Feb 7, 2019
Lisa Burdick, PTA
Basics of Breathing
Breathing is something that we must all do 24 hours a day and that can greatly impact how we move and feel in a positive (or negative) way. In physical therapy, we evaluate breathing to identify dysfunctional breathing patterns as well as muscle imbalances (e.g., tight or weak muscles) that may lead to pain and injury.
Normal breathing requires the use of the primary respiratory muscles, which consist of the diaphragm and intercostal muscles (muscles between the ribs). When we exert ourselves, we call on our secondary respiratory muscles within the neck and chest, which include the upper trapezius, scalenes, sternocleidomastoid, levator scapulae, and pectoralis minor. These secondary muscles help lift the ribcage to allow the lungs to expand further in order to bring in more air. When we develop dysfunctional breathing patterns, we begin to use our secondary respiratory muscles instead of our primary muscles, which leads to postural imbalances such as a forward head and rounded shoulders resulting in neck and shoulder pain, headaches or dizziness.
Dysfunctional breathing can also occur due to poor positioning of the ribcage. When our ribcage mobility is limited or the ribs are flared out, our diaphragm is at a disadvantage in its efficiency to pump air into our lungs. When we struggle to get air into lungs that are already full or into a tight restricted ribcage, we again depend on our secondary muscles to breathe. By repositioning our ribs into an optimal neutral position, we facilitate our diaphragm muscle and improve the neuromuscular control of our intrinsic core stabilizers. This in turn helps us to move our bodies more efficiently with less stress on our joints and spine.
The diaphragm is connected to the central nervous system and engages the vagus nerve that produces a calm state in the brain. Dysfunctional breathing patterns can contribute to feeding the sympathetic nervous system, the system that is responsible for the “fight or flight” response to stress and that is characterized by increases in heart rate and muscle tone. When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic nervous system to help calm the mind and body. With as little as one minute of slow, mindful breathing, we can alter our stress levels, relax tense muscles, improve alertness, boost the immune system, and facilitate our inner core stability (abdominal and pelvic floor muscles) to optimize movement efficiency. The upward and downward movement of the diaphragm helps move toxins from the organs, promoting better blood flow and releasing endorphins, which are natural painkillers created by our own bodies. Focusing on your breathing during physical activities can help you become more mindful of your body, improving self-awareness.
Functional Breathing Goals:
1. If standing or sitting, distribute your weight equally through your heels or sit bones. If lying down, bend your knees up to flatten your lower back. Lengthen the back of the neck and move the tailbone down to promote neutral spine alignment.
2. Consciously relax your neck and shoulders and avoid clenching your jaw.
3. Begin with an exhalation, as you cannot properly inhale until the lungs are emptied. Slowly blow out through the mouth for 3-5 seconds focusing on closing the lower ribs down and engaging the abdominal wall to flatten your lower back. PAUSE FOR 3-5 SECONDS BEFORE INHALING.
4. Slowly inhale through the nose for 3-5 seconds focusing on expanding the abdominals and ribcage smoothly in all directions but stopping at the collar bone to avoid using your neck muscles.
5. Repeat 4-5 breaths, then rest by breathing naturally. Work up to 3-5 sets at a time.
November 29, 2018
Katie McCarthy, PT, DPT
How Breathing Techniques Can Change My Shoulder Pain
Shoulder pain is one of the most common orthopedic complaints, with reports ranging from 30% of people experiencing pain at some time in their lives to 50% of people having an episode of shoulder pain annually.1 Shoulder impingement is a condition in which your rotator cuff tendons become chronically pinched and irritated. Maybe you have experienced shoulder pain that grabs sharply and aches, making it difficult to find positions of comfort. Maybe you’re struggling to reach for a plate overhead or get the carton of milk from the refrigerator. How does this happen, and what can we do to fix it or prevent it from happening?
There are several reasons why impingement can occur. It may be related to your anatomy, but many times, our postural and muscular imbalances predispose us to having nagging shoulder issues. Our lives are busy and stressful, frequently requiring us to get into funky positions that can cause increased tension manifesting in our neck, shoulders, and low back. Pectoral muscles and other muscles on the front of your chest become tight and restricted. Because of this, our shoulders are pulled forward and the shoulder blades begin to slide around the sides and off our back. This is called protraction. We begin to have an increased arch, or lordosis, in our lumbar spine due to tightness in the low back and hip musculature. As this happens, it flares open the front of the rib cage elongating our abdominal muscles and further weakening the core, which is essential for stability for the arms and legs to work off of. As the rib cage opens in the front, it will close down and flatten in the back. In an effort to keep our balance and assume what we believe to be “good upright posture,” we extend our thoracic spine as well. The shoulder blade is a concave structure meant to rest on a convex structure (the rib cage). If the thoracic spine and back of the ribs are flattened, the shoulder blade will not be stable and instead be floating around and pulled in the path of least resistance, which at this point is forward towards the tight pectoral muscles. Now we have a pelvis that is tipped forward, ribs that are flared, a thoracic spine that is extended, and shoulders that are pulled out of their natural resting position. Don’t worry, it’s not as bad as it seems, and position can be corrected!
