Movement

A Traveler’s Guide to Staying Supple, Comfortable, and Fit

Throughout the summer, many of us have been active traveling and will continue doing so through labor day. This could involve long car rides, flights, and disturbances in our usual movement and self-care routines. Some people specifically avoid traveling due to back pain or similar issues, or perhaps suffer through increased pain which detracts from the joys of vacationing.

Here are some tips to keep you and your body feeling happy and healthy throughout your travels!

Breaks from prolonged sitting

The number one most important thing is taking frequent breaks from sitting, no matter the mode of travel. Prolonged stillness, especially constricted in an enclosed space of a vehicle or plane, is the recipe for soreness and stiffness

Rather than only taking breaks for the biological need of needing to use the bathroom, consider the biological needs of your musculoskeletal system. The body’s tissues do not like to be in the same position for too long, especially positions that involve increased pressures on certain areas (e.g. the low back).

In fact, studies have shown that prolonged sitting is associated with increased pressures on the intervertebral discs of the lower back. This study demonstrated  that disc height, particularly between the L4 and L5 vertebrae, is significantly impacted by prolonged sitting without breaks. The loss of disc height was not present with brief positional changes performed every 15 minutes. Changes in disc height during prolonged sitting may be associated with low back pain, sciatica, and functional disability.

At the least, try to stand up and walk around once an hour. Consider setting timers so you remember to stop and move around. If you can do it every half an hour, great! If it is not possible to take a break this often, never go for more than two hours without getting up. If you’re not able to get up, change your position often! Trust your own experience and honor your body’s request for appropriate breaks. 

Targeted movement breaks

Maximize your breaks from sitting with specific movements/stretches that help to reverse the effects of sitting. 

Notice that in sitting, the hips and knees are flexed to around 90 degrees. Most people also tend to sit with some flexion in the low and mid back. This shortens certain muscles/tissues, particularly around the spine, hips, and knees. By specifically performing movements that lengthen those tissues, you can help prevent your body from getting quite as stiff and sore during long trips. 

Consider trying some movement snacks (see our Movement Snacks blog) to break up your car trip, particularly the first three videos that you can do standing up (perhaps using your car or a picnic table for support).

Another favorite is a standing back extension, which involves pressing the hips forward to extend the back and hips. This movement can be done as shown below, or by pressing the hips forward into a support surface such as your car, a chair, or a picnic table, while gently holding on to the support surface.

I also love to do a version of a sun salutation that you can do while standing. This involves reaching up to the sky, down to the ground, and cycling through this while breathing. 

You could also do standing pelvic circles, imagining you are standing with a small hula hoop around your waist, and you make circles with your hips within the hoop.

It may also be helpful to consider how the spine moves in space, and engage in movements in which you move the spine in each of the three directions (flexion/extension, side bending, and rotation). See our How the Spine Moves blog for more information.

At the Wellness Station, we will help you create specific, individualized movement routines that you can integrate into your travels.

Ergonomics and posture

While sitting for a while during travel, it can be helpful to enhance your ergonomics and posture. See our Posture Part II blog for more specific information.

The main factors to consider here are:

Appropriate back support

Consider having an inflatable travel ball to stick behind your back in the car or on the plane to help support your spine.

The above can be ordered from Amazon and deflated to the level that fits best for your body size and your seat.

Changing Position Often

Try not to get stuck in one stagnant sitting position. Cycle between being more reclined and less reclined. Change where you are holding your legs. Move the ball around to some different positions.

Sitting movement breaks

Similar to changing position often, try to incorporate specific movement breaks while sitting. You can be doing the pelvic clock. You can be gently pumping your ankles, stretching your hips, rolling your neck. Some planes even have specific in-flight videos for sitting stretches you can follow along to.

Establishing a vacation movement routine

Many people let their routines slip away on vacation. “I’m on vacation- why would I be exercising?” While of course you want to have plenty of time to immerse yourself in new experiences, or perhaps sit on the beach with an ice cold margarita, vacations are no time to be sedentary. Don’t you want to be feeling your very best to fully enjoy your vacation, rather than feeling stiff, achey, and out of shape? 

