Why we all need shoulder stability

Back View – notice shoulders are set

A very common problem in the clinic is neck and shoulder pain.  Every type of athlete and avid exerciser will likely experience shoulder pain at some point in their career.  Yet so often at the gym I see shoulder exercises done incorrectly.

Most people do not know that the rotator cuff is an extremely important muscle group and what it’s purpose is.  This shows up in exercise routines as either poorly executed exercises or lack of stability exercises at all.

The rotator cuff is the primary stability for the shoulder.  The muscle group (containing four muscles) holds the humerus into the pocket of the shoulder blade.  Yes, these two bones make up your shoulder! ** side note: if your shoulder blade is winged or dysfunctional you will have shoulder weakness**  If your rotator cuff muscles are not activated, your big traps and deltoids and biceps and triceps and pecs and and and etc have to hold the joint together.  These muscles need to save their energy and strength for moving objects, turning door handles, getting out of bed, sitting in a chair or any number of upper body movements.  With a properly engaged rotator cuff, these muscles will not tire out so quickly leaving you with achy, heavy shoulders or neck pain.

Side View – notice the elbows are under the shoulders

The muscles in the rotator cuff (infraspinatus, supraspinatus, teres minor, and subscapularis) hold your posture, internally and externally rotate your shoulder, and initiate lifting your arm.  I have pictured the most popular rotator cuff exercise designed to strengthen the external rotation of the shoulder (infraspinatus and teres minor).  Since we spend so long in internal rotation (sitting at a desk or using our smart phones), it’s important to restore this movement.  When our external rotators are as strong as our overworked internal rotators, we are in balance and posture improves.

The external rotation exercise is commonly used with a resistance band.

 

Front View – notice the wrists are straight and the elbows have not moved back

The important points to remember are:

• Keep your posture
• Keep your elbows touching your sides in the rotation
• Stay away from letting your shoulders fall forward during any point of the movement
• Do not squeeze your shoulder blades together

For questions regarding this exercise or other shoulder stability exercises please contact me (jenmark@dynamicliving.me) or visit the videos on our website (video #1).

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me

Stuck in Traffic? Do Your Core Work!

When can sitting in traffic be wonderful? How can you keep yourself entertained?

The very basis of having a strong core is not doing crunches and planks. Those muscles are not your core muscles. Your oblique and 6 pack muscles are primary movers and it’s too awkward to be doing planks while driving.

While sitting, put your butt right to the back of your seat. Right to the back. Sit tall! You might have to adjust your mirrors. Create a space in the small of your back, big enough for your hand to fit. Your feet must be as even as possible, by which I mean your left foot isn’t outstretched as far as it will go. Now you’re in neutral.

Everytime you need to apply the breaks tighten your pelvic floor muscles! For women, these are kegel exercises. Not enough that you squeeze your glutes though. For men, we say “stop the flow”. Imagine what you would do to stop going pee.

Once your pelvic floor is activated, lighly draw your belly button in. Do this without holding your breath! You cannot drive while holding your breath! Just “draw in” enough that your tummy flattens a little.

Hold this only for a brief moment, let go, and repeat. Repeat everytime you touch the breaks or every time you turn a corner. Hold your position in your seat – might be harder than you think!

Questions? Meet with one of our athletic therapists to learn how to set your core. You can avoid or treat many back problems with learning this valuable trick.

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me
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Choking

Did you know that the standard choking procedure has changed this year in Canada? It’s a good idea to get caught up to speed so you can help someone in their time of need.  With backyard BBQ’s in full swing we need to know how to best handle the situation.

The following are guidelines, and if you are unsure it’s best to take a standard first aid course (see below).  These courses are quick and generally simple.  You will learn valuable life saving techniques to help your loved ones.

CHOKING
When someone starts choking and they are coughing this means that they can breath, which is great!  Encourage them to continue to cough, lean forward slightly, and remain calm.  Usually the event passes and the object slides down their throat.  Have them drink some water and take a few deep breathes.  Easy.

Now, if your friend is choking on some food and suddenly stops coughing while grabbing at their throat, you need to move fast.  Now that they are not coughing, their airway is blocked.  NEW THIS YEAR: do the Heimlich maneuver five (5) times, then lean them forward and really whack on their upper back.  Hit them hard and with an upward thrust.  Do this five (5) times also.  Repeat the Heimlich and the back blows until the object either shoots out their mouth (woo hoo!) or slides down their throat.  Even if it’s your friend, ask them if they need help, and reassure them the entire time.  

