Injury Prevention: Foam Rolling, Stretching, Postural Correction & Ergonomics

Injury Prevention and Treatment

Are you guilty of ignoring aches and pains until they become full-blown problems that sideline you from exercising?

I recommend you always see a medical professional (doctor, physiotherapist, athletic therapist, osteopath, chiropractor or massage therapist) the instant you develop any type of ache or pain in your body.  Why?  Because this is the time when it is easily treatable, meaning you will be back in the game in no time.  If you stall, your aches may develop into a chronic injury that can sideline you for months until you heal.

In addition to practicing dentistry since 2005, I’m also a writer and athlete for Bodybuilding.com (the #1 online fitness website in the world). This means my body is subjected daily to a demanding fitness regime, in addition to static and repetitive awkward working postures.

I earned my Bachelor of Science in Physiotherapy from McGill University in 2001, so I know a thing or two about injury prevention and treatment. In fact, I teach a 6-hour lecture to dental professionals addressing the prevention and treatment of work related musculoskeletal injuries via:

• postural correction
• correct work station ergonomics
• stretching
• core strengthening
• foam rolling

Scary Statistic: Did you know that back pain is the most prevalent affliction to mankind after the common cold?  In fact, a staggering 70-90% of us will experience back problems! So keep reading!

Rule # 1: See a Professional

• Seek immediate medical attention at the first detection of aches and pains.
• Ideally, you should be receiving weekly maintenance care with a sports massage therapist, physiotherapist and/or a chiropractor. Realistically speaking, very few of us will be able to devote both the time and expense for this. This is why I have provided you with daily home-care strategies (rules #2 through 10). Do I adhere to these rules? Yes! I turned them into a daily habit, just like I did with daily dental flossing!

Rule # 2: Proper Footwear

• Wear correct sports-specific footwear (and potentially orthotics) to prevent injuries.  Ask your chiropractor for more information.
  • I recommend you read this article I co-wrote with a chiropractor (Dr. Joy Simon): “Does it Matter What Type Of Athletic Shoe I Wear When I Train?” In this article, we discuss:
    • Why different shoes are required for running, jumping rope, spinning and weight training.
    • The pros/cons of minimalist footwear
  • I recommend you read this article I co-wrote with Dr. Joy Simon: “Orthotics: Are They Necessary?”
• Ladies, try to minimize the time you spend in high heels. If you must, then alternate wearing heels and flats, try to keep the heels under 2 inches, opt for square heels instead of stilettos, and commute to work in runners and then change into heels. Why? Because Wearing high heels can contribute to:
  • Toe pain, numbness and deformaties (hammer toes, bunions, metatarsalgia, Morton’s neuroma).
  • Pain caused by poor posture (you have to lean back, which throws your knees, hips, shoulders and spine out of alignment). This can lead to knee, hip and back pain.
  • Increased risk for sprained ankles (because you can topple over)
  • Knee osteoarthritis. Wearing heels puts increased pressure on the knee joint.
  • Shortening of the calf muscles and achilles tendons, which can lead to insertional achilles tendonitis.
  • “Pump bump” (Haglund’s deformity). This is a bony enlargement on the back of the heel caused by the shoes (or straps) rubbing and irritating the heel.
  • Corns, callouses and blisters.
• Understand that your body is a kinetic chain. Each part of your body is interconnected, meaning, each joint is affected by and effects the joints above and below it. This is why you must be kind to your feet, because:
  • The biomechanics of your foot affect your ankle
  • The biomechanics of your ankle affect your knee
  • The biomechanics of your hip affect your spine, etc…

Rule # 3: Proper Seated and Standing Posture 

Question: Can a desk job cause back pain?

If you have a desk job, then a significant percentage of your day  is spent sitting. Did you know that sitting for prolonged periods of time with slouched and awkward postures increases your likelihood of developing neck and back pain? Why? Because slumped sitting postures place tremendous strain on your spinal ligaments, joints, discs and muscles. This is why it’s imperative you sit with correct sitting posture and regularly interrupt prolonged sitting by standing up and bending backwards 5-10 times.

KEY POINT: POOR POSTURE LEADS TO MUSCULOSKELETAL PAIN.

Question: What is lumbar lordosis?

