Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Training – Finding the Sweet Spot

Understanding your training load and tracking your acute:chronic ratio is a great tool of avoiding injury but seeing regular improvements when training.

Bourdon et al 2017

Understanding your abilities with training is a constant adaption. In the gym or on the training field, knowing your boundaries of training intensity will allow you get the best results and minimise risk of injury.

In 2016 there was conference in Doha, Qatar bringing many of the worlds leading sports science experts to discuss monitoring athletes training loads. This is Journal draws together the key points from the conference.

The importance of monitoring your training load is to get the best out of training and make improvements. But also tracking this figure helps minimise risk of injury.

Acute-Chronic Workload Ratio.jpg
Training loads of each session is referred to as ‘Acute’ workload, this is compared to each week throughout the year, it’s referred to as your ‘Chronic’ workload. The objective is to make sure there is no big spike in acute workload compared to chronic workload. A spike in acute workload will lead to fatigue, poor performance and increased risk of injury. As displayed in the diagram a ratio increase increase acute:chronic of more than 1.5 results puts you in the red zone that indicates a greater chance of injury. Also worth pointing out, taking your training level below 0.8 of your chronic workload, surprisingly showed a higher risk of injury.

Staying within the workload “sweet spot” is your goal to minimising injuries. It takes time to build up training load and this should be done gradually.

Measuring Training Load

To monitor your overall effort in your workout there is a simple method of combining:

Internal Load: These are the biological/psychological factors. This could be heart rate monitors, blood lactate levels or rate of perceived exertion.

External Load: Power output, speed and acceleration derived from GPS and accelerometer devices.

Tracking your training load is a great way of assessing your own capacity to handle the session. Over time this can provide information on training load adaptation.

Internal Road x External Road = Training Load

In CrossFit there’s too many variables to monitor with different workouts each day. Use your strength component to measure your external load, this will be a more consistent figure. Whether it’s a dead lift, back squat or strict press. Record internal load a rate of perceived exertion, using a visual analogue score, see below.

The acute:chronic workloads apply to all levels of athlete, not just beginners and people returning from injury. Even at the top level our training intensity needs to be tailored to our own individual needs.

Below is a summary of the journal.

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Bourdon et al. (2017) Monitoring Athlete Training Loads: Consensus Statement Int J Sports Physiol Perform Performance

Study: Resistance training on neck pain

This study found positive results with strengthening exercises to reduce muscle tension and pain with office workers suffering with neck pain.

Lindegaard 2013

Working in the office you’re bound to suffer with neck pain at some stage. If poorly managed this can progressively become chronic. Not only can this impact your function, but interferes with your levels of concentration and performance at work. This then feeds into your mood and becomes a negative loop which is then difficult to break.

When treating a patient with chronic neck pain there’s a range of manual techniques that have strong evidence to support them. But in addition to hands-on therapy, exercises are provided to assist in the recovery. These could be in the form of stretches, postural setting or strengthening.

This study focused on strengthening exercises using a resistance band  (Theraband). Over a 10 week period they performed lateral raises with the resistance band once per day to the point of fatigue or up to 2 minutes. They found at the end of the 10 weeks through EMG testing the neck muscles were more relaxed and had reduced pain levels.

Original Abstract

Background: This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain.

Methods: 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n = 15) or in control receiving weekly email-based information on general health (n = 15). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday.

Results: Adherence to training and control interventions were 86% and 89%, respectively. Comparedh with control, training increased isometric muscle strength 6% (P < 0.05) and decreased neck/shoulder pain intensity by 40% (P < 0.01). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius.

Conclusion: While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.

Lidegaard M, et al. Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain: randomized controlled trial. Biomed Res Int. 2013.

Sleep Deprivation and Injury Risk

Acute and chronic sleep deprivation both have negative results with athletic performance. It also poses a greater chance of injury.

Optimal sleep can help minimise athletic injury

Skaggs 2014

For most of us sleep is not taken too seriously. We forgo sleep for other priorities in our busy lives. As I previously posted about the effects of sleep on exercise.  This study demonstrates that a lack of sleep increases the chance of injury. While this studied sleep deprivation of adolescents it can be easily applied to the wider population.

