Stop Neck and Back pain NOW!

Get rid of neck and mid back

pain ASAP

Causes

There are several reasons for neck and back pain but

among the most common are improper and lack there of

movement of the neck and shoulders. Most modern jobs

are now sedentary and therefore can cause a multitude of

musculoskeletal disorders. This can create poor flexibility,

improper muscular control of the shoulders and neck, and

weakness in the cervical flexors and scapular retractors.

What we will discuss in this article are tips and even

exercises to improve and even prevent pain.

Upper Cross Syndrome

Upper Cross Syndrome is a simple way of looking at common muscular imbalances that most

individuals with desk jobs may present with. Tightness in the Upper Traps and Pec Muscles and

which form the 1st line, and weakness in the deep neck flexors and lower trap muscles creates

the crossing line. This represents a textbook complication of muscle imbalances.

What to do about it?

The answer is quite simple. How about we start with postural correction.

1. Relax your shoulders and have them slightly pinching (Think chest out)
2. Sit up straight and have your chin tucked closer to your neck.
3. Keep your computer screen eye level and keep your elbows remain at your side
4. Try and get up and move frequently. Even though this may be the optimal posture,

it is very important to keep moving - your next posture is the best posture - So stay moving!

Prevention and Exercise

Let’s take a look at some exercises that can help prevent and even relieve neck and back pain.

1. Pec Stretch -Lean into a doorway at shoulder level - Hold for 20 seconds for 3 reps

2. Shoulder Pinches - Pinch your shoulders together and downward, hold for 3 seconds and repeat 10 times

3. Chin Tucks - Draw your chin toward you neck and head level, hold for 3 seconds and repeat 15 times

  

Conclusion

These exercises can be performed several times a day especially during the work day.

Remember that movement is life and although correcting your posture can help, staying active

throughout the day will truly relieve your pain. If you continue to have issues it is

important that you discuss them with your physician or see a physical therapist.

Thank you for reading and for any questions please feel free to contact

Bonnette Elite Physical Therapy and Wellness.

Sincerely,

Dr. Alex Bonnette PT, DPT, OCS, CSCS

Dr. Bonnette is the owner and director of physical therapy of Bonnette Elite Physical Therapy

and Wellness. He has been in the healthcare industry for the past 8 years, providing treatment

and education to the Fort Worth Community. He is a Board Certified Orthopedic Clinical

Specialist. He currently has 2 clinics operating in West and South Fort Worth. Each clinic

is run by Doctors of Physical Therapy. For any questions please feel free to contact us.

www.fortworthphysicaltherapist.com

9628 Bartlett Circle, ste 300 Fort Worth, TX 76108 CALL TODAY (817) 862-9665

             

Hypertrophy Training

Hypertrophy Training

This is going to be an example hypertrophy training split/routine that I will actually be participating in over the next few months. So the goal of this routine will be to increase muscle mass and maintain or even decrease body fat. This will go through the holidays and end around March. From there a focus on decreasing body fat by clean eating and dieting will be implemented.

Weightlifting

Split 1:

1.     Chest

2.     Back

3.     Biceps, Triceps, and Shoulders

4.     Legs

5.     Repeat

Split 2:

1.     Chest, Triceps, and Shoulders

2.     Back and Biceps

3.     Legs

*Abdominals and Calves will be trained every other day

          -Abdominals will be worked in conjunction prior to cardio

These 2 will be based upon muscle fatigue and soreness(if I feel like one week I did not get very sore I will make the split shorter like Split #2)

Each Weightlifting session should be anywhere from 30-60 min.

Rest days will be implemented as needed(most likely 1 every 2 weeks)

Cardio

Cardio will be performed 3-5 times per week, 30-60 minutes each session

          -Cardio will most likely be performed in the morning on an empty stomach

                   -If cardio is not performed in the morning it will be performed after weightlifting

                   -The goal of fasted cardio is to utilized stored fat in the body(there is some discrepancy among the research regarding this, but I find it works well for me)

I prefer the elliptical or walking on an incline when performing cardio and try to target around 65-75% of my HR max. Since I am flat footed I tend to have pain after running especially when it is frequent and prolonged.