What if you are eating at home, alone? What if you start choking and no one is around.  Two things to consider: do you have a land line and do you live in a high rise building?

When you start choking, and begin to get worried, call 911 while you can still manage the phone.  Even if you can’t say anything, the EMS can track your address.  Now, here is where the consideration comes in.  If you have a land line it doesn’t matter if you live in a house or in a building since the EMS can trace your call.  If you only have a mobile phone and live in a building (like me) your address can be tracked but not your unit number.

Once you call 911 get into the hall way.  Emergency teams will go down each hall in the building until they find you.  By being in the hallway you reduce the time it takes for the EMS to find you (especially if you go unconscious in the mean time).

Stay safe and alert at all times.  By knowing how to handle a choking situation you may save a good friend’s life or your own!

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me
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Places to find First Aid Courses
Canadian Red Cross
St. John’s Ambulance

Awkward Positions

Spring and summer are glorious for us Canadians.  Great weather finally gets (almost) everyone outside and active.  This means getting into the garden, trimming trees and shrubs, and mowing the lawn.  Some people are on the roof doing repairs, or under the cottage making adjustments from the winter.  What do all these activities have in common?

Awkward positions.

In the clinic, I see a lot of summer-time injuries.  Many people are coming in with aches and pains from being stuck in an awkward position for many minutes at a time.  Bent over in the garden causes the back to become overstretched.  Trimming trees with your arms over your head causes your shoulder and neck to be placed in an unstable position.  Mowing the lawn with a push mower, without your core activated, causes your pelvis to go out of alignment.  But what can be done?  We can’t stop taking care of our precious lawns and gardens!

Be patient, get stronger, and stretch!

Be patient: take time in between flowers to change your position.  When weeding, maintain your posture.  When doing activities with your hands over your head, bring them down often and mix in a stretch.  If you get out of posture, stop, reset, and get back into alignment.  You will last much longer and you will seriously reduce your risk of injury.

Get stronger: those that are more fit, have less gardening injuries.  Even if they do get injured, they likely recover faster and are less severely injured.

Stretch: in between activities and at the end of the day.  After you are finished with your outside chores, take some time to stretch.  Treat these activities like your workout and get down on the lawn, deck, or carpeted floor and do some stretches.

Being aware of fatiguing muscles and joints, and taking the time to maintain your alignment will help your work in the garden and around your house go so much faster and longer.  Not that I don’t like the business, but us athletic therapists don’t really want to see you getting injured doing the activities you love!

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me

My Ride to Conquer Cancer

The day finally came!  The day I was looking forward to and dreading all at the same time.  Great day to test my endurance and an unknown adventure.  Nervous because I had not even ridden 100km ever before, never mind two days back to back.

So…this is how it went:

Diane picked me up at 6am.  It was raining and cold, and dark.  We loaded my bike into the back of her car and my big backpacking backpack into her trunk.  We had no traffic and made it to the CNE for about 6:24am.  When we got there, there was no rain and the sun was coming out between the clouds.  Diane gave me a big good luck hug and I went off all alone.

I got my kit (bike identification and t-shirt) from the registration tent without hassle or line up.  Some guy named Jason (our names were on our bikes), helped me figure out the chip that was to attach to my helmet.  Everyone was so nice.  Everyone was there for one purpose: get to Hamilton!  My t-shirt was huge!  But luckily the organizers had thought of everything.  I went over to the “T-shirt Exchange Tent” and got an extra small.  It fits perfectly.

I filled my water bottle and gatorade bottle up.  Brought my backpack to the Ryder trucks.  My gear went into the “Grey” Truck and would be brought to Hamilton for me – and again, no line ups.  Sweet.

All set and ready, and still not raining, I went to the corral area with thousands of other riders (4800 in total), to wait for the Open Ceremonies.  We found out that we had just raised $18.1 million and that this event was the single largest cancer fundraising event in Canadian history.  Cool! 

