 Welcome to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. This show is designed to bring you not only the most effective physical therapy tips, but also holistic information to help you achieve total body wellness. Poster is highly underrated in today's world, a world in which we spend a majority of time looking down at devices in addition to our normal everyday activities that require looking down like cooking, cleaning, washing our face, and even yard work. In the last two weeks, the most common injuries I'm seeing in the clinic, believe it or not, are posture related. Back pain, hip pain, neck pain, shoulder pain, and even thumb pain, all stemming from poor postural habits and poor spinal alignment, magnified by being stuck at home and behind a mask. In today's episode, I, your virtual physical therapist, will show you how your posture habits are causing you pain. And I'll provide you with simple tips and corrective exercises to do right now to improve your posture and resolve pain. So let's look at image number one. Is this you? Go ahead, look at yourself or have someone take a photo of your imperfect posture. Because if this is you, this can be causing your pain because you're holding your body out of alignment. If you see in the photo the man is far forward, his back is rounded, he's hunching forward. And so that takes your body out of normal alignment. And to be in proper alignment, you need to have your ear over your shoulder, your shoulder over your torso, your torso over your hips and your hips over your feet. And when you're sitting, you need to make sure that you're sitting squarely on your sit bones and not on the back part of your bottom. So let's look at image number two and I'll show you what it looks like to be in proper alignment. And so if you're the person on the right in the dark purple shirt, and I think you should try this, you'll see you line yourself so your buttocks, your upper back and your head are on the wall and your feet are about six inches away from the wall. You wanna have a space between your lower back and the wall and you want your head to touch the wall. So if you look at the image with the pink shirt, you can see that her head is a little bit off the wall. And so she's not able to get all the way back. And you could also see it looks like her lower back is touching the wall. If that person is you, that just means that you're holding yourself away from your normal spinal curves and you're putting your neck, your shoulder, your back, your hip, your wrist and your elbow at risk for injury. The closer that we are to maintaining the normal spinal curves, which are a backwards curve in your neck, a slightly forward curve in your upper back and then a backwards curve in your lower back, the more at risk we put our bodies at for injury. So I wanna introduce you to Veronica. Veronica is a patient of mine at two weeks ago. I saw her on her third session and she had thumb pain. Thumb pain that was excruciating in the morning. So terrible. She had had a fall about nine months ago maybe, but she didn't have pain after that and she was just frustrated but the biggest thing I noticed about her was that she was so hunched while she was waiting in the waiting room chair outside. So I mentioned to her, okay, well, are you doing some exercises to help improve your posture? And she says, no. And I told her, I noticed that she was kind of hunched forward and how she should sit up straight. And she wanted me to bring this to you today because I told her to remind herself by using her phone and maybe she should set a reminder to go off every five minutes for the first hour because after six or seven times she wouldn't even need the reminder. She'd be annoyed, she'd be sitting up straight. So she took it on and said it was the best thing because she was visiting with her husband and her neighbors outside. And she said every time her alarm went off she sat up straight and everybody sat up straight and they all started laughing. And so I wanted to point that out to you. It's easy to set reminders if you do tend to hunch but you're involved in your project, you're involved on your laptop now at home because you're working from home. Set a time to go off, set it frequently because you're not gonna need it that often. Your body and your brain will get trained to reproduce that habit, that habit of improving yourself in better posture. So when we're not in good posture not only does it hurt your thumb but it hurts the rest of your body. When we're too far forward we can't even raise our arms all the way up as I'll show in video three. So you see here I'm slouching and raising my arms then I sit up straight and I raise my arms up all the way over my head. I suggest you try that because it's not an optical illusion. You slouch, raise your arms up. They only go up so high and then you sit up straight and up they go. And that's because of where the ball of your shoulder bone articulates with the shoulder blade and sits on your torso. If that shoulder blade is sitting forward because you're in poor posture it pushes the shoulder bone forward and you're no longer able to lift your arm up higher because your rib cage and the position of the shoulder blade is preventing that. So let's look at video number four. Here's where your poor posture can really be a problem for you. So your shoulder blade sits on your rib cage right here and then your shoulder bone articulates right here. So if you're really far slouched forward