For quite some time now, I’ve been under the assumption that obesity is the enemy in this country. According to an article published by a UCLA professor, 42% of children in America are either obese or overweight. For adults the number is broken down into age groups. Thirty-five percent (35%) of Americans ages 60 and older are obese. In the 40-59 age group, the number jumps to forty percent (40%) and in the 20-39 age group, thirty percent (30%) are within the obese range. The numbers get even more frightening when you break it down by sex and race. For purposes of simplification, this article will reference only the aforementioned numbers. One could, at first glance, make the statement that obesity is indeed the enemy. The numbers do seem to indicate such a conclusion. American obesity has been labeled as an epidemic by experts in many different fields. However, obesity is merely a symptom; the result of a 10,000 foot view point. From the ground, it is clear that obesity is merely a symptom of a bigger problem.
Many health professionals believe that if rates of physical activity could somehow increase, the rate obesity would decrease. It is difficult to disagree with this premise. Physical activity decreases the risk of cardiovascular disease, improves immune function thus building resiliency to illnesses, increases brain function and efficiency by increasing a neurotransmitter called BDNF (brain-derived neurotrophic factor), and improves countless other measures of human biochemistry. This all makes sense and is verified in the literature over and over again. However, it is the ‘being physically active’ part that is the crux of the entire issue. If it is that simple, though, why are many people not physically active? What is the real issue at hand? Much like the client(s) that I’ve seen in the past that complained of back pain only to find out that the back pain was merely a symptom of the problem, obesity is a symptom of a bigger issue. My client(s) may have had limited/no hip mobility causing the low back to become unstable. Or maybe they had tight hip flexors and these muscles were pulling on the lumbar spine resulting in reciprocally inhibited gluteus muscle groups (a poor pattern for long-term spinal health).
Of course there are exceptions, but the real enemy is not obesity. Largely, the rise in obesity rates is a symptom of poor ergonomics. People are sedentary at work with improper posture. School days are filled with activities, or lack of activities, that can stress a child’s body. Professional athletes are notorious for overuse injuries. A wide receiver is more likely than the average person to develop tendonitis in the knee. Pilots commonly suffer from low back pain due to the nature of the job. A person who sits at a desk all day working on a computer may develop carpal tunnel syndrome, tight hip flexors, reciprocally inhibited gluteus muscle groups, and/or tight upper back and neck muscles. A surgeon or dentist looks down for long periods of time and, therefore, may develop cervical spine issues. The aches and pains obtained from jobs can and does lead people to skip workouts. Who can blame them? If the person is already sore from work, adding additional soreness from physical activity is not appealing.
As a trainer, I spend a lot of my time working with children and adults overcoming ergonomic issues first so that we can attack their actual goals. More and more, kids are sitting for long periods of time at school due to the abandonment of quality physical education and limited recess. They are saddled with loads of homework and must carry home heavy books in their backpacks, which sometimes seem to be half the size of the child. They learn early on that 8 hours of school work is not enough. They must go home and spend more time on schoolwork to ensure their learning is complete for the day. This equates to lots of sitting around at school and even more sitting around at home, all in the name of learning. As adults we carry this lesson on into our work lives. We bring work home with us, stay late, arrive early or all of the above. We work so much that we leave little time to actually live, let alone exercise. We are crammed up in a ball at our desks for so long that our body begins to tighten up into knots. (To be clear, we can’t always stretch our way out of this. I hear this all the time. People will say that they stretch their hamstrings everyday but they are still tight. In this case, tight hamstrings are probably not the problem. If there is a knot in a rope and the rope is simply pulled apart at either end, the knot is only tightened. Muscles work similarly.) We sit at our desks for hours at a time. As soon as we stand up to leave, we notice how tight our low back or shoulders have become. We had intentions of going to the gym, but now that we feel like this, how can we? Instead, we decide that it would be better to go home and rest (by ‘rest’, I mean go home and sit on the couch/chair and watch television for a few hours before bed). Pain and/or stiffness can impact the decisions we make and also give us plenty of justification to do so without the guilt. One might say, “My back and shoulders were tight and hurt, and it is not smart to train through pain. You have to listen to your body, right?”
