Good balance depends on many different parts of our nervous system and musculoskeletal system working well together. For good balance we need muscular strength in the trunk and legs, good sensation in our feet and legs, good eyesight, a well functioning equilibrium system, and good reflexes.
If you have impairments in one area (for example; poor sensation in your feet due to Diabetes), you can become overly reliant on your other systems to help with your balance. A common example of this is “visual dependence”. Without even realizing it, you may become so reliant on your vision that you have more trouble in situations with low light, such as walking at night, or in a movie theater, or in places where there is a lot of visual distraction, such as a busy shopping mall.
Balance exercises that challenge you to use your other sensory systems more (sensation and the equilibrium system of the inner ear) can help. They work by requiring you to perform balance tasks with your eyes closed or with visual distraction such as turning your eyes and head, preventing you from focusing too long on a fixed object. This “forces” your other systems to work harder, so they become stronger and more efficient. When you find yourself in those visually challenging situations, your body will be able to rely more on all your systems to stay stable.
As physical therapists we often hear from patients that they have experienced a series of problems, seemingly unrelated. For example, someone with foot pain a few years earlier may now come for treatment of a hip or knee problem, sometimes without any specific incident of injury or onset. Or someone with an old wrist fracture may develop a shoulder problem. Are they related? They can be!
Even after pain resolves subtle changes in the way you move or walk following an injury can lead to “wear and tear” elsewhere in the chain of movement. Each joint is influenced by those above and below. This is why we will evaluate the movement and strength of your hip and ankle, even though your primary complaint is knee pain. Even if you haven’t had another injury or area of pain before, differences in the mobility or strength throughout the body can result in mechanical stresses being placed on some parts of the body more than others. Just like your tires will wear unevenly if your car alignment is “off “, your body can “wear” unevenly if you stand, sit or move too asymmetrically!
Paying attention to the whole chain of movement addresses the mechanical influences which create the problem, and can help minimize the chance that symptoms will return.
Several years ago, a colleague of mine did an informal study in her physical therapy practice to find out what region of the body most commonly had the severest restrictions. What she found was that the thoracic spine and rib cage were the areas she most frequently found restricted and that when these areas were worked on to gain more flexibility and muscle relaxation, neck or low back pain resolved much more speedily. (The thorax is defined as that part of the body between the base of the neck and the diaphragm or breathing muscle which is located in line with the lower ribs.)
This conclusion should not be surprising. The thoracic region is a cage of sorts with the purpose of protecting the vital and life giving organs of the heart and lungs within it. It has a structure that forms a foundation for some of the muscle attachment of the arms and neck. The respiratory diaphragm is a large muscle traversing horizontally across the floor of the thoracic cage. Piercing through and right behind this primary breathing muscle are: the aorta carrying blood from the heart to the rest of the body and the inferior vena cava returning blood to the heart. As the diaphragm rises and falls with breathing, it pumps the blood vessels which pass through and behind it. The esophagus also pierces the diaphragm.
An important muscle group starts at the spine, level with the bottom of the diaphragm and crosses the hip joint into the legs. This muscle is the Ilio-Psoas. The diaphragm itself attaches onto the lumbar spine. So structures from the thoracic region can affect leg and spine movement as well.
If movement is restricted in any part of the thorax, the ribs are no longer free to lift and descend with each breath; so respiration is shallower and requires more effort and the diaphragm cannot fully perform its function of expanding the lungs or pumping the large vessels to assist blood flow. We become more stiff and solid through the entire region. Physical therapy treats the muscles, joint and fascia which ‘hold together’ this protective cage while allowing it to move.
The thoracic cage is also integral in expression of emotion. We instinctively protect not only our physical being but our emotional vulnerability too. We respond to emotions such as fear, grief, shame and depression by a posture of drawing in and holding our breath. Try putting yourself into a posture of feeling depressed or fearful and see what happens to your breathing. These instinctive postures all involve the thorax.
The thorax is easily disposed to hold tension. As a result not only our movements but also some of our vital functions are restricted. This is why we often work on this area area using manual therapy techniques, even if the person presents with pain far distant from the thoracic region.
Our mothers, of course, are right! We need to sit and stand up straight. But why is this so important?
When we slouch, the spine curves forwards, the shoulders come towards the chest and the head pokes out in front of us. There is no place for the head to balance on top of the spine which is what it is supposed to do. When the head projects forwards the muscles of the neck have to work extra hard to support its weight. An average head weighs around 9 pounds.
Try adopting a slouched position and notice how the head moves forwards while the muscles of the neck become tense and uncomfortable. Especially affected are the two muscles, one on each side of the throat, called the Sterno-cleido –mastoid. The inferior (bottom) end of the muscles attach onto the sternum and clavicle (cleido) and the top end attaches on to the bone behind the ear, the mastoid process, which is part of the temporal bone. It is useful to note that muscles are named very often according to the places to which they attach.
When the Sterno-cleido-mastoid muscles are tight they tug on the temporal bone, and interfere with the position of the mandibular portion of the jaw joint as it rests in a delicate balance on the disc of its joint. Stress is put on the disc and the jaw does not slide as well over its disc.
Note also the back of the neck in the slouched position. There is compression at the base of the skull with the forwards head posture and this can lead to or compound headaches.
Now, get out of the slouched posture and you will feel much better! Make sure your feet are flat on the floor. Now roll the pelvis under you or bring your belly button forwards. This will straighten the lower part of your spine and the rest of the spine will follow, lastly the head will come back to rest naturally on top of the vertebrae stacked under it.
