Here at North Jersey Physical Therapy, we believe that one of the root causes of muscle, nerve, and fascial pain is directly related to posture. Gravity is constantly pushing down on us and stressing our bodies in ways we are not always aware of it doing. Therefore, we have to be proactive against gravity. We have to realize that when we sit or stand we should be active, not passive. This is where good posture comes in. We must focus on certain muscle groups to align our spine in order to achieve posture alignment with the least amount of effort.
Correcting posture is not only possible but simple. With a little effort it can be practiced throughout the day and yield dramatic results. In fact the more you practice correct posture the simpler it becomes.
Our belief in the critical nature of good posture is so great that one of our therapists, Polixeni Katsaros, PT, DPT wrote a book on it called, “Posture, Simply Posture, Correct Simply” where she outlines the importance of understanding how gravity affects our body and the importance of understanding how posture and proper body alignment can counteract the effects of gravity.
Patient: “But it hurts when I sit or lay down… shouldn’t I feel better when I’m resting?!”
PT: Not exactly…
A common line of thinking among many PT patients is that rest will resolve pain. It’s counterintuitive to many individuals that discomfort and pain persist while resting. Let’s dive into this misconception and shed some light on the topic of rest as it relates to pain.
When it comes to pain that is musculoskeletal in nature, it’s common that the cause is overworking, stress, or strain on the muscles, tendons, ligaments, or bones. People often associate this with active movement: running, walking, or even something as simple as getting out of a chair. In reality, your body is working all the time. In fact, resting states (lying down or sitting in a chair) can be interpreted by your brain as potentially dangerous if you have overworked a muscle that is typically used for this activity. For this reason, many therapists focus on educating their clients to rest in anatomically safe postures. You might ask: what is an ideal posture? How can my resting posture be flawed? Therapists know that ideal posture is a position in which your body is working most efficiently and able to support itself with minimal effort.
In cases where an individual is experiencing pain while sitting or otherwise resting, it’s likely that the resting or seated posture causes stress on this area of the musculoskeletal system. The brain interprets this as a stressor and triggers a pain response in the physical body to alert the individual of the burden that area of the body is under. What most people don’t understand is that the body is sending them a message. Pain is a news bulletin from the brain that the position is not ideal and that a change is necessary to obtain comfort. If the individual ignores this signal, as many do, the pain will persist and the brain’s alarm system may become more sensitive. This becomes cyclical, causing a lower threshold for activity before pain comes on again. If a smoke alarm is going off in your house– do you take action to address it or let it ring and ring? More than likely, you look for a reason for the alarm. Sometimes the smoke alarm goes off when something is burning– this can be analogous to an active pain response. Other times, you are taking a shower and the steam sets it off– this is what can happen to our alarm systems they can become more sensitive to stimuli that are not dangerous– like resting postures that seem like they should be pain free.
Now that we have a clearer understanding of why rest isn’t always restful, let’s explore some solutions. A few things need to happen in order for a patient to improve tolerance for resting postures. The first is being aware of your brain’s alarm system and making adjustments to your position when pain occurs. The second is freeing up the tissue that has been overworking and experiencing strain. This is where the PT often utilizes a variety of techniques like myofascial release, instrument assisted soft tissue mobilization or cupping to name a few. The third is to support the tissue that has been overworking by re-educating inhibited muscles to turn back on and properly support the straining tissue. Finally, in some cases the fourth step is to provide the area straining with some support while the system is rebalancing. When these steps are taken with the assistance of a PT to properly assess the body and determine a treatment plan, most individuals experience a reduction in their resting pain. Like anything that is worthwhile doing this process takes time and commitment to the program outlined by your PT.
If you experience resting pain, it might be your body’s smoke detector going off. Give us a call! Our job is to evaluate you and to help devise a treatment plan to make sure your alarm system is running correctly. We look forward to working alongside you on a treatment plan that balances your body and support getting you back to the place where rest is restorative and enjoyable, not painful.
Disclosure: If you experience pain that wakes you up at night and you are unable to fall back asleep, this may be a sign of a more serious problem and is something that should be brought to the attention of your team of healthcare professionals.
North Jersey PT sponsored Patrick McKeown to come train North Jersey Physical Therapy therapists in the Buteyko Breathing Method.
The method is aimed at reducing breathing to promote our bodies to be in a state of relaxation and equilibrium, and break the cycle of sympathetic overdrive or being in a state of constant “fight or flight.” It was created by a Russian physician, Dr. Konstantin Pavlovich Buteyko, around 1952.
