Category: Injury Rehab & Prevention

As with much in life that we take for granted, we are not usually concerned with the mechanisms of how our bodies work and how they do what they do. Such knowledge is not required for use of these magnificent machines that have been freely given to us. But just as a wise consumer will care for her or his car in terms of regular scheduled maintenance, our bodies require ongoing attention in order to maintain proper function. The shoulder joint, in particular, requires such proper care.

The shoulder has the greatest range of motion of any joint in the human body. The shoulder is capable of 360º of mobility from front to back (the sagittal plane), 360º of mobility in the frontal plane, and 180º of mobility to the right and the left (horizontal plane). Taken together, these optimal ranges are termed circumduction. But the shoulder’s remarkable capabilities come at a price. The shoulder girdle is the least stable joint structure and is readily subject to sprains (of the acromioclavicular joint) and dislocation injuries (of the glenohumeral joint). Additionally, the rotator cuff, the group of muscles that protect the shoulder girdle and move the shoulder joints through three-dimensional space, is commonly injured, owing to the substantial mechanical stresses involved in such extensive motion.1

We can help prevent such injuries by engaging in regular physical exercise such as yoga and strength training. These activities place weightbearing loads on the shoulder, progressively training the muscles, tendons, and nerves that supply the shoulder joint structures to handle mechanical stresses.2,3 As a result of such training, when called upon to manage the shock of an unusual mechanical force, the shoulder will be able to respond effectively while likely preventing injury.

The choice of yoga versus strength training is not mutually exclusive. Many people will enjoy taking one yoga class per week and doing two strength training sessions per week. For persons taking yoga class, the two strength training sessions could focus on (1) the chest and back and (2) the shoulders and arms. Almost every yoga exercise involves weightbearing loads on the arms. Regarding strength training, a representative shoulder program includes seated dumbbell or barbell press (for the entire shoulder girdle), standing lateral raise (for the middle deltoids), and seated bent-over raise (for the rear deltoids). If you’re doing yoga, strength training sessions for the legs may not be necessary. Of course, a complete exercise program includes specific cardiovascular exercise such as walking, swimming, bicycling, or running.

It may not be possible to prevent every shoulder injury. Engaging in a regular program of vigorous exercise, including yoga, strength training, and cardiovascular exercise, is the best means of ensuring optimal biomechanical health and wellness and the best overall method for preventing injury.

Sources

1Camargo PR, et al: Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 5(5):634-644, 2014
2Miller RM, et al: Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. J Shoulder Elbow Surg 2015 Nov 24. pii: S1058-2746(15)00485-1
3Awad A, et al: Effect of shoulder girdle strengthening on trunk alignment in patients with stroke. J Phys Ther Sci 27(7):2195-2200, 2015

Strong bones are important for all of us, not only for the aging baby boomers about whom we’re hearing so much lately. And, “strong bones” are much more than a marketing ploy cooked-up by the dairy industry and pharmaceutical companies.

Bones are incredibly dynamic, constantly reshaping themselves in response to physical forces. Bones provide structure for our bodies, and they carry our weight around as we move from place to place. Long bones such as the thigh bone act as factories to produce blood cells. So, bones are an important part of our overall health and well-being.

Lots can go wrong when your bones aren’t strong. If you suddenly fall onto an outstretched arm, you’ll probably be OK if your bones are healthy. If not, you’ll probably be in a cast for four weeks to help repair a wrist or forearm fracture.

If an older person falls, hip fractures are the main concern. A fit, healthy person can usually walk away. With weakened bones, hip fractures can result in many other problems, both immediately and long-term.

Bones lose their strength due to a calcium imbalance and/or not enough physical exercise. For most of us, these factors can be corrected. The best approach, of course, is to be proactive and ensure enough calcium in the diet and regular exercise.

How much calcium and how much exercise? Recommended daily calcium requirements¹ vary, and 1000 mg per day is a good ballpark amount. Dairy products are the best natural source of calcium, and dark leafy greens such as spinach and broccoli, as well as dried beans, are also good sources. Vitamin/mineral supplements typically provide 25-50% of the daily calcium requirement.

Regarding exercise, both the American Heart Association² and the American College of Sports Medicine recommend 30 minutes of exercise, five days a week. This takes some effort and planning, particularly if regular exercise is a new addition to one’s routine. By making the effort and spending the time, we’re saying “yes” to health and wellness, empowering ourselves as well as our family and friends.