We had a slow start as everyone of us had to file through pretty small gates to get out onto Lakeshore.  All the lanes of the Lakeshore (west bound) were closed for us!  We filtered out, chatted to neighbours, and enjoyed the flat ride. Once we got passed the main roads and into the side streets of Mississauga, there were a lot of cheer sections with signs that read “Thank You Riders”.  Very inspirational and emotional.  The riders started thinning out also, so it was easier to ride.  We got into the country and it started to pour.  So this was my first time riding in the rain, and it wasn’t so bad.  Nothing changed really.

I was super tired now, it was really windy and the rain was a bit chilly after awhile.  I didn’t stop at the “Pit Stops” (1) because it was so damp I was worried I wouldn’t get back on my bike and (2) I had it in my head that I couldn’t stop.  After about 90km I felt really good and was very proud of myself.  We went down a huge hill that winded around and onto a main road somewhere in Ancaster.   Then the mountain.  The Hamilton Mountain.  It killed me!  I went so slow while everyone that I had passed in the last 90k passed me right back.  It was demoralizing, damp, cold, and my legs were shaking.  Haha, that hasn’t happened in a long time.  Finally I got to level ground (had the Sweep Car behind me) and rode like hell to Mohawk College.

The rain stopped around 3:30pm, I had a shower on a big tractor trailer, got some food, and got my tent.  I lined up for a massage, and ended up with a physiotherapy student from McMaster.  Worst massage ever, so I went back to my tent and took an Ibuprofen for my exhausted right quad.  I took a nap and organized my tent.  Most people were drying their clothes on top of their tents because it was so sunny and hot at this point.  I found myself doing whatever everyone else was doing.  I learn well from social learning!

There were hundreds of port-a-potties and running water for hand washing (we were spoiled).  I had a hot meal for dinner and listened to the live band play fun 70s music.  The speeches in the evening were from the directors of Princess Margaret Hospital, the Ride itself and cancer survivors/patients.  The speeches were long enough to be meaningful (and were quite funny along side emotional) and short enough to keep our attention span.

After the speeches, I had half a cup of beer and chatted with some people I knew.  Everyone seemed to filter towards the “Tent City” around 9:30 with most people in their tents by ten.

I had no trouble falling asleep, but stayed awake all night since I was in the snoring section.  I was cold too for some reason.  I made it through the night though, and wasn’t even sore the next morning!

Most of the camp was up at 5:30am, I tried to keep my eyes closed until 6am.   I changed, ate a hot breakfast, brushed my teeth with running water at a vanity beside the shower trucks and filled my water bottles up.  I left camp at 7:30am and had the ride of my life!

I had so much fun going down the big hill that previously destroyed my confidence.  I then charged up the next hill with vengeance and passed many cyclist walking their bikes up the hill.  My confidence was rising!  I met more people along the way, but was trying to ride as hard as I could so that I could make up for a somewhat tough ride the day before.  After getting through the hard parts within the first hour, I actually had a blast going through the rolling hills in Guelph and Milton.  I was chasing other riders and getting passed by big groups working together.

I did stop at the lunch “Pit Stop” to refill my water and gatorade bottles, but turned down the “vegan chicken” that was offered to the vegetarians.  I felt like a real snob!

The weather was perfect, I think I had beat the real heat and humidity so having clear skies and dry roads was a blessing.  I got back into Mississauga riding with a group of 3 men.  I eventually passed them on a hill (don’t ask how) and found another group along Lakeshore.  We all worked together and got into Toronto.  It was so fun to work with a small group, and being the token women, I felt I had to really work to earn my spot.

I rode as fast as I could up the hill near the Boulevard Club and into the CNE.  I was so pumped to be finished but also at how well I thought I did.  I have never been proud or happy with any athletic achievement.

But this day, mentally, I was so strong.  I didn’t have the training, I had never done the distance, and I had no idea what to expect.  I had a full glass of Steam Whistle this time and waited for my ride.  I smiled the whole way home, showered, and promptly fell asleep on my couch for 3 hours!

Thanks to everyone who was there to support me.  Thanks to those who sponsored me and those who encouraged me.  🙂

Day 1: 110km 4:37:00

Day 2: 102km 4:01:00 (but did 100k under 4 hours which was my goal!)

Check out my Bike Log for some of my rides leading up to this fun weekend.  I will definitely be doing this again next year!!!

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me 

Listen to your mother!

