Our lives are lived in front of us. We write, read, eat, talk, perform tasks around the house and at work, and type with our hands positioned where we can see them, which is in front of us. As a result, we develop what’s called forward head rounded shoulders posture. It occurs because of muscle imbalances that develop over time. For example, the pectoralis minor, as a result of always pulling the shoulders forward, becomes tight. This leads to weak upper back muscles (lower trap, middle trap and rhomboids) and tight neck muscles (suboccipitals) which causes the shoulder and neck to move differently. These adapted movement patterns can lead to pain in the neck, shoulder, and arm, cause headaches, and lead to a reduction in your quality of life. Therefore, it is important to take steps to prevent this:

  1. Sit with a neutral spine. In neutral, the low back (lumbar) region curves inward (called lordosis) and the upper back (thoracic) region curves outward (kyphosis). This evenly distributes the load of your upper body upon the intervertebral discs. Make sure you are sitting on your “sits bones” and not slumping back onto your tailbone and you will accomplish this.
  2. Be aware that your neck isn’t jutting forward. This will allow your cervical muscles to relax and not tighten up nearly as much. Imagine that a helium balloon is attached to the top of your head gently lifting you up. This gentle movement will help align your entire spine.
  3. Pull your shoulders down and back, but not up. Imagine gently placing the lower angle of each shoulder blade toward your opposite back pocket, and you will have it.
  4. Once you have done the above, perfect your alignment by keeping the tip of your shoulders in vertical alignment with your ear canal. This is neutral anatomic position and imparts the least amount of strain upon joints and muscles surrounding the neck and shoulders.


There are some who cannot make large changes in posture. As you age, there are many reasons for the head to move forward and the upper back to round outward (due to genetics, faulty postural habits over decades and gravity pulling us forward). This creates stability within the neck. If this is you, being aware of future changes and beginning to make small postural changes will help optimize function and reduce pain.

If you have questions or are unsure if you are correcting your posture properly, we encourage you to see one of our physical therapists or our movement expert, Jeff Bickford. Learn more about Jeff and the Feldenkrais Method of Movement and Postural Integration on our website at Or go directly to Jeff’s website at


Active Warm-up vs. Static Stretching

An active or dynamic warm-up is a crucial part of athletic readiness. The right warm-up should accomplish two things: loosen muscles and tendons to increase range of motion of various joints, and literally warm-up the body so that it is at its full potential. When your muscles are “cold” there is less blood flow to the muscles and tendons and they stiffen. They will then be less responsive and make you more prone to injury.

We all grew up with “traditional static” stretching/sustained holding type warm-ups in gym class. The latest research over the past 10-15 years points to the fact that holding a series of 20-30 second stretches prior to sport is not only ineffective but can be potentially dangerous! The evidence shows that aggressive static stretching can cause a reflexive tightening of a muscle and can also cause as much as a 30% decrease in muscle strength or activation for a period of time after stretching (the exact opposite of what you want to achieve). This means that not only can static stretching create a window where you are more prone to injury, but may also affect your sports performance negatively.

So how do we warm-up correctly? The best way to achieve actual muscle flexibility and to thereby reduce your risk of injury is by dynamic warm-up activities and through what is termed “inhibitive” or “fascilitated” stretching.

Inhibitive or Fascilitated Stretching

One way to increase the flexibility in muscles is through inhibitive stretching. This is accomplished by gentle isometric contractions of any muscle you wish to be more flexible. This sends a signal from your nervous system to a sensor in the muscle called the Golgi Tendon Organ and it signals the tight muscle to release. This form of stretching can be incorporated into any “old school” stretch position. For example, obtain the position for a static hamstring stretch, but instead of actually stretching the muscle and holding this stretch for 20 seconds, gently contract the muscle instead for 10 seconds and repeat 3 or 4 times. This sends a signal to your hamstring from your brain to relax the hamstring and is has been proven to be much more effective than static stretching:

Inhibitive Hamstring Stretch

Lean forward until you just start to feel a stretch in your hamstring. Then lightly press your heel down into the floor or bench. Hold this isometric contraction of the hamstring for 10 seconds. Repeat 3 to 4 times on each leg.
Active Dynamic Warm-Up_Page_1_Image_0002 Inhibitive Hamstring Stretch

Inhibitive Groin Stretch

Place the soles of your feet together and your elbows on your knees. Then gently press your knees up into your elbows to contract your groin muscles (do the exact opposite of static stretching in which you would have tried to get your thighs to the ground). Hold this contraction for 10 seconds and repeat 3 to 4 times.
Inhibitive Groin Stretch

Inhibitive Quad/Hip Flexor Stretch

Standing upright grasp front of ankle and gently pull heel to buttock until you begin to feel a pull in your quadriceps muscle on the front of your leg. Keep shoulder, hip and knees in a straight line. Then gently press the top of your foot down into your hand and hold for 10 seconds. Repeat 3 to 4 times with each leg.
Inhibitive Quad/Hip Flexor Stretch

Inhibitive Calf Stretch

Place a towel or a yoga strap around the ball of your foot. Then gently press into the towel like you are pressing on a gas pedal. Hold for 10 seconds. Repeat 3-4 times with each foot.
Inhibitive Calf Stretch

Inhibitive Squat

This exercise is good for relaxing all of the major leg muscles. Stand with a wide base of support. Squat down keeping your back straight and making sure your knees don’t go past your toes. Hold this position for 10 seconds. Repeat 3 to 4 times.
Active Dynamic Warm-Up_Page_3_Image_0001 Inhibitive Squat

Some great examples of dynamic warm-up include light jogging and jumping rope for 10-15 minutes to increase blood flow to the muscles and tendons. Actual dynamic “stretches” may also be performed after jogging or jumping rope. This involves actively training a muscle to lengthen through movement. The benefits include increased power, flexibility, and range of motion.

Rules of dynamic stretching

  1. You should always warm-up prior to dynamic stretching (jogging, inhibitive stretching exercise,etc.)
  2. Movements should always be pain-free.
  3. Start with shorter, smaller motions and progress to larger motions later in the set (again in pain-free range).
  4. Perform 3 to 4 sets of 12 repetitions with each movement.
  5. Do not force anything – the flexibility will come over time.

Examples of a dynamic stretching routine

  1. Leg Swings: Flexion/Extension (increases flexibility in hip flexors and back extensors/gluteals): Holding onto something for support, gently swing your leg forward and back, gradually working your leg up higher and higher. Let you body gently lean forward as you are taking your leg toward the back. Repeat 12 times on each leg for 3 to 4 sets. Do not force the movement. Your leg should be relaxed and act like a pendulum.
    Active Dynamic Warm-Up_Page_3_Image_0003 Leg Swings: Flexion/Extension
  2. Leg Swings; Abduction and Adduction (increases flexibility in groin muscles and outer hip): Holding onto something for support such as a chair or wall, begin gently swinging your leg out to the side and then back across your body. Once again, gradually swing your leg up higher and focus on pulling down in the downward portion of the leg swing. Be sure to keep your toes pointing straight ahead/ do not let you leg roll out from the hip.
    Active Dynamic Warm-Up_Page_4_Image_0001 Leg Swings; Abduction and Adduction
  3. Standing Trunk Twists (increases spinal flexibility): Gently swing your arms side to side and allow your trunk to twist back and forth. Slowly increase the range of motion or the size of the swing. Repeat 12 times each way for 3 to 4 sets.
    Active Dynamic Warm-Up_Page_4_Image_0003 Standing Trunk Twists

Utilize these simple but effective active warm-up exercises to enhance your flexibility and reduce injury risk. Happy Trails!

