Cardiac Surgery Patients: Think Posture!

If you just had your chest recently surgically opened, the last thing you want to think about is stretching, but after time it becomes very important. You may not physically remember the pain of surgery but your body does. It gradually rounds the shoulders forward, the head is carried slightly more forward, and these changes make the subtle curve in the low back gradually flatten. Many patients when they first attend cardiac rehabilitation complain of pain and spasm to their upper back and shoulders. When I worked in physical therapy I would have many patients present several years after open heart surgery with low back pain. Many had the characteristic posture I described above.

Here are a few suggestion to help you in the healing process.

Be very aware of your posture – if you are sore, think about what posture you are in. Are you seated with your shoulders slumped and head forward? If so adding a lumbar support to your chair will help to straighten your back posture. Another suggestion is to get up and move more frequently.

Pain in the shoulder blade region?

If so begin with gentle chest stretching and shoulder stretching. It is very important you avoid pain. I usually wait until my patients are approximately 6 weeks in recovery before initiating this. Do not take any stretch to pain. Do not bounce stretches.

There are three different postures to get the different muscle groups of the chest. One leg is forward simply to maintain the curve of the low back. Hold the stretch 10 to 15 seconds, repeat 1-2 times. It is ok to do this stretch a few times per day.

   These are other good stretches for the chest

Upper back stretching

The muscles act very similar to pulleys. If one side shortens the other side lengthens. If the muscles of the chest are short the muscles of the upper back are stretched. Prolonged stretch leads to muscle spasm, and this makes many people feel like they have knots in their upper back. There is a great stretch for this.

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Reach down grasp opposite knee with hand (left hand grasp right knee). Relax your head pull up gently, hold 10-15 seconds. Repeat with opposite hand/knee. repeat one to two times.

Use a lumbar support in your favorite chair, while driving, or sitting for a prolonged time. You can either purchase one at your local medical supply/pharmacy, or you can simply roll up a small towel and put it in the small of your low back.

 

 

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Cold Weather Posture Causing Angina Like Symptoms?

Cold weather changes our posture causing aches and pains, but how can you tell if it is angina?

Having poor posture when it is cold can contribute to aches and pains in the same areas that people complain of angina discomfort. When the cold weather hits many cardiac rehabilitation patients begin having complaints of discomfort that is felt between the shoulder blades, neck pains and chest discomfort. It is tough to tell the difference for many between angina and muscular skeletal pain.

Let talk about posture

What is your posture when you are cold? Do you pull your shoulders up to your ears, roll your shoulders and neck forward to hide in the warmth of our clothes or chair? Do you cross your arms shortening the chest muscles and hold them in these positions for prolonged periods of time? All of these can cause the muscles to spasm and give sensations of pain. Remember most of the time angina pains follow the same pattern, but as with anything human it can change. So your angina should usually present the same way, if it is in the chest or arms, then expect angina to primarily present this way.

               

This posture held for any prolonged pain will cause upper back discomfort, neck pain, possibly chest and arm discomfort.

So is it angina?

Well lets review  first what angina is.

Angina may feel like pressure, squeezing, or heaviness in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Stable Angina

Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.) Stable angina usually presents itself with exercise, after eating large meals, emotional stress, and a cold environment such as exertion in the cold air.

If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn’t a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina

Unstable angina doesn’t follow a pattern. It is a change from your usual angina pattern, it  is when angina occurs more often and may be more severe than stable angina. Angina occurring while resting is considered unstable angina, or when it occurs with lighter amounts of workload or effort than usual.  If it takes more nitroglycerin than usual to relieve the discomfort, or nitro doesn’t relieve it at all than that too is considered unstable angina. Rest may not relieve the pain.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Skeletal Muscular Symptoms

Can be reproduced by touching the area with symptoms and creating pain. You can’t touch your heart, but you can touch your chest, arms, back and jaw. If you touch it and it hurts that is a sign of muscular skeletal symptoms. Can you move a certain way and cause the discomfort to either show up or go away? This too is less likely to be related to the heart.

