The purpose of this series is to provide readers with an understanding of how stabilizing groups of muscles work. The more a client knows about how muscles work, the more they can learn from their trainers. This series aims to provide some of that fundamental knowledge.

During the final block of medical anatomy, my classmates and I learned the muscles of the arms and legs. It quickly became difficult to remember exactly what muscle did what and in the company of which other muscles. I found the most effective way to learn how muscles work is to learn about disorders that target specific muscle groups and see what symptoms present in patients.

This article focuses on the insanely interesting (to me) gluteus medius and gluteus minimus, which are knocked out in the Trendelenburg gait. Trendelenburg gait is a irregular walking pattern in which the hips sway excessively side to side due to lack of hip stability.

Key Terms:

Abduction: raising the leg to the side, away from the midline

Internal Rotation: twisting the thigh so the kneecap points towards the midline

Gluteus Medius and Gluteus Minimus at Prevail

Many at Prevail Conditioning train their gluteus medius and gluteus minimus whether they know it or not. They are primary stabilizers for walking and all single leg exercises. Many warm-ups include banded movements, like clamshells, that target the gluteus medius and gluteus maximus. Lateral band walks and single leg banded hip extension with external rotations also target the abduction and stabilizing roles of the gluteus medius and gluteus minimus.

VIDEO:

https://www.youtube.com/watch?v=Udkhn7_yxpM&list=PLQIblP9oJNhC2ftPcZZ2IY6g6wQa1FIC_&index=2

Anatomy

The gluteus medius and gluteus minimus lie deep to the gluteus maximus. Their function is to abduct and internally rotate the thigh. The gluteus medius is particularly important because it is the strongest abductor of the hip muscles. Both muscles begin at the outside of the hip and descend to the lateral, posterior side of the femur (see figure).

In the video above, we can see that whenever the patient plants with her left foot, her left hip lurches outward, showing a weakness in the gluteus medius and gluteus minimus. This is a common pattern in runners where it can lead to knee and lower back injuries as the hip tilts from side to side every step (Davis et al, 2016).

Conclusion

The gluteus medius and gluteus minimus are essential to every step we take. They are the primary hip abductors and critical to athletes’ stability in all single leg exercises.

Sources:

Washington University Musculoskeletal Atlas

Stanford Medicine 25

Davis IS, Futrell E. Gait Retraining: Altering the Fingerprint of Gait. Physical medicine and rehabilitation clinics of North America. 2016;27(1):339-355. doi:10.1016/j.pmr.2015.09.002.

Souza RB. An Evidence-Based Videotaped Running Biomechanics Analysis. Physical medicine and rehabilitation clinics of North America. 2016;27(1):217-236. doi:10.1016/j.pmr.2015.08.006.

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 2016. He attended Westmont College and will be attending medical school this fall. While at Westmont he graduated Summa Cum Laude, led a student-run homeless outreach program, and volunteered with medical clinics in Mexico and Bolivia.

After Tyler’s mother was diagnosed with rheumatoid arthritis (RA), he became interested in the cellular mechanisms behind the disease. He conducted his Major Honors project at Westmont on the role of the microbiome in inflammatory arthritis and conducted summers of research at Harvard Medical School studying the role of macrophages in RA. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

For Part II of the Muscle KO series we’ll be looking at the serratus anterior, the “boxer’s muscle”, which is incredibly important for stabilization during pushing movements. In the figure, Manny Pacquiao’s serratus anteriors are the dagger shaped muscles that run along his rib cage. The most important function of these muscles is to protract (shift forward) the scapula.

Work Cited

University of Pittsburgh School of Medicine Anatomy Course 2017

https://www.crossfitinvictus.com/wp-content/uploads/2009/11/Serratus-2.jpg

http://www.backoutofwhack.com/wp/wp-content/uploads/2012/04/boxer-muscles.jpg

https://upload.wikimedia.org/wikipedia/commons/f/f9/Protraction_Retraction.png

http://www.safeandhealthypeople.com.au/wp-content/uploads/2014/06/scapular-winging.jpg

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 2016. He attended Westmont College and will be attending medical school this fall. While at Westmont he graduated Summa Cum Laude, led a student-run homeless outreach program, and volunteered with medical clinics in Mexico and Bolivia.

