Articles

Staying Level Headed

When we talk about posture it is generally in terms of front to back discrepancies in the balance but side to side is just as important. A side to side postural imbalance is called Scoliosis. I’m not going to talk about structural scoliosis, where the bones of the spine have developed in such a way that the spine cannot stand vertically. Today I will be discussing functional imbalances that are more common than we think in the general population.

Our side to side movements and balance come solely from our spine and the muscles that run up and down it as well as out from it. An imbalance in these muscles or an outside influence can lead to a curve towards one side or another and this puts a lot of uneven pressure through the joints of the spine.

First of all, those squishy intervertebral discs that we have talked about so many times before will be pushed to the outer edge of this new curve and create uneven pressure on the outer tissue of the disc itself. If prolonged, this pressure will eventually weaken these tissues and increase the likelihood of the intervertebral discs herniating.

The pressure in the joints of the spine also increases the wear and tear they experience which leads to degeneration of the joints and the development of arthritis. The most noticeable and immediate symptom of this imbalance is sore and spasmed muscles up and down the spine. Really muscle spasms and functional scoliosis are a chicken/egg debate that is different for each individual but they definitely go hand-in-hand.

Functional scoliosis can be influenced and/or caused by multiple different factors. The main culprits are bags that are carried on one side like purses, messenger bags, or briefcases. This added weight unbalanced us and puts an outside pressure across the spine. Backpacks on the other hand, when worn on both shoulders balance their weight evenly across the shoulders and low back so that the pressure is vertical and not horizontal. If the backpack is not packed evenly then this protection disappears, of course. This is why it is important to distribute the weight in your pack evenly on both sides.

Our shoes can even be the problem that leads to functional scoliosis. If they wear down unevenly then it’s the same as walking along an uneven surface. This can happen if our gait is off for any reason.

If you think that you have a functional scoliosis take a look in the mirror and really examine how level your body is at all points. Take a good look at your ears, shoulders, and hips as these are generally good indicators of balance horizontally. At our shoulders there is always a little discrepancy because the muscles of our dominant arm will be mildly bigger than the non-dominant one just from frequent use. In fact, we all have a very small mild scoliosis in our upper back which curves towards our dominant arm for this reason. That scoliosis is harmless as the body has adapted to it since childhood and found a balance around it.

So what can we do about it? Really the only help that we can get fixing a functional scoliosis is through rehabilitation and chiropractic care. A chiropractor or physiotherapist can determine if a functional scoliosis is appropriate or the result of an imbalance which should be removed. Through training and manipulation an inappropriate scoliosis and its root cause(s) can be alleviated and resolved. The only thing that we can do at home by ourselves is to make sure that when we work out we stretch and exercises both sides of our body evenly.

So take a good look at the mirror now and then and honestly answer this question, “How level headed am I?”

Thanks for reading,
Dr. Ben

Winging It: Scapular Instability

In the past we have talked about the importance of our posture and our rotator cuff muscles but we really haven’t talked about how they are connected yet. Pretty much everyone can identify their shoulder blade (“Scapula”) but can you say what it is for? It’s a weird flat bone that sits on your upper back and just kind of floats there, but everything in the body has a purpose (except for those wonderful vestigial organs like the appendix). The scapula’s purpose is to act as an anchor to the arm. It holds the ends of the rotator cuff muscles as well as the Biceps, Triceps, and the Deltoid muscles. Now what is the most important aspect of an anchor? That’s right! Stability! Just like our core muscles, our shoulder blades should remain rock solid when we need them but still have some mobility to adapt to changes in arm movement and pressures.

So how can a flat bone be both stable and mobile at the same time? The scapula sits on top of the rib cage with a connection to the collar bone (“Clavicle”) at the front. This connection should not provide mechanical support but only act as a guide for the position of the scapula relative to the rest of the body. The stability of the shoulder blade comes from the muscles that surround it. These “Scapular Stabilizers” pull the boney plate in different directions and lock it down thus allowing it to remain stationary while the prime movers of the arm (Deltoid, Biceps, and Triceps) use it as their anchor.

