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
Tugging on a hose (nerve) will not be effective if something is compressing it. Several things can compress nerves in our bodies. In contrast, if a nerve is adhered to something, tugging it (typically called flossing, stretching, or gliding) is indicated. I tell patients with nerves that aren’t moving as well as we’d like that we first check to see if someone is “stepping on the hose.” If we investigate and find that to be the case, we work to remove the compression. If we rule that out, then we can start to glide the nerve to increase its length. Performing gliding without investigating potential compression will often get you nowhere - just like pulling on a hose while someone’s foot is on it won’t get you anywhere. -- Laura
Try to get to, and understand, the “why.” Why is my leg restless? Why is my patellofemoral joint hurting? Why is my bowel irritable? Why is my head aching? Why is my nerve pathological? Why is my IT band painful?
We unfortunately do not have an answer 100% of the time, but it’s close. And there is usually at least a strong hypothesis. It may take more than one clinician. If you strike out with one, try another. Once you uncover the “why,” you can treat that. -- Laura
We wash our hands to prevent infections, wear helmets to minimize head injury, and brush our teeth to reduce disease and decay. There are tips to preventing musculoskeletal problems as well. I put it succinctly recently: Move your joints. In all directions. Quite often.
Learning the basic tenets of prevention goes a long way. My goal is to help patients with their current problem and, just as importantly, to teach them what is occurring so that they can minimize or prevent recurrence. Advice to stay active, flexible, and strong to prevent injury is valid. What is lacking in my experience, however, is nuanced advice on maintaining joint balance and health. If people had a basic understanding of how joints worked, and some daily or weekly prevention strategies, a lot of aches, pains, and “injuries” that come on for no reason could be avoided. (Most musculoskeletal complaints, after all, cannot be blamed on major, or even minor, trauma.) -- Laura
Rolling an ankle impacts more than ligaments and tendons. The ankle joints (there are several) are obviously involved - and possibly the structures that get injured. Before I jump to the conclusion that pain and tenderness on the lateral (outer) aspect of the ankle is coming from the lateral ligaments, I move the joints to assess the effect. The joints of the ankle can create pain anywhere near the joints. If a joint is indeed the culprit, most will resolve rapidly with directional preference exercises. If a ligament is to blame, then traditional treatment of a ligament sprain is indicated. Looking for the problem that usually gets better the fastest not only makes diagnostic sense, but also benefits the patient. Who doesn’t want to get better as fast as possible? -- Laura
You need to investigate the source of your complaint - and not make assumptions. A spinal curve, flat foot, bowed leg, askew elbow, elevated shoulder, etc. may or may not be related to your current complaint. If your abnormality, or deformity (we all have them to some extent), has been around for years and your complaint is new, the odds that they are related decreases. If you noticed they occurred at the same time, the odds increase. Too often people make assumptions without understanding how to repeatedly move the body to test for any relationship. -- Laura
When reaching hard enough, will you feel pulling in your hamstrings? It’s likely. Tendons and muscles (unlike other structures) will usually allow you to eek out another centimeter in pursuit of your toes, which you’ll feel. But “feeling it there” does NOT mean that is necessarily the limiting factor. To touch your toes you’ll need sufficient hip mobility, low back mobility, and sciatic nerve length for starters, not to mention mid back mobility and even arm length! Whereas so many (I want to say most) fitness professionals and medical clinicians alike make assumptions such as this, I critically assess why someone cannot do something. We move your body in various ways repeatedly to understand the source of a complaint or functional deficit. And by the way: it’s usually not your hamstrings.
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