Importantly, regular exercise in combination with sufficient dietary calcium is the key. Taking calcium alone will not be effective in maintaining strong bones. Unless long bones are undergoing consistent mechanical stresses, as with exercise, there’s no need for them to use the calcium that’s available. Exercise plus calcium makes the difference!

Core strengthening³ is a hot topic in the world of fitness – Pilates training and its offshoots. But the principles of core strengthening have been around for many decades – dancers, gymnasts, boxers, and wrestlers have been doing these things all along. Only the term “core fitness” is new.

Core fitness turns out to be critically important for all of us. By adding a handful of core exercises – 10 minutes at most – to your regular routine, you will profoundly improve the mechanics of your lower back, hips, and pelvis. And, these remarkable exercises improve the efficiency of your heart and lungs. A very big “bang” for your exercise “buck”!

Your chiropractor will be able to provide expert advice and guidance on these nutritional- and exericise-related topics.

¹Daly RM, et al. Long-term effects of calcium-vitamin-D3 fortified milk on bone geometry and strength in older men. Bone 39(4):946-953, 2006.
²Haskell WL, et al. Physical Activity and Public Health. Updated Recommendations for Adults from the American College of Sports Medicine and the American Heart Association. American Heart Association, 2007.
³Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 85(3 Suppl 1):S86-92, 2004.

1. Why stretch? Stretching lengthens muscles and improves flexibility. Also, stretching the big leg muscles – the hamstrings, calves, and quads – simultaneously loosens and lengthens the muscles of your lower back. So, when you stretch, you’re helping your back!

2. When to stretch? Recent exercise physiology studies show that static stretching is best done after exercise. Pre-exercise “dynamic warm-ups”, such as torso twists, arm circles, and light jogging, prepare the body for work. Importantly, for those of us with back issues, it’s still a good idea to do the familiar static stretches even before the dynamic warm-up!

3. Don’t rush! Stretching is as important as what you’re going to do after you stretch. And, if you rush, you might pull a muscle or worse. Be sure to include 10 to 15 minutes of stretching as part of your exercise time.

4. Stretch gently and slowly. You’re not trying to accomplish anything while stretching. In other words, you’re not trying to stretch “this much” or “this far”. Nice and easy does it. Stretching is a Zen activity. There should be nor “effort”.

5. Pay attention! If your mind drifts, you’re headed for a pulled muscle.

6. Visualize! See (in your mind) what you’re doing. Hold a mental visual image of the muscle group, where it comes from, where it goes. Visualization helps establish a brain-muscle connection, making your muscles much smarter!

7. Stretch your hamstrings first. Lie on your back with one knee bent [start with the left leg bent; you’ll be stretching the right hamstring]. The left foot is on the floor and the left knee is bent approximately 90 degrees. Holding behind the right knee, gently bring that knee to your chest. Alternate this chest movement with a movement that begins to straighten the right leg in the air. The eventual goal on straightening is to achieve a 90 degree angle (or close to this) between the leg and your torso.

8. CAUTION – Progress may be quite slow. Remember – you are where you are. Stretching is gentle and slow. Alternate the bending and straightening movements gently, achieving a slightly greater straightening each time. You should work each leg for between three and five minutes.

9. Calf stretches – face a wall and place both hands lightly on the wall. Keeping both feet facing front, bend the front knee and place the foot of the leg to be stretched directly behind you. Your weight is being supported by the front leg. The back knee is pretty straight and the back heel is on or close to the floor. Maintain the stretch for 10 seconds, feeling the stretch in the calf as the back heel reaches toward the floor.

10. Quad stretches – stand on your left leg, placing a hand lightly on a wall to support the upright posture. Grasp just above the right ankle with your right hand and bring that heel close to the right buttock. The quadriceps is stretched by bringing the right thigh in line with the left thigh, just as if you were standing on both legs. The knees should also be close, in a line. You should feel a stretching sensation down the right thigh. Imagine a straight line running from your right hip socket all the way to the floor.

¹Ferreira GN, et al: Gains in flexibility related to measures of muscular performance. Clin J Sport Med 17(4):276-281, 2007.
²Peeler J, Anderson JE: Effectiveness of static quadriceps stretching in individuals with patellofemoral joint pain. Clin J Sport Med 17(4):234-241, 2007.
³Behm DG, et al: Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exercise (36(8):1397-1402, 2004.