After Tyler’s mother was diagnosed with rheumatoid arthritis (RA), he became interested in the cellular mechanisms behind the disease. He conducted his Major Honors project at Westmont on the role of the microbiome in inflammatory arthritis and conducted summers of research at Harvard Medical School studying the role of macrophages in RA. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

Introduction: There is no certainty; there is only adventure

My first powerlifting meet was a great challenge and learning experience. My goal was to get a 942 lbs. total to qualify for USA Powerlifting Collegiate Nationals in the 182 lbs. raw weight class. With five weeks to prepare, I was confident I would succeed, but realized there were many obstacles to overcome. These challenges included that I had never used a belt before, had no experience with sumo deadlifting, had just injured my elbow which had kept me from benching for a month, only high bar squat, and didn’t know how to max out a lift.

Peter was instrumental through this entire process. Without him I would have made completely wrong decisions in every step of my preparation. In fact, ever since I’ve been training with Peter it constantly amazes (and somewhat frustrates) me how he always turns out to be right whenever our opinions disagree. It’s incredible to think about how much I still have to learn about training and how my body functions.

Preparation: The chains of habit

Of my five weeks leading up to competition, weeks 1-2 were aimed at practicing squatting heavy with a belt, developing my deadlift technique, and getting my elbow well enough that I could bench pain-free. Weeks 3-5 were used to develop my warm up progressions, test my openers, and fully recover for the meet. The most challenging, and failed, part of my preparation was changing my squat depth. Powerlifters typically use a low bar squat and descend only until the crease of their hips drop below the top of their knees. I am a high bar squatter who squats far below what is required for powerlifting, which made my squat inefficient. I wasn’t able to correct this problem in training or in competition. As you can see in the picture, in my final squat at 330 lbs., my hips and even my 4 inch wide belt were below my knees. That was deep.

Competition: The man is nothing–the work is everything

I slept for 3 hours the night before the competition, got out of bed at 5:30am and got to the competition at 6:30am for equipment check. Everyone at the meet was friendly and helped me throughout the day. I spent most of the day with another first time competitor and his coach.

During my first squat attempt I was completely thrown off by the lights, the 50 people staring at me, and having to follow the judge’s commands. I squatted with a form I never use and was essentially falling forward when I completed the lift. But, I got 2 white lights and had 303 lbs. on the board. I spent the 10 minutes between attempts essentially mentally rehearsing the steps of a squat that are usually automatic for me. After mentioning the environment was affecting me the coach I was talking to said 1) it’s just like people watching you in the gym and 2) no one in the crowd knows anything about lifting so everything looks impressive to them. The next attempts at 320 lbs. and 330 lbs. were much easier.

For a first meet, lifters aim to be successful at all 9 attempts because every lift is a PR and there is no need to kill yourself. During the bench I lost my chance at going 9/9 by failing my 3rd attempt at 225 lbs., finishing with 215 lbs. on the board.

Deadlift was intense–more mentally than physically. Warming up felt normal and my opener at 382 lbs. felt fine. Then I set my next lift to 403 lbs. to set my total at 497 lbs. and qualify for nationals. My max deadlift is about 440 lbs., so 403 lbs. was going to be easy. However, when I took my attempt, the bar didn’t even leave the ground. While waiting for my next lift in the warm up room I had never felt such a singular need to have something. There was no way I was going to go home a failure. Fortunately, when the next attempt came I made the lift and finished the meet a success.

Conclusion: Art is long; life is short

I am thankful for the opportunity to compete and see how my training has prepared me thus far. It’s amazing how much I was able to learn about lifting during this process that I might have never had the chance to without completing.

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 2016. He attended Westmont College and will be attending medical school this fall. While at Westmont he graduated Summa Cum Laude, led a student-run homeless outreach program, and volunteered with medical clinics in Mexico and Bolivia.

