Physical Therapy Wellness Blog

Your Sleeping Positions Are Making You Tight and Sore

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Guest Blogger Steven Griffin, DPT

Do you often feel restless during the night and wake up with neck, shoulder, back, or hip pain? Do you feel like you can’t find a comfortable position? Have you tried multiple pillows or even a new mattress and still have the same old problems?

Sleeping is critically important to our functioning as human beings. Consistent disturbances in sleep can be the source of many issues, including but not limited to: mood, concentration, and memory issues, weakened immunity, increased risk for heart disease, high blood pressure, or diabetes, and decreased tissue growth and repair. A good night’s sleep is of dire importance for us to stay healthy.

Poor sleep quality can be caused by a number of factors. Emotional or mental stress can cause one to lie awake or toss and turn for hours. A poor sleeping environment such as too much light or noise can prohibit us from feeling rested. But what often gets overlooked is that how we position ourselves in bed can also impact the quality of our sleep. Improper positioning can stress muscles, ligaments, tendons, and other tissues. Furthermore, as humans, our bodies do not like to be in one position for long periods. This is why we often get the urge to stand up and stretch when sitting and why we find ourselves shifting around when we have been standing. However, we do not have much conscious control of our positioning while sleeping. Many times, waking up stiff or tight is a result of subjecting tissues to non-neutral positions all night long.
In general, there are three types of sleepers – back, side, and stomach sleepers. Although you might employ a combination of these, most people have a preferred position. Each position can present its own unique issues, but there are strategies to prevent these issues from having a lasting effect on your body and improve your sleep quality. The following paragraphs will cover what can cause problems in each position, and how you can combat these problems or prevent them from occurring altogether.

Back Sleepers
Ultimately, sleeping on your back with everything in a straight line is the best option if done correctly because all of your joints and muscles are in an anatomically neutral position. But, most people aren’t comfortable sleeping like a corpse, so there are issues that can arise with back sleeping.

Problem #1: You have too much pillow support. Having an extremely fluffy pillow or even more than one pillow can put the neck into excessive flexion, setting you up for tight muscles and possible disc issues. It’s also likely that if you work a desk job, you have been sitting in this position all day–so you’re living your entire life in this position, which will almost undoubtedly lead to neck pain.
Solution #1: Get a flatter pillow or remove excess pillows. This will reverse the excess flexion in the neck and optimize cervical muscle length.

Problem #2: You have too much extension in your lower back. Lying with your legs out straight often creates a significant amount of arch in your lower back, which over time stresses the joints of the spine and cause shortening of spinal musculature. This can lead to low back pain or stiffness.
Solution #2: Put a pillow or a wedge under your knees. This will reduce the arch in your back, keeping it in a more neutral position all night.

Problem #3: Your sheets are tucked too tightly over your body. This will force your feet into a point all night long, leading to tightness in the calves–which may predispose you to things like plantar fasciitis or cramping.
Solution #3: It might seem obvious, but untuck your sheets at the side and/or the bottom. This will reduce the pressure on your feet and allow them more room to move around under the covers.

Side Sleepers
Many people, including myself, prefer to sleep on their side. This position is usually fine as long as you have a supportive mattress and pillow, but there are still problems that can arise when sleeping on your side.

Problem #1: You do not have enough pillow support. In contrast to having too much when on your back, many people do not use enough support when on their side. This is especially true for people with broad shoulders, as the relatively larger distance from the mattress to their head is larger. Without proper pillow support, the neck will be forced into a side bend towards the pillow, and prolonged positioning like this is very likely to lead to some neck stiffness down the road.
Solution #1: Increase your pillow support by doubling up your current pillow, adding a second pillow, or buying a more supportive pillow so that your neck is as neutral as possible.

Problem #2: You sleep with your bottom hand under your head. Cradling your head in your hand may feel nice at the time, but this puts your shoulder in relative internal rotation all night long. This problem is compounded by the fact that most of us sit with our shoulders rounded forward much of our day, so sleeping this way ensures we rarely move out of this position. In addition to the internal rotation, this can also produce compression through the shoulder joint, and these two in combination can cause issues like impingement.
Solution #2: Put your arm under the pillow instead of under your head. This is a compromise in which you still get the cradling feeling but decrease the internal rotation of your shoulder. Also consider rolling back slightly to decrease some of the compression directly through the shoulder joint.

