A tight upper back may be attributed to stiffness in the shoulder, neck, or back muscles surrounding the thoracic spine. Rounded or slump shoulders, having sway in the lower back, or a forward head position due to weak back extensor muscles, short and tight chest muscles, or weak abdominal muscles may result in an individual having poor posture. Poor posture can place tension in the upper back and may result in irritation or pain. Sports, weightlifting, irregular sleeping positions, or car accidents may also cause tightness in the upper neck and back region. Mobilizing and strengthening the muscles surrounding the thoracic spine may relieve an individual of stiffness or pain, while improving an individual’s range of motion and functioning. Remember to have a balanced, upright posture by standing tall, bringing the shoulders down and back, tuck your chin, and keep a neutral spine to work on better posture.
Lie sideways on a mat or on the floor with both arms extended to one side and hands together. Bend the knee of the top leg to form a 90 degree angle. Place a long foam roller underneath the bent knee if you are unable to touch the ground with this top knee. Keeping your lower body in this position, twist your upper back by bringing the top arm over your body to the other side to touch the floor. Repeat 10-12 times, then lie on the other side and complete the same movement.
Begin in a table-top position with your knees hip-width apart and wrists shoulder-width apart on a mat or on the floor. Keep a neutral spine and head position. Move into the “cow” pose by inhaling as you drop your belly down towards the mat as you lift your chin and chest up to gaze toward the ceiling. Then move into the “cat” pose by exhaling as you draw your belly into your spine and round your back toward the ceiling. Repeat 10-15 times.
Begin seated in a chair with both feet planted on the floor or seated on the floor. Raise one arm up towards the ceiling. With your arm raised above your head, slowly bend to the opposite side. Return to the start position and lower your arm. Then raise the other arm and slowly bend to the opposite side. Repeat 5-10 times on each side.
Place a long foam roller perpendicular to your spine on a mat or on the floor underneath your shoulder blades. Interlace your fingers and place your hands behind your head to support the weight of your head. Slowly push with your feet to roll the foam roller up and down the thoracic region. Maintain a neutral spine and engage your abs.
This exercise helps to re-train muscle activation in the shoulder blades and mobilizes the muscles surrounding the thoracic spine for a better functional recovery. Place your hands and knees in a four point or table-top position with a neutral spine. Engage the inner core and start by walking one hand out to one side, then back to the centre, and then to the other side, then back to the centre again. Put full equal weight each time you place your hand down. Maintain a neutral spine throughout the exercise. Repeat for 30 seconds for 3 sets.
Ever feel pain or swelling on the side of your foot? These symptoms may be due to a condition called Cuboid Syndrome, also known as cuboid subluxation or lateral plantar neuritis. In addition to pain in the lateral mid-foot, redness and a restricted range of motion in the ankle may be present. This syndrome is typically associated with an inversion sprain of the ankle. This is when the foot is forced inwards causing the cuboid bone to sublux, or partially dislocate. The cuboid bone is located near the mid-point of the outer side of the foot and is one of the seven tarsal bones that make up the arch of the foot. It connects the foot and ankle as well as provides stability to the foot.
The peroneus longus muscle is a muscle that runs along the outer side of the lower leg and attaches to the lateral side of the foot. Repetitive strain of this muscle due to activities such as ballet, jumping, or running, may place tension on the cuboid bone. Commonly found in athletes, Cuboid Syndrome may also occur in sports such basketball, football, or soccer. Weight-bearing, uneven pavement, or quick changes in direction that occur in sports may aggravate symptoms. A third cause of this syndrome may be an individual’s altered foot biomechanics. Athletes who have over-pronated feet, also known as flat feet, may be more prone to cuboid subluxation.
Imaging such as x-rays, MRIs, and CT scans can be used to rule out other causes of pain. However, a cuboid subluxation can be difficult to diagnose and therefore, must be carefully assessed by a general physician or other health care professional.
Daily strengthening and mobility exercises should be performed on a pain-free basis to prevent the foot and ankle from becoming weak or stiff. Watch the videos below on how to properly perform strengthening exercises:
Other treatment options include foot support such as padding, taping, or orthotics to help stabilize the bones of the midfoot or correct for over-pronation. Rest from repetitive, weight-bearing actions such as jumping or running may help alleviate pain. Ice affected area for 10 minutes at a time to reduce swelling and inflammation. Consult your family physician, physical therapist, or podiatrist to perform a manipulation if the cuboid bone is suspected to be dislocated.
