As we explained in our last post, falls represent one of the greatest burdens on the population over 65 years, and consequently, the entire healthcare system. While not all falls result in serious injury, those that do can have significant long–term implications that results in reduced mobility and activity, fear of moving, and a greater risk for other adverse health outcomes. Experiencing a fall can also cause some older adults to enter long–term care facilities like nursing homes and long–stay hospitals, where the risk for falls is generally higher because of a more sedentary lifestyle.

This highlights the urgent need for interventions that can reduce the risk and incidence of falls in the aging population. One of the most effective strategies to accomplish this is the use of exercise–based programs intended to improve strength, flexibility, mobility, balance, and proprioception (how a person senses the position and location of their body in space.) Many of these programs have been implemented for older adults in long–term care facilities, which can generally be classified into the following groups:

• Single interventions: consists only of various exercise
• Multifactorial interventions: consists of a customized combination of various exercises and other interventions, such as reducing medication use, modifying one’s home environment, and managing low blood pressure
• Multiple component interventions: consists of a fixed combination of exercises and other interventions that are intended to promote mobility, prevent muscle loss, and improve muscle coordination during physical tasks

Research on the effectiveness of these types of programs for preventing falls in older adults is mixed, with some identifying benefits and others failing to do so. Therefore, a powerful study called a systematic review was conducted to evaluate the current evidence on various exercise-based programs for reducing falls in community-dwelling older adults.

Most studies support the use of exercise–based prevention programs

Researchers performed a comprehensive search of four major medical databases for high–quality studies that assessed the impact of exercise–based programs (single interventions, multifactorial interventions, or multiple component interventions) for preventing falls and fall risk in older adults. This search led to 34 studies fitting the necessary criteria for inclusion in the systematic review.

Twelve of the included studies were themselves systematic reviews that reported outcomes on the reduction of falls, and of these, 11 reviews concluded that exercise–based interventions significantly reduced the incidence of falls. In addition, 10 systematic reviews discussed fall risk factors as outcomes, and eight of these reviews concluded that there was a significant improvement in various risk factors, including balance, muscle strength, functional mobility, heart and lung health, gait speed, or fear of falling. Only six papers evaluated negative outcomes among patients, and most of these cases were minor, suggesting that these programs were generally safe. Further analysis revealed that the most effective exercise programs were those that accounted for the specific needs and risks of each participant with a personalized rather than a one–size–fits–all approach.

Based on these findings, it appears that various types of programs with single interventions, multifactorial interventions, or multiple component interventions that include light to moderate exercise training can reduce fall risk factors and the incidence of falls in older adults living in long–term care facilities. Physical therapists can design and implement prevention programs of this nature at these facilities or in an office setting and provide additional advice and assistance on how to manage fall risk in this population. In our next post, we’ll discuss why education should also be involved in fall prevention.

Although falls in older adults are responsible for nearly one million hospitalizations and tens of billions of dollars in healthcare spending, many people are not properly informed about the scope of the problem or what they can do to address it. This is the impetus behind Fall Prevention Month, which is a campaign put forth every September that’s intended to boost awareness about the many dangers of falling with educational resources and guidance on what can be done to manage this risk.

To do our part towards these efforts, each of our posts this month will focus on a different aspect of falls in seniors and how they can be prevented.

Eye–opening facts about falls in older adults

Falls are alarmingly common in Americans over the age of 65 years. Here are a few facts to help you better understand the extent of the issue:

• One out of every three adults over the age of 65 and one of every two adults over 85 will fall at least once each year
• Approximately 2.8 million older adults visit the ER, 800,000 are hospitalized, and 27,000 die each year because of a fall
  • This makes falls the leading cause of fatal injuries, non–fatal injuries, and hospitalizations in the population over 65
• The death rate associated with falls for seniors increased by 30% from 2007 to 2016
• Falls are among the 20 most expensive medical conditions in the U.S., with the yearly costs of fall–related injuries estimated to be about $50 billion
• About 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence

Falls can occur for a variety of reasons, but they are often due to a combination of internal and external factors. Although age certainly contributes to fall risk, health status is a far more accurate predictor of one’s individual risk. Health conditions like arthritis, balance problems, lower body weakness, dementia, diabetes, and impaired vision or hearing all become increasingly common in older age and can make falls more likely. Taking numerous medications—some of which can impair balance or have other dangerous side effects—can further elevate the risk for falls.

