Category: Good Posture

Take Care of Your Hips

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Iliac Crest Pain - Causes, Treatment and Prevention

We use our hips all the time to sit down, stand up, and walk. The hip joint is a ball-and-socket joint that allows us to move our legs and at the same time gives us the stability necessary to bear the body’s weight. Unlike the shoulder joint, the socket part of the hip joint is extremely strong and dense with surrounding ligaments to keep the head of the femur (the ball part of the hip joint) in place. You rarely hear about a hip dislocation. To watch a short video describing the anatomy of the hip joint check out the John Hopkins Medicine website. Even though our hips are designed be be weight bearing, the extra pressure on the joints does make them more likely to develop arthritis. Other potential problems include bursitis and injuries because of a fall. Problems with the hip may show up as problems with gait, that is walking. Examples of gait/hip problems include:

  • Reduced step length (the distance you cover when you take one step)
  • Reduced stride length (the distance you cover when you take two steps, one with each foot)
  • Reduced walking speed; a slower gait increases the risk of developing a disability
  • Foot angle out of the line of progression (the toes point out or in instead of forward)
  • Rounded shoulders
  • Transferring body weight from side to side
  • Quad dominance (the thigh muscles are overactive and take over for the glutes and hamstrings during squatting, lunging, running and standing)
  • Gluteal Amnesia (the muscles on the back of the hip are weak and not activated during squatting, lunging and running)
  • Difficulty with sideways movements caused by weak hip abductors

For all of these reasons, it makes sense to do exercises that keep our hips heathy and strong. There are 22 muscles that act on the hip joint. These muscles allow the hip to flex (lift forward) and extend, abduct (lift to the side) and adduct, rotate to the midline and rotate to the side. Since the muscles that lift the leg forward (hip flexors) are strong and often tight from sitting too much, it is important to emphasize extension over flexion. Here are some exercises for your hips to include in your water fitness class:

  • Squats
  • Lunge in all directions, using a clock face
  • Walking in all directions
  • Shallow water running and deep water running
  • Crossover walk
  • Knee-lifts (emphasize extension)
  • Leg curls
  • Cross-country ski
  • Cross-country ski with rotation
  • Jumping jacks
  • Kick forward (emphasize extension)
  • Kick to the side
  • Kick backward
  • Inner thigh lift

In addition to strengthening the muscles of the hips, there are some cautions to help you avoid an injury:

Do jumping jacks with the toes pointed out in the upright position

Ballistic Hip Abduction. These are known as cheerleader jumps, but since very few activities requires forceful hip abduction, this move is not functional. Instead do jumping jacks. Make sure that the feet are parallel so the move is hip abduction. It is okay to change foot positions when doing jacks upright, but if the toes point out when performing suspended jacks, you are changing the move to hip flexion.

Ballistic Karate Kicks. When karate kicks to the side are thrown forcefully, there can be an injury in the labrum of the hip. Cue “control and press” so that the throwing action is eliminated.

Prone Flutter Kicks. Flutter kicks strengthen the hips and legs, but prone flutter kicks while holding on to the wall compromise the hands, hyperextends the neck, hyperextends the lumbar spine, and compresses the spinal discs. Performing the exercise with foam dumbbells does not improve these issues. The neck and spine are still hyperextended, and the spinal discs are still compressed. Instead, perform flutter kicks in deep water in a vertical position with neutral postural alignment wearing a deep water belt.

Abdominal pike and spine extension

Prone to Supine Abdominal Exercises use the hips to change positions, but they require accurate cueing. Going all the way to prone involves too much spinal extension and going all the way to supine involves too much spinal flexion. I have heard this exercise called by the amusing name of Sun Tan/Superman. But using this cue encourages going supine all the way and prone all the way. I prefer to call the exercise Abdominal Pike and Spine Extension. Bring the legs forward to a 90-degree angle in front, then tuck and extend the legs diagonally back, as in the pictures above. Wear a belt to do the exercise in deep water; do not do the exercise using just foam dumbbells.

Supine Crunch does not work the abs Limit the “L” Position

Crunches are not functional, but they do work the abdominals. The problem in the water is that we are not horizontal as are crunches on land. Instead we are in a reclined sitting position with the legs close to the surface of the water. Most people pull their knees to the chest, which is repeated hip flexion with lumbar spine flexion. This compresses the front edges of the discs of the spine. Also, placing a noodle under the armpits impinges the shoulder joint and risks damaging the nerves in the arm pit. Instead work the muscles of the core in a vertical position. See the previous posts Take Care of Your Shoulders and Take Care of Your Spine.

