Headaches Can be a Pain in the Neck

   Headaches can have many causes. They can often be a side affect of medication or a warning of some other lurking malady. However, if the headache is accompanied by a sore neck, myofascial imbalance of muscles supporting the cervical spine could be the culprit. It should be noted that the central nervous system uses the cervical spine as a conduit for neurological signals to the rest of the body. It should be noted that a persistent headache condition with neck pain should be checked out by a doctor.

 Many Weekend Warriors spend  long time periods slouched over a computer or reading documents as a weekday job requirement. Or if they work manually, they are often using tools with their cervical spine flexed or extended in uncomfortable positions. This is known as ergonomics! After work and on weekends these weekend warriors are pursuing hobbies or sports with the poor posture having a carry over effect. Those that are Sedentary Soldiers spending leisure time on a coach or back in front of a computer can further the muscular misalignment. Poor sleeping habits can also compromise the neck muscles.     

   It is not unusual that the mechanism of injury is chronically poor posture over a long term. A physical assessment will help identify significant overactive and underactive muscles in the cervical spine region. The myofascial front lines often exert greater pull than the myofascial back lines.  Prime movers such as the deep cervical flexors tend to become weak and synergist muscle such as the sternocleidomastoid and the levator scapulae can compensate and become tight.  The weakness of the spinal extensors can cause overcompensation by the upper trapezius muscles. Tight upper trapezius muscles have even been referred to as ‘the migraine maker’.  

Less than ideal work ergononics can lead to postural misalignment.

Symptoms that headache sufferers could experience include:

• Headache, light headed sensation, dizziness
• Sore eyes
• Neck pain, usually at the sides or just below the skull at the back
• Lack of mobility of the cervical spine

Signs of the myofascial issues causing headache and neck pain that a Personal Fitness Trainer might notice include:

• Upper crossed syndrome; such as forward shoulder slouch, forward head tilt
• An inability to perform physical assessments without compensation
• Dysfunction at other kinetic checkpoints (e.g. shoulder) as compensation for cervical spine instability

Poor sleeping position (see moonlighting Fitness Trainer) can cause neck muscle malfunction 

   The first step would be determine if any muscular compensations can be observed using postural and movement assessments. Select assessments that are more specific to the cervical spine and would show the common culprits for overactive and underactive muscles. This should identify the misaligned muscle groups most likely to be responsible for the headache and neck pain issues.

Static Postural Assessment: This assessment places the client in a position in which the anatomical kinetic checkpoints from the feet up can be evaluated..

Overhead Squat: Observations that indicate cervical spine instability would be a forward head tilt and the arms falling forward during the squat. The shifting of the weight of the head anteriorly could also be a factor in lower back arching of the lumbar spine and an excessive forward lean.  (

Push-Ups Assessment:  Forward head migration indicates a weakness or dysfunction, Scapular winging (the scapula protracts), and shoulder elevation could be because the shoulders are compensating for the neck. A sagging lower back may be an indication that dysfunction in the head/cervical kinetic checkpoint is a factor in hip/pelvis compensation. 

Standing Row Assessment: The usual compensations observed are: the forward head migration, elevated shoulders, and the consequential low back arching. Care should be taken to keep the weight light enough to avoid further injury to the cervical spine.

Upper Extremity Transitional Movement Assessment: These movements assess shoulder mobility using shoulder abduction, rotation, and flexion. Overactive and underactive shoulder muscles will affect the cervical spine just as neck dysfunction can impair shoulder function. The compensations to be vigilant for are shoulder elevation, protraction, and lack of full range of motion during internal and external rotation. 
Cervical Deep Flexor Muscle Assessment (Janda Method): This could be the most important assessment since it can determine if the deep cervical flexors are underactive. Weakness here can result in overactive muscles elsewhere in the upper anatomy. The lifting of the head without a chin tuck indicates weak neck flexors.  

