Sitting and Lower Back Pain
So what is it about sitting that makes my back hurt so much? First and foremost, you’re not moving. The body likes to move, and you’ve locked it in one position. You’re driving to work, and pretty much your entire lower body is one static position the entire time. The body doesn’t like this and gives you feedback, i.e., pain, to let you know that it wants movement. Though we ignore the pain until it starts to affect our daily lives.
One of the primary muscles that contribute to this pain is the psoas(so-as). The psoas’ main action is to flex the hip; as in bringing the knee closer to the chest. However, it also has many secondary actions as well. The psoas also contributes to stabilizing the hip joint, the lumbar spine and helps when lifting heavier loads. Here is where the issue arises though. If the psoas becomes stiffened, there will be an increase of shear forces on the low back. There are a few ways that the psoas can become stiffened. Stiffening of the muscle can be due to injury, chronically shortened position due to not moving, or if it is overworked.
Through the work of McGill, a study revealed that a stiffened psoas muscle that becomes activated with activity would cause a shear force to the low back. Shear force is not dealt well from the lumbar spine and can be a source of pain if this is repetitively causing strain in this area. Most do not realize that their low back pain can come from the front of the body, so the psoas as a pain generator is often overlooked. The back is not the only place that the psoas can cause pain though. Another common area of pain resulting from the myofascial pain of the psoas is in front of the hip. The pain can feel like a pinch or dull ache. Irritated over time this muscle will start to cause a dull pain on the front of the thigh as well.
The picture above showcases this well as the “x’s” are common areas of irritation. Solid red patches are the places where the pain is felt, and the dotted area is where the pain will start to refer out when we don’t address the issue. Not only are people who sit for large portions of the day susceptible to injury in this area, but athletes are also as well. Some athletes can have an injury to the psoas, which includes those who dance or play hockey or soccer. These injuries are generally because the sport requires lots of hip flexion and it is the repetitive strain on the muscle that causes the pain.
Earlier it was mentioned that the psoas could assist with stabilizing the lumbar spine. Stabilizing is perfect for when we are lifting heavier loads. However, if our core is not doing its job to stabilize, the psoas now has to do more. The cores primary job is to stabilize the lumbar spine, and we can think of it as a cylinder. The top of the cylinder is your diaphragm, your primary breathing muscle. The bottom is the pelvic floor. The “sides” consist of your transversus abdominis(TA), external and internal obliques(EO/IO), and your rectus abdominis(RA). All these muscles play a crucial role and must work in harmony to properly stabilize the low back.
These are not the only reason that sitting can contribute to low back pain but it is a common one. In the follow-up blog, I will go through how to properly stretch your hip flexors and some exercises that can help train your core.
If you have any questions or would like more assistance on how to rid yourself of back pain, please do not hesitate to book an appointment with me, or send us an email for further clarification.
1. Sajko S, Stuber K. Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications. The Journal of the Canadian Chiropractic Association. 2009;53(4):311-318.
2. Santaguida P, McGill S. The psoas major muscle: A three-dimensional geometric study. Journal of Biomechanics. 1995;28(3):339-345.
3. Travell J, Simons D. Myofascial Pain and Dysfunction: The Trigger Point Manual: Volume 2: The Lower Extremities. Philadelphia: Lippincott Williams
The Detrimental Effects of Sitting
In the health field, there is a term that’s been going around for a few years now. I’m sure most of you have heard it as well. That term is “sitting is the new smoking.” This term has been gaining traction for a good reason too. Dr. Levine, a professor at the Mayo Clinic in Arizona State University, is credited with coining the term when quoted saying “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death”. The question becomes how? How is something so relaxing, so dangerous? I’m going to address these questions in a little series. In this first part, I will explain why sitting can become so hazardous to your health. I will follow up with the next post on why it impacts your hip mobility and how that leads to back pain. And finally, in the third post, I will provide practical reasons on how to implement change to switch up your daily sitting habits.
So why is sitting so detrimental to your health? The biggest reason: inactivity. It might seem nice for the time being, but it’s not worth it in the end. Inactivity is linked to high blood pressure, some forms of cancer, type II diabetes, and cardiovascular diseases. More than just being healthier though, your quality of life can be improved if you spend less time sitting. As many people know at least one person who is affected by chronic pain, they know that quality of life is not optimal when living with chronic illness.
You might think, “Hey, I don’t sit that often!” but think about your day for a second. You probably sit while taking in every one of your meals, driving to and from work, watching tv or spending some time sitting and browsing your smartphone. Most people sit during their work as well which does not help their case. They say the first step to overcoming an addiction is admitting you have a problem. The World Health Organization states that between 23-35% of adults are too sedentary and that 81% of adolescents aged 11-17 are inactive. Is it possible that you fall into one of these groups?
