‘Lazy Butt Syndrome’? Part 2 – Fixing With Exercise

Last time I wrote an intro about how Lazy Butt Syndrome can cause low back pain.  As a recap, recall that the pain you might be experiencing in the lower back, hips or legs may actually be a consequence of GLUTE INHIBITION…lazy butt muscles that are not doing their proportionate share of the work in moving you or supporting your body.  Read that article first if you have’t yet.

This month I will introduce 4 key exercises for you to awaken those lazy glutes.

1. Hip square exercise – Get on your hands and knees on the floor.  Position your hands so they are directly under your shoulders and your knees directly under your hip joints.  Keep your head and neck in a neutral posture while looking straight down at the floor.  Extend one leg back with the knee locked straight and point your toes back too.  From there, imagine your leg is a pen and you are drawing a square.  Move the leg out, then down, back in and then up.  Those are the 4 corners of your square.  Perform at a moderate speed, don’t rush it.  Repeat 15-20 times, then switch legs.  Your glute muscles will be burning at the end of the set.

2. Hip bridge exercise – Lie on the floor with your knees bent and feet hip width apart.  Press through your heels and push your hips up off the ground until your body is flat and straight from your knees down to your upper chest.  Squeeze your glute muscles HARD and hold this position for 5-10 seconds.  Drop back down slowly and rest for 5-10 seconds.  Repeat this 10 times.  As a more challenging progression, you can perform this exercise with one leg extended forward…this will isolate one glute at a time while also working core stability/balance.

3. Monster walk – You will need a strength band to perform this as shown in the video.  Alternatively, a latex loop band placed around the knees is another option.   With both feet, step on the strength band with feet about shoulder width apart.  Pull up on the other end of the band with your arms and get into a half squat position.  From there, take 15 side steps to the right then take 15 side steps back to the left.  You should feel the muscles in the side of your hip working.

4. Single leg deadlift – Start in a standing position and slightly lift one leg backwards off the ground.  From there, hinge forward at the hip and try to bring your arms down toward the floor.  Try to have only a slight bend in your knee (unless you are like me and have tight hamstrings!).  Slowly return to standing position and squeeze your glute at the top.  This is a challenging exercise because it requires good balance to do it properly.  Perform 10 repetitions and then switch legs.  As your technique improves, you can add weight by holding light dumbbells in each hand.

Other simple things you can do during the course of your day are:

  • actively contracting your glute each time you push off your back leg while walking
  • squeezing and contracting your glutes for a few seconds repeatedly while you quietly wait in line at Starbucks!

Not sure if you have inhibited glutes but sure you have back pain, hip pain or knee pain?  Come in for a full assessment and find out!

Saying good bye to summer!

Dr. Keith

Do You Have ‘Lazy Butt Syndrome’?

Lazy Butt Syndrome (or you could substitute the word ‘Butt’ with a different word starting with the letter ‘A’)…it’s probably something associated with your teenage kids or maybe your spouse, right?

While that certainly may be true of some of your family members, I am actually talking about Lazy Butt Syndrome in the context of how your butt or gluteal muscles may not be working properly and consequently causing aches and pains in your lower back, hips, or legs.

Believe it or not, your glutes can become ‘lazy’ in that the muscles do not fire or contract in a timely or efficient manner to do the muscular work required of them during normal daily activities or strenuous activities at work or athletics.  Chiropractors, physiotherapists and other manual medicine practitioners refer to this as Glute Inhibition.

As a result of gluteal inhibition, other muscles in your body will frequently have to take up the slack and work extra hard to make up for the deficiency.  The glutes do a less than proportionate share of the work while the other muscles such as your low back and hamstrings perform an increased share.  In simplistic terms, if you had 4 workers digging a 50 foot deep hole in the ground and one of those workers decides to go take a nap under the tree instead, then the remaining 3 workers have to take up the slack for the 25% work reduction by Mr. Sleepy Head.  Over time, one or maybe all 3 of the other workers doing overtime could get injured from the increased strain.  Solution: Wake up Mr. Sleepy Head and make him pick up his shovel!

I find that people with low back pain often have gluteal inhibition and will include tests during my physical examination to assess whether that is the case.  I’d say it is pretty common…probably close to 70% of the time, the patient will have one or both glutes inhibited.

How does one develop Lazy Butt Syndrome?

The main cause of LBS is prolonged sitting.  Many people sit at their jobs for 6-10 hours per day.  Many people commute to work in their cars or GO Train for 1-2 additional hours per day.  Many of these same people then do very little activity once they get home.  Some of these people might do 1 hour of ‘exercise’ on most days of the week but it still may not be enough to counteract the effects of the cumulated hours of sitting on their butts.

