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UES Unsupported Syndrome THE BATTLE AGAINST UES UES (Unsupported Elbow Syndrome) is a condition where the Levator Scapulae muscle spasms from being overworked due to unsupported . The muscle from the blade to the contracts, getting shorter, harder and less flexible. Without adequate support, the elbows are working as if they were holding a 20-pound dumbbell creating a painful trigger point. Fancy expensive are not the answer, but thankfully there are solutions and preventative actions that can alleviate this painful occurrence. WHY IS THIS HAPPENING TO

People withME? UES typically have the following symptoms in common: Overweight Over the years that I have been a clinician, I 69% of adults 20 years and older have discovered a pattern of dysfunction that are overweight can be commonly found in patients working at

Poor Posture a desk or driving a car. These activities have two Poor posture effects stress level, digestive system, happiness level, and much more unhealthy factors in common. First, they both Stiff Neck require a substantial amount of sitting. 10% of the adult population at any one time is suffering from a stiff neck Secondly, they both promote the use of un- Back, Neck, & supported elbows when sitting. Gravity is not Shoulder Pain your friend if you work at a desk or drive for a Americans spend at least $50 billion each substantial amount of time. year on alleviating back-related pain HOW YOU CAN HAVE RELIEF REPOSITION AT YOUR DESK Most people sit and pull their keyboard out from under the desk. RECOMMENDATION - Move the monitor back on the desk top and place keyboard and mouse on top of the desk. Your should be able to slide underneath the desk allowing you to have supported elbows.

CHANGE MUSCLE LENGTHS FREQUENTLY • For the lower back, get up and take a walk to the restroom or water cooler. • For the neck and , do recommended stretching for 5 minutes to reduce muscle tension.

CHANGE TO STANDING WORKSTATION For every 2 hours that you sit at a desk, we recommend standing for at least 20 minutes. Adjustable desks are available from various suppliers with electric and pneumatic options. THE NEGATIVE EFFECTS OF SITTING Slow Multiplies Changes Metabolism Compressive Breathing Studies have proven that Force on Pattern excessive sitting has a Lumbar Spine Sitting increases negative effect on the Sitting exerts twice as compression in the body’s metabolic system. much compressive force by forcing us to “Our bodies are on your spine as standing. elevate our chest to inhale, down from obesity, high Regularly moving and which makes our Scalene blood pressure, diabetes, stretching throughout the muscles work harder. This cancer, depression and the day will help keep your means we will take 12-15 cascade of health ills and , , muscles more breaths per minute everyday malaise that come and tendons loose - helping - 5000-8000 more breaths from what scientists have you feel more comfortable, over the course of an entire named ‘sitting disease.’” and relaxed which will work day. James Levine, MD, PhD increase your productivity. BUT I LIKE TO SIT Sitting is the new smoking — with an average of 5 hrs. and 40 minutes per workday spent sitting, our risk of serious illnesses such as diabetes, heart disease, cancer, obesity, and even depression is rapidly on the rise. Research also shows that hitting the gym is not the answer. Regardless of fitness level, sitting is bad for you. A new study puts some precise numbers on the cancer risks associated with too much sitting. For every two hours spent sitting in front of the computer or television, the average person raises his or her risk of colon cancer by 8%, of endometrial cancer by 10% and of lung cancer by 6%. Stand up, it’s good for your mind & body! INTRADISCAL PRESSURE MEASUREMENTS VARIOUS @POSITIONS

225

(kg) 200

175

150

125

100

75

50

25 INTRADISCAL PRESSURE PRESSURE INTRADISCAL HOW SITTING CAN DAMAGE YOUR LOWER SPINE

Ligament

Normal nucleus Standing Right Angle Sitting pulposus

When standing upright, the ...This can result in discomfort base of the spine is curved. and as we are become more Posterior displace- This is referred to as the sedentary, permanent damage ment degenerated lumbar curve. can occur. fibrocartilage with protrusion When we are forced to adopt of disc the three right angles seating The flat back posture when sitting, position the base of the stretches the supporting ligaments lumbar curve flattens... and soft tissues at the back of the spine. This may also exacerbate potential disc prolapses.

