Forward Head Posture (What Is It and Does It Matter?) | Chesterfield Chiropractor

The Posture of the Future

The irony of reading about computer posture while on your computer!

There is no doubt that technology has slowly consumed our everyday lives.  We spend hours everyday on our smart devices looking at the internet, checking social media, answering emails, etc.  Many of us also work jobs consisting of prolonged computer use.  These activities are thought to lead to issues such as neck pain and/or headaches.  Do the postures conveyed in "Text/Tech Neck" really cause long term problems or are we overreacting?

In my opinion, the answer is a little bit of both.  To use sitting as an example:

Sitting at a computer is not BAD.  Heck, sitting in general is not BAD.  The hysteria on social media that "sitting is the new smoking" creates a perception that any and all sitting is not ideal.  This is a little misleading, obviously.  Really, any activity that we do repetitively and for long duration can POTENTIALLY lead to issues.  What may cause an issue in one person may not affect another.

With that being said, let's highlight one of the common postural traits that are associated with technology usage, the forward head posture.

What Causes A Forward Head Posture?

Forward head posture, or anterior head carriage, is a term that describes when the head sits too far forward on the shoulders.  It is incredibly common and I would wager that every single one of us has it to a certain extent.  Is it something to worry about?  Well, it depends.  As stated above, any one posture is not inherently bad.  However, prolonged and repetitive postures can be.  This postural tendency seems to be common in those with chronic neck pain and headaches.  In fact, we find that postural dysfunctions can be one of the 3 biggest contributors to tension headaches.  

One thing to keep in mind is that many people have a forward head posture and have no symptoms.  In fact, many studies have concluded that there is no correlation with posture and pain.  I certainly look at the mechanical factors of posture but I tend to draw conclusions on the overall big picture.

An Issue of "Stacking"

The image shows Justin Bieber's forward head posture.

An evaluation of head posture involves assessing the position, curvature, and adaptations of the muscles and joints.  In theory, the further that the head translates forward, the more compensation is needed within these joints and muscles.  When you factor in the weight of the head, and gravity, the natural position of our face would be in a downward direction (when the head is pulled forward).  So in order to adapt, we crank the upper cervical vertebrae into extension.  This creates a secondary "rounding" or flexion of the lower part of the neck/upper back.  

Essentially, the upper part of the neck is "compressed" while the lower part is "hunched".  It is for this reason why the majority of cervical disc problems and degeneration occur at the levels C5/C6/C7.  So when you consider the potential long term changes, prevalence of forward head positions and the distribution of forces, it seems wise to have a strategy to reverse these positions from time to time.

It's All About the Chin Tuck

I will often have a patient demonstrate how they would go about reversing their postural position.  At first attempt, they will often just pull their head straight backwards (retraction).  This causes a "jamming" effect at the mid to lower part of the neck.  It is often uncomfortable and can exacerbate any symptomatic discs or joints.  We need to incorporate more flexion, or better stated, chin tuck.  

The images below demonstrate some common computer postures (image one and two) and a correction strategy using the chin tuck (third image).

Demonstrates a typical computer head posture where the head moves forward with compensation in the neck.

My natural computer posture.  My head sits forward as do my shoulders (red arrows). The dotted lines indicate face position relative to parallel.  Nothing wrong with this position.  However, prolonged and repetitive sitting like this MAY result in unfavorable adaptations.

Common head posture adaptation where the head moves backwards but the lack of chin tuck creates compression in the neck.

Here we see an attempt to sit up straighter with the head translated backwards (blue arrows). This is often what patients do to "correct" their posture. Due to a lack of chin tuck, there is compression in the upper part of the neck (red arrows).

Ideal sitting posture with the torso upright and the head in neutral

This is an ideal scenario where the head is stacked, the chin is tucked, and the face is parallel (blue arrows). I try to assume this position with prolonged computer use or driving.  When I don't, I often have neck issues.  Again, not everyone will have these issues so every case is different.

Exercises for Forward Head Posture

Shows the deep neck flexor muscles.

The deep neck flexors (pictured) are the unsung heroes of trying to initiate the chin tuck.  Unfortunately, they are often underutilized when compared to the larger, more superficial muscles in the front of the neck.  In addition, there is compensatory muscle tightening/shortening in the muscles in the back of the neck.  To put it simply; some muscles work too much while other muscles don't work enough.  I'm sure every workplace has this problem with employees!  The overworked muscles eventually start to cause problems.  It is important to minimize the activity of these muscles when engaging the deep neck flexors.  This is possible by pulling the head back while engaging the chin tuck.

Check out the video below on some of our favorite neck exercises:

In addition, to strengthening the muscles in the neck, it helps to incorporate some range of motion exercises to help with joint tightness.  Remember, a forward head posture often involves increased extension (compression) of the upper vertebrae of the neck as well as increased flexion (rounding) of the lower vertebrae.  Motion is Lotion when it comes to joint function so give these exercises a try:

How Do We Help Forward Head Posture?

We certainly pay attention to head posture.  Especially when neck pain, shoulder pain, and headaches are involved.  However, it is just one component of a thorough assessment.  We never draw specific conclusions to posture and pain but recognize that certain postures MAY lead to adaptations within the muscles and joints.  

We implement joint mobility techniques, like adjustments, to the joint structures that are most restricted.  Myofascial therapy is used for the overactive and "tighter" muscles.  Implementation of a rehab/exercise program is vital to help improve function by addressing muscular weakness, movement impairments, and breathing to name a few.  The purpose of this article is to recognize the biomechanical factors of forward head posture, but also to stress that it does not necessarily mean anything and may not be clinically significant.  If you are struggling with conditions such as neck pain and headaches, and think your posture may be related, give us a call (636-728-8607) to set up a FREE consultation!

