A Strong Upper Back makes a Strong System

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A Strong Back Makes a Strong System

        There are thousands of exercises directed at strengthening all the different muscles and all the different movements of your body. Many do multiple joints at once, and many isolate. The debate will always rage on between the “isolationists” and the “functionalists” as it pertains to strengthening the “right” way, especially as it pertains to dysfunction and rehabilitation. Whatever and wherever the dysfunction occurs, the muscles of the upper back are crucial to maximize muscle efficiency and maintain joint integrity. If you want an example of common dysfunction, check out my post regarding migraines and upper-crossed syndrome .

  I’ll refrain from giving you an intricate clinical anatomy lesson, but instead I’ll present a list of beginner exercises to promote improved upper back strength and improve chest extensibility. There are wide variety of different exercises and ways to approach strengthening the upper back. There are also quite a few important cues to watch out for, so if you are really insecure about trying these out…send me a message and I’ll try to go over them in more detail for you.

Above all else and before I list the exercises, I want you to drill into your brain to be aware of one MAJOR compensation that is present in almost every single weightlifting exercise…and particularly back exercises. It’s the “shrug”. When we let our shoulder blades elevate, it encourages dysfunction in our upper back that negatively affects the neck, thoracic spine, shoulder blade, and humerus. Over time, this habitual compensation will likely let you lift more, but will gradually wear down your joints so that you’ll need a PT or a surgeon to correct the problems you’ve caused yourself. I know, you lifters are saying “sure Brian, I’ve been lifting like that for years, my traps make me look huge, and I feel fine. This dude doesn’t know anything.” I get it all the time in the gym and in the clinic. If that’s you right now, just stop reading and I’ll see you in a couple years after your cervical fusion at C6-C7. Moving on…..

  1. Seated row (rhomboids, middle & lower trap, rear deltoid, biceps): This exercise is fantastic for beginners, but does require more cognitive effort than you may think. It makes you use the muscles of your upper back in between your shoulder blades. The major point of emphasis you want to focus on, is not only actively pulling your shoulder blades back, but down also. Its extremely common to shrug (elevate) your shoulder blades as you perform this exercise which minimizes the activity and changes the appropriate line of pull of the muscles you want to strengthen. It is great to implement this exercise early in your back routine and will work to not only pull your shoulder blades back (and overcome chest tightness), but begin to pull your shoulder (humerus) more posterior in the joint as well.

seated row close gri[You also don’t have to do it on a ball, that’s just the best pic I found. 🙂

2. Lat pull down (latissimus dorsi, rear deltoid, lower trap, biceps): Don’t shrug. Very important you work on keeping your upper traps off and really focus on pulling the weight down while actively holding your shoulder blades back and down. This will promote downward force to your shoulder blade and shoulder. Also, no need to ever go behind your head during this exercise.

0529_FC_S_IMG

3. Lateral raises (middle deltoid, supraspinatus, upper trap): DON’T SHRUG. Now, the upper traps will be on during this exercise, but in the way it’s supposed to. By keeping your arms directly to your side and attempting to hold your shoulder blades back, you’ll create a smooth line of pull upwards for your deltoids and upper trap to work on your shoulder and shoulder blade, and to develop a healthy movement rhythm between your shoulder and shoulder blade.

lateral raises

4. A) Pec Stretch in a doorway or B) lying on foam roller: This one is pretty self-explanatory. Chest tightness is a large contributing factor for neck, thoracic, and shoulder blade dysfunction and asymmetry. In order to maximize shoulder blade excursion for the preceding exercises, you also have to concurrently stretch the chest. Short term stretches are defined as an intense stretch/hold for 30″ to 2′ for anywhere from 3-5 repetitions.

pec stretch doorway

Longer term stretches are less commonly used and even less known. The research of “low load prolonged stretching” is not as proliferate as short term, but the findings have been nonetheless intriguing. The idea is that you are attempting to go after the muscles plasticity .  By stretching at a low load for anywhere from 5′ to 20′, the theory is that you can structurally remodel the tissue you’re stretching in order to change it for a longer duration than is achievable by a short term stretch.

pec stretch llps

To reiterate, these are just a few exercises to help you initiate a program in the right direction to improve symmetry and deconstruct dysfunction. Because if it comes to a muscle group you should become really comfortable with, especially if you’re starting a strength training program, the upper back is a great place to start.

Always remember a strong back is a strong system!

 

Thanks for reading visiting! If you’re looking for more advanced exercises, need some further instruction, or any other question regarding this post, leave a comment below and I’ll respond asap!

 

 

 

Help! I get migraines!

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Migraines and the Neck

         Migraines are debilitating for millions of people. For those of you who suffer from migraines and have yet to find relief, this post likely is for you. If you have sought medical care from multiple doctors, just to end up with no real solution other than a heavy-hitting medication. Would I be safe in assuming that those meds either put you to sleep, make you like a zombie, or doesn’t do anything at all? People experience migraine symptoms differently and when people have migraines, trying to describe it to someone who doesn’t have them is like trying to tell a “you had to be there” joke to a person who wasn’t there. It is usually frustrating and you know the person you’re telling about your headache believes “it’s just a headache, whats the big deal?”. Makes you want to give THEM a migraine right? So next time, give them the following stats.