Deprived sleep will lead to higher perceptions of effort and fatigue, impaired strength, endurance and accuracy. Gym go’ers to aspiring athletes should look at this aspect of their life more seriously to protect themselves.

For optimal recovery we should prioritise sleep as much as we do with other remedies like recovery drinks, stretching, ice baths and foam rolling. Tapping into the right amount of sleep will improve performance and recovery from injury.

Original Abstract

Background: Much attention has been given to the relationship between various training factors and athletic injuries, but no study has examined the impact of sleep deprivation on injury rates in young athletes. Information about sleep practices was gathered as part of a study designed to correlate various training practices with the risk of injury in adolescent athletes.

Methods: Informed consent for participation in an online survey of training practices and a review of injury records was obtained from 160 student athletes at a combined middle/high school (grades 7 to 12) and from their parents. Online surveys were completed by 112 adolescent athletes (70% completion rate), including 54 male and 58 female athletes with a mean age of 15 years (SD=1.5; range, 12 to 18 y). The students’ responses were then correlated with data obtained from a retrospective review of injury records maintained by the school’s athletic department.

Results: Multivariate analysis showed that hours of sleep per night and the grade in school were the best independent predictors of injury. Athletes who slept on average <8 hours per night were 1.7 times (95% confidence interval, 1.0-3.0; P=0.04) more likely to have had an injury compared with athletes who slept for ≥8 hours. For each additional grade in school, the athletes were 1.4 times more likely to have had an injury (95% confidence interval, 1.2-1.6; P<0.001).

Conclusion: Sleep deprivation and increasing grade in school appear to be associated with injuries in an adolescent athletic population. Encouraging young athletes to get optimal amounts of sleep may help protect them against athletic injuries.

The effect of food on your recovery

When feeling sore or recovering from injury there are other lifestyle factors to consider. Your diet may be slowing down your rate of recovery.

Your nutrition could be what tips the scales on your road to recovery

You’ve come in for treatment of your shoulder. It’s to be expected that it will consist of some manual therapy and education, followed by a home exercise routine to develop strength or improve mobility. But then there are other factors that can impact your recovery. Lifestyle factors such as stress levels, sleep and diet. While carefully rehabbing the injury it’s important to consider what foods your putting into your body.

There are many studies that show the relationship of improved nutrition on overall health outcomes with chronic diseases. More importantly it’s specific role in reducing inflammation.

Making some dietary and lifestyle changes may help with weight loss, feeling emotionally stronger, and reduce pain intensity. Nutrition could be that missing link to recovering from your injury and also help prevent injury.

Many of you may have already found the right nutritional balance in your life. For those that may still need to make changes here are some recommendations based on evidence. Theses are the common problems associated with pain that can be alleviated with diet.

1. Inflammation

Large amounts of inflammatory foods, including refined sugars and vegetable oils, populate the Western diet. Most clinical studies show that a traditional Mediterranean diet, rich in healthy fatty acids, fruits, vegetables and fiber, provides anti-inflammatory benefits. There are other diets with smaller evidence bases that have similar anti-inflam benefits such as paleo and Keto.

Studies have also shown for specific conditions. The Med-diet is rich in polyunsaturated fatty acids and antioxidants that provides anti-inflammatory effects that benefit individuals with rheumatoid arthritis. Evidence shows an optimal diet can reduce inflammation and fight chronic diseases.

2. Obesity

One of the fastest growing problems across the western world. Obesity contributes to numerous chronic pain conditions. Multiple Studies show that weight loss is vital to overall pain rehabilitation.

3. Osteoarthritis

Osteoarthritis (OA) is the gradually degeneration of joint surfaces, one of the main causes of increased OA is obesity. Studies have shown that obesity is the most modifiable risk factor for knee OA. Pain levels of knee OA have been found to half when reducing 10% body weight.

One systematic review found scientific evidence to support some specific nutritional interventions–including omega 3 fatty acids–to relieve symptoms among patients with OA. Studies also show various nutrient deficiencies, including vitamins C and D as well as selenium, contribute to OA.