Problem #3: You sleep curled up in the fetal position, causing increased hip flexion and internal rotation. If you sit a lot at your job, this excessive hip flexion is likely one that you spend too much time in every day. This increases tightness in the hip flexors and stresses the gluteal muscles, which can ultimately lead to back pain, bursitis, or gluteal tendonitis.
Solution #3: Bring your knees down and sleep with a pillow between your knees. This will decrease the amount of hip flexion and bring your hips into a more neutral position.

Stomach Sleepers
This is typically not a position I recommend people sleep in because of the effect on the neck and the lower back. But, if you must, please consider the following potential problems and their solutions.

Problem #1: Your head is in excessive rotation. Because suffocating yourself in the pillow clearly isn’t an option, you have to rotate your head to almost its end range when sleeping on your stomach in order to breathe. Imagine sitting like this all day and how stiff and sore you would get. This position places a tremendous amount of stress on the joints and muscles in the neck, and can often lead to soreness or a “crick” in the neck.
Solution #1: Place a pillow under the arm towards which you are turned. This creates a decrease in the relative rotation of the neck by rotating the rest of the trunk towards that side as well.

Problem #2: If you like to sleep with your hands under your head, then your shoulders are in excessive elevation and internal rotation. This shortens muscle groups that are already tight in most people and can lead to stiffness of the neck and pain in the shoulders.
Solution #2: Unfortunately, there isn’t a great solution to this problem if you want to stay on your stomach. If you’re willing to compromise, then you can flip onto your back and sleep with your hands under your head. This will put your shoulders in more external rotation and also take the excessive rotation out of your neck as well.

Problem #3: You have too much extension in your lower back. This occurs because of the elevation of your head and neck on a pillow relative to the rest of your body. This excessive extension causes prolonged compression of the lumbar vertebral joints and shortening of the paraspinal muscles, which can lead to back pain.
Solution #3: Remove the pillow and sleep without support. This will reduce the amount of extension in both the lower back and the neck and decrease the pressure on the vertebral joints. Conversely, you can place a pillow under your hips to better align your lower back with your neck.

I bet you didn’t know there were so many ways to sleep incorrectly, did you? I often find with my clients that if they are having trouble progressing as quickly as they would like to in their recovery, how they sleep can be a missing piece of the puzzle. Since we spend so much time in bed and many people are not aware of their positioning during this time, it is always worth a look to assess and improve your positioning throughout the night. This can help you achieve a better night’s sleep and feel better throughout your day.

Osteoarthritis: What Does It Mean and How Can Physical Therapy Help?

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Guest Blogger Steven Griffin, DPT

Have you been suffering from joint pain for a few days, months, or even years? Does this pain feel like an aching sensation that might get sharp with certain activities? Do you notice some creaking or cracking in joints as you move them? These are some common descriptions of symptoms in those who are experiencing arthritic pain.

Osteoarthritis (OA) is the condition in which the cartilage lining the ends of bones begin to wear down. This is a natural and unavoidable part of the aging process, and the amount of U.S. adults with OA in the hand, hip, or knee is over 20 million (Neogi). Many people with OA experience pain, a sensation of pressure or grinding in their affected joints, decreased range of motion, strength, and an inability to perform some of their daily activities.

Many of my clients who are over the age of 50 come in after seeing their physician and tell me that they were diagnosed with arthritis in a painful joint after their MD looked at the X-rays. The truth is, most people at that age have some visible degenerative changes on imaging in many, if not all, of their joints. Whether or not they experience pain, or if arthritis is actually the source of the pain, is another story entirely. There have been many studies that conclude that asymptomatic individuals can have abnormal findings on X-rays or MRIs, as well as other studies indicating that symptomatic individuals can have completely normal findings on imaging. Although this is another topic of discussion, it is important to rule out other causes of pain, such as acute pain from an accident, muscle pain, referred pain from another body structure, or even pain that is tied to emotional stress. Once you have ruled out other causes and have combined imaging with other objective tests that point to OA, then it is much more likely that OA is the source of your pain.

