Category: Uncategorized

Hi sharing an interesting case of forward neck and continual back pain.A 35year old software professional presented with repeated episodes of low back pain and stiffness making sitting, standing or even lying down painful . His first episode was 3 years ago and  have been repeating since then ,each time with increasing severity  every 4-6 weeks. He had consulted many doctors and physios . He would feel better with prescription 10 day courses of anti inflammatory and muscle relaxants with physical therapy till the next episode hit and the cycle started again.Multiple MRI scans had shown that the lumbar architecture was fine and the lordosis aka the curve in the low back had flattened out. 

A detailed history and observation showed that he was a workaholic in long periods of chair sitting and screen time.  Both of these had not been kind to the back. He had a visible Forward head position, rounded shoulders and flattened out low back

Pic courtesy physioqinesis.com

Chain of events 

His habitual positioning had caused a weakening of the spinal muscles. This was made worse with the weak neck musculature.All of these had lead to poor core strength and a flat back. A flattened back is like a stretched out rubber band with poor shock absorption and flexibility. This caused repetitive microtrauma to the structures and tissue damage over a period of time. At this stage the body would respond to pain meds and passive pain management techniques like IFT and TENs but as the original faulty pattern was not addressed the tissues had never healed fully . Their ability to bear the loads in day to day life had come down and thus started another pain spasm episode. Repeated pain cycles had caused the brain to freeze or inhibit the painful part even now without actual tissue damage. This explained the constant stiffness without pain.

Solution

Phase 1( Repositioning forward head and strengthen upper back)

We started with these

Chin tucks 

https://www.instagram.com/p/CRDiIPOgQLi/?utm_source=ig_web_copy_link

Standing arm reach

https://www.instagram.com/p/CRGRx2bA52W/?utm_source=ig_web_copy_link

Wall angels

https://www.instagram.com/p/CRFwSlzgQg6/?utm_source=ig_web_copy_link

Once he was comfortable repeating each movement 30 times per day painless we moved on to phase 2

Phase 2( Functional core muscle activation and improving hip flexibility)

Chair squats

Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair . Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels . Breathe in as you go down and out as you come up. Repeat 3 to 5 times each hour. Make sure to keep the ribs in line with the hips .

Belly breathing

https://www.instagram.com/p/CPTj3FfB5N2/?utm_source=ig_web_copy_link

Toe raises with belly breathing

Stand with the feet shoulder width distance and the outer border parallel to each other.     Breathe in and lift yourself up on the toes. Breathe out  engaging the core and come down without touching the heels to the ground . Repeat this movement 3- 5 times each hour.

Outcome

Over a period of 8 weeks he reported no pain flare up. His pain at rest had gone down by 50 percent of the original reported and he had started walking at a comfortable pace outdoors for 60 min everyday.

To sum it all I’m quoting one of the foremost pain clinicians Dr Greg Lehman BKin ,Msc,DC,MscPT 

The body is more of an Ecosystem and less of a car that needs aligning. Our treatment should reflect this

References

smartphone usage and cervical pain and fatigue

file:///Users/Anju/Downloads/THE%20EFFECT%20OF%20ADDING%20FORWARD%20HEAD%20POSTURE%20CORRECTIVE%20EXERCISES%20I

Sitting posture of subjects with postural backache

https://www.sciencedirect.com/science/article/abs/pii/S0161475406000261

This blog is all about action items because as rightly said every life-changing journey starts with baby steps.  So here are the baby steps

1. Open the windows and allow sunlight to stream in. It will allow UVB to come in which is a Vit D synthesis initiator. Bask in this anytime between 7.30 am to 9.30 am for maximum benefits.
2. Add more Vit b12 to your diet. Vit b12 increases D3 absorption. A bowl of curd, 2 glasses of buttermilk, 2 helpings of greens, a cup of lentil or sprouts should do the trick.
3. Go furniture-free as much as possible. You will be using more of yourself to hold the position.
4. Add natural functional squats by getting on the floor more often.

Move more indoors

For every 40 min of chair sitting or any stationary position walk for 5 min barefoot or with minimal footwear. Walking is one of the best weight-bearing activities which helps in bone mineral synthesis. All in a day’s walk isn’t it

Find your balance

These 3 simple words have had a profound impact physically and philosophically in my life. Let us talk about the physiological benefits for now. 