Posterior (Back) Shoulder Bony Anatomy

Posterior (Back) Shoulder Bony Anatomy

 

Anterior (Front) Shoulder Bony Anatomy

Anterior (Front) Shoulder Bony Anatomy

These Scapular Stabilizers consist of the Trapezius (Upper, Middle, and Lower), Rhomboids (Major and Minor), and Serratus Anterior muscles. Both Rhomboid muscles as well as the Middle Trapezius help to pull the scapula in towards the spine while the Upper Trapezius muscle pulls the scapula up and the Lower Trapezius pull it down and in. The Serratus Anterior opposes muscles by pulling the scapula out and forwards towards the front of the ribs. There are other muscles that attach to the scapula and help to stabilize it but these are the major actors on this stage.

We’re discussing these muscles and their role in shoulder function today because we do not use them correctly. If we were properly stabilizing our shoulder blades they would remain firmly pressed to the back of our ribs but the most common postural pattern in the Western World does not do this. Generally we are slouching forward which rolls our shoulder blades out and forward, around our rib cage. This position puts a lot of mechanical pressure on the joint with the clavicle and causes the Upper Trapezius to bear the weight of the shoulder and arm. Through maintenance of this position the Lower and Middle Traps, the Rhomboids, and the Serratus Anterior all weaken from lack of use and are not able to act upon the scapula as they should. When this happens it is called a “Winging Scapula” because the inner edge of the shoulder blade pops away from the ribs and sticks out like a wing and it means that our scapula cannot provide the stability it needs to. Scapular instability leads to increased risk of injury to the shoulder and arm, specifically the rotator cuff muscles and the Acromioclavicular joint (the joint now under pressure between the scapula and the clavicle).

Winging Scapula

If you have been reading my blog for any amount of time you know that I am all about preventing injuries and reducing the risks we expose ourselves too. So to get out of this problematic position we need to retrain our muscles to hold the shoulder blades in place. There are two fairly simple exercises that can accomplish this. The first we’ve talked about before and I call it the “Pocket Push”. The second is demonstrated very well in the video. The sound is a not great so use some headphones or watch it in a quiet space to hear all the details.

No matter how much some of us might wish for wings to fly, a Winging Scapula is not going to help at all. Tuck in those flat little bones and sit up. It will do your body a world of good.

Thanks for reading,
Dr. Ben

Shoes and Our Feet

A while ago I wrote a post about our Feet and Chiropractic Care and today I would like to expand on that a bit. Today we are going to be looking at footwear and their impact on our feet. There are many different types of shoes out there but we will be looking at a few of the more common ones that people wear on a regular basis. For a reminder of proper foot biomechanics take a look back at the original post on feet

The biggest criminal in the shoe world is the high heel. I touched on this briefly last time but let’s go into more detail now. High heeled shoes take the foot, which is designed to spread the weight of the body evenly between the forefoot (toes and arch) and the hindfoot (heel and ankle), and angles it so that all that weight is now on the balls of your feet. The higher the heel, the greater the amount of weight bearing down on this one area. This puts a lot of pressure on the tissues between the bones of your toes. Add to this the restrictive nature of high heeled shoes (trying to maintain some stability) and you have a bad mixture which can lead to a condition called “Morton’s Neuroma”. Morton’s Neuroma is the build-up of scar tissue around the nerves that run between the bones of our forefoot and into our toes. This scar tissue takes up more space than we have available and so squeezes the soft tissues of the nerve and can cause significant amount of pain. The most commonly suggested solution to this problem is surgery where they cut the nerve to kill it and we lose all feeling to that part of the foot and toes. Not the most desirable of situations. Chiropractic and Acupuncture treatments can have a good effect on this condition but are much more effective if caught early.

At the other end of the foot we have the ankle being held in a toe-pointed (Dorsiflexion) position which is not good for it. The pressure that runs down the bones of our shin (Tibia and Fibula) should be transferred through the middle of the ankle joint but instead if pushing down on the back side of the bones. This puts pressure into the closest joints can causes tension in the ankle and hindfoot joints which can cause pain and discomfort. As well, this maintained dorsiflexion put the Garstrocnemius in a shortened position when, as I’ve talked about before, muscles like to reset their default length to the one they spend the most time in. That means that prolonged use of high heels will make it more difficult to bring the ankle through its natural full range of motion and thus make it hard to perform proper biomechanics of walking when not in high heels. Regular stretching and Chiropractic care can help clear up these tension and tight muscle problems.