Understanding how osteoarthritis causes pain is important in understanding how physical therapy can be useful for treatment. Decreased cartilage on the articulating areas of a joint cause abnormal pressure on bone tissue. This can lead to decreased blood flow, growth of bone spurs, development of microfractures, and a state of fairly constant bone repair and remodeling. This state of constant repair often results in  a continued cycle of inflammation within the joint, which ultimately leads to an over-excitability of pain receptors. Oftentimes pain will occur during daily activities involving use of the affected joint, so people will in turn avoid the activity, making them weaker and eventually unable to perform the activity. This cycle is then repeated and over time, people may notice they are unable to do simple things like stand up out of a chair or climb stairs without severe pain.

I often get the question, “How is PT going to help my arthritis? I thought cartilage doesn’t grow back.” No, articular cartilage does not regenerate, and unfortunately, physical therapists do not have a magic cartilage wand. What PT does do, however, is help you determine the sources of your pain, reduce inflammation in the affected joint, and address modifiable risk factors. I educate my patients about the appropriate levels of activity for their individual goals, work to improve their strength and flexibility, and address faulty movement patterns that put their joints at increased risk. Another important focus is modifying certain activities or positions to make them more efficient or manageable for a specific impairment. Finally, there are several manual therapy techniques that I perform to help reduce overall pain, such as joint mobilization, soft tissue massage, dry needling, and more.

If you have been diagnosed with pain related to OA, it is important for you to know what the appropriate actions are to take so that you can reduce its effects on your daily life. A skilled physical therapist can help you reduce pain and determine which of your modifiable risk factors can be improved. From that point, the two of you can conceive a plan moving forward to keep you living the life that you want without the fear of constant pain.  

 

Data obtained from the following article:

Neogi, Tuhina, and Yuqing Zhang. “Epidemiology of OA.” Advances in Pediatrics, U.S. National Library of Medicine, Feb. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3545412/. 

 

Runners: Forget R&R – How About Some S&S?

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Guest Blogger Steven Griffin, DPT

If you are a runner, one of the worst feelings in the world is sustaining an injury while training for a big race. An even worse feeling is having this injury slow your time down significantly or even knock you out of the race all together. Overuse injuries are notorious in the endurance athlete population, particularly in runners. One of the reasons for this is that many runners do not incorporate any kind of exercise variety into their training program. Coupled with the very high volume of activity, the lack of cross-training predisposes these athletes to many different kinds of overuse injuries that can turn chronic if the underlying issues are not addressed.

One common strategy that runners use when dealing with overuse injuries is R&R, or rest and relaxation. While R&R has its place, I often implore my runners to try what I call S&S, or strength and stability training. This type of cross-training can have numerous benefits for runners, including improving form, multiplanar strength, tissue resiliency, and kinesthetic awareness.

To understand how S&S training can help you, you must first understand the basics of how most overuse injuries affect your body. High-volume training coupled with subtle weaknesses in certain muscle groups can cause a breakdown in your running form. These weaknesses often occur in some of the stabilizing muscles such as the gluteal muscles or the muscles that support the arch of the foot. In the short term, you may not notice the effects of form breakdown, but over tens of thousands of steps, even a slight decrease in your running economy causes increased pressure and demand on your muscles, tendons, joints, and bones. Complicating matters is that many athletes will train through the injury, resulting in increased tissue damage, increased chance to develop a chronic injury, overall prolonged recovery time, and more missed training days in the long term.

S&S is also critical for runners who always feel tight; no matter how much you stretch your tight muscles, they never seem to loosen up. This is likely because your muscles aren’t physiologically shorter, but that your muscle weaknesses are causing instability in certain joints. Your body is a master at protecting itself against what it perceives as potential threats to its well-being, and so it uses the muscles that directly affect that joint as a “protective spasm,” keeping the joint from moving or shifting in various ways. If this is your issue, correcting these weaknesses is likely the underlying solution to your chronic tightness.

Incorporating strength and stability into your training has numerous benefits, including, but not limited to, the following:

  1. It improves strength and endurance of stabilizing muscles in the lower extremities. This will in turn improve overall running economy and take pressure off of tissues that compensate for weaknesses in these areas.
  2. It subjects tendons and bones to increased loading. This will improve tendon strength and bone density, decreasing risk for common running injuries like tendonitis or stress fractures.
  3. It improves proprioception, or the ability to sense where different body parts are in space. This helps running economy and also can prevent acute injuries like ankle sprains.
  4. It also improves overall function in daily activities not related to running, such as squatting, lifting objects, climbing stairs, etc.

