What Is Proper Diaphragmatic Breathing?

There is a lot of misinformation out there on diaphragmatic breathing. Considering how essential proper diaphragmatic respiration is to our overall health and success with a Postural Restoration Institute physical therapy program, we wanted to clear it up a bit. 

Diaphragmatic breathing is NOT belly breathing!

The diaphragm is our primary respiratory muscle and is positioned at the bottom of our ribcage. It attaches to the inner portion of our lower ribcage and the front portion of our lower (lumbar spine). At rest, it is supposed to be in a domed position within the ribcage. When we breathe in, the diaphragm contracts and flattens. This causes negative pressure within the chest and allows us to take in air. When we breathe out, the diaphragm relaxes and returns to its domed position (or at least it’s supposed to) and the air is moved out of our lungs. In order for this to happen, the internal obliques and transverse abdominis (deep abdominal muscles) need to be active to keep the lower ribcage in a proper position. For a more detailed explanation of this action as well as some cool visuals, check out our previous blog Balloons- Quite Possibly The Most Underrated Therapy Tool.

So, what is diaphragmatic respiration supposed to look and feel like? For a relaxed inhale, the lower ribs should move genially out toward the sides, or laterally. Then, the lower ribs will move slightly forward with the abdomen moving along with it in almost a 1:1 ratio. During a deeper breathe, the upper chest will rise slightly after the the lower ribcage and abdomen have begun their movement. 

This can easily be felt by lying on your back and placing one hand on your lower ribcage (just below your breastbone) and another hand on your stomach above your belly button. Be sure to do this when you’re either sleepy or meditating as it is more likely you are naturally diaphragmatically breathing at these times. Feel the gentle lifting and lowering of your lower ribcage and abdomen almost in unison. You should not feel one area moving significantly more than the other, particularly your abdomen moving more than your ribcage.

In order to belly breathe, those essential abdominal muscles must be turned off to allow the belly to be loose enough to take in breath. Once those muscles turn off, the diaphragm loses it’s foundation on which to work. Essentially, when our breath fills our belly, there is no way we are actually using our diaphragm. Additionally, if you think about it, it just doesn’t make sense to breathe this way. There is no lung tissue in the belly. Therefore, why would be focus on moving air into an area that our lungs are not?

If you lie on your back and notice that your belly moves first or farther than your lower ribcage, you need to correct the issue right away. Poor diaphragmatic breathing can cause anxiety, lower back/neck pain, pelvic floor or women’s health dysfunctions (such as incontinence, pain with intercourse, constipation, etc.), GI dysfunction, and many other problems. Typically, individualized, guided restoration of the diaphragmatic breath is needed. Simply doing online research and trying to fix the problem yourself will likely lead you to more misinformation or may cause you to adapt a new, non-diaphragmatic breathing pattern such as overusing the muscles of your neck. Diaphragmatic restoration can be achieved in as little as one visit with the therapists at Integrate 360 Physical Therapy so give us a call today at 314-733-5000!

Written by Lesley Callaham, MPT, PRC on October 16, 2018

Ease Headache and Neck Pain In The Car

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Although it may not seem like it, the car is a very difficult environment for your body to manage. The floor/seat is constantly shifting as you speed up, slow down, or turn. Manipulating the steering wheel is hard on your arms, neck, and shoulder muscles. The windshield set up and personal habits of where to look can irritate muscle tension. Because the car itself, environments in which you drive, and your personal compensation pattern are all highly variable, it’s best to talk to your therapist about what is best for your body. However, here are some tips to help you get started. 

1) Get grounded as best you can. Feeling as supported as possible allows your body’s resting muscle tension to ease. It also gives you more information about the forces acting on your body at any given moment and how to respond to them. Think about it, if you replaced your car’s seat with a barstool, the muscles in your body would be much more rigid to try to give you stability. Couple that rigidity with the motions of the car when you’re turning, your body cannot react appropriately to negate the force on it, and it will only become more rigid. This will end with your falling off of your stool during a turn instead of being able to rebalance your body and stay seated. 
   Allow your left foot to rest solidly only the floor, not falling against the side of the door. Adjust your seat position and lumbar support so that you can easily feel your sit bones on the seat and your lower back against the seat back. Be careful to not over-support your lower back and cause a lot of arch- you’ll notice that you’re no longer on your sit bones. 

