Which is the Posture Right for me?

Is your posture RIGHT?
We have always been told to sit upright, keep our shoulders back & much more...to have good posture.
Our bodies have been subjected to varied stresses- long hours of sitting, backpack, carrying weights (hand bags, laptops, briefcases) on single shoulders, varied work related postures are some of them.
It's easy to say use good/correct postures when beginning an activity. How many of us pay attention to our postures once we are engrossed in said activities?
I am not going to tell you to this is the right posture & this is what you have to do. Each individual is unique & hence the right posture for them would be unique too.
The common doorway to good posture- Ergonomics
What is Ergonomics?
Simply put, ergonomics is fitting the job to the worker's abilities.
Ergonomics can be applied to all our daily activities too along with our professional lives. How? Most activities- personal & professional- use the same postures- Standing, Sitting, Forward Bending & Lying (Sleeping).

The Golden Rule: Change your posture every 15-20 minutes.
Standing Ergonomics:

• When standing, always maintain equal weight on both feet. Standing with uneven weight bearing places increased load on your spine & leads to low back pain & muscle imbalances.
• If standing for long, have a small stool (1-1.5inches height) & keep one foot on the stool. This reduces load on the spine. Alternate feet on the step.

Sitting Ergonomics:

• Most of our day is spent sitting- the curse of Sedentary Lifestyle.
• Sitting obliterates the low back curve as the pelvis tilts posteriorly. Along with flattening of the low back, there is increased curvature in the upper back & the neck moves forward- Causes low back & neck stiffness & pain, reduced movement of spine & overall poor posture.

Forward Bending/ Lifting:

• Bending forwards with knees straight places increased stress on the vertebral joints & intervertebral discs-can lead to Slip Disc.
• If you are lifting (for example) 10 pounds:
• Bending forwards with knees straight, the load taken by the spine is 10 times the weight being lifted; 10x10=100 pounds!!
• When, bending with your knees bent, the load on the spine equals the weight being lifted i.e. 10 pounds. This is because the weight is being taken by the leg musculature, mainly the Quadriceps, hence reducing the load on the spine.
• Remember to hold the weight being lifted close to your body.

Lying:

• If you sleep on your back, defer from using a pillow as it aggravates the forward head posture.
• If you sleep on your side, use a pillow(s) to maintain the distance between the neck & shoulder. Do not keep your hand(s) under your head as this causes forward neck bending. Keep a pillow between your bent knees.
• Avoid sleeping on your stomach as the neck is maintained in a rotated position & leads to muscle imbalances in the neck.
• The mattress you sleep on plays an important role for having good posture & also for getting a good night's rest. A firm mattress (coir) is the best choice (Goldilocks & the 3 bears).

Ergonomics for daily living is the easiest road to maintain the right posture while working & having fun. With these simple changes in your life, you can quit worrying about poor postures.

Vertigo Exercises

Vertigo is a sudden feeling that you are unsteady or that environment around you is moving. It is generally for a short duration.


Common Symptoms are: Dizziness, light headedness, loss of balance, blurred vision, nausea, vomiting etc.

CAUSES

It stems from inner ear, more specifically an organ called the vestibular labyrinth.This tiny organ uses fine, hair-like sensor monitor that detect movement of the head.They also have tiny crystals made up of calcium carbonate that break due to ageing or injury and get dislodged.This movement of crystals causes the spinning effect.

TYPES
Peripheral causes: infection, trauma, migraine, allergies, tumor, abnormal fluid.
Central: tumor, trauma to brain or spinal cord.

BRANDT-DAROFF EXERCISE

EXERCISES

1) BRANDT-DAROFF EXERCISE
Its one of the home excercises.
Sit on a bench with feet on the floor.
Quickly lie on right side and then stay till dizziness passes.
Sit back up and stay till dizziness passes.
Repeat similar exercise on left side. Do 10-20 repetitions.