Exercises- One thing that is fairly consistent with most of my splits is that every body part is worked with 4 moves(2 complex/power exercises and 2 simple/auxiliary exercises) Studies show that exercises that involve multiple joint and muscle movements activate more muscle fibers and recruit more motor units thus increasing mass over time. Exercises that involve single joint and muscle movements are used to isolate the muscle and further fatigue the muscle. This also allows for better concentration and focus on the particular muscle group that is targeted.

Chest Example: As you can see I chose 2 “mass” moves(incline DB, flat BB) and 2 auxiliary(flyes and crossover)

1.     Incline DB 4 sets x 8-15 reps

2.     Flat BB Bench 4 sets 8-15 reps

3.     Flye machine 3 sets 10-15 reps

4.     Cable Crossover 3 sets 10-15 reps

Back Example: when working back I separate it into 2 different areas of focus(high and low) and 2 different grips(close and wide) By doing this we can target the entire back.

1.     T bar Row machine with chest plate 4 sets 8-15 reps

2.     Bentover DB rows 4 sets 8-15 reps

3.     Lat Pulldowns 4 sets 10-18 reps

4.     High pulley rows 4 sets 8-15 reps

5.     DB Shrugs 4 sets 12-20 reps

Biceps Example

1.     Heavy DB curls 4 sets 8-15 reps

2.     BB curls 4 sets 8-20 reps

3.     Machine Preacher curls 3 sets 12-20 reps

Triceps Example

1.     Tricep Cable Pressdown 4 sets 10-20 reps

2.     Skull Crushers 4 sets 10-15 reps

3.     Dips 4 sets 15-25 reps

Shoulder Example: shoulders are one body part I train differently than most. When lifting shoulders I focus on the middle delt and some light work on posterior delts and frontal delts. The anterior portion of the deltoid is always being worked anytime you do chest so I focus my attention on the middle delt with primarily lateral raises. There are times I do 10 sets of lateral raises and that’s all.

1.     DB Lateral Raises 6-8 sets 8-20 reps

2.     Upright rows 2 sets 10-15 reps(light)

3.     Machine shoulder presses 2 set 10-20 reps(light)

4.     DB Bentover Rear Delts 4 sets 10-20 reps

Legs Example: Squats, Squats, Squats… Legs respond best to complex/multijoint exercises such as squats, lunges, and leg press. Study after study have proven this, so if you want the wheels you have to do the right exercise with heavy weight.

1.     Leg Press 6 sets 10-20 reps

2.     BB Squats 4 sets 10-16 reps

3.     Leg Extension 5 sets 10-20 reps

4.     Leg Curl 4 sets 8-14 reps

Again this is a routine that I personally will be participating in and it may not suit everyone. I suggest reading articles for yourself and checking with your Doctor to see if this program or any other is appropriate for yourself

Most of this information from above can be found in the Text Book: The Essentials of Strength Training and Conditioning

Thanks,

Dr Alex Bonnette PT, DPT, OCS, CSCS

Doctor of Physical Therapy and Owner

Bonnette Elite Physical Therapy and Wellness

Cardio Options

Cardio- Which exercise is best and why

Many people have several misconceptions with cardio regarding how long to do it, what type of cardio is best and what target HR is best. Today we are going to go over a few of the highlights that I find important for whatever goal you may have set and give proper advice as well as educate you from fact and myth.

1. Type of Cardio

          Competition-If you are a competitor it is always best to practice how you will perform (cyclist need to cycle and runners need to run)

         Weight Loss-Well I have always been fond of the elliptical and recumbent bike, especially for those people who are on a little bit of the heavy side. These machines allow for low impact on the body and will leave you with less achyness in the joints and can also give you one hell of a workout.

          Heart Health-This is solely based on preference. The primary objective with heart health will be to maintain a certain HR intensity for a given amount of time(we will go over this momentarily)

2. Intensity

          Competition-Competitors typically have to do a variation of light intensity with an emphasis in endurance, and also high intensity with an emphasis in power. Again this is all dependent on the sport at hand.

          Weight Loss-For weight loss a target HR of around 60-75% of HR max is best for fat burning for at least 30 min or more. This % allows for longer durations of exercise, however  weight loss can also be attained at higher intensities(more calories will be burned per min) but it is much more difficult to maintain the higher intensity.

          Heart Health-Heart health is best attained at a higher intensity since the heart will have to work more to increase blood flow to the body. A HR max of 75-85% at which is maintained for 30 min is ideal for heart health.