“L” Position. This position is a long lever in hip flexion and it is difficult to hold the torso in neutral. Limit the amount of time used in this position.

Kick too high

High Kick with Compromised Posture. Some participants try to increase the intensity of a high kick by getting the toes to the surface of the water. This causes too much spinal flexion and too much hip flexion. Instead, lower the kick so that the lumbar spine does not slip into flexion. Emphasize hip extension, the downward movement of the leg.

Finally, there are some good stretches you can do in the the water for your hips. Side steps lengthen the inner thigh muscles. Forward steps lengthen the gluteal and hamstring muscles of the forward leg and stretch the hip flexors of the back leg. Slow motion walking is good for balance and coordination. Swing one leg forward and back to stretch the hip flexors. Bend the knee when the leg swings back to lengthen the quadriceps. Crossover steps lengthen the outer thigh. Hip figure 8’s are good for hip mobility. Use a range of motion that is controlled and pain free. Take care of your hips so that you can continue to sit down, stand up and walk without difficulty into your golden years..

Resources: Ruth Sova, MS – Hips Mini Session 9-22-22

Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander

Good Posture / Hips / water fitness

Take Care of Your Spine

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Eighty percent of Americans will suffer back pain at some time in their lives. Back pain often develops without a cause that shows up in a test or imaging study. According the Mayo Clinic, risk factors for back pain include age, lack of exercise, excess weight, diseases such as arthritis and cancer, and improper lifting. People prone to depression and anxiety and smokers have an increased risk of back pain. Regular low impact aerobics and abdominal and back muscle exercises that strengthen the core can help keep the back healthy and strong.

Exercises that improve posture is a good place to start. Bring the neck into alignment with chin tucks. Put a finger on your chin and, keeping your chin level, pull it away from your finger. Some people have trouble with this exercise and tend to pull the chin down. Another way to cue the exercise is to say “lift the sternum” which accomplishes the same thing. Next relax the shoulders and bring the shoulder blades down. Turning the palms forward can help accomplish this. When you stand, stand tall with your body weight evenly distributed between both feet and the knees pointing forward. When you sit, keep both feet on the floor with the knees bent at hip level or below,

Exercises to improve posture are exercises that strengthen the core. Although many people associate crunches with core exercises, the core includes all the muscles of the trunk. The pool is the perfect place to work the core because immersion in water activates the core muscles. It is a discreet but constant activation, and you do not feel it the same way as an abdominal crunch. The core muscles most in need of strengthening for good posture are the muscles of the upper back, the erector spinae and the glutes. Always stabilize the core before moving the arms and legs. The best exercise to strengthen the posterior muscles is to travel backwards in the pool. Some other exercises to try in the pool are:

  • Upright row. Cup the hands and pull the water toward you. You can also use webbed gloves, drag equipment or kickboards.
  • Lat pull-down. Hold resistance tubing overhead and pull the ends down to the sides. Or do jumping jacks with foam dumbbells or drag equipment.
  • Rear delt fly. Hold resistance tubing chest high and pull the ends apart.
  • Shoulder external rotation. Rotator cuff sweep out with thumbs up.
  • Straddle a noodle with the end of the noodle between the thighs; adjust the height of the knees to find the difference between extension, neutral and flexed.
  • Abdominal pike and spine extension. Go only 45 degrees to the back to avoid hyperextending the back. Use a deep-water belt. Do not try this exercise with just foam dumbbells. (See the previous post on the shoulders.)
  • Back rotation. Upper body twist or hula hoop.
  • Squats with feet hip distance apart or a narrow stance.
  • Hip extension. Skate kick or cross-country ski.
Good posture in deep water running
Poor posture in deep water running

In addition to strengthening the core, there are some cautions to help you avoid an injury. When running in deep water, maintain the spine in neutral alignment. In this position the spine is off-loaded because of the buoyancy of the water. However, people often lean forward which reduces the frontal resistance and allows them to travel faster, but this position also causes spinal compression even though there is no lower body impact.