Balancing activities are whole-body movements recruiting more muscles and the larger part of the skeletal system. Larger forces call for better bone density aka stronger bones to withstand them safely. Here are a few balance movements which have helped me greatly

1. Walk barefoot on as many surfaces as possible. You can try walking on a pebble way, sand, grass, or carpet.
2. Cushion walk– Put 3-5 cushions on a non-slip surface 5 cm apart. Stand on 1 cushion with feet hip-width distance. Take a step onto the cushion in the front without losing balance. Then you can move back to the starting cushion. Start with 2 cushions at a time and can move up to 3-5 cushions. You can repeat 2-3 times every hour.
3. Balance on 1 leg– Stand as above on a non-slip stable surface. Lift 1 leg up such that the hip and knee are bent to 90 degrees. Hold this position for 30 sec to 1 min each side and can repeat as above. 
4. Side leg lift  – Lift one leg sideways 5-6 cms from the midline of the body without tilting or leaning. Hold as above. Repeat as above.
5. Back leg raise-Stand as above and lift one leg to the back keeping the knee soft and straight. Lift the leg to about 5-8 cms and keep the toes pointed to the floor. Hold and repeat as above.
6. Vrikshasana
7. Chair pose in yoga ……… Signing off with FIND YOUR BALANCE. Cheers

We are as strong as our weakest link. This saying is aptly perfect in my practice as a pain clinician. Pain is our body’s way of telling us that it needs to be treated differently in short a lifestyle overhaul. In this perspective balanced living is vital to treat pain and remain pain-free.

For any chronic pain, fatigue, or weakness I run a blood profile specially VitD3, and have seen enough results now to say that nearly 75% of us are deficient in this naturally producing vitamin. So what has changed in the urban us?

Evolution and bone health

From the time of our evolution as homo sapiens ie present us our gene pool roughly remains the same. For our hunter-gatherers or even the farming ancestors, strong bones were essential for survival. Activities of survival like long-distance walking, occasional running, hunting, foraging for food, working for long hours in the fields, bearing and rearing children carrying heavy loads, and children placed great stresses on the skeletal system. Hence the requirement for robust bones.

So what has changed now if not the genes?

Our movement offloading. In the urban world, we have learned to outsource the so-called repetitive and boring movements. Driving for walking, robots for cleaning, washers for washing, elevator for stairs, and a supermarket jaunt for food. Even the food we get is pre-processed often not requiring the complete cooking process. 

All of these allow us to move less or not at all. When there is no stimulus to move and weight bear why should the body keep the bones robust? What you don’t use you lose…

Bone health and captivity

With the new normal our outdoor movements are reduced to non-existent. This makes us sunlight deficient. 

When your skin is exposed to sunlight, it makes vitamin D from cholesterol. The sun’s ultraviolet B (UVB) rays hit cholesterol in the skin cells, providing the energy for vitamin D synthesis to occur. That’s why vit d is the sunshine vitamin.

How does being low on Vitamin d feel like

1. Getting sick often
2. Fatigue
3. Widespread muscle pain
4. Mood swings and feeling low
5. Weight gain
6. Reduced appetite
7. Low sleep quality.

If all of this is making you think about the action items please follow my next blog the Sunshine warriors. Will delve into the how to and what to … Till then open the glass windows and allow the sunshine to come in. Lounge in it and enjoy the warmth for 15 to 20 min… cheers

Taking my thoughts on the elusive and inefficient but defined 6 packs this blog is about how to create a strong and functionally efficient core. ( Not just abs). Cosmetically it will make you look taller, leaner, and smarter. Physiologically it will keep you well-aligned and injury-free.

So let go and breathe

Do the unthinkable relax your abdominals. Allow the flexible abs to stretch out during every breath and gently tuck in by itself with each breath out. Believe me, when you do it mindfully you touch the philosophical Let go… cool, isn’t it?

Align yourself

Overarchers

  This is for those of you who breathe into the chest lifting it up and pull the shoulders back to straighten yourself up. You also have always felt that the low back is curved forwards more than others and at any given point you can easily move your hand across the low back curve. 

Make sure to stack the lower ribs with the pelvis such that they are in the same line. If you feel that you are jutting your ribs forward just breathe in into the belly and breathe out gently tucking it back in. Repeat till comfortable.

Curlers

Oh, those rock-solid abs do not allow you to straighten out. You will see that you habitually sit on the back pockets and slouch chronically. So open up. Lift the rib cage up with every breath in. Be mindful to not poke the chin.

Movement nuggets

I come to my favorite part of movement prescription. So sharing a few movements have helped me to be aligned and pain-free.

Superman on the pillow

Lie on the chest with 2 pillows approximately 10-15 cms in height under the front of hips such that they are in the same line. Drop the head forward down and keep the arms by the side of the body palms facing you. Keeping the toes pointing forwards and the knee soft and straight lift 1 leg up such that the leg is in the same line as the pillow. Go up and down keeping the upper body and hips relaxed. While lifting up be mindful to not overarch the low back. Repeat 10-15 times.