Traditional physical therapy has typically jumped to “rotator cuff strengthening” for impingement issues. While weakness or imbalances in your rotator cuff may be part of the issue, if we go right to strengthening in these faulty positions, pain may not improve. Or perhaps it will come back. Breathing techniques aim to correct dysfunctional posture. You breathe 21,000 times a day, so if we can make one task very efficient, let’s choose that! By correcting the position, you will then be able to perform stability exercises for your shoulder more effectively.
Start with a complete exhale. Exhaling gets your ribs down, getting the air out of your lungs and increasing your oblique muscle contraction. Try this exercise daily and get started with the fundamentals of posture and breathing:
1. Lie on your back with your knees bent up in a comfortable position, toes straight forward, and knees in line with your toes. Rest your arms at your sides or a little outwards in an upside down “Y” with your palms up. Keep the shoulders relaxed onto the table throughout the exercise.
2. Inhale through your nose. Allow your chest to rise. Feel the expansion happening 360 degrees into your side and back ribs. Do not inhale so hard that your neck muscles help and begin to get tight.
3. Exhale through your mouth slowly like you are blowing out of a straw. Get all the air out until you feel your ribs drop down, in, and together. You may feel a slight contraction in your abs. Let your chest fall down towards the table. At the same time you are exhaling, roll your hips backwards so that your tailbone slightly lifts (like a dog tucking its tail) and your low back flattens to the mat. This is called a posterior pelvic tilt.
4. Once your exhale is completed, pause for a moment before you inhale again.
5. Repeat this for 10 breaths, 3-4 times per day.
What just happened with that exercise? Getting the ribs down in front by exhaling has now allowed opening to occur in the back. This will begin to allow for the natural convex curve to return so that the shoulder blades can rest in their natural position. Pulling the ribs down also stretches the pectorals from their lower point of attachment on the ribs. This will put less stress on their attachment at the shoulder blade and create less tipping forward and rounding off the back. This technique will also increase abdominal wall activation and help keep the ribs and sternum from flaring up and open again. Furthermore, it will get air completely out of your lungs so there is more space for a full capacity inhalation.
Even if you can’t lie down in the middle of the day, try performing full exhales at your desk or in your car. Not only does performing breaths this way start to improve your posture, it activates the parasympathetic nervous system. This relaxes your body and can help with stress and tension. Additionally, inhaling through the nose releases nitric oxide, which will improve your blood flow.
Reducing pain can start with just a breath.
To find out more about how breathing techniques can address your pain, check out the PRI website or visit our other blog posts.
1) Br J Sports Med. 2009 Apr;43(4):259-64. doi: 10.1136/bjsm.2008.052183. Epub 2008 Oct 6.
2) Postural Restoration Institute Web site. https://www.posturalrestoration.com/. Updated 2018. Accessed April 1st, 2018.
October 5, 2018
Dylan Tanguay, CFSC
Strength Training and Injury Prevention in Athletes
Strength training is paramount when it comes to injury prevention. This is especially the case with athletes. The stronger we are, the more we will be able to withstand different types of stresses while practicing our sport. Whether that “stress” is physical contact or continuous repetition of a certain skill, an excessive amount of this stress has the potential to cause injury. These injuries then have the potential to take the athlete away from practice/game time. Ultimately, this leaves the athlete unable to develop their skill within their sport. This also tends to lead to even more strength loss, since the athlete is now injured and unable to perform or train. Pretty quickly this begins to snowball and can create a vicious cycle that can be very difficult to stay on top of. Athletes of all ages need to make strength training a priority during the off-season, and they need to focus on in-season strength maintenance training as much as possible.
Even if you’re not playing a sport at that time, you still lead a very active lifestyle (hopefully)! You can place enough stress on your body to create overuse injuries through seemingly normal movements that don’t seem to qualify as incredibly “athletic”. Going on a weekend hike, taking a bike ride with your friends, and even running a simple footrace for fun after practice are all really good examples. The bottom line is this: if you do something several times and you are not strong enough to perform that movement efficiently, there is potential for an overuse injury to occur. Athletes need to make sure that they put in the proper amount of time to take care of their bodies. If you want to be a smooth running athletic machine, there’s a lot of maintenance work that goes along with that. Strength training is a vital part of this maintenance work.
