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Ribcage gripping and back pain, neck pain, inguinal hernias and urinary incontinence

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All of these seemingly unrelated problems may be due to a very common faulty postural habit.

Do you have back pain? Either up between the shoulder blades, in your mid back or even in your low back and pelvis? Do you have degenerative disk disease? Do you have neck pain? Do you have an inguinal hernia or did you have one repaired? Do you suffer from incontinence issues, or are you always aware of where the nearest bathroom is just in case? Are you thinking about bladder suspension surgery? Do you have a prolapsed uterus? These diverse health issues may be due to or partially due to "chest gripping", a term coined by physiotherapists, Diane Lee and Linda-Joy Lee, referring to the common faulty stabilization strategy of tightening the upper abdominals (external oblique and rectus abdominis) by drawing the navel in towards the spine when stabilizing one's trunk against the forces put through it while standing, walking, lifting and carrying, or sitting and lying down. This poor stabilization strategy may develop as a result of a trauma, poor habitual posture, or even psychological factors, such as trying to hold in one's gut in order to appear thinner, or constantly tightening the upper abdominals in order to show off that six-pack.

"Chest gripping" results in a restriction of diaphragmatic breathing. The abdominal muscles act like a belt squeezed tightly around the lower ribs, making it next to impossible for the diaphragm to descend properly to get a proper breath of air. Instead, the chest expands and the shoulders are pulled upward by the small neck muscles with each breath, which can lead to neck strain, and possibly a need for a faster breathing rate, which can cause a blowing off of C02.

Furthermore, constant chest gripping tends to stiffen and compress the spinal column resulting in compressive forces through the vertebral joints and intervertebral disks causing disks to degenerate, and a loss of the segmental mobility that is needed for fluid, pain-free motion. And chest gripping frequently results in an overly-rounded upper back, and the long erector spinae muscle becoming longer and often weaker than they should be. Frequently it is long, weak muscles that become sore, rather than strong, tight ones. And an overly-rounded upper back almost always results in the head being too far forward. For every inch that the cheekbone is forward of the top of the sternum (manubrium), the upper-back muscles must counteract the weight of the head. So, if the cheekbone is two inches forward of the manubrium, assuming the head weighs between 10 and 15lbs depending on the person, there is between 20 and 30 lbs of force going through those poor upper back muscles. Simply by letting go of the upper abdominals that are gripping the ribcage and bringing the head back over the body, there would be less stress on those upper back muscles.

Chest gripping also squeezes the internal organs forcing them down, requiring a functional pelvic floor with good tone to counteract the constant pressure. When the pelvic floor isn't functioning well in women, incontinence may result. That "bearing-down" pressure can also lead to inguinal and umbilical hernias and prolapsed uteruses. I believe that the reason so many hockey players suffer from inguinal hernias and tears in the abdominal wall is that they are constantly using this faulty chest gripping and bearing down strategy to stabilize their backs rather than the more appropriate transversus abdominis, pelvic floor and multifidus stabilization strategy, not only while on the ice, but also as they go through their daily lives outside the rink. The cue to "tighten one's abs" may be appropriate when one is about to be punched in the gut, but not while skating or walking down the street.

To notice whether or not you are a chest gripper, place one hand on your upper chest and the other on your lower ribs, and observe your breathing pattern. Your rib hand should move more than your chest hand. If you are lying on the floor, as the air comes out of your lungs, notice if your upper abdomen gets soft and gushy, or if it becomes more firm. Gushy is good. You should be able to dig your fingers under your ribcage, and keep them there as you breathe. If you are gripping your ribs you won't be able to get your fingers in there. When you are standing, do you notice that you have your upper abdominals constantly contracted? If you look in the mirror, do you see big divots just below your ribs on both sides of your abdomen? Try letting go of those muscles and soften the look of your abdomen. A healthy abdomen is not contracted all the time. Breathing a normal amount of air into your lower ribcage can be a good way to let go of those ab muscles.

The trick is to change your habit so that you stop ribcage gripping all together, so every time you walk through a doorway, tune into your body and let go of your ribs if you catch yourself gripping. If you find your pain increases when you let go of your ribs, seek the help of a physiotherapist that can help you connect to your transversus abdominis, pelvic floor and multifidus, the deep local muscles that are meant to stabilize your spine and pelvis.

Related posts:
Breathe your way to a more mobile back
Back and neck pain through posture correction
Respiration - the BIG boss
Hyperventilation increases your body's pH

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Smith MD et al.Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52(1):11-6.

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Edmondston SJ et al. Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine. J Manipulative Physiol Ther. 2007 Mar-Apr;30(3):193-9.

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Ferreira PH et al. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine. 2004 Nov 15;29(22):2560-6.

Grimstone SK et al. Impaired postural compensation for respiration in people with recurrent low back pain. Exp Brain Res. 2003 Jul;151(2):218-24. Epub 2003 May 21.

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Gardner, WN The pathophysiology of hyperventilation disorders Chest 109; 516-534, 1996.

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Comments (3)

Submitted by gdean67 on Fri, 12/14/2007 - 5:46pm.

Dr. Andrew Levy of Center for advanced medicine, New Jersey 

I just wanted everyone to know- stay away from this guy. After having my PCL replaced from Dr. Edward Decter (another Dr. to stay away from) Dr Levy was fast to shoot down Dr. Decter, as he said I never needed the PCL operation in the first place- and why he calls him “Quick Eddie” Dr. Levy said the cartilage in my knee was dead and needed to be replaced- and performed the operation.  

 After the operation, my knee was actually worse then before the operation, Dr Levy told me a screw came lose and he needed to take it out. When I told him I was in between jobs and my insurance wouldn’t start for another month, he said that he would do the surgery for free- as long as I help him get the full amount from my insurance, for the first operation. I told him that I would see what I could do-and I appreciated him doing this operation for free. 

After removing the screw, my knee was still killing me and I was barely able to walk- but figured I would give it some time. I kept my promise and contacted my insurance company. I was told- what they pay the Dr. has nothing to do with me and I shouldn’t call again. After 3 months- my knee still killing me and having trouble walking, I was shocked when I received a bill from Dr. Levy for the amount of $16, 376.00. The bill was for removing the screw, plus the difference my insurance didn’t pay him for the first operation. I tried calling him for 1 month, to try and find out why I received a bill for something he said he was doing for free- He never took my call. 

After receiving a letter from his attorney a few months later- I started speaking to attorney’s to see what I could do. They all said the same thing- you signed a waiver from the first operation and you have no proof that says he was doing it for free.  I had the pleasure of finding out yesterday, that Dr. Levy’s attorney put a Levy on my on my bank account, which withdrew EVERY penny I had. My mortgage payment and many other checks I wrote bounced- leaving me scrambling to find out how I am going to pay all these bills- since my once a month commission check is now gone, along with my entire savings. 

Dr. Levy is a POS that did nothing for my knee and has now turned my life upside down- just in time for the holidays. Happy Holidays Dr. Levy!!  Stay away from him- he is a liar the worst Dr. in the tri-state area!!   

 Please pass this letter to anyone who is thinking of getting orthopedic surgery- so they don’t find themselves speaking to Dr. Levy

Submitted by Anonymous (not verified) on Wed, 01/02/2008 - 2:37pm.

I was doing some research on Dr. Levy.  He does not have a good reputation at all.  What is up with his wall of fame? 

Submitted by Neck Pain (not verified) on Wed, 03/02/2011 - 7:51am.

the article posted, intended for the person who are reader. Informative and got a lesson on it.thankful more power.

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