The body is a complex, miraculous structure, which makes having an injury sometimes more complex than you would think. I often have patients come in complaining of shoulder pain, butthe area that’s truly bothering them is their neck, with pain travelling from the neck down to the shoulder. If you look at pictures of the anatomy of this region, it would be easy to see how the two are interconnected. Many of the neck muscles connect to the shoulder blades, collar bone, and shoulder; therefore, a tightness or weakness in one of these muscles would affect both the neck and shoulder.
The same can be said about the elbow and wrist, the regions of the spine, the back and the hip, the hip and knee, and the knee and ankle.
It’s important if you have an injury, that the exercises you do to help recover from it address these muscles that cross multiple joints. This is why it is beneficial to perform a comprehensive stretching and strengthening program in order to target all of the potential areas affected (and prevent these injuries from happening in the first place).

This can be accomplished with the guidance of a physical therapist, exercise physiologist, or personal trainer. In some instances, group classes such as yoga, pilates, and Tai Chi can also be effective for balancing out any flexibility and strength deficits. Some people may work independently on stretching and strengthening, gaining knowldege from books and various online resources (Wellness Professionals – Joint Pain and Arthritis Relief) If you decide to rehabilitate yourself from a minor injury, always be mindful of what you’re feeling in your body. If an exercise causes you pain, it’s your body’s way of letting you know something isn’t right, and you should modify or eliminate the exercise. If you don’t see improvement on your own after 7-10 days, it is highly recommended that you seek the care of a health care provider.
(And always seek immediate care if you experience severe pain, altered sensation, incontinence, inability to ambulate, or other unusual symptoms.)

Some people learn best by reading how to complete a task. Others learn best by observing somebody else do it first. For others, listening is the best way for them to pick up on information. When it comes to rehabilitation and exercise, there’s now a resource designed to suit all types of learners.

Wellness Professionals – the leader in joint pain relief, has comprised a video library of rehabilitation exercises specific to the most common musculoskeletal injuries. It was designed to be useful for people with any learning style. The videos allow you to watch the exercise being done, listen to a description of how to perform it with correct technique, and also gives written instructions for you to be able to follow through on your own.

I invite you to check out the video library and share your thoughts, experience, and feedback here.

It’s often not a single incident that contributes to injuries such as tendinitis, muscle strains, and joint sprains. Although trauma can be a factor in some cases, many people don’t know what caused their pain. It usually develops as part of a gradual process of wear and tear and muscle imbalances. And then one day when you bend over, like you do every day, your body sends you a message that it won’t take any more.
You’ve gone too far. It’s “the straw that breaks the camels back.”

Many times our postural habits and patterns of activity contribute to imbalances in the body where some muscles become weak, and the opposing muscles become tight. This creates uneven forces at the various muscles and joints, and can cause injury. The other day while biking, I felt my right hip flexor getting really tight. I started to notice that when I coasted down a hill, I always rode with my left leg extended straight on the pedal and the right leg bent (so my right hip flexor was always in a shortened position, and the left relatively stretched). As I became aware of this, I changed the pattern that I unknowingly had fallen into, and started to alternate which leg I straightened. I noticed a difference in how my body felt as a result. So something as simple as that can wreak havoc on the body and contribute to pain and injuries.

So what can we do to reduce the likelihood of these sorts of gradual injuries? Here are a few suggestions:

1. Cross train: varying your sport or activity reduces the likelihood of overuse and imbalances 2. Stretch the major muscle groups on both sides of the body 3-5x/week or after any workouts 3. Engage in regular strength training to optimize muscle strength and reduce stress on the joints 4. Allow 1 or 2 days off a week to allow the body to rest and recover 5. Be aware of postural habits that you may have; if you notice pain when performing an activity, try to look and feel what’s happening in your body 6. Eat a well balanced diet and maintain a healthy weight to reduce overall stress to the joints

We can’t prevent every injury, but we can certainly try.

Parenthood is an amazing, life-altering experience for both first-time and veteran parents. The job of caring for infants and toddlers is mentally and physically demanding. Mothers and fathers spend countless hours holding their baby, carrying him in his car seat (you know how heavy and awkward that can be), and bending over changing diapers. These tasks require strength and stamina and can result in aches and pains for mom and dad if they’re not careful.

Common injuries, such as neck, back, shoulder, or wrist pain can result from the repetitive lifting, bending, and carrying of young children.
Regular exercise is one of the best ways to help prevent these injuries.
The better your endurance, strength, and flexibility, the less likely you are to develop pain.

If you don’t generally exercise, walking is often a nice way to start.
Hand and ankle weights, an exercise ball, and a jump rope are also excellent investments for the home that allow mom and dad to do basic strength and toning exercises when the kids are sleeping or playing. In addition, running outdoors, working out at a gym, or joining a group exercise class will help improve overall fitness. If alone time is sparse, you could always experiment with family fitness.

With the help of some kid-friendly gear, it can be fun for the whole family to exercise together. Strap baby into a backpack and take a hike, or exercise with kids in tow in a jogging stroller or child bicycle seat around the neighborhood. After all, what could be better motivation than a two year old yelling “Faster, faster!”?