Another cause of LBS is overuse through work or exercise without sufficient recovery.  In this case, because the glutes are excessively tense due to activity, the brain will sense that they are over-stressed and at risk of injury and send nerve signals to turn the glutes off.

Thirdly, muscle imbalances in the hip and pelvic region can also cause glute deactivation.  For example, people who have short and tight hip flexors often develop elongated glutes that are inhibited.

Finally, a traumatic fall on your back side will also trigger deactivation of your glutes.  Also, folks who have suffered ankle sprains often exhibit glute inhibition.

Some patients often say to me that their glutes can’t possibly be inhibited because they do alot of squats or lunges or deadlifts or run for distance 4-5x per week.  It is possible to have ‘strong’ glutes that don’t fire properly.  In fact, it may be the excessive amount of exercise that caused the brain to turn them off.  Muscle inhibition is different than muscle weakness.  When a muscle is inhibited, the neurological firing of the muscle is disrupted causing it not to contract sufficiently or at the right time.  In contrast, a weak muscle is firing normally, but is lacking in strength.

If you have any of the following issues, it may be due in large part to Lazy Butt Syndrome:

  1. Low back pain
  2. Hamstring strain
  3. Anterior knee pain
  4. Anterior hip pain
  5. Poor alignment of the hips, knees or ankles
  6. ACL sprains/tears, ankle instability, IT band pain

We can’t help you with the Lazy Butt Syndrome that you see in your family members!  But we can help with Lazy Butt Syndrome that may be causing your aches and pains.

Next month, I will talk about home exercises that you can do to combat LBS.

Until then, pray for better summer weather!

Dr. Keith

4 Reasons Swimming May Be Causing Your Shoulder Pain

I never used to enjoy swimming.  I would sink like an anchor whenever I tried and would be envious of other people I saw who floated effortless through the water.  Can some of you relate?

3 years ago, I began my journey into triathlon racing.  At first, I could barely swim a single length of 25m without being totally gassed!  Online information and videos helped me piece together an understanding of proper swim technique and slowly I got better and better.

But then I joined a Masters swim squad locally and after a few weeks of intense volume that I was not accustomed to, I got injured.  A shoulder injury to be precise.  Part of the reason of course was that I was not prepared to do 90-minute practices of over 3000m.  But as I delved more into swimming technique, I realized that my stroke was still flawed and the combination of poor technique and excessive volume were holding me back.

Here are the 4 freestyle stroke flaws that may be hurting your shoulder as well!

  1. Crossing the midline – I see this alot when I observe people during lane swimming at the community centre.  Imagine a line that cuts your body into equal left and right halves that extends from your head down to the feet.  As your arm recovers over the water and extends forward into the catch phase of the stroke, it should not cross the midline.  Instead, the arm should line up with your shoulder joint.  When you cross over, you place excessive stress on your shoulder joint and can create impingement pain.  If repeated hundreds of times while swimming laps, it will start to wear down on your rotator cuff tendons.  
  2. Thumb first vs fingertips first entry – This is also commonly seen in swimmer and makes Problem #1 above even worse.  A thumb-first entry results in excessive internal rotation of the shoulder further aggravating the impingement.  Conversely, focusing on a fingertip entry so that the hand enters in a more neutral shoulder position will greatly help prevent shoulder problems and set you up for a more effective catch and pull.   

    Nice finger tip entry!

  3. Pushing down on the water – Not only does pushing down with your extended arm result in a less effective pull through, it also puts a large stress on the shoulder joint.  It also has the effect of lifting your head and torso up while sinking your legs down thereby creating more drag in water.

    This swimmer has pressed her arm straight down to the bottom!

  4. Pulling through with a straight arm – Too much stress is placed on the shoulder joint when a straight arm is used to pull through the water.  While you might think that using a ‘bigger paddle’ will be more effective, it creates more stress on your tiny rotator cuff muscles.  Instead, a proper bent arm pull will engage larger muscles like your pecs and lats to help generate the pulling force.  You may see some Olympic sprinters very effectively pulling with straight arms but remember you are not an Olympian with freakish body genetics!  For the average Joe/Jane swimmer, sticking with safe biomechanics is a better idea.

If you have been having shoulder issues from swimming lately, then it is quite likely that there is something wrong with your stroke that is causing the problem.  Have someone watch you while you swim both above the water and below to give you some critical feedback.  If you can, a video recording is very instructive.  A GoPro camera or even some of the latest smartphones which are waterproof can be used.   When I developed my own shoulder pain from swimming it was extremely frustrating and took almost two months of minimal swimming and rehab.   As always, prevention is the best medicine!