2) Give your arms a chance. Most of us have flattened ribcages in the back. This is problematic because the scapular bone (the foundation of our shoulder joint) is slightly rounded. When that slightly rounded bone is sitting on a flattened ribcage, it has inherently less stability than if it was sitting on a slightly rounded one. Proper alignment allows your scapular muscles to work more efficiently and create a stable base for your long, heavy arm to work off of. 
   This is best accomplished by rounding the upper back slightly so that the area at the bottom of the scapular (bra-line for women) is touching the back of your chair and the area above that is slightly away from it. 

3) Give your arms a break. Even with a nicely rounded ribcage giving your scapula a proper foundation and good stability, keeping your arms upright on the steering wheel for long periods of time is more than most people can tolerate. Once appropriate muscles fatigue, we’ll often use our upper traps and necks to try to hold them up and this creates or worsens pain.
   Try taking turns with your arms and driving with only one arm at a time (obviously don’t sacrifice safety to do this). When you want to drive with both arms, change the spots on the steering wheel that you’re grabbing. First have your arms at 11 and 1 o’clock, then move them to 9 and 3, then again to 7 and 5. The constant change in arm elevation and rotation will help fight muscular fatigue. 

4) Optimize your eyes. Make sure you’re always driving with the correct lenses or glasses if you need them. Avoiding eye strain will not only ease ocular muscle tension and headache pain, but you won’t be straining your neck to help you see better. Also, try to not lock your vision on one thing (such as the license plate ahead of you). This places your muscular system on autopilot and produces muscular rigidity. By simply looking around your visual field, your muscular system has to stay alert and flexible. This keeps pain low!

5) Try to stay relaxed. Driving, especially in traffic, is stressful! Be mindful of any bad habits you may be slipping in to such as white knuckles on the steering wheel, clenching your teeth, holding your breath. This will all add to muscular rigidity and increase pain. Try listening to calming music or a podcast. You can even try placing stickers at various places in your car. When you see them, check to make sure you’re not clenching (or whatever your habit tends to be) and go about your day!

Happy driving!


Written by Lesley Callaham, MPT, PRC October 8, 2018

Improving Your Sleep Hygiene

Our most recent blog topic was on proper positioning during sleep. As we mentioned, this is really important to cut down on night waking due to pain or pain felt first thing in the morning. However, proper sleep hygiene is essential to allow you to fall asleep asleep and help to keep you asleep throughout the night. The Mayo Clinic has a great article on their 6 tips here. Below is the bulk of the information directly from the article. 

“1. Stick to a sleep schedule

Set aside no more than eight hours for sleep. The recommended amount of sleep for a healthy adult is at least seven hours. Most people don't need more than eight hours in bed to achieve this goal.

Go to bed and get up at the same time every day. Try to limit the difference in your sleep schedule on weeknights and weekends to no more than one hour. Being consistent reinforces your body's sleep-wake cycle.

If you don't fall asleep within about 20 minutes, leave your bedroom and do something relaxing. Read or listen to soothing music. Go back to bed when you're tired. Repeat as needed.

2. Pay attention to what you eat and drink

Don't go to bed hungry or stuffed. In particular, avoid heavy or large meals within a couple of hours of bedtime. Your discomfort might keep you up.

Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep. And even though alcohol might make you feel sleepy, it can disrupt sleep later in the night.

3. Create a restful environment

Create a room that's ideal for sleeping. Often, this means cool, dark and quiet. Exposure to light might make it more challenging to fall asleep. Avoid prolonged use of light-emitting screens just before bedtime. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs.

Doing calming activities before bedtime, such as taking a bath or using relaxation techniques, might promote better sleep.

4. Limit daytime naps

Long daytime naps can interfere with nighttime sleep. If you choose to nap, limit yourself to up to 30 minutes and avoid doing so late in the day.

If you work nights, however, you might need to nap late in the day before work to help make up your sleep debt.

5. Include physical activity in your daily routine

Regular physical activity can promote better sleep. Avoid being active too close to bedtime, however.

Spending time outside every day might be helpful, too.

6. Manage worries

Try to resolve your worries or concerns before bedtime. Jot down what's on your mind and then set it aside for tomorrow.