3. Duration/Frequency

          Competition- This is something that is very subjective and depends on how frequently the competitor is doing higher intensity exercise. The more frequent and intense the exercise the more rest will be needed for recovery. The best formula for most competitors is to have 3 days intermittently set for higher intensity with 3 days in between of lower intensity and have a rest day per week. Duration can be anywhere from 15 min of exercise to several hours.

          Weight Loss- Since most weight loss programs are low intensity, the duration and frequency can be much higher than those of a competitor. 30-90 minutes of cardio can be performed on a daily basis if so desired.

          Heart Health-According to the AHA 5 days of moderate intensity for 30 min is adequate to maintain a healthy heart. They also recommend another option which includes 3 days of vigorous aerobic exercise for 25 min and 2 days of mod-high strengthening exercise. 

Visit www.Heart.org for more information about target heart rates and guidelines 

http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.V_0qRuArKM8

http://www.webmd.com/fitness-exercise/features/the-truth-about-heart-rate-and-exercise#2

http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/Target-Heart-Rates_UCM_434341_Article.jsp#.V_0sf-ArKM8

Top 5 Ways to Alleviate Low Back Pain

Low back pain can linger for long periods and it's time to seek out a solution. Here are 5 ways that can help alleviate the pain.

1.       Movement Analysis/Assessment

a.       By going to a specialist such as a Physical Therapist, you can determine how efficiently you are moving during various positions and activities throughout the day. This is important because certain muscles can be working too much while others are not at all. This can cause muscular imbalances such as weakening, tightening, and even create “knots” for the over loaded muscles, while atrophying the others.

2.       Physical Therapy

a.       Physical Therapists are known as the Movement Specialists among the medical community and are even educated at a doctoral level. After a thorough evaluation and assessment the Physical Therapist can determine which exercises, stretches, and modalities can be most effective for you. They can also provide manual therapy to provide deep tissue massage and Myofascial release as well as perform spinal manipulation or mobilization to correct the alignment of the spine and peripheral joints.

3.       Spinal Decompression

a.       This is a modality utilized by Physical Therapists that is used primarily for Low back pain and neck pain. Spinal Decompression is a type of traction that primarily treatments ailments that involve disk pathology, such as bulging or herniated disks, degenerative disk disease, and radiculopathies. Decompression is a minimally invasive technique that stretches the spine to take pressure off the disks. As a result, bulging disks may retract, taking pressure off nerves and other structures in your spine. Decompression is a conservative approach for those trying to avoid medications, injections, and especially surgery.

4.       Dry-Needling

a.       Dry needling is a skilled intervention that uses a thin needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. The goal of Dry-needling is to reduce the hyperirritability of the targeted muscle tissue which can be felt as a taut band in the muscle. Some people may refer to this as a “knot”.

5.       Weight loss

a.       Weight obviously determines the amount of forces placed upon the body with all movements. Even from the simplest of tasks such as walking or standing up, the amount of pressure placed on the spine is exacerbated when there is excessive weight. The good news is that just the slightest amount of weight loss (5 lbs) can be statistically significant in decreasing the amount force directed throughout the body. My advice would be to start slow and easy with just a short term goal of losing 5 lbs in one month or so.

For more Info Check out:

Bonnette Elite Physical Therapy andWellness or 

Call (817) 862-9665

Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;CD000447. http://dx.doi.org/10.1002/14651858.CD000447.pub2

Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871-881.

Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976). 2000;25:3100-3103

Mense S. Morphology of myofascial trigger points: what does a trigger point look like? In: Mense S, Gerwin R, D., eds. Muscle pain; diagnosis and treatment. Heidelberg: Springer; 2010:85-102. 

Tips to Finding the Right Physical Therapy Clinic for YOU

After speaking with several patients and other PTs I put together this list of attributes for finding the right PT clinic, enjoy!

1.      Treatment by a Physical Therapist

a.      Physical Therapists are now being educated to a Doctoral level and with that comes a vast amount of knowledge to assess and treat patients. In my opinion a Physical therapist should be the primary care giver. Too many clinics are passing off their patient to the assistant or aide and there is not enough direct contact with the PT. These places typically look to have high volume and thus distribute their patients among several employees. I find this unfair to the patient in which they are now under the guidance of at many times a high school or college student with minimal experience with rehab. This does not mean an aide or assistant should not complement the treatment, but simply means that the PT should hold the majority of one on one contact. I challenge the patient to ask before they start therapy if they will be with a Physical Therapist at every treatment.