Now that I’ve fixed my own stroke flaw (I was pulling with a straight arm), I am swimming pain free with greater efficiency and for longer distances.

Athletes understand athletes…until next time!

Dr. Keith




7 Tips To Make Your Snow Shovelling Safer

The 2016-2017 winter season here in York Region has been a roller coaster ride with the large snowfalls, icy conditions, rain, cold days and warm days.  If you’re lucky, you may have a snowblower to assist with some of the heavy snow we’ve had.  But if not, fear not!  Keeping your back and spine safe is easy by following these 7 steps:

  1. Stand with stability: Stand with your feet at hip-width apart to maintain your balance. It’s also best to wear boots that are non-slip when you shovel. This will help protect you from sliding when shovelling.
  2. Keep the load close to your body: Hold the shovel close to your body to guard against straining or pulling a muscle. When the snow is deep or heavy, shovel smaller amounts (3–5 centimetres/1–2 inches) of snow at a time.
  3. Grip strategically: Space your hands apart on the handle to increase your leverage when lifting the snow.
  4. Lift with your legs: Bend from your knees, not your back, when lifting. Not only does it protect your back, but you can strengthen your legs as well!
  5. Engage your core: Tighten your stomach muscles when lifting snow. This helps to protect your back as you lift.
  6. Don’t twist: Avoid twisting your body when you lift. Move your feet instead to turn your body.
  7. Don’t toss the snow: Make sure to walk to place the snow on the side of the road rather than throwing it. Turn your feet in the direction you’re dumping the snow which will better position you to maintain good form.

Snow shovelling can be a very strenuous activity, and even more so without the correct, protective technique. With the proper preparation, tools, and technique you can make shovelling safer for yourself, and your walkways safer for your family, friends, and neighbours.

Happy shovelling!

Dr. Keith



Sleep Positions That Cause Problems

sleep-positionsOften times the things that you do unknowingly or subconsciously can be the cause or part of the cause of your pain problem.  Injuries are the sum of all stressors placed on the body and even poor sleep positions can be a major contributor to the injury equation.

In fact, the way you are draping your leg across your body and off the bed, or holding your arm under the pillow, can often be the last straw that pushes you over the edge to injury or keeps you from recovering fully.

Here are some sleep considerations:

Putting the arm under the head or above the head holds the shoulder muscles on the extreme end of their range of motion, increasing risk of shoulder impingement, rotator cuff issues and numbness in the arms or hands from reduced blood circulation.

Draping one leg over the other twists the pelvis and lower back and overstretches the hip musculature for extended periods of time. Favoring one side can also contribute to muscle imbalances.

Stomach sleeping, especially on softer beds, can hyperextend the low back, setting the stage for pain and discomfort by irritating the spinal facet joints.

Turning your head to the side to breathe is a necessity if you are a stomach sleeper, but it’s also a major contributor to stiffness and neck pain.

Plantar flexion, or a “pointed toe” position, can worsen your plantar fasciitis or Achilles tendinopathy by putting your foot and ankle into a contracted position all night.

How you sleep is a result of years of habit and you will usually gravitate toward the position that you are most comfortable in.   Although it can be difficult to change, the body can be “re-trained.”  Like trying to break any other bad habits, make small changes like a pillow between the knees to keep the pelvis stacked in a more neutral position, or re-positioning the arm upon waking—over drastic changes, which may detract from overall sleep quality.

As a general rule of thumb, back sleeping with a pillow under the knees is the ‘best position’ of rest.  Side sleeping with a pillow between the knees is ‘second best’ while the worst is sleeping on your stomach.  Keep your head and neck in a neutral position with an appropriately sized pillow – neither too elevated nor too flat.


Backpack Troubles For Kids

backpackNext time you are at the schoolyard waiting to pick  up your children, observe how many students are lugging around inappropriate backpacks for their school stuff.  Here are some criteria to consider:

1. Too big / Too small?  If the backpack is too big it can pull the child backwards straining muscles. A pack too small won’t offer enough space and will cause more pressure on the shoulders. The bottom of the pack should rest in the curve of the lower back not more than four inches below the child’s waist.

2. Proper padding. Select a backpack with well-padded shoulder straps even if it means the backpack doesn’t have your child’s favorite cartoon character on it!  Your shoulder and neck have many blood vessels and nerves. Excessive pressure in the area can cause pain and tingling in the neck, arms and hands.

3. Two shoulders straps not one.  Too often you’ll see kids with backpacks slung just over one shoulder!  This can cause the child to lean to one side.  Chronically leaning to one side (and we know that people tend to carry things on a favorite side) can cause pain, discomfort and postural issues.

