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Hallandale Beach

5 Ways to Optimize your Workstation for Productivity

Workstation ergonomics

Most individuals spend more time at their desks or workstation than they do at home. The workstation should be a place that you are able to be productive and comfortable but unfortunately, for many, the workstation is a place associated with stress, discomfort and often times, pain in the neck and back

Below we are going to give you 5 practical tips in order to optimize your workstation so that your body feels great at the end of the workday and you don’t need to be distracted by neck and back pain during your workday.

 

 

1. Ensure the Brightness and Text size on your screen are appropriate

 

This first pointer for workstation ergonomics is one that is often overlooked when an individual is looking to make their workspace neck and back-friendly. The reason that improper brightness and text size can affect neck and back pain is that if you cannot read your screen you will be more inclined to lean forwards towards your computer, resulting in excessive protrusion of the chin, upper back flexion, and lower back flexion.

 

 

2. Place your Desk and Chair at a height that allows you to sit upright 

 

Often times, individuals will neglect the importance of chair and desk height for ergonomic safety and health. Ideally, you want to have your chair at a height that allows you to have two feet on the floor and allow your forearms to rest on your desk.

If your desk is too high, you will be required to have your arms higher and ultimately this will lead to tension in the neck as well as an increased likelihood of carpal tunnel syndrome. Conversely, If the desk is too low, you may be more likely to lean forward or flex your spine excessively to reach the level of the screen.

 

 

3. Have lumbar support on your chair to maintain your natural spinal curvature

 

Contrary to popular belief, your spine is not meant to be “straight”. Your spine has three distinct curves and is shaped more like the letter “S”. When individuals sit for an extended period of time, they are likely to round their lower back. Naturally, the lower back is meant to hold a slight arch, meaning that sitting oftentimes reverses its intended curvature. 

Over time, when this flexed position of the lower back is held for an extended period of time, you are likely to experience lower back discomfort. We often recommend to our patients to use a Mckenzie Lumbar Roll or purchase a chair that allows them to maintain a normal lumbar curvature.

 

 

4. Take breaks regularly to move your hip and hips through a full range of motion

 

Microbreaks are an area of workplace ergonomics that most individuals partake in by necessity. After sitting for hours working on a project, it is natural to walk to get up, stretch, and walk around. Though walking around the office for a few minutes is a great start, we want you to be even more specific with your microbreaks. We recommended getting up for 5 minutes from your desk every hour or two.

While sitting at work, generally, the joints of the spine, as well as your hip and shoulders, are in a flexed position. Standing and walking, however, are positions considered to be relatively neutral. We know that joints love to be moved in all directions regularly, so what we want to do during our microbreaks is not only stand and walk but actively extend our joints. Here are some examples of extension based movements that can be performed during your breaks at work!

 

5. Practice Proper  and Controlled Respiration through your abdomen

 

Proper respiration is one of the most significantly overlooked aspects of posture, ergonomics, and even physical activity. When individuals become stressed at work, their posture breaks down and they begin slightly hyperventilating (taking quick breaths). 

Taking these short, choppy breaths forces you to use your shoulder elevator and neck musculature to assist in the breathing process. This causes a buildup for tension in the upper back and neck and puts small degrees of compression through your spine.

By focusing on expanding your abdomen while breathing, inhaling through your nose and exhaling through your mouth, you will be able to decompress your spine, protect your lower back and inhibition the muscles of the neck that commonly contribute to pain and tightness.

For more details on how to breathe properly and begin to train for respiration, please see the video below.

Breaking Down Weightlifting Movements: The Snatch

Athlete Performing a Snatch

The Olympic Snatch is one of the most complicated and effective weightlifting movements that is frequently used in sports performance, CrossFit, and barbell sport.

The Snatch itself involves Lifted a barbell from the ground to the overhead position in one motion. Traditionally, the snatch is caught deep in a squat position requiring a significant amount of upper-body stability and lower body mobility.

Part of what makes the snatch such a unique lift is that any small deviation from proper technique and mechanics can result in a missed lift. For other major lifts in the super total such as the deadlift, Clean and Jerk, and Squat, small deviations can be compensated for by strength and grit. This is why the Snatch is called by some “the most athletic movement in Olympic Sport”

 

The snatch itself is typically broken down into three primary phases; the first pull, the second pull, and the catch

 

The First Pull:

During the first pull, the barbell is lifted off of the ground up to the crease of the hip. Within the first pull, the knees are pulled back to make room the barbell around the knees and then return forwards as the bar is brought towards the crease of the hip.

The physical demands of this position include primarily proper thoracic (upper/middle back) extension, foot stability, and the ability to appropriately load the hamstrings

While there is much debate as to the appropriate torso height for the liftoff phase of the snatch, most coaches will agree that a rounded upper back is an efficient position to pull from, which means that some level of thoracic extension, without composing the neck or lower back is ideal.

Additionally, the ability to stabilize the arch of the foot is critical for the liftoff phase as the foot is to be in full contact with the ground and any deviation away from the balanced position can result in a missed lift or injury, particularly when the weight increases relatively to your max. Most lifters also use an Olympic weightlifting shoe designed to improve dorsiflexion capacity of the ankle, though at times at the expense of a properly centered foot and stabilized arch.

The initial lift of the bar during the snatching from the ground up to the top of the knee requires a proper hip hinge during which the hamstrings and posterior chain are adequately loaded to produce maximal force and reduced the compressive load on the spine while lifting the bar. Likewise, the bar is taught to be kept very close to the body to reduce strain place on the lower back during the lift.

 

The Second Pull:

Once the bar has reached the top of the thigh or hip crease, the second pull is initiated in which the body uses triple extension (hip, knee, ankle) to propel the bar vertically. Once the bar has reached the maximal height, the lifter descends into the catch position to receive the barbell.