S&S training comes in many different varieties. If you are considering incorporating this into your routine, then you may choose to try weight lifting, yoga, Pilates, body weight training, resistance band exercises, functional training, TRX classes — the list goes on! If you can implement a large variety, that will only magnify the benefits that you get.

If you are a runner suffering from an overuse injury, then you should consider seeing a physical therapist at Druid Hills PT. Your therapist can determine the sources of your injury, analyze your running form, and advise you on the appropriate cross-training strategies based on your individual needs and goals. And if you are not currently injured, consider implementing some S&S training to prevent future injury and help you reach your running goals.

Three Strategies to Prevent Stiffness If You Sit All Day

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Guest Blogger Steven Griffin, DPT

As technology has advanced in the past 30 years, the number of desk jobs has increased all over the world. While this has made us a more efficient and productive society, it has also encouraged a sedentary lifestyle that has a significant impact on our bodies. If you are someone who is required to sit all day for your job, particularly if you are looking at a computer screen while doing so, then here are three strategies that you need to implement to stave off stiffness and pain:

Change positions as often as you can.

The longer you sit, the more time gravity has a chance to take a toll on your body. You end up either slouched back in your chair with no support to your lower back, or you have your shoulders rounded forward and upper spine bent. Preventing this from happening  over several hours is almost impossible, so getting up every 30-60 minutes for 3-5 minutes at a time helps combat gravity’s effects on your body. If you have the ability to switch to a standing desk for parts of your day, that’s even better.

Reverse your posture.

This doesn’t mean sitting ramrod straight all day every day – that would lead to its own set of problems. This simply just means occasionally doing exercises throughout the day that facilitate the opposite movement of sitting. Three simple ones that you can perform anywhere, including work, are as follows:

  1. Scapular Squeezes – Simply squeeze your shoulder blades together (without hiking them up towards your ears). Hold this for 3 seconds and repeat 10-20 times.
  2. Chin Tucks – This doesn’t mean bringing your chin to your chest. I like to describe it as you’re pretending to pull away from someone you don’t want to kiss, or you’re trying to make a double chin. Hold this position for 3 seconds and repeat 10-20 times.
  3. Doorway Stretch – Find a doorway and put your arms on either side of the frame. Stagger your stance and lean forward so that your weight is mostly on your front foot and you feel a stretch in the chest and front of the shoulders. Hold this for 20-30 seconds and repeat 3 times.

Exercise.

Exercising outside of work has numerous health benefits. It allows you to gain postural muscle strength and flexibility that will help you avoid gravity’s toll on your body. It also introduces some cardiovascular benefits that are virtually nonexistent if you are sitting all day. Exercise is also a proven stress reliever, and we’ve all had those stressful days at the office that can weigh on us mentally and physically.

One caveat: you must do something that isn’t sitting-based. Do not go to the gym and ride a stationary bike every day. Walking, running, lifting weights, yoga, Pilates, or anything that gets you out of that sitting posture is recommended.

Consistently performing these strategies might seem like a lot of effort. But if you prioritize them, it will eventually become habit and you will feel much better at the end of those long days. Trust me, your body will thank you.

Benefits of Physical Therapy for the Aging Population

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Guest Blogger Steven Griffin, DPT

It’s a fact of life: as we age, our bodies are not quite as resilient as they used to be. Strength, endurance, flexibility, cardiovascular and pulmonary function, bone and joint health, and other physical functions begin to decline. You may have noticed that you or someone you know is having difficulty walking, bending over, lifting objects, climbing stairs, or other daily activities due to pain, weakness, or inflexibility. However, aging does not necessarily translate into dysfunction throughout our daily lives. The effects of aging can be slowed, and one of the best ways to combat these effects is through regular exercise and body maintenance.

The benefits of exercise are numerous for all ages. Some of those major benefits are as follows: 

  1. Cardiovascular health – Stressing the heart through exercise improves circulation, activity endurance, lung function, and energy levels.
  2. Muscle strength and endurance – Our muscles, even as we get older, adapt to the stresses they are subjected to. Improving strength and endurance through exercise can translate into easing daily activities like walking, standing up from a chair, picking things off the ground, and lifting heavy objects.
  3. Reducing musculoskeletal pains – Pain can arise when muscles, joints, nerves, or other structures aren’t working the way they are supposed to. Specific exercise to address body impairments related to these structures can help prevent or reduce pain.
  4. Social wellness – Going to exercise classes, the gym, playing sports, or just walking with a group is a good way to interact with your family and friends which plays a huge role in mental and emotional health.