Flip flop sandals are the next big culprit. They are on almost everyone’s feet during the summer but they are not very good for us. The problem is that we have to work to keep them on while moving around. This means that we grip them with our toes so that they don’t go flying off or twist under our feet. In doing this we eliminate a key part of the gait cycle (the pattern of our walking stride) called “Toeing Off” when we are pushing off with our back foot and our toes are relaxed and extended. This applies to both thong and Berkinstock style sandals. Sandals that strap to our feet around the ankle and will stay on without us actively keeping them there are fine. The gripping action of our toes causes tension along the bottom of the foot and can lead to discomfort and foot problems down the road. Massage, Acupuncture, Physiotherapy, and Chiropractic are all great choices in dealing with this kind of tension.

The next type of shoe I would like to discuss is ballet slippers. These little flimsy slip-on shoes are an interesting conundrum. The provide no support what-so-ever, which is not a bad thing for our feet but the majority of people do not have the muscle strength and endurance to support a barefoot because of the way we have treated our feet in the past. On the other hand we need to challenge our feet to support themselves but in this case the necessity of the shoe trumps our foot’s need. In order to stay on the slipper needs to be snug on the foot from toes to heel, which does not allow for full range of motion of the toes as they splay out and extend back as we are toeing off. So in the end I would say these shoes are not great but are definitely better then high heels by a wide margin.

Men’s dress shoes are much like women’s high heels in their rigidity compared to other shoes out there. They are stiff and do not provide much ability to accommodate the movement of the arch and toes during our gait cycle. A well worn in pair will be more flexible but to get to this point we have to put up with a lot of discomfort and dysfunction in our feet.

At the other end of the spectrum we have athletic shoes. These puppies are designed to be perfect for the foot. They cushion the foot but also allow it to move when it needs to. The only problem with these types of shoes is that they are only designed for one activity. So when doing anything else they are not necessarily what we need. Depending on the sport they can be too restrictive in the ankle or hold the forefoot too tight for everyday life. The only exception that I would say if good for most things is a real running shoe. They are designed for our gait in a wide variety of speeds.

So is all footwear bad? Can we every find something that won’t hurt us? Well, of course we can. The ideal shoe is one that is relatively flat so that the ankle is aligned and weight is spread even throughout to foot. It needs to provide some support as our feet are not used to working by themselves but not too much so that our feet will have to work a little and we can keep them strong. This shoe should also allow for full ankle range of motion and have a flexible enough sole to allow for our toes to extend during toeing off. Make sure to really explore all the aspects of a pair of shoes when buying them so that you don’t regret it later. Of course we can’t limit ourselves completely in our lives. If you have a pair of shoe that you absolutely love you can still wear them but I highly suggest only doing so sparingly. Also, no matter what shoes you wear, we should all spend a portion of the day barefoot so that our feet can move the way they were designed to. Make sure your feet and healthy and happy and the difference in your life will be amazing.

Next week we will take a look at some exercises for the feet which will help to keep us strong and mobile.

Thanks for reading.
Dr. Ben

Thoracic Outlet Syndrome: Posture’s Problem Child

Welcome back to my blog! This is the first post to DrBenRoffey.com so I would like to take a moment and say Thank You for coming by and I hope that you can learn something from what I do here. If you have any questions about what we discuss here or about any aspects of health or healthcare my door is always open. E-mail me at drroffey@gmail.com and I’ll get back to you as quickly as I can.

And now back to our regularly scheduled blogging.

One of the more common conditions that walks into a chiropractor’s office but you don’t hear much about is called “Thoracic Outlet Syndrome” (TOS). This is a condition which is not terribly serious but the symptoms can be very scary and if left long enough can cause become fairly debilitating.

First of all let’s look at what this condition is and what causes it. The Thoracic Outlet is the triangle shaped space between your collar bone, shoulder blade, and the base of your neck. Through this space all of the arteries, veins, and lymphatic ducts travel to and from the chest cavity (Thorax) and out into the arm. These structures are also joined by the nerves from the neck that travel to the muscles and skin of the arm. That is a lot of stuff going through a fairly small area. Thoracic Outlet Syndrome occurs when any or all of the nerves, arteries, or veins become compressed which causes pain, numbness, and or tingling, in the hand and arm

The compression of these structures can happen in several different ways but most are due to poor posture, specifically hunching of the upper back (Thoracic spine), rolling forwards of the shoulders, and the head pushing forward in front of the shoulders. Any or all of these postural positions will stress and strain the muscles around our skeleton and cause them to tense up to hold the weight we are not placing upon them. As the angles of these muscles change and their tension increases dramatically they will push against the nerves at the base of the neck and the arteries and veins exiting and entering the top of the rib cage (the Thoracic Outlet) thus causing Thoracic Outlet Syndrome.

