The Brugger Exercise – to counter poor upper body posture and pain.

With the kids back at school and sanity returning to many of my patients lives I figure this is an optimal time to attempt to get you interested in a good exercise routine to counter poor posture. This will be especially beneficial for all those office workers or anyone spending a lot of time in front of a computer but to be honest, I can’t think of anyone who wouldn’t benefit from this exercise. Also, the great thing about the Brugger exercise, IT ONLY TAKES 10 T0 15 SECONDS.

This seems to be the posture of our age:

How not to sit.

I’ve talked about it before; the head is carried in front of the body, the shoulders are rounded forward (and possibly worn as earrings). This posture also known as Upper Crossed Syndrome. It usually accompanies upper back (thoracic) pain/stiffness, neck pain/stiffness, cervicogenic headaches and many times, low back (lumbar) pain. This posture also affects your breathing, encouraging excessive use of accessary breathing muscles (that should only be used under times of physical stress) of the neck and shoulders instead of using your diaphragm.  I have previously written a whole blog on this condition, complete with exercise videos on how to counter it to which I have recently added further videos. So please feel free to follow this link to read the updated version.

Now let’s get on with the ‘how to’ of this exercise:

You can do this exercise either seated or standing. I think it is easier at first to do it seated. Your posture before you start the Brugger is of upmost importance so check out the video in case my written instructions are not clear enough:

Seated

• Sit perched towards the edge of your seat; this will naturally place your lower back into a curve (lumbar lordosis) with your butt sticking out a little. As you do this your breastbone (sternum) will naturally lift up.
• Separate your legs to 45 degrees each side with your feet turned out slightly and in line with your knees
• Your shoulders are relaxed and down with your chin tucked in, making the back of your neck longer – imagine a piece of string is attached to the top of your head and someone is lifting you up.
• Fully straighten (extend) both elbows. Make sure you keep your shoulders down and imagine your shoulder blades [scapula] are pushing together and down into a V.
• Turn your thumbs out (externally rotate), palms up.
• Separate your fingers.
• Hold for 10 – 15 seconds. Repeat 2-3 times per hour.

Standing

• Stand with legs slightly apart; feet in line with hips.
• Find a neutral pelvic position; you can do this by finding the centre between the extreme of tilting your butt out and then tucking your tail under. As you do this your breastbone (sternum) will naturally lift up.
• Your shoulders are relaxed and down with your chin in making the back of your neck longer – imagine a piece of string is attached to the top of your head and someone is lifting up.
• Fully straighten (extend) both elbows. Make sure you keep your shoulders down and imagine your shoulder blades [scapula] are pushing together and down into a V.
• Turn your thumbs out (externally rotate), palms up.
• Separate your fingers.
• Hold for 10 – 15 seconds. Repeat 2-3 times per hour.

For those of you that like it – the science bit!

This clever exercise was developed by a Swiss Neurologist, Alois Brugger MD and the ‘science bit’ is throughout Janda’s work, who first named Upper and Lower Cross Syndromes.

This exercise is clever because it’s not your usual straight stretch or strengthening exercise; it works neurologically and does both in a way that is complementary to the way your body is wired to work.

Our bodies are neurologically much stronger in all of our flexor muscles. This is displayed perfectly if we look at a person with a neurological disorder, e.g. cerebral palsy; their body naturally has increased tension (hypertension) in the flexor muscles, also known as the spastic posture. This demonstrates our natural prosperity to an Upper Cross Posture.

Now muscles work in groups. When one group is working then the opposing group are unable to work (inhibited).  An easy example to visualise of this is when you place food in your mouth. To do this you flex your fingers, wrist muscles, bicep muscles and pecs., all flexors. However, to be able to do this you have to inhibit your finger extensors, wrist extensors, triceps, rhomboids etc. This is called reciprocal inhibition. If you were unable to do this you would be unable to feed yourself.

The Brugger exercise works on the principal of reciprocal inhibition. When doing this exercise you are activating all your extensor muscles and therefore inhibiting all of your (usually hyper activated) flexor muscles. Clever or what?

Take a Brugger Break

If you are a patient of mine, you have probably heard me say the following; regardless of what chair you have at work, one of the best things you can do to counter back/neck pain from sitting in front of a computer is to stand up, walk around your chair and sit down again and to do this every 20 to 30 minutes. Please add the Brugger exercise to this healthy habit. It only takes 10 – 15 seconds and will reduce tension, improve breathing and improve posture. The best way to remember to do this is to put a reminder/alarm on your computer.

Written by Anne French

Lower Cross Syndrome

A while ago I wrote a blog on Upper Cross Syndrome, complete with exercise videos on how to counter it. I said at the time that I would also write one for Lower Cross Syndrome – and finally – here it is!

