Tag Archives: rehab

Why do I Keep Straining My Neck?


By Gavin Buehler, RMT

Disclaimer:  Please consult your healthcare provider before engaging in any of the activities or suggestions that are highlighted in this article/video.

During this time of the season the coaches and therapists at Active Life tend to notice a rise in complaints surrounding the neck and shoulder area.  Generally it’s a little more stiffness than usual or mild “tweaks” frequently around the posterolateral (side/back) area of the neck. 

So why the sudden rise in these occurrences during this time of the year?  Our posture seems to change with the colder weather and maybe even from the stresses that may have been incurred over the holidays.  We channel our inner turtle power (everyone knows Raphael was the coolest Ninja Turtle) and manage to suck our heads into our protective shells between our shoulders, usually with our chins poked forward, and with added stress our breathing becomes shallow adding more to strain to some of the neck musculature that assists in breathing.  Spending more time in this type of posture can make the neck and shoulder area more susceptible to these aches and injuries. 

To understand why this is happening we need to take a closer look at the functional anatomy of these muscles, and since there’s a lot of them, I’m going to focus in on a muscle that I’ve found to garner the most complaints, the levator scapula.  This muscle takes a lot of abuse and is one of the most common reasons why I see people on my table.

As you can see in the diagram, the levator scapula originates from the transverse processes of C1-C4 in your neck and attaches to the superior aspect of the medial border on your scapula (shoulder blade).   Looking at the fiber direction and attachment points, we can see that its functions include scapular elevation (lifts shoulder blade up), scapular downward rotation (rotates shoulder blade down) and ipsilateral cervical flexion and rotation (rotates and flexes neck to the same side).  The most prominent action is the downward rotation of the scapula and it’s important to recognize this along with the cervical attachment points due to the impact this can have on overall shoulder movement.  Explanation is provided in the video along with a demonstration of actions.

When we’re in a forward head carriage postural position, this puts tension on the levator scapula pulling the shoulder blade into downward rotation.  This is generally the opposite movement of where we want our shoulder blade to go for the majority of our daily activities seeing as they are performed with our arms in front of our bodies where upward rotation of the scapula is required.  So we have a muscle that’s connected to our neck that’s pulling in the opposite direction we’re trying to go with our arms, inhibiting optimal movement of our shoulder causing compensatory muscle activation and firing patterns.

The postural placement of our head can interfere with the range of motion in our shoulders.  So if our heads are forward and our shoulders a little shrugged up and we go and try to do anything with our arms, such as reaching for a door handle or shoveling, we’re putting added strain on a muscle that’s already in a stretched position making it easy to “tweak.”

Be conscious of your posture and stand tall and proud with your ear in line with your shoulder to minimize your risk of injury and maximize your shoulder movement.

How Poor Posture Creates Tight Calves

By Gavin Buehler, RMT

Disclaimer:  Please consult your healthcare provider before engaging in any of the activities or suggestions that are highlighted in this article/video.

An issue that’s becoming more prevalent in my practice is lack of ankle mobility, particularly with dorsi flexion (foot flexes up toward shin).  I’ll hear comments about how calves always feel tight even though the individual is always stretching them out.  While the calves feel like they have an issue, the problem might stem from somewhere else.   In a case where I hear comments such as above, looking at the body globally and assessing postural alignment can help find the source.

Two fairly common postural patterns that are just about guaranteed to produce limited ankle mobility as well as many other problems that I won’t dig into in this article are “sway back” and “hyper lordosis.”  In both cases a dysfunction through the core triggers compensatory patterns in order for the body to keep balanced.

Sway Back Posture

Sway Back – In the case of the sway back posture the pelvis shifts forward off the plumb line usually presenting with a posterior pelvic tilt and flattening of the lower back.  There are many possible reasons for this that may include weakness in the transversus abdominis (TVA), imbalanced internal and external obliques, glute weakness, poor sequencing etc.  But it’s the lack of support through the core that displaces the weight creating an “S” like posture when viewed from the side.  With the pelvis shifting forward, the upper torso needs to shift back making the head shift forward.  In the lower body knees will usually lock out in hyper extension and due to the angle that the weight is being driven through the tibia, a constant posterior glide at the talocrural joint (ankle) stresses the Achilles tendon.

Hyper Lordosis Posture

Hyper Lordosis – With hyper lordosis a slightly different “S” like pattern forms as the pelvis dumps forward in an anterior tilt which tends to create a flatter upper back and exaggerates the arch in the low back shifting the torso forward off the plumb line.  The weight displacement of the upper body causes the lower body to compensate by pushing the pelvis backward as well as the knees in a lockout position.  As with the “Sway Back” posture, this places the tibia at an unfavorable angle to bear load through the ankle joint.