After Tyler’s mother was diagnosed with rheumatoid arthritis (RA), he became interested in the cellular mechanisms behind the disease. He conducted his Major Honors project at Westmont on the role of the microbiome in inflammatory arthritis and conducted summers of research at Harvard Medical School studying the role of macrophages in RA. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

For: The Divot
By: Chris Ecklund, MA, CSCS, TPI, PES, USAW

What is Ergonomics?

What is Posture?

Why does it matter to me?

I recently had the opportunity to discuss this topic with a local technology corporation as the employees were looking for more information about how to deal with all the aches and pains that are popping up as well as how to better set up their “day-to-day” workstation arrangement since most of them are on computers and technology all day.

Ultimately the conversation can be fairly straightforward and simple…and the application is wide spreading to general health, tennis, golf…you name it.

Ergonomics: An applied science concerned with designing and arranging things people use to that the people and things interact most efficiently and safely.

          -Merriam Webster

Great…thanks for that, Chris…so what does that mean? 

Simple: FITTING A JOB TO THE PERSON…

          —>INSTEAD OF THE PERSON TO THE JOB

Said simpler: we are focusing on trying to set up the environment of the job better to minimize injury and maximize efficiency (because frankly, we weren’t made to do a lot of the jobs we do).

*And by the way, “job” can also mean daily habits or activities!

Believe it or not, we weren’t created to drive cars (especially for hours on end), or sit at a computer or text on cell phones…

Well that’s great, but who cares?  Why does it matter?

In a study done in 2007, they found that overuse injuries due to posture and repetitive trauma caused the longest absences from work compared to other conditions (US Department of Labor, 2002)

Common disorders:


• Neck (85%)
• Lower back pain (68%)
• Shoulder tendonitis (48%)
• Neuropathy
• Tension neck syndrome
• Trapezius myalgia

“But Chris, I’m retired, so this doesn’t apply to me.”

Of course it does. We all have repetitive positions and activities we do. Golf. Tennis. Watching TV. Reading, Writing. Working on cell phones. It is all additive in it’s effect.

Well, what is good posture then?

Simple answer: one that is CONSTANTLY CHANGING (implication…move more).

But to start with, here is a reference point (see pic):

Side:

• Ear, shoulder, hip, knee, ankle

Front:

• Nose, Adams apple, sternum, belly button, zipper, between knees and ankle, feet straight, shoulders level

Poor posture + Time = Aches & Pain & Injuries

Case in point: for every inch (or about 10˚ your head is forward it adds about 10lbs of work to your cervical extensors, trapezius, levator scapulae, etc.  Over time, our necks get unhappy.

Further, if we can’t hold good posture while we are standing still or sitting, how can we expect to have good posture or maintain good positions when we move (as it is even tougher)?

Answer:  practice and feedback. 

Just like feedback on your tennis serve.  Just like feedback on your golf swing.

If you’d like assistance learning about how your posture and daily routine influence your body’s health, please get in contact with us a.s.a.p. so we can help!

By: Chris Ecklund, MA, CSCS, TPI, PES, USAW

“Why am I going to _________?!”
(the gym, workout, torture myself, go run on a treadmill like a hamster, not eat my favorite food, fill in the blank as you see fit)

Over the past 6 months I have found myself veering back into the timeless conversation with clients that centers around questions like this. To be clear…I think it’s an extremely important question to both ask, and to answer for oneself.

Earlier in my career I was always under the impression that the perfect program design would take care of every person’s/client’s needs as it helped them move toward their goals in a healthier and efficient fashion. I couldn’t have been more wrong. My naiveté kept me from considering the other facets affecting one’s path to health, wellness, and performance. Namely, psychology, emotion, motivation, belief systems, good and bad experiences from the past, personality types…the list could go on.

Why are you doing what you are doing?

What will bring you happiness and joy?

…and yes, what sacrifices are worthwhile to you?

