The Perfect Exercise: How to Get Push-Ups Right

Many fitness experts think that it might just by the perfect exercise.  What are we talking about?  The humble push-up!  It doesn’t require any special equipment or a pricey gym membership, but it can do wonders.

What’s so special about push-ups?

Push-ups engage the whole body, and research has shown that being able to perform push-ups well is a good indicator of your ability to maintain fitness as you age.  Scientists have also noted that doing push-ups can provide seniors with the strength and muscle memory necessary to break a fall.  But did you know that push-ups are particularly good for building your core strength?  And that building your core strength is one of the keys to preventing low back pain?

For most people, it’s not really as simple as it looks.

While it’s true that doing push-ups may have lots of benefits, it’s also true that it’s very easy to do push-ups incorrectly.  Not only can this reduce the benefits, it can actually lead to pain in your shoulders, back and wrists.  Metabolic trainer B.J. Gaddour, C.S.C.S. says “Unless they’ve had instruction before, I’ve never seen someone off the bat do a push-up perfectly. I see 99.9 percent of people do it wrong.”

What makes a good push-up good?

Good push-ups have a few things in common.  Here’s what to work on if you’re trying to master the perfect exercise…

Be sure your hips don’t sag or stick up.  Your head, shoulders and hips should all be in a straight line as you perform your push-ups—neither drooping nor sticking up in the air.  If your hips droop, it could cause lower back pain and you will not gain as much core strength as you would if you kept head, shoulders and hips aligned.  To help keep your body straight, tighten your gluteal muscles (the buttocks) and your abdominals as you perform your push-ups.

Keep your elbows close to your sides.  If you look like a “T” from above, with your elbows splayed out like wings, you could be causing damage to the rotator cuff of your shoulder.  Although this is how many of us were taught to do push-ups in school, it’s not the right way to do it.  If you have trouble keeping your elbows close to your torso, try doing push-ups on your fists, with the back of your hands facing out. This helps to keep your elbows from splaying.

Go as low as possible.  Ideally, your elbows should be at somewhat less than a 90-degree angle when you are at your lowest point in the push-up.  If you have trouble doing this initially, put a block or similar object beneath your chest as a reference point.  Then gradually reduce the height of the object as you develop the strength to go lower.

Start off easy.  When first starting out, many people simply don’t have the upper body or arm strength to do even a single push-up on the floor.  When this happens, they’re often tempted to resort to so-called “knee push-ups.”  Don’t do it!  Unfortunately, knee push-ups won’t help you build the strength you’ll ultimately need for regular push-ups, and your body (especially your core) won’t benefit as much from the effort.  Instead, you can begin by doing push-ups against a wall, countertop or staircase and then gradually work your way to progressively lower (more horizontal) positions until you’re able to do a push-up on the floor.  This is a great milestone!

Stretch your wrists.  Putting all your upper body weight on your wrists can hurt after a while, since most of us are not accustomed to doing it.  Give your wrists some relief by stretching them.  While on your knees, place your hands palm-downwards, with your fingers pointed back toward your knees, lightly putting pressure on them to stretch them out.  This will allow them to support more weight for your next set.

Remember—everything starts somewhere!  If you’re struggling to maintain proper form or can’t do very many push-ups for the first few weeks, don’t give up!  The combination of strong effort and good biomechanics will eventually pay off.  The idea is to improve over time, and you shouldn’t expect great performance right off the bat.  If you’d like to track your progress, there are several good smartphone apps on the market that make it easier to do.

As chiropractic physicians, we’re especially interested in our patients’ overall musculoskeletal health.  In addition to providing in-office manual therapies such as manipulation, mobilization and massage, we can also design at-home strengthening and stretching programs to help you meet your own goals—whether they’re related to rehabilitation, injury prevention or performance.  If you or someone you care about has concerns or questions, please call or visit our office today!

Body Mass Index: A 2-Minute Primer

What is your Body Mass Index how is it used?

The Body Mass Index (BMI) is one of several ways to measure the amount of excess fat (adipose tissue) in the body. Healthcare providers use BMI to determine your overall fitness and your risk of developing chronic diseases. You can also monitor your own BMI to track the results of your own diet and exercise plan if you’re trying to manage your weight.

BMI has its critics, and it’s true that there are other techniques, including hydrodensitometry (underwater weighing), skinfold measurements (using calipers) and magnetic resonance imaging (MRI) that can provide more accurate determinations of body fat. However, BMI can be still be quite useful in most cases since it allows an effective comparison across large populations and is statistically well-correlated to adiposity. Plus, it’s easier for most people to monitor on an ongoing basis.

How do you calculate your BMI?

Your BMI is essentially the ratio of your weight to your height squared. More specifically, BMI is calculated using the following formula:

BMI = weight / (height)2

Note that the formula above uses the metric system, with weight in kilograms and height in meters. To calculate your BMI based on height in inches and weight in pounds, just multiply the result by 703.