Picture of outer elbow muscles and tendons

How To Prevent Elbow Tendinitis

How To Prevent Elbow Tendinitis

Tendinopathy is a type of condition that affects the tendons of muscles where they insert into the bone.  It can happen in many muscles and joints.  At the elbow, tendinopathy is often referred to as tennis elbow and golfer’s elbow.  In this article, we will break down how to prevent elbow tendinitis as well as how to manage it.  For more on elbow pain, Click Here.

What Is Tendinopathy?

Tendinopathy involves the inflammation, and subsequent degeneration, of a muscle’s tendon where it inserts into the bone.  It is commonly seen in the elbows, knees, wrists, and other body parts.  The misconception in society is that most cases of tendinopathy are associated with tendinITIS.  However, this is not entirely accurate.  Tendinitis refers to an acutely inflamed and swollen tendon that doesn’t have microscopic damage.  The underlying culprit is inflammation.  We find that by the time a patient is seeing us for something like tennis elbow, they are way past the inflammatory phase.

Most cases actually involve tendinOSIS. Tendinosis involves a chronically damaged tendon with disorganized fibers that appear hardened and thickened.  The underlying cause of tendinosis is degeneration. The biggest difference between the two is time.  The -ITIS stage is very early on in the process while the -OSIS is a chronic issue. So when referring to elbow tendinitis, most of the time it is a case of tendinosis.  However, for simplicity, we will refer to it as the commonly known -ITIS version.

 

Picture of muscle tendon attaching to bone
#8 depicts a tendon inserting into bone

Elbow tendinitis is typically labeled as tennis elbow and golfer’s elbow.  Tennis elbow, medically known as lateral epicondylitis, involves tendinopathy of the extensor muscles of the forearm at the common insertion (lateral epicondyle/outer elbow).  Golfer’s elbow, medically known as medial epicondylitis, involves tendinopathy of the flexor muscles of the forearm at the common insertion (medial epicondyle/inner elbow).  As stated above, these cases typically are chronic in nature and are more of the -OSIS variety.

Picture showing the muscles of tennis elbow
Tennis Elbow
Picture showing the muscles of golfer's elbow
Golfer's Elbow

What Causes Elbow Tendinitis?

Elbow tendinitis is most commonly caused by a combination of poor repetitive movements and dysfunctional lifting mechanics.  However, the elbow pain may be caused by a direct injury but this is typically rare.

Elbow Tendinitis and Repetitive Movements

The first step to preventing and managing tendinitis of the elbow is to identify the problematic movement.  This movement is one that is done on a consistent basis and is leading to the degeneration of the tendon itself.  Initially, this movement is not painful.  However, over time, the movement will be unbearable.  Common repetitive movements can be purely work related.  Mechanics and painters are a few professions that come to mind that utilize repetitive movements and often have elbow pain.  However, athletes often have repetitive motions leading to the same issue (golf and tennis).

Once the movement is identified, proper rest is needed.  It is crucial to "put out the fire" so to speak before moving forward.  Otherwise, there is a constant cycle of re-injury which makes it nearly impossible to fully heal.

Picture of fireman putting out the fire.

 

Elbow Tendinitis and Lifting Mechanics

Once the offending repetitive movement is identified, and proper rest has been utilized, it is crucial to improving HOW we lift things with our arms.  I find that the most common cause of elbow tendinitis is the over gripping of objects.  In other words, we “arm” all of our exercises or daily tasks.  I believe this is due to the inability to anchor their arm through the scapula (shoulder blade).  When the upper back and scapula are not actively engaged in upper body movement, we will overly rely on the muscles of the forearms and arm to accomplish the movement.  Check out this video that demonstrates proper technique with common pulling exercises.

Here is a simple checklist for improving lifting mechanics to prevent elbow tendinitis:

  1. Decrease weight (sometimes by half)
  2. Lighten the grip
  3. Anchor the scapula
  4. Limit shoulder shrugging, forward tilting, and decreasing elbow angle

At the end of the day, simply decrease the weight you are lifting and try to influence the movement through your upper back rather than through the arm.

Best Exercises for Elbow Tendinitis

Once the repetitive movement is identified, rest has been implemented, and lifting mechanics are addressed, the next step is to strengthen the area.  The best exercises for elbow tendinitis (tennis elbow and golfer’s elbow) are eccentric exercises.  Eccentric exercises involve the reversing of the movement with control.  For example, the concentric portion of a biceps curl is when the weight is lifted (from the side) up until it is fully flexed.  The eccentric portion is the lowering down of the weight to its starting position.  When doing eccentric exercises for tendinopathies, it is OK to have a little bit of discomfort.  However, we don’t want you pushing above a 5/10 on the pain scale.

Watch the videos below for a compilation of some of the best exercises for tennis elbow and golfer’s elbow.

How To Treat Elbow Tendinitis

As your Chesterfield chiropractor, we use a array of treatment and rehab strategies to help improve elbow pain.  Our initial visit involves an extensive evaluation using the Functional Triage method.  This helps us not only identify what is injured in the elbow but also other things that may be involved.

Treatment of the elbow consists of joint mobilization, usually at the radial head, and soft tissue treatment.  Soft tissue techniques can involve myofascial release, neurological stretching, and instrument assisted soft tissue mobilization (IASTM).  We often incorporate the FAKTR approach by combining treatment simultaneously with exercise.  In addition to hands on treatment, we will send our patients home with self stretching and mobilization techniques.  Check out the video below on some self treatment strategies for the elbow.