I don’t want to repeat the same information so I suggest you look at the first blog here to get the full explanation as it’s good to understand why you are doing something(it means you are more likely to do it). The same rules apply – you need to stretch the hypertonic (tight) muscles first before you do the exercises to strengthen the hypotonic (weak) muscles. The stretches are really important, so don’t miss them out!

Here’s a picture to help you visualise the posture (or you could possibly look in the mirror).

As with Upper Cross Syndrome, certain muscles are tight (hypertonic) while others are weak causing a posture that is results in pain, looks unattractive and is very common if you start looking for it.

And here is the list of muscle involved with Lower Cross Syndrome.

Tonic Muscles Prone to Tightness or Shortness	Phasic Muscles Prone to Weakness or Inhibition
Gastroc-SoleusTibialis PosteriorHip Adductors Hamstrings Rectus Femoris Iliopsoas Tensor Fascia Lata Piriformis Thoraco-lumbar extensors Quadratus Lumborum	Peroneus Longus, BrevisTibialis AnteriorVastus Medialis, Lateralis Gluteus Maximus, Medius, Minimus Rectus Abdominus

These are very important, large postural muscles that are possibly functioning incorrectly but with the correct stretching and strengthening exercises these muscles can improve in function which will result in improved musculoskeletal function and pain reduction (if not pain elimination).

So – let’s start!

We are going to start with the foam roller on the IT Band.

You can use these rollers for most muscles groups to work out the knots so experiment. (And yes – it really should be that painful to start with but the pain recedes quickly if you keep doing it regularly). You can also use them for core strengthening exercises. We sell these at the clinic and quite honestly, I don’t know how I survived before I had one of these. They are very versatile and extremely effective. My advice would be – get one!

Now we are going to S-T-R-E-T-C-H.

We are starting with the calf muscles. Here is a simple stretch of the Gastroc and Soleus Muscles that you can do anywhere (you will also get the Tibialis Posterior slightly).

This next video demonstrates how to stretch the hip Adductors which are the large muscle group of the inner thigh.

Now for the Hamstrings.

And then the opposing muscle from the Quadratus group of muscles, the Rectus Femoris. Make sure you tuck your tail under for this one – then you will really feel it.

This next video demonstrates how to stretch the Iliopsoas and also the Tensor Fascia Lata. This last muscle goes into the IT Band so don’t forget to foam roll first.

Here are a couple of stretches for the Piriformis. Always a favourite!

And this video shows stretches for the Quadratus Lumborum and Thoraco-lumbar Extensors.

Okay – stretching done, now we can start strengthening the opposing muscles. We will start with the Tibialis Anterior (don’t want to confuse you with an exercise for the Peroneus muscles so we will stick with this one at the moment). You need a resistance band (which we sell at the clinic) or something that will add resistance to the muscle as you work it. As with any strengthening exercise you need to do sets of repartitions and increase the number of reps and/or sets as you get stronger e.g. start with 3 sets of 10 repetitions? Here’s how…

Now for the Gluteal muscles and here’s Rich demonstrating how.

And another…

And lastly, here is a good way to start working your abdominal muscles.

If you follow these recommendations you have the opportunity to have great posture, wonderful musculoskeletal function resulting in less chance of injury and pain.

You have a wealth of knowledge available to you from all the practitioners at Coast so take advantage of us. We are here to help you reach your goals, whatever they are.

Written by Anne French, Chiropractor

The Importance of Posture (Upper Cross Syndrome)

Posture – it is part of the first impression that you make to the outside world and it says so much about how you feel about yourself. Poor posture is highly prevalent in our society and one of the most common incorrect postures you will see if you start checking people out (or look in the mirror), is this –

Anterior Head Carriage

Now this famous woman is a perfect example of someone who carries her head before her body, also known as anterior head carriage. Many people walk around like this; it’s as if they are already somewhere else or trying to be, never actually present.

Ideally, a person’s ear should be in line with their shoulder and their shoulder should be in line with their hip. For every inch the head is forward from its natural position, it is twice as heavy and heads are really heavy to start with. This results in muscle imbalances as they strain to keep the head in position. In this posture, because the head is anterior, it naturally tilts forward resulting in the small muscles at the base of the neck, called the sub-occipitals to tighten, to enable the head to tilt up so that the person can see around them.

Upper Cross Syndrome

This is a further photo of the same woman showing another posture that commonly goes with anterior head carriage; here, unfortunately, she looks rather glamorous but the reality is her shoulders are forward and her scapula (shoulder blades) are winging (sticking out). This is due to hypertonic (too strong) muscles of the chest and hypotonic (weak) muscles of the back. This posture was first named by Dr. Vladimir Janda, a Czech neurologist and physiatrist, as Upper Cross Syndrome.

