Cervical core strength

When discussing core strength and stability training, we often focus exclusively on the trunk and lumbar spine, while forgetting the cervical spine. This does not do us justice since cervical core strength is equally important, possibly more so since our modern sedentary lifestyle tend to deactivate a lot of our stabilizing postural muscles from the shoulder girdle up to the head. It should be noted that cervical strength and stability also depends a lot on the overall strength and stability of the trunk and upper extremity especially, so any attempt to stabilize the cervical spine from chronic reinjury does need to involve some shoulder strength training for sure. However this relatively simple exercise done in the supine position can be very powerful in engaging the deep cervical core muscle group, which is the equivalent of the deep abdominal group in the lumbar spine. Most patients are surprised to find out how really weak this muscle group is when we test them in the office. It will often require patients to start with relatively short interval of times in order to practice the exercise and stable form. It's also important for patients to have a slight chin tucked, imagining holding a tennis ball or an orange between their chin and the chest, in order to gauge the deep cervical muscles and other superficial muscles like the SCM.

https://www.youtube.com/shorts/VR8uic1-0N4

LEG LIFT EXERCISES WITHOUT LOW BACK INJURY

https://www.youtube.com/watch?v=Q2m3qCbinzA

After 30 years of practice there are some injuries that you know like the back of your hand. One such common injury is the lumbosacral hyperextension strain from leg lifts. It mostly happens to patients who have not been doing any form of core workout for while and decide to take on this rather challenging workout practice without the appropriate gradual ramp-up, but I've seen it happen even in seasoned gym rats. The problem is the amount of hyperextension loading when someone tries to do bilateral leg lift starting in a supine position with flat legs on the table. It's an extremely high leverage for the lumbosacral spine if the abdominals are not optimally efficient at immediate initiation and stabilization of the low back. Leg lifts can be a great addition to a core workout and can be safely done with 2 small modifications: starting with the legs in the up position, only lowering them in a range that allows the lowback to stay in contact with the exercise mat; during the exercise one leg at a time to build up strength and endurance and stability rather than both legs at the time, which may be achieved over time.

How to dodge the "senior slug": free exercise resources from Silver Sneakers

After today's 12 inch dumping of wet snow, spring much the summer feel a little bit elusive. I've had several conversations in the last 2 weeks with patients who find themselves in the same predicament: recently retired (within the last 2 years), previously physically active informally through their job, currently dealing with increased neuromusculoskeletal issues that stem from deconditioning. I found after 30 years of practice that transitioning into retirement can be fraught with loss of normal physical stamina if a retiree is not intentional about structuring a bulletproof routine that makes up the inherent physical activity that was built in the previous occupation. I think it's a phenomenon that often is below people's radar, who have the false impression that their life is busy enough to meet those needs, but in reality, when testing their strength, cardiovascular endurance, those patients often fall short and have actually rapidly deteriorated over 12 months. This being compounded by the fact that the Minnesota winter is not always conducive to normal outdoors activities when it's cold dark and slippery.

At any rate. There are a lot of opportunities out there but some patients who never formally exercised in their earlier working life are little bit at a loss of where to start. 1st, you need to try to determine what is it you'd enjoy doing enough to do it consistently. It's going to be different for different people and you need to best isolate that, since it is a lot easier to stick with something you don't hate.

1 underutilized resource for our seniors eligible for Medicare is the silver sneakers program. It's often a benefit of most Medicare C and Medicare supplemental policies. Silver sneakers is basically a free program of senior focused fitness routines that comes in a variety of formats: in person group classes for seniors only at local participating gyms, lifestream classes schedule multiple times a day, and a collection of video resources. All of them are excellent, carefully designed with senior needs in mind, and covering a variety of options from home cardiovascular walking, balance exercises, chair yoga, gentle strength training etc.

Below is the link to the silver sneakers website. To see if your particular Medicare policy offers those benefits, you can do a quick eligibility check. If eligible you just have to create your login credentials and you're all set to go. I will happily assist you in selecting a couple of good starting classes based on what I know of your health.

https://tools.silversneakers.com/Eligibility/CheckEligibility

PAIN AND EXERCISE: GOOD PAIN VERSUS BAD PAIN

“GOOD PAIN” VERSUS “ BAD PAIN” PAIN FROM ACTIVITY AND EXERCISE

A question that arises commonly as we tackle the rehabilitative phase of a patient’s treatment plan, is what level of discomfort is to be expected and tolerated when patients start resuming normal activities or pursue exercising when being treated for an acute or chronic condition. In other words, what is the defining line between good and bad pain?