There are a number of other issues that are also formed with these postures, but since this article is about tight calves, I’m just going to highlight how they are affected.  In both the sway back and hyper lordosis cases, these postures produce a constant stress on the calves through both the knee joint as well as the ankle joint.  The calves are in a lengthened state crossing the knee and working hard to fight hyper extension and stabilize the joint.  Through the ankle, because of the way the weight is being distributed through the tibia (lower leg) and the angle that it is forced to meet the talus (foot bone), they’re again stretched and working hard to combat the posterior glide and stabilize.  The body’s nervous system will perceive these areas as being unstable causing the calf muscles to brace for stability making them tight.  No amount of stretching will remedy this type of tension.  In order for mobility to take place in any joint, there needs to be stability for your nervous system to allow the movement.  

To address the constant tension through the calves, postural improvement is needed first to place the load of the body in an optimal position where the joints are stable.  Improving the function of your core will generate the greatest success in these situations.

In this video I explain the compensatory patterns and offer a simple tool to help improve your posture.

Movement Tip: The Bird Dog

In my last post I went over the McGill Curl-Up as a movement to assist in core stability to help prevent low back pain.  I mentioned that it is the first movement in Stuart McGill’s Big 3 movements.  The movements should be performed in the order of the Curl-Up, Bird Dog and Side Plank.  I’ve previously posted a demonstration of the side plank, and thought that I should probably finish off the series so that you have a full reference.  So today I will outline the Bird Dog.

The Bird Dog involves the extensor muscles in your posterior chain (back line) and can be performed with legs only or arms only as a regression.  Another option for regression is to begin with lifting your hand and knee only slightly at first and making sure that you are able to maintain your balance and stability.  From there you can slowly begin to extend in small increments over time until you are able to perform the full movement.

Taking your time with these exercises and focusing on the execution makes all the difference.  It’s the small nuances that separate okay results from great results.  These movements in particular are meant to be very controlled and deliberate.  Just flying through them using momentum and zero thought which is unfortunately how I generally see these performed, will not yield any benefit.  Please take your time and have patience.

This movement begins in the quadruped position with hands placed under shoulders, knees under hips and spine in neutral position.  Your hips and shoulders should be square with one another maintaining this throughout the entire movement avoiding torsion.

Engage your core similar to how we did with the McGill Curl-Up by thinking of cinching a corset tight around your waist, holding in your pee and poop, and bracing as if you will be punched in the stomach. There should be a slight draw in of your navel and you should still be able to breathe with this engagement.  Maintaining the slight draw in of the navel will be more challenging in this position as gravity is pulling down on your insides and your torso isn’t resting on the floor.  Your TVA will need to work a little harder.

Slowly raise opposite leg and hand and extend them thinking of placing them into position.  Think of length through your torso and reaching to touch the wall of the room you’re in with your extended hand, and the opposite wall with your extended leg as opposed to raising up toward the ceiling.  In fully extended position, leg and arm should be aligned with your torso, spine still in neutral position from head to tailbone and shoulders and hips still square.

Hold extended position for specified length of time before slowly returning to start position and repeating with opposite arm and leg.

Avoid excessive arching through your lower back and any twisting through your torso or lateral hip sway.

The video below outlines the full Bird Dog movement, but feel free to modify as necessary.  Thanks!

Recommended Variables to Start:
2-3 sets with 60 seconds rest in between, 6-10 alternating reps, 5-10 second isometric holds each rep.

Movement Tip: The McGill Curl-Up

When it comes to the topic of low back disorders, Stuart McGill is considered the top authority. His research and methods have assisted countless people. He’s authored many books such as Low Back Disorders and Back Mechanic that go into detail regarding many low back issues and how to treat or avoid them.

Low back pain is one of the most common conditions that I see, and in many cases the lack of spinal stability is due to weakness through the core region.  An easy fix is to incorporate some basic movements into your daily routine, to keep your core active and strong. Stuart McGill has a series of movements often referred to as The Big 3 that include the Curl-Up, Bird Dog and Side Plank. In today’s post I’m going to outline the Curl-Up. This movement focuses on the anterior (front) abdominals and Transversus Abdominis (TVA).  It is generally the first movement performed (after performing your Cat-Camel to warm-up to reduce spinal viscosity) of the series.

I’ll usually see this movement being performed with too much trunk flexion.  The rectus abdominis (6-pack) is the primary muscle used for trunk flexion and because this movement involves some flexion through this area, it’s easy to dominate with it.  However, the TVA is the deep muscle that provides the most spinal stability and it wraps around the torso creating a cylindrical like compression when engaged.  This is the muscle that we would like to be the most involved with this movement.  To trigger this engagement we need to focus on the compression with only some flexion.  To do this, try imagining a corset cinching tight around your waist.  Your TVA muscle is essentially a built in corset.  There will be a slight draw in of your navel (belly button) toward your spine, and then a small amount of flexion is added in the form of the curl-up to maximize the contraction.  So the curl-up isn’t the primary goal, it’s maximizing the contraction of the TVA which requires more cinching and some flexion.  When you add the curl-up portion of the movement, if you notice your stomach bulge out, so your navel is no longer slightly drawn in, you’ve lost that cinching engagement and are now primarily using your rectus abdominis.  If this happens, regroup and start over.  You may need to start out just working on the cinch without even adding any flexion, or if you can manage some flexion, you may need to start with some assistance from your elbows adding some support on the ground.