2) CANAL REPOSITIONING MANEUVER, CANALITH RE-POSITIONING


Head exercise done in clinic with help of physiotherapist.
GOAL: to move crystals out of inner ear

Start by sitting and looking forward while an assistant stands behind you. Next lie down with head over edge of the table at 45 degree to left.
Turn your head 45 degree right. Roll 135 degree until body faces downwards.Then situp without changing  head position.Turn your head forward and tilt down 20 degrees.
Repeat in other direction.

3) CAWTHORNE- COOKSEY EYE EXERCISE
This exercise gives your brain to adapt with eye movement.Gradually brain learn to work around inner ear problem which causes symptoms.

REASON FOR EYE EXERCISE
Trauma to inner ear gives a false signal to brain which makes it think that you or your surrounding are moving but in reality you arent.
The eye exercise helps to adapt brain to these false signals and work around then to lessen symptoms.

EXERCISES
1) Sit on chair without moving head,look up and down.20 repetitions  gradually increase the speed.
2) Look left then right without moving the head
3) Extend one arm in front and hold your index finger.Focus your eyes on your finger.Keep moving your finger with eyes focused on finger towards the face and then slowly out again.
4) Incorporate head movement with eye turn head one side looking over your shoulder,turn other side.

4) WALKING EXERCISE
Though walking seems to be a normal activity but dangerous for people with vertigo.

Walk back and forth with eyes open and then with someone around with eyes closed.Same way walk up and down stair or hill.



5) GAZE STABILIZATION
It helps to improve vision and helps to focus on stationaly objects'
Write a letter or an alphabet on paper and hold the paper at your eye level.1-2" high. Gaze at letter while moving head side to side. gradually increase the speed.
If dizzy stop and take rest.
This can also be performed n form of thumb tracking,

5) NODDING
Taichi movement  helps to improve balance
stand with back straight look forward hold onto wall or chair back if you are unsteady on feet.
Take deep breath with eyes open while exhaling slowly lower your chin to chest as if you are nodding.Slowly raise your head back to straight position while inhaling.

Vertigo is not completely curable but the exercises done on regular basis surely will help you to decrease the symptoms and lead a near normal life.

STAY FIT STAY HEALTHY

CHEERS!!!

DISCLAIMER: Refer your physician and physiotherapist before attempting these exercises.

Core Muscles of Neck and Exercises

Everyone talks about strengthening of "CORE MUSCLES" to prevent back pain but, we rarely hear or talk about the core muscles of neck.
Research shows that 70% people experience neck pain at some point in their life.The cause of injury may range from accident to use of wrong pillow causing strain in their neck. Any injury has shown to inhibit recruitment and strength of muscles in neck. And these muscles are your DEEP NECK FLEXORS or Core muscles.
Similar to lumbar spine, cervical spine uses these deep muscles to ensure the intersegmental spinal control.

DEEP FLEXOR MUSCLES

Small stabilizing muscles are located in anterior and antero-lateral part of cervical spine. They are located deep to sternocleidomastoid.

LONGUS COLLI
ORIGIN and INSERTION
Superior oblique arises from anterior tubercle of transverse process of third fourth and fifth cervical vertebra and inserted into narrow arch of the tubercle of atlas.
Inferior fibres originate from first 2 or 3 bodies of thoracic vertebrae and is inserted intoanterior tubercle of the transverse process of 5th and 6th cervical vertebra.
It is the most common muscle injured during whiplash injuries.
Longus colli with other muscles forms a sleeve to stabilize the neck in antigravity positions.

LONGUS CAPITIS
ORIGIN and INSERTION
It arises from four tendinous slips from the transverse processes of third, fourth, fifth and sixth cervical vertebra and is inserted into inferior surface of basilar part of occipital bone.

Both the muscles together perform following role:

• Responsible for initiating or starting neck flexion movement.
• reduce shearing force across cervical facet joint and disc.
• maintain neck posture.