Does stretching or improving your posture help the symptoms? Consider adding a small pillow to the low back area of your favorite chair, desk and car  this forces your upper body to maintain better posture. Widening and opening up the chest. If you note you have had very poor posture try the chest stretches below.

Be fluid in your upper body movement

Allow your arms to swing when walking, wiggle those shoulders and neck. Dress warm enough that you can maintain good posture. Wiggle your hips, consciously think about your body. Is it stiff and tight? If so loosen up, relax, stretch, workout.

Be Safe

If you cannot tell the difference and suspect you are having angina, follow your care plan established by your health care practitioner, and if necessary seek medical attention. If the symptoms include shortness of breath, nausea, profuse sweating, lightheaded, dizzy contact your healthcare provider ASAP or call 911. 

Get more out of your Walk

Walking, seems like a no brainer right? We don’t really think about it we just do it as it is natural. There are things you can do  to get improve benefits of walking. By focusing on style and posture you can improve muscle strength and tone, improve balance, correct postural issues and burn more calories.

Engage your arms!

Make a loose fist, consciously swing your arms, bringing your fist up to the approximate level of your breast bone, and then back to the outside of the hip. Pretend you are trying to move your arms against a force to engage the muscles even more when you walk.

Notice the posture of President Bush  – Shoulders back, arms active, stomach in,  head forward. Now compare to the gentleman next to him. Who do you think is getting more from their walk?

 Forward head, not engaging arms or stomach, rounded shoulders.

I show this to make you think about your posture while on a treadmill. Fast walkers on a treadmill who hang on to the bar often have a sway back posture. Slow walkers often lean way forward – I call it the pushing the lawnmower posture. While on the treadmill, try to either not hold on and swing your arms, or hold on with only one arm.  This will help you to have a better posture. When you hold on to the rails the entire time, your upper body is stiff and doesn’t move naturally as it does with your regular walking.

Also don’t look down the whole time this leads to forward head or thoracic kyphosis postures. Try to look 15-20 feet ahead of you. Hold your head high. Try to keep your chin parallel to the floor.  Squeeze those shoulder blades together and down…this is the military posture or the busty look, tall and proud.

Some people are so stiff with walking, add a little wiggle to your walk allow your shoulders and hips to move naturally, this is very good for your spine. Being stiff and rigid isn’t helpful. Often after open heart surgery people are very stiff in the shoulders and neck. Again swinging the arms helps this.

Tighten your stomach muscles. These support your back, they provide you with core strength. If the belly sags forward it places more stress on your lumbar spine. Tuck your pelvis under your torso.

If your have back issues or balance issues I recommend walking with ski poles. They help you to stand taller, force you to engage your arms with the walk, and you burn more calories on your walk.

Compared to regular walking, ski walking  involves applying force to the poles with each stride. Walking with ski poles uses more of their entire body (with greater intensity) and receive fitness building stimulation not present in normal walking for the chest, lats, triceps, biceps, shoulder, abdominals, spinal and other core muscles. This can produce up to a 46% increase in energy consumption compared to walking without poles. It also has been demonstrated to increase upper body muscle endurance by 38% in just twelve weeks.

This extra muscle involvement may lead to enhancements over ordinary walking at equal paces such as:

  • increased overall strength and endurance in the core muscles and the entire upper body
  • significant increases in heart rate at a given pace
  • increasing vascular pathways and oxygen delivery efficiency
  • greater ease in climbing hills
  • burning more calories than in plain walking
  • improved balance and stability with use of the poles
  • significant un-weighting of hip, knee and ankle joints
  • provides density preserving stress to bones

What about walking with weights? 

If you want to walk with weights don’t use more than 1-2 lbs in your hands. Heavier weights tend to stress the neck and spine and are not recommended. Again don’t just hold the weights pump those arms, swing up to breast bone and back to hip. You engage the arms, you burn more calories.