Neck rolls are one of the easiest and best exercises you can possibly do for your neck. Learn more by watching the video below.
[I'm teaching a seminar March 14th, 2018 entitled How to Rejuvenate the Body: Easy Exercises for a More Youthful Body which will cover this topic and much more related material. Register here.]
Most of us know that we should be doing some form of stability work for the spine so as to prevent low back pain, but stability work can be absolutely overwhelming. There are simply far too many exercises out there, and even if you do some of these exercises, you'll probably be told that you're doing them 'wrong.' For every exercise guru there is another (and absolutely critical) way that stability exercises are supposed to be done. "Flatten your stomach - but don't use your obliques!" "Breathe from the diaphragm - no, not that diaphragm, the other diaphragm!" "Don't let you pelvis move - but don't hold it rigid!" The list of commonly heard comments from exercise gurus could fill pages. It overwhelms anyone hoping to have better stability - no one except the gurus think they're doing it right.
In order to cut through the clutter, I ask people to focus almost exclusively on one stability exercise: planks. A plank is when you hold your trunk up and reasonably straight, while gravity is trying to pull it down. The standard plank is to assume the starting position for a push-up and to simply hold this position. Hold your trunk straight as you do this: don't lift your butt in the air.
A key thing to know about 'core' stability is the more you think about stability, the less you actually have it. There are two major modes for the brain: 1) sensorimotor processing (movement), and 2) reflective thought (thinking). These modes are mutually exclusive: they inhibit each other. The more you're thinking, the less well you will move, and the more challenging a movement is for you, the less clearly you can think. So if you're thinking about how to move, you really can't move well at all! Real 'core' stability is an automatic, unreflective process - there is no thinking involved. The body unconsciously stabilizes itself. This means that the best stability exercises are those that don't require you to think about them. Planks are one such exercise: as long as your butt isn't up in the air and as long as you aren't hurting while you do them, then they're making your 'core' stronger and more coordinated.
Another great thing about planks is that they are modifiable for everyone. If you aren't strong enough to do standard planks, then you can start with your hands on the wall and slowly work your way lower and lower. If you are too strong for standard planks, then you can elevate your feet. And everyone can slowly work their way from standard planks to doing one-legged, then one-armed, and finally one-legged, one-armed planks.
If you can do a 60-sec one-legged, one-armed plank (30-sec on each side), then you have excellent 'core' stability and really don't need to focus on stability anymore - just maintain your current abilities. That's yet another great thing about planks: they have a reasonable endpoint. Don't get caught in the trap of thinking that if a 60-sec plank is good, then a 5-min plank must be even better. Just get to the 60-sec plank and feel confident in your abilities. If your low back gets hurt, and you weren't doing something really crazy, then you didn't get hurt because you didn't have enough stability. Something else was the cause.
I encourage everyone to simplify spinal stability by focusing on planks. The following video walks you through my basic plan for planks. In my March 14th, 2018 seminar How to Rejuvenate the Body, I'll be covering planks and other key exercises that will simplify the world of exercise. Register here.
I'll be giving a lecture entitle A Good Stretch at Orange Coast College soon (Sept 12th, 2017), so I've got the topic of stretching on my mind. When it comes to stretching, the hamstrings are always one of the first questions to come up. So let's talk about the chronic problem of tight hamstrings.
We all know we have tight hamstrings. They're a big problem, a bigger problem than you probably realize. Not only do tight hamstrings limit knee motion, but they also limit hip motion and place excessive stress on the low back. Also, because of the sciatic nerve running with them, they can pinch this nerve and cause problems all the way down into the ankle and foot.
Most people realize that they need to stretch their hamstrings, but often what happens is that the hamstrings refuse to relax. I know many people who have spent an entire year stretching their hamstrings only to have them be just as tight, if not tighter, by the end of the year. This is because of two major problems with hamstring stretching: we stretch too vigorously, forgetting that the point is to relax them, not to literally stretch them longer, and we use stretches that are by nature not useful for relaxing the hamstrings.
Let me explain this with some examples. The most common hamstring stretch is the toe touch. Whether you do this in sitting or standing, notice what happens when you reach for your toes. You're loading your hamstrings when you do this. It's as if you're handing your hamstrings the entire weight of your upper body and then saying, “okay, relax.” This is an unreasonable request. The hamstrings won't relax under such circumstances.