Patients with neck pain exibit an increased EMG amplitude of superficial sternocleidomastoid and scalene muscles and decreased activation of deep flexors which causes a decrease in range of motion.
A low load program for craniocervical flexion exercise focusing especially on motor control of deep neck flexors have shown to reduce neck pain and headaches.

chin tuck in

EXERCISES TO ACTIVATE CORE MUSCLES


1) CHIN TUCK IN EXERCISE:
Lie on the floor with neck supported.Tuck your chin in or push your head on the floor without bending your neck. Repeat the exercise for 12 counts for 2 sets. Gradually try to hold each count for 5sec.

2)HEAD LIFT EXERCISE
Lie on the floor. Tuck your chin in and lift the head just 3-4 inches above the floor and return.

3)NECK FLEXION
Ask the patient to lie on the floor with knees bent and feet on floor. Put finger at base of the skull and lift about 1/8th inch off the floor. Make sure the neck is not liftitng off the floor. Remember core exercises are slow movements. Feel down  for a bony bump (7th cervical vertebra). Now ask patient to lift the neck till this bump and the skull but not the rest of the neck. Now gradually ask to release it.

4)BIOFEEDBACK
You can also keep a pressure sensor or pressure cuff beneath patients neck and ask him to slowly nod as if saying yes.Ask him to hold the position 2mmHg above the baseline and gradually increase the baseline to 4,6,8 10 mm Hg and 10 Sec hold. Highest level acheived in 10 repetitions 10 seconds hold.

PERFORMANCE INDEX MEASURE
Number of times patient can hold pressure level, multiply  it by pressure increment. For example: if patient can achieve 4mmHg and could do 6 repetitions of 10 sec hold without breaking the form then the performance is 24. The highest is 100 that is 10 mmHg and 10repetitions.


5) CRANIOCERVICAL FLEXION WITH CERVICAL FLEXION
It works on deep as well as superficial muscles.
Tuck in the chin and lift the head off  so that chin touches the chest.

PROGRESSION
a) Using resistance with help of theraband or manually applied resistance.
Patient is supine. The resistance is applied manually  and the patient is asked to do 12 repetitions of craniocervical and cervical flexion.
 Perform 3 sets of 12 repetitions for 2 weeks then by 4th week perform 15 repetitions.

 b) In quadruped position
Ask patient to assume quadruped (on all four) position and perform chin tuck in or nods without bending the neck.

EXERCISE IN FUNCTIONAL POSITION


a) Sit with feet flat n buttock supported.Gently roll the pelvis forward on ischial tuberosity.
Instruct the patient to move thorax slightly up and forward for slight lift.Gently and minimally lift the occiput to position the head in neutral position away from cervical extension.

b) Also, Patient must be taught to maintain optimal neck position while performing upper extremity task.

Shoulder blade stabilization is integral part of stabilization of neck and hence shoulder blade exercises should also be performed.


Also a heat pad can help to relax the muscles and the perform the exercises, make sure that mild stretches are done after the exercises are over.
While performing all exercises breathing is very very important. Make sure during the course of exercise you donot hold your breath and perform the exercise.

Thus, training these muscles along with the treatment commonly practiced by the physiotherapists will serve to prevent the later complications or recurrence of any chronic dysfunction.


 DISCLAIMER: The above given program is a general guideline to introduce the importance of the concept of core muscles of neck. Do thoroughly assess your patient before attempting any of the exercises.

Texting Injuries

Texting is a great way to communicate - and teenagers are doing just that! Modern communication devices are associated with several painful repetitive stress injuries and nerve compression injuries. People now a days are typing and just typing whole day; be it on computer or mobiles.

Lets look into some problems caused due to excessive use of mobile and mostly due to texting:

                                               1) CELL PHONE ELBOW

CELL PHONE ELBOW

It is the cubital tunnel syndrome which has hit the news last few months. It is a condition in which there is a tingling and numbness in hands caused by compression of ulnar nerve in hands when elbow is flexed for long duration

BLACKBERRY THUMB

2) TEEN TEXTING TENDONITIS / BLACKBERRY THUMB
 It is partly a tendonitits caused by repeated pressing of buttons from texting on cell phone and partly it is irritation of finger and thumb joint depending on how much the person texts.