Lumbar lordosis refers to the hollow in your low back, and is a natural feature of the lumbar spine. The lordosis is lost whenever you hunch. If your lordosis is lost on a regular basis, then low back problems may ensue. If you do this for years, this can weaken the ligaments surrounding your vertebral discs, which can ultimately lead to a disc herniation. If the disc bulges far enough backward, it can press painfully on the sciatic nerve, causing sciatica down your leg.

This is why it’s crucial to sit with correct posture. Correct sitting posture reduces your energy consumption and static muscular workload, meaning, you’re less likely to suffer from neck or back pain.

Question: How do I find my perfect sitting posture?

By using a technique developed by Robin McKenzie called the “Slouch-Overcorrect” procedure.

1. Slouch completely.
2. Sit up and accentuate your lumbar lordosis (the hollow in your low back) as far as possible.  Hold for a few seconds.
3. Sit “short” of the extreme good posture by releasing the last 10% of the lordosis strain.

Question: “Sara, what if my job makes me stand all day long?”

• Don’t let your back sag into extreme lordosis
• Do stand tall to reduce the lordosis.
  • Pretend there is a string attached the top of your head pulling you up.
  • Your chest should be up, your stomach muscles in and your buttocks tight.
  • In neutral standing posture, the ear, shoulder, hip & ankle are all in alignment when viewed from the side.
  • In this standing posture, the pelvis is at an angle that optimally supports & balances the spine & minimizes muscular exertion.

Watch my short video demonstration:

Rule # 4: Ergonomic Chair Selection & Adjustment

If you work at a desk, it’s imperative you understand the following if you want to prevent musculoskeletal injuries:

• What features to look for when purchasing an ergonomic chair.
• How to properly adjust the chair (relative to your workstation) to facilitate neutral posture.

Question: What features should I look for when purchasing a desk chair?

Refer to photo A:

• Five-caster base
• Hydraulic piston assembly
  • ≤5’4” need height adjustment from 16-21”
  • >5’10” need 21-26”
  •  you can order a short or tall cylinder
• Forward tilting seat pan
  • Tilts the pelvis forward and reminds you to maintain your lordosis.
• Waterfall-style seat contour
  • padded front waterfall edge won’t restrict blood flow to the legs
• Firm Contoured textured seat
  • anti-slip
• Adjustable Backrest (ensure it moves up/down and forward/backward)
• Seat Depth
  • ensure you can fit 2″ between the edge of the seat and the back of your knee
• Seat Width
  • not too wide – you don’t want the armrests to be too far apart
• Armrests
  • Optional, but studies support armrests in the prevention of neck and shoulder pain

Question: Should I purchase a chair with armrests?

I like this option, especially for anyone who suffers from trapezius myalgia. The armrests will support the weight of your arms, which will help reduce tension in the upper traps. Ensure the armrests are adjustable, and make sure you adjust them properly:

• if they are too high or low –> it can worsen neck and shoulder pain
• if they are too far forward –> you will hunch forward
• if they are too far apart –> it will cause shoulder abduction (which can lead to shoulder tendinitis)

Question: Should I adjust my chair so that my thighs are parallel to the floor?

NO!

• The position of your pelvis controls the curvature of your spine. Let me say that again. The position of your pelvis controls the curvature of your spine. If you sit on a flat seat pan with your thighs parallel to the floor, your pelvis will roll backwards, which will detrimentally flatten your lumbar lordosis.  If you lose your lordosis often and for long enough, then low back problems may develop.
• You want to be sitting with your buttocks positioned higher than your knees (look at photo B).
• If you sit with your buttocks positioned higher than your knees, then your pelvis will roll forward, which facilitates your lumbar lordosis.  This position minimizes disc pressure and muscle activity in your low back.

Photo B

Question: So how do I adjust my chair?

Refer to photo B

1. Sit all the way back on the seat with your feet flat on the floor.
2. There should be 2” between the chair’s edge and the back of the knee.  If more than 2”, move the backrest backwards and sit further back in the seat.
3. Bring the backrest forward and adjust it up/down until it nestles into your lordosis.
4. Adjust height of chair so buttocks is higher than knees
5. Tilt seat pan slightly forward (5-15 degrees)
6. Perform “slouch-overcorrect” to find your proper posture.  Hold this position
7. Let arms hang loosely by your sides.  Bend your elbows at 90 degrees and adjust the armrest height until they barely touch the undersides of the elbows.

Question: What if my chair offers no lumbar support?