Another option is the straight leg raise. Here you lie down, hold your thigh perpendicular to the ground, and then straighten your knee. This is a much better option than the toe touch, but it is active work and doesn't exactly encourage relaxation. Another alternative is the doorway stretch, using the doorway to hold your leg in the air. This is more like it! Now you can actually lie there and relax as you stretch. But people still don't make much progress with this stretch. This is because the knee needs to be totally straight to really get the hamstring, the calf muscle that intertwines the hamstring behind the knee, the sciatic nerve, and the surrounding fascia to all relax. Unless you're already very flexible, you won't be able to get your knee totally straight with the doorway stretch unless you're so far from the doorway that you actually have to engage your hamstrings to hold your leg in place. Once again we meet the problem of the stretch itself not being conducive to relaxation.
For all these reasons I suggest the Leaning Hamstring Stretch. This is a modified toe touch that actually encourages relaxation. You bend forward and lean your upper body into a sturdy object. The sturdy object takes away the weight of the upper body, removing the load on the hamstrings, allowing us to nicely stretch the hamstrings with little to no risk to the low back. You keep your knees completely straight the entire time, ensuring that the hamstrings, calves, sciatic nerve, and the surrounding fascia are all stretched together.
Shoulder pain is one of the extremely common pains, and a limitation in shoulder range of motion is also a major cause of poor posture and therefore many other pains in the body. Most neck, shoulder, elbow, wrist, upper back, and low back pain is at least partially caused by a lack of shoulder extension. In fact, a lack of shoulder extension is one of the crucial and forgotten root causes of many problems in the body.
Shoulder extension is the motion of moving the shoulder back behind the body. The arm hanging straight down at our side is 0 degrees of shoulder extension.
The picture above with the arm hanging at the side, looks like the shoulder is positioned at its neutral 0 degrees of shoulder extension resting place. But hardly anyone has 0 degrees of shoulder extension. Most of us have about -30 degrees (and many of my patients have something like -70 degrees). The picture below shows -70 degrees of shoulder extension.
What this means is that almost all of us should be walking around like a zombie with our arms out in front of us. Instead of walking like a zombie, we've all found ways to cheat our way into allowing our shoulders to hang straight down. What we do to get our shoulder to hang down is to hunch our shoulders forward and slump through our mid-backs.
These are two of the most common components of the poor posture that causes us so much trouble, and it's lack of shoulder extension that is the usual root cause of these problems. We often blame these posture problems on the mid-back or the shoulder blades (tight pecs, for example), but usually it's coming from the shoulders themselves. Restoring shoulder extension is vital for balancing posture and for resolving most shoulder, elbow, and neck pains.
The stretch pictured above works wonders for restoring shoulder extension. You place your hand, front of your elbow, shoulder, and chest against the wall. If you have a stretch at this point, then you just relax in this position and allow the stretch to relax whatever is tight. If you don't have a stretch, then you can advance by turning your sternum away from the wall, stopping when you get a stretch, and aiming to be able to turn your sternum 60 degrees away from the wall. Hold a gentle stretch for 10-30 seconds, ideally having the stretch completely disappear after 10 seconds. Repeat this on the other side, and repeat the whole thing once per day for a month. You'll see significant improvements in your posture and shoulder flexibility.
We ALL have tight calves. Even if you don't think you do, you have tight calves. And this tightness causes your foot, ankle, and shin to work way too hard, and it causes a terrible torque through your knee and hips, and it puts your low back in a distressed position. Any pain in the low back down into your foot is at least partially caused by your tight calves.
Fortunately, there is a simple stretch you can use to improve the tightness of your calves. But I use the word stretch hesitantly, because the calves are NOT too short in need of being stretched longer. Instead, they are too tense and in need of relaxing. So when we stretch our calves (or anything else in the body) we want to relax them, not rip them apart. Almost all of us overstretch when we stretch, and this makes our calves even tighter.
The video below walks you through this basic calf stretch. We should all do it daily.
There are few things more devitalizing than headaches. They suck the life out of us. They put us in a crabby mood and make us want to do nothing but sit around. I remember one of my patients telling me that now that her headaches were gone, she had to go and apologize to her friends for being so irritable for the last decade due to her constant pain. Headaches and their release are actually life changing things.
One of the major keys to resolving headaches is the trigeminal nerve. I was working with someone's trigeminal nerve the other day, which is a complex technique involving many moving parts, when it suddenly dawned on me that patients can do self work on the trigeminal nerve! Now, that might not seem like a big deal to most people, but that's only because most people have no idea how important the trigeminal nerve is. The trigeminal nerve comes out of the skull deep to the jaw and wraps all over the head and face. It's the major nerve responsible for headaches, and most chronic head, neck, and jaw pain is at least partially due to trigeminal nerve irritation. Being able to release this nerve on their own at home is proving to be a major help for many of my patients.