Once pain is under control, a shift to exercise is done as soon as possible.  We utilize exercises like those listed above but also tailor the rehab approach to the patient’s goals and activities of daily living.

If you or someone you know has been dealing with ongoing elbow pain, tell them to give us a call.  If we are not located near them, we can help find a provider close by.  It is our goal to not only get people to feel better, but to be better than before.  Only when the public takes ownership of their body will we truly see optimal health!

Move Better. Perform Better. Better Than Before.

Preventing Low Back Pain

How To Prevent Low Back Pain (4 Things To Consider)

Prevent Low Back Pain by Looking/Treating Elsewhere

Low back pain is one of the most costly health care conditions in the world.  It is my opinion that we, providers, have managed it poorly over the years.  We are in the middle of an opioid crisis and low back issues are one of the many reasons people seek relief.  There is no excuse for prescribing addictive medications for pain that can be helped and eliminated with conservative measures.  However, I believe even the conservative methods are less than optimal because not enough of us try to prevent low back pain.  Simply adjusting someones low back is not going to get the job done.  We need to evaluate the system as a whole. Click Here to read about the Functional Triage approach to evaluating pain and dysfunction.  In this blog post, I will outline 4 key things to consider when trying to prevent low back pain.

Joint by Joint Approach

The body alternates from mobile segments and stable segments

Low Back Pain and Core Function

Have you been banging out 500 sit ups a day for the past 25 years?  Can you do leg raises with 30-pound ankle weights plus a medicine ball in between your legs because of your super shredded “lower abs”?

What if I told you that a six pack does not equate to a strong core

It is super common for me to find that my patients with chronic lower back discomfort tend to over work their ANTERIOR core.  Needlessly crunching yourself into oblivion to sculpt that perfect 6 pack is counterproductive.  Here’s the thing, your core is actually a 3-dimensional container instead of a flat sheet of abs so the way we train it must be varied.

He Is The One (that is the most important core muscle)

The most crucial muscle for the core also happens to be the most crucial muscle with respiration, and we never use it!  I am speaking of the diaphragm of course.  Proper core stability should begin with an inhale to create intra-abdominal pressure.  In addition, the act of breathing should continue throughout the whole movement/exercise.  This may be a shocker to some since they can barely think let alone breathe during a rep in the gym.

Using the diaphragm to create intra abdominal pressure
Prague School of Rehabilitation
Stabilizing the core from the inside-out
Core Stability from the Inside-Out

You've Been Doing It All Wrong

An ideal scenario involves eccentrically activating ALL the quadrants of the core simultaneously rather than concentrically bracing the abs.  In other words, when you inhale with a tad bit of abdominal stiffness, the air/pressure in turn forces the abdominal wall to contract.  Think of it as “inside-out” core stability.  Many people find this concept abnormal.  Hell, the act of correctly breathing with their diaphragm feels abnormal.  However, we all learned it this way many, many years ago.  In fact, we can trace most of what we do movement wise back to when we were babies.  Creating proper intra-abdominal pressure is the foundation of Dynamic Neuromuscular Stabilization (DNS) and is absolutely crucial when trying to prevent low back pain.  Once the foundation is set, proper movement can be “re-trained” by revisiting the primitive positions that we spent our time in as cute little babies.  In this fashion, we are training the core to do what it is supposed to do, which is transfer load/power/force through the body.

Effective Core Exercises to Prevent Low Back Pain

Low Back Pain and Thoracic Spine Stiffness

The thoracic spine, I feel, is supremely underrated when it comes to many conditions and ailments and is usually needing some TLC when trying to prevent low back pain.  Even with a bulky rib cage attached to it, the thoracic spine should be fairly mobile especially compared to the lumbar spine.  With saying that, I need to point out that the lumbar spine is capable of plenty of movement.  However, its relationship to the core is that it helps create “Good Stiffness” in the mid-section with most physical activities.  Or in other words, we want the thoracic spine to move more during movement and the lumbar spine to move less.  Take the golf swing for example.  If you tend to wield your driver like Thor’s hammer, and in doing so, tend to “reverse spine angle” then you are at a much higher risk for low back pain.  On the flip side, if you rotate more through your hips/pelvis and T-spine you will allow the lumbar spine to do its job which is help the core transfer energy.

Thoracic Spine and Rib Cage

Thoracic spine and rib cage
Bulky but Pliable

Muscles of Rib Cage and Their Role in Respiration

Muscles of respiration and their role
Different muscles. Different roles.

Simply telling somebody to move more in the T-spine rather than the L-spine is easier said than done.  It just so happens that our society influences poor thoracic mobility due to the positions we are in most of the day.  When working with patients that need more thoracic spine mobility (most of them), we are using a combination of treatment to physically loosen up the joints and muscles and rehab/corrective exercise to teach the patient how to utilize this newfound motion.

T-Spine Mobility Drills

Try these exercises out to help mobilize the T-spine.

Low Back Pain and Hip Function

The hips, in my opinion, must be evaluated when attempting to prevent low back pain, even if there is no hip pain.  Unlike the thoracic spine where the issue is usually hypomobility, the hips can have a multitude of dysfunctions.  To make matters more complex, both hips in one individual may have different issues!  In a perfect world, the hips move freely throughout their range of motion with proper muscle activity.  Sadly, the world is not perfect.