A person’s external environment, particularly their home, is also a big determining factor in one’s fall risk. Loose rugs, clutter, slippery surfaces, poor lighting, steep or uneven stairs, and a lack of handrails or grab bars can all pose significant dangers for older adults—especially those who also have many internal, health–related risk factors. These hazards are common in many homes if no guidance is provided on how to avoid them, and this is why so many falls (up to 50%) are related to environmental causes. Collectively, the more internal and external risk factors that are present, the greater the likelihood that the individual will experience a fall.

Common consequences of falls

Fractures are by far the most serious consequence of falls, with hip fractures occurring most frequently and posing the biggest threat to older adults. In the senior community, an astonishing 95% of hip fractures are caused by falls, and more than 300,000 adults over the age of 65 are hospitalized for this type of injury every year. Other common fractures include the spine, arm, forearm, leg and ankle, and the risk for these increases even more when osteoporosis—also common in older adults—is present.

Hip fractures are particularly devastating because of their impact on mobility, as many older adults struggle to recover or regain their prior level of function afterwards. Surgery is also needed for many patients, which is associated with additional risks. Sadly, older adults have a 27% chance of dying within one year if they suffer from a hip fracture.

If a fall does occur, many individuals go on to develop an even greater fear of falling, even if they’re not injured. This can cause them to limit their activities, which leads to reduced mobility and loss of physical fitness. Worst of all, this process can develop into a vicious cycle that further raises the risk for falling because of these changes.

In our next post, we’ll talk about the importance of exercise and why it should serve as a key force for preventing falls in older adults.

Tennis is a great form of physical activity that works out many parts of the body due to its demanding dynamics, but just like every other sport, it also comes with a risk for injury. The most common injury in the sport is called lateral epicondylitis, which is often referred to as tennis elbow. Tennis elbow is a bothersome injury that can significantly interfere with gameplay, but there are several steps you can take to reduce your risk. And if it does occur, physical therapists have you covered.

The lateral epicondyle is a bony bump on the outside of the elbow that serves as an attachment point for several muscles, tendons, and ligaments of the elbow and forearm. When the arm is overworked, a muscle in this region called the extensor carpi radialis brevis (ECRB) gets weakened, which eventually leads to microscopic tears in its tendon, which attaches to the lateral epicondyle. This results in inflammation of the ECRB tendon, which is called lateral epicondylitis, or tennis elbow.

Tennis elbow is yet another example of a repetitive strain injury (RSI) that’s caused by repeatedly performing the same movements in tennis over a long period. Thus, athletes who play tennis and other racquet sports therefore have a particularly high risk for developing tennis elbow, particularly due to the groundstroke in these sports, which directly puts a strain on the ECRB. But tennis elbow can occur in anyone who performs repeated movements that involve the elbow, such as painters, plumbers, and carpenters, who are especially prone to getting tennis elbow. When tennis elbow occurs, the most common symptoms are pain and a burning sensation in the outer part of the forearm and elbow that gets worse with activity, as well as weakened grip strength.

If you play tennis regularly, following these tips can reduce your risk for tennis elbow:

• Learn to use your shoulder and upper arm muscles to take the strain off your elbow
• Stick to the middle of your range of motion during strokes, and avoid bending or straightening your arm all the way
• Make sure your racquet is the right size for you; lighter weight, larger grips, and softer strings may reduce the strain on your tendons
• Take intermittent breaks from tennis throughout the year to avoid overuse
• Try to maintain adequate fitness and flexibility levels with conditioning exercises
• Avoid repeating any one type of stroke, and practice a range of strokes instead

Physical therapy may be needed for patients with bothersome symptoms

But for those of you who are already dealing tennis elbow symptoms, or if symptoms develop in the future, the good news is that 90% of cases will significantly resolve with nonsurgical treatment alone, such as physical therapy. Physical therapists are movement experts who will first perform a thorough evaluation to identify the source of your pain and determine if any of your movements or activities may be contributing factors. From there, the therapist will design a personalized, evidence–based treatment program designed to alleviate your symptoms and restore your physical function with a variety of interventions. A typical physical therapy program for tennis elbow will consist of the following components:

• Elbow bracing, which reduces stress on the ECRB and allows it to self–repair; research has shown that using an elbow brace can significantly reduce the frequency and severity of pain in tennis elbow
• Strengthening exercises that target weakness in the wrist, forearm, and core muscles; eccentric exercises, or negative strengthening exercises, are particularly effective for tennis elbow and are likely to be included
• Manual therapy to increase the flexibility of joints and muscles of the lower arm and alleviate painful symptoms
• Activity modification training, in which the therapist will teach you how to modify any movements you perform regularly that could be contributing to your symptoms
  • For tennis players, your therapist may guide you on how to select the right type of racquet, how to modify your stroke to avoid repetitive strain of your, and how frequently you should be taking breaks to avoid overuse

As we’ve shown you over these last four posts, RSIs and occupational overuse syndrome can be the product of a wide range of movements involved in work, sports, or just about anywhere else, and the only real criterion is that the movement is performed repeatedly over a long period. The resulting pain and functional impairments often hold patients back from certain activities and can degrade their quality of life. But on the bright side, physical therapists are ideally suited to identify and treat these injuries with various interventions that both address patients’ symptoms and teach them how to modify their behaviors and prevent future injuries.

So far, we’ve been primarily focusing on repetitive strain injuries (RSIs) that result from performing the same movements regularly in one’s occupation. But sports—both as a profession and a recreational activity—typically require certain motions to be repeated as well, meaning they are yet another potential contributor to RSIs. For golfer’s, one of the most common issues is golfer’s elbow, which leads to a nagging pain on the inside of the elbow that can seriously derail a player’s game.

The medial epicondyle is a piece of bone located on the inside of the elbow that protrudes out from the humerus (upper arm bone). It contains a group of tendons and muscles, all of which allow the forearm, wrist, and hand to bend and move in several directions. When this area becomes irritated or inflamed, the result is medial epicondylitis, or golfer’s elbow.

Golfer’s elbow results from repeated bending of the wrist, which damages the muscles and tendons of the medial epicondyle and eventually leads to inflammation. The condition is especially common in golfer’s because gripping or swinging clubs incorrectly or with too much force can take a toll on these structures over time. But golfer’s elbow can also occur in other sports and from activities that strain the elbow in a similar manner, such as racquet sports, throwing sports, weight training, and even certain occupations that involve lots of bending of the wrist or elbow.

The clearest indication of golfer’s elbow is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities. Other symptoms include general weakness in the wrist and forearm when gripping, tenderness and swelling on the inside of the forearm, and elbow stiffness or numbness that radiates down from the elbow into the hand. As a result, many basic activities that require gripping or grasping can become challenging.

What a comprehensive physical therapy program can do for your elbow pain

If you start to notice elbow pain or any other signs of golfer’s elbow—especially if you golf or do any of these activities regularly—we strongly recommend visiting a physical therapist as soon as possible. Failing to address this condition early can lead to further complications down the road such as a torn tendon, which is a much more serious problem. A physical therapist will address your condition immediately by evaluating your symptoms and then developing a personalized treatment program based on your abilities, preferences, and goals. A typical treatment program for golfer’s elbow will consist of the following:

• Pain–relieving modalities ice, heat, and massage to reduce your pain levels
• Manual therapy: this type of therapy involves the physical therapist performing a series of mobilizations and manipulations to the forearm and wrist to help the muscles in that region regain their full range of motion
• Stretching exercises: since muscles will generally lose their flexibility from lack of movement, these exercises will target those areas and address any impairments present
• Strengthening exercises: weakened muscles are another consequence of golfer’s elbow, and these exercises will work to build back strength in the muscles of the forearm, elbow, arm, and hand; eccentric exercises—or negative strengthening exercises—are especially helpful for this condition
• Sport–specific functional training: for golfers and other athletes, these exercises will work specifically on the movements involved in your sport, so that you can return to the course or field more quickly and confidently

In our final post, we’ll discuss a related condition called tennis elbow, which occurs due to similar mechanisms in tennis athletes and other individuals who overuse the lower arm and elbow.

Our hands are the main tools that we use to navigate the world around us. Most—if not all—professions require some use of the hands to complete the task, whether that’s grooming dogs, typing at a computer, or trimming trees. Unfortunately, these repetitive motions can irritate and damage certain structures of the hand and wrist, as we explored in our last post. Over time, this can lead to the development of a repetitive strain injury (RSI), which can cause a variety of symptoms in the hand and wrist that will interfere with hand function and make it a challenge to perform tasks normally. Some common RSIs involve irritation of nerves as they pass through the wrist, and we’re going to discuss each of those below.