How can you re-establish a movement routine while traveling? Bringing a yoga mat and some very minimal supplies (ankle weights, therabands) might be an option while traveling. If not, perhaps there is a hotel gym and/or pool that you could enjoy. When bringing equipment and gym access is not possible, think of what body weight movements you could do (e.g. variations of squats, lunges, push ups, cat cow, step ups, etc.)

Consider opting for an active vacation. How can you explore new places with your own two legs? Is there a hike in the area you would like to explore? A bike trail? Swimming in a pristine lake or a salty sea? Or perhaps a walking tour of the downtown must-sees.

Whatever your journey may be, try to prioritize staying active so you can make the very most of your vacation. At the Wellness Station, we can help to gradually progress your fitness to help you be able to move towards the trip of your dreams. 

A biking exploration of Jasper National Park

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Balance Part II: Strategies for Improvement

Last month, we discussed factors that control and impact our balance. Consideration of these factors can help us become more aware of what to do to stay safe and prevent falls, as well as targeted exercises to improve our balance that are based on scientific principles.

How do we improve our balance and prevent falling?

If we recognize the influence that the physiological, psychological, and environmental factors have on our balance, we can be strategic in how we improve our balance and decrease our risk of falling.

  • Stay active, making sure you are keeping your muscles strong and healthy for life. Have a movement practice that incorporates functional strengthening and balance challenges.

  • Enhance your somatosensory system by regularly stimulating your feet. Think of your feet like antennas that provide messages to your brain about your balance. Massaging your feet with balance pods are a great way to keep the nerve endings responsive. 

    Consider more time spent barefoot, especially during balance exercises. This will allow your feet to feel the ground and your toes to spread out, creating wider points of contact with the ground. In daily life, consider shoes with a thinner, more flexible sole, and a wide toe box.

  • Ensure you are taking care of your eyes and vision by regularly visiting an ophthalmologist. Make sure you use a nightlight when going to the bathroom at night, and remove any trip hazards from your path.

You could also consider the role of vision to challenge your balance during exercises. Notice that keeping your gaze stable on an object in front of you helps your balance. Moving your eyes around will make balance more challenging. Closing your eyes will make it the most challenging!

Recall in Balance Part I, we discussed how being overly reliant on vision can contribute to a stooped posture, as many people will look down to the ground with their whole body rather than just with their eyes. When walking, practice looking down with just your eyeballs as needed to see the ground in front of you, rather than with your whole self. If you had a light shining from the tip of your nose, and a light from your chest bone, you should be able to maintain these lights at the level of the horizon while walking, rather than keeping the lights cast downwards. 

  • Make sure your vestibular system is healthy, and recognize the impact that vertigo, seasickness, and certain medications can have on your balance.

Likewise, you can progress your balance exercises by introducing changes in your vestibular system. If standing on one leg has become easy, can you do it while slowly turning your head from side to side, or up and down? 

  • Optimize your environment: Make sure your environment is conducive to not falling! If icy sidewalks, crowds, or uneven trails are not for you, make sure you modify appropriately, perhaps bringing an assistive device or a loved one to help you stay steady.

You can also use the environment to improve your balance, by intentionally walking on trails and standing on uneven or “squishy” surfaces.

  • Train your balance… but don’t overshoot it! A mistake many people make while training their balance is going past their edge. If standing on one leg consistently leads to excessive wiggles, wobbles, and you are unable to find your steadiness, then you are simply practicing being unsteady, rather than practicing finding steadiness. You want to be close to your edge, without going over it!

Find an exercise that feels moderately challenging, but you are able to find steadiness and ease with practice. If not, modify the activity to make it more or less challenging. Standing at the kitchen sink, by the counter, in the corner of a room, or in a door frame are excellent places to practice balance, as you have the option of supporting yourself with your arms as needed. 

By finding this edge and achieving success with practice, not only can we improve the physiological components of balance, but we can also improve the confidence we have in ourselves, thereby decreasing our fear of falling and subsequent risk of actually falling!