A study looked at the correlational effect between sitting time and health risks and found that less than 8 hours per day spent sitting, along with engaging in the recommended moderate-intensity aerobic activity decreased your chances of developing cardiovascular diseases, type II diabetes and some forms of cancer. The current recommendation for adults to engage in moderate-intensity aerobic activity is 150 minutes. If you want any further benefits from exercise, you can increase this time to 300 minutes. If not physically active enough and not meeting the requirements by the World Health Organization accounts for 20-30% of the deaths worldwide!
So how does this happen? Our physiology changes when we are not active. “Prolonged sitting has been shown to disrupt metabolic function, resulting in increased plasma triglyceride levels, decreased levels of high-density lipoprotein cholesterol, and decreased insulin sensitivity, which appear to be at least partially mediated by changes in lipoprotein lipase activity. It has also been suggested that sedentary behavior affects carbohydrate metabolism through changes in muscle glucose transporter protein content." (van der Ploeg et al., 2012)
I hope this post has inspired you to start moving more often. To stand up and maybe go for a quick walk before returning to whatever you were doing before reading this. If you have any other questions regarding sitting, please do not hesitate to ask.
Dr. Ken Alexander
“First move well, then move often”- Gray Cook
1. van der Ploeg H, Chey T, Korda R. Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults. Archives of Internal Medicine. 2012;172(6):494.
2. Physical activity [Internet]. World Health Organization. 2017 [cited 27 April 2017]. Available from: http://www.who.int/mediacentre/factsheets/fs385/en/
3. Sitting Is the New Smoking: Ways a Sedentary Lifestyle Is Killing You [Internet]. The Huffington Post. 2017 [cited 27 April 2017]. Available from: http://www.huffingtonpost.com/the-active-times/sitting-is-the-new-smokin_b_5890006.html
Choosing the right pillow
If you are like me, sleep is important and it affects your daily life if you’re not well rested. I become lethargic, grouchy and irritable. One question I get quite often as a chiropractor is “what type of pillow is best?” This following blog post will hopefully give you an idea of how to choose your next pillow if you are not satisfied with your current one.
There are a couple of reasons you may not be completely happy with your current pillow. Most common reasons would be waking up with neck pain, shoulder pain or headaches. If you are unlucky, you might even be waking up with all 3.
The current best option, and my personal favorite, is the water pillow. A study comparing the water pillow, roll pillow, and the participant's usual pillow found that the water pillow was the best! The water pillow was associated with the greatest pain relief, increased quality of sleep and decreased morning pain intensity! One of the nicest things about the water pillow is that you determine how stiff you would like the pillow to be. If it is too soft, you just add more water to the pouch, and if it is too stiff, you just remove some of the water. Simple and effective.
However, everybody has their preferences and some do not enjoy the water pillow. So what other options are available? There are two main things you want to take into consideration when buying a new pillow. Height and material.
A study performed in 2015 looked at three different pillow heights. The heights were 10cm and 20cm when the head was resting on the pillow. With each height, the researchers would radiograph (x-ray) each participant and measure the different angles of the spine. The pillow that correlated to the best position for the spine and upheld the natural curvature of the neck was the 10cm pillow. So if you are in the market to buy a new pillow, take a friend with you to the store and pull out that ruler. This may take a little extra work, but your neck will thank you for the time.
Next up, material. A study done in 2010 looked at five different types of pillows. The five types were: Polyester, foam, foam contour, latex, and feather. Now you should know that feather pillows were by far, the WORST pillows. Participants would commonly wake up with stiffness in the neck and have a headache first thing. Three members had to withdraw from the study due to being in so much pain from the feather pillow. So even though they are soft and feel comfortable at the time, don’t do it, do not buy the feather pillow! The best pillow for helping with morning headaches, shoulder, and arm pain was the latex pillow. Participants found relief with all 3 of these areas when using the latex pillow in comparison to the other four types.
So, if you’ve decided that the water pillow is not for you, try to ensure the next pillow you buy is a latex pillow that has a height of 10cm when compressed by your head.
1. Lavin R, Pappagallo M, Kuhlemeier K. Cervical pain: A comparison of three pillows. Archives of Physical Medicine and Rehabilitation. 1997;78(2):193-198.