First, we should talk about when we start introducing therapeutic activities in the first place, especially when patients are acute, as some patients are pretty eager to start exercising to get better faster. As a general rule, I may not add much beyond in office treatment and light walking, breathing, general movement and active range of motion stretching in the first week or two of treatment. You cannot inherently strengthen or stabilize something that is completely dysfunctional or structurally misaligned.

Usually by the end of the second week at the latest, we can start adding more specific activities. With the input of the patient, we look to find the right balance between pushing the patient enough to make gains, and not pushing so hard as to reinjure. It can be a bit of a balancing act, and I give the patients three guidelines to stay in the safe zone:

-          There is a difference between pain and soreness. Soreness is a normal reactivation reaction that is more of a generalized discomfort. Sharp pain is normally to be avoided as a sign that you are pushing too far too fast.

-          I like to use the 2 points on the 10 scale rule: during the therapeutic activity, it can be OK to have a little more discomfort than at baseline. For example, if youR pain at rest is a 2 on a 10 scale, it can be at a 4 on a 10 scale, but really you should not let it get much higher.

-          The discomfort associated with the activity should not significantly outlast the activity itself, ideally returning to baseline within 30-60 minutes.  If post activity related pain lasts into the rest of the day, if it interferes with sleep, if it is still present the following day, these would all be indications that you are pushing too hard, too fast, or that the exercise is not right for you.

There is not a one size fits all solution to what discomfort is OK in your situation, and you ultimately need to discuss that with your provider. Some people have underlying conditions that will carry a little more baseline pain during the rehab phase ( inflammatory arthritis, meds, fibromyalgia), that will require creative accommodations. But in the end, where there is a will, there is almost always a way to get stronger.

Photo courtesy of Freepik

Walking safely when the ground is icy

The conditions of the last few weeks often reminded me of this important seasonal resource that I never get tired of posting with great delight. Several of my patients enjoy getting some mild cardiovascular activity doing outdoor walking, and while there is nothing that will fully replace that, it's really not a safe option when we have a persistent layer of ice that may be with us until April.

The walk from home free YouTube channel allows you to get a good cardiovascular routine using a small amount of space, a huge variety of videos of different durations and complexity, and a lot of fun music and coaching. Please remember that you have alternatives, and really no excuse, to continue getting a little bit of cardiovascular endurance during the winter months.

https://www.youtube.com/@LeslieSansonesWalkatHome

3 technique pointers for a safer deadlift

3 TIPS FOR A SAFER DEADLIFT

I've found myself teaching those instructions to patients often enough that I decided to make a quick video about it so I can refer patients to view them again after the appointment. While I have not spent as much time as Dr. Steve in a traditional gym setting, I've done enough deadlifts in my own exercise time to know how quickly they can go wrong, especially if you happen to be recovering from a recent lumbar strain or any other lumbar injury. The main goal of the debt lift modification is to keep a stable flatback in maximum descent and muscular contraction. The 3 modifications, namely wide stance, slightly flexed knees, and firing up the good muscles ahead of time, facilitate maintaining a safe lumbar posture

(photo courtesy of Freepik)

https://www.youtube.com/watch?v=sFqTF5iy3WQ

Shoulder strength and stability: hug the ball

https://www.youtube.com/watch?v=YfpNnMjEsqw

When working with patients with shoulder girdle weakness and instability, whether from an acute injury or more of a chronic postural strain, there are a couple of foundational exercises that we will use as a starting point for strength and stability recovery. Those exercises can be done safely as a starting point with little to no risk of injury when performed correctly, and can be used as a progression tool to more aggressive strength building.

The "hug the ball" (or hug the pillows) exercise allows patients to recruit the scapula stabilizing muscles and prevent some of the chronic rounded shoulder and shoulder blade winging. The ball or the pillows allow for a counter resistance that can be light or intense, and allows for a slow eccentric release. The main technique to pay attention to is making sure to engage the deep interior blade muscles to squeeze the ball and not the biceps.

Shoulder strength and stability exercise: crocodile pushup

https://www.youtube.com/watch?v=frjhTszm3Cc&t=21s

On the same topic of shoulder strength and stability foundational exercises, this form of modified push-up is a great tool to be used as a stepping block when patients are extremely weak following a shoulder injury and not quite ready to do more traditional plank type exercises. Like the hug the ball exercise, it can be gradually made more challenging as the patient progresses in their recovery.

The "crocodile push-up" ensures that the elbows are facing the knees, keeping the elbows from flailing out, and the glenohumeral joint firmly centered in the socket. The patient will start doing the exercise from the knees up, and can bend as little as needed in order for the isometric hold to be tolerated for about 5 seconds before a slow release. The patient can eventually progressed to lower push up, longer hold time, and full plank starting position.