Athletes vary in at which point they initiate the second pull. Some athletes chose to extend just before the bar reaches the crease or the hip but the majority of weightlifting coaches teach the lifter to be patient during the first pull and explosively triple-extend once the bar reaches the hips in the snatch. An early second pull can result in an inefficient bar bath and potentially a leak of potential vertical force to propel the bar upwards.

Important characteristics for the second pull are more related to training athletic qualities and synchronizing extension of the hip, knee, and ankle. From a mobility and motor control standpoint, however, the ability to properly extend the hip while stabilizing the spine is arguably the most important physical characteristic for executing an efficient and safe second pull.

Hip Extension is not only an important motion for the snatch, but also a variety of fitness movements including the deadlift, running, bridging, and lunging. Often individuals possess very little hip extension and use their lumbar spine (lower back) to extend during a lift or athletic movement. When we can effectively address pure hip extension, through manual therapy and specific exercises, we can expand your force capacity as well as significantly reduce the likelihood of a lower back injury.

 

The Catch:

After the lifting drops under the barbell following the second pull, the catch position requires the lifter to have two feet planted on the floor and the arms locked out overhead. Once the lifter catches in a stable position and stands up to the standing position.

The “catch” phase of the lift is by far the most physically demanding in that it requires a tremendous ability to sit into a deep squat with an upright posture and lock the arms out overhead. The squat itself has numerous prerequisites that we will cover in a later installment of this series, but the difference during this lift is that the squat is required with a barbell locked out overhead. A traditional powerlifting squat has very little upper body mobility requirements beyond enough shoulder rotation to hold the bar. The front squat does require a relatively upright torso as well as upper body extensibility for the front-rack. However, neither of these compare to the demands of the overhead squat.

To catch the barbell in a stable enough position to stand up and maintain a successful lift, the shoulder complex must have a tremendous degree of overhead stability coupled with adequate upper back extension to take the strain off of the shoulder joint itself. 

Additionally, a physical capacity that is not talked about frequency is the ability of the wrist to radially deviate (bend towards the thumb side). Generally, at higher levels of Olympic weightlifting, lifters will grip very wide on the bar to both meet the hip crease during the second pull and reduce the overhead mobility requirement during the catch. Because the wrist is a small and complex joint, we mustn’t place the wrist in a vulnerable position during the snatch.

 

Common Injuries Seen in the Snatch

If you are a Crossfitter, Olympic weightlifter, or other athlete and would like a joint-by-joint injury risk assessment as well as therapy to correct these findings, please reach out to us at 754-231-8338, we would love to help you!

10 Push-ups Progressions for Strength, Size, and Stability

Push ups

The Push-up is one of the most battle-tested exercises to develop your chest, shoulders, triceps, and your abdominals. There is a reason that everyone from Elementary Physical Education Teachers to NFL strength and conditioning coaches uses this exercise – it’s a fundamental movement that has unlimited regressions and progressions, making it usable for anyone.

At its core, the pushup is a very simple exercise, but making slight variations to ensure proper muscle activation and technique turns this simple exercise into a challenging full-body exercise. Doing simple down-and-up push-ups in just the beginning of the endless variations and progressions of this exercise. 

Working through a proper progression on an exercise is very important for getting the most benefit from the exercise and protecting your joints from unnecessary injury. Unfortunately, due to poor technique and rapid progression, individuals frequently experience shoulder pain and wrist pain when performing pushups.

Before beginning any exercise program be sure that you have the pre-requisite joint range of motion to perform the exercise. In the case of the pushup, it’s important you have adequate shoulder extension and wrist extension in order to perform the exercise safely and properly. If you are experiencing pain during a push-up, see a qualified professional to give you an assessment to help you correct the issue!

We recommend working through these progressions slowly and once you are able to perform variation for repetitions and multiple sets with flawless technique, try the next variation!

Isometric Holds

    • Brace your abdomen
    • Be sure your entire hand is in contact with the floor and rotating slightly outwards
    • Maintain a slight Chin-tuck

Eccentric Pushups

    • Start in the same position as the isometric push-up
    • Slowly lower yourself down for 5-8 seconds without losing your brace of chin tuck
    • Once you have lowered yourself all the way down, restart at the top

Incline Pushups

    • Find a surface that is elevated and allows for a comfortable position of the wrist
    • Lower yourself to the surface over the course of 3 seconds with good form
    • Think “Push the surface away” as your press-up

1.5 Rep Pushups

    • Start by performing one full eccentric pushup to the ground
    • Instead of pressing all the way up, press yourself up until your elbow are roughly 90 degrees
    • Return down to the ground under control and press yourself back up to the top

Pushups with Shoulder Tap

    • Perform a Full Repetition of a push-up with good form
    • At the top of each repetition, lift one hand up and touch the opposite shoulder
    • When you lift the hand off the surface, maintain the integrity of the rest of the body

Single leg Pushups

    • From the starting position, lift one leg off of the ground
    • Keep the leg lifted as your perform full pushups
    • Do not arch the back or shift your hips when the leg lifts

Elbow to Knee Pushups

    • Start by performing one full pushup with good technique
    • Once you reach the top of the pushup, lift one arm and the opposite leg up off of the ground
    • Touch the lifted elbow to the lifted knee, without excessively moving your spine

Push-up to Sit out

  • Start by performing a full pushup with good technique
  • At the top of the push-up, lift one and one leg off of the table
  • Turn your body and lift the one leg up towards the ceiling with maintaining contact of the opposite limbs

Plyo Pushup

    • Perform a full eccentric pushup with good technique and a short pause at the bottom
    • From the bottom of the pushup, push explosively through your hands and attempt to lift slightly off the ground at the end of the repetitions
    • Catch yourself in the pushup position with a slight elbow bend and reset for the next repetitions

Clapping Push-ups

    • Perform a controlled eccentric pushup until your chest touches the floor
    • Once the chest touches, push explosively through the ground and clap you hands together while in the air
    • Land with “soft elbows” as to not put too much strain on the wrist and reset the position for the next repetition

Want to Train for Performance? Start with your Glutes.