 

Anterior Hip/Thigh Muscles

Muscles of the front of the hip
A lot going on in there

Posterior Hip/Thigh Muscles

Muscles of the back of the hip
More than just the glutes

Many Ways for the Hips to Fail

Let’s outline a few scenarios:

  1. Desk worker has “tight” hip flexors and “weak” glutes due to sitting all day. I put tight and weak in quotes for a reason (more on that in a sec)
  2. Dancer has trouble stabilizing on one leg and when doing so, you witness their knee collapse and their pelvis hike.
  3. Cross fitter gets a pinching type pain at the deep aspect of their squat.
  4. Soccer mom is super strong with glute bridging and other hip corrective exercises but they don’t seem to know how to utilize that strength with actual human movement.

The Big Picture

I just listed 4 scenarios for hip dysfunction and all of them are different but similar in that the hips are dysfunctional.  In addition, all four of them may also have low back pain.  It’s simply not enough to say, “oh your glutes are weak” or “my hip flexors are tight”.  The single most important thing that I can do for a patient is get them to FEEL proper hip function during actual activities.  In order to do that, there needs to be some critical thinking and evaluation involved.  I need to know the reason WHY you have reduced internal rotation (IR).  Reduced hip IR due to posterior hip tightness is in a different universe than reduced motion due to some type of impingement.  One can be taken care of with self-stretching and exercise while the other needs to be managed clinically.

Hip Mobility Routines

So what does this have to do with how to prevent pain in the low back?  Well, like the thoracic spine, if the hips are not doing their job the low back will do its best to pick up the slack.  Below are two hip circuits with different objectives.  One is to activate the hips (glute medius).  The other is to stretch and mobilize the hips.  I recommend those with pain in the low back to try these exercises.  Some people need strength AND mobility.  Others just need to loosen up!

Low Back Pain and Daily Activities

Factoring in one's daily activities is a must no matter what the condition is.  Knowing what you do on a daily basis should be the foundation for any treatment and rehab plan.  This concept ties everything mentioned above together.  Lets list two scenarios for low back pain:

  1. Desk worker that sits all day and has a chronic, achy, tight low back
  2. Carpenter that is up and down all day has frequent episodes of low back pain a year

Different Problems. Different Solutions.

Both individuals have totally different job requirements and different pain mechanisms.  They probably each have different goals for themselves as well.  Both patients get a thorough work up.  I might find that patient #1 has a stiff thoracic spine and shortened hip flexors.  My goal with treatment and rehab would be to "reverse his posture".  I would treat his back and hips but also build a daily regimen for him to work on while at work.  As long as I can get him moving in the right direction, things will go well.

Low back pain with activity

Patient #2 may be a different story.  It's the same song and dance with these guys.  They "throw" their back out 4 times a year leaving them handicapped for several weeks.  However, when I question them about it they call it "normal" and don't see any issues with that mindset.  I will have to dig a little deeper and figure out what is causing their back to flare up.  It may be a lack of hip hinging when bending down.  It may be a loading strategy (don't lift a 200 lb fridge by yourself doofus).  The point is, we have to think several steps ahead in order to prevent low back pain and injury from recurring.  Sure, treatment of the above issues is warranted but if we don't get a wrangle on the actual MECHANISM of pain then all we are doing is applying band aids to the problem.

Hip Hinge to Prevent Low Back Pain (sometimes)

Here is a simple video on how to teach yourself to properly hinge through your hips.  I'm not saying that you have to always bend over like this.  However, if you are going to pick up something up heavy I would recommend getting your hips involved.

 

Take Action

If you are a little confused by all of this then I have done my job.  The human population needs to have a better understanding for how their body works so that they can have a better grasp on how to handle whatever life throws at it.  The point is that those grueling lacrosse ball/foam roll sessions may not be helping you.  In fact, it could be hurting you.  Getting the same ole treatment over and over again is no better.  Alternatively, if you are used to banging out the same corrective exercise routine with no regard to how those clam shells apply to human function, then you are in REHAB PURGATORY.  It’s a pitiful place to be.  My challenge to you is to expect more from your body as well as those treating/coaching you.  Don't settle for chronic low back pain!  Learn how to not only manage discomfort, but how to prevent low back pain in the first place!

Contact Your Chesterfield Chiropractor

If you are in the St. Louis and Chesterfield area, we would love to help!  Call us or schedule online for a free consultation.  Can't make it to the office but like what I'm saying?  Reach out to us and I can help you find a provider in your area.


 

  • Anatomy pictures courtesy of Netter's Anatomy Flash Cards, 3rd Edition
  • Core pictures courtesy of the Prague School of Rehabilitation and Dynamic Neuromuscular Stabilization
tension headache

Top 3 Causes of Tension Headaches

The Headache Dilemma

Just about everybody has experienced a headache of some sort in their lifetime.  Maybe you get them after a long night of drinking.  Or, they pop up during stressful times at work.  Whatever the scenario, headaches are a common problem in our society.  According to WebMD, 80% of Americans suffer from tension headaches from time to time and women are twice as likely to have them.  3% of the population suffers from daily, chronic tension headaches (a number that I believe is under reported).  The key term here is “tension”.  Tension headaches are typically labeled as “cervicogenic”, meaning they generate from the cervical spine.  However, there are many more sinister reasons for pain around the head.  For the sake of this write up, we are excluding things such as head trauma, vascular issues, and migraines.

What Triggers Tension Headaches?

As mentioned above, I believe the reporting of chronic tension headaches is vastly understated.  Basically, people tend to accept them as “normal” and are unaware of their effects.  That is, until they feel relief for the first time!  Based on my training and clinical experience, I have come to find that there are three main triggers for the classic tension based headache.  They consist of upper cross posture, poor breathing patterns, and TMJ/jaw dysfunction.