We’ve all heard it: “Sit up straight!” from our mothers at one point in our life. We would sit very miliatry-like and could only hold it for a few seconds. Do you feel the same way now? What exactly is good posture and can it be for more than good looks?

Let’s start at the base, our pelvis. The spine is attached at the pelvis (Sacral Iliac Joint), and is thus very influenced by your deep core muscles and posture. You need to have a strong core in order to hold your pelvis in its neutral position. Not with your butt stuck out, and not so that your back is flat – somewhere half way in between. Once your pelvis is neutral, your lower back needs to have a small lordotic curve. This provides shock absorption for your spine. If you insist on walking around with your lower back completely flattened, you lose that valuable spring in your movements.

Your thoracic spine (where your ribs meet your vertebra) needs to have a curve also. This time, a very mild kyphotic curve. This continues the “s” shape of the spine for added absorption of movement and shock. This is the curve that can become exaggerated in seniors that is caused by osteoporosis.

Lastly, the neck should have the same curve as the lower back. A small curve oppposite to the thoracic spine. Here lies most of our problems. Many people have too much of a lordotic curve, and many have very little curve at all. If you have too much curvature, it is likely caused by an over kyphotic curve in the thoracic spine. This compensation of the neck helps to keep the eyes level for optimal vision (and we think our bodies aren’t smart!). Having either too much or no curve in the neck causes a lot of neck pain that can last a long time. This is where a therapist needs to step in and work on postural correction.

Finally, I want to touch base on shoulders. Having rounding shoulders with shoulder blades (scapula) that stick out, also causes a lot of problems. When people talk about pulling your shoulders back, it gives the wrong impression. To correct your rounded shoulders, you need to tilt your shoulder blades into your rib cage. A very small movement. Do not squeeze your shoulder blades together, this will cause more neck trouble (something we can talk about later). Having good posture through your shoulders means that your humerus is sitting in the joint in its optimal position. This allows for a greater range of motion (especially being able to lift your arm above your head), allows you to lift heavier weights, and reduces injury during sports and activities in your life.

So, straighten up! Hold your pelvis neutral, maintain a small curve in your lower back, and tilt those shoulder blades into your rib cage. It can be very fatiguing at first to hold, but keep at it. You will see a big difference over time.

For a quick demo on setting your shoulder blades and pelvis, click here. Look at the videos on shoulders and core activation.

Jen Mark BSc., CAT(C), CSCS
Dynamic Living

Saving a Life

Would you know what to do if you were the first to come along a car accident? What if you are out in the backyard and someone falls down the stairs? Do you knowhow to save their life?

If you witness someone falling and hitting their head, you need to act fast. You can really save them a lot of pain and further damage by doing a few things before the paramedics arrive.

First, block their head. A neck fracture is more serious than a concussion, which can lead to a loss of breathing and eventually a loss of a heart beat. By blocking the head, you are ensuring that they do not move their spinal column.

If someone falls and does not get up, put your hands on their head and hold it to the ground. Tell them not move their head and only answer your questions verbally. People tend to nod for yes and no, which will move their spine. Try not to panic the person, reassure them that this is all for precaution.

Ask them if they have any pain in their neck or back. Ask them if they feel any numbness or tingling into their arms or legs. Ask them to gently move their fingers then toes. And ask them if they can squeeze your hand. If they answer yes to any questions, and/or cannot move their fingers and toes, you need to keep blocking their head while someone else calls 911 – telling the dispatch that you suspect a spinal injury. You can slowly get to the top of their head, get on your knees and hold their head near (but not covering) their ears.

If the person is cold, ask someone to put a blanket over them, if your outside in the sun, someone could stand over them with an umbrella.

Keep talking to them, reassuring them, and keep them calm. By doing this you may prevent further damage, and save their life!

Running Through Cancer

Strong title, but that’s what I intend to write about. It’s April so it’s Cancer month here in Canada. The Canadian Cancer Society has commercials on the radio asking who inspires you. The answer, my dad.

Around 2003, while driving me home one weekend from university my dad told me that the ulcer he had in his stomach was no ulcer at all. After much testing and missed diagnosis’ my dad’s team of doctors discovered stomach cancer. Upon further testing they found lung and skin cancer as well.