2.      One on One Treatment with the Physical Therapist

a.      Again this relates to the previous topic, but again it is something that really is important for the patient. Like I said before many clinics opt for higher volume thus having the PT see 3-4 patients at one time. I have seen this and there not even be an aide or tech on site, so the PT is literally “treating” 3-4 patients at once. How a specialist in movement and rehabilitation provide adequate care among that many individuals is beyond me. If you are receiving less that 30 minutes of 1 on 1 time with your Physical Therapist then I suggest you look elsewhere for physical therapy if you are truly serious about reaching your goals.

3.      Attitudes and Personalities

a.      Well we all know there is nothing like going to a Doctor’s office and being treated by rude front desk staff or dealing with a stubborn physician, so why should you deal with a PT clinic any different. You’re in pain and that is the last thing you need to deal with. I have always been a believer that being positive is half the battle when trying to recover. Studies have actually shown that those people who are positive about their treatment and condition have better outcomes with pain and function. So being able to walk into a clinic and see a smiling, welcoming face can truly make a difference. This not only goes for the front office but especially the treating PT. I think it is important to find someone who not only pushes you physically but can interact socially. This in turn can motivate you to adhere to home exercises as well as actually looking forward to PT.

4.      Freedom of Choice

a.      Lastly, the Final and most important thing regarding a PT clinic is knowing that you have the choice of where to go. Many times Doctor’s offices will tell a patient they MUST go to a SPECIFIC PT clinic. This is simply not true and in fact if referred to as previously it is illegal. You as a patient have the right to chose where you will be treated. It is my advice to look up those PTs that are local, look at their reviews and websites, call and ask questions, and remember that it is your choice. Finding the right place will keep you on the right track for your full recovery.

Thanks for reading!

-Alex Bonnette PT, DPT, OCS, CSCS

Owner and Doctor Physical Therapy

Bonnette Elite Physical Therapy and Wellness

4 Ways to help decrease Knee Pain

4 Ways to help decrease knee pain

1.       Low Impact

a.       Low Impact? It is a term often thrown around when given advice about knee pain, but what does it really mean? Well basically we want to decrease the amount of force that is applied to the knee and lower extremities during walking/running that is produced by gravity. Since we cannot change gravity we must make some other external change. This can be done by losing weight, changing faulty biomechanics of walking and running, or changing the type of exercise you do.  Running will have higher impact forces on the lower extremities that cycling for example. So if running or even walking on cement cause you to have knee pain then maybe you should try the stationary cycle or elliptical or even swimming.

2.       Weight loss

a.       As mentioned before weight obviously determines the amount of forces placed upon the knee with all movements. Even from the simplest of tasks such as walking or standing up, the amount of pressure placed on the knee is exacerbated when there is excessive weight. The good news is that just the slightest amount of weight loss (5 lbs) can be statistically significant in decreasing the amount force directed to the knee. My advice would be to start slow and easy with just a short term goal of losing 5 lbs in one month or so.

3.       Physical therapy

a.       Physical therapists are known as the movement specialists among the medical community. By seeing a PT they can help address those biomechanical faults that could be causing you pain. A Gait analysis and thorough evaluation by the PT can determine if there are joint restrictions, muscular imbalances in strength or flexibility, or even if there is an alternate body part that could actually be the root cause of your knee pain.

4.       Rest

a.       There is a fine line between over training and under training. Your knee pain could be a result of too much exercise or walking. And having poor mechanics with walking will only further increase your pain. It is very important to get adequate rest to allow full muscle recovery after exercise. May times people have back pain due to long hours of sitting with little movement due to their job. Well I believe the same can be said to those who are constantly standing for prolonged periods. While there is no exact formula on sitting to standing to walking, we can agree that moving frequently is the most important take home message.

FOR MORE INFO GO TO

http://www.belitept.com

https://www.facebook.com/Belitept/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623013/?report=reader

1.       Lementowski PW, Zelicof SB. Obesity and osteoarthritis. American Journal of Orthopedics.2008;37(3):148–151

2.      J Gerontol The Effects of High-Intensity and Low-Intensity Cycle Ergometry in Older Adults With Knee Osteoarthritis. A Biol Sci Med Sci(1999) 54 (4): M184 M190