Posture and Headaches

Poor posture
Janda's Postural Syndromes

The obvious one is poor posture.  Specifically, upper cross posture.  Click here to read about the effects of technology on our posture.  It’s not that poor posture directly causes headaches.  It’s the adaptations of the muscles and joints as a result of prolonged and repetitive poor positioning.  For example, a forward positioned head often leads to excessive rounding, or hyperkyphosis, of the upper back.  This adaptation often results in subsequent muscle tightening as well as locking up of vertebral joint segments.  There is a high likelihood that when I evaluate a patient that works at a computer for a living that I will find trigger points and muscle tightness in various muscles of the upper thoracic spine and cervical spine.

In addition, their upper thoracic and lower cervical joints move like a brick compared to the segments above and below.  For these patients, treatment is centered towards these dysfunctions.  In addition, some sort of rehab program is implemented to offset the over usage of these muscles and joints.  One rule of thumb is that if there is a muscle that is being overworked, there tends to be a muscle, or muscles, that aren’t doing enough hence the implementation of strengthening.

Below are some diagrams by Dr's Travell and Simons outlining the common trigger points in the head and neck as well as their referral patterns.

Pain patterns and trigger points
Travell and Simons Trigger Points of the Head and Neck

An Exercise in Futility?

Individualized treatment and rehab is crucial to success.  However, an attempt to correct work stations and postural habits may be the most important factor.  Simply getting treated or doing a handful of exercises will not overturn years of bad habits. A diligent effort must be made to break these habits which usually involves constant reminder of postures throughout the day.  Typically, the more I show you how much you really struggle, the more likely to facilitate a change.

Posture Reminder
Sit Up Straight!

We recommend that you use some kind of reminder system to keep you in check throughout the day.  This can include stickers to place on things you look at the most, i.e. computer, rear view mirror, or phone.  Or, setting alarms on your cell phone will do the trick.  The point of constantly reminding you is to create awareness.  The more awareness, the more actions can be taken to create better postural habits.

Breathing and Headaches

The second component related to tension based headaches is poor breathing mechanics.  When most people think of the respiratory system, they picture the lungs.  However, we must understand the contribution of certain muscles in assisting the process of getting air in and out of the lungs.  I group the muscles into two categories, primary and accessory.  The primary muscle of respiration is called the diaphragm.  The accessory muscles consist of muscles in the neck (SCM and scalenes), ribs (obliques and intercostals), as well as muscles that affect the spine and scapula (levator scapulae, erectors, upper trapezius, etc).  The accessory muscles are meant to kick in during times that require more assistance such as during exercise.  While at rest, we should primarily use our diaphragm to breathe.  Instead, I find that most people rely on the accessory muscles all of the time.  A concerted effort should be made to remedy this dysfunction.  A quick drill for you to evaluate your breathing is to place one hand on your chest and another on your belly.  As you breathe, your bottom hand should push outwards with minimal movement of the top hand.  You can also place both hands around your neck to feel whether or not the neck muscles are contracting when you breathe.

Diaphragm breathing
"Belly Breathing"
Diaphragm breathing
Accessory muscles of breathing
Accessory Muscles
Neck muscle tension with breathing
Too much tension in accessory muscles

When evaluating one’s ability to use the diaphragm, we typically get one of two types of patients.  The first patient has little issue with breathing correctly; they just need to make it more of a habit.  The second patient, on the other hand, cannot grasp the concept.  These patients tend to need some TLC to help get them going in the right direction AND THEN they need to make it a habit.   I have seen so much success with simply pointing out that proper breathing is in fact a real thing.  A drastic change is seen when a concerted effort is made to decrease the activity of the accessory muscles.  Once diaphragm activity is normalized, an effort can then be made to teach proper core activation which we will discuss at a later time.

Jaw Tension and Headaches

The third reason for tension headaches may be the most prevalent of them all.  Temporomandibular dysfunction, or TMD for short, involves excessive jaw clenching, grinding, and tensing.  One thing that needs to be pointed out is that TMD is different than TMJ.  TMJ refers to the temporomandibular joint.  Humans have two of these joints.  TMD is simply the dysfunction of that joint.  If I had a dollar for every time that a patient stated that they have "TMJ" I would be, well you know!  Anyways, those that grind their teeth at night most likely are aware of it.  Whether a dentist told them, or their significant other has complained about it, it is not news to them.

Lockjaw and headaches

What these people don’t realize is that they most likely hold excessive tension in and around their jaw throughout the day as well.  The real kicker is that people can have TMD without having any issues with grinding their jaw.  They simply hold tension in their jaw like most people hold tension in their traps and neck.  Long standing TMD can result in tension headaches, TMJ degeneration and disc issues, and varying degrees of "lockjaw".  Lockjaw occurs when the muscles of the jaw become spastic, or the disc located within the TMJ becomes "stuck".  Symptoms can involve an inability to open or close the jaw fully.

Trigger points of the head and jaw.
Travell and Simons Trigger Points of the Head and Jaw

When I began to dive into assessing and treating the jaw, I found that TMD often coincides with poor breathing.  Some studies have correlated a relationship of jaw clenching and poor breathing with anxiety and stress.  So the next time your kids are giving you a fit, take a moment to see if your jaw is tightening up and how you are breathing (if you are at all).  Treatment of the jaw and head region, as well a home stretching program, can yield results so enormous that the patient is usually dumbfounded.  Like breathing, correcting the overarching habit is crucial for sustained benefits.