The pain and numbness or tingling associated with TOS can be continuous or episodic in nature depending on the amount of pressure on the structures and they usually have a specific area that they stays within. Most commonly the symptoms are experienced in the hands but over time they may spread into the forearms and even up into the shoulders. People with TOS may also notice a decrease in sensation in the areas affects. If left for a long period of time without treatment muscle weakness can occur in the hand affected.

The exact areas of numbness and tingling and change in skin sensation will be different depending on if it is the nerves, arteries, or veins involved but in general the hand and forearm are the most common areas to experience these symptoms. These symptoms can be mimicked by other conditions such as Carpal Tunnel Syndrome, Herniated Intervertebral Discs in the neck (Cervical Spine), and even active trigger points in the rotator cuff muscles that can refer pain down into the hand and fingers. Make sure you see a doctor to determine the true cause of your pain.

When you go to a doctor they should ask a series of questions and perform a number of tests on you to help determine the nature and source of the problem. Thoracic Outlet Syndrome reacts very well to complementary treatments and therapies including chiropractic, acupuncture, massage, and physiotherapy all have excellent results.

Posture is an extremely important thing in our lives and if we maintain a good posture we can avoid conditions like TOS. So I hate to say it but our mothers were right, “Sit up straight and stop slouching.”

Thanks for reading,
Dr. Ben

Chiropractic and Ribs

(Originally posted on bcotoronto.com on June 6th, 2013)

Chiropractors can adjust any movable joint in the body but the one that people seem to always be surprised at is a rib adjustment. It turns out that most people think that ribs are immobile bones that only protect the chest but there is so much more to them than that.

Ribs to function to protect the organs of the chest and stabilize the thoracic spine but they also play an important role in how we breathe. Our lungs are not muscular organs and so cannot draw air into themselves. It is the responsibility of the diaphragm and the ribs to do this. The diaphragm descends into the abdomen which pushes the ribs out and up in what is referred to as a “bucket handle” motion. This expansion of the chest pulls the lungs out in every direction drawing air in. Relaxing the diaphragm lets the ribs descend and the elasticity of the lungs pushes the air out again.

The ribs are attached to the spine at the back and the sternum in the front. At the spine, the ribs form a joint with the vertebrae which is surrounded but many little muscles. The joint between the ribs and the sternum at the front is slightly more ridged. The ribs end just short of the edge of the sternum and cartilage fills that gap. This does allow some movement as the cartilage is supple and flexible. With these joints as they are the ribs are able to move well and aid in breathing while providing the boney protection to our heart and lungs.

This is, of course, if we are treating our body correctly, which most of us are not. As a society our posture is terrible. We slouch forwards which does not allow out diaphragm to descend as well. This forces us to compensate and use the muscles of the back and shoulders to pull the ribs up to expand our lungs rather than letting them be pushed up by expanding our abdomen. As it happens in all cases of muscular compensation this puts a strain on muscles they were not meant to take. This leads to muscular spasms and pain as well as joint dysfunction in the areas of the spasm. So all these muscles clamping down and holding everything tightly means that the ribs will not be able move properly and hinder breathing. This can be quite uncomfortable and even make breathing painful.

Muscular spasm and improper movement of the ribs will eventually pull the ribs “out” which is not to say that our ribs will fall off but that they will stick out from where they should be. This is not a dislocation but it is a misalignment which can be corrected through adjustment. The adjustment will help to relax the spasm of the muscles, restore proper movement of the rib, and help to improve breathing.

This type of dysfunction is incredibly common and is so simple to reverse. Adjustments paired with postural exercise can restore full breathing capacity and maintain it. This is especially important for people who have difficulty breathing with conditions such as asthma, emphysema, and even smokers.

So make sure your ribs are moving and breathe the fresh air this summer.

Thanks for reading.
Dr. Ben