Flying superman

Same starting position. Lift the 1 arm up keeping the above correctives in mind. Can keep the palm facing down and if you want to add some rotation keep it facing towards you. Repeat as above.

Want to sign off for now wishing you a Trainable, Efficient, and Pain-free body and mind… Cheers

With the gyms finally, open I see dozens of urban fitness freaks frequenting them again. Every month parallelly I see a considerable number of patients who are gym regulars and confused about their every present neck pain. Memory foam ergonomic pillows rolled towel to no pillows they seem to have done it all with little or no relief. 

May the forces be with you

I am a strong believer in the power of forces within you and outside you to shape you. And let me tell you why

Our  urban forced abs

Abdominals aka abs are a flexible connection between 2 cages. The ribs and the pelvis. As they are functionally so strategic we have them oriented in different directions and functioning as a cohesive unit. This brings me to the most adored and photographed muscle of all “ Rectus abdominis” aka the Six-packs

Your neck and the six-packs

We have 2 recti abdominis muscles one on either side of the midline structure called the linea alba. They are long strip-like muscles connecting the lower ribs and the sternum or the breast bone to the pelvis. When contracted they bring the rib cage and the pelvis closer as in a curl up position. Optimal length and tension in these are important to keep the ribs, shoulder, and pelvis in neutral, maintain the normal curves and function of the spine and allow the diaphragm which is the main respiratory muscle to move fully. This in turn keeps the shoulders and neck relaxed. PS( for more details on these mechanics please read my previous blog  Breathing our immunity booster section Stress breathing ).

Dominoes effect

Those crunches, sit-ups, and roll-ups done to give definition only pull the ribs and pelvis closer, curl us up more, and flatten out normal curves. This curled spine shortens the pectorals which are our chest muscles. These in turn pull the shoulders forward and inwards. . To maintain a normal gaze the neck has to overarch and poke the chin forwards. 

Over a period this inefficient position sensitizes the neck, fatigues the stability muscle, and here we are The persistent pain, stiffness, and discomfort. 

So does it really matter what props you use when you sleep as long as you don’t correct how you use your body at rest and during movements?

Enough with the heavy nerdy part… My suggestion for a happy neck is to Do the unthinkable “ let go of your abs “ …I Will be putting up my next blog on how-to and till then Belly breathe and let go

I am super excited to talk about hips today. You guessed it right, I am a great fan of Shakira, and as she rightly sang “Hips don’t lie” they really don’t. Hip joints are the mobile connection between the thigh and the pelvic cage. They balance the movement and orientation of the thigh, knee, ankle, and foot. Decide which part of the foot strikes the ground, how much force it strikes with, and how does it clear the ground. They also give stability to the low back vertebra and the pelvic floor as strong muscles like glutes, flexors, rotators, and adductors cross the hip and move it in specific ways.

Our furniture cage

We love our chairs, furniture, and our desk jobs. All of these do not need us to use the hips to their full range and capacity. After a few years in this captivity, the body cleverly stops using it to its full capacity… If you don’t use it you lose it

Making do with weak hips

For starters, they are called compensations and over time become faulty patterns. 

Knee caps looking at each other( means the hips are rotated inwards ) while squatting or getting up from a chair.

One foot turned out while standing

Leaning forward a lot more while getting up.

Simple Check

 Unsupported Standing on 1 leg– Stand with feet pelvis width distance and parallel to each other. Lift one foot up keeping the hip and knee at 90 degrees. Try to hold this position for 30 sec to 1 min each side without losing balance, taking support, or hiking the hip.

Moving those Hips

Single leg standing – Same as described above. Try to hold for 30 sec each side and repeat 3-5 times every hour.

SIde leg standing– Stand the same as above. Lift 1 leg sideways upward keeping the balance. Repeat and hold as above.

Back leg standing– Stand same as above. Lift 1 leg backward keeping the knee straight and the toes pointed forward. Keep the ribs in line with the pelvis while lifting the leg backward. Hold and repeat as above.

 Knee caps facing forwards always –While getting up or sitting make sure to keep the knee caps facing forwards.

Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair. Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels. Breathe in as you go down and out as you come up. Repeat as above. Make sure to keep the ribs in line with the hips.

The key to keeping those hips healthy and active is to use them regularly during the day. Make your day’s natural movement rich with getting on the floor if medically possible, walking barefoot, kneeling, and crawling … Signing off for now and hoping that you move those hips more ….