On top of that, everyone falls every now and then. The properly designed fitness routine can help athletes develop much more awareness of where their body is in space, leading to a decreased chance of falls. Now let’s say this is one of those completely unavoidable situations and you manage to hit the ground. If we aren’t strong enough to withstand that impact, it’s very easy to get some sort of injury that can put your future athletic goals at risk. No one wants to show up at practice in a cast or a boot because they fell off their bike over the weekend, am I right?
It’s vital that athletes start to follow a fitness routine to incorporate strength training as much as they can into their athletic schedules. It may seem like a waste of time or simply unimportant right now, but I can assure you that your strength and athleticism is an investment in yourself and your athletic career.
Get strong, stay strong, keep playing!
|August 8, 2018
Matthew Chouinard, ATC
The Benefits of Playing Multiple Sports in High School
We live in an age where everyone wants to be the next LeBron James, or Tom Brady. Kids grow up falling in love with a certain sport and want to try to be the best they can at it. Everyone wants to specialize and devote all their time to just their best sport in an attempt to maximize their potential. College scholarships appear in reach for young athletes full of ambition and belief in themselves as they enter into the high school setting. Over the years, this has led to more and more high school kids choosing to specialize in just one sport year-round. They see this as an opportunity to refine their skills and get an edge on the competition, but in actuality, playing a new sport each season can potentially provide a more positive impact on an athlete than complete specialization.
The main upside of playing just one sport is that it allows for much more practice time to further develop skills, but that also comes with some downsides. When playing the same sport year-round, the athlete is also performing the same motions and muscle movements constantly. This repetitive stress on a person’s muscles, joints, and bones can lead to overuse injuries that will sideline the athlete. When playing multiple sports, an athlete is changing their motions and movements based on what is specific to the given sport. This allows different muscles to rest as other muscles begin being used more during a transition into the next season, thus making it less likely that overuse injuries will occur.
Another downside of playing just one sport is that it creates a higher chance of burnout for the athlete. If an athlete is just focused on the same sport nonstop, then it’s possible that they will get bored or mentally tired of it. The practices and skill work that they are doing over and over again will become stale to them and they may even lose the desire to play. By playing multiple sports, athletes will be given new challenges and goals each season, helping refresh them and keeping any one sport from becoming tiresome.
As much as it may appear that specialization is the key to athletic success, it may not be the case. The benefits of playing multiple sports as a high school athlete will help to prevent overuse injuries from developing, as well as prevent any one sport from becoming stale. So, the information has been laid out, but people still take both routes when it comes to high school athletics. Should people go all in on one sport or participate in multiple?
By Matthew Chouinard, ATC
July 9, 2018
Beth Carlton, BS, MS, NASM-CES, CFSC
Four Simple Mindset Rules
Personally, goal setting is something that I like to do, but it never used to be that way. It was a struggle and I would always set goals that didn’t make sense or that weren’t valuable to me. As I grew older, I learned that there is nothing more satisfying than making a "To Do" list for the day and being able to check things off. Within the last month, I read a book about mindfulness and being in the present, “The Practicing Mind” by Thomas M. Sterner. This book has taught me to learn to love the process, avoid self-judgment, eliminate impatience, end boredom, reduce stress, feel calmer, experience self-discovery, enjoy the journey, and be happier.
The author of the book, Thomas Sterner, gave 4 simple mindset rules for success:
1. Keep yourself process-oriented. Make yourself a road map on how to achieve your goals.
2. Stay in the present. Looking in the future or the past hinders the process. Keep what you want to achieve in sight.
3. Make the process the goal and use the overall goal as a rudder to steer your efforts.
4. Be deliberate, have an intention about what you want to accomplish, and remain aware of your intention.
When you set a goal, it has to mean something and has to have some sort of value, so that when you achieve it, it means something. You want to start with goals that are the highest on your priority list. So start simple, less is more. You always want to limit the number of goals to 3-5 to help focus your attention and so you can achieve goals in a timely manner. So break down your goals to your top 3 or top 5 that you really want to achieve and write down why they are so valuable to you. It creates those visual aids that you need to help maintain focus.
Something that I learned when I was in school is that we have to think SMART when goal setting. You need to be as Specific as possible, give yourself something to Measure or set realistic deadlines, be honest with yourself and make the goal Attainable, make sure that your goals are Relevant to your lifestyle, and make sure that you have enough Time to accomplish your goals.