Mechanism:
Repetitive use of muscles put constant tension on tendon causes irritation and inflammation leading to pain and muscle tightness which causes more pain.

3) THUMB ARTHRITIS
 In most serious cases excessive wear and tear and inflammation of  basal joints at base of thumb can lead to arthritis.Thumb arthritis can cause hand pain, swelling, decrease strength and range of motion. For every pound of pressure that you push at tip of your thumb it is magnified at base of your thumb over the time this can lead to problems.

4) BONE DAMAGE

TEXT NECK

Parents are giving mobiles to 10-11 year old while their bones are still developing and then they are texting whole day leading to injuries like tendinitis and stress fractures too.


5) NECK PAIN (TEXT NECK) 
Neck and arm pain arises when person texts while hunching over and types only with one thumb.

6) MENTAL DISORDERS

a)TEXTAPHRENIA: It is thinking you've heard or felt new message vibration when there is no message.

b)TEXTIETY: Feeling anxiety from not receiving/sending messages.

c) POST TRAUMATIC TEXT DISORDER:  Injuries related to texting such as walking into a object by not paying attention to surrounding

d)BING TEXTING: sending massive amount of texts to build self esteems among peers.

e) LACK OF SLEEP: Late night texting can disrupt your sleep and will leave you tired and unfocused the next day at work or in school.



Following link will provide you ways to prevent the risk of injuries because of the excessive use of mobiles: http://fitnessphysios.blogspot.in/2012/04/electronic-ergonomics.html.

Exercise and Osteoporosis

Welcome Back!!
As we have discussed in the previous blog about the causes, symptoms and diagnosis of osteoporosis. Lets look into the Preventive part of this silent disease.

EXERCISE BENEFITS
1) Weight bearing exercises regularly help to avoid damaging effects.
2) Aerobics, dancing, waking, stair limbing or any activity that uses gravity to place weight on bones will help
perform resistance exercise training with bands.

BODY BALANCE AND OSTEOPOROSIS
If you suffer from osteoporosis, you are vulnerable to fractures.So its important to ensure good balance skills.You can also reduce risk of balance-related injuries by avoiding walking in dark leave a light on if you have to regularly get up at night.Use walking stick .

Exercises
Balance exercises can be checked out here: http://fitnessphysios.blogspot.in/2012/04/coping-with-menopause_04.html

WEIGHT BEARING EXERCISE
These exercises are important because as you work your muscles tug on your bones which stimulates new cell production and helps to strengthen them.
Weight bearing exercise is, any activity in which your legs and feet take most of your body weight such as jogging, walking, dancing and aerobics.Aim for 30 min 5days per week workout.

YOGA


When practiced correctly is beneficial. Seated and standing poses most beneficial.

VIRASANA

 

SHALABHASANA

PILATES
Prevents osteoporosis and improve balance. It strengthens your body and improve posture, balance and coordination.
Best Pilates
Those done on all four position and lying on your stomach or sideways.
Best back exercises

WALL PUSHUPS

                     

BACK EXTENSION

Single leg circles done lying on back and tracing small circles above you with one leg at a time.
Starting with circling leg perpendicular to body and other flat on ground.





Modification: 
The best option is to find class designed for people with osteoporosis.
Common modifications: Always keep head down when lying on floor instead of lifting neck.

EXERCISES TO AVOID
Forward bending may cause spinal fractures, rolling spine is also dangerous.
Specific exercises to avoid: spine twisting, roll up, scissors, neck pull, spine stretch, etc
Ask your Pilates instructor who specializes in working with osteoporosis for limitations.

STRENGTH TRAINING
It helps to increase bone density.
Improves balance and coordination
Lifting weights just twice a week produces 13% increase in dynamic balance over 12 months.
Helps to reduce symptms of osteoporosis including those associated with pain,bone loss and deteriorating posture
Improves quality of life
Ability to perform everyday activities.