your shoulder blade will move forward on your rib cage and it pushes your shoulder bone forward. But also it makes this relationship of where your neck is to your head really far forward. So that's another reason why it's so important to sit up straight and correct your posture if you haven't been aware of it until now. So I think that show is a good visual of where things sit on your rib cage and that person, the skeleton is relatively normal posture minus I think the position of his neck. So with Veronica, I was trying to find something to get rid of her thumb pain and I knew that it wasn't in her hand because the other person that treated her already worked on that and she didn't have relief. So I started migrating up the arm and I went into a muscle that's underneath the shoulder blade. Does it hurt here? Does it hurt here? Does it hurt here? Because she was so slouched forward that muscle works with a different mechanical advantage. So I went in there and I poked my thumb in there and she goes, oh my gosh, my thumb hurts. So I released that muscle. I gave her a couple of posture exercise which you're gonna learn in about 10 minutes. And she came back and said, you know what? I was a little sore for a few days but then my thumb is so much better and she couldn't believe that her thumb pain could be coming from the muscle under her shoulder blade. I think it had a little bit to do with, you know, she landed funny when she fell nine months ago. She also slouched her so that muscle is overworking. Maybe it was pulled a little bit with the fall and nerves go through muscles. And so that muscle was tightened up, irritating a nerve that was running down into her thumb. So I wanted to, I know it's a lot of information for everybody but let's look at video number five right now. So this bone right here is where those pec muscles attach to the short one that I'm referring to. It runs from this bone, which is on the front of your shoulder blade here and it goes down and attaches to your ribs. So when it's tight, it pulls you forward. It pulls your shoulder blade forward. It pulls this forward. So that's why it's so important to stretch out the pec muscles to help you get into better posture. So the pec muscles are a real big deal when it comes to posture because I'm always reminding people to sit up straight, squeeze their shoulder blades. But if you have been hunched forward for 10, 20, 30, 40 years, those pec muscles can be more adaptively shortened in that position. And you're trying to squeeze your shoulder blades but you saw in the video where those pec muscles attach and you're fighting against a muscle that has become short. So when I see someone in the clinic, I loosen them up quite a bit to make the muscle more pliable so then they can also get into a better posture but it's also important to stretch those muscles to allow you to be in a better posture. Those pec muscles are so important. I was just working with a golfer yesterday as a matter of fact, he's 71. And he said, oh, I'm such a bad sloucher and we were talking about wearing those posture braces and how they can help him. And I'm always reminding him, sit up straight, sit up straight, squeeze your shoulder blades. And so I'd been loosening up his pecs on the left side which is a side he had shoulder surgery but the right side I found to be so tight. So I put them against the wall like I showed in the second image and we worked on shoulder blade squeezes against the wall and I also showed him some stretches to do which you'll see in a few minutes. Actually maybe we'll show video eight right now. If you have been slouching for a long period of time or you have developed that forward shoulder or forward neck deformity, you're first gonna need to stretch out the tight chest muscles in order to be able to sit up straight and to get into better posture. So one of my favorite things to do is to stretch in the doorway and this is how you do it. You put your arms straight out at shoulder height, put one foot in front of the other, try not to fall over. And then you push with the back leg through the door lifting your chest up and breathing in and then you relax and come back. Push with the back leg, lift your chest, breathe in and then breathe out while you hold that position then breathe in again, lift your chest and then relax. And then you just switch legs, put the other leg forward, push back, push forward, lift your chest, take a deep breath, exhale and then push forward a little more, breathe in and enjoy the openness that you feel in your chest and the ability to sit much straighter. Now all you need to do is do those re-education exercises and you'd be good. Okay, so I've got a question on this. Thank you so much for sending these in. Is there a device I can wear to help correct my posture? So it's funny, we were just talking about that with my patient and he actually bought a device and tried it on and his biggest complaint was that he's hard to get on and that tends to be the problem with some of these devices, especially if you have shoulder problems. I've had five shoulder surgeries, he had a shoulder surgery, if you have neck pain, they're hard to get on. So I brought one that is kind of a nice thing. It's a loop like this and putting it over your head when you have shoulder problems like this is kind of tough because you gotta wrestle it down your back but you can also slip it on like you're putting on a sport coat, you put it up on one arm and then you slip it