Full body workouts are usually more “functional” as they don’t focus on building hypertrophy to just one muscle, they require numerous muscles working together at the same time to build muscle strength and endurance. Some of these specific muscles that are worked during the exercise include deltoids, biceps, triceps, pecs, obliques, rectus abdominals (the 6 pack muscle), lower trapezius, latissimus dorsi, quads, hamstrings, and the psoas (hip flexors).

Cardiovascular benefits include strengthening the heart and lungs, increase blood flow, calorie burning, and a boost to the metabolism to increase fat burning. The more reps performed at high speeds leads to increased amount of energy expenditure, resulting in more calories burned. Muscle toning and fat burning, wrapped up into one simple low cost exercise.

How to perform Mountain Climbers:
1. Start in a plank position with hands flat on the floor directly under the shoulders and toes of both feet holding the lower body up so the body is in a flat starting position.
2. The right foot comes off the floor and the knee comes up towards the chest, as close to your body as possible. At this point, there is a three point contact and the core is fighting to keep the body in a straight line – core workout!
3. Extend the right hip back to the starting plank position without bobbing the hips to maintain a straight line from shoulders to the feet. As the right foot is coming back to the floor, the left foot lifts up and the knee is flexed up towards the chest as described above.
4. Ensure the shoulders are moving as least as possible from the position over top of the hands on the floor.
5. Mountain Climbers can be done slowly, with short intervals of both feet on the ground at the same time, but they are often sped up so there is a moment in time of neither foot on the ground as one hip is flexing up towards the chest and the other is extending back towards the ground. To increase the cardiovascular workout, speed up the leg motion.
6. 20 reps is a good amount, but depending on level of intensity and fitness, more or less reps can be performed while providing good health benefits.

When not to do Mountain Climbers

If you are experiencing low back pain, or radiating pain down the leg, Mountain Climbers may lead to longer duration or increased intensity of low back pain or leg pain. Do not continue to perform Mountain Climbers if you have moderate low back pain during the exercise, or if a mild level of low back pain persists the day after performing the exercise.

Have a great day,
Dr. Lucas Tisshaw
Vancouver Chiropractor and A.R.T provider

Flat water boards tend be larger (longer, wider, and with higher volume) which provides more stability. They usually have a flat bottom, which forms a big, stable platform. The size of the board you choose will ultimately be based on your weight and experience on the water.

From a fitness and postural perspective, I love the calm, relaxed nature of flat water paddleboarding which allows you to consciously focus on several aspects of your body.  For example, trying to stand up without hunching over provides a great opportunity to practice postural alignment in a dynamic setting. Think about when you are at the gym and you are trying to maintain your balance while standing on a BOSU ball or wobble board. This is conceptually the same only you have water and a board underneath you. One key aspect of maintaining a neutral standing posture in a dynamic setting is to ensure you are not locking (hyperextending) your knees. Pay attention to relaxing your quadricep (anterior thigh) muscles and ensuring you are maintaining a neutral pelvic tilt; this will provide a much more stable environment capable of recovering from small dynamic shifts in your balance. If you don’t unlock your knees, over time, this could lead to knee, hip, or back pain.

If you’re aware of your posture (or being constantly reminded by your Chiropractor ? ), tight upper traps, neck tension, and weak low back muscles are likely responsible.  With SUP, you have to consciously be paddling on both your left and right sides, so shoulder mobility is also important. Imagine trying to navigate with your paddle, while your shoulders are scrunched up by your ears (I refer to this as your “schneck”.) Wall Angels are a stretch/stability exercise I recommend to almost every patient with neck or shoulder issues.

People often ask me if SUP is good for your core. SUP provides you with a fabulous opportunity to engage your abdominal muscles to create stability and minimize rotation in a dynamic setting. This is due to the balancing and bilateral paddling motion, which is a different motion than traditional crunches or exercises like the plank that people use to work their core.

If you want to experience the serene environment of calm waters while getting in a work-out, SUP is perfect for you. Bear in mind you still need to consider other forms of exercise to create a well balanced exercise regime, but this is one of my new favourite activities to recommend to my patients. I did it for the first time while travelling in Mexico and I can’t wait to get out and do more of it.

If you are concerned you are not “conditioned” enough to start SUP yet, here are some ball exercises, core exercises, leg exercises, upper, and low back stretches to prepare you.

Enjoy the sun!
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Fortunately, you can improve your chances of avoiding recurrences by rehabilitating your back, whether you are experiencing your first bout with low back pain or have had extensive treatments or even surgery.

Causes of back pain
There are several structures in the back that can cause and/or contribute to low back pain. Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber as we go about our activities, sometimes the disc fails over time due to repetitive compressive forces, or when there is a sudden, unexpected force (such as a fall, lifting or other trauma). Unfortunately, when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.

Making matters worse, the pain often prevents us from getting enough exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities cause the disc to swell up with water and then squeeze it out – much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate.

Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material.

The muscles, ligaments and tendons in the back are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibres of ligaments and tendons can begin to adhere to each other, lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when muscles are injured they can quickly repair themselves.