Carpal tunnel syndrome

The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to most of our fingers. If these tendons and soft tissue thicken or any other swelling occurs in the area, the tunnel narrows, which puts pressure on the median nerve and leads to carpal tunnel syndrome. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm. As carpal tunnel syndrome progresses, symptoms usually get worse when holding certain items, and the weakness and numbness may occur more frequently if pressure on the nerve persists.

Carpal tunnel syndrome affects about 5% of the population, and the greatest risk factor is performing any task that requires repetitive hand motions, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Although office work and repetitive typing may be a potential cause, the professions most frequently associated with carpal tunnel syndrome are those that involve sewing, baking, cleaning, or assembly–line work.

Cubital tunnel syndrome

The ulnar nerve is a major nerve that travels from the neck down to the hand, where it provides sensation to the little finger and half of the ring finger. This nerve can become compressed—or squeezed—by nearby structures at any point along the way. But the most common place this compression occurs is behind the inside of the elbow at the cubital tunnel, a narrow passageway for the ulnar nerve.

The result of this ulnar nerve compression is cubital tunnel syndrome, which is the second most common nerve compression syndrome of the arm after carpal tunnel syndrome. Symptoms are also similar, as pain, numbness, tingling, and weakness in the arm and hand—especially in the ring and little fingers—are most common. Cubital tunnel syndrome is also caused by daily habits like leaning on the elbow for long periods of time, sleeping with the arms bent, or from direct trauma to the ulnar nerve, like hitting your “funny bone.”

Guyon canal syndrome

The Guyon canal is another “tunnel” for the ulnar nerve that is formed by two bones in the wrist (the pisiform and hamate). When the ulnar nerve is compressed at this location, the resulting condition is called Guyon canal syndrome—or ulnar tunnel syndrome—which is far less common than carpal tunnel syndrome; however, both conditions will occur at the same time in some cases.

Guyon canal syndrome often develops due to overuse, particularly from activities like heavy gripping, twisting, and other repeated hand and wrist motions. Repetitive work with the hand bent down and outward and repeated pressure on the hand—such as in cyclists, weightlifters, and with regular use of a jackhammer—can also cause pressure or irritation of the ulnar nerve at the Guyon canal. Symptoms include pins and needles in the ring and little fingers, which may progress to a burning pain, decreased sensation, weakness, and difficulty spreading the fingers and pinching.

Physical therapy and nerve mobilization exercises can effectively alleviate symptoms

If you notice symptoms that sound like any of these conditions, your first step should be to evaluate your daily habits and behaviors to detect any repetitive movements that could be contributing factors. The tips we provided in our last post can be used to treat as well as prevent overuse injuries like carpal tunnel syndrome, cubital tunnel syndrome, and Guyon canal syndrome, but they may not provide you with adequate relief on their own.

In these cases, a course of physical therapy may be needed to manage your condition. A typical physical therapy treatment program will include bracing or splinting, modalities like ultrasound and electrical stimulation, and advice on how to make modifications to your lifestyle and posture. But the central component of most programs for these nerve–related conditions is targeted exercises that help to move the affected nerve away from the compression forces. Nerve mobilization exercises are designed to help glide or mobilize the ulnar nerve and encourage normal movement through the cubital tunnel or Guyon canal, which can effectively alleviate pain and other symptoms. A similar approach is also recommended for carpal tunnel syndrome, as specific exercises can decrease swelling and adhesion in the carpal tunnel, thereby mobilizing the median nerve and reducing pain levels in the process. Below are a few examples of nerve mobilization exercises for each of these conditions:

Carpal tunnel syndrome

• Median nerve mobilization
• Nerve gliding exercise

Cubital tunnel syndrome

• Elbow flexion and wrist extension
• Head tilt
• Arm flexion in front of body
• A–OK

Guyon canal syndrome

• Wrist flexion and extension exercise
• Side wrist flexion exercise

In our next two posts, we’ll explore how RSIs can also result from overtraining in sports like golf and tennis.

Throughout a typical day, you use your hands, wrists, and elbows almost constantly. From vigorously brushing your teeth in the morning, to switching the lights off before bed, and during just about every other action in between, these joints are frequently in a state of movement. But over time, performing certain tasks on a repetitive basis can lead to damage and injury.

