Kleiman-BCT and National Heart Month
Advanced cardiovascular activities like step aerobics and running can place additional mechanical stress on the back/spine. The speed of movement and/or amplitude of movement can increase compressive forces on the spine. A simple functional test for assessing the spine’s tolerance to increased force during higher levels of activity is rope jumping. Wearing flexible-cushioned shoes on a slightly pliable floor/surface, perform 50 jumps in place (1-3 sets) with a standard swivel-handled jump rope. If able to maintain an erect trunk without increase in back symptoms during or after the session, attempt initiation of an advanced progressive exercise program beyond walking.
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True to the philosophy of Kleiman-BCT, stretching is a vital component of the prevention phase to enhance functional performance. Like other components of the comprehensive BCT program, traditional stretching exercises have been surpassed. Requirements for BCT stretching include:
1) Joints adjacent to muscles being stretched must be in a non-weightbearing position.
2) The muscle being stretched should be positioned so slack is taken up at its attachments (origin/insertion). Optimal release comes from the muscle belly.
3) A BCT stretch is maintained from 15-30 seconds or until muscle release is felt.
4) Recommend 5 repetitions per exercise session but not to exceed one session per hour.
5) Stretching can enhance the ability to strengthen and should be performed prior to strengthening.
6) Performing cardiovascular activity before stretching will facilitate a muscle release.
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Bike into Spring
If sitting is your position of comfort, and walking and standing increase your back discomfort, bicycling may be a better choice for general aerobic conditioning. Remember that sitting on a bike is a forward bent posture (flexion). Using an Airdyne bike with arm movement is added flexion of the trunk on top of the flexed sitting posture.

If walking and standing are your positions of comfort and yet you want to ride a bike for general conditioning, it is recommended that you keep your trunk erect and do not use the arm movement on a combination (arm) bike.
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National Physical Therapy Month: The science of healing…the art of caring
Congratulations to all patients who have accessed a physical therapist
"Youthful Games”
Did you ever wonder why you were unable to hula-hoop, jump rope, pogo stick, or walk on stilts?
Did you ever consider that biomechanics may have prevented you from being successful?

To hula-hoop, the pelvis needs to be symmetrical and have circular mobility. To jump rope, pogo stick or stilt walk, one must have upper trunk extension and weight centered through the pelvis and midfoot.

If balance is repeatedly lost in the same direction, the cause may be biomechanical more than lack of coordination.

It’s not too late to master these skills through BCT!
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Holiday Back Blues
Starting the new year with residual back or neck pain from holiday travel can be rough – keep in mind these tips to make travel in 2002 easier on your body:

Travel by Car: The most supportive position for the neck and back is the driver’s seat. If the back has any structural instability, the support of the steering column provides added stability. Keep the tires optimally inflated to help absorb the bumps and vibratory forces from the road. Many car seats have reversed incline and slope towards the back of the seat. Use the automatic seat adjustment (or a large phone book in which the needed number of pages can be turned) to level the seat to your comfort.

Travel by Plane: To support the back, take the flight magazine and roll lengthwise, wrap one or more airline blankets around it and secure with a rubberband. Place the roll in the arch of the back or at the base of the buttock near the tailbone for personal comfort. To support the neck, roll a magazine lengthwise, wrap the flight pillow around it and secure with a rubber band, adjust to comfort. Feet should be supported up on the edge of a carry-on bag (already placed at your feet) so feet and thighs are parallel to the floor.
When traveling by car or plane, get up and walk around as frequently as possible. Walk backwards if in a safe area and use the muscles you’ve been sitting on. There is no need to be miserable or blue if you follow these clues! Good luck!
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Hiking Through March
When “hiking” the streets of San Francisco, Camelback Mountain in Scottsdale, AZ, or your favorite local trail, be aware of the forces placed on the body. Forces accumulated in the ascent must be negated through the descent. It is of little benefit to hike up, only to be carried down.

When hiking, the vertical rise must be inversely proportionate to the horizontal distance. As the terrain gets steeper – shorten step length to minimize the displacement of joint biomechanics. Wear 3/4 to full boot-cut hiking footwear with cushioned, flexible, and gripping soles to accommodate nature’s terrain.

Hiking is a low grade march with a lot less synchronicity – Watch your step!
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Step by Step by Step
Hiking, or even walking, can seem difficult unless one can master the step.

The average step (stair) height is 8 inches – taking two steps at a time is 16 inches – for some the task and height seem irrelevant, for others, impossible.

To make steps safer, use a secured handrail when available.

To make steps easier, try one or more of these suggestions:

1) Perform a “step to” and not a “step over step” follow-through by landing on the same step with one foot at a time before proceeding to the next step.
2) Perform side stepping with “step to” step, leading with right or left foot
to comfort.
3) Wear platform soled shoes that diminish the step’s functional vertical height.
4) If it is possible, secure a 4-inch block (wood/book/brick) to each step to make an intermediary “step”. Ascend/descend on a diagonal taking two 4-inch steps on each step (before changing steps).
5) If there is a sturdy railing, turn around and face the steps and perform a "step to" pattern. Keep body weight leaning forward towards the up-step.
6) Ascend/descend steps in modified crawl facing the steps, hand/foot-hand/foot.
7) When all else fails, turn around and go up/down steps on buttocks.
Stairs are a common site for accidents. Injuries related to falls on steps often go untreated and show up later as a loss of function. Prevention is the first “step” to a “step by step” approach.
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Gardening is a great “total body” work-out because it is multi-tasked.
To prepare for gardening, warm-up by walking briskly around the yard or grounds 5-10 minutes before collecting gardening tools.

Best to use a rear-tine to keep forces distributed through the machine and minimize forces to the operator.