Janda’s approach is based on the function of the body rather than just the structure. Through observation and electromyography tests he concluded it was not just the strength of the muscle that was important but the sequence of the firing of muscle contraction, therefore an interdependence of the musculoskeletal and central nervous system, termed the ‘sensorimotor’ system, or lack of it, that was of great relevance and could predict injury patterns of a patient. Changes within one part of the system are reflected by compensations elsewhere within the system as the body tries to reach equilibrium (you’ve probably heard me say this one way or another, many times as I work on you). Janda noted that these changes in muscular tone create muscle imbalance, which leads to movement dysfunction that can result in pain elsewhere in the body and possible degeneration (wear and tear) of joints. Therefore, it is important to determine the cause of pain rather than just treat where it hurts.

I don’t want to bore you by getting into too much detail so hang in there, this is worth knowing.

The human body can reasonably be divided into two muscle type groups, Tonic and Phasic. The Tonic muscle group is made up of flexor muscles and this group is phylogenetically older and more dominant than the Phasic muscles. The Phasic group are extensor muscles that emerge shortly after birth and activate to resist the forces of gravity. Due to the dominance of the flexor muscles, they tend to tighten becoming shorter, whereas the extensor muscles are flaccid and therefore are weaker and have less tone. This can be observed when there is neurological damage e.g. a person with cerebral palsy or a cerebrovascular accident (stoke), the more dominant flexor muscles go into spasm producing a spastic posture.

Here is a table of Tonic and Phasic muscles.

Tonic muscles	Phasic muscles
Upper limb flexorsStenocleidomastoid Scalenes Levator Scapulae Upper Trapezius Pectoralis major	Upper limb extensorsDeep neck flexors Rhomboids Serratus Anterior Lower Trapezius

Now what this all really means is – many people have incorrect muscle patterns resulting in a combination of tight and weak muscles and commonly, in the upper body, the pattern of imbalance looks like this (I think a picture always helps):

Now you know what I’m talking about, don’t you? So what can be done about it?

Well, Janda determined that a tight, shortened muscle can inhibit its opposing muscle e.g. tight pectoral muscles will result in a weak serratus anterior muscle. And the good news; Janda also determined that many times just stretching the tight muscle allows the opposing muscle to function better. Therefore, the first step to counter Upper Cross Syndrome is to stretch the pectoral muscles.

Pectoralis stretch – In this video, Rich is demonstrating just that! 

Now how to strengthen the weak extensor muscles-:

Deep neck flexors – by doing this exercise, you are also stretching the tight sub-occipital muscles.

Wall Angel – stand with your back against a wall and your feet a shoes length away from the skirting board. Keep your spine, including your neck, against the wall. To do this you need to keep the ribcage/diaphragm down by activating the abdominal muscles and not let the ribcage lift as you put your arms into position. Many people can’t get into position, let alone do the exercise. Don’t give up, just keep doing it and you will improve. Here is Elke demonstrating the exercise.

Holding a Platter 1 – for those that find the Wall Angel too difficult at first, try this is exercise and then progress to the one below.

Holding a Platter 2 – once you can do this exercise well then progress to the Wall Angel.

Prone Angel – here Rich is demonstrating another way of doing the Wall Angel for those people that find it hard to get into Wall Angel position (but don’t give up on Wall Angel). 

The Y exercise – it is important with this exercise not to lift your shoulders to your ears as you stretch out your arms. Don’t activate the Upper Trapezius muscles; keep those shoulders down. Here is Elke showing us how to do it.

Serratus Anterior – this is a difficult exercise to do correctly but it’s really important as the weakness of this muscle is usually the foundation of most shoulder problems. The biggest mistake people make is they just move their shoulder blades together and apart but the exercise is about moving the blades down and to the side. (It’s also difficult to explain) Here it is demonstrated really well by Rich.

New Addition – this is the latest video addition for the Serratus Anterior – think you may find it easier to understand, feel and do.

Brugger Exercise – this exercise can be done either sitting or standing (please follow this link for the whole story)

Now obviously along with these exercises, body treatments such as Chiropractic, Osteopathy, Sports Therapy, Acupuncture and Massage really benefit to activate the sensorimotor system. Treatment and exercise, including Pilates, Yoga or Qi Gong, are the perfect combination to facilitate correct sensorimotor function and to improve your posture.

So that’s the top half of the body done. How about the bottom half? (Here’s the link to Lower Cross Syndrome).

Written by Anne French