Repetitive stress injuries are typically very difficult to treat successfully. These injuries are the result of actions done repeatedly, frequently, and consistently over time. They’ve taken a long time to build up and, therefore, the healing process also requires a fair amount of time. Shin splints, iliotibial band syndrome, and rotator cuff syndrome are examples of common repetitive stress injuries. These problems are also known as overuse injuries. Tennis elbow is another common injury that is likely caused by repetitive stress.

Tennis elbow usually involves pain on the outer bony surface of the elbow joint (the lateral epicondyle). A variant involves pain on the inner surface of the elbow (the medial epicondyle). Regardless, tennis elbow pain interferes with many activities, not only those involving tennis and golf. Even the simple act of firmly twisting the lid on a difficult-to-open jar can cause significant pain. Driving for more than 30 minutes and prolonged keyboard activity are other examples of activities that may become quite troublesome when one is hampered by tennis elbow. Treatment usually involves rest, anti-inflammatory medications, and even injections of steroid compounds.^1,2 But such treatments tend not to provide more than short-term relief. Ultimately tennis elbow may be frustrating and disheartening, as there doesn’t appear to be an effective solution.

More useful treatment for repetitive stress injuries involves directly addressing the source of the problem. In the case of tennis elbow, mechanical issues in the forearm itself need to be corrected. For those whose painful elbows are in fact caused primarily by tennis or golf, focusing on sound technique will often help to provide significant relief. For example, in both sports, if lines of force generated by the arm muscles and lines of force generated by the forearm muscles cross at the elbow, significant pain is likely to develop over time. Learning how to generate parallel lines of force will help solve the problem, and such a solution may require the services of a coach.

For the rest of us, there are additional specific solutions. First, trigger points in the major forearm muscle bundles need to be treated.³ Trigger points in themselves may be very painful, and a trigger point also causes chronic fatigue in the muscle of which it is a part. When you try to use such a pre-fatigued muscle, damage to the muscle fibers and the tendon may result. Over time the involved region, such as the elbow, becomes chronically painful. Manual trigger point treatment relaxes chronic spasm and helps restore normal muscle tone. Increased blood flows to the muscle belly, and the involved muscle fibers have an opportunity to regain their normal length and to heal. The second specific solution is to use a narrow (1.5-inch thick), nonelastic elbow brace placed approximately 1 inch below the elbow. The brace will shorten the contractile length of the major forearm muscles, allowing them to achieve relative rest. The combination of trigger point therapy and appropriate use of a specific elbow brace will help to achieve long-term resolution of painful, difficult-to-treat tennis elbows.

¹Childress MA, Buelter A: Management of chronic tendon injuries. Am Fam Physician 87(7):486-490, 2013

²Coombes BK, et al: Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751-1767, 2010

³Ajimsha MS, et al: Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch Phys Med Rehabil 93(4):604-609, 2012

Core strength is critical for everyday activities such as placing heavy grocery bags into the trunk of your automobile, carrying a gallon jug of milk from the refrigerator to the dining room table, and even walking to the mailbox. When your core strength is diminished, even bending over to pick up a pencil may result in a serious spinal injury. Weakened core musculature causes simple, daily physical activities to be problematic. When standing up from a seated position or getting into a car causes you to experience twinges in your back, you may be sure your core muscles are not working in the manner for which they were designed.

Your core muscles consist of the four abdominal muscles – the transversus abdominis, internal obliques, external obliques, and rectus abdominis – and back muscles such as the erector spinae, longissimus thoracis, and multifidi. The most important core muscle may be the transversus abdominis, a sheet of horizontally oriented muscle that lies underneath the other abdominal muscles and provides deep mechanical support to the low back and pelvis. Similarly important are the multifidi, a group of small, powerful, deep spinal muscles that interconnect pairs and series of vertebras.