Stress management might help. Start with the basics, such as getting organized, setting priorities and delegating tasks. Meditation also can ease anxiety.

Know when to contact your doctor

Nearly everyone has an occasional sleepless night — but if you often have trouble sleeping, contact your doctor. Identifying and treating any underlying causes can help you get the better sleep you deserve”

These tips with the information from our previous blog post will, over time, allow you to get more restful sleep. This is essential in tissue healing, posture modification, motor planning retraining, and progress in your journey to eliminate pain!

Sweet dreams!

Written by Lesley Callaham, MPT, PRC October 2, 2018

PRI Sleeping Tips

Image from Huffingtonpost.com

We all know sleeping is essential to overall health, but did you know that poor sleep can rob you of producing certain hormones that are necessary for tissue healing? Whether you’ve never been a “good sleeper” or pain is waking you at night, your sleep quality is important to improving your pain and needs to be addressed. Our upcoming blog post will be about improving your sleep hygiene and the quality of your sleep, but this week we will be highlighting the environment and positioning involved with sleeping to minimize pain at night. 

1) The right mattress is important! The Postural Restoration Institute (PRI) recommends a regular, coiled spring mattress. As the mattress is made up of many springs that individually adjust to different areas of the body, it is a great tool for our patients to sense and feel how their body is lying on the mattress and make appropriate adjustments. Conversely, a foam or sleep number mattress is either made of one large piece of material or much larger sections of air/foam. These designs cannot give our patient’s brains/bodies very specific information as to how they are lying, where most of their weight is, etc. Just as important as the type of mattress, be sure you have a quality mattress or make sure it is relatively new. All mattresses pad down overtime which will limit the mattress’ effectiveness in supporting our bodies, helping us realize where we are in space, or cause us to “fall into the ditch” of where the mattress is the lowest. All of these will increase pain and can cause night-time waking.

-If getting a new mattress is cost-prohibitive for you, you can usually find a donated mattress that’s under 90 days old. Most mattress companies offer free 90 day trial mattresses that are rejected are donated to off-set the company’s loss of income. Call around to your local donation centers and you’ll be able to find where the mattress companies donate their almost-new products. 

2) How you support your body differs depending on the position in which you sleep.

- Back sleeping- This is a great position to sleep in, but definitely is the least popular. Be sure to keep a pillow under your knees. This slackens the muscles on the front of our hip and thigh which can pull our pelvis forward and arch our back when we sleep with our knees straight. Use a pillow that is relatively flat, but has enough structure that the arch in your neck is maintained. 

- Stomach sleeping- Unfortunately, this is a pretty bad position to sleep in. It allows your lower back to excessively arch and places your neck in a significantly rotated position. Even if you do not use a pillow, the TMJ (jaw joint) is placed under a lot of strain as the weight of your head is directly on this non-weight bearing joint. Many people will kick a leg out to the side in this position which places a lot of strain on your pelvis and sacroiliac joints. If you are having a lot of trouble breaking this habit, try sleeping with a pillow under your stomach. Make sure your belly button is directly in the center of the pillow. This will help to keep your lower back in a less-arched position. Keep your legs together and avoid kicking them to the side. Lastly, do not use a pillow.

- Side sleeping - This is a great position to sleep in, but you want to support your body differently depending on what side you are sleeping on. This is based on the fact that our body is not symmetrical; Our diaphragm (muscle that we breathe with) does not work as well on the left which causes our left abdominals to weaken (first) allowing our left lower ribs to flare, our pelvis tends to twist to the right, and our left hip tends to rotate outward while our right tends to rotate inward.

- Left side sleeping - Use a pillow that will allow your neck to stay parallel to the mattresses or causes your head to become elevated slightly (right ear should move closer to the right shoulder). Place a pillow under your left lower ribs. This helps to keep your ribs in a better position and let your diaphragm function better. A diaphragm that works efficiently will allows our neck/shoulder/back muscles to relax as they are no longer needed to help pull in air and can decrease apnic episodes! Place another pillow between your knees and try to push your right knee forward a bit forward compared to your left. This will keep your pelvis from twisting to the right and place your hip in a better position which can decrease lower back strain and irritation to the joint itself. 