over the other arm. And this is just a reminder. So if you're gonna wear something like this, you can put it in different positions. Where you don't wanna put it is up here on your neck because it's not gonna hold you back. You wanna keep it so it goes right in the center of your shoulder bone and the round bone that you can feel there. So you get it wide and it tends to give you this little pullback but you don't wanna use it for hours and hours on end. You wanna put it on for about 10 or 15 minutes because your body's getting different inputs when you put these devices on and you don't wanna get like some neck pain from it. You can also move it down here. That's one of them. There's another one and that's really low resistance and stretchy. There's another one that's more like this where it's kind of a halter and it has a strap like this. There's many of them. This one is fine as well but I tend to put it on upside down. Like it's the correct way this way. But I have to put it on upside down because what I wanted to achieve is I wanted to achieve the shoulder blade rotation backward to pull my arms back. So let me see if I can get this on quick. I thought I had these here actually. I borrowed this one from a patient. You can't see with my black shirt. So you don't again wanna wear it up here because you can just slouch right through it but you wanna pull it out to the side here or maybe even lower to get your shoulders back. Now this is great because I cannot slouch forward. I can reach forward but I can't slouch forward. So there's different things. Now that's good. You can work on your laptop. You can see it from the back. Maybe because I have blackout that wasn't a good idea but these things can be very helpful. Just don't get caught wearing it for too long because you could get some net kinks, especially if you are further away from the wall in the test that we did. So these are some posture straps. So if anybody has any questions, feel free to write in and I'll tell you which ones that I used or I could provide a link for that. So let's look at video number six. We're gonna talk about the dangers of having poor posture and poor posture alignment. One of the biggest dangers of having poor posture is that your alignment suffers. So your alignment suffers in your neck, in your shoulders, in your upper back, and in your lower back. So some people when they get older, they get stiff because they've had bad posture and they didn't really realize it. So one exercise I give people is to stand against the wall. You put your buttocks against the wall and you walk your feet about six inches up and you try to squeeze your shoulder blades back to the wall. Now many people might not be able to touch their head to the wall but I have good posture because I work on my posture so you wanna get back here. And then what I tell people to do is do a T and then you squeeze back and you touch the wall. You touch the wall and you keep your buttocks on the wall. And then you also can make goal posts like this and touch your thumbs to the wall. Now the reason why I say some people might be here and they can't touch the wall is because when you're forward, you get tight pec muscles here and those needs to be stretched out and those attached to the front of your shoulder blade which I showed you a little bit of on the skeleton. So get on the wall now and improve your posture. So I think by now you're getting the general trend of how important posture is and also how detrimental the pec muscles are on the front of our body to achieving good posture, especially since everything we do is in front of us. As I mentioned in my introduction, washing dishes, getting dressed, playing with your grandkids, gardening, reading a book, being on your phone, being on your laptop, getting ready for bed, it's all in front of us. And so we use so much of the front muscles. And if you've seen the show before, I tend to say the undo the sport or undo the activity. And I think what I mean by that is just it's important after anything you do, even if you're just cooking dinner for two hours for your family, you wanna undo the sport. And I tend to cycle through the T's, the W's, because, or the stick them up, I think I call it, because it's a great way to exercise the upper back muscles and your pecs as you learn on the video attach right here and they pull you down and forward. So if you're not doing the doorway stretch that we saw where you take the big breath in to stretch those pecs out or Mary Massery's breathing in to stretch those chest muscles out and connect it to your rib cage, you can get tighter and tighter and tighter over the years without even being aware of it. So I wanna hammer that home, the importance of the pectoralis muscles. So we're getting a question from a viewer. Thank you again so much for sending this in. I had bad posture all my life. Is it too late to change? Can strengthening your core help with posture? Yes and yes. So if you've had bad posture all your life, like my patient who was 71, it's never too late to learn and small changes done consistently will make a huge difference. So where you wanna start is on the wall. So you wanna put your buttocks against the wall, put your upper back against the wall. If your head's not on the wall, don't worry, don't tilt it up to try to get it to the wall. Just let it be off the wall and you start pressing your shoulder blades back to the wall. You start there, but don't press your back against the wall. Start