Certain professions are associated with higher risks for pain

Occupational overuse syndrome, also known as repetitive strain injury (RSI), is a potentially disabling condition that results from overusing a region of the body–usually the hands, wrists, or elbows–through repetition of similar movements. As the name suggests, workplace habits and behaviors are some of the most common culprits of occupational overuse syndrome because they require repeating certain movements to complete the job at hand. Nearly any occupation that involves the hands and wrists can contribute to occupational overuse syndrome, but certain activities and equipment are more likely to increase the risk, such as the following:

• Vibrating equipment
• Working in a cold environment
• Carrying heavy loads
• Working with furniture, tools, or equipment that is not ergonomically designed (doesn’t comfortably conform to one’s body)
• Working long hours without breaks
• Holding the same posture or position for prolonged periods
• Working with machinery that is too fast for user comfort

As a result, some of the most at-risk occupations are those that involve office work (ie, any job performed on a computer), process work (eg, assembly line and packing), piece work (eg, sewing), and manual work (eg, bricklaying and carpentry). Professionals who use vibrating tools—like hairdressers and tattoo artists—as well as musicians, mail workers, kitchen workers, and cleaners all tend to have an elevated risk for RSIs as well. But this doesn’t mean that someone must work in a particular field to develop this type of condition. Various sports, as well as leisure and recreational activities like playing video games, scrolling on a cellphone, and gardening can lead to strain and painful symptoms, too.

A wide range of conditions fall under the umbrella of occupation overuse syndrome or RSIs, including bursitis, tendonitis, carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, golfer’s elbow, tennis elbow, Dupuytren’s contracture, and trigger finger (we will discuss several of these conditions in the next few posts). Symptoms vary depending on the specific condition present, but some of the more general symptoms are:

• Tenderness or a burning, aching, or shooting pain in the affected muscle or joint
• A throbbing or pulsating sensation in the affected area
• Tingling (especially the hand or arm)
• Loss of sensation/numbness or clumsiness
• Fatigue or weakness that makes it difficult to perform basic tasks

Tips to reduce your risk at the workplace

Since many of these conditions result from activities that one must perform in their occupation, the best way to prevent occupation overuse syndrome from occurring is by modifying certain movements and activities to reduce the strain placed on the body. Here are a few helpful tips to reduce your risk:

• Adjust your posture and the positioning of your hands and wrists
  • Try to keep your shoulders square rather than rolled forward when sitting, standing, and walking
  • Try to perform tasks with the arms at a comfortable distance from the body (not too close and not too far)
  • Keep your wrists in a neutral position that’s parallel to the ground, or slightly bent downwards towards the keyboard; avoid flexing your wrists and angling them upwards to reach the keyboard

• Try to avoid repetitive straining movements
  • Pay attention to how you use your hands when performing tasks at work and elsewhere, especially those that are done repeatedly
  • Avoid tasks that require constant bending or twisting of your hands; if these movements are part of your profession, try to take frequent short breaks, switch hands, and rotate tasks whenever possible

• Modify your workstation positioning and habits
  • Make sure your forearms are level and wrists are not flexed and in a neutral position when you type
  • Don’t rest your wrists on the table surface
  • Try to avoid reaching too far on the keyboard with one hand
  • Change your hand positions often and take frequent breaks

Physical therapy is an ideal approach for occupation overuse syndrome

If occupation overuse syndrome develops, it’s best to take a hands-on approach and see a physical therapist. The first step of every encounter with a physical therapist is a detailed interview about any factors that could be contributing to a patient’s symptoms. If the physical therapist then determines that the patient’s profession is likely to be responsible for their symptoms, he or she will offer specific recommendations to reduce the amount of stress and strain on the injured region(s) of the body, which may include the use of ergonomic tools and equipment. The therapist will also create a personalized treatment program designed to alleviate pain and improve physical function with carefully selected interventions, such as stretching exercises, strengthening exercises, posture training, passive modalities, and manual (hands-on) therapy.

In our next post, we’ll take a closer look at three RSIs: carpal tunnel syndrome, cubital tunnel syndrome, and Guyon canal syndrome.

By now, the many ways in which posture can influence the body and the importance of practicing good posture should be abundantly clear. If you’re interested in taking more control over your own posture, performing the exercises and techniques described in our last post is a great place to start, but they may not solve your issues independently.

Correcting one’s posture—especially if it’s been particularly poor for a long while—is hard work that doesn’t take place overnight. Truly improving posture usually requires a more sustained and hands–on approach, which is best provided by physical therapy. Physical therapists are perfectly positioned to correct posture, since their practice is based on evaluating the body’s mechanics—which directly contribute to posture—and then determining the best way to address any impairments or imbalances.