- Right side sleeping - Use a pillow that keeps your neck parallel to the mattress. A small pillow can be used under your right lower ribs if you have a flare on that side or know you have abdominal weakness on both sides. The last pillow is placed between your ankles which places your left hip in a better position. Lastly, pull your left knee back a bit compared to your right in order to keep your pelvis from rotating toward the right. 

3) Doing your exercises immediately before bed can have a huge impact. Our PRI exercises are designed to inhibit overactive musculature that are holding your body in a bad position/posture and decrease pain. By performing your exercises immediately before getting into bed, you’ll be going to sleep in the most balanced, relaxed, and pain-free state you can achieve! It also helps to decrease your fight or flight nervous system and increase our REST and digest system. This can have a dramatic impact on your quality of sleep, decrease in pain, and progress in your program.

Sweet dreams! 

Written by Lesley Callaham September 18, 2018

PRI Tips For Caregivers of Young Children

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Let’s face it, raising and caring for kids can be complicated! How much screen time should they have?  What foods should they eat? What is a balanced schedule? The decisions can be difficult, and keeping up with them physically can be really challenging. Here are some tips to avoid pain or keep it at bay for those that work with young children. 

1) Sit on the floor with them. Kids love to play on the floor. As caregivers we find a lot of creative ways to get closer to their level and a lot of them aren’t great for our own bodies. Go ahead and sit on the floor with them! Try to sit somewhere with a back support (wall, piece of furniture, etc.) and sit with either your knees bent up or with your legs out in front of you. Try to be sure that your midback (from the bottom of your shoulder blades or a woman’s bra-line) and below is on the wall. Lean your upper back and shoulders away from the wall slightly by using your abdominals to pull your lower ribs down. If you’re sitting with your knees bent, your shoulders will likely already be pulled away from the wall. Be sure you can feel your sitbones well on both sides. 
   - Try to avoid sitting cross-legged as this places your hips in an exaggerated amount of rotation for a prolonged period of time and places stress on your sacroiliac (SI) joints. 
   - You can also try “mermaid sitting” for short periods of time if it’s comfortable to you. This is essentially side sitting on the floor with both of your feet over toward your left hip. This will mimic proper hip rotational positions and left trunk sidebending that we try to accentuate in Postural Restoration (PRI) programs. Just be careful to NOT do it the other direction (like the woman in the picture above)!

2) Make use of your left side. As a part of our natural bias that often gets over-exaggerated over time and for people with pain, we tend to utilize the right side of our body a lot more, particularly with reaching, standing, and bending our trunks to the right. Simply try to reach more with your left hand as you’re preparing their meal, passing them a toy, or tidying up while they’re napping or playing by themselves. 
   - You can also promote left trunk sidebending by sitting on their right-hand side. Now whether you’re sitting next to them at a chair or on the floor, reading them a book or helping them eat their meal, you will constantly be practicing bending your trunk toward the left. This is essential for progression in your PRI program!

3) Hold/carry them on your right hip. This relates to tip number 2. We tend to place our kiddos on our left hip so that we can manipulate objects with our right arm. By simply placing them on our right hip, our left hand is free to be used more throughout the day. Additionally, the excess weight on your right side will force you to use your abs and bend your trunk to the left in order to counterbalance the weight. This is such a simple trick that can help in so many ways!

4) Use that stroller to your advantage. When taking your kid(s) on a walk, the added weight of the stroller can really help train your abs. When walking, especially when you’re going uphill, think about pressing/reaching your arms forward on the stroller handlebar as your lower ribs move backward and down toward your lower spine. This will help to engage your abs and properly align your spine as well as gain some strength and endurance in those postural abdominal muscles! 
   - When going uphill, be sure to keep your tailbone tucked under (or avoid arching your back) and pushing through your heel behind you as long as you can before letting your body weight move onto the ball of your foot. 

5) Relax. This is something most caregivers understand to be important as we cannot properly care for our kiddos if we are in need. Relaxation is also very important from a PRI perspective. Life in general, especially a life filled with young ones, can be very stressful. It’s easy for our bodies to live in fight-or-flight mode and it can be difficult to get out of it. This disallows the muscles associated with heightened fight-or-flight levels from fully turning off and can lead to muscular imbalances and poor joint positions in our body. Simply relaxing in some way (meditating, diaphragmatic breathing, reading, going to bed a little earlier, etc.) will help to stay in touch with our rest-and-digest systems and remain more balanced emotionally and physically. 
 