The National Academy of Sports Medicine has a corrective exercise continuum that is effective and useful for identifying and correcting muscular compensations. Overactive or tight muscles are inhibited or relaxed using self myofascial release or muscular pressure using foam rollers, balls or the fingers on knotted trigger points. They are then lengthened using static stretches. Underactive or weak muscles (especially prime movers) Are isolated and strengthened. A dynamic movement is then added to integrate the muscles and re-educate them to move in a proper coordinated manner. (see below)

National Academy of Sports Medicine (NASM) Corrective Exercise Strategies Template

INHIBIT	Sets	Duration	Notes
Thoracic spine Alternate with Latissmus dorsi SMR	1 1	30-90 seconds 30-90 seconds	Do not roll below the rib cage Roll sideways on foam roller
Sternocleidomastoid SMR	1	30-90 seconds	Tigger point can be anywhere along muscle belly. Use massage stick(or finger pressure)
Levator scapulae SMR	1	30-90 seconds	Trigger point - top medial border of the scapula. Theraball
Upper trapezius SMR	1	30 -90 seconds	Trigger point often anterior and lateral. Massage stick (or finger pressure)

LENGTHEN	Sets / Repetitions	Duration	Notes
Sternocleidomastoid (Static stretch)	1-4 Reps	20 -30 seconds	Look away -raise chin
Levator scapulae (Static stretch)	1-4 Reps	20-30 seconds	Lean on wall. Turn chin to side.
Upper trapezius (Static stretch)	1-4 Reps	20-30 seconds	Look forward -pull head away
Pectoralis major (Static stretch)	1-4 Reps	20-30 seconds	Retract scapula to stretch pecs. Tuck chin

ACTIVATE	Sets / Repetitions	Duration	Notes
Mid /Lower trapezius Seated row	1-2   10-15 reps	1-2-4 Tempo	Retract scapula and pull cord to chest. Regression-bench
Deep cervical flexors Supine neck flex	1-2   10-15 reps	1-2-4 Tempo	Tuck chin towards chest before lifting shoulders
Cervical extensors spinalis Head retraction with elastic/cord	1-2    10-15 reps	1-2-4 Tempo	Tuck chin in then retract head.
Rhomboids Scapular retraction	1-2    10-15 reps	1-2-4 Tempo	Turn thumbs upwards.

INTEGRATE	Sets / Repetitions	Duration	Notes
Integrated dynamic Movement Y-W-T-L sequence	1-3 sets  10-15 reps	Slow and controlled	Specific to neck but integrates the whole body as a unit.

Exercise Prescription 

Inhibitory Techniques - Self Myofascial Reflex - Relax the Tight Muscles

Thoracic Spine / Latissmus Dorsi:  The client might benefit by rolling on the upper spine and the side on alternate days. The back roll SMR targets the upper trapezius and the upper lats. The side rolling SMR targets the lats. Both are large and overactive muscles that compound the dysfunction.

Sternocleidomastoid: The client can use a massage stick, or he can try to palpate with his finger until he finds a trigger point. Some experimentation may be necessary to find what works best.

Levator Scapulae: It may take some practice for the client to find a trigger point just above the scapula and lateral to the midline. A massage stick is used or finger palpation if necessary.

Upper Trapezius: The trigger point is likely to be close to the tie in with the rear base of the skull. If the massage stick feels awkward, the client can palpate with the finger.

Lengthening Techniques / Static Stretching 

Sternocleidomastoid Static Stretch: Reach one hand behind the back. With the other hand gently pull the head laterally. The chin should turn slightly up and towards the direction of pull. This stretch will also help lengthen the overactive scalene muscles.  I would wait until the client perfects proper technique with the static stretches before adding a neuromuscular stretch.

Levator Scapulae Static Wall Stretch: The client leans into the wall and tilts the head towards one shoulder until a stretch is felt in the lower side of the neck.

Upper Trapezius Static Stretch: This is similar to the sternocleidomastoid static stretch except that the client does not turn the head or tilt the chin upwards. He just gently pulls the head laterally with the other hand behind the back. Reaching further behind the back increases the stretch. This can also be turned into a neuromuscular stretch by resisting the hand push rather than pulling the head.

