BBPT Health Tip: How to Adjust your Posture to Avoid Shoulder and Neck Pain

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Tina Cardenia PT, DPT

In today’s society, most of us spend time in front of the computer or other electronics for work, school, or pleasure, which contributes to poor postural habits including rounded shoulders and forward head postures. Being in these positions will cause your muscles around your shoulder and neck to accommodate into that rounded position, resulting in inefficient lengthening of some muscles and shortening of other muscles, which results in an imbalance of strength and stability and high potential for injury. Having rounded and inefficient shoulder stability can cause neck and shoulder pain, and can affect your breathing.

The experienced physical therapists have extensive training on evaluating and correcting postural alignment. They can help with posture by identifying where your limitations are and evaluating your flexibility and specific muscle weaknesses that could be contributing to poor postural alignment. They also investigate what may be causing postural malalignments by evaluating your postural strategies in sitting, standing, walking, sports, and functional activities. Focusing on ways to be in a more balanced position will help put less stress and tension through your musculature and joints allowing for increased ease in maintaining proper posture with various movements.

A good way to facilitate a more neutral shoulder blade and shoulder position is with the exercise “Pivot Prone” (Institute of Physical Art, Johnson and Johnson). To start, first turn your head to the right and then to the left. Notice the excursion of movement and if you find it to be difficult or limited. Now, shrug your shoulders up a few inches, rotate your arms back enough where your pinkies are pointing forward and your shoulder blades coming together. Once you feel that your shoulder blades are back relax your shoulder blades straight down. Now rotate your head again to the right and left and notice if there was a change. You should feel an increase in ease of movement and more range of motion. At this point you should be able to appreciate that when you are in a more neutral alignment there is less stress and tension around your shoulders and neck. A common mistake with this exercise is to want to lift your rib cage up when you bring your shoulder blades back, so make sure that the shoulder blades are the only things moving during this exercise in order to maintain a good vertical alignment.

This photo shows the pivot prone maneuver being done step by step 

This exercise is perfect and simple enough to do throughout the day. For example, when you are standing waiting for the train, waiting on line, and sitting at your desk at work or school. By continuously repeating this motion your body will eventually remember it, and down the line you should notice that you automatically will maintain that position!

 

Check out photos from BBPT’s recent inservice on functional mobilization of the shoulder!

 

Benefits of Pilates with Pain Conditions

By: Amy Stein, PT, DPT & Denise Small, PT, DPT
deniseDenise Small, Physical Therapist and resident Pilates instructor spoke on the differences between Pilates’ practices, and what aspects are important for her patients with chronic pelvic pain. Denise is third generation instructor of Joseph Pilates’ technique. She has also taken supplemental training courses with Eric Frankel and Thomas Myers, both well-known body workers and movement therapy practitioners.

Denise explores movement patterns in her patients that may have caused pain in the past, and are now labeled as something to fear. Patients try to avoid these movements; however, they are necessary for healthy functional mobility. Denise uses the Pilates method to explore these movements, and to make them pain free and more familiar. Denise is guided by Pilates’ 8 movements principles, which are the staples of Joseph Pilates’ methodology.

They are:

1. Whole Body movement- all structures are involved, even if they are not moving.

2. Breathing- Pilates refers to this as an internal shower, or a massage for your internal organs. This also helps coordinate your movement, using breath as your internal rhythm.

3. Balanced muscle development: concentric and eccentric movements happen in synchronicity with the use of the Pilates’ springs.

4. Concentration and focus: Required for all of the above to be performed together

5. Control- Pilates is not about repetitions and muscle bulk. Pilates is about Form and coordination of all the movement principles. If all of the movement principles are being incorporated, one needs only to perform 8-10 repetitions of each exercise for maximum benefit.

6. Centering- Pilates heals the mind and body, by bringing your attention to your core. That is: the abdominal wall, the diaphragm, the pelvic floor, and the deep spinal extensors.

7. Precision- If the movement is specific, there is very little room for error

In addition to being guided by the movement principles, Denise has a few staples of her own, that she uses to frame her sessions. First, Denise believes that you need to have tissue mobility before stability. For example, one needs to be able to move their abdominal muscles before they can begin strengthening their abdominal muscles. If a patient’s abdominal wall is hard, then it is not necessarily strong. A strong abdomen is a part of a strong core. A strong core requires fluid coordination of the diaphragm, pelvic floor, the spinal extensors, and the abdominal wall with movement. This lack of coordination may be observed when a patient is performing an abdominal strengthening exercise. Does the patient hold their breath? Are they tucking in the tailbone and gripping their pelvic floor muscles? Does their abdomen bulge? Many of these compensations can be avoided with the use of breath while performing more subtle core exercises, like marching, before progressing to more advanced exercises.

Second, Denise always highly recommends rolling out your patient’s feet before doing any mat or reformer work. Studies have shown that the fascia of your feet is directly connected to the fascia of your core, pelvis, and spine. So, if you release your plantar fascia, you can release restrictions all the way through your legs and torso. Once the muscles and fascia of your feet are more pliable one can better align their skeleton, from the domes of their feet to the roof of their mouth.

Lastly, Denise likes to use as few cues as possible to not confuse or overwhelm the patient. In addition, her cues are oriented around the bones. Bones are easier for patients to visualize, and focusing on the bones alleviates the possibility of dysfunctional muscle recruitment; i.e. gripping. For example, for pelvic floor muscle tightness and pain conditions, Denise cues widening the sits bones with squatting and inhalation. The patient/client needs to work on letting go of the muscles and the sits bones, while we work on eccentric control. To learn more about Denise, visit her bio and our Pilates program .  Also see her recently published health tip to get started.

Evaluating and Treating Neck Dysfunctions

By Amy Stein

Corey Silbert, who has her CFMT (certified manual therapy certification) and is an OCS (orthopedic certified specialist) led our staff on how to evaluate and treat neck dysfunctions, including those that result in headaches, dizziness, vertigo, pain and radicular symptoms. She evaluated and treated the upper cervical spine and down to upper thoracic area, assessing for decreased mobility in the spinous processes, lateral and rotational movement of the individual vertebrae, any soft tissue restrictions and decreased mobility in the ribs. She then followed the assessment with soft tissue and gentle joint mobilization, as well as neuromuscular re-education and postural training techniques.

We each assessed each other and gave each other a treatment.  If there is a musculoskeletal dysfunction in the cervical, thoracic and rib area, it can result in pain and radicular symptoms down the arm/s, back, and pelvic region as well as cause headaches and dizziness. Physical therapy, which is non invasive is the first line of treatment for these conditions and if you are experiencing any of the above symptoms you should seek out a physical therapist specializing in Manual and orthopedic therapy.

See below for some snaps of our session with Corey!

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