However, muscles contribute to chronic back pain. When nerves are damaged or pinched, the muscles they control may not work as efficiently, as sometimes happens when a herniated disc presses on a nerve. Also, since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.

Acute vs. chronic back pain
It’s important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but gradually resolves as the injured part heals.

Unlike acute pain, chronic pain comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a “neural memory” after the initial source of irritation has resolved. The adaptation of our nervous system to this chronic stimulation creates an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas.

Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Chiropractic adjustments aid in the body’s ability to regulate the neural feedback much like a dimmer switch can control light. This also helps to create the physiological conditions that allow the injured structures to heal.

Rehabilitation exercises
One of the keys to recovering from an episode of back pain and to help avoid future recurrences of back pain, is to undergo proper rehabilitation in terms of stretching, core strengthening, and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned.

There are three types of muscles that support the spine:
• Extensors (back and gluteal muscles): used to straighten the back (stand), lift and extend, and move the thighs out away from the body.
• Flexors (abdominal and iliopsoas muscles): used to bend and support the spine from the front, they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.
• Obliques or Rotators (side muscles): used to stabilize the spine when upright, they rotate the spine and help maintain proper posture and spinal curvature.

While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.

For all forms of exercise, it is advisable to see a trained and licensed chiropractor as they are the experts when it comes to your back. Depending on your specific diagnosis and level of pain, the rehabilitation program will be very different, and we are trained to develop an appropriate rehabilitation program and provide instruction on correct form and technique.


Stretching
Any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain.

Stretching exercises should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a role in lower back pain, as it is clear that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don’t make the mistake of thinking that something as simple as stretching won’t be effective. However, be cautious as you can also over stretch a muscle!

Strengthening
Re-injury is less likely to occur if core strengthening is included in your treatment plan than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than 72 hours should be addressed with your Chiropractor, treated to aid in mobility restoration and pain management, and then proper strengthening exercises to prevent a recurring cycle of pain and weakness.

There are two primary forms of exercise for strengthening and/or pain relief that tend to be used for specific conditions. When appropriate, the two forms of physical therapy may also be combined.

McKenzie exercises, in general focuses on extending the spine to reduce pain generated from the disc space. Theoretically, extension may also help reduce a herniated disc and reduce pressure on a nerve root. For patients who are suffering from leg pain due to a herniated disc (e.g. sciatica), extending the spine may help reduce the leg pain by “centralizing” the pain (moving the pain from the leg to the lower back). For most people, back pain is usually more tolerable than leg pain. Sometimes, based on the structured evaluation, flexion exercises are appropriate.

Lumbar stabilization exercises focus on finding the patient’s “neutral” spine, or the position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. Performed on an ongoing basis, these exercises can help keep the back strong and well positioned. Special attention is paid to the extensor muscles of the lower back with resistance exercises.

Additionally, a strengthening program that involves progressive loading and unloading of the lumbar spine by means of flexion/extension exercises can reduce pain and increase the perception of improved back strength. This training, called facilitation, is best accomplished when the muscles to be facilitated are isolated in some way so that other muscles cannot take over the job. Often specific equipment is required to achieve that goal.

Low-impact aerobic conditioning
Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.

Examples of low impact aerobic exercises that many people with back pain can tolerate include:


Stationary biking. Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward.

Walking. Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.

Water therapy (also called pool therapy or hydrotherapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water alleviates gravity and provides buoyancy as well as mild resistance.
Depending on your injury and exercise preferences, you may prefer a different form of exercise. It may be helpful to discuss your options with your chiropractor or physical therapist to identify an appropriate form of aerobic exercise for you and incorporate it into your exercise routine.

Guidelines for successful recovery
In addition to chiropractic care, stretching, strengthening, and aerobic exercises, there are several basic guidelines that can help you in your healing and rehabilitation process. These guidelines include:

Manage anxiety
Controlling anxiety and fear of re-injury is very important to regain normal muscle function. The basis for these psychological reactions to low back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically tells the muscles to improve their function can overcome this neurological barrier to normal muscle function.

Eat properly
The healing process can be aided with appropriate nutrition, which includes adequate calorie intake in a balanced manner. If all calories consumed are in the form of sugars (such as breads, pasta, and sweets), any calories not immediately needed for energy are converted into fat. You don’t need extra weight while you are in the healing process. Your diet should include adequate protein as a source of the building blocks of soft tissue healing. Additionally, fresh fruit and vegetables supply the vitamins and trace elements necessary for effective healing. A vitamin supplement may also be helpful.

Get adequate sleep
One of the best ways to encourage sleep is to induce physical weariness through active exercise. Chronic inactivity does not create a need for the deep sleep that is so helpful for physical and emotional healing. Clearly, stimulants such as caffeine or nicotine should be avoided at bedtime. Smoking should also be avoided because it diminishes the available blood supply and makes the nervous system more sensitive.

Control medication use
While medications are often important for pain relief, one should also be careful about the use of medications. Dr. Serné recommends natural forms of anti-inflammatories, muscle relaxants, and other tissue healing alternatives. The use of heat or cold, or liniment or massage, as a mechanism for pain control is a very safe and positive alternative for pain management.