Follow along with this video, which incorporates seven balance exercises and strategies, “Feldenkrais style”! It instructs in balance challenges including standing and walking with a narrow base of support, closing the eyes, getting up and down from the floor, dynamic weight shifting, and practice with “falling”. Best to do this video near something to hold on to as needed. 

At the Wellness Station, we can help you recognize and make changes in the factors that could be impacting your balance. We will provide you with individualized recommendations and movement lessons to help you improve your balance, your confidence in yourself, and your ability to continue to do what you love.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Balance Part I: The Science Behind our Steadiness

A keen sense of balance is crucial for a full and healthy life. Our balance tends to decline as we age, but we can prevent this decline and even improve our balance over time if we equip ourselves with knowledge and targeted exercises. 

Many people don’t realize that their balance has gotten significantly worse until they are put into a situation that reveals it. Older individuals may realize they are no longer able to get up and down from the floor, especially if they have nothing to hold on to. Or perhaps standing on one leg is no longer an option. Maybe we have become a “furniture walker”, always looking for the next piece of furniture to touch as we walk around. As balance declines, one’s life can get smaller and smaller, as fear of falling begins to impact decision making.

What controls our balance?

Our balance is an extremely complex interaction between many physiological, psychological, and environmental factors. 

  • Physiologically speaking, balance depends on the strength and responsiveness of our neuromuscular system. How quickly, and with how much force are we able to respond to perturbations? Do we have the strength in our legs to balance on one of them, or the reaction time to catch ourselves if we fall?

  • Balance also depends on our somatosensory system, which are sensations that we receive and process from our skin, muscles, and joints. The ability to feel our feet on the ground, as well as the sense of proprioception (sensing the position of our joints in space) help us to stay balanced. This is why individuals with peripheral neuropathy (loss of sensation particularly in feet) have great challenges with their balance, because they can’t feel their feet too well. 

  • Our vestibular system also controls our balance. This is the system in our inner ear that provides information to our brain regarding head position, motion, and orientation in space. We all know the feeling of being dizzy, perhaps due to a medication that affects the vestibular system, an amusement park ride that tosses your head around, or seasickness. When the vestibular system is impaired, balance is impaired.

  • Vision is a prime component of our balance system. This is why it is harder to balance in the dark, or with your eyes closed! However, some people become overly reliant on their vision for balance, and find themselves looking at the ground when they walk, as opposed to appropriately integrating information from the other systems. This is related to posture, as many people will adopt a stooped posture over time if frequently looking at the ground to maintain balance. Training your posture and training your balance can go hand in hand!

  • Psychological factors also greatly impact our balance. Of course, if we are feeling crummy, or perhaps are not well-rested, our balance will be worse. More significantly is the confidence we have in our balance. Any athlete will recognize the negative impact of anxiety/nervousness on performance, particularly in sports that require a keen sense of balance (e.g. gymnastics). Lacking confidence and having a fear of falling is actually the most significant predictor of a fall! Studies have shown that those with a fear of falling have more than twice the risk of falling than those who do not have this fear. With this fear comes diminished activity overtime. With diminished activity, a downwards spiral is set in motion that will negatively impact the functioning of all body systems.

  • Environmental factors also impact balance. What environment are we in, and how are we relative to our environment? Our base of support, and how we are able to keep our center of gravity balanced over our base of support will determine our stability (e.g. standing with your feet wide apart is far more balanced than standing on a tightrope).

    The ground we are on will impact the position of our joints and contribute to perturbations that could throw us off center (e.g. sinking into the sand, walking on uneven rocks and roots, slippery ice, etc.) Additionally, disturbances from our environment (e.g. crowds with people rushing past you and bumping into you, high winds, loud noises) can create disorientation and perturbations that can throw us off center. In general, the less familiar we are with the territory in which we are engaging with, the worse our balance

At the Wellness Station, we can help you recognize and make changes in the factors that could be impacting your balance. We will provide you with individualized recommendations and movement lessons to help you improve your balance, your confidence in yourself, and your ability to continue to do what you love. 