The questions must be asked. Why? Because the motivation for what you are doing must be there. You have to have it. I have found empirically that if my client and I don’t have a strong purpose and reason, the program will inevitably fail. This was reinforced to me as I was recently reviewing a textbook on the psychology of sports performance.

“Although extrinsic rewards can positively influence motivation and performance, the results tend to be short-term and the effects on motivation last only until the extrinsic rewards come to an end (which happens sooner or later), the longer lasting motivation, although often more difficult to achieve, is associated with intrinsic motivation. That is why it is important to help athletes [and fitness enthusiasts] discover the joy and enjoyment in participation so the sport of physical activity can be continued for a lifetime (if physically possible).”1

• Do you love the outdoors and the thought of going in a gym makes you cringe? Then never go to the gym. Set up an outdoor fitness program!
• Do you know that intervals help you decrease body fat more efficiently and are probably best in increasing VO2 Max but you absolutely despise them and stop doing cardiorespiratory exercise because of it? Then just do steady state training!
• Do you know that you need extensive core training work but hate it so have stopped exercising altogether? Then just do one per workout and structure the rest of your session to increase core usage doing things you like.

Consider your reasons, your drive, your motivation…and yes, consider what you are willing to reasonably give up to achieve that which brings joy and happiness and delayed gratification. If we can be of any assistance with this process we invite you to reach out to us.

1. McGill, E.A., Clark, I. (Eds.). 2017. Psychology in Sports Performance. Essentials of Sports Performance Training, 2nd Edition (p. 548). Jones & Bartlett Learning.
2. Image: https://healthletix.co/bother-exercise-heres/

Shiatsu and Tui Na are the two most common styles of bodywork used in Traditional East Asian Medicine. Today we will take a brief look at each and learn about what they share in common and what makes them different.

Shiatsu has Japanese origins and is a very involved form of manual therapy. The style uses light manual pressure on acupuncture points and channels with the aim of bringing the body into a better state of balance. The treatment usually begins with a diagnostic exam on the abdomen where light pressure is used over key energetic points to check upon the health of the various organs in the body. The practitioner will usually investigate the energetic relationship between two most prominent systems and then perform further diagnosis to confirm the imbalance. Once a pattern is established the treatment that follows is aimed at first grounding the body through working on the earth meridians and then moving on to the meridians that need further adjustment. 

Shiatsu treatments can also involve specific requests for joint discomfort, organ dysfunction, and even emotional imbalances. After the treatment the practitioner will repeat the diagnostic process to assess the efficacy of the treatment and provide further recommendations. 

What is unique about Shiatsu is that the style is very gentle, yet can have profound effects on the energetic system of the body. It is not uncommon to feel so relaxed while receiving a treatment that the patient falls into a deep restorative sleep while the treatment is taking place. Shiatsu is also unique, unlike other massage techniques, in that the treatment is preferentially performed over clothes, as the texture of skin can reduce the efficacy of the technique. 

Tui Na is the other common bodywork technique practice in Traditional East Asian Medicine. If Shiatsu is more gentle and replenishing, Tui Na can be seen as more direct and corrective. Tui Na, like Shiatsu, is commonly done over clothes and often works on acupressure points and meridians.  Unlike Shiatsu, it can often be very intense and take on an affinity for more of the physical body instead of the energetic one. Tui Na treatments are often sought out to correct musculoskeletal imbalances that lead to pain or discomfort. Tui Na can also be done when the patient does not respond well to needles as a means to also influence the Qi of the body without having to penetrate the skin. 

Even though these two styles can differ on their application they both work towards influencing the balance of Qi in the body and are two useful tools in the large toolbox of a Traditional East Asian Medicine practitioner. The key lines in the ability of the practitioner is to form the correct diagnosis and then prescribe the right treatment.

Next time we will look at the therapeutic application of fire in healing through the technique called Moxibustion as we continue to explore the range of healing modalities used in Traditional East Asian Medicine.

Diego Garcia, MAcOM, LAc, CSCS
Acupuncture & Oriental Medicine
Performance Coach

How does acupuncture work?