Persistent pain between the shoulder pains, or interscapular pain, may arise from a number of varying causes. The scapula is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone) on either side of the body. The intrinsic muscles of the scapula include the subscapularis, teres minor, supraspinatus, and infraspinatus, all of which make up the rotator cuff. The major muscles surrounding the scapula that make up the interscapular region include the rhomboids, trapezius, and levator scapulae.
The Achilles tendon is the thickest tendon in the human body. It attaches the gastrocnemius and soleus muscles (together known as the triceps surae) as well as the plantaris muscle to the calcaneus bone (heel) of the ankle. These muscles combined allow for plantar flexion at the ankle and flexion of the knee.
Tendinopathy of the Achilles tendon refers to a condition that causes pain, swelling, or stiffness at the tendon connecting the muscles to the bone. Commonly found in athletes such as runners, overuse of the tendon, may result in microtrauma or repeated injuries to the Achilles tendon. Wearing improper footwear, having poor training or exercising techniques, making a sudden change to your training program, or exercising on hard surfaces may also cause minor injuries to this tendon. Pain and stiffness may develop gradually and are typically worse in the morning. Pain is generally worse after exercise, but may potentially arise during training. Overtime, symptoms may be so severe that individuals may be unable to carry out their usual daily activities.
Rehabilitation occurs quickly or over several months depending on the severity of the injury. Although pain may be present, expert clinicians and researchers recommend continuing daily activities within one’s pain tolerance. As complete rest should be avoided as much as possible.
In the early stages of Achilles tendinopathy, a treatment called iontophoresis may be used to reduce soreness and improve function. This treatment involves delivering a medicine (dexamethasone) to the painful area. Ice packs are also effective in reducing swelling. Apply ice pack wrapped in a towel or dry cloth to the affected area for 10 to 30 minutes at a time.
However, researchers have found that Achilles tendinopathy is often successfully treated with strength training guided by a physical therapist. Strength training relies on using one’s body weight with or without additional weight for resistance to load the tendon and associated muscles to strengthen the calf. Do exercises slowly to decrease pain, improve mobility, and return to normal functioning.
1) Heel-raise: Stand with your feet a few inches apart. Raise up on to your tiptoes and lift the heels by using both legs. Then lower yourself down using the affected leg. Perform 3 sets of 15 repetitions twice per day. This exercise can also be performed seated in a chair.
2) Calf stretch: Stand a few steps away from a wall and place your hands at about eye level. Place the leg you want to stretch about a step behind the other leg and bend the knee of the front leg until you feel a stretch in the back leg. Remember to keep your heels planted. Hold this position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat twice per day.
3) Towel stretch: Sit with both knees straight on the ground and loop a towel around the affected foot. Gently pull on the towel until a comfortable stretch is felt in the calf. Hold position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat two to three times per day.
Acute sprains and strains may impede performance and delay return to a sport. Proper management, treatment, and prevention is essential to recovering effectively. An athlete must first understand the definition and recognize the differences between a “sprain” and a “strain.” A sprain is defined as a violent overstretching of one or more ligaments in a joint. A sprain can result in pain, tenderness, swelling or bruising at the joint. A strain is defined as a stress or direct injury to the muscle or tendon. A strain may also cause pain when moving or stretching the injured muscle, but can also cause muscle spasms.
1) Grade I – Mild Strain: slightly pulled muscle with no muscle or tendon tears and no loss of strength and low levels of pain
2) Grade II – Moderate Strain: partial tearing of the muscle or tendon at the bone attachment with reduced strength, moderate pain levels
3) Grade III – Severe Strain: complete rupture of muscle-tendon-bone attachment with separation, substantial loss in strength and high levels of pain
1) Grade I – Mild Sprain: minor tearing of some ligament, no loss of function
2) Grade II – Moderate Sprain: partial rupture of portion of ligament, moderate loss of function
3) Grade III – Severe Sprain: complete rupture of ligament or separation of ligament from bone, substantial loss of function
2) ICE: Sudden cold may help constrict capillaries and blood vessels to slow or restrict internal bleeding. Place an ice pack between a towel or dry cloth. Apply ice every hour for 10 to 20 minutes at a time.