Kim, H., Jun, H., Kim, J., Ahn, J., Chang, I., Song, J., & Oh, J. (2015). The Effect of Different Pillow Heights on the Parameters of Cervicothoracic Spine Segments. Korean J Spine, 12(3), 135. doi:10.14245/kjs.2015.12.3.135
Susan J Gordon, P. (2010). Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. Journal Of Pain Research, 3, 137. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004642/
The diaphragm is one of the most crucial muscles of our body. Primarily because it is the primary muscle that is used in breathing. Unfortunately, a lot of us rely on the accessory breathing muscles to breathe rather than the diaphragm, which can lead to a lot of dysfunction.
Before I get into the dysfunction bit, let me just give you a quick lesson on the anatomy of the diaphragm and the accessory breathing muscles. The diaphragm attaches to the lower ribs as well as to the last vertebrae in the thorax and the first couple vertebrae in the low back. When the diaphragm contracts, it moves downwards, towards the abdomen. Movement of the diaphragm depressing causes an increase of space within our rib cage causing air to rush into the lungs due to a negative pressure. Essentially this process is how we breathe when not under stress, or exercising.
The accessory breathing muscles are all above the diaphragm. Two main muscles are included in the accessory muscle group. These muscles are the scalenes and the sternocleidomastoid (SCM). Both of these muscles attach in the neck and insert on the ribs.
Now let us move on to how these muscles relate to breathing pattern disorders and resulting pain. There are two types of breathing mechanics; diaphragmatic breathing and thoracic breathing. Diaphragmatic, also known as normal breathing is defined by using the diaphragm as the primary muscle to control breathing. Thoracic breathing is when the upper ribs are moved more in relationship to the lower ribs. To get further movement in the upper ribs the accessory breathing muscles such as the scalenes and SCM are used. Over time, since this is not their main function the muscles get overused and can be a potential source of pain. On top of having pain, there will also be a decrease in range of motion in the neck as well as a decreased ability to take in more air to the lungs.
So the next part of the puzzle is why did we start breathing more with the neck and chest muscles rather than our diaphragm? Unfortunately, there is no easy answer to this question as the reality is that everybody is different. Some people who sit a lot tend to have a more rounded out posture known as the upper cross syndrome. (If you need a refresher on this postural condition, see an earlier post). This posture can lead to a breathing pattern disorder as these muscles are not in their most functional position.
Alternatively, people tend to “hold their stress” in their upper back and neck. Hopefully, I can break this down into a simple way to understand. Initially, it starts with a stressful situation, something happens at work, stress at home, traffic is backed up, and your late for an appointment and you start to develop a bit of anxiety. This event causes your sympathetic nervous system to kick in. The sympathetic nervous system is initiated for a fight or flight situation. You’ll start to breathe more quickly as the body believes you will need to start moving and get your butt in gear. To breathe faster, the accessory breathing muscles that we talked about earlier are recruited. Breathing this way is a natural response and quite necessary, the issue arises when we don’t rid ourselves of the stressful stimulus and don’t remember to focus on breathing with our diaphragm. Because these muscles are being used to help us breathe, they continue and are forced to carry out lengthy periods of breathing when they were never made to do this action for an extended time. This situation is how we start to develop pain in the neck, shoulders, and head.
So now what? You realize that you are doing something as simple as breathing incorrectly, how do you fix it?
It’s all about retraining yourself to do it properly again. Start by lying on your back and get comfortable. You can bend your knees a little bit if that helps. Next take each hand and place one on your stomach, and the other on the center of your chest. Now breathe. The hand on your belly should be the only one that moves. With only the bottom hand moving means you are using your diaphragm to breathe rather than the accessory muscles. Once you feel like you are more confident, try breathing while sitting or standing while using the diaphragm. An old professor of mine used to say “Practice doesn’t make perfect, perfect practice makes perfect.” So start slow, begin with the basics and then move on to harder stuff when the foundation is already set.
After all of this, I do not want you never to use your accessory breathing muscles. You are going to need them whenever you exercise intensely or need to go on a quick sprint to cross the street. You just don’t need to use them all the time! And these are not the only things that can cause neck pain; there is a multitude of structures in your neck that can be injured in different ways. Breathing incorrectly is just one of those ways.
If you are still a little bit confused or would like more guidance in this area, please do not hesitate to book an appointment with me to talk more about this.
1. Chaitow L. Breathing pattern disorders, motor control, and low back pain. Journal of Osteopathic Medicine. 2004;7(1):33-40.
2. Kapreli E, Vourazanis E, Billis E, Oldham J, Strimpakos N. Respiratory Dysfunction in Chronic Neck Pain Patients. A Pilot Study. Cephalalgia. 2009;29(7):701-710.
