Provide an easy stretching program to improve poor posture and increase flexibility

Muscles are meant to move. The advancements of modern society have made our lives more efficient, but also more stressful. While modern man can communicate and travel great distances, the methods require very little movement on the part of each traveler. Former Mayo Clinic physical therapist Dennis Zacharkow wrote, “Compared to primitive man living an outdoor life, civilized man has become a standing-around and a sitting-around animal rather than a running-around one.”¹

Today, when people say they have been running around, it usually entails sitting in a car, standing in lines, and sitting in waiting rooms. None of these activities actually challenge the muscles to move through their full range of motion (ROM).

Stiff as a Poker
Repetitive immobility, replicated on a daily basis, leads to chronic, postural overload and adaptive shortening of the muscles and fascia. This shortening of the myofascia presents as stiff joints, decreased flexibility, loss of fluidity, and poor posture. Fascia, according to Rene Cailliet, MD, “envelops individual muscle groups that separate that group from adjacent muscle groups. There is a fluid between the fibers of this fascia that acts as a lubricant to permit freedom of movement of each adjacent muscle group.”²

In his book, Bodywise³, Joseph Heller explains, “What most of us think of as balance is this sort of a state of contraction, of holding things together so they will not fall apart. Over time, this sort of posture becomes habitual, and it results in chronic rigidity.” The goals of any chiropractor, when looking to correct vertebral subluxations, are to help the body regain balance and reduce this chronic rigidity.

When a body is out of alignment, an unequal pull of gravity exists on all the body parts. Ida Rolf, PhD, recognized this years ago and addressed the relationship between gravity and posture. She noted that “man is an upright animal, and if that upright body is out of line, then the rules of the game say that the gravity is pulling unequally.”⁴ If you, as a doctor, wish to realign the spine for the better, then you must recognize the relationship between the body and gravity.

Doctors intent on the restoration of health in their patients should observe the patient’s standing and walking posture. Watch for instability and restricted movement. In Posture and Pain,⁵ Kendall et al, notes that “normal joint range for adults should provide an effective balance between motion and stability. A joint which is either too limited in range or not sufficiently limited is vulnerable to strain.” Testing and observing patients through their full ROM, from the neck to their feet, will reveal the results of habits and patterns that may have begun in infancy.

Habit-forming
How do you attempt to correct those postural imbalances? And once there is improvement, what do you do to help the patient maintain that balance? A stretching program is one tool in a chiropractor’s arsenal that is often overlooked. Most patients who enter chiropractic offices have sedentary lifestyles. Their favorite excuse is that they do not have time to stretch or exercise.

Stretching should become a habit, done regularly, like brushing your teeth. Without stretching, the patient continues to promote a pattern of restricted movement and muscle fatigue. Arthur C. Guyton, MD, points out that muscle fatigue comes from a prolonged and strong contraction of a muscle. It is the interruption of blood flow, due to contracting muscle tissue that leads to muscle fatigue due to the loss of the nutrient supply and the lack of oxygen.⁶

Teach your patients that inactivity is going to create postural imbalances, with muscles that are both tight from contraction and weak from being overstretched. One local irritating factor or metabolic abnormality of muscle is that pain and other sensory impulses can be transmitted to the spinal cord, which leads to a reflex muscle contraction.6 This means that influences, such as overworked muscles, lack of blood flow, or severe cold, will promote continued muscle contraction.

Interspersed within the muscle fibers are stretch reflexes which serve as sensory feedback for muscle fiber length.⁷ One set of reflexes, when sensing muscle stretching, will work in opposition to keep the muscle from overstretching. A different set of reflexes, sensing muscle contraction, will work to oppose the continual contraction.

Stretching regularly helps overcome the body’s natural tendency to move toward imbalance. Vertebrae, when properly aligned, have a natural fluidity. This fluidity is lost, however, if the soft tissues are in constant holding patterns, influenced by tension, stress, and pain.

A stretching program does not require a lot of time, nor should it be done only at the onset of pain or stiffness. Any program can be successful if done consistently and with purpose. Most muscles need 20 to 30 seconds to begin releasing tension, but a longer holding time is preferable. Give your patients a small number of stretches that they can easily do at home or at work. They can do stretches, either standing or sitting, and stretches should address their major area of complaint.

There should also be a set of basic stretches for the spine that include the four directions of movement: flexion, extension, rotation, and lateral flexion. These back stretches should be done daily. Some people use the stretches to help wake up in the morning, while others prefer to stretch at night. Anytime is acceptable as long as the stretches are done slowly and gently, although warmed up muscles will stretch more easily.

Your patients should know that stretching may be accompanied with mild discomfort, which is normal. If sharp or moderate pain occurs while attempting to stretch a muscle, caution patients to stop and see whether they are stretching correctly. If they resume the stretch and the pain persists, have them stop and consult you. It is important for you, as the teacher, to observe how your patients perform the stretches the next time they come into the office. This helps you assure them that they are stretching correctly, and secondly, you can determine whether they have been compliant.

Let your patients know that this is not a chore that they have to do, but rather a mini-vacation for their muscles to relax and release any built-up tension. Patients of all ages and in all occupations will benefit from having a regular stretching program. If the program comes from you, then whenever they stretch, they are going to think of you and the importance of chiropractic health care. CP

Benjamin Griffes, DC, MA, operates two practices in Tarzana and Thousand Oaks, Calif, and is a team chiropractor for local high schools. He has produced and hosted the local cable television show, “Chiropractic and You,” for the San Fernando Valley Chiropractic Society and has written a book, Stretching for Life. Griffes may be reached at 818-702-0740 or via email: stretching4life@aol.com.

References
1. Zarcharkow D. Posture: Sitting, Standing, Chair Design & Exercise. Springfield, Ill: Charles Thomas; 1988.
2. Cailliet R. Soft Tissue Pain and Disability. Philadelphia: FA Davis Co; 1984:9.
3. Heller J, Henkin W. Bodywise. Los Angeles: Jeremy P. Tarcher Inc; 1986:42.
4. Rolf I. Ida Rolf Talks: About Rolfing and Physical Reality. New York: Harper & Row; 1976:87.
5. Kendall HO, Kendall FP, Boynton DA. Posture and Pain. Malabar, Fla: Krieger Publishing Co; 1985:167.
6. Guyton AC. Medical Physiology. New York: WB Saunders Co; 1986:133, 617.
7. Schafer RC. Clinical Biomechanics. 2nd ed. Baltimore: Williams & Wilkins; 1987:155.