Although these are some of the major benefits, they are by no means the only benefits of exercising. When I work with clients, I often hear them say things like “I’m too old to do that” or “I just have to accept the fact that I’m getting old.” I believe this is the wrong mindset. As an expert on the human body, I know that exercising can help slow the aging process. I often respond to those clients’ claims with the following: “You don’t stop doing physical activity because you got old, you got old because you stopped doing physical activity.”

Now, where does physical therapy come into this? What if you are having pain that is preventing you from exercising? What if you want to exercise but you aren’t sure what you should be doing? Physical therapists are extensively trained in both pain management and exercise programming. If you are suffering from pain, weakness, difficulty with daily activities, low energy levels, or any combination of these, then you should consider making an appointment at Druid Hills Physical Therapy. A highly skilled physical therapist on staff will evaluate your needs and select the appropriate interventions based on their findings.

These are your golden years. Don’t let the fact that you are getting older get in the way of living the life that you want to live. You may find that you are capable of things that you previously thought were only possible for the much younger version of yourself. Make your appointment today, and start your journey towards a more active and enjoyable life!

Dry Needling: How and Why It Works

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Guest Blogger Steven Griffin, DPT

We’ve all been there at some time or another. You’ve been staring at the computer for hours, slumped over in your chair and shoulders up to your ears, carrying all of the stress from the impending deadline at work or the test that you have to take tomorrow. You’ve noticed that a headache is starting to come on, but you shrug it off, attesting it to simply staring at a screen for too long. The only problem is that it doesn’t go away once you leave the computer, and you feel like you have tons of “knots” or “kinks” in the top of your shoulders and into your neck that need to be worked out.

Not a desk kind of person? Maybe you decided to break out the tennis racket for the weekend because the weather was so nice. You had a blast, but when you wake up Monday morning, you notice this dull aching pain that is radiating from your shoulder blade into your upper arm that you can’t quite pinpoint. You may even notice a feeling of tightness in the shoulder, or possibly even some tenderness if you poke around.

In either of these scenarios, it’s likely that your pain is being caused by myofascial trigger points. These trigger points are those painful “knots” in the muscles and can be caused by many things, like poor posture during standing, sitting, or sleeping; over-exertion; direct trauma; or protective spasms. Regardless of how they come about, trigger points can be a nagging source of pain and tightness for many people, and sometimes simply stretching isn’t enough to oust them.

Fortunately, there are treatments–in combination with proper movement–that can help alleviate the issue. One of these is trigger point dry needling. Dry needling involves the use of a very thin needle that directly enters into the trigger point. This causes a cascade of biochemical events in the muscle fiber and allows it to release, reducing pain.

What exactly happens in the trigger point during dry needling that causes it to release? The research isn’t conclusive, but the three main theories are:

  1. Increased neurotransmitter activity at the muscle causes prolonged contraction which causes sensitization of the tissues and therefore pain. Needling to the area increases the pH in the muscle fiber and decreases neurotransmitter activity, which then decreases the  muscle contraction and the pain.
  2. Prolonged muscle contraction causes decreased blood flow, which causes decreased tissue healing and therefore increased pain. Needling to the trigger point improves blood flow and, with it, tissue healing and pain.
  3. Sustained muscle contraction puts pressure on nerves which causes pain. Needling to the area helps release the contraction and therefore decreases pressure on nerves and decreases pain.

There’s nothing like a little science to get you amped up, is there?

You may be saying to yourself, “This definitely sounds like something that may help me, but where can I have it done? What can I expect?” Luckily for you, there are physical therapists who have had years of experience studying and treating the human body, as well as countless hours of practice with dry needling. Druid Hills Physical Therapy has an expert dry needling therapist on staff.

When having the procedure performed, you can expect a deep aching feeling  or pressure, and you may even feel the muscle twitch. That twitch response is the muscle fiber letting go of the sustained contraction that has you feeling your pain. Side effects are rare, but the two most common are muscle soreness (which should just feel like a workout type soreness) and minor bruising.

If you are suffering from trigger point pain, then dry needling can help you. Your physical therapist is an expert in analyzing movement and performing a comprehensive treatment of the musculoskeletal system. A combination of dry needling, other appropriate manual therapy techniques, and specific exercise should have you feeling much better in no time!

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