Posture - Is There Perfect?

I'm not exactly sure when physios became the posture nazis, but somewhere along the way the Catholic matron with her yard stick has been replaced by us; physiotherapists.  Instead of wrapping knuckles, we gracefully demonstrate how the perfect posture looks and expect our patients to dutifully adopt it forever...

Okay, so on every account, that is a massive exaggeration; but there is this idea that there is an ideal posture, but like most things, it isn't that simple.  There is no perfect posture that is best for all 7 billion of us on this planet; with all of the normal and healthy variability in the forms of human beings, how could there be a single posture for us all.

This isn't to say that if you sit in front of a computer screen, slumped in half for most of the day, that you'll be fine; you might be, but more than likely, it will cause you pain sooner than later.  And it's these types of examples that do indeed give credence to posture improvement exercises because anything that gets you out of the continuous slumping will show an improvement.

What do I think is the best posture? The next posture!

The human body was meant to move, and varying our positions and posture is likely more important that adopting a single, 'best' posture. 

How do we apply this to our lives, especially when our livelihood depends upon our ability to complete work-related tasks?

  1. If you work at a desk, setting an alarm to remind you to stand up and stretch for 1 minute, is a good start.  Sit-stand desks are another option, though they are expensive, it is worth asking your employer if that is an option they would look into (it IS in their best interest to keep you healthy, pain free and functioning at a high level).  An ergonomic assessment of your work station can help to reduce strain, but even holding the 'optimal' posture for 8 hours is too much, so you will still need to get up and move and stretch regularly.

  2. Let's say you work in manufacturing and you have to stand at a line for 8+ hours a day; it may not be feasible to stop your work when you want.  Prevention in this case is key, outside work hours, you should be strengthening the muscle groups that have the biggest demands.  If your muscles and body are stronger than the demand at work, as well as having some varied movement, then they will be able to cope with the work load much better.

  3. In sports training, cross-training is an excellent way of increasing the tolerance our body has, as well as improving fitness. The same is important for work; cross-training your body on the evenings and/or weekends will do wonders for increasing your body's tolerance of the work load.  So take up a recreational sport, do a Pilates or yoga class a few times a week, do some strengthening work 1-2 times a week, etc. 

The worst thing you can do is nothing, so don't let things sneak up on you, get out and get active.

Exercise; It's Not a Dirty Word

As a Physiotherapist, I think I've heard every conceivable excuse for not exercising; some clever, some lazy and some down right funny.  I've even make a number of them myself, and I understand that there is significant amount of effort required to change our behaviour, and thus, it's hard to do.

I think that the word 'exercise' has something to do with it; there are lots of connotations, and it can mean so many things to so many people, but inevitably it seems to be something that is suggested we do (or made to) that is 'for our own good'.  This makes it easy to shove it down the list of important things to do, right down next to polishing your shoes.

However, the benefits of physical activity are too good to ignore.  There has been increasing amounts of research done on the benefits and they are far reaching; improved heart health, improved muscle and bone strength, increased flexibility, better cognition, less depression and anxiety, increased energy...it improves basically everything about us, and yet, so many people view exercise as a dirty word.

I think the fitness and beauty industries (or at least part of it) need to be blamed for part it for creating impossible ideals for everyone.  It is great that some guys can get great six-pack abs, but if that is what everyone's goal is, then the vast majority of people are going to be disappointed; and that is what we see.  This is especially important with weight loss; those who are obese are told they need to lose weight as a matter of course by health professionals.  While this has some truth to it, it is not the whole story, as it is entirely possible for someone to exercise and start to see a number of those benefits, but see no change on the scale.  So if their health professional told them to lost weight, did they fail?  That's what most people are going to see, to feel, and it is a huge shame, because they are quite likely to cease their exercise plan.

So what do we do?  Well, I think first it is imperative to change how we perceive exercise; or to even stop thinking in terms of exercise at all.  Some people may be able to stay committed to a gym program or a running regimen, but those people (99% at least) ENJOY it!  The difference...make it fun.