See Part II next month for specific strategies to improve your balance over time.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

  1. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03018-2#:~:text=Supporting%20this%20research%2C%20FoF%20is,those%20without%20FoF%20%5B6%5D

Images:

  1. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.vecteezy.com%2Fvideo%2F17553944-animated-strength-training-program-building-muscle-full-body-flat-person-on-white-background-with-alpha-channel-transparency-colorful-cartoon-style-4k-video-footage-of-character-for-animation&psig=AOvVaw2uqpDfUHBMFBkIQ4PKB0BR&ust=1687708894348000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCMCvo9uj3P8CFQAAAAAdAAAAABAJ

  2. https://www.google.com/url?sa=i&url=https%3A%2F%2Fankorpilates.com%2Fwhy-are-your-feet-are-important-in-movement%2F&psig=AOvVaw0jamvwH_vA57wplaDnXLRL&ust=1687708834693000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCLDn976j3P8CFQAAAAAdAAAAABAK

  3. https://premierneurologycenter.com/wp-content/uploads/sites/436/2021/11/shutterstock_2030974061-min-1024x784.jpg.optimal.jpg

  4. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.behance.net%2Fgallery%2F31077731%2FFIELD-OF-VISION-Animation&psig=AOvVaw1lU0R4-RZNel4eGhj1b5EK&ust=1687708970802000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCLjwu_-j3P8CFQAAAAAdAAAAABAE

  5. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.pngwing.com%2Fen%2Ffree-png-muppf&psig=AOvVaw32JCXn74IG9G-4YIiLasLW&ust=1687709020307000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCPChlZek3P8CFQAAAAAdAAAAABAE

  6. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.mtbproject.com%2Fphoto%2F3764918%2Fthe-ultimate-rocks-and-roots-trail&psig=AOvVaw3DuNVVu8W3HBbtlKEfFwV3&ust=1687709068276000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCKDhia6k3P8CFQAAAAAdAAAAABAw

  7. https://www.google.com/url?sa=i&url=https%3A%2F%2Fhealth.clevelandclinic.org%2Fwork-life-balance%2F&psig=AOvVaw183XchyKfQMFvvdcX81Erq&ust=1687709187802000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCIj0geek3P8CFQAAAAAdAAAAABAI

  8. https://cdn.w600.comps.canstockphoto.com/walking-off-cliff-eps-vectors_csp19293038.jpg

  9. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.shutterstock.com%2Fsearch%2Fbalance-exercise-cartoon&psig=AOvVaw0bSfZJyOS8lVuP4o9emqg5&ust=1687709566883000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCJCCiZym3P8CFQAAAAAdAAAAABAE 

Doing Dishes With Back Pain: Strategies for Success

For most of us, doing the dishes is not exactly the highlight of our day. For those of us with back pain, this chore can be daunting, uncomfortable, or even seem impossible. There are many strategies that can help this task become possible, manageable, or even easy. A lot of this comes down to our posture and movement patterns, our attitudes, and our willingness to break down the task into chunks.

Posture and Movement Patterns

How we hold ourselves can make a big difference in how our bodies feel. Being in a forward bent position for a long time puts extra strain on the back. Because the dishes are down and forward, it is easy to find yourself in this slumped position, but it is possible to do it differently!

  1. Position yourself for readiness:

The closer you place your body to the sink, the shorter the lever arm is that your body has to hold. In other words, if you’re holding a heavy pan far away from your body, this is a lot more work on your back than holding the pan close to yourself. Just wear an apron so your clothes don’t get wet! 

You could also bring the dishes closer to you by using two dish pans. One on the bottom, and the other one upside down which would bring everything up closer to you. This will allow you to wash the dishes a little higher, and not have to bend down as far to scrub dishes at the bottom of the sink. A long handled scrubber may also be helpful.

2. What’s under your feet?

Think about your feet, as you are holding your weight through your legs as you stand. Try standing on a soft cushy pad to help spread the forces coming up from the ground.