Behind the Neck Chest Stretch: The pectoralis major is a powerful muscle. When overactive it can overpower the myofascial back lines. The client should tuck the chin forward and not push forward on the back of the head during this static stretch..

Activation Techniques – Isolated Strengthening

Seated Row - Elastic/Cable: This can be done seated on the floor. A progression would be to use a stability ball. The isolated strength focus is on the middle/lower trapezius and also the rhomboids which get overpowered by the pectoralis major causing compensation by the upper trapezius. The client should not thrust the head forward during this movement.

Scapular Retraction: The client lies prone and lifts the arms back as he retracts the scapula. Turning the thumbs upwards finishes the movement. This targets the rhomboids and somewhat the middle trapezius. A progression is to use light dumbbells. A further progression is to add a stability ball.

Cervical Extension - Elastic: This movement focuses on the spinalis: capitus division  of the erector spinae.  Cervical extension is significant because it is opposite to the mechanism of injury which is chronic improper flexion.

Supine Neck Flex: This may be the most crucial exercise since the deep cervical flexors are a neglected yet significant muscle group. Despite its simplicity, the neck flex is often done incorrectly which will compound the postural dysfunction. The chin tuck must be emphasized.

Integrated Dynamic Movement Techniques

Y-W-T-L Sequence on Stability Ball: This exercise is an integrated dynamic movement, but it also emphasizes the weaker myofascial back lines. The client uses light dumbbells and forms alphabet letters. Each set of letters constitutes a repetition.

This exercise prescription should alleviate the myofascial issues causing the headache and neck pain. Adjustments to the program can be progressions or regressions depending on how the client adapts. 

Don't let a pain in the neck cause you a headache.

Little Bobby Strong

References

Clark, M.A Lucent S.C. Sutton B.G.; NASM Essentials of Corrective Exercise Training; National Academy of Sports Medicine; ,2014, Jones and Bartlett Learning

Hewlings Horak Kalman, Klika Lucett McCall, Miller Rhea, Richey Robles Stull, Valency, Weinberg: NASM Essentials of Personal Fitness Training, ,2017, Jones and Bartlett Learning

Myers, Thomas W.; Anatomy Trains; ,2014, Churchill Livingston Elsevier

Page, Frank, Lander; Assessment and treatment of muscle imbalance -the Janda approach.; Human Kinetics ,2010, Chapter 6

http://myemail.constantcontact.com/The--Migraine-Maker----Can-this-Shoulder-Muscle-be-the-Cause-of-Your-Headache-.html?soid=1101121545271&aid=F4kTfHC2oo4

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The Winter Olympics! Magnificent Medal Melodrama or Malignant Money Milking Mess?

They're baaaaaaack! Wait.....they're over already!
The Winter Olympics were on once again. I should be more enthused but somehow the luster is no longer as shiny and bright. When the Winter Olympics were held in Calgary in 1988 and Vancouver/Whistler in 2010, my enthusiasm was fueled by home grown pride. However, even with that going for it, years of corruption, politics, cheating, doping, and out- of-control expenditure has left a certain taint that isn't easy to wash away. But being the sports aficionado that I am, I did watch many of the events. To see the worlds best athletes doing what they do best does have its appeal.

   Here are some views from this armchair athlete:

• North Korean athletes will be in attendance at these South Korean Olympics. 
• North and South marched in under the same flag at the opening ceremonies. 
• There will even be a North Korean on the South Korean Women's hockey team. How can somebody not be moved by that.
• Russia has been sanctioned by the International Olympic Committee for 'alleged' state sponsored doping at the2014 Olympics in Sochi, Russia.
• Approved Russian athletes can compete without a flag as 'Athletes of Russia'. AOR
• A Russian male bronze medalist in mixed curling was under investigation for a positive doping violation. Then he was disqualified.
• The Russian got popped for Meldonium, a heart medication that can enhance endurance.
• I'm confused on this one. Curling requires flexibility, precision and timing. Endurance is not much of a factor. It would make more sense if he tested positive for beta blockers.
• Former Canadian Football League running back Jesse Lumsden is competing in his third Olympics as a bobsledder. After 4 or 5 injury plagued years in football it looked like his sports career was kaput. 
• Bobsled draws speed power athletes from sports such as track and field. Hurdlers seem to take to bobsledding well. 
• Whoops! An AOR athlete also got popped for Meldonium in Bobsled - a speed and power sport. Maybe Meldonium boosts muscle power as well! 
•  The NHL has opted out of these Olympics. The Canadian Hockey team has many former NHL pros looking for a last hurrah in hockey. They got bronze. Good showing!
• Alex Harvey just missed scoring Canada's first medal in cross country skiing by finishing 4th. The bronze medalist was from AOR -Athlete from Russia. Could a retroactive medal from a belated doping find be in the future?
• As a Fitness Trainer, I am interested in what the athletes do for dryland training. Usually they just show brief clips. Coaches can sometimes be secretive.

Stay tuned. The Olympics are over but the aftermath can linger.

Keep fit for the next Olympics

Little Bobby Strong
                                                         

Bobsled recruits from track and field athletes. I was once a track man. Is it time?????

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Is Donald Trump Physically Fit to be President?

President Donald Trump recently had a medical test done to determine his physical health.This is an important topic.
    Us Canadians can boast of a Prime Minister who was a lifelong adherent to the martial arts and won a celebrity boxing match by a technical knockout while he was a youthful member of parliament. The Russians have a President who rides bareback and shirtless through cold Siberian weather and allegedly wrestles bears.  The Cuban head of state was once a semi-professional baseball player - whoops sorry- that was his late brother Fidel. The North Koreans are led by someone with the nickname Rocket Man so he must likely possess unworldly athletic speed. A succession of Brazilian leaders  have shown Olympic quality gymnastic agility in avoiding political scandal after political scandal.
   President Trump should not be expected to be a local wrestling champ like Abe Lincoln, a football sensation like Jack Kennedy or a fearless big game Hunter like Teddy Roosevelt. In fact Franklin D. Roosevelt, arguably the best President ever,  suffered from polio and in later years was confined to a wheelchair. Nevertheless, good health and fitness would be a desired asset for the the leader of western civilization.
   It is time to answer the question that the whole world - not just Americans - have been asking.
IS DONALD TRUMP PHYSICALLY FIT TO BE PRESIDENT?????

This is the data from President Trumps most recent medical evaluation.

• Body Mass Index or BMI.  BMI is calculated by dividing the height in meters squared by the weight in kilograms. If we convert from pounds and feet/inches to the metric units we get a BMI of 29.9. That puts him barely in the overweight class. A score of 30 would rank him as obese. That is generally regarded as unhealthy but not necessarily. A slightly overweight person can be healthier than an extremely underweight person. Someone with lower fat but a great deal of muscle mass be healthy but score a high BMI. (see picture below)

• Blood Pressure is 122/74. This is a healthy blood pressure reading. The 122 represents his systolic reading of mercury pressure on the testing device when the blood is pumped from the left ventricle of the heart. A reading over 140 is in the risky zone. The 74 is the blood pressure in the arteries between heart contractions. A reading over 90 can be a reason for concern.
• Resting Heart Rate is 68 beats per minute. The average is 72. Usually a lower rate represents a more efficient heart.
• Fasting Blood Glucose. His reading is 89 mg/dl. Any reading below 100 mg/dl is normal.
• Cholesterol levels. These are slightly into the unhealthy range. For this reason he is on the medication  Crestor.  This is a statin drug used to lower cholesterol. This should keep him healthy but there can be side effects.
• Appendectomy. This should not affect his future fitness.
• Supposedly President Trump abstains from alcohol. He is more of Stormy Daniels than Jack Daniels. (Thanks to Bruce G. for this one)