3) COMPRESS: Compression can help reduce swelling post-injury. Wrap the injured part firmly with an elasticized bandage, compression sleeve, or a cloth. Do NOT wrap the cloth too tightly as it may cut off blood circulation and lead to more swelling.
4) ELEVATE: Elevate the injured part about level of the heart to reduce swelling and pain. Place a soft object such as a pillow or piece of clothing to use as a prop below the body part.
Continue to follow the above RICE method for two to three days post-injury. Daily stretching may help loosen the muscle. Key to prevention is to stretch the tight muscles and strengthen the weak muscles.
Watch the videos below on how to recover from a common ankle sprain or shoulder strain:
The term “tendinitis” is frequently used by injured individuals, family practitioners, and medical specialists. Commonly present in the Achilles, lateral elbow, and rotator cuff tendons, many still believe that there is a large inflammatory component in overuse tendinitis and anti-inflammatory medication can be used to treat this condition.
According to Assistant Professor Khan of the Department of Family Practice at the University of British Columbia (2002), “ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendinitis despite the lack of a biological rationale or clinical evidence for this approach.”
Patients who present with a painful overuse tendon condition more likely have a non-inflammatory pathology. Studies have revealed that the cause of tendon pain arises from collagen separation. Collagen is the main structural protein found in connective tissues. When these tendon fibrils become thin, frayed, and fragile, they begin to separate and become disrupted in cross section. This leads to an increase in tendon repair cells rather than inflammatory cells.
There is limited evidence of short term pain relief and no clear evidence of effectiveness when relying on anti-inflammatory medications. A more appropriate term would be to use “tendinopathy” to acknowledge that the overuse condition is not in fact tendinitis. Correctly utilizing this term provides patients with a more accurate description of their condition, prevent ineffective pharmacotherapy, avoid medical costs, and allow time for collagen to repair. Tendon disorders realistically take months rather than weeks to resolve. Allow time for rest and slowly incorporate exercises for area of concern. See a physiotherapist for proper diagnosis and treatment options.
Weak scapular muscles can lead to an array of injuries including shoulder impingement, rotator cuff tears, and other shoulder-related pains. Pain may be followed by a restricted range of motion and may severely worsen if left untreated. Strengthening the scapular muscles can provide long-term benefits for rehabilitation and performance. Try the five following exercises below:
1. Lie down flat on a bench with a light dumbbell in each hand.
2. Hold the dumbbells on either side of your chest with the palms facing away from your shoulders and your elbow at a 90 degree angle.
3. Push your arms upwards and feel your shoulder blades separate. Remember to keep the dumbbells parallel to each other until the very top of the press.
3. Inhale and slowly bring down both dumbbells to the sides of your chest until you reach the 90 degree angle at the elbow. Breathe out on your next rep. Perform 3 sets of 10 reps.
1. Stand a few steps away from a wall, then place your hands on the wall so that they are slightly more than shoulder-width apart and arms are locked out.
2. Maintain a neutral back and neck, then slowly lean towards the wall by bending your elbow.
3. Squeeze your shoulder blades together as you lower yourself and hold this forward position for 2-3 seconds.
4. Slowly straighten your arm and relax your shoulder blades. Repeat 10 times.
1. In a comfortable standing position, hold a light band in between both hands about shoulder-width apart.
2. Pull the band as wide as you can, then slowly bring the arms back to the starting position. Perform 3 sets of 10 reps.
1. Lie on your stomach on a bench or Swiss ball with a light dumbbell in each hand.
2. Straighten your arms so that the dumbbell is in front of your head.
3. Lift the dumbbells up, keeping your arms straight, to make a “Y” shape with your torso.
4. Slowly lower them down. Perform 3 sets of 10 reps.
1. Hold a very light dumbbell straight in front of you at approximately 45 degree angle.
2. Maintain this position for about 10 seconds.
3. Then, slowly lower the dumbbell to the side of your body. Perform 10 holds on each side.
BONUS: Watch this video to learn an extra exercise for the scapula muscles!