Instead of talking the advice of doctors to have chemotherapy, my dad decided to cleanse his body and “run through the cancer”. My dad has always been a runner, a fast runner. His personal best is 2:18 in the marathon and he used to run a 46 second 400m. Now he had a new hurdle.

We ran together, taught clinics at the local Running Room and got on our road bikes. We would ride all through Mount Albert, Udora, Sandford and Queensville on our bikes – trash talking each other the whole way! He cleaned up his diet, nothing drastic, but ate well. I remember one summer biking through Quebec’s Mount St. Anne mountains then turning around and going for a run.

Every month my dad had to make trips to Princess Margaret Hospital. He would never let us go with him because he didn’t want us to see the death and dying around him. He was apart of a group of regulars that would wait in the waiting room together. Some brought cookies, some stopped coming. My dad braved this on his own. We weren’t allowed to say that he was a cancer patient, we had to say he had cancer. It wasn’t apart of him.

My dad is cancer free. He never accepted the cancer. He’s brave and strong, as a father should be. This inspires me everyday. To be just like dad.

Who inspires you?

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me

MLB Concussion Policy

Finally a professional sports organization has put together a concrete policy to handle brain trauma. Major League Baseball has created a system to protect their players, which is something that hockey and football as failed to do. Mind you, there were only 8 concussions in all of baseball in the 2010 season, while the NFL had 1 concussion in 60% of all their games.

The players must be seen by a doctor and have neurological testing done and submit a Return to Play protocol to the doctors belonging to MLB, not the team. This is key, since doctors (as anyone) can be influenced or pressured by the owners and coaches to return a player sooner than is safe. The doctors for MLB will likely be less bias and have the players/umpires best interest in mind. In order for the player to return to the game, they must pass neurological testing. They must also miss at least 7 days of training/games, regardless of symptoms.

I’m glad to see that someone is finally looking out for professional athletes. Congratulations to the MLB players association for getting this done. There is no reason why the NFL or NHL or even NBA should not adopt this system. There has already been one player to use this policy, a Blue Jay! He returned today after running into a third baseman’s knee while sliding head first, last Sunday.

Let’s watch and see what happens over the next few months. Will exceptions be made for higher priced athletes? Can the MLB doctors be bought or influenced the same as the team doctors (I am not implying this happens with all team doctors, but it does happen).

So let’s rejoice in a step forward for professional sports. I imagine that other leagues will follow suit soon enough.

Check out my poll on concussion in the right panel, under “pages”.

Concussions in the Classroom

Exceptions need to be made for invisible injuries.

High schools across the country are filled with student athletes. Some play within the school system and some are involved in sports above the high school level. Students that participate in contact sports have a special risk; concussions. The percentage of student athletes who get concussions will likely never be known since most do not report any symptoms. But what about those who do report how they feel? Are we protecting them enough in the classroom? Is it worth it for these athletes to explain to their teachers what has happened?

I’ve noticed that most coaches and players don’t fully understand concussions, even though they are around the sport and probably see them all the time. What about teachers in the schools? Especially those that have nothing to do with sport or fitness? It seems many of them are not sensitive to the injuries that are invisible.

Often with concussions it is difficult for the student to concentrate without getting a headache. There is often a sensitivity to lights and noise, which happens in high schools and elementary schools. The prescribed treatment for concussions is to stay home and do nothing; no TV, no video games, and no school work – they need to let the brain rest. I have had many athletes who have had to take a week off or more from school. That week is generally filled with sleeping and being in the dark. This is what is best for a concussion to heal properly. Upon returning to school the student needs to catch up with school work and get comfortable being in the classroom again. Teachers need to allow this transition time – allow for more time on assignments and perhaps guidance.

When a student returns to school around exam time, they need those extensions in order to regain confidence and do well academically. Teachers need to allow the student to finish their term papers in an appropriate amount of time and allowed to study for each exam accordingly. We are not talking about adults, who are often less affected by concussions. Student athletes are a special bred. They are in the middle of their learning and their brain is forming into a mature adult brain.

We need to help our student athletes achieve greatness on the field and in the classroom. Teachers need to be sensitive to head traumas and help students through these often difficult times. Exceptions are made in the “real” working world and we need to have them in the classroom.

Jen Mark BSc., CAT(C), CSCS
jen@bodysmithinternational.com