Breathe into your Belly

Breathing is typically not an action most people think about on a daily process.  

For most people, breathing is an action that happens on its own like blinking the eyes.  Who has the time to think about something you don’t have to think about?  On top of not thinking about breathing, most don’t pay too much attention to their posture.  When sitting for a while, our shoulders tend to roll forward and our lower back begins to round.  Spending majority of the day in this position can lead to back, shoulder, and neck pain.  This posture also fosters poor breathing.  The forward shoulder position leads to muscle tightness which causes our ribcage to elevate leading to chest dominate breathing.  The pec major attaches from the front of the shoulder to the rib cage and the scalenes attach from the neck to the ribcage.  When these two muscles become overactive, they cause a forward rounding of the shoulders.  In addition, the trapezius muscles in the upper back (the shrugging muscles) become tight, further contributing to this position.  

Along with the above mentioned muscle tightness, there is muscle weakness, primarily in the abdomen.  Weak abdominal muscles can cause a hollowing out of the midsection leading to low back pain and further promotion of chest breathing. Chest breathing continues to promote the poor posture by keeping the tight muscles tight and keeping the unused abdominal muscle weak.

Belly breathing, on the other hand, utilizes the diaphragm which is the major muscle that should be used in breathing.  Shifting the focus of breathing down towards the belly (or, more accurately the diaphragm) has several benefits:

• Assists in promoting better posture
• Can alleviate neck and back pain
• Promotes relaxation

Belly breathing allows the pec major, scalenes, and trapezius muscles to decrease their contribution to breathing, thus, allowing them to relax.   This relaxation contributes to decreased tightness of these muscles that may be causing pain in the upper back.  Focusing the breathing to the belly will help engage the under-utilized abdominal muscles and can also help alleviate pain felt in the lower back.  Finally, belly breathing contributes to a more relaxed physical and mental state.  Chest breathing is quick and involves many breaths per minute promoting an excited body.  Belly breathing is slower and more controlled and leads to an overall calming and more focused body and mind.  

Learning to “belly breathe” will improve posture, alleviate pain, and promote relaxation.

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Article by Drew Emanuelson, a licensed personal trainer and exercise rehab specialist at Fusion Gym. He received his B.S. in Kinesiology from the University of Wisconsin-Milwaukee. He is currently accepting new personal training clients.

For more information about how to minimize your back pain, contact Goodyear Health Center/Fusion Gym in Glendale, Wisconsin. (414) 332-6001. Our licensed personal trainers, physical therapists, massage specialists, and pain doctors work together to detect, treat, and rehab pain all under one roof. In network with most major insurance, medicare, and Workers Compensation Insurance.

Remember to Hinge and You'll Save Your Back!

Ever pick up something heavy and throw your back out?  

The simple technique of "hinging" can help prevent the next painful tweak.

Hinging requires a person to keep their stomach braced and bend at the hips...not the back. Bending at the hips allows the individual to better utilize their glutes (specifically the gluteus maximus, also known as the butt) to stand back up.  When bending through the back, it is less likely the glutes will be utilized and instead, the lower back extensors will be recruited.  The low back muscles are designed more as postural muscles which maintain the natural curves of the spine--they weren't made to withstand heavy lifting.  Therefore, the glutes should be the muscle of choice when standing back up (extending the hips).  They are a much larger muscle mass and capable of handling heavier loads and repetitive bending and extending.  Due to poor posture, bad mechanics, and sometimes laziness, people now have a tendency to round their backs when bending over.  While this doesn’t seem like a big deal at the time, all of these poor movements add up over a period of time (weeks, months, years).  The body becomes wired to now load the postural muscles of the low back and forget how to use the more effective glutes.  So, now when it is time to pick up something heavy (a child, a box when moving, or laundry basket), the lower back muscles are utilized, causing the back to "tweak".

Article by Drew Emanuelson, a licensed personal trainer and exercise rehab specialist at Fusion Gym. He received his B.S. in Kinesiology from the University of Wisconsin-Milwaukee. 

For more information about how to minimize your back pain, contact Goodyear Health Center/Fusion Gym in Glendale, Wisconsin. (414) 332-6001. Our licensed personal trainers, physical therapists, massage specialists, and pain doctors work together to detect, treat, and rehab pain all under one roof. In network with most major insurance, medicare, and Workers Compensation Insurance.

The Core Defined

Written by: Jeffrey Sergent, DC

This is a debated topic. A fun nerd-fight if you will? I find the difficult part is really defining the core. Many different groups and clinicians have different muscle groups associated with their definition of the core. But I suppose I will define my own opinion of the groups of muscles that define core and why.

Outer core muscle examples

I like to divide the core into 2 parts: the outer core and inner/deep core. The outer core is what most people typically think of the core as: Rectus abdominis (6 pack muscles), obliques (inner and outer), transverse abdominis, quadratus lumborum (QL), latissimus dorsi and erector spinae. This creates the outer shell. For example, if you think of a can of soda, they would be the outer aluminum shell.