You must pay attention to your sitting posture. It amazes me how many people fail to adjust their backrests to nestle into their lumbar lordosis. Most of them tell me they didn’t even realize the backrest could adjust inward. Be sure to adjust your backrest for immediate relief!  If your chair provides inadequate lumbar support, then you can purchase a lumbar roll to facilitate correct lordosis and posture. If you do not wish to spend money on a lumbar roll, then roll up a towel instead. Do not rely solely on your chair’s lumbar support or a lumbar roll. It is important you also strengthen the stabilizing muscles of your low back to help you maintain correct posture (which is addressed in rule #7). These muscles include your transverse abdominals (deep abs), obliques, quadratus lumborum, erector spinae and multifidi.

Question: What other types of chairs do you recommend?

Because of my ergonomics lecturing gig, I’ve had the opportunity to try every chair under the sun.

I was most impressed with the Salli-Style Stool. In fact, I use this chair at work! When sitting on a saddle-style stool, your thighs are pointing steeply downwards (approx. 45 degrees) and your pelvis is in a neutral position.  It is almost like standing. No backrest is required because the saddle posture and position of the hips naturally stabilize the pelvis in an upright orientation. The saddle stools place your legs in a wide angle, which is actually the neutral position of the hips (mild hip flexion-abduction-external rotation), which minimizes pressure on the hip joint cartilage. I like that this chair is suitable for men or women of any height. The only catch with this chair is that your workstation (desk) must be not be too low (otherwise you won’t be able to adjust the chair to the correct height, which is actually quite high (remember, you’re practically standing in this chair… it looks like you are riding a horse). My current desk is too low to accommodate this chair. I use it at the dental office because I can adjust the height of my patient’s chair quite high. So measure everything before you purchase anything!

This is a divided Salli Stool. The gap minimizes the uncomfortable feeling of pressure on the pubic bone or genitalia, making it suitable for both men & women.

Here’s another option: The Evolution Ball Chair:

• This chair improves your posture and the endurance of your core stabilizers
• It balances muscle activity between your abs and back
• It encourages frequent spinal movement (which nourishes the discs). This is beneficial in reducing low back pain.

Rule # 5: Use Correct Lifting/Lowering Technique

Pay attention to the manner in which you lift and lower your weights/equipment to and from the floor between exercises. Incorrect lifting/lowering technique can lead to back injury.

Correct lifting/lowering technique: 

1. Stand close to the object (eg. dumbbell) with a wide stance. Make sure your back is straight
2. Bend down with your knees (squat), keeping your back straight
3. With a secure grip, hold the object as close as possible to your body.
4. Lift the object by straightening the knees. (keep your back straight).
5. Once in stance, avoid twisting the low back. Shift your feet instead.
6. Lower the object to the ground by bending the knees while keeping your back straight.

Watch my short video demonstration:

Rule #6: Stretch Tight Muscles

Stretching is the one aspect of fitness training that is most often overlooked by people. Stretching improves your flexibility, which can improve your athletic performance, decrease your risk for injury and reduce muscle tension.

Do you have back pain?  Did you know that back pain is associated with poor flexibility? If you sit all day long at a desk with poor posture, this can cause muscle tightening and subsequent muscle imbalances. Your chest muscles will become tight, which causes the upper back muscles to become overworked. This creates pain and spasm in the neck, upper trapezius and between the shoulder blades. This is why it is important to stretch.

When you spend prolonged periods in static postures or performing repetitive movements, certain muscles will inevitably become overworked and tight. It is important to stretch muscles that are short, tight or overworked. These typically include the following: scalenes, upper traps, levator scapulae, upper back, lower back, lats, chest (pecs), wrist flexors, prirformis (glute), hip flexor (iliopsoas), hamstrings, quadratus lumborum, quads, calves (especially if you wear high heels), hip adductors and the iliotibial band.

Stretching Rules:

• no bouncing (bouncing can cause microtears)
• gentle stretch (no pain). Do not force your muscles to stretch beyond the level of moderate discomfort.  A forced stretch can result in serious INJURY!
• hold for 30 seconds
• perform daily
• Never stretch “cold” muscles.  To prevent injury, always warm up with walking, cycling, etc for 10 minutes before stretching.  Ideally, wait until the after your workout to stretch, when your muscles are “warm”.