Acupuncture’s claim to fame comes from its ability to influence blood flow in the body. When a needle is inserted into an acupuncture point, a unique effect occurs within the network system of tissues, organs, nerves, and the brain. The needle has the effect of promoting blood flow to a specific region, and this fresh healthy blood is what brings about the effect of healing. If you’ve ever benefited from acupuncture, you might remember that areas where acupuncture points were used feel warm, heavy, or full. These sensations illustrate the miraculous ability of needles to govern blood flow in the body.

Why is blood so important?

Blood contains all of the vital nutrients and oxygen needed to nourish tissues. You are only as healthy as the quality of blood that flows through your body. It’s safe to say that almost all disease and aging processes can be traced back to deficits of blood quality, quantity, and flow. That is why aging can be seen beginning at the hands and feet and moving towards the torso. The best thing you can do to slow aging and prolong and improve your quality of life is to ensure fantastic production and movement of blood in your body.

What is disease?

At the beginning stages of illness, a body tissue experiences a compromised supply of qi and blood. Qi can be thought of as oxygen or the means of cellular energy needed to help a cell perform its job. Once a tissue is deprived of qi and blood it begins to express a state of malfunction, in this state there might not be any symptoms present. If that condition persists and malfunctioning tissue does not receive blood and qi, the malfunction will develop into a disease process. At this point symptoms will become evident and the condition will continue to worsen if the originating cause of blood and qi obstruction does not resolve.

Why am I achy and stiff?

When a tissue is in pain, the brain will actively reduce blood flow and nerve impulses to that area in hopes of improving the success of healing. After all, if there are torn tissues you don’t want to move them excessively before they heal and if infection happens to set in, reduced blood flow to the area will lower the likelihood of spreading infection to the rest of the body. That’s why injured tissues become cold, stiff, heavy, and weak. They simply do not have the same amount of blood, energy, and nerve impulses compared to the rest of the body.

If the underlying condition is not treated, then healing will not set in. Pain is the means by which tissues communicate important information to the brain. If you are stuck in a loop of chronic pain, the system which relays this pain information is broken and needs a jump start. Needles serve this purpose and help relay a clear message to the brain to indicate that the injury has been resolved and the pain signal can be cleaned up. Numbing the pain is not the best answer!

The function of acupuncture, medicinal herbs, and oriental medicine as a whole is to remove the cause of qi and blood obstruction, and in turn reverse the symptoms caused by the disease process and prior malfunctions. By restoring healthy blood and qi flow, the healing can begin and the communication between the body and brain can improve to break free from the pain cycle.

Diego Garcia LAc
MAcOM, CSCS

The season of the common cold is approaching. For many of us here in Santa Barbara, our Fall and Winter season can be pretty manageable, but the relative seasonal changes can still present a challenge to our immune systems. 

Chinese Medicine divides the common cold into different types of bodily “invasions” based on the external pathogen’s signs and symptoms. In general, colds set in acutely, so they are categorized as a Wind Invasion. This occurs in the external layers of the body first, then the skin and lungs, and if left untreated or if the body is weak, the invasion will go into deeper layers.

Wind invasions are often differentiated as either Wind Heat or Wind Cold. This means that two people may present with symptoms of a general cold in Western medicine and be treated similarly for it, but in the Traditional Chinese Medicine paradigm, further assessment will reveal the specifics of the invasion and a unique treatment will be given to each presentation.

To better understand the differences, we will look at each one individually.

Wind Heat

Wind invasions set in quickly with symptoms of fatigue, loss of appetite, fever and chills, and malaise. Wind Heat, however, expressed swelling of the tissues in the upper respiratory tract, feelings of heat in the face, upper neck, and body, and possibly headaches related to sinus congestion, and more of a fever than chills. They will generally avoid warm temperatures of fluids and will gravitate to neutral to slightly cool temperatures and experience more thirst than normal.