Written by Lesley Callaham, MPT, PRC September 6, 2018

The Right Way To Recovery Breathe

Image from livestrong.com

Almost as divisive as proper squat form, how to properly recovery breathe is highly debated. What’s our preference? We like the form pictured above - hands on knees and bent over. I know, I know - you’ve been told by many high school coaches and possibly some personal trainers to breathe with your hands over your heads because it “opens your lungs”. It turns out bending over is a much more efficient plan. 

Let’s start with the basics, your diaphragm is your primary muscle of respiration. It is located in the bottom part of the ribcage and attaches to the backside of your lower ribcage and the front of your lumbar (lower back) spine. It is a domed muscle that contracts and flattens when you inhale. The flattening of the muscle creates a vacuum in the thorax and pulls air into the lungs. The diaphragm then reflexively coils back into its domed shape which pushes air out of the thorax. We also have accessory respiratory muscles that should only be used when one is breathing hard like after a run or sprint. Some of these muscles are the pecs, upper traps, and sternocleidomastoids - basically the muscles of your chest, neck, and shoulders. They help to increase the circumference of the thorax and take in air more rapidly than the diaphragm can alone. 

By bending forward and anchoring your arms on your legs you’re placing many muscles in a position where they are better leveraged to work. You can now use your pecs to help lift and widen the ribcage, your abs to help expel air more fully, and you’ve opened up your upper back (known as the posterior mediastinum) for air to flow into more easily. Additionally, the forwardly bent position of the spine helps to keep the bottom of the ribcage more narrow. This assists the diaphragm in returning to it’s fully domed state with each breath. It also makes it much more difficulty to “belly breathe” - the air is essentially forced into the thoracic cage.

When one stands up and places their hands over their heads, it significantly the actions above to occur. The pecs and shoulder muscles no longer have leverage to help move the ribcage; The neck muscles have to do the lion’s share. The abs are then moved into an elongated position and can no longer help to push air out of the thorax. As the abdomen is positionally opened, it becomes much easier to belly breathe and not get as much air into the lung tissue. It also disallows the diaphragm from fully returning to its domed position and less air is exchanged with each breath. 

Happy breathing!

Written by Lesley Callaham on August 8, 2018

Is Your Gym Routine Holding You Back?

Image from wmagazine.com

Finding some sort of physical fitness is essential in today’s culture of sedentary jobs and lifestyles. For many, the gym is their primary location for fitness. This can be due to weather restricting outside activities, convenience, comfort (working out is always more comfortable in a temperature controlled setting with easily accessible water), range of activities offered, etc. However, the gym can create an environment where your body actually develops problems, instead of maintaining optimal health. 

Aside from burning calories and improving our cardiovascular fitness and physical strength, fitness activities should help us become more aware of our bodies. As we are active, we should notice groups of muscles that are working hard, areas of tension or discomfort, how taxing each activity is, etc. It should be a time to connect with our bodies and learn about them. This will help us to determine areas of weakness or dysfunction, or track our progress and functional goals. 

However, the gym is set up for things to be easy and convenient. Cardio equipment is typically grouped near TVs with magainzes nearby. While this can make our time on machines go faster as you're not constantly watching the clock, it can have a negative impact on our bodies. First, diverting your concentration to a TV or magazine takes your consciousness completely away from the body. We no longer are able to perceive if our weight is staying more to one side than the other, if there is slight tension in our lower backs, or what muscle groups are actually working. This makes it easy for our bodies to use compensation patterns to complete the activity. These compensation patterns eventually lead to breakdown, pain, and/or dysfunction.

Additionally, machines of any nature can also be problematic. They are designed to help place the user in a safe position and be sure the motion is happening around the correct axis (ie the knee extension machine makes sure that we are straightening at the knee and not the hip). This is helpful for someone new to fitness or is not very body-aware, but it becomes really easy for the machine to passively hold us upright. It is important that no matter if we’re doing a strength machine or cardio machine, be sure that you are “owning your body.” If you’re doing a simple bicep curl machine, don’t simply let your entire upper body rest upon the chest bar, use your own core musculature to hold yourself up in space and control unwanted motion at the core and shoulder, THEN perform your bicep curl. On the elliptical, use your abs to help rotate your ribcage as you articulate the handlebars and position your hip over your foot. Don’t simply “throw” your weight back and forth by sticking out your hip and/or leaning with your shoulders. Either way will cause the pedals to go down and calories to burn, but only one is truly beneficial for your body in a holistic manner. 

