Two exercises to help a 'stiff' upper back

If you spend most of your working day bent over a desk it is likely you will end up with a stiff upper back or neck. 

This type of posture is not limited to desk-workers though. Tradesman (e.g. plumbers or tilers) may also have their upper body constantly in a forward position while working; this is called kyphosis. People who spend lot of time driving will also be susceptible to this type of posture. 

If you find that, by the end of the day, your upper back (between the shoulders) and neck are very stiff the exercises below are very likely to help your stiffness. Both exercise 1 and 2 (below) are designed to create extension in the upper back and thoracic spine. This is very important as we all spend far too much time in a flexed or forward position. By creating extension in the spine, these exercises can 'off set' some of the poor posture that has taken place through the day.

Exercise 2 requires a foam roller. If you do not have a foam roller I would recommend getting one, as there is great benefit in doing both sets of exercises. However, if you haven't got one don't worry as you can start right away with exercise 1. For this exercise all you require is a large bath towel. The exercises can be done multiple times daily.

Exercise 1 - Instructions 

1) Roll up a large bath towel, length ways, as tightly as possible - and place on the floor

2) Lie across the towel, with it underneath your mid back and your arms out stretched. 

3) Take deep breaths and aim to relax the muscles in your back, chest and neck as you breathe out.

4) Lie for 3-10mins in this position whilst repeating the exercise. 

You may feel a few pops or clicks in your back as you lie down on the towel - this is normal.

Exercise 2 – Instructions

1) Lie on your back and position yourself so that your mid back (thoracic region) is on the foam roller.

2) Cross your arms behind your head and slowly roll backwards and forwards on the foam roller.

3) Repeat this exercise 5 x 1 mins.

A full size printable sheet of the exercises is available here

Exercise 1.

Thoracic Extension Exercise - Towel

Exercise 2.

Thoracic Extension Exercise - Foam Roller

Is it normal to have a tight IT band?

Everyone has a tight IT band, right?

Anyone who has had massage or soft tissue work done on a tight IT band will know exactly how tight and tender this area can get. It really is quite horrible.

For those of you that haven't heard of the IT band before it is simply a piece of connective tissue that runs down the outside of the thigh. The IT band is short for the iliotibial band (sometimes also known as the iliotibial tract). Along with a muscle called call the tensor fascia lata the IT band helps stabilise the knee, from the outside, in weight bearing activities such as running and hiking.

A tight IT band can cause a number of problems such as anterior knee pain and IT band syndrome. It can get tight for a number reasons, however poor bio-mechanics in walking and running as demonstrated in the video in this blog post are most often related to increased tension in the IT band.

The two major tests that we use in the clinic to assess the tension in the IT band are:

Obers test

Thomas test 

In a significant number of cases we will find these tests show 'positive' results, indicating that the IT band is overly tight. There are many reasons for this including poor bio-mechanics as mentioned above. However, one aspect that must not be missed is that many people simply put their body under huge load without taking the appropriate measures to offset this load. High training volume, with poor postural patterns (e.g. poor sitting position at work), can lead to imbalances, increased tension and specific weaknesses in the tissue. If your training volume is high, and you are not carrying out regular basic maintenance on yourself, then it is very likely you will end up with a tight IT band and consequently injuries can occur.

So, back to the original question, 'Is it normal to have a tight IT band?' My answer, NO, it is not normal however it IS very common. For this reason it is hugely important to carry out regular self maintenance e.g. Foam rolling, mobilising, self trigger point work, stretching, glute and core strengthening exercises, balance and proprioceptive work as well as regular massage will all help reduce your chances of developing a tight IT band. 

What exactly is a tendonitis injury?

In its most basic terms a tendonitis injury is where a tendon - usually at its insertion point - becomes inflamed. The suffix ‘itis’ in the term tendonitis simply means inflammation.

You will also see tendonitis being spelt tendinitis - this isn't a different term; simply a spelling variation.

There are many examples of tendonitis injuries, some common ones are:

• Patella tendonitis
• Achilles tendonitis
• Rotator cuff tendonitis
• Bicipital tendonitis
• Tennis elbow / golfer’s elbow (both types of tendonitis)

Tendonitis injuries generally come about through over-use or repeated overload of the tendon.

Symptoms include a gradual onset of pain, aching in the tissue and localised tenderness at the injury site. Occasionally there will be reddening of the tissue around the injury site. There may also be palpable nodules on the tendon.

One problem with tendonitis injuries is that they are often mis-diagnosed. Many of these injuries are NOT inflammatory based, in many cases the tissue has degenerated instead. If this is the case the injury is now called a tendinosis and will need to be treated in a different way. Imaging, such as an ultrasound scan, can confirm which type of process has occurred.

As a general rule longer term degenerative tendinosis occurs in the slightly older patient. Inflammatory based tendonitis will occur in the younger to middle aged patient, though there is no consensus on the exact incidence of these injuries.

To confuse matters even further the term tendinopathy can also be used. This describes the overall symptoms of the injury and is an umbrella term which describes both pathologies i.e. a tendonitis or a tendinosis.

As stated previously, treatment for these injuries will differ depending on the exact underlying issue. In both cases, however, there will need to be a period of rest - or relative rest - to allow the tissue to respond to treatment. Biomechanical / technique issues will have to be assessed as more often than not these are contributing heavily to the tendon problem.

These types of injuries can be complex and will require very specific treatment plans.

However the main thing to take away from this blog post is to not 'work through' a problem like this. You must take early rest from any activities that aggravate the problem and seek advice early. These injuries are MUCH easier to address in their early stages of development rather then when they have become chronic.

In summary:

Tendonitis = an inflammatory based issue.

Tendinosis = a degenerative process

Tendinopathy = a ‘catch all’ term that could be a tendonitis or a tendinosis.