In times past, when the concept of work meant actual physical labor, there was no need to pay attention to training the core. In those days, your core muscles were being trained all day long by lifting, carrying, pushing, and pulling loads with heavy resistances and/or bending, digging, hoeing, planting, and raking. Working on a farm or in a factory provided more than sufficient exercise for the core. But in today’s developed world, farming and manufacturing jobs have been greatly reduced and the large majority of work is done in the so-called service sector. In the 21st century, people living in developed nations spend the largest portion of their day sitting at a desk. In such circumstances the core musculature will weaken drastically, unless specific attention is paid to training these muscles.^1,2

The good news is that a wide variety of exercises are available for training the core. Most of them require no equipment. Many of them may be done at home and do not even require a gym membership. For example, yoga provides thorough and complete exercise for core muscles. Self-motivated persons might only need a yoga DVD and a yoga mat, minimizing financial cost and doing their yoga training at home. For others, taking yoga classes at a gym or yoga center might be more appropriate. But yoga is only one possible solution. Numerous highly efficient core exercises may be done on a physioball. Dynamic exercises such as the plank provide substantial core benefit and the only equipment requirement is a mat. Other dynamic exercises include squats, gluteus bridge, lunges, jumping jacks, and the grapevine.

When you spend the time to make sure your core musculature is strong, daily physical activities begin to be done with ease and grace. Back pain and other mechanical aches and injuries fade into memory.³ The overall result is a body that works efficiently and optimally. Thus, a strong core helps provide for a lifetime of health and well-being.

¹Kumar T, et al: Efficacy of core muscle strengthening exercise in chronic low back pain patients. J Back Musculoskel Rehabil 2014 Dec 2. [Epub ahead of print]
²Granacher U, et al: Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology 59(2):105-113, 2013
³Huxel Bliven KC, Anderson BE: Core stability training for injury prevention. Sports Health 5(6):514-522, 2013

Many adults begin to develop shoulder pain, even though they may not have sustained a specific injury. It’s important to pay attention to such shoulder issues, as a healthy shoulder joint is the key to full function of the upper extremities. We all know at least one person whose ability to perform normal activities of daily living has been significantly compromised by chronic shoulder pain. Conservative treatment may be of benefit, but the key, as always, is to prevent these problems before they occur. The primary prophylactic intervention, as is the case for most musculoskeletal conditions, is exercise.

We all agree that the human body’s design is magnificent. Every component has a purpose, down to the smallest cell. Every system is deeply interconnected with every other. Miraculously, the whole is much greater than the sum of the parts. And yet, there are a few “gotchas” built-in to this ingenious design. With respect to the shoulder, the “gotcha” relates to the shoulder joint’s extraordinary mobility. The shoulder joint has the greatest range of motion of all the joints in your body. But this extreme mobility comes at a price, that is, the shoulder joint is not a particularly stable joint. For example, shoulder dislocations comprise approximately 50% of all such injuries.

Shoulder pain in the absence of a specific injury often represents damage to the rotator cuff. Again, the design of the shoulder joint and surrounding soft tissues is implicated in these rotator cuff problems. The blood supply to the bones, muscles, ligaments, and tendons of the shoulder is consistently compromised during normal motion of the shoulder above 90º, as in placing an object on or taking an object down from the top shelf in a kitchen cabinet. If much of your day is spent with your arm elevated above 90º to the front or to the side, over time you may develop nagging shoulder pain. Worse, with persistent repetitive motion above 90º, nagging shoulder pain may become chronic pain that restricts activities.

The best approach to shoulder problems is to become aware of the rotator cuff’s well-known tendency to develop degenerative changes. We can be proactive by doing strength-training exercises for the shoulder and incorporating these exercises in our weekly exercise program as soon as possible.^1,2 Beginning such exercises in the teenage years would be ideal. For those of us who are older, the right time to begin shoulder strength training is now. Shoulder exercises stimulate growth of new muscle fibers, increase the size of muscle fibers already in existence, and stimulate growth of nerve fibers bringing information to and from all shoulder girdle structures.

Shoulder exercises should be done once or twice a week as part of your overall fitness program. As with all exercise that’s new to you, start slowly and gradually increase the level of difficulty over time.³ The result of all this activity is a dramatically improved blood supply to the shoulder region and a dramatically reduced tendency for rotator cuff degeneration and injury.