3. Chaitow L, Bradley D, Gilbert C. What are breathing pattern disorders?. In: Chaitow L, ed. by. Recognizing and treating breathing disorders. 1st ed. 2017. p. 1-10.
4. Bradley HEsformes J. BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT. The International Journal of Sports Physical Therapy. 2014;9(1):28-39.
A Case for Foam Rolling
There has been a surge over the last few years at local gyms and clubs with clients using foam rollers in the stretching area. Alternatively, there are still lots of us who have no idea what a foam roller even is. A foam roller is used as a self-massaging tool and has been touted to help with performance, injury recovery and flexibility. But does it do all these things? Others will claim that rather than help it will cause tissue damage and can make performance worse! So, who is right?
Recent research has shown that foam rolling is beneficial. In 2014, Macdonald et al. did a study that included a group that used a foam roller after doing a controlled exercise while the others just did the exercise. The result of the study showed that foam rolling was beneficial in decreasing post-exercise soreness as well as increasing the range of motion. Other benefits seen from this study included the fact that the foam-rolling group could jump higher compared to those that did not use a foam roller.
So, foam rolling essentially decreased pain in participants and increased their performance!
In a similar study, Healey et al., showed that individuals who used a foam roller following an exercise of planking had a decrease in post-exercise fatigue in comparison to those who did not. Meaning they weren’t as tired following the exercise! The authors of this study suggested that due to the decrease in the post-exercise fatigue, participants would be able to exercise more frequently and therefore would lead to an increase in performance.
But can foam rolling cause damage?
If foam rolling is done incorrectly there is a possibility to injure oneself. When I have asked some clients in the past to show me how they are using a foam roller, I have seen some unstable and incorrect form. When watching someone use a foam roller, I am looking to see that they are not putting their back or shoulders in an unstable position just to get a stretch out of the muscle. There are always ways to correct these bad habits, and only a few simple corrections are needed to do it safer.
Another theory I have heard in the past from a good friend is that foam rolling itself causes damage to the muscle rather than helping it. Their chiropractor had told them that the compression on the tissue caused a decrease in blood flow to the area and therefore would lead to cell death. However, this does not seem to be supported by the research. A study by Okamoto et al. did a study measuring blood flow and arterial stiffness following a session of foam rolling and found that the arteries had decreased stiffness and the levels of nitric oxide in the blood increase. These results show that blood flow increases following foam rolling rather than reducing blood flow to the area.
If your goals are to decrease pain following exercise or to increase performance, then maybe implementing some foam rolling into your exercise routine is advisable.
If you are still on the fence on whether to implement foam rolling, set a measurable goal and see if foam rolling can help you out. If the aim is to jump higher and you seemed to have plateaued with your current training, measure your current jumping height then do a trial of 4 weeks of foam rolling every time you exercise. At the end of the 4-week trial see if there is a difference; if there is no difference then remove it from your routine. However, if it worked then keep up the good work!
Alternatively, if you feel you would like to exercise more often but every time you go to the gym or exercise your muscles just scream nonstop and are begging you not to move, try foam rolling the area you just worked out and see if the next day feels a little better.
There are a few ways to use a foam roller, and for every muscle group, the technique is slightly different. If you need a hand with how to use a foam roller without harming yourself maybe introducing yourself to somebody at your gym and asking him or her for assistance would be beneficial. Alternatively, you could always ask your chiropractor or other health care professional to give you some guidance in that area as well.
We here at Remedy Wellness can also help you with your foam rolling techniques, book in with myself, Dr. Ken Alexander or Justine Aichelberger for a private one on one foam rolling session or join our Foam Rolling Workshop taught by Justine where she will guide you through a series of foam rolling techniques that focus on different areas, allowing you to stretch muscles and tendons that can contribute to tightness, soreness, reduced flexibility and pain.
In this innovative foam rolling class, you will be guided through a series of foam rolling techniques that focus on different areas. Intensity levels will vary as the classes move forward. Here at the clinic, we have a variety of foam rollers as well as tennis balls, lacrosse balls, etc. to help you get into those tough to reach areas and target specific trigger points to decrease pain and tightness. Justine will work with you in a group setting, coupled with one on one interaction, to ensure that all exercises are performed correctly and effectively. Foam rolling can have positive effects for everyone, including:
-Athletes of any fitness level, from professionals to beginners
-Those recovery from, or currently treating an injury
-People who have an interest in self-treatment and body knowledge
-General overall tight muscles and stiffness
-Chronic pain sufferers
Feel free to book online through our website: www.remedywellness.ca or call Remedy Wellness Centre at 250-590-5221 where our staff can help book you in.