Whether a patient has a specific postural problem or a painful condition that may be related to a postural deficit, the physical therapist’s first step is always to perform a thorough screening examination. This involves the patient performing several everyday movements while the therapist observes the position of the spine, head, shoulders, and various other body parts in relation to one another. From there, the therapist will create a personalized treatment plan that focuses on correcting any postural faults and/or painful conditions present, which may include the following:

• Strengthening exercises that target the muscles that attach to the shoulder blades and core muscles
• Stretching exercises to increase the flexibility of the head, neck, and shoulders
• Manual (or hands–on) therapy, especially if any neck, back, or shoulder pain is present
• Posture tips and recommendations, such as setting frequent alarms to remind you to change your posture, working in front of a mirror, or using a foam roller

Evidence supporting physical therapy for posture correction

Research on the use of physical therapy for posture is not abundant, but there are some key examples in the literature. In one high–quality study called a randomized–controlled trial, 99 adults aged 60 years and older with hyperkyphosis were randomly assigned to either a treatment group or a control group. The treatment group participated in three hour–long exercise sessions each week for six months. These sessions were led by a physical therapist and included various exercises that targeted muscle impairments that were known to be associated with hyperkyphosis, with a particular focus on strengthening and improving the flexibility of certain back muscles. These patients were also given training to help improve their posture. Patients in the control group attended an education session every month for four months and did not undergo any physical therapy.

Results showed that patients who followed the physical therapist–led exercise program experienced several significant improvements compared to the control group. Most importantly, the angle of the curvature of the spine reduced by an average of 3.3° in the treatment group, compared to only 0.3° in the control group. In addition, the treatment group reported better self–image and satisfaction with their appearance after completing their treatment. These findings suggest that a treatment program consisting of spine strengthening exercises and posture training can lead to physical improvements in older patients with hyperkyphosis, which in turn appears to boost their confidence.

Contact a physical therapist for any posture issue or pain you’re dealing with

So if you’ve noticed that your posture is less than optimal or if you’ve been bogged down by pain that could be related to your posture, we strongly encourage you to see a physical therapist, preferably sooner rather than later. Doing so will help you address any issues before they progress further and reduce the risk for long–term complications

In our first post, we briefly mentioned how bad posture, neck pain, and respiratory function are all related. This relationship is worth a closer examination, too, as improving the way you breath is a key to better posture, reduced pain, and less stress.

A brief overview of breathing and posture

At first glance, posture and breathing may seem like separate bodily functions of the body. But when you understand how each one works, you can see that they are deeply interconnected, and that the health of one function can directly impact the other.

The diaphragm is the main muscle of respiration. It’s a dome–shaped muscle located between the chest and abdomen that contracts and relaxes during different points of the breathing cycle. When you take a breath in, the diaphragm contracts until it becomes flat to create room in the chest cavity for the lungs to expand, which lifts the ribs outward. Intercostal muscles, located between the ribs, also assist the diaphragm by elevating the ribcage to allow more air into your lungs. When you exhale, the diaphragm relaxes and assumes its full dome shape, while the ribcage contracts and returns to its original resting state.

Poor posture, especially when seated, keeps the diaphragm compressed and prevents it from opening fully when breathing. Similarly, rounded shoulders and a forward head posture can cause the muscles around the chest to tighten. This limits the ribcage from expanding completely and causes people to take more rapid, shallow breaths.

There is also potential for a vicious cycle to develop between posture and breathing. Breathing from the chest relies on secondary muscles in the neck and collarbone instead of the diaphragm, and when this breathing pattern occurs along with poor posture, it can weaken many muscles in the upper body and prevent them from functioning properly. Having weak core and upper back muscles makes it more difficult to practice good posture, and these two forces continue to impact one another in a cyclical fashion. Over time, this can lead to the development of many of the painful conditions we’ve described, such as neck, back, or shoulder pain.

