Question
Hi Dr Shawn,

Thanks for your considered and helpful response.

I don't think tennis is the problem. I am a righty, and had the shoulder and neck problems before I took it up. As I said, tennis has actually helped to reduce the tension - I don't feel any aches whatsoever during or after a good session on the courts (aside from the feet/knees but that's different and fades soon enough).

I think, as it sounds do you, sitting at the computer all day is the root cause.

A few more questions if I may:

1. I'm ready and eager to take up a weights program, provided I can be sure it's the right one for me. The familydoctor.org exercises look great - given what we've discussed, would you recommend I get started right away?

2. If so, how many times per week should I do the exercises?

3. Your article is brilliant, very relevant. I tried the Global Flexion, feels really good, I'll try to work it into my sitting day as much as possible. One time when I did it, and this happens occasionally when I stretch my chest, a cracking noise came from the sternum area. It doesn't hurt at all, and gives a sense of relief, but I imagine it's not a "good" thing. Should doing the stretch regularly and the weights help with this, too?

Many thanks again,

Rob


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The text above is a follow-up to ...

-----Question-----
Hi,

I'm 26, work at a computer all day, but play tennis 3 times a week, and take a half hour walk

once a day, so figure I get a fair bit of exercise.

I've had various aches a twinges over the last 3 or so years, most of which have eased since

taking up tennis (1 year ago).

I'm now left with three consistent (chronic?) symptons:

1. Tense neck - comes and goes, worst when I'm stressed out, which makes me think it might be a

purely mental thing - maybe I just need to relax more! But, it does feel somehow linked to...

2. Clunky left shoulder - when I'm sitting at my desk, I sometimes find myself a bit hunched

over. I know this is bad, so I push my shoulders back. When I do this, the left shoulder makes a

clunking noise/feeling, kind of like it's slightly dislocated. It doesn't hurt at all, just

leaves me always feeling that things aren't quite aligned, and that it just needs a good shove to

set it straight!

3. Achy/twingey right shoulder - comes and goes, sends a general achey/bruised feeling all down

my right arm. Not feeling it at all right now (morning), usually comes after sitting at the

machine for too long, so I usually just take it as a message that I need to take a break -

perhaps I should be preempting it...

So, the main one is 2, the clunky shoulder. It feels really weird, I can move it forward and back

now and get the clunking sound every time. I just don't know which is the right position to

encourage - all the way forward, back or somewhere in the middle?

Many many thanks in advance for any pointers you can give - exercises, who to go see, etc.

Rob
-----Answer-----
Dear Rob,

The first thing that comes to mind is that you sit in front of a computer all day.  This is horrible for the spine, especially the neck and upper back.  the second thing is that you play tennis...are you a lefty?  If so, your tennis game may be wearing on the shoulder joint depending on your form. Lets move on.

If you are a righty, then tennis is probably not a factor concerning the shoulder, but it still sound as though you have instability in the joint.  the shoulder joint is the most unstable in the body, but that is why we have such great range of motion there.  The most likely cause of shoulder instability is rotator cuff muscles.  They can easily be rehabbed with light weights, but it will take 3 to 6 weeks to see an appreciable difference.  Check out this website:  http://familydoctor.org/265.xml   Great information on rotator cuff exercises as well as illustrations on how to perform them.

Concerning the neck, achyness etc...this has become such a problem that I have actually written a small article about it for a local news paper.  I would recommend that you read the article (enclosed at the bottom), and also schedule an appointment with a local chiropractic physician for an orthopedic examination of the neck and shoulders. A sports certified chiropractor will be the best, but most chiro's can perform a thorough orthopedic evaluation of the neck and shoulder complex.

If you need any help finding a good chiropractor in your area, Please feel free to contact me with your location and I will check my contact organizations to try to help you.

Respectfully,
Dr. J. Shawn Leatherman  (article below)

Training for Stability of the Neck and Back

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.  In addition it is important to train for balance and symmetry to reduce 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 seatback 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 and 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?

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, 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 in an extended position.  

Most people are flexed forward at the hips, 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.

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.  Additionally you should see a medical or chiropractic doctor before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  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 postural biomechanics and 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.


J. Shawn Leatherman, BA, BS, DC, CCST, CCSP?br> Director of Clinical Rehabilitation
Suncoast Healthcare Professionals


Answer
Dear Rob,

Thanks for the accolades on the article, I am glad you found it relevant.

Concerning the shoulder (rotator cuff) exercises...yes I would start them right away, and they should be performed daily. Just remember that more is not always a good thing, start slow with approximately 10 repetitions per exercise, and build up your tolerance to 50 repetitions per exercise.  A good rule of thumb is to increase the number of repetitions by 5 each week.  You also do not need heavy weights to rehab the rotator cuff...as a matter of fact, heavier weight will actually hurt the rotator cuff.. I would recommend that you start with 1lb dumbbells and work up to 3lb dumbbells over the course of 6 weeks.  Use your body as a guide, the exercises may make you a bit sore, but they shouldn't increase or cause new pain.

The global extension position should continue to help reduce muscular strain in the neck, mid back, and low back.  The popping you had mentioned at the sternum is nothing to worry about, and in fact will actually release pressure on the joint spaces where the rib heads articulate with the sternum.  Remember to take breaks and allow your body to relax from the cumulative seated postural stress and you should see continual improvements.

I would still recommend that you have the neck examined to rule out any further dysfunction that can only be assessed with a hands on examination.

Good Luck Rob.
Respectfully,
Dr. J. Shawn Leatherman