The scapulae and shoulders are areas of the body that suffer greatly from poor ergonomics. Many people have jobs that require them to sit in front of a computer and type all day or drive a car from place to place. Their hands are on the keyboard or steering wheel for much of the day. Both of these scenarios place the shoulders in a forward rolled position, which means the scapula (shoulder blade) is protracted for much of the day. The chest muscles are in a contracted or shortened state during this time and the neck is usually in a forward or anterior carriage position. Here is a demonstration: contract your bicep muscle for 30 seconds and then try to straighten your arm. Do you notice that it is difficult to straighten your arm? This is what happens to your chest muscles when they are maintained in a shortened state for long periods. Over time, the chest muscles get tight and will pull the shoulders forward. The muscles that are supposed to support the upper back, the rhomboids, levator scapula, trapezius, teres groups, rear deltoid, etc., are relegated to being movers without much role in spinal and shoulder stabilization. This forward position limits shoulder mobility and pain is likely to happen at some point if this is not corrected. Many people feel the tightness and try to stretch it out but it doesn’t really help (refer to the knotted rope example from above.) Some go see a chiropractor, PT, or a massage therapist and they may see some improvements for a short time. But the underlying factor has not changed. Your job still requires you to be in this poor ergonomical position, so unless you win the lottery or inherent a ton of cash, you still have to work. What’s the solution?
Joint by joint approach
We must first try to understand the body, and the way it works, if we are ever going to make any traction in solving the problem. The body is very complex and understanding its complexities can be very challenging. However, two great minds have made it easier for everyone to understand. Mike Boyle (strength coach) and Gray Cook (PT and strength coach) developed the ‘Joint by Joint Approach’ one night at dinner. Mike Boyle, as the story goes, casually stated the joint by joint approach and Gray simply wrote this idea out on a napkin because it struck him to be very important. The two of them hashed out the idea and it has made an impact in various fields (fitness, physical therapy, chiropractic medicine, etc.) Their thought was that the body was designed in an alternating pattern of stable and mobile joints and if something disrupts this pattern, dysfunction will ensue.
This means that if the hips, which are mobile, for some reason become restricted, then dysfunction will result, likely in the low back or knees. This also introduces the possibility of pain in these joints. When pain is present, localized stabilizers are inhibited. The muscles that generally provide support will not be protecting the joint. This puts the joints of the body at a greater risk of injury. When the neck and shoulders become anteriorly positioned, mobility of the shoulders is limited and pain may develop at some point. If the hips are not able to externally or internally rotate, the low back will pick up the slack and ultimately destabilize, which, too, may ultimately cause pain. The answer to the problem is to move. The joints that should be mobile should be mobilized and the joints that should be stable should be stabilized. The body should be programmed/re-programmed to move as intended. One way this can be accomplished is by training like an athlete.
Train like an athlete?
I do not mean that we should necessarily be doing all the things professional athletes do to train. However, much of what they do would do some of us a great deal of good. What I mean by ‘train like an athlete’ is ‘train for what you do’. Running backs (NFL) train for agility because their job requires them to be agile. Sprinters train for speed and explosiveness because their jobs require them to be fast and explosive. A person who works in front of a computer sitting at a desk five days/week needs to train his/her back for better posture. They need to make sure their hip flexors are lengthened regularly. A dentist or surgeon might need to do McKenzie exercises to improve neck mobility and function. Athletes look at what they need to do to compete to win and they attack it methodically and consistently. The general population needs to examine job requirements and determine what is necessary to overcome the inherent physical pitfalls. You do not need a kinesiology degree to do this. Think about the areas in your body that are chronically tight and then work on improving the opposite side (yes, the opposite side.) Dr. Perry Nickelston, a New Jersey chiropractor, often talks about the idea of “chasing pain.” If the low back hurts, the low back may not necessarily be the problem. If the chest is tight, it may be a symptom of a problem elsewhere. Dr. Perry often says that most of the time he is treating areas of the body far from the sight of pain. For a golfer, an ankle issue can be the culprit of a neck issue. You should train the opposite side/end of the body that is tight. We have to start thinking outside the box. The old way of thinking lead us to where we are, and that is not necessarily a great place to be.
If we are going to make any headway in combating the obesity issue, we are going to first have to tackle the issue of poor ergonomics. We must remember that we are designed to move. We have to make a living, but we must also remember that we should be able to enjoy the fruits of our labor. However, if we are unable to move because of pain or stiffness, we are cheating ourselves and our loved ones. There are people who suffer from pain that is out of their control, but most of us do not have to live this way. Remember, train like an athlete.
Move as intended: be strong, be fast, be quick, be balanced, be flexible and be able to do these things on command. Don’t be afraid to face your weaknesses. A discovered weakness is just an opportunity for growth. Growth is your opportunity to be better. The opposite of being great is not being bad, but settling for being good.
Jeremy Crowe, MS, CSCS
Nathan Williams, DC (thanks for the edits buddy)