¹Choi SH, Lee BH: Clinical Usefulness of Shoulder Stability Exercises for Middle-aged Women. J Phys Ther Sci 25(10):1243-1246, 2013
²Saltychev M, et al: Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil 37(1):1-8, 2015
Another example of a common issues
³Daenen L, et al: Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain 31(2):108-114, 2015

Most of us have experienced a painful bout of low back pain brought on by a seemingly innocuous movement such as bending over to pick up a pencil or a dropped set of keys. These painful episodes may last a couple of days or be more severe and last more than a week. We’re left wondering, “What exactly happened?” After all, we weren’t trying to pick up a 100-pound crate. When our chiropractor asks what caused the problem we say, “I don’t know. I didn’t do anything.” For the patient, the mystery often remains unsolved. But it’s important to know there is an answer. The deep background to these unexpected, troublesome back problems is loss of viscoelasticity.

Viscoelasticity is a physical property of both materials and soft tissues. When these structures undergo deformation, they exhibit properties of viscosity and elasticity. Materials and soft tissues that demonstrate viscoelasticity resist shearing forces when a stress is applied (viscosity) and strain when stretched or compressed and quickly return to their initial state after removal of a transient load (elasticity). For viscoelastic structures, the relationship between strain and stress depends on the factor of time.

In terms of spinal biomechanics, viscoelastic structures include joint cartilage (for example, intervertebral discs), ligaments, and tendons.¹ If a substantial load is placed on the low back when viscoelastic properties of intervertebral discs and spinal ligaments have not returned to optimum, injury to low back muscles and ligaments may result.² For example, if you’ve been sitting for more than 15 minutes the soft tissue structures of your low back have been compressed for that length of time. Standing up and bending over to retrieve something causes your low back to attempt to support all the weight of your torso and head. If you haven’t prepared your low back to receive this substantial burden, that is, restored viscoelasticity, you will likely suffer an injury that may be not only very painful but also inconvenient in terms of time and resources spent on recovery.

Injury prevention in these circumstances largely depends upon understanding.³ Being aware of the requirements for maintaining viscoelasticity will help you remember to “wake up” the soft tissues of your low back prior to any load-bearing activities such as bending over or twisting and turning. A simple way to restore viscoelasticity is to pause before suddenly changing a position you’ve been in for a while, such as getting out of a chair after working at your desk for 30 minutes, and gently rotating your torso from side to side eight or ten times. These rotational movements immediately restore viscoelastic properties to baseline and increase circulation to intervertebral discs, muscles, and ligaments. The result is a spine that is ready for action and prepared for the demands of new physical work. As always, proper preparation and attention help prevent injury.

1Troyer KL, Puttlitz CM: Nonlinear viscoelasticity plays an essential role in the functional behavior of spinal ligaments. J Biomech 45(4):684-691, 2012
²Freddolini M, et al: Stiffness properties of the trunk in people with low back pain. Hum Mov Sci 36:70-79, 2014
³Mörl F, Bradl I: Lumbar posture and muscular activity while sitting during office work. J Electromyogr Kinesiol 23(2):362-368, 2013

“There I am,” a very fit patient is saying, “out on my five-mile run, motoring my way up a steep incline. Suddenly, I feel a throbbing pain in the middle of my right shin. Oh, no, I think, not again.”

As things turned out, the patient recovered from the shin splints¹ quickly, but he knew he’d dodged a bullet. “Why did I get hurt?” he wanted to know. “I wasn’t doing anything wrong.…What can I do to make sure this doesn’t happen again?”
All very good questions. One answer is – basically − we need a plan for exercise. A powerful strategy that helps us train smart and train safe. When you’re working this way − training smart and safe − then you can also train hard.

Training safe and smart means paying attention to what’s happening in your body as you do your workout. “Paying attention” is a learned skill. It requires focus and repetition. Visualization is an important part of focus ─ and, if you’re working on visualization, you’re definitely paying attention!

You can visualize when you’re running, too.
• Visualize an erect, fluid spine and strong abdominal muscles.
• Your head is upright, you’re looking forward and slightly down, and your chest is open.
• Your arms are active yet relaxed, and your shoulders sit comfortably on your rib cage.
• Visualize a long stride, a soft landing, and a strong pushoff, with your leg kicking straight behind you.

Training smart means trusting your instincts, rather than listening to your ego. This is a tough one. At the time, it seems so important to do that last rep. Now, you can do that last rep if you maintain your form. Form is everything. If you have to sacrifice form in order to do those last few reps, you may get an unexpected, unwelcome result.