We look forward to seeing you there!
1. MacDonald G, Button D, Drinkwater E, Behm D. Foam Rolling as a Recovery Tool after an Intense Bout of Physical Activity. Medicine & Science in Sports & Exercise. 2014;46(1):131-142.
2. Pearcey G, Bradbury-Squires D, Kawamoto J, Drinkwater E, Behm D, Button D. Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. Journal of Athletic Training. 2015;50(1):5-13.
3. Healey K, Hatfield D, Blanpied P, Dorfman L, Riebe D. The Effects of Myofascial Release with Foam Rolling on Performance. Journal of Strength and Conditioning Research. 2014;28(1):61-68.
4. Okamoto T, Masuhara M, Ikuta K. Acute Effects of Self-Myofascial Release Using a Foam Roller on Arterial Function. Journal of Strength and Conditioning Research. 2014;28(1):69-73.
From a young age, we are always told by our parents to “stand up straight!” “Don't slouch!” As we get older, we lose those constant reminders from our parents and forget to correct our posture falling back into old habits of slouching. We are also using a computer more often than ever before, and we are often in a seated position. Over time this has a detrimental effect on our body, particularly the neck.
Furthermore, technology while extremely beneficial in a lot of ways can also cause physical pain if used too much. For example, using our smartphones on a regular basis. When we’re walking and texting at the same time, playing a game on our phones, or catching up on social media we assume a bad posture, a posture of looking down. The longer we stay looking down at our phones, the more tired our muscles will become. Look how easily changing the angle of our posture effects how much harder or easier our muscles must work.
I’d be lying if I told you that I was never in a bad position like this before. However, it is about how long we spend in these poor postures. If we accidentally fall into bad posture, we just need to be conscious of it and try not to stay in that position for long.
As we spend more time in this posture, our body adapts in a not so pleasant way. The upper fibers of the trapezius muscle start to become chronically tight as well as our pectoral muscles, which are main muscles of the chest. What also happens is the deep muscles on the front of our neck, as well as the lower fibers of the trapezius, become inhibited. With this inhibition, it allows us to assume a bad posture more often which leads to even more pain. This postural condition is known as upper cross syndrome and can we can understand why it is called this with the following picture.
As you can see, the tight muscles form a straight line through the neck, and the weakened, or inhibited muscles also form a straight line through the neck. Vladimir Janda first recognized this postural condition in the 1980’s. Janda noted that over time with increased muscle activation in these areas, the muscles had a lower threshold for activity. Meaning, that any movement in the slightest could cause these muscles to fire inadvertently and cause movement dysfunction, which could lead to even more pain.
The goal then is to decrease the tightness and increase strength and endurance in the weak and inhibited muscles. Some simple things you can try at home to help are:
1. Stretch the upper fibers of your trapezius muscle by tilting your head to the side, then taking your hand on the same side you are leaning towards and place it on the top of your head. Encourage the stretch by moving your head with the assistance from your hand. Do this to both sides, but DO NOT overstretch! It should be a comfortable stretch and not painful.
2. Stand in a doorway. Place the hand flat against the doorway with the shoulder to be stretched away from your body (at a 90-degree angle or parallel with the floor). Now place the inside of the bent arm on the surface of the wall. Gently lean
in till you feel a comfortable stretch. If you do not feel the stretch, try moving your elbow up or down in the doorway and see if you can find the tight spot.
3. Start to strengthen the lower fibers of your trapezius by assuming a good posture. Draw your shoulder blades together and then bring them downwards, imagining that you are trying to put your shoulder blades in your rear pockets. You should feel a light stretch in your upper trapezius muscle if you are doing this correctly.
4. Finally, strengthen your deep muscles on the front of your neck by tucking your chin in to your throat and give yourself a “double chin.” This exercise will activate the deepest muscles in your neck.
If these exercises seem over confusing, or too easy make sure to book an appointment with your chiropractor to help give you guidance. Especially if you are currently experiencing pain, see a chiropractor first to help minimize the pain and then begin the exercises.
Janda Syndromes. (2010). The Janda Approach. Retrieved 3 December 2016, from http://www.jandaapproach.com/the-janda-approach/jandas-syndromes/
Dr. Ken Alexander
Dr. Ken Alexander is a Chiropractor at Remedy Wellness Centre in Victoria.
Remedy Wellness Centre
214-852 Fort St.
Victoria, BC V8W 1H8
M-F: 8am - 7pm
S: 9am - 3pm