Wind Cold

On the other hand, Wind Cold invasions are associated with more tightness throughout the body, less sore but drier throat, possibly worse headaches as the cold contracts tissues and produces a sensation of acute pain. They will still experience chills and fever, but more chills than fever. They will experience less thirst and there will be a preference for warm temperatures and fluids.

Often a Wind Invasion will begin as Wind Cold, and quickly, within a day or so, transform into Wind Heat with the associated changes of signs and symptoms from one to the other. If you can catch this initial stage and intervene through acupuncture or herbal medicine, you can generally stop the progression of symptoms and kick the invasion out. An individualized approach to acupuncture with a custom herbal formulation will address the present patterns, assist the body in healing, and avoid the potential two to three weeks of lingering symptoms that so many people just accept as the natural course. 

If you know that you’ll be around people who are sick, be sure to wash your hands often and apply a small amount of oil of your choice to the inside of your nostrils. This will hydrate and strengthen those membranes and reduce the likelihood of micro cracks from dry, cooler air that allows pathogens to enter the body. Prevention by strengthening the immune system through herbal medicine is the best method, but needless to say, if you find yourself caught with a Wind Invasion, take a moment to do the following. 

If based on the above, you think it is Wind Heat:

• Do not force yourself to eat if you are not hungry, fasting is okay during this time if it is sage for you
• Make time to rest, since your body’s resources are being redirected to the immune system during this time 
• Make a strong mint tea (preferably fresh) and sip throughout the day to maintain hydration and cool some of the heat symptoms

If you think you have Wind Cold:

• Do not force yourself to eat if you are not hungry, fasting is okay during this time if it is sage for you
• Make time to rest, since your body’s resources are being redirected to the immune system during this time 
• Make a strong tea of fresh ginger slices and slices of the whites of green onions. Consume this tea hot, while you wrap yourself in a warm blanket to induce a strong sweat. Sweating will aid the body in releasing the pathogen and reducing the severity and length of sickness. 

If you do not know what you have but know that you do not want to deal with it, come see me for an evaluation and treatment. It is good to keep herbal formulas around to begin taking at the first signs of a Wind Invasion. In Eastern Asia, these previous practices are common, and, as a result, the general population does not consider the common cold an unavoidable nuisance. Good news is that now, we don’t have to either. 

Thanks for reading, and I hope you found some useful tips to keep yourself healthier and thriving through the next few months. 

Diego Garcia, LAc
MAcOM, Acupuncture and Oriental Medicine Practitioner
CSCS, Performance Coach

Today we are looking into a less well-known modality called Moxibustion. This technique employs the burning of a commonly used herb called Artemesia Vulgaris, Mugwort, or Ai Ye in Pinyin. The unique chemical, and structural makeup of the herb, along with its volatile oil content allows this herb to burn cooler than most, burn for longer, and keep its structural integrity in the burning process. For these reasons, and for its warming and energetically moving qualities, Ai Ye is processed in to Moxa, which is then used for Moxibustion.

Ai Ye is an herb that has a warm and spicy nature to it. Its actions on the body are one and the same. By igniting the herb, its therapeutic and warming actions are heightened. The heat produced has an ability to penetrate the skin and warm up surrounding tissues. This is useful for promoting blood and qi flow and to dispel lingering cold from a body area. This technique is referred to as Moxibustion, and there are a few different ways of applying it based on the region and medical school of thought that a practitioner of oriental medicine comes from.

The more Chinese way of applying Moxibustion is by using larger quantities of Moxa that are rolled up and placed on top of an inserted needle. This technique warms up the needle and delivers heat deeply and very accurately into the acupuncture point and body. Sometimes the herb is rolled into a large cone and burned on top of a slice of another herb like ginger, garlic, or even a small pile of salt.