Deep breathing and other techniques to improve breathing patterns

Since breathing and posture are so closely intertwined, taking steps to improve one of these functions will likely have a positive impact on the others and lead to several other benefits as well. Keeping a slow, steady breathing pattern has been found to enhance core stability, improve tolerance to high–intensity exercise, and reduce the risk for muscle fatigue and injury. Paying more attention to your breath may also improve sleep habits and alleviate stress and anxiety, since breath focus is considered a common feature in several techniques intended to put one in a state of calm. Below are a few examples of breathing techniques and other exercises that can help you take better control of your breath and posture:

• Deep breathing: sit somewhere comfortable, relax your shoulders and inhale slowly to fill your lungs completely; then exhale slowly, emptying the lungs completely
• Pursed lip breathing: breathe in through the nose, then breathe out through the mouth with pursed lips while making the exhaled breath twice as long as the inhaled breath
• Box breathing: breathe in through the nose for four seconds, filling the lungs, then hold the breath in the lungs for another four seconds; next, breathe out slowly through the mouth for four seconds, emptying the lungs fully, then wait another four seconds before breathing in again
• Flexibility and resistance exercises: these exercises help realign posture and train the body to breathe better
• Traditional quadriceps stretch: bend your right knee and reach behind to grab your right foot with your right hand and bring it to your buttocks; try to keep your knees aligned throughout this stretch
• Head–to–hand neck release: in cross–legged position, bring your right ear toward the right shoulder, then lift your left arm to your shoulders and spread your fingers with palms facing up; place your right hand lightly on top of your head and apply slight pressure; retract the left shoulder blade toward the spine and hold the posture; repeat on the other side
• Wall chest stretch: face a wall and place your hands on the wall at shoulder height; walk your feet and push your hips back so your torso is parallel to the floor; keep the toes pointed forward and the feet under the pelvis; you should feel a stretch in the back of the legs and chest muscles

In our next and final post, we’ll show you why physical therapy may be necessary to if you want to commit to improving your posture.

In our last post, we introduced you to the concept of posture, explained what is meant by good versus poor posture, and offered a few examples of painful conditions and other dysfunctions that may be related to poor posture. But since this was only the introduction to the topic, there’s a great deal more to discuss when it comes to posture, pain, and how the two might influence one other.

To dive a bit deeper, in this post we take a closer look at posture by answering some of the most frequently asked questions about the topic.

Q: How common is forward head posture?

A: As we explained previously, forward head posture is when the head is positioned in front of the shoulders—by more than one inch—instead of directly over the shoulders. Also referred to as “text neck” due to its relationship with staring down at one’s phone too frequently, forward head posture is the most common of all postural faults, affecting between 66% and 90% of the population.

Q: How does forward head posture affect the body?

A: Forward head posture forces the muscles of the neck to work harder to hold up the head, and the further forward it’s positioned, the harder these muscles must work. Over time, overworking these muscles can lead to muscle imbalances as the body tries to adapt while figuring out other ways to hold the head up straight. Excessive forward head posture may also lead to reduced flexibility of the neck—particularly when rotating and flexing the neck—and have a negative impact on balance.

Q: What is hyperkyphosis?

A: Recall that the spine has three curves. The first curve (at the neck) and third curve (in the lower back) are forward curves called lordosis. The second curve, which runs from the shoulders to the bottom of the ribcage, is a backward curve called kyphosis. All these curves are necessary in the normal spine to balance the trunk and head over the pelvis, but in some cases, they can curve too far inward or outward. The normal angle of the second curve is between 20-40°, but when it increases beyond 40°, the condition is called hyperkyphosis, which is more common in older adults but can also occur in children and adolescents. Poor posture and excessive slouching are the biggest contributors to hyperkyphosis, and over time, it can cause a noticeable hunching forward of the back.

Q: What other painful conditions may be related to poor posture?

A: We already listed several examples of painful conditions that may result from or cause poor posture in the medical literature. Here are a few more:

• Pain between the shoulder blades (interscapular pain), which can result from muscle strain due to leaning forward with prolonged sitting or standing
• Shoulder impingement, which is the painful pinching of the shoulder’s muscles against surrounding bone from repetitive shoulder movements; slouching or hunching over can narrow an important space in the shoulder and cause tendons to become pinched and rub against other structures
• Tight hamstrings: when the hamstrings are too tight, it rotates the pelvis backward, which can flatten the natural curvature of the back and cause poor posture while seated or standing
• Tight hip flexor muscles can pull on the spine and lead to bad posture

Q: Do all experts agree that poor posture directly causes pain?

A: In short, no. Although there is an abundance of research that supports a connection between poor posture and various painful conditions—as we’ve shown—there is also ample evidence to show that there is no association between these factors, or that the association is not very important. For example, a powerful review called a systematic review analyzed 54 studies and found no evidence of a relationship between excessive curvature of the spine and health issues, including neck or back pain. However, it should be noted that the general quality of the studies included in this review was rated as low.