pressing your shoulder blades against the wall because that gives your body input of somewhere to go. You can do it in the car seat too. I tell people when you see your shoulders forward in the car seat, push them back and try to get your shoulders to meet the car seat. That's where you wanna start. And also doing the exercises where you just start opening up here and squeezing your shoulder blades, keeping your elbows in at your side, starts working the muscles on the back that you haven't been using while you've been slouching forward or the stick them up to try to open up your chest and activate those shoulder muscles. Now the second part of your question we're talking about strengthening your core can help with posture, absolutely. And also posture can help with your core. When you're slouched forward, your rib cage gets closer to your pelvis and that crunches down your abdominal muscles. Your rectus abdominis lives in the front. Your transversus abdominis which is the most important one that I like to talk about runs from the side, it's D. And then your obliques come in on angles from the side. All those become in this shortened slacked position and worse, the back muscles are rounded and so they're stretched out. So they just get tired just like your upper back muscles when you slouch too much. When you sit up straight, you can engage your core better but also when you work your core muscles you will sit up straighter. So I want everybody to try it right now. Just sit, sit how you are. Don't slouch terribly but you can, you can slouch a little bit and pull your belly button in. Just suck it in like that, just like that. And you see when I pull it in it kind of rises my chest muscle a little bit. I can also pull it in and sit up straight but that's extra action on the upper back muscles. So suck your stomach in. You can perform kegels where you're tense your pelvic floor and you notice that your torso gets elongated because that's the action of your trans or subdominous to help support that middle section of your trunk. So thank you for that question. That's perfect because we're talking about the pec muscles and posture and core. So let's go to video number seven for a more aggressive way to stretch your chest if you can get down onto this object. This is an excellent way if you can safely get on a foam roll to stretch your chest. It's my favorite is save my neck since my car accident when I was in my, gosh, I was in my teens. So you pop on your foam roll with your tailbone on the end so that your head can go on here and you get your shoulder blades together and out of the way so that your arms aren't forward. You bring them back and you bring your arms out into the letter T. Then you're gonna lean your head over to the right, roll a little bit to the right and then you'll stretch out the tight pack on the left. You take a bunch of deep breaths in and then a bunch of deep breaths out. I usually do three and then I come over the other side. I lean, I roll, bunch deep breaths in all the way in and all the way out. You go back and forth a few times, three breaths each side and then you tuck your chin down because you're gonna help get that neck stretched out to get it back against the wall. Then you could do mini snow angels squeezing your shoulder blades back. If your hands pop up, that's okay. You're gonna have to shoot strive for getting them on the table and then I also bend my elbows, touch back, squeeze your shoulder blades, keeping my neck down. You don't wanna tilt your head and if your head is too far from the front row you might need to put a pillow because I don't want you to kink your neck either. You can also do this in the corner of your bed if you don't have a roll. Or you could roll up a beach towel or a yoga mat and try it on that because it's softer. So there's your T's and your W's and the rotations again. There are so many ways to work on your posture. I'm sure if you've looked it up on the internet, you'll see that. I'm just trying to give you the ones that work the best for me, for my patients, for my family, for my friends that really cut to the chase and get you where you need to be with your posture without you having to take tons of time out of your day to do it. And these are simple. You can integrate that into your day. The foam roll is abrupt. I love it. But if you're older and you're really stiff you're not gonna get on the foam roll. You're gonna stand against the wall and you're gonna work on the wall posture. You can roll a vertical towel and put it in your back and neck against the wall and try to give yourself more, what is it? More room to go back in the T once you get to the wall. So that can make it a little bit more challenging for you. But it's difficult to get on the foam roll, especially as we get older. And I want people to be safe while they're stretching their pecs and getting into good posture. So let's go to video number nine. If you wanna help your posture and get rid of that slouch, grab your swiffer, bring your arms up over your head, try to bring it down behind your head and neck. I can bring mine all the way behind my back, as you can see here. But a lot of people with the stiff upper backs can't even get it that way because they're punched. So you wanna practice bringing it up, squeeze your shoulder blades back. Feels good. Stretch that posture out. You can't do that at first. You can put it up here. So it's high up in your arms to try to lift your chest up and turn side