Watch the video: I take you through an entire stretching program.

Rule # 7: Strengthen Weak Muscles

Don’t make the mistake of exclusively performing abdominal exercises. It’s equally important to strengthen your back muscles (an often neglected area). Failure to do so may lead to muscle imbalances and back pain. A strong core will support your spine (like a corset), protecting you from back injuries and pain. This is especially important for people who sit all day long on the job with slouched posture. I recommend you do my free real time workout videos with me, because I don’t just select exercises on a whim or for aesthetic reasons. Thanks to my background in physiotherapy, I select functional exercises that keep you muscularly balanced.

• REMEMBER: Weak & imbalanced core muscles make you susceptible to poor posture and neck & back injuries.

Think about it for a moment: just as weakened muscles can result from poor posture, other muscles will become stronger or overworked with prolonged, static, repetitive, or poor posture.  While you need to strengthen weakened muscles, you must be cautious not to further strengthen the stronger muscles …  otherwise you will further exaggerate your muscular imbalances. If you have a desk job, then you should be careful not to concentrate all your strength training on your anterior neck muscles, levator scapulae, upper traps, rectus abdominus and pecs, as this will exacerbate your predilection to a slouched, forward head, and rounded shoulders posture. These are the areas you want to STRETCH!

**Key Points: If you sit on the job all day long, then it is important you do the following:

1. Sit with proper posture
2. Strengthen the muscles that pull your shoulder blades down and back, rotate the shoulders back and extend your neck:  rhomboids, lower trapezius, serratus anterior, teres minor, infraspinatus, posterior deltoid, longus colli and capitus.
3. Stretch the muscles that become tight, overworked and shortened as a result of poor sitting postures: scalenes, upper traps, levator scapulae, upper back, lower back, lats, chest (pecs), wrist flexors, prirformis (glute), hip flexor (iliopsoas), hamstrings, quadratus lumborum, quads, calves (especially if you wear high heals), hip adductors and the iliotibial band.

My goal is to keep you injury free!

Rule # 8: Daily Foam Rolling

Injuries and repetitive motions can degrade your muscles and fascia. (The fascia is the connective tissue surrounding and supporting your muscles). This can cause localized areas of tenderness, called trigger points (or knots). Trigger points can restrict the range of motion of the muscle and can even refer pain to other locations (eg. headaches). If left untreated, they can lead to scar tissue formation, which is why it’s important to treat trigger points!

You can eliminate trigger points in your muscles using a $30 tube of foam! Foam rollers offer many of the same benefits as a sports massage, but without the hefty price tag.

Foam rolling applies pressure to the trigger points. When you pause the roller on a trigger point for a few seconds, it helps release the tension (myofascial release) in the muscle and the pain starts to abate.

By using your own body weight and a cylindrical foam roller you can:

• perform a self-massage (myofascial release)
• break down soft tissue adhesions and scar tissue, making your muscles more pliable and functional
• break up trigger points
• increase flexibility
• minimize soreness and help your muscles feel relaxed
• increase blood flow and circulation to the soft tissues

I like to use both plain foam rollers, as well as the ones with “teeth”. The teeth kneed your muscles and stretch your fascia, helping to erode trigger points. This helps improve flexibility and minimize injury. Plus it feels good. I prefer using the foam roller with teeth because it allows me to do more intense myofacscial work compared to the conventional foam roller.

These are the foam rollers I have in my house. Click on the photos for more information.

Note: foam rollers even come in travel sizes! Click on the photo for more information.

Technique:

1. Position the area of your body you want to work on top of the foam roller.
2. Your body weight creates the pressure that massages and releases tight spots in the fascia. You control the pressure by applying more or less body weight on the foam roller.  Only apply as much pressure as you can tolerate.
3. Roll the foam roller under each muscle group until a tender area (trigger point) is found. Maintain pressure on the tender area for 30–60 seconds. But be warned, it can feel excruciating.  Roll over each area a few times until you feel it relax.  Over time, foam rolling will become less painful, which means that your muscles are responding!  It may take 2 to 3 weeks before foam rolling starts to feel good.
4.  You can roll before or after training, or even before bed. Just roll!
5. Stay on soft tissue and avoid rolling directly over bone or joints.

Watch the video: I take you through an entire foam rolling program.

Rule # 9: Use a Mat!