Likewise in running. When your form breaks down, that’s a signal to slow down and recover your good mechanics. If your training is done with attention to proper, effective form, you’ll be more likely, when the time comes, to run a good race at a good pace.

And, of course, we want to do these things to be healthy and well. The American College of Sports Medicine² states, “Resistance training, particularly when incorporated into a comprehensive fitness program, reduces the risk factors associated with coronary heart disease and non-insulin-dependent diabetes, prevents osteoporosis, promotes weight loss and maintenance, improves dynamic stability and preserves functional capacity, and fosters psychological well-being.”

As in much of life, there’s a fine line between training hard and overtraining. Remember, the benefit of training is for the long term.

¹Couture CJ, Karlson KA: Tibial Stress Injuries: Decisive Diagnosis and Treatment of “Shin Splints”. Physician and Sportsmedicine 36(6):29-36, 2002
²Kraemer WJ, et al: Progression Models in Resistance Training for Healthy Adults. Med Sci Sports Exercise 34(2):364-380, 2002

You’re driving to work and stop for a red light. You’re minding your own business and – bam! – your car rocks forward and backward, slammed in the rear by another car driven by some guy yakking on his cell phone. Or you’re a passenger in a New York City taxi. The driver’s cruising down Fifth Avenue when a teenager suddenly dashes into the intersection, running across the street against the light. The cabbie slams on the brakes and your head rocks forcefully backward and forward.

Or for reasons known only to yourself you decide it’s a good idea to go bungee jumping. You dive into space, the cord extends, and finally the cord is fully played out. Significant physical forces blast through your body as you helplessly bounce back and forth, dangling in the air like a gaffed flying fish.
The result of each of these demonstrations of Isaac Newton’s First Law of Motion? Later that day, or possibly within several days, you begin to experience neck pain. You might also have shoulder pain, headache, nausea, dizziness, and pain or numbness traveling down one or both arms. You have whiplash – a traumatic injury to the muscles, ligaments, and spinal joints of your neck and upper back.^1,2

If you’re lucky you’ll get better in a few days. If the injuries are moderate or severe the various complaints will linger and may even get worse. As with any injury or illness, if you’re not getting better right away you need to see your doctor. As you’ve suffered an injury to your head and neck, it may be a good idea to see your doctor as soon as you can, in any case, even if you think the injury is mild.

Your chiropractor is an excellent choice for examination and evaluation of injuries due to whiplash. She will be able to determine the nature and extent of the damage to muscle, ligament, and bone. Taking an x-ray series is a very important part of the evaluation of whiplash, as even seemingly modest forces can result in fracture of one or more vertebras in your neck. Evaluation of nerve function, including both spinal nerves and cranial nerves, is critically important. Pain and/or numbness radiating into one or both arms suggests injury to a cervical nerve root and needs to be thoroughly assessed.

If no fractures have been identified, chiropractic treatment can begin immediately. Over time, chiropractic treatment helps reduce inflammation of injured muscles and ligaments. Over time, chiropractic treatment helps restore normal ranges of motion to your neck and upper back. With this natural form of healing you begin to make incremental, steady progress, recovering the ability to participate in all your daily activities with reduced levels of pain and discomfort.

Chiropractic treatment provides optimal therapy for whiplash injuries, allowing your body to recover and return to normal by utilizing its own restorative powers.³

¹Kasch H, et al: Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. Eur J Neurol 15(11):1222-1230, 2008
²Chen HB, et al: Biomechanics of whiplash injury. Chin J Traumatol 12(5):305-314, 2009
³Michaleff ZA, et al: A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol. BMC Musculoskeletal Disord 10:149, 2009 (12/2/09)

Looking your best might not always be the best thing for you. Today’s society is extremely fashion and style conscious. Unfortunately, clothing designers and stylists aim to please by creating unique looks that might not always be practical or even comfortable.

The look of the season shows runway models in high platform heels and tight skirts or pants. Models have perfected the runway “walk,” but the popular looks and accessories are frequently impractical and could create leg, back, and spine or neck problems. “Sometimes I see a woman walking down the street with high heels and a two-ton bag, and I want to stop her and make her aware of what she is doing to her body,” said ACA national spokesperson, Dr. Jerome McAndrews.