To summarize, set goals that motivate you and make sure they are SMART, write those goals down, put a plan in action, and work on that plan. Working on that plan is what makes you successful. Just trust your instincts and don’t get ahead of yourself.
By Beth Carlton, BS, MS, NASM-CES, CFSC
June 4, 2018
Claudia Burns, PT, DPT
Most of us, when prompted, could likely find at least one thing we could improve when it comes to our health. We could all likely exercise and sleep a little more, consume alcohol and sugar a little less, quiet our minds a little more completely, and form closer bonds with our loved ones. Recognizing this fact is a crucial first step, however, developing strategies to reach our health and wellness goals is famously difficult resulting in a barrage of “solutions” presented to you by a variety of different media sources (including this one?!).
The methods that I, and others, have found to be the most successful involve some concentrated, but not difficult, effort. Finding the strategies that will work for you involves knowing yourself – your strengths, weaknesses, favorite excuses, and loopholes that you employ to avoid things you find unpleasant or unenjoyable. It’s helpful to know WHY you skipped that spin class so that you can take a more tailored approach next time. For example, maybe you think the time of day played a role in your playing hooky. So you register for an AM class instead, but skip that one too. Likely, it isn’t the time of day that’s to blame. Maybe you just hate spin class, or group exercise, or endurance training. If so, this isn’t your avenue to fitness. Maybe you need a race date to motivate you, or a partner. You might need a rigid exercise schedule to follow or flexibility to be compliant.
Similar questions can be asked when it comes to your diet, sleep schedule, work life, etc. The important question is “why?” and the important answer is the truth. The truth is void of judgment. So you’re not a group exercise person? Lots of people aren’t. So you’re not a morning person? Stop trying to be. Lots of successful, happy people stay up late and sleep in. You may find the key to your self-improvement success involves realizing you’re trying to be someone you think you should be rather than the person you are. As a friend of mine once put it, “Don’t should on yourself.”
It’s important to remember that everyone is different, and no one is wrong. The only right way to be healthy is the way that works for you. Find what you like, what works, and what’s fun. If it feels like a chore, you’ll treat it like one and try to get out of it. After all, we are our own worst enemies. But we could also be our own best friends.
For more practical, individualized advice, there are a barrage of personality assessments that you can take to help determine personal preferences. One that I have found personally and professionally very useful was developed by the wise, self-described “happiness bully,” Gretchen Rubin. She has developed a super simple, quick test to help you determine your expectational tendencies. You can find the quiz here.
By Claudia Burns, PT, DPT
April 30, 2018
Shawn Paquette, PT, DPT, CSCS
Cancer Survivorship and Physical Therapy
A cancer diagnosis often results in a huge impact not just on a patient’s physical well-being, but also on other aspects of the patient’s wellness, such as their mental health, social interactions, and financial standing. It is a very stressful time in these patients’ lives. Between the onslaught of different doctors’ appointments and the uncertainty of their ultimate prognosis, it is not uncommon for these patients to have high stress and anxiety levels. While patients are being treated for their cancer, participation in physical therapy is probably not the first thing on their mind. However, there are many ways in which physical therapy can assist these patients to achieve better health and an improved quality of life.
One of the biggest complaints associated with a cancer diagnosis is cancer-related fatigue. Cancer-related fatigue is defined as a “distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion.” Up to 80% of all cancer survivors report experiencing cancer-related fatigue, and this side effect can persist for years even after treatment ends.
One of the best ways to combat cancer-related fatigue is through exercise. Though it may seem counterintuitive, exercise has the highest quality evidence for treating cancer-related fatigue. It is recommended that cancer survivors participate in 150 minutes of moderate intensity activity each week, including 2-3 strength training sessions. Physical therapists are in a unique position to guide these patients through an individualized exercise program since they have a sound understanding of how the side effects of cancer and its associated treatments can affect a patient and how to modify their exercise program accordingly.
Though cancer-related fatigue is one of the biggest complaints associated with a cancer diagnosis, there are several other issues that may arise from cancer itself or its associated treatments. Some of the other medical issues commonly encountered after a cancer diagnosis include pain, joint or muscle stiffness, generalized weakness and deconditioning, and balance or gait impairments. All of these issues can be effectively addressed with physical therapy treatment and result in an improved quality of life for the patient.
If you are dealing with physical limitations as a result of cancer or cancer treatments and would like to be evaluated by one of our physical therapists, please give our office a call at 207-442-0325.
By Shawn Paquette, PT, DPT, CSCS
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 1.2017. December 19, 2016.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Survivorship. Version 2.2016. September 27, 2016.