55˚ 95˚

Sitting like the above illustration encourages fidgeting in an effort Standing upright to minimize discomfort and the results in transferring onset of back pain. weight forward onto the discs. Exercise Program For: Date: 9/11/2014 ExerciseMorgan Program Stanley For: Page:Date: 19/11/2014 Morgan Stanley Page: 1 Exercise Program For: Date: 9/11/2014 Stretch cerv sidebend w/pressure same side Morgan Stanley Page: 1 ExercisesStretch cerv sidebend w/pressure same side • Place palm of against opposite side of head. <<<<< • GentlyPlace palm push of as hand shown. against opposite side of head. Stretch cerv sidebend w/pressure same side SITTING CAN DAMAGE YOUR LOWER SPINE • RepeatGently push with otheras shown. hand in opposite direction. • Place palm of hand against opposite side of head. • Repeat with other hand in opposite direction. CERVICAL SIDEPerform BEND 1 set of 4 repetition(s), STRETCH twice a day. WITH • Gently push as shown. Perform 1 set of 4 repetition(s), twice a day. • Repeat with other hand in opposite direction. OPPOSITE-SIDEHold exercisePRESSURE for 20 Seconds. Perform 1 set of 4 repetition(s), twice a day. RestHold 30exercise Seconds for 20between Seconds. sets. Rest 30 Seconds between sets. Hold exercise for 20 Seconds. 9/11/2014 Date: For: Program Exercise Rest 30 Seconds between sets. • Place palm of hand against opposite side of head. 1 Page: Stanley Morgan

• Gently pull as shown. side same w/pressure sidebend cerv Stretch • Place palm of hand against opposite side of head. of side opposite against hand of palm Place • • Gently push as shown. as push Gently • • Repeat with other hand in opposite direction. direction. opposite in hand other with Repeat • Perform 1 set of 4 repetition(s), twice a day. a twice repetition(s), 4 of set 1 Perform Perform 1 set of 4 repetitions, twice a day. Hold exercise for 20 seconds.Seconds. 20 for Restexercise Hold Rest 30 Seconds between sets. between Seconds 30 Rest 30 seconds between sets. Stretch cerv ext w/Pectoral Stretch cerv ext w/Pectoral • Sit or stand with proper posture. Stretch cerv ext w/Pectoral • InterlaceSit or stand with properbehind posture.neck elbows out to side. • Sit or stand with proper posture. • MoveInterlace neck fingers and shoulders behind neck backward elbows untilout toa stretchside. • Interlace fingers behind neck elbows out to side. CERVICAL EXTENSION WITH PECTORAL • Move neck and shoulders backward until a stretch is• Move felt on neck front and of neck shoulders and chest. backward until a stretch is felt on front of neck and chest. •is Hold felt on and front repeat. of neck and chest. • Hold and repeat. • Hold and repeat. STRETCHPerform 1 set of 4 repetition(s), twice a day. Perform 1 set of 4 repetition(s), twice a day. Perform 1 set of 4 repetition(s), twice a day. Hold exercise for 20 Seconds. Hold exercise for 20 Seconds. Hold exercise for 20 Seconds. •Rest Sit 30 or Seconds stand between with sets. proper posture. Rest 30 Seconds between sets. Rest 30 Seconds between sets. 2) 2) 2) w/Pectoral ext cerv Stretch • Interlace fingers behind neck - elbowsposture. outproper with to thestand or Sit side.• • Interlace fingers behind neck elbows out to side. to out elbows neck behind fingers Interlace • • Move neck and shoulders backward until a stretch a until backward shoulders and neck Move • • Move neck and shoulders backward untilchest. and neck aof stretchfront on felt is is felt on front of neck • Hold and repeat. and Hold • and chest. day. a twice repetition(s), 4 of set 1 Perform Date: 9/11/2014 Hold exercise for 20 Seconds. 20 for exercise Hold Exercise Program For: Date: 9/11/2014 Perform 1 set of 3 repetitions, twice a day.sets. Holdbetween Seconds exercise30 Rest for 10 seconds. Morgan Stanley Page: 2 2) Stretch Scalleni diag • Stand, hold behind back. • Lower shoulder, tilt head to opposite side, and Issued By: David Dobson slightly upward. Issued By: David Dobson These exercises are to be used only under the direction of a licensed, qualified professional.• Repeat with other side. TheseIssued exercisesSCALLENI By: are to beDavid used only Dobson under the direction of a licensed, DIAGONAL qualified professional. STRETCH SpecialExcept Instructions: as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. These exercises are to be used only under the direction of a licensed, qualified professional. Special Instructions: Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. This stretch may also be done while lying on back. Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. This stretch may also be done while lying on back. • Stand, hold hands behind back. Perform 1 set of 4 repetition(s), twice a day.