4. Use the buckles.  A good quality backpack will have additional buckle straps across the chest and waist.  Using these buckles can help distribute the weight of the backpack evenly to prevent against and strains or pains.

Once your child has the perfect bag, it is just as important to make sure they are loading it correctly

The bag should weigh no more than 10 per cent of your child’s body weight. If the bag is too heavy, discuss with your child about only bringing home what is necessary for the day’s homework. If he/she has to regularly bring home a lot of necessary school stuff, consider a book bag on wheels  or encourage your child to hand carry a book or another item in front of them. When packing the bag make sure your child is putting the heaviest items closest to your child’s back. It is also important to arrange the materials so they don’t slide around inside the bag.

These simple tips will help prevent alot of the neck and back pains that we are seeing kids getting more of these days!  If you need to address an ongoing problem, Drs. Keith & Kelly and Leanna our physio are available to help!

Laser Therapy for Bone Fractures

14114096_10157312270280534_1456339368_oA few days ago I received a text message from my friend that he was cut off by a car and thrown from his bicycle.  He ended up in a heap on the ground and suffered a broken collar bone (clavicle).  The car drove away but fortunately a passerby got the car’s license plate on camera.

My friend said he went to the hospital where x-rays revealed a fracture and he would be seeing an orthopedic surgeon next week to determine if surgery was required.  When he also texted me a photo of the x-ray, I could tell immediately that he would have a date with a surgeon…the fracture was significantly displaced.

But most often, fractures that are less severe simply require casting or immobilization for about 8 weeks.  If you are lucky enough that whatever bone you broke will not require a hard cast (for example, ribs, fingers, toes, tail bone, small stress fractures) then we can speed up your recovery time using low intensity laser therapy.

I’ve had the opportunity to use laser on patients many times over the years for various fractures with good success.

There is also medical research available now in animal models that show enhanced healing of bone using low level laser.  For example:

In addition to laser therapy, you can ensure an optimal healing environment for your bones by making sure you get enough calcium, magnesium, Vitamin E & C, zinc, protein, omega-3 fatty acids, all of which are either involved in actual bone repair or will help with reducing inflammation or harmful free radicals.

Key Factors For Ankle Sprain Rehab

ankle sprainThere has been a rash of recent patients coming in for sprained ankle treatment at Meridian!  So far, causes have included basketball, soccer, taekwondo and stepping into a hole on the pavement.

Treating an acute ankle sprain is relatively straight forward: control the swelling and pain, stabilize the ankle joint, encourage early active range of motion, prevent scar tissue and adhesion development.

But often times when patients fail to rehab their ankle injury properly, they develop chronic ankle instability and recurrent ankle sprains.  What were the missing factors?

  1. Return to work or sport too quickly.  Depending on the severity of the ankle sprain, proper healing time can range anywhere from 2 weeks to well over 90 days.  Often patients try to return to activity as soon as the pain goes away.  Unfortunately, even though there may not be any pain, it does not mean that the sprained ligament has fully remodeled and healed yet….which takes time.
  2. Failing to do the right exercises or not doing them at all.  Some of the exercises are quite basic: Theraband resistance for dorsiflexion, plantarflexion, eversion and inversion (basically all of the normal ankle ranges of motion) and seated/standing calf raises.  With improvement of symptoms and strength, there needs to be a progressive increase in loading on the ankle joint with multidirectional movements to retrain strength and stability.  Exercises like lateral hops, star lunges, rotation jumps, rhythmic stabilization drills, etc.  In addition, exercises should incorporate the integration of the entire leg so that the hip and knee joints and muscles are also involved.
  3. Failing to include proprioceptive and balance work.  Proprioception refers to the body’s ability to sense movement within joints and joint position. This ability enables us to know where our limbs are in space without having to look.  The proprioceptive system is made up of receptor nerves that are positioned in the muscles, joints and ligaments around joints.  Following injury to joints and ligaments the receptors are also damaged, which means the information that is usually sent to the brain is impaired.  If you fail to retrain these proprioceptive nerve receptors with appropriate exercises, there will be a tendency to land improperly on your foot with walking, running and jumping activities.  This will of course lead to another, if not multiple, recurrence of ankle sprains.  The simplest exercise to do is single leg balancing with eyes opened and then eyes closed.  Balance work on unstable surfaces, wobble boards and BOSU balls are also critical.

Keep these key points in mind when you work with your chiropractor, physiotherapist or athletic therapist in order to ensure a more successful ankle rehab outcome!