to side or bend left to right to begin your journey to improve your posture. This one's fantastic because while the swiffer is up behind your back and you're lifting it up and down, you're actually undoing the sport, you're squeezing your shoulder blades and stretching your chest at the same time and add breathing to it. It really feels like such a good open, especially when you pull it down. Breathe in, let those tight pecs pull your ribcage up and lengthen and then come up and relax. It's such a great exercise. The reason why I'm showing you the doorway stretch, the wall stretch, the foam roll, the swiffer is again, you need to stretch out those tight pecs to allow yourself to get into better posture. You will feel less tension on your neck. You'll feel less pain in your shoulder. So many people get bicep tendonitis and supraspinitis, tendonitis and even thumb pain from poor posture and tennis elbow from poor posture. I have a tennis elbow person right now from poor posture and poor shoulder blade function. So it's so important to have the core engaged to have your shoulder over your hip, to have your shoulder blades engaged on your thorax so that your whole upper extremity and your neck can function optimally. And let's look at video number 10 for some of these exercises now. Okay. I'm gonna give you my top, get rid of your shoulder pain, get rid of your neck pain, get rid of the tightness that you felt sitting at your desk stretches. Number one, you are gonna rotate your hands out to the side, keeping your elbows in like this and squeezing your shoulder blades. Number two, arms at shoulder height. Pull back squeezing the shoulder blades until the band hits your chest. Number three, I call X's. You form the angle of one X, pull back, squeezing those shoulder blades, keep your chin down and your neck long, switch the other X and squeeze. I like to do 10 of each. And then the last one, arms up over your head, pull down and lift your chest. Come back up, pull down and lift your chest. Legs long, everything feels good. Enjoy feeling better, everybody. Those are my go-to with or without a band. I've been doing them for decades to help with my neck and my shoulders at the end of my work day. So I'm gonna go to a little bonus video right now. Video number 11. What I've been unfortunately seeing more of since this pandemic is people that have back and hip pain and shoulder pain from being stuck in a posterior pelvic tilt. And it's something that physical therapists refer to as the no butt syndrome. And here's why. So if you are standing like this, you've got your butt in front of your back. And so there's nowhere for your hip to go. So your glute muscles just disappeared because you're walking like this. And how people get like that is from years and years of slouching over at their laptops or leaning forward over things like this. So it's really important. I have a few people right now who have hip pain and back pain and one who has shoulder pain because they've been sitting like this and now when they walk, that's how they walk. I used to tell people if your pelvis enters the room before you do, you have a posterior pelvic tilt. So it's really important to start opening up, getting your chest, stretch out your pec muscles, suck your stomach in, stretch your hamstrings. There's so many exercises that we can do for that but I wanted to call your attention to it. Have someone take a picture of you. If you're getting fixed like this, you need to start learning how to support your back with a pillow while you sit at your laptop, at your desk, on your sofa, everything that we've been doing because we've been stuck at home. So I hope that's helpful. That's perfect. Okay, I know that's a lot of information and that's my bonus video. And I just so happened to get another question right now. Thanks for sending it in just the nick of the time. I've noticed that I have a flat back. How do I get my lumbar curve back? That's lumbar curve is your low back. The best way to get, well, there's several ways and maybe I can do that next show, but one of the great ways to get your low back curve back is to start sitting with a pillow placed in your low back, scoot your buttocks all the way back in whatever surface you're sitting and get a pillow in the low back. If you're sitting on the sofa, scoot your buttocks all the way back, put a pillow in your low back. You have to start teaching your body to have that normal curve again because you don't wanna enter the room with your pelvis first. You wanna enter the room with your face first because that's what everybody wants to see. If you squeeze your shoulder blades back and your pelvis is forward, you're gonna feel like you wanna fall over backwards. And I showed that a little bit in that last video where you push your buttocks back. You don't arch your back. You just shift the weight of your feet into the center and move your buttocks back. It's more towards your heels and then you lift your chest up like that. So I hope that answers your question. You wanna put a pillow in your back. You wanna start doing some shoulder blade squeezes. You wanna sit with the weight on those two sit bones, not rolled back with the weight on your back. So thank you so much everyone for joining us today. I hope you learned some good information. Thank you ThinkTech and all our sponsors and donors for allowing us to bring this to you in your home. As always, life is better when you listen to your physical therapist. Aloha.