Proper Lifting Tips to Avoid Back Injury

Do you have a physically demanding job? Do you often lift things and end up hurting afterwards? Are you a weekend warrior who likes to hit the gym but is unsure of technique? These concerns can be addressed by discussing lifting techniques. For most people, there is a correct way and an incorrect way to lift. It is too often that I see people lifting with a rounded back. I hear “lift with your legs” often enough, but it does not address the position of the back. To protect the back fully, a couple things must be done:

  1. Keep your spine in neutral as you lift. Never let the low back round outward (i.e. don’t “tuck your tail”). This places tremendous pressure on a small area of the intervertebral discs, increasing your risk for herniation or bulge.
  2. Bend or hinge at the hips. This will engage the large and strong buttock muscles while allowing you to maintain neutral spine.
  3. Keep your center of gravity between midfoot and heel. This will force your knees backward, reducing the amount of force imparted upon them.
  4. Keep each knee centered over the midline of each foot. Do not let your knees go to the inside of your feet. This is called valgus collapse, and it is a significant biomechanical deficit, a sign of weakness, and a predictor of injury.
  5. Never rotate at the spine when it is under load. This greatly reduces the stability of the spine and the disc and reduces the effectiveness of the back muscle stabilizers and movers. Always pivot your body by moving your feet.

Practice these principles before performing any kind of lifting and make sure that you continue to utilize them while lifting. Making these rules habit will greatly reduce your risk for injury and keep you healthy for longer!

Proper lifting illustration

Spring 2014 Newsletter

An employee holds a gold medal for the 2014 Winter Olympic Games during a presentation for the public at a jewellery shop in St. Petersburg. The gold, silver and bronze medals for the Sochi Olympics weigh 531g, 525g and 460g, respectively. (Alexander Demianchuk/Reuters photo)
An employee holds a gold medal for the 2014 Winter Olympic Games during a presentation for the public at a jewellery shop in St. Petersburg. The gold, silver and bronze medals for the Sochi Olympics weigh 531g, 525g and 460g, respectively. (Alexander Demianchuk/Reuters photo)

Hot off the presses: our Spring Newsletter: Melinda’s Olympic Experience in Sochi.

Also, the February 2014 issue of PT in Motion features a story about Melinda. Correction to article: Melinda has worked for US Figure Skating for 15 years, not 5 years.

Sochi 2014 – From Our Perspective

Melinda Couch, PT and Jen Burke, MD - Medical staff for US Figure Skating at the 2014 Winter Olympic Games
Melinda Couch, PT and Jen Burke, MD – Medical staff for US Figure Skating at the 2014 Winter Olympic Games

Preparation for these Olympic Games was a daunting task.  We wanted to be ready for anything we could do to help our team have a great time and perform at their best. As we prepared, we considered so many scenarios and asked so many questions of those who had “been there” before (Thank you!!!).  The media and lack of detailed information from the LOC, of course, fueled our imaginations. I don’t know how many rolls of extra tape, Cipro tablets, antidiarrheals, and Tamiflu capsules that we actually had between all of us, but the good news was that we didn’t need it….well we needed some of tape J.

What is it like to be behind the scenes at an Olympic Games? First of all, the Team Processing experience was quite amazing. Our first stop was in Munich, Germany.  We were greeted by the Awesome Katie McCarter, who took care of all the details while we were there.  After checking in, we were driven to the Old Olympic Park. That was cool!  It seemed like the perfect way to begin our Olympic adventure. There was a huge warehouse-type space set up as a personal shopping mall for all of Team USA.  Each sponsor had a booth: Nike, Ralph Lauren, Hamilton Watches, Oakley sunglasses, USADA and more! We visited each booth and were issued Olympic Village clothing, Opening and Closing Ceremonies outfits, watches, sunglasses, luggage, toiletries from Proctor and Gamble and placed an order for an Olympic ring…it was like Christmas as a kid all over again! We even had our own stylists from Ralph Lauren helping us with sizing and styling of the Opening and Closing Ceremonies attire (good thing too…you never know how we would have styled ourselves).   We can tell you first hand that sweaters were beautiful and so patriotic! We heard they were selling for almost $6000 on Ebay toward the end of the Games! Our stylists made us feel pretty awesome as we tried on the off-white pants and pulled our sock up over the bottoms.  We couldn’t remember the last time we did that?  Maybe 8th grade…or was that leg warmers? Regardless, we had so much fun and felt so proud to wear the clothing and to be a part of the Team.