If you have tried running and hated it, stop forcing yourself to keeping plodding on in something you don't enjoy, because while your body may start getting some benefits, the mind is not going to reward you, and that is what most of us respond to.

So find some form of activity that appeals to you (hiking, swimming, skiing, tennis, squash, team sports, pilates, yoga, martial arts...the list is indeed very long) and find some other people who like it too, and you will be way more likely to stick it out.  It's time we stopped forcing ourselves with guilt or shame and attempting to conform to forms of beauty or fitness that most of us cannot attain, and start having fun while getting outdoors or being active in the way that is enjoyable to us!

If you have some past injuries or pain that is stopping you, then make an appointment and we can help you get back to what you enjoy!

Pains that Sneak Up on Us

Why does something I've done hundreds/thousands of times without any issue all of a sudden start hurting?

I get asked this question a lot, and I understand why.  We experience pain and want an answer as to why, because if we know why, we can do something to fix it; right?  Sometimes it's easy, ie. you stub your toe on that brick that is slightly higher than the rest, and break your toe...simple.  But what about those times when there is no simple reason why you are now in pain, and the longer it goes on the harder we search for answers.

The strain that accumulates in our body has 2 main avenues of becoming problematic;

  1. Increasing the amount of strain we place on our bodies without allowing it time to accommodate.

  2. Not taking care of our bodies when we are placing more strain on them.

Now, it is a multi-factorial issue and does not just include the actual strain on our tissues; stress and anxiety, lack of sleep, and poor diet/nutrition are a few things that can also play a role, but lets look at those 2 causes.

  1. Our bodies are awesome and capable of so much; just look around at what our fellow human beings are able to accomplish.  However, you have to give your body time to adapt and accommodate to new things or risk injury.  If your idea of running is to catch a bus, you need to start small and slowly increase the amount you run before attempting a marathon.

    This is a simple example, but try to put what you do into that context; relative to what your body normally deals with, what are you asking of it?  Does it seem like a big jump it what it has been used to?  Its the relative increases that I'm talking about here, it may not seem like much, but if you keep piling on additional strains without giving your body the chance to increase its tolerance, you will get closer and closer to your pain threshold.

  2. The other side of the issue is when something you have done seemingly forever, all of a sudden is painful.  This fits most times when people "throw their back out" (a term that generally annoys me, because their back didn't actually go anywhere, or change in structure, but that's another blog post).

    Your daily routine hasn't changed for years, but all of a sudden what you normally do hurts, it is most likely due to the fact that you haven't taken care of those muscles and joints properly.  Muscles get tight with use, even healthy ones, and if they stay tight enough for long enough, they can prevent joints from functioning properly, which can lead to increased sensitivity and pain.

If you are experiencing pain, then it is best to see a physiotherapist to help you, but if you haven't had pain yet, then there are some simple things you can do to help prevent pain from showing up.

  • Move; if you adopt 1-2 postures all day, then you need to start adding 'movement breaks'; 1-2 minutes every 20-30 minutes to perform a few simple stretches or exercises.

  • Take 10 minutes a day to perform muscle releases on tight/knotted muscles that can cause pain (if unsure where to start, come see us and we can help).

  • Ensure you get enough sleep; this can seem overly simple, but a good sleep can positively affect numerous areas of our lives.

  • Improve your work-life balance; ensure that you take time for fun/enjoyment, again this seems overly simple, but it's important for stress/anxiety management to have fun.

  • Get active; physical activity/exercise is by far the best medicine known to humankind; study after study have proven that this is the best investment we can make in our bodies.

Remember, our bodies are amazing and have almost limitless potential, but they won't get there overnight, and as even the finest sports car needs maintenance, so do we.

Stretching and Muscles Releases - When and Why

Stretching has been around a long time, and it is a well-established way of helping us move more and feel better, but another way to do this is with muscle releases.