This technique gently releases the nerve, making changes all over the head, face, jaw, and neck. All you have to do is get in the position, hold the position for about one minute on each side, and breathe deeply while you do so. The deep breathing changes the pressure inside the skull and helps to move and release the nerve. This technique has proven so useful to my patients that I now teach it to most of my patients with head and neck pain and to other bodyworkers in my Balancing the Head and Neck course. I consider it one of the first steps in managing head and neck problems.
The best way to imagine what we're doing with this technique is improving the blood flow through the opening in your skull, freeing the nerve and allowing it to function better. This area can become very stagnant, and stagnation means too much pressure and not enough flow of the fluids through the area. This pressure causes irritation. The technique helps to resolve this pressure by improving the blood flow through the region.
Instructions: Get into a hands-and-knees position and then drop your bottom to your ankles, and drop your head to the floor. Turn your head to the left so that you are resting the right side of your forehead on the ground (aim for the part of your forehead mid-way between the center of your forehead and your right ear). You'll probably feel an odd but painless pressure deep to your jaw on the right side. This is where the trigeminal nerve exists the skull, and this is where we want a gentle release to occur. Breathe deeply for about one minute. Each time you inhale the pressure will slightly increase, and each time you exhale the pressure will slightly decrease. This helps to pump blood and fluid through the opening in your skull, which helps the nerve to function much better. Then turn your head to the left and repeat for the left side. This technique should never be painful: if it ever is painful, then stop doing it.
Give this trigeminal nerve release a try for a few days and see how good your head and neck feels.
I taught my own course for the first time last month. It was a lot of fun to present my own material, showing others what I do in my practice all day. One of the major things we discussed is an imbalance in the tissues of the body that ancient healers throughout history have called "moisture." In modern terms, we call it an "excess of inflammatory fluid" in a tissue of the body, but the ancient word "moisture" or "fluid" is a more useful image.
Inflammatory fluid is a thick fluid, more like ketchup than water. It is the result of a previous injury and/or stagnant positioning. It's a big problem for almost everyone. This fluid does damage to the tissues with which it comes in contact, and it inhibits the strength of the muscles on which it presses. Many people with chronic pain are in chronic pain because of a ball of inflammatory fluid, a thick glob of ketchup, just sitting in a region of the body and making everything a mess. This glob of thick fluid creates pressure inside the tissues, overstretching them from the inside, which makes the tissues feel stiff. Many people experience this stiffness, especially in the morning.
The video below is from the class I taught. It jumps in with me explaining what it's like to have an imbalanced tissue full of moisture. I then go on to explain the opposite syndrome: dryness. You might recognize your own symptoms when you watch this video. If you do, hopefully it will prompt you to start managing the moisture, which we'll discuss below.
Managing moisture (excessive inflammatory fluid in a region of the body) is simple enough, but it takes consistent work. Basically, we have to stir the fluid, thinning it, so that the body can absorb it. The key is to keep the body moving as much as possible during the day without irritating the tissue. Walking is the number one exercise for this purpose. A fifteen minute walk really helps to stir and thin the fluid and helps to pump it out of the region. Any gentle motion that can be done easily for three minutes without causing fatigue or irritation is also very helpful for managing the fluid. The Cat Camel exercise from yoga is a good example of a pumping exercise that helps to pump fluid out of the low back in a gentle but effective way. Three minutes of Cat Camel followed by a fifteen minute walk done three times per day is a remedy I give at least two or three people per week for managing a moist low back. It works amazingly well.
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It seems like almost everyone is doing self-massage these days, using foam rollers, etc to massage their tissues. This is a great trend, helping a lot of people prevent and manage problems. But there is one aspect of this trend that is really bad: people are turning to harder and harder object to use for their self-massage. This is a really bad idea and it's leading to a lot of unnecessary injuries.
The Lacrosse ball is the best example of this terrible trend. It has become very popular to use a Lacrosse ball to do self-massage. But Lacrosse balls are so hard that they are essentially a rock. The body should not be massaged with a rock!