Exercise properly
Exercise in a controlled, gradual, and progressive manner is the only way we can tell our body to heal. Injections and medications can provide pain relief but cannot stimulate the healing process. If a pain problem has persisted for many weeks, the body is demonstrating that there are barriers to the healing process that need to be eliminated. The natural stimulus for the healing process is active exercise. Active exercise means we use our nervous system to tell the muscles what to do, and includes dedication to an appropriate, comprehensive exercise and rehabilitation program.

Finally, an important guideline is to seek the assistance of an appropriately trained and licensed health professional for your rehabilitation. Likewise, it’s always important to see the Chiropractor if your lower back pain lasts for more than a few days or if you have any symptoms that cause you concern, as the continued pain and/or symptoms may signify a serious medical condition.

Ultimately, participating in developing and maintaining an active rehabilitation program for back pain should help you heal faster and have fewer recurrences of pain.

Have a great weekend,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

General Advice:

1. Balance activities with rest. Change positions and take short rest periods often. Slowly increase activities over a period of time.
2. Use ice or contrast treatments to help alleviate muscle tension and increase circulation. Moist heat applied to the muscle is the next best alternative for non-acute problems.

Sleeping:

Avoid sleeping on stomach

A. When sleeping on back:

1. Use a Therapeutica© pillow or towel rolled under neck
2. Elevate your legs by placing one pillow under the knees.
3. Attempt to quiet the mind; when our minds are active, so are our muscles. Focus on deep breathing.

B. When sleeping on side:

1. Lay head on a pillow large enough to fill from one ear to shoulder(neck should lay 90 degrees to shoulder.)
2. Place a pillow between the knees and ankle to support the hips and sacroiliac joint.

Standing or Sitting:

1. Keep the chin tucked in, shoulders back and relaxed, abdomen tightened, maintain the hollow in the back, and knees slightly relaxed. REMEMBER: head over shoulders and chin level!
2. Avoid bending head backwards into extreme positions.
3. Avoid pushing the head forward (think of an apple between the chin and chest)
4. Sit and stand, pretending a string is pulling up from the back of the head.
5. When sitting, have support in the small of the back.

Working:

1. Perform all work with hands as close to the body and elbows at your sides.
2. Avoid holding arms overhead or at shoulder height
3. Pull the seat forward and hold onto the bottom of the steering wheel when driving.
4. Place your work surface high enough so that it is not necessary to bend over your work.
5. Change your work position often to avoid stiffening of weight bearing joints.
6. Avoid lifting. If you have to lift, keep your back straight, stoop with knees bent, keep the close to you, and then lift with your legs.
7. Check your alignment several times throughout your work day. Keep your head over your shoulders.

Remember the rule of 90°; ankles, knees, hips, elbows, shoulder, and chin should all be 90° to the floor.

Should you wish to book an appointment with one of our Chiropractors, please call the office.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

Related Articles:
Upper Body Stretches
Stretches for Nursing Moms (or anyone else with stiff upper Back)
Mouse Placement
Sleeping Positions to Alleviate Neck Pain
Correcting Faulty Posture
Pillow Talk

TIP: Sleep on your side with a pillow between your knees. The pillow under your neck should be large and firm enough that when you lie on it, your neck is maintained at 90 degrees to your shoulder. 

You should not sleep on your side with a contoured pillow as it will create a tilt in your neck. Contoured pillows are only designed for sleeping on your back. *

Sleeping on your back is another alternative. It is best to sleep with a pillow tucked under your knees, and a contoured pillow behind your neck. If you find it difficult to “turn off” the brain when on your back, consider purchasing black out blinds to make the room as dark as possible, or wear an eye mask.

Have a great day and great sleep everyone!
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

*if you would like more information regarding pillows, mattresses, or sleeping positions, please contact reception to book an appointment.

1.  Child Pose

This is a great pose designed to stretch out the paraspinal muscles (the muscles that run along side your spine).  Ensure that the buttocks is as close to the heels as possible to maximize the effect of this stretch.  However, know your limits and don’t push your body beyond what it is capable of!

2.  Double Sided Spinal Twist

I find this a great stretch for the lower back.  I never recommend that patients attempt to do a single leg twist as they will often malposition themselves and cause pinching of their SI joint.  If you find it challenging to lower both knees to the floor, stack some pillows under them so that you can ease into the stretch.

3. Hamstring Wall Stretch

One of my favourite stretches as it is a very gentle stretch for the hamstrings, and the lower back is in a neutral positon while  esting on the floor.  It also allows for one to see if the legs are different lengths when they rest against the wall so you can correct for it.

4.  Glut Cross Over Stretch

When doing this stretch, make sure you hug your leg tight to the chest to maximize the stretch.  You should feel the stretch right behind the hip of the leg that is crossed over, but often in other locations as well.

The above stretches can be modified to your individual needs, so please ensure that speak to your health care provider prior to attempting any of them.

Have a great week!

Dr. Crysta Serné

Chiropractor and owner of Vitality Clinic

*If you have an injury, or have never attempted to perform these stretches before, please consult with your health care provider.  Vitality Clinic and Dr. Crysta Serné accepts no responsibility.