Athletes deadlifting

For anyone that participates in athletic training or has been through physical therapy, some phrases that might sound familiar are “strengthen your glutes”, “Turn on your glutes”, “Active your glutes”, “Your glute isn’t firing”, etc. If you are able to use the prime movers and stabilizers of your hip effectively, then you will take the strain off of the joints of your pelvis, lower back, and knee.

 

The reality is that a muscle is never on or off, and even for every given muscle strength is very specific. A muscle may be weak in one position and strong in another depending upon the position of your body.

 

It is for this reason that a lot of rehabilitation and strength training for athletic performance emphasizes strengthening the glutes. In a performance setting, this may include Weighted Hip Thrusts, sled drags, and sumo stance deadlifts. In a therapy setting, this may include exercises such as glute bridges, clamshells, and kickbacks.

 

When most individuals are referring to the “glutes”, the muscles specifically they are referring to are the glutes Maximus, our bodies most powerful hip extensor, as well as our Gluteus Medius, a hip abductor and internal rotator. The gluteus medius is also responsible for the stability of the pelvis during locomotion. There are, however, a number of other small muscles in the hip that support the larges glute muscles and provide both stability and motor control to the hip.

 

While training the glute to prevent injury and performance is a great idea, oftentimes the proper intent behind the training is lacking. The ability to use and control the hip through a full range of motion is significantly more important than being able to generate a lot of force in one exercise. Additionally, activation of the diaphragm and proper respiration builds a critical foundation for adequate hip movement and glute activation.

 

When training the glutes in a therapeutic or rehabilitation setting, it is more valuable to break down exercises into the joint being used and specific motion or function, rather than focus excessively on which muscles are working. 

 

Hip Extension: Hip extension is an important move because it is used every day during walking. Each step we take requires a slight amount of hip extension. During running or sprinting, our hip demands even more extension. 

If we do not have an adequate hip extension range of motion and control, then other parts of your body such as your lumbar spine with compensating by excessively extending during movement. Because the primary muscles of the hip extension are the glute and hamstring group, it is important that we have the ability to use these muscles functionally and independently of the muscles of the lower back.

 

Examples of exercises that will help improve hip extension include Bridge Variations, Birddogs, and lunge variations.

 

 

Hip Abduction:

 Hip Abduction is when the leg travels laterally from the midline of your body. A common compensation for this movement is the lateral bending of the lumbar spine and torso. 

If the hip does not have proper abduction range of motion and control, you will generally compensation by tilting your pelvis and using your obliques and lower back muscles to compensate. Over time, this can lead to overuse of the joint of the lower back and pelvis and ultimately pain.

Exercises that improve hip abduction included Sidelying clamshells, band walks, and side bridges.

Hip Rotation:

The ability to adequately internally and externally rotate your hip is one of the most important joint motions in your whole body. Not only does your ability to control hip rotation improve your performance in athletics, but it also is a great indicator of overall hip health.

Hip rotation is driven by smaller muscles of the hip such as the Gemelli group and the piriformis. Though these muscles are often stretched and massaged, they are underdeveloped and often neglected when it comes to training and therapy. Having adequate hip rotation will prevent excessive rotation of the lower back or knee during movements such as a golf swing, a tennis stroke, or a roundhouse kick.

Because in many cases, the active rotation of the hip may be minimal, it is best to train this motion through repeated hip rotation, isometric contractions, and end range holds.

Hip Stability Training:

In addition to the three movements described above, The gluteal muscles and piriformis also act to stabilize the hip during single-leg stance and gait. This is why single-leg training has tremendous benefit even beyond improving balance and are an important part of your overall glute and hip development.

Starting with timed single leg balances and progressing to eye-closed variation or standing on an unstable surface is a great starting point for single-leg training. Once you feel comfortable and stable in a single leg stance, you can begin to incorporate exercises such as single-leg RDLs or single leg plyometric variations.

 

Remember, if you want to perform well in the gym, on the court or on the field and keep your lower body and spine healthy, you need to train your glutes through a variety of loading patterns and planes of motion. 

 

If you are dealing with hip, pelvic, or lower back discomfort and want some direction on how to improve your function long-term, give us a call and book an assessment with one of our physicians!

 

 

Get the scoop on POOP!

“What does my stool have to do with my health?! ”

Patients in my practice are often surprised when I ask about their bowel movements. Let’s face it, talking about our pooping habits can be embarrassing. We may feel shy or uncomfortable talking about something so private and as a result, we may choose not to discuss our symptoms with our healthcare provider. Sometimes we may not be aware that our pooping habits are irregular at all. We may be accustomed to bothersome symptoms like gas, bloating, constipation, and accepted them as part of our “norm”. Addressing our gastrointestinal (GI) symptoms can have favorable effects on our health. 

Our poop can offer us valuable insight into our health status. It can inform us about the health of our digestion, absorption, inflammation, gut health, brain health, and many other systems in our bodies. The gut is the gateway to our health. It’s the home of 80% of your immune system and powerful neurotransmitters are made there as well.1 Trillions of microflora work together to ensure proper digestive function. They aid in the production of essential vitamins such as B vitamins and act as a protective barrier for the immune system. The bacterial balance in our gut also discourages the growth of unfavorable bacterial, parasitic, and/or fungal infections from compromising our gut function. Because our stool is formed in our GI tract we investigate the integrity of our gut to understand it’s a contribution to our signs and symptoms. 

