I do not preach sitting 100% upright 100% of the time, but I believe that the majority of sitting time should be in the upright position. A chair like this in which the back slopes backward makes it difficult to attain upright posture since there is no upper mid back support in the upright position. Without that support or tactile feedback you are (much) less likely to sit upright - nothing is cueing, reminding, or helping you to do so. (It’s not as though we commonly lean back and therefore need this slope anyhow.)
A good work chair does not have to be expensive. In general, I prefer a straight back that comes up to the shoulder blades, a comfortable bottom portion, depth that fits your femur, arm rests that allow you to navigate your desk, and a lumbar roll that can be added and removed. --Laura
It takes many weeks for tissue to form adhesions and become tight. And when it is indeed tight, it does NOT vary day to day or week to week. I understand that the sensation patients report is one of “tightness,” but if there is variability, then the source of this tight feeling is not the tissue itself.
When I say tissue, what do I mean? I subdivide it into two main categories: contractile tissue (muscles and tendons) and non-contractile tissue. In the second group, most of the time we’re talking about joint capsular tissue, but there could also be problems with skin, fascia, etc.
Tissue can become tight for many reasons. Think of a simple cut on your skin. If you don’t move the affected tissue, over time the tissue will become tight as scar tissue lays down haphazardly, restricting normal, fluid motion. (This is a good thing - you want scar tissue to be strong! But consistent movement in the right direction will make it flexible.) Surgery is like a simple cut writ large. Many tissues are cut and repaired and, without proper re-integration of movement, often are tight months or years later. Some tissues get tight because they don’t get moved properly. That could be from life habits, patterns after a prior injury, or from 8 weeks in a cast, for instance. A frozen shoulder is another example of tight tissue - which, in the absence of an instigating trauma, usually comes on insidiously.
In these examples, it’s clear that tissue can certainly get tight - and that it can restore to normal length (with informal or formal therapy). It’s also obvious from these scenarios that this process doesn’t allow for a patient to report, “Well, some days it feels really tight, but then some days I’m fine.” Tissue does not behave like that. But joints do ... and they refer that tight feeling to nearby tissue. When I take a patient’s history, I ask very specific questions that narrow my possible diagnoses. If the patient describes variability, local tissue tightness is not the cause. --Laura
For patients with one-sided neck pain, the large majority of patients have a diagnosis (joint derangement) that warrants movements that go backward (retraction and/or extension) or movements toward (not away from) the side of pain. It is rare that the answer is moving forward (protrusion and/or flexion) or moving away from the side of pain.
This is unfortunately not how most orthopedic clinicians think. Most clinicians (and non-clinicians) tell patients to stretch away from the pain, with neck pain and other pains as well. If you really understand how joints, muscles, and nerves work, however, you would realize stretching away makes no sense in most cases. While this may be commonly disseminated, it is by no means intuitive.
If you have left neck pain, moving into retraction, extension, or left side bend, for example, may initially hurt when performed. My job is to assess the overall response. Does the pain reduce with repetition? Does the pain move? Does movement increase? Does the pain only exist at the end of the movement and then disappear? And so on. To find the correct movement (directional preference exercise), we closely gauge the response.
As always, it boils down to being specific, to diagnosis. But having done this for years and taken time to work with several mentors, we can appreciate patterns and percentages regarding diagnoses. While a small minority of patients with left neck pain will indeed need to move right to get better, the majority will not. With competent use of the MDT system, we quickly deduce the specific movement you need for your specific pain. -- Laura
A tight flexor muscle will be apparent with extension. End-range extension will be limited, painful, or both. Other motions are not commonly as affected, if at all. For certain, flexion won’t be limited because, with flexion, the tight flexor muscle is on slack.
As I’ve stated before, muscles are incorrectly incriminated as someone’s problem way too often. While I see tendinopathies (a contractile issue, not usually a length or tightness issue), I can’t remember the last time I diagnosed a “tight muscle” or had a patient stretch a muscle. What I typically find are joint derangements - joint problems which refer symptoms to muscles. Joint derangements are fixed (often very quickly) with directional preference exercises.
Tight muscles exist, but they are very rarely the source of someone’s complaints. The better we are at diagnosing a problem, the better we are at fixing it. -- Laura
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