4. Autoimmune disease

Over 80 autoimmune disorders exist, including Crohn’s disease, rheumatoid arthritis, multiple sclerosis, and type 1 diabetes. Genetic predisposition and environmental factors play major roles in the development of autoimmune diseases. But increasingly, researchers believe adverse dietary changes over the past 50 years. Including gluten intolerance, altered gut bacteria, and vitamin D deficiency contribute to an increased rate of autoimmune diseases.

Those main changes being a high-sugar, high-salt, processed-food heavy diet that paves the pathway for autoimmune diseases. Nutrient depleted diets only worsen this problem with a studies showing vitamin D, vitamin A, selenium, zinc, omega-3 fatty acids, probiotics, and flavanol deficiencies contribute to autoimmune diseases.


Most patients I treat deal with inflammation in one way or another. But if you suffer from any of the other of the above issues, adjusting your nutrition could be the needle-mover to alleviate pains and helps your recovery.

This is only a recommendation for adjusting your diet if you think there could be something exacerbating an inflammatory response. For any major dietary changes seek the advice of a nutritionist.

Foods that fight inflammation

Neck Pain

In New Zealand neck pain is a growing problem due to a more sedentary lifestyle. They can be tricky injuries to recover from. Take a look at how physio can help.

Neck pain is a growing musculoskeletal problem with more of us sitting over longer periods of time. But also from doing heavy manual jobs or exercise.

This condition can cause various symptoms, including the following:

  • PainNeck pain Symptoms 1
  • Stiffness
  • Muscle spasm
  • Referred pain (face, arm, mid back)
  • Headaches
  • Altered sensation (ie numbness/tingling)
  • Nausea
  • Dizziness

These symptoms may be caused by strain to any of the structures around your spine. Structures such as the ligaments, muscles, joints, discs or nerves. Acute injuries are often brought on through excessive loading, this could be from an accident playing sport or in your vehicle.

Other more chronic forms of neck pain could have developed from an acute injury that was poorly managed. Or with an increasingly sedentary lifestyle, the sustained postures can overload tissue of the neck.

Preventing Neck Pain

Your next posture is your best posture

Our body is designed to handle multiple positions. Set regular intervals every 20-30 minutes to change your sitting position. Try alternating between sitting and standing. See my other blog Sitting Posture how important is it really”

Lifting correctly

We’re not all Olympic lifters, but understanding the basic principles of lifting are important to preventing neck pain. Also understanding your limits to lifting. If it’s too heavy be honest with yourself and ask for help.

Keeping calm and dealing with stress

Stress can have a significant impact with pain and ignoring stressful situations can lead to the development of neck pain. Dealing with these gremlins will be great for you in so many ways. See my other blog on “Coping with stress”.

How can Physio help my neck pain?

Identifying the source of your injury is our primary goal with a detailed assessment. Once the root cause of your neck pain has been identified you will receive an effective evidence based treatment. Treatment may consist of the following.

The aim of the your rehab is to fully recover with the confidence to use your neck normally, without fear. Also to leave with a greater understanding of your neck to prevent any injuries in the future.

For an appointment, call on 095290990

Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

Sleep Deprivation and Exercise

Trying to balance a busy life, the easiest thing to neglect can be sleep. Trying to exercise in this state can produce poor results.

Souiss 2013 & Rae 2017

How many of us burn the candle at both ends? Balancing a busy workload, maintaining a healthy and social lifestyle. What often leads to sleep deprivation.

These two studies demonstrate the impact of sleep deprivation on performance.

Souiss tested his judo athletes with a number of measures including grip strength, anaerobic capacity and isometric test of elbow flexion. Tests were performed at 9am and 4pm after a judo match. There were 3 scenarios, full sleep (7.5hrs), partial sleep early (10pm-2am) and late (3am-6am).

The results showed with a full sleep performance was better in the afternoon. But with both groups with only partial sleep performance dropped in both the morning and afternoon. The partial sleep group woken early performed worse later in the afternoon.

Rae’s study of cyclists, measuring their strength the day after high intensity interval training, one group with full sleep (7.5hrs) and partial sleep (4hrs). They tested 24 hours later, testing peak power output and surveying fatigue and motivation.