   With a doctor's recommendations, Mr. Trump would be a good candidate for an exercise prescription from a Fitness Trainer. If I were President Trump's Fitness Trainer I would use various incentives as cues to exercise:

• The President is an avid golfer. My advice is to ditch the golf cart and walk the 18 holes. It boosts a fun recreation into a calorie burning workout.
• Anytime the President has the urge to send out a controversial tweet he must instead power walk a lap of the White House rose garden. 
• Each time the words Russia and Collusion occur in the same sentence,  Mr. Trump must walk up a flight of stairs. Throw in special counsel and it becomes 2 flights of stairs.
• The mention of the names 'Comey', Flynn, or 'Mueller' require a set of 10 push ups each.
• Every utterance of the phrase 'fake news' requires a set of overhead squats.
• Each reference to 'building a wall' merits 10 lateral lunges to each side. 
• The use of the word 'deportation' earns a half hour of swimming laps in the White House pool. 
• Every time the President fires someone, the penance will be 30 minutes of High Intensity Interval Training.
• Should he fire his Fitness Trainer it will be 60 minutes of the above.

No fitness training program can be successful without a rewards program built in to it. Of course, the end result would be the reward of improved fitness, mobility and health. Further rewards may be added to make the training prescription more enjoyable and thus more attainable - such as:

• Any favorable trade deal with Canada warrants a sit down session with a cold Canadian made micro brew!

Let's make fitness great again!

                                                    

                                                                              
                                                 

Until next time,  Keep Fit

Little Bobby Strong

                                                                                                

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#MeToo - Sexual Accusation - Fitness Training?

With all that is going on in the entertainment and political world lately regarding sexual impropriety and the Me#too backlash movement it might be a good time to revisit and revise one of my blogs from a few years back.  It is now more relevant than ever. Fitness Trainers are not immune to scandal and litigation!    

   Some time ago I was reading an article in the Saturday 'Life' section of a local newspaper. The article was about which professions are best for meeting potential partners for romance. Fitness Trainer was one of the listed occupations. I'm sure the article was meant more as light entertainment that as a piece of informative journalism. However, reading this raised some red flags and got my sleaze scanner going into overdrive. In fact, if you are thinking of becoming a Fitness Trainer because you are looking for such action, my advice is.....................Don't do it!    This is especially true for men but not exclusive to them.
   Nothing will make you look less professional than a reputation for hitting on your clients. 
Sure, some of your trainees may feel flattered and like the attention. But all it takes is one person to file a complaint! News can spread fast in a fitness center environment. Twenty years ago a Fitness Trainer might have gotten away with it. We are in a different era now. A harassment charge can put an abrupt end to a fitness career! Even a mere allegation of impropriety can haunt a Fitness trainer and drag him down like Jacob Marley's ghostly chains. A sexual assault charge is not only career suicide it could be a legal nightmare!
      Fitness Training often involves working one-on-one with an adult client. There must be a level of trust and comfort. There has to be a rapport which should remain appropriate. It is often necessary for a Fitness Trainer to have physical contact with a client in order to demonstrate proper technique.
   Always ask before touching! Another no-brainer is for a trainer to be sensible about where they lay hands on a client. I've seen some spotting technique that could have earned a well-deserved punch in the jaw if I'd have tried it on any of my protegees. .
   A woman Fitness Trainer doesn't get a free ride either. I don't know of many of my male cronies that would be offended by a flirtatious woman trainer but remember it only takes one complaint to cause a trainer grief! Women trainers may also have the instance of some poor love-starved sap who can't differentiate between friendly banter and a come-on. You want the training sessions to be fun but always tread carefully! Things can backfire fast!
   Okay, I don't want to be a complete killjoy for any single Fitness Trainers. There are only so many hours in the day and much of it is spent in a Fitness Center. Better that you should meet someone active like yourself than spend your time cruising some gin soaked den of iniquity seeking companionship.