 

Any questions or comments?  Reach out to us via Facebook, Instagram, or our website.  Want to know if we can help your headache issues?  Call and schedule a free consultation to discuss your case and how we can help! (636) 728-8607.

pain relief exam

Functional Triage, The Future of Pain Relief

Pain Relief and Why Healthcare Has Been Failing

It is not hard to poke holes in our nations healthcare.  Instead of magnifying the issues with coverage and costs, we should be focusing on how we address pain relief.  Over the years, the healthcare industry has been far too reliant on drugs and surgery which has resulted in an opioid epidemic and overuse of unnecessary procedures.  Standard conservative measures, such as chiropractic, are effective for pain relief but the results are not always long lasting due to failure to treat the body as a system.  Everybody in the healthcare game (MD, DC, DO, DPT...) has been guilty of being entirely too focused on short term pain relief instead of long term solutions.  We are starting to see a renaissance of chiropractors, PT's, and the like who are starting to evaluate and treat the body in a different fashion.  The concept of a "Functional Triage" approach involves collecting data and information via communication and assessment and then establishing a treatment plan and approach based on what the patient gives you, rather than what you've always done or what your bank account needs.

A doctor talking with a patient
"Mrs. Jones, your non complicated mechanical low back pain will require at least 26 chiropractic visits. If that doesn't work we can try a course of surgery. Whaddya say?!"

The Functional Triage Approach

At Elite Chiropractic and Performance, we use the functional triage as the foundation of our evaluation process.  We call it a triage because it allows us the ability to funnel the patient into different assessments and categories based on their exam findings.

To better highlight the functional approach, let's outline a patient scenario.  Mrs. Jones, who is a middle aged female that enjoys playing golf and doing crossfit, walks into our clinic complaining of shoulder pain.  Right away, a subjective history and conversation is initiated to learn the patient's previous injury history, family history, social history, etc.  We can sometimes speculate what is going on just by having a conversation with the patient.  Mrs. Jones states that she has pain when lifting overhead and also when she does push-ups.  Occasionally, she has pain doing menial tasks such as grabbing her purse.  Once any potential red flags are ruled out and the need for an immediate referral is not needed, the evaluation starts.

During the evaluation process, other systems may be examined, such as the heart and lungs, but Mrs. Jones has nothing indicating a need to do so.  The functional approach combines several different examination types into one streamlined process.  Each test and assessment is done in order to collect bits and pieces of the patient's overall status and function.  Depending on the findings, the exam can funnel into different focuses.  Essentially, we take what the patient gives us in order to deduce not only the diagnosis, but all of the contributing factors as well.  For example, we assess Mrs. Jones' overall shoulder mobility in the standing position.  We want to know how far she can raise her arms overhead and whether or not she "cheats" to do so.  Very commonly, humans can get the job done but we may do so using the wrong strategies.  Called dysfunctions, these faulty strategies can eventually lead to problems.  In Mrs. Jones' case, she has to over extend her mid to low back in order to get her arms fully overhead.  Without the over extending, her overhead range of motion decreases significantly.  It is my belief that she should avoid overhead lifting until she improves her mechanics because she is sacrificing her shoulder joint and low back in order to get her arms overhead.  Adding weights and barbells to the scenario further complicates things.  After a general movement assessment, we can start to evaluate with more detail.  For the shoulder, we pay special attention to the neck (cervical spine), upper back (thoracic spine), shoulder blade (scapula), and the shoulder joint itself (glenohumeral joint).  By the end of the evaluation, we want an accurate diagnosis of why Mrs. Jones has shoulder pain but most importantly, what involvement does the surrounding joints and muscles have on the shoulder.

 

"He who treats the sign of pain is lost."

Karel Lewit, MD - pioneer of modern diagnostics and manual therapy

 

At Elite Chiropractic and Performance, we utilize several well known and effective techniques during our evaluation process.  Things like Dynamic Neuromuscular Stabilization (DNS), Selective Functional Movement Assessment (SFMA) and Mechanical Diagnosis and Therapy (McKenzie Method) are gold standards in the industry for comprehensive assessments as well as treatment.  Below is an example of the thought process and exam flow for a clinician using the functional triage approach for shoulder pain.

shoulder pain relief
***Initial evaluation for shoulder pain***

Information Overload

confused child
HUH?

So Why Does This Matter?

Explaining the nuances of a comprehensive and exceptional functional based assessment can make even the up to speed individual's head spin.  In a nutshell, a functional triage is meant to figure out the "Why" to the "What".  The "What" is the patient's shoulder pain, the "Why" is all of the details that are gathered during the process.  In addition, the process allows the clinician to figure out the right tools for the job.

 

pain relief appropriate treatment
Picking the right tool for the appropriate job.

 

Every treatment and rehab approach must be specifically tailored to the individual patient.  What may work for one patient may not work for another.  We like to say that if you aren't assessing, then you're guessing!  Below is a diagram that simplifies the functional approach.

Pain Relief Treatment

The Future of Pain Relief

We are seeing an evolution with how we assess and treat pain and function.  Many chiropractors, physical therapists, and physicians are realizing that what they have been doing has not been good enough.  Adjusting your low back repeatedly is a great way to reduce pain for the short term.  However, we should incorporate stability and rehab not just for the low back, but above and below the chain as well.  Physical therapists that mostly use corrective exercise are also selling you short.  If you have major joint restriction and muscular tightness then you won't be able to perform many movements correctly.  Muscle relaxers and other pain relievers have their place, but medical doctors are realizing that they are only addressing symptoms and not the cause.  Not to mention that many prescriptions for pain are highly addictive.

It is time that the public demands more from their healthcare.  The functional triage approach has the potential to impact the quality and efficiency of musculoskeletal based care.  In addition, it requires that the provider is well versed in other techniques instead of being a one or two trick pony.  With this mindset, we can not only help people feel better, but function and perform better as well.