STRETCHING
Stiff joints leads to tightened muscles.Your abdomen and chest muscles pull your body forward which can result in stooped posture.Avoid stretched that bend the spine.


AMBULATORY EXERCISES

ZUMBA

WALKING: try up and down hill and alternate between faster and slower speed.
Dancing: fun way to get weight bearing exercises for leg. Zumba, lone dancing, ballroom, tapdance and others can help to keep the bones healthy.



TAI CHI
Involves slow movements combined with deep breathing and meditation.



FALL PREVENTION
You should take measures to prevent yourself from falling and having fractures.
Following link will give you a insight of the fall prevention strategies: http://fitnessphysios.blogspot.in/2012_02_01_archive.html

Need more Evidence: http://www.hygenicblog.com/2012/04/19/bone-mineral-density-and-function-improve-after-exercise-in-osteoporosis-patients/



Age gracefully.......
Cheers!!!

DISCLAIMER: Refer your doctor before attempting any of the mentioned exercises.

OSTEOPOROSIS- An Introduction

Osteoporosis is a silent disease that can progress with little or no symptom until bone density loss is severe.The effects of the disease can remain hidden until a fracture occurs from a minor injury or fall.
It is commonly seen in elderly and more so is women.

TYPES
Primary Osteoporosis: It is seen with ageing and after menopause more commonly seen in women.
Secondary Osteoporosis: It is seen in people taking medications such as corticosteroids, anti-seizures medication , barbiturates, and in certain conditions such as chronic endocrine disease ,kidney diseases etc.



IDENTIFICATION                                                                                        

Bone thinning from osteoporosis may lead to curved spine known as Dowangers hump.When bones in spine compress or fracture the spine becomes curved which can lead to significant loss of height.
Potential: Collapse from fractured vertebrae may potentially compress heart, lungs and intestines.
Significance: Negative impact on life fear of falling, limited mobility and adaptive lifestyle changes can lead to decrease socialization and isolation.



EXPERT INSIGHT
Testing for osteoporosis is important for all women older than 55 years and who have risk for bone density loss.Women who have experienced fracture at young age from minor injury should be tested.
Adult men and women should undergo bone density testing for complaints of unexplained backache that may be a symptom of fractured vertebra.

Men and Osteoporosis
Osteoporosis doesnot just affect older women but also men. Men who are likely to have osteoporosis are more than 75 years of age with low BMI and have lost 5% of bodyweight from last 4 years.Currently smoking and are physically inactive.

   COMMON SIGNS

1.  Loss of height
2. Kyphosis /dowangers hump
3. Back pain
4. Spontaneous fracture

DIAGNOSIS
Risk Factors: increased age, family history, having small thin frame, being inactive, smoking, diet less in calcium, medications etc.

X-ray shows compression fracture and decreased bone mineral density.

T-SCORE
+1and -1 Normal
-1 and -2.5 Osteopenia
less than -2.5 Osteoporosis

Common fractures in osteoporosis: Vertebrae,hip and wrist.

HOW TO PREVENT OR IMPROVE
DIET
1) Calcium: The average person's daily requirement: 200mg to 1200mg
Sources: dairy products, broccolli, cauliflower, legumes, nuts, seeds, tofu, soybean, apricot, fig.

2) Vitamin D
Sources: Egg yolk,expose to sun,butter,liver,fish oil-salmon sardine,mackerel

3)Phytoestrogens or flavonoids
These are the molecules in plants which mimic some hormones manufactured in gonads.Whole grain, beans, seeds and their oil, leafy vegetables, garlic onion,soya.

Food to limit: very high protein and salt intake.
Beverage < 3 cups of coffee,decrease colas



 Exercises to be performed to prevent Osteoporosis:
 http://fitnessphysios.blogspot.in/2012/04/exercise-and-osteoporosis.html.