Women generally wear high heels to complement an outfit, not for comfort, but some might not realize that these shoes can cause serious discomfort in the feet and can also exacerbate back pain. High heels alter the balanced position of a person’s body. When a woman wears high heels, a new dynamic equilibrium occurs. Dr. McAndrews compared the musculoskeletal system to a mobile, hanging in dynamic equilibrium, each part balancing the other. If one part becomes ‘fixed,’ the whole system will compensate with a movement or restriction. Essentially, wearing high heels for any length of time increases the normal forward curve of the back and causes the pelvis to tip forward. This alters the normal configuration of the pelvis and spine necessary for the body to maintain a center of gravity.

“The legs are the foundation of the musculoskeletal system, and a person standing flat-footed or bare-footed would be completely balanced,” said Dr. McAndrews. “While standing, the hamstrings are taut and both parts of the pelvis are stabilized so that the support is normal. By bringing the heel up, you encourage the shortness of the hamstring muscles.”

Women and men alike fall into the fashion trap. However, women, more than men, tend to wear clothes that are too tight. Stylish tight tube skirts and tight pants can be attractive, but are often too restrictive. Clothes that are too tight throw a person off-balance, and simple everyday tasks such as bending, sitting and walking become difficult. “Tight clothes restrict a person from moving comfortably, resulting in poor posture and misalignment of the spine,” said Dr. McAndrews.

Another unhealthy fashion statement is the use of heavy purses, backpacks and handbags. Women and men tend to carry too many items in one bag, or briefcase, and are often not aware of the potential health risks associated with toting an excessive amount of “stuff.” Carrying a bag with detectable weight-more than 10 percent of your body weight-can cause improper balance. When hiked over one shoulder, it interferes with the natural movement of the upper and lower body. “The person carrying the bag will hike one shoulder to subconsciously guard against the weight, holding the other shoulder immobile,” said Dr. McAndrews. “This results in the unnatural counterbalance movement of one shoulder and little control over the movements of the arms and legs. Even worse, the spine curves toward the shoulder.”

More and more people carry their credit cards, ATM cards and personal identification in the back pocket of their pants. This might be a convenient way of carrying the necessary items with you each day, but carrying your wallet in the back pocket of your pants can cause discomfort. Dr. McAndrews suggested men and women remove their wallets or other items before sitting for long periods of time. “Sitting on your wallet or card holder for the entire day will create a pocket in the muscle lying underneath the wallet, and whether your pants are tight or loose-fitting, this can result in discomfort or pain.”

In today’s society, it might be important to you to look fashionable, but it is more important to choose clothes, shoes and bags that are comfortable and that suit your style. By following and remembering these simple steps, it is possible to look and feel your best.

• Choose comfortable shoes. If you must wear high heels, bring a pair of flat shoes along with you to change into should you become uncomfortable. If you walk to work, wear flat shoes and change into your more fashionable shoes when you arrive to alleviate any pain or discomfort.
• If the shoe is uncomfortable while standing, chances are it will not be any more comfortable while walking. The wrong shoe can affect the body’s center of gravity.
• Choose supportive shoes. Designer spikes or non-supportive loafers may look nice but do not allow for easy, symmetrical walking.
• While sitting, whether or not you are wearing heels, it is important to take frequent stretch breaks to alleviate atrophy of the hamstring muscles.
• Avoid excessive wear of tight pants or clothing. If you prefer tighter clothes, choose styles that allow you to perform daily tasks with ease.
• Select a briefcase or purse with a wide adjustable strap. Ideally, the strap should be long enough to place over the head. This evenly distributes the bulk of the weight across the body.
• When carrying a bag, or briefcase, switch sides frequently to avoid placing the burden of the weight on one side of your body.
• Take the time to empty unnecessary items from your bag.
• Place all necessary items-such as wallets and cellular phones-in the front pockets of the bag. Stretching around to reach for your wallet can result in a pulled neck or back.
• If you are driving or sitting for long periods of time, remove your wallet or card holder from the back pocket of your pants.
• Think about your daily tasks. If your clothes affect your movements, consider outfits that fit your lifestyle.

Designers and stylists tend to be more concerned about the way something looks rather than the way it feels. Listen to your body. One of the most important aspects of being in style and looking your best is to maintain healthy judgement. By following simple suggestions, being fashionable can be comfortable.