The Bristol Stool Chart is otherwise known as the “poop chart” is a very helpful tool used to characterize our stool. This chart was devised by doctors in the Bristol Royal Infirmary in England and it is used by doctors around the world to help characterize different types of stool.  

  • Type 1–2 indicate constipation
  • Type 3–4 are ideal stools as they are easier to pass
  • Type 5–7 may indicate diarrhea and urgency.

Every person will have different bowel habits, but there are a few important characteristics to consider when discussing our stool. Ideally, poop should be soft, well-formed, and easily passed within a few minutes of sitting down on the toilet. The bowel movement should pass without pain or straining, and you should experience complete emptying of the bowels.

 

The following situations may suggest that it’s time to get your poop checked:

  • You’re not pooping every day or not pooping enough. 
  • You see undigested foods in your stool except for some fibrous foods like beans, corn, grains, such as quinoa, peas, seeds, sunflower seeds, flax seeds, sesame seeds, or skins of vegetables, such as bell peppers or tomatoes.
  • You’re exhibiting some other type of digestive discomforts such as consistently loose bowel movements, stomach cramping, bloating, gas, indigestion, and hemorrhoids.
  • You’ve been diagnosed with an autoimmune condition. Scientific evidence shows that imbalances in our gastrointestinal bacteria are related to inflammation and autoimmune conditions. 2
  • Gut imbalances can also present as chronic fatigue, brain fog, skin-related symptoms, and other symptoms.3

 

Testing our poop can give us valuable information about our symptoms. Stool testing can help you and your doctor identify the types of bacteria that live in your GI and any potential bacterial, yeast or parasitic infections in the gut. A comprehensive stool test also looks at how well you break your food down into fiber, screens your immune system, determines your level of digestive enzymes, and how well you are digesting and absorbing your fats.

I want to encourage you to speak to your healthcare provider about your bowel habits and gut health. Get comfortable sharing information about your poop and don’t allow embarrassment to discourage you! At Miami Spine + Performance we offer comprehensive stool testing via Doctor’s Data Lab, to understand your unique digestive system. If you are interested in learning more about stool testing, please give us a call.

 

*If you’re getting gut symptoms regularly and experiencing any of the following symptoms, make sure to see your doctor immediately: unexplained weight loss, changes in bowel habits, such as loss of bowel control, persistent diarrhea, persistent constipation, blood in the stool.

The 7 Habits of a Highly Effective Shoulder

Shoulder Health

 

1. Cervical Spine (Neck) Mobility

The Neck and the Shoulder complex are intimately related due to their joint proximity as well as the number of muscles that attached to both the shoulder complex and cervical spines, such as the upper trapezius and SCM (sternocleidomastoid). If these muscles become restricted at their cervical attachment, this can put a significant strain on the shoulder and restrict motion. Individuals with poor mobility in their necks have a tendency to compensate for neck motion with shoulder motion, leading to overuse and unnecessary muscle tension and adhesion development.

 

 

2. Thoracic (Upper Back) Extension

 

In order for the shoulder to be able to express its full range of motion, the thoracic spine (upper back) but be able to extend in order to create an environment for the shoulder to work properly. If the thoracic spine does not extend and you are performing a task that requires the shoulder to lift overhead, you will be forced to compensate through lumbar (lower back) extension as well as put excessive strain on your glenohumeral joint (shoulder). Because of the intimate relationship between the scapulothoracic joint and the shoulder, a poorly moving upper back will lead to poor shoulder blade movement and ultimately will impact the entire shoulder.

 

3. Proper Diaphragm Function

 

Of all of the requisites on this list, this one may the one that is hardest to connect to the shoulder. Most individuals think of the diaphragm as an involuntary muscle associated with breathing and abdomen, how could it be related to the shoulder? A strong case could be made that in order for any joint, particularly the spinal joints, shoulder, and hip, that the diaphragm respiratory and stability system must first be intact to express proper movement. This concept of “proximal stability for distal mobility” starts with core stability and proper diaphragm function. By using the diaphragm to produce intra-abdominal pressure, you are able to lay down a strong foundation for your shoulders to move off of.

 

4. Shoulder Blade (Scapula) Movement

 

The glenohumeral joint or the shoulder cannot be talked about without also mentioning the shoulder blade. The humerus and the scapula work very intimately together to produce movement in the shoulder joint which is the meaning of the nerve” Scapulo-humeral rhythm” The shoulder relies on the shoulder blade to slide and glide for all motions of the shoulder. Even if you have a very strong and mobile shoulder if your shoulder blade does not do its part in moving and stabilizing the shoulder, you will not be able to move effectively. Be sure that when you are training and mobilizing your shoulder that you don’t neglect its partner in crime… The scapula!

5. Adequate Joint Centration

 

The shoulder joint itself is a “ball in socket” joint meaning that the humerus has a round end that fits into the glenoid fossa which is a carved out socket for the shoulder. While this type of joint is able to express a large amount of range of motion, all of this freedom comes at a cost… instability. There are numerous muscles, ligaments, tendons, and other soft tissues that are required to work in sync in order for the shoulder to move properly and safely. The function of these tissues is not only to move the shoulder but also to center the shoulder in the glenoid fossa. When the shoulder sits nice and snug into the capsule, it is most able to express its full range of motion and significantly decreases the likelihood of a soft tissue injury related to the shoulder. Joint centration can be best trained through carries, get-ups, and plank variations.