Best to use a newly sharpened pointed blade shovel that allows placement of the right/left
foot securely on the edge for better body weight distribution.

Dual front wheels make it easier to move a heavy load but requires a bigger area to
maneuver around.  When the load is too heavy to push, reverse direction and pull the wheelbarrow to designated dump site.

Garden Weasel-Weeder:
Standing or kneeling on all fours keep trunk weight directly over the tool as the weeds are loosened from the dirt. Move to/over the weeds to be pulled to avoid excessive reaching. It is easier to pull weeds after a rainstorm or after watering the area.
It is important to vary activity and take body breaks - survey the work accomplished!
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As summer approaches, weekends are an opportunity to escape daily routines and go camping. The experience can be relaxing and revitalizing if activities are done safely.

Camping requires a lot of physical work to pack and set-up. As a precaution, BCT recommends the following items be packed to go.

1) Light-weight wagon:

- To haul equipment from car/trailer to set-up site.
- Haul firewood back to the fire pit.
- Transport children back/forth from restrooms and playground.
- To haul cooler/bags of ice.

2) Stackable – Plastic/Rubbermaid laundry baskets with handles:

- Haul food and kitchen supplies/utensils.
- Store dirty towels/laundry.
- Throw shoes in at the door to avoid tripping on the clutter.

3) Sturdy portable two-step stool.
Allows positioning to reach the top of the tent pole/awning for set-up.
- Allows one to sit comfortably hammering in tent stakes.
- Allows one to sit level to the hitch to get better cranking leverage when hooking up the trailer.

4) Pack a comfortable higher back rocking lawn chair.
If you enjoy sitting – keep moving but in a relaxed rhythmic fashion.

Enjoy the time away but do it safely so you can continue to play!
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Water Transfers
Boating is a great deal of fun when the days get hot. To transfer safely in/out of a boat, the key is to have two level stationary supports for transfers. Many times the boat is loosely anchored and the dock and boat are seldom the same height, increasing the risk of injury. To minimize risk, we suggest:

A sturdy, portable pool/boat ladder with hand rails that can be securely anchored to the side of a dock or boat to provide better foot/hand placement to control body weight during transfers.

In canoes and kayaks, a looped tow strap can be secured on/around the end of the boat so foot/knee placement can be shortened to provide leverage to get into the boat safely without tipping. It is recommended that another body or weighted object be placed at the opposite end to keep both ends of the boat in the water.

Use non-slip footwear to ensure secure footing and the assistance of a boating buddy to be safe and injury-free when engaging in water sports.
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Boating and Tubing, back to back fun!
Summer is here and with the holiday approaching, many of you will be on the water.
It is important to protect your back (spine) while enjoying water sports.
Be aware of the following:
  1. Rough waters and wakes increase vertical compression to the spine.
  2. When sitting on the boat, use a compressible cushion and sit centered with weight equally distributed on buttocks.
  3. When tubing, try to avoid hyperextending the back. It is better to sit and recline on the tube than lie on your stomach.
  4. When done boating, get in the water and swim to take advantage of the water’s buoyancy to unload your spine before heading back on land.
Don’t let your fun ruin your back or you won’t be back!
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Recreational Vehicles can make or take away the FUN!
With summer coming to an end, be aware of biomechanical changes that can occur while riding in recreational vehicles.

Be aware of the following:
  1. Personal water craft may have a wide seat requiring thighs to be positioned far apart. Depending on leg length of a taller person, the knees may also be higher than the hips. If this is the case, positioning can tip the pelvis back, decreasing the normal low back (lumbar) curve. A decrease in lumbar curve puts the back muscles at risk for excessive stretching and possible tearing.
  2. Motorcycles have a narrower seat, but the rider in back can be put in a vulnerable position while straddling the driver in front. Lowering knees below the hips can minimize stress to the low back as the lumbar curve is maintained.
  3. Gripping handlebars with arms forward can cause excessive pull on the mid back. Changing seat location (front to back) will change the arm position, decreasing stress on one area.
    Ride wise and have fun!
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Movement - Marching is Stimulating
Digestive symptoms such as constipation and bloating can be secondary to a lack of movement.

Bowel movements can be as frequent as 3X/day to as infrequent as 3X/week and still be considered normal. What is important to understand is that food taken in should produce a bi-product that needs to be eliminated.

Elimination can be enhanced from internal stimulation of the sacrum and external stimulation though body movement.

Sacral Movement (Internal):
  1. Deep breathing with full inspiration and exhalation rocks the sacrum back and forth stimulating the bowels.
  2. Forward and backward bending of the trunk, in standing or sitting, rocks the sacrum.
Body Movement (External):
  1. Moving the lower trunk and the legs stimulates the bowels.
  2. Moving the legs through brisk walking, running, jumping on a trampoline, stair stepper, elliptical machine and of course marching are all helpful.
Prolonged immobility can put one at risk – so this month make a commitment to get physical.
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Spring and Summer Activities
Spring and summer brings a parade of physical activities that may challenge your physical well-being.

Repetitive activities can place stress on any body that isn’t fully functional. When experiencing repeated patterns of restriction or pain, assess the area that continues to grab your attention.

Stress fractures commonly occur with repetitive activities.

Marching, especially in parades can lead to a stress fracture of the foot, commonly called “march fracture”. If marching were the primary cause, every bone in the foot should have the same fracture pattern, but it is not the case. Often it is the increased force placed on the second metatarsal (toe). If the force stops short, accumulating to, rather than distributing through, the body part can be compromised.
Time alone doesn’t fully resolve a stress fracture. Restoring biomechanics in conjunction with force distribution is a big part of the solution.
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