The more common Japanese method of using Moxibustion is quite different. Only the highest quality Moxa is used in this application. This quality of Moxa is very fine and looks like a big golden ball of fluff. This fluffy Moxa is rolled between two wooden planks to make long thin tubes about the diameter of a toothpick. The Moxibustionist will apply an oil-based barrier on the skin and then plucks a piece of rolled Moxa about the size of a grain of rice and place it perpendicularly on the skin. The Moxa is ignited and it slowly burns down close to the skin where it is snuffed out at the last moment. This technique is called direct Moxibustion and since the higher quality of Moxa burns cooler and the amount used is significantly smaller, the skin is not damaged in the burning process.

Both of these systems work well to activate acupuncture points, restore the balance of warming energy of the body, move blood and qi, and also dispel cold that has invaded and caused illness.

I hope you enjoyed learning about Moxibustion! Next time we will take a look at the role of nutrition and how Dietary Therapy is applied under the lens of Oriental Medicine.

In our first few installments, we’ve touched on what posture and ergonomics involve in our daily life, exercise/training, and sleep.

Today, we are going to get into the nebular world of the “other stuff.”

What’s the other stuff?  Great question.  Just a catch-all category I could throw two other common issues into that we all tend to deal with (some of us better than others!).

First: DRIVING!

And no, not on the golf course…that’s Scott’s area of expertise (unless, of course, you’re stiffness and stability are problematic and keeping you from getting into the postures Scott wants you to get into…then you can come talk to us).  No we are talking about the on the on the 101 and backstreets of Santa Barbara kind of driving of our wonderful automobiles.

Who cares?

According to a AAA survey in 2014, the average American spends 48 minutes per day in their car (which translates to 294 hours per year). (1) Here in Santa Barbara, that might be a slightly high average since we don’t tend to commute as much.  However, the point is clear, we are in our cars and sitting… A LOT.  Just as we discussed some of the prolonged sitting issues in our first installment, there are no major differences and/or issues that arise here (cervical pain and postural distortion, lumbar pain and postural distortion, hip or lower leg pain from prolonged compression of soft and neural tissue and/or repetitive patterns).  The strategies, however, are slight different:

• Bring the seat back forward until you are reclined at a 100-110˚.
• Bring the steering wheel down and toward you to minimize reach.
• Head adjustment so you can set your head back in good cervical stacked position.
• Rearview mirror to keep you sitting tall (great reminder).

Next:  Move while you drive (SAFELY!). Here are some simple things you can do and keep your attention focused on the road!

• Pelvic tilts/shifts/turns.
• Shoulder circles.
• Use cruise control.
• Change hand positions frequently.

The final topic of our Ergonomics and posture conversation is in regards to another primary cause of “orthopedic” pain and injury: emotions.  Here’s the lowdown:

• Worldwide, 1 in 10 people suffers from lower back pain and it’s the No. 1 cause of job disability. In the U.S., $90 billion is spent on back pain each year.
• Few people want to be told that their pain is psychological or emotional in origin, but there’s quite a bit of evidence that backs this up. Studies suggest that, to be effective, pain needs to be addressed from a biopsychosocial perspective.
• The late Dr. John Sarno used mind-body techniques to treat patients with severe low back pain. He believed you unconsciously cause your own pain, and that pain is your brain’s response to unaddressed stress, anger or fear.
• Pain acts as a distraction from the anger, fear or rage you don’t want to feel or think about, acting as a lid to keep unwanted emotions from erupting. Sarno believed most pain can be overcome by acknowledging its psychological roots.

Recent research supports Sarno’s ideas. In one recent study, emotion awareness and expression therapy reduced chronic musculoskeletal pain by 30 percent in two-thirds of patients; one-third of patients improved by 70 percent. (2)

Suffice it to say, I have had multiple conversation with medical professionals about the reality of patients experiencing pain with no mechanical, chemical or tissue abnormalities present…it could just be emotions or stress-related.

I hope this series has been helpful and insightful.  Clearly we are complex beings.  Care for yourself well.  Move!  Seek help and share your life with the right people.

1. https://aaafoundation.org/wp-content/uploads/2017/12/AmericanDrivingSurvey2015FS.pdf
2. https://articles.mercola.com/sites/articles/archive/2017/10/25/back-pain-repressed-emotions.aspx