 

6. Rotator Cuff Activation

 

When most individuals think of shoulder health, they think of the rotator cuff. This muscle group is made up of four muscles; the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles have two primary roles, shoulder movement, and shoulder stability. These four muscles play a significant role in shoulder joint centration (see #5) by stabilizing the head of the humerus in the joint during motion. If an individual does have good control and strength in the rotator cuff, they will more likely to use large muscles such as the Latissimus Dorsi and Pectoralis Major. Not only are these large muscles no designed to be stabilizers for the shoulder, but if too much is asked of them (primary movers and secondary stabilizers), these muscles can be more prone to injury and long term overuse. 

 

7. Full Range of Motion

 

As you can see from the prior 6 key factors to shoulder health, there are many joints and muscles that all act in synergy with the shoulder to ultimately lead to healthy and functional movement of the shoulder. Of course, improving your range of motion in the shoulder itself should be a priority. Regular stretching and mobilization of the shoulder is an important piece of shoulder health. If the thoracic spine, shoulder blade, and stability are all working properly, but the shoulder itself does not move well, then you will be limited functionally. Work on your shoulder range of motion regularly through controlled articular rotation and end range training. The shoulder is one of the most unique, complicated, and impressive joints in the body, treat it well and it will give you an abundance of movement options!

If you are currently dealing with any shoulder pain, discomfort, or want to improve your shoulder health long term, give us a call!

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Does your posture really matter?

Lower Back pain poor posture

Let’s talk POSTURE! 

From a very young age, we are reminded of the importance of good posture. Patients often talk about how their parents, grandparents, teachers, etc always told them to “sit up straight” or “stop slouching”. When we think about how many hours a day we spend looking at screens with our heads tilted forward and/or our back rounded over, it would make sense why people who care about us would give us this advice. We may be watching TV, reading a book, or doing the dishes and notice that our posture isn’t the best. We are reminded of our “bad posture” by our own bodies alerting us of the discomfort it’s feeling. 

What is Posture?

Posture involves a sustained position of the body for prolonged periods of time. This position may be held while standing, sitting or lying down. Being in sustained positions is not harmful. However, the accumulation of sustained positions over an extended period of time may inevitably cause discomfort in some individuals. Especially those who have preexisting musculoskeletal pain. 

What causes poor posture?

Poor posture can be due to a number of reasons such as obesity, pregnancy, stress, and muscle fatigue. Contrary to popular belief, poor posture is not caused by a weakness in core strength. Dr. Yoav Suprun, faculty with the Mckenzie Institute USA, debunks this common myth. He states that core strength does not hold someone in an upright position. In other words, the muscle development around the abdomen and low back will not help you achieve perfect posture. Instead, Dr. Suprun proposes that we learn how to sit, stand, lie down properly to avoid mechanical stresses especially when this stress is contributing to neck and low back pain that radiates down the arm or leg.  

How can posture affect you?

Long term poor posture can lead to various health problems that can contribute to conditions such as carpal tunnel syndrome, sciatica, neck pain, thoracic outlet syndrome, breathing problems, and more. It is important to address postural stresses for the prevention and treatment of musculoskeletal pain. 

Good posture can:

  • Decrease stress on the joints that support the spine
  • Maintain correct alignment of bones and joints
  • Reduce stress on ligaments, minimizing the risk of injury
  • Prevent muscle strain, overuse, and pain

How can we maintain the correct posture?

The first step is body awareness! It is important to pay attention to your posture as you sit, stand or lie down. Keeping your spine in a neutral position can help decrease the discomfort of postural stress. Using back support when sitting and bringing screens to eye level can drastically reduce discomfort in the low back and neck. Taking short breaks to stand, walk, or stretch when sitting for prolonged periods of time can also help decrease pain. Slouch – Over Correct is a simple exercise to perform to help train your body to recognize proper posture. Sit slumped in your chair and round your back, then slowly raise up and over-arch your lower back. Do this about 10 times every few hours to improve seated posture and decrease back pain.

It is also important to monitor our posture during sleep. Be sure to find an ergonomically friendly pillow and mattress to support your sleeping postures at night. There is no one-size-fits-all when it comes to posture. Be sure to find the pillow, mattress, back support, exercise, and/or stretching routine that works for YOU.

If you are experiencing numbness, tingling, or burning sensations in your arm, hand, leg, and/or foot in certain postural positions, it is possible that you may be experiencing Sciatica or Carpal Tunnel like symptoms. With this particular presentation, it is important that you receive a proper movement assessment by your healthcare practitioner. Night pain that is constant and is unchanged by position may be a more serious health presentation and it important to seek medical attention as soon as possible.

How can Chiropractic Care help?

Your chiropractor can help you to maintain and correct your posture through chiropractic adjustments, soft tissue therapies, exercises and recommendations on proper positions during different activities. At Miami Spine + Performance we take a thorough look at your body’s biomechanics to address the root cause of your postural imbalances as well as teach you strategies to stay pain-free. It is our mission to build resiliency in your body and equip you with the tools necessary to prevent future episodes.

If you or someone you know is currently dealing with a postural pain and looking for permanent relief, we are here to help! Please click the link below to book an appointment.

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Maximizing your Mobility while at Home

stretching mobility exercise at home

Why Focus on mobility training now?

We are currently in a state of affairs in which most individuals are working from home and exercising at home. Many commercial gyms have closed down and individuals are looking for ways to stay active during this time. While home exercise programs involving bodyweight exercises are a great option for maintaining health and in some cases, sanity, this experience we are all going through is an excellent opportunity for us to work on some of the mobility deficits we’ve all been neglecting during our busy work, social and training lives.