Lastly, don’t get stuck in a rut! If you’ve been doing the same machines, strengthening exercises, or routines for more than 2 weeks, you’re on your way to an overuse injury or muscular imbalance. Our bodies are very good at being efficient and it’s easy for them to go into auto-pilot when performing the same activities over and over. Switch it up! Try the machines in a different order, use a cardio machine you’ve never tried before, run the track instead of using a machine, take a class that’s new to you, etc. The more variability you introduce in your routine, the more your body will respond and the more balanced it will stay. If you’re worried about hurting yourself or using proper form, talk to your physical therapist or set up an appointment with a personal trainer. 

You’ve already done the hard work by getting to the gym consistently and putting in the time, now make sure you get the most out of it you can! 

Written by Lesley Callaham, MPT, PRC on July 24, 2018

Where You Walk Matters

image from Consumerreports.org

Walking is a great activity for fitness. It’s free, low impact, and you can do it almost anywhere. It’s appropriate for individuals with and without pain. However, choosing where you walk is important. The right environment can challenge your body while helping you stay in neutral and make strides with your therapy program. The wrong environment can wreck it. 

The worst place to walk is on the treadmill. The mechanics of walking on a treadmill are completely different than walking on the ground. Walking on land requires you to pull yourself over the ground by using your hamstrings. You also have to shift your weight from side to side in order to power the swinging leg forward. As the ground is essentially pulled out from under you on a treadmill, your only goal is to not fall over. There is no signficant and variable change in direction, incline, or stability of the ground. The body doesn’t have to work as hard or focus on keeping your core stable. Additionally, many people hold on to handrails to keep their balance. This is not great for your spine. As your legs are moving, your pelvis and lower back are rotating. When your hands are fixed, the tension cannot be destributed along the spine as designed. Lastly, many people watch TV or look at a magazine while walking on a treadmill. This also causes the body to lock down and operate on auto-pilot as the visual system is now anchored on a visual target.

Walking on a track or inside the mall is better. Your body now has to pull you forward in space and you’ll likely be using your arms, but there is still no change in incline, flooring surface, and it’s still relatively easy to lock your visual system.

Walking outdoors is great. Simply walking in the neighborhood gives you enough incline variability and visual stimulation to keep your body awake and attentive. Walking on a trail is even better. Even if it’s a paved trail, the surface is not completely flat. Your muscles and brain have to constantly monitor how your foot is hitting the ground to keep your balance. Different chains of muscles have to turn off/on depending on if you’re going up or downhill. It’s hard to visually anchor as there is so much visual stimuli for your brain to monitor. 

So get outside and get those steps in! Your body will thank you!

Written by Lesley Callaham, MPT, PRC July 9, 2018.

PRI Tips For The Car

What goes hand-in-hand with summer? Summer road trips! This can mean many hours in the car resulting in pretty significant pain. In order to help quell this, try to keep in mind the following helpful hints. A lot of these will be helpful for your daily commute too!

1) Keep your knees at hip height or higher as well as pointed straight ahead. Keeping your knees high helps to promote a rounded lower back. This can be adjusted by lowering your seat height (available in most cars) or by bringing your seat closer to the steering wheel. Keeping your knees pointed straight forward (versus letting your left leg roll out to the side and resting on the door) will help to keep your hips from rotating while in a poor position. This is especially important if you have hip/buttock/SI/sciatic/piriformis pain!

2) Reduce your lumbar support. In a PRI program, we want to allow the lumbar spine to get out of its overly-extended position and into a more neutral state. This means taking away the lumbar support in your car. Not everyone can do this cold-turkey. Some people need to reduce this slowly. Also, if you’re going to be driving for over an hour, know it’s ok to change your lumbar support as time goes on. The lumbar spine was not meant to be static for more than 20 minutes. Small changes to the lumbar support in your car seat effectively lets your lumbar spine change positions and stave off pain and stiffness. Just keep your lumbar support to a minimum and always return to the lowest amount you can tolerate when you are finished with your drive. That way you’re set up in the correct position when you next get in the car. 