Another strategy is to have one foot placed on something, such as on a stool, or inside the cabinet that is in front of you. Every so often, switch which foot is elevated. This will both keep you more upright, and allow your legs to alternate sharing the load. However, the downside of using a stool is that it brings you further away from the sink. This makes it all the more important to elevate the dishes by using two dish pans, as described in #1 above. 

Notice that this individual in the left-hand picture does not need to be bending from the waist in order to see the dishes. This position causes the back to work harder than it needs to. This person should instead be looking down at the dishes by tipping just their head, not their whole back. 

3. Dishwasher strategy:

Use the automatic dishwasher as much as you can. Believe it or not, this actually saves water! However, loading and unloading the washer can be troublesome for many with back pain. At the Wellness Station, we can teach you how to optimize your body mechanics for success based on your individual characteristics.

Generally speaking, try to position yourself as close to where you are putting the dish as possible. In other words, don’t try to reach and crane to the far corner of the bottom rack holding a heavy plate! Walk around to the side, send your bottom back, and place each dish with ease. In other words, keep your center of mass (your pelvis) over your base of support (your feet) so that when you reach forward, you can counterbalance by sending your bottom back. This is something we can teach you to do effortlessly at the Wellness Station.

Attitude and Mindset

If we see dishes as a cumbersome chore, it will continue to be so. How can we change our attitude and mindset relative to this task to make the most out of it?

  1. Mindfulness:

Don’t have time to meditate? Make doing dishes your meditation. Pay full attention to your experience. Notice the sensory information coming from the splashing water. Notice your fine dexterity skills required to grasp and scrub. Relish in the small dopamine hit from each completed dish, and the sense of accomplishment from finishing the task. Feel gratitude for having food to eat, dishes to use, and modern technology to support the ability to feed yourself and your loved ones.

2. Bring the joy to the experience:

If mindfulness isn’t cutting it, what else can you bring to the experience? How about playing your favorite music and making it into a dance? Listening to your favorite podcast to educate yourself while you work? Or perhaps rewarding yourself upon completion with a tasty snack or self care routine. 

Breaking it down

Many of us can’t tolerate dishes because of the amount of time spent standing. If the above strategies are not helping as much as you would like, consider breaking down the task into chunks and taking movement breaks.

  1. Break into chunks:

Rather than trying to push through and finish dishes as quickly as possible at the expense of a sore back, how about breaking it into chunks? Unload the dishwasher, sit down. Load the top rack, sit down. Load the bottom rack, sit down. Wash the pots and pans, sit down. Remember the lesson of the tortoise and the hare! If sitting down is not necessary, or even preferable, consider moving about with other household responsibilities and coming back to washing dishes later. 

2. Movement breaks:

Try incorporating some gentle movement breaks into your dishwashing routine. It might be helpful to do movements that incorporate the opposite movement of your body. As doing the dishes involves some bending forward with your arms in front of you, how about some bending back with your arms behind you? Here is a movement break that are great for incorporating into your dishes routine: Hip and Shoulder Extension

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Exercise and Chronic Pain: A Guide

It is well known that exercise is an extremely beneficial activity that can elicit substantial improvements in many different measures of health, well-being and fitness.

Exercise is a broad category, as there are many different types and manners in which exercise can be carried out. (See Movement, Physical Activity, & Exercise blog for more information.)

There are many factors to consider when determining what kind of exercise might be best for an individual. These individual considerations might include health conditions, fitness level and experience with exercise, injuries, goals, cultural factors, socioeconomic status, access to safe spaces to exercise, personality, and the existence of chronic pain. One size does not fit all when it comes to exercise.

At the Wellness Station, we provide holistic care based on the biopsychosocial model, which takes these differences into account to create individualized movement programs.

 Can Exercise Help with Pain?

Pain is an extremely complex, subjective experience, it is difficult to apply generalizations to this topic. That being said, exercise can be extremely helpful for individuals with chronic pain for several reasons.