The next morning, it was off to Sochi on chartered flights that were loaded with not only athletes, but with all the various equipment and gear: luge sleds, skis, snow boards, guns and ammunition for the biathlon team, and of course figure skates. We could only image what it must be like to travel with the Paralympic Team! We arrived at the Sochi airport and were met by shuttle buses that escorted us to the Olympic Village. The whole process was so well coordinated and thought out by the USOC.  The smiling and encouraging USOC staff were present each step of the way, creating a great sense of excitement and comfort.

It was pretty surreal wandering around the Olympic Park and Village those first few days.  After quite a bit a rain leading up to the Games and rumors about “mud over your ankles”, by the time we arrived it was sunny and the temperatures were moderate, 50 degrees or so during the day, in the 40s at night.  The Coastal Village was located along the Black Sea and Team USA buildings were in the middle of the row of dorms, on the water side.   It took a couple of days to “get the lay of the land,” but then it became routine and pretty soon felt like a new home away from home.  The USOC Sports Medicine clinic was located in the building right next to us.  It was like having the Sports Medicine Clinic from the Olympic Training Centers transplanted in the Coastal Village.  They were there as support for us and were  a great resource for us and our athletes.

The Olympic Village condos were very comfortable. The rooms were big and the beds were comfortable.   Due to the forethought and planning of our amazing Team Leaders (Mitch, John and Kathy) the rooms were all decorated with photos from home, American Flags and other decorations were displayed in the halls, our beds were made and the furniture arranged.  They even ensured we each had a memory foam mattress topper, extra converters, adaptors, an umbrella and many other essentials.    We had a view of the mountains, the Bolshoy (Hockey Venue) and the rest of the Olympic Park.  Those living on the other side of the hall looked out onto the Black Sea.  It was truly beautiful.

The dining hall was a 10 minute walk away.  The food in the dining hall was great.  There was even a McDonald’s for the occasional McFlurry, like after Charlie and Meryl won their Gold Medal! Of course a day would be not be complete with at least one cappuccino!  John Millier became acquainted with the “Pizza Guy” who gladly made special request pizza, including pineapple and ham pizza.  He may have started an international phenomenon.

The Figure Skating events were held in the Iceberg, one of many new venues built in the Coastal Cluster for this Games, and all located within a 30 minute walk from our dorm.  We hope you saw some footage of the Iceberg on TV.  It is a beautiful building that seemed to change color throughout the day, sort of the like the light reflecting off the ocean.  In many ways, the figure skating portion of the Olympic Winter Games was very much like being at a long World Championship event, just like Judy and Skip told us.  The “skating family” was the same with familiar skaters, coaches, officials and team leaders. After several weeks went by, even with few words said between us, they all became our friends. The structure was the same with the medical staff attending practice sessions throughout the day, competition at night and performing various medical and physical therapy services as needed. It was different in that the “figure skating world” was woven in as a small but very special part of a much grander world that surrounded us:  The sight and the sound of the Olympic Flame when walking through the Olympic Park, Interacting with athletes and medical staff from other sports in the Park and dining hall, Seeing the vast snow-capped mountains on the horizon and knowing our athletes were competing there as well, Witnessing the best athletes in the world from other sports compete, Watching medals ceremonies in the Olympics Park – Seeing our extraordinary athletes receive the first ever Team Event Bronze Medals (congratulations Ashley, Gracie, Jason, Jeremy, Marissa, Simon, Meryl and Charlie!)  and our breathtaking ice dance team receive the first ever Ice Dance Gold Medals (congratulations Meryl and Charlie!), and so much more.

As we sit here and write this, it is even more evident to us just how difficult it is to put this huge experience into a framework of words.  We just feel very fortunate, grateful and honored to have had the opportunity to have an Olympic experience and to have been a contributing part of our Team Behind the Scenes!  Thank you for all of you for your generous support and encouragement. We still get goosebumps…just thinking about it.  Thank you.

Melinda Couch, PT and Jen Burke, MD
Medical staff for US Figure Skating at the 2014 Winter Olympic Games