In our next post, we’ll explore how your breath affects your posture, and why working on improving one could also improve the other.

Osteoarthritis affects up to 31 million Americans, making it one of the most common conditions in the nation. The resulting joint pain can be devastating for these individuals, and the longer osteoarthritis progresses, the greater the disability becomes. It’s no surprise, then, that there is a plethora of treatments, medications, and products available that claim to alleviate pain related to osteoarthritis or even prevent it from progressing.

Over the past 20 years, glucosamine and chondroitin sulfate have emerged as two of the more popular products that claim to resolve osteoarthritis–related issues. But what are glucosamine and chondroitin sulfate, and what does the research say about their effectiveness? In this post, we try to answer these questions and help guide you towards an informed decision about whether taking these is right for you.

Nutritional supplements are not FDA–regulated

Glucosamine and chondroitin sulfate are naturally occurring substances that make up many connective tissues throughout the body, including the cartilage that protects the ends of bones in joints. Glucosamine is a major building block of large compounds called proteoglycans, which contributes to the elasticity of cartilage, while chondroitin sulfate is a larger molecule that also plays a key role in the elasticity and function of cartilage. Either of these chemicals can be extracted from the tissue of certain animals and then packaged in pill form—either individually or combined—to be taken as a treatment for joint pain related to osteoarthritis. The typical dose is about 1500 mg for glucosamine and 1200 mg for chondroitin sulfate, taken once daily.

However, it’s important to note that products containing glucosamine and/or chondroitin sulfate are labeled as nutritional (or dietary) supplements rather than approved medications. Status as a nutritional supplement means that these products are not subjected to the same aggressive regulations as prescription medications and claims regarding their indication or effectiveness have not been evaluated by the U.S. Food and Drug Administration (FDA). Glucosamine and chondroitin sulfate supplements typically claim to alleviate joint pain from osteoarthritis and help to slow or prevent the breakdown of joint cartilage, which is the major underlying cause of osteoarthritis pain. But do they deliver on these supposed benefits?

Loads of research both for and against

The short answer: possibly, but it’s difficult to say with certainty. Evidence to support glucosamine and chondroitin sulfate supplements for osteoarthritis has been mixed, with some studies suggesting that one or both chemicals can relieve pain and others identifying no clear benefits.

For example, a key analysis of multiple studies published in 2010 called a meta–analysis concluded that glucosamine and chondroitin—both independently and in combined formulations—did not reduce joint pain or have any impact on the narrowing of joint space. Another study published in 2016 that administered combined glucosamine and chondroitin sulfate to half the patients and placebo to the other half had to be stopped early because those taking the supplement reported worse symptoms than those taking placebo.

On the other hand, a 2008 study found no statistically significant improvements in knee pain overall for patients with knee osteoarthritis taking glucosamine and chondroitin sulfate supplements, but a group of patients with moderate–to–severe knee pain did experience some improvements. A 2014 review concluded that these supplements may lead to a small but significant reduction in joint space narrowing, while another key 2018 meta–analysis found that chondroitin sulfate alone was more effective than placebo for relieving pain and improving function in knee and/or hip osteoarthritis, and glucosamine was found to reduce stiffness.

Although most guidelines from professional societies do not currently recommend glucosamine and/or chondroitin sulfate for osteoarthritis, some experts believe that newer supportive research could lead to some future changes in these guidelines. But as you can see, the jury is still out on these supplements. It’s possible that the evidence is so mixed because some patients do truly experience benefits—possibly from the placebo effect, which is a real benefit nonetheless—while others do not.

Consult your doctor before making a decision

Therefore, a clear–cut answer on the therapeutic value of glucosamine and chondroitin sulfate for osteoarthritis may be difficult to reach, but should you still consider taking these supplements? Since answering this question is out of our scope as physical therapists, we strongly recommend talking to your doctor and evaluating the potential benefits compared to the risks involved. These supplements are generally considered to be safe, but some side effects have been reported, including diarrhea, abdominal pain, heartburn, drowsiness, and headaches. If you and your doctor agree that the benefits outweigh the risks, it’s probably best to try a short trial of one or both supplements, and if you don’t experience any notable improvements after a designated period, consider discontinuing their use. And as always, keep realistic expectations and understand that these supplements can only go so far. Proper care for osteoarthritis also requires regular movement and exercise, and as physical therapists, we can help you get there with a comprehensive, customized treatment program.