BMI = weight (lbs.) / (height [in.])2 x 703.

What does your BMI mean?

Here are the standard weight categories associated with BMI ranges for adults who are 20 years of age and older:

BMI  Below 18.5         Underweight

BMI 18.5 to 24.9         Normal or Healthy Weight

BMI 25.0 to 29.9         Overweight

BMI 30.0 and Above   Obese

Does having a high BMI always mean carrying extra fat, and vice-versa?

No, it doesn’t. As we mentioned earlier, BMI is generally a useful way to measure body fat. However, there are a few scenarios in which BMI doesn’t accurately capture the true situation. For examples:

  • Athletes and others with a high lean body mass (muscle and bone) may fall into the overweight category despite having very little body fat.
  • Elderly people and those who have lost muscle mass may fall into the underweight category despite having excess body fat.
  • At the same BMI, women tend to have more body fat than men do.
  • At the same BMI, Whites tend to have less body fat than Asians but more than African-Americans.

Experts believe that body composition and weight distribution can also affect your health. However, BMI doesn’t provide any information about these factors. The fact that BMI isn’t perfect is a good reason to look at other measures as well—such as your waist circumference—to get a clearer picture. It’s also a good reason to have your overall health evaluated by a trained healthcare provider who can interpret your BMI and other measurements correctly and put them in proper context.

Health Risks Associated with High BMI

High BMI is associated with a variety of other risk factors related to chronic health problems such as Type 2 diabetes, heart disease, high blood pressure, gallbladder disease and some types of cancer. These other risk factors include:

  • High LDL cholesterol (“bad” cholesterol)
  • Low HDL cholesterol (“good” cholesterol)
  • High blood sugar
  • High triglycerides
  • Sedentary lifestyle
  • Smoking

How much BMI do I need to loss to see improvements?

It may seem like you need to increase exercise and/or cut calories a LOT to lose a meaningful amount of weight. However, even a 5% or 10% reduction in body weight can help lower the risk of obesity-related diseases. Be sure to check with your doctor before beginning a new weight management program. This is especially important if you have a known medical condition or if you haven’t been physically active for a while.

If you or someone you care about is interested in weight loss or weight management as a way to improve overall health and wellness, we can help! Just call or visit our office today!

Obesity and Your Musculoskeletal System

It’s no secret that being overweight or obese is a significant risk factor for a wide variety of health conditions.  By one estimate, the treatment of obesity and the medical problems associated with it costs $168 billion each year in the US alone.  And while many of these diseases have familiar names—Type 2 diabetes, heart disease, cancer, high blood pressure, high cholesterol and metabolic syndrome, to name a few—being overweight or obese can also take a significant toll on the body’s musculoskeletal system.

Based on the body of research available today, it’s useful to talk about three different ways that being overweight or obese may also contribute to chronic musculoskeletal Pain (CMP).

A Simple Matter of Wear and Tear

At one level, the problem involves a simple combination of gravity and biomechanics.  Additional weight causes additional wear and tear on the body’s muscles and joints.  And wear and tear is cumulative over time.  This is particularly true of the knees, hips and back.  For instance:

  • Osteoarthritis has grown increasingly common as the rate of obesity has increased. The American Obesity Association warns that individuals with a body mass index (BMI) higher than 25 are at greater risk of osteoarthritis.  Obese women are nine times more likely to suffer from osteoarthritis of the knee, often leading to the need for a total joint replacement.  However, researchers have found that losing as little as 11 pounds can reduce the risk of knee osteoarthritis by half.
  • Excess weight, particularly around the stomach, pulls the pelvis forward and causes an excess curvature in the vertebrae of the lower back, causing pain and stress on the muscles and supporting structures of the back.
  • Being overweight or obese may lead to bulging or herniated discs, which may in turn contribute to the development of nerve compression, sciatica or piriformis syndrome.

The Downward Spiral of Inactivity

It’s pretty clear that inactivity can contribute to someone becoming overweight or obese.  But it’s more complicated than that because physical Inactivity is both a cause and effect when it comes to obesity.  Carrying all that extra weight places a great deal of extra strain on the musculoskeletal system as well as the circulatory and respiratory systems.  For those who are overweight, even short periods of exercise often cause pain, fatigue, lightheadedness and shortness of breath.  They also face a higher likelihood of injury.  It’s hardly surprising that these factors would discourage overweight and obese people from being physically active.

This downward spiral may help explain some dismal statistics produced by the University of Alabama’s Nutrition Obesity Research Center and published in the December 2013 Mayo Clinic Proceedings.  The average obese man in the US gets just 3.6 hours of vigorous exercise per year, while the average obese woman gets the equivalent of only 1 hour.