Good Posture in Shallow Water
Poor Posture in Shallow Water

It is also important to maintain good posture in shallow water. Other things to avoid include prone flutter kicks at the wall. This compromises the grip, the neck, and the lumbar spine. Do not hang on the wall and do double leg lifts; this overloads the lumbar spine. Wall-hanging sit-ups do not exercise the abdominals and it is too difficult for many water exercise participants to get into that position. The risks outweigh any benefit. Crunches in a supine position put stress on the neck and use the hip flexors instead of the abdominals. Do not do rotation and forward flexion at the same time (opposite elbow to knee) as it puts stress on the lumbar spine. Participants with compressed discs or osteoporosis should avoid trunk flexion. It is better to work on core stabilization by bracing the core and emphasizing good posture.

The supine position puts stress on the neck
Supine crunches work the hip flexors
Avoid forward flexion & rotation

Working on good posture and strengthening your core muscles are good ways to take care of your spine and reduce your risk of back pain in the future.

Resources:

Ruth Sova, MS – Backs Mini Session 9-1-22

Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander

Back Care / Good Posture / water fitness

Take It Back

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Did your mother remind you to sit up straight when you were a teenager? Most of us don’t think much about our posture, but poor posture can lead to a variety of health problems.

  • Headaches. Your head weighs about 10 pounds, but every inch you tilt it forward adds10 pounds. If you tilt forward 1 inch, your head weighs 20 pounds. If you tilt forward 2 inches, your head weighs 30 pounds.
  • Rotator cuff tears. Rounding your shoulders forward pinches the tendons in your rotator cuff, which can lead to a rotator cuff tear.
  • Back pain. Slouching stresses the muscles of your back which can lead to chronic back pain.
  • Reduced lung capacity. Poor posture compresses your chest area, which means your diaphragm is not able to fully expand.
  • Increased risk of injury during exercise. Neutral spine with the core engaged is the safest position for exercising. It makes sense that working out with forward head, rounded shoulders, poor posture and an inability to fill the lungs completely with air is a recipe for injury.

For more information on problems caused by poor posture, see “What Really Happens to Your Body When You Have Poor Posture” in Live Strong.

Good posture requires core strength. Often when you hear the term core strength, you think of abdominals and crunches. But the core includes all the muscles from your shoulder girdle to your pelvic girdle, in other words, the entire trunk area. There are a variety of exercises you can do to improve core strength. These include head retractions, overhead arm raises, bridges, the Yoga tree pose and planks. There are also a variety of stretches that are helpful. These include neck stretches, chest stretches, and hip flexor stretches. For more information on these exercises see “These 12 Exercises Will Help You Reap the Health Benefits of Good Posture” from Healthline.

To improve core strength, it is also helpful to pay attention to your daily activities. Often we use our arms to support ourselves when it would be better to use our core strength instead. If you are unstable because of an illness or an injury, then you may need to use your arms. Otherwise it is better to straighten up your posture and take back your ability to move from your core. Ruth Sova did a series of 30-second videos about situations in which doing things the easy way may cause us to lose function. She entitled the series “Take It Back” and gave permission to share the videos. There are links to the videos in the titles of the six pictures above. The videos show Ruth’s sense of humor and they are delightful.

Don’t forget to also practice good posture when you exercise. See you in the pool!

Author/Instructor Photo
Chris Alexander

Exercise / Good Posture

Why Exercise?

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I have been teaching water fitness for 26 years. Clearly I enjoy exercising. But I know there are a lot of people out there who do not exercise. The excuses include not being motivated, not having enough time, being too tired, exercise is not fun, being too out of shape and not liking to sweat.

Motivation. Everyone wants to look younger and live longer. The secret to longer life is not a magic pill but exercise. Scientists can predict how long someone will live by how well they perform 5 simple tasks. How many times can you stand up from a chair and sit back down in 60 seconds? How long can you balance on one leg? How long is your stride length? How is your grip strength? How good is your posture? A good reason to exercise is to make improvements in these areas to improve your longevity and make the activities of everyday life easier.

Not Enough Time. Instead of trying to find time, try to make time. Some activity is better than none. Find a time during your day when you are free of commitments and schedule some exercise during that time. It doesn’t have to be a lot of time. Start with 10 minutes and increase it by a minute a week. Soon it will become part of your routine.