The deeper or inner core muscles create the top and bottom of that can. This would be the diaphragm, pelvic floor, multifidus, longus colli and longus capitis (deep neck flexors). I do include neck muscles, dnf, in the core. My reason for this is basically that the spine works as a unit. If the neck is too far out of alignment, then the lower back will be too. To see what I mean try to do this easy exhale technique on yourself: Place your hands on your low back and now protrude, or jut your neck and chin forward.  Feel how the lower back follows, resulting in increased muscle activation down there.

        

Deeper/Inner core muscles

Deeper/Inner core muscles in the neck.

The reason for the distinction of inner and outer core is in the development of performance and rehab. The goal is to be able to create a brace and muscle stiffness that don’t allow the spine to move. This stiffness protects the spine from mechanical stress during lifting, bending, sitting, standing... pretty much everything. If there is inefficiency in the core, then the energy will be displaced from the muscle and stiffness to the only still structure: the spine.

Really the purpose of the core is to create intra abdominal pressure and stiffness. Let's go back to the can analogy. If you had only the outer shell, no top or bottom, you would be able to deform it without much effort. Now add a lid and bottom, the inner core. This creates more rigidity and stiffness, making you put in a little more effort to crush that can. Now imagine increasing the pressure within by carbonating and shaking up the can. This creates an even greater stiffness. At this point that can would be pretty difficult to deform, and unless someone gets thirsty would last quite a bit longer than any of the individual parts of the can on their own.

Photo sources: www.slamdunk.ru, mikescottdpt.com, www.cityedgephysio.com.au

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

Rants From a Chiropractor: Part 2

Written by: Jeffrey Sergent, DC


Low Back Pain and my Personal Struggle

Let's start at the beginning.  The lower back vertebrae, cartilage, ligaments and muscles are beautifully constructed architecture.  My favorite thoughts on the architecture come from one of my favorite researchers, Stu McGill, PhD.  Professor McGill asks a simple question: If you were an engineer how would you create a structure that needs to resist shear, bending and compression? The common sense answer would describe a stiff bonded pole like structure, think cement cylinders that hold up highways and bridges. Well now, that same structure needs to bend and rotate slightly. Engineering would create multi sections that allow for limited motion and say that this concept is crazy to make possible. Our bodies, our low backs in particular, are designed to take compression, resist shear forces, and allow for bending and rotating. This is possible due to the core systems. See my 'Core Defined' article for my definition of the core.

Disc Bulge of 15/s1 centrally.

Now let's go into my personal story of my struggle with low back pain and sciatica (leg pain). How did I manage to do this to myself with my knowledge of the spine and mechanics? The short answer… I got cocky. The thing with intervertebral discs is that we know they fail. They fail from repetitive movement, most notably flexion and rotation. Day in and day out I was showing people what they were doing wrong at home or with their movement. I would stupidly then do my Core exercises and lifting with good form, thinking that would fix the damage I was doing all day. Like I said… cocky. So cocky I thought somehow my discs won't fail like my patients, because I have great trunk stability, good hip mobility and balance. I was wrong and that wrong caused my disc to not only bulge but fragment in.


In the pictures to the left, the top shows a disc bulge of l5/s1 centrally. You can see the nerve, the line coming down from the bulge is the s1.  The bottom is just to the right of center and reveals a fragment, the cloudy part off the 

A fragment.

disc bulge. This fragment is surrounding the nerve root. Due to the bulge and fragmentation I had right leg pain, numbness and weakness without lower back pain.

Disc injuries come in a variety of shapes and sizes. The size and shape do not correlate to the amount of pain or symptoms. This is a great area of discussion in the pain community (a great nerd fest).  The amount of tissue damage does not equal pain. Actually with disc injuries the more significant the bulge the quicker recovery. Sometimes a small bulge can cause severe symptoms, while a large bulge causes less pain and less direct quality of life issues.  This again is a newer concept within spine literature. The hypothesis is that the larger bulges send more signals of immune mediators to start the re-absorption process. 

Going back to my case, I had a moderate bulge with large fragments; this caused severe stenosis, or narrowing of the opening for my nerve. Due to the size and compression being done to my nerve you would think I would have severe back and leg pain. In reality, I had calf pain, cramping in my foot and calf, weakness in the calf and numbness in the lateral (outer) foot.

Below is a good representation of disc herniations and the type of pain they most likely would create.

 

www.necksolutions.com

Citations:

1.J Craniovertebr Junction Spine. 2013 Jan;4(1):16-20. doi: 10.4103/0974-8237.121619.

Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral discdisease: A cross-sectional double blind analysis.

Bajpai J, Saini S, Singh R.

2. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.

Predictive value of MRI in decision making for disc surgery for sciatica.

el Barzouhi A¹, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group.

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.