Physical inactivity can indirectly lead to CMP, especially in the back, where inactivity is often a major contributing factor and a lack of exercise leaves core muscles stiff, weak and out of condition.

Increased Pain Sensitivity

A link between obesity and pain sensitivity has not been conclusively proven, but researchers have noticed some clues that suggest a relationship.  In one recent study, overweight participants—those with BMIs between 25 and 29—reported about 20% more pain than normal-weight participants.  At the same time, participants with BMIs between 30 and 34 had about 68% more pain. Participants with BMIs between 35 and 39 had 136% more pain and those with BMIs over 40 reported having 254% more pain.

However, the data are noisy, and it is difficult to control for the fact that excess weight contributes to other health problems that may actually be the cause of participants’ pain.  When researchers accounted for the influences of these other health problems and pain-causing conditions, being overweight was no longer associated with being in pain.  But participants who were obese still reported more pain than those with normal BMIs.

All this said, fat cells are known to produce chemicals that increase inflammation, which is very closely linked to pain perception.  This means that there could very well be a physiological mechanism that translates additional body weight into additional pain sensitivity.

The Good News

So the bad news is that—for a growing number of people—more weight seems to equal more pain.  The good news, though, is that the opposite also seems to be true.  Losing weight appears to have an immediate effect on pain.  If you suffer from back pain and are more than 10 pounds above your ideal weight, losing that weight may significantly reduce the amount of pain you are experiencing.  According to Dr. Andre Panagos, co-director of The Spine Center at New York’s Presbyterian Hospital, “Although research on weight loss and back pain is minimal, in my clinic, every single person who loses a significant amount of weight finds their pain to be significantly improved.”

The Links Between Weight Management and Musculoskeletal Health

Anyone who struggles with being overweight knows that it is more than just a matter of appearance. Being overweight affects the way you feel, how much energy you have, and your overall health. There are several serious health conditions linked to obesity, including heart disease, diabetes and some types of cancer. The bones and soft tissue that make up the musculoskeletal system are also vulnerable. Joints in particular are compromised when too much body weight places a greater force on them than they’re designed to handle. When the musculoskeletal system is compromised, the body is no longer able to perform as efficiently.

As a result, being overweight can cause an increased risk of musculoskeletal problems such as:

  • Arthritis
  • Joint Failure
  • Back Pain
  • Lower Limb Pain
  • Loss of Mobility

The Impact of Body Weight on Joints

Joint stress is a serious concern for people who suffer from osteoarthritis. The normal wear-and-tear that occurs in the joints diminishes their protective cushioning and leads to pain and loss of range-of-motion and/or mobility. In addition, the pressure caused by excess weight is greater than the actual number of pounds. For example, one pound of excess body weight causes four pounds of stress on knee joints. As a result, people with osteoarthritis of the knee can experience much more severe symptoms just from being a few pounds overweight. On the plus side, losing just a few pounds of weight can have a very positive impact on the condition of your joints.

A Different Perspective for Overweight Patients

People who are obese are not the only ones putting their musculoskeletal system at risk. Any degree of excess body weight will put more stress on the joints and supportive tissues that keep the body in motion. Although being ten pounds overweight may not seem like a big deal, think about the difference in difficulty you have carrying a bag of groceries up the steps or a basket of laundry down the stairs in comparison to walking freely without the load. Only a few pounds can change your posture and biomechanics, making a difference in your ability to go up a step or to walk for a longer distance.

Another way to gain perspective for how a few pounds of body weight can impact your frame is to carry a ten pound weight with you through your normal activities. For people who are obese or highly obese, the amount of excess weight they are carrying might be an amount they are not even able to lift! These pounds are exerting stress on the bones and joints all over your body all the time.

Losing weight is never easy, but it is worth the effort to improve your musculoskeletal health and prevent the pain excess pounds can cause. Talk to your chiropractor about safe, healthy ways to lose weight and see what a difference your efforts can make!

A Simple Change to Combat Obesity

How many times have you heard the admonishment “slow down and chew your food”? For many people, the answer is “countless times.” But it turns out that mom was right—slowing down and chewing your food thoroughly is a great idea, as it helps to reduce obesity. Obesity has become an increasingly common and damaging condition over the past 20 years, and there are many questions being raised by doctors and researchers. One very important question is why obesity happens, and there is no simple answer—but one factor is certainly how fast or slow you chew your food.

According to the National Institutes of Health (NIH), the idea of slow, thorough chewing leading to less food consumption goes back to Horace Fletcher, nicknamed “The Great Masticator” for his enthusiasm regarding chewing. The NIH recently conducted studies on Fletcher’s hypothesis and found that it had scientific merit. “Horace Fletcher (1849–1919) spread his doctrine to chew each mouthful thoroughly in order to prevent gaining weight. We sought to test this idea by manipulating chewing instructions whilst using electromyography to monitor chewing behavior. Comparing 35 with 10 chews per mouthful, we showed that higher chewing counts reduced food intake despite increasing chewing speed, and despite doubling meal duration for achieving a subjective reference point for feeling ‘comfortably full.’”