The mandible (lower jaw) will rest in a position which gives space to the disc so that the bone can slide easily over it. Space will also open up at the base of the skull to relieve compressed structures. And, you will be able to breathe more deeply! Can you feel what happens to your rib cage as you straighten up?
Feeling and being aware of these changes between tension and relaxation, compression and space in your body structures goes a long way to altering old habits.
Everyone talks about “core strengthening.” It’s not a fad? For the past 100 years we’ve known that the core of our trunk (abdominals, lower shoulder blade muscles, inside thigh muscles) needs to be strong in order for our arms and legs to function best. Among other exercise programs, Pilates is one form of training that does focus on this. But, if you only participate in an exercise routine and don’t transfer that strength into functional use, you’ve accomplished little.
Everyday actions to engage your core:
- when lifting your child, pull your abdominals in for back support
- reaching to put a dish in an upper cabinet, put one foot in front of the other, hip width apart and support your posture with your abdominals
- when in line at the store, stand evenly on both feet and lift tall through your inside thighs
- when moving laundry, emptying the dishwasher or mowing the lawn, tighten your abdominals and lower shoulder blades
- when bending over to fill the dog/cat bowl on the floor, tighten your abdominal muscles
- stand up from a chair or sofa with a tall spine, belly pulled in and strong leg and hip muscles, NOT by pushing on your arms
- squat with a tall spine (belly in) and return to standing with strong legs when getting into a low cupboard or drawer
- When pulling your abdominals in, don’t forget to breathe!
“Aren’t our ribs just above our waists?” The 1st rib is actually just below the collarbone in the front and 11 more ribs travel down to where you feel them at your waist. They attach to the spine along the back and to the breast bone in front. With every breath you take (5-8/minute) they move! With every reach of your arm, they move. With every turn of your head they move. The upper ribs provide support for some of the neck muscles. When we breathe, the ribs move up in front and expand laterally.
When the neck musclesare tight or go into spasm it is often because the ribs and muscles attached to them have insufficiently provided support. Treatment of the rib cage to ensure proper mobility and strength, can remarkably improve chronic neck problems and help you breathe easier too!
Many falls happen at home due to environmental hazards. You can minimize your fall risk by taking some of these easy steps.
Remove all throw rugs. If you must have one, make sure it is taped down to the floor securely.
Make sure all extension cords are secured to the wall or behind heavy furniture where they will not be a tripping hazard.
Handrails and grab bars should be installed anywhere you have a step or need help standing – by the toilet, in the tub/shower, up the garage steps etc.
Clean your glasses so you can see properly!
Reduce clutter – stepping over piles of newspapers etc. can be risky.
Take care around pets – cats like to rub against your legs. Dogs can get excited and get underfoot.
Have a place around your house where you seem to always trip? Put some contrasting color tape around it so that you recognize it as a hazard.
Make sure there is adequate lighting in doorways or on stairs.
Jerilyn Stalford PT, OCS is our Balance Specialist. She can provide many more suggestions for making you safer at home.
Let’s try a little experiment. Stand next to the back of a chair or a wall that you can use to hold onto if you need it. Now, stand on one leg and try and keep your balance. Try each leg and see if you are steadier on one leg rather than another.
Now stand on the “steadier leg” and close your eyes. Is it harder or easier to keep your balance? For most people, balancing is much harder. That’s because our eyes are “hard-wired” to assist our bodies with balance. It is an internal rule that our bodies always want our eyes parallel to the horizon. When our eyes are closed, the body depends on the input it gets from our inner ears and our foot on the floor to tell the brain where we are in space and if we are upright.
If we need our eyes for good balance, then conversely if our eyesight is poor, our balance is compromised. It is possible to train our bodies to compensate for poor vision by doing exercises designed to strengthen the brain’s dependence on inner ear and foot contact (called proprioception).
Jerilyn Stalford PT, OCS is our Balance Specialist at ABA Physical Therapy. She can provide exercises to help you feel more stable. But even with the right exercises, you still have to practice!
Ever notice that when you get a headache, you also get neck and upper shoulder pain? The area of the shoulder that people often grab and massage when they are in pain is called the “shawl area” because it is where a shawl would rest.
This achey “shawl” muscle is the trapezius – one of the largest muscles in the body. It starts at the base of the skull, widens until it covers the shoulders and then narrows down to a point in the middle of the back.
When we are feeling stress from pain or anxiety, the upper portion of the trapezius is held contracted or tight. This part of the muscle pulls on the base of the skull and across our “shawl area” causing headache and pain.
What most people don’t know is that different areas of the trapezius muscle can contract independently in different directions. When we shrug our shoulders from pain/stress, it weakens and inhibits the lower portion of the muscle. But if we make the lower portion of the muscle contract, it “turns off” (inhibits) the upper part of the muscle that is pulling on our head and causing a headache.
How do we activate the lower portion of the trapezius? Sit or stand tall and pull your shoulder blades down and back and hold them for a count of 5. Don’t strain. If you repeat this exercise gently, but regularly, it helps to turn off the tension in the shoulders and neck and eases the pain.
If this or any exercise increases your symptoms, discontinue it. At ABA Physical Therapy Associates we have been treating headache and cervical problems for 30 years. We know a variety of techniques that can help ease your pain.