  • However, individuals with chronic pain may become more physically inactive which may be due to fear-avoidant behavior (they may avoid movement for fear of triggering their pain), depression, or many other reasons.

  • Inactivity can make chronic pain worse, as the tissues of the body will become deconditioned, inflammatory processes may increase, and weakened tissues may become more likely to be irritated and strained from acute stressors.

  • Exercise, when performed appropriately, can have tremendous health benefits for all individuals, those with chronic pain included. Engaging in intentional exercise can help improve metabolic, cardiorespiratory, and musculoskeletal functioning, and also triggers the release of endogenous hormones (endorphins) that help us to feel good and decrease our sensitivity to pain.

  • Exercise can improve the confidence we have in ourselves and in our painful body parts, which can also help with our experience of pain. This confidence helps us feel empowered to make positive changes, and less limited by fear of movement.

  • Targeted exercise can help to nourish tissues with fresh blood and nutrients and  improve tissue strength and resilience.

It is clear that exercise is helpful for pain both directly and indirectly, but one must consider how exercise might be applied differently for someone experiencing chronic pain compared to an individual using exercise solely for fitness gains.

An Exercise Program with Chronic Pain: Factors to Consider

 The interventions chosen at the Wellness Station are highly individualized, as the intervention will depend on the unique characteristics of the individual.

  • The individual will be encouraged to be generally more active in physical activities that are enjoyable and do not trigger pain.

  • If the activities (such as walking) do trigger pain, it is a matter of changing the movement patterns involved in the activity. Often, people with chronic pain experience a pain pattern during specific activities because they have adopted compensatory, stressful and inefficient movement patterns. Unless these patterns of movement change, the pain cycle may continue. It is our job at the Wellness Station to identify these movement patterns and help you to change them.

  • In addition to changing movement patterns, we can also make changes in the parameters of the activity (including the frequency, intensity, or duration of the activity). For example, engaging in several shorter walks throughout the day rather than a longer walk, if long walks trigger pain.

  • The individual will learn not to push into pain, as this oftentimes will reinforce the pain pattern, contributing to flare ups. Rather than pushing into pain, the individual should learn how to listen and respond to the pain, as pain is your body’s way of communicating information to you. Contrary to the popular mentality of “no pain no gain”, “it’s got to hurt to be effective” when it comes to exercise, if you want exercise to be helpful for your pain you must take a different path.

  • The movement program should also include specific, intentional practices that directly and/or indirectly involve the affected body area. If low back pain is the problem, the movement program will most likely involve the low back, whether that is performing movements that improve mobility, strength and control of the low back, or perhaps improving the movement capacity of a related body area (e.g. mid back or hips) to help spread out the forces of movement over more of the body. Engaging with the involved body part in this way is helpful not just biomechanically, but also psychologically, as it will improve the confidence you have in this area.

  • The movement program for an individual with chronic pain will likely be progressive, meaning it will increase in complexity over time, but the progressions will often be much more gradual than a program that is more oriented towards fitness gains. The parameters of the program and the decision to progress will be based on evidence of neuromuscular learning, comfort, and effect on the pain pattern. By contrast, progressions for a program solely for fitness would likely be based more on the subjective challenge of the activity (e.g. it begins to feel too easy).

Enhance your Fitness for a Better Life

Physical fitness can be described as the ability for all body systems to work together in order for us to maintain health, and perform daily tasks with ease. Strength, balance, agility, cardiorespiratory endurance, and body composition are all components of fitness. It is extremely important for all of us, including those of us with chronic pain, to maintain our fitness through exercise. As we age, it becomes harder to maintain our fitness, as our muscle mass and bone density begin to fade unless we regularly strengthen ourselves. Maintaining and enhancing our fitness will help us stay independent, active and involved in the activities we love, while helping us avoid falls, fractures, metabolic diseases, and more. Pain is often a huge barrier that discourages people from exercising, so addressing the pain as described above can contribute to improvements in fitness overtime.

At the Wellness Station, we use movement to empower people with and without chronic pain to take control in order to live happier, healthier lives.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461882/ 

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491894/