3) Change your headrest if needed. A lot of cars now come with an inclined headrest. This helps to reduce the amount of brain and neck trauma in a car accident, but can be irritating when driving. As the upper portion of the head rest comes forward, we will assume a forward head posture to keep our head from bumping against it. Ladies, we also do this when we wear our hair in a bun or ponytail so try to avoid these hairstyles when driving long distances. To fix this, some headrests can change the amount of inclination. For those that can’t, raise the headrest as much as possible. If this is really irritating to you, try calling your dealership to see if alternate headrests exist for your vehicle. DO NOT DRIVE WITHOUT A HEADREST!

4) Change the inclination of your back rest. Your seat back needs to be in whatever position necessarily to allow your back from your bra-line and below to be resting on the back of the seat. Everything above this should be away from it. If your seat is too reclined, you will not get curvature in your upper back and you will bring your head far forward in order to see the road in front of you as your upper back rests on the chair back. If you seat is too inclined, your entire spine will be straight. 

5) Take breaks. Again, our bodies are not meant to be in any one position for more than 20-30 minutes at a time. You can change your lumbar support and buy yourself some time, but try to take frequent breaks where you can get out of the car and walk around. This lets you mobilize every muscle and joint instead of just your lumbar joints. 

6) Look around. Obviously, you need to be safe while you drive and keep your eyes on the road, but staring at the car in front of you for hours at a time essentially puts the body and its muscles into “auto-pilot” (har har har). If you simply glance around with your eyes as you drive, it helps to keep your body and neurological system from locking into a particular pattern.

Happy vacationing!

Written by Lesley Callaham, MPT, PRC May 15, 2017

The Best Summer Footwear For Your Body

image from shoes.com

It’s finally here- sandal season! Although this can be very exciting, it can aggravate your pain whether it’s new or old. One way to avoid this is to wear the best footwear possible, especially if you have lower back pain, hip pain, or pain in your legs or feet. 

To be clear, the BEST choice of footwear is a tennis shoe. If you don’t already know, ask your physical therapist what that means for you. You can also find the Hruska Clinic 2018 shoe list here.  However, as many people will be wearing sandals over the summer, keep these things in mind when selecting your shoes over the summer:

1) Choose a shoe that attaches to your foot. Try to avoid flip flops or other shoes that can easily fall off of your foot. This will cause you to move your foot different through space or use your toes to help keep the shoe on. This will cause more compensation patterns when you walk and create more pain. 

2) Pick a flat. All heels make your weight move forward to your toes. When this happens, your shoulders will automatically lean back in order to resdistribute your weight and keep you from falling forward. This causes your lower back to excessively arch and your head to move forward which can aggravate ankle, lower back, neck, and shoulder pain as well as headaches. If you do have to choose a heel, pick the smallest one possible. 

3) Choose stability. Grab your shoe at the heel and toe and try to bend it in half. A good shoe will bend at the ball of the foot and nowhere else. The more the sole bends, the less stability it has to offer your body. If your ballet flat can easily fold in half, you are essentially walking around in a sock, not a shoe.

4) Have support. Supporting and stabilizing your arch is essential for maintaining good mechanics and avoiding pain. Sure, having arch support is a good idea, it is not the end all be all. The arch rises and falls as a direct result of where the heel is in space. Therefore, picking a shoe with a good heel counter, or at least has the heel covered or encompassed in fabric will give you more arch support than a shoe with an open back. The more firm the heel counter is, the more support you have. If you have an open feel, try to find a shoe with a heel cup. This is a small indentation for the heel to sit in so that it has more support on the sides and cannot rock around as much. 

5) Pick something comfortable. Even if your shoes passes all of the above tests, it won’t make a difference if the shoe itself is uncomfortable. Everyone will move their foot different to avoid putting pressure on painful areas of the foot like a blister or sore spot. 

Have more questions? Call us at 314-733-5000 or email Lesley@Integrate360pt.com or Nancy@Integrate360PT.com today!

Written by Lesley Callaham, MPT, PRC May 7, 2018.