One of the principles that we are always reinforcing with our patients is to regularly train their mobility just as they train for strength, skill and cardiovascular health depending upon their goals. Simply warming up before activity and occasionally stretching will not result in long term gains to your range of motion and functional control of that range. Additionally, mobility training does not require any equipment and can be performed from any location including your home or outside. Regular Mobility training can prevent conditions such as lower back stiffness, shoulder pain, and hip arthritis.

 

What causes a limitation in mobility?

Mobility can be defined as the ability of an individual to control soft tissues at their end range of motion. This is contrasted to flexibility, which is the ability to passively stretch muscular, tendonous and ligamentous tissues beyond its resting length. Flexibility is, therefore, a prerequisite for mobility, and mobility is a prerequisite for efficient movement.

Stretching, yoga, pilates and other forms of flexibility training provide a lot of value both physically and psychologically to their practitioners, however training mobility is a specific form of training and needs to be treated as such. Static stretching and spending extended periods in specific positions have been shown to improve flexibility and tissue elasticity over time but do not necessarily result in improved functional mobility that will carry over to activities of daily living and athletic pursuits.

The first step in performing at-home mobility training is to break down mobility into 3 groups: upper body, spine and lower body. 

 

Upper body mobility includes shoulder, elbow, and wrist

Spine mobility includes cervical (neck), thoracic (middle back), and lumbar spine (lower back). 

Lower body mobility includes hip, knee, and ankle.

 

There are going to be areas in your joints that you feel are particularly limited, we advise that you spend some time in each of these 9 key body areas while increasing your focus to the joint(s) that feel particularly limited. After performing your “Controlled Articular Rotations”, also known as CARS, you will have a much better sense of which particularly joints may require more specific mobility training. 

The first component of mobility training we like to address is using CARS to both assess, warm-up, and train the joint. In our office, we use these exercises as one of the key indicators for overall joint function because they demonstrate all the movements of the joint as well as transitions between movements. For ball-in-socket joints such as the shoulder and hip, we will utilize full joint CARs as well as capsular CARS (movements that target the tough outer sheath that encloses the joint). For the spine, we will be using segmental motion as well as rotation motion for the cervical and thoracic spine.

For “Controlled Articular Rotations” to be effective, the technique of the movement must be the number one priority. The movements are very simple but the true benefit is hidden within the fine details of the movement. Every joint in your body, not being moved through the joint rotation, should be kept still and slightly contracted to isolate the joint being trained. The idea is to move only the joint being worked and not any of the surrounding joints. 

Controlled Articular rotations increase mechanoreceptor activity in the joints, which is how the nervous system collects information about the environment which sends signals to the joint indicating that it is safe to move. By regularly moving the joint through a full range of motion your body will lift any “neurological restriction” brought on by poor posture or lack of movement. There is also evidence to support that muscle spasm and stiffness around the joint, designed for protection, will also be lessened by regular joint movement.

If you are planning on performing an at-home workout using bodyweight, bands, kettlebells, dumbbells or other equipment you have around the house, you can perform each of the CARs variations below for 5 repetitions to warm your body up and prepare yourself for your workout. Additionally, at the end of your training, you can perform each of these for 3 repetitions to ensure that you have maintained a full range of motion throughout your exercises program and your joints will be ready for activity the rest of the day.

Another benefit of using an active exercise such as “CARs” as a warm-up/ cooldown is that this movement will increase the total volume of your workout and ultimately increase the total caloric expenditure. If you are low on equipment at home, controlled articular rotations with added resistance, range of motion or active blocking can be used as a workout in themselves. At our clinic, we regularly use ankle and wrist weights to increase the difficulty, as well as yoga blocks to keep the range of motion strict and place more emphasis on the joint you are intending to work.

Below we have attached videos of “Controlled Articular Rotations” for a few of the major body areas. Keep in mind while you are training your mobility using these movements that there are unlimited variations such as partial CARs, half CARs, and many more.

We are also uploading home mobility workouts on our Instagram as well as our youtube channel. Utilize the principles discussed in the article as well as the videos and get creative with your mobility training!

5 Things You Need to Know About Pain

Neck and Back pain

Pain is one of the most complicated and interesting topics in modern healthcare because of the unique blend of biology, neurology, and psychology behind it. No matter what condition an individual is dealing with, their pain experience is going to be inherently different. It is nearly impossible for us as healthcare providers to compare one individual’s pain levels to another because we are always working off a different scale. 

Being in pain can be frustrating and scary, so here are 5 things you need to know about your pain

1. Your Pain is real

One of the most frustrating occurrences for a patient is going to see a doctor, being given a physical exam and imaging only to be told: “there is nothing wrong with you”. Just because there are no or very few objective findings associated with your pain does not mean that it is not real. The experience of pain is a biological, neurological and psychological experience. 

For example, you may sit and watch a funny movie and forget about your back pain but while you are stressed at work your back pain flares up. Even if all variables are the same, just the fact that you are in a stressful environment increases your lower back pain. Do not ever let a medical professional or otherwise convince your that your pain “is not real” and you need to somehow just convince yourself to be pain-free. Central and Affective pain are very real and require unique treatment plans of their own.

2. Your Pain is a message from your body

When you remain in a static postural position or perform a movement and feel pain in your body, it is your body’s way of sending you a message that the particular activity your are performing does not feel safe. There are numerous reasons why the body sends a painful message including improper joint alignment, injury to soft tissue and moving outside of your controllable range of motion. Your body’s job is to protect you from serious injury. However, this does not mean that pain always means to avoid a particular movement (see the video in #5 for details).

Feeling pain does not necessarily equate to a serious structural injury, even an activity such as sitting in a static posture may cause pain after a few hours, which is your body’s way of saying “Time to stand up and move your joints”. The body doesn’t like sustained postures or doing activities beyond its capabilities. If you are unable to lift your shoulder over your head normally, then your body will send you a pain signal if you try to do so with a barbell. This is protective!