Do not do it while you're on the clock. Try working out at another place that you don't train your clients out of.  Just don't become the weight room pest! Better yet, check out some fitness related dating websites! (That's an idea. I could start my own dating website - PlentyofMuscle.com???)
    On a related note, Fitness Trainers must be extremely careful about what comes out of their mouth! Save the jokes for a locker room but not the one in the fitness center where you work. Sexual and racial comments are verboten. Politics and religion can be trap laden conversation topics as well. A comment that may seem benign can blow up in your face easily. Remember many of your clients may have issues that don't show up in a fitness appraisal.
  
The moral of this story -cover your ass and keep your hands off everyone else's !!!!

 I can sense the potential for trouble ahead!
Brother, what are you thinking?

Until next time,.........keep fit! 
and keep your mitts to yourself!!!!!

Little Bobby Strong!

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20 Years of Personal Fitness Training at NAIT

 Has it really been that long?  Twenty years ago last September was the first ever  Personal Fitness Trainer (PFT) course of study at Northern Alberta Institute of Technology in Edmonton, Alberta, Canada. September 16 was the reunion date. I eagerly attended even though it meant traversing Canada. Here are some of my comments and observations:

• It was, purportedly, the first ever college level course of its kind in Canada.
• The intent was to fill the void between Fitness Trainers with a Bachelors degree in Kinesiology /Physical Education and those with lesser educational credentials
•  Back in those days, anybody could call themselves a Fitness Trainer and charge clients money to in return for fitness guidance. 
• In fact, any gym rat or muscle head can still call themselves a Fitness Trainer but they are less likely to be hired by a fitness center let alone get liability insurance.
• The curriculum consisted a year and a half plus of subjects related to anatomy, physiology, functional fitness, resistance training, aerobic conditioning and sports first aid topped off by some nationally recognized certificate exams.
• We also were required to do 100 practicum hours of Personal Fitness Training with volunteer clients/guinea pigs. Fortunately, there were no fatalities!
• Out of an initial class of 40, we were soon whittled down to 32 through attrition. Studying anatomy can take its toll on the sponge like organ within the human cranium!   
• It wasn't an easy ride and I pushed myself quite hard. I did enjoy the experience.
• I was actually somewhat sad when the course was all over and everyone went their separate ways.                             

Couldn't they have at least pretended to look proud of me?
That's me, kneeling, surrounded by some of my NAIT instructors past and present.

 

It hasn't been the easiest 20 years since then.There were  bumpy roads, some misdirection and even road blocks along the way.

• Alberta was still bouncing back from another boom and bust oil price recession. We were still in the bust phase. People didn't have deep pockets for luxuries.
• At first our certification was not recognized at city of Edmonton recreation facilities and some other fitness centers. Fortunately that has changed. 
• Even though we studied for a year and a half for our NAIT PFT certificate, the general public could not always differentiate between that and a weekend course certificate.
• NAIT has since turned it into a 2 year college diploma course. I am currently updating. It is time to recondition the sponge like organ of my cranium for textbook jargon.
• Some prospective clients thought we offered free services or worked only for tips.
• Many fitness center managers (even still) looked at Fitness Trainers as expendable cannon fodder rather than fitness professionals that they should be working with to best use their talents.
• It must be a character flaw. I also have a problem with some fitness center manager half my age trying to treat me like 'the lowly hired help'.  I'm barred from the premises of one or two such clubs for holding my ground.
• If you are weak in sales, align yourself with a Fitness Trainer who is strong at it. (Thank you Greg Harvey of FitNwell)
• Some of my clients were also great referral machines as well as super business mentors. Those clients are irreplaceable. (Thanks Charlie and Mordi)
• After 20 years I still  have my hand in the game as a sports/fitness blogger. Thanks for reading!

   The reunion was enjoyable. Only 1 other classmate from the first year attended. He is also an instructor in the program. I was hoping to catch up with more of the first year tribe but people move on and people get busy with their lives. Time goes and you have to go with it. At least let's do it with a pumping heart and contracting muscles!


Until next time, 
Keep Fit

Little Bobby Strong 

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