Hold exercise for 20 Seconds. 2) • Lower shoulder, tilt head to right, and slightly upward. 2) Rest 30 Seconds between sets.

• Repeat with other side. Dobson David By: Issued These exercises are to be used only under the direction of a licensed, qualified professional. qualified licensed, a of direction the under only used be to are exercises These

Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. Systems, BioEx 1995-2013 Copyright materials, supplied user to as Except Perform 1 set of 3 repetitions, twice a day. Hold exercise for 10 seconds.

David Dobson Issued By: David Dobson These exercises are to be used only under the direction of a licensed, qualified professional. These exercises are to be used only under the direction of a licensed, qualified professional. Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. Exercise Program For: Date: 9/11/2014 Exercise Program For: Date: 9/11/2014 Morgan Stanley Page: 1 Morgan Stanley Page: 1 Exercise Program For: Date: 9/11/2014 Morgan Stanley Page: 1 1) Stretch shld capsule inferior 1) Stretch shld capsule inferior • Raise involved over and behind head, elbow • Raise involved arm over and behind head, elbow 1) Stretch shld capsule inferior bent. •bent. Grasp elbow or of involved arm with • Raise involved arm over and behind head, elbow • Grasp elbow or wrist of involved arm with bent. uninvolved arm. INFERIOR SHOULDERbent. CAPSULE STRETCH uninvolved arm. • Grasp elbow or wrist of involved arm with • Pull gently until a stretch is felt. • Grasp elbow or wrist of involved arm with • Pull gently until a stretch is felt. uninvolved arm. Perform 1 set of 4 repetition(s), twice a day. • Raise involved arm over• Pull and gently untilbehind a stretch is head, felt. elbow bent. Perform 1 set of 4 repetition(s), twice a day. Perform 1 set of 4 repetition(s), twice a day. Hold exercise for 20 Seconds. RestHold 30exercise Seconds for 20between Seconds. sets. • Grasp elbow or wrist ofHold involved exercise for 20 Seconds.arm with uninvolved arm. Rest 30 Seconds between sets. Hold exercise for 20 Seconds. 2) Rest 30 Seconds between sets. 2) 2) • Pull gently until a stretch is felt. Perform 1 set of 3 repetitions, twice a day. Hold exercise for 10 seconds.

1) Stretch lumbar flx sit 1) 1) Stretch lumbar flx sit 1) Stretch lumbar flx sit • Sit in chair with apart. • Sit in chair with knees apart. • SlowlySit in chair bend with forward knees and apart. reach between legs. • Slowly bend forward and reach between legs. • HoldSlowly stretch bend andforward return and to reach sitting between position legs.and SITTING• Hold stretch and return to sitting LUMBAR position and FLEXION STRETCH repeat.• Hold stretch and return to sitting position and repeat. repeat. Perform 1 set of 4 repetition(s), twice a day. Perform 1 set of 4 repetition(s), twice a day. Perform 1 set of 4 repetition(s), twice a day. • Sit in chair with knees apart. Hold exercise for 20 Seconds. Hold exercise for 20 Seconds. Hold exercise for 20 Seconds. Rest 30 Seconds between sets. Rest 30 Seconds between sets. •Rest Slowly 30 Seconds bend between forwardsets. and reach between legs. Rest 30 Seconds between sets. 2) 2) 2) 2) • Hold stretch and return to sitting position and repeat. Perform 1 set of 3 repetitions, twice a day. Hold exercise for 10 seconds.

