Why I Avoid Sit-Ups and Crunches

I hinted last week that sit-ups and crunches are not good exercises for strengthening your core, and if you’ll indulge me, I’d like to explain why.

1) They aren’t performed correctly
So many times I see people pulling on their head/neck to close the gap between sternum and knees (see picture below). What this does is initiate the motion from the front neck muscles, allowing them to be the dominant muscle group and the abdominals kicking in later (not to mention pulling the head farther in front of the body than it’s supposed to go).
                             
OR I see people tuck their feet under a couch or have someone hold their ankles (see picture below). This allows the hip flexors (the muscles that cross over the front of the groin area) to be the primary muscle that pulls the body off the floor.
                          
So in their pursuit of strong abs, these people have instead given themselves neck and low back strains. And don’t even get me started on the people who do sit-ups at lightning speed, as if trying to beat some unseen buzzer (increased momentum needs less muscle recruitment).

2) These exercises don’t match their purpose
Of the 4 different abdominal muscles (see last week’s post) crunches and sit-ups use the rectus abdominis and obliques since these are the muscles that move the trunk. It’s not guaranteed that the transverse abdominis and multifidus will activate in the correct way (especially if you have pain or have had surgery) since it’s not required for movement, only stability. Therefore, reasons like “I’m trying to strengthen my back” or “I want to improve my core” aren’t being met by crunches.

They will, however, train your body to repeatedly bend the spine forward, but you shouldn’t be doing that anyway. Anyone who’s taken an OSHA class should know you “bend the knees, not the back” when picking something up. We’re not supposed to bend forward to pick up objects because there’s a risk of straining the back—so why train it that way in the gym?

3) Increased abdominal pressure
When trying to bring the head down toward the knees during a sit-up it’s almost impossible to keep from internally directing pressure downward onto the back and pelvic area. If you have any kind of back injury or have had surgery this increase in pressure puts strain on weakened tissues beyond what they can tolerate. And if you are a woman from adolescence to post-menopause the increase in pressure onto a weakened pelvic floor can result in bowel/bladder incontinence or even organ prolapse. (More on the topic of the pelvic floor in a later post.)

All in all, there are so many other exercises that target core stability in a safer and much more effective way than either sit-ups or crunches. If you’re like me, you don’t have hours to spend at the gym working out; so what are some quick and easy exercises that will promote core strength? Tune in next week…

Core Stability Explained

What is “Core Stability”? This is a  topic where I geek out like none other and could spend hours discussing. Honestly, though, I think everyone would benefit from more knowledge in this area. So, over the next couple of weeks we’re going to cover core stability, what happens when your core is weak, and safe and effective ways to retrain and strengthen your core.

I guess first I should explain that you have four layers of abdominal muscles:

Rectus abdominis (RA): (aka: the six-pack muscle) Runs from the bottom of the ribcage to the pubic bone and gives “The Situation” his, uh, situation. This muscle’s main function is moving the ribcage and pelvis closer together.

External oblique (EO): Runs diagonally on either side of the RA. These muscles allow the trunk to twist to the opposite side. Ex: the right EO contracts to rotate the trunk to the left

Internal oblique (IO): Runs diagonally on either side of the RA but underneath the EO. These muscles also allow the trunk to twist but to the same side. Ex: Twisting to the left requires motion from the right EO and the left IO

Transversus abdominis (TrA): The deepest abdominal muscle layer—runs horizontally across the trunk and attaches to thick tissue on the back. Its role is to stabilize the trunk and maintain internal abdominal pressure. (Think about the effect of wearing a corset.)

There’s also another muscle I want to introduce you to—the multifidus. This muscle is located in the back, deep inside, along the spine. It works with the TrA to provide spinal stability, which helps protect the back against injury with increased movement or strain.

The TrA and multifidus are your primary stability muscles (along with your pelvic floor, but I’ll save that muscle group for another blog). The EO and IO provide secondary stability but their primary function is moving the trunk.

