Muscles are meant to move. The advancements of modern society have made our lives more efficient and more stressful. While modern man can communicate and travel great distances, the methods require very little movement on the part of each traveler. D. Zacharow wrote, "compared to primitive man living an outdoor life, civilized man has become a standing-around and a sitting-around animal rather than a running-around one."

1. Today, when someone says they've been running around, it usually entails sitting in a car, standing in an elevator, standing in lines and sitting in waiting rooms. None of these activities actually challenge the muscles to move through their full range of motion. Repetitive immobility, replicated on a daily basis, leads to chronic, postural overload and adaptive shortening of the muscles and fascia. This shortening of the myofascia exhibits itself as stiff joints, decreased flexibility, loss of fluidity, and poor posture. Fascia, according to Cailliet, "envelops individual muscle groups that separate that group from adjacent muscle groups. There is a fluid between the fibers of this fascia that acts as a lubricant to permit freedom of movement of each adjacent muscle group."

2. If you continually stress and tighten a muscle group, the fascia and muscles will adhere together, restricting their range of motion and creating postural imbalances. "What most of us think of as balance is this sort of a state of contraction, of holding things together so they will not fall apart. Over time, this sort of posture becomes habitual, and it results in chronic rigidity,"explains Joseph Heller in his book, Bodywise. The goal of any chiropractor, when looking to correct vertebral subluxations, is to help the body regain balance and reduce this chronic rigidity.

When a body is out of alignment, there exists an unequal pull of gravity upon all the body parts. Ida Rolf recognized this years ago and addressed the relationship between gravity and posture. She noted that "man is an upright animal, and if that upright body is out of line, then the rules of the game say that the gravity is pulling unequally."

3. If you, as a physician, wish to realign the spine, for the better, then you must recognize the relationship between the body and gravity. As Ida states, "you must find that pattern in which a body can be aligned so that gravity can pull symmetrically."

4. Physicians who are intent upon the restoration of health in each of their patients should observe the patient's standing and walking posture. Watch for instability and restricted movement. In Posture and Pain, Kendall notes that "normal joint range for adults should provide an effective balance between motion and stability. A joint which is either too limited in range or not sufficiently limited is vulnerable to strain."

5. Testing and observing the patient through their full range of motion, from the neck to their feet, will reveal the results of habits and patterns which may have begun in infancy. How will you attempt to correct those postural imbalances? And once there is improvement, what do you do to help the patient maintain that balance? One tool in a chiropractor's arsenal that is often overlooked is a stretching program. Most patients who enter chiropractic offices have sedentary lifestyles, and lack of movement is their primary activity of the day. Their favorite excuse is that they don't have time to stretch or exercise. It should be part of physician's job, as Edison once said, to "interest the patient in the care of the frame and health of the body." Stretching should become a habit, done regularly, just like brushing your teeth. Without stretching, the patient continues to promote a pattern of restricted movement and muscle fatigue. Guyton points out that muscle fatigue comes from a prolonged and strong contraction of a muscle. It is the interruption of blood flow, due to contracting muscle tissue, which leads to muscle fatigue, due to the loss of the nutrient supply and the lack of oxygen.

6. Teach your patients that inactivity is going to create postural imbalances, with muscles that are both tight from contraction and weak from being overstretched. One local irritating factor or metabolic abnormality of muscle is that pain and other sensory impulses can be transmitted to the spinal cord which leads to a reflex muscle contraction.

7. This means that influences such as overworked muscles, lack of blood flow or severe cold will promote continued muscle contraction. Interspersed within the muscle fibers are stretch reflexes which serve as sensory feedback for muscle fiber length.

8. One set of reflexes, when sensing muscle stretching, will work in opposition to keep the muscle from overstretching. A different set of reflexes, sensing muscle contraction, will work to oppose the continual contraction. Stretching regularly helps to overcome the body's natural tendency to move towards imbalance. "Balance is not a static condition," states Heller, "but is a process of constant flux, a fluid expression of wholeness and ease."

9. Patients should know that frequent movement is necessary for good spinal health. Vertebrae, when properly aligned, have a natural fluidity. This fluidity is lost, however, if the soft tissues are in constant holding patterns, influenced by tension, stress and pain.

A stretching program does not require a lot of time, nor should it be done only at the outset of pain or stiffness. Any program can be successful if it is done consistently and with purpose. Most muscles need 20 to 30 seconds to begin releasing tension, but a longer time is preferable. Give your patients a small number of stretches that they can easily do at home or at work. They can do stretches which may be done standing or sitting, and should address their major area of complaint.

There should also be a set of basic stretches for the spine which include the four directions of movement; flexion and extension, rotation, and lateral flexion. These back stretches should be done daily. Some people use the stretches to help wake up in the morning while others prefer to stretch at night. Anytime is acceptable as long as the stretches are done slowly and gently, although warmed up muscles are going to stretch more easily.

Your patients should know that stretching may be accompanied with mild discomfort. This is normal. If sharp or moderate pain occurs while attempting to stretch a muscle, caution the patient to stop and see if they are stretching correctly. If they resume the stretch and the pain persists, have them stop and consult you. It is important for you, as the teacher, to observe how your patients do the stretches the next time they come into the office. This helps you assure them that they are stretching correctly, and secondly, it tells you if they have been compliant in following your directions.

Let your patients know that this is not a chore that they have to do, but rather a mini vacation for their muscles to relax and release any built-up tension. Patients of all ages and in all occupations will benefit from having a regular stretching program. If the program comes from you, then whenever they stretch, they are going to think of you and the importance of chiropractic healthcare.

Printed as "A Stretch in Time" in Chiropractic Products Magazine, Sept., 2002

Cumulative Trauma Disorders
And how to prevent them

Cumulative trauma disorders (CTDs) are conditions caused by the continuous and repetitive use of muscles, tendons, ligaments, joints and nerves. They can occur in nearly every area of the body, but the most common area are the wrist and low back. The symptoms of tightness, stiffness, numbness, pain or discomfort, tingling or loss of strength and stability are due to an inflammatory breakdown of that particular body part. CTDs will develop over long periods of time and are chronic in nature. This is why it is necessary to get up and move often throughout the day and to incorporate a regular stretching program which will relax and release accumulated stress and tension.

Common causes can occur from over-activity involving constant repetitiveness, lifting heavy loads or improper body mechanics. How you sit, stand, grip, lift carry, type, sew, repair, pull, push, assemble, or play a sport has an inherent risk of injury, particularly if there are faulty body mechanics and/or the absence of adequate rest.

Because stretching affects the muscles, joints, and tendons, the first line of defense against CTDs is to stretch daily to prevent, or at least reduce, the risk of creating a CTD somewhere. This stretching should be coupled with adequate rest in order for the body to repair itself and recover from the repetitive activity.

Another line of defense against CTD is good posture. This comes from an awareness of your body position, how long you stay immobile, and how much excess stress is influencing your activity. Often simple adjustments in chair or desk height, or repositioning equipment to a more accessible place helps in eliminating problems.

While some occupations have a greater risk of creating a CTD, and some body types tend to be at greater risk, all CTDs are preventable at some point in time. If you start performing a new activity incorrectly, the chance of preventing a problem in the future is diminished. If you work, or play, so hard and for so long that you never allow yourself time to rest, then the odds of you creating a CTD increase dramatically. Remember, you were not born with back pain or Carpal Tunnel Syndrome, and many people never get a CTD in their life, so why should you?