Exercise Program For: Date: 9/11/2014 Morgan Stanley Page: 2

1) 1) Stretch thoracic sidebend sit Issued By: David Dobson • Sit toward front of chair so that can hang in These exercises are to be used only under the direction of a licensed, qualified professional. Issued By: David Dobson These exercises are to be used only under the direction of a licensed, qualified professional. line with front chair legs. TheseIssued exercises By: are to beDavid used only Dobson under the direction of a licensed, qualified professional. SITTING SIDE BENDExcept as to user supplied materials,THORACIC Copyright 1995-2013 BioEx Systems, Inc. STRETCH These exercises are to be used only under the direction of a licensed, qualified professional.• Keep feet and knees wide to help maintain balance.Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. balance.Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. • Sit towards front of chair so that arms hang in line with front chair legs. • Place left hand on left side of head. • Lean to right, sliding right hand down the right leg of chair. • Keep feet and knees wide to help maintain balance. • Return to start position and repeat. Special Instructions: 2) Repeat exercise to other direction if so instructed. • Place left hand on left side of head. Perform 1 set of 4 repetition(s), twice a day. Hold exercise for 20 Seconds. • Lean to right, sliding right hand down the right leg of chair. Rest 30 Seconds between sets. • Return to start position and repeat.

1) Perform 1 set of 3 repetitions, twice a day. 1) Stretch hamstring sit active • Sit against a wall, chair, or on firm surface, bent. Hold exercise for 10 seconds. • Keep a proper curve in low back, as shown. • Flex left upward, while straightening knee. • Repeat stretch with other leg. Special Instructions: Do not allow low back to lose the curve. It is Perform 1 set of 4 repetition(s), twice a day.

2) Hold exercise for 20 Seconds. Rest 30 Seconds between sets.

Issued By: David Dobson These exercises are to be used only under the direction of a licensed, qualified professional.

Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. Exercise Program For: Date: 9/11/2014 Morgan Stanley Page: 2

1) Stretch thoracic sidebend sit • Sit toward front of chair so that arms can hang in line with front chair legs. • Keep feet and knees wide to help maintain balance. • Place left hand on left side of head. • Lean to right, sliding right hand down the right leg of chair. • Return to start position and repeat. Special Instructions: 2) Repeat exercise to other direction if so instructed. Perform 1 set of 4 repetition(s), twice a day.

Hold exercise for 20 Seconds. Rest 30 Seconds between sets.

1) Stretch hamstring sit active ACTIVE• Sit against a wall, chair, SITTING or on firm surface, knee HAMSTRING STRETCH bent. • Keep a proper curve in low back, as shown. •• FlexSit leftagainst foot upward, a whilewall, straightening chair, knee. or on firm surface, knees bent. • Repeat stretch with other leg. •Special Keep Instructions: a proper curve in lower back, as shown. Do not allow low back to lose the curve. It is •Perform Flex 1 left set of foot4 repetition(s), upward, twice a day.while straightening knee. 2) Hold exercise for 20 Seconds. •Rest Repeat 30 Seconds stretch between sets.with other leg. Special Instructions: Do not allow low back to lose the curve. It is common to experience shaking in the leg. Perform 1 set of 4 repetitions, twice a day. Hold exercise for 10 seconds.

Issued By: David Dobson These exercisesDIAPHRAGMATIC are to be used only under the direction of a licensed, qualified professional. BREATHING Except as to user supplied materials, Copyright 1995-2013 BioEx Systems, Inc. • Place hands on near bellybutton. • When inhaling, stomach should push hands outward.

Optional Variation: • Put hands on top of shoulders. • When breathing in chest should not elevate. Perform 10 sets for 10 seconds. SEE... WASN’T THAT EASY! Feel Better. Play Better. Live Better.

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