Stretching (the classic, ‘pull and hold’) often makes us feel good, it helps us move and get into positions that we wouldn’t normally get into throughout the day, and it can form an important part of rehab from some tendon overuse injuries. There have been lots of studies done that show stretching can increase your flexibility as well, especially when performed after physical activity. However, it is most effective if you have a muscle that is tight throughout its length, if you have specific ‘knots’ in a muscle, stretching will not get rid of these, and if you have nerve tightness or irritation, stretching can actually aggravate your symptoms.

Muscle releases however, target those specific muscle knots and can help them to, you guessed it, release.  Now, I should be clear, the term 'Knots' is misleading; there is no evidence to suggest that our muscles somehow detach themselves and tie themselves into bows as the term implies.  What does happen, is muscles develop focal areas that are especially painful when pressure is applied to them.  We know that when this happens muscles do not function as well (produce as much force) and if they persist, then they can affect other muscles or joints, as well as cause nerve irritation.  Okay, rant over, but seriously, why do they occur?  They usually develop in hard working muscle; normal healthy muscle that gets used a lot (work or the gym), and over-worked muscles due to weakness in other areas, or mal-adaptive compensation patterns.

How do I release muscles?  Once you have identified a muscle that needs releasing, you can use either a trigger point ball (lacrosse ball or tennis ball) or foam roller.  If the muscle is too painful to apply direct pressure to it, you can work around the area, but otherwise you want to apply pressure right on the painful spot.  This should be uncomfortable, but not unbearable, and you need to hold it for at least 90 seconds for it to have a long term effect; then repeat 2-3 more times.

So, to summarize, stretching muscles and moving our joints (safely) to their limits, is great for maintaining (or gaining) flexibility and function, and muscle releases are great for maintaining our hard working muscles and keeping them functioning at a high level.

Both are excellent tools, and neither are wrong, but you should be employing them for what they are best at.  If you have any questions about which muscles you should be working on, or if you may have some nerve irritation, it's best to book in with a physiotherapist, and we can help you develop a 'maintenance' plan (for lack of a better term).

Normal Aging, How Does it Look on the Inside?

A lot of my patients have to me come with a scan (X-ray, CT Scan or MRI) they have had done because they had some pain somewhere and a helpful doctor has referred them for imaging.  Not in and of itself a bad practice per se, but sometimes it can lead to people thinking they are more frail than they actually are.

Now, medical imaging is a GREAT tool available to us, and can absolutely pick up things unseen by the naked eye, things like tumours, cancer, growths, broken bones and stress fractures, etc.  When patients exhibit a certain set of symptoms, referral for imaging is paramount, and I am not questioning this.

What I am questioning is when someone has some pain that does not necessarily point to sinister pathology, but gets sent for a scan.  The problem, is that there is absolutely no scan in the world that will show pain, so what often ends up happening is the doctor/radiologist makes a comment on what they see in the scan and presto, that is the 'cause'...

Now, the doctor or radiologist is not wrong in what they see, but the connection between what is in the scan and your pain is not clear.  As an example we'll use back pain (but the same things happens with the neck, knees and shoulders); disc bulges, decreased disc height, thinner cartilage, 'degenerative disc disease' are all comments that can be made after an X-ray or MRI of the low back. 

What happens though when someone WITHOUT pain gets imaging?  A series of studies were done that looked at exactly this, and what did they find; almost exactly the same amount of 'disease' and 'degenerative changes' as people with pain.  So what causes all these changes? In a word, aging.  It happens to all of us eventually right, just like grey hair and wrinkles, it is inevitable, but it DOES NOT mean that you are guaranteed to have pain because of it!

This is a very important point to make, because pain is multi-factorial, and beliefs about what causes pain does in fact affect what pain we feel.  Our brains are very powerful, and if you believe something is going to hurt, guess what, it will.

So what can we do?  Move; exercise is paramount to reducing your risk of pain, especially joint pain, because our joints are supported by and moved by muscles.  The stronger our muscles are, the more support our joints have, plus you will get all the ancillary benefits of exercise.

It sounds simple, but it isn't necessarily easy, so if you have any questions, please see your physiotherapist about getting you moving again and giving your exercises to help reduce your risk of pain.