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 rotator cuff is a group of 4 muscles (supraspinatus, infraspinatus, subscapularis, teres minor) around the shoulder that help to stabilize the humerus (upper arm bone) and coordinate the movement of the shoulder. These muscles are responsible for keeping the bones aligned and allow full overhead motion without jamming or compression at the top of the shoulder joint.

Injuries to the rotator cuff are common. These muscles and tendons are small, often not specifically stretched or strengthened, and used every day. They are susceptible to micro tears from overuse and can also be injured due to poor posture or trauma.

Muscle imbalances within the shoulder, for example very strong deltoids, chest muscles, and biceps in the presence of weak upper back and rotator cuff muscles can result in problems with the cuff’s ability to function effectively. Using free weights or resistance bands to strengthen the rotator cuff is a very important part of a weight training program in order to ensure healthy shoulders. (There are no specific nautilus machines I’ve seen that target these muscles; however, pulley systems can be adjusted and set up to perform the correct exercises. One word of caution, the minimum weight for the pulleys is usually 10 pounds which may be too heavy to start with, particularly if you have an injury.) Performing shoulder rotation exercises can help to strengthen the cuff and help prevent injuries as well as encourage healing.

As with any other body part, maintaining good posture is important so the joint rests in the correct position. In addition, when a rotator cuff injury is suspected, I recommend people avoid overhead motion and any other activities that reproduce the pain in order to minimize the amount of inflammation within the joint.

I commented in a post on shoulder pain about the issues that can arise from carrying a heavy weight on one shoulder. In the past few years, there has been an increase in the number of school-age backpack related causes of musculoskeletal pain. With students required to carry multiple heavy textbooks between classes and to and from school, there has been an increase in postural dysfunction and back pain in this typically healthy age group.

Some students in front of my local high school use the wheeled, luggage style backpacks, likely to ease the burden from carrying the weight. Others load on a heavy backpack on one or both shoulders, and there are of course the few who seem to exit the building just carrying a piece of paper and a pencil. What I’m going to focus on here are the backpack wearing crowd.

A heavy weight, as previously mentioned, carried on just one shoulder can predispose the individual to imbalances in the neck, shoulder, and spinal muscles. This could potentially result in injury and pain in these areas. It is better to wear the back pack with both shoulder straps on, but even then a very heavy load can cause the individual to alter their posture. There are a few different scenarios.

An individual may unknowingly have the backpack strap on one side adjusted tighter than the opposite side. I have first hand experience with this…I went on a long hike wearing my then 6 month old daughter in a hiking pack. I noticed about an hour into the hike that more weight seemed to be distributed on my left shoulder. That night and for the following week I experienced significant shoulder and rib pain. The shoulder pain resolved, but the rib pain persisted for many months until I was able to re-align and strengthen my spine. Take home message here: be sure the weight is evenly distributed between the right and left shoulders.

The next possibility is that to compensate for the heavy load on the back, the person may bend forward at the hips or spine to counteract the tendency to fall over backwards. This places stress on the spine and hamstrings, and can create problems for the lower back and hips. In other instances, the individual may not attempt to counter the weight of the pack behind them and allow their chest and spine to hyperextend. This places stress on the shoulders and spine as well and can contribute to similar injuries mentioned above.

The best thing to remedy this would be to try to minimize the weight you carry. Only transport the items that are necessary. I had one high school student I worked with who carried a large binder with class notes in addition to all his books to and from school. We worked out a system where only the relevant notes were placed in a paper folder which took a couple of pounds out of the equation. He also invested in an ergonomic backpack designed to help reduce some of the stress on the spine. (The same applies to those of you carrying heavy pocketbooks…only carry the essentials!)

I hope some of these suggestions are helpful if you find yourself carrying too heavy of a load this week.

Shoulder pain is a common complaint among athletes, men, women, people who sit at computers, and people who work with their hands. I’m referring to the kind of shoulder pain that’s not a result of trauma which would be different in many regards. I’m talking about the kind of shoulder pain from overuse, poor posture, weakness or tightness in the shoulders or of an unknown cause. This type of shoulder pain can be frustrating and significantly limit day to day function, particularly if the dominant side (if you’re a righty, your right shoulder) is affected. Here are a few suggestions to help ward off and relieve the burden of shoulder pain.

1. Be proactive. As soon as your shoulder starts to feel sore, ice and rest it. This will relieve any acute inflammation and may prevent you from developing a more serious or chronic problem.

2. Be mindful and aware of your posture. The majority of people with non-traumatic shoulder injuries have associated postural dysfunction. Slouching, rounding of the shoulders, and the head jutting forward are all abnormal postures which place stress on the muscles that connect the nec, shoulder blades, collar bone, and upper back to the shoulder. This can cause an abnormal pull/tightness or stretch/weakness. When any of the mechanics in the shoulder are altered, pain and injury are more likely to occur.

3. Strengthen your rotator cuff…particularly the external rotators. These muscles which are not usually strengthened in an isolated way with typical exercise programs help orchestrate the movement of the shoulder and when weak can contribute to tendinitits, impingement, and rotator cuff tears. Click here to learn how to strengthen the rotator cuff.

