DEM BONES

Most people are at least familiar with the child song “Dem Bones.” Remember, the foot bone’s connected to the leg bone, the leg bone’s connected to the knee bone…and so on.
Turns out this isn’t just a silly song. Rather, it is a nice reminder that our body is connected from top to bottom. As a result, any problems you have in one part of the body can affect other parts of the body near or far. In medical terms, we call this interregional dependence. An extreme example is your poor foot mechanics or anatomy causing a pain in your neck (the foundation can affect the whole building effect). A more probable example is your limited thoracic spine mobility (mid and upper back) affecting your neck and/or shoulder. And that region, your cervicothoracic region, is the focus of this post. In fact, it is not uncommon for desk workers or those who are largely sedentary to have pain or movement disorders in this area ranging from a nuisance to a nightmare!

Photo Credit: Washington PostPhoto Credit: Washington Post

So, what to do? First, it is important to remember that education is therapy. So let’s take a quick review of what might be happening before digging into some possible evaluation and treatment strategies you might want to discuss with your physical therapist.

WHAT’S GOING ON

– In the modern era, most work is by nature sedentary. We sit all day…at work looking at our computer, during our commutes while driving, at home while watching television, playing/working on the computer, checking our smartphones/tablets/laptops and even working out on our recumbent bikes!
– In these positions, we tend to slouch with an unsupported lumbar spine, rounded thoracic spine, flexed cervical spine and rounded shoulders. We do this over and over again for hours at a time. As a result, certain muscles get overworked, others get underworked and anatomical structures change their length leading to sub-optimal adaptations. All of this can result in asymmetries that then have the capacity to lead to dysfunction and possibly pain.

WHAT CAN I DO – ERGONOMICS

– First, let’s start with your work station. You want your screen set at about a 15 to 20 degree angle down from your eyes. For most people this means elevating their screens (but in rare cases you may need to lower it).

Photo Credit: Forbes

– Second, if you have a laptop, smartphone or tablet you’re going to want to invest in 2 things:
- A stand to help elevate the screen
- A Bluetooth keyboard to ensure that correcting your viewing angle doesn’t lead to unwelcomed reaching and straining at your shoulders, forearms and wrists.
- Finally, you may want to consider a lumbar roll for low back support. Often if we provide the proper low back support it makes it exceedingly difficult to slouch, makes it less taxing to maintain good posture and promotes healthy positioning up through the chain. One additional note, you don’t have to buy anything for this one. Just grab a (clean) towel, fold it over, roll it up and stick it right in the small of your back in sitting (after you have ensured your hips are all the way back in the chair of course).

– Bonus, super simple tip: Take breaks, stand up, walk around.

WHAT CAN I DO – EXERCISE AND ACTIVITY

- Thoracic Extension 

– Thoracic Rotation

– Deep Cervical Neck Flexor Training

– Cervical Retraction

– Scapular Stabilization

– Bonus, super simple tip: Take breaks, stand up, walk around (it’s so important we had to say it twice).

– Don’t worry if you aren’t 100% familiar with these exercises. There’s a reason we recommend seeing a trained professional and following the advice of your physical therapist, but a link to videos of these exercises is embedded above in case you missed it.

FINAL THOUGHTS

So remember, if you aren’t in pain don’t freak out about your posture. Instead, just begin making small and steady changes to improve your sitting environment, your posture and your activity choices. If you are in pain, take a deep breath and feel good knowing that there is a lot you can do about it with the support and guidance of a physical therapist. This type of upper back pain usually responds very well to treatment by a physical therapist. So remember to #getPT1st, #MakePTHappen, and get on the road to recovery safely, quickly and without the need for drugs or referrals.
If you are experiencing symptoms of upper back pain, schedule an appointment with a physical therapist in your area. A referral is not needed for treatment in Ohio. Click here to search for a physical therapist in your area.

Resources:

http://www.jospt.org/doi/full/10.2519/jospt.2015.0103
http://www.ncbi.nlm.nih.gov/pubmed/23057991
http://lebauerptblog.com/2013/12/16/your-hidden-cause-of-neck-pain-headaches-and-tension/
http://www.washingtonpost.com/news/morning-mix/wp/2014/11/20/text-neck-is-becoming-an-epidemic-and-could-wreck-your-spine/
http://www.washingtonpost.com/wp-srv/special/health/sitting/Sitting.pdf

Bio:

Dr. Chris WilsonDr. Chris Wilson earned his Doctor of Physical Therapy from the University of Cincinnati after earning his B.S. in Health & Sports Studies from Miami University. Between his undergraduate and graduate studies, Dr. Wilson served as a Munitions Officer in the U.S. Air Force and later worked for a small, private IT company as a project manager and business developer.

Dr. Wilson currently provides outpatient physical therapy services out of his outpatient physical therapy clinics in Centerville and Springboro, OH. He has a strong focus on outpatient physical therapy and incorporating active management and healthy habits into his evaluations, treatments and consultations.

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