 

Chesterfield's Go-To for Pain Relief and Human Performance

Do you have chronic pain or recurring injuries and you're located in Chesterfield or its surrounding communities?  Do you know someone that can't seem to find the right fix?  Now is the time to take control of how you feel and function.  Elite Chiropractic and Performance is a clinic for all things related to pain relief, fitness, and performance.  We believe that it is a fundamental human privilege to be able to do the things that we love habitually and to function pain free.  Interested in all of the tools that we use to get you feeling better as soon as possible? Click Here!!

Baby yawning

The Power of Sleep

The act of sleeping.  Something so routine and overlooked may be the key to one’s health and well-being.  Sleeping issues have plagued humans for centuries but today’s technological advancements are feeding an every growing monster.  Lack of sleep can contribute to small things such as fatigue but can also facilitate more sinister of problems.  On the other hand, advanced sleeping regimens can offer an performance advantage in the office as well as on the field.


 

Gorilla Sleeping

A Sleep Sick Society

Sleep awareness was a second rate concept for many years and was nearly nonexistent in the medical community.  Thanks to pioneers such as Dr. William C. Dement we have come to understand the importance that adequate sleep plays in the function of the well-oiled machine we call the human body.  However, in order to appreciate the benefits of sleep, we must recognize the current issues and trends in society today.  Dr. Dement, who is considered by many as the pioneer in sleep medicine speculates that half of us mismanage our sleep to the point where it negatively affects our health and safety and that, on average, each of us sleeps one and half fewer hours each night than our great-grandparents did a century ago.  In his book, The Promise of Sleep, he states:

 

Study after study has revealed that people who are chronically sleep deprived can be completely unaware of the root cause of their overwhelming fatigue.  Many people conclude that being run down, apathetic, and glum, must be the normal human condition, or can be attributed to boredom, warm rooms, or heavy meals.

 

According to sleepassociation.org:

  • 50-70 million US adults have a sleep disorder
  • 37.9% reported unintentionally falling asleep during the day at least once in the preceding month.
  • 4.7% reported nodding off or falling asleep while driving at least once in the preceding month. Drowsy driving is responsible for 1,550 fatalities and 40,000 nonfatal injuries annually in the United States.
  • 48.0% of adults report snoring.
  • 25 Million U.S. adults have obstructive sleep apnea
  • 100,000 deaths occur each year in US hospitals due to medical errors and sleep deprivation have been shown to make a significant contribution.

 

The evidence that we are malnourished sleep wise is concrete.  The exact mechanisms for why, however, is not.  Before we can lay blame to our habits and rituals, it helps to understand what happens while we sleep.


 

Brain waves
Baby sleeping

Stages of Sleep

During sleep, the body cycles between 4 non-REM (rapid eye movement) stages and one REM stage totaling 5 stages.  Throughout the night, the body will go through these 5 stages 4-6 times, spending an average of 90 minutes in each stage.  Stage 1 and 2 (non-REM) are considered light sleep while 3, 4, and REM are labeled as deep sleep.  Each stage serves a unique restorative function which means it is crucial to properly cycle through each stage.  The following is a brief description of each stage:

 

  • Stage 1 – Often called the transitional phase. In this stage, we may be partially awake as our mind begins to drift into light sleep.  This is also the stage of sleep where we experience hypnic myoclonia, which is when your muscles involuntarily jerk.  Many embarrassing moments have gone down in history as a result of this reflex!

  • Stage 2 – Our heart rate begins to slow, our core body temperature decreases, eye movement stops, and our brain waves slow down. We spend about 50% of the night in stage 2.

  • Stages 3 and 4 – Called slow wave sleep and is our deepest sleep that is often very hard to wake up from. Our blood pressure drops and our breathing becomes deeper, slower, and more rhythmic.  Our body is immobile at this point but our muscles can still function such as when we sleepwalk.  During these stages, hormones are released to aid in growth and appetite control thus making it an important stage for rejuvenating the body.

  • REM – The dreaming stage. Eye movement dramatically increases and our brain is bursting with activity.  Adults spend about 20% of the night in REM sleep.  REM sleep is crucial for revitalizing the brain and allowing for sharper focus for the day.

 


 

Burnt out

Sleep Debt – Myth or Real?

Most people have probably said at one point in their life that they need to “catch up on their sleep” but is this accurate?  Based on several scientific studies, not only is the possibility of sleep debt real, its effects can be detrimental.  Dr. Dement describes sleep debt as “nature’s loan shark”.   Generally, people need to sleep one hour for every two hours awake which translates to roughly 8 hours a night.  Of course, some people need more and some need less, and a few people require a great deal more or less.  The premise is that if an individual only gets 6 hours of sleep a night they will end up with 14 hours of sleep debt by the end of the week.  Sleeping in over the weekend can help reduce the debt but is not enough to overcome the total burden.  Essentially, all wakefulness is sleep deprivation.   Like hunger and food, when the former increases to a considerable level the latter is all that the individual will desire.  It is easy to understand sleep debt in great scales, such as pulling an all-nighter to study.  However, studies are revealing the effects of minor sleep debt which can range from subtle problems like sleepiness to more significant issues like insomnia, stress, and anxiety.

Absent Mind
Work stress

So What Can You Do?

Well for starters, make sleep a priority like you would diet and exercise.  In fact, quality sleep may be the missing link to achieving your fitness and performance goals.  My biggest recommendation is to establish a night time routine that consists of winding down and relaxing.  These routines should also consist of avoiding stimulatory mediums like cell phones and TV’s.   The following are some Do’s and Don’ts for assuring a quality night sleep:

DO's

  • Have a set “bed time” that consists of a winding down process with a goal to be in bed by a certain time.