1. Do not do sit-ups on a hard surface (the floor).

• The last time I did sit-ups on a hard floor, I developed visible bruising and open wounds (yes, my skin was abraded!) over my tailbone and a few areas of my spine! I could barely sit for a week!

2. Do not kneel on a hard surface (the floor).

• Housemaids knee (pre-patellar bursitis) is a swelling of the knee’s bursa, which causes pain and tenderness on and below the kneecap. It’s caused by pressure to the knee (ie. repeating kneeling on the floor). So put a mat under your knees when doing the ab wheel or women’s push-ups, or wear knee pads.

3. Do not jump rope on a hard surface (the floor, pavement, concrete) or with bare feet, unless you want shin splints or a stress fracture!

• Use Cross Training Shoes with adequate forefoot padding
• Jump on a surface that has give, such as wood, or a surface that will absorb impact, such as a rubberized surface or interlocking foam mats. I sometimes jump rope in my living room (which is a plush carpet).

Key points: –>Exercise on a padded mat, a knee pad mat, a plush rug, or heavy duty interlocking foam floor mats. Consider wearing foam knee pads.

Rule #10: Ideal Sleeping Positions & Pillows

First I would like to say: DO NOT WORK ON YOUR BED! I have a friend who always work in bed. This forces him into the most deleterious spinal and neck flexion postures I have ever witnessed!. And guess what? He herniated a disc, which caused excruciatingly painful sciatica. He underwent spinal surgery, and even though he no longer has pain, he has decreased strength in his leg and calf muscle. He can no longer run or jump.

• Even though he listened to me explain why his disc was herniated (because of years of poor working posture), he continues to work on his bed with the most deleterious postures I have ever seen!!! He’s so stubborn!
• So for this person (and you know who you are), and for anyone else who works on their bed, please consider compromising by purchasing a bed lumbar support pillow like this:

There are certainly different opinions about the “healthiest” sleeping position. There is no argument; however, that you should never sleep on your stomach.  Back sleeping offers the sleeper the most neutral position to support the spine. One must sleep with a pillow under the knees, as well as a proper cervical support to maintain this neutral position. Side sleeping can be more ‘hit and miss’ in terms of ensuring the sleeper uses the proper neck and hip support …and doesn’t favour one side. In addition, side sleeping has the disadvantage of causing shoulder, arm, hip and jaw pain (TMD sufferers).  The fact side sleeping also contributes to sleep lines and the unnecessary aging of our facial skin is also a reason many anti-aging experts tell their clients to sleep on their backs. Most people are very resistant to changing their sleep habits that have been unchanged since childhood.

I’m guilty of being a side sleeper, which exacerbates my longstanding history of shoulder and neck pain. I like to use enVy™ the anti-aging wellness pillow, which was created by two side sleeping Registered Nurses in the Preventative Health field.  Since obtaining this pillow, I no longer wake up in the middle of the night with shoulder pain.  It offers the option of side sleeping with the benefits of back sleeping: optimal neck support, superior sleep quality, no pain or sleep lines in the morning and it gently encourages back sleeping with every restful night.

References:

• McGill S M.  Brown S.  Creep response of the lumbar spine to prolonged flexion.  Clin Biomech 1992; 7: 43-46.
• Beach T A C, Parkinson R J, Stothart J, Callaghan J P.  Effects of prolonged sitting on passive stiffness of the in vivo lumbar spine.  Spine J 2005; 5: 145-154
• Wipf JE.  Devo RA.  Low back pain.  Med Clin North Am 1995: 79:231-46
• Wheeler AH.  Diagonosis and management of low back pain and sciatica.  Am Fam Phys 1995; 52:1333-41
• McKenzie, Robin.  Treat Your Own Back.  7th ed.  New Zealand: Spinal Publications 1998.
• Gandavadi A et al.  Assessment of dental student pposture in two seating condition using RULA methodology – a pilot study.  British Dental Journal. vol 203 No10. Nov 24 2007
• Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Wing Chiu TT.  Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010 Apr 28.
• http://www.ccohs.ca/oshanswers/ergonomics/office/chair_adjusting.html
• Dentistry Today” September 2005 issue-, Ahearn DJ. The Eight Keys to Selecting Great Seating for Long-Term Health. Dentistry Today.  Sept 2005.
• http://www.ccohs.ca/oshanswers/ergonomics/office/chair_adjusting.html

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