The mistake people are making is the common idea that if some is good, then more must be better. If a little pressure is good, then a lot must be better. The idea is to upgrade from the wimpy pressure to the heroic pressure as a sign of progress. But when it comes to massage, this is not the case. I often give people a tennis ball to massage the bottom of their feet. Soon the feet would feel better, and almost invariably the patient would suggest that they now "graduate" to a golf ball, since the tennis ball no longer made the feet hurt. But the point of massage is to relax the tissues, not to make them hurt. If it no longer hurts to use a tennis ball, that's great! We don't need to keep adding pressure just so that it will hurt. Pain is not the goal; relaxation of the tissue is. Try to burn this statement into your brain so that you don't make the same mistake that so many people are making these days.
From now on, when you do self-massage (which is a great thing to do!), please treat your body well while you do so. Rolling the body on a rock is not a good idea! Use Lacrosse balls to play Lacrosse. Save your golf balls for the golf course. Tennis balls and standard basic white foam rollers, on the other hand, make great tools for self-massage. They, like the palms of the hands, provide just the right amount of pressure to help the body without hurting it. They are not rocks, and so they are perfectly fine to roll on.
In my practice, I am daily faced with the two basic types of people: those who error on the side of doing too much, and those who error on the side of doing too little. About half the people in this world exercise hard, play hard, and rarely get enough rest, and the other half doesn't exercise enough, enjoys passive activities, and generally gets an excessive amount of rest.
Those who do too much are almost always coming to see me because they injured themselves by doing something excessive. They hiked a mountain in record time, they lifted more weight than they have ever lifted before, they fell while skiing. For these people, if a little is good, then a lot must be a lot better. These people are always looking for an active solution to their problems: "What can I do to fix it?" If these people would just do half as much exercise and activity as they already do, then they'd be perfectly healthy and rarely have need to see me again. These people even hurt themselves with the wimpy therapeutic exercises that I give them, either doing too much of the exercises or doing them way too aggressively. The answer for these people is simply to do less.
On the other side are those who error toward doing too little. These people get hurt because they are out of shape, overloaded by the reasonable demands of life. They may have been hurt doing something active, but it's because they weren't physically prepared to do the activity that got them into trouble. More often, these people are hurting from some unknown cause: random headaches, neck aches, low back pain, etc. Again, this all occurs because their bodies are under-prepared for life. In general, these people would prefer a passive solution: "just fix me," they say. I can barely get them to do one or two wimpy therapeutic exercises. The answer for these people is obviously to do more. If these people would just go for a walk and do a couple of mild exercises each day, then they'd probably feel much better and rarely come to see me.
One of the big problems for both groups of people is that we all think that we need to do way more than we actually need to do. To be healthy, we don't have to train like athletes. Those who do too much are trying to fill some ridiculously high imaginary quota, trying to train like an Olympian, while those who do too little are discouraged by how much they think they need to do in order to be healthy. But here's what Hippocrates, the ancient Greek physician and Father of Medicine says, "The extreme of this athletic state, which is [the athlete's] ultimate aim, actually endangers health." And let's hear what the ancient Roman physician Galen has to say:
The point is that moderation is key. We need to do some exercise, but we certainly don't need to train like athletes if health is our aim. This should be great news for everyone! Those who do too much can take it easy, and those who do too little don't need to take on some major burden of exercise.
Finding the moderate point is what Hippocrates repeatedly tries to encourage in his writings. He has powerful, ancient wisdom toward this end. He is the voice of moderation, and he can help us find a moderate exercise regimen that will work for all of us. Those who do to much, prepare to be convinced to do less, and those who do too little, prepare to be encouraged to be a bit more active.
In my new book What Would Hippocrates Say?, I describe Hippocrates' plan to keep us healthy, giving a detailed regimen for exercising, massaging, bathing, eating, and sleeping the way Hippocrates recommends. Here's a short excerpt from my book:
It is amazing that the ancient Greeks, writing in the 400's BC, discussed diet and exercise as being the keys to health. We in the modern world have only realized the importance of diet and exercise in the last 50 years or so! They are way ahead of us on these topics. Hippocrates has thousands of years of ancient health practices to share with us. Here's one of his great quotes: "For food and exercise, while possessing opposite qualities, yet work together to produce health. For it is the nature of exercise to use up material, but of food and drink to make good deficiencies."
Spend a moment reflecting on how you exercise. Are you an over-exerciser or an under-exerciser? Either way, how can you move toward a more moderate regimen? Hint: If you're an over-exerciser, then the answer isn't to add new activities, but to remove some, and if you're an under-exerciser, then the answer is to get a little more exercise into your life. If you want some sage advice from someone who guided Western health practices for thousands of years, try reading What Would Hippocrates Say? This was a book born from my own fascination with how much these ancient people knew about being healthy and how wise their advice is. While reading Hippocrates, I quickly noticed that I was a severe over-exerciser who was brutalizing myself for no good reason. Hippocrates saved me from a lot of future aches and pains, and I'm convinced that he can do the same for everyone, under-exercisers and over-exercisers alike.