Okay, how these core muscles are supposed to work:
Imagine you’re lying on your bed, about to take a nap (and on a Wed afternoon, who wouldn’t want a nap?). The majority of your arm and leg muscles are not active as you lie still. (Think of them as a light switch that just turns on and off) Your core muscles, however, are still firing at a low level. (Think of them as a light switch on a dimmer—always on to some extent.) When you get up from your nap and walk across the house to the kitchen for a snack, the muscle activity of your core muscles increases. (Slide the light switch up) Then as you lean into the fridge, pick up the full gallon of milk, put it on the counter, reach for an empty glass, fill the glass with milk, and then take a drink, your core muscles are increasing and decreasing their activity level to stabilize the spine at a level that matches the amount of work you’re doing. (Picture the light switch sliding up and down like crazy)

                    vs   

                  Most other muscles              TrA and multifidus

However…
When a person has back pain or if he/she has just had back or abdominal surgery these deep muscles change how they function. They no longer are acting like the light switch on a dimmer (always on) but switch to be more like an on/off light switch. This means that when your body goes to move or lift in a certain direction there can be a fraction of a second’s delay in core muscle activation—which greatly affects your spine’s stability. Most of the time the TrA and multifidus will continue to work in this dysfunctional way, forcing other abdominal and back muscles (whose primary function is movement, not stability) to compensate—which can create a whole host of other issues, not to mention the perpetuation of back pain.

Fortunately, there are many exercises you can do to maintain or regain core stability in a way that is safe for your body. (Note: NONE of these exercises are sit-ups or crunches. If you have back pain, please do not start or continue to do either of these exercises. I’ll explain in a future post, but for now, please trust me and stop doing them.) The physical therapists at Mountain Valley Physical Therapy are trained to assess for muscle imbalances and/or compensations. We can help you find ways to decrease your pain and retrain your core muscles to work the way they were designed. If you don’t have pain but just want some guidance on a safe and effective way to strengthen your core, we would love to get you started on a progressive stabilization program.

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/abdominal_muscles

Laptop Ergonomics

Households, businesses, and even classrooms are now switching from desktops to laptops, and who can blame them? They’re smaller, lighter, and portable and they can do everything a desktop can…EXCEPT encourage good posture. Let’s face it: the keyboards are too small, the screen is too low, and the mouse is placed in the middle (I don’t know about you but I’ve never seen a person with arms coming from the belly button). With as much time as we spend on our computers, it’s no wonder that many people continue to suffer from wrist/shoulder/neck/back pain and headaches.  There are, however, quick and easy modifications we can make to our workspace when using a laptop that will make a world of a difference.

This is a short post because one of my colleagues showed me these two sites and these guys sum up what I wanted to share with you. So why invent the wheel?  If you have questions about what’s shared on either of these two links, please let me know. And if you are experiencing pain at work, I and the other physical therapists at Mountain Valley PT would love to show you how you can continue working without pain (unless the headache is because you happen to be working in an office space resembling Initech, which in that case the only advise I have for you is to hold onto your red Swingline stapler at all times).

VIDEO: http://video.about.com/ergonomics/Easy-Laptop-Ergonomics.htm

BROCHURE: http://uhs.berkeley.edu/facstaff/pdf/ergonomics/laptop.pdf

Backpacks and Back Pain

Here in Colorado August signals the transition from hot summer days to cooler fall weather.  Growing up in Texas, however, I couldn’t look forward to that transition until mid-October (and only then for a couple of weeks). But August did mean another transition for me: the start of school. I remember my mom taking me shopping for back-to-school clothes; then we’d swing by Target and stock up on school supplies—new folders, spirals, pencils, calculators, and backpacks.

Parents, as you gear up for another year of science fair projects, book reports, and dioramas, make sure you take a look at not only the quality of your child’s backpack, but also how much he/she carries in it. There have been an increasing number of reports from children of shoulder, neck and/or back pain due to carrying too many books and school supplies. To protect your kids’ spines, pay attention to these guidelines.

DON’T OVERLOAD!
The American Physical Therapy Association recommends these weight limits (roughly 5-15% of the child’s weight):

Weight of Child	Maximum Backpack Weight
60 lbs	5 lbs
60-70 lbs	10 lbs
100 lbs	15 lbs
125 lbs	18 lbs
150 lbs	20 lbs
200 lbs	25 lbs

* No one should carry more than 25 lbs. in a school backpack.