Mommy and baby Yoga and Pilates classes and videos are gaining popularity and are a great way to tone stomach muscles and improve flexibility (and there’s no reason Daddy can’t join in). On a rainy day, parents can join their toddler in dancing along to their favorite music or video. It may feel a little silly, but exercise benefits the body, and children enjoy this quality time. Exercising not only keeps the body fit and pain free, but also helps parents model a healthy lifestyle that children can embrace from an early age.

If despite your best efforts you develop pain, don’t ignore it. Aches and pains should be addressed promptly to prevent a chronic condition from developing. Your primary care doctor can evaluate you and prescribe the appropriate treatment, which could include medication, exercise, physical therapy, chiropractic care, massage therapy, or acupuncture.
Your health is essential to you, your children, and your family’s well-being, so make yourself a priority. You deserve it!

Any NBA fans watching last night’s game must have winced to see Paul Pierce lying on the ground in such severe pain that he had to be carried off the court by 4 others. I thought for sure he had done some serious damage to cartilage in his knee, though none of the replays gave a good angle to see exactly what happened. To say I was surprised when he returned to the court only a few minutes later is an understatement. And the fact that with a sprained knee (where the ligaments that stabilize the knee get overstretched and partially tear) he went on to score another 11 points and help lead the Celtics to victory, with the aid of a Neoprene sleeve, is not typical!

This type of performance following such an acute injury is certainly an exception. First, he’s an elite athlete. He’s highly motivated to win an NBA championship (especially given the Celtics record in the past 2
decades) and adrenaline can work wonders to get you through certain situations. He also has a team of athletic trainers, physical therapists, massage therapists, and chiropractors who can give him very intensive treatment following last night’s game and over the course of this series.

My point here is that most of us aren’t Paul Pierce. For even a good, non-professional athlete, continuing to run and jump on a sprained knee is not a wise choice and not worth the risk of sustaining further injury to the knee. The steps to take following an injury such as the one he sustained would be to:

1. Protect
2. Rest
3. Ice
4. Compress
5. Elevate

Seeking emergency medical attention if you find yourself needing to be carried off a field/court would also be recommended to ensure there is not a fracture or injury requiring surgical correction.

Let’s keep our fingers crossed the Pierce’s knee holds up for the remaining games. Go Celts!

Many of my patients with back pain experience an increase in pain when they get in and out of bed. And believe it or not, there is a right and a wrong way to get out of bed, or at least a way to do it that minimizes the forces on the spine.

If you are on your back, roll onto your side with your knees bent. If you are a side sleeper, you will already be in this position. Bring your legs over the side of the bed as you simultaneously push your torso up to a sitting position. The incorrect method is to transition from supine (flat on your back) to a long sitting position (sitting with legs straight in front of you). This movement requires significant abdominal strength and places strain on the lower back. Particularly if you have tight hamstrings and upper back muscles, this will be a difficult and potentially aggravating way to do it.

Using this “logroll” technique to get back into bed is also effective. Start by sitting at the edge of the bed. Start to lower onto one arm as you bring your legs up with the knees bent, into a side lying position. Keeping the knees bent, you can then roll onto your back.

Growing up I loved the Wizard of Oz. The combination of the music, costumes, and the absurdness of it was really so entertaining. In my work, I often think of the poor Tin Man, who was so stiff and constantly needed to oil his joints to keep mobile. That’s really not too far off from our bodies in a way. We have special lubricating fluid in our joints that helps the joints move smoothly.

The joints in the body bend and straighten, but they also glide in multiple directions. For example, the knee bends and straightens, but as it bends, the tibia (shin bone) glides backwards on the femur (thigh bone). And at the same time, the knee cap glides down. There’s a lot of complexity to that really, and if any part of the bending or gliding is limited, pain can occur.

I’m going to stay with the knee as an example because it’s an easier joint to explain. If you sit with your legs straight out in front of you and relax your thigh muscles, you can use your hands to gently wiggle your kneecap up and down and side to side. If the joint capsule (which is essentially like saran wrap around the joint) here becomes tight due to a new or old injury, a disease process, or disuse, knee dysfunction could occur. In addition, tight muscles can restrict the kneecap’s ability to glide. For example, a tight IT Band will tend to pull the knee cap out to the side, decreasing it’s ability to glide inward and altering the resting and functional alignment of the kneecap. This can cause wearing on the underside of the kneecap which would inflame the joint. Injuries to the knee such as chondromalacia patella, IT Band syndrome, patella dislocation, and patella tenndinitis can all be related to a disruption in the gliding mechanism of the kneecap.

So sometimes when you stretch on your own and don’t see an improvement in flexibility, it may be because the joint isn’t gliding correctly and that is what is limiting your motion and progress. The only way to restore normal flexibility in that case is by mobilizing the joint and stretching the joint capsule. This could be done by a chiropractor or physical therapist. There are also self mobilization straps and wedges you can be instructed to use for mobilizing the neck and back. It’s important to maintain the flexibility of both muscles and joints in order to keep from getting stiff and creaky like my friend the Tin Man.