4. Do not carry bags, packages, or a purse on the involved shoulder. The weight of the item and the pressure it places on the shoulder can contribute to increased pain, swelling, and imbalances in the muscles surrounding the shoulder. An ergonomically designed backpack worn with the weight evenly distributed between both shoulders may be a safer option if you need to carry things with you.

5. Avoid any and all activities that reproduce or increase your pain. Certain activities, such as yard work, cleaning, blow drying and styling hair may best be left undone until your shoulder pain resolves. If it isn’t possible to postpone these tasks, do short periods of activity followed by rest and ice to limit inflammation and irritation.

As with any injury or painful condition, it’s always best to consult with your health care provider to rule out a more serious condition and to get an accurate diagnosis for treatment. And an earlier diagnosis and path to relief means a lower likelihood of suffering with a chronic condition. Be proactive and get it taken care of.

Perhaps you’ve heard of fascia. It’s a layer of connective tissue throughout the body that lies over and between the muscles and skin and surrounds the internal organs. (It’s the stuff on raw chicken that looks like clear saran wrap). The fascia moves as the tissues do, and restrictions of the fascia can contribute to various painful conditions, including back pain, neck pain, foot pain, and shoulder pain among many others. It is also a contributor to myofascial pain syndrome and some cases of fibromyalgia.

You can visualize a restriction of the fascia like taking part of a saran wrap coating and shrink wrapping it. That area gets adhered, doesn’t move, and in the case of human fascia causes problems for the surrounding skin, muscle, and organs.
There are a few things I find helpful for fascial restrictions and pain.

1. Work with a physical or massage therapist trained in myofascial release. It’s a gentle hands on technique that helps release the fascia in its various planes. To learn more about myofascial release click here.

2. Work with a Rolfer. Rolfing is a manual therapy technique that uses more firm/deep pressure to release the fascia throughout the body. Often done as a series of 12 visits, Rolfing is a way to restore fascial mobility and reduce pain. To learn more about Rolfing visit www.rolf.org.

3. Practice Yin Yoga. Yin Yoga is a passive, quiet form of yoga. All of the postures are performed in a seated or reclined position with the muscles completely relaxed. The poses are held for 5-10 minutes in order to allow the fascia to release.

If you have pain that hasn’t resolved despite faithful stretching, strengthening, and work with a health care professional specializing in musculoskeletal injuries, maybe fascial restrictions in the body that haven’t been addressed are part of the problem.

Swimming is recognized as an excellent form of exercise, particularly for individuals with joint pain or musculoskeletal injuries. It has many benefits including the following:

• It’s a great cardiovascular workout, which can help lower blood pressure, cholesterol, and body weight, improving overall health and well-being.
• It works all the major muscle groups for a total body workout and toning.
  The hydrostatic pressure helps reduce inflammation and pain, allowing someone with a swollen knee, for example, to do gentle range of motion or even shallow water walking with less pain.
• The properties of buoyancy allow individuals with significant mobility loss, pain, or obesity to exercise with limited risk for injury.
• It’s non-weight bearing and non-impact so any conditions that are aggravated by weight bearing, such as certain cases of back, hip, knee, or foot/ankle pain, can benefit.
• The water helps promote range of motion. You don’t have to swim in the traditional sense of doing laps to use water to help encourage movement in the joints. Standing in shallow water and gently moving the affected area can be of great help.

• Various tools are available for use in the water, such as water weights and flippers that help increase resistance for additional strengthening. In addition, aqua joggers are buoyancy belts that keep you afloat and can be used to do deep water jogging for runners (and non-runners too) who are off the road due to pain with high impact activities.

If you are NOT a swimmer, meaning you don’t know how to swim the various traditional strokes (such as the crawl, freestyle, breast stroke, or backstroke) I don’t recommend swimming if you have back, neck, or shoulder pain. Faulty mechanics could actually cause more problems for you. If you’re unsure where to begin in the water, consult with a physical therapist who has experience with aquatic therapy. They can help you establish a safe program for your specific needs.

Whether at work on a computer or home in the kitchen making dinner…when the phone rings and it’s just so easy to cradle it between your ear and shoulder and continue on with the task at hand. Though convenient, doing this for even short periods can cause problems. Let’s consider, for example, that you cradle the phone between your right ear and shoulder. In this position, the neck and shoulder alignment are altered in the following ways:

1. The muscles on the right side of the neck (such as the upper trapezius) are shortened and the left side are stretched. The muscles on the right may eventually get tight, and those on the left will weaken from over-stretching.

2. The joints on the right side of the neck get compressed, and those on the left side are opened. This can cause joint mobility problems where the joints on the right don’t glide as well due to being stiff/compressed. In addition, the left neck joints can start to move too much due to excess mobility.

3. The right shoulder shrugs up, causing the muscles around the shoulder blade as well as the upper traps to work over-time. This can contribute to problems in the upper back, with the shoulder blade, as well as with the entire shoulder complex.

So, given all that, it’s best to keep the neck and shoulder in their neutral, upright position while using the phone. In order to multi-task, this can best be achieved using a phone headset/earpiece or speakerphone if available. These allow the hands to stay free and the body to maintain a more ideal alignment, reducing the risk for neck and shoulder injuries.