Question
Mr. Leatherman,

My wife has recently been having what I feel are some posture-related issues with her mid/upper back. Sometimes after an extended period at the sewing machine or computer, or after a night's sleep in a softer-than-normal bed, she will experience a raft of various symptoms ranging from localized back pain to shooting leg and arm pain, tingling in the limbs, and even nausea.

In the past, I have usually been able to relieve all these symptoms immediately with a simple popping of her upper back. This has occured maybe about 10-15 times in the past 6 months; however, last night, after the usual popping, she experienced no relief and now she has pain in her upper back, neck and shoulder blades, tingling in her legs and arms, and persistent nausea.

I am wondering what the best course of action might be here. She seems to be skeptical that nervous system problems can cause this kind of nausea, but I think it most likely related to her bad posture. Also, can you give us any hints on supplements and exercises that might be helpful in alleviating this problem once and for all?

Thanks for your help.

Answer
Dear Brad,

Well the first thing I need to tell you is that you should not be "popping " her back in any way.  It may be able for you to do, but that doesn't mean that you are qualified to do it, or that you are using the correct technique, or that you are applying the pressure in the appropriate area.  You could actually be making the problem worse by manipulating the incorrect segments.  Please leave this type of maneuver to a qualified professional who has spent years of education and training to learn the appropriateness of the technique, and when and why to utilize it or not.

Okay, I'll get off my soap box...Your interest in her posture is very significant, and you are correct that this can cause a host of problems.  Moreover, an un-supportive mattress is worthless...you are better off sleeping on the floor.  It is imperative that the spine have support throughout the night, and that it is not placed under too much stress during the day.  Unfortunately, our modern environments contribute to the horrible postures I see in my patients everyday.  

Now, concerning the nausea, this can be from an increase in forward head posture alone.  It has been proven in the medical literature to have deleterious effects to the spinal cord, nerve roots and the brain stem.  Additionally, fixations of the vertebra in the back can also compromise the nerve function to the abdominal organs which can be contributory or cause nausea.  I have some quotes for you to appreciate.

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

I would recommend that you have her schedule an appointment with a local chiropractic physician for a proper diagnosis and treatment program to combat these issues.  If her posture is as bad as you say it is, I would recommend that you seek a chiropractor who is trained in the structural remodeling of the spine.  You can find one by checking out this site:  www.idealspine.com. Read the site as well, It will help to educate you on the technique and the research.

Supplements to recommend would be things that aid in metabolic support and reduce oxidative stress and inflammation:   I recommend omega III fatty acids for many reasons, but foremost is that they significantly work to reduce system wide inflammation in the body. They work similarly as Celebrex does, but without side effects.  I recommend eicosapentanoic acid and docosahexanoic acid (EPA and DHA).  You want a product that is mollecularly distilled for purity and 4000-5000mg per day is a good dosage for the first 2 months, afterward 2000-3000mg daily is a good maintenance dose.  In addition foods and spices that are anti-inflammatory help:  Reduce sugar intake, reduce trans-fats, increase ginger, tumeric, curcumin, cinnamon, bosweilla, green teas, and brightly colored fruits and vegetables.  Antioxidants such as vitamins A, C, E, selenium, biofavanoids, coenzyme Q-10, and alpha lipoic acid are all important to reduce degeneration system wide and will promote healthy tissue.  There are many products on the market that have antioxidant formulations of the above.  Again a good chiropractic physician will be able to help you choose products that are cost effective, but are also manufactured well for purity.

Lastly Brad, I am going to attache below an article I have written on some exercises that your wife can begin at home to help combat the stresses that her posture is placing on her body.  

Training for Stability of the Neck and Back匩ot What You Think!

A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments.  Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor!  Shouldn抰 you work to prevent injury and strain?  The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma.  It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury.  Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity.  We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.  

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine.  Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor.  Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.  

Lifting technique is important for optimal health and the reduction of injury.  To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back).  This position will activate the musculature properly for stability while not recruiting the ligaments for support.  Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift.   Stooping should be avoided, especially with repetitive movements.  Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk.  This can easily result in a rupture of the disk.  In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer.  The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core.  You can easily accomplish this by sucking the belly button in toward the spine.  This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair.  These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.  

Many of us spend the majority of our days at a desk, computer or workstation.  We need to consider and modify our workspace carefully.  Adding a support for the lumbar spine reduces disk pressures.  A seat-back angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure.  Proper desk height is approximately 30 centimeters from the seat of the chair.  Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae.  The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.  

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain.  Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead.  This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex.  This will also help reduce those 搘ork headaches?  Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key.  You must have a balanced and relaxed spinal cord for optimal function.  That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it.  If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.  

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion.  Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion.  The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension.  If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body.  This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration.  Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary.  This is mostly common sense, and your mother has telling you to do this since you were a child.  Exercise your postural muscles while walking.  Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground.  Pull your shoulders back, breathe deeply, and take confident long strides.  This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures.  You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance.  Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability.  If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse.  It is essential to incorporate stability into your spine and your life before starting any exercise program.  You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  If you have any cardiovascular issues, a stress test should be performed.  Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics.  Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications.  To learn more about postural correction check out www.idealspine.com. In addition, a Certified Pilates instructor, www.nypilates.info, www.pilates-trainning.com or Certified Personal Trainer www.nsca-lift.org, www.ncsf.org  can have great benefit.  Remember to check their qualifications as well.

If you have any further comments or questions, please feel free to write back.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net