The remaining excuses. Once your fitness starts to improve, you will find you have increased energy. If one type of exercise is not fun, try something active that you do enjoy. Here’s where I put in a plug for water exercise. Hanging out in the pool when we were children was so much fun that many of us find getting in the water to exercise is really enjoyable. The buoyancy of the water supports your weight so that it seems easier to exercise even if you are out of shape. And the water cools your body so that you are not aware that you are sweating.

Many of the simple tasks that predict longevity can be worked on in the pool. Squats can improve your ability to stand up from a chair and sit back down. The pool is the perfect place to work on balance because the water supports the body and reduces the fear of falling while at the same time water movement makes balancing more challenging. You can work on increasing stride length by water walking. Hand grip exercisers are best for improving grip strength, but gripping pool equipment helps some. You can also concentrate on exercising with good posture in the water to help improve posture on land.

Exercising regularly makes the activities of daily life such as climbing stairs, playing with grandchildren and carrying groceries easier. It also improves blood flow to the brain which decreases the risk of cognitive decline. We cannot stop from aging, but we can work to maintain our functional fitness well into our retirement years.

See you in the pool!

Chris Alexander

balance exercises / Benefits of water fitness / Fall Prevention / Good Posture / shallow water / water fitness

How to Fall Safely

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More than one out of every four people 65 or older falls each year. One out of five falls causes a serious injury such as broken bones or a head injury. Over 800,000 patients a year are hospitalized because of a fall injury. Each year at least 300,000 older people are hospitalized for hip fractures. These statistics from the Centers for Disease Control and Prevention are a concern for many of my water exercise class participants and for me. When I came across some articles on How to Fall Safely, I decided the information was worth passing on.

I found articles from several sources, including AARP, physical therapist blogs and wikiHow. The pictures in this Blog post come from wikiHow. The co-author of the post was Chris M. Matsko, MD.

Protect your head. Head injuries can be very serious. Make sure you prioritize protecting your head. Tuck your chin down to lower your head. If falling face first turn your head to the side. Use your arms for additional protection. Put them in front of your head if falling forwards or behind your head if falling backwards.

Turn as you fall. If you are falling either straight forward or straight backwards, try to turn your body so you land on your side. This reduces the risk of injuring your head, face, arms or back.

Keep arms and legs bent. It may be tempting to try and catch yourself with your arms. However, landing with your arms straight out can break your wrists and/or your arms.

Stay loose. Tensing up increases the chance of sustaining an injury. The tense parts of the body are more likely to break. Try breathing out as you fall to help keep your body relaxed.

Spread out the force of the fall. A big part of falling safely is to spread out the force of the impact over a large area of your body. This reduces the risk of a serious injury to a single part of the body.

Another suggestion is to roll out of the fall. This is difficult to do unless you have practiced beforehand. If you wish to learn the technique, you can ask a physical therapist to show you how, or practice falling and rolling in a gym with padded and cushioned floors.

Just as important as knowing how to fall is taking steps to prevent falls in the first place. Wear shoes with slip resistant soles. Pay attention when you walk. Be aware of uneven areas on the ground, curbs and stairs. Hold the hand rail when taking stairs. In the home, close drawers after you are done with them. Don’t leave cords in walkways. Keep the area well lit. Use non-slip bath mats. Remove small throw rugs.

Another way to reduce your risk of falling is to improve your strength and balance with exercise. The pool is the perfect place to work on both strength and balance. Because the water’s buoyancy and resistance helps support the body, exercises can be done without fear of falling. Options include the following:

Gait training. Gait training is walking practice. The goal is to lengthen the stride and improve confidence while walking.


Core Strength Training. Core strength training is training for the postural muscles of the trunk. This includes the Trapezius and Rhomboids, the Latissimus dorsi and the Erector spinae. Exercises to try are rowing, bowstring pull, and lat pull-down using the water’s resistance or drag equipment. Walking backward strengthens the Erector spinae.

Deep-Water Exercise. Deep-water exercise is performed, while wearing a flotation device, in water in which a person can remain vertical without the feet touching the floor. Exercisers must aggressively engage the stabilizing muscles of the core to remain upright.

Balance Challenges. Balance challenges are exercises performed with a narrow base of support, such as the feet together, one foot in front of the other, or standing on one foot. Slow movements are more challenging than fast ones.

Falling is scary, but learning how to fall and taking steps to prevent falls in the first place are things we can all do now to reduce the risk.

See you in the pool!

Chris Alexander

balance exercises / Benefits of water fitness / deep water / Fall Prevention / shallow water / water fitness