Because our systems are stuck “on,” many of us have the tendency to breathe too much (clinically known as chronic hyperventilation), which alters the level of the gases in the blood and leads to numerous problems. Some signs of dysfunctional breathing include mouth breathing, hearing breathing during rest, excessive sighing, frequent yawning, regular sniffling, and taking deep breaths before talking. Things that can lead to dysfunctional breathing include over eating, lack of exercise, excessive talking, stress, high temperature in the home, and asthma.
Through a series of breathing exercises we are able to reset the respiratory centers in the brain and restore the normal balance to the system and allow the body to be in a parasympathetic state, or a state or relaxation and equilibrium. Through the Buteyko Breathing Method we are able to help patients change their pain levels and use it in conjunction with other treatment methods and modalities to address headaches, neck pain, jaw pain, low back pain, pain from fibromyalgia, as well as other forms of soft tissue pains.
Call to schedule an appointment with a North Jersey Physical Therapy therapist today to see how we can help you decrease your pain and improve your quality of life.
By John Vicchio, PT, CCTT
Breathing is unquestionably a key function of the human body. It sustains life by providing oxygen needed for metabolism and removing the by-product of these reactions, carbon dioxide. Breathing has other functions that affect motor control, postural stability and roles in maintaining homeostasis function (maintain internal stability such as balance and equilibrium) in the autonomic nervous system and circulatory system. When breathing becomes dysfunctional it affects people’s lives, challenging homeostasis, creating symptoms that most patients do not associate with their pain and compromising health.
The primary muscles of breathing are the diaphragm, intercostals (muscles running between the ribs) and abdominals, which allow the average person to take over 21,000 breaths per day. These muscles are located in the chest wall compromised of the rib cage/thorax and the abdomen, creating an effective respiratory pump. The respiratory pump can become dysfunctional due to many factors, which are altered and paradoxical motion between rib cage and abdomen called paradoxical breathing, thus increasing use of upper body muscles such as the scalenes, upper trapezius and sternocleidomastoids. Abdominal weakness and rib cage stiffness are common dysfunctions that we see at North Jersey Physical Therapy Associates (NJPTA).
At our clinic we evaluate and treat on how breathing affects postural stability and motor control. Muscles such as the diaphragm, transverse abdominals and pelvic floor muscles are important for motor control and postural support as well as for breathing. If their function is compromised there is an increased susceptibility to low back pain and injury.
At NJPTA, we take a unique approach in treatment, which includes an extensive assessment and treatment using manual therapy interventions, neuromuscular exercises (90/90 Diaphragm breathing, Buteyko breathing) and dry needling. These are all helpful tools in restoring and maintaining motor control/postural stability.
Below is an illustration of optimal breathing from Integrative Core Dynamics:
By Carol Cote, PT, CCTT, CODN, CMTPT
In the general medical population we make the mistake that muscles are under 100% voluntary control. This is partially true, however, the majority of our muscles are more automatic (i.e. autonomic nervous system) than voluntary (somatic nervous system). Our muscles are controlled by 2 nervous systems. The somatic nervous system is our voluntary nervous system. When we bend our elbow and move our bodies voluntarily that is done through the somatic nervous system via our motor cortex.
Our second auto pilot nervous system is our autonomic nervous system which is more about bodily functions that help us survive (heart beat, body temperature, blood pressure, digestion, etc). Muscles are innervated by both nervous systems. For example, breathing. We have voluntary control with our breath but breathing is more automatic than voluntary. Muscles of our spine, shoulder blades and pelvis are more autonomic than voluntary. Autonomic muscle control has to do with how we hold our body against gravity. Our brain is blind to gravity, reflexes (such as balance) and habits (motor activation patterns
and muscle memory). Holding our head up and balancing is automatic very much like breathing. When it comes to neck and back pain and muscles this problem is an involuntary muscle problem.
Dry needling works to change our autonomic motor control affecting our auto pilot muscle activation pattern by releasing the trigger points (involuntary muscle contractures) that exist in chronic soft tissue pain. Dry needling works faster than traditional manual therapy like massage and even joint manipulations, treatment strategy needs to address the right level of where the problem is. Dry needling works at the three levels of how our bodies process pain:
1. Peripheral (skin, muscle, bones, joints)
2. Spinal (spinal cord, nerve roots) and
3. Brain (motor and sensory cortex along with our thinking/decision making and emotional brain).
Dry needling is a key treatment strategy which works at all levels (voluntary and involuntary) all at once and allows for permanent sustained change.