There is good reason to heed Fletcher’s (and your mother’s) advice. There are many serious consequences of obesity such as type 2 diabetes, hypertension, and heart disease. Other health complications associated with obesity include sleep apnea, metabolic syndrome, gallbladder disease, infertility, liver disease, cancer, stroke, and high cholesterol.

Many people don’t know that obesity puts you at risk for musculoskeletal disorders. One of the reasons many chiropractors urge patients to eat well and exercise is the fact that excess weight puts a lot of strain on the body’s musculoskeletal system. Again, the NIH: “The global epidemic of obesity has far-reaching effects on the musculoskeletal system and associated conditions such as osteoarthritis, rheumatoid arthritis, spondyloarthropathy, and fibromyalgia. Obesity increases the need for, and reduces the health outcomes from, joint replacement surgery, which has enormous implications for societal economic burden. New insights have been gained into the possible mechanisms by which obesity is associated with musculoskeletal disease incidence, symptom severity and treatment outcomes particularly for osteoarthritis.”

To reduce your risk of obesity, here are some practical tips for chewing your food thoroughly. First, give yourself enough time to eat—set aside 20 to 30 minutes to eat a meal. It can take up to 20 minutes for your brain to get the signal from your stomach that it is full, so eat slowly. Also, don’t eat amidst distractions, such as the TV, computer, or while driving. It helps to be fully present while you eat—it can even be a pleasurable experience if you notice the smell, temperature, texture, color, and subtle flavor differences of each food you consume.

Take smaller portions, and take a break before refilling. Put your fork down after each bite and eat mindfully, chewing each bite as many times as necessary to pulverize any texture. If you’re eating in a group, be aware of the speed at which others are eating. As a game, you can challenge yourself to be the last to finish. Your body will thank you for it.

5 Exercise Tips for Better Posture

“Good posture” is more than an indication of whether you paid attention as a kid when your parents admonished you to “Stand up straighter” or “Don’t slump your shoulders like that”. Posture is the position in which you naturally hold your body when you are standing, sitting, and even lying down. “Good posture” is when you do this while maintaining the correct alignment of your body parts, supported by the right amounts of muscle tension against the pull of gravity.

Most of us normally give no thought to our posture. Our muscles tend to “do it for us,” without us even thinking about it. The problem with this largely unconscious process is that over time our muscles can become weak or improperly trained to hold our bodies in less than an optimum position. This is bad because proper posture helps us to keep our bones in correct alignment so that their supporting muscles are used correctly. Proper posture also reduces stress on our ligaments, and helps to prevent muscle strain and overuse disorders. Improper posture can have many negative effects on our general health, including excessive strain on our postural-support muscles, reduced lung capacity and chronic back or neck pain.

There are many exercises that can help strengthen your postural-support muscles, but the best approach to take if you want to improve your posture in a more systematic way is to see your chiropractor. He or she can analyze your posture and then prescribe a customized set of exercises to restore strength and balance to your postural-support muscles. Your chiropractor can also make adjustments to your spine and other joints to eliminate abnormalities that encourage improper posture.

When using exercise to help improve your posture, it’s a good idea to follow a few simple guidelines.

  • Focus first on core-strengthening exercises. That is, work to strengthen the sets of muscles around your waist and lower back, which do most of the work of maintaining proper posture. Don’t simply rely on old-fashioned “sit-ups,” however. Pilates, yoga, and the set of core-strengthening exercises recommended by the North American Spine Society are more effective, providing more benefits with less strain.
  • Keep these core-strengthening exercises safe. Practice the single-leg lifts, crunches or “curl-ups,” and crossovers slowly and with controlled motions, avoiding the tendency to “overdo it.” Pull your abdominal muscles in (up and towards the spine) as you exercise, and breathe normally. Start with a low number of repetitions tailored to your current fitness level and increase the number only as you grow stronger.
  • Perform shoulder and neck exercises to strengthen your upper body. Weak shoulder muscles are the most common cause of “slumped shoulders.” Also, stiff muscles in the neck and upper back can aggravate and perpetuate poor posture.
  • Strengthen your hips and pelvis. Exercises such as anterior pelvic tilts strengthen your hip and butt muscles, which are essential to enabling you to stand and walk with correct posture.
  • Don’t forget your feet. Good posture and a healthy musculoskeletal system start from the ground up. You should work with your chiropractor on this one, especially if he or she has indicated that you suffer from either “pigeon toes” or “duck feet,” meaning that your feet point at an angle either inward or outward, rather than straight ahead. Chiropractic adjustments can help to correct this, but there are also exercises that can strengthen your muscles to correct these conditions, and allow you to stand and walk more normally.