OTHER GUIDELINES
- Pack heavier items at the bottom. The goal is to transfer the weight to the hips. A backpack with separate compartments helps to keep the load where you place it.
- Pack flat items where they will rest on the back keeping bulky or pointy items away from the back.
- Use both shoulder straps. Always use both shoulder straps.
- Tighten the shoulder straps so that the backpack hangs slightly below the shoulders with no more that 4 inches hanging below the waist line. Note: the waist line is where the belly button is, not the hips.
-Do NOT use a shoulder bag; it is all the weight with only half the support.

Regarding roller bags: you want to make sure the handle is long enough so your child isn’t twisting or stooping to roll the backpack. While it’s much less spinal compression than a regular backpack, if the child has to lift the bag up several steps and lifts incorrectly, a roller bag can still potentially cause back pain.

If your child complains of neck, shoulder, or back pain, regardless of the type or weight of the backpack, please bring him/her into Mountain Valley Physical Therapy. Our physical therapists can provide some pain-relieving techniques and suggest alternatives to help preserve your child’s healthy spine.

For additional tips, you can visit http://www.ptworkingforyou.com/bpsafe.html

Healthy Snacking

Confession: I’m a bored eater.

I eat ridiculous amounts of food to pass the time, especially when I’m in front of the computer or TV. Personally, I blame it on the fact that I’m very tactile (which is why I’m a good manual therapist), but that doesn’t justify the pint of Blue Bell ice cream I polished off while updating my budget on Excel or the new bag of Sun Chips that mysteriously disappeared during a NCAA basketball game (if only those calories could have been converted into Duke baskets).  If you’re like me, the challenge of healthy snacking is about as favorable as making the bed—you know you should do it every day, but if no one else is around it’s so much easier to just “forget about it.”

Most of us know the basic rules:
1) Protein and fiber vs. carbs and sweets
2) Portion control. Portion control. Portion control.

But what does this look like in real life? How can a mom of 3 kids find the time to do the research on what’s right? What about the man who has business meetings from before breakfast until late at night? Maybe some of these tips will help. Even trying out one or two for the next week will make a difference. As my college advisor used to say, “Karen, how do you eat an elephant?” Answer: One bite at a time. (Not that I recommend elephant for healthy snacking—see rule #2)

TIPS FOR HEALTHY SNACKING
1) Forgo pretzels and chips for an apple or a small handful of almonds (the protein and fiber keep you full longer). And try dipping your apple slices or raw veggies into hummus instead of Ranch for added protein.

2) Swap that soda for a home-made fruit smoothie. Just toss whatever fruit you have at home into the blender, add a dash of juice, maybe a little honey and voila! Less calories and refined sugar than Smoothie King and packed with great vitamins. (I’ve got a great recipe for Green Monster Smoothies if anyone’s interested.)
3) Unless you’re planning to be active for the next hour or two, an energy bar isn’t the best snack choice. It’s packed with way more calories and fat than you’ll need for sitting in front of the computer filling out that expense report. A cup of peppermint tea will help increase circulation and give you a natural afternoon boost.

4) The grocery store has lots of those 100-calorie packs that are a great size for snacking. You can also divvy a box of Multi-Grain Wheat Thins into your own 100-calorie Ziploc baggies. This technique cuts down on cost—and the urge to eat the entire box in one sitting.

My personal favorite is roasted edamame(dried soy beans)—they give the same satisfying crunch as chips or nuts but are packed with protein and iron. Plus a handful or two of these are enough to tide me over until the next mealtime. From a physical therapy perspective, people who have diets high in sugar (refined sugar especially) are more likely to have problems with chronic inflammation and suppressed immune systems, which do not bode well if you’re trying to recover from surgery or an injury. If you have other tips on healthy (and realistic) snacking, please feel free to share them!

(PS-This isn’t a rigid prescription for eating. Obviously, if you have dietary restrictions or blood sugar issues you should stick to those guidelines.)