  • Develop a winding down process. This can consist of drinking night time tea, reading a book, planning for the next day, light stretching, etc.

  • Investing in a good mattress. You spend roughly a third of your life in bed so get something that works for you.  This does not mean it has to cost a fortune.  I purchased a king sized mattress from Tuft and Needle for under a $1,000.  They allow a 100 day trial period and even ship the mattress to your door!  I always recommend that people sleep on a newly bought mattress for a few weeks to make sure it works for them.

  • Use supplements and other tricks. Melatonin gummies can help with sleep especially if you work night shifts or have jet lag.  Essential oil products can help the sleep process as well.  Try using lavender and peace and calming shortly before bed.  My favorite approach is to drink night time oriented tea.   My favorite is Yogi Bedtime which has valerian root extract and passionflower plant extract.

  • Have a bedroom temperature set between 60-67 degrees.  When trying to fall asleep, your body temperature decreases so having a cooler bedroom room can help facilitate this.

  • Read a book. The act of reading in a quiet setting sets the mood for a restful night.
Bedtime Reading

DON'Ts

  • Avoid alcohol before bed. Although alcohol can help you feel sleepy, the metabolism that occurs can disrupt your sleep cycles, interrupt circadian rhythm, block REM sleep and aggravate breathing problems.  In addition, it results in increased bathroom trips.

  • Limit caffeine intake to 300 mg to 400 mg and avoid intake at least 6 hours before bed.

  • Avoid blue light during the winding down process. Objects that contain blue light are cell phones, tablets, computers, and TV’s.  Blue light suppresses melatonin production and interferes with your normal circadian rhythm.

  • Avoid stimulatory activities and mediums. Avoid planning for the next day if this is generally a stressful process.  I tend to read a fictional book before bed because it helps me take my mind somewhere other than clinic and business.

  • Eating large portions of crappy food before bed. Small snacks consisting of protein and complex carbs may help you sleep better.
Phone at Bedtime

The biggest violator to good sleep in our society is the increased blue light and stimulatory activities before bed which often results in an increased time to fall asleep.  Also, the workaholic mentality that is a hallmark of our country is silently destroying us.  Pushing our work into the late hours of the night all but virtually guarantees starting the next day with a struggle.


 

Take It Seriously!

So put down your phones and make an attempt to get around 8 hours a sleep a night.  Plan ahead and coordinate an effective routine to get you on track in the evenings.  If there are potential medical problems preventing quality of sleep, then seek help from a medical provider.  If you are unsure of whether or not you are sleeping well, a well-executed sleep study may uncover more than you think.  You owe it to yourself and your family to operate on a full tank.


 

Text Neck

Text Neck – Fad or For Real?

Text neck, or tech neck, is a term that seems to be commonly tossed around nowadays.  So what exactly does it mean?  Put simply, it refers to the poor postures and positions that we put ourselves in when using our electronic devices.  I don’t think anybody will argue with the increasing trend of technology in our society.  However, I find that many people are in denial on whether or not they are guilty of the accusation of text neck and poor posture.


 

An Evolving Trend

As society continues to rely of technology, and technology continues to be at our finger tips, I believe that the ramifications of text neck and poor posture will increase.  Just look around!  Human beings, once thought of as social animals, sit in groups amongst each other staring at their digitized screens in silence.  To make matters worse, text neck and poor posture is not limited to cell phone use.   Computers, tablets, and even driving a car are all perpetuators of poor posture.  The uses of these devices seem to have one thing in common, flexed postures.  Flexed posture involves excessive forward head positioning, slouched shoulders, and a rounded spine (especially the upper back).  These characteristics typically result in a common term in the rehab and fitness world, upper cross syndrome.  The reason this posture is such a problem is not because it looks unappealing, but because of the ramifications it has on the musculoskeletal system.  Our body was designed for a specific reason, movement.  Continued slouching, regardless of cell phone use, ultimately causes restrictions in our spine and adaptive changes within our muscles.   We often find that certain muscles become “tight” or “short” while others become “weak” or “long”.  This is obviously an over simplification but the basic principles are fairly consistent when evaluating people who work jobs based around technology.  Not to mention, these postural characteristics seem to be more prevalent in our younger populations.  All in all, prolonged poor posture when using technology has contributed to us becoming an imbalanced mess resulting in neck pain, low back pain, and headaches.

 

Text Neck

Control by Pawel Kuczynski


 

Good

Good Texting Form

Bad

Bad Texting Posture

So what can you do?

Well, the first step is admitting you have a problem.  Frankly, the majority of us do.  It is the product of our society, and as stated earlier, it’s only getting worse.  Have you seen a teenager not looking at a cell phone lately?  Neither have I.  Without proper efforts to address posture in all ages, we may all look drastically different in our old age.

At Elite Chiropractic and Performance, we will assess you in a comprehensive manner which includes discussing your lifestyle and habits and possibly calling you out on your posture!  Treatment consists of joint manipulation/mobilization and various soft tissue techniques to help remedy the effects of text neck and poor posture.  Functional rehabilitation is implemented to further help balance the body out.  We will design a personalized home exercise program for you to employ while at work or at the gym to help you maintain positive results.  The ultimate goal is to optimize the individual so that they can move well and move often.  So correct your kids, correct yourselves, and most importantly, get checked out!  In the long run, your body will thank you.  It’s the only one you have!

 

---M. Chris Collier, DC