These results showed that with sleep deprivation peak performance output reduced compared with normal sleep. Also sleep deprived felt more tired and less motivated to train. This is just from one night of disrupted sleep.

Sitting back and thinking about the relationship of sleep and performance these results seem pretty obvious. Giving your self normal levels of sleep can improve performance and brain function. Try and make sleep more of a priority in the life balance. The choices we make, dictate the lives we live.

 

Souissi et al, (2013) Effects of time-of-day and partial sleep deprivation on short-term maximal performances of judo competitors. J Strength Cond Res.

Rae et al, (2017), One night of partial sleep deprivation impairs recovery from a single exercise training session. Eur J Appl Physiol.

Continue reading “Sleep Deprivation and Exercise”

Knee OA – The importance on strength training

Knee osteoarthritis can cause major disability. This piece of current literature supports that resistance training plays a major role in pain relief.

Bartholdy 2017

Knee osteoarthritis is a condition that gets treated overly careful due to its painful nature and limiting factors functionally.

Osteoarthritis is the gradual wearing down of the joint surfaces (cartilage) over time. Deterioration over time based on may factors, from the type of work and sport, injury history, genetics (collagen type) etc.

Knee Extensors OA

An exacerbation of osteoarthritis, especially in the knee can be debilitating. Reducing strength, restricting movement and limiting mobility. This recent study analysed almost 5000 participants from 45 trials. It found that the best results for reducing pain and disability was through increasing quads strength by over 30%.

This puts resistance training top of the agenda when trying to alleviate pain in an arthritic knee. Grading the exercises appropriately with the guidance of an expert. This study shows good results of strengthening the quads, we should approach it balanced by also working the other connecting muscles.

Original Abstract

OBJECTIVES: To analyse if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyse associations between changes in muscle strength, pain, and disability.

METHODS: A systematic search in 5 electronic databases was performed to identify randomised controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardised mean differences (SMD) with 95% confidence intervals (95% CI). Interventions were categorised as ACSM interventions or not-ACSM interventions and compared using stratified random effects meta-analysis models. Associations between knee extensor strength gain and changes in pain/disability were assessed using meta-regression analyses.

RESULTS: The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091-0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30-40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively.

CONCLUSION: Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability

https://www.ncbi.nlm.nih.gov/m/pubmed/28438380/

The Office WOD

Do your best when no one is looking. If you do that, then you can be successful at anything that you put your mind to.

Following up from last weeks piece about SITTING POSTURE. It’s not about holding the perfect posture. Whats more important is changing position regularly, adding variation. Holding postures long enough results in changes to the strength of a muscle and how quickly it activates.

Neuroplasticity

This refers to the brain constantly changing to its environment, trying to find more efficient neural connections.

Consider your memory at school, studying a particular subject and you ace the exams. Now think 10 years on and you’ve done nothing relating to the subject, you’ll likely struggle with the same exam paper. The neural connections changed, these memories were not regularly reinforced and were forgotten.

Look at the typical sitting posture above that we find most of us in. Multiple changes are happening from head to toe. This also happens on a neural level. The longer we hold this posture the more the change will be ingrained. When doing complex activities that require fast reactions or more strength the adapted structures will make the task more challenging.

The Office WOD

The office workout is focusing on the neglected muscles we forget to stretch or use throughout the working day. Following this routine, 10-15 minutes at Lunch or on a coffee break will help maintain healthy muscle activity and length.

**This does not substitute exercise that gets your heart rate elevated.

The Workout won’t draw too much attention to you in the office. I won’t have you doing planks off the office chair or dead lifting the photocopier.

1. Chin Tucks (1 minute)

2. Neck Extensor stretch (1 minute)

3. Thoracic Spine Stretch (2 minute)

4. Posterior Shoulder Strengthening (1 minute)

5. Forearm  Stretch (1 minute Each)

6. Glute Strengthening (1 minute)

7. Hip Flexor Stretch (1 minute each)

8. Hamstring Stretch (1 minute each)

9. Calf Stretch (1 minute each)

Try these exercises in your workplace to get muscles fired up again and working. Feel free to leave a comment about any of the exercises or any suggestions for changes.