Last month we talked about the shoulder blades and the chest muscles as one of the major root causes of aches and pains throughout the body. This month we're going to talk about what is an even more important root cause of pains throughout the body: the forgotten "core" of the body: the rib cage.
The rib cage is the central "core" between the neck above, the low back below, and the shoulders on each side. Any problems with the rib cage, any tightness, lack of full motion, or weakness, will force the neck, low back, and shoulders to work too hard. Much neck pain, shoulder pain, and low back pain has its root in the rib cage. It really is the forgotten center of the body.
Michelangelo started his drawings of the human body with the torso, the ribs and upper region of the abdomen, because in his mind it was the torso that dictated the rest of the display of the body. He would often just barely sketch the face and limbs, even leaving them blank many times, in order to ensure his portrayal of the torso was accurate.
In mythology and ancient physiology around the world, the trunk and rib cage carries very significant meaning. The ancient understanding was that the trunk housed our consciousness. Who we think we are, what we might nowadays call "the ego," resides not in our heads, as we imagine it today, but in the rib cage. Ancient Greeks imagined the soul to be in the head (as discussed in an earlier post Your Head Has a Mind of Its Own), but a person's conscious actions and thoughts came out of the rib cage. The ancient Greeks called this region the phrenes, which means lungs. (We get the word schizophrenic from these old ideas. Schizophrenic means split lungs: the consciousness is split.)
In the Old Testament of the Bible, the ruah was the vital breath that makes humans living creatures. It lives in the rib cage. For ancient people around the world, it was the rib cage and the breath inside it that in many ways is the human. It is the breath that made this concept obvious to ancient people. Breathing changes with our emotional state, and it is the breath that comes out through the throat to generate our voice. What a person says is generated from within the rib cage both literally as a mechanical reality, and figuratively in these ancient ways of imagining how the body works.
In the modern world, "knowing" what we know about the anatomy of the body, stuffing our entire existence into the brain, forsaking the rest of the body as dead matter, it isn't surprising that unless one has suffered with rib pain, one is unlikely to have done anything but completely ignore this region of the body. We might even imagine that rib pain is a scream from the ruah, the phrenes, the ribs, or one's own heart, for attention. It wants to be imagined as an important part of your body. It wants you to know that everything you do, say, and even think, comes from deep within its breath. It wants you to know that without its breathing, you'd be gone very quickly from this world.
Breathing is the obvious way to tend to the rib cage. There are various schools of thought on how we should breathe. A singing instructor might tell us to breathe from the diaphragm. A Pilates instructor would tell us use "Pilates' breathing." A yoga instructor may tell us to breathe from the belly. But I think it's extremely foolish to think that we have any real understanding of how breathing affects the body and how to "breathe properly," as if we could consciously breathe in different ways without severely interfering with how the body functions. I spent three years "breathing properly" according to one school of thought and the result was a number of stiff ribs and a habitually poor breathing pattern that took me years to unravel.
A much better option is to spend a few minutes each day breathing in a number of different ways, opening and closing each part of the rib cage. This gives the rib cage some attention and simultaneously doesn't attempt to "fix" the way we breathe. Instead, it gives the rib cage options for breathing, and then trusts the rib cage to breathe how it needs to breathe at any given moment. Let's keep the conscious mind where it belongs: in the rib cage, not thinking about the rib cage.
The following simple breathing exercises can help to get the entire rib cage opened, giving it its full options. Spend 30 seconds (or more) in each of five positions while alternatively breathing deeply into your chest and then deeply into your abdomen. Focus on expanding the chest in three dimensions: forward and backward, upward and downward, and to the right and left. Do the same for the belly when breathing into the belly. The five positions to use are: 1) lying face-up with your knees bent (not shown), 2) in the Cobra pose (left), 3) in the Child's pose (upper right), and 4 and 5) lying twisted on one side and then on the other (lower right).
Try these breathing exercises for a month and see what it does for you neck, low back, and arms.
Dr. Jake Caldwell, DPT
I have a doctorate degree in physical therapy, an advanced certification in Functional Manual Therapy™, a bachelor’s degree in biology, a bachelor’s degree in psychology, and a bachelor’s degree in history. I draw from these diverse fields in my approach to working with the body.