This is the time of year when many of my patients express frustration at not being ableto enjoy gardening because of pain or an injury. Personally, I look forward to making changes to my perennial garden and planning our vegetable and herb garden each spring. And though I’m careful and try to be safe, there are evenings where I find myself sore from a day’s worth of digging and planting.

The back, neck, knees, and shoulders are often taxed with the various motions and positions assumed while tending to a garden. Kneeling, for example can be hard put a lot of pressure on the knee joint and bursa. Squatting repeatedly or for sustained periods can be aggravating to the knees, low back, pelvis, and hips. Raking, weed pulling, and digging require the neck and shoudlers to do a lot of work. So what’s a gardener to do?

I always promote the use of proper body mechanics, however I am realistic too. It’s often difficult to keep the joints in neutral alignment whn working in the garden. In situations where the body is under stress or working in a less than ideal alignment, the following tips may help prevent soreness and injury:

1. Vary your position every 5-10 minutes. Alternate between half kneeling on one knee, kneeling on both knees, and squatting when working low to the ground. It’s also a good idea to vary between standing and squatting to minimize the likelihood of strain to the joints and overuse type injuries.
2. Stretch often. Every 10-15 minutes, do a few simple stretches. Since a lot of positions I find myself in when gardening involve bending forward, I try to do stretches where I bend backward. Placing the hands on the lower back and gently arching back while standing is a nice way to stretch the front of the body. You can also do various stretches for the neck, chest, hip, and hamstring. This gives the muscles a well deserved break, allows better circulation to reach the tissues, and helps restore symmetry and balance to the body.
3. Don’t overdo it. (This is where I often go wrong.) I sometimes get on such a roll and can be in the garden for hours working. Try to limit the length of time you spend to perhaps one hour, maybe more or less, each day.
4. Sit back and enjoy. Allow yourself time to relax and take in the sights and sounds in your garden, even if you aren’t finished.

The large exercise balls have become popular at rehabilitation centers, gyms, and in peoples homes and offices. There are so many great exercises that can be done for the core, back, arms, and legs. It’s also a great tool to use for strengthening the neck muscles.

Unlike some of the other muscles in the body, you really can’t lift weights or use resistance bands for the neck. You can, however, use the ball (and gravity) in various positions to help strengthen the muscles in the front, back, and both sides of the neck.

To strengthen the front of the neck, you can perform any exercise where you lie on the ball on your back with the head unsupported. This requires the muscles on the front of the neck to work to support the weight of the head against gravity. An example of such an exercise is lying on your back and doing a chest press with the head off the ball. If this is too difficult, you can start out by sitting on the ball and slowly reclining back as far as you can, and gently returning to an upright position. This will allow the muscles to gradually develop strength without over-stressing them.

To strengthen the back of the neck, you can perform any exercises where you lay on your belly on the ball with the head unsupported. Doing back strengthening, such as rowing in this position is an excellent example of a way to strengthen the back of the neck as well as upper back muscles. In this position be sure to keep the neck in a neutral position, so you’re not straining to look up at the ceiling or down to the floor.

The side muscles of the neck can be targeted by doing exercises on the right and left side lying positions on the ball. For example, you could lie on your side with the head unsupported and perform side leg lifts to tone the outer thighs and train the side neck muscles at the same time. If it’s difficult to balance on your side, position your feet at a wall for added stability and safety.

The neck, as with any region of the body, is more susceptible to injury when there is an imbalance in terms of strength and flexibility. Finding creative ways to strengthen the neck can help with prevention as well as rehabilitation of neck injuries.

Adequate hydration is important for all of the cells and tissues of the body that rely on water to function properly. Of relevance here, the discs of the spine contain water which aids in shock absorption and smooth gliding of the joints. Though it is known that with aging the discs become dehydrated, causing a decrease in disc height (Raj, et. al.) and often contributing to pain, I wasn’t able to find any scientific research that supports the theory that drinking more water may ward off back pain.

That said, it is still important to drink enough water each day. And I mean plain old water without added sugar, coffee/tea, or chemicals (though I know some disagree on this, I think plain water is the best for removing toxins and replenishing the body). There has been a lot of controversy recently about the recommendation for 8-10, 8 ounce glasses of water a day, as this doesn’t take into account the water that is consumed in foods. The amount you need to drink also depends on your health and how much you exercise. In general, a good way to know if you are drinking enough is to check that your urine is clear or pale yellow.

If you don’t drink any water during the day, start to add in a glass or two a day. You may or may not notice a change in back pain, but you will be doing your body a favor by supplying it with one of its main components. Always drink a glass of water after exercise, and if it’s a vigorous workout, you should drink before, during, and after to help prevent dehydration.

I think I’m getting thirsty…

P. Prithvi Raj MD, FIPP, ABIPP (2008) Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment
Pain Practice 8 (1) , 18–44