 

3. You can control your pain better than you think

Every Painful Condition has behaviors. For example, certain conditions have constant pain, others are intermittent, some respond well to NSAIDs, while others respond to movement. As pain medicine clinicians, our first take when we see a patient is to first understand their goals and then do figure out the behaviors of conditions. If we know what times of day conditions act up, which movements are pain, and which postures are relieving, we are able to not only narrow down an effective treatment plan but also closely control the symptoms.

If your pain is intermittent (meaning that there are certain times it is painful and others it is not) then you are able to control your pain. For example, if sitting causes you lower back pain, then you are able to work standing or take frequent micro-breaks to offset the hours of sitting. Additionally, we know from the medical literature that symptoms that are intermittent and activity dependant are much more likely to be resolved quickly and conservatively than those that are constant because we are able to control when and where symptoms occur.

 

4. Your diagnosis does not tell the story

Diagnoses such as “Arthritis”, “Disc Herniation”, and a number of soft tissue injuries can be very disheartening to hear and if not accompanied by proper education on the part of your clinician, can lead to a life of disability. The truth of many of these diagnoses is that they are a normal part of aging and being active. Of course, this doesn’t mean to simply ignore your diagnosis or MRI, but there are many individuals with arthritis, disc herniations, rotator cuff tears and meniscus tears that are completely asymptomatic and have had these conditions for years.

Because in some cases the diagnosis or finding on imaging may be irrelevant or may have been present long before you felt symptoms, it is a better assessment to look at movement and symptom baselines. For example, the ability of your shoulder to function during work, activities of daily living and exercise are a better indicator of shoulder health than what you MRI says. When you are being assessed for a musculoskeletal injury, we advise that you see a conservative care physician first to see if your injury is manageable without the use of invasive surgery or medication.

5. You can stay active even when in pain

 

If you are currently dealing with pain and want a thorough assessment and a treatment plan specifically tailored to you, please give us a call or book online. We are here to help!

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Disclaimer: If you are in pain, please get a thorough assessment from a chiropractor or medical doctor! These tips are not designed to replace a visit to the doctor, but rather to be educational.

 

 

How to Beat Lower Back Pain

Lower Back pain treatment

Is Lower Back pain an epidemic?

Lower Back pain is one of the most common reasons an individual visits a doctors office. Over 80% of Americans suffer from lower back pain at some point in their life, and 50% of these individuals have multiple occurrences within 1 year’s time of their first episode. Many companies, large and small are seeing increases in medical cost as it related to back pain as well as a greater number of disability claims. These increase in costs and disability are driven by poor diagnostics, over-utilization of procedures, rising costs of invasive procedures/medications, increased length of disability claims and high recurrence of injury. Current research in the field of orthopedic spine pain indicates that the following factors result in increased disability during the course of treatment for the presenting complaint: early MRI, multiple MD providers, more than 5 MD visits, specialist consultations, early use of narcotics. Conservative care has been shown to be highly effective in many cases as a first line of strategy to avoid the stress and pitfalls of invasive therapy.

 

What can cause lower back pain?

There are a number of sources of lower back pain and even more predisposing factors that make lower back pain a challenging puzzle and ultimately an epidemic.  Lower back pain can be caused by a seemingly harmless activity such as sitting in a poor posture to more serious conditions involving internal organs referring pain to the low back. The wide range of conditions responsible for lower back pain is why it is very important to get a thorough assessment once you start to feel symptoms.

 

                                 Specific Lower Back Conditions

Degenerative Disc Disease: DDD is a commonly diagnosed condition associated with the normal aging process of the spine. When you are younger, your spinal discs function as the perfect shock absorbers, but as you get older the disc(s) slowly loses hydration and the space between vertebrae decreasesBecause degeneration is a normal part of aging, not every individual with degeneration will experience pain, so if you are experiencing lower back pain and have been told you have “DDD”, be sure to see a clinician that performs a thorough movement assessment.  

 

Disc Herniation: Disc herniations are one of the most frequently diagnosed conditions of the spine but unfortunately because diagnostics are heavily reliant on imaging (MRI primarily), disc herniation can be mis-diagnosed as the pain generator or even operated on inappropriately due to a lack of understanding of the source of pain thus a thorough movement assessment is needed to compliment and confirm imaging findings. A disc herniation occurs when the disc material called “nucleus pulposus” leaves the outer casing called the “annulus fibrosus”. The severity of a herniation can range anywhere from a minor bulge (nucleus still within the annulus) to a disc sequestration in which the discal material is displaced into the spinal canal. A more severe disc herniation will produce symptoms into the leg and can potentially cause neurological deficit (weakness, numbness, tingling).

 

Lumbar Stenosis: Similar to degenerative disc disease, lumbar stenosis is often found in individuals over the age of 60. An individual with stenosis will prefer a bent-over posture and will generally feel discomfort walking around and standing for too long. Also, an individual with stenosis may not only feel symptoms in the lower back but down the leg as well. Physiologically, the stenosis is narrowing of the spinal canal itself that can be caused by bone spurs, hardening on the disc and herniation into the canal, spondylolisthesis (vertebra slips forward onto the bone below it) and a number of other space occupying lesions.

 

Facet Syndrome: Facet joint syndrome is a painful condition of the spine involving degenerative arthritis of the joints that connect the lateral ends of the vertebrae that ultimately results in poor movement and inflammation in the area leading to pain. Facet syndrome can also come as a result of aging, but staying active, maintaining good spinal mobility and performing strength training for the core can help prevent and/or mitigate symptoms of spinal discomfort. Inflammation of the facet joint itself can result in muscle spasm as well as referred pain into the lower back, buttock and lateral hip. An X-ray can help point out areas of degeneration but does not necessarily correlate to the cause of symptoms for this reason it is critical that an appropriate orthopedic and neurological exam follow an X-ray for the diagnosis of a facet issue.

