Tag: ribcage

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Back Pain? How to Address the Root Cause

50 year old woman with back pain

Almost everyone will struggle with back pain at some point in their lives. For some it comes and goes, for others it’s a once in a while thing, and for others it becomes a part of their lives.

What’s even more concerning is that the outcomes for surgery for back pain are not that great. Several studies have shown that long term results for patients who had surgery for their back pain were the same as those who were treated with exercise and cognitive therapy.

Why doesn’t surgery work?

Our spines are complex, we humans are complex! The thinking that the source of the pain is always at the location of the pain is almost always wrong unless you had a direct trauma to that area.

This is because we compensate, and we do it really darn well.

Have you ever had to wear a cast or boot after spraining (or breaking) your ankle or your foot? Maybe you even had to use crutches. Soon, your arms, neck, and hips and probably some other body parts will start to hurt. (Don’t worry, I’ll get back to the back pain soon, stick with me here!)

But there was no direct injury to anything except your ankle! The pain in those other areas occur because you are compensating for not being able to use your foot properly.

The problem is, we all have histories of injuries that make us compensate slightly, and underlying all of that we have an asymmetrical brain and an asymmetrical body that will make us prefer to do things differently on one side than the other.

That’s not really a problem if you’re a wild human foraging for berries or climbing trees all day. But if you’re a modern human, you’re forced into positions (sitting at your desk or your car) and actions (writing, typing, opening doors) that your body will do over and over and over again on the same side.

This creates asymmetries that become ingrained, and now we have to compensate somehow.

So what does this have to do with back pain?

The Postural Restoration Institute, or PRI, clarifies how these asymmetries affect us and can cause problems. Here is a brief synopsis of why and how our asymmetrical nature impacts our lives…

We have a more stable, domed, strong diaphragm on the right accompanied by a flatter, weaker diaphragm on the left. this makes us feel much more comfortable standing over our right leg.

This orients our pelvis slightly to the right.

But nobody walks around with their body pointed to the right! No, we compensate to bring our chest back around to the left, so we can see where we’re going.

So, basically, our pelvis is pointing right, while our ribcage is pointing left. With walking and other alternating activities, we alternate by turning our pelvis to the left and ribcage to the right, but because of the strong anatomical tendencies listed above, we can lose this ability to alternate symmetrically.

Over time, or with repetitive activity, or injuries, we can become “stuck” in this twist. Some degenerative changes can occur, but the research unequivocally shows that disc degeneration or arthritis is usually NOT the cause of back pain (in studies where they scanned hundreds of people, some with back pain and some without, there was no correlation with back pain and arthritis/disc disease or other imaging findings. In fact, some people had severe pain and no findings on imaging, while others had severe degeneration, arthritis, and bulging discs, but no pain)!

The key to getting out of back pain for good is not going under the knife, but rather learning how to bring your pelvis back around to the left, and your trunk back around to the right.

To do so, breathing must become re-organized and re-balanced (remember that the diaphragm is the start of all this asymmetry!) and new movement patterns need to be established.

One very simple thing you can do to start training your body out of compensation is working on getting your left lower ribs down, in, and back. This will promote doming of the left diaphragm and bring your trunk back to a neutral position over your pelvis.

Here’s how to start re-orienting your ribcage to untwist your spine:

References:

Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983;8(2):131. 

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976). 2009;34(10):1094-1109. doi:10.1097/BRS.0b013e3181a105fc

Brox JI, Nygaard ØP, Holm I, Keller A, Ingebrigtsen T, Reikerås O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010;69(9):1643-1648. doi:10.1136/ard.2009.108902

Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci. 2018;8:30. Published 2018 Aug 24. doi:10.4103/jcis.JCIS_16_18

Wáng YXJ, Wu AM, Ruiz Santiago F, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat. 2018;15:21-34. Published 2018 Aug 27. doi:10.1016/j.jot.2018.07.009

Lateef H, Patel D. What is the role of imaging in acute low back pain?. Curr Rev Musculoskelet Med. 2009;2(2):69-73. doi:10.1007/s12178-008-9037-0

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Find Your Wings: 3 Things You Should Know About Your Shoulder Blades

We all have them, the big broad bones that fold onto the back of your ribcage like wings. But what do we really know about them?

To understand the function of the shoulderblade, or “scapula,” we must first understand their form.

1. The only bone to bone attachment of the scapula to your trunk is a tiny joint where your collarbone meets the top tip of the scapula.

This joint, called the acromioclavicular joint, or AC joint, is about as secure as if you put the tips of your two index fingers together head on, i.e. it’s pretty flimsy.

picture of two hands with the tip of the index finger touching. This represents the AC joint.
The joint between your shoulderblade and the rest of your body is about as secure as the joining of two fingertips.

The crazy thing is that the arm bone attaches to the scapula bone via a shallow concavity, and the scapula is attached to the rest of your body via the above mentioned AC joint. Literally the only bony attachment of your arm to your torso is via a tiny, flimsy joint.

Small attachment of scapula to torso via the acromioclavicular joint, aka the AC joint.
The acromio-clavicular joint, or AC joint, is the only connection between the scapula and the rest of your torso.

So, you’re probably wondering at this point, “how is my arm not falling off?” It is pretty amazing that our arms not only stay attached, but that we are able to climb, crawl, draw, reach, swim, etc with such precision and stability.

2. It is mostly muscle that holds our arm onto the rest of our body.

This is an amazing design because it allows for a huge degree of mobility in the shoulder, which is necessary to do all the precise tasks and vast ranges of motion required of our arms.

However, this can also create a lot of problems. Muscles change their function based on their position, and repetitive, habitual movement patterns can place muscles in suboptimal positions. If we always sit at the same desk, with our phone on the same side, or we always sit the same way in the car, or always throw a ball with one hand, we are slowly but surely ingraining one-sided patterns into our bodies.

When this occurs in the shoulder and shoulderblade regions it is especially impactful due to the heavy reliance of the shoulder on muscles for stability. This is why shoulder injuries often have little to do with the shoulder, unless it was due to a direct trauma. Usually it is a muscle imbalance or aberrant positioning around the scapula that is the issue, even if the pain is felt in the shoulder.

3. Our shoulderblades are concave in shape

Even though at first glance it seems that are shoulderblades are flat, they actually have a concave shape. This allows for the shoulderblade to sit on the ribcage, which is egg-shaped.

Shoulder blade (Scapula) shown from the side. It has a concave shape.
Side view of a shoulderblade showing the concave surface that touches the ribcage.

However, many of us tend to change the shape of our ribcage by changing the way we breathe. For example, a common pathological breathing pattern is pushing the front lower ribs up in order to get air in without completely exhaling. This is a common breathing pattern when we are stressed- it is a shallow, more rapid breath. If we are a little stressed most of the time, our breathing will reflect that, and over time the shape of our ribcage will reflect that as well.

What this “stress breathing” pattern does is create a flattened ribcage in the back, so now we have a concave shoulderblade trying to sit on a flat surface. At this point the muscle activity cannot be restored because it is the structure underneath that is the issue, and must be corrected before the shoulder can start to move better and feel better.

The shoulderblade is often overlooked when we think about how we move our bodies, but its position and function is vital to our arms being able to move well and without pain. Keeping the muscles around your shoulderblade strong and in an optimal position, as well as keeping your ribcage well positioned with proper breathing, will preserve the life of your shoulders and make for a much happier and painfree shoulder complex.

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