Below are the instructions and notes to perform this movement. Please watch the video for the full description. Enjoy!

  • Lie on your back on the floor with one leg bent about 90 degrees so that knee points up to ceiling and place hands under the arch of your low back with palms down so that finger tips touch one another.  If placing your hands in this position is uncomfortable, you may use a rolled towel as a bolster.
  • Engage core by thinking of cinching a corset tight around your waist, holding in your pee and poop, and bracing as if you will be punched in the stomach. There should be a slight draw in of your navel and you should still be able to breathe with this engagement.
  • Slowly raise your torso off the ground just enough that shoulder blades are hovering, maintaining a fairly neutral spine from head to tail bone with only slight flexion.  Think of being long and cinching around waist as opposed to crunching.  Hold position for specified time.
  • Slowly return to start position and repeat.  Switch bent leg each rep or set.

**Note: Only raise torso as far as you can control your core and stability.  If you begin to crunch and your low back arches excessively (loses contact with your hands), or you notice your stomach pushing out instead of slightly drawing in, back off a little until you can control the movement throughout.  You may need to assist with a little pressure into the floor from your elbows until core becomes strong enough to support without.

Recommended Variables to Start:
2-3 sets with 60 seconds rest in between, 3-5 reps, 5-10 second isometric holds at the top of each rep.

This video/article is intended to assist those who have consulted with their health practitioner regarding their specific condition and received this exercise as a prescription. Please consult your health practitioner before performing any exercise on your own.

Movement Tip: A Proper Side Plank

The side plank is an often prescribed exercise intended to help build core strength focusing on the oblique abdominal muscles.  It’s an exercise that I find many people brush off as relatively easy.  They feel that to really get those oblique muscles they should be torquing and twisting their torsos.  If we’re being honest, a medicine ball twist certainly looks like more fun that just hanging out in a static hold.  So, I can appreciate the allure.

I always feel that simple is often better, and if you think a side plank is too easy, then you are not doing it properly.  I don’t think that anyone would argue that gymnasts have some of the strongest mid sections around, and as a former gymnast I can tell you that before we ever started twisting, we spent a lot of time in basic static holds.  Another consideration is that if you’ve already got some sort of low back discomfort and you’ve been told to “strengthen your core,” picking twisting movements that require you to already have a strong core are not going to help you, and you’ll probably end up hurting even more.

The side plank is a fail-safe exercise to build a strong mid-section.  If done right, it is highly effective and difficult at nearly any level.  It’s a rare occasion that I see it performed properly, so I hope that this article will help you with nailing down a proper side plank.

To execute this exercise, lie on your side on the floor and prop your torso up by using the floor side arm and placing the elbow stacked under your shoulder with forearm flat on the ground.
Align your body so that head, shoulders, hips and ankles are all square and stacked with one another.

Raise hips off the ground creating a straight line from the top of the head through to your feet with a neutral spine as if a steel rod were passing through you.

Core should be engaged by thinking of cinching a corset tight around your waist, holding in a poo and pee, and bracing as if you will be punched in the stomach. You should still be able to breathe with this engagement.  Hold for specified time.

Think driving elbow and forearm through the ground to give shoulder space and proper support. Shoulder blade should be braced against rib cage throughout movement.

Your body should have a slight tilt forward so that your shoulder blade follows the curvature of your rib cage and is in optimal position for support.  The slight tilt will also put emphasis on the obliques.  If stacked perfectly perpendicular to the ground, the load distribution begins to be shared with other lateral support muscles such as the quadratus lumborum (QL).  This might be okay if that’s your goal, but I have found that most people are fine in this position, but as soon as the slight tilt is implemented, they start to collapse.

Slowly return to start position and repeat.

The most common error I see with this exercise is a twist through the torso where the shoulders are usually tilting forward and the hips are rolled back.  This will give you the illusion that you can hold the position for a long time as instead of using your muscles, you are counter balancing the load.  Shoulders and hips should remain square with one another.  Avoid twisting and rolling back of hips.  I find that balancing on the side of your mid-foot with your heel slightly floating off the ground helps keep you conscious of this.

See the video below for instructions.

Suggested Variables to Start:

2-3 sets with 45-60 seconds rest in between, 3-5 reps each side of 5-10 second isometric holds.