FIBROMYALGIA

Fibromyalgia is characterized by chronic widespread pain, and a heightened and painful response to pressure. It is described as "Central sensitization syndrome" caused by neurobiological abnormalities which  produces a physiological pain and cognitive impairments as well as neuro-psychiatric symptomatology.

SIGNS AND SYMPTOMS
Chronic widespread pain, fatigue, heightened response to tactile pressure.
Tingling of skin, prolonged spasm, weakness in limbs, palpitation, functional bowel disturbance and chronic sleep disturbance.Some may also experience cognitive dysfunction
Other symptom often attribute to fibromyalgia that may possibly include myofacial pain syndrome.


CAUSES
Unknown.
Possible: Genetic predisposition, stress, hypodopaminergia, abnormal serotonin metabolism,deficient growth hormone, physical trauma, poor sleep etc



DIAGNOSIS
There is no single diagnostic test.
Most widely accepted set of classification criteria for research purposes was given  in 1990 by multicentre criteria committee of American College of Rheumatology: a history of widespread pain lasting for >3 months, affecting 4 or more quadrants of body i.e both sides and above and below waist.

                                                Tender points

18 designated points.the patient must feel pain at 11 or more points to consider him for fibromyalgia.

Criteria :
Location throughout

Particularly in neck,shoulder,arm, buttocks,hip,thigh

It hurts when pressed but pain doesn't radiate.




TREATMENT
Psychological/behavioural therapy
Pharmaceutical

Physical therapy
Exercise improves fitness and sleep and may reduce pain and fatigue. Strong evidence suggest that cardiovascular exercise is effective for some patients. Long term aquatic exercises has been proved beneficial as it combines aerobic and resistance training.

AEROBICS
Modes of exercise such as walking and biking can yield long term benefits for fibromyalgia . Startoff with low intensity below your actual capacity and gradually progress.Water aerobics ideal for people with increased pain in patients with chances of worsening of symptoms with exercise

Strength training
To minimize fibromyalgia relates pain.With strength training you focus on one muscle group per session alternate upper and lower extremity training. Isometrics can also be performed.

Avoid eccentric exercises including those with heavy weights which may cause injury.using light weights start with low number of repetitions also rest is very important. Perform exercise 2-3days per week with duration of 25-30 minutes of workout everyday.

Flexibility Stretches should be performed for all major muscle groups.

Combination therapy
Medicine +diet+exercise+cognitive behavioral therapy.


SIGNIFICANCE OF EXERCISE

• It controls pain and fatigue and prevents decline of muscle strength and endurance, improve flexibility, sleep and energy.
• Muscles that are not conditioned use excess energy which can contribute to fatigue and aggravate pain,hence exercise helps to improve oxygen delivery and increase muscle temperature leading to pain relief and relaxation.
• Strengthen ligaments tendons.
• Increase endorphin pain relief.
• Decrease anxiety and depression.

OTHER
Yoga:Which incorporates exercises, stretching, and meditation, is a great way to increase fitness.The physical postures(Asanas)can alleviate aches and pains, concentration exercises help to overcome fibrofog (loss of mental clarity), and meditation helps you to focus on present instead of ruminating about your pain/

Tai-chi has also been found beneficial. It emphasizes on relaxation. Its like"meditation with movement"with dramatic flowing movements instead of forceful movement The goal of Tai-chi is to bring principles of Ying and yang into harmony.


Daily activities and hobbies: Experts say that daily activities a household chores as playing with kids, washing windows, mowing yard, gardening an all be beneficial when it comes to increasing fitness and reducing symptoms.

Qigong and meditation: Its called the mother of Chinese healing. It combines meditation dance movements and breathing exercises.It helps to improve energy, decrease fatigue and alleviate pain.

Heat therapy: dry and moist :helps you to relax and alleviate pain.


NUTRITION
EAT : fruits and veg raw, natural protein.
DON'T EAT: fried food, veg meat, food with white flour, increase sugar caffeinated drinks.

We would love to hear from you, coping up skills you have incorporated in your daily life to deal with fibromyalgia.