always happen, but when people’s back pain responds so nicely to repeated movements into one direction, they often progress faster than those who do not demonstrate any directional preference. Long et al (2004) developed a brilliant study where they identified those people who showed a directional preference to a lower back movement, and asked would happen if the person did not continue with exercise in their direction of preference?

 Three hundred twelve people with lower back pain had an assessment to determine who demonstrated a directional preference with lower back movements.  Those who did (n=230) were placed into one of three directional subgroups:  flexion (rounding), extension (arching) or lateral (sideways) preference. Each subgroup was then randomized into a matched (n=80), opposite (n=70), or non-directional exercise program (n=80).   All 3 groups were given education on posture and keeping active as able. For example, if one person showed a directional preference for lumbar extension (arching back) during their assessment, they were then randomly allocated to continue with exercises into lumbar extension (matched preference), or lumbar flexion exercises (opposite), or a third control group of generalized strengthening and stretching exercises of the lower back, hips and thighs (commonly prescribed multi-directional mid-range exercises).

Elevation Physiotherapy & Wellness :: Lower Back Pain Testing

After two weeks, 95% of the people doing the exercises in their preferred matched direction were improved or completely better and no one was worse. Yes, you read that right—95%!!!

This was over four times better than the group performing the opposite movement to their direction of preference (23% better or resolved and 15% reported being worse). The control general exercise group had 45% report they were improved and  15% were worse, but interestingly, 55% of these control group did not feel they were improved despite performing commonly prescribed exercises and general movement.  This study strongly demonstrates how individualized directional exercises can be very powerful to improve or resolve back pain quickly.  One does not have to suffer for weeks or longer to help the source of the problem.  A proper mechanical assessment can determine the proper course of action to help get better, faster… and stay that way!

Reference:

Long, A. et al.. Does it matter which exercise? A randomized control trial of exercise for low back pain.2004, Spine 29(23): 2593-2602

Why Would You Strengthen Your Hips When It’s Your Knees That Hurt?

Elevation Physiotherapy & Wellness :: Why Strengthen Your Hips When It's Your Knees that Hurt?

Pain at the front of your knee is often called patellofemoral syndrome, and can be a nagging ache or a sharp pain that you might feel after exercising or even sitting too long.  Over time, your knee might start to hurt during exercise or throughout your day, and may cause you to limit your activities. 

Recent research showed that in people with patellofemoral syndrome, strengthening the thigh muscles can be helpful, but it is even more helpful to strengthen hip muscles.  One study followed 33 women who did consistent knee or hip strengthening exercises over four weeks:  the group that strengthened their hip muscles reported 43% less pain than the group who did knee/ thigh strengthening exercises—they reported only 3% decrease in their knee pain. 

Pain relief and function were similar for both groups by 8 weeks.

Why?

The power for you to move your body around is supposed to come from your hip muscles, specifically the “outer” butt muscles.  Often people are fairly weak through these muscles and your brain makes your thigh muscles take over and do more of the work than they should.  It is thought that getting or keeping the hip muscles strong helps to improve the mechanics of the whole leg and therefore reduces stress on the knee itself.

Strengthening your hip muscles can help decrease knee pain faster, but it is also thought that keeping those muscles strong can actually prevent knee pain from beginning. Examples of targeted hip strength exercises are clamshells, lateral walking with a resistance loop around your legs, and even squats—these exercises need to be done properly and should not be painful. It is always best to see your Physiotherapist who can determine specifically what is causing knee pain, and can then design a program individualized to help you.