“1 BILLION PEOPLE worldwide suffer from migraines every year, and nearly 38 million people in the United States”(1) alone. This makes the migraine the “3rd most prevalent illness in the world” (1) and “1 in 4 households in the U.S. includes someone with a migraine” (1). For more stats click HERE . Seriously, click the link, it will blow your mind how common migraines are.

I have to preface this and say that in order to run with my recommendations, you need to seek out medical consultation as to rule out common non-orthopedic triggers of migraines that include, but are not limited to, sinus issues, sleep disturbances, over-exertion, smoke, air pressure changes, hormone changes (menstruation, menopause), over-use of pain medication, and certain foods.

Ok, so you’ve ruled out all of those triggers. So why are you still having these massive headaches?! Well, before my patients come to me, what I’ve often seen happening is the practitioners before me just “chase the pain” (which you’ll see as a theme is many upcoming posts). What I mean by “chase the pain” is to implement strategies, usually medication, that sole purpose is to address symptoms but often don’t remedy a solution as to the cause. What I propose, is the cause, not the symptom.

In the eyes of a good Physical Therapist, one cannot look at the head without evaluating the neck. The head is a bowling ball sitting on top of an extra-large golf tee supported by ligaments and muscles thats sole job is to support and move it. The symbiotic interdependence that these structures provide, gives us the ability to do a multitude of tasks ranging from deliberate movements (i.e. driving) to powerful multi-directional movements required for sport. Others just need the support to look down at their phone. 😉 Regardless of the demands we place on the head and neck, there are certain vital structures within the neck that can, when aggravated, create massive headaches like many migraine sufferers experience. In PT, we usually call those “cervicogenic headaches.” Which commonly, are misdiagnosed with the blanket diagnosis of “migraines”. The first thing I see in these evaluations is usually bad posture. The patient usually has a forward head, rounded upper back, and forward and rounded shoulders.  What I see in my physical exam is usually a combination of tight and weak upper trapezius, levator scapula, pec major and minor muscles, along with weak muscles of the anterior neck and shoulder blades (rhomboids, mid/lower traps, serratus anterior, and the rotator cuff). Sometimes referred to as “upper crossed syndrome”.

upper-cross-syndrome-300x276

This creates a large imbalance of forces on the head that usually takes a long time to develop any symptoms related to this dysfunction. So the onset of headaches/migraines can be very gradual in frequency and intensity. The region of the head called the sub-occipital triangle is where many of these headaches originate. It is a small region located directly below the bottom of the skull where C1 (Atlas) & C2 (Axis) meet and interact with the skull. When the shoulders round and the shoulder blades round up and forward, the thoracic spine (upper back) rounds, and the cervical spine must adapt in order to keep our vision aligned to the horizon. This chronic sequence ultimately produces narrowing of the sub-occiptal triangle of the cervical spine.

sub-occiptal triangle

This narrowing causes impingement (pinching) of a very sensitive nerve bundle involving two primary sensory nerves called the Great Occipital nerve (GON) and the Lesser Occipital nerve (LON). The GON travels up and around the top of your head, while the LON runs up and to the side of your head usually terminating above your ear near the top of the jaw.

Occipital-neuralgia

This is commonly called “occipital neuralgia” and can present as all the same symptoms as a standard migraine. Pain behind the eyes, on the top & side of the head, in your ear or jaw, and I have even had it described as the pain follicles of your hair. You will also be chronically sore to touch in the sub-occiptal triangle itself. Now if MDs discover the cause, they usually do something called an Occipital nerve block by injecting a pharmaceutical mixture in to the sub-occipital space essential numbing the nerve in order to “turn it off” and stop the symptoms. Get it? Chasing the pain, not attacking the cause.

     As Physical Therapists, we implement a combination of manual therapy and exercise in order to stop the dysfunction of the tight and weak muscles and promote symmetry between right/left and front/back. We stretch the sub-occipital muscles, upper-trapezius, levator scapula, pec major and pec minor (future post about the pec minor), and concurrently strengthen the anterior neck muscles, mid/lower trap, rhomboids, serratus anterior, rotator cuff, deltoids, biceps, triceps, and pecs. The goal is to pull the shoulder-blade back and down, return the thoracic and cervical spine to normal position and alignment, while teaching you behavioral changes in order to promote chronic relief and prevention. Essentially just taking the “dys” out of dysfunction.

Now it took a LONG time for your headaches to get this bad, so it will take a while to fully eliminate the dysfunction. So don’t expect these improvements to happen overnight. So if you stick with the exercise program and change the behaviors that facilitated the bad posture, you will get relief. Many people suffer from debilitating headaches, I hope that this post gave you a possible strategy to ending your chronic headaches/migraines.

In the next post I’ll present simple exercises to treat this dysfunction and specific cues to minimize compensation in order to safely and efficiently be successful.

Thanks for reading! Stay healthy and stay active!

Brian Blevins PT, DPT

References:

  1. Migraine Facts – Migraine Research Foundation. (n.d.). Retrieved August 01, 2016, from https://migraineresearchfoundation.org/about-migraine/migraine-facts/