 

How do we treat lower back pain?

The treatment for lower back pain is largely dependent upon dependent upon the findings of the orthopedic and neurological exam. If you are experiencing a neurological deficit (weakness, numbness, tingling) or pain that does not change with position, it is likely you may benefit from a referral to a pain medicine specialist or orthopedic doctor. If the pain is above the knee and intermittent (comes and goes with specific positions), it is more likely that your condition can be resolved with conservative therapy which may include chiropractic manipulation, soft tissue therapy and therapeutic exercise. The specific “diagnosis” must be supplemented with a functional diagnosis that includes a thorough history, palpation as well as a movement exam. X-ray and/or MRI imaging does not provide your healthcare provider with sufficient information to construct a treatment plan designed to reduce pain and improve function long term.

 

What are a few ways you can prevent future occurrences of lower back pain?

A few of the predisposing factors for lower back pain include being overweight, smoking, being physically inactive, poor posture, aberrant breathing, limited motion in the upper back and restricted hip range of motion. 

  • Breathing is one of the most overlooked aspects of spinal stability and decompression. Due to aesthetics and stress, individuals generally with through their chest and use the superficial musculature of their neck (scalenes, SCM, Upper trapezius, pec minor) to create a forceful inhale.
  • Posture can be a critical piece of the puzzle when it comes to preventing lower back pain. The lumbar spine

Top 5 Things you need to know about Chiropractic Medicine

Hallandale Beach Chiropractor

 

1. Chiropractors are physicians

Though Chiropractors are traditionally thought of as “Spine adjusters”, we are much more than that. To become a chiropractic physician, we attend 4 years of undergraduate pre-medical schooling followed by 4 years of Chiropractic school which includes hundreds of hours in the physical exam, diagnosis, nutrition, chiropractic manipulation. physical therapy and spend at least one year in a clinical internship treating patients. 

Our license gives us the full scope of practice of a medical doctor without the ability to prescribe medications and perform surgeries. This means that we do not require a referral and are trained to diagnose musculoskeletal and internal conditions using clinical history, physical exam, blood labs, and imaging if necessary. Because we take a “conservative first” approach, we are an excellent first option when you are considering seeking medical care or consultation.

 

2. Chiropractic Adjustments are just one tool in the toolbox

The chiropractic profession was founded on the premise that a disruption in spinal alignment can lead to excessive strain on the nervous system resulting in disease and dysfunction. One of the most powerful tools we have in conservative manual medicine today is the chiropractic adjustment, as we can use a hands-on approach to restoring proper movement of the spine and ultimately high functionality of our nervous system.

While the adjustment is an excellent tool and treats a wide variety of musculoskeletal conditions, utilizing manual soft tissue work to ease muscular tension and physical therapy to improve movement quality leads to exceptional clinical outcomes and long-term relief.

 

3. Chiropractors take a holistic approach to your health

As conservative healthcare physicians, we pride ourselves on spending significant time with you as the patient, listening to your concerns and establishing clear goals for us to accomplish together during your course of care. The initial consultation will typically last an hour because we will discuss your full health history and make sure that we understand not only what is not working well in your body but also what is working great. Our philosophy is that because your body is a closed system, we cannot neglect the whole picture to treat one area.

For example, if you are experiencing lower back pain, we may also ask about nutrition, sleep, stress and what you do for a living. This not only gives us context for your treatment but also allows us to explore and utilize all avenues of care to make sure that we get you to 100% as quickly as possible. Improving lifestyle factors like these will not only potentially help you with your pain but also create an environment for health to prevent future occurrences. 

 

4. Chiropractors are extensively trained in hands-on care

One of the unique differentiating factors of seeing a chiropractic physician is that generally, a large portion of our treatment is hands-on. Taking a hands-on approach allows us to even better understand your condition by assessing joint motion and muscular tension, which is an important piece of our clinician assessment. Though a neurological, orthopedic and functional movement examination are an important part of telling the story of your condition, hands-on palpation will allow us as the clinician to interpret messages from your body in the form of muscular tension and joint restriction.

In treatment, we utilize a hands-on approach in several ways including chiropractic adjustments, active release technique, instrument assisted soft tissue therapy, dry needling, and therapeutic cupping. The specific manual therapy tool that we use is always dependent on the findings of each case as well as patient preference. We want to make sure you are not only feeling better but also happy with your care.

 

5. Chiropractors can treat more than just joint and muscle pain

Most individuals consider chiropractors to be primarily specializing in musculoskeletal disorders (joint, muscle and nerve pain) but chiropractors are also trained extensively in acupuncture, nutrition, and functional medicine. Some chiropractors chose to specialize in Sports Chiropractic while others spend hundreds of hours in the training of internal disorders such as digestive issues, nutritional deficiencies, allergies, and hormone imbalances.

If you are dealing with any of the conditions listed previously, a chiropractor may be a great first option for resolving these issues. For Functional Medicine conditions, we take the same holistic approach we do with every patient but our visit will be more focused on your symptoms and lab work to find conservative solutions involving nutritional intervention, therapeutic supplementation, lifestyle recommendations as well as hands-on care or acupuncture as part of the treatment plan.

If you are currently dealing with musculoskeletal pain or would like to inquire about our functional medicine and acupuncture treatments, please give us a call or schedule below with one of our physicians. We are here to help and guide you through your health journey.

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Miami Spine and Performance

1250 East Hallandale Beach Blvd. #305.

Hallandale Beach, FL 33009

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